Amended in Assembly March 28, 2014

California Legislature—2013–14 Regular Session

Assembly Bill No. 2612

Introduced by Assembly Member Dababneh

February 21, 2014

An act to begin delete amend Section 1250.2 of the Health and Safety Code, relating to health facility licensing end delete begin insert add Sections 14124.27, 14124.28, and 14129 to the Welfare and Institutions Code, relating to Medi-Cal end insert .

LEGISLATIVE COUNSEL’S DIGEST

AB 2612, as amended, Dababneh. begin delete Health facilities: licensing: psychiatric health facility. end delete begin insert Medi-Cal: substance use disorder treatment. end insert

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Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid Program provisions. Existing federal law prohibits federal financial participation for care or services provided to inmates of a public institution and care or services provided to patients in an institution for mental diseases. Existing law establishes the Drug Medi-Cal Treatment Program (Drug Medi-Cal) under which the department is authorized to enter into contracts with counties for various drug treatment services to Medi-Cal recipients, or is required to directly arrange for these services if a county elects not to do so.

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This bill would provide that eligible individuals who are not inmates of a public institution may access medically necessary Drug Medi-Cal benefits. The bill would also authorize the department to establish a 10-year pilot project with 6 counties to develop models for housing individuals with substance use disorders to provide substance use disorder treatment to those individuals who do not fall within the institution for mental diseases exclusion. The bill would provide that these provisions shall only be implemented if and to the extent that federal financial participation is not jeopardized. The bill would also require the department, in completing a specified application for a wavier of federal law, to request approval to create a process by which counties may receive federal financial participation under the Drug Medi-Cal program for stays of 90 days or less in an institution for mental diseases for beneficiaries with a substance use disorder diagnosis.

end insert begin insert

Existing law authorizes the department, subject to federal approval, to create a health home program for enrollees with chronic conditions, as prescribed.

end insert begin insert

This bill would require the department, in implementing that program, to request a waiver of federal law to authorize counties to designate a provider of behavioral health services, including a nonhospital facility that would otherwise be designated as an institution for mental diseases, as a health home.

end insert begin delete

Existing law provides for the licensure and regulation by the State Department of Public Health of health facilities. Under existing law, a health facility includes a psychiatric health facility, as defined to mean a health facility, licensed by the State Department of Health Care Services, that provides 24-hour inpatient care for mentally disordered, incompetent, or other specified persons.

end delete begin delete

This bill would make technical, nonsubstantive changes to these provisions.

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Vote: majority. Appropriation: no. Fiscal committee:  begin delete no end delete begin insert yes end insert . State-mandated local program: no.

The people of the State of California do enact as follows:

begin insert

begin insert SECTION 1. end insert   

end insert

begin insert Section 14124.27 is added to the end insert begin insert Welfare and
Institutions Code end insert begin insert , end insert immediately following Section 14124.26 begin insert , to
read: end insert

begin insert

begin insert 14124.27. end insert   

(a) In order to increase access to substance use
disorder treatment for individuals in the criminal justice system,
eligible individuals who are not inmates of a public institution
may access medically necessary Drug Medi-Cal benefits as
provided in this article.

(b) The department may establish a 10-year pilot program with
six counties to develop models for housing individuals with
substance use disorders to provide substance use disorder
treatment to those individuals who do not fall within the institution
for mental diseases exclusion in federal law, thereby maximizing
federal financial participation.

(c) This section shall not create a state-only funded benefit or
program. The department shall implement this section only if and
to the extent that federal financial participation is not jeopardized.

end insert

begin insert

begin insert SEC. 2. end insert   

end insert

begin insert Section 14124.28 is added to the end insert begin insert Welfare and
Institutions Code end insert begin insert , to read: end insert

begin insert

begin insert 14124.28. end insert   

(a) The department shall, in completing its
application for a waiver under Section 1115 of the federal Social
Security Act (42 U.S.C. Sec. 1315), include a request for approval
to create a process by which counties may receive federal financial
participation for stays of 90 days or less in an institution for mental
diseases, as defined in Section 1396d(i) of Title 42 of the United
States Code, for beneficiaries with a substance use disorder
diagnosis for purposes of treating the individual’s medically
necessary substance use disorder.

