BILL NUMBER: AB 1955AMENDED BILL TEXT AMENDED IN ASSEMBLY MAY 1, 2014 AMENDED IN ASSEMBLY APRIL 22, 2014 AMENDED IN ASSEMBLY MARCH 28, 2014 INTRODUCED BY Assembly Member Pan (Coauthors: Assembly Members Gonzalez and Nazarian) FEBRUARY 19, 2014 An act to add and repeal Section 42238.054 of the Education Code,and to amend Section 14132.47 of the Welfare and Institutions Code,relating to pupil health. LEGISLATIVE COUNSEL'S DIGEST AB 1955, as amended, Pan. Pupil health: Healthy Kids, Healthy Minds Demonstration. Existing law establishes a public school financing system that requires state funding for county superintendents of schools, school districts, and charter schools to be calculated pursuant to a local control funding formula, as specified. Existing law requires the Superintendent of Public Instruction to annually calculate a local control funding formula grant for each school district and charter school based on data submitted by local educational agencies, as specified, in accordance with instructions specified by the Controller. This bill would require the Superintendent to establish and implement the Healthy Kids, Healthy Minds Demonstration for the period of July 1, 2015, until June 30, 2018, under which participating schoolsites would employ a school nurse and a mental health professional, as defined, and extend library hours. The bill would authorize local educational agencies that have a percentage of unduplicated pupils, as defined, in excess of 55 percent of the local educational agency's total school enrollment to apply to the Superintendent for funding for these purposes, as specified and upon appropriation. The bill would authorize individual schoolsites to apply for this funding if the local educational agency does not have the required percentage of unduplicated pupils. The bill would require participating local educational agencies to collect and aggregate certain pupil data, and transmit this data annually to the State Department of Education. The bill would encourage participating local educational agencies to offer specified library programs. The bill would require the State Department of Education to compile, analyze, and present the results of the demonstration to the State Board of Education and the Legislature no later than December 31, 2018.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 and funded by federal Medicaid Program provisions. Existing law establishes an Administrative Claiming process under which local governmental agencies and local educational consortia contract with the State Department of Health Care Services for the purpose of obtaining federal matching funds to assist with the performance of administrative activities relating to the Medi-Cal program.This bill would require the State Department of Health Care Services and the State Department of Education to cooperate and coordinate efforts in order to maximize receipt of federal matching funds under these provisions, and would require the State Department of Health Care Services to, through an interagency agreement with the State Department of Education, provide technical advice and consultation services to local educational agencies, as specified.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. The Legislature finds and declares all of the following: (a) School-based health services lead to academic improvements, better attendance, reduced suspension and expulsion rates, and lower dropout rates. (b) Adverse childhood experiences, such as abuse or neglect, violence, and physical health conditions, such as asthma and dental caries, impact school readiness, classroom behavior, and absentee rates. (c) Only 2 percent of California's schools have a school-based health center and 57 percent of California school districts report not having any full-time school nurse. (d) The ratio of pupils to school nurses in California is 2,815 to 1, and the National Association of School Nurses recommends that school districts provide one nurse for every 750 well pupils. (e) The ratio of pupils to school psychologists in California is 1,469 to 1, and the National Association of School Psychologists' Practice Model recommends a ratio of one psychologist for every 500 to 700 pupils. (f) School library programs and the presence of school librarians can make significant differences in pupil success, literacy, information technology skills, and overall academic achievement. (g) Research shows that, when children have access to libraries with plenty of books and adequate staffing, they read more and do better on reading tests. (h) California ranks 51st nationally, including the District of Columbia, in the number of pupils per librarian. (i) Given the promise of education reform, the scarcity of health professionals in the schools, and the steady decline in numbers of library staff, the state must find innovative ways to spend its limited fiscal resources and leverage federal funding, in order to facilitate for local educational agencies the task of connecting health services to schools, and assist in returning schools and school libraries to their traditional missions as centers of learning and community life. SEC. 2. Section 42238.054 is added to the Education Code, to read: 42238.054. (a) The demonstration project established pursuant to this section shall be known, and may be cited, as the Healthy Kids, Healthy Minds Demonstration. (b) The Superintendent shall establish the Healthy Kids, Healthy Minds Demonstration in accordance with this section to increase the base grant amounts received by local educational agencies pursuant to Sections 2574 and 42238.02. The purpose of the demonstration is for participating schoolsites to employ one full-time school nurse and one full-time mental health professional, and to ensure that the schoolsites' libraries are open one hour before, and three hours after, the regular schoolday. (c) The Superintendent shall implement the demonstration for the period of July 1, 2015, to June 30, 2018, inclusive. (d) (1) Except as provided in paragraph (2), a local educational agency is eligible to participate in the demonstration if it has a percentage of unduplicated pupils, as determined pursuant to Section 42238.02, in excess of 55 percent of the local educational agency's total school enrollment. (2) Notwithstanding paragraph (1), local educational agencies that do not meet the requirements of paragraph (1) shall