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

California Assembly Bill 1175 (Prior Session Legislation)

NOTE: There are more recent revisions of this legislation. Read Latest Draft

Bill Title: Medi-Cal: mental health services.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Vetoed) 2020-01-21 - Consideration of Governor's veto stricken from file. [AB1175 Detail]

Download: California-2019-AB1175-Amended.html

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 amend Section 14715 of the Welfare and Institutions Code, relating to Medi-Cal.

LEGISLATIVE COUNSEL'S DIGEST

AB 1175, as amended, Wood. Medi-Cal: specialty mental health ~~services.~~ services: memorandum of understanding.

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. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions.

Under existing law, specialty mental health services are covered under the Medi-Cal program. Existing law requires the department to implement managed mental health care for Medi-Cal beneficiaries through contracts with mental health plans. Existing law authorizes the department to contract with qualifying individual counties, counties acting jointly, or other qualified entities approved by the department for the delivery of specialty mental health services in any county. Existing law requires the department to require any mental health plan that provides Medi-Cal specialty mental health services to enter into a memorandum of understanding (MOU) with a Medi-Cal managed care plan that provides Medi-Cal health services to some of the same Medi-Cal recipients served by the mental health plan. These provisions are only implemented to the extent that necessary federal waivers are obtained.

~~This bill would make a technical, nonsubstantive change to a related provision.~~
This bill would require the department to require that the MOU include a referral protocol between the mental health plan and the Medi-Cal managed care plan that tracks, among other things, the number of referrals for service from one plan to the other plan. The bill would require the MOU to include processes through which a Medi-Cal beneficiary receiving services from a provider of one plan may continue to receive specialty or nonspecialty mental health services from that same provider, if the provider is able to continue providing care to that beneficiary.

Vote: MAJORITY Appropriation: NO Fiscal Committee: NOYES Local Program: NO

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

SECTION 1.

Section 14715 of the Welfare and Institutions Code is amended to read:

14715.

(a) (1) The department shall require any mental health plan that provides Medi-Cal specialty mental health services to enter into a memorandum of understanding with any Medi-Cal managed care plan that provides Medi-Cal health services to some of the same Medi-Cal recipients served by the mental health plan. The memorandum of understanding shall comply with applicable regulations.

(2) For purposes of this section, a “Medi-Cal managed care plan” means any prepaid health plan or Medi-Cal managed care plan contracting with the department to provide services to enrolled Medi-Cal beneficiaries under Chapter 7 (commencing with Section 14000) or Chapter 8 (commencing with Section 14200), or Part 4 (commencing with Section 101525) of Division 101 of the Health and Safety Code.

(b) The department shall require the memorandum of understanding to include all of the following:

(1) A process or entity to be designated by the local mental health plan to receive notice of actions, denials, or deferrals from the Medi-Cal managed care plan, and to provide any additional information requested in the deferral notice as necessary for a medical necessity determination.

(2) A requirement that the local mental health plan respond by the close of the business day following the day the deferral notice is received.

(3) A referral protocol between the mental health plan and the Medi-Cal managed care plan that tracks all of the following:
(A) The number of referrals for service from one plan to the other plan.
(B) The mean and median time from initial contact to date of service following a transfer from one plan to the other plan.
(C) The number of requests for service that result in service within 10 business days.
(4) (A) A process through which a Medi-Cal beneficiary receiving services from a mental health plan provider may continue to receive nonspecialty mental health services from that same provider, if the provider is able to continue providing care to that beneficiary.
(B) A process through which a Medi-Cal beneficiary receiving services from a Medi-Cal managed care plan mental health provider may continue to receive specialty mental health services from that same provider, if the provider is able to continue providing care to that beneficiary.

(c) The department may sanction a mental health plan pursuant to subdivision (e) of Section 14712 for failure to comply with this section.

(d) This section applies to any contracts entered into, amended, modified, extended, or renewed on or after January 1, 2001.