BILL ANALYSIS Ó
SB 296
Page 1
SENATE THIRD READING
SB
296 (Cannella)
As Amended August 28, 2015
Majority vote
SENATE VOTE: 40-0
------------------------------------------------------------------
|Committee |Votes|Ayes |Noes |
| | | | |
| | | | |
| | | | |
|----------------+-----+----------------------+--------------------|
|Health |18-0 |Bonta, Maienschein, | |
| | |Bonilla, Burke, Chiu, | |
| | |Gomez, Gonzalez, | |
| | |Roger Hernández, | |
| | |Lackey, McCarty, | |
| | |Nazarian, Patterson, | |
| | |Ridley-Thomas, | |
| | |Rodriguez, Steinorth, | |
| | |Thurmond, Waldron, | |
| | |Wood | |
| | | | |
|----------------+-----+----------------------+--------------------|
|Appropriations |17-0 |Gomez, Bigelow, | |
| | |Bloom, Bonta, | |
| | |Calderon, Chang, | |
| | |Nazarian, Eggman, | |
| | |Gallagher, Eduardo | |
SB 296
Page 2
| | |Garcia, Holden, | |
| | |Jones, Quirk, Rendon, | |
| | |Wagner, Weber, Wood | |
| | | | |
| | | | |
------------------------------------------------------------------
SUMMARY: Requires the Department of Health Care Services (DHCS)
to clarify and simplify documentation requirements when
conducting an audit of claims and reimbursements for
expenditures for specialty mental health services provided by
mental health plans to Medi-Cal eligible individuals, with
consultation from various entities as specified, for the
provision of specialty mental health (SMH) services by January
1, 2017, for use commencing July 1, 2017.
FISCAL EFFECT: According to the Assembly Appropriations
Committee, potential administrative staff costs to DHCS in the
range of several hundred thousand dollars in staff costs for at
least one to two years.
COMMENTS: According to the author, this bill is necessary
because it would address concerns of mental health officials and
the community agencies they contract with that the state's
interpretation of the guidelines in audits might disallow some
services if the additional documentation were not included. The
author further states that while the state guidelines on billing
are not much different from other states, counties have added so
many requirements that it takes up to 20 minutes of
documentation to prepare progress notes on things like
psychotherapy, while in other states it takes five minutes.
This costs manpower and money to the state and counties. The
author concludes that this bill would end this pattern by
creating a single set of documentation requirements developed by
the state, in consultation with counties and providers, that
should limit audit disallowances and is designed to be the
SB 296
Page 3
minimum documentation requirements necessary to comply with
federal law and other applicable state laws.
Specialty Mental Health 1915(b) waiver. Specialty Medi-Cal
mental health services are provided under the terms of the
federal Medicaid Medi-Cal Specialty Mental Health Services
Consolidation 1915(b) waiver program. The waiver established a
managed care program for specialty mental health services
separate from the overall Medi-Cal program. Medi-Cal
beneficiaries must receive specialty mental health services
though county-operated mental health plans (MHPs). County MHPs
provide services directly or through contracts in the local
community using a combination of county funds, realignment
revenues and Mental Health Services Act funds. Counties pay for
services locally, incurring certified public expenditures, which
the state then uses as the state match to claim federal Medicaid
reimbursement and the state, in turn, returns the federal funds
to the county MHPs.
During regular monitoring and in ongoing communications, the
Centers for Medicare and Medicaid Services (CMS) has asked
questions on specific areas of the SMH waiver. CMS reviews MHP
triennial and External Quality Review Organization reports and
raised concern about the findings and continued noncompliance
with specific waiver requirements. CMS believes that
significant improvement is needed in identified areas and
expects the state to closely monitor, ensure, and provide
evidence of compliance. In addition to a number of identified
areas of focus, CMS has expressed concern about the ongoing
elevated inpatient and outpatient disallowance rates resulting
from chart reviews (i.e., disallowed claims under the Medi-Cal
program). Due to past deficiencies, CMS is requiring the state
to provide oversight to ensure that the Medi-Cal claims
submitted by MHPs for SMH services meet medical necessity
criteria for reimbursement and that the documentation in the
medical records provided contains the required evidence of
medical necessity. CMS has requested that DHCS explore
SB 296
Page 4
establishing a process to enact fines, sanctions and penalties,
or corrective actions as a way to ensure compliance.
The sponsors of this bill, California Council of Community
Mental Health Agencies, state that paperwork reduction is one
great way of increasing the efficiency of our health care system
while actually helping to improve outcomes. The sponsors state
that this bill achieves that by requiring DHCS to develop a
single set of service documentation requirements for the
provision of SMH services. The California Chapter of the
American College of Emergency Physicians state in support of
this bill that individual counties across the state have their
own documentation requirements, adding substantially to the
amount of time Medi-Cal providers spend documenting their
services. The American Association for Marriage and Family
Therapy California Division argues that paperwork overload
contributes to workplace fatigue and that this bill will improve
the morale of mental health workers.
There is no known opposition.
Analysis Prepared by:
Paula Villescaz / HEALTH / (916) 319-2097 FN:
0001953
SB 296
Page 5