Amended in Assembly June 27, 2016

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

This bill would require the department to post the plans, any corrective action plan prepared by the mental health plan to address deficiencies identified by the EQRO review, and the EQRO data on its Internet Web 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,
begin insert and end insert 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 begin insert county end insert 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 begin delete county end delete 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 begin delete to end delete begin insert to, end insert and timeliness begin delete of end delete begin insert of, end insert 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 child welfare
psychotropic medication measures developed by the State
Department of Social Services and any Healthcare Effectiveness
Data and Information Set (HEDIS) measures related to
psychotropic medications, including, but not limited to, the
following:

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

(B) Use of Multiple Concurrent Antipsychotics in Children and
Adolescents (HEDIS APC).

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

(D) Metabolic Monitoring for Children and Adolescents on
Antipsychotics (HEDIS APM).

(b) The department shall post each plan on its Internet Web 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 begin delete court,
including foster parents, end delete begin insert court end insert 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 begin delete to end delete begin insert to, end insert and timeliness begin delete of end delete begin insert of, end insert 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 begin delete Regulations end delete
begin insert Regulations, end insert 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 begin delete Regulations end delete begin insert Regulations, end insert 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 child welfare
psychotropic medication measures developed by the State
Department of Social Services and any Healthcare Effectiveness
Data and Information Set (HEDIS) measures related to
psychotropic medications, including, but not limited to, the
following:

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

(B) Use of Multiple Concurrent Antipsychotics in Children and
Adolescents (HEDIS APC).

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

(D) Metabolic Monitoring for Children and Adolescents on
Antipsychotics (HEDIS APM).

(b) (1) The department shall 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.

(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.

(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 begin delete youth end delete begin insert care end insert mental health begin insert service end insert 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 begin delete youth end delete begin insert care end insert mental health begin insert service end insert 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.