BILL ANALYSIS Ó
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: SB 1113
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|AUTHOR: |Beall |
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|VERSION: |April 14, 2016 |
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|HEARING DATE: |April 20, 2016 | | |
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|CONSULTANT: |Teri Boughton |
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SUBJECT : Pupil health: mental health
SUMMARY : Permits a county and a local education agency to enter into a
partnership to provide mental health services to pupils.
Establishes the County and Local Education Agency Partnership
Fund (Fund) and requires the State Department of Education (CDE)
to use the Fund for the partnerships established in this bill.
Requires CDE to expand its reporting system for mental health
services to include academic performance outcomes and enter into
an agreement with the Department of Health Care Services (DHCS)
to utilize the information in DHCS' Early and Periodic
Screening, Diagnosis and Treatment mental health service
performance outcome system.
Existing law:
1)Establishes the Medi-Cal program, administered by DHCS, under
which qualified low-income persons receive health care
benefits.
2)Establishes the Medi-Cal Early and Periodic Screening,
Diagnosis and Treatment (EPSDT) program for eligible
individuals under 21 years, including screening, vision,
dental, hearing, and other necessary services to correct or
ameliorate defects and physical and mental illnesses and
conditions discovered by the screening services, whether or
not the services are covered under the Medicaid State Plan.
3)Establishes, under the terms of a federal Medicaid waiver, a
managed care program providing Medi-Cal specialty mental
health services for eligible low-income persons administered
through local county mental health plans under contract with
DHCS.
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4)Defines a local education agency (LEA) as the governing body
of any school district or community college district, the
county office of education, a state special school, a
California State University campus, or a University of
California campus.
5)Defines the scope of covered services that an LEA may provide
for children with an individualized education plan (IEP) or an
individualized family service plan (IFSP).
6)Requires that specified services provided by a LEA are
Medi-Cal benefits, to the extent federal financial
participation (FFP) is available, are subject to utilization
controls and standards adopted by DHCS, and are consistent
with Medi-Cal requirements for physician prescription, order,
and supervision.
7)Requires county mental health plans to provide specialty
mental health services to eligible Medi-Cal beneficiaries,
including both adults and children. Includes EPSDT within the
scope of specialty mental health services for eligible
Medi-Cal beneficiaries under the age of 21 pursuant to federal
Medicaid law.
8)Establishes the Mental Health Services Oversight and
Accountability Commission (MHSOAC) to oversee the
implementation of the Mental Health Services Act (MHSA),
enacted by voters in 2004 as Proposition 63, which provides
funds to counties to expand services, and develop innovative
programs and integrated service plans, for mentally ill
children, adults, and seniors through a one percent income tax
on personal income above $1 million.
9) Requires DHCS, in collaboration with the California Health
and Human Services Agency (CHHS), and in consultation with the
MHSOAC, to create a plan for a performance outcome system for
EPSDT mental health services provided to eligible Medi-Cal
beneficiaries under the age of 21.
This bill:
1)Requires CDE to expand its reporting system for mental health
services provided pursuant to an IEP for children with a
primary mental health diagnosis as emotional disturbance to
include academic performance and any measures included within
DHCS' EPSDT mental health services performance outcome system
SB 1113 (Beall) Page 3 of ?
within 18 months after those measures have been adopted by
DHCS.
2)Requires CDE to enter into an agreement with DHCS to provide
relevant academic performance data as determined by CDE to
DHCS for utilization in its performance outcome system
regarding individuals enrolled in Medi-Cal and special
education who receive mental health services.
