BILL ANALYSIS Ó
SB 1113
Page 1
Date of Hearing: August 3, 2016
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Lorena Gonzalez, Chair
SB 1113
(Beall) - As Amended August 1, 2016
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|Policy |Education |Vote:|7 - 0 |
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| |Health | |17 - 0 |
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Urgency: No State Mandated Local Program: NoReimbursable: No
SUMMARY:
This bill authorizes county and local educational agencies
(LEAs) to establish partnerships for the purpose of providing
mental health services to students. Specifically, this bill:
1)Authorizes the county mental health plan (county MHP) or the
qualified provider, and an LEA, to utilize "designated
governmental funds" for eligible Early and Periodic Screening,
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Diagnosis, and Treatment (EPSDT) mental health services for
students enrolled in MediCal, for special education students
with an individualized education plan (IEP), and for
non-special education students served by county mental health
or a qualified provider.
2)Requires the partnership to determine the Medi-Cal mental
health provider that is county operated or county contracted,
for purposes of providing mental health services to students
in LEAs. This can include the delivery of campus-based mental
health services to special education students and students who
a teacher believes may require those services, conditioned
upon parental consent.
3)Requires the partnership agreement to determine how to cover
the cost of mental health services if they are not covered by
the partnership.
4)Requires the partnership to participate in the existing EPSDT
performance outcome system to measure results of services
provided under the partnership agreement.
5)Requires a partnership to be established in at least one
school within the LEA in the first year and to expand the
partnership to three additional schools within three years.
6)Establishes the County and Local Educational Agency
Partnership Fund (Partnership Fund) to provide funding for
partnerships through a competitive grant program. Authorizes
the Superintendent of Public Instruction (SPI) to allocate
funds from this account, contingent upon an appropriation in
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the annual budget act.
7)Requires the Department of Health Care Services (DHCS), as
part of the existing EPSDT performance outcome system
reporting requirements, to collect and utilize certain data,
including academic performance data, on children that receive
mental health services as part of an IEP or educationally
related mental health services from an LEA participating in
the LEA Medi-Cal Billing Program as part of an IEP. The
California Department of Education (CDE) is required to
provide academic information to DHCS.
FISCAL EFFECT:
1)Proposition 98/GF cost pressure, in the millions of dollars,
to implement a competitive grant program to fund county and
LEA partnerships. The author's office estimates approximately
$1.8 million would be needed per LEA. The bill intends for at
least three LEAs to be funded. Actual costs could be higher or
lower depending upon available funding.
This bill establishes a Partnership Fund to provide
competitive grants to partnerships, available upon
appropriation by the Legislature. The 2016-17 Budget Act does
not provide funding for this purpose. The bill does not
specify a fund source for the Partnership Fund and does not
expressly prohibit the use of Proposition 98/GF, thereby
creating cost pressure on state funds.
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2)Annual administrative costs to the California Department of
Education (CDE) of approximately $236,000 to administer the
competitive grant process and work with DHCS to provide data,
as specified.
COMMENTS:
1)Purpose. Federal law establishes the Medi-Cal EPSDT program to
provide individuals 21 years and under, periodic screenings to
determine health care needs and, based upon the identified
health care need and diagnosis, to provide treatment services.
EPSDT provides a broad set of services to Medi-Cal eligible
children, but the mental health portion of EPSDT is a smaller
set of services which include group therapy, family therapy,
case management, crisis counseling, medication, and other
medically necessary services for children with serious mental
illness.
A Bureau of State Auditor report (January 2016) found that
LEAs and counties could improve student access to mental
health services by collaborating to provide services to
Medi-Cal eligible students. Currently, LEAs cannot access
funding for EPSDT services unless they contract with their
respective counties. According to the author, although there
are current successful partnerships, only six of the 122
Special Education Local Planning Areas (SELPAs) have an
agreement with counties. One major barrier to forming
partnerships is disagreement over who should pay for the state
match as required under the EPSDT program. This bill is
intended to provide a financial incentive, through a
competitive grant process, for LEAs to enter into agreements
with counties.
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2)Background on EPSDT. County MHPs are responsible for funding
and providing EPSDT mental health services to Medi-Cal
eligible children who meet clinical criteria. County MHPs
fulfill EPSDT obligations through direct service provision and
contracts. Many county MHPs contract with LEAs or Special
Education Local Plan Area (SELPAs) to provide certain
services. County MHPs pay 100% of the costs of services and
submit reimbursement claims to the federal government, through
DHCS, to claim federal financial participation (FFP). By
claiming FFP, counties can be reimbursed for about 50% of
their costs. Counties fund their portion of the cost of these
services through a combination of 2011 realignment funding,
1991 realignment funding, and Proposition 63 funds.
3)Background on mental health mandate. Prior to 1984, school
districts were responsible for providing all special education
services to children. In 1984, the Legislature enacted AB
3632, which transferred responsibility for providing mental
health services to special education pupils from school
districts to county mental health departments. The intent was
to build on counties' existing expertise, and provide
collaboration between schools and public mental health. AB
3632 services were deemed a state-reimbursable mandate.
In 2010, during the state's fiscal crisis, state funding for
AB 3632 was vetoed and the mandate was suspended. AB 114
(Budget Committee), Chapter 43, Statutes of 2011, repealed
provisions of AB 3632, thereby ending the state mandate on
county mental health agencies to provide mental health
services to students with disabilities. With the passage of AB
114, school districts are now solely responsible for ensuring
that students with disabilities receive special education and
related services, including some services previously arranged
for, or provided by, county mental health agencies.
4)Bureau of State Audit recommendations. 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 audit
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recommended that the Legislature require counties to enter
into agreements with SELPAs to allow SELPAs and LEAs to access
EPSDT funding. The Auditor gave the example of the Desert
Mountain SELPA arrangement with San Bernardino County. Desert
Mountain SELPA contributes to the county's required match of
federal funds. 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
without IEPs.
5)Comments. The 2011 realignment left counties fully responsible
for providing and funding specialty mental health services for
Medi-Cal eligible individuals. Counties receive state funding
to provide EPSDT services. If the state were to provide
funding through competitive grants, as proposed by this bill,
to directly draw down federal reimbursement for EPSDT
services, the state could be double-paying for those services
if there is not a decrease in county funding for such
services.
6)Opposition. The Special Opportunities for Access and Reform
Coalition (SOAR), a coalition which includes seven SELPAs, is
opposed to the bill unless amended. SOAR notes there are
several barriers to developing partnerships between LEAs and
counties. They note 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 recommend that the bill be amended to instead require
DHCS to develop a mediation or appeals process in state law
when an LEA/SELPA and county mental agency cannot agree on
delivery of service for an eligible recipient or when EPSDT
funding is not accessible for the LEA/SELPA.
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Analysis Prepared by:Misty Feusahrens / APPR. / (916)
319-2081