BILL NUMBER: SB 1291 ENROLLED
BILL TEXT
PASSED THE SENATE AUGUST 26, 2016
PASSED THE ASSEMBLY AUGUST 18, 2016
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 Section 14717.5 to the Welfare and Institutions
Code, relating to Medi-Cal.
LEGISLATIVE COUNSEL'S DIGEST
SB 1291, Beall. Medi-Cal: specialty mental health: 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 annual mental health plan reviews to be
conducted by an external quality review organization (EQRO) and,
commencing July 1, 2018, would require those reviews to include
specific data for Medi-Cal eligible minor and nonminor dependents in
foster care, including the number of Medi-Cal eligible 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
mental health service plans and performance outcome system data and
metrics, as specified.
This bill would require the department to post 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.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
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) 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
minor and nonminor dependents in foster care, including all of the
following:
(1) The number of Medi-Cal eligible minor and nonminor dependents
in foster care served each year.
(2) Details on the types of mental health services provided to
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.
(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 minor and nonminor dependents in
foster care.
(4) Quality of mental health services available to Medi-Cal
eligible minor and nonminor dependents in foster care.
(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 minor and nonminor
dependents in foster care.
(6) Performance data for Medi-Cal eligible minor and nonminor
dependents in foster care.
(7) Utilization data for Medi-Cal eligible minor and nonminor
dependents in foster care.
(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 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 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 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 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, 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
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 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
minor and nonminor dependents in foster care. These data shall be in
a format that can be analyzed.