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§ 51491. Local Educational Agency (LEA) Eligibility for Payment.

22 CA ADC § 51491Barclays Official California Code of Regulations

Barclays California Code of Regulations
Title 22. Social Security
Division 3. Health Care Services
Subdivision 1. California Medical Assistance Program (Refs & Annos)
Chapter 3. Health Care Services
Article 6. Eligibility for Payment
22 CCR § 51491
§ 51491. Local Educational Agency (LEA) Eligibility for Payment.
Currentness
Reimbursement for LEA Services shall be limited to those services provided to an LEA Eligible Beneficiary, by an LEA Practitioner, through an LEA Provider.
(a) LEA health and mental health evaluation and health and mental health education services shall be reimbursable only if those services are provided by an LEA Practitioner who:
(1) If licensed or certified under the Business and Professions Code, Healing Arts Division, Section 500 et seq., furnishes LEA Services within the scope of practice of the practitioner as defined in that code;
(2) If not licensed or certified under the Business and Professions Code, Healing Arts Division, furnishes LEA Services within the following limitations:
(A) A credentialed school psychologist meeting the qualifications defined in Education Code, Section 49422, may provide psychosocial assessments, and health education and anticipatory guidance only;
(B) A credentialed school social worker meeting the qualifications defined in Education Code, Section 44874, may provide psychosocial assessments and health education and anticipatory guidance only;
(C) A credentialed school counselor meeting the qualifications defined in Education Code, Section 49600, may provide psychosocial assessments only;
(D) A registered school audiometrist registered pursuant to Health and Safety Code, Sections 1685 and 1686 may provide hearing assessments only;
(E) A registered credentialed school nurse meeting the qualifications defined in Education Code, Sections 49426 and 44877, may provide vision, hearing, developmental, and psychological assessments, health education and anticipatory guidance, and nutritional assessments and nutrition education. Registered credentialed school nurses may provide hearing assessments only if they are a registered school audiometrist.
(F) A credentialed language, speech and hearing specialist meeting the qualifications defined in Education Code, Sections 44225(b)(4) and 44268 may perform hearing assessments and developmental assessments related to language only.
(b) LEA physical therapy services shall be reimbursable only if those services are rendered by a licensed physical therapist who meets the standards of Section 51201.1.
(c) LEA occupational therapy services shall be reimbursable only if those services are rendered by a registered occupational therapist who meets the standards of Section 51203.1.
(d) LEA speech pathology or audiology services shall be reimbursable only if those services are rendered by a licensed speech therapist who meets the standards of Section 51202; or a licensed audiologist who meets the standards of Section 51219.
(e) LEA psychology and counseling services shall be reimbursable only if those services are rendered by a licensed psychiatrist, licensed psychologist, or licensed clinical social worker who meets applicable State licensure requirements; or a licensed marriage, family, and child counselor meeting the qualifications defined in Business and Professions Code, Sections 4980 through 4981.
(f) LEA nursing services shall be reimbursable only if those services are rendered by a licensed registered nurse, certified nurse practitioner, certified public health nurse, or registered credentialed school nurse meeting the requirements of Education Code, Section 49426; or a licensed physician's assistant or licensed vocational nurse meeting State licensure requirements, including supervision requirements.
(g) LEA school health aide services shall be reimbursable only if those services are rendered by a trained health care aide as specified in Education Code, Section 49423.5 under the supervision of one of the following:
(1) A licensed physician and surgeon,
(2) A registered credentialed school nurse, or
(3) A certified public health nurse;
(h) LEA specialized medical transportation services and associated LEA mileage shall be reimbursable only if all vehicles, drivers and attendants meet the standards specified in Sections 51231, 51231.1 and 51231.2.
(i) LEA Services shall be reimbursable only when provided at one of the following sites:
(1) At a school site within the LEA Provider's domain in accordance with Section 51270;
(2) In the office or normal place of business of an LEA Practitioner; or
(3) For authorized LEA specialized medical transportation services and associated LEA mileage, between a school site and a location at which health services are rendered to the LEA eligible beneficiary.

Credits

Note: Authority cited: Section 20, Health and Safety Code; and Sections 10725, 14105, 14115.8 and 14124.5, Welfare and Institutions Code. Reference: Sections 14000, 14018.2, 14053, 14059, 14100.2, 14105, 14115.8, 14124.1, 14124.5, 14132, 14132.06, 14133, 14136.5 and 14170, Welfare and Institutions Code; Sections 500 et seq., 4980 and 4981, Business and Professions Code; Sections 44225(b)(4), 44268, 44874, 44877, 49600, 49422, 49423.5 and 49426, Education Code; Sections 1685 and 1686, Health and Safety Code; and Section 300.34, Title 34 Code of Federal Regulations.
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 including new opening statement and amendment of subsections (g)-(g)(3) and (i)(1) and (3) transmitted to OAL 4-20-94 and filed 6-2-94 (Register 94, No. 22).
3. Amendment of subsections (h) and (i)(3) and amendment of Note filed 12-10-2015; operative 4-1-2016 (Register 2015, No. 50).
This database is current through 5/10/24 Register 2024, No. 19.
Cal. Admin. Code tit. 22, § 51491, 22 CA ADC § 51491
End of Document