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LEA Medi-Cal Billing Option Collaborative

 

LOCAL EDUCATION AGENCY MEDI-CAL BILLING OPTION COLLABORATIVE

Palmdale School District 

The purpose of the collaborative is to create a focus for local collective decision making about planning, financing, and monitoring the school-linked support services for students and their families. The collaborative should set forth priorities for reinvestment.

The membership in the local collaborative may vary according to regional needs. Generally, representation may include the schools, major public agencies serving children and families including health, metal health, social services, and juvenile justice, civic business leadership, the advocacy community, parents or guardians, and current safety net and traditional health care providers.

The Local Educational Agency (LEA) Medi-Cal Billing Option was established in 1993 in conjunction with the California Department of Education. The LEA Program is authorized under the California's Welfare and Institutions Code, Sections 14132.06. Regulations governing the TCM Program are contained in Title 22, California Code of Regulations (22CCR), Division 3, Chapter 3. Reimbursement is based upon a "fee-for-service." 

Palmdale School District, in cooperation with the California Department of Health Services and Education, participates in this School-based Medi-Cal Services Program.  The District is able to be reimbursed with federal Medicaid dollars for specific health services (assessments and direct services, including hearing and vision testing, speech/language, and mental health) provided to eligible students at school.  These funds are separate from individual benefits, and are set aside specifically for allocation to school districts, and do not affect students' or families' individual Medi-Cal status, benefits, or claims.

In accordance with FERPA, Local Education Agency, and California Department of Healthcare Services privacy guidelines, eligible student's related records may be forwarded to the District's contracted billing agency, in accordance with specific HIPAA compliant confidentiality measures to ensure that information is not disclosed inappropriately.
 
School health services currently provided to all students will not be changed or affected by this program, in that students will not be denied services they require to attend school, and parents will not be billed by the school district. 
  
The goal is to enhance integrated health and social services for Palmdale School District students and their families through reinvestment of funds obtained by participating in the Medi-Cal Billing Option Program, for reimbursement of billable services provided to Medi-Cal eligible students at district expense.
 

In order to reach that goal, committee members will:

  • Provide input about reinvestment of federal funds obtained by billing Medi-Cal for services provided to Medi-Cal eligible students at district expense, in accordance with C.E.C. section 8800.
  • Coordinate fiscal strategies to assure more comprehensive services and interagency collaboration.
  • Address needs of children and families when proposing enhancements of school-linked and school-based services to be purchased with Medi-Cal reimbursement funds.
  • Propose accountability and quality assurance mechanisms and documentation required for Medi-Cal billing.
  • Articulate the needs and concerns of parents/guardians and primary care givers of the students.

The LEA Medi-Cal Billing Option:

  • was established in 1993 by the California Department of Health Services (DHS) in conjunction with the California Department of Education (CDE)
  • To provide comprehensive health services to Medi-Cal eligible students, and when applicable, to their families.
  • To allow school districts to bill the Medi-Cal program for the health services provided by the medical professionals employed by the LEA.
  • To facilitate reinvestment in health and social services for students and their families.

Services that may be claimed under the LEA Billing Option:

  • Nursing Services
  • Medical Transportation
  • Occupational Therapy
  • Speech Therapy
  • Vision Assessment
  • Hearing Assessment
  • Psychosocial Status and Mental Health Assessment

A Reinvestment into school-linked support services (CEC Section 8804):

  • Health care (immunizations, vision/hearing testing/services, dental services, physical exam and referral, prenatal care)
  • Mental Health services (prevention, crisis intervention mental health training)
  • Substance abuse prevention/treatment
  • Family support/ parenting education (including child abuse prevention)
  • Counseling/Intervention services (including suicide prev.)
  • Academic Support Services (tutoring, community service internships, inservice training)
  • Nutrition services
  • Case management
  • Youth development services
  • Case Management Services
  • LEA administrative/support staff costs related to program coordination