AB 38,
as amended, Eggman. Mentalbegin delete Health Delivery Demonstration Project:end deletebegin insert health:end insert Early Diagnosis andbegin delete Psychosisend deletebegin insert Preventiveend insert Treatment Program.
Existing law, the Bronzan-McCorquodale Act, sets out a system of community mental health care services provided by counties and administered by the State Department of Health Care Services.
end insertbegin insertThis bill would establish the EDAPT pilot program in the department to utilize integrated systems of care to provide early intervention, assessment, diagnosis, a treatment plan, and necessary services for individuals with severe mental illness and children with severe emotional disturbance, as specified. The bill would require the department to use funds appropriated for this purpose by the Legislature to provide reimbursement to the EDAPT program for services provided to persons who are referred to that program, but whose private health benefit plan, as defined, does not cover the full range of required services. The bill would require the University of California, Davis, if they accept money from the program, in the 4th year after the program is established but no later than January 1, 2022, to report specified information to the health committees of both houses of the Legislature. The bill would repeal the program as of January 1, 2022.
end insertExisting law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care. Existing law requires health care service plans to meet specified criteria. Existing law makes a willful violation of that act a crime.
end deleteThis bill would, commencing July 1, 2017, authorize health care service plans that offer health care services within the greater Sacramento area to require enrollees seeking services for a mental health condition to participate in a Mental Health Delivery Demonstration Project through an Early Diagnosis and Psychosis Treatment (EDAPT) program, as defined. The bill would require plans that choose to participate to develop clinical guidelines for enrollees and to make those guidelines available as part of their evidence of coverage and to primary care providers and specialty mental health providers in their contracted network. The bill would allow an enrollee to opt out of the EDAPT program if a psychiatrist notifies the plan that the enrollee is under his or her care. These provisions would be repealed on January 1, 2020. Because a willful violation of these provisions would be a crime, this bill would impose a state-mandated local program.
end deleteThe California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
end deleteThis bill would provide that no reimbursement is required by this act for a specified reason.
end deleteVote: majority.
Appropriation: no.
Fiscal committee: yes.
State-mandated local program: begin deleteyes end deletebegin insertnoend insert.
The people of the State of California do enact as follows:
(a) The Legislature finds and declares all of the
2following:
3
(1) There are approximately 1.2 million adult Californians who
4suffer from severe mental illness and over 700,000 children in
5California who deal with severe emotional disturbance.
3 6(1)
end delete
P3 1begin insert(2)end insert Despite the importance of and emphasis on mental health
2parity, management of mental illness within a system of care is
3far more difficult than most types of physical illness. There are
4significant differences between the delivery systems for the
5Medi-Cal population and the delivery systems for those covered
6by private insurance, and there are unique problems associated
7with each system. While changes are needed in both, there is an
8immediate need to look for ways to better serve the insured
9population.
3 10(2)
end delete
11begin insert(3)end insert The limited number of providers, the lack of facilities for
12treatment,
and the difficulties of arranging for and coordinating
13ancillary services have made it extremely difficult for health
14insurers to meet the needs of enrollees facing significant mental
15health issues.
8 16(3)
end delete
17begin insert(4)end insert Attempts to develop truly accessible provider networks that
18can link with the array of administrative and ancillary services that
19the mentally ill need to manage their disease and to improve will
20take an investment of time and resources.
12 21(4)
end delete
22begin insert(5)end insert Systems of care known as Early Diagnosis andbegin delete Psychosisend delete
23begin insert Preventiveend insert Treatment (EDAPT) programs may hold the key to
24these problems. These integrated systems of care provide early
25intervention, assessment, diagnosis, a treatment plan, and the
26services necessary to implement that plan. EDAPT programs have
27interdisciplinary teams of physicians, clinicians, advocates, and
28staff that coordinate care on an outpatient basis.
19 29(5)
end delete
30begin insert(6)end insert EDAPT programs do not yet exist in sufficient number to
31allow them to meet the provider network requirements health
32insurers must meet. While it is possible under existing law for
33health insurers to contract with existing EDAPT programs, there
34are a number of regulatory and practical issues that stand in the
35way of directing patients to them so that the patients’ conditions
36can be effectively managed. If insurers could designate an EDAPT
37program as an exclusive provider for their enrollees, an assessment
38can be made of the overall efficacy of the model.
39(b) Therefore, it is the intent of the Legislature to establish a
40demonstration projectbegin delete or projects in geographic areas of the state
to allow health insurers to opt in to
P4 1where EDAPT programs existend delete
2utilizing thebegin insert full range ofend insert EDAPTbegin delete programs as exclusive provider begin insert services to preserve the functioning ofend insert the insurers’
3networks forend delete
4enrollees in need of these services.
