اسناد ثبت نام و انطباق برنامه LEA
به روز شده: 1 ژوئن 2024
توافقنامه اجباری مشارکت ارائه دهنده برنامه LEA و الزامات گزارش سالانه
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).
الزامات قرارداد استفاده از داده
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.
موافقت نامه مشارکت ارائه دهنده، گزارش سالانه، و توافق نامه و دستورالعمل استفاده از داده ها
(برای درخواست بستههای PPA، AR، و DUA به LEA.AnnualReport@dhcs.ca.gov ایمیل بزنید)
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.
لطفا برای تکمیل فرم ها از Adobe Acrobat یا Reader استفاده کنید.
Please direct any questions regarding the LEA PPA & AR to: LEA@dhcs.ca.gov
همه LEAهایی که به تازگی ثبت نام کرده اند باید PPA، AR، و DUA (در صورت وجود) را برای شروع مشارکت در برنامه گزینه صورتحساب LEA Medi-Cal ارسال کنند.
الزامات نگهداری اسناد
گزارش سالانه LEA و اسناد پشتیبانی باید توسط هر LEA حداقل به مدت سه سال از تاریخ ارائه به DHCS نگهداری شود و اطلاعات موجود در آن باید توسط کارکنان ممیزی و تحقیقات DHCS در صورت لزوم قابل تأیید باشد.
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.
توضیح حسابرسی و گزارش بهای تمام شده
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.
پس از صدور تسویه موقت، DHCS ارزیابی ریسک CRCS را برای تعیین سطح حسابرسی CRCS انجام خواهد داد. ممیزی CRCS به عنوان یک حسابرسی حداقلی، ممیزی محدود، یا ممیزی میدانی انجام می شود و ممکن است شامل بررسی هزینه های مجاز مطابق با قوانین فدرال، قوانین ایالتی و خط مشی LEA BOP باشد. DHCS هرگونه یافته حسابرسی CRCS را با LEA مورد بحث قرار می دهد و با LEA برای حل سؤالات، نگرانی ها یا اختلاف نظرهای حسابرسی در طول فرآیند حسابرسی همکاری می کند. هنگامی که تفاوت بین مبلغ گزارش شده که در هنگام ارسال ذکر شده است بیشتر از 25 درصد تسویه نهایی باشد، DHCS کمک فنی به LEA ارائه می کند تا به LEA کمک کند تا خطا را درک کند تا در آینده از آن اجتناب شود.