BILL NUMBER: SB 1291 AMENDED
BILL TEXT
AMENDED IN SENATE APRIL 14, 2016
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 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:
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. These plans shall be
consistent with the Special Terms and Conditions outlined in the
federal Centers for Medicare and Medicaid Services (CMS) approved
waiver authorized under Section 1915 of the Social Security Act,
Sections 438.204, 438.240 and 438.358 of Title 42 of the Code of
Federal Regulations. 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 members,
including foster parents, of children and youth under the
jurisdiction of the juvenile court served by the county mental health
plans.
(3) Details on the types of mental health services
provided to children and youth under the jurisdiction of the juvenile
court and their families, including prevention and treatment
services. These types of services may include, but are not
limited to, screenings, assessments, home-based mental health
services, outpatient services, day treatment services, or inpatient
services, psychiatric hospitalizations, crisis interventions, case
management, and psychotropic medication support services.
(4) Access to and timeliness of mental health services
services, as described in Sections 1300.67.2,
1300.67.2.1, and 1300.67.2.2 of Title 28 of the California Code of
Regulations and consistent with Section 438.206 of Title
42 of the Code of Federal Regulations 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
services, consistent with Section 438.10(c)(4) and (5) of Title
42 of the Code of Federal Regulations and Section 1810.410 of Title 9
of the California Code of Regulations 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. monitoring
consistent with the Healthcare Effectiveness Data and Information Set
(HEDIS), including, but not limited to, the child welfare
psychotropic medication measures developed by the State Department of
Social Services and the following HEDIS measures related to
psychotropic medications:
(A) Follow-Up Care for Children Prescribed Attention Deficit
Hyperactivity Disorder Medication (HEDIS ADD), which measures the
number of children 6 to 12 years of age, inclusive, who have a visit
with a provider with prescribing authority within 30 days of the new
prescription.
(B) Use of Multiple Concurrent Antipsychotics in Children and
Adolescents (HEDIS APC), which does both of the following:
(i) Measures the number of children receiving an antipsychotic
medication for at least 60 out of 90 days and the number of children
who additionally receive a second antipsychotic medication that
overlaps with the first.
(ii) Reports a total rate and age stratifications, including 6 to
11 years of age, inclusive, and 12 to 17 years of age, inclusive.
(C) Use of First-Line Psychosocial Care for Children and
Adolescents on Antipsychotics (HEDIS APP), which measures whether a
child has received psychosocial services 90 days before through 30
days after receiving a new prescription for an antipsychotic
medication.
(D) Metabolic Monitoring for Children and Adolescents on
Antipsychotics (HEDIS APM), which does both of the following:
(i) Measures testing for glucose or HbA1c and lipid or cholesterol
of a child who has received at least two different antipsychotic
prescriptions on different days.
(ii) Reports a total rate and age stratifications, including 6 to
11 years of age, inclusive, and 12 to 17 years of age, inclusive.
(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. deficiencies pursuant to
subdivision (e) of Section 14712.
(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 members,
including foster parents, 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 mental health services
provided to children and their caregivers, including prevention and
treatment services. These types of services may include, but are
not limited to, screenings, assessments, home-based mental health
services, outpatient services, day treatment services or inpatient
services, psychiatric hospitalizations, crisis interventions, case
management, and psychotropic medication support services.
(4) Access to and timeliness of mental health services
services, as described in Sections 1300.67.2,
1300.67.2.1, and 1300.67.2.2 of Title 28 of the California Code of
Regulations and consistent with Section 438.206 of Title 42 of the
Code of Federal Regulations 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
services, consistent with Section 438.10(c)(4) and (5) of Title
42 of the Code of Federal Regulations and Section 1810.410 of Title 9
of the California Code of Regulations 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. monitoring
consistent with the Healthcare Effectiveness Data and
Information Set (HEDIS), including, but not limited to, the child
welfare psychotropic medication measures developed by the State
Department of Social Services and the following HEDIS measures
related to psychotropic medications:
(A) Follow-Up Care for Children Prescribed Attention Deficit
Hyperactivity Disorder Medication (HEDIS ADD), which measures the
number of children 6 to 12 years of age, inclusive, who have a visit
with a provider with prescribing authority within 30 days of the new
prescription.
(B) Use of Multiple Concurrent Antipsychotics in Children and
Adolescents (HEDIS APC), which does both of the following:
(i) Measures the number of children receiving an antipsychotic
medication for at least 60 out of 90 days and the number of children
who additionally receive a second antipsychotic medication that
overlaps with the first.
(ii) Reports a total rate and age stratifications, including 6 to
11 years of age, inclusive, and 12 to 17 years of age, inclusive.
(C) Use of First-Line Psychosocial Care for Children and
Adolescents on Antipsychotics (HEDIS APP), which measures whether a
child has received psychosocial services 90 days before through 30
days after receiving a new prescription for an antipsychotic
medication.
(D) Metabolic Monitoring for Children and Adolescents on
Antipsychotics (HEDIS APM), which does both of the following:
(i) Measures testing for glucose or HbA1c and lipid or cholesterol
of a child who has received at least two different antipsychotic
prescriptions on different days.
(ii) Reports a total rate and age stratifications, including 6 to
11 years of age, inclusive, and 12 to 17 years of age, inclusive.
(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, consistent
with Section 14707.5, unless the director determines there is
good cause for additional reviews. The reviews shall use the
standards and criteria established pursuant to Se
ctions 1300.67.2, 130067.2.1, and 1300.67.2.2 of Title 28 of the
California Code of Regulations related to access to
, and timelines of, services adopted 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 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 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: s anctions
allowable under subdivision (e) of Section 14712.
(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.