3)Permits a county and a 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 pupils of the LEA. Permits the agreement
to include provisions for the delivery of campus-based
mental health services through qualified mental health
clinicians to provide on-campus support to identify
pupils not in special education who a teacher believes
may require those services and, with parental consent,
to provide mental health services to those pupils;
b) That the county mental health plan and the LEA
utilize designated governmental funds as required for
eligible Medi-Cal EPSDT reimbursement for services
provided to pupils enrolled in Medi-Cal, for mental
health service costs for non-Medi-Cal enrolled pupils
in special education with IEPs, and for pupils not
part of special education if the services are provided
by a provider described in 3a) above;
c) That the LEA, with permission of the pupil's
parent, provides the county mental health plan
provider with the information of the health insurance
carrier for each pupil;
d) That the agreement between the county mental
health plan and the LEA addresses how to cover the
costs of mental health provider services not
reimbursed by funds pursuant to 3b) 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
yearend cost reconciliation process, and in the event
that the LEA does not elect to provide the services
through other means;
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e) That the agreement between the county mental
health plan and the LEA fulfills reporting
requirements under state and federal Individuals with
Disabilities Education Act (IDEA) and Medi-Cal EPSDT
provisions, and measure the effect of the mental
health intervention and how that intervention meets
the goals in a pupil's IEP or relevant plan for
non-IEP pupils;
f) That the county mental health plan
participates in any performance outcome system
established by DHCS to measure results of services
provided under the partnership agreement between the
county mental health plan and the LEA.
g) That the LEA participates in any performance
system established by CDE, as specified, 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. The LEA also reports
applicable information to the performance outcome
system established by DHCS for those pupils whose
information is not reported under 3f); and,
h) A plan to establish a partnership described in
this bill with at least one school within the LEA in
the first year and to expand the partnership to three
additional schools within three years.
4)States legislative intent, where applicable and to the extent
mutually agreed to by a school district and a plan or insurer,
a health care service plan or a health insurer is authorized
to participate in the partnerships described in this bill.
5)Establishes the Fund in the State Treasury. Requires moneys
in the Fund to be appropriated by the Legislature to CDE for
the purpose of funding the partnerships described in this
bill. Requires CDE to fund partnerships through a competitive
grant program.
6)Requires the Superintendent of Public Instruction to allocate
funds from the appropriation to the Fund for the 2017-2018
fiscal years and each fiscal year thereafter, to the extent
there is an appropriation in the annual Budget Act. Permits
other funds identified and appropriated by the Legislature to
be deposited into the Fund.
SB 1113 (Beall) Page 5 of ?
7)Requires funds made available in the Annual Budget Act for the
purposes of providing educationally related mental health
services, including out-of-home residential services for
emotionally disturbed pupils, required by an IEP 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.
FISCAL
EFFECT : This bill has not been amended by a fiscal committee.
COMMENTS :
1)Author's statement. According to the author, SB 1113 remedies
a key problem uncovered by a Joint Legislative audit request
that investigated whether school districts are meeting their
legal obligations to provide the appropriate services to
students with a mental health condition identified in their
IEP following the transition from AB 3632 (Willie Brown,
Chapter 26, Statutes of 1984) to AB 114 (Committee on Budget,
Chapter 43, Statutes of 2011). The audit was triggered by many
families and advocacy organizations who expressed difficulty
accessing mental health services for children with a mental
health-related component in their IEP. The audit found that
LEAs and counties could benefit financially and improve access
to mental health services by collaborating to provide services
to Medi-Cal eligible students. However, these types of
partnerships were rarely implemented. As an example, the audit
researched the records of the Mt. Diablo Unified School
District and found the District receives roughly $1.3 million
in federal funds per year through their partnership with
Contra Costa County. Desert Mountain Special Education Local
Plan Area's (SELPA's) agreement with San Bernardino County has
allowed it to access almost $4 million for FY 14/15. LEAs
cannot access funding for those EPSDT services unless they
contract with their respective counties. SB 1113 provides
financial incentives to create these partnerships.
2)Background. The federal IDEA provides that students with
exceptional needs identified as having emotional disturbance
may be eligible to receive mental health services, which are
considered related services and include counseling,
psychological services, parent counseling and training, and
residential placement, among others. Prior to 2012, a student
with exceptional needs, who also had mental health needs and
services documented in their IEP, was referred by the LEAs to
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county mental health agencies for treatment, pursuant to AB
3632. AB 114 shifted responsibility for providing and funding
IDEA-related mental health services from county mental health
agencies to LEAs (the Superintendent of Public Instruction is
responsible for monitoring LEAs to ensure compliance). Any and
all services identified in a student's IEP must be provided,
whether directly by LEA employees or through contract with
outside providers, such as county mental health agencies. LEAs
are required to ensure services are provided to students
regardless of who provides or pays for those services.
