AB 763

Version: Amended+Assembly
Author: Asm. Adam Gray (D-CA)



Introduced by Assembly Member Gray

February 19, 2019


An act to amend Section 14093.06 of Sections 14681 and 14683 of, and to add Section 14682.2 to, the Welfare and Institutions Code, relating to children's services. Medi-Cal.


LEGISLATIVE COUNSEL'S DIGEST


AB 763, as amended, Gray. Children's services. Medi-Cal specialty mental health services.
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 healthcare services. health care services, including specialty mental health services, and Early and Periodic Screening, Diagnosis, and Treatment services for an individual under 21 years of age. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Existing law requires the Director of Health Care Services to enter into contracts with managed care plans, including, among other entities, health maintenance organizations, prepaid health plans, and primary care case management plans for the provision of medical benefits to all persons who are eligible to receive medical benefits under publicly supported programs. Existing law requires, among other things, a managed care contractor serving children with conditions eligible under the California Children's Services Program to maintain and follow standards of care established by the program, including, among others, the use of paneled providers and CCS-approved special care centers. Existing law provides that specified information regarding appeals and fair hearings shall be part of an annual report to the Legislature on managed care contractor compliance, and the report shall be made available to the public. Under existing law, one of the methods by which Medi-Cal services are provided is pursuant to contracts with various types of managed care health plans, including mental health plans that provide specialty mental health services. Existing law requires the department to ensure that Medi-Cal managed care contracts include a process for screening, referral, and coordination with mental health plans of specialty mental health services. Existing law requires the department to convene a steering committee to provide advice on the transition and continuing development of the Medi-Cal mental health managed care systems, and to ensure that the mental health plans comply with various standards, such as maintaining a system of outreach to enable Medi-Cal beneficiaries and providers to participate in and access Medi-Cal specialty mental health services under the mental health plans.
This bill would require, on or before March 31, 2020, the department to convene a stakeholder workgroup, including representatives from the County Behavioral Health Directors Association of California, to develop standard forms to be used by Medi-Cal managed care contractors, including mental health plan contractors and contractor provider networks, for performing the intake of, the assessment of, and the treatment planning for, Medi-Cal beneficiaries who are eligible for specialty mental health services under the Early and Periodic Screening, Diagnosis, and Treatment Program. The bill would require the forms to be completed by January 1, 2021. The bill would require, on or before July 1, 2021, representatives from the department and the workgroup to provide regional trainings for mental health plans and their provider networks on the standard forms. The bill would require Medi-Cal managed care contractors to distribute the training material and standard forms to their provider networks, and, by July 1, 2021, to commence exclusively using the standard forms.

This bill would delete the requirement for an annual report, and would instead require the specified information regarding appeals and fair hearings to be updated monthly, and be made available to the public on the Whole Child Model program performance dashboard.

Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: NO  

The people of the State of California do enact as follows:


SECTION 1.

 Section 14681 of the Welfare and Institutions Code is amended to read:

14681.
 The department shall ensure that all both of the following:
(a) Contracts for Medi-Cal managed care include a process for screening, referral, and coordination with any mental health plan established, plans of medically necessary specialty mental health care services.
(b) (1) Medi-Cal managed care plan contractors and the provider networks of these plans utilize the standard forms developed by the department and stakeholder workgroup, as described in subdivision (a) of Section 14682.2, for performing the intake of, the assessment of, and the treatment planning for, Medi-Cal beneficiaries who are eligible for specialty mental health services under the Early and Periodic Screening, Diagnosis, and Treatment Program.
(2) No later than July 1, 2021, Medi-Cal managed care plans shall commence using the standard forms described in paragraph (1). After July 1, 2021, Medi-Cal managed care plans shall not use any other forms related to intake, assessment, treatment planning, eligibility determination, or reimbursement.

SEC. 2.

 Section 14682.2 is added to the Welfare and Institutions Code, to read:

14682.2.
 (a) (1) On or before March 31, 2020, the department shall convene a stakeholder workgroup to develop standard forms to be used by Medi-Cal managed care contractors, including mental health plan contractors that serve Medi-Cal beneficiaries and providers who render services under these contracts, for performing the intake of, the assessment of, and the treatment planning for, Medi-Cal beneficiaries who are eligible for specialty mental health services under the Early and Periodic Screening, Diagnosis, and Treatment Program. The forms shall be completed by January 1, 2021.
(2) The department shall ensure that the standard forms developed pursuant to this section comply with the federal Medicaid program law and regulations and applicable state and federal privacy laws that govern medical information, including the Confidentiality of Medical Information Act (Part 2.6 (commencing with Section 56) of Division 1 of the Civil Code) and the federal Health Insurance Portability and Accountability Act of 1996.
(b) The stakeholder workgroup shall include representatives from the County Behavioral Health Directors Association of California and associations that represent children's hospitals, foster youth, parents and caregivers, community-based children's mental health providers, and children's health legal advocates.
(c) (1) On or before July 1, 2021, representatives from the department and the workgroup shall provide regional trainings for mental health plans and their provider networks on the standard forms to ensure that individuals receive adequate training to appropriately complete the standard forms.
(2) (A) Training material developed pursuant to paragraph (1) shall be made available to Medi-Cal managed care contractors, including mental health plans, as determined appropriate by the department, for use in local trainings.
(B) Medi-Cal managed care contractors, including mental health plans, shall distribute the training material and standard forms to their provider networks.

