Amended in Senate March 28, 2016

Senate Bill No. 1113

Introduced by Senator Beall

February 17, 2016

An act begin insert to add Section 56601.3 to the Education Code, to add Section 1374.18 to the Health and Safety Code, to add Section 10123.23 to the Insurance Code, and to add Section 5846.5 to, and to add Part 6 (commencing with Section 5920) to Division 5 of, the Welfare and Institutions Code, end insert relating to pupil health.

LEGISLATIVE COUNSEL’S DIGEST

SB 1113, as amended, Beall. Pupil health: mental begin delete health services: funding. end delete begin insert health. end insert

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Existing law requires school districts, county offices of education, and special education local plan areas (SELPAs) to comply with state laws that conform to the federal Individuals with Disabilities Education Act, in order that the state may qualify for federal funds available for the education of individuals with exceptional needs. Existing law requires school districts, county offices of education, and SELPAs to identify, locate, and assess individuals with exceptional needs and to provide those pupils with a free appropriate public education in the least restrictive environment, and with special education and related services, including mental health services, as reflected in an individualized education program.

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Existing law contains provisions governing the operation and financing of community mental health services for the mentally disordered in every county through locally administered and locally controlled community mental health programs. Existing law, the Mental Health Services Act (MHSA), an initiative measure enacted by the voters as Proposition 63 at the November 2, 2004, statewide general election, funds a system of county mental health plans for the provision of mental health services, as specified. The MHSA establishes the Mental Health Services Oversight and Accountability Commission to oversee the administration of various provisions of the act.

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This bill would specifically authorize a county and a local educational agency to enter into a partnership that includes, among other things, an agreement between the county mental health plan and the local educational agency that establishes a Medi-Cal mental health provider that is county-operated or county-contracted, for the provision of mental health services to students of the local educational agency and in which there are provisions for the delivery of campus-based mental health services through qualified mental health clinicians to provide on-campus support to identify students not in special education who a teacher believes may require those services and, with parental consent, to provide mental health services to those students. The bill would require the commission to provide guidance and best-practices guidelines for counties that choose to implement partnership programs for early intervention and prevention with local educational agencies and public schools pursuant to these provisions.

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Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care and makes a willful violation of the act a crime. Existing law also provides for the regulation of health insurers by the Department of Insurance.

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This bill would require a health care service plan to reimburse services provided by a mental health provider operating within the scope of its practice for services provided on a school campus pursuant to a partnership described above, as specified. Because a violation of that provision would be a crime, the bill would impose a state-mandated local program. The bill would also require a health insurer to reimburse services provided by a mental health provider operating within the scope of its practice for services provided on a school campus pursuant to a program meeting the criteria set forth above, as specified.

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Existing law requires, pursuant to specified provisions of federal law, each special education local plan area to annually report to the Superintendent of Public Instruction the number of pupils receiving special education services participating in the regular school and district assessments and the number participating in an alternate assessment process.

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This bill would require the Department of Education to expand its reporting system for mental health services provided pursuant to an individual education plan pursuant to the federal Individuals with Disabilities Education Act for children with a primary mental health diagnosis as emotional disturbance to include academic performance and any measures included within the State Department of Health Care Services’ Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) mental health services performance outcome system within 18 months after those measures have been adopted by the State Department of Health Care Services. The bill would also require the Department of Education to enter into an agreement with the State Department of Health Care Services to provide academic performance data to the Department of Health Care Services for utilization in its performance outcome system regarding individuals enrolled in Medi-Cal and special education who receive mental health services.

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The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

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This bill would provide that no reimbursement is required by this act for a specified reason.

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Existing law requires each special education local plan area submitting a local plan to the Superintendent of Public Instruction to ensure that its policies, procedures, and programs are consistent with state and federal laws governing, among other things, free appropriate public education and individualized education programs, and requires the local plan to contain specified information, including an annual budget plan.

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Existing law provides for the Medi-Cal program under which qualified low-income individuals receive health care services. Existing law provides that Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) for any individual under 21 years of age is covered under Medi-Cal, consistent with the requirements of federal law.

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This bill would declare the intent of the Legislature to enact legislation relating to mental health services in schools that would require counties to enter into agreements with special education local plan areas to allow access to Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) funding through the county mental health programs by providing EPSDT mental health services.

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Vote: majority. Appropriation: no. Fiscal committee:  begin delete no end delete begin insert yes end insert . State-mandated local program:  begin delete no end delete begin insert yes end insert .

The people of the State of California do enact as follows:

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begin insert SECTION 1. end insert   

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begin insert Section 56601.3 is added to the end insert begin insert Education Code end insert begin insert ,
to read: end insert

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begin insert 56601.3. end insert   

(a) The Department of Education shall expand its
reporting system for mental health services provided pursuant to
an individual education plan pursuant to the federal Individuals
with Disabilities Education Act (20 U.S.C. Sec. 1400 et seq.) for
children with a primary mental health diagnosis as emotional
disturbance to include academic performance and any measures
included within the State Department of Health Care Services’
Early and Periodic Screening, Diagnosis, and Treatment (EPSDT)
mental health services performance outcome system within 18
months after those measures have been adopted by the State
Department of Health Care Services.

(b) The Department of Education shall enter into an agreement
with the State Department of Health Care Services to provide
academic performance data to the State Department of Health
Care Services for utilization in its performance outcome system
regarding individuals enrolled in Medi-Cal and special education
who receive mental health services.

