Bill Text: CA SB123 | 2015-2016 | Regular Session | Amended
NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Medi-Cal: school-based administrative activities.
Spectrum: Partisan Bill (Democrat 3-0)
Status: (Vetoed) 2016-11-30 - Last day to consider Governor's veto pursuant to Joint Rule 58.5. [SB123 Detail]
Download: California-2015-SB123-Amended.html
Bill Title: Medi-Cal: school-based administrative activities.
Spectrum: Partisan Bill (Democrat 3-0)
Status: (Vetoed) 2016-11-30 - Last day to consider Governor's veto pursuant to Joint Rule 58.5. [SB123 Detail]
Download: California-2015-SB123-Amended.html
BILL NUMBER: SB 123 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY JUNE 16, 2016
AMENDED IN ASSEMBLY MAY 16, 2016
AMENDED IN SENATE MAY 12, 2015
AMENDED IN SENATE APRIL 6, 2015
INTRODUCED BY Senator Liu
(Principal coauthor: Assembly Member Santiago)
JANUARY 15, 2015
An act to amend, repeal, and add
Sections amend Section 14115.8 and
14132.47 of, and to add Sections 14005.272, 14005.273,
14132.471, 14132.472, and 14132.473 and
14132.472 to, the Welfare and Institutions Code, relating to
Medi-Cal.
LEGISLATIVE COUNSEL'S DIGEST
SB 123, as amended, Liu. Medi-Cal: school-based administrative
activities.
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 establishes an administrative claiming
process under which the department is authorized to contract
with local governmental agencies and local educational
consortia contract with the department for the
purpose of obtaining federal matching funds to assist with the
performance of administrative activities relating to the Medi-Cal
program. Existing law defines a local educational agency for these
purposes as a local educational agency that participates under the
process as a subcontractor to the local educational consortium in its
service region.
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 to meet the requirements relating to
the LEA billing option, the annual amount of which may not exceed
$1,500,000. LEAs, including amendment of the Medicaid
state plan to ensure that schools shall be reimbursed for all
eligible services they provide. Existing law requires the department
to regularly consult with the State Department of Education, school
district representatives, county offices of education, the local
educational consortium, and local educational agencies to assist in
formulating those state plan amendments.
This bill would, commencing with the 2017-18 fiscal year,
recast and revise the Administrative Claiming process for local
educational agencies that conduct school-based administrative
activities relating to the Medi-Cal program. The bill would require
would additionally authorize the department to
contract directly with each participating
a local educational agency to perform
administrative activities necessary for the proper and efficient
administration of the Medi-Cal program, as specified, and would
designate this activity as the School-Based Administrative Claiming
process program. The bill would eliminate the authority for
the establishment of local educational consortia in this regard, as
well as the authority of local governmental agencies or local
educational consortia, to 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. The bill
would require the department to administer or oversee the
administration of a single statewide random moment time survey for
the purposes of the program. The bill would make related legislative
findings and declarations.
This bill would require the department to prepare and file an
annual report with the Legislature for the School-Based
Administrative Claiming process program, which would include
specified information relating to the operation, components, and
rates of school-based Medicaid systems. The bill would require the
department to prepare and post on its Internet Web site an annual
report of the costs of administering the School-Based Administrative
Claiming process program and the LEA billing option and list local
educational agency participation in each.
This bill would require the department to enter into an
interagency agreement or memorandum of understanding (MOU) with the
State Department of Education to coordinate the efforts of both
departments with respect to the process. LEA
billing option and the School-Based Administrative Claiming process
program. The bill would require the department and the State
Department of Education to develop an appeals process, as specified,
to contest an action of the department or the State Department of
Education. Any savings available to the department from the
restructuring of the Administrative Claiming process made by the bill
would be directed toward the implementation of the interagency
agreement or MOU described in the bill, including, but not limited
to, providing necessary State Department of Education staff
support. and support to county offices of education.