SEC. 3.

 Section 14683 of the Welfare and Institutions Code is amended to read:

14683.
 The department shall ensure all of the following:
(a) That mental Mental health plans include a process for screening, referral, and coordination with other necessary services, including, but not limited to, health, housing, and vocational rehabilitation services. For Medi-Cal eligible children, the mental health plans shall also provide coordination with education programs and any necessary medical or rehabilitative services, including, but not limited to, those provided under the California Children's Services Program (Article 5 (commencing with Section 123800) of Chapter 3 of Part 2 of Division 106 of the Health and Safety Code) and the Child Health and Disability Prevention Program (Article 6 (commencing with Section 124025) of Chapter 3 of Part 2 of Division 106 of the Health and Safety Code), and those provided by a fee-for-service provider or a Medi-Cal managed care plan. This subdivision shall not be construed to does not establish any higher level of service from a county than is required under existing law. The mental health plan shall not be liable for the failure of other agencies responsible for the provision of nonmental health services to provide those services or to participate in coordination efforts.
(b) That mental Mental health plans include a system of outreach to enable Medi-Cal beneficiaries and providers to participate in and access Medi-Cal specialty mental health services under the plans, consistent with existing law.
(c) That standards Standards for quality and access developed by the department in consultation with the steering committee established pursuant to Section 14682.1 are included in mental health plans serving Medi-Cal beneficiaries.
(d) (1) Mental health plans and the provider networks of these plans utilize the standard forms developed by the department and stakeholder workgroup, as described in subdivision (a) of Section 14682.2, for performing the intake of, the assessment of, and the treatment planning for, Medi-Cal beneficiaries who are eligible for specialty mental health services under the Early and Periodic Screening, Diagnosis, and Treatment Program.
(2) No later than July 1, 2021, mental health plans shall commence using the standard forms described in paragraph (1). After July 1, 2021, mental health plans shall not use any other forms related to intake, assessment, treatment planning, eligibility determination, or reimbursement.

SECTION 1.Section 14093.06 of the Welfare and Institutions Code is amended to read:
14093.06.

(a)When a managed care contractor that is authorized to provide California Children's Services (CCS) covered services pursuant to subdivision (a) of Section 14094.3 or Article 2.985 (commencing with Section 14094.4) expands a managed care plan's CCS coverage area to other counties, the contractor shall comply with CCS program standards including, but not limited to, referral of newborns to the appropriate neonatal intensive care level, referral of children requiring pediatric intensive care to CCS-approved pediatric intensive care units, and referral of children with CCS eligible conditions to CCS-approved inpatient facilities and special care centers in accordance with subdivision (c) of Section 14093.05.

(b)The managed care contractor shall comply with CCS program medical eligibility regulations. Questions regarding interpretation of state CCS medical eligibility regulations, or disagreements between the county CCS program and the managed care contractor regarding interpretation of those regulations, shall be resolved by the local CCS program, in consultation with the state CCS program. The resolution determined by the CCS program shall be communicated in writing to the managed care contractor.

(c)In following the treatment plan developed in accordance with CCS program requirements, the managed care contractor shall ensure the timely referral of children with special healthcare needs to CCS-paneled providers who are board-certified in both pediatrics and in the appropriate pediatric subspecialty.

(d)The managed care contractor shall report expenditures and savings separately for CCS covered services and CCS eligible children, in accordance with paragraph (1) of subdivision (d) of Section 14093.05.

(e)(1)Children who are enrolled with a managed care contractor who are seeking CCS program benefits shall retain all rights to CCS program appeals and fair hearings of denials of medical eligibility or of service authorizations.

(2)Information regarding the number, nature, and disposition of appeals and fair hearings shall be updated monthly, and made available to the public on the Whole Child Model program performance dashboard, as described in Section 14094.7.

(f)The department, in consultation with stakeholder groups, shall develop unique pediatric plan performance standards and measurements, including, but not limited to, the health outcomes of children with special health care needs.

