Bill Text: CA AB1299 | 2015-2016 | Regular Session | Amended
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 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 AUGUST 1, 2016
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, Section 14717.5 to, 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
specialty mental health services and Early and Periodic
Screening, Diagnosis, and Treatment (EPSDT) for any individual under
21 years of age is are 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. 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 foster youth 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 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
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 t hat 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.
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. 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 as state-mandated
local program.
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. 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 ap proval 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.
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no yes .
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 resides.
(B) The department shall establish the 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 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) 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. (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 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, and
consistent with, Section 14695.1. in Section 14717.5.
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,
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 thereunder.
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 14717.5 is added to the
Welfare and Institutions Code , to read:
14717.5. (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.