This bill would authorize the State Department of Health Care
Services to withhold a percentage of funds to be reimbursed to local
educational agencies for the purpose of defraying the cost of
operating the School-Based Administrative Claiming process program,
the LEA billing option, and the appeals process, as specified. The
bill would provide that the Local Educational Agency Medi-Cal
Recovery Fund shall fund the LEA billing option program until the
earlier of the termination of federal financial participation in the
LEA billing option, or January 1, 2018. The bill would require the
department to return funds in the Local Educational Agency Medi-Cal
Recovery Fund to local educational agencies, as specified, no later
than January 1, 2018.
This bill would require the department to establish a School-Based
Health Program and Policy Workgroup, as specified, in order to
assist the department in formulating state plan amendments required
to implement the LEA billing option described above and for the
purpose of advising the department on issues related to the delivery
of school-based Medi-Cal services to students in the state. The bill
would require the department to consult with the advisory group in
connection with developing the interagency agreement or MOU described
above.
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. (a) The Legislature finds and declares all of the
following:
(1) Effective cross-agency collaboration is vital to deliver
high-quality school-based health services to California students.
(2) Existing federal directives require the chief executive
officer of a state or designee of that officer to ensure that an
interagency agreement or other mechanism for interagency coordination
is in effect between each noneducational public agency (health) and
the state education agency to ensure that a Free Appropriate Public
Education (FAPE) is provided for students. California does not
currently have the required interagency agreement.
(3) The federal United States
Department of Education and the federal
United States Department of Health and Human Services, in a key
January 2016 policy letter, recognize the critical role that health
care coverage and health services play in ensuring all students are
ready and able to learn, and recommend action steps to better
coordinate health and education services to build strong and
sustainable partnerships and commitments between health and education
agencies at the local, state, and federal levels.
(4) The student success strategic priority in State Superintendent
of Public Instruction Tom Torlakson's 2015 Blueprint 2.0 includes
Section 3.13, which prioritizes the development of infrastructure at
the State Department of Education to improve cross-agency
collaboration in support of student health.
(5) In Report 2014-130 issued on August 20, 2015, the State
Auditor recommended that the State Department of Health Care Services
institute significant structural changes to school-based Medi-Cal
programs in order to improve administration and oversight, increase
federal funding, and cut costs.
(6) Building an effective, transparent infrastructure and
accountability system to fully utilize all available federal Medicaid
funds is a critical component of developing the capacity to deliver
school-based health and mental health programs.
(7) These vital programs must be operated at a level that meets
the benchmark of national best practices in order to meet the needs
of California's most vulnerable children.
(b) It is the intent of the Legislature to ensure effective
coordination between health and education agencies at the state,
county, and local levels to address the achievement gap in our
schools and health and education equity issues in California.
SEC. 2. Section 14005.272 is added to the Welfare and Institutions
Code, to read:
14005.272. (a) The department, in consultation with the State
Department of Education, shall establish a School-Based Health
Program and Policy Workgroup in order to assist the department
in formulating the state plan amendments required by subdivisions (a)
and (b) of Section 14115.8, and for the purpose of advising
the department on issues related to the delivery of school-based
Medi-Cal services to students in the state. The scope of the
workgroup shall include, but not be limited to, improving the
operation of and participation in all of the following school-based
health programs:
(1) The School-Based Administrative Claiming process program
described in Section 14132.471.
(2) The local educational agency (LEA) Medi-Cal billing
option described in Section 14132.06.
(3) The Early and Periodic Screening, Diagnosis, and Treatment
(EPSDT) Program described in Section 14700.
(4) Other school-based health and mental health programs,
including school-based health centers which may receive Medi-Cal
funding.
(b) The workgroup shall, on a regular basis, provide input to the
department and the State Department of Education on the degree to
which the process and implementation of the School-Based
Administrative Claiming process program described in Section
14132.471 and the local educational agency Medi-Cal billing option
program described in Section 14132.06 is meeting the needs of LEAs
with respect to cost-effectiveness, program structure, and
operational effectiveness, including the process of balancing
withheld funds and actual expenses.
(b)
(c) The workgroup shall also provide input to the
department and the State Department of Education on the development
and continuing operations of an office of school-based health
programs within the State Department of Education.
