Amended in Senate April 14, 2016

Amended in Senate March 28, 2016

Senate BillNo. 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 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 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 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:

P2    1

SECTION 1.  

Section 14717.2 is added to the Welfare and
2Institutions Code
, to read:

3

14717.2.  

(a) Each mental health plan shall submit an annual
4foster care mental health service plan to the department detailing
5the service array, from prevention to crisis services, available to
6Medi-Cal eligible children and youth under the jurisdiction of the
7juvenile court and their families.begin insert These plans shall be consistent
8with the Special Terms and Conditions outlined in the federal
9Centers for Medicare and Medicaid Services (CMS) approved
10waiver authorized under Section 1915 of the Social Security Act,
11Sections 438.204, 438.240 and 438.358 of Title 42 of the Code of
12Federal Regulations.end insert
Plans shall be submitted by July 1 of each
13year, beginning in 2017. Prior to submission to the department,
14the board of supervisors of each mental health plan shall approve
15the plan. The plan shall include, but not be limited to, all of the
16following elements:

17(1) The number of Medi-Cal eligible children and youth under
18the jurisdiction of the juvenile court served each year.

19(2) The number of familybegin delete membersend deletebegin insert members, including foster
20parents,end insert
of children and youth under the jurisdiction of the juvenile
21court served by the county mental health plans.

P3    1(3) Details on the types ofbegin insert mental healthend insert services provided to
2children and youth under the jurisdiction of the juvenile court and
3their families, including prevention and treatment services.begin insert These
4types of services may include, but are not limited to, screenings,
5assessments, home-based mental health services, outpatient
6services, day treatment services, or inpatient services, psychiatric
7hospitalizations, crisis interventions, case management, and
8psychotropic medication support services.end insert

9(4) Access to and timeliness of mental healthbegin delete servicesend deletebegin insert services,
10as described in Sections 1300.67.2, 1300.67.2.1, and 1300.67.2.2
11of Title 28 of the California Code of Regulations and consistent
12with Section 438.206 of Title 42 of the Code of Federal Regulationsend insert

13 available to Medi-Cal eligible children and youth under the
14jurisdiction of the juvenile court.

15(5) Quality of mental health services available to Medi-Cal
16eligible children and youth under the jurisdiction of the juvenile
17court.

18(6) Translation and interpretationbegin delete servicesend deletebegin insert services, consistent
19with Section 438.10(c)(4) and (5) of Title 42 of the Code of Federal
20Regulations and Section 1810.410 of Title 9 of the California Code
21of Regulationsend insert
available to Medi-Cal eligible children and youth
22under the jurisdiction of the juvenile court.

23(7) Coordination with other systems, including regional centers,
24special education local plan areas, child welfare, and probation.

25(8) Family and caregiver education and support.

26(9) Performance data for Medi-Cal eligible children and youth
27under the jurisdiction of the juvenile court in the annual external
28quality review report required by Section 14717.5.

29(10) Utilization data for Medi-Cal eligible children and youth
30under the jurisdiction of the juvenile court in the annual external
31quality review report required by Section 14717.5.

32(11) Medicationbegin delete monitoring.end deletebegin insert monitoring consistent with the
33Healthcare Effectiveness Data and Information Set (HEDIS),
34including, but not limited to, the child welfare psychotropic
35medication measures developed by the State Department of Social
36Services and the following HEDIS measures related to psychotropic
37medications:end insert

begin insert

38
(A) Follow-Up Care for Children Prescribed Attention Deficit
39Hyperactivity Disorder Medication (HEDIS ADD), which measures
40the number of children 6 to 12 years of age, inclusive, who have
P4    1a visit with a provider with prescribing authority within 30 days
2of the new prescription.

end insert
begin insert

3
(B) Use of Multiple Concurrent Antipsychotics in Children and
4Adolescents (HEDIS APC), which does both of the following:

end insert
begin insert

5
(i) Measures the number of children receiving an antipsychotic
6medication for at least 60 out of 90 days and the number of
7children who additionally receive a second antipsychotic
8medication that overlaps with the first.

