BILL ANALYSIS                                                                                                                                                                                                    Ó



          SENATE COMMITTEE ON APPROPRIATIONS
                             Senator Ricardo Lara, Chair
                            2015 - 2016  Regular  Session

          SB 614 (Leno) - Medi-Cal:  mental health services:  peer and  
          family support specialist certification
          
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          |Version: April 6, 2015          |Policy Vote: HEALTH 9 - 0       |
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          |Urgency: No                     |Mandate: No                     |
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          |Hearing Date: April 27, 2015    |Consultant: Brendan McCarthy    |
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          This bill meets the criteria for referral to the Suspense File.



          


          Bill  
          Summary:  SB 614 would require the Department of Health Care  
          Services to establish a program for certifying peer and family  
          support specialists (PFSS) to provide services to Medi-Cal  
          beneficiaries with mental health care needs.


          Fiscal  
          Impact:  
           One-time costs, likely in the hundreds of thousands per year  
            for one to three years, to develop program standards and seek  
            federal approvals by the Department of Health Care Services  
            (Mental Health Services Act funds, General Fund, and federal  
            funds). The bill requires the Department to establish a  
            certifying body for PFSS, to define the responsibilities of  
            PFSS, specify training requirements, set other standards, and  







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            adopt regulations. The bill also requires the Department to  
            amend its State Plan for the Medi-Cal program to allow PFSS to  
            provide services. Staff estimates that the Department will  
            incur additional staff costs in the hundreds of thousands per  
            year for one to three years.

           Uncertain ongoing costs to manage the program (Mental Health  
            Service Act funds, General Fund, federal funds, or special  
            funds). The bill requires the Department to establish a  
            certifying body to provide for the certification of PFSS.  
            However, the bill also requires the Department to provide for  
            statewide certification of PFSS. If the Department is able to  
            designate one or more third-party bodies to provide  
            certification to PFSS, then the annual cost to administer the  
            certification program is likely to be minimal. However, if the  
            Department is unable to identify a third-party organization to  
            certify PFSS, then the bill appears to require the Department  
            to fulfill that role. The total cost to actually provide  
            certification services is unknown, and will depend on the  
            number of applicants. If the Department fulfills that  
            responsibility, the annual costs could be in the hundreds of  
            thousands to millions per year (although they could be offset  
            by application fee revenues).

           Uncertain impact on county mental health plans that provide  
            specialty mental health services in the Medi-Cal program  
            (county funds and federal funds). Under current law, county  
            mental health plans provide services for Medi-Cal  
            beneficiaries with moderate to severe mental health issues.  
            Creating a new provider type who can provide services to this  
            population may increase overall service utilization, by  
            addressing shortages of providers, which would increase costs.  
            On the other hand, PFSS are likely to be a less costly  
            provider type than other mental health providers in Medi-Cal  
            and could potentially reduce expenditures by providing certain  
            services in a more cost-effective manner. Also, to the extent  
            that counties are already providing peer support services,  
            they are currently unable to draw down federal funding for  
            those costs. Under this bill, they would be able to do so.  
            Finally, to the extent that PFSS are able to provide support  
            and assistance to Medi-Cal beneficiaries with mental illness,  
            it is also possible that the program may reduce the need for  
            more expensive services such as inpatient hospitalizations.  
            The extent to which such cost avoidance may occur is unknown.








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           Uncertain impact on Medi-Cal managed care plans that provide  
            mental health services to Medi-Cal beneficiaries when the  
            mental illness is not severe (General Fund and federal funds).  
            Under current law, Medi-Cal managed care plans provide  
            coverage for mental health service needs of enrolled  
            beneficiaries when the mental illness is not severe enough to  
            warrant specialty mental health services. Creating a new  
            provider type who can provide services to this population may  
            increase overall service utilization, by addressing shortages  
            of providers, which would increase costs. On the other hand,  
            PFSS are likely to be a less costly provider type than other  
            mental health providers in Medi-Cal and could potentially  
            reduce expenditures by providing certain services in a more  
            cost-effective manner. Finally, to the extent that PFSS are  
            able to provide support and assistance to Medi-Cal  
            beneficiaries with mental illness, it is also possible that  
            the program may reduce the need for more expensive services  
            such as inpatient hospitalizations. The extent to which such  
            cost avoidance may occur is unknown.


          Background:  Under state and federal law, the Department of Health Care  
          Services operates the Medi-Cal program, which provides health  
          care coverage to low income individuals, families, and children.  
          Medi-Cal provides coverage to childless adults and parents with  
          household incomes up to 138 percent of the federal poverty level  
          and to children with household incomes up to 266 percent of the  
          federal poverty level. The federal government provides matching  
          funds that vary from 50 percent to 90 percent of expenditures  
          depending on the category of beneficiary.
          Under current law, the provision of mental health services to  
          Medi-Cal beneficiaries is divided between service delivery  
          systems, based on the severity of the mental illness.  
          Beneficiaries with mild mental illness are provided with mental  
          health services by Medi-Cal managed care plans (the vast  
          majority of Medi-Cal beneficiaries are enrolled in managed care  
          plans). Beneficiaries with moderate to severe mental illness are  
          provided mental health services by county mental health plans.


          Federal law allows states to include peer and family support  
          specialists to provide services in state Medicaid programs,  
          provided that PFSS are certified in that state. In California,  








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          PFSS are an eligible service provider for substance use disorder  
          services, but not for mental health services.




          Proposed Law:  
            SB 614 would require the Department of Health Care Services to  
          establish a program for certifying peer and family support  
          specialists (PFSS) to provide services to Medi-Cal beneficiaries  
          with mental health care needs.
          Specific provisions of the bill would:


           Require the Department of Health Care Services to establish a  
            peer and family support specialist program by July 1, 2016;
           Require the Department to establish a certifying body, define  
            the responsibilities and training requirements for PFSS, and  
            establish other requirements on PFSS;
           Require the Department to amend its State Medicaid Plan to  
            include PFSS as a provider type and peer support specialist  
            services as a service type;
           Authorize the use of Mental Health Services Act and Workforce  
            Training and Education Program funds to implement the bill;
           Require the Department to adopt implementing regulations by  
            July 1, 2018, but allow the Department to implement the bill  
            without adopting regulations until the regulations are  
            adopted.




          Related  
          Legislation:  SB 2374 (Mansoor, Statutes of 2014) requires the  
          Department to conduct periodic reviews of certifying  
          organizations for substance use disorder counselors.


          Staff  
          Comments:  Current federal law allows states to apply for  
          "Section 1115 waivers" of requirements of the federal Social  
          Security Act. This process allows states, on a case by case  
          basis, to make changes to their Medicaid program with the  
          approval of the federal Centers for Medicare and Medicaid  








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          Services. In general, for the federal government to approve a  
          waiver, the state must demonstrate that will assist in promoting  
          the objectives of Medicaid and that total federal costs will not  
          exceed fee-for-service equivalent costs to the federal  
          government over the period of the waiver, typically five years.
          The Department of Health Care Services has been engaged in the  
          process for developing a new Section 1115 waiver and has  
          submitted a preliminary proposal to the federal government.  
          Under that proposal, the state would be eligible for about $17  
          billion in additional federal funding to invest in innovative  
          programs, such as more comprehensive care for the uninsured  
          population, workforce development, and programs to transform  
          health care delivery systems. In the state's preliminary  
          proposal to the federal government, the Department included peer  
          support specialists as a target for additional workforce  
          development funding. To the extent that the state's initial  
          proposal is ultimately adopted, there may be additional federal  
          funding available to support the use of peer and family support  
          specialist in the Medi-Cal program.




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