LEA Program Glossary of Terms
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A | B | C | D | E | F | G | H | Kuv | J | K | L | M |
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O | P | Q | R | S | T | U | V | W | X | Y | Z |
A
Annual Report – All LEAs enrolled in the LEA Medi-Cal Billing Option must submit an “Annual Report” to the Department of Health Care Services each year. The report includes information on LEA Medi-Cal reimbursement, reinvestment expenditures, anticipated reinvestment service priorities, certification of state matching funds, and commitment to reinvest.
C
Cal-SAFE (California School Age Families Education) – The Cal-SAFE program is designed to increase the availability of support services necessary for enrolled expectant/parenting students to improve academic achievement and parenting skills and to provide a quality child care/development program for their children. This comprehensive, continuous, and community-linked school-based program replaces the Pregnant Minors Program (PMP), School Age Parenting and Infant Development (SAPID) Program, and Pregnant and Lactating Students (PALS) Program.
CalWORKs (California Work Opportunity and Responsibility to Kids) – The CalWORKs program provides temporary assistance in the form of cash aid and services to needy families with minor children. The program includes welfare reform measures and services designed to encourage recipients to qualify for and find jobs that will enable families to be self-supporting. Unless exempt, all recipients are required to participate in CalWORKs Welfare-to-Work program as a condition of eligibility.
CCN (Claim Control Number) – Number assigned to each claim that enters the California Medicaid Management Information System. The CCN contains a Julian date indicating the date the claim was received.
CCS (California Children's Services) - Qhov kev pab cuam CCS muab kev pab kho mob rau cov menyuam yaus uas tsim nyog uas muaj qee yam kev txwv lub cev thiab tej yam mob lossis kab mob ntev. CCS them rau cov kev pabcuam kws kho mob, kev saib xyuas hauv tsev kho mob thiab kev phais mob, kev kho lub cev thiab kev ua haujlwm, kev kuaj mob hauv chaw kuaj mob, duab X-ray, cov khoom siv pob txha, cov khoom siv kho mob, thiab kev tswj hwm cov ntaub ntawv kho mob. Cov nyiaj se ntawm lub xeev, lub nroog, thiab tsoomfwv teb chaws tau txais nyiaj los ntawm cov nyiaj no, nrog rau qee cov nqi uas cov niam txiv them.
CHDP (Child Health and Disability Prevention) – The CHDP program provides periodic preventive health services to California children who are Medi-Cal eligible or with family incomes equal to or less than 200% of federal income guidelines. CHDP provides periodic preventive health assessments; children with suspected problems are then referred for diagnosis and treatment.
Child Find – Through the Individuals with Disabilities Education Act of 1997 (IDEA), all children with disabilities residing in the state who are in need of special education and related services must be identified and evaluated to determine if services are required.
CIF (Daim Ntawv Nug Txog Kev Thov Nyiaj) - Daim ntawv no yog siv tom qab xa daim ntawv thov nyiaj los thov ib qho ntawm cov hauv qab no: kev hloov kho rau qhov kev thov nyiaj uas tau them tsawg lossis them ntau dhau, kev rov xav txog qhov kev thov nyiaj uas tsis tau lees paub; lossis tus neeg taug qab qhov kev thov nyiaj uas tau xa ua ntej uas tsis muaj ntaub ntawv them nyiaj lossis tsis lees paub.
CMS (Centers for Medicare & Medicaid Services) - Yav tas los hu ua Health Care Financing Administration (HCFA), CMS yog lub koom haum tsoomfwv uas saib xyuas Medicare, Medicaid, State Children's Health Insurance Program (SCHIP), thiab ntau lwm yam kev pab cuam ntsig txog kev noj qab haus huv.
CRCS (Cost Reimbursement and Comparison Schedule) – All LEAs enrolled in the LEA Medi-Cal Billing Option must submit a CRCS to the Department of Health Care Services. LEA providers must annually certify that the public funds expended for LEA services are eligible for federal financial participation. The CRCS will be used to compare each LEA’s actual costs for LEA services to the LEAs Medi-Cal reimbursement.
D
DHCS (Lub Chaw Haujlwm Saib Xyuas Kev Noj Qab Haus Huv) - Lub koom haum hauv xeev uas muaj lub luag haujlwm tswj hwm qhov kev pab cuam Medicaid rau Tsoom Fwv Tebchaws.
Diagnosis Codes – All Medi-Cal claims require a diagnosis code. The approved codes may be found in the ICD-9-CM (International Classification of Diseases, 9th Revision, Clinical Modification), a statistical classification system that arranges diseases and injuries into groups according to established criteria.
