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Fiscal Year 2010-11 State Budget Reimbursement Contingency

Since the State of California did not enact the fiscal year 2010-11 budget by June 30, 2010, the Department of Health Care Services (DHCS) will direct the fiscal intermediary, HP Enterprise Services, to implement provisions pursuant to state law, to continue processing and adjudicating claims as outlined below.

HP Enterprise Services will process and adjudicate claims for the following programs, regardless of date of service:

  • Medi-Cal
  • Family PACT (Planning, Access, Care and Treatment)
  • California Children’s Services (CCS)/Medi-Cal
  • Child Health and Disability Prevention (CHDP)/Medi-Cal
  • Abortion

HP Enterprise Services will withhold all reimbursements for the following programs regardless of dates of service. The last warrant date for claims for these programs will be June 17, 2010:

  • CCS-only
  • Genetically Handicapped Persons Program (GHPP)
  • Healthy Families (HF)
  • CHDP-only (that is, claims for clients with aid code 8Y) 

Effective for dates of service on or after July 1, 2010, claims submitted by the following programs, for which contingency funding is not available will continue to be processed, but reimbursement for these claims will be withheld until the state budget is approved and HP Enterprise Services receives approval from the state to resume reimbursement. (Claims will continue to pay for dates of services prior to July 1, 2010). The following programs will be affected by the temporary withhold:

  • Expanded Access to Primary Care Programs (EAPC)
  • Cancer Detection Programs: Every Woman Counts (CDP: EWC)

All providers are asked to continue to render services and submit claims for processing.