Report 2014-130 Recommendation 19 Responses

Report 2014-130: California Department of Health Care Services: It Should Improve Its Administration and Oversight of School‑Based Medi-Cal Programs (Release Date: August 2015)

Recommendation #19 To: Health Care Services, Department of

To better maximize federal reimbursements for the administrative activities program, Health Care Services should, within six months, determine the extent to which claiming units can claim the unreimbursed difference between the 50 percent and 75 percent reimbursement rates for translation activities for past years and inform claiming units of the findings.

Annual Follow-Up Agency Response From September 2017

CMS approved retroactive claiming for all claims within the 2-year claiming limit. CMS approval allows retroactive claiming to begin with invoices submitted for the FY 2014-15 Q3 period of service. The invoices for the FY 2014-15 Q3 were submitted to DHCS on December 2016, and 2014-15 Q4 were submitted on February 28, 2017 for payment

  • Completion Date: December 2016

California State Auditor's Assessment of Annual Follow-Up Status: Partially Implemented

We cannot confirm that Health Care Services fully implemented this recommendation. It did not submit for our review a copy of CMS' approval of retroactive claiming nor copies of documents informing claimants of their ability to claim the unreimbursed difference for translation activities.

  • Auditee did not substantiate its claim of full implementation

1-Year Agency Response

CMS will provide a response to our request for retroactive claiming once the SMAA manual and new invoice have been approved. The SMAA manual and invoice were submitted on August 15, 2016.

  • Estimated Completion Date: Awaiting CMS approval
  • Response Date: September 2016

California State Auditor's Assessment of 1-Year Status: Pending


6-Month Agency Response

DHCS is revising the current SMAA invoice to allow LEAs to claim the enhanced 75% reimbursement rate for translation related Medi-Cal activities. DHCS has reached out to CMS to determine the period of service for which retroactive claiming can be applied and will develop a mechanism to collect and distribute the additional funding to LEAs as a result of the increased reimbursement rate. DHCS is still awaiting a response from CMS.

  • Estimated Completion Date: June 2016
  • Response Date: March 2016

California State Auditor's Assessment of 6-Month Status: Pending


60-Day Agency Response

DHCS is currently working to incorporate the increased reimbursement for translation services into the current invoice. Once the invoice has been updated and a process is in place to track this activity, DHCS will ask CMS if retroactive claiming will be allowed. Once DHCS develops a process, with the collaboration of stakeholders, we will submit to CMS for approval.

  • Estimated Completion Date: December 2015
  • Response Date: October 2015

California State Auditor's Assessment of 60-Day Status: Pending


All Recommendations in 2014-130

Agency responses received are posted verbatim.


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