Amended in Senate April 12, 2016

Amended in Senate March 28, 2016

Senate Bill No. 1113

Introduced by Senator Beall

February 17, 2016

An act to add Section 56601.3 to the Education Code, begin delete to add Section 1374.18 to the Health and Safety Code, to add Section 10123.23 to the Insurance Code, end delete 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.

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 begin delete county-operated or county-contracted, end delete begin insert county operated or county contracted end insert for the provision of mental health services to begin delete students end delete begin insert pupils end insert 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 begin delete students end delete begin insert pupils end insert not in special education who a teacher believes may require those services and, with parental consent, to provide mental health services to those begin delete students. end delete begin insert pupils. end insert 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.

begin insert

The bill would require funds made available in the annual Budget Act for the purpose of providing educationally related mental health services required by an individualized education program to be used only for that purpose unless the State Board of Education grants a waiver allowing those funds to be expended for other purposes.

end insert begin delete

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.

end delete begin delete

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 begin delete special education local plan area end delete begin insert SELPA end insert 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 begin insert State end insert Department of Education to expand its reporting system for mental health services provided pursuant to an begin delete individual end delete begin insert individualized end insert education begin delete plan end delete begin insert program end insert 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 begin insert State end insert Department of Education to enter into an agreement with the State Department of Health Care Services to provide academic performance data to the begin insert State end insert 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.

end delete begin delete

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

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

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 begin insert State end insert Department of Education shall expand
its reporting system for mental health services provided pursuant
to an begin delete individual end delete begin insert individualized end insert education begin delete plan end delete begin insert program end insert 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 begin insert State end insert 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.

begin delete

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.

end delete

begin delete SEC. 4. end delete

begin insert SEC. 2. end insert   

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.

begin delete SEC. 5. end delete

begin insert SEC. 3. end insert   

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 begin delete students end delete begin insert pupils end insert 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
begin delete students end delete begin insert pupils end insert not in special education who a teacher believes
may require those services and, with parental consent, to provide
mental health services to those begin delete students. end delete begin insert pupils. end insert

(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
begin delete students end delete begin insert pupils end insert enrolled in Medi-Cal, for mental health service
costs for non-Medi-Cal enrolled begin delete students end delete begin insert pupils end insert in special education
with begin delete an individual end delete begin insert individualized end insert education begin delete plan (IEP) end delete begin insert programs
(IEPs) end insert pursuant to the federal Individuals with Disabilities
Education Act (20 U.S.C. Sec. 1400 et seq.), and for begin delete students end delete begin insert pupils end insert
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 begin delete students end delete begin insert pupils end insert 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 begin delete services as set forth in Section
1374.18 of the Health and Safety Code and Section 10123.23 of
the Insurance Code. end delete begin insert services. end insert

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

(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 yearend 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 begin insert State end insert 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.

begin insert

(b) Funds made available in the annual Budget Act for the
purpose of providing educationally related mental health services,
including out-of-home residential services for emotionally
disturbed pupils, required by an individualized education program
shall be used only for that purpose unless the State Board of
Education grants a waiver allowing those funds to be expended
for other purposes.

end insert begin delete

(b)

end delete

begin insert (c) end insert  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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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.

end delete