BILL ANALYSIS Ó
SB 1113
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Date of Hearing: June 15, 2016
ASSEMBLY COMMITTEE ON EDUCATION
Patrick O'Donnell, Chair
SB
1113 (Beall) - As Amended: June 8, 2016
[Note: This bill has been double referred to the Assembly
Committee on Health, and if passed will be heard by that
committee as it relates to issues under its jurisdiction.]
SENATE VOTE: 39-0
SUBJECT: Pupil health: mental health
SUMMARY: 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. Specifically,
this bill:
1)Authorizes an LEA to enter into a partnership with a county,
or a qualified provider operating as part of the county mental
health plan network, that includes all of the following:
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a) An agreement between the county mental health plan, or
the qualified provider, 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. Authorizes the agreement
to include provisions for the delivery of campus-based
mental health services through qualified providers or
qualified professionals 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, or the qualified
provider, and the LEA use designated governmental funds for
eligible Medi-Cal EPSDT program services provided to
students enrolled in Medi-Cal, 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 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.
d) The agreement between the county mental health plan, or
the qualified provider, and the LEA addresses how to cover
the costs of mental health provider services not covered by
governmental funds in the event that mental health service
costs exceed the agreed-upon funding outlined in the
partnership agreement between the county mental health
plan, or the qualified provider, and the LEA, following a
year-end cost reconciliation process, and in the event that
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the LEA does not elect to provide the services through
other means.
e) The agreement between the county mental health plan, or
the qualified provider, and the LEA fulfills reporting
requirements under state and federal law and Medi-Cal EPSDT
provisions, and measures the effect of the mental health
intervention and how that intervention meets the goals in a
student's individualized education program (IEP) or
relevant plan for students without an IEP.
f) The county mental health plan, or the qualified
provider, and LEA participate in the EPSDT performance
outcome system to measure results of services provided
under the partnership agreement.
g) A plan to establish a partnership in at least one school
within the LEA in the first year and to expand the
partnership to three additional schools within three years.
1)Establishes the County and Local Educational Agency
Partnership Fund in the State Treasury. States that moneys in
the fund, upon appropriation by the Legislature, would be
available to the CDE for the purpose of funding the
partnerships established by the bill, through a competitive
grant program.
2)Requires the SPI, starting in the 2017-18 fiscal year, to
allocate funds appropriated in the Budget Act or another
measure for purposes of the partnerships established by this
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bill to the County and Local Educational Agency Partnership
Fund.
3)Authorizes other funds identified and appropriated by the
Legislature to be deposited into the County and Local
Educational Agency Partnership Fund.
4)Requires 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 students, 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.
5)Requires, as part of the EPSDT performance outcome system,
that the Department of Health Care Services (DHCS) identify
children with an IEP who have a primary mental health
diagnosis as emotional disturbance, and collect and utilize in
the performance outcome system academic performance data and
any other data required for the measures included within the
performance outcome system for these children.
6)Requires DHCS to enter into an agreement with the CDE for the
CDE to provide to DHCS relevant academic performance data, as
determined DHCS, in consultation with the CDE, for utilization
in the performance outcome system.
7)Requires that, within 18 months of DHCS completing the first
report on comprehensive performance outcomes, it begin to
include the above data in its reporting.
8)Defines LEA for purposes of the partnership section to mean a
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school district, a county office of education, a nonprofit
charter school participating as a member of a special
education local plan area, or a special education local plan
area.
EXISTING LAW:
1)Federal law establishes the Individuals with Disabilities
Education Act (IDEA) and related regulations, which requires
that students with disabilities have access to a free and
appropriate public education based on their individual needs,
and establishes procedures for implementing these
requirements.
2)State law defines "related services" to mean services,
including psychological services other than assessment and
development of the IEP, and counseling services, designed to
enable an individual with exceptional needs to receive a free
appropriate public education as described in the IEP of the
child, and to benefit from special education.
3)State law, by removing the responsibility for providing mental
health services for students with disabilities from counties,
establishes that LEAs are responsible for providing these
services.
4)Federal 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
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identified health care need and diagnosis, to provide
treatment services. Existing law provides that EPSDT services
are to be administered through local county mental health
plans under contract with the DHCS.
FISCAL EFFECT:
According to the Senate Appropriations Committee (based on the
April 14, 2016 amended version):
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 depending upon
available funding. (Proposition 98)
To the extent Partnership funds are used for mental health
services not required by an 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)
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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)
COMMENTS:
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 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."
Recent state audit on student mental health services. AB 114
(Chapter 43, Statutes of 2011) transferred the responsibility
for providing mental health services for students with IEPs from
county mental health departments to LEAs.
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In January, 2016, the Bureau of State Audits released a report,
requested by the author and other members of the Legislature, on
the effect of AB 114 on mental health services for students.
The report, titled 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,
found that:
The most commonly offered types of mental health
services and the providers of those services generally did
not change.
The number of students who received these mental health
services remained steady or grew.
The provider of the most common mental health services
generally had already been, and continues to be, the LEA.
The majority of changes to services were unrelated to AB
114, though IEP teams did not always record in the IEP
document their rationale for why a service was removed.
The audit recommended that the Legislature require counties to
enter into agreements with SELPAs to allow SELPAs and LEAs to
access EPSDT funding through the county mental health programs
by providing EPSDT mental health services.