end insert
begin insert

9
(ii) Reports a total rate and age stratifications, including 6 to
1011 years of age, inclusive, and 12 to 17 years of age, inclusive.

end insert
begin insert

11
(C) Use of First-Line Psychosocial Care for Children and
12Adolescents on Antipsychotics (HEDIS APP), which measures
13whether a child has received psychosocial services 90 days before
14through 30 days after receiving a new prescription for an
15antipsychotic medication.

end insert
begin insert

16
(D) Metabolic Monitoring for Children and Adolescents on
17Antipsychotics (HEDIS APM), which does both of the following:

end insert
begin insert

18
(i) Measures testing for glucose or HbA1c and lipid or
19cholesterol of a child who has received at least two different
20antipsychotic prescriptions on different days.

end insert
begin insert

21
(ii) Reports a total rate and age stratifications, including 6 to
2211 years of age, inclusive, and 12 to 17 years of age, inclusive.

end insert

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

25(c) (1) If the department identifies deficiencies in a plan, the
26department shall notify the mental health plan, in writing, of those
27
begin delete deficiencies.end deletebegin insert deficiencies pursuant to subdivision (e) of Section
2814712.end insert

29(2) After notification, the mental health plan shall provide a
30written corrective action plan to the department within 60 days.
31The department shall notify the mental health plan of approval or
32shall request changes, if necessary, within 30 days after receiving
33the corrective action plan. Final plans shall be made publicly
34available by, at minimum, posting on the department’s Internet
35Web site.

36

SEC. 2.  

Section 14717.5 is added to the Welfare and
37Institutions Code
, to read:

38

14717.5.  

(a) A mental health plan review shall be conducted
39annually by an external quality review organization (EQRO). The
40review shall include specific data for Medi-Cal eligible children
P5    1and youth under the jurisdiction of the juvenile court and their
2families, including all of the following:

3(1) The number of Medi-Cal eligible children and youth under
4the jurisdiction of the juvenile court served each year.

5(2) The number of familybegin delete membersend deletebegin insert members, including foster
6 parents,end insert
of children and youth under the jurisdiction of the juvenile
7court, including foster parents, served by the mental health plans.

8(3) Details on the types ofbegin insert mental healthend insert services provided to
9children and their caregivers, including prevention and treatment
10services.begin insert These types of services may include, but are not limited
11to, screenings, assessments, home-based mental health services,
12outpatient services, day treatment services or inpatient services,
13psychiatric hospitalizations, crisis interventions, case management,
14and psychotropic medication support services.end insert

15(4) Access to and timeliness of mental healthbegin delete servicesend deletebegin insert services,
16as described in Sections 1300.67.2, 1300.67.2.1, and 1300.67.2.2
17of Title 28 of the California Code of Regulations and consistent
18with Section 438.206 of Title 42 of the Code of Federal Regulationsend insert

19 available to Medi-Cal eligible children and youth under the
20jurisdiction of the juvenile court.

21(5) Quality of mental health services available to Medi-Cal
22eligible children and youth under the jurisdiction of the juvenile
23court.

24(6) Translation and interpretationbegin delete servicesend deletebegin insert services, consistent
25with Section 438.10(c)(4) and (5) of Title 42 of the Code of Federal
26Regulations and Section 1810.410 of Title 9 of the California Code
27of Regulationsend insert
available to Medi-Cal eligible children and youth
28under the jurisdiction of the juvenile court.

29(7) Performance data for Medi-Cal eligible children and youth
30under the jurisdiction of the juvenile court.

31(8) Utilization data for Medi-Cal eligible children and youth
32under the jurisdiction of the juvenile court.

