Bill Text: CA AB1299 | 2015-2016 | Regular Session | Chaptered


Bill Title: Medi-Cal: specialty mental health services: foster children.

Spectrum: Bipartisan Bill

Status: (Passed) 2016-09-25 - Chaptered by Secretary of State - Chapter 603, Statutes of 2016. [AB1299 Detail]

Download: California-2015-AB1299-Chaptered.html
BILL NUMBER: AB 1299	CHAPTERED
	BILL TEXT

	CHAPTER  603
	FILED WITH SECRETARY OF STATE  SEPTEMBER 25, 2016
	APPROVED BY GOVERNOR  SEPTEMBER 25, 2016
	PASSED THE SENATE  AUGUST 23, 2016
	PASSED THE ASSEMBLY  AUGUST 29, 2016
	AMENDED IN SENATE  AUGUST 18, 2016
	AMENDED IN SENATE  AUGUST 1, 2016
	AMENDED IN SENATE  JULY 16, 2015
	AMENDED IN ASSEMBLY  APRIL 21, 2015

INTRODUCED BY   Assembly Member Ridley-Thomas
   (Coauthor: Assembly Member Cristina Garcia)
   (Coauthors: Senators Anderson, Hertzberg, and Huff)

                        FEBRUARY 27, 2015

   An act to amend Section 14714 of, and to add Section 14717.1 to,
the Welfare and Institutions Code, relating to Medi-Cal.


	LEGISLATIVE COUNSEL'S DIGEST


   AB 1299, Ridley-Thomas. Medi-Cal: specialty mental health
services: foster children.
   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 law provides that specialty
mental health services and Early and Periodic Screening, Diagnosis,
and Treatment (EPSDT) for any individual under 21 years of age are
covered under Medi-Cal, consistent with the requirements of federal
law. Federal law defines EPSDT to include screening services, vision
services, dental services, hearing services, and other necessary
services to correct or ameliorate defects and physical and mental
illnesses and conditions discovered by the screening services,
whether or not the services are covered under the state plan.
Existing law provides that specialty mental health services include
EPSDT services provided to eligible Medi-Cal beneficiaries under 21
years of age.
   Existing law requires each local mental health plan to establish a
procedure to ensure access to outpatient specialty mental health
services, as required by the EPSDT program standards, for children in
foster care who have been placed outside their county of
adjudication. Existing law includes standardized contracts,
procedures, documents, and forms, to facilitate the receipt of
medically necessary specialty mental health services by a foster
child who is placed outside his or her county of original
jurisdiction.
   This bill would declare the intent of the Legislature to ensure
that foster children who are placed outside of their county of
original jurisdiction, are able to access mental health services in a
timely manner consistent with their individualized strengths and
needs and the requirements of EPSDT program standards and
requirements. The bill would require the department to issue policy
guidance that establishes the conditions for and exceptions to
presumptive transfer of responsibility for providing or arranging for
mental health services to a foster child from the county of original
jurisdiction to the county in which the foster child resides, as
prescribed. The bill would define presumptive transfer for these
purposes. The bill would authorize any interested party who owes a
legal duty to the child involving the child's health or welfare to
seek a waiver of presumptive transfer and would provide that the
county probation agency or child welfare services agency with
responsibility for the care and placement of the child is responsible
for determining whether presumptive transfer is appropriate under
specified conditions, including when a determination is made that the
transfer of mental health services would disrupt continuity of care
or timely access to services, as specified. The bill would require
the mental health plan in the host county to assume responsibility
for the authorization and provision of mental health services, and
payments for services, upon the presumptive transfer. By increasing
the responsibilities of county probation agencies or child welfare
services agencies with respect to determining whether presumptive
transfer is appropriate, the bill would impose a state-mandated local
program.
   This bill would require the department to seek approval from the
United States Department of Health and Human Services, federal
Centers for Medicare and Medicaid Services (CMS) prior to
implementing these provisions if the department determines that
approval is necessary. The bill would authorize the department and
the State Department of Social Services to adopt regulations to
implement these provisions by July 1, 2019, as specified.
   The California Constitution requires the state to reimburse local
agencies and school districts for certain costs mandated by the
state. Statutory provisions establish procedures for making that
reimbursement.
   This bill would provide that, if the Commission on State Mandates
determines that the bill contains costs mandated by the state,
reimbursement for those costs shall be made pursuant to these
statutory provisions.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