AB 763

Version: Amended+Assembly
Author: Asm. Adam Gray (D-CA)



Introduced by Assembly Member Gray

February 19, 2019


An act to amend Section 14093.06 of Sections 14681 and 14683 of, and to add Section 14682.2 to, the Welfare and Institutions Code, relating to children's services. Medi-Cal.


LEGISLATIVE COUNSEL'S DIGEST


AB 763, as amended, Gray. Children's services. Medi-Cal specialty mental health services.
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 healthcare services. health care services, including specialty mental health services, and Early and Periodic Screening, Diagnosis, and Treatment services for an individual under 21 years of age. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Existing law requires the Director of Health Care Services to enter into contracts with managed care plans, including, among other entities, health maintenance organizations, prepaid health plans, and primary care case management plans for the provision of medical benefits to all persons who are eligible to receive medical benefits under publicly supported programs. Existing law requires, among other things, a managed care contractor serving children with conditions eligible under the California Children's Services Program to maintain and follow standards of care established by the program, including, among others, the use of paneled providers and CCS-approved special care centers. Existing law provides that specified information regarding appeals and fair hearings shall be part of an annual report to the Legislature on managed care contractor compliance, and the report shall be made available to the public. Under existing law, one of the methods by which Medi-Cal services are provided is pursuant to contracts with various types of managed care health plans, including mental health plans that provide specialty mental health services. Existing law requires the department to ensure that Medi-Cal managed care contracts include a process for screening, referral, and coordination with mental health plans of specialty mental health services. Existing law requires the department to convene a steering committee to provide advice on the transition and continuing development of the Medi-Cal mental health managed care systems, and to ensure that the mental health plans comply with various standards, such as maintaining a system of outreach to enable Medi-Cal beneficiaries and providers to participate in and access Medi-Cal specialty mental health services under the mental health plans.
This bill would require, on or before March 31, 2020, the department to convene a stakeholder workgroup, including representatives from the County Behavioral Health Directors Association of California, to develop standard forms to be used by Medi-Cal managed care contractors, including mental health plan contractors and contractor provider networks, for performing the intake of, the assessment of, and the treatment planning for, Medi-Cal beneficiaries who are eligible for specialty mental health services under the Early and Periodic Screening, Diagnosis, and Treatment Program. The bill would require the forms to be completed by January 1, 2021. The bill would require, on or before July 1, 2021, representatives from the department and the workgroup to provide regional trainings for mental health plans and their provider networks on the standard forms. The bill would require Medi-Cal managed care contractors to distribute the training material and standard forms to their provider networks, and, by July 1, 2021, to commence exclusively using the standard forms.

This bill would delete the requirement for an annual report, and would instead require the specified information regarding appeals and fair hearings to be updated monthly, and be made available to the public on the Whole Child Model program performance dashboard.

Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: NO  

The people of the State of California do enact as follows:


SECTION 1.

 Section 14681 of the Welfare and Institutions Code is amended to read:

14681.
 The department shall ensure that all both of the following:
(a) Contracts for Medi-Cal managed care include a process for screening, referral, and coordination with any mental health plan established, plans of medically necessary specialty mental health care services.
(b) (1) Medi-Cal managed care plan contractors and the provider networks of these plans utilize the standard forms developed by the department and stakeholder workgroup, as described in subdivision (a) of Section 14682.2, for performing the intake of, the assessment of, and the treatment planning for, Medi-Cal beneficiaries who are eligible for specialty mental health services under the Early and Periodic Screening, Diagnosis, and Treatment Program.
(2) No later than July 1, 2021, Medi-Cal managed care plans shall commence using the standard forms described in paragraph (1). After July 1, 2021, Medi-Cal managed care plans shall not use any other forms related to intake, assessment, treatment planning, eligibility determination, or reimbursement.

SEC. 2.

 Section 14682.2 is added to the Welfare and Institutions Code, to read:

14682.2.
 (a) (1) On or before March 31, 2020, the department shall convene a stakeholder workgroup to develop standard forms to be used by Medi-Cal managed care contractors, including mental health plan contractors that serve Medi-Cal beneficiaries and providers who render services under these contracts, for performing the intake of, the assessment of, and the treatment planning for, Medi-Cal beneficiaries who are eligible for specialty mental health services under the Early and Periodic Screening, Diagnosis, and Treatment Program. The forms shall be completed by January 1, 2021.
(2) The department shall ensure that the standard forms developed pursuant to this section comply with the federal Medicaid program law and regulations and applicable state and federal privacy laws that govern medical information, including the Confidentiality of Medical Information Act (Part 2.6 (commencing with Section 56) of Division 1 of the Civil Code) and the federal Health Insurance Portability and Accountability Act of 1996.
(b) The stakeholder workgroup shall include representatives from the County Behavioral Health Directors Association of California and associations that represent children's hospitals, foster youth, parents and caregivers, community-based children's mental health providers, and children's health legal advocates.
(c) (1) On or before July 1, 2021, representatives from the department and the workgroup shall provide regional trainings for mental health plans and their provider networks on the standard forms to ensure that individuals receive adequate training to appropriately complete the standard forms.
(2) (A) Training material developed pursuant to paragraph (1) shall be made available to Medi-Cal managed care contractors, including mental health plans, as determined appropriate by the department, for use in local trainings.
(B) Medi-Cal managed care contractors, including mental health plans, shall distribute the training material and standard forms to their provider networks.