allow individual schoolsites that meet the requirements of paragraph (1) and are interested in participating to apply and participate in the demonstration. (e) To participate in the demonstration, a local educational agency's application shall, at a minimum, demonstrate all of the following: (1) The local educational agency meets the requirements of subdivision (d) and is able to achieve the goal of the demonstration with a combination of current and additional local funds and funding received from the grant program. (2) The local educational agency can meet the goal of employing one full-time nurse and one full-time mental health professional, and providing the extended library hours described in subdivision (b), for three fiscal years. (3) The local educational agency can show that the proposed use of the funds provided under the demonstration is consistent with its local control and accountability plan. (f) Upon appropriation by the Legislature, the Superintendent shall reserve funds each year necessary to operate the demonstration as a grant program. (g) A participating local educational agency, with assistance from the department, shall collect and aggregate data from schoolsites under the jurisdiction of the local educational agency that measures changes in pupil absenteeism, school climate, reductions in the incidence of violence, successful intervention against suicide attempts and pupil bullying, changes in health status among high-needs pupils, such as low income, English learners, and foster youth, general pupil outcomes and achievement, and other relevant benchmarks as defined and determined by the state board. A participating local educational agency shall transmit this data to the department annually. (h) Participating local educational agencies are encouraged to offer library programs that may include, but are not limited to, reading circles, tutoring programs, online research, parent engagement or classes, and parent outreach for homework assistance. To the extent feasible, schoolsites shall make every effort to offer library programming with the participation of certified bilingual staff that aims to serve the language needs of its local community. Participating local educational agencies or individual schoolsites shall ensure that programs are adequately staffed by qualified personnel, as described in subdivision (i), but may also include adult volunteers who are approved by the schoolsite. (i) This section shall not be interpreted to modify existing law or school policy regarding what staff classification is permitted to operate libraries, which includes levels of certificated and classified staff, to include media technicians and library aides. (j) The department shall compile, analyze, and present the results of the demonstration to the Legislature and the state board no later than December 31, 2018. (k) The state board may adopt emergency regulations for purposes of this section, including, but not limited to, the process for selecting applicants to participate in the demonstration, and the adoption of the emergency regulations shall be deemed to be an emergency and necessary for the immediate preservation of the public peace, health and safety, or general welfare for purposes of Sections 11346.1 and 11349.6 of the Government Code. (l) For purposes of this section, "mental health professional" means a school psychologist or social worker. (m) This section shall remain in effect only until January 1, 2019, and as of that date is repealed, unless a later enacted statute, that is enacted before January 1, 2019, deletes or extends that date.SEC. 3.Section 14132.47 of the Welfare and Institutions Code is amended to read: 14132.47. (a) It is the intent of the Legislature to provide local governmental agencies the choice of participating in either or both of the Targeted Case Management (TCM) and Administrative Claiming process programs at their option, subject to the requirements of this section and Section 14132.44. (b) The department may contract with each participating local governmental agency or each local educational consortium to assist with the performance of administrative activities necessary for the proper and efficient administration of the Medi-Cal program, pursuant to Section 1903a of the federal Social Security Act (42 U.S.C. Sec. 1396b(a)), and this activity shall be known as the Administrative Claiming process. (c) (1) Subject to the requirements of paragraph (2) of subdivision (f), as a condition for participation in the Administrative Claiming process, each participating local governmental agency or each local educational consortium shall, for the purpose of claiming federal Medicaid reimbursement, enter into a contract with the department and shall certify to the department the total amount the local governmental agency or each local educational consortium expended on the allowable administrative activities. (2) The department shall deny the claim if it determines that the certification is not adequately supported, or does not otherwise comply with federal requirements, for purposes of claiming federal financial participation. (d) Each participating local governmental agency or local educational consortium may subcontract with private or public entities to assist with the performance of administrative activities necessary for the proper and efficient administration of the Medi-Cal program under the conditions specified by the department in regulations. (e) Each Administrative Claiming process contract shall include a requirement that each participating local governmental agency or each local educational consortium submit a claiming plan in a manner that shall be prescribed by the department in regulations, developed in consultation with local governmental agencies. (f) (1) The department shall require that each participating local governmental agency or each local educational consortium certify to the department both of the following: (A) The expenditure of 100 percent of the cost of performing Administrative Claiming process activities. The funds expended for this purpose shall be from the local governmental agency's general fund or the general funds of local educational agencies or from any other funds allowed under federal law and regulation. (B) In each fiscal year that its expenditures represent costs that are eligible for federal financial participation for that fiscal year. The