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SMAA Weekly Update #12 June 23, 2014

 

School-Based Medi-Cal Administrative Activities (SMAA)

Weekly Update #12

RANDOM MOMENT TIME SURVEY (RMTS) NEXT STEPS

The RMTS Next Steps document that was posted on Monday June 16, 2014 references a Stakeholder Conference Call to be scheduled for the week of June 23, 2014.  This call will be postponed in order to provide the Department of Health Care Services (DHCS) additional time to develop a more all-inclusive list of Next Steps necessary to finalize an RMTS implementation plan.  This will allow for the development of a more comprehensive agenda and a more effective use of time during the conference call.  Details on a future stakeholder discussion will be posted as soon as available.

REASONABLENESS TEST CRITERIA (RTC) REVIEW PROCESS

The RTC review process is moving forward and DHCS has been able to approve a number of RTC submissions and submit them for payment.  However, after consulting with the Centers for Medicare and Medicaid Services (CMS), many of the justifications that are being submitted are proving to be inadequate to resolve issues related to the inclusion of unauthorized job classifications, activity code benchmark overages, and clerical/administration ratio overages.  DHCS will begin issuing Conditional Denial letters this week to the LECs and LGAs that will have specific items that will need to be resolved before approvals can be issued.  DHCS has posted a list of criteria to be considered to create an acceptable justification as well as a number of examples of acceptable justifications to the SMAA web site.  LECs, LGAs and LEAs are encouraged to review these examples when developing new justifications in response to the pending conditional denial letters.  The sample RTC justifications can be found here: http://www.dhcs.ca.gov/provgovpart/Pages/RTCSampleJust.aspx

DEFERRED INVOICE DEADLINE

The deadline for resolving the deferred invoices that were paid on the CMS 64 for the quarters ending December 2011, March 2012, and June 2012 is September 30, 2014, and for September 2012 the deadline is October 31, 2014.  Although a timeline has been issued for RTC submissions for these invoices, DHCS encourages the LECs, LGAs and LEAs not to wait until the last day to submit the RTC documentation for these invoices.  Earlier submissions will provide the Department more time to communicate with interested parties on issues related to these submissions.

Last modified on: 7/3/2015 5:58 PM