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 billing 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 billing documentation requirements no less than every 2 years. The bill would generally prohibit counties from requiring additional billing documentation requirements for Medi-Cal specialty mental health services that go beyond the billing 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:
The Legislature finds and declares all of the
2following:
3(a) Counties and private providers that contract for service
4delivery estimate that over 40 cents out of every dollar spent on
5Medi-Cal mental health services goes to paperwork to document
6that the services meet federal billing standards and to avoid
7potential state audit disallowances.
8(b) A national expert reviewed what counties in California were
9requiring of providers and noted that it took 20 minutes of
10documentation to prepare progress notes for a single session of
11psychotherapy, as compared to an estimated five minutes in
other
12states.
13(c) State guidelines on billing are not significantly different
14from the requirements of other states, however, counties have
15added other documentation requirements based on the fear that
16interpretations of the guidelines during audits may result in some
17services being disallowed if the additional documentation is not
18included.
19(d) In order to eliminate this pattern, it is necessary for the State
20Department of Health Care Services to develop a single set of
21documentation requirements, in consultation with counties and
22providers, that limits audit disallowances to circumstances clearly
23spelled out in the requirements.
Section begin delete14727end deletebegin insert14728end insert is added to the Welfare and
25Institutions Codebegin delete, end deleteimmediately following Section 14726, to read:
(a) The State Department of Health Care Services shall
28consult with counties, providers, and other stakeholders to develop
29a single set of service billing documentation requirements for the
30provision of specialty mental health services.
31(b) The billing documentation requirements developed pursuant
32to this section shall do both of the following:
P3 1(1) Minimize time and paperwork required of counties and
2providers, consistent with
federal standards.
3(2) Eliminate duplicative or outdated requirements.
4(c) The billing documentation requirements shall be completed
5by January 1, 2017, for use commencing on July 1, 2017, and shall
6thereafter be updated no less than every two years through a
7stakeholder process, unless changes in the Medicaid state plan or
8other federal rules require that the billing requirements be updated
9more often.
10(d) After adoption of the standard billing requirements by the
11department, a county may not require additional billing
12documentation for Medi-Cal specialty mental health services that
13go beyond these requirements unless necessary for funding from
14other funding sources that are also used to pay for the
services, or
15for purposes other than documentation for billing.
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