BILL NUMBER: AB 1808 INTRODUCED
BILL TEXT
INTRODUCED BY Assembly Member Galgiani
FEBRUARY 10, 2010
An act to amend Section 5777 of the Welfare and Institutions Code,
relating to Medi-Cal.
LEGISLATIVE COUNSEL'S DIGEST
AB 1808, as introduced, Galgiani. Medi-Cal: Mental health
services.
Existing law provides for the Medi-Cal program, administered by
the State Department of Health Care Services, under which qualified
low-income persons are provided with health care services, including
mental health services.
This bill would make technical, nonsubstantive changes in Medi-Cal
Mental health provisions.
Vote: majority. Appropriation: no. Fiscal committee: no.
State-mandated local program: no.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 5777 of the Welfare and Institutions Code is
amended to read:
5777. (a) (1) Except as otherwise specified in this part, a
contract entered into pursuant to this part shall include a provision
that the mental health plan contractor shall bear the financial risk
for the cost of providing medically necessary mental health services
to Medi-Cal beneficiaries irrespective of whether the cost of those
services exceeds the payment set forth in the contract. If the
expenditures for services do not exceed the payment set forth in the
contract, the mental health plan contractor shall report the
unexpended amount to the department, but shall not be required to
return the excess to the department.
(2) If the mental health plan is not the county's, the mental
health plan may not transfer the obligation for any mental health
services to Medi-Cal beneficiaries to the county. The mental health
plan may purchase services from the county. The mental health plan
shall establish mutually agreed-upon protocols with the county that
clearly establish conditions under which beneficiaries may obtain
non-Medi-Cal reimbursable services from the county. Additionally, the
plan shall establish mutually agreed-upon protocols with the county
for the conditions of transfer of beneficiaries who have lost
Medi-Cal eligibility to the county for care under Part 2 (commencing
with Section 5600), Part 3 (commencing with Section 5800), and Part 4
(commencing with Section 5850).
(3) The mental health plan shall be financially responsible for
ensuring access and a minimum required scope of benefits, consistent
with state and federal requirements, to the services to the Medi-Cal
beneficiaries of that county regardless of where the beneficiary
resides. The department shall require that the definition of medical
necessity used, and the minimum scope of benefits offered, by each
mental health contractor be the same, except to the extent that any
variations receive prior federal approval and are consistent with
state and federal statutes and regulations.
(b) Any A contract entered into
pursuant to this part may be renewed if the plan continues to meet
the requirements of this part, regulations promulgated pursuant
thereto, and the terms and conditions of the contract. Failure to
meet these requirements shall be cause for nonrenewal of the
contract. The department may base the decision to renew on timely
completion of a mutually agreed-upon plan of correction of any
deficiencies, submissions of required information in a timely manner,
or other conditions of the contract. At the discretion of the
department, each contract may be renewed for a period not to exceed
three years.
(c) (1) The obligations of the mental health plan shall be changed
only by contract or contract amendment.
(2) A change may be made during a contract term or at the time of
contract renewal, where there is a change in obligations required by
federal or state law or when required by a change in the
interpretation or implementation of any law or regulation. To the
extent permitted by federal law and except as provided under
paragraph (10) of subdivision (c) of Section 5778, if any
a change in obligations occurs that affects the
cost to the mental health plan of performing under the terms of its
contract, the department may reopen contracts to negotiate the state
General Fund allocation to the mental health plan under Section 5778,
if the mental health plan is reimbursed through a fee-for-service
payment system, or the capitation rate to the mental health plan
under Section 5779, if the mental health plan is reimbursed through a
capitated rate payment system. During the time period required to
redetermine the allocation or rate, payment to the mental health plan
of the allocation or rate in effect at the time the change occurred
shall be considered interim payments and shall be subject to increase
or decrease, as the case may be, effective as of the date on which
the change is effective.
(3) To the extent permitted by federal law, either the department
or the mental health plan may request that contract negotiations be
reopened during the course of a contract due to substantial changes
in the cost of covered benefits that result from an unanticipated
event.
(d) The department shall immediately terminate a contract when the
director finds that there is an immediate threat to the health and
safety of Medi-Cal beneficiaries. Termination of the contract for
other reasons shall be subject to reasonable notice of the department'
s intent to take that action and notification of affected
beneficiaries. The plan may request a public hearing by the Office of
Administrative Hearings.
