ARTICLE 1.5. Office of School-Based Health Programs [49418 - 49421.5]
( Article 1.5 added by Stats. 2021, Ch. 44, Sec. 61. )
For purposes of this article, “office” means the Office of School-Based Health Programs established within the department that is dedicated to expanding access to school-based health programs pursuant to this article.
(Added by Stats. 2021, Ch. 44, Sec. 61. (AB 130) Effective July 9, 2021.)
(a) The department shall, no later than January 1, 2022, establish an Office of School-Based Health Programs for the purpose of assisting local educational agencies regarding the current health-related programs under the purview of the department. The scope of the office shall include collaborating with the State Department of Health Care Services and other departments and offices involved in the provision of school-based health services. The scope of the office shall also include assisting local educational agencies with information on, 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 Medi-Cal Billing Option Program described in Section 14132.06 of the Welfare and Institutions Code.
(3) All other programs under the federal Early and Periodic Screening, Diagnostic, and Treatment services entitlement supporting the provision of health services to eligible pupils, including screening, diagnostic, and treatment services to prevent, identify, or address physical and behavioral health needs.
(4) Providing consultation and technical assistance to local educational agencies on school-based nursing and health services.
(5) Coordinating school health program activities with public health, social services, environmental, and local educational agencies, and other public and private entities.
(6) Participating in the development of policies, standards, and guidelines, interpreting updates, and disseminating policies, standards, guidelines, and procedures to enhance coordinated school health programs.
(7) Promoting quality assurance in school health services by initiating and coordinating a quality assurance program that includes needs assessment, data collection and analysis, and evidenced-based practices.
(8) Initiating, participating in, and using research studies related to a coordinated school health program, the health needs of children and youth, school nursing practice, and related issues.
(9) Additional school-based health efforts available to local educational agencies through the California Health and Human Services Agency and its
offices and departments.
(b) The office shall advise the department on opportunities for effective coordination between health and education systems at the state, regional, and local levels to advance school-based health programs, and on strategies to leverage school-based Medi-Cal programs to sustain school-based health services.
(c) The office shall collaborate with the local educational agency selected to provide guidance around Medi-Cal billing pursuant to Section 49422.
(d) The office may provide technical assistance to local educational agencies on matters such as expanding services, simplifying the administration of school-based health programs, and increasing local educational agency participation in, and maximizing allowable federal financial participation in, the school-based health programs.
(e) The office shall assist in the development of the telehealth guidelines required pursuant to Section 49429.
(f) The office shall provide technical assistance, outreach, and informational materials to local educational agencies on allowable services and on the submission of claims. The office shall not otherwise provide informational materials related to the State Department of Health Care Services’ school-based health programs that have not been approved by the State Department of Health Care Services, as the State Department of Health Care Services is the sole state agency with authority from the federal Centers for Medicare and Medicaid Services to define allowable services and submit claims for federal matching funds.
(g) The office shall oversee the School Health Demonstration Project established pursuant to
Section 49421.
(h) The office may form, or participate in, advisory groups for technical assistance and other purposes as deemed necessary.
(i) To the extent necessary, the State Department of Health Care Services shall make available to the office any information on other school-based dental, health, and mental health programs, and school-based health centers, that may receive Medi-Cal funding.
(j) (1) This section shall not prohibit the department from using an existing branch or division within the department to serve as the office, in lieu of establishing a new office, for purposes of implementing this section.
(2) This section shall not limit or modify Section 14132.06 of the Welfare and Institutions
Code.
(Added by Stats. 2021, Ch. 44, Sec. 61. (AB 130) Effective July 9, 2021.)
(a) The department shall by January 1, 2022, appoint a state school nurse consultant to be housed within the office, as established pursuant to Section 49419. The state school nurse consultant shall be a school nurse with a services credential with a specialization in health for a school nurse issued by the Commission on Teacher Credentialing, who has a minimum of five years of experience in school health program management. The state school nurse consultant shall work with local educational agencies and school nurses to promote quality school nursing services and school health programs that address the broad health needs of pupils. The state school nurse consultant, in performing the duties of the position, shall collaborate with the State Department of Public Health, the State Department of Health Care
Services, the Governor’s Office of Emergency Services, and the Board of Registered Nursing.
(b) The state school nurse consultant shall be responsible for all of the following:
(1) Serving as a liaison and resource expert in school nursing and school health program areas for local, regional, state, and national school health care providers and policy setting groups.
(2) Monitoring, interpreting, synthesizing, and working to ensure that the office disseminates relevant information associated with changes in health, nursing, and medical care, school nursing practice, legislation, and legal issues that impact schools and the pupils they serve.
(3) Fostering and promoting staff development for school nurses, which may include planning and providing
orientation, coordinating or providing educational offerings, and networking with universities and other providers of continuing education to meet identified needs.
