AB 3192: LEA Medi-Cal billing option: program guide.

Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed by, and funded pursuant to, federal Medicaid program provisions. Existing law also provides that specified services provided by a local educational agency (LEA) are covered Medi-Cal benefits and are reimbursable on a fee-for-service basis under the LEA Medi-Cal billing option.

Existing law requires the department to engage in specified activities relating to the LEA Medi-Cal billing option, including, among others, amending the Medicaid state plan to ensure that schools would be reimbursed for all eligible services and examining methodologies for increasing school participation in the LEA Medi-Cal billing option. Existing law also requires the department to develop and update written guidelines to LEAs regarding best practices to avoid audit exceptions, as needed.

This bill would require the department, in consultation with the LEA Ad Hoc Workgroup, to issue and regularly maintain a program guide for the LEA Medi-Cal Billing Option program, as specified. The bill would require the department to distribute the program guide to all participating LEAs, charter schools, and community colleges by January 1, 2020. The bill would require the department to provide specific written notice prior to adopting a revision to the program guide and would further require the department to conduct an audit of a Medi-Cal billing option claim consistent with, among other things, the program guide, any revisions that are in effect at the time the service was provided, and specified principles and regulations.

The bill would authorize the department to issue and regularly maintain the program guide without taking regulatory action.