BILL ANALYSIS Ó
SB 123
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Date of Hearing: June 14, 2016
ASSEMBLY COMMITTEE ON HEALTH
Jim Wood, Chair
SB
123 (Liu) - As Amended May 16, 2016
SENATE VOTE: 39-0
SUBJECT: Medi-Cal: school-based administrative activities.
SUMMARY: Recasts and revises the administrative claiming
process for local educational agencies (LEAs) that conduct
school-based administrative activities relating to the Medi-Cal
program and authorizes the State Department of Health Care
Services (DHCS) to withhold a percentage of funds to be
reimbursed to LEAs for the purpose of defraying the cost of
operating the School-Based Administrative Claiming process
program (SBAC program), the LEA billing option, and the appeals
process, as specified. Specifically, this bill:
1)Requires DHCS, in consultation with the California Department
of Education (CDE), to establish a School-Based Health Program
and Policy Workgroup (Workgroup), as specified for the purpose
of advising DHCS on issues related to the delivery of
school-based Medi-Cal services to students. Requires the
scope of the workgroup to include, but not be limited to,
improving the operation of and participation in all of the
following school-based health programs:
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a) The SBAC program;
b) The LEA billing option;
c) The Early and Periodic Screening, Diagnosis, and
Treatment (EPSDT) Program; and,
d) Other school-based health and mental health programs,
including school-based health centers which may receive
Medi-Cal funding.
2)Requires DHCS, beginning the 2017-18 state fiscal year (FY),
and annually thereafter, to publish the following reports on a
section of its Internet Web site:
a) A report that details the costs of operating the SBAC
program, including the cost of conducting the random moment
time survey (RMTS) and any vendor fees, lists each
participating LEA, and cost savings realized through the
restructuring and implantation of the SBAC program;
b) A report that details the costs of operating the LEA
Medi-Cal billing option program that lists each
participating LEA; and,
c) A report regarding the rate of participation of LEAs in
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the EPSDT Program.
3)Establishes that it is the intent of the Legislature to
provide local governmental agencies (LGAs) with the option to
participate in the Targeted Case Management (TCM) program and
to provide LEAs with the option to participate in the SBAC
program.
4)Requires, beginning no later than FY 2017-18, DHCS to
administer, or oversee the administration of, a single
statewide quarterly RMTS for the SBAC program. Exempts the
Los Angeles Unified School District (LAUSD) from the statewide
RMTS and permits LAUSD to conduct its own RMTS. Prohibits
data from the RMTS conducted by LAUSD shall from being
included in the statewide RMTS.
5)Requires DHCS to contract with each participating LEA to
perform administrative activities necessary for the proper and
efficient administration of the SBAC program.
6)Requires each participating LEA, as a condition of
participation in the SBAC program for the purpose of claiming
federal Medicaid reimbursement, to enter into a contract with
DHCS and certify the total amount expended on allowable
administrative activities.
7)Requires DHCS to deny a claim if it determines that the
certification is not adequately supported, or otherwise does
not comply with federal requirements, for purposes of claiming
federal financial participation (FFP). Permits an LEA to
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request a reconsideration of a denied claim within 30 days
after receipt of written notice of the denial and establishes
a denial review process, as specified. Permits DHCS to recoup
the cost of disallowed claims that have been paid to an LEA
with interest.
8)Requires each SBAC program contract to include a requirement
for each participating LEA to submit a claiming plan, as
prescribed by DHCS in regulations developed in consultation
with LEAs.
9)Requires each participating LEA to certify to DHCS that: a)
the LEA expended funds from its general fund or from any other
fund allowed under federal law and regulation to pay for 100%
of the cost of performing SBAC program activities; and, b) for
each FY, that the LEA's expenditures represent costs that are
eligible for FFP for that FY.
10)Holds the state harmless from any federal audit disallowance
and interest resulting from payments made to a participating
LEA for a disallowed claim. If a federal audit disallowance
results from a claim for a participating LEA that has already
received reimbursement, allows DHCS to recoup the disallowed
claim from the LEA, as specified.
11)Requires DHCS, in consultation with LEAs, to adopt
regulations that prescribe the requirements for the submission
and payment of claims for administrative activities performed
by each participating LEA.
