Amended in Senate July 16, 2015

Amended in Assembly April 21, 2015

California Legislature—2015–16 Regular Session

Assembly Bill No. 1299

Introduced by Assembly Member Ridley-Thomas

February 27, 2015

An act to begin insert amend Section 14714 of, and to end insert add Article 6 (commencing with Section 14695.1) to Chapter 8.8 of Part 3 of Division 9 begin delete of end delete begin insert of, end insert the Welfare and Institutions Code, relating to Medi-Cal.

LEGISLATIVE COUNSEL’S DIGEST

AB 1299, as amended, Ridley-Thomas. Medi-Cal: specialty mental health services: foster children.

Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Existing law provides that Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) for any individual under 21 years of age is covered under Medi-Cal, consistent with the requirements of federal law. Federal law defines EPSDT mental health services to include screening services, vision services, dental services, hearing services, 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. EPSDT is classified under the Medi-Cal program as a specialty mental health service.

Existing law requires each local mental health plan to establish a procedure to ensure access to outpatient specialty mental health services, as required by the EPSDT program standards, for children in foster care who have been placed outside their county of adjudication. Existing law includes standardized contracts, procedures, documents, and forms, to facilitate the receipt of medically necessary specialty mental health services by a foster child who is placed outside his or her county of original jurisdiction.

This bill would declare the intent of the Legislature to ensure that foster children who are placed outside of their county of original jurisdiction, are able to access mental health services in a timely manner consistent with their individualized strengths and needs and the requirements of EPSDT program standards and requirements. The bill would require the department to issue policy guidance that establishes the begin insert conditions for and exceptions to end insert presumptive transfer of responsibility for providing or arranging for mental health services to foster youth from the county of original jurisdiction to the begin insert county in which the end insert foster begin delete child’s county of residence, end delete begin insert child resides, end insert as prescribed. The bill would define presumptive transfer for these purposes. begin insert The bill would authorize the person or agency that is responsible for making health care decisions on behalf of the foster child to waive the presumptive transfer if specified conditions occur, including when a determination is made that the transfer of mental health services would disrupt continuity of care or timely access to services, as specified. The bill would require the mental health plan in the host county to assume responsibility for the authorization and provision of mental health services, and payments for services, upon the presumptive transfer. The bill would require the department, no later than July 1, 2016, to amend its contract with each mental health plan to ensure that the mental health plan in the host county is reimbursed for mental health services provided within the fiscal year in which services are provided. end insert

This bill begin delete would require the Department of Finance, by May 1,2016, to set or adjust its allocation schedule of the Behavioral Health Subaccount pursuant to realignment provisions enacted pursuant to a specified measure, in order that counties that have paid, or will pay, for the specialty mental health services provided pursuant to the bill, are fully reimbursed during the fiscal year in which the services were provided. This bill end delete would require the department to determine whether it is necessary to seek approval under the state’s Section 1915(b) Medicaid waiver from the federal Centers for Medicare and Medicaid Services (CMS) prior to implementing the bill, and if so, to do everything within its power necessary to secure an expeditious approval.

Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: no.

The people of the State of California do enact as follows:

SECTION 1.  

Article 6 (commencing with Section 14695.1) is
added to Chapter 8.8 of Part 3 of Division 9 of the Welfare and
Institutions Code, to read:

 

Article 6.  Specialty Mental Health Services for Foster Children

 

14695.1.  

(a) (1) It is the intent of the Legislature to ensure
that foster children who are placed outside of their county of
original jurisdiction, are able to access mental health services in
a timely manner, consistent with their individualized strengths and
needs and the requirements of Early Periodic Screening Diagnosis
and Treatment (EPSDT) program standards and requirements.

(2) It is the further intent of the Legislature to overcome the
barriers to care that exist under existing law, which place
responsibility for providing or arranging for mental health services
to foster children who are placed outside of their county of original
jurisdiction, on those same counties.

