Amended in Assembly June 13, 2016

Amended in Senate June 1, 2016

Amended in Senate April 14, 2016

Amended in Senate March 28, 2016

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 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. begin insert The bill would require the department to share data with county boards of supervisors, including data that will assist in the development of foster youth mental health plans and performance outcome system data and metrics, as specified. end insert

This bill would require the department to post the begin delete plans and end delete begin insert plans, end insert any corrective action plan prepared by the mental health plan to address deficiencies identified by the EQRO begin delete review end delete begin insert review, and the EQRO data end insert on its Internet Web begin delete site. end delete begin insert site, as specified. end insert 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.

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, 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, 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, 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 consistent with begin delete the Healthcare
Effectiveness Data and Information Set (HEDIS), including, but
not limited to, end delete the child welfare psychotropic medication measures
developed by the State Department of Social Services and begin delete the
following HEDIS end delete begin insert any Healthcare Effectiveness Data and
Information Set (HEDIS) end insert measures related to psychotropic

begin delete medications: end delete begin insert medications, including, but not limited to, the
following: end insert

(A) Follow-Up Care for Children Prescribed Attention Deficit
Hyperactivity Disorder Medication (HEDIS begin delete 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. end delete begin insert ADD). end insert

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

begin insert APC). end insert

begin delete

(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.

end delete begin delete

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

end delete

(C) Use of First-Line Psychosocial Care for Children and
Adolescents on Antipsychotics (HEDIS begin delete 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. end delete begin insert APP). end insert

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

begin insert APM). end insert

begin delete

(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.

end delete

(b) The department shall post each plan on its Internet Web begin delete site. end delete

begin insert site in a manner that is publicly accessible. end insert

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, 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, 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, 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 consistent with begin delete the Healthcare
Effectiveness Data and Information Set (HEDIS), including, but
not limited to, end delete the child welfare psychotropic medication measures
developed by the State Department of Social Services and begin delete the
following HEDIS end delete begin insert any Healthcare Effectiveness Data and
Information Set (HEDIS) end insert measures related to psychotropic

begin delete medications: end delete begin insert medications, including, but not limited to, the
following: end insert

(A) Follow-Up Care for Children Prescribed Attention Deficit
Hyperactivity Disorder Medication (HEDIS begin delete 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. end delete begin insert ADD). end insert

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

begin insert APC). end insert

begin delete

(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.

end delete

(C) Use of First-Line Psychosocial Care for Children and
Adolescents on Antipsychotics (HEDIS begin delete 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. end delete begin insert APP). end insert

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

begin insert APM). end insert

begin delete

(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.

end delete begin delete

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

end delete

(b) (1) The department shall begin delete review end delete begin insert post the EQRO data
disaggregated by Medi-Cal eligible children and youth under the
jurisdiction of the juvenile court on the department’s Internet Web
site in a manner that is publicly accessible. end insert

begin insert (2) end insert begin insert   end insert begin insert The department shall review end insert the EQRO data for Medi-Cal
eligible children and youth under the jurisdiction of the juvenile
court and their families.

begin delete

(2)

end delete

begin insert (3) end insert  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.

begin delete

(3)

end delete

begin insert (4) end insert  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.

begin insert

(c) To the extent possible, the department shall, in connection
with its duty to implement Section 14707.5, share with county
boards of supervisors data that will assist in the development of
foster youth mental health plans, such as data described in
subdivision (c) of Section 16501.4 and paragraph (1) of subdivision
(a) of Section 1538.8 of the Health and Safety Code.

end insert begin insert

(d) The department shall annually share performance outcome
system data with county boards of supervisors for the purpose of
informing foster youth mental health plans. Performance outcome
system data shared with county boards of supervisors shall include,
but not be limited to, the following disaggregated data for
Medi-Cal eligible children and youth under the jurisdiction of the
juvenile court:

end insert begin insert

(1) The number of youth receiving specialty mental health
services.

end insert begin insert

(2) The racial distribution of youth receiving specialty mental
health services.

end insert begin insert

(3) The gender distribution of youth receiving specialty mental
health services.

end insert begin insert

(4) The number of youth, by race, with one or more specialty
mental health service visits.

end insert begin insert

(5) The number of youth, by race, with five or more specialty
mental health service visits.

end insert begin insert

(6) Utilization data for intensive home services, intensive care
coordination, case management, therapeutic behavioral services,
medication support services, crisis intervention, crisis stabilization,
full-day intensive treatment, full-day treatment, full-day
rehabilitation, and hospital inpatient days.

end insert begin insert

(7) A unique count of youth receiving specialty mental health
services who are arriving, exiting, and continuing with services.

end insert begin insert

(e) The department shall ensure that the performance outcome
system data metrics include disaggregated data for Medi-Cal
eligible children and youth under the jurisdiction of the juvenile
court. These data shall be in a format that can be analyzed.

end insert