More instructions re: reimbursement for expenses during 3-month retroactive Medi-cal coverage period. This one pertains to reimbursement of IHSS recipients who have paid excess out-of-pocket Share of Cost (SOC) expenses.  The “complex issue” of IHSS-buy out cases will be deferred to a future ACL, but in the meantime, recipients who believe they have paid a SOC in excess of their obligation must submit their claims through the Department of Health Care Services (CDHCS) Beneficiary Services Center (BSC), unless it is a Buy-Out claim for reimbursement for the current month or one month prior. That category of buy-out claims is to be made bay the County using the Special Pre-Authorized Transaction (SPEC) created for this purpose. [Download]

The long-awaited-for notice and process for the submission and handling of claims for reimbursement for bills paid out of pocket by folks later found eligible for Medi-Cal, and who are IHSS recipients. CDSS is handling the IHSS claims. (DHS is doing the “straight” Medi-Cal — see All Plan Letter 07002.) The notice is set to be mailed to 11.5 million folks. Wow. [Download]

The incredibly LONG title of this ACL matches the incredibly LONG ACL. 54 pages of details about the Share of Cost (SOC) issues stemming from the IHSS plus waiver. There are some key tidbits buried in the extensive acronym- and form-laden text, so, sorry, but you should at least skim it. For example, the Medi-Cal SOC “buy out” (where a person pays only the IHSS SOC and not the higher Medi-Cal one) is calculated only once a month, and once that’s done it won’t be changed for the current or prior months. Also, the IHSS SOC will no longer automatically be deducted from the wages. Rather, the IHSS computer system will check first for Medi-Cal Point of Service deductions, and then determine the remaining spenddown amount to deduct from the provider wages. This change in turn, has generated the need for two new notices: one to the recipient to explain how much is owed the provider, and one to the provider saying how much is owed for the work. Good luck! [Download]