BILL ANALYSIS Ó
SENATE COMMITTEE ON EDUCATION
Senator Carol Liu, Chair
2015 - 2016 Regular
Bill No: AB 1018
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|Author: |Cooper |
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|Version: |May 28, 2015 Hearing |
| |Date: June 24, 2015 |
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|Urgency: |No |Fiscal: |Yes |
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|Consultant:|Lynn Lorber |
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Subject: Medi-Cal: Early and Periodic Screening, Diagnosis,
and Treatment (EPSDT)
NOTE: This bill has been referred to the Committees on
Education and Health. A "do pass" motion should include
referral to the Committee on Health.
SUMMARY
This bill requires the California Department of Education and
the Department of Health Care Services to convene a task force
to examine the delivery of mental health services through the
Early and Periodic Screening, Diagnosis, and Treatment services.
BACKGROUND
The federal Individuals with Disabilities Education Act provides
that students with exceptional needs identified as having
"emotional disturbance" may be eligible to receive mental health
services. Mental health services are considered "related
services" and include counseling, psychological services, parent
counseling and training, and residential placement, among
others. (United States Code, Title 20, § 1400 et seq. and Code
of Federation Regulations, Title 34, § 300.34)
AB 114 (Committee on Budget), Chapter 43, Statutes of 2011,
shifted responsibility for mental health services for students
from counties to local educational agencies (LEAs). Any and all
services identified in a student's individualized education
program (IEP) must be provided, whether directly by LEA
AB 1018 (Cooper) Page 2
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employees or through contract with outside providers such as
county mental health agencies. LEAs are required to ensure
services are provided to students regardless of who provides or
pays for those services. (Education Code § 56139)
The Early and Periodic Screening, Diagnostic and Treatment
program (EPSDT) is a Medi-Cal benefit for people 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
provides eligible children access to a range of mental health
services that include, among other things, mental health
assessment, mental health services, therapy, rehabilitation,
therapeutic behavioral services, crisis
intervention/stabilization, day rehabilitation/day treatment,
medication support and case management.
ANALYSIS
This bill requires the California Department of Education (CDE)
and the Department of Health Care Services (DHCS) to convene a
task force to examine the delivery of mental health services
through the Early and Periodic Screening, Diagnosis, and
Treatment (EPSDT) services. Specifically, this bill:
1)Provides that the goal of the task force is to ensure that
children are provided accessible and coordinated care that is
compliant with state and federal law, in a way that is
maximally cost-effective for the State.
2)Requires the task force to consider all of the following:
a) Whether current technical assistance and guidance
to county mental health plans and schools is sufficient to
optimize service delivery and overall cost-effectiveness of
service delivery.
b) Whether current funding arrangements for services
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available through the EPSDT program and pursuant to the
federal IDEA maximize federal funding to the State for
provision of these services.
c) Issuing best practice guidelines for how special
education local plan areas and county mental health plans
can work together to optimize access to federal financial
participation for eligible services in both systems.
d) How disputes over responsibility for service
delivery is, and should be, resolved in cases where
children are dually eligible for EPSDT services and
services pursuant to the federal Individuals with
Disabilities Education Act (IDEA).
3)Requires the task force to hold at least two public meetings by
October 1, 2016, and report to the Legislature by January 1,
2017, a summary of key findings and recommendations for
further action, if any.
4)Requires the task force to solicit information from relevant
stakeholders.
5)Sunsets the provision of this bill on January 1, 2021.
STAFF COMMENTS
1)Need for the bill. According to the author, "The Early and
Periodic Screening, Diagnosis, and Treatment program (EPSDT)
Medi-Cal funding has always been part of the total funding
package for serving the mental health needs of pupils with
disabilities. The state shifted 100% of the mental health
service responsibility to schools in 2011 but did not shift
access to all the funding that is available to reimburse
schools for delivering the services to students. There is no
state policy or direction on how a local educational agency
(LEA) or special education local plan area (SELPA) can seek
direct access to the Medi-Cal funding for the EPSDT program
through county managed care. 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. This has created a hurdle for many local
educational agencies (LEAs) and special education local plan
areas (SELPAs) across the state."
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2)Specialty mental health services. Prior to 2012, a student with
exceptional needs with mental health needs and services
documented in the student's individualized education plan
(IEP) was referred by the LEA to county mental health agencies
for treatment, as called for under AB 3632 (Willie Brown,
Ch. 26, 1984). AB 114 (Committee on Budget, Ch. 43, 2011)
shifted responsibility for providing and funding Individuals
with Disabilities Education Act (IDEA)-related mental health
services from county mental health agencies to LEAs (the
Superintendent of Public Instruction is responsible for
monitoring LEAs to ensure compliance).
