as amended, Mitchell.
begin deleteMental health benefits: children: medical necessity. end 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
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:
Section 14059.6 is added to the Welfare and
6Institutions Code, to read:
(a) The department, in partnership with the State
8Department of Social Services, shall convene a stakeholder
9workgroup to revise and update the definition of “medically
10necessary” and “medical necessity,” which would be applied
11specifically with respect to children, youth, and their families for
12purposes of access to mental health services provided under the
13Early and Periodic Screening, Diagnosis, and Treatment Program
14(EPSDT). The workgroup shall be convened no later than February
16(b) Stakeholders shall include, but need not be limited to,
17representatives of all of the following:
18(1) The California State Association of Counties.
19(2) The County Behavioral Health Directors Association of
21(3) The County Welfare Directors Association of California.
22(4) The Chief Probation Officers of California.
23(5) Current or former foster youth.
24(6) Legislative staff.
25(7) Any other representatives determined appropriate by the
26department and the State Department of Social Services.
27(c) In developing the definition, the workgroup shall consider
28all of the following:
29(1) Acknowledgment that the current diagnosis system for
30children and youth affected by trauma, including from abuse and
31neglect, does not accurately identify those who need services to
32maintain appropriate functioning in the community, nor prevent
33the onset of mental health needs and is inconsistent with emerging
34research and national practices in meeting the behavioral health
35needs of children and youth.
36(2) Services should promote health, well-being, and independent
37functioning of children and youth so that they may safely remain
38with families, in their own communities, and avoid institutional
39care whenever possible.
P4 1(3) Services should be individualized to meet the child’s or
2youth’s needs, inclusive of the family or adult caregivers,
3regardless of whether the services are described in the state plan.
4(4) The objective of these services should be to improve or
5maintain the health of the child or youth in the best condition
6possible, prevent conditions from worsening or interfering with
7the child’s or youth’s capacity for normal activity, and improve
8or maintain the overall health and well-being of the child or youth.
9(5) Both currently accepted standard clinical practices, as well
10as emerging and promising practices, should be recognized to
11achieve the desired outcomes, and support the delivery of those
12services in community-based settings, without delay, upon the
13initial identification of need. The service delivery system should
14allow for a combination of licensed and paraprofessional staff,
15working in collaborative partnerships.
16(d) The department shall adopt emergency regulations
17implementing the definition developed pursuant to this section no
18later than October 1, 2017. The department may readopt any
19emergency regulation authorized by this section that is the same
20as, or substantially equivalent to, any emergency regulation
21previously adopted pursuant to this section. The initial adoption
22of regulations pursuant to this section and one readoption of
23emergency regulations shall be deemed to be an emergency and
24necessary for the immediate preservation of the public peace,
25health, safety, or general welfare. Initial emergency regulations
26and the one readoption of emergency regulations authorized by
27this section shall be exempt from review by the Office of
28Administrative Law. The initial emergency regulations and the
29one readoption of emergency regulations authorized by this section
30shall be submitted to the Office of Administrative Law for filing
31with the Secretary of State and each shall remain in effect for no
32more than 180 days, by which time final regulations shall be
34(e) The department shall submit to the federal Centers for
35Medicare and Medicaid Services any state plan amendments or
36waiver applications necessary to implement this section.