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12)Permits LEAs to claim the actual costs of nonemergency,
nonmedical transportation of Medi-Cal eligibles to Medi-Cal
covered services only through the Medi-Cal administrative
activities program.
13)Requires LEAs participating in the SBAC program to pay an
annual participation fee through a mechanism agreed to by the
state and LEAs to be used to cover the cost of administering
the SBAC program, including, but not limited to, claims
processing, technical assistance, and monitoring. Requires the
amount of the participation fee to be based upon the
anticipated salaries, benefits, and operating expenses to
administer the SBAC program and other costs related to that
process.
14)Defines LEA as county offices of education, special education
local plan areas, Healthy Start programs, any governing body
of any school district or community college district, the
county office of education, a charter school, a state special
school, a California State University campus, or a University
of California campus.
15)Requires each LEA to notify DHCS of its intent to participate
in the SBAC program 90 days prior to the initial
participation.
16)Requires each participating LEA to prepare and submit claims
directly to DHCS.
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17)Requires DHCS, by July 1, 2017, to enter into an interagency
agreement or memorandum of understanding (MOU) with CDE to
coordinate the efforts of both CDE and DHCS with respect to
the SBAC program and the LEA billing option. Requires the
agreement or MOU to focus on the following:
a) Maximizing DHCS's Medicaid program expertise;
b) Coordinating functions and resources between DHCS and
CDE, and building personnel capacity at CDE, to assist LEAs
in implementing and meeting the requirements of the SBAC
program and the LEA billing option at the local level,
including an agreement of the use of funds provided for the
administration of these programs; and,
c) Developing a process by which an LEA may appeal an
action of DHCS or CDE with respect to the SBAC program or
the LEA billing option. Requires the appeals process to
utilize the Office of Administrative Hearings, or another
neutral third party acceptable to the DHCS and CDE, as the
appeals authority.
18)Requires DHCS to do the following in developing the
interagency agreement or MOU with CDE:
a) Estimate the cost savings resulting from the
restructuring of the SBAC program through implementation of
the new SBAC program. Requires DHCS to provide the
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estimate of cost savings, data used to support the
estimate, and a description of the methodology used to
calculate the estimate to CDE;
b) Consult with relevant nonprofit organizations involved
in facilitating information sharing among state Medicaid
and education agencies involved in the administration of
Medicaid claiming for school-based services to identify,
and implement if feasible, best practices that accomplish
the coordination of efforts required; and,
c) Consult with the Workgroup regarding the impact of the
implementation of the SBAC program on operations at the
local level.
19)Requires any savings resulting from the restructuring of the
Administrative Claiming process program through implementation
of the SBAC program and available to DHCS, to be directed
toward implementation of the interagency agreement or MOU
entered into pursuant to this section.
20)Requires DHCS, by July 1, 2017, in conjunction with CDE
pursuant to the interagency agreement or MOU to provide
technical assistance to all participating LEAs in order to
maximize the allowable FFP in the SBAC program.
21)Specifies that county offices of education or LGAs are not
prohibited from providing services to LEAs to facilitate
participation in school-based health programs on a
fee-for-service (FFS) basis.
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22)Specifies that county offices of education or a local
educational consortium providing services to LEAs are not
prohibited from contracting with private or public entities to
assist with the performance of administrative activities
necessary for the proper and efficient administration of the
Medi-Cal program.
23)Requires any savings resulting from the restructuring of the
SBAC program through implementation of the SBAC program and
available to DHCS to be directed toward implementation of the
interagency agreement or MOU.
24)Permits, commencing with FY 2017-18, and for each FY
thereafter, DHCS to withhold up to 5% of the total funds to be
reimbursed to LEAs pursuant to the SBAC program under the LEA
Medi-Cal billing option program, for the following purposes:
a) Defraying the costs of administering the SBAC program
and the LEA billing option program;
b) Implementing the interagency agreement or MOU;
c) Providing necessary staff support to CDE;
d) Providing necessary staff support to county offices of
education and LEAs; and,
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e) Carrying out the duties and activities required by this
bill.
