California Assembly Bill AB2608 Amended / Bill

 BILL NUMBER: AB 2608AMENDED BILL TEXT AMENDED IN ASSEMBLY MAY 25, 2012 AMENDED IN ASSEMBLY MARCH 29, 2012 INTRODUCED BY Assembly Member Bonilla FEBRUARY 24, 2012 An act to amend Section 14115.8 of the Welfare and Institutions Code, relating to Medi-Cal. LEGISLATIVE COUNSEL'S DIGEST AB 2608, as amended, Bonilla. Medi-Cal: local educational agency billing option. Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income persons receive health care benefits. The Medi-Cal program is, in part, governed and funded by federal Medicaid Program provisions. Existing law provides that specified services provided by local educational agencies (LEAs) are covered Medi-Cal benefits, and requires the department to perform various activities with respect to the billing option for services provided by LEAs. Existing law establishes the Local Educational Agency Medi-Cal Recovery Fund, which consists of proportionately reduced federal Medicaid funds allocable to LEAs, to be used, upon appropriation by the Legislature, only to support the department, until January 1, 2013, to meet the requirements relating to the LEA billing option, the annual amount of which may not exceed $1,500,000. Existing law requires, as of January 1, 2013, that all moneys in the fund be returned proportionally to all LEAs whose federal Medicaid funds were used to create the fund. This bill would delete the repeal of these provisions and would require the department to amend the Medicaid state plan and regulatory requirements pertaining to the provision of medical transportation services by LEAs to be no more restrictive than federal requirements. This bill would  provide that the payments allocable to LEAs that are reduced pursuant to these provisions shall be reduced no more than as specified and would  require that the department provide an accounting of funds collected as a result of  those   the   above-referenced  reductions in its annual report submitted to the Legislature  . It would also   and would  require the department to collaborate with the State Department of Education to help ensure LEA compliance with state and federal Medicaid requirements. Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated 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) The department shall amend the Medicaid state plan and regulatory requirements pertaining to the provision of medical transportation services by LEAs to be no more restrictive than federal requirements in order to allow LEAs to seek reimbursement for school transportation services that are not precluded by federal requirements. (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. (8) An accounting of funds collected from federal Medicaid payments allocable to LEAs pursuant to subdivision (g). The report shall detail amounts withheld from federal Medicaid payments to each participating LEA for the year. (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.  (A) Federal Medicaid payments allocable to LEAs under this section shall be reduced by no more than 1 percent for the purpose of funding administrative and processing services costs related to the management of the LEA Medi-Cal Billing Option Program.   (B)     In addition to the amounts described in subparagraph (A), federal Medicaid payments allocable to LEAs under this section shall be reduced for the purpose of supporting the department to meet all of the requirements of this section.  The annual amount funded pursuant to this subparagraph shall not exceed one million five hundred thousand dollars ($1,500,000).  (C) In addition to the amounts described in subparagraphs (A) and (B), federal Medicaid payments allocable to LEAs under this section shall be reduced by no more than 1 percent for the purpose of funding the work and related administrative costs associated with audit requirements to ensure the fiscal accountability of the Medi-Cal billing option for LEAs and to comply with the Medicaid state plan. The annual amount funded pursuant to this subparagraph shall not exceed six hundred fifty thousand dollars ($650,000).  (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  requirement   requirements  and to help improve LEA participation in the Medi-Cal billing option for LEAs.