department shall deny the claim if it determines that the certification is not adequately supported for purposes of federal financial participation. (2) (A) (i) A city that is not a participating local governmental agency, or any other local public entity, that contracts with a local governmental agency pursuant to subdivision (d) and that is located within a county that is a participating local governmental agency pursuant to this section, may submit certification to the local governmental agency of amounts expended for Administrative Claiming services in accordance with Section 433.51 of Title 42 of the Code of Federal Regulations. (ii) A city or other local public entity that submits certification pursuant to this paragraph shall comply with the requirements of paragraph (1), with other requirements applicable to local governmental agencies that the department determines, in regulations, to be applicable, and with all applicable federal requirements. (iii) The local governmental agency shall forward the city's or local public entity's certification to the department for the purposes of claiming federal financial participation. (iv) As applicable, the local governmental agency shall obtain and retain appropriate certifications from the expending city or local public entity, together with documentation of the underlying expenditures, as required by the department. (B) A tribe or tribal organization, as defined in subdivision (n), that is not participating in Administrative Claiming process activities as a local governmental agency, may contract with, and submit to a tribe or tribal organization that is contracting with, the department pursuant to subdivision (b) amounts expended for Administrative Claiming process activities that it is certifying in accordance with Section 433.51 of Title 42 of the Code of Federal Regulations and other applicable federal law and regulations. The tribe or tribal organization receiving the certification shall forward it to the department for purposes of claiming federal financial participation. The certification shall comply with all of the requirements for certification set forth in subparagraph (A). (g) (1) Notwithstanding any other provision of this section, the state shall be held harmless, in accordance with paragraphs (2) and (3), from any federal audit disallowance and interest resulting from payments made to a participating local governmental agency or local educational consortium pursuant to this section, for the disallowed claim. (2) To the extent that a federal audit disallowance and interest results from a claim or claims for which any participating local governmental agency or local educational consortium has received reimbursement for Administrative Claiming process activities, the department shall recoup from the local governmental agency or local educational consortium that submitted the disallowed claim, through offsets or by a direct billing, amounts equal to the amount of the disallowance and interest, in that fiscal year, for the disallowed claim. All subsequent claims submitted to the department applicable to any previously disallowed administrative activity or claim, may be held in abeyance, with no payment made, until the federal disallowance issue is resolved. (3) Notwithstanding paragraph (2), to the extent that a federal audit disallowance and interest results from a claim or claims for which the participating local governmental agency or local educational consortium has received reimbursement for Administrative Claiming process activities performed by an entity under contract with, and on behalf of, the participating local governmental agency or local educational consortium, the department shall be held harmless by that particular participating local governmental agency or local educational consortium for 100 percent of the amount of the federal audit disallowance and interest, for the disallowed claim. (h) The use of local funds required by this section shall not create, lead to, or expand the health care funding obligations or service obligations for current or future years for any participating local governmental agency or local educational consortium, except as required by this section or as may be required by federal law. (i) The department shall deny any claim from a participating local governmental agency or local educational consortium if the department determines that the claim is not adequately supported in accordance with criteria established pursuant to this subdivision and implementing regulations before it forwards the claim for reimbursement to the federal Medicaid Program. In consultation with local governmental agencies and local educational consortia, the department shall adopt regulations that prescribe the requirements for the submission and payment of claims for administrative activities performed by each participating local governmental agency and local educational consortium. (j) Administrative activities shall be those determined by the department to be necessary for the proper and efficient administration of the state's Medicaid plan and shall be defined in regulation. (k) If the department denies any claim submitted under this section, the affected participating local governmental agency or local educational consortium may, within 30 days after receipt of written notice of the denial, request that the department reconsider its action. The participating local governmental agency or local educational consortium may request a meeting with the director or his or her designee within 30 days to present its concerns to the department after the request is filed. If the director or his or her designee cannot meet, the department shall respond in writing indicating the specific reasons for which the claim is out of compliance to the participating local governmental agency or local educational consortium in response to its appeal. Thereafter, the decision of the director shall be final. (l) To the extent consistent with federal law and regulations, participating local governmental agencies or local educational consortium may claim the actual costs of nonemergency, nonmedical transportation of Medi-Cal eligibles to Medi-Cal covered services, under guidelines established by the department, to the extent that these costs are actually borne by the participating local governmental agency or local educational consortium. A local educational consortium may only