(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
1396 a(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.
Notes
Cal. Code Regs. Tit. 22, §
51270
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).
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.
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).