BILL ANALYSIS Ó
SENATE COMMITTEE ON EDUCATION
Senator Carol Liu, Chair
2015 - 2016 Regular
Bill No: SB 1113
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|Author: |Beall |
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|Version: |March 28, 2016 Hearing |
| |Date: April 6, 2016 |
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|Urgency: |No |Fiscal: |Yes |
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|Consultant:|Lynn Lorber |
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NOTE: This bill has been referred to the Committees on
Education and Health. A "do pass" motion should
include referral to the Committee on Health.
Subject: Pupil health: mental health
SUMMARY
This bill authorizes local educational agencies (LEAs) to enter
into partnerships, as specified, with county mental health plans
for the provision of Early and Periodic Screening, Diagnosis,
and Treatment (EPSDT) mental health services and to expand the
allowable uses of specified mental health funds, and requires
the California Department of Education (CDE) to expand its
reporting system for mental health services to include academic
performance and other measures.
BACKGROUND
Existing law requires:
1) The Superintendent of Public Instruction (SPI) to ensure
that student and program performance results are monitored
at the state and local levels by evaluating student
performance against key performance indicators.
2) The SPI, as part of state monitoring and enforcement, to
use quantifiable indicators, and qualitative indicators as
needed, to adequately measure performance in the indicators
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established by the United States Secretary of Education in
the priority areas described in #1 above.
(Education Code § 56600.6)
Existing law establishes the Medi-Cal EPSDT program for eligible
people under 21 years of age to provide periodic screenings to
determine health care needs and based upon the identified health
care need and diagnosis, treatment services are provided.
Existing law provides that EPSDT services are to be administered
through local county mental health plans under contract with the
State Department of Health Care Services.
(Welfare & Institutions Code § 14700, et seq.)
ANALYSIS
This bill authorizes LEAs to enter into partnerships, as
specified, with county mental health plans for the provision of
EPSDT mental health services and to expand the allowable uses of
specified mental health funds, and requires the CDE to expand
its reporting system for mental health services to include
academic performance and other measures. Specifically, this
bill:
1) Authorizes a local educational agency (LEA) to enter
into a partnership that includes all of the following:
a) An agreement between the county mental health
plan and the LEA 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 LEA 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 a
student not in special education who a teacher
believes may require those services and, with parental
consent, to provide mental health services to those
students.
b) The county mental health plan and the LEA use
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,
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for mental health service costs for non-Medi-Cal
enrolled students in special education, and for
students not part of special education if the services
are provided by a provider pursuant to the agreement
described above.
c) 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.
d) The LEA, 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.
e) The LEA covers the costs of mental health
provider services not reimbursed by governmental funds
or from insurers 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 LEA following a year-end cost
reconciliation process, and in the event that the LEA
does not elect to provide the services through other
means.
f) 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 LEA.
g) The LEA participates in any performance system
established by the California Department of Education
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 LEA.
h) A plan to establish a partnership in at least
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three schools within the local educational agency
(LEA) in the first year and to expand the partnership
to three additional schools in the second year.
1) Requires the California Department of Education (CDE) to
expand its reporting system for mental health services
provided pursuant to a student's individualized education
program (IEP) to include academic performance and any
measures included within the Early and Periodic Screening,
Diagnosis, and Treatment (EPSDT) mental health services
performance outcome system.
2) Requires the CDE to enter into an agreement with the
State Department of Health Care Services (DHCS) to provide
academic performance data to DHCS for use in its
performance outcome system regarding students who are
enrolled in Medi-Cal and special education who receive
mental health services.
3) Requires the Mental Health Services Oversight and
Accountability Commission to provide guidance and
best-practices guidelines for counties that choose to
implement partnership programs for early intervention and
prevention with LEAs and public schools.
4) Requires 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, as specified.
5) Requires 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, as
specified.
STAFF COMMENTS
1) Need for the bill. According to the author, "A key finding
of the audit (Student Mental Health Services: Some
Students' Services Were Affected by a New State Law, and
the State Needs to Analyze Student Outcomes and Track
Service Costs; January 2016) was that LEAs and counties
could benefit financially and improve student access to
mental health services by collaborating to provide services
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to Medi-Cal eligible students. Although successful models
have demonstrated partnerships like SB 1113 benefit both
the counties and LEAs by increasing access to necessary
mental health services for all Medi-Cal eligible school-age
children, they are rarely implemented by LEAs. LEAs cannot
access funding for those EPSDT services unless they
contract with their respective counties. Some LEAs and
counties disagree over who should pay for the state match
as required under the EPSDT program.
