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Medi-Cal Reimbursement Programs

Medi-Cal Program staff manage the LAUSD 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 LAUSD 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