Amended in Senate August 1, 2016

Amended in Senate July 16, 2015

Amended in Assembly April 21, 2015

California Legislature—2015–16 Regular Session

Assembly BillNo. 1299


Introduced by Assembly Member Ridley-Thomas

February 27, 2015


An act to amend Section 14714 of, and to addbegin delete Article 6 (commencing with Section 14695.1) to Chapter 8.8 of Part 3 of Division 9 of,end deletebegin insert Section 14717.5 to,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 thatbegin insert specialty mental health services andend insert Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) for any individual under 21 years of agebegin delete isend deletebegin insert areend insert 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 statebegin delete plan. EPSDT is classified under the Medi-Cal program as a specialty mental health service.end deletebegin insert plan. Existing law provides that specialty mental health services include EPSDT servicesend insertbegin insert provided to eligible Medi-Cal beneficiaries under 21 years of age.end insert

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 conditions for and exceptions to presumptive transfer of responsibility for providing or arranging for mental health services tobegin delete foster youthend deletebegin insert a foster childend insert from the county of original jurisdiction to the county in which the foster child resides, as prescribed. The bill would define presumptive transfer for these purposes. The bill would authorizebegin delete 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, includingend deletebegin insert any interested party who owes a legal duty to the child involving the child’s health or welfare to seek a waiver of presumptive transfer and would provide that the county probation agency or child welfare services agency with responsibility for the care and placement of the child is responsible for determining whether presumptive transfer is appropriate under specified conditions, includingend insert 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.begin delete 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 deletebegin insert By increasing the responsibilities of county probation agencies or child welfare services agencies with respect to determining whether presumptive transfer is appropriate, the bill would impose as state-mandated local program.end insert

This bill would require the department tobegin delete 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.end deletebegin insert seek approval from the United States Department of Health and Human Services, federal Centers for Medicare and Medicaid Services (CMS) prior to implementing these provisions if the department determines that approval is necessary. The bill would authorize the department and the State Department of Social Services to adopt regulations to implement these provisions by July 1, 2019, as specified.end insert

begin insert

The 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 insert
begin insert

This bill would provide that, if the Commission on State Mandates determines that the bill contains costs mandated by the state, reimbursement for those costs shall be made pursuant to these statutory provisions.

end insert

Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: begin deleteno end deletebegin insertyesend insert.

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

begin delete
P3    1

SECTION 1.  

Article 6 (commencing with Section 14695.1) is
2added to Chapter 8.8 of Part 3 of Division 9 of the Welfare and
3Institutions Code
, to read:

4 

5Article 6.  Specialty Mental Health Services for Foster Children
6

 

7

14695.1.  

(a) (1) It is the intent of the Legislature to ensure
8that foster children who are placed outside of their county of
9original jurisdiction, are able to access mental health services in
10a timely manner, consistent with their individualized strengths and
11needs and the requirements of Early Periodic Screening Diagnosis
12and Treatment (EPSDT) program standards and requirements.

P4    1(2) It is the further intent of the Legislature to overcome the
2barriers to care that exist under existing law, which place
3responsibility for providing or arranging for mental health services
4to foster children who are placed outside of their county of original
5jurisdiction, on those same counties.

6(b) In order to facilitate the receipt of medically necessary
7specialty mental health services by a foster child who is placed
8outside of his or her county of original jurisdiction, the California
9Health and Human Services Agency shall coordinate with the
10department and the State Department of Social Services to take
11all of the following actions:

12(1) On or before July 1, 2016, all of the following shall occur:

13(A) The department shall issue policy guidance, pursuant to
14Section 14716, that establishes the conditions for and exceptions
15to, as described in subdivision (d), presumptive transfer of
16responsibility for providing or arranging for mental health services
17to foster youth, consistent with the requirements of EPSDT
18program standards and requirements, from the county of original
19jurisdiction to the county in which the foster child resides.

20(B) The department shall establish the policy guidance to
21presumptive transfer and exceptions in consultation with the State
22Department of Social Services, and with the input of stakeholders
23that include the County Welfare Directors Association of
24California, the County Behavioral Health Directors Association
25of California, provider representatives, and family and youth
26advocates. The conditions and exceptions to presumptive transfer
27are intended to ensure that the transfer of responsibility improves
28access to mental health care services and does not impede the
29continuity of existing care.

30(C) The department shall establish the procedures for
31implementing presumptive transfer that are consistent with the
32purposes and intent of this section and Early Periodic Screening
33Diagnosis and Treatment program standards and requirements,
34and shall include a procedure for expedited transfer within 48
35hours.