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Audit recommendation regarding EPSDT program. This bill relates
to the section of the audit that is specific to the EPSDT
program. The audit recommended that the Legislature require
counties to enter into agreements with SELPAs to allow SELPAs
and LEAs to access EPSDT funding. This bill does not require
that counties to enter into these agreements, but authorizes a
specific kind of such an agreement, and suggests that there will
be additional state funding to incentivize such agreements.
EPSDT 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. EPSDT services are
administered through county mental health plans under contract
with the DHCS. LEAs may provide and bill for EPSDT mental
health services only pursuant to a contract with the county
mental health plan. EPSDT federal funds must be matched by
county funds.
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. The audit cited the case of Desert Mountain SELPA,
which contracts with San Bernardino County to provide mental
health services to Medi-Cal eligible students using EPSDT funds.
Under this arrangement, Desert Mountain SELPA contributes to
the county's required match of federal funds. According to the
Auditor, this arrangement is mutually beneficial: San
Bernardino County does not need to provide the full match, and
Desert Mountain is able to access EPSDT funding to provide
mental health services to Medi-Cal eligible students with and
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without IEPs. The audit noted that "if California's other
SELPAs established agreements with their county mental health
plans, these entities in total could potentially receive
millions of dollars in federal reimbursements for mental health
services provided to Medi-Cal eligible children."
According to the Special Opportunities for Access and Reform
Coalition (SOAR), a coalition which includes seven SELPAs, there
are several barriers to developing these partnerships. They
note, "In those regions that have not been able to develop a
partnership, some of the hurdles center on county mental health
not being willing to contract/vendorize the LEA/SELPAs to
provide EPSDT services, or the county mental health agency
charging the LEA/SELPA a high indirect cost for developing this
partnership." They note that there is no state policy on how an
LEA can seek direct access to the Medi-Cal funding for the EPSDT
program through county managed care, and that instead it is up
to each individual LEA or SELPA to negotiate directly with their
county mental health program. They also note that under current
law there is no appeal or mediation process for circumstances
when the two agencies do not agree.
Use of special education mental health funds for non-IEP
services? This bill establishes a County and Local Educational
Agency Partnership Fund, for the purpose of providing state
funds for competitive grants to partnerships established by the
bill. The bill requires the SPI to allocate any funds
appropriated in the Budget Act for purpose of these partnerships
to this fund. The bill also prohibits funds for
educationally-related mental health services (AB 114 funds) from
being used for other purposes unless a waiver is granted by the
State Board of Education.
The annual Budget Act appropriates funding for mental health
services for special education students on the basis of average
daily attendance. This bill suggests that these funds could be
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deposited into the County and Local Education Agency Partnership
Fund, be allocated on a competitive basis, and be used for
students who are not in special education.
The author indicates that this is not his intent. Accordingly,
staff recommends that this bill be amended as shown below, and
to add intent language encouraging partnerships to seek other
sources of funding for students who are in need of mental health
services but do not have IEPs:
5921 (c) 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 . These funds shall
not be deposited into the County and Local Educational Agency
Partnership Fund.
In addition, the Committee may wish to consider a technical
amendment to clarify that, for the purpose of the partnership
section of this bill, the definition of a local educational
agency includes all charter schools, not just those
participating as members of a SELPA.
Arguments in support. The California Council of Community
Behavioral Health Agencies writes that SB 1113 will 1) ensure
access to EPSDT funds for students who may need mental health
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care, 2) provide support to teachers to identify those students
as early as possible and before they become severe enough to
require special education, 3) address the needs of all students
through incentive start-up funds that are likely to be offset by
savings in special education, and 4) develop outcome measures to
measure program effectiveness. The Council notes, "There are
now 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."
The Community Health Partnership writes that such partnerships
are mutually beneficial but seldom implemented. They note,
"Only six out of 122 SELPAs are known to have agreements in
place with a county mental health plan or qualified provider
that operated in the county mental health plan. The bottom line
is that California is leaving tens of millions of dollars on the
table."
Arguments in opposition. The California Teachers Association
writes that SB 1113 suggests that resources could be diverted
from special education in order to serve other students.
Similarly, the SELPA Administrators Association of California
writes that this bill "suggests that money budgeted for schools
to provide mental health services to students as a related
service to special education should be used to help pay the
state match for EPSDT reimbursement regardless of whether these
students have special education needs."
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The SOAR Coalition recommends that the bill be amended to
instead require the DHCS to develop a mediation or appeals
process when an LEA or SELPA and county mental health agency
cannot agree on delivery of service for an eligible recipient or
when EPSDT funding is not accessible.
Related legislation. AB 884 (Beall) of this Session is also
related to the audit of student mental health services. It
requires LEAs and SELPAs to collect and report specific
information relative to mental health services, requires the CDE
to monitor and compare specific information relative to mental
health services, and requires LEAs to provide specified
informational materials to parents. AB 884 is pending in this
Committee.
REGISTERED SUPPORT / OPPOSITION:
Support
Mental Health America of California (Sponsor)
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California Youth Empowerment Network
California Association of Marriage and Family Therapists
California Council of Community Behavioral Health Agencies
Community Health Partnership
Steinberg Institute
Opposition
California Teachers Association
Los Angeles Unified School District (unless amended)
Special Education Local Plan Area Administrators (unless
amended)
Analysis Prepared by:Tanya Lieberman / ED. / (916)
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319-2087