LEAs are responsible for educationally-necessary mental health
services that are identified in a student's IEP, but are
prohibited from directly providing or billing for EPDST
services unless the county mental health department chooses to
contract with the LEA for those services (Early and Periodic
Screening, Diagnosis, and Treatment program (EPSDT) is
considered "specialty" mental health). LEAs are required to
ensure services identified in a student's IEP are provided,
regardless of whether the county directly provides services,
denies services, or reimburses the school for any costs if the
LEA provides services (in cases where LEA provides services
covered under general Medi-Cal that overlap with EPSDT
services).
According to California Department of Education (CDE), LEAs may use
one or more of the following options for sourcing mental
health services to Medi-Cal eligible students (including EPSDT
and other mental health services):
a) Provide and pay for services without seeking Medi-Cal
reimbursement.
b) Use the LEA Medi-Cal Billing Option Program. Through
this program, the LEA employs or contracts with qualified
practitioners to provide the services pursuant to the IEP,
pays for the services, and submits a claim for
reimbursement. In order to use this option, the LEA must
meet a number of administrative conditions, including
enrollment as a Medi-Cal provider.
c) For EPSDT services, collaborate with county mental
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health departments to secure the specialty mental health
services through the county mental health plan. There are
two ways an LEA can secure these services:
i) Enter into a contract or Memorandum of
Understanding with the mental health plan for a
specialty mental health service or an array of
specialty mental health services. In this case, county
mental health plans provide the service and incur the
cost, and bill Medi-Cal for federal reimbursement.
ii) Request to be a certified provider of Medi-Cal
specialty mental health services from the county mental
health plan. If the county mental health plan
certifies the LEA as an organizational provider, the
LEA would provide
the specialty mental health service through a local
educational agency (LEA)-qualified employee and submit
a claim to the county mental health plan for
reimbursement.
http://www.cde.ca.gov/sp/se/ac/optsrltdsvcs.asp
1)Audit request. Senator Beall requested an audit of mental health
services for students, which was approved by the Joint
Legislative Audit Committee on April 22, 2015. The audit
request covers mental health services more broadly than Early
and Periodic Screening, Diagnosis, and Treatment program
(EPSDT) services. Specifically, the request asks for the
audit to, among other things:
a) Provide the following information for pre- and post-AB 114
disaggregated by students for whom an IEP identifies them
as emotionally disturbed, for students whose IEP may also
call for mental health services, and for students who
qualify or do not quality for Med-Cal services:
i) Compare the number of students each special
education local plan area (SELPA) served under AB 3632
to the number served under AB 114.
ii) Determine whether the type of frequency of
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service, and the providers of services, changed under
the transition from AB 3632 to AB 114.
iii) For a selection of students served under AB
3632, determine whether their IEPs were changed during
the SELPA's transition to AB 114.
a) Determine whether changes in treatment were made by service
providers as a result of the transition from AB 3632 to AB
114.
b) Identify the state and federal funding sources for mental
health services for students with disabilities, for the
past five fiscal years.
c) Identify the number of students with mental health issues
in California and compare that to the number of students
actually receiving services.
1)Fiscal impact. According to the Assembly Appropriations
Committee, this bill would impose one-time administrative
costs to DHCS, likely under $100,000 (General Fund/federal) to
staff support for a stakeholder workgroup.
2)Related and prior legislation.
RELATED LEGISLATION
AB 1133 (Achadjian, 2015 ) establishes a four year pilot program,
the School-Based Early Mental Health Intervention and
Prevention Services Support Program (EMHI Support Program), to
provide outreach, free regional training, and technical
assistance for LEAs in providing mental health services at
school sites. AB 1133 was held on the Assembly Appropriations
Committee's suspense file.
AB 1299 (Ridley-Thomas, 2015) requires the California Health and
Human Services Agency to coordinate with Department of Health
Care Services (DHCS) and the Department of Social Services to
facilitate the receipt of medically necessary specialty mental
health services by foster youth, as specified, and for
Department of Health Care Services (DHCS) to meet specific
conditions on or before July 1, 2016. AB 1299 is pending in
the Senate Human Services Committee.
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PRIOR LEGISLATION
AB 2212 (Gray, 2014) required DHCS to allow county mental health
plans to contract with local educational agencies (LEAs) to
provide Early and Periodic Screening, Diagnosis, and Treatment
program (EPSDT) services. AB 2212 was held on the Assembly
Appropriations Committee's suspense file.
SUPPORT
Association of California School Administrators
California Association of School Business Officials
California School Boards Association
Coalition for Adequate Funding for Special Education
Santa Clara County Office of Education
SELPA Administrators of California
Special Opportunities for Access & Reform Coalition
OPPOSITION
California Right to Life Committee
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