Senate BillNo. 276


Introduced by Senator Wolk

February 19, 2015


An act to amend Section 14132.06 of the Welfare and Institutions Code, relating to Medi-Cal.

LEGISLATIVE COUNSEL’S DIGEST

SB 276, as introduced, Wolk. Medi-Cal: local educational agencies.

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.

This bill would require the department to seek federal financial participation for covered services that are provided by an LEA to a child who is an eligible Medi-Cal beneficiary regardless of whether the child has an individualized education plan or an individualized family service plan, or whether those same services are provided at no charge to the beneficiary or to the community at large, if the LEA takes all reasonable measures to ascertain and pursue claims for payment of covered services against legally liable third parties.

Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: no.

The people of the State of California do enact as follows:

P2    1

SECTION 1.  

The Legislature finds and declares all of the
2following:

3(a) Local educational agencies (LEA) must have an approved
4provider participant agreement with the State Department of Health
5Care Services through the Centers for Medicare and Medicaid
6Services to be eligible to provide services. To participate in the
7LEA Medi-Cal billing option program, LEAs must reinvest the
8federal reimbursement they receive under this program in health
9and social services for children and families, and develop and
10maintain a collaborative committee to assist them in decisions
11regarding the reinvestment of federal reimbursements. The
12providers and supervisors of staff for the assessment and medically
13necessary health services are school nurses.

14(b) The LEA billing option facilitates reinvestment in health
15and social services for students and their families so that schools
16can foster access to and provide comprehensive health services to
17eligible Medi-Cal students.

18(c) The funds are reimbursement for services rendered and can
19be used as matching dollars to draw down federal financial
20participation. The funds are restricted in their use; they must
21supplement existing services, not supplant.

22(d) It is, therefore, the intent of the Legislature in enacting this
23act to ensure that a school district or county office of education
24that is authorized as an LEA Medi-Cal provider is assured that all
25options for federal financial participation are available. The
26Legislature encourages LEAs to utilize reimbursed funds to hire
27credentialed school nurses to supplement, not supplant, existing
28LEA health services personnel.

29

SEC. 2.  

Section 14132.06 of the Welfare and Institutions Code
30 is amended to read:

31

14132.06.  

(a) Services specified in this section that are
32provided by a local educational agency are covered Medi-Cal
33benefits, to the extent federal financial participation is available,
34and subject to utilization controls and standards adopted by the
35department, and consistent with Medi-Cal requirements for
36physician prescription, order, and supervision.

P3    1(b) Any provider enrolled on or after January 1, 1993, to provide
2services pursuant to this section may bill for those services
3provided on or after January 1, 1993.

4(c) Nothing in this section shall be interpreted to expand the
5current category of professional health care practitioners permitted
6to directly bill the Medi-Cal program.

7(d) Nothing in this section is intended to increase the scope of
8practice of any health professional providing services under this
9section or Medi-Cal requirements for physician prescription, order,
10and supervision.

11(e) (1) For the purposes of this section, the local educational
12agency, as a condition of enrollment to provide services under this
13section, shall be considered the provider of services. A local
14educational agency provider, as a condition of enrollment to
15provide services under this section, shall enter into, and maintain,
16a contract with the department in accordance with guidelines
17contained in regulations adopted by the director and published in
18Title 22 of the California Code of Regulations.

19(2) Notwithstanding paragraph (1), a local educational agency
20providing services pursuant to this section shall utilize current
21safety net and traditional health care providers, when those
22providers are accessible to specific schoolsites identified by the
23local educational agency to participate in this program, rather than
24adding duplicate capacity.

25(f) For the purposes of this section, covered services may include
26all of the following local educational agency services:

27(1) Health and mental health evaluations and health and mental
28health education.

29(2) Medical transportation.

30(A) The following provisions shall not apply to medical
31transportation eligible to be billed under this section:

32(i) Section 51323(a)(2)(A) of Title 22 of the California Code
33of Regulations.

34(ii) Section 51323(a)(3)(B) of Title 22 of the California Code
35of Regulations.

