Senate Bill 276 Passes, Taking One Step Closer to Rollout of Free Care

September 2, 2015 – Sacramento, CA – The California Senate recently passed Senate Bill (SB) 276, introduced by Senator Wolk; this is exciting news because this directly impacts both the free care and Third Party Liability (TPL) billing issues for California schools.

You may recall, in December 2014 the Centers for Medicare & Medicaid Services (CMS) reversed their opinion on “free care” which in effect, removed the federal restriction for LEAs to get reimbursed for eligible non-IEP services. Though this was great news, the California Department of Health Care Services (DHCS) still needed to provide guidance on exactly how this would be executed in California. The rollout has been initiated by the passage of SB 276, and now DHCS is required to seek federal financial participation for covered services, regardless of whether an Individualized Education Plan (IEP) is in place.

Additionally, the Bill requires legally liable 3rd party payers either reimburse the claim or issue notice of denial of non-coverage. Third Party Liability (TPL) has always been a barrier when seeking reimbursement from Medi-Cal for non-IEP services. Historically, private insurers have not recognized LEAs as Providers of services; however, this bill codified the ability for LEAs to bill Medi-Cal if there is no response by the liable 3rd party within 45 days.

The passing of SB 276 is a positive move forward and takes LEAs one step closer to the final goal of being able to bill, and get reimbursed for, non-IEP services. For more information about the passing of SB 276 and Issue Analysis of both Free Care and TPL please see our Policy Center post here.