BILL ANALYSIS Ó
SENATE COMMITTEE ON HUMAN SERVICES
Senator McGuire, Chair
2015 - 2016 Regular
Bill No: SB 1291
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|Author: |Beall |
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|Version: |March 28, 2016 |Hearing | |
| | |Date: | |
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|Urgency: |No |Fiscal: |Yes |
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|Consultant|Mareva Brown |
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Subject: Medi-Cal: specialty mental health: children and
youth
SUMMARY
This bill requires each county mental health plan to submit an
annual foster care mental health service plan to the state
Department of Health Care Services (DHCS) 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, as specified. It requires
annual mental health plan reviews to be conducted by an external
quality review organization (EQRO) and to include specific data
about Medi-Cal eligible children and youth under the
jurisdiction of the juvenile court and their families. The bill
requires DHCS to review the plans and the EQRO reviews and post
them on its Internet Web site. The bill also requires DHCS to
notify the mental health plans of any deficiencies and
establishes sanctions for failure to provide benefits, as
defined.
ABSTRACT
Existing law:
1) Under federal statute, vests responsibility for caring
for a child who has been removed from home and placed in
foster care with the state and any public agency which is
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administering the foster care plan with the state. (42
U.S.C. 672 (a)(2)(B))
2) In California statute, establishes a state and local
system of child welfare services, including foster care,
for children who have been adjudged by the court to be at
risk or have been abused or neglected, as specified. (WIC
202 et seq.)
3) Places the care of a child who has been removed from his
or her parents or guardian under the jurisdiction of the
juvenile court and defines abuse and neglect criteria for
such removal. (WIC 300 et seq)
4) Establishes the Medi-Cal program, administered by DHCS,
under which qualified low-income individuals receive health
care services. (WIC 14000, et seq.)
5) Establishes that foster children have met eligibility
requirements for the Medi-Cal program. (WIC 14007.4)
6) Establishes within DHCS the state administration of
Medi-Cal specialty mental health managed care, the Early
and Periodic Screening, Diagnosis, and Treatment (EPSDT)
Program, and applicable functions related to federal
Medicaid requirements. (WIC 14700)
7) Requires DHCS in collaboration with the California
Health and Human Services Agency, and in consultation with
the Mental Health Services Oversight and Accountability
Commission to create a plan for a performance outcome
system for EPSDT mental health services provided to
eligible Medi-Cal beneficiaries under the age of 21, as
specified. (WIC 14707.5)
8) Requires DHCS to implement managed mental health care
for Medi-Cal beneficiaries through contracts with mental
health plans. Mental health plans may include individual
counties, counties acting jointly, or an organization or
nongovernmental entity determined by the department to meet
mental health plan standards. A contract may be exclusive
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and may be awarded on a geographic basis. (WIC 14712)
9) Requires a mental health plan to provide specialty
mental health services, and, if the mental health plan is
not administered by a county, prohibits the mental health
plan from transferring the obligation for any specialty
mental health services to Medi-Cal beneficiaries to the
county and permits the plan to purchase services from the
county. (WIC 14714)
10) Requires DHCS to provide oversight to the mental health
plans to ensure quality, access, cost efficiency, and
compliance with data and reporting requirements. At a
minimum, requires DHCS through a method independent of any
agency of the mental health plan contractor, to monitor the
level and quality of services provided, expenditures
pursuant to the contract, and conformity with federal and
state law. (WIC 14714 (g))
This bill:
1) Requires each county mental health plan to submit an
annual foster care mental health service plan to DHCS,
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.
2) Requires annual plans to be submitted by July 1 of each
year, beginning in 2017.
3) Requires that, prior to submission to DHCS, the board of
supervisors of each county's mental health plan shall
approve the plan.
4) Mandates that the plan shall include, but not be limited
to, all of the following elements:
a. The number of Medi-Cal eligible children and
youth under the jurisdiction of the juvenile court
served each year.
b. The number of family members of children and
youth under the jurisdiction of the juvenile court
served by the county mental health plans.
