BILL ANALYSIS                                                                                                                                                                                                    ”



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          SENATE THIRD READING


          SB  
          1466 (Mitchell)


          As Amended  August 15, 2016


          Majority vote


          SENATE VOTE:  39-0


           ------------------------------------------------------------------ 
          |Committee       |Votes|Ayes                  |Noes                |
          |                |     |                      |                    |
          |                |     |                      |                    |
          |                |     |                      |                    |
          |----------------+-----+----------------------+--------------------|
          |Health          |15-0 |Wood, Maienschein,    |                    |
          |                |     |Bonilla, Burke,       |                    |
          |                |     |Campos, Chiu,         |                    |
          |                |     |                      |                    |
          |                |     |                      |                    |
          |                |     |Roger HernŠndez,      |                    |
          |                |     |Lackey, Nazarian,     |                    |
          |                |     |Olsen, Patterson,     |                    |
          |                |     |Ridley-Thomas,        |                    |
          |                |     |Rodriguez, Thurmond,  |                    |
          |                |     |Waldron               |                    |
          |                |     |                      |                    |
          |----------------+-----+----------------------+--------------------|
          |Human Services  |7-0  |Bonilla, Grove,       |                    |
          |                |     |Arambula, Lopez,      |                    |
          |                |     |Maienschein,          |                    |
          |                |     |                      |                    |








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          |                |     |                      |                    |
          |                |     |Mark Stone, Thurmond  |                    |
          |                |     |                      |                    |
          |----------------+-----+----------------------+--------------------|
          |Appropriations  |20-0 |Gonzalez, Bigelow,    |                    |
          |                |     |Bloom, Bonilla,       |                    |
          |                |     |Bonta, Calderon,      |                    |
          |                |     |Chang, Daly, Eggman,  |                    |
          |                |     |Gallagher, Eduardo    |                    |
          |                |     |Garcia, Holden,       |                    |
          |                |     |Jones, Obernolte,     |                    |
          |                |     |Quirk, Santiago,      |                    |
          |                |     |Wagner, Weber, Wood,  |                    |
          |                |     |McCarty               |                    |
          |                |     |                      |                    |
          |                |     |                      |                    |
           ------------------------------------------------------------------ 


          SUMMARY:  Requires that screening services provided under the  
          Early and Periodic Screening, Diagnosis, and Treatment (EPSDT)  
          Program include screening for trauma as consistent with  
          protocols developed by the Department of Health Care Services  
          (DHCS).  Establishes trauma to mean an event, series of events,  
          or set of circumstances that is experienced by an individual as  
          physically or emotionally harmful or threatening and that has  
          lasting adverse effects on the individual's functioning and  
          physical, social, emotional, or spiritual well-being.


          EXISTING STATE LAW:  


          1)Establishes the Medi-Cal program, administered by DHCS, under  
            which qualified low-income individuals receive health care  
            services.
          2)Establishes a schedule of benefits under the Medi-Cal program,  
            which includes EPSDT for any individual less than 21 years of  
            age, consistent with federal Medicaid requirements. Defines,  








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            through regulation, "screening services" for purposes of EPSDT  
            to mean:


              a)    An initial, periodic, or additional health assessment  
                of a Medi-Cal eligible individual under 21 years of age  
                provided in accordance with the requirements of the Child  
                Health and Disability Prevention (CHDP) program; 
              b)    A health assessment, examination, or evaluation of a  
                Medi-Cal eligible individual under 21 years of age by a  
                licensed health care professional acting within his or her  
                scope of practice, at intervals other than the CHDP  
                intervals, to determine the existence of physical or  
                mental illnesses or conditions; or,


              c)    Any other encounter with a licensed health care  
                professional that results in the determination of the  
                existence of a suspected illness or condition or a change  
                or complication in a condition for a Medi-Cal eligible  
                person under 21 years of age.


          3)Requires mental health plans to provide specialty mental  
            health services to eligible Medi-Cal beneficiaries, including  
            both adults and children.  Includes EPSDT within the scope of  
            specialty mental health services for eligible Medi-Cal  
            beneficiaries under the age of 21 pursuant to federal Medicaid  
            law.
          4)Requires DHCS, in collaboration with the California Health and  
            Human Services Agency, and in consultation with the Mental  
            Health Services Oversight and Accountability Commission, to  
            create a plan for a performance outcome system for EPSDT  
            mental health services provided to eligible Medi-Cal  
            beneficiaries under the age of 21.


          Establishes the Mental Health Services Act, enacted by voters in  
          2004 by Proposition 63, to provide funds to counties to expand  








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          services, develop innovative programs, and integrated service  
          plans for mentally ill children, adults, and seniors through a  
          1% income tax on personal income above $1 million.


          FISCAL EFFECT:  According to the Assembly Appropriations  
          Committee, unknown local assistance costs, potentially in the  
          range of $1 million annually, for additional screening services  
          provided to Medi-Cal-eligible children (General Fund  
          (GF)/federal).  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).  Additionally, DHCS and DSS will  
          incur minor staff costs to consult with stakeholders and provide  
          guidance to operationalize the required trauma screening  
          (GF/federal).


          COMMENTS:  According to the author, children in foster care have  
          suffered from abuse, neglect, or exploitation, and have suffered  
          secondary trauma as a result of being removed from their  
          parents.  This bill is needed to ensure that distressed children  
          are appropriately screened for trauma without delay.  Under  
          California law, the treatment of children's mental health needs  
          is determined by the severity of the diagnosis.  Because we do  
          not currently screen under EPSTD for trauma, we run the risk of  
          delaying treatment to this vulnerable population because of this  
          complicated delivery model.  By requiring trauma screening by a  
          designated agency on the front-end, we minimize possible delays  
          in critically-needed treatment.


          Californians for Safety and Justice (CSJ) writes in support that  
          this bill ensures that medical professionals conducting already  
          mandated health screenings look for signs of trauma to ensure  
          that children who have suffered trauma receive the care they  
          need - care they are legally entitled to receive.  In light of  
          the overwhelming evidence confirming the traumatic nature of  
          child abuse and neglect and the secondary trauma of removal from  








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          one's home, this measure unambiguously establishes that foster  
          children have suffered trauma and should be assessed for  
          appropriate EPSDT services.  CSJ argues that the state has the  
          legal and moral obligation to act as the parent of all children  
          in the child welfare system, and this bill is consistent with  
          long-standing policies that ensure children in the child welfare  
          system receive the best possible care that will help them thrive  
          as adults. 



          The San Luis Obispo County Department of Social Services  
          (SLOCDSS) states that it serves, in conjunction with its  
          partners in the County Probation Department, over 300 foster  
          children who have experienced abuse or neglect that span the  
          spectrum of severity.  SLOCDSS states it has encountered  
          difficulties in ensuring that these children receive the  
          therapeutic services they need, as mental health providers  
          debate with one another over the relative severity of the trauma  
          these children have endured.  Too often, these  
          children-especially those who suffered secondary trauma as a  
          result of being removed from their caregivers-are shuffled back  
          and forth between unresponsive systems of care, are denied the  
          therapy they need to heal from the impacts of trauma, and  
          ultimately suffer the cumulative effects of untreated trauma as  
                          they transition to adulthood.Analysis Prepared by:                
                                                       Paula Villescaz /  
          HEALTH / (916) 319-2097  FN: 0004146



















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