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Medi-Cal Reimbursement Programs

Medi-Cal Program staff manage the DNUSD participation in:

  • The Local Education Agency Medi-Cal Billing Option Program (LEA BOP)
    • Reimbursement is claimed for students who are Medi-Cal eligible and have been provided Medi-Cal covered health services
    • Reimbursement dollars are reinvested in health services and support for students and families

 

  • The School Medi-Cal Administrative Activities (SMAA) Program-Random Moment Time Survey (RMTS)
    • Selected staff are surveyed to determine the amount of time spent enrolling students in Medi-Cal insurance, referring students to Medi-Cal covered health and mental health services, and coordinating care of students who are Medi-Cal enrollees
    • The federal share of reimbursable costs comes to DNUSD without restriction for use in the general fund to benefit students

 

  • Third Party Reimbursement under Medi-Cal or other local, state, or federal programs through services provided at the District’s school-based health and mental health clinics

Types of Services

  • Claims preparation and reconciliation for the LEA Billing Option Program, invoicing for the SMAA program, and billing of third-party payers
  • Quality review of Medi-Cal and third-party claims
  • Program and policy development for participation in Medi-Cal Programs
  • Roster development and coding for the SMAA / RMTS Program
  • Audit preparation and support