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 ----------------------------------------------------------------- | | | | | | ----------------------------------------------------------------- |--------------------------------+--------------------------------| | | | |Version: April 14, 2016 |Policy Vote: HEALTH 9 - 0, | | | HUMAN S. 5 - 0 | | | | |--------------------------------+--------------------------------| | | | |Urgency: No |Mandate: No | | | | |--------------------------------+--------------------------------| | | | |Hearing Date: May 9, 2016 |Consultant: Brendan McCarthy | | | | ----------------------------------------------------------------- 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 ? (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 ? 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: SB 1291 (Beall) Page 3 of ? 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 SB 1291 (Beall) Page 4 of ? 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. -- END --