(4) Participating in state-level public interagency partnerships and private partnerships with statewide stakeholders to foster a coordinated school health program, representing school nurses in multidisciplinary collaborations.
(Added by Stats. 2021, Ch. 44, Sec. 61. (AB 130) Effective July 9, 2021.)
(a) The sum of five million dollars ($5,000,000) is hereby appropriated from the General Fund to the Superintendent on a one-time basis for the School Health Demonstration Project. The School Health Demonstration Project is hereby established in the office as a pilot project to expand comprehensive health and mental health services to public school pupils by providing local educational agencies with intensive assistance and support to build the capacity for long-term sustainability by leveraging multiple revenue sources. For these purposes, the project is intended to provide training and technical assistance on the requirements for health care provider participation in the Medi-Cal program pursuant to Article 1.3 (commencing with Section 14043) of Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions Code to enable
local educational agencies to participate in, contract with, and conduct billing and claiming in the Medi-Cal program through all of the following:
(1) The Local Educational Agency Medi-Cal Billing Option Program.
(2) The School-Based Medi-Cal Administrative Activities Program.
(3) Contracting or entering into a memorandum of understanding with Medi-Cal managed care plans as a participating Medi-Cal managed care plan contracting provider.
(4) Contracting with or entering into a memorandum of understanding with county mental health plans for specialty mental health services, such as through the Early and Periodic Screening, Diagnostic and Treatment Program.
(5) Contracting with
community-based providers to deliver health and mental health services to pupils in school through contracts with Medi-Cal managed care plans or county mental health plans.
(b) On or before June 30, 2022, the Superintendent, in consultation with the executive director of the state board and the State Department of Health Care Services, shall select up to three organizations to serve as technical assistance teams for purposes of the pilot project. Technical assistance teams selected to serve shall be a consortia that consists of one or more local educational agencies, county agencies, or community-based organizations with experience in general and special education mental health program and service development, school finance, health care, Medi-Cal managed care contracting and benefits, Medicaid billing, commercial health insurance, and data analysis. The technical assistance teams are intended to provide hands-on, intensive support for a
two-year period to the local educational agencies selected to be pilot participants to create capacity for those local educational agencies to become self-sustaining by securing federal reimbursement and other revenue sources for health and mental health services provided to pupils. In selecting the technical assistance teams, consideration shall be given to demonstrated expertise, including, but not limited to, all of the following:
(1) Knowledge of the process to submit claims through the Local Educational Agency Medi-Cal Billing Option Program, the School-Based Medi-Cal Administrative Activities Program, and drawing down federal reimbursement for Medi-Cal services.
(2) The knowledge and capacity to provide direct, hands-on assistance and support to selected local educational agencies in securing federal reimbursement for health and mental health services provided to pupils, and
identifying additional sources of funding through programs identified in subdivision (a).
(3) Experience working with the department, the State Department of Health Care Services, county health departments, county behavioral health departments, Medi-Cal managed care plans, private health care service plans and health insurers, and the Mental Health Services Oversight and Accountability Commission.
(4) Experience in the legally compliant development and sustainable funding of general and special education mental health programs and supports in public schools, including the Multi-Tiered System of Supports, positive behavioral interventions and supports services for children under the federal Individuals with Disabilities Education Act (20 U.S.C. Sec. 1400 et seq.) and Section 504 of the federal Rehabilitation Act of 1973 (29 U.S.C. Sec. 794), public school contracting requirements,
and relevant state and federal privacy protections.
(c) On or before September 1, 2022, the department, in consultation with the State Department of Health Care Services, shall select up to 25 local educational agencies to serve as pilot participants for a period of two years. In selecting local educational agencies to serve as pilot participants, consideration shall be given to all of the following factors:
(1) Demonstrated need for health and mental health services for pupils.
(2) Commitment of the local educational agency’s leadership to expand health and mental health services for all pupils through school-based services, school-connected services, or both.
(3) Willingness to reinvest increased reimbursements gained through the pilot project into
direct health and mental health services for pupils.
(4) Unduplicated pupil count.
(5) Geographic diversity of the state.
(6) Mix of urban, suburban, and rural.
(d) A local educational agency selected to serve as a pilot participant pursuant to subdivision (c) shall receive up to one hundred thousand dollars ($100,000) per year for each of the two years it participates in the pilot project. Funds shall be used for contracting with one of the technical assistance teams identified by the department pursuant to subdivision (b), and may also be used to address needs identified by the in-depth analysis conducted by the technical assistance provider.
(e) The technical assistance teams selected
pursuant to subdivision (b) shall, under the direction of the department, work with each pilot participant to do all of the following:
(1) Conduct an analysis of all of the following related to the local educational agency:
(A) The need for health and mental health services for pupils.
