BILL ANALYSIS Ó ----------------------------------------------------------------- |SENATE RULES COMMITTEE | SB 1291| |Office of Senate Floor Analyses | | |(916) 651-1520 Fax: (916) | | |327-4478 | | ----------------------------------------------------------------- UNFINISHED BUSINESS Bill No: SB 1291 Author: Beall (D) Amended: 8/15/16 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 SENATE FLOOR: 39-0, 6/2/16 AYES: Allen, Anderson, Bates, Beall, Berryhill, Block, Cannella, De León, Fuller, Gaines, Galgiani, Glazer, Hall, Hancock, Hernandez, Hertzberg, Hill, Hueso, Huff, Jackson, Lara, Leno, Leyva, Liu, McGuire, Mendoza, Mitchell, Monning, Moorlach, Morrell, Nguyen, Nielsen, Pan, Pavley, Roth, Stone, Vidak, Wieckowski, Wolk NO VOTE RECORDED: Runner ASSEMBLY FLOOR: 78-0, 8/18/16 - See last page for vote SUBJECT: Medi-Cal: specialty mental health: minor and nonminor dependents SOURCE: Mental Health America of California National Center for Youth Law DIGEST: This bill requires a mental health plan review to be SB 1291 Page 2 conducted annually by an external quality review organization (EQRO) that includes specific data for specific data for Medi-Cal eligible minor and nonminor dependents in foster care. Assembly Amendments delete provisions requiring a county specialty mental health plan to submit an annual foster care mental health service plan to DHCS, require the EQRO mental health plan review to be on minor and non-minor dependents in foster care, instead of children and youth under the jurisdiction of the juvenile court and their families, delete specific drug-related monitoring performance measures, and require DHCS to share data with county boards of supervisors to assist in the development of foster youth mental health plans. ANALYSIS: 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 SB 1291 Page 3 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 a county specialty mental health plan review to be conducted annually by an external quality review organization (EQRO) pursuant to federal regulations. 2) Requires, commencing July 1, 2018, the review to include specific data for Medi-Cal eligible minor and nonminor dependents in foster care, including all of the following: a) The number of Medi-Cal eligible minor and nonminor dependents in foster care served each year; b) Details on the types of mental health services provided to children, including prevention and treatment services. These types of services may include, but are 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 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 available to Medi-Cal eligible minor and nonminor dependents in foster care; f) Performance data for Medi-Cal eligible minor and nonminor dependents in foster care; g) Utilization data for Medi-Cal eligible minor and nonminor dependents in foster care. h) Medication monitoring consistent with the child welfare psychotropic medication measures developed by the Department of Social Services and any Healthcare Effectiveness Data and Information Set (HEDIS) measures SB 1291 Page 4 related to psychotropic medications, including but not limited to, specified measures. 3)Requires DHCS to post the EQRO data disaggregated by Medi-Cal eligible minor and nonminor dependents in foster care on the department's Internet Web site in a manner that is publicly accessible. 4) Requires DHCS to review the EQRO data for Medi-Cal eligible minor and nonminor dependents in foster care. 5) Requires DHCS, if the EQRO identifies deficiencies in a mental health plan's ability to serve Medi-Cal eligible minor and nonminor dependents in foster care, to notify the mental health plan in writing of identified deficiencies. 6) 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 to 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 DHCS Internet Web site. 7) Requires DHCS, to the extent possible, to share with county boards of supervisors data that will assist in the development of mental health service plans. 8) Requires DHCS to annually share performance outcome system data with county boards of supervisors for the purpose of informing mental health service plans. 9) Requires performance outcome system data shared with county boards of supervisors to include, but not be limited to, the following disaggregated data for Medi-Cal eligible minor and nonminor dependents in foster care: a) The number of youth receiving specialty mental health services. b) The racial distribution of youth receiving specialty mental health services. SB 1291 Page 5 c) The gender distribution of youth receiving specialty mental health services. d) The number of youth, by race, with one or more specialty mental health service visits. e) The number of youth, by race, with five or more specialty mental health service visits. f) Utilization data for intensive home services, intensive care coordination, case management, therapeutic behavioral services, medication support services, crisis intervention, crisis stabilization, full-day intensive treatment, full-day treatment, full-day rehabilitation, and hospital inpatient days. g) A unique count of youth receiving specialty mental health services who are arriving, exiting, and continuing with services. 