NAME regions

Update from California

Cathy Bennett (CA)

The result from a recent CMS audit has determined that California’s School-Based Medi-Cal Administrative Activities (SMAA) claims do not comply with the claiming plan for school-based services approved by CMS in 2003. CMS is deferring California’s SMAA claims until adequate documentation can be provided. To read the deferral notice click here. CMS is requesting additional documentation including LEA’s to provide certification of activities performed to support submitted invoices. In addition, The California Department of Health Care Services (DHCS) must submit a revised time study methodology and statewide claiming plan for use beginning July 1, 2012. DHCS is working with CMS and stakeholders to resolve these issues as quickly as possible. (Exceptions to this deferral include LAUSD which utilizes the recently approved RMTS, and Santa Barbara County Education Office-Special Education)

Update From Arizona: Melinda Hollinshead (AZ)

In July 2011, Arizona's Medicaid School Based Claiming program began operating under a Cost Based Reimbursement methodology. We have completed our first year of claiming and are preparing to begin the cost reporting phase of the program. As we reflect on lessons learned over our first year what we find is that much of what our LEAs do regarding the delivery of services, collecting supporting documentation and claims submission has not changed much under the new methodology. As a result the new methodology did not pose significant challenges for districts in the area of claiming. Gathering and submitting costs for those direct service providers was the aspect of the new program that was the most challenging for LEAs as it required additional resources to complete the reporting requirements. This will be even more true as we enter the annual cost report phase.

One of the important take-aways for Arizona districts from this first year is the importance of coordination among departments within the district. In order to be successful all the internal stakeholders, from the finance department, to human resources, to the school base coordinators must work together and share information in a timely way to complete all the tasks as hand. As we begin the annual cost collection phase, Arizona districts are using that knowledge to guide them.