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
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|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 | |
| | | | |
SB 276
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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 | |
| | | | |
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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
SB 276
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