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What is SMAA?

SMAA 101. What is SMAA?. SMAA 101. Medi-Cal in California Schools. LEA Medi-Cal Billing Option provides reimbursement for direct health services at fee-for-service rates.

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What is SMAA?

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  1. SMAA 101 What is SMAA?

  2. SMAA 101 Medi-Cal in California Schools • LEA Medi-Cal Billing Optionprovides reimbursement for direct health services at fee-for-service rates. • School-Based Medi-Cal Administrative Activities (SMAA)provides partial reimbursement to school districts, community colleges, charter schools and county offices of education for administrative activities necessary for the proper and efficient administration of the Medi-Cal program.

  3. SMAA 101 • PURPOSE: Improve availability and accessibility of Medi-Cal services for students and their families • The SMAA program is a federal reimbursement program available from the Centers for Medicare and Medicaid Services (CMS). • In California, the program is managed by the Department of Health Care Services (DHCS). • Locally, the program is administered by a Local Educational Consortium (LEC), a County Office of Education (COE).

  4. SMAA 101 SMAA Program Structure

  5. SMAA 101 Who participates in SMAA? • Time Survey Participants (TSPs) are identified and determined eligible to participate by each district SMAA Coordinator (or other district administrator) based on their job duties and funding stream. • A TSP list is created and updated each quarter by each district’s SMAA Coordinator. • Participants are district employees or personal service contractors who perform Medi-Cal health related services or administrative activities associated with those Medi-Cal health related services on a regular basis. • Eligible employees must: • Perform SMAA related activities on a regular or routine basis • Not be100% federally funded • Not be100% funded by the district’s indirect cost rate

  6. SMAA 101 Examples of Potential Participants • Examples of district employees that might perform SMAA activities: • Special Education Staff • Occupational Therapists, Physical Therapists • Nurses, Health clerks, Health aides • School Psychologists • Counselors • Speech Language Pathologists • Principals, Asst. Principals, Special Ed Teachers (Resource or SDC) • District Office Administrators or Administrative Staff

  7. SMAA 101 Examples of SMAA Activities • SMAA activities may include: • Medi-Cal outreach • Facilitating the Medi-Cal application • Arranging the transportation of Medi-Cal eligible individuals to and/or from Medi-Cal covered services • Referring, coordinating, and monitoring Medi-Cal services • Program planning and policy development • MAA coordination and claims administration • General administration • Third-party translation related to Medi-Cal services

  8. SMAA 101 SMAA Reimbursements • Once all of the coding for a quarter has been finalized, percentages will be sent to all participating districts by the LEC • Coding percentages are for the entire region • An SMAA Invoice is then prepared using the approved DHCS invoice template found on DHCS’ website • http://www.dhcs.ca.gov/provgovpart/Pages/SMAAInvoices.aspx • Finalized blue ink signature invoices with all requested supporting documentation should be submitted to the LEC by each deadline.

  9. SMAA 101 SMAA Reimbursements (cont’d) • The LEC will review and approve each invoice prior to submittal to DHCS. • The LEA is responsible for maintaining copies of all invoice related supporting documentation. • All invoices must be submitted to DHCS by their deadline • Failure to submit invoices in a timely manner may result in non-payment of invoices. • There is a 24 month calendar in which invoices must be reported to CMS for funds to be available for payment.

  10. SMAA 101 Roles & Responsibilities District SMAA Coordinators Third-Party Vendors • Attend regional trainings and meetings • Update and maintain information in the RMTS system • Ensure TSPs respond to assigned moments and maintain district compliance minimum of 85% • Maintain Audit File documentation • Invoice preparation and certification • Vendors may prepare district SMAA Invoices • Vendors may not have access to the RMTS system or retain district audit files

  11. SMAA 101 Roles & Responsibilities (cont’d) LEC Coordinator/LEC Office • Work with districts, RMTS system vendor (PCG) and DHCS • Monitor SMAA program with DHCS and CMS guidelines • Implement and maintain the RMTS system • Code all moments and ask clarifying questions as necessary • Review min. 10% of all random moment samples • Review and submit SMAA Invoices to DHCS • Optional service began in 2016-2017 for LEC to prepare SMAA invoice s for districts • Review all training materials and resource documents created/used by a district (prior to use) for DHCS approval • Randomly identify districts for site reviews (at least once every three years)

  12. SMAA 101 Roles & Responsibilities (cont’d) DHCS CMS • Update the SMAA Manual and website • Clarify policy in Policy and Procedure Letters (PPLs) • Contract with LECs and CMS • Provide RMTS coder training • Review and approve for payment SMAA Invoices • Conduct desk and site reviews • Review min. 10% of all random moment samples • Approve California SMAA Manual and Invoice template • Approve all RMTS processes, trainings, materials, and substantive updates • Conduct random LEC/LEA claiming unit reviews • Oversee California compliance with federal regulations

  13. SMAA 101 SMAA Program Resources • Department of Health Care Services website www.dhcs.ca.gov • School-Based Medi-Cal Administrative Activities (SMAA) webpage www.dhcs.ca.gov/provgovpart/Pages/SMAA.aspx • Region 9 LEC website http://www.ocde.us/Medi-CalAdministrativeActivities/Pages/default.aspx

  14. SMAA 101 Questions on SMAA?

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