Bill Text: CA AB483 | 2023-2024 | Regular Session | Amended
Bill Title: Local educational agency: Medi-Cal billing option.
Spectrum: Partisan Bill (Democrat 3-0)
Status: (Passed) 2023-10-08 - Chaptered by Secretary of State - Chapter 527, Statutes of 2023. [AB483 Detail]
Download: California-2023-AB483-Amended.html
Amended
IN
Senate
September 08, 2023 |
Amended
IN
Senate
July 13, 2023 |
Introduced by Assembly Members Muratsuchi and Wood (Principal coauthor: Senator Cortese) |
February 07, 2023 |
LEGISLATIVE COUNSEL'S DIGEST
Digest Key
Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: NOBill Text
The people of the State of California do enact as follows:
SECTION 1.
Section 14115.8 of the Welfare and Institutions Code is amended to read:14115.8.
(a) (1) The department shall amend the Medicaid state plan with respect to the billing option for services by local educational agencies (LEAs), to ensure that schools shall be reimbursed for all eligible services that they provide that are not precluded by federal requirements.(2)The department shall establish a revised audit process for Medi-Cal Billing Option claims submitted for dates of service on or after January 1, 2025, as follows:
(A)The department’s audit process shall make fraud, waste, and abuse the primary focus of recoupment.
(B)(i)
(ii)The department shall provide interim settlement of a claim within 12 months and perform final settlement on a claim, including completion of the appeals process, as defined in Section 14171, within three years from the date the CRCS is submitted.
(iii)In the event that an LEA’s audit appeal is not fully and finally resolved by the department within 300 days after the date a notice of appeal is filed, the LEA may elect to seek immediate relief in superior court in the same manner as if the department’s appeal process had been concluded.
(C)If an audit finding results in an LEA being required to pay back more than 25 percent of the LEA’s total value of claims in a given year, the department shall provide technical assistance to the LEA that is specific to the reasons that claims were required to be paid back, and shall assist with the preparation of a corrective action plan that outlines the actions needed to avoid future pay backs.
(D)For appeals of audit findings that result in an LEA being required to pay back 50 percent or more of an LEA’s total value of claims in a given year, those appeals, including both informal and formal appeals, shall be completed within 180 days.
(E)Recognizing that schools shall be reimbursed for all eligible services that they provide that are not precluded by federal requirements, an auditor shall not determine that an LEA must pay back reimbursements for any claim that meets the requirements of Section 51190.4 of Title 22 of the California Code of Regulations unless the claim is out of compliance with the standards of the LEA program guide that was in place at the time the claim was filed, as described in subparagraph (A) of paragraph (1) or the state plan in effect at the time of submission. When reviewing an audit appeal, as described in Section 14171, the person reviewing the audit appeal shall use the LEA program guide described in subparagraph (A) of paragraph (1), including the guidance contained in any internet website links in the LEA program guide, to determine whether the auditor’s finding was appropriate.
(3)(A)The department shall revise the state plan pursuant to paragraph (2) only to the extent necessary to obtain federal approval of the state plan amendment and upon consultation with the workgroup described in subdivision (e).
(B)The department shall report to the relevant policy committees and post on its internet website any changes made to the state plan pursuant to this section.
(4)
(8)A summary of the number of audits conducted of Medi-Cal Billing Option program claims, the amount of funds that each LEA was required to pay back, broken down by those related to reimbursements for interim payments made in excess of actual costs, as well as those related to audit findings of noncompliance, and efforts made to provide technical assistance and develop corrective action plans, pursuant to subparagraph (C) of paragraph (2) of subdivision (b).
(i)
(j)
(k)
(l)For purposes of these claims, the department shall ensure that for a beneficiary under 21 years of age, “medical necessity” has the same meaning as that term is defined in paragraph (1) of subdivision (b) of Section 14059.5.