  SECTION 1.  Section 14714 of the Welfare and Institutions Code is
amended to read:
   14714.  (a) (1) Except as otherwise specified in this chapter, a
contract entered into pursuant to this chapter shall include a
provision that the mental health plan contractor shall bear the
financial risk for the cost of providing medically necessary
specialty mental health services to Medi-Cal beneficiaries.
   (2) If the mental health plan is not administered by a county, the
mental health plan shall not transfer the obligation for any
specialty mental health services to Medi-Cal beneficiaries to the
county. The mental health plan may purchase services from the county.
The mental health plan shall establish mutually agreed-upon
protocols with the county that clearly establish conditions under
which beneficiaries may obtain non-Medi-Cal reimbursable services
from the county. Additionally, the plan shall establish mutually
agreed-upon protocols with the county for the conditions of transfer
of beneficiaries who have lost Medi-Cal eligibility to the county for
care under Part 2 (commencing with Section 5600), Part 3 (commencing
with Section 5800), and Part 4 (commencing with Section 5850) of
Division 5.
   (3) The mental health plan shall be financially responsible for
ensuring access and a minimum required scope of benefits and
services, consistent with state and federal requirements, to Medi-Cal
beneficiaries who are residents of that county regardless of where
the beneficiary resides, except as provided for in Section 14717.1.
The department shall require that the same definition of medical
necessity be used, and the minimum scope of benefits offered by each
mental health plan be the same, except to the extent that prior
federal approval is received and is consistent with state and federal
laws.
   (b) (1) Any contract entered into pursuant to this chapter may be
renewed if the mental health plan continues to meet the requirements
of this chapter, regulations promulgated pursuant to this chapter,
and the terms and conditions of the contract. Failure to meet these
requirements shall be cause for nonrenewal of the contract. The
department may base the decision to renew on timely completion of a
mutually agreed-upon plan of correction of any deficiencies,
submissions of required information in a timely manner, or other
conditions of the contract.
   (2) In the event the contract is not renewed based on the reasons
specified in paragraph (1), the department shall notify the
Department of Finance, the fiscal and policy committees of the
Legislature, and the Controller of the amounts to be sequestered from
the Mental Health Subaccount, the Mental Health Equity Account, and
the Vehicle License Fee Collection Account of the Local Revenue Fund
and the Mental Health Account and the Behavioral Health Subaccount of
the Local Revenue Fund 2011, and the Controller shall sequester
those funds in the Behavioral Health Subaccount pursuant to Section
30027.10 of the Government Code. Upon this sequestration, the
department shall use the funds in accordance with the provisions of
Section 30027.10 of the Government Code.
   (c) (1) The obligations of the mental health plan shall be changed
only by contract or contract amendment.
   (2) Notwithstanding paragraph (1), the mental health plan shall
comply with federal and state requirements, including the applicable
sections of the state plan and waiver.
   (3) A change may be made during a contract term or at the time of
contract renewal, when there is a change in obligations required by
federal or state law or when required by a change in the
interpretation or implementation of any law or regulation.
   (4) To the extent permitted by federal law, either the department
or the mental health plan may request that contract negotiations be
reopened during the course of a contract due to substantial changes
in the cost of covered benefits that result from an unanticipated
event.
   (d) The department shall immediately terminate a contract when the
director finds that there is an immediate threat to the health and
safety of Medi-Cal beneficiaries. Termination of the contract for
other reasons shall be subject to reasonable notice of the department'
s intent to take that action and notification to affected
beneficiaries. The plan may request a hearing by the Office of
Administrative Hearings and Appeals.
   (e) A mental health plan may terminate its contract in accordance
with the provisions in the contract. The mental health plan shall
provide written notice to the department at least 180 days prior to
the termination or nonrenewal of the contract.
   (f) Upon the request of the director, the Director of the
Department of Managed Health Care may exempt a mental health plan
from the Knox-Keene Health Care Service Plan Act of 1975 (Chapter 2.2
(commencing with Section 1340) of Division 2 of the Health and
Safety Code). These exemptions may be subject to conditions the
director deems appropriate. Nothing in this chapter shall be
construed to impair or diminish the authority of the Director of the
Department of Managed Health Care under the Knox-Keene Health Care
Service Plan Act of 1975, nor shall anything in this chapter be
construed to reduce or otherwise limit the obligation of a mental
health plan contractor licensed as a health care service plan to
comply with the requirements of the Knox-Keene Health Care Service
Plan Act of 1975, and the rules of the Director of the Department of
Managed Health Care promulgated under the Knox-Keene Health Care
Service Plan Act of 1975. The director, in consultation with the
Director of the Department of Managed Health Care, shall analyze the
