BILL NUMBER: SB 1291 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY JUNE 13, 2016
AMENDED IN SENATE JUNE 1, 2016
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.
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.
This bill would require the department to post the plans
and plans, any corrective action plan prepared
by the mental health plan to address deficiencies identified by the
EQRO review review, and the EQRO data
on its Internet Web site. site, as specified.
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 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 any Healthcare
Effectiveness Data and Information Set (HEDIS) measures related
to psychotropic medications: medications,
including, but not limited to, the following:
(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. ADD).
(B) Use of Multiple Concurrent Antipsychotics in Children and
Adolescents (HEDIS APC), which does both of the following:
APC).
(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. APP) .
(D) Metabolic Monitoring for Children and Adolescents on
Antipsychotics (HEDIS APM), which does both of the
following: APM).
(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 post each plan on its Internet Web
site. site in a manner that is publicly
accessible.
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 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 any Healthcare
Effectiveness Data and Information Set (HEDIS) measures related
to psychotropic medications: medications,
including, but not limited to, the following:
(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. ADD).
(B) Use of Multiple Concurrent Antipsychotics in Children and
Adolescents (HEDIS APC), which does both of the following:
APC).
(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. APP).
(D) Metabolic Monitoring for Children and Adolescents on
Antipsychotics (HEDIS APM), which does both of the
following: APM).
(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 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.
(2) 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)
(3) 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)
(4) 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) 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.
(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:
(1) The number of youth receiving specialty mental health
services.
(2) The racial distribution of youth receiving specialty mental
health services.
(3) The gender distribution of youth receiving specialty mental
health services.
(4) The number of youth, by race, with one or more specialty
mental health service visits.
(5) The number of youth, by race, with five or more specialty
mental health service visits.
(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.
(7) A unique count of youth receiving specialty mental health
services who are arriving, exiting, and continuing with services.
(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.