California Senate Bill Seeks to Push Free Care Billing to Forefront

Senator Lois Wolk (3rd District) has put forward Senate Bill (SB)-276 which would require the Department of Health Care Services (DHCS) to submit school-based claims for covered health services provided to Medi-Cal students regardless of whether those services are included in an Individualized Education Plan (IEP).

While the federal Centers for Medicare and Medicaid Services (CMS) reversed their guidance on free care, a policy that had prohibited schools from billing for health services provided to Medicaid beneficiaries if those same services were provided to the rest of the student population at no charge, California’s DHCS has yet to implement this change at the local level and allow school districts to begin taking advantage. Shortly after CMS released their policy reversal, DHCS issued an email stating that until they published guidance for schools on the change, that billing for these services would not be allowed. SB-276 would compel the Department to process so-called ‘free care’ claims and submit these to CMS for payment.

In addition to addressing free care, SB-276 was recently amended to include a component to address the barrier posed by third party liability (TPL) requirements. Before a school can submit a claim to Medi-Cal for students with both Medi-Cal and other health coverage (a circumstance that impacts over 8% of children nationwide), they must first prove that the other coverage is not liable for any amount of the claim. Unfortunately, because schools are not recognized by health insurers as providers, they cannot even obtain a necessary denial for the service that would then allow them to turn around and bill Medi-Cal — meaning the school is unable to bill for the service at all. SB-276 would compel legally liable third parties to issue a notice of denial for claims submitted by a school district.

 

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Read Senate Bill (SB) 276…

Read our Issue Analysis on Free Care…

Read our Issue Analysis on TPL…