BILL NUMBER: SB 1291 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY AUGUST 15, 2016
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
INTRODUCED BY Senator Beall
FEBRUARY 19, 2016
An act to add Sections 14717.2 and Section
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. minor and
nonminor dependents.
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 This bill would require
annual mental health plan reviews to be conducted by an external
quality review organization (EQRO) and and,
commencing July 1, 2018, would require those reviews to include
specific data for Medi-Cal eligible children and youth
under the jurisdiction of the juvenile court and their families,
minor and nonminor dependents in foster care,
including the number of Medi-Cal eligible children and youth
under the jurisdiction of the juvenile court minor
and nonminor dependents in foster care 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
county foster care mental health service 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,
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, and 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 county 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 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 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 1. 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 (EQRO) pursuant to federal regulations at 42
C.F.R. 438.350 et seq.. Commencing July 1, 2018, the review
shall include specific data for Medi-Cal eligible children
and youth under the jurisdiction of the juvenile court and their
families, minor and nonminor dependents in foster
care, including all of the following:
(1) The number of Medi-Cal eligible children and youth
under the jurisdiction of the juvenile court minor and
nonminor dependents in foster care 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 mental health plans.
(3)
( 2) Details on the types of mental health
services provided to children and their caregivers,
children, 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)
(3) 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.
minor and nonminor dependents in foster care.
(5)
(4) Quality of mental health services available to
Medi-Cal eligible children and youth under the jurisdiction
of the juvenile court. minor and nonminor dependents
in foster care.
(6)
(5) 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.
minor and nonminor dependents in foster care.
(7)
(6) Performance data for Medi-Cal eligible
children and youth under the jurisdiction of the juvenile court.
minor and nonminor dependents in foster care.
(8)
(7) Utilization data for Medi-Cal eligible
children and youth under the jurisdiction of the juvenile court.
minor and nonminor dependents in foster care.
(9)
(8) 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 minor and nonminor dependents in
foster care 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. minor and nonminor
dependents in foster care.
(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, minor and
nonminor dependents in foster care, 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 care mental health service plans, such as data
described in federal regulations at 42 C.F.R. 438.350 et seq.,
subdivision (c) of Section 16501.4
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 care mental health service 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: minor
and nonminor dependents in foster care:
(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. minor and nonminor dependents in foster care.
These data shall be in a format that can be analyzed.