(b) In order to facilitate the receipt of medically necessary
specialty mental health services by a foster child who is placed
outside of his or her county of original jurisdiction, the California
Health and Human Services Agency shall coordinate with the
department and the State Department of Social Services to take
all of the following actions:

(1) On or before July 1, 2016, all of the following shall occur:

(A) The department shall issue policy guidance, pursuant to
Section 14716, that establishes the begin insert conditions for and exceptions
to, as described in subdivision (d), end insert presumptive transfer of
responsibility for providing or arranging for mental health services
to foster youth, consistent with the requirements of EPSDT
program standards and requirements, from the county of original
jurisdiction to the begin insert county in which the end insert foster begin delete child’s county of
residence. end delete begin insert child resides. end insert

(B) The department shall establish the begin delete conditions and exceptions end delete
begin insert policy guidance end insert to presumptive transfer begin insert and exceptions end insert in
consultation with the State Department of Social Services, and
with the input of stakeholders that include the County Welfare
Directors Association of California, the County Behavioral Health
Directors Association of California, provider representatives, and
family and youth advocates. The conditions and exceptions to
presumptive transfer are intended to ensure that the transfer of
responsibility improves access to mental health care services and
does not impede the continuity of existing care.

(C) The department shall establish the procedures for
implementing presumptive transfer that are consistent with the
purposes and intent of this section and Early Periodic Screening
Diagnosis and Treatment program standards and requirements,
and shall include a procedure for expedited transfer within 48
hours.

(c) “Presumptive transfer” for the purposes of this section, means
that absent any conditions or exceptions as established pursuant
to this article, responsibility for providing or arranging for mental
health services shall immediately transfer from the county of
original jurisdiction to the begin delete county of residence, when all of the
following conditions occur: end delete begin insert county in which the foster child resides,
under any of the following conditions: end insert

(1) A foster child is placed in a county other than the county of
original jurisdiction.

begin delete

(2) The transfer of responsibility is requested by the county
child welfare services agency, county probation department, foster
caregiver, or any other person authorized to make medical decisions
on behalf of the foster child.

end delete begin insert

(2) A foster child who resides in a county other than the county
of original jurisdiction is not receiving mental health services
consistent with his or her treatment plan and the child’s caregiver
who is responsible for making health care decisions on behalf of
the foster child, in consultation with the county probation or county
child welfare services agency with responsibility for the care and
placement of the child, or the Child and Family Team, if one exists,
requests transfer of responsibility under this article.

end insert begin insert

(d) Consistent with the conditions and exceptions to presumptive
transfer established under this article, the person or agency that
is responsible for making health care decisions on behalf of the
foster child, in consultation with the Child and Family Team, if
one exists, may waive the presumptive transfer, in which case the
responsibility for the provision of mental health services shall
remain with the county of original jurisdiction.

end insert begin insert

(1) (A) On a case-by-case basis, the presumptive transfer may
be waived and the responsibility for the provision of mental health
services shall remain with the county of original jurisdiction if
any of the following conditions described in this paragraph occur.
These exceptions to presumptive transfer may include, but are not
limited to, any of the following:

end insert begin insert

(i) It is determined that the transfer of services would disrupt
continuity of care or timely access to services provided to the foster
child, as described in paragraph (2).

end insert begin insert

(ii) It is determined that the transfer of services would interfere
with family reunification efforts.

end insert begin insert

(iii) The foster child’s placement in a county other than the
county of original jurisdiction is expected to last less than nine
months.

end insert begin insert

(B) These exceptions shall be documented in the foster child’s
case plan pursuant to Section 16501.1.

end insert begin insert

(2) Exceptions to the presumptive transfer shall be contingent
upon the mental health plan in the county of original jurisdiction
demonstrating an existing contract with a foster care provider, or
the ability to enter into a contract within 30 days of the exception
decision, and the ability to deliver timely services directly to the
foster child. This shall be documented in the child’s case plan.

