Amended in Assembly July 7, 2015

Amended in Senate April 20, 2015

Amended in Senate March 26, 2015

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 amended, 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, 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, including targeted case management services for children with anbegin delete individualend deletebegin insert individualizedend insert education plan (IEP) or an individualized family service plan (IFSP), provided by local educational agencies (LEAs) are covered Medi-Cal benefits, and authorizes an LEA to bill for those services. Existing law 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 anbegin delete individualized education planend deletebegin insert IEPend insert or anbegin delete individualized family service plan,end deletebegin insert IFSP,end insert 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 3rd parties. The bill would require a legally liable 3rd party to either reimburse the claim or issue a notice of denial of noncoverage of services or benefits if the legally liable 3rd party receives a claim for payment of covered services submitted by an LEA. The bill would authorize an LEA to bill the Medi-Cal program if there is no response to a claim for payment of covered services submitted to a legally liable 3rd party within 45 days, and would require the LEA to retain a copy of the claim submitted to the legally liable 3rd party for a period of 3 years.begin insert The bill would provide that these provisions shall not be implemented until the department obtains necessary federal approvals.end insert

This bill would also expand the authority of an LEA to provide targeted case management services.

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 federal Centers for Medicare and
6Medicaid Services to be eligible to provide services. To participate
7in the LEA Medi-Cal billing option program, LEAs must reinvest
8the federal 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 those qualified medical practitioners
14the LEA employs or contracts with to render certain health services.

15(b) The LEA billing option facilitates reinvestment in health
16and social services for students and their families so that schools
17can foster access to and provide comprehensive health services to
18eligible Medi-Cal students.

19(c) The funds are reimbursement for services rendered and can
20be used as matching dollars to draw down federal financial
P3    1participation. The funds are restricted in their use; they must
2supplement existing services, not supplant.

3(d) It is, therefore, the intent of the Legislature in enacting this
4act to ensure that a school district or county office of education
5that is authorized as an LEA Medi-Cal provider is assured that all
6options for federal financial participation are available. The
7 Legislature encourages LEAs to utilize reimbursed funds to hire
8credentialed school nurses to supplement, not supplant, existing
9LEA health services personnel.

10

SEC. 2.  

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

12

14132.06.  

(a) Services specified in this section that are
13provided by a local educational agency are covered Medi-Cal
14benefits, to the extent federal financial participation is available,
15and subject to utilization controls and standards adopted by the
16department, and consistent with Medi-Cal requirements for
17physician prescription, order, and supervision.

18(b) Any provider enrolled on or after January 1, 1993, to provide
19services pursuant to this section may bill for those services
20provided on or after January 1, 1993.

21(c) Nothing in this section shall be interpreted to expand the
22current category of professional health care practitioners permitted
23to directly bill the Medi-Cal program.

24(d) Nothing in this section is intended to increase the scope of
25practice of any health professional providing services under this
26section or Medi-Cal requirements for physician prescription, order,
27and supervision.

28(e) (1) For the purposes of this section, the local educational
29agency, as a condition of enrollment to provide services under this
30section, shall be considered the provider of services. A local
31educational agency provider, as a condition of enrollment to
32provide services under this section, shall enter into, and maintain,
33a contract with the department in accordance with guidelines
34contained in regulations adopted by the director and published in
35Title 22 of the California Code of Regulations.

36(2) Notwithstanding paragraph (1), a local educational agency
37providing services pursuant to this section shall utilize current
38safety net and traditional health care providers, when those
39providers are accessible to specific schoolsites identified by the
P4    1local educational agency to participate in this program, rather than
2adding duplicate capacity.

3(f) For the purposes of this section, covered services may include
4all of the following local educational agency services:

5(1) Health and mental health evaluations and health and mental
6health education.

7(2) Medical transportation.

8(A) The following provisions shall not apply to medical
9transportation eligible to be billed under this section:

10(i) Section 51323(a)(2)(A) of Title 22 of the California Code
11of Regulations.

12(ii) Section 51323(a)(3)(B) of Title 22 of the California Code
13of Regulations.

14(iii) For students whose medical or physical condition does not
15require the use of a gurney, Section 51231.1(f) of Title 22 of the
16California Code of Regulations.