(c)
(d) The workgroup shall be representative of the
diversity of California local education
educational agencies with respect to size, type, and geographic
diversity and shall include representatives from county offices of
education and urban, suburban, and rural local educational agencies.
The workgroup shall also include the LEA Ad Hoc Workgroup described
in Section 14132.06 and members with expertise in the school-based
health programs described in paragraphs (1) to (4), inclusive, of
subdivision (a).
SEC. 3. Section 14005.273 is added to the Welfare and Institutions
Code, to read:
14005.273. Commencing with the 2017-18 state fiscal year, and
annually for each year thereafter, the department shall publish the
following information together on a section of its Internet Web
site site:
(a) An annual report that details the costs of operating the
School-Based Administrative Claiming process program described in
Section 14132.471, including the cost of conducting the
random moment time survey described in subdivision (b) of Section
14132.471 and any vendor fees. The report shall also list
each participating local educational agency. The initial report
prepared and posted pursuant to this subdivision shall also report on
cost savings realized through from the
restructuring of the Administrative Claiming process program through
implementation of the School-Based Administrative Claiming process
program described in Section 14132.471.
(b) An annual report that details the costs of operating the local
educational agency (LEA) Medi-Cal billing option program described
in Section 14132.06. The report shall also list each local
educational agency participating in the LEA Medi-Cal billing option
program.
(c) An annual report regarding the rate of participation of local
educational agencies in the Early and Periodic Screening, Diagnosis,
and Treatment (EPSDT) Program described in Section 14700.
SEC. 4. 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)
(c) 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)
(d) 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)
(e) 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)
(f) (1) These activities shall, until the
earlier of the termination of federal financial participation in the
billing option for services by LEAs pursuant to this section or
January 1, 2018, 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.
(3) No later than January 1, 2018, the department shall
proportionately return all funds in the Local Educational Agency
Medi-Cal Recovery Fund to all LEAs whose federal Medicaid funds were
used to create the fund.
(h)
(g) (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)
(h) 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.
(j)
This section shall remain in effect only until January 1, 2018,
and as of that date is repealed, unless a later enacted statute, that
is enacted before January 1, 2018, deletes or extends that date.
SEC. 5. Section 14115.8 is added to the Welfare
and Institutions Code, 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,
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 9 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 those barriers.
(g) The activities described in this section shall be funded
pursuant to Section 14132.473.
(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.
(j) This section shall become operative on January 1, 2018.
SEC. 6. 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 the 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 any 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) (1) Subject to paragraph (2), 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.
(2) This section shall not be applicable to Administrative
Claiming process activities performed in the 2017-18 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) This section shall remain in effect only until January 1,
2018, and as of that date is repealed, unless a later enacted
statute, that is enacted before January 1, 2018, deletes or extends
that date.
SEC. 7. Section 14132.47 is added to the
Welfare and Institutions Code, to read:
14132.47. (a) It is the intent of the Legislature to provide
local governmental agencies the choice of participating in the
Targeted Case Management (TCM) or the Administrative Claiming process
program, or both, 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 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 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 expended on the allowable administrative
activities.
(2) The department shall deny the claim if the department
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 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 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 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 from any other funds allowed under federal law and
regulation.
(B) That the agency's expenditures represent costs that are
eligible for federal financial participation for each fiscal year.
The department shall deny the claim if the department 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, or
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 the certification 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, 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 has received reimbursement for Administrative
Claiming process activities, the department shall recoup from the
local governmental agency 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 has received
reimbursement for Administrative Claiming process activities
performed by an entity under contract with, and on behalf of, the
participating local governmental agency, the department shall be held
harmless by that particular participating local governmental agency
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, 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 if the department determines that the claim is
not adequately supported in accordance with criteria established
pursuant to this subdivision and implementing regulations before the
department forwards the claim for reimbursement to the federal
Medicaid program. In consultation with local governmental agencies,
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.
(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 may,
within 30 days after receipt of written notice of the denial, request
that the department reconsider its action. The participating local
governmental agency may request a meeting with the director or his or
her designee within 30 days to present the agency's 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 to the
participating local governmental agency in response to its appeal,
indicating the specific reasons for which the claim is out of
compliance. The decision of the director shall be final.