36(c) “Presumptive transfer” for the purposes of this section, means
37that absent any conditions or exceptions as established pursuant
38to this article, responsibility for providing or arranging for mental
39health services shall immediately transfer from the county of
P5    1original jurisdiction to the county in which the foster child resides,
2under any of the following conditions:

3(1) A foster child is placed in a county other than the county of
4original jurisdiction.

5(2) A foster child who resides in a county other than the county
6of original jurisdiction is not receiving mental health services
7consistent with his or her treatment plan and the child’s caregiver
8who is responsible for making health care decisions on behalf of
9the foster child, in consultation with the county probation or county
10child welfare services agency with responsibility for the care and
11placement of the child, or the Child and Family Team, if one exists,
12requests transfer of responsibility under this article.

13(d) Consistent with the conditions and exceptions to presumptive
14transfer established under this article, the person or agency that is
15responsible for making health care decisions on behalf of the foster
16child, in consultation with the Child and Family Team, if one
17exists, may waive the presumptive transfer, in which case the
18responsibility for the provision of mental health services shall
19remain with the county of original jurisdiction.

20(1) (A) On a case-by-case basis, the presumptive transfer may
21be waived and the responsibility for the provision of mental health
22services shall remain with the county of original jurisdiction if any
23of the following conditions described in this paragraph occur.
24These exceptions to presumptive transfer may include, but are not
25limited to, any of the following:

26(i) It is determined that the transfer of services would disrupt
27continuity of care or timely access to services provided to the foster
28child, as described in paragraph (2).

29(ii) It is determined that the transfer of services would interfere
30with family reunification efforts.

31(iii) The foster child’s placement in a county other than the
32county of original jurisdiction is expected to last less than nine
33months.

34(B) These exceptions shall be documented in the foster child’s
35case plan pursuant to Section 16501.1.

36(2) Exceptions to the presumptive transfer shall be contingent
37upon the mental health plan in the county of original jurisdiction
38demonstrating an existing contract with a foster care provider, or
39the ability to enter into a contract within 30 days of the exception
P6    1decision, and the ability to deliver timely services directly to the
2foster child. This shall be documented in the child’s case plan.

3(e) If the mental health plan in the county of original jurisdiction
4has completed an assessment of needed services for the foster
5child, the mental health plan in the host county shall accept that
6assessment. The mental health plan in the host county may conduct
7additional assessments if the foster child’s needs change.

8(f) Upon presumptive transfer, the mental health plan in the host
9county shall assume responsibility for the authorization and
10provision of mental health services, and payments for services.

11(g) The department, in consultation with counties and through
12any administrative means within existing authority, shall amend
13its contract with each mental health plan no later than July 1, 2016,
14to ensure that a mental health plan in a host county is reimbursed
15for services provided pursuant to this article during the fiscal year
16in which the services are provided.

17

14695.2.  

(a) If the department determines it is necessary, it
18shall seek approval under the state’s Section 1915(b) Medicaid
19waiver from the United States Department of Health and Human
20Services, Centers for Medicare and Medicaid Services (CMS) prior
21to implementing this article.

22(b) If the department makes the determination that it is necessary
23to seek CMS approval pursuant to subdivision (a), the department
24shall make an official request for approval from CMS no later than
25July 1, 2016, and shall do everything within its power necessary
26to secure an expeditious approval from CMS.

27(c) The department shall not be required to implement any
28provision of this article that CMS determines is not permitted under
29the state’s waiver.

end delete
30

begin deleteSEC. 2.end delete
31
begin insertSECTION 1.end insert  

Section 14714 of the Welfare and Institutions
32Code
is amended to read:

33

14714.  

(a) (1) Except as otherwise specified in this chapter,
34a contract entered into pursuant to this chapter shall include a
35provision that the mental health plan contractor shall bear the
36financial risk for the cost of providing medically necessary
37specialty mental health services to Medi-Cal beneficiaries.

38(2) If the mental health plan is not administered by a county,
39the mental health plan shall not transfer the obligation for any
40specialty mental health services to Medi-Cal beneficiaries to the
P7    1county. The mental health plan may purchase services from the
2county. The mental health plan shall establish mutually
3agreed-upon protocols with the county that clearly establish
4conditions under which beneficiaries may obtain non-Medi-Cal
5 reimbursable services from the county. Additionally, the plan shall
6establish mutually agreed-upon protocols with the county for the
7conditions of transfer of beneficiaries who have lost Medi-Cal
8eligibility to the county for care under Part 2 (commencing with
9Section 5600), Part 3 (commencing with Section 5800), and Part
104 (commencing with Section 5850) of Division 5.

