LEA 计划注册和合规文件
更新日期：2024 年 6 月 1 日
强制性 LEA 计划提供商参与协议和年度报告要求
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).
数据使用协议要求
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.
提供商参与协议、年度报告以及数据使用协议和说明
（发送电子邮件至 LEA.AnnualReport@dhcs.ca.gov以请求 PPA、AR 和 DUA 包）
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.
请使用 Adobe Acrobat 或 Reader 填写表格。
Please direct any questions regarding the LEA PPA & AR to: LEA@dhcs.ca.gov
所有新注册的 LEA 必须提交 PPA、AR 和 DUA（如适用）才能开始参与 LEA Medi-Cal 账单选项计划。
文件保留要求
每个执法机构必须自提交给 DHCS 之日起至少保存执法机构年度报告和支持文件三年，并且其中包含的信息必须能够由 DHCS 审计和调查人员验证（如有必要）。
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.
审计和成本报告的解释
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.
在临时结算发出后，DHCS 将进行 CRCS 风险评估，以确定 CRCS 审计级别。 CRCS 审计以最低限度审计、有限审计或现场审计的形式进行，可能包括根据联邦法律、州法律和 LEA BOP 政策审查允许的成本。 DHCS 将与 LEA 讨论任何 CRCS 审计结果，并与 LEA 合作在审计过程中解决审计问题、疑虑或分歧。 当提交时所报告的应付金额与最终结算金额的差额超过 25% 时，DHCS 将向 LEA 提供技术援助，帮助 LEA 了解错误，以便在将来避免再次发生此类错误。