Bill Text: CA AB1175 | 2019-2020 | Regular Session | Enrolled


Bill Title: Medi-Cal: mental health services.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Vetoed) 2019-10-13 - Vetoed by Governor. [AB1175 Detail]

Download: California-2019-AB1175-Enrolled.html

Enrolled  September 12, 2019
Passed  IN  Senate  September 04, 2019
Passed  IN  Assembly  September 09, 2019
Amended  IN  Senate  August 30, 2019
Amended  IN  Senate  August 12, 2019
Amended  IN  Senate  July 08, 2019
Amended  IN  Senate  June 24, 2019
Amended  IN  Assembly  May 16, 2019
Amended  IN  Assembly  April 23, 2019
Amended  IN  Assembly  April 02, 2019
Amended  IN  Assembly  April 01, 2019
Amended  IN  Assembly  March 18, 2019

CALIFORNIA LEGISLATURE— 2019–2020 REGULAR SESSION

Assembly Bill
No. 1175


Introduced by Assembly Member Wood

February 21, 2019


An act to add Sections 14197.08 and 14715.5 to the Welfare and Institutions Code, relating to Medi-Cal.


LEGISLATIVE COUNSEL'S DIGEST


AB 1175, Wood. Medi-Cal: mental health services.
Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income individuals receive health care services, including specialty mental health services and nonspecialty mental health services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions.
Existing law requires the department to implement managed mental health care for Medi-Cal beneficiaries through contracts with county mental health plans. Under existing law, the county mental health plans are responsible for providing specialty mental health services to enrollees, and Medi-Cal managed care plans deliver nonspecialty mental health services to enrollees. Existing law requires county mental health plans and Medi-Cal managed care plans to be governed by various guidelines, including network adequacy standards and a requirement that a county mental health plan that provides Medi-Cal specialty mental health services enter into a memorandum of understanding with a Medi-Cal managed care plan that provides Medi-Cal health services to some of the same Medi-Cal recipients served by the county mental health plan. Existing regulations provide for a dispute resolution process to be used to resolve matters between a Medi-Cal managed care plan and a county mental health plan.
This bill would require a county mental health plan and a Medi-Cal managed care plan to provide, on a monthly basis, to the respective Medi-Cal managed care plan and county mental health plan a list that identifies specified information, including the contact information of the patient and provider, relating to the members of the respective plans who are receiving, or have received, any specialty mental health services. The bill would require the department to consult with specified subject matter experts, including Medi-Cal beneficiary advocates, to develop implementing guidance to assist plans in meeting these requirements. The bill would require the department to implement, by July 1, 2020, these provisions by any of various means, including plan letters, that direct county mental health plans and Medi-Cal managed care plans to exchange the required information.
This bill would require a county mental health plan and Medi-Cal managed care plan that are unable to resolve a dispute to submit a request for resolution to the department, and to ensure that there is no delay in the provision of medically necessary services pending the resolution of the dispute. The bill would require the department to issue a written decision to the plans within 30 calendar days from receipt of the request.
Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: NO  

The people of the State of California do enact as follows:


SECTION 1.

 Section 14197.08 is added to the Welfare and Institutions Code, to read:

