BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | SB 123|
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UNFINISHED BUSINESS
Bill No: SB 123
Author: Liu (D), et al.
Amended: 8/18/16
Vote: 21
SENATE EDUCATION COMMITTEE: 9-0, 4/22/15
AYES: Liu, Runner, Block, Hancock, Leyva, Mendoza, Monning,
Pan, Vidak
SENATE HEALTH COMMITTEE: 9-0, 4/29/15
AYES: Hernandez, Nguyen, Hall, Mitchell, Monning, Nielsen,
Pan, Roth, Wolk
SENATE APPROPRIATIONS COMMITTEE: 7-0, 5/28/15
AYES: Lara, Bates, Beall, Hill, Leyva, Mendoza, Nielsen
SENATE EDUCATION COMMITTEE: 9-0, 8/26/16 (Pursuant to Senate
Rule 29.10)
AYES: Liu, Block, Hancock, Huff, Leyva, Mendoza, Monning, Pan,
Vidak
SENATE FLOOR: 39-0, 6/1/15
AYES: Allen, Anderson, Bates, Beall, Berryhill, Block,
Cannella, De León, Fuller, Gaines, Galgiani, Glazer, Hall,
Hancock, Hernandez, Hertzberg, Hill, Hueso, Huff, Jackson,
Lara, Leyva, Liu, McGuire, Mendoza, Mitchell, Monning,
Moorlach, Morrell, Nguyen, Nielsen, Pan, Pavley, Roth, Runner,
Stone, Vidak, Wieckowski, Wolk
NO VOTE RECORDED: Leno
ASSEMBLY FLOOR: 79-0, 8/23/16 - See last page for vote
SUBJECT: Medi-Cal: school-based administrative activities
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SOURCE: Author
DIGEST: This bill establishes a revised process for
school-based and non-school-based administrative claiming,
beginning January 1, 2018, authorizes the Department of Health
Care Services (DHCS) to administer or oversee a single statewide
quarterly random moment time survey, requires the DHCS and
California Department of Education to enter into an interagency
agreement or memorandum of understanding by July 1, 2018, and
establishes a workgroup to provide advice on issues related to
the delivery of school-based Medi-Cal services to students.
Assembly Amendments recast the provisions of this bill, which
now sunset the existing School-Based Medi-Cal Administrative
Activities (SMAA) process, recast a new School-Based
Administrative Claiming process, move the existing
non-school-based Administrative Claiming process into a separate
section, establish a stakeholder workgroup, and establish an
appeals process.
ANALYSIS:
Existing law:
1) Establishes the SMAA program, which 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.
2) Authorizes DHCS to contract with each participating local
governmental agency (LGA) or each local educational
consortium (LEC) to assist with the performance of
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administrative activities.
3) Requires DHCS to deny the claim if it determines that the
certification is not adequately supported, or does not
otherwise comply with federal requirements.
4) Authorizes each participating LGA or LEC to subcontract with
private or public entities to assist with the performance of
administrative activities.
(Welfare and Institutions Code § 14132.47)
The federal Centers for Medicare and Medicaid Services
administers the SMAA program at the federal level, and DHCS
administers the SMAA program for the State.
This bill:
Existing SMAA
1) Sunsets these provisions on January 1, 2018, and specifies
that these provisions are not applicable to Administrative
Claiming process activities performed on or after January 1,
2018.
Revised School-Based Administrative Claiming
2) Recasts and establishes as the School-Based Administrative
Claiming process, beginning January 1, 2018, the authority
for DHCS to contract with a participating LEC or LGA and if
an LEA chooses and DHCS has developed a process for direct
contracting, to contract with an LEA to perform school-based
administrative activities necessary for the proper and
efficient administration of the Medi-Cal program. This bill
sets forth contracting provisions, processes for the denial
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of claims and appeals of denials, and other requirements for
participation.
3) Authorizes LEAs to contract directly with DHCS and submit
claims directly to DHCS (the existing structure provides for
contracting only between LECs or LGAs and DHCS, and for LECs
or LGAs to submit claims to DHCS).
