BILL ANALYSIS Ó
SENATE COMMITTEE ON APPROPRIATIONS
Senator Ricardo Lara, Chair
2015 - 2016 Regular Session
SB 1113 (Beall) - Pupil health: mental health
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|Version: April 14, 2016 |Policy Vote: ED. 8 - 1, HEALTH |
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|Urgency: No |Mandate: No |
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|Hearing Date: May 9, 2016 |Consultant: Jillian Kissee |
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This bill meets the criteria for referral to the Suspense File.
Bill 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. It also requires the California Department of
Education (CDE) and the Department of Health Care Services
(DHCS) to enter into an agreement and update their reporting
systems to track academic outcomes and other measures for
individuals enrolled in Medi-Cal and special education who
receive mental health services.
Fiscal Summary:
Unknown costs to implement the grant program as it would
depend upon the amount of funding that is transferred into
the County and Local Educational Agency Partnership Fund
(Partnership Fund). The author's office intends for this
bill to fund about 10 LEAs at $600,000 each year for three
schools per LEA. Under this scenario, costs would be $18
million per year. Actual costs could be higher or lower
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depending upon available funding. See staff comments.
(Proposition 98)
To the extent Partnership funds are used for mental
health services not required by an individualized education
program (IEP), there would be a cost pressure to increase
state funds by a similar amount that is transferred, to
backfill the special education program to meet the federal
maintenance of effort requirement. (Proposition 98)
CDE estimates the costs to prepare and report required
data and to administer the competitive grant process, to be
up to $150,000 General Fund across several positions.
Unknown, potentially significant costs to the Department of
Health Care Services and CDE to enter into a data sharing
agreement. Associated cost pressures and potential
significant mandate for LEAs to report the required data to
CDE (Proposition 98).
To the extent the use of moneys from the Partnership
Fund leads to increased access to federal Medi-Cal funds,
LEAs would presumably be able to provide additional
services to eligible students in their jurisdiction.
(Federal funds)
Background: This bill is in response to a finding of an audit
conducted by the Bureau of State Audits, 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) that LEAs and counties could
benefit financially and improve student access to mental health
services by collaborating to provide services to Medi-Cal
eligible students. According to a survey conducted of the SELPA
Administrators of California members, six SELPAs report having
an EPSDT partnership in place.
In 2011, AB 114 shifted the responsibility of providing
educationally-related mental health services from county mental
health agencies to LEAs. LEAs are required to ensure services
are provided to students regardless of who provides or pays.
The EPSDT program is a Medi-Cal benefit for people under the age
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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 provides eligible
children access to a range of mental health services including,
mental health assessments, mental health services, therapy,
rehabilitation, therapeutic behavioral services, crisis
intervention/stabilization, day rehabilitation/day treatment,
medication support, and case management.
LEAs 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. According to CDE, LEAs can use one or
more of the following options for sourcing mental health
services to Medi-Cal eligible students: (1) provide and pay for
services without seeking Medi-Cal reimbursement; (2) use the LEA
Medi-Cal Billing Option Program (which does not cover as many
services as EPSDT); or (3) for EPSDT services, collaborate with
county mental health departments to secure the specialty mental
health services through the county mental health plan. LEAs can
do this by entering into a Memorandum of Understanding with the
county mental health plan for 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.
The LEA can also request to be a certified provider of Medi-Cal
specialty mental health services from the county mental health
plan. This would allow the LEA to provide the specialty mental
health services through an LEA qualified employee and submit a
claim to the county mental health plan for federal
reimbursement.
Proposed Law:
Requires the CDE to expand its reporting system to
include academic performance and any measures with the
DHCS' EPSDT mental health services performance outcome
system, as specified.
Requires the CDE and the DHCS to enter into an agreement
to provide relevant academic data, to the DHCS 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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Authorizes a county and LEA to enter into a partnership
that, among other things, utilizes designated governmental
funds for eligible 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 IEPs, and for students not part of
special education; utilizes, with consent, information of
the health insurance carrier for each student; allows
participation of the county mental health plan and the LEA
in a performance outcome system, as specified.
This bill creates the Partnership Fund for which moneys
are available upon appropriation by the Legislature to the
CDE to fund these partnerships through a competitive grant
program.
This bill requires that to the extent there is an
appropriation in the annual budget act for educationally
related mental health services, the Superintendent of
Public Instruction allocate these funds to the Partnership
Fund. This bill also requires that funding for
educationally related mental health services pursuant to an
IEP provided in the budget be used only for that purpose
unless the State Board of Education grants a waiver
allowing these funds to be expended for other purposes.
Related Legislation: SB 884 (Beall) requires, among other
things, LEAs and SELPAs to collect and report specific
information relative to mental health services, and requires CDE
to monitor and compare specified information related to the
level of special education services being provided. SB 884 is
scheduled to be heard by this Committee on May 9, 2016.
Staff Comments: The bill requires, to the extent educationally
related mental health services funding is appropriated in the
budget (which has been an ongoing appropriation for several
years), those funds are to be transferred into the Partnership
Fund. Though the current year budget provides $431 million for
this purpose, it is unclear how much would be transferred into
the new fund. The bill provides that agreements entered into
between the county mental health plan and the LEA may include
provisions for the delivery of mental health services to
students not in special education. However, this bill requires
that before providing services outside an IEP using these funds,
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a waiver must first be granted by the State Board of Education.
Staff notes that the federal Individuals with Disabilities
Education Act prohibits states from providing state financial
support for special education and related services below the
amount of the preceding fiscal year. Therefore the state would
not be able to count mental health services provided to students
not required by an IEP towards the maintenance of effort (MOE)
requirement. This would either require a Proposition 98
backfill to maintain the same level of state program support, or
the state could be required to return the portion of federal
funds to the United States Department of Education that it fell
short from meeting the MOE requirement. LEAs are also held to a
similar MOE requirement at the local level.
This bill authorizes the partnerships to address how to cover
the costs of mental health provider services not reimbursed by
Medi-Cal EPSDT and how to pay the required match. Though these
obstacles are similar to those experienced today, in order to
receive a grant pursuant to this bill, counties and LEAs would
have to come to an agreement, locally, on the provision of
services and the corresponding financial responsibility.
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