BILL NUMBER: SB 1291 AMENDED
BILL TEXT
AMENDED IN SENATE MARCH 28, 2016
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 amended, 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
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
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.