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Atascadero USD |  AR  5141.6  Students

Student Health And Social Services   

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Medi-Cal Billing

In order to provide services as a Medi-Cal provider, the district shall enter into and maintain a contract with the California Department of Health Services. (Welfare and Institutions Code 14132.06)

The Superintendent or designee shall submit a claim for Medi-Cal reimbursement whenever the district provides one or more of the following services to a Medi-Cal-eligible student under age 22 and/or a member of his/her family: (Welfare and Institutions Code 14132.06; 22 CCR 51051, 51190.1, 51360)

1. Health and mental health evaluation and educational services described in 22 CCR 51360

(cf. 5141.3 - Health Examinations)

2. Physical therapy services described in 22 CCR 51309(b)

3. Occupational therapy services described in 22 CCR 51309(c)

4. Speech pathology services described in 22 CCR 51096 and audiology services described in 22 CCR 51098

5. Psychology and counseling services consisting of diagnosis and psychological counseling of identified mental health, substance abuse, behavioral adjustment or social problems

(cf. 5131.6 - Alcohol and Other Drugs)

6. Preventive and medically necessary nursing services rendered at the school site and services for accompanying the student off campus for health services specified as medically necessary in the student's individualized education program (IEP) or individualized family service plan (IFSP) pursuant to Government Code 95020

(cf. 5141.26 - Tuberculosis Testing)

(cf. 5141.31 - Immunizations)

(cf. 6159 - Individualized Education Program)

7. School health aide services consisting of the direct provision of specialized physical health care services at the school site and services for accompanying the student off campus for health services specified as medically necessary in the student's IEP or IFSP

(cf. 5141.24 - Specialized Health Care Services)

8. Medical transportation services and associated mileage in accordance with 22 CCR 51323(a) and 51360

9. Physician services

10. For students with an IEP or IFSP, targeted case management services which may include determining needs, developing a plan, linking and consulting, accessing services outside the school system, assisting with crises and reviewing progress

The district shall maintain records of the type and extent of services provided to a Medi-Cal beneficiary. (22 CCR 51270)

The Superintendent or designee shall maintain the confidentiality of student health records in accordance with law.

(cf. 5125 - Student Records)

The Superintendent or designee shall ensure that all practitioners employed by or under contract with the district possess the appropriate license, certification, registration or credential and provide only those services that are within their scope of practice. (22 CCR 51190.3, 51270, 51491)

Any federal funds received by the district as reimbursement for the costs of services under the Medi-Cal billing option shall be reinvested in services for students and their families as specified in Education Code 8804(g). The Superintendent or designee shall consult with a local school-linked services collaborative group, such as that defined in Education Code 8806, regarding decisions on reinvestment of federal funds. (22 CCR 51270)

Medi-Cal Administrative Activities

Designated school staff shall document, on a time survey form, the amount of time spent on activities identified by the California Department of Health Services which are related to the administration of the Medi-Cal program. Such activities include, but may not limited be to, outreach; referral of health and mental health services; translation services; facilitation of applications; nonemergency, nonmedical transportation of eligible individuals; contracting for services; program planning and policy development; claims administration; and general administration.

The Superintendent or designee shall, on a quarterly basis, submit an invoice to the local educational consortium or local governmental agency through which the district has contracted to receive reimbursement.

Staff responsible for completing the time survey shall annually participate in training regarding eligible activities and the time survey methodology, and shall receive additional training whenever there are changes or updates in administrative claiming categories and activities. New or reassigned staff shall receive training before beginning their duties completing time surveys.

The Superintendent or designee shall maintain an audit file containing original time survey documentation and other records specified by the Department of Health Services. Such documentation shall be kept for three years after the end of the quarter in which expenditures were incurred or, if an audit is in progress, until the completion of the audit.


Approved: April 14, 2005 Atascadero, California