Non-School-Based Administrative Claiming
4) Establishes as the Administrative Claiming process,
beginning January 1, 2018, the existing authority for DHCS to
contract with each participating LGA to assist with the
performance of non-school-based administrative activities
necessary for the proper and efficient administration of the
Medi-Cal program. This bill sets forth contracting
provisions, processes for the denial of claims and appeals of
denials, and other requirements for participation.
Random Moment Time Survey (RMTS)
5) Authorizes DHCS, beginning no later than July 1, 2018, based
on the input of the workgroup, to administer and oversee the
administration of a single statewide quarterly RMTS for the
School-Based Administrative Claiming process program, or a
reduction in the number of RMTSs conducted in the state.
6) Prohibits the statewide quarterly RMTS from applying to the
Los Angeles Unified School District, which shall conduct its
own RMTS.
Appeal
7) Requires DHCS to develop a process by which an LEA may
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appeal an action of the DHCS.
8) Requires the appeals process to use the Office of
Administrative Hearings and Appeals or another neutral third
party and requires the LEA to pay for the cost of the appeal.
Interagency Agreement or Memorandum of Understanding (MOU)
9) Requires DHCS, by July 1, 2018, to enter into an interagency
agreement or MOU with California Department of Education
(CDE) to coordinate the efforts of both departments with
respect to the School-Based Administrative Claiming process
program and the LEA Medi-Cal billing option. This bill
requires the interagency agreement or MOU to take into
consideration the recommendations of the workgroup.
10)Requires DHCS, in developing the interagency agreement or
MOU, to do all of the following:
a) Consult with relevant non-profit organizations
involved in facilitating information sharing among state
Medicaid and education agencies to identify, and implement
if feasible, best practices that accomplish the
coordination of efforts.
b) Consult with the workgroup regarding the role of CDE
and any changes to the MOU that the workgroup recommends.
c) Develop a schedule for the regular ongoing meetings of
the workgroup to provide feedback to DHCS and CDE.
d) Ensure that the MOU components developed in
collaboration with CDE and the input of the workgroup are
severable.
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Workgroup
11)Requires the DHCS and the CDE, by July 1, 2017, to establish
and jointly administer a School-Based Health Program and
Policy Workgroup (workgroup) to provide advice on issues
related to the delivery of school-based Medi-Cal services to
students.
12)Requires the scope of the workgroup to include but not be
limited to improving the operation of and participation in
the following school-based health programs:
a) The School-Based Administrative Claiming process.
b) The LEA Medi-Cal billing option.
13)Requires the workgroup to provide input to DHCS and CDE, by
January 1, 2018, on the development and continuing operations
of the interagency agreement or MOU. This bill requires the
recommendations of the workgroup to identify opportunities
for effective coordination between the state's health and
education systems at the state, regional, and local level,
identify ways DHCS can maximize its school-based Medicaid
program expertise, recommend an appeals process for the
School-Based Administrative Claiming process program and the
LEA billing option, and identify necessary legislation or
state plan amendments to support its recommendations.
14)Requires the workgroup to make recommendations that include
but are not limited to determining the opportunities for and
the benefits, costs, and feasibility of the following:
a) Increasing LEA participation and maximizing allowable
federal financial participation in the School-Based
Administrative Claiming process program and the LEA
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Medi-Cal billing option program.
b) Increasing contracting options for LEAs participating
in the School-Based Administrative Claiming process
program, such as allowing an LEA to contract with an LEC
or LGA outside of the LEA's region.
c) Reducing the number of quarterly RMTS.
d) Identifying areas that may require a state plan
amendment.
e) Integrating and expanding other school-based health
and mental health programs with the School-Based
Administrative Claiming process program and the LEA
Medi-Cal billing option program, including but not limited
to those being implemented in accordance with the LEA's
local control and accountability plan.
f) Improving and streamlining the annual school-based
Medi-Cal report pursuant to 15) below.
School-Based Medi-Cal Report
15)Requires DHCS, beginning with the 2017-18 state fiscal year
and annually for each year thereafter, to publish the
following information in a single annual school-based
Medi-Cal report on a section of its Web site:
a) The costs to the state of operating the School-Based
Administrative Claiming process program and any related
fees passed on to LEAs.