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c. Details on the types of services provided to
children and youth under the jurisdiction of the
juvenile court and their families, including
prevention and treatment services.
d. Access to and timeliness of mental health
services available to Medi-Cal eligible children and
youth under the jurisdiction of the juvenile court.
e. Quality of mental health services available to
Medi-Cal eligible children and youth under the
jurisdiction of the juvenile court.
f. Translation and interpretation services
available to Medi-Cal eligible children and youth
under the jurisdiction of the juvenile court.
g. Coordination with other systems, including
regional centers, special education local plan areas,
child welfare, and probation.
h. Family and caregiver education and support.
i. Performance data for Medi-Cal eligible
children and youth under the jurisdiction of the
juvenile court in the annual external quality review
report, as specified.
j. Utilization data for Medi-Cal eligible
children and youth under the jurisdiction of the
juvenile court in the annual external quality review,
as specified.
aa. Medication monitoring.
5) Requires an annual mental health plan review to be
conducted by an external quality review organization
(EQRO), and that the review include specific data for
Medi-Cal eligible children and youth under the jurisdiction
of the juvenile court and their families, including many of
the same categories as identified in the annual plan, as
specified.
6) Requires DHCS to review the annual plan and the EQRO
review for each mental health plan, and to post both items
on its Internet Web site.
7) Requires DHCS, if it identifies deficiencies in an
annual plan or the EQRO review, to notify the mental health
plan, in writing, of those deficiencies.
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8) Requires a mental health plan that has been notified of
a deficiency in either it's annual plan or its EQRO review
to provide a written corrective action plan to DHCS within
60 days. Requires DHCS to notify the mental health plan of
approval or requested changes, if necessary, within 30 days
after receiving the corrective action plan.
9) Requires that final plans and EQRO reviews be made
publicly available by, at minimum, posting on the
department's Internet Web site.
10) Requires DHCS to conduct annual audits of each mental
health plan for the administration of EPSDT benefits for
children and youth under the jurisdiction of the juvenile
court, unless the director of DHCS determines there is good
cause for additional reviews. Requires that the reviews
shall use the standards and criteria established pursuant
to the Knox-Keene Health Care Service Plan Act of 1975, as
appropriate.
11) Permits DHCS to contract with professional
organizations, as appropriate, to perform required periodic
reviews. Requires DHCS or its designee to make a finding of
fact with respect to the ability of the mental health plan
to provide quality health care services, effectiveness of
peer review, and utilization control mechanisms, and the
overall performance of the mental health plan in providing
mental health care benefits.
12) Requires the director of DHCS to publicly report the
findings of finalized annual audits no later than 90 days
following completion of a corrective action plan, or as
specified.
13) Requires the director of DHCS to inform the county
behavioral health director and the board of supervisors in
writing if formal action may be necessary because DHCS
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believes that a mental health plan is substantially failing
to comply with any provision of law or regulation
pertaining to the administration of EPSDT benefits for
children and youth under the jurisdiction of the juvenile
court.
14) Requires DHCS to specify a period of time of at least 30
days for a county behavioral health director and board of
supervisors to comply with the law or regulations.
15) Permits the director of DHCS order the county to appear
at a hearing to show cause why the director should not take
administrative action to secure compliance if the county
and mental health plan to do not comply or provide
reasonable assurances in writing that they will comply
within the specified time frame. Sets time frames for
noticing the hearing and rendering a decision. Establishes
the county's right to present oral arguments about the
proposed decisions before the director of DHCS issues a
final administrative decision.
16) If the director determines that the county is failing to
comply with laws or regulations pertaining to a program
administered by DHCS, or is in violation of state law
relating to merit standards, as defined, and finds that an
administrative sanction is necessary to secure compliance,
the director may invoke one of a series of sanctions, but
may not invoke concurrent sanctions.
17) Establishes the following sanction options for DHCS:
a. Withhold all or part of state and federal
funds from the county until the county demonstrates to
the director that it has complied.
b. Suspend all or part of an existing contract
with the mental health plan and assume, temporarily,
the direct responsibility for the administration of
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all or part of any programs administered by DHCS in
the county until the county provides reasonable
written assurances to the director of DHCS of its
intention and ability to comply. During the period of
direct state administrative responsibility, the
director or his or her authorized representative shall
have all of the powers and responsibilities of the
county director, except that he or she shall not be
subject to the authority of the board of supervisors.
c. Requires a county to provide any funds
necessary for the continued operation of all programs
administered by DHCS in the county. If a county fails
or refuses to provide these funds, including a
sufficient amount to reimburse all costs incurred by
DHCS in directly administering a county's program,
permits the Controller to deduct an amount certified
by DHCS as necessary for the continued operation of
these programs by the department from any state or
federal funds payable to the county for any purpose.
