Amended in Assembly March 28, 2014

California Legislature—2013–14 Regular Session

Assembly Bill No. 1955

Introduced by Assembly Member Pan

February 19, 2014

An act to begin insert add and repeal Section 42238.054 of the Education Code, and to end insert amend Section 14132.47 of the Welfare and Institutions Code, relating to begin delete Medi-Cal end delete begin insert pupil health end insert .

LEGISLATIVE COUNSEL’S DIGEST

AB 1955, as amended, Pan. begin delete Medi-Cal: Administrative Claiming process. end delete begin insert Healthy Kids, Healthy Minds Demonstration. end insert

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Existing law establishes a public school financing system that requires state funding for county superintendents of schools, school districts, and charter schools to be calculated pursuant to a local control funding formula, as specified. Existing law requires the Superintendent of Public Instruction to annually calculate a local control funding formula grant for each school district and charter school based on data submitted by local educational agencies, as specified, in accordance with instructions specified by the Controller.

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This bill would require the Superintendent to establish and implement the Healthy Kids, Healthy Minds Demonstration for the period of September 1, 2015, until December 31, 2018, under which participating schoolsites would employ a school nurse and a mental health professional, and extend library hours. The bill would authorize local educational agencies that have a percentage of unduplicated pupils, as defined, in excess of 55 percent of the local educational agency’s total school enrollment to apply for funding for these purposes, as specified and upon appropriation. The bill would authorize individual schoolsites to apply for this funding if the local educational agency does not have the required percentage of unduplicated pupils. The bill would require participating local educational agencies to collect and aggregate certain pupil data and would encourage participating local educational agencies to offer specified library programs. The bill would require the State Department of Education to compile, analyze, and present the results of the demonstration to the State Board of Education and the Legislature no later than August 31, 2018.

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Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid Program provisions. Existing law establishes an Administrative Claiming process under which local governmental agencies and local educational consortia contract with the begin delete department end delete begin insert State Department of Health Care Services end insert for the purpose of obtaining federal matching funds to assist with the performance of administrative activities relating to the Medi-Cal program.

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This bill would make technical, nonsubstantive changes to these provisions.

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This bill would require the State Department of Health Care Services and the State Department of Education to cooperate and coordinate efforts in order to maximize receipt of federal matching funds under these provisions, and would require the State Department of Health Care Services to, through an interagency agreement with the State Department of Education, provide technical advice and consultation services to local educational agencies, as specified.

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Vote: majority. Appropriation: no. Fiscal committee:  begin delete no end delete begin insert yes end insert . State-mandated local program: no.

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

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begin insert SECTION 1. end insert   

end insert

begin insert The Legislature finds and declares all of the
following: end insert

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(a) School-based health services lead to academic
improvements, better attendance, reduced suspension and expulsion
rates, and lower dropout rates.

end insert begin insert

(b) Adverse childhood experiences, such as abuse or neglect,
violence, and physical health conditions, such as asthma and dental
caries, impact school readiness, classroom behavior, and absentee
rates.

end insert begin insert

(c) Only 2 percent of California’s schools have a school-based
health center and 57 percent of California school districts report
not having any full-time school nurse.

end insert begin insert

(d) The ratio of pupils to school nurses in California is 2,815
to 1, and the National Association of School Nurses recommends
that school districts provide one nurse for every 750 well pupils.

end insert begin insert

(e) The ratio of pupils to school psychologists in California is
1,469 to 1, and the National Association of School Psychologists’
Practice Model recommends a ratio of one psychologist for every
500-700 pupils.

end insert begin insert

(f) School library programs and the presence of school
librarians can make significant differences in pupil success,
literacy, information technology skills, and overall academic
achievement.

end insert begin insert

(g) Research shows that when children have access to libraries
with plenty of books and adequate staffing, they read more and do
better on reading tests.

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(h) California ranks 51st nationally, including the District of
Columbia, in the number of pupils per librarian.