36(iii) For students whose medical or physical condition does not
37require the use of a gurney, Section 51231.1(f) of Title 22 of the
38California Code of Regulations.

P4    1(iv) For students whose medical or physical condition does not
2require the use of a wheelchair, Section 51231.2(e) of Title 22 of
3the California Code of Regulations.

4(B) (i) Subparagraph (A) shall become inoperative on January
51, 2018, or on the date the director executes a declaration stating
6that the regulations implementing subparagraph (A) and Section
714118.5 have been updated, whichever is later.

8(ii) The department shall post the declaration executed under
9clause (i) on its Internet Web site and transmit a copy of the
10declaration to the Assembly Committee on Budget and the Senate
11Committee on Budget and Fiscal Review and the LEA Ad Hoc
12Workgroup.

13(iii) If subparagraph (A) becomes inoperative on January 1,
142018, subparagraph (A) and this subparagraph shall be inoperative
15on January 1, 2018, unless a later enacted statute enacted before
16that date, deletes or extends that date.

17(iv) If subparagraph (A) becomes inoperative on the date the
18director executes a declaration as described in clause (i),
19subparagraph (A) and this subparagraph shall be inoperative on
20the January 1 immediately following the date subparagraph (A)
21becomes inoperative, unless a later enacted statute enacted before
22that date, deletes or extends that date.

23(3) Nursing services.

24(4) Occupational therapy.

25(5) Physical therapy.

26(6) Physician services.

27(7) Mental health and counseling services.

28(8) School health aide services.

29(9) Speech pathology services. These services may be provided
30by either of the following:

31(A) A licensed speech pathologist.

32(B) A credentialed speech-language pathologist, to the extent
33authorized by Chapter 5.3 (commencing with Section 2530) of
34Division 2 of the Business and Professions Code.

35(10) Audiology services.

36(11) Targeted case management services for children with an
37individualized education plan (IEP) or an individualized family
38service plan (IFSP).

39(g) Local educational agencies may, but need not, provide any
40or all of the services specified in subdivision (f).

P5    1(h) For the purposes of this section, “local educational agency”
2means the governing body of any school district or community
3college district, the county office of education, a state special
4school, a California State University campus, or a University of
5California campus.

6(i) Any local educational agency provider enrolled to provide
7service pursuant to this section on January 1, 1995, may bill for
8targeted case management services for children with an
9begin delete individualized education plan (IEP)end deletebegin insert IEPend insert or anbegin delete individualized family
10service plan (IFSP),end delete
begin insert IFSP,end insert provided on or after January 1, 1995.

11(j) Notwithstanding any otherbegin delete provision ofend delete law, a community
12college district, a California State University campus, or a
13University of California campus, consistent with the requirements
14of this section, may bill for services provided to any student,
15regardless of age, who is a Medi-Cal recipient.

16(k) No later than July 1, 2013, and every year thereafter, the
17department shall make publicly accessible an annual accounting
18of all funds collected by the department from federal Medicaid
19payments allocable to local educational agencies, including, but
20not limited to, the funds withheld pursuant to subdivision (g) of
21Section 14115.8. The accounting shall detail amounts withheld
22from federal Medicaid payments to each participating local
23educational agency for that year. One-time costs for the
24development of this accounting shall not exceed two hundred fifty
25thousand dollars ($250,000).

begin insert

26(l) (1) If the requirement in paragraph (2) is satisfied, the
27department shall seek federal financial participation for covered
28services that are provided by a local educational agency pursuant
29to subdivision (a) to a child who is an eligible Medi-Cal
30beneficiary, regardless of either of the following:

end insert
begin insert

31(A) Whether the child has an IEP or an IFSP.

end insert
begin insert

32(B) Whether those same services are provided at no charge to
33the beneficiary or to the community at large.

end insert
begin insert

34(2) The local educational agency shall take all reasonable
35measures to ascertain and pursue claims for payment of covered
36services specified in this section against legally liable third parties
37pursuant to Section 1902(a)(25) of the Social Security Act (42
38U.S.C. Sec. 1396a(a)(25)).

end insert


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