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AB-254 Local Educational Agency Pilot for Overall Needs.(2017-2018)

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Date Published: 04/17/2017 09:00 PM
AB254:v97#DOCUMENT

Amended  IN  Assembly  April 17, 2017
Amended  IN  Assembly  March 23, 2017

CALIFORNIA LEGISLATURE— 2017–2018 REGULAR SESSION

Assembly Bill No. 254


Introduced by Assembly Member Thurmond

January 31, 2017


An act to add Article 2.986 (commencing with Section 14094.25) to Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions Code, relating to health care services.


LEGISLATIVE COUNSEL'S DIGEST


AB 254, as amended, Thurmond. Local Educational Agency Pilot for Overall Needs.
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 by, and funded pursuant to, federal Medicaid program provisions. Existing law provides that specified services provided by local educational agencies (LEAs) are covered Medi-Cal benefits, including, but not limited to, mental health evaluations, mental health education, and mental health and counseling services. Existing law provides that an LEA may be reimbursed for the provision of those benefits on a fee-for-service basis through the Medi-Cal billing option for LEAs.
This bill would require the department, upon appropriation of funds, to establish the Local Educational Agency Pilot for Overall Needs (program) for the purpose of improving the mental health outcomes of students through a whole person care approach that is accomplished by providing funding to an eligible participant for the provision of direct health services, as defined. The bill would require the department to encourage eligible participants to participate in the program, to provide technical assistance to eligible participants, and to develop a request for proposals process to determine funding allocation. The bill would require an LEA receiving funding through the program to use funds received to increase direct health services provided to all registered students, with a concerted effort toward providing services to students enrolled in the Medi-Cal program. The bill would authorize an LEA to provide direct health services through direct employment of health care providers, or by contracting, as specified, with health care providers or school health centers, as defined. The bill would require a school health center that contracts with an LEA under the program to work in partnership with the school nurse to deliver direct health services, to serve all registered students, and to seek reimbursement for services provided from private health insurers or health care service plans, if applicable. The bill would provide for implementation of the program upon appropriation of funds for the program and to the extent that any necessary federal approvals have been obtained. The bill would require the program to operate for 4 years from the date of that appropriation. The bill would require the department, upon termination of the program and depletion of appropriated funds, to report to the Legislature, as specified, on the outcomes of the program and the need for funding school-based health services and their connection to early mental health outcomes.
Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: NO  

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


SECTION 1.

 Article 2.986 (commencing with Section 14094.25) is added to Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions Code, to read:
Article  2.986. Local Educational Agency Pilot for Overall Needs

14094.25.
 For the purposes of this chapter, the following definitions shall apply:
(a) “Department” means the State Department of Health Care Services.
(b) “Eligible participant” means either of the following:
(1) A local educational agency (LEA) that does not participate in the Medi-Cal billing option for LEAs authorized pursuant to Section 14132.06.
(2) An LEA that participates in the Medi-Cal billing option for LEAs authorized pursuant to Section 14132.06, but which receives low reimbursement relative to the number of students enrolled in the Medi-Cal program who would be eligible to receive covered services.
(c) “Direct health services” means those services that the department has identified as reimbursable services under the Medi-Cal billing option for LEAs pursuant to Section 14132.06. 14132.06 and physical and mental health care services that are not covered under the Medi-Cal billing option for LEAs, including, but not limited to, any or all of the following:
(1) Management of chronic medical conditions.
(2) Basic laboratory tests.
(3) Reproductive health services.
(4) Nutrition services.
(5) Mental health and alcohol and substance abuse service assessments, crisis intervention, counseling, treatment, and referral to a continuum of services, including, but not limited to, emergency psychiatric care, evidence-based mental health or alcohol and substance abuse treatment services, community support programs, inpatient care, and outpatient programs.
(6) Oral health services, including, but not limited to, preventive services, basic restorative services, and referral to specialty services.
(d) “Program” means the Local Educational Agency Pilot for Overall Needs established pursuant to this article.
(e) “School health center” means a center or program, located at or near an LEA, that provides age-appropriate health care services at the program site or through referrals.

