BILL ANALYSIS Ó
SB 1291
Page 1
SENATE THIRD READING
SB
1291 (Beall)
As Amended August 15, 2016
Majority vote
SENATE VOTE: 39-0
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|Committee |Votes|Ayes |Noes |
| | | | |
| | | | |
| | | | |
|----------------+-----+----------------------+--------------------|
|Health |17-0 |Wood, Maienschein, | |
| | |Bonilla, Burke, | |
| | |Campos, Chiu, Gomez, | |
| | |Roger Hernández, | |
| | |Lackey, Nazarian, | |
| | |Patterson, | |
| | | | |
| | | | |
| | |Ridley-Thomas, | |
| | |Rodriguez, Santiago, | |
| | |Steinorth, Thurmond, | |
| | |Waldron | |
| | | | |
|----------------+-----+----------------------+--------------------|
|Appropriations |20-0 |Gonzalez, Bigelow, | |
| | |Bloom, Bonilla, | |
| | |Bonta, Calderon, | |
SB 1291
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| | |Chang, Daly, Eggman, | |
| | |Gallagher, Eduardo | |
| | |Garcia, Holden, | |
| | |Jones, Obernolte, | |
| | |Quirk, Santiago, | |
| | |Wagner, Weber, Wood, | |
| | |McCarty | |
| | | | |
| | | | |
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SUMMARY: Requires, beginning July 1, 2018, mental health plan
(MHP) reviews conducted by an external quality review
organization (EQRO), pursuant to federal regulations, to include
specific data for Medi-Cal eligible minor and minor dependents
in foster care, as specified. Specifically, this bill:
1)Requires MHP reviews to include the following information:
a) The number of Medi-Cal eligible minor and nonminor
dependents in foster care;
b) Details on the types of mental health services provided
to minor and nonminor dependents in foster care and their
families, including prevention and treatment services.
Allows the types of services to include, but not limited
to, screenings, assessments, home-based mental health
services, outpatient services, day treatment services, or
inpatient services, psychiatric hospitalizations, crisis
interventions, case management, and psychotropic medication
support services;
c) Access to and timeliness of mental health services
available to Medi-Cal eligible minor and nonminor
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dependents in foster care;
d) Quality of mental health services available to Medi-Cal
eligible minor and nonminor dependents in foster care;
e) Translation and interpretation services;
f) Coordination with other systems, including regional
centers, special education local plan areas, child welfare,
and probation;
g) Family and caregiver education and support;
h) Performance data for Medi-Cal eligible minor and
nonminor dependents in foster care;
i) Utilization data for Medi-Cal eligible minor and
nonminor dependents in foster care; and,
j) Medication monitoring consistent with the Healthcare
Effectiveness Data and Information Set (HEDIS), including,
but not limited to, the child welfare psychotropic
medication measures developed by the State Department of
Social Services and HEDIS measures related to psychotropic
medications, as specified.
2)Requires the Department of Health Care Services (DHCS) to
review the EQRO data and post the data, disaggregated by
Medi-Cal minor and nonminor dependents in foster care, on its
Internet Web site.
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3)Requires DHCS to notify the MHP in writing of any identified
deficiencies found by the EQRO that would impact a MHP's
ability to serve Medi-Cal eligible minor and nonminor
dependents in foster care.
4)Requires the MHP to provide a written corrective action plan
to DHCS within 60 days of receiving the notice required
pursuant to 3) above. Requires DHCS to notify the MHP of
approval of the corrective action plan or to request changes,
if necessary, within 30 days after receipt of the corrective
action plan. Requires a final corrective action plan to be
made publicly available by, at minimum, posting on the DHCS's
Internet Web site.
5)Requires DHCS to annually share performance outcome system
data, as specified, with county boards of supervisors for the
purpose of informing mental health service plans.
FISCAL EFFECT: According to the Assembly Appropriations
Committee:
1)Ongoing costs in the range of $200,000 per year for DHCS to
oversee EQRO findings and corrective action plans (50% General
Fund (GF)/50% federal funds (FF)).
2)Ongoing costs of about $450,000 per year for additional items
to be reviewed by the external quality review organization
(50% GF/50% FF).
3)Unknown potential cost pressure on counties to provide
additional or enhanced specialty mental health services
(local/FF).
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COMMENTS: 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 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
MHPs to report out this data for children in the dependency and
juvenile systems in a standardized format. Additionally, it
increases accountability and transparency by requiring an
external review of the data and for the results to be made
public.
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: 1) Medicaid beneficiaries, policies, data systems, and
processes; 2) managed care delivery systems, organizations, and
financing; 3) quality assessment and improvement methods; and,
4) 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.
Funding for EQROs is 75% FF/25% GF. California contracts with
two EQROs, one for its Medi-Cal managed care plans and a second
for its review of specialty MHPs. The State conducted a
procurement process to assure an ongoing external quality review
process is in place. The EQRO contract with Behavioral Health
Concepts for review of specialty MHPs was secured by the state
for fiscal year (FY) 2014-15 through FY 2016-17 with an option
to extend the contract for two additional one year extension
periods. The MHP contract specifies the standards for the MHP's
quality management and quality improvement programs which
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includes conducting at least two Performance Improvement
Projects (PIPs), one clinical and one non-clinical that meet the
validation standards applied by the EQRO contractor.
Data gathered from the PIPs will be available to assist MHPs to
continue to make program enhancements to improve the
coordination, quality, effectiveness, and/or efficiency of
service delivery to children who are receiving Early and
Periodic Screening, Diagnostic and Treatment program services.
Currently, there are ongoing discussions between DHCS and the
EQRO regarding the possible development of a statewide PIP
related to timeliness of and access to services, although
timeliness and access may instead be validated through
Performance Measures.
The National Center for Youth Law, sponsor of the bill, states
that a 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.
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 needs. This bill requires county MHPs to create
a subsection for foster youth and an annual foster care MHP
detailing the service array - from prevention to crisis services
- available to these children and youth.
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,
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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.
Analysis Prepared by:
Paula Villescaz / HEALTH / (916) 319-2097 FN:
0004127