E
EDS (Electronic Data Systems) – EDS is the Medi-Cal Fiscal Intermediary responsible for processing claims submitted by Medi-Cal providers through a contract with the Department of Health Care Services (DHCS). EDS also provides a variety of support services to Medi-Cal providers.
EPC (Erroneous Payment Correction) – Process used to make adjustments for specific services or claims determined to have been erroneously overpaid or underpaid. The EPC process voids the original claim, appearing as a negative on the provider’s Remittance Advice Detail followed by a new claim line showing the corrected amount.
EPSDT (Early and Periodic Screening, Diagnosis, and Treatment) – The EPSDT service is Medicaid’s comprehensive and preventive child health program for individuals under the age of 21. The EPSDT program consists of two mutually supportive, operational components: (1) assuring the availability and accessibility of required health care resources and (2) helping Medicaid eligibles and their parents or guardians effectively use these resources. In California, the Child Health and Disability Prevention (CHDP) program provides periodic preventive health services to Medi-Cal eligible children based on the EPSDT program.
F
FFP (Federal Financial Participation) – States must meet certain federal requirements to participate in the Medicaid program. States that meet these requirements receive federal funding in the form of FFP for all Medicaid expenditures.
FFS (Fee-for-Service) – The traditional method of billing for health services under which a health care provider charges separately for each patient encounter or service rendered.
FMAP (Federal Medical Assistance Percentage) – The federal government’s share of a state’s expenditures for Medicaid. The FMAP is determined annually for each state.
H
HCPCS (Healthcare Common Procedure Coding System) – HCPCS is a national, uniform coding structure developed by the Centers for Medicare & Medicaid Services (CMS) to standardize the coding systems used to bill for Medicare and Medicaid services on a national basis. All Medi-Cal claims require HCPCS service codes.
Healthy Families – The Healthy Families Program offers low cost insurance for children and teens up to age 19. It provides health, dental, and vision coverage for children who meet the program rules and do not qualify for Medi-Cal. Health Families contracts with selected insurance plans, and program members pay low monthly premiums.
Healthy Start – The Healthy Start program is a state initiative that provides students and their families with links to community resources through school-based family resource centers.
HMO (Health Maintenance Organization) – An organization that assumes responsibility for providing health care to members for a fixed payment without regard to the amount of actual services provided to an individual enrollee. The HMO is responsible for providing most health and medical care services required by enrolled individuals or families, and these services are specified in the contract between the HMO and the enrollees.
Kuv
IDEA (Individuals with Disabilities Education Act) – The federal law that mandates that all children with disabilities have available to them a free appropriate public education (FAPE) that includes special education and related services to meet their unique needs. Part B of IDEA provides formula grant assistance to state education agencies for the education of children with disabilities, ages three through 21. Part C of IDEA provides funds to state lead agencies to assist in the provision of early intervention services to infant and toddlers with disabilities, ages birth through two.
IEP (Individualized Education Plan) – A legal agreement composed by educational professionals, with input from the child’s parents, for students identified as disabled in accordance with IDEA requirements. This agreement guides, coordinates, and documents instruction that is specially designed to meet the student’s unique needs.
IFSP (Individualized Family Service Plan) – A written plan for providing early intervention services to a child eligible under IDEA and the child’s family. The IFSP enables the family and service provider(s) to work together as equal partners in determining the early intervention services that are required for the child with disabilities and the family.
L
LEA (Local Education Agency) – The governing body of any school district or community college district, the County Office of Education, a state special school, a California State University campus, or a University of California.
LEA Collaborative – A collaborative interagency human services group (local collaborative) at the county level or sub-county level that makes decisions about the reinvestment of funds made available through the LEA Medi-Cal Billing Option. Generally, representation will include the schools, major public agencies serving children and families including health, mental health, social services and juvenile justice, the courts, civic and business leadership, the advocacy community, parents or guardians, and current safety net and traditional health care providers.
LEA Medi-Cal Billing Option – A program for LEAs to bill Medi-Cal for specific health and medical services provided to students and their families in the school setting. Services provided through this program include assessments, treatments, and Targeted Case Management.
LEC (Local Education Consortium) - Ib lub LEA uas koom tes nrog Medi-Cal Administrative Activities (MAA) rau ib qho ntawm 11 thaj chaw pabcuam ntawm California County Superintendents Educational Services Association (CCSESA). Cov LEAs yuav tsum thov MAA los ntawm lawv cheeb tsam LEC lossis lawv lub koom haum kev noj qab haus huv hauv zos lossis lub nroog (tseem hu ua Lub Koom Haum Tsoomfwv Hauv Zos lossis LGA). >
M
MAA (Medi-Cal Administrative Activities) – A program for LEAs to be reimbursed for staff activities necessary for the proper and efficient administration of the Medi-Cal program. The amount of reimbursement is based on an operational plan and periodic time surveys. The MAA program is separate from the LEA Medi-Cal Billing Option.
