Senate Bill No. 1291

Introduced by Senator Beall

February 19, 2016

An act to add Sections 14717.2 and 14717.5 to the Welfare and Institutions Code, relating to Medi-Cal.

LEGISLATIVE COUNSEL’S DIGEST

SB 1291, as introduced, Beall. Medi-Cal: specialty mental health: children and youth.

Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services, including specialty mental health services. The Medi-Cal program is, in part, governed and funded by federal Medicaid Program provisions. Under existing law, specialty mental health services are provided by mental health plans and the department is responsible for conducting investigations and audits of claims and reimbursements for expenditures for specialty mental health services provided by mental health plans to Medi-Cal eligible individuals.

This bill would require each mental health plan, annually on or before July 1 of each year, to submit a foster care mental health service plan to the department 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. The bill would require annual mental health plan reviews to be conducted by an external quality review organization (EQRO) and to include specific data for Medi-Cal eligible children and youth under the jurisdiction of the juvenile court and their families, including the number of Medi-Cal eligible children and youth under the jurisdiction of the juvenile court served each year.

This bill would require the department to review the plans and the EQRO reviews and post them on its Internet Web site. The bill would also require the department to notify the mental health plan of any deficiencies and would require the mental health plan to provide a written corrective action plan to the department. The bill would also authorize the director, if he or she believes that a mental health plan is substantially failing to comply with any provision pertaining to the administration of specified benefits for children and youth under the jurisdiction of the juvenile court, to take specified action, including bringing an action for injunctive relief or imposing certain sanctions.

Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: no.

The people of the State of California do enact as follows:

SECTION 1.  

Section 14717.2 is added to the Welfare and
Institutions Code, to read:

14717.2.  

(a) Each mental health plan shall submit an annual
foster care mental health service plan to the department 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. Plans shall be submitted by July
1 of each year, beginning in 2017. Prior to submission to the
department, the board of supervisors of each mental health plan
shall approve the plan. The plan shall include, but not be limited
to, all of the following elements:

(1) The number of Medi-Cal eligible children and youth under
the jurisdiction of the juvenile court served each year.

(2) The number of family members of children and youth under
the jurisdiction of the juvenile court served by the county mental
health plans.

(3) Details on the types of services provided to children and
youth under the jurisdiction of the juvenile court and their families,
including prevention and treatment services.

(4) Access to and timeliness of mental health services available
to Medi-Cal eligible children and youth under the jurisdiction of
the juvenile court.

(5) Quality of mental health services available to Medi-Cal
eligible children and youth under the jurisdiction of the juvenile
court.

(6) Translation and interpretation services available to Medi-Cal
eligible children and youth under the jurisdiction of the juvenile
court.

(7) Coordination with other systems, including regional centers,
special education local plan areas, child welfare, and probation.

(8) Family and caregiver education and support.

(9) Performance data for Medi-Cal eligible children and youth
under the jurisdiction of the juvenile court in the annual external
quality review report required by Section 14717.5.

(10) Utilization data for Medi-Cal eligible children and youth
under the jurisdiction of the juvenile court in the annual external
quality review report required by Section 14717.5.

(11) Medication monitoring.

(b) The department shall review the plan required pursuant to
subdivision (a) and shall post each plan on its Internet Web site.

(c) (1) If the department identifies deficiencies in a plan, the
department shall notify the mental health plan, in writing, of those
deficiencies.

(2) After notification, the mental health plan shall provide a
written corrective action plan to the department within 60 days.
The department shall notify the mental health plan of approval or
shall request changes, if necessary, within 30 days after receiving
the corrective action plan. Final plans shall be made publicly
available by, at minimum, posting on the department’s Internet
Web site.

SEC. 2.  

Section 14717.5 is added to the Welfare and
Institutions Code, to read:

14717.5.  

(a) A mental health plan review shall be conducted
annually by an external quality review organization (EQRO). The
review shall include specific data for Medi-Cal eligible children
and youth under the jurisdiction of the juvenile court and their
families, including all of the following:

(1) The number of Medi-Cal eligible children and youth under
the jurisdiction of the juvenile court served each year.

(2) The number of family members of children and youth under
the jurisdiction of the juvenile court, including foster parents,
served by the mental health plans.

(3) Details on the types of services provided to children and
their caregivers, including prevention and treatment services.

(4) Access to and timeliness of mental health services available
to Medi-Cal eligible children and youth under the jurisdiction of
the juvenile court.

(5) Quality of mental health services available to Medi-Cal
eligible children and youth under the jurisdiction of the juvenile
court.

(6) Translation and interpretation services available to Medi-Cal
eligible children and youth under the jurisdiction of the juvenile
court.

(7) Performance data for Medi-Cal eligible children and youth
under the jurisdiction of the juvenile court.

(8) Utilization data for Medi-Cal eligible children and youth
under the jurisdiction of the juvenile court.

(9) Medication monitoring.

(b) (1) The department shall review the EQRO data for
Medi-Cal eligible children and youth under the jurisdiction of the
juvenile court and their families.

(2) If the EQRO identifies deficiencies in a mental health plan’s
ability to serve Medi-Cal eligible children and youth under the
jurisdiction of the juvenile court, the department shall notify the
mental health plan in writing of identified deficiencies.

