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Updated as of September 17, 2013

On September 16, 2013, the Centers for Medicare and Medicaid Services (CMS) granted an informal approval to the Department of Health Care Services (DHCS) for interim claiming for State Fiscal Year (SFY) 2013-14, release of deferred invoices through the application of a reasonableness test criteria (RTC), and a timeline delineating the milestones that must be met to ensure implementation of a new claiming plan in SFY 2014-15.  DHCS anticipates the formal approval for these key issues will be forthcoming by the end of September 2013.  Once a formal approval is granted by CMS, policy and procedure letters will be issued.


Interim Claiming 2013/14 SFY

The interim claiming for SFY 2013-14 will be based on the school-based administrative claiming plan approved in 2003, updated to include changes that will ensure costs are in compliance with Office of Management and Budget (OMB) Circular A-87 and 42 Code of Federal Regulations, Section 433.15(B)(7), which require that costs be limited to those that are reasonable and necessary for the proper and efficient administration or the Medi-Cal program.

Deferred Claims 

A reasonableness test, based on the requirements of OMB Circular A-87, will be applied to all deferred invoices and invoices for FY 2012-13 dates of service. Once a formal approval is granted, DHCS will conduct a webinar training to the LECs, LGAs, and LEAs on this process.

State Random Moment Time Study (RMTS) Work Group 

DHCS has developed a milestones and timeline document outlining the various stages of completion of the revised statewide claiming plan and new time survey methodology to ensure implementation beginning July 1, 2014.

DHCS has formed a state RMTS work group to collaboratively assist with the development of the new revised statewide claiming plan and new time survey methodology. The work group consists of two LECs, LGAs, and LEAs, along with DHCS. The work group will be responsible for developing strategies on how DHCS will implement the new plan as well as ensuring it meets the directive imposed by CMS in which it will be in compliance with the OMB Circular A-87. Currently, there are three meetings scheduled to be held in Sacramento:

September 18, 2013, October 1, 2013, and October 16, 2013.


If any LEAs have questions, they may contact their LEC/LGA or email at

Last modified on: 7/3/2015 5:56 PM