BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | SB 1291|
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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
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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
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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
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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.
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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,
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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
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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
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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
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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
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Prepared by:Scott Bain / HEALTH / (916) 651-4111
8/25/16 17:45:11
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