ເອກະສານການລົງທະບຽນ ແລະປະຕິບັດຕາມໂຄງການ LEA
ອັບເດດ: 1 ມິຖຸນາ 2024
ຂໍ້ຕົກລົງການມີສ່ວນຮ່ວມຂອງຜູ້ໃຫ້ບໍລິການໂຄງການ LEA ບັງຄັບ & ຄວາມຕ້ອງການລາຍງານປະຈໍາປີ
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).
ຂໍ້ກໍານົດການນໍາໃຊ້ຂໍ້ມູນ
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.
ຂໍ້ຕົກລົງການມີສ່ວນຮ່ວມຂອງຜູ້ໃຫ້ບໍລິການ, ບົດລາຍງານປະຈໍາປີ, ແລະຂໍ້ຕົກລົງການນໍາໃຊ້ຂໍ້ມູນ ແລະຄໍາແນະນໍາ
(ສົ່ງອີເມວຫາ LEA.AnnualReport@dhcs.ca.gov ເພື່ອຮ້ອງຂໍຊຸດ PPA, AR, ແລະ 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.
ກະລຸນາໃຊ້ Adobe Acrobat ຫຼື Reader ເພື່ອປະກອບແບບຟອມ.
Please direct any questions regarding the LEA PPA & AR to: LEA@dhcs.ca.gov
LEA ທີ່ລົງທະບຽນໃໝ່ທັງໝົດຈະຕ້ອງສົ່ງ PPA, AR, ແລະ DUA (ຖ້າມີ) ເພື່ອເລີ່ມຕົ້ນການເຂົ້າຮ່ວມໃນໂຄງການທາງເລືອກການເອີ້ນເກັບເງິນ LEA Medi-Cal.
ຄວາມຕ້ອງການເກັບຮັກສາເອກະສານ
ບົດລາຍງານປະຈໍາປີຂອງ LEA ແລະເອກະສານສະຫນັບສະຫນູນຕ້ອງໄດ້ຮັບການຮັກສາໄວ້ໂດຍແຕ່ລະ LEA ເປັນເວລາຢ່າງຫນ້ອຍສາມປີນັບຈາກວັນທີຍື່ນສະເຫນີໃຫ້ DHCS ແລະຂໍ້ມູນທີ່ມີຢູ່ໃນນັ້ນຈະຕ້ອງຖືກກວດສອບໂດຍພະນັກງານກວດສອບແລະສືບສວນຂອງ DHCS, ຖ້າຈໍາເປັນ.
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.
ຄໍາອະທິບາຍການກວດສອບແລະລາຍງານຄ່າໃຊ້ຈ່າຍ
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.
ຫຼັງຈາກການແກ້ໄຂຊົ່ວຄາວໄດ້ຖືກອອກ, DHCS ຈະດໍາເນີນການປະເມີນຄວາມສ່ຽງ CRCS ເພື່ອກໍານົດລະດັບຂອງການກວດສອບ CRCS. ການກວດສອບ CRCS ແມ່ນດໍາເນີນເປັນການກວດສອບຫນ້ອຍ, ການກວດສອບຈໍາກັດ, ຫຼືການກວດສອບພາກສະໜາມ ແລະອາດຈະລວມເຖິງການທົບທວນຄ່າໃຊ້ຈ່າຍທີ່ອະນຸຍາດຕາມກົດໝາຍຂອງລັດຖະບານກາງ, ກົດໝາຍຂອງລັດ, ແລະນະໂຍບາຍ LEA BOP. DHCS ຈະປຶກສາຫາລືທຸກຜົນການກວດສອບ CRCS ກັບ LEA ແລະຮ່ວມມືກັບ LEA ເພື່ອແກ້ໄຂຄໍາຖາມການກວດສອບ, ຄວາມກັງວົນ ຫຼືຄວາມບໍ່ເຫັນດີຜ່ານຂະບວນການກວດສອບ. ເມື່ອຄວາມແຕກຕ່າງລະຫວ່າງຈໍານວນທີ່ຕ້ອງຈ່າຍຕາມທີ່ໄດ້ລະບຸໄວ້ໃນການຍື່ນສະເຫນີແມ່ນຫຼາຍກ່ວາ 25 ສ່ວນຮ້ອຍຂອງການຊໍາລະສຸດທ້າຍ, DHCS ຈະສະເຫນີການຊ່ວຍເຫຼືອດ້ານວິຊາການກັບ LEA ເພື່ອຊ່ວຍໃຫ້ LEA ເຂົ້າໃຈຄວາມຜິດພາດເພື່ອວ່າມັນອາດຈະຫຼີກເວັ້ນໄດ້ໃນອະນາຄົດ.