Amended in Assembly May 5, 2014

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 add Sections 14124.27, 14124.28, and 14129 to the Welfare and Institutions Code, relating to Medi-Cal.

LEGISLATIVE COUNSEL’S DIGEST

AB 2612, as amended, Dababneh. Medi-Cal: substance use disorder treatment.

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.

This begin delete bill would provide that eligible individuals who are not inmates of a public institution may access medically necessary Drug Medi-Cal benefits. The end delete bill would also authorize the department to establish a begin delete 10-year end delete begin insert 5-year end insert 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 begin delete , in completing a specified application for a wavier of federal law, to request approval to create a process by which counties may receive end delete begin insert to submit an application for a specified waiver or waiver amendment necessary to create a process by which end insert federal financial participation begin delete under the Drug Medi-Cal program for stays of 90 days end delete begin insert may be claimed for stays of 120 days end insert or less in an institution for mental diseases for beneficiaries with a substance use disorder diagnosis.

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

This bill would require the department, in implementing that program, to request a waiver of federal law to authorize begin delete 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 delete begin insert the state to claim federal financial participation for health home services provided to individuals, who are otherwise eligible under the health home program and who are state or county inmates in their last 30 days in custody, by a provider or team of providers, as specified, to ensure coordination of care and reduce gaps in care. end insert

Vote: majority. Appropriation: no. Fiscal committee: yes. 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

(a) The Legislature finds and declares all of the
following:

end insert begin insert

(1) The federal Patient Protection and Affordable Care Act,
also known as health care reform, is designed to ensure every
American has access to health care. Eligibility for the federal
low-income health insurance program, which is Medi-Cal in
California, was expanded to include childless adults earning less
than 138 percent of the federal poverty level.

end insert begin insert

(2) The cost of the Medi-Cal expansion will be fully paid by the
federal government until 2017, when the federal government
contribution will decline gradually to 90 percent, where it will
remain in 2020 and each year thereafter.

end insert begin insert

(3) According to research done by the National Health Law
Program, a large percentage of individuals in county jails, and
those being released, are uninsured and may be eligible for
Medi-Cal.

end insert begin insert

(4) According to a study published in the American Journal of
Public Health, many individuals in county jails, and those being
released, have untreated substance use disorders.

end insert begin insert

(5) In implementing health care reform, California expanded
insurance benefits for substance use disorder treatment for new
and existing Medi-Cal beneficiaries.

end insert begin insert

(6) Placement in residential programs can treat issues
associated with substance use disorders and thereby reduce costs
and recidivism associated with individuals in county jails.

end insert begin insert

(b) Therefore, it is the intent of the Legislature to encourage
the use of appropriate residential substance use disorder treatment
programs for individuals in the criminal justice system.

end insert begin insert

(c) It is further the intent of the Legislature, in order to increase
access to primary care, mental health treatment, and substance
use disorder treatment for individuals in the criminal justice
system, that individuals who are otherwise eligible for Medi-Cal
and who are not inmates of a public institution shall be eligible
for Medi-Cal benefits. This includes, but is not limited to,
individuals in formal or informal diversion or deferred entry of
judgment programs; individuals on probation, as defined in Section
1203 of the Penal Code; individuals on parole, as described in
Section 3000 of the Penal Code; individuals on postrelease
community supervision, as described in Section 3451 of the Penal
Code; and individuals on mandatory supervision as defined in
clause (ii) of subparagraph (B) of paragraph (5) of subdivision
(h) of Section 1170 of the Penal Code.

end insert

begin delete SECTION 1. end delete
begin insert SEC. 2. end insert   

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

begin delete

14124.27.  

(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)

end delete

begin insert

begin insert 14124.27. end insert   

end insert

begin insert (a) end insert  The department may establish a begin delete 10-year end delete begin insert five-year end insert
pilot program with six counties begin insert , which shall include three urban
counties and three rural counties, end insert 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.

begin delete

(c)

end delete

begin insert (b) end insert  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.

begin delete SEC. 2. end delete
begin insert SEC. 3. end insert   

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

14124.28.  

begin delete (a) end delete begin delete   end delete The department shall begin delete , 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 end delete begin insert submit an
application for any Section 1115 waiver or waiver amendment
necessary to create a process by which end insert federal financial
participation begin insert may be claimed end insert for stays of begin delete 90 end delete begin insert 120 end insert 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 begin delete medically necessary end delete begin insert diagnosed end insert substance use disorder.

begin delete

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

end delete

begin delete SEC. 3. end delete
begin insert SEC. 4. end insert   

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

14129.  

begin delete (a) end delete begin delete   end delete The department shall, in implementing this article,
request a waiver of federal law to authorize begin delete 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. end delete begin insert the state to claim federal
financial participation for health home services provided to
individuals, who are otherwise eligible to receive health home
services under this article and who are state or county inmates in
their last 30 days in custody, by a provider or team of providers,
as described in subdivision (c) of Section 14127, to ensure
coordination of care and reduce gaps in care. Prerelease health
home services shall be limited to services described in Section
14127.2 and shall not include health care services. end insert

begin delete

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

end delete