LEA Medi-Cal Billing Option
State and Federal Authorization for LEA Medi-Cal Billing Option ProgramThe Local Education Agency (LEA) Medi-Cal Billing Option Program is a fee-for-service program authorized by state and federal governments. In 1986 Congress authorized schools to bill the Medicaid (note: in California, Medicaid is called Medi-Cal) program for some health-related services for students with disabilities. The health-related services for students with disabilities include both assessments and the treatments specified on a student’s Individualized Education Program (IEP) including: audiology, counseling, nursing services, occupational therapy, physical therapy, speech therapy, and transportation related to these services. Medi-Cal regulations set the same high professional standards for school-based providers as providers who work in hospitals, rehabilitation centers, and other settings.As per the Individuals with Disabilities Education Act (IDEA) regulations, the Los Angeles Unified School District (LAUSD) provides all required services as specified on a child’s IEP at no cost to parents. However, LAUSD can be reimbursed for the cost of those services from the federal government’s Medicaid program – which increases the ability to provide health-related services for all LAUSD students.Parents of students who are Medi-Cal eligible authorize LAUSD to submit claims for reimbursement by Medi-Cal for Medi-Cal funded services when a parent signs consent for a Special Education Assessment Plan or an IEP. The frequency of claims is aligned with assessment authorizations and/or the type and frequency of the Medi-Cal funded services a parent authorizes on the student’s IEP. School-based Medi-Cal reimbursement does not affect the child’s Medi-Cal benefits in other health care settings and there is no cap on Medi-Cal for students with disabilities in California. LAUSD never bills a family’s private insurance for the health care services specified on a child’s IEP. The District adheres to IDEA and its requirement to provide students with disabilities with a free and appropriate public education (FAPE). Parents of Medi-Cal eligible students may choose not to allow the LAUSD to seek reimbursement for the services provided to their child by requesting a Parent Medi-Cal Non-Authorization to Bill form from the LAUSD Medi-Cal Reimbursement and Compliance office. Call 213-241-0558.
Medi-Cal Fund ReinvestmentFunds recovered by the Local Education Agency (LEA) Medi-Cal Billing Option are reinvested in District programs. These funds are distributed through a multi-disciplinary community collaborative group called the LEA Collaborative Board. For more information about the LEA Collaborative Board click here.
Welligent Service Tracking System (STS)Service providers document assessment and services information using the District’s web-based system called Welligent. The LAUSD Medi-Cal Reimbursement and Compliance Program offers support in a variety of ways to the providers who use Welligent STS.
- The Medi-Cal Reimbursement and Compliance office meets quarterly with the administrators of the provider groups to review service documentation issues. This committee known as the Internal Quality Assurance and Review (IQAR) committee conducts quality assurance activities to support compliance with Medi-Cal service documentation requirements. Provider-specific service documentation training modules have been developed by this committee and are located in the web-based training system known as the Learning Zone.
- The Medi-Cal Reimbursement and Compliance office staff members coordinate activities with the Information Technology Division, including trouble shooting the Welligent system and making recommendations for enhancements to Welligent STS.
For more information, please contact:
Manager, Medi-Cal Reimbursement and Cost Recovery
Ron Tanimura, Ed.D
333 S. Beaudry Ave., 29th Floor
Los Angeles, CA 90017
P: (213) 202-7584
Fax: (213) 580-0559