Today's Law As Amended

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AB-834 School-based health programs.(2017-2018)



SECTION 1.

 Article 14 (commencing with Section 32445) is added to Chapter 3 of Part 19 of Division 1 of Title 1 of the Education Code, to read:

Article  14. Office of School-Based Health Programs
32445.
 For purposes of this article the following definitions shall apply:
(a) “Department” means the State Department of Education.
(b) “Office” means the Office of School-Based Health Programs established pursuant to this article.
32447.
 (a) The department shall, no later than July 1, 2018, establish an Office of School-Based Health Programs for the purpose of administering current health-related programs under the purview of the department, advising on issues related to the delivery of school-based Medi-Cal services in the state, developing recommendations for an interagency agreement or memorandum of understanding between the Department of Health Care Services and the department, and assisting the Department of Health Care Services in formulating the Medi-Cal state plan amendments required by subdivisions (a) and (b) of Section 14115.8 of the Welfare and Institutions Code. The scope of the office shall include, but not be limited to, improving the operation of, and participation in, the following school-based health programs:
(1) The Administrative Claiming process described in Section 14132.47 of the Welfare and Institutions Code.
(2) The local educational agency (LEA) Medi-Cal billing option described in Section 14132.06 of the Welfare and Institutions Code.
(b) (1) The office shall, no later than January 1, 2019, provide input to the department on the development of, and, if applicable, continuing operations of, the interagency agreement or memorandum of understanding described in subdivision (a). The recommendations of the office shall identify opportunities for effective coordination between the state’s health and education systems at the state, regional, and local levels, identify ways the department can maximize its school-based Medicaid program expertise, review and recommend any improvements to appeals processes for the Administrative Claiming process and the LEA Medi-Cal billing option, and identify necessary legislation or state plan amendments to support its recommendations.
(2) The office shall advise the department on contracts and processes for the Administrative Claiming process described in Section 14132.47 of the Welfare and Institutions Code.
(3) The office shall advise the department on recommendations to the State Department of Health Care Services regarding changes or flexibility that would make Medi-Cal programs easier to administer in a school-based setting.
(4) The office shall determine the opportunities for, and the benefits, costs, and feasibility of program improvements, including, but not limited to, the following:
(A) Increasing LEA participation and maximizing allowable federal financial participation in the Administrative Claiming process and the LEA Medi-Cal billing option, including, but not limited to, informing LEAs about the availability of training and guidance on permissible services for which to bill and how to submit claims through the LEA Medi-Cal billing option.
(B) Identifying areas that may require a state plan amendment.
(C) Integrating and expanding other school-based health and mental health programs with the Administrative Claiming process and the LEA Medi-Cal billing option.
(c) The office may form advisory groups for technical assistance, for support in establishing the office, and other purposes as deemed necessary.
(d) The department shall make available to the office any information on other school-based dental, health, and mental health programs, including, but not limited to, the mental health programs described in Section 14700 of the Welfare and Institutions Code and school-based health centers that may receive Medi-Cal funding.
(e) The office shall be supported through an interagency agreement with the State Department of Health Care Services as authorized by paragraph (1) of subdivision (g) of Section 14115.8 of the Welfare and Institutions Code, and by federal matching funds for eligible staff time as authorized by subdivision (w) of Section 14132.47 of the Welfare and Institutions Code. Additional funds from grants and other sources may be used to support the office.

SEC. 2.

 Section 14115.8 of the Welfare and Institutions Code is amended to read:

