BILL ANALYSIS Ó
SENATE COMMITTEE ON APPROPRIATIONS
Senator Ricardo Lara, Chair
2015 - 2016 Regular Session
SB 123 (Liu) - Report: School-Based Medi-Cal Administrative
Activities program.
-----------------------------------------------------------------
| |
| |
| |
-----------------------------------------------------------------
|--------------------------------+--------------------------------|
| | |
|Version: May 12, 2015 |Policy Vote: ED. 9 - 0, HEALTH |
| | 9 - 0 |
| | |
|--------------------------------+--------------------------------|
| | |
|Urgency: No |Mandate: No |
| | |
|--------------------------------+--------------------------------|
| | |
|Hearing Date: May 18, 2015 |Consultant: Jillian Kissee |
| | |
-----------------------------------------------------------------
This bill meets the criteria for referral to the Suspense File.
Bill Summary: This bill requires the Legislative Analyst's
Office (LAO), in consultation with the California Department of
Education (CDE) and the State Department of Health Care Services
(DHCS) to review and prepare specific recommendations on the
administration and oversight of the School-Based Medi-Cal
Administrative Activities (SMAA) program and to submit
recommendations to the Legislature and the Governor by July 1,
2016.
This bill also requires DHCS to annually post on its website the
administrative fee percentage charged by each local governmental
agency or local educational consortium.
Fiscal Summary:
LAO indicates that it would need at least $150,000 to
complete the report required by this bill.
DHCS espresses the need for one limited-term position
(about $100,000 General Fund) to provide the necessary
SB 123 (Liu) Page 1 of
?
support to LAO with regard to compiling data.
DHCS and CDE indicate other workload required by this
bill to be minor and absorbable.
This bill also creates a potentially significant cost
pressure to implement the LAO's recommendations.
Background: The SMAA program provides federal reimbursements to
local educational agencies (LEAs) for the federal share (50%) of
certain costs for administering the Medi-Cal program. Those
activities include: outreach and referral, facilitating the
Medi-Cal application, arranging non-emergency/non-medical
transportation, program planning and policy development, and
Medi-Cal administrative activities claims coordination.
The federal Centers for Medicare and Medicaid Services (CMS)
administers the SMAA program at the federal level, and the
California Department of Health Care Services (DHCS) administers
the SMAA program for the state.
Current law authorizes DHCS to contract with each participating
local governmental agency or each local educational consortium
to assist with the performance of administrative activities. In
turn, local governmental agencies and local educational
consortiums are allowed to subcontract with private or public
entities. Local governmental agencies and local educational
consortiums are required to certify to DHCS the total amount
expended on the allowable administrative activities. DHCS is
required to deny claims if it determines that the certification
is not adequately supported or does not comply with federal
requirements.
For purposes of this program, a local educational consortium
means a local agency that is one of the service regions of the
California County Superintendent Educational Services
Association. In addition, a LEA 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 that
participates under the Administrative Claiming process as a
subcontractor to the local educational consortium in its service
region.
SB 123 (Liu) Page 2 of
?
In the 2010-11 fiscal year, CMS performed a Financial Management
Report of SMAA to determine if California properly claimed
federal Medicaid reimbursement for administrative costs
consistent with federal regulations and California guidance.
The review found serious deficiencies with the program which led
to the deferral of claim payments imposed by CMS. DHCS
indicates that despite corrective measures implemented, $122
million in deferred claims are outstanding. An audit of this
program by the Bureau of State Audits is expected to be complete
in August 2015.
According to the author's office, the intent of this bill is for
the LAO, in consultation with CDE and DHCS, to use information
from the audit to develop recommendations on improving the
structure and administration of the program through coordination
with LEAs.
Proposed Law: This bill requires the LAO, in consultation with
CDE and DHCS, to review and prepare specific recommendations on
the administration and oversight of SMAA and to submit
recommendations to the Legislature and the Governor by July 1,
2016. This bill also requires DHCS to annually post on its
website the administrative fee percentage charged by each local
governmental agency or local educational consortium.
Specifically, the report must consider the State Auditor's 2015
report and include an evaluation of:
1. The appropriate state agency to administer the program;
2. Oversight of the administration of the program, at the
state and local level;
3. The structure of the program and role of each entity and
the efficiency of those structures and roles in providing
funds to LEAs;
4. The relationships state agencies have with the federal
CMS, and the process used to disseminate information from
the federal level to LEAs;
SB 123 (Liu) Page 3 of
?
5. The process for reimbursing claims submitted by LEAs,
including the amount reimbursed compared to the amount
claimed and how the processes vary across the state;
6. The purposes for which LEAs use program funds;
7. The relationship between local governmental agencies or
local educational consortia and other entities that have
been subcontracted to assist with the performance of
administrative activities;
8. The rates charged by the local governmental agencies and
local educational consortia and how they vary across the
state and are determined;
9. The ability of a LEA to contract with a local
governmental agency or local educational consortium of its
choosing;
10. The feasibility of convening a LEA advisory body to
provide technical assistance to LEAs and communicating with
the administering state agency.
11. The extent to which the state is maximizing federal
funds available for the program; and
12. How capacity to operate the program can be built within
LEAs.
Related Legislation: AB 1955 (Pan, 2014), among other things,
required DHCS and the CDE to cooperate and coordinate efforts in
order to maximize receipt of federal financial participation
under the Administrative Claiming process. AB 1955 was held on
the Assembly Appropriations Committee's suspense file.
-- END --
SB 123 (Liu) Page 4 of
?