(a) A Local Educational Agency (LEA) Provider, as defined in Section 51190.2, shall be certified by the Department of Education as meeting all of the following conditions for participation:
(1) The LEA Provider meets the definition of an LEA as stated in Education Code, Section 33509(e), and
(2) The LEA Provider has signed a contract with the Department of Health Services.
(b) As a condition for participation, LEA Providers shall comply with the following requirements:
(1) Any federal funds received by an LEA Provider for LEA Services shall be reinvested by the LEA Provider in services, as identified in Education Code Section 8804(g), for school children and their families,
(2) LEA Providers shall consult with a local school-linked services collaborative group, such as defined in Education Code, Section 8806, regarding decisions on reinvestment of federal funds referred to in (b)(1) above,
(3) LEA Providers shall submit annually, on or before October 10th, a certification of the specific amount available in non-federal matchable funds to draw down federal Medicaid funds for the specific fiscal year.
(4) LEA Providers shall adhere to and comply with all federal and state third party liability requirements prior to billing Medi-Cal, including but not limited to policy directives issued by the federal Department of Health and Human Services and Health Care Financing Administration and those standards found in 42 United State Code Section 1396a(a)(25); 42 Code of Federal Regulations Section 433.139; Welfare and Institutions Code, Sections 14005, 14023.7, 14124.90; and Title 22, California Code of Regulations, section 51005 and Article 15 commencing with Section 50761.
(5) LEA Providers shall comply with confidentiality requirements as specified in 42 United States Code Section 1320c-9; 42 Code of Federal Regulations, Section 431.300; Welfare and Institutions Code, Section 14100.2; California Code of Regulations, Title 22, Section 51009; and Education Code, Sections 49060 and 49073 through 49079.
(6) LEA Providers shall submit an Annual Report which shall include, but is not limited to, the following:
(A) Identification of who participates in the community collaborative;
(B) Concise summary financial statement identifying funds received as a result of claiming for LEA Services and identifying both, how funds will be reinvested and how funds were reinvested in the previous year; and
(C) Identification of anticipated services priorities for the future.
(c) LEA Providers shall maintain records as necessary to fully disclose the type and extent of services provided to a Medi-Cal beneficiary.
(d) LEA Providers shall maintain records showing that all LEA Practitioners, which it employs or with which it contracts, meet and shall continue to meet all appropriate licensing and certification requirements.
(e) LEA Providers shall review each publication of the “suspended and ineligible list” of Medi-Cal providers periodically published and distributed by the Department. LEA Providers may not bill for services rendered by any practitioners found on this list during the suspended or ineligible period.
(f) LEA Providers shall adhere to and comply with all federal Health and Human Services and Health Care Financing Administration requirements with respect to billing for services provided by other health care professionals under contract with the LEA.
(g) The LEA Provider shall ensure that its practitioners provide only those services which are within their appropriate scope of practice.
Credits
Note: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions Code. Reference: Sections 14005, 14023.7, 14053, 14059, 14100.2, 14124.5, 14124.90, 14131 and 14132, Welfare and Institutions Code; Sections 8804(g), 8806, 33509(e), 49060 and 49073 through 49079, Education Code; 42 United States Code Sections 1320c-9 and 1396a(a)(25); and 42 Code of Federal Regulations Sections 431.300 and 433.139.
History
1. New section filed 12-22-93 as an emergency; operative 12-22-93 (Register 93, No. 52). A Certificate of Compliance must be transmitted to OAL by 4-22-94 or emergency language will be repealed by operation of law on the following day.
2. Certificate of Compliance as to 12-22-93 order transmitted to OAL 4-20-94 and filed 6-2-94 (Register 94, No. 22).
This database is current through 4/26/24 Register 2024, No. 17.
