LEA Program Enrollment and Compliance Documents
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Updated: June 1, 2024
Mandatory LEA Program Provider Participation Agreement & Annual Report Requirements
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).
Data Use Agreement Requirement
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.
Provider Participation Agreement, Annual Report, and Data Use Agreement and Instructions
(Email LEA.AnnualReport@dhcs.ca.gov to request the PPA, AR, and DUA packets)
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.
Please use Adobe Acrobat or Reader to complete the forms.
Please direct any questions regarding the LEA PPA & AR to: LEA@dhcs.ca.gov
All newly enrolling LEAs must submit the PPA, AR, and the DUA (if applicable) to begin participation in the LEA Medi-Cal Billing Option Program.
Documentation Retention Requirements
The LEA Annual Report and supporting documentation must be maintained by each LEA for a minimum of three years from the date of submission to DHCS and the information contained therein must be verifiable by DHCS Audits and Investigations staff, if necessary.
Copies of Prior Reporting Year's PPA or AR
Explanation of Audit and Cost Reporting
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.
After the interim settlement is issued, DHCS will conduct a CRCS risk assessment to determine the level of CRCS audit. CRCS audits are conducted as a minimal audit, limited audit, or field audit and may include reviewing the allowable costs in accordance with federal laws, state laws, and the LEA BOP policy. DHCS will discuss any CRCS audit findings with the LEA and collaborate with the LEA to resolve audit questions, concerns, or disagreements through the course of the audit process. When the difference between the reported amount due as noted upon submission is greater than 25 percent of the final settlement, DHCS will offer technical assistance to the LEA to help the LEA understand the error so that it may be avoided in the future.