end insert begin insert

(e) If the mental health plan in the county of original jurisdiction
has completed an assessment of needed services for the foster
child, the mental health plan in the host county shall accept that
assessment. The mental health plan in the host county may conduct
additional assessments if the foster child’s needs change.

end insert begin insert

(f) Upon presumptive transfer, the mental health plan in the
host county shall assume responsibility for the authorization and
provision of mental health services, and payments for services.

end insert begin insert

(g) The department, in consultation with counties and through
any administrative means within existing authority, shall amend
its contract with each mental health plan no later than July 1,
2016, to ensure that a mental health plan in a host county is
reimbursed for services provided pursuant to this article during
the fiscal year in which the services are provided.

end insert

begin delete

14695.2.  

By May 1, 2016, the Department of Finance shall set
or adjust its allocation schedule of the Behavioral Health
Subaccount pursuant to the requirements of Senate Bill 1020
(Chapter 40, Statutes of 2012), in order that counties that have
paid, or will pay, for specialty mental health services for foster
children placed out of county pursuant to this article, are fully
reimbursed during the fiscal year in which the services are
provided.

end delete

begin delete 14695.3. end delete
begin insert 14695.2. end insert   

(a) If the department determines it is necessary, it
shall seek approval under the state’s Section 1915(b) Medicaid
waiver from the United States Department of Health and Human
Services, Centers for Medicare and Medicaid Services (CMS) prior
to implementing this article.

(b) If the department makes the determination that it is necessary
to seek CMS approval pursuant to subdivision (a), the department
shall make an official request for approval from CMS no later than
July 1, 2016, and shall do everything within its power necessary
to secure an expeditious approval from CMS.

(c) The department shall not be required to implement any
provision of this article that CMS determines is not permitted under
the state’s waiver.

begin insert

begin insert SEC. 2. end insert   

end insert

begin insert Section 14714 of the end insert begin insert Welfare and Institutions Code end insert begin insert is
amended to read: end insert

14714.  

(a) (1) Except as otherwise specified in this chapter,
a contract entered into pursuant to this chapter shall include a
provision that the mental health plan contractor shall bear the
financial risk for the cost of providing medically necessary
specialty mental health services to Medi-Cal beneficiaries.

(2) If the mental health plan is not administered by a county,
the mental health plan shall not transfer the obligation for any
specialty mental health services to Medi-Cal beneficiaries to the
county. The mental health plan may purchase services from the
county. The mental health plan shall establish mutually
agreed-upon protocols with the county that clearly establish
conditions under which beneficiaries may obtain non-Medi-Cal
reimbursable services from the county. Additionally, the plan shall
establish mutually agreed-upon protocols with the county for the
conditions of transfer of beneficiaries who have lost Medi-Cal
eligibility to the county for care under Part 2 (commencing with
Section 5600), Part 3 (commencing with Section 5800), and Part
4 (commencing with Section 5850) of Division 5.

(3) The mental health plan shall be financially responsible for
ensuring access and a minimum required scope of benefits and
services, consistent with state and federal requirements, to
Medi-Cal beneficiaries who are residents of that county regardless
of where the beneficiary begin delete resides. end delete begin insert resides, except as provided for
in, and consistent with, Section 14695.1. end insert The department shall
require that the same definition of medical necessity be used, and
the minimum scope of benefits offered by each mental health plan
be the same, except to the extent that prior federal approval is
received and is consistent with state and federal laws.

(b) (1) Any contract entered into pursuant to this chapter may
be renewed if the mental health plan continues to meet the
requirements of this chapter, regulations promulgated pursuant
thereto, and the terms and conditions of the contract. Failure to
meet these requirements shall be cause for nonrenewal of the
contract. The department may base the decision to renew on timely
completion of a mutually agreed-upon plan of correction of any
deficiencies, submissions of required information in a timely
manner, or other conditions of the contract.