2) Recent State audit and EPSDT. The Bureau of State Audits
released a report in January 2016, title Student Mental
Health Services: Some Students' Services Were Affected by a
New State Law, and the State Needs to Analyze Student
Outcomes and Track Service Costs. This bill relates to the
section of the audit that is specific to the EPSDT program,
which is a Medi-Cal benefit for people under the age of 21
who have "full-scope" Medi-Cal eligibility. The EPSDT
program provides eligible children access to a range of
mental health services that include, among other things,
mental health assessment, mental health services, therapy,
rehabilitation, therapeutic behavioral services, crisis
intervention/stabilization, day rehabilitation/day
treatment, medication support and case management. Early
and Periodic Screening, Diagnosis, and Treatment (EPSDT)
services are administered through county mental health
plans under contract with the California Department of
Health Care Services; local educational agencies (LEAs) may
provide and bill for EPSDT mental health services only
pursuant to a contract with the county mental health plan
(either the county mental health plan provides and bills
for the service, or the LEA becomes a certified provider
via the county mental health plan and the LEA provides and
bills for the service).
The audit noted that although LEAs cannot access funding for
EPSDT services unless they contract with their respective
counties, such collaborations could financially benefit
both counties and LEAs and increase the provision of
services to children. This audit recommended that the
Legislature require counties to enter into agreements with
special education local plan areas (SELPAs) to allow SELPAs
and their LEAs to access EPSDT funding through the county
mental health programs by providing EPSDT mental health
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services.
[http://www.bsa.ca.gov/pdfs/reports/2015-112.pdf]
3) Partnerships. According to the recent State audit, the
Children's Center at Desert Mountain SELPA's collaboration
with San Bernardino County is financially beneficial for
both the SELPA and the county. The SELPA contributes a
portion of San Bernardino's match of federal
reimbursements, saving the county funds that it would
otherwise have to contribute as the local entity. Under
the terms of its agreement with San Bernardino, Desert
Mountain was able to access approximately $4 million in
federal EPSDT funds to provide mental health services in
fiscal year 2014-15. This arrangement enables Desert
Mountain to provide mental health services to
Medi-Cal-eligible students with and without individualized
education programs (IEPs). The State audit also describes
a contractual agreement between Mt. Diablo Unified School
District and the county mental health department for Mt.
Diablo to receive Medi-Cal funds as a provider of EPSDT
services to Medi-Cal-eligible students.
This bill establishes a framework for partnerships and
authorizes counties and LEAs to enter into such
partnerships. It is unnecessary to provide statutory
authority to form a partnership, as the Education Code is
permissive, and the examples of existing partnerships
described above demonstrates that such partnerships exist
without explicit statutory authority.
Could this bill restrict the use of funds by LEAs that are not
in a partnership, or provide flexibility for the use of
funding only to those partnerships that follow the model
provided for in this bill? It is unclear if either of the
two existing partnerships mentioned above meet the
parameters established by this bill.
4) Responsibility for costs. This bill requires partnerships
to include provisions for LEAs to be responsible for the
costs of providing mental health services in specific
situations. Should the State endorse the formation of
partnerships that pre-determine fiscal decisions that may
be best left to the local partners?
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This bill provides that a partnership is to include an agreement
that the LEA is to cover the costs of mental health
provider services not reimbursed by governmental funds or
from insurers 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
LEA. Should LEAs always be responsible for the costs of
services that are not reimbursed by Medi-Cal or by
insurers?
This bill provides that a county mental health plan and an LEA
in a partnership are to use designated governmental funds
as the required match for eligible Medi-Cal Early and
Periodic Screening, Diagnosis, and Treatment (EPSDT)
reimbursement. Should this bill specify which funds may,
and may not, be used for the match?
This bill provides that a partnership is to require the county
mental health plan provider to bill non-Medi-Cal insurers
for services to students with health insurance for
non-IEP-related covered services. Should this bill be
amended to include a cross-reference to existing law that
requires parental consent prior to billing the parent's
insurance?
5) IEP funds for non-IEP based services? Existing law
restricts the use of AB 114 funds by providing that they
may only be used to provide IEP-based mental health
services. The audit found that some LEAs had not spent all
of the state mental health funds it had received, but did
not specifically recommend expanding the allowable uses of
AB 114 funds. It is not clear that IEP-based services
suffered as a result. This bill allows AB 114 funds to be
used for non-IEP-based mental health services. Will
authorizing AB 114 funds to be utilized for mental health
services outside of a student's IEP result in a reduction
in funding for IEP-based services? Staff recommends an
amendment to prohibit the use of AB 114 funds for
non-IEP-bases services unless the LEA first receives a
waiver from the State Board of Education.
