Amended in Assembly August 28, 2015

Amended in Assembly July 2, 2015

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 14728 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. begin delete 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. end delete begin insert The department is responsible for conducting investigations and audits of claims and reimbursements for expenditures for specialty mental health services provided by mental health plans to Medi-Cal eligible individuals. end insert

begin delete

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.

end delete begin insert

This bill would limit the scope of the service billing documentation requirements the department may apply when conducting an audit of Medi-Cal specialty mental health services to criteria that is clearly and explicitly set forth in specified state regulations, letters, and directives, federal Medicaid terms and conditions, and the Medicaid state plan. The bill would require the department to allow counties and county contract providers of behavioral health services to incorporate by reference any information in a patient’s existing case record in subsequent documentation and would prohibit the department from requiring any unchanged information in a patient’s existing case record to be copied or reentered into specified treatment documents, unless required by a federal directive. The bill would require the department to consider further revisions to its service billing documentation requirements, and to prepare, in consultation with counties, providers, and other stakeholders, and submit to the Legislature, a proposal to accomplish those objectives, as specified.

end insert

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 begin delete develop a single set of end delete
begin insert simplify and clarify end insert documentation requirements, in consultation
with counties and providers, begin delete that limits end delete begin insert and limit end insert audit
disallowances to circumstances clearly spelled out in begin delete the
requirements. end delete begin insert advance. end insert

SEC. 2.  

Section 14728 is added to the Welfare and Institutions
Code, to read:

14728.  

(a)  begin delete The end delete begin insert When conducting an audit pursuant to this
chapter, the end insert State Department of Health Care Services shall begin delete consult
with counties, providers, and other stakeholders to develop a single
set of service billing documentation requirements for the provision
of specialty mental health services. end delete begin insert limit the scope of any service
billing documentation requirements it applies, to criteria that is
clearly and explicitly set forth in any of the following: end insert

begin insert

(1) Regulations, interpretive letters, and compliance directives
sent by the department to counties in a previous fiscal year.

end insert begin insert

(2) Federal terms and conditions of the Medicaid Program.

end insert begin insert

(3) The Medicaid state plan.

end insert begin delete

(b) The billing documentation requirements developed pursuant
to this section shall do both of the following:

end delete begin delete

(1) Minimize time and paperwork required of counties and
providers, consistent with federal standards.

end delete begin delete

(2) Eliminate duplicative or outdated requirements.

end delete begin delete

(c) The billing 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 Medicaid state plan or
other federal rules require that the billing requirements be updated
more often.

end delete begin delete

(d) After adoption of the standard billing requirements by the
department, a county may not require additional billing
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 services, or
for purposes other than documentation for billing.

end delete begin insert

(b) An audit requirement relating to service billing
documentation that is not in compliance with subdivision (a) shall
be considered an advisory finding only, for which no disallowance
may be made, unless and until the department modifies its
regulations to make the audit requirement explicit, or provides an
interpretive letter or other written clarification to counties that
clearly prescribes the requirement, consistent with subdivision
(a).

end insert begin insert

(c) The department shall not require a county or county contract
provider of behavioral health services to copy or reenter any
unchanged information from a patient’s existing case record into
any subsequent progress note, assessment, or treatment plan for
that patient, unless explicitly required by a federal directive. A
regulation, interpretive letter, compliance directive, or audit
requirement of the department relating to service billing
documentation shall allow counties and county contract providers,
when documenting a patient’s treatment, to incorporate by
reference any information from the patient’s entire case record,
including, but not limited to, assessments, treatment plans,
evaluations, and progress notes.

end insert begin insert

(d) (1) The department shall consider further revisions to its
service billing documentation requirements, to accomplish both
of the following objectives:

end insert begin insert

(A) Minimize the time and paperwork required of counties and
providers, consistent with federal standards.

end insert begin insert

(B) Eliminate duplicative or obsolete requirements.

end insert begin insert

(2) (A) The department shall submit a proposal to the
Legislature to accomplish the objectives described in paragraph
(1). The proposal shall be submitted in the same fiscal year in
which the department submits to the federal Centers for Medicare
and Medicaid Services its proposal to revise the billing method
for mental health services from the current practice of billing by
the minute to a system that provides for greater documentation
streamlining, including, but not limited to, a capitated system.

end insert begin insert

(B) In preparing the proposal developed pursuant to this
paragraph, the department shall consult with counties, providers,
and other stakeholders.

end insert begin insert

(C) A proposal submitted to the Legislature pursuant to this
paragraph shall be submitted in compliance with Section 9795 of
the Government Code.

end insert