Bill Text: CA AB1175 | 2019-2020 | Regular Session | Amended
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
April 23, 2019 |
Amended
IN
Assembly
April 02, 2019 |
Amended
IN
Assembly
April 01, 2019 |
Amended
IN
Assembly
March 18, 2019 |
Assembly Bill | No. 1175 |
Introduced by Assembly Member Wood |
February 21, 2019 |
LEGISLATIVE COUNSEL'S DIGEST
Digest Key
Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: NOBill Text
The people of the State of California do enact as follows:
(a)As part of the federally required external quality review organization (EQRO) review of Medi-Cal managed care health plans in the annual detailed technical report required by Section 438.364 of Title 42 of the Code of Federal Regulations, effective for contract periods commencing on or after July 1, 2018, the EQRO designated by the department shall compile the data described in subdivision (b), by plan and by county, for the purpose of informing the status of implementation of the requirements of Section 14197.
(b)(1)The information compiled by the EQRO shall include all of the following:
(A)Number of requests for alternative access standards in the plan service area for time and distance, categorized by provider types, including specialists, and by adult and pediatric.
(B)Number of allowable exceptions for the appointment time standard, if known, categorized by provider types, including
specialists, and by adult and pediatric.
(C)Distance and driving time between the nearest network provider and ZIP Code of the enrollee furthest from that provider for requests for alternative access standards.
(D)Approximate number of beneficiaries impacted by alternative access standards or allowable exceptions.
(E)Percentage of providers in the plan service area, by provider and specialty type, that are under a contract with a Medi-Cal managed care health plan.
(F)The number of requests for alternative access standards approved or denied by ZIP Code and provider and specialty type, and the reasons for the approval or denial of the request for alternative
access standards.
(G)The process of ensuring out-of-network access.
(H)Descriptions of contracting efforts and explanation for why a contract was not executed.
(I)Timeframe for approval or denial of a request for alternative access standards by the department.
(J)Consumer complaints, if any.
(2)The information described in paragraph (1) shall be presented in a chart format to enable comparison among counties, provider types, and plans.
(c)The EQRO shall develop a methodology to assess information that will help inform the experience
of individuals placed in a skilled nursing facility or intermediate care facility and the distance that they are placed from their place of residence. The EQRO shall report the results from the use of this methodology in the EQRO annual Medi-Cal managed care health plan technical report.
(d)The department shall comply with the requirements of subsection (c) of Section 438.364 of Title 42 of the Code of Federal Regulations in making the information described in this section publicly available.
(e)It is the intent of the Legislature to provide data to inform strategies to improve access to mental health services.
(1)The EQRO shall annually collect performance and comparison data for each Medi-Cal managed care
health plan and county mental health plan that enables comparison of data relating to access to mental health services rendered by each entity, the use of electronic health records and electronic health record
systems, and expenditures on mental health services.
(2)By January 1, 2021, and annually thereafter, the department shall publish on its internet website a performance outcome report for Medi-Cal specialty mental health services. The performance outcome report shall include the measures that are published in the county mental health plans’ performance outcome systems reports, in addition to measures on nonspecialty mental health services that are developed pursuant to paragraph (3). The department’s performance outcome report shall set forth an easily understandable summary of quality, access, timeliness, and translation and interpretation capabilities regarding the performance of each Medi-Cal managed care health plan and county mental health plan.
(3)Commencing no later than January 15, 2020, and as needed thereafter, the department shall consult with and inform stakeholders, including subject matter experts who represent providers, consumer advocates, consumers, family members, counties, Medi-Cal managed care health plans, county mental health plans, and the Legislature, on the development of the performance outcome system and performance outcomes systems reports, as described in Sections 14707.5 and 14707.7, and the data collected on matters identified in subdivision (b) of Section 14715 and the Special Terms and Conditions of the Medi-Cal Specialty Mental Health Services Waiver, as approved pursuant to Section 1915(b) of the federal Social Security Act (42 U.S.C. Sec. 1396n(b)). The stakeholder consultation shall continuously inform stakeholder participants on the development of performance outcome measures for the county
mental health plans and Medi-Cal managed care health plans.
(4)(A)For purposes of further developing the performance outcomes reports for specialty mental health services and nonspecialty mental health services, the EQRO shall, at a minimum, consider all of the following:
(i)High-quality, culturally and linguistically competent, and accessible specialty mental health services and nonspecialty mental health services for eligible beneficiaries, consistent with federal law.
(ii)Strategies to reduce suicide rates, and populations with low treatment prevalence rates.
(iii)The Healthcare Effectiveness Data and Information Set measures
and Consumer Assessment of Healthcare Providers and Systems measures, as reported by Medi-Cal managed care health plans, stratified by individuals that are diagnosed with severe mental illness.
(B)The performance outcomes reports for specialty and nonspecialty mental health services shall consider the Special Terms and Conditions of the Medi-Cal Specialty Mental Health Services Waiver in 2015, as approved pursuant to Section 1915(b) of the federal Social Security Act (42 U.S.C. Sec. 1396n(b)) and the Medicaid Managed Care Quality Rating System.
(C)In order to evaluate the county mental health plan and Medi-Cal managed care health plan performance, at a minimum, the performance outcomes reports for specialty and nonspecialty mental health services shall be stratified by both the
statewide, county, and plan levels in the following areas:
(i)Access, including timely access to services, such as the waiting time for an assessment and for a first appointment.
(ii)Language capacity and language access.
(iii)Quality, including outcomes and patient experience.
(iv)Utilization by service type and penetration.
(v)Grievance and appeals.
(D)(i)The data specified in subparagraph (C) shall be stratified by age, sex, gender identity, race, ethnicity, primary language, sexual orientation, and any other data
elements for which there is peer-reviewed evidence to assess performance outcomes related to mental health disparities.
(ii)The department shall not report any demographic data described in subparagraph (C) or this subparagraph that would permit identification of individuals.
(5)Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may implement, interpret, or make specific this subdivision by means of all-county letters, plan letters, plan or provider bulletins, or similar instructions, without taking regulatory action.
SEC. 2.SECTION 1.
Section 14197.06 is added to the Welfare and Institutions Code, to read:14197.06.
On and before January 1, 2021, and two years thereafter, the department shall require the federally required external quality review organization to report on all of the following:SEC. 2.
Section 14707.7 of the Welfare and Institutions Code is amended to read:14707.7.
(a) It is the intent of the Legislature to build upon performance outcomes system reports the department has developed pursuant to Section 14707.5 and the Special Terms and Conditions of the Medi-Cal Specialty Mental Health Services Waiver, as approved pursuant to Section 1915(b) of the federal Social Security Act (42 U.S.C. Sec. 1396n(b)), in order to provide data to inform strategies to increase access to mental health services and to reduce mental health disparities.(C)Quality.