Senate Bill 276 Recently Passed Addressing Some Billing Issues in Schools

A new law will require the Department of Health Care Services (DHCS) to seek federal dollars for EPSDT-type health services provided by schools to their general education population. SB 276 also seeks to address the barrier to reimbursement for students with both Medi-Cal and other health coverage known as Third Party Liability (TPL).

Senate Bill (SB) 276, which Paradigm has been tracking, was recently passed. This bill addresses the recent free care win and the passing of this bill directly impacts both the free care and Third Party Liability (TPL) billing issues for schools. Now that this bill has passed California’s Department of Health Care Services (DHCS) is required to seek federal financial participation for covered services, regardless of whether an Individualized Education Plan (IEP) is in place.

In passing this bill also now requires legally liable 3rd party payers either reimburse the claim or issue notice of denial of non-coverage. This in turn allows the school district to bill that service to Medi-Cal, attempting to address the TPL barrier previously faced by many schools.

Read more
Read SB 276
Issue Analysis: Medicaid’s Free Care Practice – Resolved in 2014!
Issue Analysis: Third Party Liability in Medicaid