(l) To the extent consistent with federal law and regulations,
participating local governmental agencies 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.
(m) As a condition of participation in the Administrative Claiming
process and in recognition of revenue generated to each
participating local governmental agency in the Administrative
Claiming process, each participating local governmental agency shall
pay an annual participation fee through a mechanism agreed to by the
state and local governmental agencies, 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 the purposes of this section, "participating local
governmental agency" means a county, charter 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). A participating local
governmental agency for the purposes of this section does not include
a local educational agency or an agency under contract with the
department for the purpose of claiming reimbursement for school-based
administrative activities related to the Medi-Cal program.
(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) A participating local governmental agency may charge an
administrative fee to any entity claiming Administrative Claiming
through that agency.
(p) The department shall continue to administer the Administrative
Claiming process in conformity with federal requirements.
(q) The department shall provide technical assistance to all
participating local governmental agencies in order to maximize
federal financial participation in the Administrative Claiming
process.
(r) 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.
(s) 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.
(t) This section shall become operative on January 1, 2018.
SEC. 8. SEC. 5. Section 14132.471 is
added to the Welfare and Institutions Code, to read:
14132.471. (a) It is the intent of the Legislature to provide
local governmental agencies with the option to participate in the
Targeted Case Management (TCM) program and to provide local
educational agencies with the option to participate in the
Administrative Claiming process program, subject to the requirements
of this section and Section 14132.44.
(b) (1) Beginning no later than the 2017-18 state fiscal year, the
department shall administer, or oversee the administration of, a
single statewide quarterly random moment time survey for the
School-Based Administrative Claiming process program.
(2) The statewide quarterly random moment time survey described in
paragraph (1) shall not apply to the Los Angeles Unified School
District (LAUSD), which shall conduct its own random moment time
survey. Data from the random moment time survey conducted by LAUSD
shall not be included in the statewide random moment time survey
described in paragraph (1).
(c)
(b) The department shall may
contract with each a
participating local educational agency to perform 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 School-Based Administrative Claiming process.
(d)
(c) (1) As a condition of participation in the
School-Based Administrative Claiming process program, each
participating local educational agency, for the purpose of claiming
federal Medicaid reimbursement, shall enter into a contract with the
department and shall certify to the department, pursuant to
subdivision (f), the total amount the local educational agency
expended on the allowable administrative activities.
(2) The department shall deny the claim if the department
determines that the certification is not adequately supported, or
otherwise does not comply with federal requirements, for purposes of
claiming federal financial participation.
(e)
(d) Each School-Based Administrative Claiming process
contract shall include a requirement for each participating local
educational agency to submit a claiming plan in a manner that shall
be prescribed by the department in regulations developed in
consultation with local educational agencies.
(f)
(e) (1) The department shall require each participating
local educational agency to certify to the department both of the
following:
(A) That the local educational agency expended funds from its
general fund or from any other fund allowed under federal law and
regulation to pay for 100 percent of the cost of performing
School-Based Administrative Claiming process program activities.
(B) For each fiscal year, that the local educational agency's
expenditures represent costs that are eligible for federal financial
participation for that fiscal year.
(2) A tribe or tribal organization, as described in subdivision
(n), may contract with, or submit to a tribe or tribal organization
that is contracting with, the department pursuant to subdivision (b)
amounts expended for School-Based 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 the certification 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) of paragraph (1).
(g)
(f) (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
educational agency 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 a participating local
educational agency has received reimbursement for School-Based
Administrative Claiming process activities, the department shall
recoup from the local educational agency 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 a 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 educational agency has received
reimbursement for School-Based Administrative Claiming process
activities performed by an entity under contract with, and on behalf
of, the participating local educational agency, the department shall
be held harmless by that particular participating local educational
agency for 100 percent of the amount of the federal audit
disallowance and interest for the disallowed claim.
(h)
(g) 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 a
participating local educational agency, except as required by this
section or as may be required by federal law.
(i)
(h) (1) The department shall, in consultation with
participating local educational agencies, adopt regulations
that prescribe the requirements for the submission and payment of
claims for administrative activities performed by each participating
local educational agency.
