BILL NUMBER: SB 1113 AMENDED
BILL TEXT
AMENDED IN SENATE MARCH 28, 2016
INTRODUCED BY Senator Beall
FEBRUARY 17, 2016
An act 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, relating to pupil health.
LEGISLATIVE COUNSEL'S DIGEST
SB 1113, as amended, Beall. Pupil health: mental health
services: funding. health.
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.
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.
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.
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.
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.
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.
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.
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.
This bill would provide that no reimbursement is required by this
act for a specified reason.
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.
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.
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.
Vote: majority. Appropriation: no. Fiscal committee: no
yes . State-mandated local program: no
yes .
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 56601.3 is added to the
Education Code , to read:
56601.3. (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.
SEC. 2. Section 1374.18 is added to the
Health and Safety Code , to read:
1374.18. 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.
SEC. 3. Section 10123.23 is added to the
Insurance Code , to read:
10123.23. 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.
SEC. 4. Section 5846.5 is added to the
Welfare and Institutions Code , to read:
5846.5. 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.
SEC. 5. Part 6 (commencing with Section 5920) is
added to Division 5 of the Welfare and Institutions Code
, to read:
PART 6. County and Local Educational Agency Partnerships
5920. (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.
SEC. 6. 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.
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.