BILL ANALYSIS �
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UNFINISHED BUSINESS
Bill No: SB 1045
Author: Beall (D)
Amended: 6/19/14
Vote: 21
SENATE HEALTH COMMITTEE : 9-0, 5/7/14
AYES: Hernandez, Morrell, Beall, De Le�n, DeSaulnier, Evans,
Monning, Nielsen, Wolk
SENATE FLOOR : 35-0, 5/15/14
AYES: Anderson, Beall, Berryhill, Block, Cannella, Corbett,
Correa, De Le�n, DeSaulnier, Evans, Fuller, Gaines, Galgiani,
Hancock, Hernandez, Hill, Hueso, Huff, Jackson, Knight, Lara,
Leno, Lieu, Liu, Mitchell, Monning, Morrell, Nielsen, Padilla,
Pavley, Roth, Torres, Vidak, Wolk, Wyland
NO VOTE RECORDED: Calderon, Steinberg, Walters, Wright, Yee
ASSEMBLY FLOOR : 74-0, 6/23/14 - See last page for vote
SUBJECT : Medi-Cal Drug Treatment Program: group outpatient
drug free
services
SOURCE : County Alcohol and Drug Program Administrators
Association of
California
DIGEST : This bill, for the purposes of Drug Medi-Cal
Treatment Program (DMC) reimbursement, changes the number from a
minimum of four and a maximum of 10 individuals to a minimum of
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two and a maximum of 12 allowed in a group for outpatient
drug-free services.
Assembly Amendments reduce the maximum number allowed in a group
for outpatient drug free services from 14 to 12 and specify that
if one of the individuals in a two-member group is ineligible
for Medi-Cal, that the individual who is ineligible for Medi-Cal
is required to receive outpatient drug-free services, as
specified.
ANALYSIS : 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.Allows DHCS to enter into DMC contracts with each county for
the provision of alcohol and drug use services within the
county service area.
3.Requires DHCS to contract for DMC services in a county that
does not enter into or terminates its DMC contract with DHCS
to ensure beneficiary access to alcohol and drug use services.
Requires contracts be made in accordance with federal
Medicaid and state Medi-Cal laws and in accordance with the
federal court order and any future action in the case of Sobky
v. Smoley (E.D.Cal 1994) 855 F.Supp. 1123.
4.Requires a group for outpatient drug free services and
narcotic treatment programs to consist of a minimum of 4 and a
maximum of 10 individuals, of which at least one must be a
Medi-Cal-eligible beneficiary.
5.Defines "group counseling" for DMC substance use disorder
(SUD) services as face-to-face contacts in which one or more
therapists or counselors treat two or more clients at the same
time and focus on the needs of the individuals served.
This bill, for the purposes of DMC reimbursement, changes the
number from a minimum of four and a maximum of 10 individuals to
a minimum of two and a maximum of 12 allowed in a group for
outpatient drug free services. Specifies that for groups
consisting of two individuals, if one of the individuals is
ineligible for Medi-Cal, that individual is required to receive
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outpatient drug-free services for an SUD diagnosed by a
physician.
Background
According to the National Institute on Drug Abuse's (NIDA)
Principles of Drug Addiction Treatment, Third Edition (revised
December 2012), because addiction is a disease, most people
cannot simply stop using drugs for a few days and be cured.
Patients typically require long-term or repeated episodes of
care to achieve the ultimate goal of sustained abstinence and
recovery of their lives. NIDA states that substance abuse costs
the nation over $600 billion annually, and treatment is much
less expensive than its alternatives, such as incarcerating
addicted people.