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(i) Given the promise of education reform, the scarcity of health
professionals in the schools, and the steady decline in numbers of
library staff, the state must find innovative ways to spend its limited
fiscal resources and leverage federal funding, in order to facilitate
for local educational agencies the task of connecting health
services to schools, and assist in returning schools and school
libraries to their traditional missions as centers of learning and
community life.

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begin insert

begin insert SEC. 2. end insert   

end insert

begin insert Section 42238.054 is added to the end insert begin insert Education Code end insert begin insert , to
read: end insert

begin insert

begin insert 42238.054. end insert   

(a) The demonstration project established pursuant
to this section shall be known, and may be cited, as the Healthy
Kids, Healthy Minds Demonstration.

(b) The Superintendent shall establish the Healthy Kids, Healthy
Minds Demonstration in accordance with this section to increase
the base grant amounts received by local educational agencies
pursuant to Sections 2574 and 42238.02. The purpose of the
demonstration is for participating schoolsites to employ one
full-time school nurse and one full-time mental health professional,
and to ensure that the schoolsites’ libraries are open one hour
before, and three hours after, the regular schoolday.

(c) The Superintendent shall implement the demonstration for
the period of September 1, 2015, to December 31, 2018, inclusive.

(d) (1) Except as provided in paragraph (2), a local educational
agency is eligible to participate in the demonstration if it has a
percentage of unduplicated pupils, as determined pursuant to
Section 42238.02, in excess of 55 percent of the local educational
agency’s total school enrollment.

(2) Notwithstanding paragraph (1), local educational agencies
that do not meet the requirements of paragraph (1) shall allow
individual schoolsites that meet the requirements of paragraph
(1) and are interested in participating to apply and participate in
the demonstration.

(e) To participate in the demonstration, a local educational
agency’s application shall, at a minimum, demonstrate all of the
following:

(1) The local educational agency meets the requirements of
subdivision (d) and is able to achieve the goal of the demonstration
with current and additional local funds.

(2) The local educational agency can meet the goal of employing
one-full time nurse and one full-time mental health professional,
and providing the extended library hours described in subdivision
(b), for three fiscal years.

(3) The local educational agency can show that the proposed
use of the funds provided under the demonstration is consistent
with its local control and accountability plan.

(f) (1) Applicants selected to participate in the demonstration
shall receive a 5 percent increase in their base grant per unit of
average daily attendance for kindergarten and grades 1 to 8,
inclusive, as certified on July 20 for each budget year and
calculated for purposes of the advance principal apportionment.

(2) Applicants selected to participate in the demonstration shall
receive a 2 percent increase in their base grant per unit of average
daily attendance for grades 9 to 12, inclusive, as certified on July
20 for each budget year and calculated for purposes of the advance
principal apportionment.

(g) Upon appropriation by the Legislature, the Superintendent
shall reserve funds each year necessary to operate the
demonstration, and establish a separate account from which to
apportion the additional base grant amounts to local educational
agencies pursuant to subdivision (f).

(h) A participating local educational agency, with assistance
from the department, shall collect and aggregate data from
schoolsites under the jurisdiction of the local educational agency
that measures changes in pupil absenteeism, school climate,
reductions in incidence of violence, successful intervention against
suicide attempts and pupil bullying, changes in health status among
high-needs pupils, such as low income, English learners, and foster
youth, general pupil outcomes and achievement, and other relevant
benchmarks as defined and determined by the state board.

(i) Participating local educational agencies are encouraged to
offer library programs that may include, but are not limited to,
reading circles, tutoring programs, online research, parent
engagement or classes, and parent outreach for homework
assistance. To the extent feasible, schoolsites shall make every
effort to offer library programming with the participation of
certified bilingual staff that aims to serve the language needs of
its local community. Participating local educational agencies or
individual schoolsites shall ensure that programs are adequately
staffed by qualified personnel, as described in subdivision (j), but
may also include adult volunteers who are approved by the
schoolsite.

(j) This section shall not be interpreted to modify existing law
or school policy regarding what staff classification is permitted
to operate libraries, which includes levels of certificated and
classified staff, to include media technicians and library aides.

(k) The department shall compile, analyze, and present the
results of the demonstration to the Legislature and the state board
no later than August 31, 2018.

