LEA 프로그램 등록 및 규정 준수 문서
업데이트되었습니다: 업데이트: 2024년 6월 1일
필수 LEA 프로그램 제공자 참여 계약 & 연례 보고서 요구 사항
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).
데이터 사용 동의 요건
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.
제공자 참여 계약, 연례 보고서, 데이터 사용 계약 및 지침
(PPA, AR 및 DUA 패킷을 요청하려면 LEA.AnnualReport@dhcs.ca.gov 으로 이메일을 보내세요.)
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
새로 등록하는 모든 LEA는 LEA Medi-Cal 청구 옵션 프로그램 참여를 시작하려면 PPA, AR 및 DUA(해당되는 경우)를 제출해야 합니다.
문서 보존 요건
LEA 연례 보고서 및 증빙 서류는 각 LEA에서 DHCS에 제출한 날로부터 최소 3년 동안 보관해야 하며, 필요한 경우 DHCS 감사 및 조사 담당자가 그 안에 포함된 정보를 확인할 수 있어야 합니다.
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.
감사 및 비용 보고에 대한 설명
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.
중간 정산이 발행된 후 DHCS는 CRCS 위험 평가를 실시하여 CRCS 감사 수준을 결정합니다. CRCS 감사는 최소 감사, 제한 감사 또는 현장 감사로 수행되며 연방법, 주법 및 LEA BOP 정책에 따라 허용되는 비용을 검토하는 것이 포함될 수 있습니다. DHCS는 모든 CRCS 감사 결과를 LEA와 논의하고 감사 과정 중에 감사 질문, 우려 사항 또는 의견 불일치를 해결하기 위해 LEA와 협력합니다. 제출 시 명시된 보고 금액과 최종 정산 금액의 차이가 25% 이상인 경우, DHCS는 LEA가 오류를 이해할 수 있도록 기술 지원을 제공하여 향후 이러한 오류를 방지할 수 있도록 합니다.