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
SB 614 (Leno) Page 1 of
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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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