(B) The current capacity within the local educational agency to meet those needs.
(C) Current participation in the programs identified in paragraphs (1) and (2) of subdivision (a).
(D) The barriers to participating in the programs identified in paragraphs (1) and (2) of subdivision (a).
(E) Any existing partnerships with county agencies or
community-based agencies to provide health and mental health services to pupils.
(2) Work with local educational agency staff to establish or expand the expertise necessary to maximize federal reimbursement revenue through an analysis of past claims and review eligible school expenditures to ensure maximum usage of potential Medi-Cal reimbursements, including the Early and Periodic Screening, Diagnostic, and Treatment services provided to eligible pupils.
(3) Facilitate the exploration of opportunities to collaborate with county mental health plans, Medi-Cal managed care plans, and private health care service plans and health insurers to establish partnerships through memoranda of understanding or other means to coordinate the funding and provision of health and mental health services to pupils.
(4) Complete, and
provide to the department, a final report at the conclusion of the pilot project with data on any increases in the level of health and mental health services provided to pupils in the local educational agency, any improved measurable outcomes for pupils, increased funding secured, plans for ongoing sustainability of health and mental health services beyond the pilot project period, and recommendations on maximizing federal reimbursement and other revenue sources to provide effective health and mental health services to pupils.
(f) (1) The department, in consultation with the State Department of Health Care Services, participating local educational agencies, and the technical assistance teams established pursuant to subdivision (b), shall prepare and submit to the relevant policy and fiscal committees of the Legislature on or before January 1, 2025, or six months after the final local educational agency has ended its
service as a pilot participant, whichever comes first, a final report of the pilot programs established pursuant to this section. The report shall include, but not be limited to, all the following:
(A) Best practices developed by local educational agencies that ensure every pupil receives an uninterrupted continuum of effective care services.
(B) Program requirements and support services needed for the Local Educational Agency Medi-Cal Billing Option Program, the School-based Medi-Cal Administrative Activities Program, and medically necessary federal Early and Periodic Screening, Diagnostic, and Treatment benefits, to ensure ease of use and access for local educational agencies.
(C) Total dollars drawn down from federal sources by local educational agencies participating in the pilot project.
(D) The number of pupils receiving health and mental health services by participating local educational agencies throughout the course of the pilot project, including breakdowns by subgroups, and measurable improved outcomes for those pupils.
(E) Recommendations for expanding the program statewide, including an estimate of the cost of fully funding an ongoing technical assistance and support program on a statewide basis.
(F) Strategies for working with the State Department of Health Care Services to coordinate, streamline, and prevent the duplication of Medi-Cal covered services.
(G) Recommendations on specific changes needed to state regulations or statute, the need for approval of amendments to the state Medicaid plan or federal waivers, changes to
implementation of federal regulations, changes to state agency support and oversight, and associated staffing or funding needed to implement recommendations.
(2) A report to be submitted pursuant to paragraph (1) shall be submitted in compliance with Section 9795 of the Government Code.
(g) The department, in consultation with the technical assistance teams, the State Department of Health Care Services, and the Mental Health Services Oversight and Accountability Commission, shall prepare materials for use by local educational agencies in developing the capacity to effectively secure sustainable funding for the delivery of comprehensive health and mental health services to pupils.
(h) The State Department of Health Care Services shall seek federal financial participation for the activities conducted pursuant to this
section.
(i) The following definitions apply to this section:
(1) “County mental health plan” means an entity authorized pursuant to Article 5 (commencing with Section 14680) of Chapter 8.8 of Part 3 of Division 9 of the Welfare and Institutions Code.
(2) “Medi-Cal managed care plan” means an individual, organization, or entity that enters into a contract with the department to provide services to enrolled Medi-Cal beneficiaries pursuant to any of the following:
(A) Article 2.7 (commencing with Section 14087.3) of Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions Code, excluding dental managed care programs developed pursuant to Section 14087.46 of the Welfare and Institutions Code.
(B) Article 2.8 (commencing with Section 14087.5), Article 2.81 (commencing with Section 14087.96), Article 2.82 (commencing with Section 14087.98), Article 2.9 (commencing with Section 14088), or Article 2.91 (commencing with Section 14089) of Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions Code.
(C) Chapter 8 (commencing with Section 14200) of Part 3 of Division 9 of the Welfare and Institutions Code, excluding dental managed care plans.
(D) Chapter 3 (commencing with Section 101675) of Part 4 of Division 101 of the Health and Safety Code.
(j) For purposes of making the computations required by Section 8 of Article XVI of the California Constitution, the appropriation made by subdivision (a) shall be deemed to be “General Fund revenues appropriated for school districts,” as defined in
subdivision (c) of Section 41202, for the 2020–21 fiscal year, and included within the “total allocations to school districts and community college districts from General Fund proceeds of taxes appropriated pursuant to Article XIII B,” as defined in subdivision (e) of Section 41202, for the 2020–21 fiscal year.
