AN ACT Relating to
health services provided by school districts; amending RCW 74.09.5243, 74.09.5247,
74.09.5249, 74.09.5253, and 28A.150.390; adding new sections to chapter 74.09
RCW; creating a new section; and repealing RCW 28A.155.150.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF
WASHINGTON:
Sec. 1. RCW 74.09.5243 and 1993
c 149 s 2 are each amended to read as follows:
((For the purposes
of)) Unless the context clearly requires otherwise, the following
definitions apply throughout RCW 74.09.5241 through 74.09.5253 ((and
28A.155.150, the terms)) and sections 5 through 7 of this act.
(1)
"District" means a school district, educational service district, or
educational cooperatives offering special education services under chapter
28A.155 RCW.
(2) "Medical
assistance" and "medicaid" means federal and state-funded
programs under which medical ((care)) services are provided
under Title XIX of the federal social security act.
(3) "Medical
services" means district services that qualify for medicaid funding.
Sec. 2. RCW 74.09.5247 and 1993
c 149 s 4 are each amended to read as follows:
(1) Chapter 149, Laws
of 1993 does not apply to contracts between individual ((school))
districts and private firms entered into for the purpose of billing either
medicaid or private insurers, or both, for ((health)) medical
services and agreed to before April 30, 1993, except as provided in RCW
28A.155.150(2).
(2) A ((school))
district may elect to act as its own billing agent as of the start of any
school year. For a ((school)) district being served by the state-wide
billing agent, the district shall notify the billing agent in writing, no less
than thirty days before the start of the school year, of its intent to
terminate the agency relationship. A district that acts as its own billing agent
((may retain)) or a district with a preexisting contract under
subsection (1) of this section is entitled to an administrative fee ((proportional))
equivalent to that of the state-wide billing agent.
Sec. 3. RCW 74.09.5249 and 1993
c 149 s 5 are each amended to read as follows:
(1) The agency awarded
the contract under RCW 74.09.5245 shall:
(a) Enroll all ((school))
districts in this state, except those with preexisting contracts under RCW
74.09.5247, as medicaid providers ((by)) effective the beginning
of the 1993-94 school year;
(b) Develop a
state-wide system of billing the department and private insurers for medical
services provided in special education programs;
(c) Train health care
practitioners employed by or contracting with ((school)) districts in
medicaid and insurer billing;
(d) Verify the medicaid
eligibility of students enrolled in special education programs in each ((educational
service)) district;
(e) Provide ongoing
technical assistance to practitioners and districts; and
(f) Process and forward
all medicaid claims to the department and all other claims to private insurers.
(2) For each student,
individual ((school)) districts may, in consultation with the billing
agent, deliver to the student's parent or guardian a letter, prepared by the
billing agent, requesting the consent of the parent or guardian to bill the
student's health insurance carrier for services provided through the special
education program. If a district chooses to do this, the letter must be
accompanied by a consent form, on which the parent may identify the student's
health insurance carrier so that the billing agent may bill the carrier for
medical services provided to the student. The letter must clearly state the
following:
(a) That the billing
program is designed in part to raise additional funds to improve education
services;
(b) That under no
circumstances will the parent or guardian be personally charged for any portion
of the bill not paid by the insurer, including copayments, deductibles, or
uncovered services;
(c) That the amount of
the billing will apply to the policy's annual deductible even though the parent
will not be billed for the amount of the deductible;
(d) That the amount of
the billing, will, however, apply towards annual or lifetime benefit caps if
these are included in the policy;
(e) That it is possible
that their premiums would be increased as a result of their consent;
(f) That if any of the
possible negative consequences of consent were to affect them, they are free to
withdraw their consent at any time; and
(g) That their consent
is entirely voluntary and that the services the student receives through the ((school))
district will not be affected by their willingness or refusal to consent
to the billing of their private insurer.
Sec. 4. RCW 74.09.5253 and 1993
c 149 s 7 are each amended to read as follows:
(1) Each ((educational
service)) district ((in the state)) shall participate in the program
of billing for medical services ((under RCW 74.09.5249 and)) provided
in the district's special education program. Each participating district
shall provide the ((billing agent)) superintendent of public
instruction with a list, ((at the start of each academic quarter)) as
of the first school day in October, December, and May of each year, of all
students enrolled in special education programs within the area served by the
((educational service)) district, for purposes of verifying the medicaid
eligibility of the students.
(2) A person employed
by or contracting with a ((school)) district who provides ((services
within the categories established by the)) medical ((assistance
administration under RCW 74.09.5251)) services shall provide the
billing agent with information necessary to promptly complete monthly billings
for each medicaid-eligible student he or she serves as part of the
district's special education program.