25)Permits CDE to use funds from the withholding in 24) above to
support an office of school-based health programs within CDE.
26)Permits DHCS to withhold an additional 1% of the total funds
to be reimbursed to LEAs pursuant to the SBAC program under
the LEA Medi-Cal billing option program for the purpose of
defraying the costs of the development of an appeals process.
27)Specifies that the provisions of this bill be implemented
only to the extent that FFP is not jeopardized and requires
DHCS to seek any federal approvals necessary for the
implementation of this section.
EXISTING FEDERAL LAW:
1)Authorizes federal grants to states for a proportion of
expenditures for medical assistance under the approved
Medicaid state plan, and for expenditures necessary for
administration of the state plan.
2)Requires that claims for FFP come directly from the single
state Medicaid agency.
3)Authorizes FFP claims to be paid for health services and
health-related administrative activities provided in a school
setting through MAA.
EXISTING STATE LAW:
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1)Establishes the Medi-Cal program, is administered by DHCS,
under which qualified low-income individuals receive health
care services.
2)Permits DHCS to contract with each participating LGA or each
local education consortium (LEC) to assist with the
performance of administrative activities necessary for the
proper and efficient administration of the MAA program.
3)Requires DHCS to amend the Medicaid state plan with respect to
the billing option for services by LEAs to ensure that schools
are reimbursed for all eligible services that they provide
that are not precluded by federal requirements and requires
DHCS to eliminate and modify state plan and regulatory
requirements that exceed federal requirements when they are
unnecessary.
4)Requires DHCS to 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 and
requires DHCS to simplify claiming processes for LEA billing.
5)Requires DHCS to regularly consult with CDE, representatives
of urban, rural, large and small school districts, county
offices of education, the LEC, and LEAs to assist in
formulating the state plan amendments.
6)Requires DHCS to take whatever action is necessary to ensure
that, to the extent there is capacity in its certified match,
an LEA be reimbursed retroactively for the maximum period
allowed by the federal government for any department change
that results in an increase in reimbursement to LEA providers.
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7)Requires DHCS to file an annual report with the Legislature
that includes at least all of the following:
a) An annual comparison of the school-based Medicaid
systems in comparable states;
b) A state-by-state comparison of school-based Medicaid
total and per eligible child claims and federal revenues.
The comparison to include a review of the most recent two
years for which completed data is available;
c) 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;
d) A listing of all school-based services, activities, and
providers approved for reimbursement by the federal Centers
for Medicare and Medicaid Services (CMS) in other state
plans that are not yet approved for reimbursement in
California's state plan and the service unit rates approved
for reimbursement and a one-year timetable for state plan
amendments and other actions necessary to obtain
reimbursement for these items;
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e) The official recommendations made to DHCS by CDE,
representatives of urban, rural, large, and small school
districts, county offices of education, the LEC, and LEAs
in order to assist in formulating the state plan amendments
and the action taken by DHCS regarding each recommendation;
and,
f) Identification of any barriers to LEA reimbursement that
are not imposed by federal requirements and a description
of the actions that have been, and will be, taken to
eliminate those barriers.
8)Requires DHCS to undergo the following:
a) An annual comparison of the school-based Medicaid
systems in comparable states;
b) Efforts to improve communications with the federal
government, CDE, and LEAs;
c) The development and updating of written guidelines to
LEAs regarding best practices to avoid audit exceptions, as
needed;
d) The establishment and maintenance of a LEA
user-friendly, interactive Internet Website; and,
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e) Collaboration with CDE to help ensure LEA compliance
with state and federal Medicaid requirements and to help
improve LEA participation in the LEA billing option.
9)Requires the activities in 2) through 8) above to be funded by
a reduction in federal Medicaid payments allocable to LEAs and
to be deposited into the LEA Medi-Cal Recovery Fund, which
shall not exceed $1.5 million.
10)Requires each LEA that elects to participate in the MAA
program to submit claims through its LEC or LGA, but not both.
11)Requires each LEA participating as a subcontractor to a LEC
to comply with all requirements of the MAA program established
for LGAs.
12)Defines a LEA for purposes of the MAA program as 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 in the Administrative
Claiming process as a subcontractor to the LEC in its service
region.