6) Reporting systems for mental health services. This bill
requires the California Department of Education (CDE) to
expand its reporting system for mental health services
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provided pursuant to a student's individualized education
programs (IEP) to include academic performance. It is
unclear exactly which academic measures are excluded from
CDE's existing reporting system, or if this data is
currently available. Will this provision increase data
collection and reporting requirements? Is the data related
to a provision in SB 884 (Beall) that requires LEAs to
provide student outcomes on specific indicators?
7) Role for the Senate Health Committee. This bill has been
double-referred to the Senate Health Committee as it
contains provisions within the jurisdiction of that
Committee. This analysis reflects only provisions within
the jurisdiction of this Committee. It is presumed that
the Senate Health Committee analysis will reflect relevant
provisions, such as those that require health care service
plan and health insurers to reimburse services provided by
a mental health provider operating within the scope of its
practice for services provided on a school campus, as
specified.
Further, any amendments that may be approved by this
Committee must be adopted by the Senate Health Committee,
due to time constraints and legislative deadlines.
8) Related legislation. SB 884 (Beall) requires local
educational agencies and special education local plan areas
to collect and report specific information relative to
mental health services, requires the California Department
of Education (CDE) to monitor and compare specific
information, and expands the situations in which parents
must be provided with notice of procedural safeguards and
prior written notification of proposed activities. SB 884
is scheduled to be heard by this Committee on April 6.
AB 1644 (Bonta), the School-Based Early Mental Health
Intervention and Prevention Services Support Program,
establishes a four-year pilot program to encourage and
support local decisions to provide funding for the eligible
support services. AB 1644 is pending in the Assembly
Education Committee.
9) Prior legislation. AB 1025 (Thurmond, 2015) required a
designated county office of education to establish a
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three-year pilot program in school districts to encourage
inclusive practices that integrate mental health, special
education, and school climate interventions following a
multi-tiered framework. AB 1025 was held in the Senate
Appropriations Committee.
SB 463 (Hancock, 2015) required the CDE, to the extent that
funding is available in the Budget Act of 2015, to
designate a county office of education to be the fiduciary
agent for the Safe and Supportive Schools Train the Trainer
Program. SB 463 is pending in the Assembly Education
Committee.
AB 1133 (Achadjian, 2015) required the State Public Health
Officer to establish a four-year pilot program to, among
other things, provide free regional training and technical
assistance in support services that include intervention
and prevention services, use of trained staff to meet with
students on a short-term weekly basis in a one-on-one
setting, the potential for support services to help fulfill
state priorities described by the local control funding
formula and local goals described by local control and
accountability plans, and state resources available to
support student mental health and positive learning
environments. AB 1133 was held in the Assembly
Appropriations Committee.
AB 580 (O'Donnell, 2015) required the CDE to develop model
referral protocols for voluntary use by schools to address
the appropriate and timely referral by school staff of
students with mental health concerns. AB 580 vetoed by the
Governor, whose veto message read:
California does not currently have specific model
referral protocols for addressing student mental
health as outlined by this bill. However, the
California Department of Education recently
received a grant from the federal Department of
Health and Human Services, Substance Abuse and
Mental Health Services Administration to identify
and address critical student and family mental
health needs. It's premature to impose an
additional and overly prescriptive requirement
until the current efforts are completed and we
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can strategically target resources to best
address student mental health.
AB 1018 (Cooper, 2015) required the California Department
of Education (CDE) and the Department of Health Care
Services to convene a task force to examine the delivery of
mental health services through the Early and Periodic
Screening, Diagnosis, and Treatment services. AB 1018 was
held in the Senate Appropriations Committee.
SB 596 (Yee, 2014) required the CDE to establish a
three-year pilot program to encourage inclusive practices
that integrate mental health, special education, and school
climate interventions following a multi-tiered framework.
SB 596 was held at the Assembly Desk.
AB 174 (Bonta, 2014) required the Department of Public
Health to establish a pilot program in Alameda County, to
the extent that funding is made available, to provide
grants to eligible applicants for activities and services
that directly address the mental health and related needs
of students impacted by trauma. AB 174 was vetoed by the
Governor, whose veto message read:
I support the efforts of the bill but am
returning it without my signature, as Alameda
County can establish such a program without state
intervention and may even be able to use Mental
Health Services Act funding to do so. Waiting
for the state to act may cause unnecessary delays
in delivering valuable mental health services to
students. All counties - not just Alameda- should
explore all potential funding options, including
Mental Health Services Act funds, to tailor
programs that best meet local needs.
SUPPORT
None received.
OPPOSITION
None received.
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