(2) The department shall deny a claim from a participating local
educational agency if the department determines that the claim is not
adequately supported in accordance with criteria established
pursuant to this subdivision and implementing regulations before the
department forwards the claim for reimbursement to the federal
Medicaid program.
(j)
(i) 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)
(j) If the department denies a claim submitted under
this section, the affected participating local educational agency,
within 30 days after receipt of written notice of the denial, may
request that the department reconsider its action. The participating
local educational agency 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 to the
participating local educational agency in response to its request for
reconsideration, indicating the specific reasons for which the claim
is out of compliance. The local educational agency may appeal the
decision of the director pursuant to the appeals process established
by the department and the State Department of Education pursuant to
paragraph (3) of subdivision (a) of Section 14132.471.
(l)
(k) To the extent consistent with federal law and
regulations, participating local educational agencies 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 educational agencies. A local educational
agency 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)
( l ) As a condition of
participation in the School-Based Administrative Claiming process and
in recognition of revenue generated to each
a participating local educational agency in the School-Based
Administrative Claiming process, each participating local
educational agency shall pay an annual participation fee through a
mechanism agreed to by the state and the participating
local educational agencies. The participation fee shall be used to
cover the cost of administering the School-Based Administrative
Claiming process, including, but not limited to, claims
processing, technical assistance, and monitoring.
process. 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 School-Based
Administrative Claiming process and other costs related to that
process.
(n)
(m) (1) For the purposes of this section,
"participating local educational agency" includes a 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 (c).
(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, including, but not limited to,
using the California Healthcare Eligibility, Enrollment, and
Retention System.
(o)
(n) For purposes of this section, "local educational
agency" includes county offices of education, special education local
plan areas, Healthy Start programs, and local educational agencies,
as defined in subdivision (h) of Section 14132.06, that participate
in the School-Based Administrative Claiming process program as a
contractor with the department.
(p)
(o) (1) Each participating local educational agency
shall be responsible for the preparation and submission of all
administrative claiming plans, training of local educational agency
staff, and the submission of detailed quarterly invoices.
(2) Each participating local educational agency shall comply with
all requirements of the School-Based Administrative Claiming process
program.
(3) Ninety days prior to the initial participation in the
School-Based Administrative Claiming process program, each local
educational agency shall notify the department of its intent to
participate in the program.
(q)
(p) Each local educational agency that elects to
participate in the School-Based Administrative Claiming process
program shall submit claims directly to the department.
(r)
(q) The department shall continue to administer the
School-Based Administrative Claiming process program in conformity
with federal requirements.
(s)
(r) The department shall, by July 1, 2017, in
conjunction with the State Department of Education pursuant to the
interagency agreement or memorandum of understanding developed
pursuant to Section 14132.471, provide technical assistance to all
participating local educational agencies in order to maximize the
allowable federal financial participation in the School-Based
Administrative Claiming process program.
(t)
(s) This section shall be applicable to School-Based
Administrative Claiming process activities performed in the 2017-18
fiscal year and thereafter.
(u)
(t) The department shall prepare and file an annual
report with the Legislature for the School-Based Administrative
Claiming process program, similar to the annual report the department
is required to file for the local educational agency Medi-Cal
billing option program pursuant to Section 14115.8.
(v)
(u) This section and Section 14132.44 shall not be
construed to prevent a state agency from participating in the
School-Based Administrative Claiming process program or from
contracting with others to engage in these activities.
(w)
(v) This section shall not be construed to prohibit
county offices of education or local government agencies from
providing services to local educational agencies to facilitate
participation in school-based health programs on a fee-for-service
basis. This section shall not be construed to prohibit a county
office of education or a local educational consortium providing
services to a local educational agency from contracting 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.
SEC. 9. SEC. 6. Section 14132.472 is
added to the Welfare and Institutions Code, to read:
14132.472. (a) By July 1, 2017, the department shall enter into
an interagency agreement or memorandum of understanding (MOU) with
the State Department of Education to coordinate the efforts of both
departments with respect to the School-Based Administrative Claiming
process program described in Section 14132.471 and the local
educational agency (LEA) Medi-Cal billing option (the LEA billing
option) described in Section 14132.06. The agreement or MOU shall
focus on the following:
(1) Maximizing the department's Medicaid program expertise.