13)Permits an LGA or LEC to charge an administrative fee to any
entity MAA program costs through that agency.
FISCAL EFFECT: This bill has not yet been analyzed by a fiscal
committee.
COMMENTS:
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1)PURPOSE OF THIS BILL. According to the author, MAA program
typically supports school nurses, psychologists, health aides,
family resource centers and other activities ensuring that
California's neediest students are accessing and receiving
health and mental health services. The LEA Billing Option
Program currently supports health services for special
education students. These programs have been fraught with
issues including the federal deferral of funds for the MAA
program that resulted in hundreds of millions of dollars being
owed to California schools going back to 2010. This bill
builds on the recommendations of the State Audit of MAA
programs issued last year which Senator Liu requested via the
Joint Legislative Audit Committee (JLAC). This bill provides
more options and local control for school districts, charters
and other LEAs to utilize technical support providers they
feel meet their needs rather than require them to use the
intermediary structure currently mandated in statute by
allowing local education agencies to contract directly with
DHCS in a more streamlined, accountable, and cost effective
structure as recommended by the state auditor.
Improving school-based health services requires effective
coordination between California's health and education
systems. This bill requires development of an interagency
agreement between DHCS and CDE to help ensure that
collaboration is institutionalized and represents the best
practices outlined in the recent federal guidance regarding
high impact opportunities to support healthy students through
inter-agency collaboration at the federal, state, and local
level. Federal requirements call for an interagency agreement
between the health and education agencies in states to operate
these programs. California currently does not have that
interagency agreement.
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The author concludes that improving school-based health
services is a critical strategy to address the achievement gap
in our schools and health and education equity issues in
California. These vital programs must be operated at a level
that meets the benchmark of national best practices in order
to meet the needs of California's most vulnerable children.
2)BACKGROUND.
a) LEA Billing Option vs. MAA. California established the
LEA Medi-Cal Billing Option Program in 1993 and the MAA
program in 1994. The LEA Medi-Cal Billing Option program
is a FFS program which includes direct assessment and
services to Medi-Cal eligible children. Claims which
capture this direct service require the name of the
student, the name of the provider, the date of service, and
supporting documentation for the nature and extent of the
services. Reimbursements for LEA direct services are
returned to school districts as General Fund- Restricted
funds. Funds are restricted by the oversight of a
Collaborative Board as defined in the California education
code.
The SMAA program claims reimbursement for administrative
activities, including outreach and enrollment, referral to
Medi-Cal services, and other specific administrative
activities that improve and support Medi-Cal services to
children. The district is required to implement a
quarterly time study methodology completed by district
personnel in order to claim this revenue. LAUSD uses a time
sampling methodology known as RMTS. Reimbursements for the
MAA/RMTS program are returned to school districts as
General Funds.
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b) MAA. MAA activities include: outreach and referral;
facilitating the Medi-Cal application; arranging
non-emergency/non-medical transportation; program planning
and policy development; and, claims coordination. MAA
funds were typically reimbursed directly to school
districts for services already provided.
In 2012-13, 825 LEAs were involved in the MAA program, a
decrease from 836 in FY 2010-11. LEAs that elect to
participate in MAA must submit claims through a LEC or LGA.
As a condition of participation in MAA, each participating
LGA and LEC is required to pay an annual fee to DHCS. The
participation fee is used to cover the DHCS' cost of
administering the MAA claiming process, including claims
processing, technical assistance, and monitoring. Due to
concerns regarding a lack of compliance and oversight, CMS
has deferred reimbursements for claims through the MAA
program since 2012. Approximately $0.5 billion in
reimbursable funds has not been paid to California school
districts in the last five years.
i) MAA payment deferral. On June 26, 2012, the CMS
informed DHCS that the MAA program was on payment
deferral, because implementation of DHCS's approved MAA
claiming plan did not comply with the requirements
detailed in the Office of Management and Budget (OMB)
Circular A-87. OMB Circular A-87 requires that any costs
claimed be limited to those that are reasonable and
necessary for the proper and efficient administration of
the Medi-Cal program. Exceptions to the CMS payment
deferral include LAUSD, which uses a CMS-approved RMTS
system (discussed below) and the Santa Barbara County
Education Office - Special Education, which was found to
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be compliant with OMB Circular A-87. The CMS payment
deferral applies retroactively to claims submitted. To
lift the deferral, CMS required DHCS to implement a
revised claiming plan that is in compliance with OMB
Circular A-87. CMS also informed DHCS that any invoices
submitted for quarters after July 1, 2012, using the
currently approved methodology, may be subject to
deferral.
