BILL ANALYSIS Ó
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: AB 1018
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|AUTHOR: |Cooper |
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|VERSION: |May 28, 2015 |
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|HEARING DATE: |July 1, 2015 | | |
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|CONSULTANT: |Reyes Diaz |
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SUBJECT : Medi-Cal: Early and Periodic Screening, Diagnosis, and
Treatment (EPSDT).
SUMMARY : Requires the Department of Health Care Services and the
Department of Education to convene a task force, as specified,
to examine the delivery of mental health services through the
EPSDT services.
Existing law:
1)Establishes the Medi-Cal program, administered by the
Department of Health Care Services (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
individuals under 21 years, including screening, vision,
dental, hearing, and other necessary services to correct or
ameliorate defects and physical and mental illnesses and
conditions discovered by the screening services, whether or
not the services are covered under the State Plan.
3)Establishes, under the terms of a federal Medicaid waiver, a
managed care program providing Medi-Cal specialty mental
health (MH) services for eligible low-income persons
administered through local county MH plans under contract with
DHCS.
This bill:
1)Requires DHCS and the Department of Education to convene a
joint task force to examine the delivery of MH services to
children eligible for EPSDT services and for services pursuant
to the federal Individuals with Disabilities Education Act
(IDEA). Specifies that the goal of the task force is to ensure
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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 MH plans and schools is sufficient
to optimize service delivery and overall
cost-effectiveness of service delivery;
b) Whether current funding arrangements for
services available through the EPSDT program and
pursuant to IDEA maximize federal funding to the state
for provision of these services;
c) Issuing best practice guidelines for how
special education local plan areas (SELPAs) and county
MH plans can work together to optimize access to
federal financial participation for eligible services
in both systems; and,
d) How disputes over responsibility for service
delivery is, and should be, resolved in cases where
children are dually eligible for EPSDT and IDEA
services.
3)Requires the task force to solicit information from relevant
stakeholders; to hold at least two public meetings by October
1, 2016; and to report to the Legislature by January 1, 2017,
a summary of key findings and recommendations for further
action, if any.
4)Repeals the provisions in this bill on January 1, 2021.
FISCAL
EFFECT : 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.
PRIOR
VOTES :
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|Assembly Floor: |71 - 0 |
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|Assembly Appropriations Committee: |17 - 0 |
AB 1018 (Cooper) Page 3 of ?
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|Assembly Health Committee: |18 - 0 |
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COMMENTS :
1)Author's statement. According to the author, EPSDT Medi-Cal
funding has always been part of the total funding package for
serving the MH needs of pupils with disabilities. The state
shifted 100% of the MH 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
education agency (LEA) or SELPA can seek direct access to
Medi-Cal funding for EPSDT through county managed care.
Instead, it is up to each LEA or SELPA to negotiate directly
with county MH programs. This has created a hurdle for many
LEAs/SELPAs across the state. The county MH program
determines at the local level whether they want the LEA or
SELPA to be vendorized or certified to bill Medi-Cal. EPSDT is
a federal entitlement program without a cap. LEAs should be
eligible for direct access to EPSDT funding in order to
provide eligible children a range of MH services. It is in the
state's best interest to seek federal funding to serve the
needs of the eligible recipient, regardless of who the service
provider is, whether the services are offered by county MH or
a LEA/SELPA.
2)Background. The federal IDEA provides that students with
exceptional needs identified as having emotional disturbance
may be eligible to receive MH services, which are considered
related services and include counseling, psychological
services, parent counseling and training, and residential
placement, among others.
Prior to 2012, a student with exceptional needs, who also had
MH needs and services documented in their individualized
education plan (IEP), was referred by the local educational
agencies (LEAs) to county MH agencies for treatment, pursuant
to AB 3632 (Willie Brown, Chapter 26, Statutes of 1984). AB
114 (Committee on Budget, Chapter 43, Statutes of 2011)
shifted responsibility for providing and funding IDEA-related
MH services from county MH agencies to LEAs (the
Superintendent of Public Instruction is responsible for
monitoring LEAs to ensure compliance). Any and all services
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identified in a student's IEP must be provided, whether
directly by LEA employees or through contract with outside
providers, such as county MH agencies. LEAs are required to
ensure services are provided to students regardless of who
provides or pays for those services.
The EPSDT program 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 MH services that include, among other things, MH
assessment, MH services, therapy, rehabilitation, therapeutic
behavioral services, crisis intervention/stabilization, day
rehabilitation/day treatment, medication support, and case
management.
