Z-1503.2 _______________________________________________
HOUSE BILL 2743
_______________________________________________
State of Washington 53rd Legislature 1994 Regular Session
By Representatives Sommers, Silver, Dorn and King; by request of Superintendent of Public Instruction and Office of Financial Management
Read first time 01/21/94. Referred to Committee on Appropriations.
AN ACT Relating to health services provided by school districts; amending RCW 74.09.5243, 74.09.5247, 74.09.5249, 74.09.5253, 28A.155.150, and 28A.150.390; adding a new section to chapter 74.09 RCW; and creating a new section.
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)).
(1) "District" means a school district, educational service district, or educational cooperative.
(2) "Medical assistance" and "medicaid" mean medical care provided under Title XIX of the federal social security act.
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 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 or a district with a preexisting contract under subsection (1) of this
section may retain an administrative fee proportional 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 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 shall provide the ((billing
agent)) superintendent of public instruction with a list, at the
start of each academic quarter, 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 shall provide the billing agent with information necessary
to promptly complete monthly billings for each medicaid-eligible student he or
she serves.
(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 medicaid ((eligibility rate))
eligibles, as determined by the medical assistance administration. The
superintendent may require a letter of explanation from any district whose
receipts under the program, in the judgment of the superintendent, indicate
nonparticipation or underparticipation.
Sec. 5. RCW 28A.155.150 and 1993 c 149 s 8 are each amended to read as follows:
(1) Of the projected
federal and private insurance revenue collected under RCW 74.09.5249, the
following incentive payments, calculated after deduction of the agent's fees,
shall remain with the ((school)) districts: Twenty percent of the
federal portion of medicaid payments; and twenty percent of payments made by
private insurers. The amount remaining with the district shall only be used
for children with disabilities. The billing agent shall periodically
provide the office of the superintendent of public instruction and each
educational service district with a report showing for each individual school
district the total amount of federal funds, less the billing agent's fee, realized
through medicaid billing and the total amount, less the billing agent's fee,
realized through the billing of private insurers. The superintendent shall use
the report to reduce allocations to the districts by eighty percent of the
total amount of ((medicaid and)) private insurance payments received by
each district, calculated after deduction of the billing agent's fee.
(2) A 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 and the appropriate educational
service district with a report indicating the total amount of federal money and
private insurance money, less the ((contractor's)) billing fee,
earned by each district through billing for health services. The
superintendent shall reduce allocations to the districts by eighty percent of
the ((total amount of medicaid and)) private insurance payments received
by each district, calculated after deduction of the ((contractor's)) billing
fee.
(3) A school district
that has elected to act as its own billing agent under RCW 74.09.5247(2) shall,
at times designated by the superintendent of public instruction, provide the
office of the superintendent of public instruction and the appropriate ((educational
service)) district with a report indicating the total amount of ((federal
money and)) private insurance money received by the district. The
superintendent shall reduce allocations to the district by eighty percent of
the total amount of ((medicaid and)) private insurance payments received
by the district, calculated after deduction of ((administrative fees
retained by the district)) an amount equal to the state-wide billing
agent's fee.
(((4) For the
purposes of this section, "medicaid" means medical care provided
under Title XIX of the federal social security act.))
Sec. 6. 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, 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. 7. A new section is added to chapter 74.09 RCW to read as follows:
The medicaid fund is hereby established in the state treasury. The fund shall receive 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 school districts for medical services provided under an individualized educational program established under RCW 28A.155.010 through 28A.155.100.
Moneys in the fund may only be disbursed by the office of the superintendent of public instruction for the following purposes:
(1) Reimbursement to the department of social and health services for the state-funded portion of medical assistance payments provided under RCW 28A.155.010 through 28A.155.100;
(2) Reimbursement to the state-wide billing agent for the state-wide billing agent's fee;
(3) Making incentive payments to school districts equal to twenty percent of the federal portion of medicaid payments after deduction for the billing agent's fee;
(4) Reimbursement to districts that act as their own billing agent or contract with a firm that is not the state-wide billing agent an amount equal to the billing agent's fee; and
(5) Transfer to the state general fund an amount equal to eighty percent of the federal portion of medicaid payments after deduction for the billing agent's fee.
The fund is subject to chapter 43.88 RCW, but no appropriation or allotment is required.
NEW SECTION. Sec. 8. 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. 9. 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.
--- END ---