On April 1, 2015, DHCS submitted a backcasting methodology
for all deferred invoice claims submitted to the MAA
program based on an October 7, 2014 CMS deferral
settlement agreement. Under that agreement, DHCS would
apply the following criteria to each unresolved deferred
invoice:
(1) Claims under $25,000 will be paid in whole and
backcasting will not be required;
(2) Claims between $25,001 and $50,000 will
require claiming units to choose one of the following
options:
(a) An interim payment of 75% and agree to
backcasting; or,
(b) A settlement payment of 75% of the claimed
amount or $25,000, whichever is higher with no
backcasting; and,
(3) Claims greater than $50,001 will receive an
interim payment of 40% and backcasting will be
required.
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In February 2015, DHCS indicated $216 million in
deferred current placeholder claims that have yet to
be paid to date, and $122 million is the total
deferred claims that have been paid.
DHCS indicates all interim payments for under $25,000
have been made, and DHCS hopes to have the interim
payments made in this fiscal year. The final
reconciliation amounts will depend upon CMS's approval
of the state's submission.
ii) RMTS. The new RMTS claiming methodology will
replace the worker log methodology that has been used in
the MAA program. Under the worker log methodology, MAA
participants fill out paper time surveys in which they
state the amount of time they spent on MAA and non-MAA
activities. Under the RMTS method of time surveying,
participants will receive an email questionnaire that
asks what they are doing at a specified time. That
information will be sent to the LECs and LGAs, who will
code the answer to MAA billable or MAA non-billable
codes. The RMTS method provides means of determining
what portion of a participant's workload is spent
performing activities which are reimbursable by Medicaid,
and will be the basis for claiming federal Medicaid
matching funds.
c) Definitions. A LEA is any school district or community
college district, a county office of education, a state
special school, a California State University campus, or a
University of California campus. A LEC is a group of LEAs
that are all in one same region out of the 11 service
regions established by the California County Superintendent
Educational Services Association. A LGA is a county,
county agency, chartered city, Native American Indian
tribe, tribal organization, or subgroup of a Native
American Indian tribe or tribal organization. DHCS
currently contracts with LGAs and LECs that consolidate
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claims provided by LEAs for a fee.
d) Federal financial report on MAA. CMS performed a
Financial Management Report of MAA for the period July 2010
through June 2011, during which time California claimed
$188.9 million in federal Medicaid matching funds. The
purpose of the review was to determine if California
properly claimed federal Medicaid reimbursement for
administrative costs in accordance with federal regulations
and California's approved School-Based Administrative
Claiming Guide. CMS' review found serious deficiencies
within the program.
The CMS review included visiting Turlock Unified School
District (Turlock), Tulare County Office of Education -
Special Services Division (Tulare) and Santa Barbara County
Education Office - Special Education (Santa Barbara). The
review found two (Turlock and Tulare) of the three entities
did not comply with federal regulations or the federal OMB
Circular A-87. The review was critical of DHCS for its
lack of oversight and monitoring of invoices submitted, and
inconsistency across school districts over the oversight
that each individual LEC/LGA performs in a review over the
amounts claimed. CMS found a lack of internal controls,
operating procedures and financial oversight to ensure
compliance with federal regulation and the OMB circular,
and the approved claiming plan did not comply with federal
regulation and the OMB circular.
