Bill Text: CA AB1576 | 2015-2016 | Regular Session | Amended
Bill Title: Mental Health Delivery Demonstration Project: Early
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Failed) 2016-11-30 - From committee without further action. [AB1576 Detail]
Download: California-2015-AB1576-Amended.html
BILL NUMBER: AB 1576 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY MARCH 18, 2016
INTRODUCED BY Assembly Member Eggman
JANUARY 4, 2016
An act to add and repeal Section 1367.020 of the Health and
Safety Code, relating to pupil mental
health.
LEGISLATIVE COUNSEL'S DIGEST
AB 1576, as amended, Eggman. Pupil health: school-based
mental health services. Mental Health Delivery
Demonstration Project: Early Diagnosis and Psychosis Treatment
Program.
Existing law, the Knox-Keene Health Care Service Plan Act of 1975,
provides for the licensure and regulation of health care service
plans by the Department of Managed Health Care. Existing law requires
health care service plans to meet specified criteria. Existing law
makes a willful violation of that act a crime.
This bill would, commencing July 1, 2017, authorize health care
service plans that offer health care services within the greater
Sacramento area to require enrollees seeking services for a mental
health condition to participate in a Mental Health Delivery
Demonstration Project through an Early Diagnosis and Psychosis
Treatment (EDAPT) program, as defined. The bill would require plans
that choose to participate to develop clinical guidelines for
enrollees and to make those guidelines available as part of their
evidence of coverage and to primary care providers and specialty
mental health providers in their contracted network. The bill would
allow an enrollee to opt out of the EDAPT program if a psychiatrist
notifies the plan that the enrollee is under his or her care. These
provisions would be repealed on January 1, 2020. Because a willful
violation of these provisions would be a crime, this bill would
impose a state-mandated local program.
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 no reimbursement is required by this
act for a specified reason.
Existing law establishes a system of public elementary and
secondary schools in this state, and provides for the establishment
of school districts and other local educational agencies to operate
these schools and provide instruction to pupils.
This bill would declare the intent of the Legislature to enact
future legislation that would utilize school-based mental health
services to address the mental health needs of children in the state.
Vote: majority. Appropriation: no. Fiscal committee: no
yes . State-mandated local program: no
yes .
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. (a) The
Legislature finds and declares all of the following:
(1) Despite the importance of and emphasis on mental health
parity, management of mental illness within a system of care is far
more difficult than most types of physical illness. There are
significant differences between the delivery systems for the Medi-Cal
population and the delivery systems for those covered by private
insurance, and there are unique problems associated with each system.
While changes are needed in both, there is an immediate need to look
for ways to better serve the insured population.
(2) The limited number of providers, the lack of facilities for
treatment, and the difficulties of arranging for and coordinating
ancillary services have made it extremely difficult for health
insurers to meet the needs of enrollees facing significant mental
health issues.
(3) Attempts to develop truly accessible provider networks that
can link with the array of administrative and ancillary services that
the mentally ill need to manage their disease and to improve will
take an investment of time and resources.
(4) Systems of care known as Early Diagnosis and Psychosis
Treatment (EDAPT) programs may hold the key to these problems. These
integrated systems of care provide early intervention, assessment,
diagnosis, a treatment plan, and the services necessary to implement
that plan. EDAPT programs have interdisciplinary teams of physicians,
clinicians, advocates, and staff that coordinate care on an
outpatient basis.
(5) EDAPT programs do not yet exist in sufficient number to allow
them to meet the provider network requirements health insurers must
meet. While it is possible under existing law for health insurers to
contract with existing EDAPT programs, there are a number of
regulatory and practical issues that stand in the way of directing
patients to them so that the patients' conditions can be effectively
managed. If insurers could designate an EDAPT program as an exclusive
provider for their enrollees, an assessment can be made of the
overall efficacy of the model.
(b) Therefore, it is the intent of the Legislature to establish a
demonstration project or projects in geographic areas of the state
where EDAPT programs exist to allow health insurers to opt in to
utilizing the EDAPT programs as exclusive provider networks for the
insurers' enrollees in need of these services.
SEC. 2. Section 1367.020 is added to the
Health and Safety Code , to read:
1367.020. (a) Notwithstanding any other law, commencing July 1,
2017, a health care service plan that offers health care services on
an individual or group basis in the greater Sacramento area may
require enrollees seeking services for a mental health condition to
participate in a Mental Health Delivery Demonstration Project through
an Early Diagnosis and Psychosis Treatment Program.
(b) If a plan chooses to require its enrollees to participate in
the project, it shall develop clinical guidelines for those enrollees
and make those guidelines available as part of its evidence of
coverage. The plan shall also make those guidelines available to all
primary care providers and specialty mental health providers in its
contracted network.
(c) An enrollee directed to a Mental Health Delivery Demonstration
Project site for services shall be able to opt out of those services
if a psychiatrist notifies the plan that the enrollee is under his
or her care.
(d) For purposes of this section, "Early Diagnosis and Psychosis
Treatment Program" means a mental health service program that
provides early intervention, diagnosis, treatment, and necessary
support through interdisciplinary teams of physicians, mental health
professionals, social workers, and advocates on an outpatient basis
and through a single point of entry.
(e) This section shall remain in effect only until January 1,
2020, and as of that date is repealed, unless a later enacted
statute, that is enacted before January 1, 2020, deletes or extends
that date.
SEC. 3. No reimbursement is required by this act
pursuant to Section 6 of Article XIII B of the California
Constitution because the only costs that may be incurred by a local
agency or school district will be incurred because this act creates a
new crime or infraction, eliminates a crime or infraction, or
changes the penalty for a crime or infraction, within the meaning of
Section 17556 of the Government Code, or changes the definition of a
crime within the meaning of Section 6 of Article XIII B of the
California Constitution.
SECTION 1. (a) The Legislature finds and
declares both of the following:
(1) California supplies only one social worker for every 12,000
pupils.
(2) Seventy percent of children in California with mental health
needs receive no treatment.
(b) It is therefore the intent of the Legislature to enact future
legislation that would utilize school-based mental health services to
address this need.
