SB 1161, as amended, Beall. Drug Medi-Cal.
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 patients in an institution for mental diseases (IMD). 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 for Medi-Cal recipients, or is required to directly arrange for these services if a county elects not to do so.
This bill would require the department to seek a specified waiver of the IMD exclusion under Drug Medi-Cal to provide short-term residential treatment in facilities with a bed capacity in excess of 16 beds and short-term inpatient medical detoxification in a hospital setting.
end deleteThis bill would authorize the department to seek federal approval to obtain federal financial participation for services provided by IMDs, which are otherwise excluded from federal financial participation under federal law.
end insertVote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: no.
The people of the State of California do enact as follows:
(a) The Legislature finds and declares all of the
2following:
3(1) The federal Patient Protection and Affordable Care Act
4(PPACA) (Public Law 111-148), as amended by the federal Health
5Care and Education Reconciliation Act of 2010 (Public Law
6111-152), offers previously uninsured Californians unprecedented
7access to health services, including mental health and substance
8use disorder services.
9(2) In 2013, the Legislature passed Assembly Bill 1 and Senate
10Bill 1 in the 2013-14 First Extraordinary Session, which expanded
11Medi-Cal coverage to low-income adults with
incomes at or below
12138 percent of the federal poverty level who were not previously
13eligible, established the Medi-Cal benefit package for this
14expansion population, and required the Medi-Cal program to cover
15additional mental health and substance use disorder services.
16(3) An estimated 1.2 million people enrolled in the Medi-Cal
17program have substance use treatment needs.
18(4) Substance use disorder treatment often requires medical
19detoxification and residential treatment services, services that have
20been included in California’s Medi-Cal expansion under PPACA.
21(5) The federal exclusion for institutions for mental diseases
22(IMD) only permits residential care for substance use disorder in
23facilities
with 16 beds or fewer and medical detoxification only in
24a general acutebegin insert careend insert hospital, making both services inaccessible
25to Medi-Cal and Drug Medi-Cal beneficiaries.
26(6) Capacity for both medical detoxification and residential
27treatment is severely limited in California in settings in compliance
28with the federal exclusion for IMD.
29(7) According to a letter from the Director of Health Care
30Services to the federal Centers for Medicare and Medicaid Services,
31only 21 percent of California’s beds are in facilities with a capacity
P3 1of 16 and under. Furthermore, other than 11 perinatal programs,
2there are no Drug Medi-Cal licensed residential substance use
3disorder facilities in California.
Therefore, California is severely
4limited in providing the expanded substance use disorder residential
5treatment benefits as provided for by the Medi-Cal expansion.
6(8) The Commonwealth of Massachusetts successfully included
7IMD expenditure authority in its Section 1115 waiver. California
8has a similar need for IMD expenditure authority.
9(b) It is the intent of the Legislature to expeditiously expand
10statewide capacity for mental health and substance use disorder
11treatment services for all Californians eligible for health care
12services under Medi-Cal who are in needbegin delete ofend deletebegin insert of,end insert orbegin insert
areend insert currently
13seeking treatment.
Section 14124.27 is added to the Welfare and
15Institutions Code, immediately following Section 14124.26, to
16read:
(a) The department shall seek a waiver of federal
18law under Section 1115 of the federal Social Security Act (42
19U.S.C. Sec. 1315) to receive federal financial participation under
20the Drug Medi-Cal program in accordance with this section.
21(b) The department shall seek a waiver of the institution for
22mental diseases (IMD) exclusion in Section 1396d(a)(29)(B) of
23Title 42 of the United States Code to provide short-term residential
24treatment in facilities with bed capacities in excess of 16 beds and
25short-term
inpatient medical detoxification in a hospital setting,
26including, but not limited to, free-standing acute psychiatric and
27chemical dependency recovery hospitals.
28(c) This section shall be implemented only to the extent federal
29approval is obtained and to the extent that federal financial
30participation is available.
begin insertSection 14124.29 is added to the end insertbegin insertWelfare and
32Institutions Codeend insertbegin insert, to read:end insert
(a) The department may seek federal approval to
34obtain federal financial participation for services provided by
35institutions for mental diseases (IMDs), which are otherwise
36excluded from federal financial participation by Section
371396d(a)(29)(B) of Title 42 of the United States Code.
38(b) In enacting this section, the Legislature intends to improve
39access to short-term residential treatment in facilities with bed
40capacities in excess of 16 beds and short-term inpatient medical
P4 1detoxification in a hospital setting, including, but not limited to,
2free-standing acute psychiatric and chemical dependency recovery
3hospitals.
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