CalMHSA 803 – AB1051 Presumptive Transfer Report

Report Description

This report generates the AB1299 (Presumptive Transfer) upload file in the format required by the CalMHSA portal. It identifies eligible Medi-Cal services for clients who meet Presumptive Transfer criteria and prepares them for submission.

How Records Are Selected

1. Approved Medi-Cal Claims (835 Data) –

The report includes only services tied to: Claims that have been processed and posted and Medi-Cal payments (specific payer identifier) with only finalized, valid claims.

2. Date Range Filtering

Records are limited to:   Claims posted within the selected date range

Services with a Date of Service within the same range

3. Presumptive Transfer (Special Population) Requirement

Clients must be flagged under specific Presumptive Transfer special populations.

The report: Retrieves each client’s special population start and end dates

Limits eligibility to when the special population is active

4. Age 21 Limitation

Client eligibility is automatically capped at age 21. The report calculates each client’s 21st birthday

The effective eligibility end date is the earlier of: Special population end date, or 21st birthday

👉 Services occurring after age 21 are excluded, even if the population is still active.

5. County of Responsibility Rules

The report includes only: Services where the county of jurisdiction is different from the current system’s county and counties that are part of the AB1299 participating counties list

👉 Ensures only valid inter-county transfer cases are included.

6. Service and Financial Filters

The report excludes: Services with no associated charge, services where Medi-Cal paid the full amount, and services with Kin-GAP aid codes

The report includes: Federal share (FFP), transfer request amount (county portion)

7. Program and Service Data

Each record includes:

Client demographics (name, DOB, gender), Service details (date, procedure code, units), Provider and facility information (NPI, names), Diagnosis (primary ICD-10), Billing codes (HCPCS/CPT with modifiers)

8. Special Flags

AB1051 Flag is set based on presence of a specific special population and EPSDT Flag is derived from claim reference data

Key Definition

Eligible Record:

A service tied to an approved Medi-Cal claim, for a client in the Presumptive Transfer population, within the allowed date range, under age 21, and meeting all county and financial criteria.

Important Notes:

A client is excluded automatically after turning 21, regardless of population end date

Only participating counties are considered valid

The report is designed specifically to meet CalMHSA AB1299 portal upload requirements

Report Name

Menu Path

Client Based

Report RDL Name

CalMHSA 803 – AB1051 Presumptive Transfer Report

Reports/ CalMHSA 803 – AB1051 Presumptive Transfer Report

No

RDLCALMHSA_803AB1051.rdl

Parameters

Data Type

Hidden

Comments

Start Date

Date

N

End Date

Date

N

Show Header

Y/N

N

Toggle to display header/footer of report.   Defaults to N

DataSets

Form(s)

CDAG enforced

Comments

Primary

Staff service information

N/A

a query to pull out the AB1299 (Presumptive Transfer) upload file in the layout requested on the CalMHSA portal (as of April 2024)
REQUIRED fields for the upload are tagged as such, some non required fields are included as well.  Requires clients to be flagged using the “Presumptive Transfer” special population in Smartcare. Pulls approved 835s posted in the date range parameters used. Pulls only those approved with a county of responsibility NOT for the current system that is one of the AB1299 Participant Counties
Matches to the Special Population list (which also drops clients at age 21 regardless of population end date) based on date of service
Excludes Kin Gap aid codes
Drops services where Medi-Cal paid the full amount
Added AB1051

Default User Roles

Billing

Billing Supevisor

CalMHSA SysAdmin

County Affiliate SysAdmin