e) 2015 State Auditor's Report. In July 2014, Senator Liu
requested JLAC approve an audit of MAA and the LEA Billing
Option, the effectiveness of the LECs and LGAs associated
with administering the program, the extent to which the
necessary administrative controls and structures are in
place to ensure schools receive the allowed Medicaid
funding. The State Auditor concluded that while the
reasonableness test criteria process DHCS used to review
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reimbursement claims for the MAA program from October 2013
through October 2014 was reasonable and not inconsistent
with federal requirements, DHCS approved fewer than 10% of
the claims submitted under this process. The entities with
which DHCS contracts to review reimbursement claims-LECs
and LGAs-added little value during this review process;
they approved and forwarded to DHCS claims that did not
comply with the reasonableness test criteria benchmarks and
other limits. The Audit noted that at the time, DHCS was
behind in its required reviews of LECs and LGAs, which the
Auditor noted increased the risk that these entities are
not performing the administrative tasks for which they are
responsible. DHCS also does not effectively oversee the
contracts between the LECs or LGAs and the claiming units.
The Auditor also found that DHCS missed an opportunity to cut
costs through the implementation of a single statewide quarterly
time survey when it implemented the RMTS methodology. The Audit
estimated that the administrative activities program could save
as much as $1.3 million annually in coding costs alone if DHCS
conducted a single statewide quarterly time survey. However, if
DHCS implemented its own single statewide quarterly survey and
took over responsibility for overseeing the administrative
activities program, thus eliminating the need to use the LECs
and LGAs for these purposes, it would result in significant
savings to the administrative activities program.
The Auditor found that DHCS could increase federal funding by an
estimated $10.2 million annually if more claiming units
participated in the program and could have increased federal
reimbursements by about $4.6 million from February 2009 through
June 2015 if it increased the reimbursement rate for translation
activities to the rate allowed by federal law. Additionally,
DHCS has not complied with state law requiring the adoption of
regulations for its administrative activities program and has
failed to issue a required annual report for its billing option
program
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3)SUPPORT. The California School-Based Health Alliance states
that this bill will provide needed reform for School-based
Medi-Cal programs. These programs provide a vital source of
funding for school-based health services in California.
Effective cross-agency collaboration is vital to deliver
high-quality school-based health services to California
students. This bill will build an essential link between
California's healthcare and education systems to provide
support services for our state's most vulnerable students.
The California Teachers Association states that the current
program has become too cumbersome with many districts dropping
out of the program over the last several years even through it
can provide a vital source of funding for school-based health
services in California. What is missing is an active role for
the education community where the school community can bring
to the program its expertise and help to create an effective
program. California should maximize all allowable federal
funds and ensure that as many dollars as possible reach local
schools to provide services to children. Creating a hub
within CDE to oversee the various health programs operated by
school districts would help to sharpen the focus on these
programs that provide vital support to students and their
families.
4)OPPOSITION. The California County Superintendent Educational
Services Association states that there is merit in the
priorities of this bill concerning the commitment to
school-based health care centers and community schools,
broad-based collaboration, and an improved appeals process.
However, these potential positives are overwhelmed by the
disruption that would occur by changing the organizational
structure precisely when the program is beginning to stabilize
again.
The Kern County Superintendent of Schools states that while
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the bill purports to address a long history of confusion among
governmental agencies in the federal MAA claiming process and
attempts to implement recommendations that have been made by
the State Auditor General designed to help LEAs better
understand the claiming process, the bill replaces the current
structure of LEC support and oversight of LEA reporting and
claiming with a structure that requires LEAs to contract
directly to CDE/DHCS. All LEAs, would be responsible for
preparation and submission of claiming plans, training of
staff and submission of detailed quarterly invoices. LEAs
would now be required to pay for additional support and
technical assistance in preparing claiming plans on a FFS
basis. This bill will make it harder for LEAs to file
accurate claims and may result in significant increased costs
that school districts pay for claim filings by eliminating:
a) the essential role that LECs play in assisting districts
with their SMAA claims; and, b) assurances that claims are
filed in a manner that is consistent with the requirements of
federal law. This is particularly true for the small
districts with less than 5,000 ADA.
5)RELATED LEGISLATION.
a) AB 1133 (Achadjian) makes technical changes to existing
law regarding grants to LEAs to pay the state share of
costs of providing school-based early mental health
intervention and prevention services to eligible students.