Managed Care – A health care delivery system that provides services within a defined network of health care providers who are given the responsibility to manage and provide quality, cost-effective health care. Managed care plans, which may include but are not limited to Health Maintenance Organizations (HMOs), typically receive a prepaid rate for each member enrolled in the plan.
Match – The portion of the cost of providing a LEA Medi-Cal service that is not reimbursed by the federal government. In the LEA Medi-Cal Billing Option, school districts receive only the federal portion of the reimbursement rate. When they enroll and in each subsequent annual report, LEAs certify that they will pay the match for the federal share for LEA services.
Medicaid – A federal program established in 1965 under Title XIX of the Social Security Act and jointly funded by the Federal and State governments. Medicaid provides health care coverage for low-income families; aged, blind, and disabled persons; and individuals whose income and resources are insufficient to meet the costs of necessary medical services. Medi-Cal is California’s Medicaid program and is administered by the Department of Health Care Services (DHCS).
Medi-Cal Eligibility Data Match – A process established for LEAs to obtain verification of Medi-Cal eligibility for enrolled students.
Medicare – A federal program, established in 1965 under Title XVIII of the Social Security Act. Medicare provides health care coverage for people age 65 or older, some people under age 65 with disabilities, and people with End-Stage Renal Disease (ESRD), which is permanent kidney failure requiring dialysis or a kidney transplant.
N
NPI (National Provider Identifier) – Unique national 10-digit provider identification number that is Health Insurance Portability and Accountability Act (HIPAA) compliant.
O
OIG (Chaw Ua Haujlwm Saib Xyuas Kev Noj Qab Haus Huv) - Lub OIG tiv thaiv kev ncaj ncees ntawm cov kev pab cuam uas US Department of Health and Human Services (HHS) tswj hwm, nrog rau kev noj qab haus huv thiab kev noj qab haus huv ntawm cov neeg tau txais txiaj ntsig ntawm cov kev pab cuam no. HHS muab nyiaj pab rau cov kev pabcuam tseem ceeb rau tib neeg hauv ntau dua 300 qhov kev pab cuam, suav nrog Medicare thiab Medicaid. Lub OIG cov dej num raug ua tiav los ntawm kev sib koom tes thoob plaws lub tebchaws ntawm kev tshuaj xyuas thiab kev tshawb nrhiav ntawm HHS cov kev pab cuam.
OMB Circular A-87 (Office of Management and Budget) – A codified Federal Executive Branch regulation that provides mechanisms and guidelines for state and local governments for accounting for costs when administering federal programs.
P
PPA (Provider Participation Agreement) – The Provider Participation Agreement (PPA) is the contract through which qualified Local Educational Agencies enroll to participate in the LEA Medi-Cal Billing Option.
R
RAD (Remittance Advice Details) – A report listing provider claims that have been paid for a particular payment period. The RAD is used by providers to reconcile their records with claims that have been paid, denied or suspended.
S
SNF (Safety Net Financing Division) - SNFD tswj hwm cov nyiaj them ntxiv raws li "Choj Mus Rau Kev Hloov Kho" Tshooj 1115 Medicaid Waiver thiab Medicaid State Plan. Lub Chaw Them Nyiaj Ntxiv ntawm Medi-Cal (MSPS) ua cov txheej txheem thiab saib xyuas kev them nyiaj rau cov tsev kho mob thiab lwm hom kev muab kev pabcuam rau ntau yam kev pabcuam ntxiv thiab tswj hwm qhov kev pabcuam Nqi Saib Xyuas Kev Zoo ntawm Tsev Kho Mob (QAF). Pawg Neeg Saib Xyuas Kev Kho Mob/Kev Qhia Txog Kev Tsis Muaj Kev Pov Hwm thiab Kev Kho Mob Me (HUDSS) soj ntsuam cov nqi thiab cov nqi kho mob pej xeem uas tau teev tseg thiab saib xyuas California txoj kev zam txim tag nrho. Pawg Neeg Txheeb Xyuas Kev Kuaj Mob (DRG) saib xyuas kev siv txoj kev them rov qab ntawm tsev kho mob thiab tswj hwm Subacute Care Program. Lub Chaw Haujlwm Saib Xyuas Kev Thov Nyiaj Txiag, Chaw Pabcuam Hauv Zos, thiab Chaw Pabcuam Tsev Kawm Ntawv muab nyiaj rov qab rau tsoomfwv rau cov nroog thiab cov koog tsev kawm ntawv rau cov haujlwm tswjfwm, kev tswj hwm cov ntaub ntawv raug tsom, thiab qee yam kev pabcuam kho mob uas tsim nyog rau tsev kawm ntawv. Lub Chaw Pab Nyiaj Txiag Rau Tsev Kho Mob Sib Koom Ua Ke Thiab Lub Chaw Pab Nyiaj Rov Qab Rau Tsev Kho Mob Uas Tsis Yog Daim Ntawv Cog Lus (DSH) them rov qab rau cov tsev kho mob uas tsim nyog rau cov nqi kho mob uas tsis tau them rau cov kev pabcuam hauv tsev kho mob thiab them rov qab cov nyiaj them ntau dhau rau cov kev pabcuam hauv tsev kho mob uas muab los ntawm cov tsev kho mob uas tsis yog daim ntawv cog lus.
