LEAプログラム登録およびコンプライアンス文書
更新日:2024年6月1日
必須のLEAプログラムプロバイダー参加契約および年次報告書の要件
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).
データ使用契約の要件
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.
プロバイダー参加契約、年次報告書、およびデータ使用契約と指示
(PPA、AR、DUAパケットをリクエストするための電子メール LEA.AnnualReport@dhcs.ca.gov)
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.
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Please direct any questions regarding the LEA PPA & AR to: LEA@dhcs.ca.gov
新しく登録するすべてのLEAは、LEA Medi-Cal請求オプションプログラムへの参加を開始するために、PPA、AR、およびDUA(該当する場合)を提出する必要があります。
ドキュメントの保持要件
LEA年次報告書と補足文書は、DHCSへの提出日から最低3年間、各LEAによって維持されなければならず、そこに含まれる情報は、必要に応じてDHCS監査および調査スタッフによって検証可能でなければなりません。
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.
監査とコストレポートの説明
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.
中間和解が発行された後、DHCSはCRCSリスク評価を実施し、CRCS監査のレベルを決定します。 CRCS監査は、最小監査、限定監査、またはフィールド監査として実施され、連邦法、州法、およびLEA BOPポリシーに従って許容コストの見直しが含まれる場合があります。 DHCSは、CRCS監査の調査結果についてLEAと話し合い、LEAと協力して、監査プロセスの過程で監査に関する質問、懸念、または意見の相違を解決します。 提出時に記載された報告された未払い額の差額が最終和解金の25%を超える場合、DHCSはLEAに技術支援を提供し、LEAがエラーを理解し、将来エラーを回避できるようにします。