BILL ANALYSIS Ó SB 1466 Page 1 Date of Hearing: August 3, 2016 ASSEMBLY COMMITTEE ON APPROPRIATIONS Lorena Gonzalez, Chair SB 1466 (Mitchell) - As Amended August 1, 2016 ----------------------------------------------------------------- |Policy |Health |Vote:|15 - 0 | |Committee: | | | | | | | | | | | | | | |-------------+-------------------------------+-----+-------------| | |Human Services | |7 - 0 | | | | | | | | | | | |-------------+-------------------------------+-----+-------------| | | | | | | | | | | | | | | | ----------------------------------------------------------------- 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: SB 1466 Page 2 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 SB 1466 Page 3 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, SB 1466 Page 4 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. SB 1466 Page 5 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