Bill Text: CA SB296 | 2015-2016 | Regular Session | Amended
Bill Title: Medi-Cal: specialty mental health services: documentation requirements.
Spectrum: Partisan Bill (Republican 1-0)
Status: (Engrossed - Dead) 2016-11-30 - Died on the inactive file. [SB296 Detail]
Download: California-2015-SB296-Amended.html
BILL NUMBER: SB 296 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY AUGUST 28, 2015
AMENDED IN ASSEMBLY JULY 2, 2015
AMENDED IN SENATE APRIL 20, 2015
AMENDED IN SENATE APRIL 7, 2015
INTRODUCED BY Senator Cannella
FEBRUARY 23, 2015
An act to add Section 14728 to the Welfare and Institutions Code,
relating to Medi-Cal.
LEGISLATIVE COUNSEL'S DIGEST
SB 296, as amended, Cannella. Medi-Cal: specialty mental health
services: documentation requirements.
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 specialty mental health services. The Medi-Cal program is,
in part, governed and funded by federal Medicaid Program provisions.
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, existing law
requires the department to create a standardized set of documentation
standards and forms. The department is responsible
for conducting investigations and audits of claims and reimbursements
for expenditures for specialty mental health services
provided by mental health plans to Medi-Cal eligible individuals.
This bill would require the department, in consultation with
specified stakeholders, to develop a single set of service billing
documentation requirements for the provision of specialty mental
health services by January 1, 2017, for use commencing July 1, 2017,
and would require the department to update the billing documentation
requirements no less than every 2 years. The bill would generally
prohibit counties from requiring additional billing documentation
requirements for Medi-Cal specialty mental health services that go
beyond the billing documentation requirements developed by the
department.
This bill would limit the scope of the service billing
documentation requirements the department may apply when conducting
an audit of Medi-Cal specialty mental health services to criteria
that is clearly and explicitly set forth in specified state
regulations, letters, and directives, federal Medicaid terms and
conditions, and the Medicaid state plan. The bill would require the
department to allow counties and county contract providers of
behavioral health services to incorporate by reference any
information in a patient's existing case record in subsequent
documentation and would prohibit the department from requiring any
unchanged information in a patient's existing case record to be
copied or reentered into specified treatment documents, unless
required by a federal directive. The bill would require the
department to consider further revisions to its service billing
documentation requirements, and to prepare, in consultation with
counties, providers, and other stakeholders, and submit to the
Legislature, a proposal to accomplish those objectives, as specified.
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. The Legislature finds and declares all of the
following:
(a) Counties and private providers that contract for service
delivery estimate that over 40 cents out of every dollar spent on
Medi-Cal mental health services goes to paperwork to document that
the services meet federal billing standards and to avoid potential
state audit disallowances.
(b) A national expert reviewed what counties in California were
requiring of providers and noted that it took 20 minutes of
documentation to prepare progress notes for a single session of
psychotherapy, as compared to an estimated five minutes in other
states.
(c) State guidelines on billing are not significantly different
from the requirements of other states, however, counties have added
other documentation requirements based on the fear that
interpretations of the guidelines during audits may result in some
services being disallowed if the additional documentation is not
included.
(d) In order to eliminate this pattern, it is necessary for the
State Department of Health Care Services to develop a single
set of simplify and clarify documentation
requirements, in consultation with counties and providers,
that limits and limit audit disallowances to
circumstances clearly spelled out in the requirements.
advance.
SEC. 2. Section 14728 is added to the Welfare and Institutions
Code, to read:
14728. (a) The When conducting an audit
pursuant to this chapter, the State Department of Health Care
Services shall consult with counties, providers, and other
stakeholders to develop a single set of service billing documentation
requirements for the provision of specialty mental health services.
limit the scope of any service billing documentation
requirements it applies, to criteria that is clearly and explicitly
set forth in any of the following:
(1) Regulations, interpretive letters, and compliance directives
sent by the department to counties in a previous fiscal year.
(2) Federal terms and conditions of the Medicaid Program.
(3) The Medicaid state plan.
(b) The billing documentation requirements developed pursuant to
this section shall do both of the following:
(1) Minimize time and paperwork required of counties and
providers, consistent with federal standards.
(2) Eliminate duplicative or outdated requirements.
(c) The billing documentation requirements shall be completed by
January 1, 2017, for use commencing on July 1, 2017, and shall
thereafter be updated no less than every two years through a
stakeholder process, unless changes in the Medicaid state plan or
other federal rules require that the billing requirements be updated
more often.
(d) After adoption of the standard billing requirements by the
department, a county may not require additional billing documentation
for Medi-Cal specialty mental health services that go beyond these
requirements unless necessary for funding from other funding sources
that are also used to pay for the services, or for purposes other
than documentation for billing.
(b) An audit requirement relating to service billing documentation
that is not in compliance with subdivision (a) shall be considered
an advisory finding only, for which no disallowance may be made,
unless and until the department modifies its regulations to make the
audit requirement explicit, or provides an interpretive letter or
other written clarification to counties that clearly prescribes the
requirement, consistent with subdivision (a).
(c) The department shall not require a county or county contract
provider of behavioral health services to copy or reenter any
unchanged information from a patient's existing case record into any
subsequent progress note, assessment, or treatment plan for that
patient, unless explicitly required by a federal directive. A
regulation, interpretive letter, compliance directive, or audit
requirement of the department relating to service billing
documentation shall allow counties and county contract providers,
when documenting a patient's treatment, to incorporate by reference
any information from the patient's entire case record, including, but
not limited to, assessments, treatment plans, evaluations, and
progress notes.
(d) (1) The department shall consider further revisions to its
service billing documentation requirements, to accomplish both of the
following objectives:
(A) Minimize the time and paperwork required of counties and
providers, consistent with federal standards.
(B) Eliminate duplicative or obsolete requirements.
(2) (A) The department shall submit a proposal to the Legislature
to accomplish the objectives described in paragraph (1). The proposal
shall be submitted in the same fiscal year in which the department
submits to the federal Centers for Medicare and Medicaid Services its
proposal to revise the billing method for mental health services
from the current practice of billing by the minute to a system that
provides for greater documentation streamlining, including, but not
limited to, a capitated system.
(B) In preparing the proposal developed pursuant to this
paragraph, the department shall consult with counties, providers, and
other stakeholders.
(C) A proposal submitted to the Legislature pursuant to this
paragraph shall be submitted in compliance with Section 9795 of the
Government Code.
