BILL ANALYSIS Ó SB 276 Page 1 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 | | | | | | | SB 276 Page 2 |----------------+-----+----------------------+--------------------| |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. SB 276 Page 3 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. SB 276 Page 4 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 Page 5