11(3) The mental health plan shall be financially responsible for
12ensuring access and a minimum required scope of benefits and
13services, consistent with state and federal requirements, to
14Medi-Cal beneficiaries who are residents of that county regardless
15of where the beneficiary resides, except as provided forbegin delete in, and
16consistent with, Section 14695.1.end delete
begin insert in Section 14717.5.end insert The
17department shall require that the same definition of medical
18necessity be used, and the minimum scope of benefits offered by
19each mental health plan be the same, except to the extent that prior
20federal approval is received and is consistent with state and federal
21laws.

22(b) (1) Any contract entered into pursuant to this chapter may
23be renewed if the mental health plan continues to meet the
24requirements of this chapter, regulations promulgated pursuant
25begin delete thereto,end deletebegin insert to this chapter,end insert and the terms and conditions of the
26contract. Failure to meet these requirements shall be cause for
27nonrenewal of the contract. The department may base the decision
28to renew on timely completion of a mutually agreed-upon plan of
29correction of any deficiencies, submissions of required information
30in a timely manner, or other conditions of the contract.

31(2) In the event the contract is not renewed based on the reasons
32specified in paragraph (1), the department shall notify the
33Department of Finance, the fiscal and policy committees of the
34Legislature, and the Controller of the amounts to be sequestered
35from the Mental Health Subaccount, the Mental Health Equity
36Account, and the Vehicle License Fee Collection Account of the
37Local Revenue Fund and the Mental Health Account and the
38Behavioral Health Subaccount of the Local Revenue Fund 2011,
39and the Controller shall sequester those funds in the Behavioral
40Health Subaccount pursuant to Section 30027.10 of the
P8    1Government Code. Upon this sequestration, the department shall
2use the funds in accordance with the provisions of Section
330027.10 of the Government Code.

4(c) (1) The obligations of the mental health plan shall be
5changed only by contract or contract amendment.

6(2) Notwithstanding paragraph (1), the mental health plan shall
7comply with federal and state requirements, including the
8applicable sections of the state plan and waiver.

9(3) A change may be made during a contract term or at the time
10of contract renewal, when there is a change in obligations required
11by federal or state law or when required by a change in the
12interpretation or implementation of any law or regulation.

13(4) To the extent permitted by federal law, either the department
14or the mental health plan may request that contract negotiations
15be reopened during the course of a contract due to substantial
16changes in the cost of covered benefits that result from an
17unanticipated event.

18(d) The department shall immediately terminate a contract when
19the director finds that there is an immediate threat to the health
20and safety of Medi-Cal beneficiaries. Termination of the contract
21for other reasons shall be subject to reasonable notice of the
22department’s intent to take that action and notification to affected
23beneficiaries. The plan may request a hearing by the Office of
24Administrative Hearings and Appeals.

25(e) A mental health plan may terminate its contract in accordance
26with the provisions in the contract. The mental health plan shall
27provide written notice to the department at least 180 days prior to
28the termination or nonrenewal of the contract.

29(f) Upon the request of the director, the Director of the
30Department of Managed Health Care may exempt a mental health
31plan from the Knox-Keene Health Care Service Plan Act of 1975
32(Chapter 2.2 (commencing with Section 1340) of Division 2 of
33the Health and Safety Code). These exemptions may be subject to
34conditions the director deems appropriate. Nothing in this chapter
35shall be construed to impair or diminish the authority of the
36Director of the Department of Managed Health Care under the
37Knox-Keene Health Care Service Plan Act of 1975, nor shall
38anything in this chapter be construed to reduce or otherwise limit
39the obligation of a mental health plan contractor licensed as a
40health care service plan to comply with the requirements of the
P9    1Knox-Keene Health Care Service Plan Act of 1975, and the rules
2of the Director of the Department of Managed Health Care
3promulgatedbegin delete thereunder.end deletebegin insert under the Knox-Keene Health Care
4Service Plan Act of 1975.end insert
The director, in consultation with the
5Director of the Department of Managed Health Care, shall analyze
6the appropriateness of licensure or application of applicable
7standards of the Knox-Keene Health Care Service Plan Act of
81975.

9(g) The department shall provide oversight to the mental health
10plans to ensure quality, access, cost efficiency, and compliance
11with data and reporting requirements. At a minimum, the
12department shall, through a method independent of any agency of
13 the mental health plan contractor, monitor the level and quality of
14services provided, expenditures pursuant to the contract, and
15conformity with federal and state law.