DMC . According to DHCS, the DMC program provides SUD treatment
services to Medi-Cal beneficiaries. Funding for the program was
realigned to the counties as part of the 2011 Public Safety
Realignment, but the delivery system remained unchanged. DHCS
certifies and monitors DMC treatment providers to ensure
adherence to Title 9 and Title 22, California Code of
Regulations (CCR), which govern DMC treatment. DMC SUD services
include narcotic treatment programs, outpatient drug free
treatment, day care habilitative, perinatal residential SUD, and
naltrexone treatment. Title 22, CCR, defines group counseling as
face-to-face contacts in which one or more therapists or
counselors treat two or more clients at the same time, focusing
on the needs of the individuals served. However, for outpatient
drug free treatment services and narcotic treatment programs,
group counseling is required to be conducted with no less than 4
and no more than 10 individuals at the same time, of which only
one individual needs to be a Medi-Cal-eligible beneficiary
Group modality and size. According to a 2002 publication,
Motivational Groups for Community Substance Abuse Programs, by
the Mid-Atlantic Addiction Technology Transfer Center (MAATTC)
with funding from the federal Substance Abuse and Mental Health
Services Administration, a group approach to therapy can be a
powerful vehicle for providing clients support, modeling, and
relief from a sense of isolation. The group environment can
enhance most clients' willingness to thoroughly examine their
life situations and substance use, and reduce their hesitation
for considering new ways of being. The MAATTC states that in
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some localities group treatment may be the primary service an
agency can afford to provide for most clients. MAATTC also
states the ideal size for a group may be between six and twelve
individuals; however, if a group size exceeds that range, the
leaders of the group might consider increasing the length of the
group session. The Administration's Center for Substance Abuse
Treatment's Treatment Improvement Protocols No. 47 from 2006
states that the optimal size of a group in most intensive
outpatient treatment programs is between 8 and 15 individuals.
According to SUD providers in the state, groups consisting of
more than 15 individuals may be difficult to manage, but some
have had effective group sessions with as many as 18
individuals.
FISCAL EFFECT : Appropriation: No Fiscal Com.: No Local:
No
SUPPORT : (Verified 6/24/14)
County Alcohol and Drug Program Administrators Association of
California (source)
California Council of Community Mental Health Agencies
California Mental Health Directors Association
Mental Health America of California
Pacific Clinics
ARGUMENTS IN SUPPORT : The County Alcohol and Drug Program
Administrators Association of California, the sponsor, argues
that both small and large population counties often have
difficulties meeting the minimum and maximum requirements for a
group, respectively, so programs often cannot receive Medi-Cal
reimbursement and program participants may have to be excluded
when the maximum is reached. The Association states that this
bill modifies group size requirements to be consistent with
provisions of state law for other types of Medi-Cal services
that specify groups sizes are two or more individuals. Pacific
Clinics writes that this bill removes antiquated billing
restrictions on DMC group outpatient services. Pacific Clinics
argues that due to clients' no-show rates, meeting or exceeding
the current number requirement is detrimental to clients and
service providers.
ASSEMBLY FLOOR : 74-0, 06/23/14
AYES: Achadjian, Alejo, Allen, Ammiano, Bigelow, Bloom,
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Bocanegra, Bonilla, Bonta, Bradford, Brown, Buchanan, Ian
Calderon, Campos, Chau, Ch�vez, Chesbro, Conway, Cooley,
Dababneh, Dahle, Daly, Dickinson, Eggman, Fong, Fox, Frazier,
Beth Gaines, Garcia, Gatto, Gomez, Gonzalez, Gordon, Gray,
Grove, Hagman, Hall, Harkey, Roger Hern�ndez, Holden, Jones,
Jones-Sawyer, Levine, Linder, Lowenthal, Maienschein, Mansoor,
Medina, Melendez, Mullin, Muratsuchi, Nazarian, Olsen, Pan,
Patterson, Perea, John A. P�rez, V. Manuel P�rez, Quirk,
Quirk-Silva, Rendon, Ridley-Thomas, Rodriguez, Salas, Skinner,
Stone, Ting, Wagner, Waldron, Weber, Wieckowski, Williams,
Yamada, Atkins
NO VOTE RECORDED: Donnelly, Gorell, Logue, Nestande, Wilk,
Vacancy
JL:nl 6/24/14 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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