AR – Annual Report is required by DHCS from each LEA, due every November. It summarizes the expected expenditures for services covered by the LEA program (budget) and outlines (1) how the LEA spent it’s funds in the previous year and (2) how it expects to spend funds in the upcoming year. An LEA collaborative must be formed to decide on how to spend the funds and each member of the Collaborative must sign the report.
CMS – Centers for Medicare and Medicaid Services is part of the US Department of Health and Human Services. It administers the Medicaid program and oversees each state’s Medicaid program, including Medi-Cal.
CRCS – Cost and Reimbursement Comparison Schedule is an extensive report required by the DHCS in order to reconcile interim LEA payments. It compares the actual costs incurred by the LEA for providing reimbursed student services to the state’s interim reimbursement amount. LEAs are required to submit this report every November for the previous fiscal year. MBT collects cost information from the LEA and prepares the report for our clients. The LEA will either owe the state (overpayment) or the state will owe the client (underpayment).
DHCS – Department of Health Care Services is a California state department that regulates and manages the LEA program. The programs and services offered by the DHCS include Denti-Cal, Medi-Cal, and California Children’s Services, aiming to increase access to health care for economically disadvantaged Californians.
HIPAA – Health Insurance Portability and Accountability Act was passed by Congress in 1996 to protect patient confidentiality and privacy, enable the transferring of health insurance coverage in the event of job changes or loss, prevent abuse and fraud in the health care system, and standardize electronic billing information. The LEA program follows HIPAA regulations.
IEP – Individualized Educational Plan is an extensive legal document defining educational goals and placement for each special education student aged 3-21. IEPs are customized for each student following a set of guidelines and processes. IEPs are updated annually, at a minimum, and require signature from the parent or guardian. Every three years, a triennial IEP meeting is held with a review of updated assessment information to ensure that the plan is relevant and appropriate.
IFSP – Individualized Family Service Plan is similar to an IEP, but is written for children aged 0-3.
LEA – Local Educational Agency Direct Medi-Cal Billing Option Program (LEA Program) provides federal Medicaid reimbursement for certain direct medical and special education services to students in Pre-K through high school and post-secondary programs. Examples include nursing services, speech therapy, occupational therapy, health aides, and psychological/mental health services. The term â€œLEAâ€ can also be used to refer to a school district or county office of educationâ€¦as a Local Educational Agency.
PPA – Provider Participation Agreement must be signed every 3 years by the LEA. It outlines the requirements of the LEA program.
TCM – Targeted Case Management, under the LEA program, provides federal Medicaid reimbursement for case management services to special education students. Examples include special education teachers, vocational education teachers, IEP service providers, and transition specialists with a special education credential.