(2) In the event the contract is not renewed based on the reasons
specified in paragraph (1), the department shall notify the
Department of Finance, the fiscal and policy committees of the
Legislature, and the Controller of the amounts to be sequestered
from the Mental Health Subaccount, the Mental Health Equity
Account, and the Vehicle License Fee Collection Account of the
Local Revenue Fund and the Mental Health Account and the
Behavioral Health Subaccount of the Local Revenue Fund 2011,
and the Controller shall sequester those funds in the Behavioral
Health Subaccount pursuant to Section 30027.10 of the
Government Code. Upon this sequestration, the department shall
use the funds in accordance with the provisions of Section
30027.10 of the Government Code.

(c) (1) The obligations of the mental health plan shall be
changed only by contract or contract amendment.

(2) Notwithstanding paragraph (1), the mental health plan shall
comply with federal and state requirements, including the
applicable sections of the state plan and waiver.

(3) A change may be made during a contract term or at the time
of contract renewal, when there is a change in obligations required
by federal or state law or when required by a change in the
interpretation or implementation of any law or regulation.

(4) To the extent permitted by federal law, either the department
or the mental health plan may request that contract negotiations
be reopened during the course of a contract due to substantial
changes in the cost of covered benefits that result from an
unanticipated event.

(d) The department shall immediately terminate a contract when
the director finds that there is an immediate threat to the health
and safety of Medi-Cal beneficiaries. Termination of the contract
for other reasons shall be subject to reasonable notice of the
department’s intent to take that action and notification to affected
beneficiaries. The plan may request a hearing by the Office of
Administrative Hearings and Appeals.

(e) A mental health plan may terminate its contract in accordance
with the provisions in the contract. The mental health plan shall
provide written notice to the department at least 180 days prior to
the termination or nonrenewal of the contract.

(f) Upon the request of the director, the Director of the
Department of Managed Health Care may exempt a mental health
plan from the Knox-Keene Health Care Service Plan Act of 1975
(Chapter 2.2 (commencing with Section 1340) of Division 2 of
the Health and Safety Code). These exemptions may be subject to
conditions the director deems appropriate. Nothing in this chapter
shall be construed to impair or diminish the authority of the
Director of the Department of Managed Health Care under the
Knox-Keene Health Care Service Plan Act of 1975, nor shall
anything in this chapter be construed to reduce or otherwise limit
the obligation of a mental health plan contractor licensed as a
health care service plan to comply with the requirements of the
Knox-Keene Health Care Service Plan Act of 1975, and the rules
of the Director of the Department of Managed Health Care
promulgated thereunder. The director, in consultation with the
Director of the Department of Managed Health Care, shall analyze
the appropriateness of licensure or application of applicable
standards of the Knox-Keene Health Care Service Plan Act of
1975.

(g) The department shall provide oversight to the mental health
plans to ensure quality, access, cost efficiency, and compliance
with data and reporting requirements. At a minimum, the
department shall, through a method independent of any agency of
the mental health plan contractor, monitor the level and quality of
services provided, expenditures pursuant to the contract, and
conformity with federal and state law.

(h) County employees implementing or administering a mental
health plan act in a discretionary capacity when they determine
whether or not to admit a person for care or to provide any level
of care pursuant to this chapter.

(i) If a county discontinues operations as the mental health plan,
the department shall approve any new mental health plan. The new
mental health plan shall give reasonable consideration to affiliation
with nonprofit community mental health agencies that were under
contract with the county and that meet the mental health plan’s
quality and cost efficiency standards.

(j) Nothing in this chapter shall be construed to modify, alter,
or increase the obligations of counties as otherwise limited and
defined in Chapter 3 (commencing with Section 5700) of Part 2
of Division 5. The county’s maximum obligation for services to
persons not eligible for Medi-Cal shall be no more than the amount
of funds remaining in the mental health subaccount pursuant to
Sections 17600, 17601, 17604, 17605, and 17609 after fulfilling
the Medi-Cal contract obligations.