Amended in Senate March 28, 2016

Senate Bill No. 1466

Introduced by Senator Mitchell

February 19, 2016

An act to add Section begin delete 14059.6 end delete begin insert 14132.19 end insert to the Welfare and Institutions Code, relating to Medi-Cal.

LEGISLATIVE COUNSEL’S DIGEST

SB 1466, as amended, Mitchell. begin delete Mental health benefits: children: medical necessity. end delete begin insert Early and Periodic Screening, Diagnosis, and Treatment Program: trauma screening. end insert

begin insert

Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services, including early and periodic screening, diagnosis, and treatment for any individual under 21 years of age who is covered under Medi-Cal consistent with the requirements under federal law. The Medi-Cal program is, in part, governed and funded by federal Medicaid Program provisions.

end insert begin insert

Existing federal law provides that EPSDT services include periodic screening services, vision services, dental services, hearing services, and other necessary services to correct or ameliorate defects and physical and mental illnesses and conditions discovered by the screening services, whether or not the services are covered under the state plan. In addition to the required periodic screening services, existing federal law provides that Medicaid-eligible children are entitled to interperiodic screenings in order to identity a suspected illness or condition not present or discovered during the periodic exam.

end insert begin insert

The bill would require those screening services under the EPSDT Program to include screening for trauma. The bill would provide that child abuse and neglect or removal of the child from the parent or legal guardian by a child welfare agency shall be prima facie evidence of trauma for purposes of conducting a screening under the EPSDT Program.

end insert begin delete

Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid Program provisions. Existing law provides that a service is “medically necessary” or a “medical necessity,” for purposes of these provisions, when it is reasonable and necessary to protect life, to prevent significant illness or significant disability, or to alleviate severe pain.

end delete begin delete

This bill would require the department, in partnership with the State Department of Social Services, to convene a stakeholder workgroup to revise and update the existing definition of “medically necessary” and “medical necessity” to be applied specifically with respect to children, youth, and their families for purposes of access to mental health services provided under the Early and Periodic Screening, Diagnosis, and Treatment Program (EPSDT). The bill would require the workgroup to convene by February 1, 2017, and to include representatives of specified organizations, foster youth, and legislative staff. The bill would set forth the information for the department to consider when developing the definition, and would require the department to adopt emergency regulations implementing the revised definitions by October 1, 2017. This bill would require the department to submit to the federal Centers for Medicare and Medicaid Services any state plan amendments or waiver applications necessary to implement those provisions.

end delete

Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: no.

The people of the State of California do enact as follows:

begin insert

begin insert SECTION 1. end insert   

end insert

begin insert Section 14132.19 is added to the end insert begin insert Welfare and
Institutions Code end insert begin insert , to read: end insert

begin insert

begin insert 14132.19. end insert   

(a) Screening services provided under the Early
and Periodic Screening, Diagnosis, and Treatment (EPSDT)
Program pursuant to subdivision (v) of Section 14132 shall include
screening for trauma.

(b) Child abuse and neglect or removal of the child from the
parent or legal guardian by a child welfare agency shall be prima
facie evidence of trauma for purposes of conducting a screening
consistent with this section under the EPSDT Program.

end insert

begin delete

SECTION 1.  

Section 14059.6 is added to the Welfare and
Institutions Code, to read:

14059.6.  

(a) The department, in partnership with the State
Department of Social Services, shall convene a stakeholder
workgroup to revise and update the definition of “medically
necessary” and “medical necessity,” which would be applied
specifically with respect to children, youth, and their families for
purposes of access to mental health services provided under the
Early and Periodic Screening, Diagnosis, and Treatment Program
(EPSDT). The workgroup shall be convened no later than February
1, 2017.

(b) Stakeholders shall include, but need not be limited to,
representatives of all of the following:

(1) The California State Association of Counties.

(2) The County Behavioral Health Directors Association of
California.

(3) The County Welfare Directors Association of California.

(4) The Chief Probation Officers of California.

(5) Current or former foster youth.

(6) Legislative staff.

(7) Any other representatives determined appropriate by the
department and the State Department of Social Services.

(c) In developing the definition, the workgroup shall consider
all of the following:

(1) Acknowledgment that the current diagnosis system for
children and youth affected by trauma, including from abuse and
neglect, does not accurately identify those who need services to
maintain appropriate functioning in the community, nor prevent
the onset of mental health needs and is inconsistent with emerging
research and national practices in meeting the behavioral health
needs of children and youth.

(2) Services should promote health, well-being, and independent
functioning of children and youth so that they may safely remain
with families, in their own communities, and avoid institutional
care whenever possible.

(3) Services should be individualized to meet the child’s or
youth’s needs, inclusive of the family or adult caregivers,
regardless of whether the services are described in the state plan.

(4) The objective of these services should be to improve or
maintain the health of the child or youth in the best condition
possible, prevent conditions from worsening or interfering with
the child’s or youth’s capacity for normal activity, and improve
or maintain the overall health and well-being of the child or youth.

(5) Both currently accepted standard clinical practices, as well
as emerging and promising practices, should be recognized to
achieve the desired outcomes, and support the delivery of those
services in community-based settings, without delay, upon the
initial identification of need. The service delivery system should
allow for a combination of licensed and paraprofessional staff,
working in collaborative partnerships.

(d) The department shall adopt emergency regulations
implementing the definition developed pursuant to this section no
later than October 1, 2017. The department may readopt any
emergency regulation authorized by this section that is the same
as, or substantially equivalent to, any emergency regulation
previously adopted pursuant to this section. The initial adoption
of regulations pursuant to this section and one readoption of
emergency regulations shall be deemed to be an emergency and
necessary for the immediate preservation of the public peace,
health, safety, or general welfare. Initial emergency regulations
and the one readoption of emergency regulations authorized by
this section shall be exempt from review by the Office of
Administrative Law. The initial emergency regulations and the
one readoption of emergency regulations authorized by this section
shall be submitted to the Office of Administrative Law for filing
with the Secretary of State and each shall remain in effect for no
more than 180 days, by which time final regulations shall be
adopted.

(e) The department shall submit to the federal Centers for
Medicare and Medicaid Services any state plan amendments or
waiver applications necessary to implement this section.

end delete