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 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 deleteThis bill would require the department, if the department seeks a specified waiver to implement Drug Medi-Cal, to pursue federal approvals to address the need for greater capacity in both short-term residential treatment facilities and hospitals settings for short-term voluntary inpatient detoxification.
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
13
eligible, 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 acute care 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.
P3 1(7) According to a letter from the Director of Health Care
2Services to the federal Centers for Medicare and Medicaid Services,
3only 21 percent of California’s beds are in facilities with a capacity
4of 16 and under. Furthermore, other than 11 perinatal programs,
5there are no Drug Medi-Cal licensed residential substance use
6disorder facilities in California. Therefore, California is severely
7limited in providing the expanded substance use disorder residential
8treatment benefits as provided for by the Medi-Cal expansion.
9(8) The Commonwealth of Massachusetts successfully included
10IMD expenditure authority in its Section 1115 waiver. California
11has a similar
need for IMD expenditure authority.
12(b) It is the intent of the Legislature to expeditiously expand
13statewide capacity for mental health and substance use disorder
14treatment services for all Californians eligible for health care
15services under Medi-Cal who are in need of, or are currently
16seekingbegin insert,end insert treatment.
Section 14124.29 is added to the Welfare and
18Institutions Code, to read:
(a) The department may seek federal approval to
20obtain federal financial participation for services provided by
21institutions for mental diseases (IMDs), which are otherwise
22excluded from federal financial participation by Section
231396d(a)(29)(B) of Title 42 of the United States Code.
24(b) In enacting this section, the Legislature intends to improve
25access to short-term residential treatment in facilities with bed
26capacities in excess of 16 beds and short-term inpatient medical
27detoxification in a hospital setting, including, but not limited to,
28free-standing acute psychiatric and chemical dependency recovery
29hospitals.
begin insertSection 14124.29 is added to the end insertbegin insertWelfare and
31Institutions Codeend insertbegin insert, to read:end insert
(a) If the department seeks a waiver pursuant to
33subdivision (a) of Section 14021.35, the department shall pursue
34federal approvals to address the need for greater capacity in both
35short-term residential treatment facilities and hospital settings for
36short-term voluntary inpatient detoxification, including, but not
37limited to, licensed chemical dependency recovery hospitals.
38(b) Nothing in this section shall be construed to limit the
39authority of the department pursuant to Section 14021.35.
P4 1(c) This section shall be implemented only to the extent federal
2approvals are obtained and to the extent that federal financial
3participation is
available.
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