BILL ANALYSIS Ó
AB 1018
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Date of Hearing: April 21, 2015
ASSEMBLY COMMITTEE ON HEALTH
Rob Bonta, Chair
AB 1018
(Cooper) - As Amended April 13, 2015
SUBJECT: Medi-Cal: Early and Periodic Screening, Diagnosis,
and Treatment (EPSDT).
SUMMARY: Requires the Department of Health Care Services (DHCS)
to allow county mental health plans (MHPs) to contract with
local educational agencies (LEAs) to provide services for
Medi-Cal eligible pupils. Specifically, this bill:
1)Requires DHCS to allow county MHPs to contract with LEAs to
provide EPSDT services to eligible students. EPSDT services
are federally mandated services and benefits offered by
Medi-Cal for children.
2)Requires DHCS to allow the MHP to obtain federal financial
participation (FFP) for nonpublic agencies under contract with
the LEA to provide EPSDT services if the LEA does not have a
contract with the county MHP.
3)Requires LEAs to pay the nonfederal share of EPSDT
expenditures in order to receive FFP.
4)Specifies that county MHPs may contract for, and nonpublic
agencies may receive, federal funds for the following
services:
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a) Mental health assessments;
b) Targeted case management services;
c) Behavioral services;
d) Mental health, social work, and counseling services;
e) Individual and group services;
f) Crisis intervention;
g) Day treatment;
h) Residential treatment; and,
i) Medication support services.
5)Requires DHCS to examine methodologies for increasing LEA
participation in the Medi-Cal program so that schools can meet
the educationally related healthcare needs of their students,
including simplifying the claiming processes for Medi-Cal
billing to the extent possible.
6)Requires DHCS to seek any necessary Medi-Cal state plan or
waiver amendments to implement this bill and to undertake any
and all necessary activities to obtain federal funding for
services provided by LEAs or entities an LEA contracts with
for services.
EXISTING LAW:
1)Provides for the Medi-Cal program, administered by DHCS, under
which eligible low-income individuals receive health care
services subject to state and federal laws and funding.
2)Establishes the Medi-Cal EPSDT program for eligible
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individuals under 21 years.
3)Defines LEAs as a school district, a county office of
education, a nonprofit charter school participating as a
member of a special education local plan area, or a special
education local plan area and allows LEAs to provide and bill
for Medi-Cal services provided to students receiving special
education services on Medi-Cal (generally, special education
students).
4)Establishes, under the terms of a federal Medicaid waiver, a
managed care program providing Medi-Cal specialty mental
health services for eligible low-income persons administered
through local county MHPs under contract with the state.
FISCAL EFFECT: This bill has not yet been analyzed by a fiscal
committee.
COMMENTS:
1)PURPOSE OF THIS BILL. According to the author, this bill will
provide LEAs and Special Education Local Plan Areas (SELPAs)
with direct access to EPSDT funding for healthcare services,
including mental health and trans-disciplinary assessments,
both as an equitable funding mechanism and as an incentive for
schools to intervene early before at-risk children show signs
of failing. These vulnerable students are often trauma
exposed, chemically exposed, autistic, developmentally
challenged, and children stressed daily by impoverishment.
The author states that this bill will allow these students to
receive specifically targeted services in a timely manner.
2)BACKGROUND. Schools are a main provider of mental health
services for children in California. The federal Individuals
with Disabilities Education Act (IDEA) was adopted in 1975 to
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guarantee children with disabilities a right to public
education in the least restrictive setting. In California, the
federal IDEA mandate to provide special education services is
administered by local school districts and local education
agencies. Special education students may be eligible for
health care services, including mental health services, in
specific IDEA disability categories. Mental health services
provided to special education students include counseling and
guidance, psychological services, parental counseling and
training, and residential placement, among others.
