BILL ANALYSIS Ó
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