Legal Resources | | T22 51491
Subdivision 1. California Medical Assistance Program. Article 6. Eligibility for Payment (Refs & Annos). Local Educational Agency (LEA) Eligibility for Payment
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 medical transportation services and 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 medical transportation services and LEA mileage, between a school site and a location at which health services are rendered to the beneficiary except as provided in Section 51360(b)(8).
Authority cited:
Welfare and Institutions Code 10725
Welfare and Institutions Code 14105
Welfare and Institutions Code 14124.5
Reference:
Welfare and Institutions Code 14000
Welfare and Institutions Code 14018.2
Welfare and Institutions Code 14053
Welfare and Institutions Code 14059
Welfare and Institutions Code 14100.2
Welfare and Institutions Code 14105
Welfare and Institutions Code 14124.1
Welfare and Institutions Code 14124.5
Welfare and Institutions Code 14132
Welfare and Institutions Code 14133
Welfare and Institutions Code 14136.5
Welfare and Institutions Code 14170
Business and Professions Code 500 et seq
Business and Professions Code 4980
Business and Professions Code 4981
Education Code 44225(b)(4)
Education Code 44268
Education Code 44874
Education Code 44877
Education Code 49600
Education Code 49422
Education Code 49423.5
Education Code 49426
Health and Safety Code 1685
Health and Safety Code 1686
(Amended by Register 94, No. 22.)