(3) The superintendent
of public instruction shall submit to the legislature at the beginning of each
legislative session a report indicating the district-by-district participation
and the medicaid and private insurance payment receipts during the preceding
fiscal year. The report must further indicate for each district the total
number of special education students, and the number eligible for
medicaid ((eligibility rate)), as determined by the medical assistance
administration. The superintendent may require a letter of explanation from
any district whose ((receipts)) billings for medical assistance
under the program, in the judgment of the superintendent, indicate
nonparticipation or underparticipation.
NEW SECTION. Sec.
5. A new section is added to
chapter 74.09 RCW to read as follows:
(1) Each district that
has elected to act as its own billing agent under RCW 74.09.5247(2) and each
firm that is a party to a preexisting contract under RCW 74.09.5247(1) shall,
at times designated by the superintendent of public instruction, provide the
office of the superintendent of public instruction with a report indicating the
total amount of medicaid and private insurance moneys billed by the district.
(2) The state billing
agent shall, at times designated by the superintendent of public instruction,
provide the superintendent of public instruction with a report for each
district enrolled by the billing agent, indicating the total amount of medicaid
and private insurance moneys billed through medicaid and private insurer
billing.
NEW SECTION. Sec.
6. A new section is added
to chapter 74.09 RCW to read as follows:
Of the projected
federal medicaid and private insurance revenue collected under RCW 74.09.5249,
twenty percent, after deduction for billing fees, shall be for incentive
payments to districts. Incentive payments shall only be used by districts for
children with disabilities.
NEW SECTION. Sec.
7. A new section is added
to chapter 74.09 RCW to read as follows:
(1) Districts shall
reassign medicaid payments to be received under RCW 74.09.5249 through
74.0.5253, sections 5 and 6 of this act, and this section to the superintendent
of public instruction.
(2) The superintendent
of public instruction shall receive medicaid payments from the department of
social and health services for all state and federal moneys under Title XIX of
the federal social security act due to districts for medical assistance
provided in the district's special education program.
(3) The superintendent
shall use reports from the department of social and health services, the state
billing agent, districts acting as their own billing agent, and firms to
calculate the appropriate amounts of incentive payments and state special
education program moneys due each district.
(4) Moneys received by
the superintendent of public instruction shall be disbursed for the following
purposes:
(a) Reimbursement to
the department of social and health services for the state-funded portion of
medicaid payments;
(b) Reimbursement for
billing agent's fees, including those of districts acting as their own agent
and billing fees of firms;
(c) Incentive payments
to school districts equal to twenty percent of the federal portion of medicaid
payments after deduction for billing fees; and
(d) The remainder shall
be distributed to districts as part of state allocations for the special
education program provided under RCW 28A.150.390.
(5) With respect to private
insurer funds received by districts, the superintendent of public instruction
shall reduce state special education program allocations to the districts by
eighty percent of the amount received, after deduction for billing fees.
Sec. 8. RCW 28A.150.390 and 1993
c 149 s 9 are each amended to read as follows:
The superintendent of
public instruction shall submit to each regular session of the legislature
during an odd-numbered year a programmed budget request for handicapped
programs. Funding for programs operated by local school districts shall be on
an excess cost basis from appropriations provided by the legislature for
handicapped programs and shall take account of state funds accruing through RCW
28A.150.250, 28A.150.260, federal medical assistance and private funds accruing
under RCW 74.09.5249 through 74.09.5253 and sections 5 through 7 of this act,
and other state and local funds, excluding special excess levies. ((However,
the superintendent of public instruction shall reimburse the department of
social and health services from state appropriations for handicapped education
programs for the state-funded portion of any medical assistance payment made by
the department for services provided under an individualized education program
established pursuant to RCW 28A.155.010 through 28A.155.100. The amount of
such interagency reimbursement shall be deducted by the superintendent of
public instruction in determining additional allocations to districts for
handicapped education programs under this section.))
NEW SECTION. Sec.
9. RCW 28A.155.150 and 1993
c 149 s 8 are each repealed.
NEW SECTION. Sec.
10. If any part of this act
is found to be in conflict with federal requirements that are a prescribed
condition to the allocation of federal funds to the state, the conflicting part
of this act is inoperative solely to the extent of the conflict and with
respect to the agencies directly affected, and this finding does not affect the
operation of the remainder of this act in its application to the agencies
concerned. The rules under this act shall meet federal requirements that are a
necessary condition to the receipt of federal funds by the state.
NEW
SECTION. Sec. 11. If any provision of this
act or its application to any person or circumstance is held invalid, the
remainder of the act or the application of the provision to other persons or
circumstances is not affected.