14115.8.
 (a) (1) The department shall amend the Medicaid state plan with respect to the billing option for services by local educational agencies (LEAs), to ensure that schools shall be reimbursed for all eligible services that they provide that are not precluded by federal requirements.
(2) The department shall examine methodologies for increasing school participation in the Medi-Cal billing option for LEAs so that schools can meet the health care needs of their students.
(3) The department, to the extent possible, possible  shall simplify claiming processes for LEA billing.
(4) The department shall eliminate and modify state plan and regulatory requirements that exceed federal requirements when they are unnecessary.
(5) (A) The department shall, in consultation with the LEA Ad Hoc Workgroup established pursuant to subdivision (c), and consistent with any applicable federal requirements, issue and regularly maintain a program guide for the LEA Medi-Cal Billing Option program. The program guide shall contain fiscal and programmatic compliance information regarding processes, documentation, and guidance necessary for the proper submission of claims, and auditing of LEAs, charter schools, and community colleges, as required under the LEA Medi-Cal Billing Option program.
(B) The program guide described in subparagraph (A) shall include, but not be limited to, state plan amendments, Frequently Asked Questions, policy and procedure letters, trainings, provider manuals, and all other types of instructional materials relevant to the LEA Medi-Cal Billing Option program.
(C) The department shall distribute the program guide to all participating LEAs, charter schools, and community colleges by January 1, 2020. Distribution of the program guide may occur by electronic mail or by notification by electronic mail of the posting of the guide on the department’s Internet Web site.
(D) The department shall only adopt a revision of the program guide after providing 30 calendar days’ written notification of the revision, including a statement of justification, to the LEA Ad Hoc Workgroup and all other participating LEAs, charter schools, and community colleges. The department may provide written notice by electronic mail. Under extraordinary circumstances, when revisions are necessary to reflect changes required by state or federal law or otherwise mandated by the federal Centers for Medicare and Medicaid Services and those changes require immediate action, the department may provide less than 30 calendar days’ written notice.
(E) The department shall conduct an audit of a Medi-Cal billing option claim consistent with, but not limited to, all of the following:
(i) The program guide and any revisions made pursuant to subparagraph (D), including any revisions that are necessary to reflect changes required by state or federal law or otherwise mandated by the federal Centers for Medicare and Medicaid Services, that are in effect at the time the service was provided.
(ii) Generally accepted accounting principles.
(iii) Federal audit regulations, as set forth in Part 200 (commencing with Section 200.0) of Title 2 of the Code of Federal Regulations (Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards), or its successor.
(iv) Reasonable cost principles under the federal Medicare Program, as set forth in Part 413 (commencing with Section 413.1) of Title 42 of the Code of Federal Regulations, or its successor.
(v) The federal Centers for Medicare and Medicaid Services Provider Reimbursement Manual Part 1 (CMS Publication 15-1).
(vi) Any and all applicable federal or state statutes and regulations.
(F) For purposes of this paragraph, an audit shall refer to the audit and cost recovery process described in Section 14170.
(G) Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may issue and regularly maintain the program guide described in this paragraph without taking regulatory action.
(b) If a rate study for the LEA Medi-Cal billing option is completed pursuant to Section 52 of Chapter 171 of the Statutes of 2001, the department, in consultation with the entities named in subdivision (c), shall implement the recommendations from the study, to the extent feasible and appropriate.
(c) In order to assist the department in formulating the state plan amendments required by subdivisions (a) and (b), the department shall regularly consult with the State Department of Education, representatives of urban, rural, large and small school districts, and county offices of education, the local education consortium, and local educational agencies. It is the intent of the Legislature that the department also consult with staff from Region IX of the federal Centers for Medicare and Medicaid Services, experts from the fields of both health and education, and state legislative staff.
(d) Notwithstanding any other law, or any other contrary state requirement, the department shall take whatever action is necessary to ensure that, to the extent there is capacity in its certified match, an LEA shall be reimbursed retroactively for the maximum period allowed by the federal government for any department change that results in an increase in reimbursement to local educational agency providers.
(e) The department may undertake all necessary activities to recoup matching funds from the federal government for reimbursable services that have already been provided in the state’s public schools. The department shall prepare and take whatever action is necessary to implement all regulations, policies, state plan amendments, and other requirements necessary to achieve this purpose.
(f) The department shall file an annual report with the Legislature that shall include at least all of the following:
(1) A copy of the annual comparison required by subdivision (i).
(2) A state-by-state comparison of school-based Medicaid total and per eligible child claims and federal revenues. The comparison shall include a review of the most recent two years for which completed data is available.
(3) A summary of department activities and an explanation of how each activity contributed toward narrowing the gap between California’s per eligible student federal fund recovery and the per student recovery of the top three states.
(4) A listing of all school-based services, activities, and providers approved for reimbursement by the federal Centers for Medicare and Medicaid Services in other state plans that are not yet approved for reimbursement in California’s state plan and the service unit rates approved for reimbursement.
(5) The official recommendations made to the department by the entities named in subdivision (c) and the action taken by the department regarding each recommendation.
(6) A one-year timetable for state plan amendments and other actions necessary to obtain reimbursement for those items listed in paragraph (4).
(7) Identification of any barriers to local educational agency reimbursement, including those specified by the entities named in subdivision (c), that are not imposed by federal requirements, and a description of the actions that have been, and will be, taken to eliminate them.
(g) (1) These activities shall be funded and staffed by proportionately reducing federal Medicaid payments allocable to LEAs for the provision of benefits funded by the federal Medicaid program under the billing option for services by LEAs specified in this section. Moneys collected as a result of the reduction in federal Medicaid payments allocable to LEAs shall be deposited into the Local Educational Agency Medi-Cal Recovery Fund, which is hereby established in the Special Deposit Fund established pursuant to Section 16370 of the Government Code. These funds shall be used, upon appropriation by the Legislature, only to support the department to meet all the requirements of this section. If at any time this section is repealed, it is the intent of the Legislature that all funds in the Local Educational Agency Medi-Cal Recovery Fund be returned proportionally to all LEAs whose federal Medicaid funds were used to create this fund. The annual amount funded pursuant to this paragraph shall not exceed one million  two million dollars ($2,000,000). Of this amount  five hundred thousand dollars ($1,500,000). ($500,000) shall be available for transfer through an interagency agreement to the State Department of Education for the support of the Office of School-Based Health Programs established pursuant to Section 32447 of the Education Code. 
(2) Moneys collected under paragraph (1) shall be proportionately reduced from federal Medicaid payments to all participating LEAs so that no one LEA loses a disproportionate share of its federal Medicaid payments.
(h) (1) The department may enter into a sole source contract to comply with the requirements of this section.
(2) The level of additional staff to comply with the requirements of this section, including, but not limited to, staff for which the department has contracted for pursuant to paragraph (1), shall be limited to that level that can be funded with revenues derived pursuant to subdivision (g).
(i) The activities of the department shall include all of the following:
(1) An annual comparison of the school-based Medicaid systems in comparable states.
(2) Efforts to improve communications with the federal government, the State Department of Education, and local educational agencies.
(3) The development and updating of written guidelines to local educational agencies regarding best practices to avoid audit exceptions, as needed.
(4) The establishment and maintenance of a local educational agency user-friendly, interactive Internet Web site.
(5) Collaboration with the State Department of Education to help ensure LEA compliance with state and federal Medicaid requirements and to help improve LEA participation in the Medi-Cal billing option for LEAs.