BILL ANALYSIS �
SB 1045
Page 1
SENATE THIRD READING
SB 1045 (Beall)
As Amended June 19, 2014
Majority vote
SENATE VOTE :35-0
HEALTH 17-0
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|Ayes:|Pan, Maienschein, | | |
| |Ammiano, Bonilla, Bonta, | | |
| |Chesbro, Gomez, Roger | | |
| |Hern�ndez, Lowenthal, | | |
| |Mansoor, Nazarian, | | |
| |Nestande, Patterson, | | |
| |Ridley-Thomas, Rodriguez, | | |
| |Wagner, Wieckowski | | |
| | | | |
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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; for groups consisting of two
individuals, the individual that is not a Medi-Cal eligible
beneficiary must be receiving outpatient drug free services for
a diagnosed substance abuse disorder.
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.
SB 1045
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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 : 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.
Alcohol and other drug 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.
SB 1045
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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.
This bill has no opposition.
Analysis Prepared by : Paula Villescaz / HEALTH / (916)
319-2097
FN: 0004020