d. Limits the sanction to no greater than the
amount of county funds that the county would be
required to contribute to fully match the General Fund
allocation for the particular program or programs for
those programs that are not public safety programs
realigned pursuant to 2011 Realignment Legislation.
e. Limits the sanction for the public safety
programs realigned pursuant to 2011 Realignment
Legislation that are administered by DHCS, to be no
greater than the amount of funding originally provided
to the county in the 2011-12 fiscal year for the
particular program from the Behavioral Services
Subaccount, adjusted as specified.
FISCAL IMPACT
This bill has not been analyzed by a fiscal committee.
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BACKGROUND AND DISCUSSION
Purpose of the bill:
Data on mental health treatment of foster youth, while
collected, is not always readily available. This bill requires
counties to pull together information from various existing
sources and to create an annual mental health plan which defines
the range of service options for children in foster care. The
bill also requires a review by an external quality review
organization (EQRO), and both the plan and the review then must
be reviewed by DHCS.
According to the author, counties currently are required to
report the data elements identified in this bill, but often the
data are scattered in various reports, do not include
demographic or priority population information such as children
in foster care, and lack descriptions of service-delivery
barriers. Furthermore, the author states, the reports vary
widely by county. Developing a streamlined reporting structure
that is shared with county boards of supervisors will enable
each county to learn from successful service interventions and
set goals for improving mental health service delivery, the
author states.
The author states, "As we passed legislation last year to stop
the over-prescription of psychotropic drugs to control foster
youth with behavioral problems, there were lingering questions
about the responsiveness and efficient delivery of mental health
services. To get answers and increase accountability, my bill
proposes to consolidate data from existing sources into one plan
under the oversight of the appropriate regulatory agency.
Specifically, it requires county mental health plans to report
out this data for children in the dependency and juvenile
systems in a standardized format. It empowers the Department of
Health Care Services to take corrective action. To increase
transparency, the data will be posted on the web."
Child welfare system
California's county-based child welfare system is designed to
protect children at risk of child abuse and neglect or
exploitation by providing intensive services to families to
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allow children to remain in their homes, or by arranging
temporary or permanent placement of the child in the safest and
least restrictive environment possible. It is the legal "parent"
for children in the foster care system. Approximately 62,600
children were in the custody of the child welfare system in
California as of October 1, 2015, according to data produced by
UC Berkeley's Child Welfare Indicators website.<1>
National studies have documented the poor outcomes of children
and youth who are removed from their homes into the child
welfare system. Current and former foster youth have heightened
rates of chronic health problems, developmental delays and
disabilities, mental health needs, and substance abuse
problems.<2> Twenty-five percent of youth who age-out of care
experience Post-Traumatic Stress Disorder (PTSD)-double the rate
for U.S. war veterans, according to the report. Nationally, the
birth rate for teen girls in foster care is more than double the
rate for those outside the foster care system.
Mental health
California's county-operated mental health system provides a
range of "specialty" mental health services and supports to
Medi-Cal beneficiaries and other vulnerable individuals whose
mental health needs are serious, including foster youth. Youth
with mild to moderate mental health needs, which are not covered
by the county mental health plans, are intended to be treated by
Medi-Cal managed care plans. Foster children and other children
enrolled in Medi-Cal are eligible for EPSDT, which provides for
periodic screenings and, if health conditions are identified,
treatment. DHCS oversees provision of services under Medi-Cal.
Specialty mental health services are a Medi-Cal entitlement for
adults and children that meet medical necessity criteria, which
consist of having a specific covered diagnosis, functional
impairment, and meeting intervention criteria. Mental health
services for Medi-Cal beneficiaries who do not meet the criteria
for specialty mental health services are provided under the
broader Medi-Cal program either through managed care plans (by
primary care providers within their scope of practice) or
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<1>http://cssr.berkeley.edu/ucb_childwelfare
<2>
http://www.childrensaidsociety.org/files/upload-docs/report_final
_April_2.pdf
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fee-for-service. DHCS has reported about 6 million children and
youth were eligible to receive Medi-Cal services in 2013-14, and
of that 262,318 received specialty mental health services, for a
penetration rate of 4.4%. The count of children and youth with 5
or more specialty mental health visits was 201,192, for a
penetration rate of 3.3%. The average per beneficiary
expenditure for approved services in 2013-14 was $6,092.