Section 1367.020 is added to the Health and Safety
6Code, to read:
(a) Notwithstanding any other law, commencing
8July 1, 2017, a health care service plan that offers health care
9services on an individual or group basis in the greater Sacramento
10area may require enrollees seeking services for a mental health
11condition to participate in a Mental Health Delivery Demonstration
12Project through an Early Diagnosis and Psychosis Treatment
13Program.
14(b) If a plan chooses to require its enrollees to participate in the
15project, it shall develop clinical guidelines for those enrollees and
16make those guidelines available as part of its evidence of coverage.
17The plan shall also make those guidelines available to all primary
18care providers and specialty mental health providers in its
19contracted network.
20(c) An enrollee directed to a Mental Health Delivery
21Demonstration Project site for services shall be able to opt out of
22those services if a psychiatrist notifies the plan that the enrollee is
23under his or her care.
24(d) For purposes of this section, “Early Diagnosis and Psychosis
25Treatment Program” means a mental health service program that
26provides early intervention, diagnosis, treatment, and necessary
27support through interdisciplinary teams of physicians, mental health
28professionals, social workers, and advocates on an outpatient basis
29and through a single point of entry.
30(e) This section shall remain in effect only until January 1, 2020,
31and as of that date is repealed, unless a later enacted statute, that
32is enacted before January 1, 2020, deletes or extends that date.
No reimbursement is required by this act pursuant to
34Section 6 of Article XIII B of the California Constitution because
35the only costs that may be incurred by a local agency or school
36district will be incurred because this act creates a new crime or
37infraction, eliminates a crime or infraction, or changes the penalty
38for a crime or infraction, within the meaning of Section 17556 of
39the Government Code, or changes the definition of a crime within
P5 1the meaning of Section 6 of Article XIII B of the California
2Constitution.
begin insertPart 6 (commencing with Section 5950) is added to
4Division 5 of the end insertbegin insertWelfare and Institutions Codeend insertbegin insert, to read:end insert
5
(a) There is hereby established the EDAPT pilot
9program within the State Department of Health Care Services to
10utilize integrated systems of care to provide early intervention,
11assessment, diagnosis, a treatment plan, and necessary services
12for individuals with severe mental illness and children with severe
13emotional disturbance using an interdisciplinary team of
14physicians, clinicians, advocates, and staff who coordinate care
15on an outpatient basis.
16
(b) (1) The department shall use funds appropriated for this
17purpose by the Legislature to provide reimbursement to the EDAPT
18program for services provided to persons who are referred to that
19program, but whose private health benefit plan does not cover the
20full range of
required services.
21
(2) The department may solicit and accept funds from private,
22federal, or other sources to use for purposes of this program.
23
(c) Funds provided pursuant to this program shall not be used
24to pay for services normally covered by the patient’s private health
25benefit plan and shall only be used to augment private health
26benefit plan coverage to provide the patient with the full range of
27necessary services.
28
(d) For purposes of this part, the following definitions shall
29apply:
30
(1) “EDAPT program” means the Early Diagnosis and
31Preventive Treatment program provided at the Davis campus of
32the University of California.
33
(2) “Private health benefit plan” means a program or entity
34
that provides, arranges, pays for, or reimburses the cost of health
35benefits, but does not include coverage provided through the
36Medi-Cal system.
(a) If the University of California, Davis accepts money
38from the department through the EDAPT pilot program, in the
39fourth year after the program is established but no later than
P6 1January 1, 2022, it shall report to the health committees of both
2houses of the Legislature all of the following:
3
(1) Evidence as to whether the early psychosis approach reduces
4the duration of untreated psychosis, reduces the severity of
5symptoms, improves relapse rates, decreases the use of inpatient
6care in comparison to standard care, supports educational and
7career progress, and reduces the cost of treatment in comparison
8to standard treatment methodologies.
9
(2) The number of patients with
private health benefit plans
10served by the EDAPT pilot program in the 12 months prior to the
11implementation of the pilot program.
12
(3) The number of patients with private health benefit plans
13served by the EDAPT pilot program.
14
(4) The number of patients in the program who are considered
15stabilized, as a percentage of patients served.
16
(5) The number of patients needing services beyond those
17provided in the program and the nature of those services.
18
(6) Any other information the university deems necessary.
19
(b) A report to be submitted pursuant to this section shall be
20submitted in compliance with Section 9795 of the Government
21Code.
This part shall remain in effect only until January 1,
232022, and as of that date is repealed, unless a later enacted statute,
24that is enacted before January 1, 2022, deletes or extends that
25date.
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