(e) A plan may terminate its contract in accordance with the
provisions in the contract. The plan shall provide written notice to
the department at least 180 days prior to the termination or
nonrenewal of the contract.
(f) Upon the request of the Director of Mental Health, the
Director of Managed Health Care may exempt a mental health plan
contractor or a capitated rate contract from the Knox-Keene Health
Care Service Plan Act of 1975 (Chapter 2.2 (commencing with Section
1340) of Division 2 of the Health and Safety Code). These exemptions
may be subject to conditions the director deems appropriate. Nothing
in this part shall be construed to impair or diminish the authority
of the Director of Managed Health Care under the Knox-Keene Health
Care Service Plan Act of 1975, nor shall anything in this part be
construed to reduce or otherwise limit the obligation of a mental
health plan contractor licensed as a health care service plan to
comply with the requirements of the Knox-Keene Health Care Service
Plan Act of 1975, and the rules of the Director of Managed Health
Care promulgated thereunder. The Director of Mental Health, in
consultation with the Director of Managed Health Care, shall analyze
the appropriateness of licensure or application of applicable
standards of the Knox-Keene Health Care Service Plan Act of 1975.
(g) (1) The department, pursuant to an agreement with the State
Department of Health Care Services, shall provide oversight to the
mental health plans to ensure quality, access, and cost efficiency.
At a minimum, the department shall, through a method independent of
any agency of the mental health plan contractor, monitor the level
and quality of services provided, expenditures pursuant to the
contract, and conformity with federal and state law.
(2) (A) Commencing July 1, 2008, county mental health plans, in
collaboration with the department, the federally required external
review organization, providers, and other stakeholders, shall
establish an advisory statewide performance improvement project (PIP)
to increase the coordination, quality, effectiveness, and efficiency
of service delivery to children who are either receiving at least
three thousand dollars ($3,000) per month in the Early and Periodic
Screening, Diagnosis, and Treatment (EPSDT) Program services or
children identified in the top 5 percent of the county EPSDT cost,
whichever is lowest. The statewide PIP shall replace one of the two
required PIPs that mental health plans must perform under federal
regulations outlined in the mental health plan contract.
(B) The federally required external quality review organization
shall provide independent oversight and reviews with recommendations
and findings or summaries of findings, as appropriate, from a
statewide perspective. This information shall be accessible to county
mental health plans, the department, county welfare directors,
providers, and other interested stakeholders in a manner that both
facilitates, and allows for, a comprehensive quality improvement
process for the EPSDT Program.
(C) Each July, the department, in consultation with the federally
required external quality review organization and the county mental
health plans, shall determine the average monthly cost threshold for
counties to use to identify children to be reviewed who are currently
receiving EPSDT services. The department shall consult with
representatives of county mental health directors, county welfare
directors, providers, and the federally required external quality
review organization in setting the annual average monthly cost
threshold and in implementing the statewide PIP. The department shall
provide an annual update to the Legislature on the results of this
statewide PIP by October 1 of each year for the prior fiscal year.
(D) It is the intent of the Legislature for the EPSDT PIP to
increase the coordination, quality, effectiveness, and efficiency of
service delivery to children receiving EPSDT services and to
facilitate evidence-based practices within the program, and other
high-quality practices consistent with the values of the public
mental health system within the program to ensure that children are
receiving appropriate mental health services for their mental health
wellness.
(E) This paragraph shall become inoperative on September 1, 2011.
(h) County employees implementing or administering a mental health
plan act in a discretionary capacity when they determine whether or
not to admit a person for care or to provide any level of care
pursuant to this part.
(i) If a county chooses to discontinue operations as the local
mental health plan, the new plan shall give reasonable consideration
to affiliation with nonprofit community mental health agencies that
were under contract with the county and that meet the mental health
plan's quality and cost efficiency standards.
(j) Nothing in this part shall be construed to modify, alter, or
increase the obligations of counties as otherwise limited and defined
in Chapter 3 (commencing with Section 5700) of Part 2. The county's
maximum obligation for services to persons not eligible for Medi-Cal
shall be no more than the amount of funds remaining in the mental
health subaccount pursuant to Sections 17600, 17601, 17604, 17605,
17606, and 17609 after fulfilling the Medi-Cal contract obligations.