Psychotropic Medication Use in Children
Concern over the use of psychotropic medications among children
has been well-documented in research journals and the mainstream
media for more than a decade. The category of psychotropic
medication is fairly broad, intending to treat symptoms of
conditions ranging from ADHD to childhood schizophrenia. Some of
the drugs used to treat these conditions are FDA-approved,
including stimulants like Ritalin for ADHD, however only about
31 percent of psychotropic medications have been approved by the
U.S. Food and Drug Administration (FDA) for use in children or
adolescents. It is estimated that more than 75 percent of the
prescriptions written for psychiatric illness in this population
are "off label" in usage, meaning they have not been approved by
the FDA for the prescribed use, though the practice is legal and
common across all manner of pharmaceuticals.<3>
Anti-psychotic medications, used to treat more severe mental
health conditions, include powerful brand-name drugs such as
Haldol, Risperdal, Abilify, Seroquel and Zyprexa. They have very
limited approval by the FDA for pediatric use beyond rare and
severe conduct problems that are resistant to other forms of
treatment, such as Tourette's syndrome, behavioral symptoms
associated with autistic disorder, childhood schizophrenia, and
bipolar disorder.<4> However, the off-label use of these
anti-psychotics among children is high, particularly among
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<3>https://www.magellanprovider.com/mhs/mgl/providing_care/clinic
al_guidelines/clin_monographs/psychotropicdrugsinkids.pdf
<4> Harrison, et al, "Antipsychotic Medication Prescribing
Trends in Children and Adolescents," Journal of Pediatric Health
care, March 2012.
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foster children. According to a study published in 2011,
children who took antipsychotic medications were likely to
suffer ill health effects including "cardio metabolic and
endocrine side-effects" as well as significant weight gain.<5>
The authors recommended that collaboration between child and
adolescent psychiatrists, general practitioners and
pediatricians is essential to "reduce the likelihood of
premature cardiovascular morbidity and mortality."
Drugging our Children Media Series
A series of stories published last year in the San Jose Mercury
News and the Los Angeles Times, highlighted growing concerns
that psychotropic medications have been relied on by
California's child welfare and children's mental health systems
as a means of controlling, instead of treating, youth who suffer
from trauma-related behavioral health challenges. The series
detailed significant challenges in accessing pharmacy benefits
claims data held by DHCS, eventually overcome through a Public
Records Act request and lengthy negotiations, and demonstrated
that prescribing rates were far higher than had been anticipated
by child welfare system experts.
Existing data
Katie A. dashboard
In 2002, plaintiffs filed a class action lawsuit, Katie A. vs
Bonta, alleging violations of federal Medicaid laws, and the
American with Disabilities Act. The suit sought to improve the
provision of mental health and supportive services for children
and youth in, or at imminent risk of placement in, foster care
in California. Katie A. entered foster care at age 4 and, by age
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<5> DeHert, Dobbelaere, Sheridan, et al "Metabolic and endocrine
adverse effects of second-generation antipsychotics in children
and adolescents: A systematic review of randomized, placebo
controlled trials and guidelines for clinical practice,"
European Psychiatry, April 2011, pgs 144-58.
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14, had been assigned 37 foster care placements, 19 psychiatric
institution placements and 7 stays in children's shelters. The
Katie A. lawsuit alleged a failure to properly assess her mental
health needs or to provide adequate mental health treatment and
an overuse of congregate and shelter care. A subsequent
settlement requires children in foster care who are being
considered for high-level group care, inpatient psychiatric care
or other intensive treatments, as specified, to be eligible for
Early and Periodic Screening, Diagnosis, and Treatment (EPSDT)
services. The state subsequently developed a series of intensive
mental health services for such children, a manual for care
coordination between state and local mental health and child
welfare providers, and a program of therapeutic foster care.
DHCS provides a monthly update of services provided to members
of the Katie A. class. The most recent report, published in
December 2015, noted: <6>
There were 11,792 foster youth identified as being
members of the Katie A. subclass.
Total approved funding was $102 million, a decrease of
$83 from the prior month.
There were 13 million approved minutes of Intensive Care
Coordination for about 6,800 youth.
