Legal Resources | | T22 51360
Subdivision 1. California Medical Assistance Program. Article 4. Scope and Duration of Benefits (Refs & Annos). Local Educational Agency (LEA) Services
(a) Local Educational Agency (LEA) Services, as defined in Section 1190.4, are covered to the extent specified in this section. Frequency limitations are set forth in Section 51535.5.
(b) LEA Services shall include (1) through (8) below:
(1) LEA health and mental health evaluation and health and mental health education services, which include any or all of the following:
(A) Nutritional assessment and nutrition education, consisting of assessments and non-classroom nutrition education delivered to the LEA eligible beneficiary based on the outcome of the nutritional health assessment (diet, feeding, laboratory values, and growth).
(B) Vision assessment, consisting of examination of visual acuity at the far point conducted by means of the Snellen Test.
(C) Hearing assessment, consisting of testing for auditory impairment using at-risk criteria and appropriate screening techniques as defined in Title 17, California Code of Regulations, Sections 2951(c).
(D) Developmental assessment, consisting of examination of the developmental level by review of developmental achievement in comparison with expected norms for age and background.
(E) Assessment of psychosocial status, consisting of appraisal of cognitive, emotional, social, and behavioral functioning and self-concept through tests, interviews, and behavioral evaluations.
(F) Health education and anticipatory guidance appropriate to age and health status, consisting of non-classroom health education and anticipatory guidance based on age and developmentally appropriate health education.
(2) LEA physical therapy, which consists of physical therapy services as set out in Section 51309(b) when provided by an LEA practitioner to an LEA eligible beneficiary.
(3) LEA occupational therapy, which consists of physical therapy services as set out in Section 51309(c) when provided by an LEA practitioner to an LEA eligible beneficiary.
(4) LEA speech pathology and audiology services, which consist of: speech pathology services as defined in Section 51096, and audiology services as defined in Section 51098 when provided by an LEA practitioner to an LEA eligible beneficiary.
(5) LEA psychology and counseling services, consisting of diagnosis and psychological counseling of LEA eligible beneficiaries with identified mental health, substance abuse, behavioral adjustment, or social problems.
(6) LEA nursing services, consisting of preventive and medically necessary nursing services rendered at the school site. Services for accompanying the LEA eligible beneficiary off-campus for delivery of health services are also reimbursable if specified as medically necessary in the Individualized Education Plan (IEP), as defined in Education Code, Section 56340 et seq.; Individualized Family Service Plan (IFSP), as set forth in Government Code, Section 95020; or Individualized Health and Support Plan (IHSP), as set forth in Section 51535.5(f)(2)(C).
(7) LEA school health aide services, consisting of the direct provision of specialized physical health care services rendered at the school site. Services for accompanying the LEA eligible beneficiary off-campus for delivery of health services are also reimbursable if specified as medically necessary in the child's IEP, as set forth in Education Code, Section 56340 et seq.; IFSP, as set forth in Government Code, Section 95020; or IHSP, as set forth in Section 51535.5(f)(2)(C).
(8) LEA medical transportation, which consists of medical transportation as described in Section 51323(a), and the associated mileage.
(A) For beneficiaries without an IEP or IFSP, services are limited to trips between the school site and a location at which health services are rendered.
(B) For beneficiaries with an IEP or IFSP, LEA medical transportation may include trips to and from the residence, school site or other sites of service when all of the following conditions are met on the day of service:
1. The beneficiary receives a Medicaid covered service other than medical transportation at the site being transported to; and
2. Both, the Medicaid covered service and medical transportation are included in the beneficiary's IEP or IFSP.
Authority cited:
Welfare and Institutions Code 10725
Welfare and Institutions Code 14124.5
Reference:
Welfare and Institutions Code 14124.5
Welfare and Institutions Code 14131
Welfare and Institutions Code 14132
Welfare and Institutions Code 14132.15
Welfare and Institutions Code 14133
Welfare and Institutions Code 14133.1
Welfare and Institutions Code 14133.3
Welfare and Institutions Code 14133.6
Welfare and Institutions Code 14133.9
Education Code 56340 et seq
Government Code 95020
(Added by Register 94, No. 22.)