BILL NUMBER: AB 2608 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY MAY 25, 2012
AMENDED IN ASSEMBLY MARCH 29, 2012
INTRODUCED BY Assembly Member Bonilla
FEBRUARY 24, 2012
An act to amend Section 14115.8 of the Welfare and Institutions
Code, relating to Medi-Cal.
LEGISLATIVE COUNSEL'S DIGEST
AB 2608, as amended, Bonilla. Medi-Cal: local educational agency
billing option.
Existing law provides for the Medi-Cal program, which is
administered by the State Department of Health Care Services and
under which qualified low-income persons receive health care
benefits. The Medi-Cal program is, in part, governed and funded by
federal Medicaid Program provisions. Existing law provides that
specified services provided by local educational agencies (LEAs) are
covered Medi-Cal benefits, and requires the department to perform
various activities with respect to the billing option for services
provided by LEAs. Existing law establishes the Local Educational
Agency Medi-Cal Recovery Fund, which consists of proportionately
reduced federal Medicaid funds allocable to LEAs, to be used, upon
appropriation by the Legislature, only to support the department,
until January 1, 2013, to meet the requirements relating to the LEA
billing option, the annual amount of which may not exceed $1,500,000.
Existing law requires, as of January 1, 2013, that all moneys in the
fund be returned proportionally to all LEAs whose federal Medicaid
funds were used to create the fund.
This bill would delete the repeal of these provisions and would
require the department to amend the Medicaid state plan and
regulatory requirements pertaining to the provision of medical
transportation services by LEAs to be no more restrictive than
federal requirements. This bill would provide that the
payments allocable to LEAs that are reduced pursuant to these
provisions shall be reduced no more than as specified and would
require that the department provide an accounting of funds
collected as a result of those the
above-referenced reductions in its annual report submitted to
the Legislature . It would also and would
require the department to collaborate with the State Department
of Education to help ensure LEA compliance with state and federal
Medicaid requirements.
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 14115.8 of the Welfare and Institutions Code is
amended to read:
14115.8. (a) (1) The department shall amend the Medicaid state
plan with respect to the billing option for services by local
educational agencies (LEAs), to ensure that schools shall be
reimbursed for all eligible services that they provide that are not
precluded by federal requirements.
(2) The department shall examine methodologies for increasing
school participation in the Medi-Cal billing option for LEAs so that
schools can meet the health care needs of their students.
(3) The department, to the extent possible shall simplify claiming
processes for LEA billing.
(4) The department shall eliminate and modify state plan and
regulatory requirements that exceed federal requirements when they
are unnecessary.
(5) The department shall amend the Medicaid state plan and
regulatory requirements pertaining to the provision of medical
transportation services by LEAs to be no more restrictive than
federal requirements in order to allow LEAs to seek reimbursement for
school transportation services that are not precluded by federal
requirements.
(b) If a rate study for the LEA Medi-Cal billing option is
completed pursuant to Section 52 of Chapter 171 of the Statutes of
2001, the department, in consultation with the entities named in
subdivision (c), shall implement the recommendations from the study,
to the extent feasible and appropriate.
(c) In order to assist the department in formulating the state
plan amendments required by subdivisions (a) and (b), the department
shall regularly consult with the State Department of Education,
representatives of urban, rural, large and small school districts,
and county offices of education, the local education consortium, and
local educational agencies. It is the intent of the Legislature that
the department also consult with staff from Region IX of the federal
Centers for Medicare and Medicaid Services, experts from the fields
of both health and education, and state legislative staff.
(d) Notwithstanding any other law, or any other contrary state
requirement, the department shall take whatever action is necessary
to ensure that, to the extent there is capacity in its certified
match, an LEA shall be reimbursed retroactively for the maximum
period allowed by the federal government for any department change
that results in an increase in reimbursement to local educational
agency providers.
(e) The department may undertake all necessary activities to
recoup matching funds from the federal government for reimbursable
services that have already been provided in the state's public
schools. The department shall prepare and take whatever action is
necessary to implement all regulations, policies, state plan
amendments, and other requirements necessary to achieve this purpose.
