BILL ANALYSIS �
SB 1045
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Date of Hearing: June 10, 2014
ASSEMBLY COMMITTEE ON HEALTH
Richard Pan, Chair
SB 1045 (Beall) - As Amended: May 13, 2014
SENATE VOTE : 35-0
SUBJECT : Medi-Cal Drug Treatment Program: group outpatient drug
free services.
SUMMARY : Changes the number of individuals allowed in a group
to a minimum of two and a maximum of 14 for outpatient drug free
services for the purposes of Drug Medi-Cal (DMC) reimbursement
and requires at least one individual in the group to be a
Medi-Cal eligible beneficiary.
EXISTING LAW :
1)Establishes the Medi-Cal program, administered by the
Department of Health Care Services (DHCS), under which
qualified low-income individuals receive health care services.
2)Establishes the DMC program, which provides substance use
disorder services to Medi-Cal recipients.
3)Allows DHCS to enter into contracts with counties for the
provision of DMC services. If a county declines to contract
with DHCS, existing law requires DHCS to contract for services
in the county to ensure beneficiary access.
4)Requires each county to fund the nonfederal share for DMC
services through realignment funds, as specified.
5)Requires providers of DMC services to obtain certification
from DHCS to provide those services.
6)Requires a group for outpatient drug free services and
narcotic treatment programs to consist of a minimum of four
and a maximum of 10 individuals, of which at least one must be
a Medi-Cal-eligible beneficiary.
FISCAL EFFECT : None
COMMENTS :
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1)PURPOSE OF THIS BILL . According to the author, even though
DMC treatment services have been expanded, many counties find
it difficult to offer these benefits due to state
restrictions, such as the limitation on group size for
outpatient treatment (counseling services). Current state law
specifies that outpatient counseling groups must have between
four and 10 participants in order for the program to bill for
and receive Medi-Cal reimbursement.
The author further states that this restriction poses a problem
for both small and large population counties.
Small-population rural counties, in which program participants
may have to travel long distances to attend group counseling
sessions, often have trouble getting four or more people
together for a group, but if they have less than four
participants, they cannot receive Medi-Cal reimbursement for
that counseling session. Large-population counties have the
opposite problem. According to the author, when more than 10
people show up for a group session, a common occurrence, some
participants may have to be excluded, otherwise the county
cannot bill Medi-Cal for any of the services provided to the
Medi-Cal-eligible participants. Thus, the group size
restriction presents a significant barrier to effective
treatment.
2)BACKGROUND . Alcohol and other drug (AOD) use disorders are
substantial public health problems, affecting approximately
10% of the population and resulting in economic costs to the
Nation of around $360 billion annually, with roughly half of
this amount attributable to alcohol use disorders (Office of
National Drug Control Policy 2004). According to the National
Institute on Drug Abuse, in 2011, 21.6 million people aged 12
years or older needed treatment for an illicit drug or alcohol
use problem, but only 2.3 million received treatment at a
specialty substance abuse facility.
a) Drug Medi-Cal. The DMC program was established to
provide outpatient substance use disorder treatment
services to Medi-Cal beneficiaries. In 2011, funding for
the program was transferred from the Department of Alcohol
and Drug Programs to DHCS as part of the Public Safety
Realignment initiated by AB 109 (Committee on Budget),
Chapter 15, Statutes of 2011. Current regulations create
requirements for oversight of DMC providers at both the
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state and county levels. DHCS is tasked with
administrative and fiscal oversight, monitoring, auditing
and utilization review. Counties that elect to contract
with DHCS to provide DMC services are required to maintain
a system of fiscal disbursement and controls, monitor to
ensure that billing is within established rates, and
process claims for reimbursement. Most counties choose to
contract with DHCS; however, 13 counties (Alpine, Amador,
Calaveras, Colusa, Del Norte, Inyo, Modoc, Mono, Plumas,
Sierra, Siskiyou, Trinity, and Tuolumne) do not participate
in DMC. In addition, 15 providers statewide currently
operate without a county contract, instead contracting
directly with DHCS.
b) Group Treatment. According to the 2011 publication,
"Treatment Improvement Protocol (TIP) No. 41 'Quick Guide
for Clinicians'" by the federal Substance Abuse and Mental
Health Services Administration, group therapy can be a
powerful therapeutic tool for treating substance abuse. In
many cases, it is as effective as individual therapy
because groups intrinsically have many rewarding traits,
such as reducing isolation and enabling members to witness
the recovery of others. These qualities can draw clients
into a culture of recovery. TIP No. 41 also states that
treatment groups should generally have no more than 15
members in order to maximize treatment effectiveness and,
to the extent possible individuals be divided into groups
best suited to their needs based on other factors such as
gender, age, and stage of recovery.