appropriateness of licensure or application of applicable standards
of the Knox-Keene Health Care Service Plan Act of 1975.
   (g) The department shall provide oversight to the mental health
plans to ensure quality, access, cost efficiency, and compliance with
data and reporting requirements. At a minimum, the department shall,
through a method independent of any agency of the mental health plan
contractor, monitor the level and quality of services provided,
expenditures pursuant to the contract, and conformity with federal
and state law.
   (h) County employees implementing or administering a mental health
plan act in a discretionary capacity when they determine whether or
not to admit a person for care or to provide any level of care
pursuant to this chapter.
   (i) If a county discontinues operations as the mental health plan,
the department shall approve any new mental health plan. The new
mental health plan shall give reasonable consideration to affiliation
with nonprofit community mental health agencies that were under
contract with the county and that meet the mental health plan's
quality and cost efficiency standards.
   (j) Nothing in this chapter shall be construed to modify, alter,
or increase the obligations of counties as otherwise limited and
defined in Chapter 3 (commencing with Section 5700) of Part 2 of
Division 5. The county's maximum obligation for services to persons
not eligible for Medi-Cal shall be no more than the amount of funds
remaining in the mental health subaccount pursuant to Sections 17600,
17601, 17604, 17605, and 17609 after fulfilling the Medi-Cal
contract obligations.
  SEC. 2.  Section 14717.1 is added to the Welfare and Institutions
Code, to read:
   14717.1.  (a) (1) It is the intent of the Legislature to ensure
that foster children who are placed outside of their county of
original jurisdiction are able to access specialty mental health
services in a timely manner, consistent with their individual
strengths and needs and the requirements of federal Early and
Periodic Screening, Diagnosis, and Treatment (EPSDT) services.
   (2) It is the further intent of the Legislature to overcome any
barriers to care that may result when responsibility for providing or
arranging for specialty mental health services to foster children
who are placed outside of their county of original jurisdiction is
retained by the county of original jurisdiction.
   (b) In order to facilitate the receipt of medically necessary
specialty mental health services by a foster child who is placed
outside of his or her county of original jurisdiction, the California
Health and Human Services Agency shall coordinate with the
department and the State Department of Social Services to take all of
the following actions on or before July 1, 2017:
   (1) The department shall issue policy guidance concerning the
conditions for and exceptions to presumptive transfer, as described
in subdivisions (c) and (d), in consultation with the State
Department of Social Services and with the input of stakeholders that
include the County Welfare Directors Association of California, the
Chief Probation Officers of California, the County Behavioral Health
Directors Association of California, provider representatives, and
family and youth advocates.
   (2) Policy guidance concerning the conditions for and exceptions
to presumptive transfer shall ensure that:
   (A) The transfer of responsibility improves access to specialty
mental health care services consistent with the mental health needs
of the foster youth.
   (B) Presumptive transfer does not disrupt the continuity of care.
   (C) Conditions and exceptions are applied consistently statewide
giving due consideration to the varying capabilities of small,
medium, and large counties.
   (D) Presumptive transfer can be waived only with an individualized
determination that an exception applies.
   (E) A party to the case who disagrees with the presumptive
transfer individualized exception determination made by the county
placing agency pursuant to subdivision (d) is afforded an opportunity
to request judicial review prior to a transfer or exception being
finalized.
   (F) There is a procedure for expedited transfer within 48 hours of
placement of the child outside of the county of original
jurisdiction.
   (c) "Presumptive transfer," for the purposes of this section,
means that absent any exceptions as established pursuant to this
section, responsibility for providing or arranging for specialty
mental health services shall promptly transfer from the county of
original jurisdiction to the county in which the foster child
resides, under either of the following conditions:
   (1) A foster child is placed in a county other than the county of
original jurisdiction on or after July 1, 2017.
   (2) A foster youth who resides in a county other than the county
of original jurisdiction after June 30, 2017, and is not receiving
specialty mental health services consistent with his or her mental
health needs, requests transfer of responsibility. A foster child who
resided in a county other than the county of original jurisdiction
after June 30, 2017, and who continues to reside outside the county
of original jurisdiction after December 31, 2017, shall have
jurisdiction transferred no later than the child's first regularly
scheduled status review hearing conducted pursuant to Section 366 in
the 2018 calendar year unless an exception described under
subdivision (d) applies.
   (d) (1) On a case-by-case basis, and when consistent with the
medical rights of children in foster care, presumptive transfer may
be waived and the responsibility for the provision of specialty
mental health services shall remain with the county of original