The EPSDT program is a Medi-Cal benefit for people under the
age of 21 who have "full-scope" Medi-Cal eligibility. This
benefit allows for periodic screenings to determine health
care needs and, based upon the identified health care need and
diagnosis, treatment services are provided. EPSDT services
include all services otherwise covered by Medi-Cal, and EPSDT
beneficiaries can receive additional medically necessary
services. EPSDT 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.
LEAs are responsible for educationally necessary mental health
services that are identified in a student's IEP, but are
prohibited from directly providing or billing for EPSDT
services unless the county mental health department chooses to
contract with the LEA for those services (EPSDT is considered
specialty mental health). LEAs are required to ensure services
identified in a student's IEP are provided, regardless of
whether the county directly provides services, denies
services, or reimburses the school for any costs if the LEA
provides services (in cases where the LEA provides services
covered under general Medi-Cal that overlap with EPSDT
services).
According to CDE, LEAs may use one or more of the following
options for sourcing mental health services to Medi-Cal
eligible students (including EPSDT and other mental health
services):
a) Provide and pay for services without seeking
Medi-Cal reimbursement;
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b) Use the LEA Medi-Cal Billing Option Program. Through
this program, the LEA employs or contracts with qualified
practitioners to provide the services pursuant to the
IEP, pays for the services, and submits a claim for
reimbursement. In order to use this option, the LEA must
meet a number of administrative conditions, including
enrollment as a Medi-Cal provider; and,
c) For EPSDT services, collaborate with county mental
health departments to secure the specialty mental health
services through the county mental health plan. There are
two ways an LEA can secure these services:
i. Enter into a contract or Memorandum of
Understanding with the mental health plan for a
specialty mental health service or an array of
specialty mental health services. In this case,
county mental health plans provide the service and
incur the cost, and bill Medi-Cal for federal
reimbursement.
ii. Request to be a certified provider of
Medi-Cal specialty mental health services from the
county mental health plan. If the county mental
health plan certifies the LEA as an organizational
provider, the LEA would provide the specialty mental
health service through an LEA qualified employee and
submit a claim to the county mental health plan for
reimbursement.
1)Student Mental Health Services Audit. In January 2016, the
California State Auditor released report 2015-112 which
reviewed the effect of AB 114 of mental health services
provided to pupils through IEPs. Among the findings are: 1)
The mental health services and providers did not change at the
four programs reviewed; 2) In some cases LEAs removed mental
health services from student IEPs because of AB 114 and for
other students, the LEAs could not explain why services were
removed; 3) CDE has not performed an analysis of the education
outcomes to determine if pupil outcomes have improved; 4) CDE
does not require LEAs to track total expenditures for mental
health services; 5) None of the four LEAs could determine
their total costs to provide mental health services; and, 6)
Only one of the four LEAs has contracted with its county to
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access certain funding for mental health services through
Medi-Cal. The audit recommends the Legislature should require
CDE to report annually regarding the outcomes for students
receiving mental health services relative to key performance
indicators; and, require counties to enter into agreements
with SELPAs to allow SELPAs and their LEAs to access EPSDT
funding through county mental health programs by providing
EPSDT mental health services.
2)DHCS Performance Outcome System. The performance outcome
system for EPSDT mental health services is intended to improve
outcomes at the individual, program, and system levels and
inform fiscal decision-making related to the purchase of
services, and is part of the reporting effort for the
implementation of a performance outcome system for Medi-Cal
specialty mental health services for children and youth.
Since 2012, DHCS has worked with several groups to create a
structure for reporting, develop the Performance Measurement
Paradigm, and develop indicators and measures. The performance
outcome system will be used to evaluate the domains of access,
engagement, service appropriateness to need, service
effectiveness, linkages, cost effectiveness and satisfaction.
Three reports will be provided: statewide aggregate data;
population-based county groups, and county-specific data.
Initial reports have been released in 2015.
3)Double referral. This bill has been doubled referred. It was
approved in the Senate Education Committee on April 6, 2016
with a vote of 8 to 1.
