Amended in Senate April 20, 2015

Amended in Senate April 7, 2015

Senate Bill No. 296

Introduced by Senator Cannella

February 23, 2015

An act to add Section 14727 to the Welfare and Institutions Code, relating to Medi-Cal.

LEGISLATIVE COUNSEL’S DIGEST

SB 296, as amended, Cannella. Medi-Cal: specialty mental health services: documentation requirements.

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, including specialty mental health services. The Medi-Cal program is, in part, governed and funded by federal Medicaid Program provisions. 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, existing law requires the department to create a standardized set of documentation standards and forms.

This bill would require the department, in consultation with specified stakeholders, to develop a single set of service begin insert billing end insert documentation requirements for the provision of specialty mental health services by January 1, 2017, for use commencing July 1, 2017, and would require the department to update the begin insert billing end insert documentation requirements no less than every 2 years. The bill would generally prohibit counties from requiring additional begin insert billing end insert documentation requirements for Medi-Cal specialty mental health services that go beyond the begin insert billing end insert documentation requirements developed by the department.

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.  

The Legislature finds and declares all of the
following:

(a) Counties and private providers that contract for service
delivery estimate that over 40 cents out of every dollar spent on
Medi-Cal mental health services goes to paperwork to document
that the services meet federal billing standards and to avoid
potential state audit disallowances.

(b) A national expert reviewed what counties in California were
requiring of providers and noted that it took 20 minutes of
documentation to prepare progress notes for a single session of
psychotherapy, as compared to an estimated five minutes in other
states.

(c) State guidelines on billing are not significantly different
from the requirements of other states, however, counties have
added other documentation requirements based on the fear that
interpretations of the guidelines during audits may result in some
services being disallowed if the additional documentation is not
included.

(d) In order to eliminate this pattern, it is necessary for the State
Department of Health Care Services to develop a single set of
documentation requirements, in consultation with counties and
providers, that limits audit disallowances to circumstances clearly
spelled out in the requirements.

SEC. 2.  

Section 14727 is added to the Welfare and Institutions
Code, immediately following Section 14726, to read:

14727.  

(a) The State Department of Health Care Services shall
consult with counties, providers, begin delete national experts, other states, end delete and
other stakeholders to develop a single set of service begin insert billing end insert
documentation requirements for the provision of specialty mental
health services.

(b) The begin insert billing end insert documentation requirements developed pursuant
to this section shall do begin delete all end delete begin insert both end insert of the following:

(1) Minimize time and paperwork required of counties and
providers, consistent with federal begin delete standards and practices of other
states. end delete begin insert standards. end insert

(2) Eliminate duplicative or outdated requirements.

begin delete

(3) Reflect outcome reporting requirements developed pursuant
to the performance outcome system for Early and Periodic
Screening, Diagnosis, and Treatment mental health services
developed pursuant to Section 14707.5.

end delete

(c) The begin insert billing end insert documentation requirements shall be completed
by January 1, 2017, for use commencing on July 1, 2017, and shall
thereafter be updated no less than every two years through a
stakeholder process, unless changes in the begin delete state Medi-Cal end delete begin insert Medicaid
state end insert plan or other federal rules require that the begin insert billing end insert requirements
be updated more often.

(d) After adoption of the standard begin insert billing end insert requirements by the
department, a county may not require additional begin insert billing end insert
documentation for Medi-Cal specialty mental health services that
go beyond these requirements unless necessary for funding from
other funding sources that are also used to pay for the begin delete services. end delete
begin insert services, or for purposes other than documentation for billing. end insert