BILL NUMBER: SB 276 AMENDED
BILL TEXT
AMENDED IN SENATE MARCH 26, 2015
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
and 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
services, including targeted case management services for children
with an individual 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 an individualized education plan or an individualized
family service plan, 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 third
3rd parties. The bill would require a
legally liable 3rd party to issue a notice of denial of noncoverage
of services or benefits if the legally liable 3rd party denies a
claim for payment of covered services submitted by a n LEA.
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:
SECTION 1. The Legislature finds and declares all of the
following:
(a) Local educational agencies (LEA) must have an approved
provider participant agreement with the State Department of Health
Care Services through the federal Centers for Medicare and
Medicaid Services to be eligible to provide services. To participate
in the LEA Medi-Cal billing option program, LEAs must reinvest the
federal reimbursement they receive under this program in health and
social services for children and families, and develop and maintain a
collaborative committee to assist them in decisions regarding the
reinvestment of federal reimbursements. The providers and supervisors
of staff for the assessment and medically necessary health services
are school nurses.
(b) The LEA billing option facilitates reinvestment in health and
social services for students and their families so that schools can
foster access to and provide comprehensive health services to
eligible Medi-Cal students.
(c) The funds are reimbursement for services rendered and can be
used as matching dollars to draw down federal financial
participation. The funds are restricted in their use; they must
supplement existing services, not supplant.
(d) It is, therefore, the intent of the Legislature in enacting
this act to ensure that a school district or county office of
education that is authorized as an LEA Medi-Cal provider is assured
that all options for federal financial participation are available.
The Legislature encourages LEAs to utilize reimbursed funds to hire
credentialed school nurses to supplement, not supplant, existing LEA
health services personnel.
SEC. 2. Section 14132.06 of the Welfare and Institutions Code is
amended to read:
14132.06. (a) Services specified in this section that are
provided by a local educational agency are covered Medi-Cal benefits,
to the extent federal financial participation is available, and
subject to utilization controls and standards adopted by the
department, and consistent with Medi-Cal requirements for physician
prescription, order, and supervision.
(b) Any provider enrolled on or after January 1, 1993, to provide
services pursuant to this section may bill for those services
provided on or after January 1, 1993.
(c) Nothing in this section shall be interpreted to expand the
current category of professional health care practitioners permitted
to directly bill the Medi-Cal program.
(d) Nothing in this section is intended to increase the scope of
practice of any health professional providing services under this
section or Medi-Cal requirements for physician prescription, order,
and supervision.
(e) (1) For the purposes of this section, the local educational
agency, as a condition of enrollment to provide services under this
section, shall be considered the provider of services. A local
educational agency provider, as a condition of enrollment to provide
services under this section, shall enter into, and maintain, a
contract with the department in accordance with guidelines contained
in regulations adopted by the director and published in Title 22 of
the California Code of Regulations.
(2) Notwithstanding paragraph (1), a local educational agency
providing services pursuant to this section shall utilize current
safety net and traditional health care providers, when those
providers are accessible to specific schoolsites identified by the
local educational agency to participate in this program, rather than
adding duplicate capacity.
(f) For the purposes of this section, covered services may include
all of the following local educational agency services:
(1) Health and mental health evaluations and health and mental
health education.
(2) Medical transportation.
(A) The following provisions shall not apply to medical
transportation eligible to be billed under this section:
(i) Section 51323(a)(2)(A) of Title 22 of the California Code of
Regulations.
(ii) Section 51323(a)(3)(B) of Title 22 of the California Code of
Regulations.
(iii) For students whose medical or physical condition does not
require the use of a gurney, Section 51231.1(f) of Title 22 of the
California Code of Regulations.
(iv) For students whose medical or physical condition does not
require the use of a wheelchair, Section 51231.2(e) of Title 22 of
the California Code of Regulations.
(B) (i) Subparagraph (A) shall become inoperative on January 1,
2018, or on the date the director executes a declaration stating that
the regulations implementing subparagraph (A) and Section 14118.5
have been updated, whichever is later.
(ii) The department shall post the declaration executed under
clause (i) on its Internet Web site and transmit a copy of the
declaration to the Assembly Committee on Budget and the Senate
Committee on Budget and Fiscal Review and the LEA Ad Hoc Workgroup.
(iii) If subparagraph (A) becomes inoperative on January 1, 2018,
subparagraph (A) and this subparagraph shall be inoperative on
January 1, 2018, unless a later enacted statute enacted before that
date, deletes or extends that date.
(iv) If subparagraph (A) becomes inoperative on the date the
director executes a declaration as described in clause (i),
subparagraph (A) and this subparagraph shall be inoperative on the
January 1 immediately following the date subparagraph (A) becomes
inoperative, unless a later enacted statute enacted before that date,
deletes or extends that date.
(3) Nursing services.
(4) Occupational therapy.
(5) Physical therapy.
(6) Physician services.
(7) Mental health and counseling services.
(8) School health aide services.
(9) Speech pathology services. These services may be provided by
either of the following:
(A) A licensed speech pathologist.
(B) A credentialed speech-language pathologist, to the extent
authorized by Chapter 5.3 (commencing with Section 2530) of Division
2 of the Business and Professions Code.
(10) Audiology services.
(11) Targeted case management services for children with
an regardless of whether the child has an
individualized education plan (IEP) or an individualized family
service plan (IFSP).
(g) Local educational agencies may, but need not, provide any or
all of the services specified in subdivision (f).
(h) For the purposes of this section, "local educational agency"
means 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.
(i) Any local educational agency provider enrolled to provide
service pursuant to this section on January 1, 1995, may bill for
targeted case management services for children with an IEP or an
IFSP, provided on or after January 1, 1995.
(j)
( i) Notwithstanding any other law, a
community college district, a California State University campus, or
a University of California campus, consistent with the requirements
of this section, may bill for services provided to any student,
regardless of age, who is a Medi-Cal recipient.
(k)
( j) No later than July 1, 2013, and every
year thereafter, the department shall make publicly accessible an
annual accounting of all funds collected by the department from
federal Medicaid payments allocable to local educational agencies,
including, but not limited to, the funds withheld pursuant to
subdivision (g) of Section 14115.8. The accounting shall detail
amounts withheld from federal Medicaid payments to each participating
local educational agency for that year. One-time costs for the
development of this accounting shall not exceed two hundred fifty
thousand dollars ($250,000).
(l)
( k) (1) If the requirement in paragraph (2)
is satisfied, the department shall seek federal financial
participation for covered services that are provided by a local
educational agency pursuant to subdivision (a) to a child who is an
eligible Medi-Cal beneficiary, regardless of either of the following:
(A) Whether the child has an IEP or an IFSP.
(B) Whether those same services are provided at no charge to the
beneficiary or to the community at large.
(2) The local educational agency shall take all reasonable
measures to ascertain and pursue claims for payment of covered
services specified in this section against legally liable third
parties pursuant to Section 1902(a)(25) of the federal
Social Security Act (42 U.S.C. Sec. 1396a(a)(25)).
(3) If a legally liable third party denies a claim submitted by a
local educational agency pursuant to paragraph (2), the legally
liable third party shall issue a notice of denial of noncoverage of
services or benefits.