jurisdiction if any of the exceptions described in paragraph (5)
exist.
   (2) A request for waiver in a manner established by the department
may be made by the foster child, the person or agency that is
responsible for making mental health care decisions on behalf of the
foster child, the county probation agency or the child welfare
services agency with responsibility for the care and placement of the
child, or any other interested party who owes a legal duty to the
child involving the child's health or welfare, as defined by the
department.
   (3) The county probation agency or the child welfare services
agency with responsibility for the care and placement of the child,
in consultation with the child and his or her parent, the child and
family team if one exists, and other professionals who serve the
child as appropriate, is responsible for determining whether waiver
of the presumptive transfer is appropriate pursuant to the conditions
and exceptions established under this section. The person who
requested the exception, along with any other parties to the case,
shall receive notice of the county agency's determination.
   (4) The individual who requested the exception or any other party
to the case who disagrees with the determination made by the county
agency pursuant to paragraph (3) may request judicial review prior to
the county's determination becoming final. The court may set the
matter for hearing and may confirm or deny the transfer of
jurisdiction or application of an exception based on the best
interest of the child.
   (5) Presumptive transfer may be waived under any of the following
exceptions:
   (A) It is determined that the transfer would disrupt continuity of
care or delay access to services provided to the foster child.
   (B) It is determined that the transfer would interfere with family
reunification efforts documented in the individual case plan.
   (C) The foster child's placement in a county other than the county
of original jurisdiction is expected to last less than six months.
   (D) The foster child's residence is within 30 minutes of travel
time to his or her established specialty mental health care provider
in the county of original jurisdiction.
   (6) A waiver processed based on an exception to presumptive
transfer shall be contingent upon the mental health plan in the
county of original jurisdiction demonstrating an existing contract
with a specialty mental health care provider, or the ability to enter
into a contract within 30 days of the waiver decision, and the
ability to deliver timely specialty mental health services directly
to the foster child. That information shall be documented in the
child's case plan.
   (7) A request for waiver, the exceptions claimed as the basis for
the request, a determination whether a waiver is determined to be
appropriate under this section, and any objections to the
determination shall be documented in the foster child's case plan
pursuant to Section 16501.1.
   (e) If the mental health plan in the county of original
jurisdiction has completed an assessment of needed services for the
foster child, the mental health plan in the county in which the
foster child resides shall accept that assessment. The mental health
plan in the county in which the foster child resides may conduct
additional assessments if the foster child's needs change or an
updated assessment is needed to determine the child's needs and
identify the needed treatment and services to address those needs.
   (f) Upon presumptive transfer, the mental health plan in the
county in which the foster child resides shall assume responsibility
for the authorization and provision of specialty mental health
services and payments for services. The foster child transferred to
the mental health plan in the county in which the foster child
resides shall be considered part of the county of residence caseload
for claiming purposes from the Behavioral Health Subaccount and the
Behavioral Health Services Growth Special Account, both created
pursuant to Section 30025 of the Government Code.
   (g) The State Department of Social Services and the State
Department of Health Care Services shall adopt regulations by July 1,
2019, to implement this section. Notwithstanding the rulemaking
provisions of the Administrative Procedure Act (Chapter 3.5
(commencing with Section 11340) of Part 1 of Division 3 of Title 2 of
the Government Code), the State Department of Social Services and
the State Department of Health Care Services may implement and
administer the changes made by this legislation through all-county
letters, information notices, or similar written instructions until
regulations are adopted.
   (h) If the department determines it is necessary, it shall seek
approval from the United States Department of Health and Human
Services, federal Centers for Medicare and Medicaid Services (CMS)
prior to implementing this section.
   (i) If the department makes the determination that it is necessary
to seek CMS approval pursuant to subdivision (h), the department
shall make an official request for approval from CMS no later than
January 1, 2017.
   (j) This section shall be implemented only if and to the extent
that federal financial participation under Title XIX of the federal
Social Security Act (42 U.S.C. Sec. 1396, et seq.) is available and
all necessary federal approvals have been obtained.
  SEC. 3.  If the Commission on State Mandates determines that this
act contains costs mandated by the state, reimbursement to local
agencies and school districts for those costs shall be made pursuant
to Part 7 (commencing with Section 17500) of Division 4 of Title 2 of
the Government Code.      
feedback