SCHIP (Lub Xeev Txoj Haujlwm Pov Hwm Kev Noj Qab Haus Huv Rau Menyuam Yaus) - Ib qho kev pab cuam hauv tsoomfwv tebchaws, zoo ib yam li Medicaid, tau tsim muaj xyoo 1997 raws li Lub Npe XXI ntawm Txoj Cai Kev Ruaj Ntseg Hauv Zej Zog. SCHIP muab kev pov hwm kho mob rau cov menyuam yaus uas lawv tsev neeg khwv tau nyiaj ntau dhau los tsim nyog rau Medicaid, tab sis tsis muaj nyiaj txaus los yuav kev pov hwm kho mob ntiag tug. California txoj kev pab cuam hu ua Healthy Families Program thiab yog tswj hwm los ntawm Managed Risk Medical Insurance Board (MRMIB).
Section 504 Accommodations – Section 504 of the Rehabilitation Act of 1973 requires school districts to provide or pay for certain services to make education accessible to handicapped children. These services are described in an Individualized Health Service Plan (IHSP) or 504 Plan.
Lub Chaw Haujlwm Ib Leeg Hauv Xeev - Lub chaw haujlwm hauv xeev uas muaj lub luag haujlwm tswj hwm qhov kev pab cuam Medicaid. Hauv California, lub koom haum hauv xeev yog Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv (DHCS) thiab qhov kev pab cuam Medicaid hu ua Medi-Cal.
SSI (Cov Nyiaj Tau Los Ntxiv ntawm Kev Ruaj Ntseg) - Ib qho kev pab nyiaj txiag hauv tsoomfwv rau cov neeg laus, dig muag lossis xiam oob qhab uas muaj nyiaj tsawg uas tau tsim los ntawm Title XVI ntawm Social Security Act. Cov xeev yuav siv cov kev txwv ntawm cov nyiaj tau los ntawm SSI los tsim kom muaj cai tau txais Medicaid.
State Plan – A written plan between a State and the Federal Government that outlines Medicaid eligibility standards, provider requirements, payment methods, and health benefit packages. A Medicaid State Plan is submitted by each State and approved by the Centers for Medicare & Medicaid Services (CMS).
SPA (State Plan Amendment) – States may submit amendments to their Medicaid State Plans to change eligibility standards, provider requirements, payment methods, or health benefit packages. The amendments are reviewed and processed according to specific statutory timelines by the Centers for Medicare & Medicaid Services (CMS) Regional Offices with consultation and review by the CMS Central Office, if necessary.
T
TANF (Kev Pab Ib Ntus Rau Cov Tsev Neeg Xav Tau Kev Pab) - Ib qho kev pab nyiaj txiag hauv xeev rau cov tsev neeg uas muaj nyiaj tsawg. TANF hloov qhov kev pab cuam qub hu ua Kev Pab rau Tsev Neeg uas Muaj Menyuam Nyob Nrog (AFDC). CalWORKs yog lub npe ntawm California txoj kev pab cuam TANF.
TCM (Targeted Case Management) – LEA Medi-Cal TCM services assist eligible children and eligible family members to access needed medical, social, educational and other services when TCM is covered by the student’s IEP or IFSP. The components of TCM include: Determining needs, Developing a plan, Linking & consulting coordination, Accessing services outside the school system, Assisting with crises, and Reviewing Progress.
U
UB 04 – This form is used to submit claims for Outpatient Medi-Cal services, including LEA Medi-Cal Billing Option services.