BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | SB 1291|
|Office of Senate Floor Analyses | |
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THIRD READING
Bill No: SB 1291
Author: Beall (D)
Amended: 6/1/16
Vote: 21
SENATE HEALTH COMMITTEE: 9-0, 4/6/16
AYES: Hernandez, Nguyen, Hall, Mitchell, Monning, Nielsen,
Pan, Roth, Wolk
SENATE HUMAN SERVICES COMMITTEE: 5-0, 4/12/16
AYES: McGuire, Berryhill, Hancock, Liu, Nguyen
SENATE APPROPRIATIONS COMMITTEE: 7-0, 5/27/16
AYES: Lara, Bates, Beall, Hill, McGuire, Mendoza, Nielsen
SUBJECT: Medi-Cal: specialty mental health: children and
youth
SOURCE: National Center for Youth Law
DIGEST: This bill requires each county mental health plan to
submit an annual foster care mental health service plan to the
Department of Health Care Services (DHCS) detailing the services
available to Medi-Cal eligible children and youth under the
jurisdiction of the juvenile court and their families. Requires
a mental health plan review to be conducted annually by an
external quality review organization (EQRO) that includes
specific data for Medi-Cal eligible children and youth under the
jurisdiction of the juvenile court and their families.
ANALYSIS:
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Existing law:
1)Establishes the Medi-Cal program, which is administered by the
DHCS, under which qualified low-income individuals receive
health care services.
2)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 DHCS to meet mental health plan
standards. A contract may be exclusive and may be awarded on a
geographic basis.
3)Requires mental health plans to provide specialty mental
health services to eligible Medi-Cal beneficiaries, including
both adults and children.
4)Requires DHCS to be 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.
5)Requires DHCS to provide oversight to the mental health plans
to ensure quality, access, cost efficiency, and compliance
with data and reporting requirements. Requires DHCS, at a
minimum, 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.
This bill:
1)Requires each 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. Requires the plans to
be consistent with the Special Terms and Conditions of the
federal Medicaid waiver for specialty mental health waiver and
specified provisions of federal regulation. Requires plans to
be submitted by July 1 of each year, beginning in 2017.
2)Requires each mental health plan to submit an annual foster
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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. Requires plans to be
submitted by July 1st of each year, beginning in 2017.
3)Requires the board of supervisors of each mental health plan
to approve the plan prior to submission of the plan.
4)Requires a mental health plan review to be conducted annually
by an external quality review organization (EQRO). Requires
the review to include specific data for Medi-Cal eligible
children and youth under the jurisdiction of the juvenile
court and their families.
5)Requires the mental health plan and the mental health plan
review done by the EQRO to 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, including foster parents,
of children and youth under the jurisdiction of the
juvenile court served by the county mental health plans;
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, using specified
standards for appointments and geographic accessibility
applicable to health plans regulated under the Knox-Keene
Act;
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 (this requirement is limited to mental health
service plan);
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h) Family and caregiver education and support (this
requirement is limited to mental health service plan);
i) Performance data for Medi-Cal eligible children and
youth under the jurisdiction of the juvenile court in the
annual EQRO report required by this bill;
j) Utilization data for Medi-Cal eligible children and
youth under the jurisdiction of the juvenile court in the
annual EQRO report required by this bill; and,
aa) Medication monitoring, consistent with specified
Healthcare Effectiveness Data and Information Set measures.
6)Requires DHCS to post each plan on its Internet Web site.
7)Requires DHCS to review the EQRO data for Medi-Cal eligible
children and youth under the jurisdiction of the juvenile
court and their families. Requires DHCS to notify the mental
health plans in writing of identified deficiencies 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.
8)Requires the mental health plan to provide a written
corrective action plan to DHCS within 60 days of receiving the
notice. Requires DHCS to notify the mental health plan of
approval of the corrective action plan or request changes, if
necessary, within 30 days after receipt of the corrective
action plan. Requires final corrective action plans to be made
publicly available by, at minimum, posting on the DHCS
Internet Web site.
Comments
1)Author's statement. According to the author, as the
Legislature 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,
this 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 DHCS to take corrective action. To increase
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transparency, the data will be posted on the web.
2)EQRO. Federal Medicaid regulations require states to contract
with an EQRO to perform external quality review activities.
The EQRO must have staff with demonstrated experience and
knowledge of (a) Medicaid beneficiaries, policies, data
systems, and processes; (b) managed care delivery systems,
organizations, and financing; (c) quality assessment and
improvement methods; and (d) research design and methodology,
including statistical analysis. The EQRO and its
subcontractors are independent from the state Medicaid agency
and the health plans that they review. States must ensure that
the EQR produces at least the following information:
a) A detailed technical report that describes the manner in
which the data from all activities conducted were
aggregated and analyzed and conclusions were drawn as to
the quality, timeliness, and access to the care furnished
by the plan;
b) An assessment of each plan's strengths and weaknesses
with respect to the quality, timeliness, and access to
health care services furnished to Medicaid beneficiaries;
c) Recommendations for improving the quality of health care
services furnished by each plan;
d) As the State determines methodologically appropriate,
comparative information about all plans; and,
e) An assessment of the degree to which each health plan
has addressed effectively the recommendations for quality
improvement made by the EQRO during the previous year's
EQR.