17(iv) For students whose medical or physical condition does not
18require the use of a wheelchair, Section 51231.2(e) of Title 22 of
19the California Code of Regulations.

20(B) (i) Subparagraph (A) shall become inoperative on January
211, 2018, or on the date the director executes a declaration stating
22that the regulations implementing subparagraph (A) and Section
2314118.5 have been updated, whichever is later.

24(ii) The department shall post the declaration executed under
25clause (i) on its Internet Web site and transmit a copy of the
26declaration to the Assembly Committee on Budget and the Senate
27Committee on Budget and Fiscal Review and the LEA Ad Hoc
28Workgroup.

29(iii) If subparagraph (A) becomes inoperative on January 1,
302018, subparagraph (A) and this subparagraph shall be inoperative
31on January 1, 2018, unless a later enacted statute enacted before
32that date, deletes or extends that date.

33(iv) If subparagraph (A) becomes inoperative on the date the
34director executes a declaration as described in clause (i),
35subparagraph (A) and this subparagraph shall be inoperative on
36the January 1 immediately following the date subparagraph (A)
37becomes inoperative, unless a later enacted statute enacted before
38that date, deletes or extends that date.

39(3) Nursing services.

40(4) Occupational therapy.

P5    1(5) Physical therapy.

2(6) Physician services.

3(7) Mental health and counseling services.

4(8) School health aide services.

5(9) Speech pathology services. These services may be provided
6by either of the following:

7(A) A licensed speech pathologist.

8(B) A credentialed speech-language pathologist, to the extent
9authorized by Chapter 5.3 (commencing with Section 2530) of
10Division 2 of the Business and Professions Code.

11(10) Audiology services.

12(11) Targeted case management services for children regardless
13of whether the child has an individualized education plan (IEP) or
14an individualized family service plan (IFSP).

15(g) Local educational agencies may, but need not, provide any
16or all of the services specified in subdivision (f).

17(h) For the purposes of this section, “local educational agency”
18means the governing body of any school district or community
19college district, the county office of education, a state special
20school, a California State University campus, or a University of
21California campus.

22(i) Notwithstanding any other law, a community college district,
23a California State University campus, or a University of California
24campus, consistent with the requirements of this section, may bill
25for services provided to any student, regardless of age, who is a
26Medi-Cal recipient.

27(j) No later than July 1, 2013, and every year thereafter, the
28department shall make publicly accessible an annual accounting
29of all funds collected by the department from federal Medicaid
30payments allocable to local educational agencies, including, but
31not limited to, the funds withheld pursuant to subdivision (g) of
32Section 14115.8. The accounting shall detail amounts withheld
33from federal Medicaid payments to each participating local
34educational agency for that year. One-time costs for the
35development of this accounting shall not exceed two hundred fifty
36thousand dollars ($250,000).

37(k) (1) If thebegin delete requirement in paragraph (2) isend deletebegin insert requirements in
38paragraphs (2) and (4) areend insert
satisfied, the department shall seek
39federal financial participation for covered services that are provided
40by a local educational agency pursuant to subdivision (a) to a child
P6    1who is an eligible Medi-Cal beneficiary, regardless of either of
2the following:

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

4(B) Whether those same services are provided at no charge to
5the beneficiary or to the community at large.

6(2) The local educational agency shall take all reasonable
7measures to ascertain and pursue claims for payment of covered
8services specified in this section against legally liable third parties
9pursuant to Section 1902(a)(25) of the federal Social Security Act
10(42 U.S.C. Sec. 1396a(a)(25)).

11(3) If a legally liable third party receives a claim submitted by
12a local educational agency pursuant to paragraph (2), the legally
13liable third party shall either reimburse the claim or issue a notice
14of denial of noncoverage of services or benefits. If there is no
15response to a claim submitted to a legally liable third party by a
16local educational agency within 45 days, the local educational
17agency may bill the Medi-Cal program pursuant to subdivision
18(b). The local educational agency shall retain a copy of the claim
19submitted to the legally liable third party for a period of three
20years.

begin insert

21(4) This subdivision shall not be implemented until the
22department obtains any necessary federal approvals.

end insert


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