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begin insert SEC. 2. end insert   

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begin insert Section 1374.18 is added to the end insert begin insert Health and Safety
Code end insert begin insert , to read: end insert

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begin insert 1374.18. end insert   

A health care service plan shall reimburse services
provided by a mental health provider operating within the scope
of its practice for services provided on a school campus pursuant
to a program meeting the criteria set forth in Section 5920 of the
Welfare and Institutions Code as if the services were authorized
by a provider authorized to make that authorization. If the provider
is a member of the health care service plan’s network of providers,
the reimbursement shall be in accordance with the health care
service plan’s contract with that provider. If the provider is not
part of the health care service plan’s network, the services shall
be reimbursed in the manner provided for out of network services
in the same manner as out of network services for patients who
are traveling to a location where there is no in network provider
available.

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begin insert SEC. 3. end insert   

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begin insert Section 10123.23 is added to the end insert begin insert Insurance Code end insert begin insert , to
read: end insert

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begin insert 10123.23. end insert   

A health insurer shall reimburse services provided
by a mental health provider operating within the scope of its
practice for services provided on a school campus pursuant to a
program meeting the criteria set forth in Section 5920 of the
Welfare and Institutions Code as if the services were authorized
by a provider authorized to make that authorization. If the provider
is a member of the health insurer’s network of providers, the
reimbursement shall be in accordance with the health insurer’s
contract with that provider. If the provider is not part of the health
insurer’s network, the services shall be reimbursed in the manner
provided for out of network services in the same manner as out of
network services for patients who are traveling to a location where
there is no in network provider available.

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begin insert SEC. 4. end insert   

end insert

begin insert Section 5846.5 is added to the end insert begin insert Welfare and Institutions
Code end insert begin insert , to read: end insert

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begin insert 5846.5. end insert   

The commission shall provide guidance and
best-practices guidelines for counties that choose to implement
partnership programs for early intervention and prevention with
local educational agencies and public schools pursuant to Section
5920.

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begin insert SEC. 5. end insert   

end insert

begin insert Part 6 (commencing with Section 5920) is added to
Division 5 of the end insert begin insert Welfare and Institutions Code end insert begin insert , to read: end insert

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PART  begin insert 6. end insert   County and Local Educational Agency
Partnerships

 

begin insert 5920. end insert   

(a) Notwithstanding any other law, a county and a local
educational agency may enter into a partnership that includes all
of the following:

(1) An agreement between the county mental health plan and
the local educational agency that establishes a Medi-Cal mental
health provider that is county operated or county contracted, for
the provision of mental health services to students of the local
educational agency and in which there are provisions for the
delivery of campus-based mental health services through qualified
mental health clinicians to provide on-campus support to identify
students not in special education who a teacher believes may
require those services and, with parental consent, to provide mental
health services to those students.

(2) The county mental health plan and the local educational
agency utilize designated governmental funds as required match
for eligible Medi-Cal Early and Periodic Screening, Diagnosis,
and Treatment (EPSDT) reimbursement for services provided to
students enrolled in Medi-Cal, for mental health service costs for
non-Medi-Cal enrolled students in special education with an
individual education plan (IEP) pursuant to the federal Individuals
with Disabilities Education Act (20 U.S.C. Sec. 1400 et seq.), and
for students not part of special education if the services are
provided by a provider specified in paragraph (1).

(3) The county mental health plan provider bills non-Medi-Cal
insurers for services to students with health insurance for
non-IEP-related covered services, and the relevant insurer
reimburses the provider for these services at the usual rates paid
for out of network mental health services as set forth in Section
1374.18 of the Health and Safety Code and Section 10123.23 of
the Insurance Code.

(4) The local educational agency, with permission of the
student’s parent, provides the county mental health plan provider
with the information of the health insurance carrier for each
student.

(5) The local educational agency covers the costs of mental
health provider services not reimbursed by funds pursuant to
paragraph (2) or (3) in the event that mental health service costs
exceed the agreed upon funding outlined in the partnership
agreement between the county mental health plan and the local
educational agency following a year-end cost reconciliation
process, and in the event that the local educational agency does
not elect to provide the services through other means.

(6) The county mental health plan participates in any
performance outcome system established by the State Department
of Health Care Services or the Mental Health Services Oversight
and Accountability Commission to measure results of services
provided under the partnership agreement between the county
mental health plan and the local educational agency.

(7) The local educational agency participates in any
performance system established by the Department of Education
pursuant to Section 56601.3 of the Education Code to measure
performance of special education mental health services and other
mental health services provided under the partnership agreement
between the county mental health plan and the local educational
agency.

(8) A plan to establish a partnership described in this section
in at least three schools within the local educational agency in the
first year and to expand the partnership to three additional schools
in the second year.

(b) For purposes of this section, “local educational agency”
has the same meaning as that term is defined in Section 56026.3
of the Education Code.

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begin insert SEC. 6. end insert   

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No reimbursement is required by this act pursuant to
Section 6 of Article XIII B of the California Constitution because
the only costs that may be incurred by a local agency or school
district will be incurred because this act creates a new crime or
infraction, eliminates a crime or infraction, or changes the penalty
for a crime or infraction, within the meaning of Section 17556 of
the Government Code, or changes the definition of a crime within
the meaning of Section 6 of Article XIII B of the California
Constitution.

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SECTION 1.  

It is the intent of the Legislature to enact
legislation relating to mental health services in schools that would
require counties to enter into agreements with special education
local plan areas to allow the special education local plan areas and
the local educational agencies to access Early and Periodic
Screening, Diagnostic, and Treatment (EPSDT) funding through
the county mental health programs by providing EPSDT mental
health services.

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