3)Specialty mental health "carve out." The Medi-Cal Specialty
Mental Health Services Program is "carved-out" of the broader
Medi-Cal program and is administered by DHCS under a federal
waiver approved by the Centers for Medicare and Medicaid
Services (CMS). DHCS contracts with a MHP in each county to
provide or arrange for the provision of Medi-Cal specialty
mental health services. All MHPs are county mental health
departments. Specialty mental health services are Medi-Cal
entitlement services for adults and children that meet medical
necessity criteria, which consist of having a specific covered
diagnosis, functional impairment, and meeting intervention
criteria. MHPs must certify that they incurred a cost before
seeking federal reimbursement through claims to the State.
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MHPs are responsible for the non-federal share of Medi-Cal
specialty mental health services. 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
fee-for-service (for children exempt from mandatory enrollment
in Medi-Cal managed care). Children's specialty mental health
services are provided under the federal requirements of the
EPSDT benefit, which is available to full-scope beneficiaries
under age 21.
DHCS has reported data on the number of children and youth
eligible to receive Medi-Cal services in 2013-14 as slightly
over 6 million. Of these 6 million children, 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.
An estimated 66,000 children and youth are in foster care
under the jurisdiction of the juvenile court due a finding of
abuse or neglect or who have been removed from their home and
are under supervised probation. Except for foster youth in the
six county organized health systems (COHS, which operate in 22
counties), foster youth are exempt from mandatory enrollment
in Medi-Cal managed care plans.
FISCAL EFFECT: Appropriation: No Fiscal
Com.:YesLocal: No
According to the Senate Appropriations Committee:
1)Ongoing costs likely in the hundreds of thousands per year for
the Department of Health Care Services to review county plans,
EQRO reports, and take necessary enforcement actions (General
Fund [GF] and federal funds).
2)Ongoing costs of about $450,000 per year for additional items
to be reviewed by the external quality review organization (GF
and federal funds).
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3)Likely administrative costs in the low millions for county
mental health plans to develop the required foster youth
mental health service plans (GF and federal funds). 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.
4)Unknown impact on the costs for counties to provide additional
specialty mental health services (local funds or GF and
federal funds). 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.
SUPPORT: (Verified 5/31/16)
National Center for Youth Law (source)
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|American Association for Marriage and Family Therapy, |
| California Division |
|Bay Area Youth Center |
|California Alliance of Child and Family Services |
|California Council of Community Behavioral Health |
| Agencies |
|California Court Appointed Special Advocates |
| Association |
|California Youth Connection |
|California Youth Empowerment Network |
|California Association of Marriage and Family |
|Therapists |
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|CASA of Santa Cruz County |
|Center for the Study of Social Policy |
|Children Now |
|Children's Advocacy Institute |
|Consumer Watchdog |
|Contra Costa County |
|Family Voices of California |
|First Focus Campaign for Children |
|Hillsides |
|Jamestown Community Center, San Francisco |
|John Burton Foundation for Children Without Homes |
|Kids in Common |
|Mental Health America of California |
|National Association of Social Workers, California |
|Chapter |
|Pacific Juvenile Defender Center |
|Peers Envisioning and Engaging in Recovers Services |
|San Luis Obispo County Department of Social Services |
|The Children's Partnership |
|Therapists for Peace & Justice |
|Woodland Community College Foster and Kinship Care |
|Education |
|Therapists for Peace and Justice |
|An individual |
| |
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OPPOSITION: (Verified5/31/16)
County Behavioral Health Directors Association
ARGUMENTS IN SUPPORT: This bill is sponsored by the National
Center for Youth Law, which argues the vast majority of
California's children and youth in foster care do not receive
safe, quality mental health services during their time in care
despite a well-documented need. An August 2011 report found
California's child welfare system reported only 34.7% of foster
children and youth received mental health services, excluding
medication and case management, well below national prevalence
rates showing need in 60% of the foster care population. At the
same time, 25% of foster children ages 6-17 are receiving one or
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more psychotropic medications and over 50% of children in group
homes are receiving these powerful drugs. Guidelines establish
that the decision to treat children with psychotropic
medications cannot be taken lightly, the benefits must outweigh
the risks, and other treatments must have been tried prior to
their use. Unfortunately, it is common for foster children to be
quickly referred for medication without other supports that will
help address their underlying mental and behavioral health
needs. This bill requires county mental health plans to create a
subsection for foster youth and include an annual foster care
mental health plan detailing the service array-from prevention
to crisis services-available to these children and youth to
enable the state and county to track access, quality and
outcomes specific to foster children.
ARGUMENTS IN OPPOSITION: The County Behavioral Health Directors
Association (CBHDA) writes in opposition that this bill would
duplicate existing county reporting requirements. CBHDA argues
California's EQRO conducts reviews of county Medi-Cal Specialty
Mental Health Services annually. These reviews are conducted in
accordance with Medi-Cal regulations and address, in detail,
quality, outcomes, timeliness of services, and access to
services provided by Mental Health Plans. CBHDA states the
reporting requirements established in this bill will create
substantial county workload, and this duplicative demand on
county staffing would result in a net loss of available
resources to serve youth. Finally, CBHDA writes that it is
concerned about the requirements in the bill that would apply
Knox-Keene Act standards to counties, arguing county mental
health plans are in no way Knox-Keene full service managed care
plans and applying this standard is not appropriate.
Prepared by:Scott Bain / HEALTH /6/1/16 18:41:36
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