LEA 計劃註冊和合規文件
更新日期：二零二四年六月一日
強制性 LEA 計劃提供者參與協議 & 年度報告要求
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).
資料使用協議要求
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.
提供者參與協議、年度報告及資料使用協議與說明
（發送電子郵件 LEA.AnnualReport@dhcs.ca.gov 以要求 PPA，AR 和 DUA 數據包）
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.
請使用 Adobe Acrobat 或閱讀器填寫表格。
Please direct any questions regarding the LEA PPA & AR to: LEA@dhcs.ca.gov
所有新註冊 LEA 必須提交 PPA、AR 和 DUA（如適用）才能開始參與 LEA Medi-Cal 計費選項計劃。
文件保留要求
每一個局局長必須保存 LEA 年報及證明文件，自遞交給 DHCS 之日起至少三年，而該報告中所包含的資料必須在有需要時可由 DHCS 審核和調查人員進行驗證。
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.
稽核及成本報告說明
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.
在發行中期結算後，DHCS 將進行 CRCS 風險評估，以確定 CRCS 審計的水平。 CRCS 稽核是以最小稽核、有限稽核或現場稽核方式進行，並可能包括根據聯邦法律、州法律和 LEA BOP 政策檢討允許的成本。 DHCS 將與 LEA 討論任何 CRCS 審計結果，並在審核過程中與 LEA 合作解決審計問題、疑慮或異議。 當提交時註明的報告金額之間的差額大於最終結算的 25% 時，DHCS 將向 LEA 提供技術協助，以幫助 LEA 了解錯誤，以便將來避免錯誤。