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AB-3192 LEA Medi-Cal billing option: audit guide.(2017-2018)

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Date Published: 08/17/2018 05:29 PM
AB3192:v95#DOCUMENT

Amended  IN  Senate  August 17, 2018
Amended  IN  Senate  May 30, 2018
Amended  IN  Assembly  April 02, 2018
Amended  IN  Assembly  March 20, 2018

CALIFORNIA LEGISLATURE— 2017–2018 REGULAR SESSION

Assembly Bill No. 3192


Introduced by Assembly Member O’Donnell
(Coauthor: Senator Roth)

February 16, 2018


An act to amend Section 14115.8 of the Welfare and Institutions Code, relating to Medi-Cal.


LEGISLATIVE COUNSEL'S DIGEST


AB 3192, as amended, O’Donnell. LEA Medi-Cal billing option: audit guide.
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 program provisions. Existing law also provides that specified services provided by a local education educational agency (LEA) 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 department to engage in specified activities relating to the LEA Medi-Cal billing option, including, among others, amending the Medicaid state plan to ensure that schools would be reimbursed for all eligible services and examining methodologies for increasing school participation in the LEA Medi-Cal billing option. Existing law also requires the department to develop and update written guidelines to LEAs regarding best practices to avoid audit exceptions, as needed.
This bill would require the department, in consultation with the LEA Ad Hoc Workgroup and the State Department of Education, to prepare and complete a fiscal and program compliance audit guide for the LEA Medi-Cal billing option. Workgroup, to issue and regularly maintain a program guide for the LEA Medi-Cal Billing Option program, as specified. The bill would require the department to distribute the audit guide to LEAs by June 30, 2019. program guide to all participating LEAs, charter schools, and community colleges by January 1, 2020. The bill would require the department to provide specific written notice prior to adopting a revision to the audit program guide and would further require the department to only conduct an audit of a Medi-Cal billing option claim according to the audit consistent with the program guide and any revisions that are in effect at the time the service was provided.
The bill would authorize the department to issue and regularly maintain the program guide without taking regulatory action.
Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: NO  

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


SECTION 1.

 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.
(5) (A) The department shall, in consultation with the LEA Ad Hoc Workgroup and the State Department of Education consistent with established pursuant to subdivision (c), and consistent with any applicable federal requirements, prepare and complete a fiscal and program compliance audit issue and regularly maintain a program guide for the LEA Medi-Cal billing option described in Section 14132.06. Billing Option program. The program guide shall serve as a single, comprehensive document containing 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 audit guide program guide described in subparagraph (A) shall include, but not be limited to, state plan amendments, Frequently Asked Questions for the LEA Medi-Cal billing option as issued by the department, and Questions, policy and procedure letters issued by the department. 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 audit guide to LEAs by June 30, 2019. 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 audit program guide after providing 60 calendar days’ written notification of the revision, including a statement of justification, to the LEA Ad Hoc Workgroup and all other participating LEAs and charter schools. 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 60 calendar days’ written notice.

(E)For purposes of this paragraph, an audit shall refer to the audit and cost recovery process described in Section 14170.

(6)

(E) The department shall only conduct an audit of a Medi-Cal billing option claim according to the audit consistent with the program guide and any revisions made pursuant to subparagraph (D) of paragraph (5) (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.
(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 five hundred thousand dollars ($1,500,000).
(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.