14197.08.
 (a) In enacting this section, it is the intent of the Legislature to improve the treatment and care coordination of individuals receiving services from both Medi-Cal managed care plans and county specialty mental health plans.
(b) (1) Effective 180 days after the issuance of the guidance required pursuant to subdivision (f), each county mental health plan shall electronically provide, on a monthly basis, and in a standard data format that is mutually agreed upon by the county mental health plan and the Medi-Cal managed care plan, to the Medi-Cal managed care plans or plan providing services in that county a list that identifies the members of the respective Medi-Cal managed care plans provided pursuant to paragraph (2) who are receiving, or have received, any specialty mental health services within that month.
(2) A Medi-Cal managed care plan shall furnish, on a monthly basis, and in a standard data format that is mutually agreed upon by the Medi-Cal managed care plan and the county mental health plan, to the county mental health plan a list of its members for purposes of meeting the requirement of paragraph (1).
(c) For purposes of complying with paragraph (1) of subdivision (b), each county mental health plan shall include, as part of the transferred data, all of the following information:
(1) The name of the patient.
(2) The patient’s date of birth.
(3) The patient’s Medi-Cal beneficiary identification number or social security number.
(4) The patient’s current mental health diagnosis.
(5) The patient’s current medication, if known by the plan.
(6) The date of service in the reporting period and services provided.
(7) The patient’s contact information, including residential address and telephone number, if known.
(8) The provider’s contact information, including telephone number, email address, and office address, if known.
(9) Any additional data elements selected by the department, as necessary, for managed care plans to implement, calculate, or monitor quality measures established by the department.
(d) (1) Following the exchange of information between the plans as described in subdivision (b), each Medi-Cal managed care plan shall electronically provide, on a monthly basis, and in a standard data format that is mutually agreed upon by the Medi-Cal managed care plan and the county mental health plan, to the county mental health plan both of the following:
(A) A list of those members of the Medi-Cal managed care plan who are also receiving specialty mental health services from the county mental health plan based on the information provided pursuant to subdivision (b).
(B) The information specified in subdivision (e) relating to those members of the Medi-Cal managed care plan who are also receiving specialty mental health services from the county mental health plan.
(2) Effective 180 days after the issuance of the guidance required pursuant to subdivision (f), each Medi-Cal managed care plan shall comply with the requirements specified in paragraph (1).
(e) For purposes of complying with paragraph (2) of subdivision (b) and subdivision (d), each Medi-Cal managed care plan shall include, as part of the transferred data, all of the following information:
(1) The name of the patient.
(2) The patient’s date of birth.
(3) The patient’s Medi-Cal beneficiary identification number or social security number.
(4) The patient’s current physical health diagnosis, including any chronic health conditions, such as diabetes and hypertension.
(5) The patient’s current mental health diagnosis.
(6) The patient’s prescription medication that is known to the Medi-Cal managed care plan.
(7) The patient’s contact information, including residential address and telephone number, if known.
(8) The name, telephone number, email address, and office address, if known, of the patient’s primary care provider and date of the most recent primary care visit.
(9) Any additional data elements selected by the department, as necessary, for county mental health plans to implement, calculate, or monitor performance measures established by the department.
(f) (1) The department shall consult with subject matter experts who represent county mental health plans, Medi-Cal beneficiary advocates, and Medi-Cal managed care plans to develop implementing guidance to assist county mental health plans and Medi-Cal managed care plans in meeting the requirements of this section. The guidance shall include recommendations for timely health information exchange as required to implement this section in a manner that is compliant with all relevant privacy protections described in subdivision (g).
(2) Notwithstanding the data elements required for transfer contained in subdivisions (c) and (e), the department, following consultation with stakeholders pursuant to paragraph (1), may reduce or modify those data elements required to be provided pursuant to subdivisions (c) and (e).
(3) Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, by July 1, 2020, the department shall implement, interpret, or make specific this section by means of all-county letters, plan letters, plan or provider bulletins, or similar instructions that direct county mental health plans and Medi-Cal managed care plans to exchange information consistent with the requirements of this section, including the recommendations developed through the stakeholder consultation process described in paragraph (1).
(g) This section shall not be construed to diminish or undermine the privacy protections under the Confidentiality of Medical Information Act (Part 2.6 (commencing with Section 56) of Division 1 of the Civil Code), the Health Insurance Portability and Accountability Act privacy rule (Part 160 and Subparts A and E of Part 164 of Title 45 of the Code of Federal Regulations), or under any other state or federal law.

SEC. 2.

 Section 14715.5 is added to the Welfare and Institutions Code, immediately following Section 14715, to read:

14715.5.
 (a) (1) If a county mental health plan and a Medi-Cal managed care plan have a dispute, as described in Section 1850.505 of Title 9 of the California Code of Regulations, and are unable to reach a resolution within 15 business days from the initiation of the dispute resolution process, both the county mental health plan and the Medi-Cal managed care plan shall submit a request for resolution to the department.
(2) The department shall, within 30 calendar days from the receipt of the request, issue a written decision to the county mental health plan and the Medi-Cal managed care plan.
(b) A dispute between the county mental health plan and the Medi-Cal managed care plan shall not delay the provision of medically necessary services by the Medi-Cal managed care plan or the county mental health plan. Pending resolution of the dispute, both plans shall comply with Section 1850.525 of Title 9 of the California Code of Regulations.

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