BILL NUMBER: AB 2608 AMENDED
BILL TEXT
AMENDED IN SENATE AUGUST 23, 2012
AMENDED IN SENATE JUNE 28, 2012
AMENDED IN ASSEMBLY MAY 25, 2012
AMENDED IN ASSEMBLY MARCH 29, 2012
INTRODUCED BY Assembly Member Bonilla
FEBRUARY 24, 2012
An act to amend Sections 14115.8 and 14132.06 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 the provisions governing the fund
and would provide that specified regulations do not apply to medical
transportation eligible to be billed under these provisions until
January 1, 2018, or until the date the director executes a
declaration stating that its regulations have been updated .
This bill would require that the department provide an
accounting of funds collected as a result of the above-referenced
reductions in its annual report submitted to the Legislature and
would require the department to collaborate with the State
Department of Education to help ensure LEA compliance with state and
federal Medicaid requirements. This bill would make
conforming changes. require the department, no later
than July 1, 2013, and every year thereafter, to make publicly
accessible an annual accounting of all funds collected by the
department from Medicaid payments allocable to local educational
agencies, as specified.
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. The annual amount funded pursuant to this
paragraph shall not exceed one million five hundred thousand dollars
($1,500,000).
(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 requirements
and to help improve LEA participation in the Medi-Cal billing option
for LEAs.
SEC. 2. Section 14132.06 of the Welfare and Institutions Code is
amended to read:
14132.06. (a) Services specified in this section that are
provided by a local educational agency are covered Medi-Cal benefits,
to the extent federal financial participation is available, and
subject to utilization controls and standards adopted by the
department, and consistent with Medi-Cal requirements for physician
prescription, order, and supervision.
(b) Any provider enrolled on or after January 1, 1993, to provide
services pursuant to this section may bill for those services
provided on or after January 1, 1993.
(c) Nothing in this section shall be interpreted to expand the
current category of professional health care practitioners permitted
to directly bill the Medi-Cal program.
(d) Nothing in this section is intended to increase the scope of
practice of any health professional providing services under this
section or Medi-Cal requirements for physician prescription, order,
and supervision.
(e) (1) For the purposes of this section, the local educational
agency, as a condition of enrollment to provide services under this
section, shall be considered the provider of services. A local
educational agency provider, as a condition of enrollment to provide
services under this section, shall enter into, and maintain, a
contract with the department in accordance with guidelines contained
in regulations adopted by the director and published in Title 22 of
the California Code of Regulations.
(2) Notwithstanding paragraph (1), a local educational agency
providing services pursuant to this section shall utilize current
safety net and traditional health care providers, when those
providers are accessible to specific schoolsites identified by the
local educational agency to participate in this program, rather than
adding duplicate capacity.
(f) For the purposes of this section, covered services may include
all of the following local educational agency services:
(1) Health and mental health evaluations and health and mental
health education.
(2) Medical transportation.
(A) The following provisions shall not apply to medical
transportation eligible to be billed under this section:
(i) Section 51323(a)(2)(A) of Title 22 of the California Code of
Regulations.
(ii) Section 51323(a)(3)(B) of Title 22 of the California Code of
Regulations.
(iii) For students whose medical or physical condition does not
require the use of a gurney, Section 51231.1(f) of Title 22 of the
California Code of Regulations.
(iv) For students whose medical or physical condition does not
require the use of a wheelchair, Section 51231.2(e) of Title 22 of
the California Code of Regulations.
(B) (i) Subparagraph (A) shall become inoperative on January 1,
2018, or on the date the director executes a declaration stating that
the regulations implementing subparagraph (A) and Section 14118.5
have been updated, whichever is later.
(ii) The department shall post the declaration executed under
clause (i) on its Internet Web site and transmit a copy of the
declaration to the Assembly Committee on Budget and the Senate
Committee on Budget and Fiscal Review and the LEA Ad Hoc Workgroup.
(iii) If subparagraph (A) becomes inoperative on January 1, 2018,
subparagraph (A) and this subparagraph shall be inoperative on
January 1, 2018, unless a later enacted statute enacted before that
date, deletes or extends that date.
(iv) If subparagraph (A) becomes inoperative on the date the
director executes a declaration as described in clause (i),
subparagraph (A) and this subparagraph shall be inoperative on the
January 1 immediately following the date subparagraph (A) becomes
inoperative, unless a later enacted statute enacted before that date,
deletes or extends that date.
(A) Medical transportation provided in accordance with Section
440.170 of Title 42 of the Code of Federal Regulations shall be
eligible to be billed.
(B) Section 51323 of Title 22 of the California Code of
Regulations shall not apply to the forms of medical transportation
eligible to be billed under this section.
(3) Nursing services.
(4) Occupational therapy.
(5) Physical therapy.
(6) Physician services.
(7) Mental health and counseling services.
(8) School health aide services.
(9) Speech pathology services. These services may be provided by
either of the following:
(A) A licensed speech pathologist.
(B) A credentialed speech-language pathologist, to the extent
authorized by Chapter 5.3 (commencing with Section 2530) of Division
2 of the Business and Professions Code.
(10) Audiology services.
(11) Targeted case management services for children with an
individualized education plan (IEP) or an individualized family
service plan (IFSP).
(g) Local educational agencies may, but need not, provide any or
all of the services specified in subdivision (f).
(h) For the purposes of this section, "local educational agency"
means the governing body of any school district or community college
district, the county office of education, a state special school, a
California State University campus, or a University of California
campus.
(i) Any local educational agency provider enrolled to provide
service pursuant to this section on January 1, 1995, may bill for
targeted case management services for children with an individualized
education plan (IEP) or an individualized family service plan
(IFSP), provided on or after January 1, 1995.
(j) Notwithstanding any other provision of law, a community
college district, a California State University campus, or a
University of California campus, consistent with the requirements of
this section, may bill for services provided to any student,
regardless of age, who is a Medi-Cal recipient.
(k) No later than July 1, 2013, and every year thereafter, the
department shall make publicly accessible an annual accounting of all
funds collected by the department from federal Medicaid payments
allocable to local educational agencies, including, but not limited
to, the funds withheld pursuant to subdivision (g) of Section
14115.8. The accounting shall detail amounts withheld from federal
Medicaid payments to each participating local educational agency for
that year. One-time costs for the development of this accounting
shall not exceed two hundred fifty thousand dollars ($250,000).