(l) The department may adopt emergency regulations for
purposes of this section, including, but not limited to, the process
for selecting applicants to participate in the demonstration, and
the adoption of the emergency regulations shall be deemed to be
an emergency and necessary for the immediate preservation of
the public peace, health and safety, or general welfare for purposes
of Sections 11346.1 and 11349.6 of the Government Code.

(m) This section shall remain in effect only until January 1,
2019, and as of that date is repealed, unless a later enacted statute,
that is enacted before January 1, 2019, deletes or extends that
date.

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begin delete SECTION 1. end delete
begin insert SEC. 3. end insert   

Section 14132.47 of the Welfare and Institutions Code
is amended to read:

14132.47.  

(a) It is the intent of the Legislature to provide local
governmental agencies the choice of participating in either or both
of the Targeted Case Management (TCM) and Administrative
Claiming process programs at their option, subject to the
requirements of this section and Section 14132.44.

(b) The department may contract with each participating local
governmental agency or each local educational consortium to assist
with the performance of administrative activities necessary for the
proper and efficient administration of the Medi-Cal program,
pursuant to Section 1903a of the federal Social Security Act (42
U.S.C. Sec. 1396b(a)), and this activity shall be known as the
Administrative Claiming process.

(c) (1) Subject to the requirements of paragraph (2) of
subdivision (f), as a condition for participation in the
Administrative Claiming process, each participating local
governmental agency or each local educational consortium shall,
for the purpose of claiming federal Medicaid reimbursement, enter
into a contract with the department and shall certify to the
department the total amount the local governmental agency or each
local educational consortium expended on the allowable
administrative activities.

(2) The department shall deny the claim if it determines that the
certification is not adequately supported, or does not otherwise
comply with federal requirements, for purposes of claiming federal
financial participation.

(d) Each participating local governmental agency or local
educational consortium may subcontract with private or public
entities to assist with the performance of administrative activities
necessary for the proper and efficient administration of the
Medi-Cal program under the conditions specified by the department
in regulations.

(e) Each Administrative Claiming process contract shall include
a requirement that each participating local governmental agency
or each local educational consortium submit a claiming plan in a
manner that shall be prescribed by the department in regulations,
developed in consultation with local governmental agencies.

(f) (1) The department shall require that each participating local
governmental agency or each local educational consortium certify
to the department both of the following:

(A)  The expenditure of 100 percent of the cost of performing
Administrative Claiming process activities. The funds expended
for this purpose shall be from the local governmental agency’s
general fund or the general funds of local educational agencies or
from any other funds allowed under federal law and regulation.

(B) In each fiscal year that its expenditures represent costs that
are eligible for federal financial participation for that fiscal year.
The department shall deny the claim if it determines that the
certification is not adequately supported for purposes of federal
financial participation.

(2) (A) (i) A city that is not a participating local governmental
agency, or any other local public entity, that contracts with a local
governmental agency pursuant to subdivision (d) and that is located
within a county that is a participating local governmental agency
pursuant to this section, may submit certification to the local
governmental agency of amounts expended for Administrative
Claiming services in accordance with Section 433.51 of Title 42
of the Code of Federal Regulations.

(ii) A city or other local public entity that submits certification
pursuant to this paragraph shall comply with the requirements of
paragraph (1), with other requirements applicable to local
governmental agencies that the department determines, in
regulations, to be applicable, and with all applicable federal
requirements.

(iii) The local governmental agency shall forward the city’s or
local public entity’s certification to the department for the purposes
of claiming federal financial participation.

(iv) As applicable, the local governmental agency shall obtain
and retain appropriate certifications from the expending city or
local public entity, together with documentation of the underlying
expenditures, as required by the department.

(B) A tribe or tribal organization, as defined in subdivision (n),
that is not participating in Administrative Claiming process
activities as a local governmental agency, may contract with, and
submit to a tribe or tribal organization that is contracting with, the
department pursuant to subdivision (b) amounts expended for
Administrative Claiming process activities that it is certifying in
accordance with Section 433.51 of Title 42 of the Code of Federal
Regulations and other applicable federal law and regulations. The
tribe or tribal organization receiving the certification shall forward
it to the department for purposes of claiming federal financial
participation. The certification shall comply with all of the
requirements for certification set forth in subparagraph (A).