There were 14.5 million minutes of intensive home based
service provided to approximately 5,300 Katie A. subclass
members.
The Performance Outcome System
The performance outcome system requires annual posting of the
usage of specialty mental health services by children and youth,
including foster youth. The system was intended to develop
outcomes for the EPSDT program to improve individual outcomes
and inform decision making related to purchase of services, per
Legislative intent language that was codified with the bill.
While the data is broken out by age, gender and frequency of
service visits, it does not identify foster youth.<7>
External Quality Review Organization
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<6> http://www.dhcs.ca.gov/Pages/SMHSReports2015.aspx
<7> http://www.dhcs.ca.gov/individuals/Documents/FebPOSFinal.pdf
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The United States Department of Health and Human Services
Centers for Medicare and Medicaid Services (CMS) requires an
annual, independent external evaluation of State Medicaid
Managed Care programs by an EQRO. The EQRO provides an analysis
and evaluation of aggregate information on quality, timeliness,
and access to health care services furnished by Prepaid
Inpatient Health Plans and their contractors to recipients of
Managed Care services. The CMS (42 CFR §438; Medicaid Program,
External Quality Review of Medicaid Managed Care Organizations)
rules specify the requirements for evaluation of Medicaid
Managed Care programs. These rules require an on-site review or
a desk review of each county Medi-Cal mental health plan. DHCS
contracts with 56 county Medi-Cal mental health plans to provide
specialty mental health services to Medi-Cal beneficiaries. <8>
Dashboards
Additionally, information from the EQRO report may be used in
compiling an annual mental health dashboard for each county that
is required by CMS as part of the 1915 (b) waiver to be posted
on the county's Internet Website. The dashboard must include a
summary of quality, access, timeliness and interpretation or
translation capabilities of the mental health plan. The first
dashboard is due to be published Sept. 1, 2016.
Child Welfare Services / Case Management System
The CWS/CMS is a collaborative venture with the University of
California at Berkeley and CDSS. The project is housed in the
School of Social Welfare, and provides policymakers, child
welfare workers, researchers, and the public with direct access
to customizable information on California's child welfare
system.
Related legislation:
SB 1466 (Mitchell, 2016) requires screening services provided
under EPSDT to include screening for trauma. Requires child
abuse and neglect or removal from the parent or legal guardian
by a child welfare agency to be prima facie evidence of trauma
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<8> "Eternal Quality Review 2014-2015, Performance Improvement
Status Report," Behavioral Health Concepts, Inc., May-June 2015.
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for purposes of conducting a screening consistent with the
requirement to screen for trauma. SB 1446 is scheduled to be
heard before this committee on April 12.
SB 238 (Mitchell, Chapter 534, Statutes of 2015) required
additional training on psychotropic medications for foster care
providers, and required CDSS to provide a monthly report to each
county placing agency with information about each child for whom
one or more psychotropic medications have been paid for under
Medi-Cal.
SB 1009 (Committee on Budget and Fiscal Review, Chapter 34,
Statutes of 2012), required DHCS, in collaboration with the
California Health and Human Services Agency, and in consultation
with the Mental Health Services Oversight and Accountability
Commission and a stakeholder advisory committee to develop a
plan for a performance outcomes system for EPSDT specialty
mental health services provided to eligible Medi-Cal
beneficiaries under the age of 21.
COMMENTS
The author and other members of the Legislature requested data
on psychotropic medication usage among foster children in 2015
and found that while data is compiled, it was unclear how many
children were prescribed psychotropic medications while in
foster care. While this has since been resolved with a data
sharing agreement between CDSS and DHCS, this bill requires the
data be assembled and provided publicly.
Amendments were negotiated with the author in Health Committee
and will be taken in Human Services Committee due to condensed
time frames to move the bill. These amendments strike the
penalties and provide more specific detail about measurements to
be used. They are as follows:
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 CMS approved waiver authorized under Section
1915 of the Social Security Act, 42 CFR 238.204 , 42 CFR
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438.240 and 42 CFR 438.358 . 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 not limited
to: screenings, assessments, home based mental health services,
outpatient, day- treatment, or inpatient services, psychiatric
hospitalizations, crisis interventions, case management, and
psychotropic medication support services.
