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
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 |
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:
SECTION 1.
Section 14197.06 is added to the Welfare and Institutions Code, to read:14197.06.
(a) The department shall require the federally required external quality review organization to report, on or before January 1, 2021, and annually thereafter, on both of the following:
(a)For Medi-Cal managed care health plans and county mental health plans, the
average expenditure per plan member that received mental health services, identified by the type of mental health service and in the aggregate.
(b)For county mental health plans,
(1)
(2)
(c)For Medi-Cal managed care health plans,
(d)For county mental health plans,
(1)
(2)An electronic health record system that is interoperable with
(3) An electronic health record system that is interoperable with one or more Medi-Cal managed health care
(4)An electronic health record system that it is interoperable with one or more Medi-Cal managed health care
(e)For Medi-Cal managed care health plans,
(1)
(2)An electronic health record system that is interoperable with
(3)An electronic health record system that is interoperable with
(4)An electronic health record system that it is interoperable with
SEC. 2.
Section 14197.08 is added to the Welfare and Institutions Code, to read:14197.08.
(a) Effective on and after July 1, 2020, 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 health plan, to the respective Medi-Cal managed care health plans a list that identifies the members of the Medi-Cal managed care health plans who are receiving, or have received, any specialty mental health services within that month.SEC. 3.
Section 14197.09 is added to the Welfare and Institutions Code, to read:14197.09.
(a) A Medi-Cal managed care health plan shall provide continuity of care to a Medi-Cal enrollee who receives specialty mental health services from a county mental health plan by ensuring that the specialty mental health services provider may also provide nonspecialty mental health services to the enrollee if all of the following requirements are met:SEC. 2.SEC. 4.
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.(ii)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, that are stratified
by individuals who are diagnosed with mental illness.
(9)
SEC. 3.SEC. 5.
Section 14715 of the Welfare and Institutions Code is amended to read:14715.
(a) (1) The department shall require a county 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 county mental health plan. The memorandum of understanding shall comply with applicable regulations, including Section 1810.370 of Title 9 of the California Code of Regulations.(3)A referral protocol between the county mental health plan and the Medi-Cal managed care health 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 the enrollee receiving the requested service within 10 business days.
(4)
(5)(A)A process through which a Medi-Cal enrollee receiving specialty mental health services from a county mental health plan provider may continue to receive nonspecialty mental health services from that same mental health care provider if the enrollee has an ongoing relationship with the mental health care provider and the mental health care provider is willing to accept the Medi-Cal managed care health plan’s rate for the service offered, or the applicable county mental health plan rate, whichever is higher. The Medi-Cal managed care health plan shall
also determine that the mental health care provider meets applicable professional standards and has no disqualifying quality of care issues. The county mental health plan shall inform the enrollee of this option whenever the enrollee has previously received specialty mental health services, and is subsequently referred to the Medi-Cal managed care health plan for nonspecialty mental health services.
(B)A process through which an enrollee receiving nonspecialty mental health services from a mental health care provider that participates in a Medi-Cal managed care health plan’s network may continue to receive specialty mental health services from that same mental health care provider if the enrollee has an ongoing relationship with the mental health care provider and the mental health care provider is willing to accept the county
mental health plan’s rate for the service offered, or the applicable Medi-Cal managed care health plan rate, whichever is higher. The county mental health plan shall also determine that the mental health care provider meets applicable professional standards and has no disqualifying quality of care issues. The Medi-Cal managed care health plan shall inform the enrollee of this option whenever the enrollee has previously received nonspecialty mental health services, and is subsequently referred to the county mental health plan for specialty mental health services.
(C)The covered services provided pursuant to subparagraphs (A) and (B) shall be provided for a period of time necessary to complete a course of treatment and to arrange for a safe transfer to another provider, as determined by the mental health plan in the case of
subparagraph (B), or the Medi-Cal managed care health plan in the case of subparagraph (A), in consultation with the enrollee and the terminated provider or nonparticipating provider and consistent with good professional practice. Completion of covered services under this paragraph shall not exceed 12 months from the contract termination date or 12 months from the effective date of coverage for a newly covered enrollee.
(6)
(7)