BILL ANALYSIS �
AB 1297
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Date of Hearing: May 4, 2011
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Felipe Fuentes, Chair
AB 1297 (Chesbro) - As Introduced: February 18, 2011
Policy Committee: HealthVote:19-0
Urgency: No State Mandated Local Program:
No Reimbursable: No
SUMMARY
This bill limits requirements governing federal reimbursement to
county Medi-Cal mental health plans to requirements outlined in
federal law and in the approved Medicaid state plan and waivers.
FISCAL EFFECT
1)Costs to the state Department of Mental Health (DMH), not
likely to exceed $50,000, to modify regulations governing
reimbursement to county Medi-Cal mental health plans.
2)Unknown, significant increased federal funding to counties
from loosening state restrictions on leveraging federal funds.
Counties estimate that statewide, they may be able to claim
additional federal finding in the range of $50-100 million.
COMMENTS
1)Rationale . According to the sponsor, the California Mental
Health Directors Association (CMHDA), this bill seeks to
eliminate unnecessary state-only Medi-Cal requirements in the
provision of Medi-Cal specialty mental health services. CMHDA
notes that California has established a number of state-only
requirements that needlessly limit the amount of federal
Medicaid reimbursement that is available, such as shorter
billing periods and lower reimbursement amounts than are
allowed under federal law.
2)Background . Mental health services in the Medi-Cal program
are "carved out" of regular Medi-Cal services. The Mental
Health Managed Care program provides specialty mental health
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services to Medi-Cal-eligible adults through county Mental
Health Plans (MHPs). Individuals are entitled to specialty
mental health services if the service is both covered under
the Medi-Cal Program and deemed medically necessary. Services
include mental health assessments, group or individual
therapy, medication support services, intensive day treatment,
crisis intervention and stabilization, and residential
treatment services.
The scope and features of the specialty mental health services
provided at the county level are determined by the state's
Medicaid 1915(b) waiver, the federally-approved Medicaid state
plan, and state plan amendments.
3)State Restrictions Loosened . In some cases, the state DMH has
imposed requirements on county MHPs beyond what federal law
requires, in an attempt to provide greater oversight of
expenditures. There are three specific provisions that limit
the amount of federal reimbursement counties can claim:
a) The state has created a Schedule of Maximum Allowances
(SMAs) that are effectively maximum rates for each service
category (in state regulation), which are in some cases
lower than the federal maximum payments.
b) The state restricts the time to submit claims for six
months (in state regulation), which is shorter than the 12
months allowed under federal law.
c) The state imposes a statutory administrative cost cap of
15%, whereas federal law has no such cap.
By preventing state requirements for claiming FFP from
exceeding federal requirements, this bill provides counties
the ability to leverage federal funding for costs that exceed
the state's SMA and would allow counties to submit claims
after the state's six-month limit. It also eliminates the
statutory 15% administrative cap, which counties indicate is
needed due to increased administrative duties that have been
imposed since the cap was put in to place.
Seven counties provided county-specific estimates of the
increases in federal funding expected as a result of this
bill: Marin ($3 million), Orange ($4 million), San Francisco
($12 million), San Mateo ($5.4 million), Sutter-Yuba ($2.2
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million), and Solano ($2.1 million).
Analysis Prepared by : Lisa Murawski / APPR. / (916) 319-2081