3)LEAs. LEAs are responsible for educationally necessary MH
services that are identified in a student's IEP, but are
prohibited from directly providing or billing for EPDST
services unless the county MH department chooses to contract
with the LEA for those services (EPSDT is considered specialty
MH). 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 the LEA provides services covered under general Medi-Cal
that overlap with EPSDT services).
According to CDE, LEAs may use one or more of the following
options for sourcing MH services to Medi-Cal eligible students
(including EPSDT and other MH 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
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enrollment as a Medi-Cal provider.
c) For EPSDT services, collaborate with county MH
departments to secure the specialty MH services through
the county MH plan. There are two ways an LEA can secure
these services:
i. Enter into a contract or Memorandum of
Understanding with the MH plan for a specialty MH
service or an array of specialty MH services. In
this case, county MH 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 MH services from the county MH
plan. If the county MH plan certifies the LEA as an
organizational provider, the LEA would provide the
specialty MH service through an LEA qualified
employee and submit a claim to the county MH plan
for reimbursement.
1)Audit request. Senator Beall requested an audit of MH
services for students, which was approved by the Joint
Legislative Audit Committee on April 22, 2015. The audit
request covers MH services more broadly than 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 MH 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 service, and the providers of
services, changed under the transition from AB
3632 to AB 114; and,
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iii. For a selection of students served
under AB 3632, determine whether their IEPs were
changed during the SELPA's transition to AB 114.
b) Determine whether changes in treatment were
made by service providers as a result of the
transition from AB 3632 to AB 114.
c) Identify the state and federal funding sources
for MH services for students with disabilities for the
past five fiscal years.
d) Identify the number of students with MH issues
in California and compare that to the number of
students actually receiving services.
2)Double referral. This bill was heard in the Senate Education
Committee on July 24, 2015, and passed out with a vote of 9-0.
3)Related legislation. AB 1299 (Ridley-Thomas), requires the
California Health and Human Services Agency to coordinate with
DHCS and the Department of Social Services to facilitate the
receipt of medically necessary specialty MH services by foster
youth, as specified, and for DHCS to meet specific conditions
on or before July 1, 2016. AB 1299 is set for hearing on July
14, 2015, in the Senate Human Services Committee.
AB 1133 (Achadjian), establishes a four year pilot program,
the School-Based Early Mental Health Intervention and
Prevention Services Support Program to provide outreach, free
regional training, and technical assistance for LEAs in
providing MH services at school sites. AB 1133 was held on the
Assembly Appropriations Committee's suspense file.
4)Prior legislation. AB 2212 (Gray, of 2014), required DHCS to
allow county MH plans to contract with local educational
agencies (LEAs) to provide EPSDT services. AB 2212 was held on
the Assembly Appropriations Committee's suspense file.
AB 114 (Committee on Budget), shifted responsibility for MH
services for students from counties to LEAs.
5)Support. The sponsors and other supporters of this bill,
including special education advocates and LEAs, argue that
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when responsibility was shifted, from county agencies 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. Supporters argue that it is critical that
LEAs have access to these additional Medi-Cal dollars to help
serve the needs of their pupils.
6)Opposition. The California Right to Life Committee, Inc.
(CRLC) argues that this bill focuses on providing more MH
services through schools for young children and youth. CRLC
states they are concerned about this trend because it will
lead to an identification of children having one MH diagnosis
or another based on a subjective evaluation, which may not
have been correct at the time.
SUPPORT AND OPPOSITION :
Support:
Special Opportunities for Access & Reform Coalition (SELPAs of
Merced, Napa, Solano, Sutter, and Yolo Counties) (sponsor)
Association of California School Administrators
Butte County Special Education Local Plan Area (previous
version)
California Association for School Business Officials (previous
version)
California Black Health Network (previous version)
California Medical Association (previous version)
California School Boards Association (previous version)
Coalition for Adequate Funding for Special Education
Elk Grove Unified School District Special Education Local
Planning Area (previous version)
Medical Billing Technologies, Inc. (previous version)
Mount Diablo Unified Special Education Local Plan Area (previous
version)
NAMI California (previous version)
Santa Clara County Office of Education
Special Education Local Plan Area Administrators of California
Twin Rivers Unified School District (previous version)
Oppose: California Right to Life Committee, Inc.
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