4)Related legislation. SB 1291 (Beall) would require each county
mental health plan to submit an annual foster care mental
health service plan to DHCS detailing the service array, from
prevention to crisis services, available to Medi-Cal eligible
children and youth under the jurisdiction of the juvenile
court and their families. In addition, SB 1291 requires a
mental health plan review to be conducted annually by an
external quality review organization (EQRO) that includes
specific data for Medi-Cal eligible children and youth under
the jurisdiction of the juvenile court and their families. SB
1291 is pending in the Senate Appropriations Committee.
5)Prior legislation. AB 1018 (Cooper) would require DHCS and CDE
to convene a joint taskforce to examine the delivery of mental
health services to children. AB 1018 was held in the Senate
SB 1113 (Beall) Page 9 of ?
Appropriations Committee.
SB 276 (Wolk, Chapter 653, Statutes of 2015), requires DHCS to
seek federal financial participation for covered services that
are provided by a LEA to a child who is an eligible Medi-Cal
beneficiary, regardless of whether the child has an IEP or an
individualized family service plan, or whether those same
services are provided at no charge to the beneficiary or to
the community at large, if the LEA takes all reasonable
measures to ascertain and pursue claims for payment of covered
services against legally liable third parties.
SB 1009 (Committee on Budget and Fiscal Review, Chapter 34,
Statutes of 2012), requires DHCS, in collaboration with CHHS,
and in consultation with the MHSOAC and a stakeholder advisory
committee to develop a plan for a performance outcomes system
for EPSDT specialty mental health services provided to
eligible Medi-Cal beneficiaries under the age of 21. The
purpose of the system is to improve beneficiary outcomes and
inform decisions regarding the purchase of services.
AB 2608 (Bonilla, Chapter 755, Statutes of 2012), made
permanent and expanded provisions relating to program
improvement activities in the Medi-Cal Local Billing Option
program, through which LEAs can draw down federal funding for
health care services provided to Medi-Cal-eligible students.
AB 2608 also expanded the scope of transportation services for
which Medicaid reimbursements can receive reimbursement.
AB 114 (Committee on Budget), shifted responsibility for
mental health services for students from counties to LEAs.
6)Support. According to the California Council of Community
Behavioral Health Agencies, this bill incentivizes counties
and LEAs to establish comprehensive partnerships for school
based mental health services that ensure access to EPSDT
funding through county mental health to all Medi-Cal students
who may need mental health care; provides support to teachers
to identify those students as early as possible before they
require special education building on the Early Mental Health
Initiative; addresses the needs of all students through
incentive start-up funds that are likely to lead to offsetting
special education cost savings; develops outcome measures for
all students- especially those with serious emotional
disturbances; and coordinates the outcome systems for academic
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performance developed by CDE. Mental Health America of
California writes schools are the best place to identify and
serve a child early in the onset of a mental disorder as is
unfortunately common especially for those who experience
traumatic events at home or in their communities. There are
examples of excellent partnerships between schools and
counties or county funded mental health providers. This bill
is intended to broaden those types of partnerships throughout
the state.
7)Concerns. The SELPA Administrators of California writes this
bill would require LEAs to contribute to counties' required
match for EPSDT. In addition, under existing law counties and
schools can already enter into EPSDT partnerships, and some
have. The problem has been that very few counties are willing
to allow LEAs to provide EPSDT services. In a survey conducted
of the SELPA Administrators of California membership, which
includes 135 members statewide, only six reported having any
such EPSDT partnership in place. It is worth noting that each
of these programs is unique, and the details are typically
best left up to local partners rather than proscribed by
statute. Another major concern is that this bill would require
LEAs to contribute financially toward the counties' match for
EPSDT. Requiring LEAs to subsidize what is a county
responsibility is misguided, especially in light of the fact
that California ranks 46th in the nation in per-student
spending and that special education costs have risen while
funding for special education has remained flat.
8)Opposition. The California Right to Life Committee believes
the establishment of schools as a headquarters for preventive
mental health services is improper, unwise and costly.
SUPPORT AND OPPOSITION :
Support: California Council of Community Behavioral Health
Agencies (sponsor)
Mental Health America of California
Oppose: California Right to Life Committee, INC
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