(b) This section shall be implemented only if the department
obtains federal approval for the Section 1115 waiver.

end insert

begin insert

begin insert SEC. 3. end insert   

end insert

begin insert Section 14129 is added to the end insert begin insert Welfare and Institutions
Code end insert begin insert , end insert immediately following Section 14128 begin insert , to read: end insert

begin insert

begin insert 14129. end insert   

(a) The department shall, in implementing this article,
request a waiver of federal law to authorize counties to designate
a provider of behavioral health services, including a nonhospital
facility that would otherwise be designated as an institution for
mental diseases as defined in Section 1396d(i) of Title 42 of the
United States Code, as a health home.

(b) The department shall implement this section only if the
waiver of federal law is obtained.

end insert

begin delete

  

SECTION 1.  

Section 1250.2 of the Health and Safety Code is
amended to read:

1250.2.  

(a) (1) As defined in Section 1250, “health facility”
includes a “psychiatric health facility,” defined to mean a health
facility, licensed by the State Department of Health Care Services,
that provides 24-hour inpatient care for mentally disordered,
incompetent, or other persons described in Division 5 (commencing
with Section 5000) or Division 6 (commencing with Section 6000)
of the Welfare and Institutions Code. This care shall include, but
not be limited to, the following basic services: psychiatry, clinical
psychology, psychiatric nursing, social work, rehabilitation, drug
administration, and appropriate food services for those persons
whose physical health needs can be met in an affiliated hospital
or in outpatient settings.

(2) It is the intent of the Legislature that a psychiatric health
facility shall provide a distinct type of service to psychiatric
patients in a 24-hour acute inpatient setting. The State Department
of Health Care Services shall require regular utilization reviews
of admission and discharge criteria and lengths of stay in order to
ensure that these patients are moved to less restrictive levels of
care as soon as appropriate.

(b) (1) The State Department of Health Care Services may issue
a special permit to a psychiatric health facility for that facility to
provide structured outpatient services (commonly referred to as
SOPS) consisting of morning, afternoon, or full daytime organized
programs, not exceeding 10 hours, for acute daytime care for
patients admitted to the facility. This subdivision shall not be
construed as requiring a psychiatric health facility to apply for a
special permit to provide these alternative levels of care.

(2) The Legislature recognizes that, with access to structured
outpatient services, as an alternative to 24-hour inpatient care,
certain patients would be provided with effective intervention and
less restrictive levels of care. The Legislature further recognizes
that, for certain patients, the less restrictive levels of care eliminate
the need for inpatient care, enable earlier discharge from inpatient
care by providing a continuum of care with effective aftercare
services, or reduce or prevent the need for a subsequent readmission
to inpatient care.

(c) Reference in any statute to Section 1250 of the Health and
Safety Code shall be deemed and construed to also be a reference
to this section.

(d) Notwithstanding any other law, and to the extent consistent
with federal law, a psychiatric health facility shall be eligible to
participate in the medicare program under Title XVIII of the federal
Social Security Act (42 U.S.C. Sec. 1395 et seq.), and the medicaid
program under Title XIX of the federal Social Security Act (42
U.S.C. Sec. 1396 et seq.), if all of the following conditions are
met:

(1) The facility is a licensed facility.

(2) The facility is in compliance with all related statutes and
regulations enforced by the State Department of Health Care
Services, including regulations contained in Chapter 9
(commencing with Section 77001) of Division 5 of Title 22 of the
California Code of Regulations.

(3) The facility meets the definitions and requirements contained
in subdivisions (e) and (f) of Section 1861 of the federal Social
Security Act (42 U.S.C. Sec. 1395x(e) and (f)), including the
approval process specified in Section 1861(e)(7)(B) of the federal
Social Security Act (42 U.S.C. Sec. 1395x(e)(7)(B)), which
requires that the state agency responsible for licensing hospitals
has assured that the facility meets licensing requirements.

(4) The facility meets the conditions of participation for hospitals
pursuant to Part 482 of Title 42 of the Code of Federal Regulations.

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