AB 1133 was held in the Assembly Appropriations Committee.
b) AB 1018 (Cooper) requires DHCS and CDE to convene a
joint task force to examine the delivery of mental health
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services to children eligible for Early and Periodic
Screening, Diagnosis, and Treatment services and for
services required by the federal Individuals with
Disabilities Education Act. AB 1018 is pending in the
Senate Education Committee.
6)PREVIOUS LEGISLATION. AB 1955 (Pan) of 2014, would have
required DHCS and CDE to cooperate and coordinate efforts in
order to maximize receipt of FFP under the Administrative
Claiming process. AB 1955 was held on the Assembly
Appropriations Committee's suspense file.
7)DOUBLE REFERRAL. Upon passage in this Committee, this bill
will be referred to the Assembly Education Committee.
8)COMMITTEE COMMENTS.
a) LECs. The bill prohibits, beginning January 1, 2018,
LECs from participating in the MAA program. While the
Audit points out that some LECs "add little value" to the
process, others provide complicated technical assistance to
LEAs throughout the billing process. This holds true for
smaller school districts that may not have the means to
train staff properly and, should they be required to claim
on their own, may disproportionately be affected by
inaccurate and therefore disallowed claims.
b) RMTS. Currently this bill creates one single state-wide
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RMTS survey, but exempts LAUSD and permits it to administer
its own RMTS, creating two across the state. It is unclear
why this exemption is necessary, and defacto creates two
RMTS surveys across the state.
c) Withhold. Currently the bill permits DHCS to withhold
5% of funds from reimbursed MAA claims and an additional 1%
for purposes of administering appeals processes. Based on
claims submitted between 2013-2014, this could be up to
$11.5 million. Current statute permits $1.5 million to be
withheld for DHCS to administer the program. This number
is seemingly arbitrary, and it is not clear of transferring
$10 million from schools to DHCS is necessary or
appropriate. Additionally, it is not clear if the
withholding of such a significant amount would meet CMS
approval.
9)SUGGESTED AMENDMENTS. Currently this bill creates significant
changes to the MAA program on a relatively short timeline.
The intent, which is to ameliorate a long-standing problem
that has resulted in schools not being reimbursed in a timely
manner for health care services provided on school sites, is
laudable. However, without input from DHCS on how these
changes would be received or implemented, it is unclear if the
administrative claiming program provided for in this bill
actually fixes the many problems the current system faces. The
Committee may wish to consider only the following provisions
of the bill, until more collaboration and consideration can be
had:
a) Workgroup. Current law vaguely requires DHCS to consult
with various stakeholders. The Committee may wish to
consider formally establishing the Workgroup as provided
for by this bill, and to add direction to the Workgroup
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including examining the cost effectiveness, program
structure, and operational effectiveness, including the
process of balancing withheld funds and actual expenses of
the MAA and LEA billing option programs.
b) Direct billing. The Committee may wish to permit,
instead of require, LEAs to directly bill to DHCS and
establish an appeal process for that purpose.
c) MOU. The Committee may wish to consider requiring DHCS
and CDE to formally establish a working relationship to
provide input on whether the SBAC program and the LEA
billing option program are meeting the needs of LEAs with
respect to cost effectiveness, program structure, and
operational effectiveness.
d) Duplicative reporting. As currently drafted the bill
requires DHCS to publish five different reports regarding
the MAA program, LEA billing option and EPSDT program. The
Committee may wish to consider combining these reporting
requirements.
REGISTERED SUPPORT / OPPOSITION:
Support
California School-Based Health Alliance
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California Teachers Association
National Association of Social Workers
Teachers for Healthy Kids
American Federation of State, County, and Municipal Employees,
AFL-CIO (previous version)
California School Boards Association (previous version)
California School Employees Association (previous version)
Los Angeles Unified School District (previous version)
Riverside County Superintendent of Schools (previous version)
San Francisco Unified School District (previous version)
Santa Clara County Office of Education (previous version)
Small School Districts' Association (previous version)
Opposition
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California County Superintendents Educational Services
Association
Kern County Superintendent of Schools
Orange County Department of Education
Sonoma County Office of Education
Analysis Prepared by:Paula Villescaz / HEALTH / (916)
319-2097