(g) (1) Notwithstanding any other provision of this section, the
state shall be held harmless, in accordance with paragraphs (2)
and (3), from any federal audit disallowance and interest resulting
from payments made to a participating local governmental agency
or local educational consortium pursuant to this section, for the
disallowed claim.

(2) To the extent that a federal audit disallowance and interest
results from a claim or claims for which any participating local
governmental agency or local educational consortium has received
reimbursement for Administrative Claiming process activities, the
department shall recoup from the local governmental agency or
local educational consortium that submitted the disallowed claim,
through offsets or by a direct billing, amounts equal to the amount
of the disallowance and interest, in that fiscal year, for the
disallowed claim. All subsequent claims submitted to the
department applicable to any previously disallowed administrative
activity or claim, may be held in abeyance, with no payment made,
until the federal disallowance issue is resolved.

(3) Notwithstanding paragraph (2), to the extent that a federal
audit disallowance and interest results from a claim or claims for
which the participating local governmental agency or local
educational consortium has received reimbursement for
Administrative Claiming process activities performed by an entity
under contract with, and on behalf of, the participating local
governmental agency or local educational consortium, the
department shall be held harmless by that particular participating
local governmental agency or local educational consortium for
100 percent of the amount of the federal audit disallowance and
interest, for the disallowed claim.

(h) The use of local funds required by this section shall not
create, lead to, or expand the health care funding obligations or
service obligations for current or future years for any participating
local governmental agency or local educational consortium, except
as required by this section or as may be required by federal law.

(i) The department shall deny any claim from a participating
local governmental agency or local educational consortium if the
department determines that the claim is not adequately supported
in accordance with criteria established pursuant to this subdivision
and implementing regulations before it forwards the claim for
reimbursement to the federal Medicaid Program. In consultation
with local governmental agencies and local educational consortia,
the department shall adopt regulations that prescribe the
requirements for the submission and payment of claims for
administrative activities performed by each participating local
governmental agency and local educational consortium.

(j) Administrative activities shall be those determined by the
department to be necessary for the proper and efficient
administration of the state’s Medicaid plan and shall be defined
in regulation.

(k) If the department denies any claim submitted under this
section, the affected participating local governmental agency or
local educational consortium may, within 30 days after receipt of
written notice of the denial, request that the department reconsider
its action. The participating local governmental agency or local
educational consortium may request a meeting with the director
or his or her designee within 30 days to present its concerns to the
department after the request is filed. If the director or his or her
designee cannot meet, the department shall respond in writing
indicating the specific reasons for which the claim is out of
compliance to the participating local governmental agency or local
educational consortium in response to its appeal. Thereafter, the
decision of the director shall be final.

(l) To the extent consistent with federal law and regulations,
participating local governmental agencies or local educational
consortium may claim the actual costs of nonemergency,
nonmedical transportation of Medi-Cal eligibles to Medi-Cal
covered services, under guidelines established by the department,
to the extent that these costs are actually borne by the participating
local governmental agency or local educational consortium. A
local educational consortium may only claim for nonemergency,
nonmedical transportation of Medi-Cal eligibles for Medi-Cal
covered services, through the Medi-Cal administrative activities
program. Medi-Cal medical transportation services shall be claimed
under the local educational agency Medi-Cal billing option,
pursuant to Section 14132.06.

(m) As a condition of participation in the Administrative
Claiming process and in recognition of revenue generated to each
participating local governmental agency and each local educational
consortium in the Administrative Claiming process, each
participating local governmental agency and each local educational
consortium shall pay an annual participation fee through a
mechanism agreed to by the state and local governmental agencies
and local educational consortia, or, if no agreement is reached by
August 1 of each year, directly to the state. The participation fee
shall be used to cover the cost of administering the Administrative
Claiming process, including, but not limited to, claims processing,
technical assistance, and monitoring. The department shall
determine and report staffing requirements upon which projected
costs will be based. The amount of the participation fee shall be
based upon the anticipated salaries, benefits, and operating
expenses, to administer the Administrative Claiming process and
other costs related to that process.