a) Section 1915(b) Medi-Cal Specialty Mental Health
Services Waiver. Specialty Medi-Cal mental health services
are provided under the terms of the federal Medicaid
Medi-Cal Specialty Mental Health Services Consolidation
1915(b) waiver program. The waiver established a managed
care program for specialty mental health services separate
from the overall Medi-Cal program. Medi-Cal beneficiaries
must receive specialty mental health services though
county-operated MHPs. County MHPs provide services
directly or through contracts in the local community using
a combination of county funds, realignment revenues, and
Mental Health Services Act funds. Counties pay for
services locally, incurring Certified Public Expenditures,
which the state then uses as the state match to claim
federal Medicaid reimbursement and the state, in turn,
returns the federal funds to the county MHPs. The Medi-Cal
Specialty Mental Health Services Consolidation waiver has
been in place since the mid-1990s and was just submitted
for renewal by DHCS to the Centers for Medicare and
Medicaid Services for a new five-year term, from July 1,
2015, through June 30, 2020.
b) Individual Education Plans (IEPs). Prior to 2011,
special education students who had an severe emotional
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disturbance condition documented in their IEPs were
referred by their schools to county mental health agencies
for treatment, as called for under AB 3632 (Willie Brown),
Chapter 26, Statutes of 1984. Funding for AB 3632-mandated
services became an ongoing financial struggle between the
state and counties, with counties accusing the state of not
fully reimbursing them for costs associated with providing
these services. In 2011, the Legislature repealed the
state mandate on county mental health agencies to provide
IDEA-related mental health services and shifted this
financial responsibility to the California Department of
Education (CDE). Local education agencies and local county
MHPs were required to develop new agreements defining
agency responsibilities that reflected the changes in state
law. MHPs remain responsible for providing EPSDT services
for students who are Medi-Cal beneficiaries with
IDEA-related individualized education, if they meet medical
necessity criteria.
c) EPSDT. EPSDT is a Medi-Cal benefit for individuals
under the age of 21 who have full-scope Medi-Cal
eligibility. This benefit allows for periodic screenings
to determine health care needs and based upon the
identified health care need and diagnosis, treatment
services are provided. EPSDT services include all services
otherwise covered by Medi-Cal and EPSDT beneficiaries can
receive additional medically necessary services. EPSDT
mental health services are Medi-Cal services that correct
or improve mental health problems that have been determined
by a physician, psychologist, counselor, social worker or
other health or social services provider. EPSDT provides
eligible children access to a range of mental health
services that include, but are not limited to:
i) Mental health assessment;
ii) Collateral contracts;
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iii) Therapy;
iv) Rehabilitation;
v) Mental health services;
vi) Medication support services;
vii) Day rehabilitation; day treatment intensive;
viii) Crisis intervention/stabilization;
ix) Targeted case management; and,
x) Therapeutic behavioral services.
3)SUPPORT. The Elk Grove Unified School District SELPA, the
California School Boards Association and others state in
support that this bill will allow LEAs to provide mental
health services for Medi-Cal eligible students under the
federal EPSDT program. Prior to 2012, county mental health
agencies were able to access Medi-Cal reimbursement through
county managed care plans seeking reimbursement from the DHCS
who has direct access to the federal Medi-Cal funding for
related services such as the EPSDT. Unfortunately, when the
state shifted the responsible agency for mental health
services for students with IEPs (from county mental health to
schools), the state did not address the issue of how school
districts could access or seek reimbursement directly from
Medi-Cal and the federal government for related services under
the EPSDT program. This bill would allow LEA to access EPSDT
program Medi-Cal reimbursements through county MHPs.
It is critical that LEAs have access to these additional
Medi-Cal dollars to help serve the needs of their pupils.
Unfortunately, there is no state policy or direction on how a
local education agency can seek direct access to the Medi-Cal
funding for the EPSDT program through county managed care.
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Instead, it is up to each individual LEA or SELPA to negotiate
directly with their county mental health program on whether
this option would work in their area. The county mental
health program determines at the local level whether they want
the LEA or SELPA to be vendorized or certified to provide and
bill Medi-Cal.
The Coalition for Adequate Funding for Special Education
states that this bill would allow school agencies to access
EPSDT program Medi-Cal reimbursements through county MHPs.
