Temecula Valley Unified outlines plan to bill services under state CYBHI after $983,835 capacity grant

Temecula Valley Unified School District trustees heard a May 27 presentation on a plan to seek reimbursement for school-based behavioral health services through the California Youth Behavioral Health Initiative (CYBHI) and to use a newly awarded $983,835 capacity grant to build billing capacity and hire two positions.

The presentation outlined how the district already bills Medi‑Cal for certain special‑education services, described the CYBHI fee schedule and explained that the district intends to align existing MTSS (multi‑tiered system of supports) interventions to CYBHI billing categories. Kelly Gradstein, director of student welfare and success, told the board, “Our grant award is $983,835.”

Why it matters: if implemented and operationally sustained, the reimbursement program would create a new local revenue stream to fund SEL (social‑emotional learning) staff and systems the district already uses. Board members and staff raised implementation questions about parent notification, confidentiality for minors, explanation‑of‑benefits (EOB) issues and long‑term financial sustainability.

Most important facts: district billing today and what would change - The district currently bills Medi‑Cal for services provided to students with services listed on Individualized Education Programs (IEPs), Gradstein said; that billing is processed through the district’s LEA billing program. Examples given included behavioral health, speech and language, physical therapy and adapted physical education. - CYBHI creates a separate fee schedule that allows participating LEAs to submit claims for a broader range of school‑based services and supports, including screening, management and treatment categories. Staff are working to map existing interventions (for example, small group stress‑management or anxiety groups) into the appropriate CYBHI categories. - Gradstein described the operational workflow: teachers identify concerns and collect data; if additional supports are needed staff contact parents, obtain consent for Tier 2/3 plans, document interventions in the student information system (Infinite Campus), implement supports and monitor outcomes. If the parent consents to billing, staff would collect insurance information and submit claims to CYBHI’s third‑party administrator once interventions are completed.

Parent notice, confidentiality and EOBs - Gradstein said the district intends to seek insurance information and bill on a case‑by‑case basis, not by blanket notice to all families. “Our plan is to do it on a case by case basis,” she said, adding that the district prefers one‑on‑one conversations with parents as needs arise. - Board members asked whether parents would receive an explanation of benefits (EOB). Gradstein said, according to CYBHI rules as she understands them, insurance companies will not send an EOB to parents and there will be no copay charged to families; instead, parents would receive district‑produced summaries on request. Dr. Joseph Komrovsky also noted AB 1184 and related state law affecting confidentiality of some sensitive services (for example, certain transgender‑related care) and told the board that the district must ensure any policy does not conflict with that statute. - Gradstein said the district does not plan to bill insurance when parents do not consent. She said, “if a parent was on board with a plan, but they weren't on board with providing their insurance ... we just wouldn't submit for reimbursement. We would still continue to provide the support.” She also said that existing provisions in the Education Code permit limited circumstances (for minors 12 and older) in which parents are not notified; the district does not intend to bill for confidential services where parental notification is excluded under law.

Capacity grant and implementation steps - The district applied for a CYBHI capacity grant and learned in January that the county approved its application. Gradstein identified the award amount as $983,835 and said contracts were expected in June or July; the capacity funding is intended to support operational readiness and build back‑office systems needed to bill reliably. - Planned uses the presenter listed: two grant‑funded positions for two years (a lead SEL team member and a billing specialist), an electronic health record (EHR), training and professional development, materials and resources, and additional funding to support campus wellness centers and “friendship rooms.” Gradstein said the capacity funding is expected to be spent by June 2027. - On sustainability, staff said the district will plan for the two grant‑funded positions and an EHR to be sustained by revenue generated from reimbursements if the program proves viable. Gradstein and other staff recommended reevaluation after one year; one board member said the district should assume a conservative one‑year horizon while testing the fee schedule.

Operational questions board members raised - Data and transparency: trustees asked for disaggregated data on wellness‑center use (how many “pop‑ins,” how many frequent users) and how parents would be notified about nonbillable Tier 1 usage; Gradstein said the district has begun collecting such data and plans to disaggregate it next year. - Liability and malpractice: trustees asked whether medical‑malpractice coverage would be required for staff; staff said cost estimates for sustaining two positions and an EHR were still being refined and would be part of future budgeting, and that an RFP will be required for the EHR. - Implementation timeline: staff said contracts were expected in June or July; operational rollout would be phased as systems and training are completed.

Board action and next steps - This item was presented as an information item; the board did not take formal action during the May 27 meeting. Gradstein told the board she would return with contract details and a funding plan for future board action.

Closing note: Gradstein emphasized service continuity. “The resounding sentiment on our team is really that we want to preserve time with kids and continue to provide the support and care that we do,” she said. The district said families who decline to provide insurance information will continue to receive district‑provided supports regardless of billing status.