(Amended by Stats. 2021, Ch. 252, Sec. 23. (AB 167) Effective September 23, 2021.)
(a) (1) On or before June 30, 2022, the State Department of Education shall establish a process to select, with approval from the executive director of the state board, a local educational agency to provide guidance around Medi-Cal billing and increase local educational agencies’ capacity to successfully submit claims through the Local Educational Agency Medi-Cal Billing Option Program. The local educational agency selected shall have demonstrated success in submitting claims through the Local Educational Agency Medi-Cal Billing Option Program and drawing down federal reimbursement for Medi-Cal services, and a willingness and capacity to perform the duties described in paragraph (2). The State Department of Health Care Services shall provide relevant data, including, but not limited to, the number of years
participating in the program and cost reimbursement data for each local educational agency, in the form and manner requested by the State Department of Education and the executive director of the state board no later than August 31, 2021, to aid in the selection process. The State Department of Health Care Services shall assist the State Department of Education, as needed, with the selection process, including verifying information provided by local educational agencies regarding program participation during the selection process.
(2) The local educational agency selected pursuant to paragraph (1) shall do all of the following:
(A) Provide effective assistance and support to local educational agencies in securing federal reimbursement for services provided to Medi-Cal eligible pupils.
(B) Work in coordination and
collaboration with expert lead agencies identified pursuant to Section 52073.1, special education resource leads identified pursuant to Section 52073.2, the State Department of Education, and the State Department of Health Care Services.
(C) Identify and disseminate information regarding existing resources, professional development activities, and other efforts currently available to assist local educational agencies in successfully submitting claims through the Local Educational Agency Medi-Cal Billing Option Program and drawing down federal reimbursement for Medi-Cal services.
(D) Upon request by the State Department of Education and the State Department of Health Care Services, develop new resources and activities designed to build capacity for local educational agencies to secure federal reimbursement for services provided to Medi-Cal eligible pupils.
(E) Serve as a point of contact for local educational agencies, and regularly participate and share the perspectives of local educational agencies in the Local Educational Agency Program Advisory Workgroup convened by the State Department of Health Care Services.
(F) Other duties, as prescribed by the State Department of Education, to enhance Medi-Cal services on schoolsites, increase access of care for pupils, and increase Medi-Cal reimbursement for local educational agencies.
(3) A local educational agency may partner as a consortium with other local educational agencies, institutions of higher education, nonprofit educational services providers, county mental health providers, or other local partners to submit a proposal to the State Department of Education to be considered for selection as the local educational
agency pursuant to paragraph (1).
(b) (1) The term of a local educational agency selected pursuant to subdivision (a) shall not exceed five years.
(2) The selected local educational agency shall commit to providing program data to the State Department of Education, as specified by the Superintendent, to evaluate the effectiveness of the activities performed under paragraph (2) of subdivision (a).
(3) At the conclusion of the term of the selected local educational agency, the State Department of Education, with approval from the executive director of the state board, may renew the term of the selected local educational agency or select a new local educational agency in a manner consistent with subdivision (a).
(4) If a selected
local educational agency requests that its term be renewed, it shall provide a description of the efforts it has made to carry out the duties described in paragraph (2) of subdivision (a), and before renewing the term, the State Department of Education shall evaluate the local educational agency’s success in carrying out those duties.
(c) Notwithstanding Section 13340 of the Government Code, commencing with the 2021–22 fiscal year, each fiscal year the sum of two hundred fifty thousand dollars ($250,000) shall be appropriated from the General Fund to the State Department of Education to be awarded to the local educational agency selected pursuant to this section.
(d) (1) For purposes of making the computations required by Section 8 of Article XVI of the California Constitution, the appropriation made by subdivision (c) shall be deemed to be “General Fund
revenues appropriated for school districts,” as defined in subdivision (c) of Section 41202, for the fiscal year in which they are appropriated, and included within the “total allocations to school districts and community college districts from General Fund proceeds of taxes appropriated pursuant to Article XIII B,” as defined in subdivision (e) of Section 41202, for the fiscal year in which they are appropriated.
(2) Notwithstanding paragraph (1), the appropriation made by subdivision (c) for the 2021–22 fiscal year shall be deemed to be “General Fund revenues appropriated for school districts,” as defined in subdivision (c) of Section 41202, for the 2022–23 fiscal year, and included within the “total allocations to school districts and community college districts from General Fund proceeds of taxes appropriated pursuant to Article XIII B,” as defined in subdivision (e) of Section 41202, for the
2022–23 fiscal year.
(Amended by Stats. 2023, Ch. 48, Sec. 56. (SB 114) Effective July 10, 2023.)