Amended in Senate June 1, 2016

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 tobegin delete reviewend deletebegin insert postend insert the plans andbegin delete the EQRO reviews and post themend deletebegin insert any corrective action plan prepared by the mental health plan to address deficiencies identified by the EQRO reviewend insert 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.begin delete 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.end delete

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. 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
12of Federal Regulations. 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.

P3    1(2) The number of family members, including foster parents,
2of children and youth under the jurisdiction of the juvenile court
3served by the county mental health plans.

4(3) Details on the types of mental health services provided to
5children and youth under the jurisdiction of the juvenile court and
6their families, including prevention and treatment services. These
7types of services may include, but are not limited to, screenings,
8assessments, home-based mental health services, outpatient
9services, day treatment services, or inpatient services, psychiatric
10hospitalizations, crisis interventions, case management, and
11psychotropic medication support services.

12(4) Access to and timeliness of mental health services, as
13described in Sections 1300.67.2, 1300.67.2.1, and 1300.67.2.2 of
14Title 28 of the California Code of Regulations and consistent with
15Section 438.206 of Title 42 of the Code of Federal Regulations
16available to Medi-Cal eligible children and youth under the
17jurisdiction of the juvenile court.

18(5) Quality of mental health services available to Medi-Cal
19eligible children and youth under the jurisdiction of the juvenile
20court.

21(6) Translation and interpretation services, consistent with
22Section 438.10(c)(4) and (5) of Title 42 of the Code of Federal
23Regulations and Section 1810.410 of Title 9 of the California Code
24of Regulations available to Medi-Cal eligible children and youth
25under the jurisdiction of the juvenile court.

26(7) Coordination with other systems, including regional centers,
27special education local plan areas, child welfare, and probation.

28(8) Family and caregiver education and support.

29(9) Performance 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(10) Utilization data for Medi-Cal eligible children and youth
33under the jurisdiction of the juvenile court in the annual external
34quality review report required by Section 14717.5.

35(11) Medication monitoring consistent with the Healthcare
36Effectiveness Data and Information Set (HEDIS), including, but
37not limited to, the child welfare psychotropic medication measures
38developed by the State Department of Social Services and the
39following HEDIS measures related to psychotropic medications:

P4    1(A) Follow-Up Care for Children Prescribed Attention Deficit
2Hyperactivity Disorder Medication (HEDIS ADD), which measures
3the number of children 6 to 12 years of age, inclusive, who have
4a visit with a provider with prescribing authority within 30 days
5of the new prescription.

6(B) Use of Multiple Concurrent Antipsychotics in Children and
7Adolescents (HEDIS APC), which does both of the following:

8(i) Measures the number of children receiving an antipsychotic
9medication for at least 60 out of 90 days and the number of children
10who additionally receive a second antipsychotic medication that
11overlaps with the first.

12(ii) Reports a total rate and age stratifications, including 6 to 11
13years of age, inclusive, and 12 to 17 years of age, inclusive.

14(C) Use of First-Line Psychosocial Care for Children and
15Adolescents on Antipsychotics (HEDIS APP), which measures
16whether a child has received psychosocial services 90 days before
17through 30 days after receiving a new prescription for an
18antipsychotic medication.

19(D) Metabolic Monitoring for Children and Adolescents on
20Antipsychotics (HEDIS APM), which does both of the following:

21(i) Measures testing for glucose or HbA1c and lipid or
22cholesterol of a child who has received at least two different
23antipsychotic prescriptions on different days.

24(ii) Reports a total rate and age stratifications, including 6 to 11
25years of age, inclusive, and 12 to 17 years of age, inclusive.

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

begin delete

28(c) (1) If the department identifies deficiencies in a plan, the
29department shall notify the mental health plan, in writing, of those
30deficiencies pursuant to subdivision (e) of Section 14712.

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

end delete
38

SEC. 2.  

Section 14717.5 is added to the Welfare and
39Institutions Code
, to read:

P5    1

14717.5.  

(a) A mental health plan review shall be conducted
2annually by an external quality review organization (EQRO). The
3review shall include specific data for Medi-Cal eligible children
4and youth under the jurisdiction of the juvenile court and their
5families, including all of the following:

6(1) The number of Medi-Cal eligible children and youth under
7the jurisdiction of the juvenile court served each year.

8(2) The number of family members, including foster parents,
9of children and youth under the jurisdiction of the juvenile court,
10including foster parents, served by the mental health plans.

11(3) Details on the types of mental health services provided to
12children and their caregivers, including prevention and treatment
13services. These types of services may include, but are not limited
14to, screenings, assessments, home-based mental health services,
15outpatient services, day treatment services or inpatient services,
16psychiatric hospitalizations, crisis interventions, case management,
17and psychotropic medication support services.

18(4) Access to and timeliness of mental health services, as
19described in Sections 1300.67.2, 1300.67.2.1, and 1300.67.2.2 of
20Title 28 of the California Code of Regulations and consistent with
21Section 438.206 of Title 42 of the Code of Federal Regulations
22available to Medi-Cal eligible children and youth under the
23jurisdiction of the juvenile court.

24(5) Quality of mental health services available to Medi-Cal
25eligible children and youth under the jurisdiction of the juvenile
26 court.

27(6) Translation and interpretation services, consistent with
28Section 438.10(c)(4) and (5) of Title 42 of the Code of Federal
29Regulations and Section 1810.410 of Title 9 of the California Code
30of Regulations available to Medi-Cal eligible children and youth
31under the jurisdiction of the juvenile court.