16(h) County employees implementing or administering a mental
17health plan act in a discretionary capacity when they determine
18whether or not to admit a person for care or to provide any level
19of care pursuant to this chapter.

20(i) If a county discontinues operations as the mental health plan,
21the department shall approve any new mental health plan. The new
22mental health plan shall give reasonable consideration to affiliation
23with nonprofit community mental health agencies that were under
24contract with the county and that meet the mental health plan’s
25quality and cost efficiency standards.

26(j) Nothing in this chapter shall be construed to modify, alter,
27 or increase the obligations of counties as otherwise limited and
28defined in Chapter 3 (commencing with Section 5700) of Part 2
29of Division 5. The county’s maximum obligation for services to
30persons not eligible for Medi-Cal shall be no more than the amount
31of funds remaining in the mental health subaccount pursuant to
32Sections 17600, 17601, 17604, 17605, and 17609 after fulfilling
33the Medi-Cal contract obligations.

34begin insert

begin insertSEC. 2.end insert  

end insert

begin insertSection 14717.5 is added to the end insertbegin insertWelfare and Institutions
35Code
end insert
begin insert, to read:end insert

begin insert
36

begin insert14717.5.end insert  

(a) (1) It is the intent of the Legislature to ensure
37that foster children who are placed outside of their county of
38original jurisdiction are able to access specialty mental health
39services in a timely manner, consistent with their individual
P10   1strengths and needs and the requirements of federal Early and
2Periodic Screening, Diagnosis, and Treatment (EPSDT) services.

3
(2) It is the further intent of the Legislature to overcome any
4barriers to care that may result when responsibility for providing
5or arranging for specialty mental health services to foster children
6who are placed outside of their county of original jurisdiction is
7retained by the county of original jurisdiction.

8
(b) In order to facilitate the receipt of medically necessary
9specialty mental health services by a foster child who is placed
10outside of his or her county of original jurisdiction, the California
11Health and Human Services Agency shall coordinate with the
12department and the State Department of Social Services to take
13all of the following actions on or before July 1, 2017:

14
(1) The department shall issue policy guidance concerning the
15conditions for and exceptions to presumptive transfer, as described
16in subdivisions (c) and (d), in consultation with the State
17Department of Social Services and with the input of stakeholders
18that include the County Welfare Directors Association of
19California, the Chief Probation Officers of California, the County
20Behavioral Health Directors Association of California, provider
21representatives, and family and youth advocates.

22
(2) Policy guidance concerning the conditions for and exceptions
23to presumptive transfer shall ensure that:

24
(A) The transfer of responsibility improves access to specialty
25mental health care services consistent with the mental health needs
26of the foster youth.

27
(B) Presumptive transfer does not disrupt the continuity of care.

28
(C) Conditions and exceptions are applied consistently statewide
29giving due consideration to the varying capabilities of small,
30medium, and large counties.

31
(D) Presumptive transfer can be waived only with an
32individualized determination that an exception applies.

33
(E) A party to the case who disagrees with the presumptive
34transfer individualized exception determination made by the county
35placing agency pursuant to subdivision (d) is afforded an
36opportunity to request judicial review prior to a transfer or
37exception being finalized.

38
(F) There is a procedure for expedited transfer within 48 hours
39of placement of the child outside of the county of original
40jurisdiction.

P11   1
(c) “Presumptive transfer,” for the purposes of this section,
2means that absent any exceptions as established pursuant to this
3section, responsibility for providing or arranging for specialty
4mental health services shall promptly transfer from the county of
5original jurisdiction to the county in which the foster child resides,
6under either of the following conditions:

7
(1) A foster child is placed in a county other than the county of
8original jurisdiction on or after July 1, 2017.

9
(2) A foster youth who resides in a county other than the county
10of original jurisdiction after June 30, 2017, and is not receiving
11specialty mental health services consistent with his or her mental
12health needs, requests transfer of responsibility. A foster child who
13resided in a county other than the county of original jurisdiction
14after June 30, 2017, and who continues to reside outside the county
15of original jurisdiction after December 31, 2017, shall have
16jurisdiction transferred no later than the child’s first regularly
17scheduled status review hearing conducted pursuant to Section
18366 in the 2018 calendar year unless an exception described under
19subdivision (d) applies.

20
(d) (1) On a case-by-case basis, and when consistent with the
21medical rights of children in foster care, presumptive transfer may
22be waived and the responsibility for the provision of specialty
23mental health services shall remain with the county of original
24jurisdiction if any of the exceptions described in paragraph (5)
25exist.

