Bills We’re Tracking: California Senate Bill 1239

Several bills working their way through California’s legislature may be of interest to school Medicaid program stakeholders. Here we profile Senate Bill (SB) 1239, authored by Senator Lois Wolk and supported by the California School Nurses Organization (CSNO).

SB 1239 (Senator Wolk), Public Health Care Services: School Nurses

The goal of SB 1239 is to address the shortage of school nurses throughout California, which is currently ranked 45th in the nation at one school nurse to every 2,740 students. In addition to requiring certain school districts to employ at least one school nurse as a supervisor of health, SB 1239 would also authorize districts to bill a pupil’s health insurer, just as they bill Medi-Cal, for health care services provided to pupils. As a result, this bill could potentially increase access to federal reimbursement through the LEA Billing Option program for eligible services provided to Medi-Cal beneficiaries that also have other health coverage (a common situation for children of divorced parents, and other circumstance).

School districts are generally not recognized by private insurers as providers of health care services. As such, they are unable to obtain appropriate denials for services provided to pupils with both Medi-Cal and other health coverage. Since federal third party liability requirements dictate that Medicaid is the payer of last resort, without these denials schools are unable to bill Medi-Cal and left to bear the full financial burden for these otherwise billable services. If SB 1239 is passed as written, private insurers could be required to supply a denial letter in lieu of payment for school claims which would allow districts to recoup reimbursement from Medi-Cal as the confirmed payer of last resort.

 

Other Bills We’re Tracking

  • SB-1322: Medi-Cal: preventive services: providers
  • SB-1466: Health care professionals
  • SB-1055: Public School Health Center Support Program
  • SB-596: Pupil health: multitiered and integrated interventions pilot program
  • AB-1000: Physical therapists: direct access to services: professional corporations
  • AB-1955: Pupil health: Healthy Kids, Healthy Minds Demonstration