BILL ANALYSIS Ó
SENATE COMMITTEE ON APPROPRIATIONS
Senator Ricardo Lara, Chair
2015 - 2016 Regular Session
SB 1291 (Beall) - Medi-Cal: specialty mental health: children
and youth
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|Version: April 14, 2016 |Policy Vote: HEALTH 9 - 0, |
| | HUMAN S. 5 - 0 |
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|Urgency: No |Mandate: No |
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|Hearing Date: May 9, 2016 |Consultant: Brendan McCarthy |
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This bill meets the criteria for referral to the Suspense File.
Bill
Summary: SB 1291 would require county mental health plans to
submit an annual foster care mental health service plan to the
Department of Health Care Services. The bill would require
county mental health plans to be reviewed by an external quality
review organization with specified requirements. The bill would
require the Department to conduct annual audits of county mental
health plans to assess the provision of services to foster
youth.
Fiscal
Impact:
Ongoing costs of about $1.9 million per year for the
Department of Health Care Services to review county plans,
conduct audits, and take necessary enforcement actions
(General Fund and federal funds).
Ongoing costs of about $450,000 per year for additional items
to be reviewed by the external quality review organization
SB 1291 (Beall) Page 1 of
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(General Fund and federal funds).
Likely administrative costs in the low millions for county
mental health plans to develop the required foster youth
mental health service plans (General Fund). Much of the
information required for the plans is already possessed by
county mental health plans. However, there are likely to be
administrative costs to compile that information and develop
the required plans. Under the state constitution, the state
would be responsible for reimbursing counties for any
additional administrative costs incurred due to the bill.
Unknown impact on the costs for counties to provide additional
specialty mental health services (local funds or General
Fund). By increasing the scrutiny on the provision of services
to Medi-Cal beneficiaries by county mental health plans, the
bill may bring to light shortcomings in the provision of those
services (such as delays in access to services or provider
shortages). To the extent that occurs, it may result in
counties providing additional services. To the extent that
there is an increase is services due to the bill and to the
extent that counties could demonstrate that the increase in
utilization was due to the effects of the bill, the state
could be responsible for those costs. Whether that would
actually occur is unknown, as there is no formal process yet
in place for determining when and how the state should
reimburse counties for additional costs relating to realigned
programs.
Background: Under current law, specialty mental health (i.e. services for
severe mental illness) is "carved-out" of the regular Medi-Cal
managed care program and is provided by county mental health
plans. County mental health plans are funded with county
realignment funds and federal funds. Mild to moderate mental
illness is covered by Medi-Cal managed care plans or the
fee-for-service Medi-Cal system.
Under federal law, the state must contract with an external
quality review organization (EQRO) to perform quality reviews of
Medi-Cal managed care system. The state is responsible for
contracting with and paying for the EQRO. The federal government
provides 75% matching funds for those activities. The Department
of Health Care Services contracts with one EQRO for review of
Medi-Cal managed care plans and one for review of specialty
SB 1291 (Beall) Page 2 of
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mental health services provided by county mental health plans.
Under current law, only a juvenile court judicial officer may
order the administration of psychotropic medications for a minor
who is a dependent of the court (i.e. a foster youth). Foster
youth are categorically eligible for Medi-Cal benefits and hence
Medi-Cal provides coverage for those psychotropic medications.
Psychotropic medications are intended to treat a variety of
mental health conditions. While many patients benefit from the
use of psychotropic medications, there are often serious side
effects, particularly when taken in combination. In general, the
use of psychotropic medications on children and adolescents is
"off label" meaning that those drugs have not been specifically
approved for use in children or adolescents. According to the
Department of Social Services, about 11% of foster youth under
age 17 are authorized to receive psychotropic medications.
Concerns have been raised by advocates for foster youth that
many foster youth are being prescribed these medications to
sedate them, rather than to appropriately address their mental
health and behavioral health needs.
In response to concerns about the high rate of psychotropic
drugs administered to foster youth, the Department of Health
Care Services expanded its existing policy requiring treatment
authorization requests for psychotropic drugs for Medi-Cal
beneficiaries. Previously, the Department required a prior
treatment authorization request before Medi-Cal would authorize
psychotropic drugs for Medi-Cal beneficiaries under age six. In
October 2014, the Department expanded this requirement for
children and adolescents up to age 17. The treatment
authorization request process allows for emergency prescriptions
while the request is under review. In addition, in April 2015
the Department of Health Care Services and the Department of
Social Services released guidelines for the use of psychotropic
medications in foster youth.
Proposed Law:
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SB 1291 would require county mental health plans to submit an
annual foster care mental health service plan to the Department
of Health Care Services. The bill would require county mental
health plans to be reviewed by an external quality review
organization with specified requirements. The bill would require
the Department to conduct annual audits of county mental health
plans to assess the provision of services to foster youth.
Specific provisions of the bill would:
Require each county mental health plan to submit an
annual foster care mental health service plan to the
Department of Health Care Services and require the county
Board of Supervisors to approve the plan;
Specify the information that must be included in the
plan;
Require the Department to review each plan and notify a
county if any deficiencies are found;
Require county mental health plans to be reviewed
annually by an EQRO, with specified information for all
Medi-Cal eligible children and foster youth;
Require the Department to review the EQRO data and
notify a county mental health plan of any deficiencies;
Require the Department to conduct annual audits of each
county mental health plan for the administration of Early
and Periodic Screening Diagnosis and Treatment benefits for
children and foster youth, using the criteria established
in the Knox-Keene Act for health plans;
Authorize the Department to impose sanctions as provided
in law for failure to comply by a county mental health
plan.
Related
Legislation: SB 1174 (McGuire) would require the Department of
Health Care Services to provide data to the Medical Board of
California relating to the prescribing of psychotropic
medications to foster youth and require the Medical Board to
review the data to determine if overprescribing is occurring.
That bill is on this committee's Suspense File.
Under current law, both Medi-Cal specialty mental health has
been realigned to the counties. Generally, this require counties
to provide the non-federal share of program costs using
realignment funds. However, Proposition 30 of 2012 provides that
any legislation enacted after September 30, 2012 that has an
overall effect of increasing the costs already borne by a local
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agency for realigned services applies to local agencies only to
the extent that the State provides annual funding for the cost
increase. Therefore, any additional costs experienced by the
counties due to the reporting requirements in the bill would be
a state responsibility. Whether the state would be responsible
for costs associated with the provision of additional specialty
mental health services is unknown, as there is no formal process
in place for determining state responsibility for local costs
under realignment.
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