14094.27.
 (a) The department, in cooperation with the State Department of Education, shall establish the Local Educational Agency Pilot for Overall Needs for the purpose of improving the mental health outcomes of students through a whole person care approach that is accomplished by providing funding to an eligible participant for the provision of direct health services. increasing comprehensive and integrated physical and mental health services as part of a whole person care approach.
(b) In implementing the program, the department shall do all of the following:
(1) Encourage the participation in the program of eligible participants that are not yet participating in the program.
(2) Provide technical assistance to LEAs that seek to participate in the program or that are eligible participants. For the purposes of this article, technical assistance includes, but is not limited to, identifying public and private funding sources that will assist the LEA in enrolling students in the Medi-Cal program.
(3) Develop a request for proposals process that collects applicant information and determines which proposals shall receive funding.

14094.29.
 (a) An LEA that participates in the program shall do all of the following:
(1) Use funds received through the program to increase direct health services provided to all registered students, with a concerted effort toward providing services to students enrolled in the Medi-Cal program. Funds received through the program shall be used to fund new on-site direct health services not already provided by the LEA, including, but not limited to, mental health services. LEA.
(2) Make a concerted effort toward enrolling students eligible for the Medi-Cal program into the Medi-Cal program.
(3) Strive to provide integrated physical and mental health services that are individualized and supportive of students and, where appropriate, their families, to ensure that health, social, or behavioral challenges are addressed.
(4) Create a sustainability plan that establishes how the LEA will seek to maximize the use of public funds, including, but not limited to, participation in federal reimbursement programs.
(b) An LEA that participates in the program shall participate in the Medi-Cal billing option for LEAs by the time the LEA begins participation in the program.
(c) A reimbursement received through the program for direct health services provided by the LEA shall be used in accordance with applicable federal laws, regulations, or guidelines.
(d) An LEA participating in the program may provide direct health services through direct employment of health care providers, such as school nurses, or by contracting with other health care providers or school health centers for the purpose of supplementing services. The Legislature does not intend for a school health center to serve as a substitute for a school nurse directly employed by an LEA.

14094.31.
 An LEA that contracts with a health care provider or school health center pursuant to subdivision (d) of Section 14094.29 shall do both of the following:
(a) Create and maintain a mechanism, described in writing, to coordinate services provided to individual students among school staff and school health center staff while maintaining the confidentiality and privacy of health information consistent with applicable state and federal law.
(b) Create and maintain a contract or memorandum of understanding between the LEA, the health care provider or school health center, and any other provider agencies that describes the relationship between the LEA and the school health center, if applicable.

14094.33.
 (a) A school health center that contracts with an LEA pursuant to subdivision (d) of Section 14094.29 shall be or shall be eligible to become an enrolled Medi-Cal provider at the time of contracting and shall do all of the following:
(1) Work in partnership with the school nurse, if one is employed by the LEA, to provide direct health services that are either not provided by the LEA or that are provided by the LEA but require supplementation in order to improve services delivered to students under the program.
(2) Serve all registered students enrolled in school without regard to ability to pay, with a concerted effort toward providing services to students enrolled in the Medi-Cal program.
(3) Seek reimbursement from and have procedures in place for billing public and private health insurers or health care service plans for covered services provided to students by the school health center.
(b) For the purposes of the program, a school health center may provide direct health services and may provide referrals for services not offered at the school health center site.
(c) A school health center may serve two or more nonadjacent schools or LEAs.

14094.35.
 (a) This article shall be implemented only upon appropriation of funds for the program and to the extent that any necessary federal approvals have been obtained.
(b) The program shall operate for four years from the date of the appropriation described in subdivision (a), notwithstanding fiscal years.

14094.37.
 (a) Upon the depletion of funds appropriated for the program and the termination of the program, the department shall submit a report to the Assembly Committee on Appropriations and the Senate Committee on Appropriations that shall include, but not be limited to, all of the following information:
(1) An evaluation of the need for funding school-based health services and their connection to early mental health outcomes.
(2) The impact of the program on student well-being, academic achievement, school engagement, attendance, and other outcome and indicator measures collected by LEAs participating in the program.
(b) Information reported pursuant to subdivision (a) shall be reported in the aggregate and shall not be reported in a manner that would compromise the privacy of any individual student.