32(7) Performance data for Medi-Cal eligible children and youth
33under the jurisdiction of the juvenile court.

34(8) Utilization data for Medi-Cal eligible children and youth
35under the jurisdiction of the juvenile court.

36(9) Medication monitoring consistent with the Healthcare
37Effectiveness Data and Information Set (HEDIS), including, but
38not limited to, the child welfare psychotropic medication measures
39developed by the State Department of Social Services and the
40following HEDIS measures related to psychotropic medications:

P6    1(A) Follow-Up Care for Children Prescribed Attention Deficit
2Hyperactivity Disorder Medication (HEDIS ADD), which measures
3the number of children 6 to 12 years of age, inclusive, who have
4a visit with a provider with prescribing authority within 30 days
5of the new prescription.

6(B) Use of Multiple Concurrent Antipsychotics in Children and
7Adolescents (HEDIS APC), which does both of the following:

8(i) Measures the number of children receiving an antipsychotic
9medication for at least 60 out of 90 days and the number of children
10who additionally receive a second antipsychotic medication that
11overlaps with the first.

12(ii) Reports a total rate and age stratifications, including 6 to 11
13years of age, inclusive, and 12 to 17 years of age, inclusive.

14(C) Use of First-Line Psychosocial Care for Children and
15Adolescents on Antipsychotics (HEDIS APP), which measures
16whether a child has received psychosocial services 90 days before
17through 30 days after receiving a new prescription for an
18antipsychotic medication.

19(D) Metabolic Monitoring for Children and Adolescents on
20Antipsychotics (HEDIS APM), which does both of the following:

21(i) Measures testing for glucose or HbA1c and lipid or
22cholesterol of a child who has received at least two different
23antipsychotic prescriptions on different days.

24(ii) Reports a total rate and age stratifications, including 6 to 11
25years of age, inclusive, and 12 to 17 years of age, inclusive.

26(b) (1) The department shall review the EQRO data for
27Medi-Cal eligible children and youth under the jurisdiction of the
28juvenile court and their families.

29(2) If the EQRO identifies deficiencies in a mental health plan’s
30ability to serve Medi-Cal eligible children and youth under the
31jurisdiction of the juvenile court, the department shall notify the
32mental health plan in writing of identified deficiencies.

33(3) The mental health plan shall provide a written corrective
34action plan to the department within 60 days of receiving the notice
35required pursuant to paragraph (2). The department shall notify
36the mental health plan of approval of the corrective action plan or
37shall request changes, if necessary, within 30 days after receipt of
38the corrective action plan. Final corrective action plans shall be
39made publicly available by, at minimum, posting on the
40department’s Internet Web site.

begin delete

P7    1(c) The department shall conduct annual audits of each mental
2health plan for the administration of EPSDT benefits for children
3and youth under the jurisdiction of the juvenile court, consistent
4with Section 14707.5, unless the director determines there is good
5cause for additional reviews. The reviews shall use the standards
6and criteria established pursuant to Sections 1300.67.2, 130067.2.1,
7and 1300.67.2.2 of Title 28 of the California Code of Regulations
8related to access to, and timelines of, services adopted pursuant to
9the Knox-Keene Health Care Service Plan Act of 1975, as
10appropriate. The department may contract with professional
11organizations, as appropriate, to perform the periodic review
12required by this section. The department, or its designee, shall
13make a finding of fact with respect to the ability of the mental
14health plan to provide quality health care services, effectiveness
15of peer review, and utilization control mechanisms, and the overall
16performance of the mental health plan in providing mental health
17care benefits to its enrollees. The director shall publicly report the
18findings of finalized annual audits conducted pursuant to this
19section as soon as possible, but no later than 90 days following
20completion of a corrective action plan initiated pursuant to the
21audit, if any, unless the director determines, in his or her discretion,
22that additional time is reasonably necessary to fully and fairly
23report the results of the audit.

24(d) If the director believes that a mental health plan is
25substantially failing to comply with any provision of this code or
26any regulation pertaining to the administration of EPSDT benefits
27for children and youth under the jurisdiction of the juvenile court,
28and the director determines that formal action may be necessary
29to secure compliance, he or she shall inform the county behavioral
30health director and the board of supervisors of that failure. The
31notice to the county behavioral health director and board of
32supervisors shall be in writing and shall allow the county and the
33mental health plan a period of time specified by the department,
34but in no case less than 30 days, to correct the failure to comply
35with the law or regulations. If within the specified period the county
36and the mental health plan do not comply or provide reasonable
37assurances in writing that they will comply within the additional
38time as the director may allow, the director may order a
39representative of the county to appear at a hearing before the
40director to show cause why the director should not take
P8    1administrative action to secure compliance. The county shall be
2given at least 30 days’ notice of the hearing. The director shall
3consider the case on the record established at the hearing and,
4within 30 days, shall render proposed findings and a proposed
5decision on the issues. The proposed findings and decisions shall
6be submitted to the county, and the county shall have the
7opportunity to appear within 10 days, at a time and place as may
8be determined by the director, for the purpose of presenting oral
9arguments respecting the proposed findings and decisions.
10Thereupon, the director shall make final findings and issue a final
11administrative decision.

12(e) If the director determines, based on the record established
13at the hearing pursuant to subdivision (d), that the county is failing
14to comply with laws or regulations pertaining to a program
15administered by the department, and that administrative sanctions
16are necessary to secure compliance, the director may invoke
17sanctions allowable under subdivision (e) of Section 14712.

end delete


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