(4) Access to and timeliness of mental health services as
defined in 28 CCR §§1300.67.2, 1300.67.2.1, 1300.67.2.2 and
consistent with 42 CFR § 438.206, 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 42
CFR §438.10(c) (4) and (5) and 9 CCR §1810.410, available to
Medi-Cal eligible children and youth under the jurisdiction of
the juvenile court.
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(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. Including but not
limited to the child welfare psychotropic medication measures
developed by the department of social services and the following
Healthcare Effectiveness Data and Information Set (HEDIS)
measures related to psychotropic medications:
(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.
(B) Use of Multiple Concurrent Antipsychotics in Children and
Adolescents (HEDIS APC), which does both of the following:
(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
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antipsychotic medication.
(D) Metabolic Monitoring for Children and Adolescents on
Antipsychotics (HEDIS APM), which does both of the following:
(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 review the plan required pursuant to
subdivision (a) and shall post each plan on its Internet Web
site.
(c) (1) If the department identifies deficiencies in a plan, the
department shall notify the mental health plan, in writing, of
those deficiencies, pursuant to WIC § 14712 (e) .
(2) After notification, the mental health plan shall provide a
written corrective action plan to the department within 60 days.
The department shall notify the mental health plan of approval
or shall request changes, if necessary, within 30 days after
receiving the corrective action plan. Final plans shall be made
publicly available by, at minimum, posting on the department's
Internet Web site.
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.
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(2) The number of family members 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 services provided to children and
their caregivers, including prevention and treatment services.
These types of services may include, but not limited to:
screenings, assessments, home based mental health services,
outpatient, day- treatment, or inpatient services, psychiatric
hospitalizations, crisis interventions, case management, and
psychotropic medication support services.
(4) Access to and timeliness of mental health services , as
defined in 28 CCR §§1300.67.2, 1300.67.2.1, 1300.67.2.2 and
consistent with 42 CFR § 438.206 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 42
CFR §438.10(c) (4) and (5) and 9 CCR §1810.410, 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 which is consistent with the
Healthcare Effectiveness Data and Information Set. Including but
not limited to the child welfare psychotropic medication
measures developed by the department of social services and the
following
Healthcare Effectiveness Data and Information Set (HEDIS)
measures related to psychotropic medications:
(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
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a visit with a provider with prescribing authority within 30
days of the new prescription.
(B) Use of Multiple Concurrent Antipsychotics in Children and
Adolescents (HEDIS APC), which does both of the following:
(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.
(D) Metabolic Monitoring for Children and Adolescents on
Antipsychotics (HEDIS APM), which does both of the following:
(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 the EQRO data for Medi-Cal
eligible children and youth under the jurisdiction of the
juvenile court and their families.
(2) 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.
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(3) 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) The department shall conduct annual audits of each mental
health plan for the administration of EPSDT benefits for
children and youth under the jurisdiction of the juvenile court,
consistent with the WIC §14707.5, unless the director determines
there is good cause for additional reviews. The reviews shall
use the standards and criteria established pursuant to the
Knox-Keene Health Care Service Plan Act of 1975, as appropriate,
such as 28 CCR §§1300.67.2, 1300.67.2.1, 1300.67.2.2 related to
access to and timeliness of services . The department may
contract with professional organizations, as appropriate, to
perform the periodic review required by this section. The
department, or its designee, shall make a finding of fact with
respect to the ability of the mental health plan to provide
quality health care services, effectiveness of peer review, and
utilization control mechanisms, and the overall performance of
the mental health plan in providing mental health care benefits
to its enrollees. The director shall publicly report the
findings of finalized annual audits conducted pursuant to this
section as soon as possible, but no later than 90 days following
completion of a corrective action plan initiated pursuant to the
audit, if any, unless the director determines, in his or her
discretion, that additional time is reasonably necessary to
fully and fairly report the results of the audit.
