BILL ANALYSIS Ó
SB 1291
Page 1
Date of Hearing: August 3, 2016
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Lorena Gonzalez, Chair
SB 1291
(Beall) - As Amended June 27, 2016
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|Policy |Health |Vote:|17 - 0 |
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Urgency: No State Mandated Local Program: NoReimbursable: No
SUMMARY:
This bill institutes more stringent oversight of county Medi-Cal
mental health plans' provision of services to foster youth
requiring treatment for severe mental illness. Specifically,
this bill:
1)Requires each county mental health plan to submit an annual
foster care mental health service plan to the Department of
Health Care Services (DHCS, the department that administers
Medi-Cal). The plan must be approved by the applicable board
of supervisors, and must include specified elements related to
provision of mental health services to foster children.
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2)Requires an external quality review organization (EQRO) review
of each mental health plan annually, and requires the review
to include a number of specified elements related to foster
youth.
3)Requires DHCS to review the EQRO's review, and to post the
EQRO results publicly.
4)Specifies a process whereby deficiencies are identified by the
department and corrected by the county mental health plans
through written corrective action plans.
5)Requires DHCS to annually share performance outcome system
data with counties in order to inform the foster care mental
health service plans, and to ensure the performance outcome
system data metrics include disaggregated data for Medi-Cal
eligible foster children.
FISCAL EFFECT:
1)Ongoing costs of about $1 million per year for DHCS to review
county plans, review EQRO findings and corrective action
plans, and provide data on foster youth to counties (50%
GF/50% federal).
2)Ongoing costs of about $450,000 per year for additional items
to be reviewed by the external quality review organization
(50% GF/50% federal).
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3)Administrative costs, potentially in the millions statewide,
for county mental health plans to develop the required foster
youth mental health service plans (50% GF/50% federal). Much
of the required information is already collected. However,
there are likely to be administrative costs to compile that
information and develop the plans. Under the State
Constitution, local governments are not required to implement
state laws that increase local costs to administer programs
realigned in 2011, including specialty mental health, unless
the state provides additional funding annually to pay for the
increased costs. This estimate assumes funding is provided by
the state to implement this bill. For example, if each
mental health plan dedicated one full-time staff on average to
the foster youth-specific efforts, costs would be $9.8 million
annually (GF/federal).
4)Unknown potential cost pressure on counties to provide
additional or enhanced specialty mental health services
(likely local/federal funds, but potentially GF/federal). By
increasing scrutiny, the bill may bring to light shortcomings
in the provision of mental health services (such as delays in
access to services or provider shortages). To the extent that
occurs, it may result in counties providing additional
services, for which the nonfederal share of cost would be
local funds, pursuant to 2011 realignment. However, to the
extent it can be it can be demonstrated that there are
additional costs due to the effects of this bill, there could
be state fiscal liability. This does not appear likely, but it
could be possible. For example, in the bill's description of
the process of identifying and correcting deficiencies, it
does not limit a deficiency to a failure to meet requirements
under current law or contract. Any requirements beyond those
currently in place would become a state fiscal responsibility.
As of yet, there is no formal process in place for
determining the state responsibility to reimburse counties for
additional costs relating to realigned programs.
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COMMENTS:
1)Purpose. According to the author, after legislation passed
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 efficiency of
local mental health service delivery. To 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 MHPs to report data for children on foster youth in a
standardized format. Additionally, it increases
accountability by requiring an external review of the data and
for the results to be made public.
2)Background. Specialty Medi-Cal mental health services, those
services provided for severe mental illness, are provided
exclusively by county-operated mental health plans (MHPs)
under the terms of a federal waiver. Efforts related to the
2011 public safety realignment included the transfer of fiscal
responsibility for specialty mental health services for
Medi-Cal-eligible youth to counties. Counties provide mental
health services directly or through contracts in the local
community using a combination of realignment revenues, county
funds, and Mental Health Services Act funds. For Medi-Cal
beneficiaries, the state matches local funds with federal
funds on behalf of the counties, and also monitors the county
MHPs to ensure delivery and payment of services consistent
with state and federal rules. State oversight for the
provision of mental health services to Medi-Cal eligible
children and youth includes monitoring access to care,
utilization, quality, and other performance measures. It also
includes an EQRO review of county MHPs. Requirements
governing MHPs are found in federal and state code,
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regulations, federal special terms and conditions (STCs) of
waiver approval, and contracts between the state and the MHPs.
3)Support. This bill is sponsored by National Center for Youth
Law and supported by youth and foster advocacy groups, as well
as mental health providers.
4)Concerns. The County Behavioral Health Directors Association
(CBHDA) states 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 MHPs. 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.
5)Staff Comments. Although it is desirable for certain purposes
to have data related to foster youth collected and reported
through one mechanism as the bill envisions, it is unclear
whether the cost to reimburse counties for additional
administrative work to create a brand-new annual plan is an
efficient use of state funds. To the extent this reporting
could be streamlined to reduce administrative costs by
aligning more closely with existing activities, this could
reduce state fiscal exposure. Also, it is worth considering
whether it is necessary to report data, externally review, and
conduct a state review of the data and the external review
every year, or whether it could be done on a less frequent
basis.
In addition, being more explicit that the bill's requirement
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for counties to correct deficiencies only refers to
deficiencies in compliance with existing-law requirements, and
does not require a level of service beyond what is required
under applicable laws, STCs, and contracts, would eliminate
any potential for GF risk related to provision of enhanced
service levels.
The required "foster care mental health service plan" seems
more like a data report than a plan. The author may wish to
clarify whether it is a plan that governs the provision of
care to foster youth, or a report that simply consolidates and
makes public data relevant to foster youth- and adjust the
language accordingly.
Finally, the intent of this bill appears to be to align with
the department's existing oversight and data collection
activities, but to ensure the needs of foster youth are
specifically considered. However, the bill as written is
fairly prescriptive, and codifies a number of existing
practices in addition to putting in place new requirements
specific to foster youth. The bill could benefit from
additional clarification about what is actually a new or
enhanced activity versus an existing practice or requirement,
and the language could better express the stated intent to
align with existing activities.
Analysis Prepared by:Lisa Murawski / APPR. / (916)
319-2081
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