Mga Dokumento sa Pagpapatala at Pagsunod sa Programa ng LEA
Na-update: Hunyo 1, 2024
Mandatorying LEA Program Provider Participation Agreement at 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).
Kinakailangan sa Kasunduan sa Paggamit ng Data
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.
Kasunduan sa Paglahok ng Provider, Taunang Ulat, at Kasunduan at Mga Tagubilin sa Paggamit ng Data
(I-email ang LEA.AnnualReport@dhcs.ca.gov para humiling ng mga PPA, AR, at DUA packet)
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.
Mangyaring gamitin ang Adobe Acrobat o Reader upang kumpletuhin ang mga form.
Please direct any questions regarding the LEA PPA & AR to: LEA@dhcs.ca.gov
Dapat isumite ng lahat ng bagong enroll na LEA ang PPA, AR, at ang DUA (kung naaangkop) upang simulan ang paglahok sa LEA Medi-Cal Billing Option Program.
Mga Kinakailangan sa Pagpapanatili ng Dokumentasyon
Ang Taunang Ulat ng LEA at pansuportang dokumentasyon ay dapat pangalagaan ng bawat LEA sa loob ng hindi bababa sa tatlong taon mula sa petsa ng pagsusumite sa DHCS at ang impormasyong nakapaloob dito ay dapat ma-verify ng mga kawani ng DHCS Audits and Investigations, kung kinakailangan.
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.
Paliwanag ng Audit at Pag-uulat ng Gastos
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.
Pagkatapos mailabas ang pansamantalang pag-areglo, magsasagawa ang DHCS ng pagtatasa ng panganib sa CRCS upang matukoy ang antas ng pag-audit ng CRCS. Ang mga pag-audit ng CRCS ay isinasagawa bilang isang minimal na pag-audit, limitadong pag-audit, o pag-audit sa larangan at maaaring kabilangan ng pagrepaso sa mga pinapahintulutang gastos alinsunod sa mga pederal na batas, mga batas ng estado, at sa patakaran ng LEA BOP. Tatalakayin ng DHCS ang anumang mga natuklasan sa pag-audit ng CRCS sa LEA at makikipagtulungan sa LEA upang malutas ang mga tanong, alalahanin, o hindi pagkakasundo sa pag-audit sa pamamagitan ng proseso ng pag-audit. Kapag ang pagkakaiba sa pagitan ng iniulat na halagang dapat bayaran gaya ng nabanggit sa pagsusumite ay higit sa 25 porsiyento ng huling kasunduan, ang DHCS ay mag-aalok ng teknikal na tulong sa LEA upang matulungan ang LEA na maunawaan ang pagkakamali upang ito ay maiwasan sa hinaharap.