(d) If the director believes that a mental health plan is
substantially failing to comply with any provision of this code
or any regulation pertaining to the administration of EPSDT
benefits for children and youth under the jurisdiction of the
juvenile court, and the director determines that formal action
may be necessary to secure compliance, he or she shall inform
the county behavioral health director and the board of
supervisors of that failure. The notice to the county behavioral
health director and board of supervisors shall be in writing and
shall allow the county and the mental health plan a period of
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time specified by the department, but in no case less than 30
days, to correct the failure to comply with the law or
regulations. If within the specified period the county and the
mental health plan do not comply or provide reasonable
assurances in writing that they will comply within the
additional time as the director may allow, the director may
order a representative of the county to appear at a hearing
before the director to show cause why the director should not
take administrative action to secure compliance. The county
shall be given at least 30 days' notice of the hearing. The
director shall consider the case on the record established at
the hearing and, within 30 days, shall render proposed findings
and a proposed decision on the issues. The proposed findings and
decisions shall be submitted to the county, and the county shall
have the opportunity to appear within 10 days, at a time and
place as may be determined by the director, for the purpose of
presenting oral arguments respecting the proposed findings and
decisions. Thereupon, the director shall make final findings and
issue a final administrative decision.
(e) If the director determines, based on the record established
at the hearing pursuant to subdivision (d), that the county is
failing to comply with laws or regulations pertaining to a
program administered by the department, or if the Department of
Human Resources certifies to the director that a county is not
in conformity with established merit system standards under Part
2.5 (commencing with Section 19800) of Division 5 of Title 2 of
the Government Code, and that administrative sanctions are
necessary to secure compliance, the director may invoke either
of the following sanctions allowable under WIC § 14712 (e).
except that the sanctions shall not be invoked concurrently:
(1) Withhold all or part of state and federal funds from the
county until the county demonstrates to the director that it has
complied.
(2) (A) Suspend all or part of an existing contract with the
mental health plan and assume, temporarily, direct
responsibility for the administration of all or part of any
programs administered by the department in the county until the
county provides reasonable written assurances to the director of
its intention and ability to comply. During the period of direct
state administrative responsibility, the director or his or her
authorized representative shall have all of the powers and
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responsibilities of the county director, except that he or she
shall not be subject to the authority of the board of
supervisors.
(B) (i) In the event that the director invokes sanctions
pursuant to this section, the county shall be responsible for
providing any funds necessary for the continued operation of all
programs administered by the department in the county. If a
county fails or refuses to provide these funds, including a
sufficient amount to reimburse all costs incurred by the
department in directly administering a program in the county,
the Controller may deduct an amount certified by the director as
necessary for the continued operation of these programs by the
department from any state or federal funds payable to the county
for any purpose.
(ii) In the event of a state-imposed sanction, the amount of the
sanction shall be no greater than the amount of county funds
that the county would be required to contribute to fully match
the General Fund allocation for the particular program or
programs for which the county is being sanctioned for those
programs that are not public safety programs realigned pursuant
to 2011 Realignment Legislation.
(iii) In the event of a state-imposed sanction pursuant to this
paragraph for the public safety programs realigned pursuant to
2011 Realignment Legislation that are administered by the State
Department of Health Care Services, the amount of the sanction
shall be no greater than the amount of funding originally
provided to the county in the 2011-12 fiscal year for the
particular program from the Behavioral Services Subaccount
within the Support Services Account of the Local Revenue Fund
2011, as adjusted by the county's share of the additional
incremental funding provided pursuant to paragraph (1) of
subdivision (f) of Section 30027.5 of, paragraph (1) of
subdivision (f) of Section 30027.6 of, paragraph (1) of
subdivision (f) of Section 30027.7 of, and paragraph (1) of
subdivision (f) of Section 30027.8 of, the Government Code, the
estimated growth funding for the program from the Support
Services Growth Subaccount within the Sales and Use Tax Growth
Account, and any adjustment to the county allocation pursuant to
subdivision (a) of Section 30029.6 of the Government Code.
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POSITIONS
Support:
Bay Area Youth Center (Co-Sponsor)
Cecil H. Bullard, MD, FACP (Co-Sponsor)
Children's Advocacy Institute (Co-Sponsor)
Family Voices of California (Co-Sponsor)
Kids in Common (Co-Sponsor)
National Youth Law Center (Co-Sponsor)
Peers Envisioning and Engaging in Recovery Services
(Co-sponsor)
American Association for Marriage and Family Therapy,
California Division
California Council of Community Behavioral Health Agencies
California Youth Connection
Children's Advocacy Institute
Children Now
Children's Partnership
Consumer Watchdog
First Focus Campaign for Children
John Burton Foundation for Children Without Homes
National Association of Social Workers
Therapist for Peace & Justice
Woodland Community College
Oppose:
None received.
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