California Assembly Bill AB 483 Aims to Improve Medi-Cal Billing Option for Local Educational Agencies

In a significant effort to improve the efficiency of California's Medi-Cal program and ensure fair reimbursement for eligible services provided by local educational agencies (LEAs), Assembly Bill AB 483 has been introduced in the state legislature. Assembly Member Muratsuchi is the primary sponsor of this bill, which focuses on revising the state plan and audit process for the LEA Medi-Cal Billing Option. The primary objective is to streamline administrative activities and maximize federal matching funds. Let's delve into the key provisions of AB 483 and the recent history of its progress.

AB 483 encompasses several crucial revisions and requirements that aim to enhance the LEA Medi-Cal Billing Option. The key provisions of the bill include:

• State Plan Revision: This bill mandates the Department of Health Care Services (DHCS) to revise the state plan and establish an improved audit process for LEA Billing claims submitted on or after January 1, 2025. The revised audit process will follow specific requirements and limitations, ensuring greater efficiency.

• Reporting and Transparency: The bill necessitates the department to promptly report any changes made to the state plan to the relevant policy committees and make them publicly available on its official website. This measure ensures transparency and keeps stakeholders informed about modifications.

• Technical Assistance and Appeals: AB 483 addresses the timely resolution of audit-related issues. If an audit finds that an LEA must repay a percentage of its total value of claims, the department is obligated to provide technical assistance or complete appeals within 180 days. This provision aims to expedite the resolution process for LEAs, preventing unnecessary delays.

• Limitations on Auditors: To protect LEAs from undue financial burdens, the bill sets limitations on auditors. Reimbursement repayments will only be required if the auditors determine that the claims are out of compliance with the LEA Billing Program Guide or the State Plan at the time of submission, providing a fair and reasonable approach to the auditing process.

• Enhanced Reporting: AB 483 adds important components to the department's annual report to the Legislature. It now includes a summary of the training provided to LEAs, along with the number of audits conducted for LEA Billing claims. Additionally, the report highlights efforts made to improve LEA participation and clarifies the meaning of "medical necessity" for beneficiaries under 21 years of age, ensuring accurate and appropriate reimbursements.

Should AB 483 successfully pass, it holds the potential to significantly improve the LEA Billing program. By simplifying claiming processes, enhancing transparency, and offering timely technical assistance and appeals, the bill seeks to facilitate effective reimbursement for eligible services provided by LEAs. Furthermore, the revised audit process prioritizes the prevention of fraud, waste, and abuse while ensuring that schools receive proper compensation for their services.

Regarding the recent history of AB 483, the bill has made notable progress through the legislative process. On May 18, 2023, it was read for the second time and ordered to the third reading. Additionally, the bill passed in committee with a unanimous vote of 15 ayes and 0 noes. Prior to that, it was referred to the suspense file after its first hearing on April 19, 2023. Notably, on March 22, 2023, the bill passed in committee with a unanimous vote of 14 ayes and 0 noes. Subsequently, it was re-referred to the Committee on APPR (Appropriations) with a recommendation to place it on the Consent Calendar. Furthermore, coauthors of the bill were revised on the same day.

While AB 483 has demonstrated progress, it is important to note that further actions and votes are still required for the bill to become law. The ongoing journey of this bill in the California Legislature signifies the commitment to improving the LEA Medi-Cal Billing Option and ensuring fair reimbursement for eligible services. Stakeholders and advocates will closely follow the bill's developments as it moves toward its final stages, eagerly awaiting its potential positive impact on LEAs and the Medi-Cal program as a whole.

Update Oct. 8, 2023: We are pleased to inform our readers that the legislation discussed in this article, was enacted on Oct. 8, 2023.