(3) The mental health plan shall provide a written corrective
action plan to the department within 60 days of receiving the notice
required pursuant to paragraph (2). The department shall notify
the mental health plan of approval of the corrective action plan or
shall request changes, if necessary, within 30 days after receipt of
the corrective action plan. Final corrective action plans shall be
made publicly available by, at minimum, posting on the
department’s Internet Web site.

(c) The department shall conduct annual audits of each mental
health plan for the administration of EPSDT benefits for children
and youth under the jurisdiction of the juvenile court, unless the
director determines there is good cause for additional reviews. The
reviews shall use the standards and criteria established pursuant
to the Knox-Keene Health Care Service Plan Act of 1975, as
appropriate. The department may contract with professional
organizations, as appropriate, to perform the periodic review
required by this section. The department, or its designee, shall
make a finding of fact with respect to the ability of the mental
health plan to provide quality health care services, effectiveness
of peer review, and utilization control mechanisms, and the overall
performance of the mental health plan in providing mental health
care benefits to its enrollees. The director shall publicly report the
findings of finalized annual audits conducted pursuant to this
section as soon as possible, but no later than 90 days following
completion of a corrective action plan initiated pursuant to the
audit, if any, unless the director determines, in his or her discretion,
that additional time is reasonably necessary to fully and fairly
report the results of the audit.

(d) If the director believes that a mental health plan is
substantially failing to comply with any provision of this code or
any regulation pertaining to the administration of EPSDT benefits
for children and youth under the jurisdiction of the juvenile court,
and the director determines that formal action may be necessary
to secure compliance, he or she shall inform the county behavioral
health director and the board of supervisors of that failure. The
notice to the county behavioral health director and board of
supervisors shall be in writing and shall allow the county and the
mental health plan a period of time specified by the department,
but in no case less than 30 days, to correct the failure to comply
with the law or regulations. If within the specified period the county
and the mental health plan do not comply or provide reasonable
assurances in writing that they will comply within the additional
time as the director may allow, the director may take one or both
of the following actions:

(1) Bring an action for injunctive relief to secure immediate
compliance. A county that is found to be failing to substantially
comply with the law or regulations pertaining to a program
administered by the department may be enjoined by any court of
competent jurisdiction. The court may make orders or judgments
as necessary to secure county compliance.

(2) Order a representative of the county to appear at a hearing
before the director to show cause why the director should not take
administrative action to secure compliance. The county shall be
given at least 30 days’ notice of the hearing. The director shall
consider the case on the record established at the hearing and,
within 30 days, shall render proposed findings and a proposed
decision on the issues. The proposed findings and decisions shall
be submitted to the county, and the county shall have the
opportunity to appear within 10 days, at a time and place as may
be determined by the director, for the purpose of presenting oral
arguments respecting the proposed findings and decisions.
Thereupon, the director shall make final findings and issue a final
administrative decision.

(e) If the director determines, based on the record established
at the hearing pursuant to paragraph (2) of subdivision (d), that
the county is failing to comply with laws or regulations pertaining
to a program administered by the department, or if the Department
of Human Resources certifies to the director that a county is not
in conformity with established merit system standards under Part
2.5 (commencing with Section 19800) of Division 5 of Title 2 of
the Government Code, and that administrative sanctions are
necessary to secure compliance, the director may invoke either of
the following sanctions, except that the sanctions shall not be
invoked concurrently:

(1) Withhold all or part of state and federal funds from the
county until the county demonstrates to the director that it has
complied.

(2) (A) Suspend all or part of an existing contract with the
mental health plan and assume, temporarily, direct responsibility
for the administration of all or part of any programs administered
by the department in the county until the county provides
reasonable written assurances to the director of its intention and
ability to comply. During the period of direct state administrative
responsibility, the director or his or her authorized representative
shall have all of the powers and responsibilities of the county
director, except that he or she shall not be subject to the authority
of the board of supervisors.

(B) (i) In the event that the director invokes sanctions pursuant
to this section, the county shall be responsible for providing any
funds necessary for the continued operation of all programs
administered by the department in the county. If a county fails or
refuses to provide these funds, including a sufficient amount to
reimburse all costs incurred by the department in directly
administering a program in the county, the Controller may deduct
an amount certified by the director as necessary for the continued
operation of these programs by the department from any state or
federal funds payable to the county for any purpose.

(ii) In the event of a state-imposed sanction, the amount of the
sanction shall be no greater than the amount of county funds that
the county would be required to contribute to fully match the
General Fund allocation for the particular program or programs
for which the county is being sanctioned for those programs that
are not public safety programs realigned pursuant to 2011
realignment legislation.

(iii) In the event of a state-imposed sanction pursuant to this
paragraph for the public safety programs realigned pursuant to
2011 realignment legislation that are administered by the State
Department of Health Care Services, the amount of the sanction
shall be no greater than the amount of funding originally provided
to the county in the 2011-12 fiscal year for the particular program
from the Behavioral Services Subaccount within the Support
Services Account of the Local Revenue Fund 2011, as adjusted
by the county’s share of the additional incremental funding
provided pursuant to paragraph (1) of subdivision (f) of Section
30027.5 of, paragraph (1) of subdivision (f) of Section 30027.6
of, paragraph (1) of subdivision (f) of Section 30027.7 of, and
paragraph (1) of subdivision (f) of Section 30027.8 of, the
Government Code, the estimated growth funding for the program
from the Support Services Growth Subaccount within the Sales
and Use Tax Growth Account, and any adjustment to the county
allocation pursuant to subdivision (a) of Section 30029.6 of the
Government Code.