Bill Text: CA SB1466 | 2015-2016 | Regular Session | Amended

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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Bill Title: Early and Periodic Screening, Diagnosis, and Treatment

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Vetoed) 2016-11-30 - Last day to consider Governor's veto pursuant to Joint Rule 58.5. [SB1466 Detail]

Download: California-2015-SB1466-Amended.html

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BILL NUMBER: SB 1466	AMENDED
	BILL TEXT

	AMENDED IN SENATE  MARCH 28, 2016

INTRODUCED BY   Senator Mitchell

                        FEBRUARY 19, 2016

   An act to add Section  14059.6   14132.19
 to the Welfare and Institutions Code, relating to Medi-Cal.


	LEGISLATIVE COUNSEL'S DIGEST


   SB 1466, as amended, Mitchell.  Mental health benefits:
children: medical necessity.   Early and Periodic
Screening, Diagnosis, and Treatment Program: trauma screening. 

   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,
including early and periodic screening, diagnosis, and treatment for
any individual under 21 years of age who is covered under Medi-Cal
consistent with the requirements under federal law. The Medi-Cal
program is, in part, governed and funded by federal Medicaid Program
provisions.  
   Existing federal law provides that EPSDT services include periodic
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. In addition to the required periodic screening
services, existing federal law provides that Medicaid-eligible
children are entitled to interperiodic screenings in order to
identity a suspected illness or condition not present or discovered
during the periodic exam.  
   The bill would require those screening services under the EPSDT
Program to include screening for trauma. The bill would provide that
child abuse and neglect or removal of the child from the parent or
legal guardian by a child welfare agency shall be prima facie
evidence of trauma for purposes of conducting a screening under the
EPSDT Program.  
   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 a service is
"medically necessary" or a "medical necessity," for purposes of these
provisions, when it is reasonable and necessary to protect life, to
prevent significant illness or significant disability, or to
alleviate severe pain.  
   This bill would require the department, in partnership with the
State Department of Social Services, to convene a stakeholder
workgroup to revise and update the existing definition of "medically
necessary" and "medical necessity" to be applied specifically with
respect to children, youth, and their families for purposes of access
to mental health services provided under the Early and Periodic
Screening, Diagnosis, and Treatment Program (EPSDT). The bill would
require the workgroup to convene by February 1, 2017, and to include
representatives of specified organizations, foster youth, and
legislative staff. The bill would set forth the information for the
department to consider when developing the definition, and would
require the department to adopt emergency regulations implementing
the revised definitions by October 1, 2017. This bill would require
the department to submit to the federal Centers for Medicare and
Medicaid Services any state plan amendments or waiver applications
necessary to implement those provisions. 
   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.    Section 14132.19 is added to the 
 Welfare and Institutions Code   , to read:  
   14132.19.  (a) Screening services provided under the Early and
Periodic Screening, Diagnosis, and Treatment (EPSDT) Program pursuant
to subdivision (v) of Section 14132 shall include screening for
trauma.
   (b) Child abuse and neglect or removal of the child from the
parent or legal guardian by a child welfare agency shall be prima
facie evidence of trauma for purposes of conducting a screening
consistent with this section under the EPSDT Program.  
  SECTION 1.    Section 14059.6 is added to the
Welfare and Institutions Code, to read:
   14059.6.  (a) The department, in partnership with the State
Department of Social Services, shall convene a stakeholder workgroup
to revise and update the definition of "medically necessary" and
"medical necessity," which would be applied specifically with respect
to children, youth, and their families for purposes of access to
mental health services provided under the Early and Periodic
Screening, Diagnosis, and Treatment Program (EPSDT). The workgroup
shall be convened no later than February 1, 2017.
   (b) Stakeholders shall include, but need not be limited to,
representatives of all of the following:
   (1) The California State Association of Counties.
   (2) The County Behavioral Health Directors Association of
California.
   (3) The County Welfare Directors Association of California.
   (4) The Chief Probation Officers of California.
   (5) Current or former foster youth.
   (6) Legislative staff.
   (7) Any other representatives determined appropriate by the
department and the State Department of Social Services.
   (c) In developing the definition, the workgroup shall consider all
of the following:
   (1) Acknowledgment that the current diagnosis system for children
and youth affected by trauma, including from abuse and neglect, does
not accurately identify those who need services to maintain
appropriate functioning in the community, nor prevent the onset of
mental health needs and is inconsistent with emerging research and
national practices in meeting the behavioral health needs of children
and youth.
   (2) Services should promote health, well-being, and independent
functioning of children and youth so that they may safely remain with
families, in their own communities, and avoid institutional care
whenever possible.
   (3) Services should be individualized to meet the child's or youth'
s needs, inclusive of the family or adult caregivers, regardless of
whether the services are described in the state plan.
   (4) The objective of these services should be to improve or
maintain the health of the child or youth in the best condition
possible, prevent conditions from worsening or interfering with the
child's or youth's capacity for normal activity, and improve or
maintain the overall health and well-being of the child or youth.
   (5) Both currently accepted standard clinical practices, as well
as emerging and promising practices, should be recognized to achieve
the desired outcomes, and support the delivery of those services in
community-based settings, without delay, upon the initial
identification of need. The service delivery system should allow for
a combination of licensed and paraprofessional staff, working in
collaborative partnerships.
   (d) The department shall adopt emergency regulations implementing
the definition developed pursuant to this section no later than
October 1, 2017. The department may readopt any emergency regulation
authorized by this section that is the same as, or substantially
equivalent to, any emergency regulation previously adopted pursuant
to this section. The initial adoption of regulations pursuant to this
section and one readoption of emergency regulations shall be deemed
to be an emergency and necessary for the immediate preservation of
the public peace, health, safety, or general welfare. Initial
emergency regulations and the one readoption of emergency regulations
authorized by this section shall be exempt from review by the Office
of Administrative Law. The initial emergency regulations and the one
readoption of emergency regulations authorized by this section shall
be submitted to the Office of Administrative Law for filing with the
Secretary of State and each shall remain in effect for no more than
180 days, by which time final regulations shall be adopted.
   (e) The department shall submit to the federal Centers for
Medicare and Medicaid Services any state plan amendments or waiver
applications necessary to implement this section.