33(9) Medicationbegin delete monitoring.end deletebegin insert monitoring consistent with the
34Healthcare Effectiveness Data and Information Set (HEDIS),
35including, but not limited to, the child welfare psychotropic
36medication measures developed by the State Department of Social
37Services and the following HEDIS measures related to psychotropic
38medications:end insert

begin insert

39
(A) Follow-Up Care for Children Prescribed Attention Deficit
40Hyperactivity Disorder Medication (HEDIS ADD), which measures
P6    1the number of children 6 to 12 years of age, inclusive, who have
2a visit with a provider with prescribing authority within 30 days
3of the new prescription.

end insert
begin insert

4
(B) Use of Multiple Concurrent Antipsychotics in Children and
5Adolescents (HEDIS APC), which does both of the following:

end insert
begin insert

6
(i) Measures the number of children receiving an antipsychotic
7medication for at least 60 out of 90 days and the number of
8children who additionally receive a second antipsychotic
9medication that overlaps with the first.

end insert
begin insert

10
(ii) Reports a total rate and age stratifications, including 6 to
1111 years of age, inclusive, and 12 to 17 years of age, inclusive.

end insert
begin insert

12
(C) Use of First-Line Psychosocial Care for Children and
13Adolescents on Antipsychotics (HEDIS APP), which measures
14whether a child has received psychosocial services 90 days before
15through 30 days after receiving a new prescription for an
16antipsychotic medication.

end insert
begin insert

17
(D) Metabolic Monitoring for Children and Adolescents on
18Antipsychotics (HEDIS APM), which does both of the following:

end insert
begin insert

19
(i) Measures testing for glucose or HbA1c and lipid or
20cholesterol of a child who has received at least two different
21antipsychotic prescriptions on different days.

end insert
begin insert

22
(ii) Reports a total rate and age stratifications, including 6 to
2311 years of age, inclusive, and 12 to 17 years of age, inclusive.

end insert

24(b) (1) The department shall review the EQRO data for
25Medi-Cal eligible children and youth under the jurisdiction of the
26juvenile court and their families.

27(2) If the EQRO identifies deficiencies in a mental health plan’s
28ability to serve Medi-Cal eligible children and youth under the
29jurisdiction of the juvenile court, the department shall notify the
30mental health plan in writing of identified deficiencies.

31(3) The mental health plan shall provide a written corrective
32action plan to the department within 60 days of receiving the notice
33required pursuant to paragraph (2). The department shall notify
34the mental health plan of approval of the corrective action plan or
35shall request changes, if necessary, within 30 days after receipt of
36the corrective action plan. Final corrective action plans shall be
37made publicly available by, at minimum, posting on the
38department’s Internet Web site.

39(c) The department shall conduct annual audits of each mental
40health plan for the administration of EPSDT benefits for children
P7    1and youth under the jurisdiction of the juvenile court,begin insert consistent
2with Section 14707.5,end insert
unless the director determines there is good
3cause for additional reviews. The reviews shall use the standards
4and criteria established pursuantbegin insert to Sections 1300.67.2, 130067.2.1,
5and 1300.67.2.2 of Title 28 of the California Code of Regulations
6related toend insert
begin insert access toend insertbegin insert, and timelines of, services adopted pursuantend insert
7 to the Knox-Keene Health Care Service Plan Act of 1975, as
8appropriate. The department may contract with professional
9organizations, as appropriate, to perform the periodic review
10required by this section. The department, or its designee, shall
11make a finding of fact with respect to the ability of the mental
12health plan to provide quality health care services, effectiveness
13of peer review, and utilization control mechanisms, and the overall
14performance of the mental health plan in providing mental health
15care benefits to its enrollees. The director shall publicly report the
16findings of finalized annual audits conducted pursuant to this
17section as soon as possible, but no later than 90 days following
18completion of a corrective action plan initiated pursuant to the
19audit, if any, unless the director determines, in his or her discretion,
20that additional time is reasonably necessary to fully and fairly
21report the results of the audit.