3)SUPPORT . Mental Health America of California and the
California Council of Community Mental Health Agencies, write
that this bill creates more flexibility in group outpatient
drug free services under the DMC program by decreasing the
minimum size from four to two and increasing the maximum size
from 10 to 14. They argue that given the shortage of
facilities and low reimbursement rates that create a
significant access problem, this bill helps address that
problem.
4)RELATED LEGISLATION .
a) AB 1644 (Medina) would have required DMC providers to be
designated as a 'high' categorical risk and be subject to
criminal background checks as a condition of DMC
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certification. AB 1644 was held under submission in the
Assembly Appropriations Committee.
b) SB 1339 (Cannella) requires a county or DHCS, before
contracting with a DMC provider, to obtain criminal
background checks for the owner and key staff. SB 1339 is
in the Assembly pending referral.
c) AB 1967 (Pan) requires DHCS, when it commences or
concludes an investigation of a DMC provider, to notify
counties that contract with the provider. AB 1967 is in
the Senate Health Committee.
d) SB 570 (DeSaulnier) requires AOD counselors to submit
criminal background checks for review by DHCS. SB 570 is
in the Assembly pending referral.
5)PREVIOUS LEGISLATION .
a) SB 1529 (Alquist), Chapter 797, Statutes of 2012,
revises screening, enrollment, disenrollment, suspensions,
and other sanctions for fee-for-service Medi-Cal providers
and suppliers to conform to the federal Patient Protection
and Affordable Care Act.
b) SB 857 (Speier), Chapter 601, Statutes of 2003, makes
numerous changes to the Medi-Cal program intended to
address provider fraud, including establishing new Medi-Cal
application requirements for new providers, existing
providers at new locations, and providers applying for
continued enrollment.
6)POLICY QUESTIONS . Lowering the minimum requirement of a group
to consist of only two individuals raises questions regarding
the effectiveness of group treatment versus individual
treatment for just two individuals. It is not clear that
group treatment for two individuals is more effective than a
provider treating a single individual. Individual counseling
requirements are significantly more restrictive than
requirements for group counseling, and consequently it may be
more difficult to make referrals for individual counseling
than it is for group counseling. Current requirements for
individual and group treatment as described in Section
51341.1of Title 22 of the California Code of Regulations are
as follows: group counseling sessions shall focus on
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short-term personal, family, job/school, and other problems
and their relationship to substance abuse or a return to
substance abuse. Individual counseling shall be limited to
intake crisis intervention, collateral services, and treatment
and discharge planning. It is possible that providers are
referring individuals to group treatment when individual
treatment might be more appropriate, but is restricted due to
current limitations.
In addition to concerns regarding the restrictions of individual
counseling requirements, allowing for a group as small as two
individuals may result in one Medi-Cal beneficiary being
joined by another individual solely for the purposes of
meeting the group requirement and the provider receiving
Medi-Cal reimbursement. For this reason, the Committee may
wish to amend this bill to ensure that in instances where just
two individuals are being treated, both are receiving
medically necessary services for a diagnosed substance abuse
disorder.
7)RECOMMENDED AMENDMENT . On page 3, line 5 insert, "For groups
consisting of two individuals, any individual that is not a
Medi-Cal eligible beneficiary must be receiving outpatient
drug free services for a substance abuse disorder diagnosis as
determined by a physician."
REGISTERED SUPPORT / OPPOSITION :
Support
County Alcohol and Drug Program Administrators Association of
California (sponsor)
California Council of Community Mental Health Agencies
Mental Health America of California
Opposition
None on file.
Analysis Prepared by : Paula Villescaz / HEALTH / (916)
319-2097
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