BILL ANALYSIS                                                                                                                                                                                                    



                                                                    SB 1466  


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          Date of Hearing:  August 3, 2016


                        ASSEMBLY COMMITTEE ON APPROPRIATIONS


                               Lorena Gonzalez, Chair


          SB 1466  
          (Mitchell) - As Amended August 1, 2016


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          Urgency:  No  State Mandated Local Program:  NoReimbursable:  No


          SUMMARY:


          This bill enhances screening for mental health services need  
          among Medi-Cal eligible children and youth.  Specifically, this  
          bill:









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          1)Requires screening services provided under the Early and  
            Periodic Screening, Diagnosis, and Treatment (EPSDT) Medi-Cal  
            benefit to include screening for trauma at all screenings. 


          2)Requires foster children be assessed by the county mental  
            health plan for specialty mental health services.


          3)Requires the Department of Health Care Services (DHCS), in  
            consultation with the Department of Social Services (DSS) and  
            specified stakeholders, to adopt, employ, and/or develop, as  
            appropriate, tools and protocols for the screening of children  
            for trauma, consistent with existing law and this section.


          FISCAL EFFECT:


          Staff assumes the state would be responsible for any nonfederal  
          share of costs under this bill based on the requirements of  
          Article XIII, Section 36 of the California Constitution  
          (Proposition 30), which states new legislation that increases  
          costs already borne by a local agency for programs mandated for  
          2011 Realignment shall apply to local agencies only to the  
          extent the state provides annual funding for the cost increase.   
          EPSDT specialty mental health services were included in 2011  
          Realignment. 


          1)Costs, likely in the millions annually for additional  
            screening and assessment services provided to  
            Medi-Cal-eligible children, including foster children  
            (GF/federal).


          2)Depending how screening is operationalized and the take-up of  
            services, state costs for additional specialty mental health  
            services for children who screen positive and receive  
            specialty mental health services could be significant.  For  







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            every thousand children who receive specialty mental health  
            services, the state would incur about $6 million in costs  
            annually. Costs associated with a significantly higher  
            referral rate to specialty mental health services could cost  
            in tens or hundreds of millions of dollars (GF/federal).   


            The state could also experience unknown additional cost  
            pressure for provision of additional mental health services  
            for mild to moderate diagnoses through Medi-Cal managed care  
            plans (GF/federal). 


          3)To the extent increased provision of mental health services to  
            Medi-Cal-eligible children results in improved social,  
            emotional and health outcomes, the state could experience some  
            unknown reductions in Medi-Cal costs over the long term,  
            associated with reductions in higher-cost behavioral health  
            treatment services such as psychiatric hospitalizations  
            (GF/federal).


          4)DHCS and DSS will incur minor staff costs to consult with  
            stakeholders and provide guidance to operationalize the  
            required trauma screening (GF/federal). 


          COMMENTS:


          1)Purpose. According to the author, this bill is needed to  
            ensure that distressed children are appropriately screened for  
            trauma without delay.
          


          2)ESPDT.  EPSDT is a Medi-Cal benefit for individuals under the  
            age of 21 who have full-scope Medi-Cal eligibility.  It allows  
            for periodic screenings to determine health care needs and,  
            based upon the identified health care need and diagnosis,  







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            treatment services are provided.  EPSDT services include a  
            range of medical as well as mental health treatment services.



          3)Children's mental health in Medi-Cal. Mental health screening  
            and services for children are delivered by both Medi-Cal  
            managed care plans and county mental health plans, Managed  
            care plans are responsible for a number of screening,  
            diagnostic and treatments services covered under EPSDT, as  
            well as mental health coverage for "mild to moderate"  
            diagnoses.  A subset of EPSDT services, specialty mental  
            health services for seriously emotionally disturbed children,  
            are carved out of managed care, and delivered by county mental  
            health plans under contract with the state.  Pursuant to 2011  
            realignment, such specialty mental health services are locally  
            funded. 

          4)Federal guidance on screening for complex trauma. A 2013  
            letter to Medicaid state directors signed by three federal  
            agencies, including the Centers for Medicare and Medicaid  
            Services (CMS), encourages screening for complex trauma, and  
            notes that rates of trauma exposure are approximately 90  
            percent among children in foster care. It notes complex trauma  
            exposure involves the simultaneous or sequential occurrence of  
            child maltreatment, including psychological maltreatment,  
            neglect, exposure to violence and physical and sexual abuse.  
            It also explains complex trauma has been linked to overuse of  
            psychotropic drugs. 





          5)Related Legislation. SB 1291 (Beall), also being heard today,  
            requires each county mental health to submit an annual foster  
            care mental health service plan, and requires a mental health  
            plan reviews to be conducted annually by an external quality  
            review organization.








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          6)Staff Comments.  Mandatory screening should always be  
            approached with caution in order to ensure the screening is  
            targeted and effective.  Studies of cost-effectiveness of  
            screening often use measures such as "number needed to screen"  
            (the number who must be screened in order to find one positive  
            case).  Federal guidance related to trauma screening focused  
            on complex trauma, and targeting screening to foster children  
            with high likelihood of trauma seems appropriate.  The author  
            may wish to consider allowing more flexibility with respect to  
            the requirement for mandatory trauma screening to ensure  
            efficiency and effectiveness. 





          Analysis Prepared by:Lisa Murawski / APPR. / (916)  
          319-2081