10)Requires DHCS to ensure that the performance outcome system data metrics include disaggregated data for Medi-Cal eligible minor and nonminor dependents in foster care, and requires this data to be in a format that can be analyzed. 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 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, SB 1291 Page 6 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. 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 SB 1291 Page 7 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. FISCAL EFFECT: Appropriation: No Fiscal Com.:YesLocal: No According to the Assembly Appropriations Committee: 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)). Ongoing costs of about $450,000 per year for additional items to be reviewed by the EQRO (50% GF/50% FF). Unknown potential cost pressure on counties to provide additional or enhanced specialty mental health services (local/FF). SUPPORT: (Verified 8/18/16) Mental Health America of California (co-source) National Center for Youth Law (co-source) Accessing Health Services for California's Children in Foster Care Task Force Advokids American Association for Marriage and Family Therapy, California Division Bay Area Youth Center California Alliance of Child and Family Services California Association of Marriage and Family Therapists California CASA Association California Council of Community Behavioral Health Agencies California Youth Connection California Youth Empowerment Network SB 1291 Page 8 Center for the Study of Social Policy Children Now Children's Advocacy Institute Consumer Watchdog Contra Costa County Board of Supervisors County Welfare Directors Association of California David Walker, PhD., Member, NCYL, Medical and Scientific Advisory Board Family Voices of California First Focus Campaign for Children Hillsides John Burton Foundation for Children Without Homes Kids in Common National Association of Social Workers, California Chapter Pacific Juvenile Defender Center Peers Envisioning and Engaging in Recovery Services (PEERS) San Luis Obispo County Department of Social Services Sunny Hills Services The Children's Partnership The Jamestown Community Center Therapists for Peace and Justice Woodland Community College Foster & Kinship Care Education OPPOSITION:(Verified 8/18/16) Department of Finance 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 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 SB 1291 Page 9 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 Department of Finance (DOF) writes in opposition to the previous version of this bill, arguing this bill would result in unknown, but likely significant General Fund costs. In addition, DOF states that DHCS indicates that the bill may increase administrative costs for local Child Health and Disability Prevention (CHDP) programs and county Mental Health Plans. DHCS and DSS may incur additional workload associated with developing the new tools and protocols for trauma screenings; however, it is unknown what level of additional resources may be needed. The state would be responsible for the non-federal share of all new costs under this bill based on the requirements of Article XIII, Section 36 of the California Constitution (Proposition 30) which prohibits local agencies from being obligated to provide levels of service above the level for which funding has been provided under 2011 Realignment. ASSEMBLY FLOOR: 78-0, 8/18/16 AYES: Achadjian, Alejo, Travis Allen, Arambula, Atkins, Baker, Bigelow, Bloom, Bonilla, Bonta, Brough, Brown, Burke, Calderon, Campos, Chang, Chau, Chávez, Chiu, Chu, Cooley, Cooper, Dababneh, Dahle, Daly, Dodd, Eggman, Frazier, Beth Gaines, Gallagher, Cristina Garcia, Eduardo Garcia, Gatto, Gipson, Gomez, Gonzalez, Gordon, Gray, Grove, Hadley, Harper, Holden, Irwin, Jones, Jones-Sawyer, Lackey, Levine, Linder, Lopez, Low, Maienschein, Mathis, Mayes, McCarty, Medina, Melendez, Mullin, Nazarian, Obernolte, O'Donnell, Olsen, Patterson, Quirk, Ridley-Thomas, Rodriguez, Salas, Santiago, Steinorth, Mark Stone, Thurmond, Ting, Wagner, Waldron, Weber, Wilk, Williams, Wood, Rendon NO VOTE RECORDED: Roger Hernández, Kim SB 1291 Page 10 Prepared by:Scott Bain / HEALTH / (916) 651-4111 8/25/16 17:45:11 **** END ****