These additional funds will be used to help ensure that the
mental health needs of these students will be met and closes
the loophole that currently prevents school agencies from
applying directly to the federal government for reimbursement.
4)OPPOSITION. The California Council of Community Mental Health
Agencies states in opposition that this bill would require the
state to seek federal approval to expand the scope of the
school Medi-Cal billing option for LEAs to provide all
services covered by the EPSDT county mental health program.
According to the opposition, this is the wrong approach to
this issue, as it ignores the need for a partnership between
counties and schools. Moreover, it is not likely to be
successful in getting federal approval as it is inconsistent
with the managed care approach of the Medi-Cal county mental
health system. The opposition states that a better approach
is to ensure that counties fulfill their responsibilities to
provide services to Medi-Cal enrolled students under the EPSDT
program and partner with schools to identify and serve all
youth who may need such services.
5)RELATED LEGISLATION.
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a) AB 1025 (Thurmond) requires CDE to establish a
three-year pilot program to encourage inclusive practices
that integrate mental health, special education, and school
climate interventions following a multitiered framework.
AB 1025 is pending in the Assembly Education Committee.
b) AB 1133 (Achadjian) makes technical changes to existing
law regarding grants to LEAs to pay the state share of
costs of providing school-based early mental health
intervention and prevention services to eligible students.
AB 1133 is pending in the Assembly Health Committee.
6)PREVIOUS LEGISLATION.
a) AB 114 (Committee on Budget), Chapter 43, Statutes of
2011, a companion measure to the 2011-12 Budget bill,
relieved county mental health departments of the
responsibility to provide mental health services to
students with disabilities (AB 3632 program) and
transferred that responsibility to school districts.
b) AB 2212 (Gray) of 2014 was substantially similar to this
bill. AB 2212 was held in the Assembly Appropriations
Committee.
7)POLICY COMMENTS.
a) Permissive or mandate. According to the author and
sponsors of this bill, it would give LEAs direct access to
EPSDT mental health services funding and reimbursement.
However, the provisions of this bill may not fully
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accomplish the author's stated intent. For example, this
bill requires DHCS to allow counties to contract with LEAs
which is an option already available. County MHPs can
directly provide or contract with community-based and local
providers, including LEAs, to provide the services for
which the MHPs are responsible. Some counties do contract
with LEAs and some do not. It also requires DHCS to allow
LEAs without a county MHP contract to obtain federal
Medi-Cal funds for entities under contract with the state.
If the intent of this bill is to require county MHPs to
contract with LEAs, or to require DHCS to allow LEAs
without a county MHP contract to bill directly for EPSDT
mental health services, this bill as drafted may not
accomplish that.
b) Specialty mental health waiver. This bill requires DHCS
to seek any and all federal waivers and amendments and
pursue activities to ensure federal funds are available for
LEAs and entities LEAs contract with for services. The
state is in the process of negotiating a complex waiver
with the Centers for Medicare and Medicaid Services. The
waiver is built on a continuation of the managed care
concept for behavioral health with more responsibility and
authority being granted to counties. This bill allows LEAs
and the entities they contract with to have a
fee-for-service arrangement outside of the county MHP
structure and the waiver that created it. The state would
face significant difficulties in gaining federal approval.
REGISTERED SUPPORT / OPPOSITION:
Support
California Academy of Family Physicians
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California Association for School Business Officials
California Black Health Network
California Medical Association
California School Boards Association
Coalition for Adequate Funding for Special Education
Elk Grove Unified School District Special Education Local Plan
Area
Medical Billing Technologies, Inc.
Napa County Special Education Local Plan Area
Special Education Local Plan Area Administrators of California
Solano County Special Education Local Plan Area
Special Opportunities for Access & Reform Coalition
One individual
Opposition
California Council of Community Mental Health Agencies
California Right to Life Committee, Inc.
Analysis Prepared by:Paula Villescaz / HEALTH / (916) 319-2097
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