School-Based Medi-Cal Administrative Activities: Local Education Consortium - Region VII
California School-Based Medi-Cal Administrative Activities Claiming Plan Background
On January 1, 1995, Welfare and Institutions Code, Section 14132.47, School-Based Medi-Cal Administrative Activities (SMAA) became a covered benefit for reimbursement. SMAA are activities necessary for the administration of the Medi-Cal Program.
Passage of AB2780 in 1997-98 established Local Education Consortium (LEC) regions that are the same as the Superintendents' Regions of the California Department of Education. In each Region, one county office of education serves as LEC lead. LEC leads process and submit SMAA claims for reimbursement on behalf of school districts and county offices of education throughout the Region. LEC leads also receive and distribute SMAA reimbursement funds.
The Madera County Superintendent of Schools is the Region VII LEC
Why Involve Education?
Children and their families are unnecessarily going without Medi-Cal covered medical care. California, as a state, has comparatively low participation in Medi-Cal.
In addition, too many children, undocumented aliens, the homeless, the elderly, unemployed heads of families and others are not getting the health care they need. Many of them do not know they are eligible or are apprehensive about applying for benefits.
Often, Medi-Cal eligible people are involved with schools and county office of education programs such Student Study Team (SST) Meetings, School Attendance Review Board (SARB) Meetings and Parent/Teacher Conferences, to name a few. Through these programs, a level of mutual trust is established between the LEA's and their families. In order to get health care to more people in need, AB2780 made it possible for school districts and county offices of education to be reimbursed for administrative and other costs related to getting eligible people to apply for Medi-Cal for providing related services to children.
Reimbursed SMAA funds are unrestricted for use by the claiming districts or county offices.
What are School-Based Medi-Cal Administrative Activities?
Staff in most school districts already assist parents, guardians and caregivers to get needed health care. Now, districts and county offices that make the following a part of their routine can be reimbursed:
- Providing information to the general population about Medi-Cal to encourage people who may be eligible to apply.
- Directing Medi-Cal eligible people into specific covered services.
- Assisting people believed to be eligible to complete a Medi-Cal application.
- Getting specific high-risk populations into Medi-Cal covered services.
- Providing activities targeting Medi-Cal participants and directing them to health care, such as Speech Therapy, Psychological Services and Occupational Therapy.
- Arranging for transportation of Medi-Cal eligible people to Medi-Cal covered services.
Eligibility for Reimbursement
School districts served by a county office of education (listed below) can participate in SMAA. Region VII is full service. Our staff will complete most of the duties for your district, allowing your district to bypass the vendor component of claiming for SMAA, thus negating additional fees. Agencies choosing to participate in SMAA must comply with the program requirements established by the state Department of Health Care Services (DHCS). Each district or county office participating in SMAA must:
- Contract with the Madera County Superintendent of Schools to receive, process and submit claims on its behalf.
- Submit a Time Survey Participant Universe list for pre-approval.
- Submit school calendars and work schedules for their participants.
- Ensure participants are not 100% Federally Funded or 100% Indirect Cost Rate.
- Complete a Roster Report.
- Review LEA Coding Report.
- Maintain an operational/audit file.
- Ensure randomly selected participants complete one-minute moments.
- Meet the 85% compliance level requirement.
County Offices of Education - Region VII:
The School-Based Medi-Cal Administrative Activities (SMAA) program is mandated by the Welfare & Institutions (W&I) Code, Section 14132.47, which authorizes the Department of Health Care Services (DHCS) to contract with Local Governmental Agencies (LGA) to assist with the performance of administrative activities necessary for the proper and efficient administration of the Medi-Cal program.
The 1998-99 Budget Trailer Bill, Assembly Bill (AB) No. 2780, Statutes of 1998, Chapter 310, W&I Code, Section 14132.47 was amended to allow Local Educational Agencies (LEAs) to claim SMAA through a Local Educational Consortium (LEC) rather than subcontracting through their respective LGA. One LEC will be designated for each service region of the California County Superintendent Educational Services Association.