​​​​​LEA Program Enrollment and Compliance Documents

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Mandatory LEA Program Provider Participation Agreement & Annual Report Requirements

The Provider Participation Agreement (PPA) and Annual Report (AR) are required for participation in the LEA Program. The PPA contains two exhibits: Exhibit A - Health Insurance Portability and Accountability Act (HIPAA) Business Associate Addendum (BAA), and Exhibit B - Data File Description. In addition to complying with the terms listed in the PPA, all LEA providers must abide by the terms listed in the BAA. The purpose of the BAA is to guard the privacy and security of protected health information and personal information that may be created, received, maintained, transmitted, used or disclosed pursuant to the PPA, and to comply with certain standards and requirements of HIPAA regulations. Exhibit B is a description of the data provided to the LEA via data tape match. LEAs do not need to sign or return Exhibits A and B to the Department of Health Care Services (DHCS).

Data Use Agreement Requirement

LEA providers that designate a third-party billing vendor as their 'Custodian of the Files' must also submit a DUA, which is signed by representatives of DHCS, the LEA provider and the vendor. A DUA is required for non-providers (provider representatives, such as a billing vendor) to order and receive Medi-Cal eligibility information on behalf of the LEA provider. If a LEA provider does not utilize services of a third-party billing vendor and performs its own in-house billing, the submission of the DUA is not required.

Provider Participation Agreement, Annual Report, and Data Use Agreement and Instructions

(Email LEA.AnnualReport@dhcs.ca.gov to request the PPA, AR, and DUA packets)

All newly enrolling LEAs must submit the PPA, AR, and the DUA (if applicable) to begin participation in the LEA Medi-Cal Billing Option Program. ​

Documentation Retention Requirements

Copies of Prior Reporting Year's PPA or AR