SEC. 3.

 Section 14683 of the Welfare and Institutions Code is amended to read:

14683.
 The department shall ensure all of the following:
(a) That mental Mental health plans include a process for screening, referral, and coordination with other necessary services, including, but not limited to, health, housing, and vocational rehabilitation services. For Medi-Cal eligible children, the mental health plans shall also provide coordination with education programs and any necessary medical or rehabilitative services, including, but not limited to, those provided under the California Children's Services Program (Article 5 (commencing with Section 123800) of Chapter 3 of Part 2 of Division 106 of the Health and Safety Code) and the Child Health and Disability Prevention Program (Article 6 (commencing with Section 124025) of Chapter 3 of Part 2 of Division 106 of the Health and Safety Code), and those provided by a fee-for-service provider or a Medi-Cal managed care plan. This subdivision shall not be construed to does not establish any higher level of service from a county than is required under existing law. The mental health plan shall not be liable for the failure of other agencies responsible for the provision of nonmental health services to provide those services or to participate in coordination efforts.
(b) That mental Mental health plans include a system of outreach to enable Medi-Cal beneficiaries and providers to participate in and access Medi-Cal specialty mental health services under the plans, consistent with existing law.
(c) That standards Standards for quality and access developed by the department in consultation with the steering committee established pursuant to Section 14682.1 are included in mental health plans serving Medi-Cal beneficiaries.
(d) (1) Mental health plans and the provider networks of these plans utilize the standard forms developed by the department and stakeholder workgroup, as described in subdivision (a) of Section 14682.2, for performing the intake of, the assessment of, and the treatment planning for, Medi-Cal beneficiaries who are eligible for specialty mental health services under the Early and Periodic Screening, Diagnosis, and Treatment Program.
(2) No later than July 1, 2021, mental health plans shall commence using the standard forms described in paragraph (1). After July 1, 2021, mental health plans shall not use any other forms related to intake, assessment, treatment planning, eligibility determination, or reimbursement.

SECTION 1.Section 14093.06 of the Welfare and Institutions Code is amended to read:
14093.06.

(a)When a managed care contractor that is authorized to provide California Children's Services (CCS) covered services pursuant to subdivision (a) of Section 14094.3 or Article 2.985 (commencing with Section 14094.4) expands a managed care plan's CCS coverage area to other counties, the contractor shall comply with CCS program standards including, but not limited to, referral of newborns to the appropriate neonatal intensive care level, referral of children requiring pediatric intensive care to CCS-approved pediatric intensive care units, and referral of children with CCS eligible conditions to CCS-approved inpatient facilities and special care centers in accordance with subdivision (c) of Section 14093.05.

(b)The managed care contractor shall comply with CCS program medical eligibility regulations. Questions regarding interpretation of state CCS medical eligibility regulations, or disagreements between the county CCS program and the managed care contractor regarding interpretation of those regulations, shall be resolved by the local CCS program, in consultation with the state CCS program. The resolution determined by the CCS program shall be communicated in writing to the managed care contractor.

(c)In following the treatment plan developed in accordance with CCS program requirements, the managed care contractor shall ensure the timely referral of children with special healthcare needs to CCS-paneled providers who are board-certified in both pediatrics and in the appropriate pediatric subspecialty.

(d)The managed care contractor shall report expenditures and savings separately for CCS covered services and CCS eligible children, in accordance with paragraph (1) of subdivision (d) of Section 14093.05.

(e)(1)Children who are enrolled with a managed care contractor who are seeking CCS program benefits shall retain all rights to CCS program appeals and fair hearings of denials of medical eligibility or of service authorizations.

(2)Information regarding the number, nature, and disposition of appeals and fair hearings shall be updated monthly, and made available to the public on the Whole Child Model program performance dashboard, as described in Section 14094.7.

(f)The department, in consultation with stakeholder groups, shall develop unique pediatric plan performance standards and measurements, including, but not limited to, the health outcomes of children with special health care needs.