Robert Powell
CSHA Legislative Counsel
Draft 10/11/02

Confused About School Medi-Cal Program Rules?

School LEA Medi-Cal Billing Program Panel at CSHA State Convention will have experts with the latest federal and state interpretations.

Plan to attend the April 4, 2003 CSHA Convention panel presentation and discussion on the School LEA Medi-Cal Billing

Program. Panel members include:

• Pam Wagner, RN - LA USD Medi-Cal Coordinator & State DHS School Medi-Cal Workgroup Consultant;
  
• Michele Berry, EdD, formerly with San Diego City Schools; initiated LEA Medi-Cal Billing Program
  
• Kathryn Kinslow, CCC-SLP, - Sweetwater High School Medi-Cal Program;
  
• Sherrin Massie, CSHA Commissioner on Professional Services (Aud) & Progam Manager, Fresno COE; and
  
• Robert Powell, JD, CSHA Legislative Counsel.

California's Medi-Cal health system is a federal matching system. For every dollar California spends on services, the federal government matches a similar amount of dollars. Several years ago, states successfully argued that state education dollars were being spent on a variety of "health" type services, which could be used to request a matching amount of federal dollars. Thus a few California school districts started billing the Medi-Cal system and generated new funding worth millions. Services included school nursing, counseling, immunizations, dental services as well as special education speech therapy, etc.

California policy experts in the special education community have identified two major sources of substantial new funding possibilities for special education: 1) The U.S. Congress' "Full Funding" of special education at the originally promised 40% level; and 2) the School LEA Medi-Cal Billing Program. It has been estimated that California's LEA Medi-Cal Billing Program generates only about half of what New York generates for the same number of students. A Department of Health Services (DHS) School Medi-Cal Workgroup has been working for the last two years on a "Rate Study" of other states and how California could generate millions of new federal dollars. This effort is now in the final stages. (Note this rate study includes all cost related to developing IEPs including due process costs. After the rate study is completed, anticipate discussions of DHS authorizing the use of OT, PT & SLP Assistants which is not now authorized.) One common funding issue is how does your local school utilize funds generated from the LEA Medi-Cal Billing Program and why do some local special education (and speech & hearing programs) realize different amounts of dollars their programs generate?

Aside from funding issues, many CSHA professionals continue to have a variety of questions as to various interpretations and/or unanswered school LEA Medi-Cal Billing Program regulations, rules, guidelines, and interpretations.

One major unresolved issue surrounds SLP "supervision". Why are "licensed" SLPs required in the public schools, which are generally exempt from licensing, and have a separate state Commission on Teacher Credentialing (CTC) system? What does supervision mean? What responsibilities and liability does the supervising licensed SLP incur? What are the ethical, legal and malpractice insurance issues? What about the employing school's insurance coverage? What indemnification issues does the individual SLP have? Should the SLP carry individual malpractice insurance? Can the supervising SLP' license be at risk? How is the SLP school employment contract affected and have any of the local bargaining units/unions been involved with these issues?

Federal Medicaid SLP personnel standards require the national Certificate of Clinical Competence (CCC) standards or the equivalent state licensing. Federal requirements do allow for speech therapy "under direction" of qualified SLPs.

DHS LEA Medi-Cal Billing Provider Policy Manual of March 2002 includes a new provision for Credentialed SLPs under Licensed SLP supervision. See: http://www.help4schools.com ; http://www.medi-cal.ca.gov
Under Provider Manuals; Inpatient/Outpatient; Local Ed Agency; pages 15-19:

The supervising speech pathologist is individually involved with patient care under his or her direction and accepts responsibility for the actions of the credentialed language, speech & hearing specialists that he/she supervises. Amount & type of supervision required should be consistent with the skills & experience of the credentialed LSH specialist and with the standard of care necessary to provide appropriate patient treatment.

The annual duties of the supervising SLP include, but are not limited to:

1. Periodically observe assessments, evaluation and therapy.
   
2. Periodically observe the preparation and planning activities.
   
3. Periodically review client records; monitor/evaluate assessment & treatment decisions.
   A licensed speech pathologist shall be available by telephone during the workday to consult with the credentialed speech, language hearing specialists, as needed.

The Center for Medicare & Medicaid (CMS) CMS Region IX Office in San Francisco, the state DHS, LA USD , SLPAB licensing staff and CSHA continue discussions as to interpretations of "supervision".

Information from around the state and from the State DHS Workgroup will be available at the CSHA Convention.

See also CSHA web site under "Position Papers" for "CSHA Q & As on School LEA Medi-Cal Billing Program" (updated 5/1/02):