A recent Medi-Cal Update announced new Local Educational Agency (LEA) practitioner types, services and rates. The article instructed providers that as of March 16, 2021, LEAs could begin submitting claims for the new SPA 15-021-related services and practitioner types for dates of service on or after July 1, 2020.
Practitioners are now notified there is a six-month timeliness override for claims with dates of service on July 1, 2020, through June 30, 2021. The timeliness override begins on July 1, 2021, and extends through December 31, 2021. The six-month timeliness override will allow LEA claims with dates of service in state fiscal year 2020 – 2021 to be paid through December 31, 2021.
For policy details about the new LEA services, practitioner types and rates, providers may refer to the State Plan Amendment Updates: New LEA Practitioner Types, Services and Rates article in the March 16, 2021, Local Educational Agency Medi-Cal Update. The article includes various charts with locator keys of the Part 2, LEA provider manual sections where policy for the new services and provider types are located and the modifiers providers must include on claims to identify the new group of qualified LEA rendering practitioners.
Reminder: Retroactive Claim Submission
SPA 15-021 has an effective date of July 1, 2015; however, at this time the Department of Health Care Services (DHCS) instructs LEAs not to submit claims for services rendered prior to July 1, 2020. In a forthcoming Policy and Procedure Letter (PPL), DHCS will provide instructions for services rendered July 1, 2015 through June 30, 2020.