AB 516 — Revises provisions relating to Medicaid coverage for certain health services provided to children at schools. (BDR 38-348)

EXEMPT (Reprinted with amendments adopted on April 18, 2025) FIRST REPRINT A.B.

EfEffectEffect on theLocal State:Government:

No.

Effect on the State:

LegExistingLegislative lawCounsel’s requiresDigest: the Department of Health and Human Services, through the Division of Health Care Financing and Policy of the Department, to administer Medicaid.

Existing law requires the Department of Health and Human Services, through the Division of Health Care Financing and Policy of the Department, to administer Medicaid.

(1) take any action necessary to ensure that local educational agencies and statethe educationalDepartment agenciesof Education are able to receive reimbursement for health services covered - *AB516**AB516_R1* – 2 – health services covered by Medicaid when provided on the premises of a school to certain children who are recipients of Medicaid;

and (2) establish incentives for certain providers to enter into an agreement with a schoollocal district,educational aagency charter school or the Department of Education to provide health services to such children who are enrolledAccess inResource aCenter public within the Division for the purpose of assisting providers of services under Center Medicaid and persons and entities who wish to provide services to recipients of Medicaid on the premises of a school to evaluate and utilize different methods of participating in and billing Medicaid.

Sectionoperating 5 the Center.l makes appropriations to the Division to cover certain costs of operating Section 6 of this bill requires the Director to apply for any federal authority that is necessary to increase by at least 5 percent the rates of reimbursement for services covered by Medicaid when provided on the premises of a school by an employee or independent contractor of:

(1) a schoollocal districteducational oragency; charter school;

Section 6 also requires the Director to apply for any forfederal reimbursingauthority primary care and preventative services covered by Medicaid whenlogywhen such services are provided by a school-based health center;

and (2) increase by at least 10 percent the rates of reimbursement under Medicaid for such services provided by a school-basedschool- based health center.

(a) Take any action necessary to ensure that schoollocal districts,educational charteragencies schools and the Department of Education are able to receive reimbursement for health services covered by Medicaid when such services are provided on the premises of a school to children who are recipients of Medicaid.

(b) Establish a program of incentive payments that increase the effective rates of reimbursement provided under Medicaid to a certified community behavioral health clinic or federally-qualified health center that enters into an agreement with a schoollocal district,educational aagency charter school or the Department of Education to provide services covered by Medicaid to children who are:

The Department shall apply to the Secretary of Health and Human Services for any necessary waiver, amendment of the State - *AB516**AB516_R1* – 3 – Plan for Medicaid or other federal authority that authorizes the Department to receive federal funding to carry out the provisions of this section.

(c) “Value-based“Local paymenteducational model”agency” meanshas athe methodmeaning ofascribed paymentto forit healthin care20 servicesU.S.C. that provides incentives based on the quality of care.

§ 7801(30)(A).

(d) “Value-based payment model” means a method of payment for health care services that provides incentives based on the quality of care.

- *AB516_R1* – 4 – (2) The Administrator of the Division of Welfare and Supportive Services;

- *AB516* – 4 – (3) The Administrator of the Division of Child and Family Services;

and (6) Contain any other information necessary for the Department to communicate effectively with the Federal Government concerning demographic trends, formulas for the - *AB516_R1* – 5 – distribution of federal money and any need for the modification of programs administered by the Department.

- *AB516* – 5 – (e) May, by regulation, require nonprofit organizations and state and local governmental agencies to provide information regarding the programs of those organizations and agencies, excluding detailed information relating to their budgets and payrolls, which the Director deems necessary for the performance of the duties imposed upon him or her pursuant to this section.

and (2) By an employee or independent contractor of a schoollocal district,educational aagency, charteras schooldefined orin the20 DepartmentU.S.C. of Education;

(b)§ Simplify7801(30)(A), andor streamline the methodologyDepartment forof reimbursingEducation; primary care and preventative services covered by Medicaid when - *AB516* – 6 – such care and services are provided by a school-based health center;

and- (c)*AB516_R1* Increase– by6 at– least(b) 10Simplify percentand streamline the ratesmethodology offor reimbursementreimbursing underprimary Medicaidcare forand preventative services describedcovered inby paragraphMedicaid (b) when such car2.anAscare usedand inservices thisare section,provided “school-basedby health center” means a school-based health centercenter; located on or in school grounds, property, buildings or any other school district facilities for the purpose of rendering care or services to any person.

and under Medicaid for services described in paragraph (b) when sucht care and services are provided by a school-based health center.

2.

As used in this section, “school-based health center” means a health center located on or in school grounds, property, buildings or any other school district facilities for the purpose of rendering care or services to any person.

H - *AB516**AB516_R1*