(f) The department shall file an annual report with the
Legislature that shall include at least all of the following:
(1) A copy of the annual comparison required by subdivision (i).
(2) A state-by-state comparison of school-based Medicaid total and
per eligible child claims and federal revenues. The comparison shall
include a review of the most recent two years for which completed
data is available.
(3) A summary of department activities and an explanation of how
each activity contributed toward narrowing the gap between California'
s per eligible student federal fund recovery and the per student
recovery of the top three states.
(4) A listing of all school-based services, activities, and
providers approved for reimbursement by the federal Centers for
Medicare and Medicaid Services in other state plans that are not yet
approved for reimbursement in California's state plan and the service
unit rates approved for reimbursement.
(5) The official recommendations made to the department by the
entities named in subdivision (c) and the action taken by the
department regarding each recommendation.
(6) A one-year timetable for state plan amendments and other
actions necessary to obtain reimbursement for those items listed in
paragraph (4).
(7) Identification of any barriers to local educational agency
reimbursement, including those specified by the entities named in
subdivision (c), that are not imposed by federal requirements, and a
description of the actions that have been, and will be, taken to
eliminate them.
(8) An accounting of funds collected from federal Medicaid
payments allocable to LEAs pursuant to subdivision (g). The report
shall detail amounts withheld from federal Medicaid payments to each
participating LEA for the year.
(g) (1) These activities shall be funded and staffed by
proportionately reducing federal Medicaid payments allocable to LEAs
for the provision of benefits funded by the federal Medicaid program
under the billing option for services by LEAs specified in this
section. Moneys collected as a result of the reduction in federal
Medicaid payments allocable to LEAs shall be deposited into the Local
Educational Agency Medi-Cal Recovery Fund, which is hereby
established in the Special Deposit Fund established pursuant to
Section 16370 of the Government Code. These funds shall be used, upon
appropriation by the Legislature, only to support the department to
meet all the requirements of this section. If at any time this
section is repealed, it is the intent of the Legislature that all
funds in the Local Educational Agency Medi-Cal Recovery Fund be
returned proportionally to all LEAs whose federal Medicaid funds were
used to create this fund.
(A) Federal Medicaid payments allocable to LEAs under this section
shall be reduced by no more than 1 percent for the purpose of
funding administrative and processing services costs related to the
management of the LEA Medi-Cal Billing Option Program.
(B) In addition to
the amounts described in subparagraph (A), federal Medicaid payments
allocable to LEAs under this section shall be reduced for the purpose
of supporting the department to meet all of the requirements of this
section. The annual amount funded pursuant to this
subparagraph shall not exceed one million five hundred thousand
dollars ($1,500,000).
(C) In addition to the amounts described in subparagraphs (A) and
(B), federal Medicaid payments allocable to LEAs under this section
shall be reduced by no more than 1 percent for the purpose of funding
the work and related administrative costs associated with audit
requirements to ensure the fiscal accountability of the Medi-Cal
billing option for LEAs and to comply with the Medicaid state plan.
The annual amount funded pursuant to this subparagraph shall not
exceed six hundred fifty thousand dollars ($650,000).
(2) Moneys collected under paragraph (1) shall be proportionately
reduced from federal Medicaid payments to all participating LEAs so
that no one LEA loses a disproportionate share of its federal
Medicaid payments.
(h) (1) The department may enter into a sole source contract to
comply with the requirements of this section.
(2) The level of additional staff to comply with the requirements
of this section, including, but not limited to, staff for which the
department has contracted for pursuant to paragraph (1), shall be
limited to that level that can be funded with revenues derived
pursuant to subdivision (g).
(i) The activities of the department shall include all of the
following:
(1) An annual comparison of the school-based Medicaid systems in
comparable states.
(2) Efforts to improve communications with the federal government,
the State Department of Education, and local educational agencies.
(3) The development and updating of written guidelines to local
educational agencies regarding best practices to avoid audit
exceptions, as needed.
(4) The establishment and maintenance of a local educational
agency user-friendly, interactive Internet Web site.
(5) Collaboration with the State Department of Education to help
ensure LEA compliance with state and federal Medicaid
requirement requirements and to help improve LEA
participation in the Medi-Cal billing option for LEAs.