Documentos de Inscripción y Cumplimiento del Programa LEA
Volver a la página de inicio de LEA
Actualizado: 1 de junio de 2024
Acuerdo Obligatorio de Participación del Proveedor del Programa LEA y Requisitos del Informe Anual
The Provider Participation Agreement (PPA) and Annual Report (AR) are required for participation in the LEA Program. The PPA contains two exhibits: Exhibit A – Health Insurance Portability and Accountability Act (HIPAA) Business Associate Addendum (BAA), and Exhibit B – Data File Description. In addition to complying with the terms listed in the PPA, all LEA providers must abide by the terms listed in the BAA. The purpose of the BAA is to guard the privacy and security of protected health information and personal information that may be created, received, maintained, transmitted, used or disclosed pursuant to the PPA, and to comply with certain standards and requirements of HIPAA regulations. Exhibit B is a description of the data provided to the LEA via data tape match. LEAs do not need to sign or return Exhibits A and B to the Department of Health Care Services (DHCS).
Requisito del acuerdo de uso de datos
LEA providers that designate a third-party billing vendor as their “Custodian of the Files” must submit a tri-annually DUA, which is signed by representatives of DHCS, the LEA, and the vendor. If a LEA provider does not utilize services of a third-party billing vendor and performs its own in-house billing, the LEA must submit a two-party DUA, which is signed by representatives of DHCS and the LEA.
Acuerdo de Participación del Proveedor, Informe Anual y Acuerdo e Instrucciones de Uso de Datos
(Envíe un correo electrónico LEA.AnnualReport@dhcs.ca.gov para solicitar los paquetes PPA, AR y DUA)
The SFY 2023-24 AR is due November 30, 2023. The SFY 2023-24 AR is available upon request. Please send requests, and submissions to LEA.AnnualReport@dhcs.ca.gov.
Utilice Adobe Acrobat o Reader para completar los formularios.
Please direct any questions regarding the LEA PPA & AR to: LEA@dhcs.ca.gov
Todas las LEA recién inscritas deben presentar el PPA, AR y el DUA (si corresponde) para comenzar a participar en el Programa de Opciones de Facturación de Medi-Cal de LEA.
Requisitos de retención de documentación
El Informe Anual de la LEA y la documentación de respaldo deben ser conservados por cada LEA durante un mínimo de tres años a partir de la fecha de presentación al DHCS y la información contenida en ellos debe ser verificable por el personal de Auditorías e Investigaciones del DHCS, si es necesario.
Copies of Prior Reporting Year’s PPA or AR
To obtain a copy of a prior year’s PPA or AR, please send your request to LEA.AnnualReport@dhcs.ca.gov.
Explicación de la auditoría y la presentación de informes de costos
Local Educational Agencies (LEAs) enrolled in the Local Educational Agency Medi-Cal Billing Option Program (LEA BOP) must submit the annual Cost and Reimbursement Comparison Schedule (CRCS) to the Department of Health Care Services (DHCS) for audit by March 1 each year. DHCS’ Audits and Investigations staff will review the CRCS submission for completeness. After the CRCS is accepted as complete, DHCS will issue an interim or final settlement of the Medi-Cal share of each LEA’s costs within 12 months of the March 1 filing due date. The interim settlements were included as part of State Plan Amendment 15-021 and was initiated with the CRCS for fiscal year (FY) 2021-22 that was due on March 1, 2023. The interim settlement is based on 100 percent of the as-reported settlement due to DHCS and 60 percent of the as-reported settlement due to the LEA. Beginning with FY 2022-23 CRCS that was due on March 1, 2024, when a final settlement is not issued within 12 months of the March 1 due date, DHCS shall complete final settlement no later than 18 months after the date that the CRCS is submitted.
Después de que se emita el acuerdo provisional, DHCS llevará a cabo una evaluación de riesgos de CRCS para determinar el nivel de auditoría de CRCS. Las auditorías de CRCS se llevan a cabo como una auditoría mínima, una auditoría limitada o una auditoría de campo y pueden incluir la revisión de los costos permitidos de acuerdo con las leyes federales, las leyes estatales y la política de BOP de la LEA. DHCS discutirá cualquier hallazgo de auditoría de CRCS con la LEA y colaborará con la LEA para resolver preguntas, inquietudes o desacuerdos de auditoría durante el curso del proceso de auditoría. Cuando la diferencia entre el monto adeudado reportado como se anotó en el momento de la presentación es mayor que el 25 por ciento del acuerdo final, DHCS ofrecerá asistencia técnica a la LEA para ayudar a la LEA a comprender el error para que pueda evitarse en el futuro.