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b) A list of all participating LEAs.
c) The costs and fees being charged to LEAs as reported
to DHCS by LECs and LGAs.
d) Comparisons of costs with other states, summary of
DHCS activities, workgroup recommendations for program
improvement, identifications of barriers to reimbursement
and actions taken to eliminate barriers, and other
information in the format required for the existing LEA
Medi-Cal billing option program report.
e) The costs of operating the LEA Medi-Cal billing option
program, and a list of each LEA participating in the LEA
Medi-Cal billing option program.
Comments
Notable changes to administrative claiming. This bill sunsets
the existing SMAA claiming process and recasts that process.
Some notable changes in the new School-Based Administrative
Claiming process include:
1) Authorizes LEAs to contract directly with DHCS and submit
claims directly to DHCS (the existing structure provides for
contracting between LECs or LGAs and DHCS, and for LECs or
LGAs to submit claims to DHCS).
2) Requires DHCS and CDE to enter into an interagency agreement or
MOU.
3) Establishes a stakeholder workgroup administered by DHCS and
CDE.
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4) Prohibits county offices of education, LECs or LGAs from being
kept from providing services to LEAs to facilitate
participation in school-based health programs on a fee-for
service basis.
5) Provides that LGAs and LECs shall only require LEAs to contract
for services that are actually provided and necessary for the
performance of oversight and monitoring responsibilities, as
specified.
6) Specifies that county offices of education 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.
7) Requires additional reporting related to state costs of
operating the Medi-Cal program.
FISCAL EFFECT: Appropriation: No Fiscal
Com.:YesLocal: No
According to the Assembly Appropriations Committee:
1)This bill requires DHCS to develop an appeals process, staff a
workgroup, and develop an MOU. Staffing the workgroup and
developing the MOU would be a one-time cost of $600,000.
Costs for the appeals process could be in the range of $2
million or more ongoing, including informal and formal
appeals, and related legal services (LEA reimbursement
funds/federal).
2)Additional costs are possible if the workgroup recommends and
DHCS conducts activities that are authorized (not required)
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under this bill, including the following:
a) A statewide random moment time survey (cost of $9
million in year-one costs and $6 million ongoing. One-time
costs would include $3 million in General Fund costs, while
the fund source for the remainder and the ongoing costs
would be LEA reimbursement funds/federal funds).
b) Making available direct contracting with LEAs ($2.4
million ongoing in LEA reimbursement funds/federal funds).
3)Ongoing cost to CDE of $222,000 to jointly co-chair the
workgroup, assist in developing recommendations for the
School-Based Administrative Claiming and LEA Billing Option
programs, provide consultation, and develop an interagency
agreement or MOU with DHCS (likely LEA reimbursement
funds/federal).
4)If the role and responsibilities of CDE increase upon
completion of the workgroup MOU, potential additional costs to
CDE (likely LEA reimbursement funds/federal/potentially
General Fund).
SUPPORT: (Verified8/24/16)
California School-Based Health Alliance
California School Boards Association
California Teachers Association
Los Angeles Unified School District
National Association of Social Workers, California Chapter
Teachers for Healthy Kids
OPPOSITION: (Verified8/24/16)
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None received
ASSEMBLY FLOOR: 79-0, 8/23/16
AYES: Achadjian, Alejo, Travis Allen, Arambula, Atkins, Baker,
Bigelow, Bloom, Bonilla, Bonta, Brough, Brown, Burke,
Calderon, Campos, Chang, Chau, Chávez, Chiu, Chu, Cooley,
Cooper, Dababneh, Dahle, Daly, Dodd, Eggman, Frazier, Beth
Gaines, Gallagher, Cristina Garcia, Eduardo Garcia, Gatto,
Gipson, Gomez, Gonzalez, Gordon, Grove, Hadley, Harper, Roger
Hernández, Holden, Irwin, Jones, Jones-Sawyer, Kim, Lackey,
Levine, Linder, Lopez, Low, Maienschein, Mathis, Mayes,
McCarty, Medina, Melendez, Mullin, Nazarian, Obernolte,
O'Donnell, Olsen, Patterson, Quirk, Ridley-Thomas, Rodriguez,
Salas, Santiago, Steinorth, Mark Stone, Thurmond, Ting,
Wagner, Waldron, Weber, Wilk, Williams, Wood, Rendon
NO VOTE RECORDED: Gray
Prepared by:Lynn Lorber / ED. / (916) 651-4105
8/26/16 14:26:49
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