(n) (1) For purposes of this section, “participating local
governmental agency” means a county, chartered city, Native
American Indian tribe, tribal organization, or subgroup of a Native
American Indian tribe or tribal organization, under contract with
the department pursuant to subdivision (b).

(2) Each participating Native American Indian tribe, tribal
organization, or subgroup of a Native American Indian tribe or
tribal organization may claim, as a Medi-Cal Administrative
Activity, facilitating Medi-Cal applications, which includes, but
is not limited to, using the California Healthcare Eligibility,
Enrollment, and Retention System.

(o) For purposes of this section, “local educational agency”
means a local educational agency, as defined in subdivision (h) of
Section 14132.06, that participates under the Administrative
Claiming process as a subcontractor to the local educational
consortium in its service region.

(p) (1) For purposes of this section, “local educational
consortium” means a local agency that is one of the service regions
of the California County Superintendent Educational Services
Association.

(2) Each local educational consortium shall contract with the
department pursuant to paragraph (1) of subdivision (c).

(q) (1) Each participating local educational consortium shall
be responsible for the local educational agencies in its service
region that participate in the Administrative Claiming process.
This responsibility includes, but is not limited to, the preparation
and submission of all administrative claiming plans, training of
local educational agency staff, overseeing the local educational
agency time survey process, and the submission of detailed
quarterly invoices on behalf of the participating local educational
agency.

(2) Each participating local educational consortium shall ensure
local educational agency compliance with all requirements of the
Administrative Claiming process established for local governmental
agencies.

(3) Ninety days prior to the initial participation in the
Administrative Claiming process, each local educational
consortium shall notify the department of its intent to participate
in the process, and shall identify each local educational agency
that will be participating as its subcontractor.

(r) (1) Each local educational agency that elects to participate
in the Administrative Claiming process shall submit claims through
its local educational consortium or through the local governmental
agency, but not both.

(2) Each local educational agency participating as a
subcontractor to a local educational consortium shall comply with
all requirements of the Administrative Claiming process established
for local governmental agencies.

(s) A participating local governmental agency or a local
educational consortium may charge an administrative fee to any
entity claiming Administrative Claiming through that agency.

(t) The department shall continue to administer the
Administrative Claiming process in conformity with federal
requirements.

(u) The department shall provide technical assistance to all
participating local governmental agencies and local educational
consortia in order to maximize federal financial participation in
the Administrative Claiming process.

(v) This section shall be applicable to Administrative Claiming
process activities performed, and to moneys paid to participating
local governmental agencies for those activities in the 1994-95
fiscal year and thereafter, and to local educational consortia in the
1998-99 fiscal year and thereafter.

(w) Nothing in this section or Section 14132.44 shall be
construed to prevent any state agency from participating in the
Administrative Claiming process or from contracting with others
to engage in these activities.

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(x) (1) The department and the State Department of Education
shall cooperate and coordinate efforts in order to maximize receipt
of federal financial participation under the Administrative
Claiming process pursuant to this section. To the extent permitted
by federal law, funds used by local educational agencies under
the local control funding formula, including funds used under
Section 42238.054 of the Education Code, may be included in
expenditures certified under subdivision (f).

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(2) The department, through an interagency agreement with the
State Department of Education, shall provide technical advice and
consultation to local educational agencies participating in the
demonstration project established pursuant to Section 42238.054
of the Education Code, in order to help set up accounting systems,
conduct initial staff time studies, and any other necessary
requirements to certify and bill valid claims for allowable activities
under the Administrative Claiming process. Any entity contracted
by the department, a local educational agency, or educational
consortium for purposes of this subdivision shall be a public agency
or incorporated as a nonprofit agency or public benefit corporation
under state law.

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(3) The department shall seek any necessary federal approvals
to implement this subdivision.

end insert