TITLE
Recommendation to authorize the refund of $658,620 to the State of California Department of Health Care Services for overpayments made to the City of Long Beach by the County-Based Medi-Cal Administrative Activities Program for Fiscal Years 2011, 2012, and 2013; and
Authorize the refund of $94,191 to the State of California Department of Health Care Services for overpayments made to the City of Long Beach by the Targeted Case Management Program for Fiscal Year 2013. (Citywide)
DISCUSSION
BACKGROUND
The State of California Department of Health Care Services (DHCS) administers the County-Based Medi-Cal Administrative Activities (CMAA) Program, which provides the partial reimbursement of costs incurred for performing administrative activities and services that directly support efforts to identify and enroll potential eligible individuals into Medi-Cal. Such activities and services are already performed by certain Health and Human Services Department (Health Department) staff as part of other programs. As of June 5, 2018, the DHHS has received $6,767,970 in reimbursements through the CMAA Program since the mid-1990’s.
The Health Department also administers the Targeted Case Management (TCM) Program, which provides reimbursement for case management services to Medi-Cal beneficiaries under the age of 21; the medically fragile; and individuals at-risk of institutionalization, communicable diseases, or negative health or psycho-social outcomes. As of June 5, 2018, the Health Department has participated in the TCM Program since the early 1990s and has received $3,002,947 in reimbursements.
DISCUSSION
The refunds to the DHCS are a result of a change in methodology for calculating reimbursement amounts instituted by the CMAA and TCM Programs in 2013, and applied retroactively to Fiscal Years 2011, 2012, and 2013. On June 23, 2011, State Policy and Procedure Letter (PPL) Number 11-011 notified Local Government Agencies (LGAs) that continuation in the CMAA a...
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