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

California Assembly Bill 1299 (Prior Session Legislation)

NOTE: There are more recent revisions of this legislation. Read Latest Draft
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-Amended.html
BILL NUMBER: AB 1299	AMENDED
	BILL TEXT

	AMENDED IN SENATE  JULY 16, 2015
	AMENDED IN ASSEMBLY  APRIL 21, 2015

INTRODUCED BY   Assembly Member Ridley-Thomas

                        FEBRUARY 27, 2015

   An act to  amend Section 14714 of, and to  add Article 6
(commencing with Section 14695.1) to Chapter 8.8 of Part 3 of
Division 9  of   of,  the Welfare and
Institutions Code, relating to Medi-Cal.



	LEGISLATIVE COUNSEL'S DIGEST


   AB 1299, as amended, 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 Early and
Periodic Screening, Diagnosis, and Treatment (EPSDT) for any
individual under 21 years of age is covered under Medi-Cal,
consistent with the requirements of federal law. Federal law defines
EPSDT mental health services 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. EPSDT
is classified under the Medi-Cal program as a specialty mental health
service.
   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 foster youth from the county
of original jurisdiction to the  county in which the  foster
 child's county of residence,   child resides,
 as prescribed. The bill would define presumptive transfer for
these purposes.  The bill would authorize the person or agency
that is responsible for making health care decisions on behalf of the
foster child to waive the presumptive   transfer if
specified conditions occur, 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.
The bill would require the department, no later than July 1, 2016, to
amend its contract with each mental health plan to ensure that the
mental health plan in the host county is reimbursed for mental health
services provided within the fiscal year in which services are
provided. 
   This bill  would require the Department of Finance, by May
1,2016, to set or adjust its allocation schedule of the Behavioral
Health Subaccount pursuant to realignment provisions enacted pursuant
to a specified measure, in order that counties that have paid, or
will pay, for the specialty mental health services provided pursuant
to the bill, are fully reimbursed during the fiscal year in which the
services were provided. This bill  would require the
department to determine whether it is necessary to seek approval
under the state's Section 1915(b) Medicaid waiver from the federal
Centers for Medicare and Medicaid Services (CMS) prior to
implementing the bill, and if so, to do everything within its power
necessary to secure an expeditious approval.
   Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.


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

  SECTION 1.  Article 6 (commencing with Section 14695.1) is added to
Chapter 8.8 of Part 3 of Division 9 of the Welfare and Institutions
Code, to read:

      Article 6.  Specialty Mental Health Services for Foster
Children


   14695.1.  (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 mental health services in a
timely manner, consistent with their individualized strengths and
needs and the requirements of Early Periodic Screening Diagnosis and
Treatment (EPSDT) program standards and requirements.
   (2) It is the further intent of the Legislature to overcome the
barriers to care that exist under existing law, which place
responsibility for providing or arranging for mental health services
to foster children who are placed outside of their county of original
jurisdiction, on those same counties.
   (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:
   (1) On or before July 1, 2016, all of the following shall occur:
   (A) The department shall issue policy guidance, pursuant to
Section 14716, that establishes the  conditions for and
exceptions to, as described in subdivision (d),  presumptive
transfer of responsibility for providing or arranging for mental
health services to foster youth, consistent with the requirements of
EPSDT program standards and requirements, from the county of original
jurisdiction to the  county in which the  foster 
child's county of residence.   child resides. 
   (B) The department shall establish the  conditions and
exceptions   policy guidance  to presumptive
transfer  and exceptions  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 County Behavioral Health Directors Association of California,
provider representatives, and family and youth advocates. The
conditions and exceptions to presumptive transfer are intended to
ensure that the transfer of responsibility improves access to mental
health care services and does not impede the continuity of existing
care.
   (C) The department shall establish the procedures for implementing
presumptive transfer that are consistent with the purposes and
intent of this section and Early Periodic Screening Diagnosis and
Treatment program standards and requirements, and shall include a
procedure for expedited transfer within 48 hours.
   (c) "Presumptive transfer" for the purposes of this section, means
that absent any conditions or exceptions as established pursuant to
this article, responsibility for providing or arranging for mental
health services shall immediately transfer from the county of
original jurisdiction to the  county of residence, when all
of the following conditions occur:   county in which the
foster child resides, under any of the following conditions: 
   (1) A foster child is placed in a county other than the county of
original jurisdiction. 
   (2) The transfer of responsibility is requested by the county
child welfare services agency, county probation department, foster
caregiver, or any other person authorized to make medical decisions
on behalf of the foster child.  
   (2) A foster child who resides in a county other than the county
of original jurisdiction is not receiving mental health services
consistent with his or her treatment plan and the child's caregiver
who is responsible for making health care decisions on behalf of the
foster child, in consultation with the county probation or county
child welfare services agency with responsibility for the care and
placement of the child, or the Child and Family Team, if one exists,
requests transfer of responsibility under this article.  
   (d) Consistent with the conditions and exceptions to presumptive
transfer established under this article, the person or agency that is
responsible for making health care decisions on behalf of the foster
child, in consultation with the Child and Family Team, if one
exists, may waive the presumptive transfer, in which case the
responsibility for the provision of mental health services shall
remain with the county of original jurisdiction.  
   (1) (A) On a case-by-case basis, the presumptive transfer may be
waived and the responsibility for the provision of mental health
services shall remain with the county of original jurisdiction if any
of the following conditions described in this paragraph occur. These
exceptions to presumptive transfer may include, but are not limited
to, any of the following:  
   (i) It is determined that the transfer of services would disrupt
continuity of care or timely access to services provided to the
foster child, as described in paragraph (2).  
   (ii) It is determined that the transfer of services would
interfere with family reunification efforts.  
   (iii) The foster child's placement in a county other than the
county of original jurisdiction is expected to last less than nine
months.  
   (B) These exceptions shall be documented in the foster child's
case plan pursuant to Section 16501.1.  
   (2) Exceptions to the presumptive transfer shall be contingent
upon the mental health plan in the county of original jurisdiction
demonstrating an existing contract with a foster care provider, or
the ability to enter into a contract within 30 days of the exception
decision, and the ability to deliver timely services directly to the
foster child. This shall be documented in the child's case plan.
 
   (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 host county shall accept
that assessment. The mental health plan in the host county may
conduct additional assessments if the foster child's needs change.
 
   (f) Upon presumptive transfer, the mental health plan in the host
county shall assume responsibility for the authorization and
provision of mental health services, and payments for services. 

   (g) The department, in consultation with counties and through any
administrative means within existing authority, shall amend its
contract with each mental health plan no later than July 1, 2016, to
ensure that a mental health plan in a host county is reimbursed for
services provided pursuant to this article during the fiscal year in
which the services are provided.  
   14695.2.  By May 1, 2016, the Department of Finance shall set or
adjust its allocation schedule of the Behavioral Health Subaccount
pursuant to the requirements of Senate Bill 1020 (Chapter 40,
Statutes of 2012), in order that counties that have paid, or will
pay, for specialty mental health services for foster children placed
out of county pursuant to this article, are fully reimbursed during
the fiscal year in which the services are provided. 
    14695.3.   14695.2.   (a) If the
department determines it is necessary, it shall seek approval under
the state's Section 1915(b) Medicaid waiver from the United States
Department of Health and Human Services, Centers for Medicare and
Medicaid Services (CMS) prior to implementing this article.
   (b) If the department makes the determination that it is necessary
to seek CMS approval pursuant to subdivision (a), the department
shall make an official request for approval from CMS no later than
July 1, 2016, and shall do everything within its power necessary to
secure an expeditious approval from CMS.
   (c) The department shall not be required to implement any
provision of this article that CMS determines is not permitted under
the state's waiver.
   SEC. 2.    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.   resides, except as
provided for in, and consistent with, Section 14695.1.  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 thereto, 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 thereunder. 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.