26
(2) A request for waiver in a manner established by the
27department may be made by the foster child, the person or agency
28that is responsible for making mental health care decisions on
29behalf of the foster child, the county probation agency or the child
30welfare services agency with responsibility for the care and
31placement of the child, or any other interested party who owes a
32legal duty to the child involving the child’s health or welfare, as
33defined by the department.

34
(3) The county probation agency or the child welfare services
35agency with responsibility for the care and placement of the child,
36in consultation with the child and his or her parent, the child and
37family team if one exists, and other professionals who serve the
38child as appropriate, is responsible for determining whether waiver
39of the presumptive transfer is appropriate pursuant to the
40conditions and exceptions established under this section. The
P12   1person who requested the exception, along with any other parties
2to the case, shall receive notice of the county agency’s
3determination.

4
(4) The individual who requested the exception or any other
5party to the case who disagrees with the determination made by
6the county agency pursuant to paragraph (3) may request judicial
7review prior to the county’s determination becoming final. The
8court may set the matter for hearing and may confirm or deny the
9transfer of jurisdiction or application of an exception based on
10the best interest of the child.

11
(5) Presumptive transfer may be waived under any of the
12following exceptions:

13
(A) It is determined that the transfer would disrupt continuity
14of care or delay access to services provided to the foster child.

15
(B) It is determined that the transfer would interfere with family
16reunification efforts documented in the individual case plan.

17
(C) The foster child’s placement in a county other than the
18county of original jurisdiction is expected to last less than six
19months.

20
(D) The foster child’s residence is within 30 minutes of travel
21time to his or her established specialty mental health care provider
22in the county of original jurisdiction.

23
(6) A waiver processed based on an exception to presumptive
24transfer shall be contingent upon the mental health plan in the
25county of original jurisdiction demonstrating an existing contract
26with a specialty mental health care provider, or the ability to enter
27into a contract within 30 days of the waiver decision, and the
28ability to deliver timely specialty mental health services directly
29to the foster child. That information shall be documented in the
30child’s case plan.

31
(7) A request for waiver, the exceptions claimed as the basis
32for the request, a determination whether a waiver is determined
33to be appropriate under this section, and any objections to the
34determination shall be documented in the foster child’s case plan
35pursuant to Section 16501.1.

36
(e) If the mental health plan in the county of original jurisdiction
37has completed an assessment of needed services for the foster
38child, the mental health plan in the county in which the foster child
39resides shall accept that assessment. The mental health plan in
40 the county in which the foster child resides may conduct additional
P13   1assessments if the foster child’s needs change or an updated
2assessment is needed to determine the child’s needs and identify
3the needed treatment and services to address those needs.

4
(f) Upon presumptive transfer, the mental health plan in the
5county in which the foster child resides shall assume responsibility
6for the authorization and provision of specialty mental health
7services and payments for services. The foster child transferred
8to the mental health plan in the county in which the foster child
9resides shall be considered part of the county of residence caseload
10for claiming purposes from the Behavioral Health Subaccount and
11the Behavioral Health Services Growth Special Account, both
12created pursuant to Section 30025 of the Government Code.

13
(g) The State Department of Social Services and the State
14 Department of Health Care Services shall adopt regulations by
15July 1, 2019, to implement this section. Notwithstanding the
16rulemaking provisions of the Administrative Procedure Act
17(Chapter 3.5 (commencing with Section 11340) of Part 1 of
18Division 3 of Title 2 of the Government Code), the State
19Department of Social Services and the State Department of Health
20Care Services may implement and administer the changes made
21by this legislation through all-county letters, information notices,
22or similar written instructions until regulations are adopted.

23
(h) If the department determines it is necessary, it shall seek
24approval from the United States Department of Health and Human
25Services, federal Centers for Medicare and Medicaid Services
26(CMS) prior to implementing this section.

27
(i) If the department makes the determination that it is necessary
28to seek CMS approval pursuant to subdivision (h), the department
29shall make an official request for approval from CMS no later
30than January 1, 2017.

31
(j) This section shall be implemented only if and to the extent
32that federal financial participation under Title XIX of the federal
33Social Security Act (42 U.S.C. Sec. 1396, et seq.) is available and
34all necessary federal approvals have been obtained.

end insert
35begin insert

begin insertSEC. 3.end insert  

end insert
begin insert

If the Commission on State Mandates determines that
36this act contains costs mandated by the state, reimbursement to
37local agencies and school districts for those costs shall be made
P14   1pursuant to Part 7 (commencing with Section 17500) of Division
24 of Title 2 of the Government Code.

end insert


O

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