BILL ANALYSIS                                                                                                                                                                                                    Ó



                                                                     SB 276


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          SENATE THIRD READING


          SB  
          276 (Wolk)


          As Amended  July 16, 2015


          Majority vote


          SENATE VOTE:  40-0


           ------------------------------------------------------------------ 
          |Committee       |Votes|Ayes                  |Noes                |
          |                |     |                      |                    |
          |                |     |                      |                    |
          |                |     |                      |                    |
          |----------------+-----+----------------------+--------------------|
          |Health          |19-0 |Bonta, Maienschein,   |                    |
          |                |     |Bonilla, Burke,       |                    |
          |                |     |Chávez, Chiu, Gomez,  |                    |
          |                |     |Gonzalez, Roger       |                    |
          |                |     |Hernández, Lackey,    |                    |
          |                |     |Nazarian, Patterson,  |                    |
          |                |     |Ridley-Thomas,        |                    |
          |                |     |Rodriguez, Santiago,  |                    |
          |                |     |Steinorth, Thurmond,  |                    |
          |                |     |Waldron, Wood         |                    |
          |                |     |                      |                    |
          |----------------+-----+----------------------+--------------------|
          |Education       |7-0  |O'Donnell, Chávez,    |                    |
          |                |     |Kim, McCarty,         |                    |
          |                |     |Santiago, Thurmond,   |                    |
          |                |     |Weber                 |                    |
          |                |     |                      |                    |








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          |----------------+-----+----------------------+--------------------|
          |Appropriations  |17-0 |Gomez, Bigelow,       |                    |
          |                |     |Bloom, Bonta,         |                    |
          |                |     |Calderon, Chang,      |                    |
          |                |     |Nazarian, Eggman,     |                    |
          |                |     |Gallagher, Eduardo    |                    |
          |                |     |Garcia, Holden,       |                    |
          |                |     |Jones, Quirk, Rendon, |                    |
          |                |     |Wagner, Weber, Wood   |                    |
          |                |     |                      |                    |
           ------------------------------------------------------------------ 


          SUMMARY:  Requires the Department of Health Care Services (DHCS)  
          to seek federal financial participation (FFP) for covered  
          services that are provided by a local education agency (LEA) to  
          a Medi-Cal eligible child regardless of whether the child has an  
          individualized education plan (IEP) or an individualized family  
          service plan (IFSP), or whether those same services are provided  
          at no charge to the child or to the community at large, and  
          authorizes 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 third party within 45 days.  


          EXISTING LAW: 


          1)Establishes the Medi-Cal program, administered by DHCS, under  
            which qualified low-income persons receive health care  
            benefits.


          2)Defines an LEA 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.










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          3)Requires that specified services provided by a LEA are covered  
            Medi-Cal benefits, to the extent FFP is available. 


          4)Requires that specified services be subject to utilization  
            controls and standards adopted by DHCS, and are consistent  
            with Medi-Cal requirements for physician prescription, order,  
            and supervision. 


          5)Defines the scope of covered services that an LEA may provide,  
            which include targeted case management services for children  
            with an IEP or an IFSP.


          FISCAL EFFECT:  According to the Assembly Appropriations  
          Committee, unknown, significant ongoing increased expenditures  
          in the Medi-Cal program, one-time costs of $250,000  
          (local/federal) for the fiscal intermediary to adjust  
          information technology systems and potentially significant  
          General Fund impact based on a potential for lawsuits  
          challenging whether DHCS adequately confirmed that the LEA took  
          reasonable measures to ascertain legally liable third parties. 


          COMMENTS:  According to the author, this bill will allow LEAs to  
          receive reimbursement for services provided to Medi-Cal eligible  
          students regardless of whether the student has an IEP or IFSP or  
          whether similar services are provided to regular education  
          students at no cost.  The author states that this increased  
          funding would enable schools to be more active in managing the  
          conditions affecting all students, may increase the services  
          they provide and may result in the hiring of more school nurses.  
           The author concludes that with school districts and county  
          offices of education having the ability to be reimbursed for all  
          covered services to Medi-Cal eligible students, FFP will  
          increase.










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          This bill is sponsored by the California School Nurses  
          Organization (CSNO), which states that schools nurses provide  
          direct health care services that are medically necessary and  
          ordered by the child's physician for all children in the  
          schools. CSNO states the provision of these services allows the  
          schools to meet the requirements under the federal Individuals  
          with Disabilities Education Act for students who are in the  
          special education category.  With the revised guidance from CMS,  
          LEAs are now able to seek reimbursement for all health care  
          provided to all Medi-Cal eligible students in both regular and  
          special education.  CSNO states that health care delivered in  
          the schools is an economic and efficacious model.  With this CMS  
          change and the access to increased reimbursement, CSNO  
          anticipates that LEAs will improve the coordination of students  
          with chronic conditions some which impact their ability to be  
          successful in school.  CSNO believes this will be a value added,  
          particularly to those schools with students less likely to have  
          access to comprehensive care, and it believes the increased  
          emphasis on prevention, early intervention and chronic disease  
          management.  CSNO conclude enhanced LEA billing will augment the  
          current system while providing care for children who require  
          medical services to function in the least restrictive  
          environment.


          There is no opposition on file.




          Analysis Prepared by:                                             
                          Paula Villescaz / HEALTH / (916) 319-2097  FN:  
          0001659














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