22(d) If the director believes that a mental health plan is
23substantially failing to comply with any provision of this code or
24any regulation pertaining to the administration of EPSDT benefits
25for children and youth under the jurisdiction of the juvenile court,
26and the director determines that formal action may be necessary
27to secure compliance, he or she shall inform the county behavioral
28health director and the board of supervisors of that failure. The
29notice to the county behavioral health director and board of
30supervisors shall be in writing and shall allow the county and the
31mental health plan a period of time specified by the department,
32but in no case less than 30 days, to correct the failure to comply
33with the law or regulations. If within the specified period the county
34and the mental health plan do not comply or provide reasonable
35assurances in writing that they will comply within the additional
36time as the director may allow, the director may order a
37representative of the county to appear at a hearing before the
38director to show cause why the director should not take
39administrative action to secure compliance. The county shall be
40given at least 30 days’ notice of the hearing. The director shall
P8    1consider the case on the record established at the hearing and,
2within 30 days, shall render proposed findings and a proposed
3decision on the issues. The proposed findings and decisions shall
4be submitted to the county, and the county shall have the
5opportunity to appear within 10 days, at a time and place as may
6be determined by the director, for the purpose of presenting oral
7arguments respecting the proposed findings and decisions.
8Thereupon, the director shall make final findings and issue a final
9administrative decision.

10(e) If the director determines, based on the record established
11at the hearing pursuant to subdivision (d), that the county is failing
12to comply with laws or regulations pertaining to a program
13administered by the department,begin delete or if the Department of Human
14Resources certifies to the director that a county is not in conformity
15with established merit system standards under Part 2.5
16(commencing with Section 19800) of Division 5 of Title 2 of the
17Government Code,end delete
and that administrative sanctions are necessary
18to secure compliance, the director may invokebegin delete either of the
19following sanctions, except that the sanctions shall not be invoked
20concurrently:end delete
begin insert sanctionsend insertbegin insert allowable under subdivision (e) of Section
2114712.end insert

begin delete

22(1) Withhold all or part of state and federal funds from the
23county until the county demonstrates to the director that it has
24complied.

25(2) (A) Suspend all or part of an existing contract with the
26mental health plan and assume, temporarily, direct responsibility
27for the administration of all or part of any programs administered
28by the department in the county until the county provides
29reasonable written assurances to the director of its intention and
30ability to comply. During the period of direct state administrative
31responsibility, the director or his or her authorized representative
32shall have all of the powers and responsibilities of the county
33director, except that he or she shall not be subject to the authority
34of the board of supervisors.

35(B) (i) In the event that the director invokes sanctions pursuant
36to this section, the county shall be responsible for providing any
37funds necessary for the continued operation of all programs
38administered by the department in the county. If a county fails or
39refuses to provide these funds, including a sufficient amount to
40reimburse all costs incurred by the department in directly
P9    1administering a program in the county, the Controller may deduct
2an amount certified by the director as necessary for the continued
3operation of these programs by the department from any state or
4federal funds payable to the county for any purpose.

5(ii) In the event of a state-imposed sanction, the amount of the
6sanction shall be no greater than the amount of county funds that
7the county would be required to contribute to fully match the
8General Fund allocation for the particular program or programs
9for which the county is being sanctioned for those programs that
10are not public safety programs realigned pursuant to 2011
11Realignment Legislation.

12(iii) In the event of a state-imposed sanction pursuant to this
13paragraph for the public safety programs realigned pursuant to
142011 Realignment Legislation that are administered by the State
15Department of Health Care Services, the amount of the sanction
16shall be no greater than the amount of funding originally provided
17to the county in the 2011-12 fiscal year for the particular program
18from the Behavioral Services Subaccount within the Support
19Services Account of the Local Revenue Fund 2011, as adjusted
20by the county’s share of the additional incremental funding
21provided pursuant to paragraph (1) of subdivision (f) of Section
2230027.5 of, paragraph (1) of subdivision (f) of Section 30027.6
23of, paragraph (1) of subdivision (f) of Section 30027.7 of, and
24paragraph (1) of subdivision (f) of Section 30027.8 of, the
25Government Code, the estimated growth funding for the program
26from the Support Services Growth Subaccount within the Sales
27and Use Tax Growth Account, and any adjustment to the county
28allocation pursuant to subdivision (a) of Section 30029.6 of the
29Government Code.

end delete


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