(2) Coordinating functions and resources between the department
and the State Department of Education, and building personnel
capacity at the State Department of Education, to assist local
educational agencies in implementing and meeting the requirements of
the School-Based Administrative Claiming process and the LEA billing
option at the local level. That coordination shall include an
agreement regarding the use of funds withheld pursuant to Section
14132.473.
(3) Developing a process by which a local educational agency may
appeal an action of the department or the State Department of
Education with respect to the School-Based Administrative Claiming
process program or the LEA billing option. The appeals process shall
utilize the Office of Administrative Hearings, or another neutral
third party acceptable to the department and the State Department of
Education, as the appeals authority.
(b) In developing the interagency agreement or MOU described in
subdivision (a), the department shall do all of the following:
(1) Estimate the cost savings resulting from the restructuring of
the Administrative Claiming process program through implementation of
the School-Based Administrative Claiming process program described
in Section 14132.471. The department shall provide the estimate of
cost savings, data used to support the estimate, and a description of
the methodology used to calculate the estimate to the State
Department of Education.
(2) Consult with relevant nonprofit organizations involved in
facilitating information sharing among state Medicaid and education
agencies involved in the administration of Medicaid claiming for
school-based services to identify, and implement if feasible, best
practices that accomplish the coordination of efforts required by
subdivision (a).
(3) Consult with the School-Based Health Program and Policy
Workgroup established pursuant to Section 14005.272 regarding the
impact of the implementation of the School-Based Administrative
Claiming process program and the LEA billing option on
operations at the local level. level and any
changes to the MOU that the workgroup recommends.
(4) Develop a schedule for the regular ongoing meetings of the
School-Based Health Program and Policy Workgroup to provide feedback
to the department and the Department of Education.
(c) Any savings resulting from the restructuring of the
Administrative Claiming process program through implementation of the
School-Based Administrative Claiming process program and available
to the department shall on an ongoing basis be directed
toward implementation of the interagency agreement or MOU entered
into pursuant to this section, including, but not limited to,
providing necessary State Department of Education staff support and
support to county offices of education.
SEC. 10. Section 14132.473 is added to the
Welfare and Institutions Code, to read:
14132.473. (a) Commencing with the 2017-18 state fiscal year, and
for each year thereafter, the department may withhold up to 5
percent of the total funds to be reimbursed to local educational
agencies pursuant to the School-Based Administrative Claiming process
program described in Section 14132.471 and the local educational
agency Medi-Cal billing option program described in Section 14132.06,
for the following purposes:
(1) Defraying the costs of administering the School-Based
Administrative Claiming process program and the local educational
agency Medi-Cal billing option program.
(2) Implementing the interagency agreement or MOU entered into
pursuant to Section 14132.472.
(3) Providing necessary staff support to the State Department of
Education.
(4) Providing necessary staff support to county offices of
education and local educational agencies.
(5) Carrying out the duties and activities required by Section
14115.8.
(b) The State Department of Education may use funds from the
withholding described in subdivision (a) to support an office of
school-based health programs within the State Department of
Education.
(c) Commencing with the 2017-18 state fiscal year, and for each
year thereafter, the department may withhold an additional 1 percent
of the total funds to be reimbursed to local educational agencies
pursuant to the School-Based Administrative Claiming process program
described in Section 14132.471 and the local educational agency
Medi-Cal billing option program described in Section 14132.06, for
the purpose of defraying the costs of the appeals process developed
pursuant to paragraph (3) of subdivision (a) of Section 14132.472.
(d) To the extent that the department withholds reimbursed funds
pursuant to subdivision (a), the department shall adjust the
percentage withheld based on an annual reconciliation of the costs
necessary to carry out the purposes described in paragraphs (1) to
(5), inclusive, of subdivision (a).
(e) This section shall be implemented only to the extent that
federal financial participation is not jeopardized. The department
shall seek any federal approvals necessary for the implementation of
this section.
