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

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Date Published: 06/15/2017 09:00 PM
AB834:v95#DOCUMENT

Amended  IN  Senate  June 15, 2017
Amended  IN  Assembly  May 30, 2017
Amended  IN  Assembly  April 20, 2017
Amended  IN  Assembly  March 28, 2017

CALIFORNIA LEGISLATURE— 2017–2018 REGULAR SESSION

Assembly Bill
No. 834

Introduced by Assembly Member O'Donnell
(Coauthors: Assembly Members Bocanegra, Chávez, Cristina Garcia, and Voepel)

February 16, 2017

An act to add Article 14 (commencing with Section 32445) to Chapter 3 of Part 19 of Division 1 of Title 1 of the Education Code, and to amend Section 14115.8 of the Welfare and Institutions Code, relating to school health.


LEGISLATIVE COUNSEL'S DIGEST


AB 834, as amended, O'Donnell. School-based health programs.
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 establishes the Administrative Claiming process under which the department is authorized to contract with local governmental agencies and local educational consortia for the purpose of obtaining federal matching funds to assist with the performance of administrative activities relating to the Medi-Cal program that are provided by a local governmental agency or local educational agency (LEA). Existing law also provides that specified services provided by LEAs are covered Medi-Cal benefits and are reimbursable on a fee-for-service basis under the LEA Medi-Cal billing option. Existing law requires the State Department of Health Care Services to engage in specified activities relating to the LEA Medi-Cal billing option, such as amending the Medicaid state plan to ensure that schools shall be reimbursed for all eligible services and examining methodologies for increasing school participation in the LEA Medi-Cal billing option. Existing law requires that these activities be funded and staffed by proportionately reducing federal Medicaid payments allocable to LEAs for the provision of benefits funded by federal Medicaid program payments under the LEA Medi-Cal billing option in an amount not to exceed $1,500,000 annually.
This bill would require the State Department of Education to, no later than July 1, 2018, establish an Office of School-Based Health Programs for the purpose of, among other things, administering health-related programs under the purview of the State Department of Education and advising on issues related to the delivery of school-based Medi-Cal services in the state. The bill would authorize the office to develop a workgroup for the purpose of assisting the office’s efforts that shall be representative of the diversity of California LEAs and include representatives of specified entities involved in the delivery of school-based Medi-Cal services, as specified. The bill would authorize the office to form additional technical advisory groups, as specified, and would require the State Department of Education to make available to the office any information on other school-based dental, health, and mental health programs. The bill would require the office to be supported through an interagency agreement with the State Department of Health Care Services, by federal matching funds available through the Administrative Claiming process for eligible staff time, and would authorize the office to receive additional funds from grants and other sources. The bill would increase the annual funding limit for the activities of the State Department of Health Care Services that support the LEA Medi-Cal billing option to $2,000,000, and require that $500,000 of that amount be available for transfer to the State Department of Education to support the office pursuant to that interagency agreement.
Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: NO  

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


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, recommend an appeals process 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 creating consistency across local educational consortia (LECs), local governmental agencies (LGAs), and the department with respect to 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.

(3)

(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)Increasing contracting options for LEAs participating in the Administrative Claiming process, such as allowing an LEA to contract with an LEC or LGA outside of the LEA’s region.

(C)

(B) Identifying areas that may require a state plan amendment.

(D)

(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)(1)The office may develop a workgroup to assist its efforts that shall be representative of the diversity of California LEAs with respect to size, type, and geographic diversity and shall include representatives from county offices of education, urban, suburban, and rural LEAs, and LECs and LGAs described in Section 14132.47 of the Welfare and Institutions Code. The workgroup shall also include representatives of the LEA Ad Hoc Workgroup described in Section 14132.06 of the Welfare and Institutions Code, members with expertise in school-based health and mental health programs, representatives from the LEC Advisory Committee, and representatives of the Local Governmental Agency Consortium.

(2)The workgroup described in paragraph (1) shall, on a regular basis, provide input to the office on the degree to which the process and implementation of the Administrative Claiming process described in Section 14132.47 of the Welfare and Institutions Code and the LEA Medi-Cal billing option described in Section 14132.06 of the Welfare and Institutions Code are meeting the needs of LEAs with respect to cost-effectiveness, program structure, and operational effectiveness, including the process of appeals and balancing withheld funds and actual expenses.

(d)

(c) The office may form technical advisory groups as necessary that shall report back to the office on the development of plans and timelines to implement the changes and expanded options described in this section. advisory groups for technical assistance, for support in establishing the office, and other purposes as deemed necessary.

(e)

(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.

(f)

(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 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.
(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 two million dollars ($2,000,000). Of this amount five hundred thousand dollars ($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.