claim for nonemergency, nonmedical transportation of Medi-Cal eligibles for Medi-Cal covered services, through the Medi-Cal administrative activities program. Medi-Cal medical transportation services shall be claimed under the local educational agency Medi-Cal billing option, pursuant to Section 14132.06. (m) As a condition of participation in the Administrative Claiming process and in recognition of revenue generated to each participating local governmental agency and each local educational consortium in the Administrative Claiming process, each participating local governmental agency and each local educational consortium shall pay an annual participation fee through a mechanism agreed to by the state and local governmental agencies and local educational consortia, or, if no agreement is reached by August 1 of each year, directly to the state. The participation fee shall be used to cover the cost of administering the Administrative Claiming process, including, but not limited to, claims processing, technical assistance, and monitoring. The department shall determine and report staffing requirements upon which projected costs will be based. The amount of the participation fee shall be based upon the anticipated salaries, benefits, and operating expenses, to administer the Administrative Claiming process and other costs related to that process. (n) (1) For purposes of this section, "participating local governmental agency" means a county, chartered city, Native American Indian tribe, tribal organization, or subgroup of a Native American Indian tribe or tribal organization, under contract with the department pursuant to subdivision (b). (2) Each participating Native American Indian tribe, tribal organization, or subgroup of a Native American Indian tribe or tribal organization may claim, as a Medi-Cal Administrative Activity, facilitating Medi-Cal applications, which includes, but is not limited to, using the California Healthcare Eligibility, Enrollment, and Retention System. (o) For purposes of this section, "local educational agency" means a local educational agency, as defined in subdivision (h) of Section 14132.06, that participates under the Administrative Claiming process as a subcontractor to the local educational consortium in its service region. (p) (1) For purposes of this section, "local educational consortium" means a local agency that is one of the service regions of the California County Superintendent Educational Services Association. (2) Each local educational consortium shall contract with the department pursuant to paragraph (1) of subdivision (c). (q) (1) Each participating local educational consortium shall be responsible for the local educational agencies in its service region that participate in the Administrative Claiming process. This responsibility includes, but is not limited to, the preparation and submission of all administrative claiming plans, training of local educational agency staff, overseeing the local educational agency time survey process, and the submission of detailed quarterly invoices on behalf of the participating local educational agency. (2) Each participating local educational consortium shall ensure local educational agency compliance with all requirements of the Administrative Claiming process established for local governmental agencies. (3) Ninety days prior to the initial participation in the Administrative Claiming process, each local educational consortium shall notify the department of its intent to participate in the process, and shall identify each local educational agency that will be participating as its subcontractor. (r) (1) Each local educational agency that elects to participate in the Administrative Claiming process shall submit claims through its local educational consortium or through the local governmental agency, but not both. (2) Each local educational agency participating as a subcontractor to a local educational consortium shall comply with all requirements of the Administrative Claiming process established for local governmental agencies. (s) A participating local governmental agency or a local educational consortium may charge an administrative fee to any entity claiming Administrative Claiming through that agency. (t) The department shall continue to administer the Administrative Claiming process in conformity with federal requirements. (u) The department shall provide technical assistance to all participating local governmental agencies and local educational consortia in order to maximize federal financial participation in the Administrative Claiming process. (v) This section shall be applicable to Administrative Claiming process activities performed, and to moneys paid to participating local governmental agencies for those activities in the 1994-95 fiscal year and thereafter, and to local educational consortia in the 1998-99 fiscal year and thereafter. (w) Nothing in this section or Section 14132.44 shall be construed to prevent any state agency from participating in the Administrative Claiming process or from contracting with others to engage in these activities. (x) (1) The department and the State Department of Education shall cooperate and coordinate efforts in order to maximize receipt of federal financial participation under the Administrative Claiming process pursuant to this section. To the extent permitted by federal law, funds used by local educational agencies under the local control funding formula, including funds used under Section 42238.054 of the Education Code, may be included in expenditures certified under subdivision (f). (2) The department, through an interagency agreement with the State Department of Education, shall provide technical advice and consultation to local educational agencies participating in the demonstration project established pursuant to Section 42238.054 of the Education Code, in order to help set up accounting systems, conduct initial staff time studies, and any other necessary requirements to certify and bill valid claims for allowable activities under the Administrative Claiming process. Any entity contracted by the department, a local educational agency, or educational consortium for purposes of this subdivision shall be a public agency or incorporated as a nonprofit agency or public benefit corporation under state law. (3) The department shall seek any necessary federal approvals to implement this subdivision.