AB 1058

Version: Amended+Assembly
Author: Asm. Rudy Salas (D-CA)



Introduced by Assembly Member Salas

February 21, 2019


An act to add Section 14685 to and repeal Article 3.3 (commencing with Section 14124.30) of Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions Code, relating to Medi-Cal.


LEGISLATIVE COUNSEL'S DIGEST


AB 1058, as amended, Salas. Medi-Cal: specialty mental health services and substance use disorder treatment.
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 health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Existing law provides for various benefits under the Medi-Cal program, including mental health services and substance use disorder treatment. treatment that are delivered through the Medi-Cal Specialty Mental Health Services program and the Drug Medi-Cal Treatment Program, respectively.
This bill would establish the County Behavioral Health Integration Pilot Program to integrate the administration and financing of the Drug Medi-Cal Treatment Program and the Medi-Cal Specialty Mental Health Services program in 9 counties that meet specified criteria, including that the county has implemented the Drug Medi-Cal organized delivery system, and which are selected by a selection committee consisting of representatives from the department and the County Behavioral Health Directors Association, for purposes of administering a county pilot project for a 4-year period. The bill would require a county that has been selected to administer a pilot project to perform specified tasks, such as developing a county-specific pilot implementation plan, and satisfying quality assurance and quality improvement requirements as established in state-county contracts for the Drug Medi-Cal organized delivery system and the Medi-Cal Specialty Mental Health Services program. The bill would require the department to perform specified tasks related to the pilot program, including approving each county's pilot implementation plan, posting these plans on the department's internet website, and preparing an annual and final pilot project evaluation report for the Legislature. The bill would authorize the department to implement these requirements by various instructions, including plan letters, to enter into contracts for procuring qualified consultant services, and to seek funding from federal agencies, foundations, or other nongovernmental sources.

This bill would declare the intent of the Legislature to enact legislation to establish a pilot program in several counties to support the integration of specialty mental health services and substance use disorder treatment provided under the Medi-Cal program, as specified.

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

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


SECTION 1.

 The Legislature hereby finds and declares all of the following:
(a) Eight and one-half percent of Californians over 12 years of age have a substance use disorder, and more than 15 percent of adults have a mental health condition.
(b) More than 30 percent of the population that receives mental health services for severe and persistent mental illness through the Medi-Cal Specialty Mental Health Services program in California have co-occurring substance use disorders.
(c) Substance use disorders and mental health conditions that are untreated may lead to chronic physical health problems, increased rates of emergency room visits, higher risk for homelessness, unemployment, and justice-system involvement, and trauma, suicide, or premature death.
(d) Nearly every California county has merged the administration of publicly funded substance use disorder treatment and specialty mental health services into integrated behavioral health systems. Care for both conditions is now typically managed using the same administrative infrastructure within the county and an overlapping workforce.
(e) Nonetheless, reimbursement, county contracts with the state, documentation and reporting, oversight and other administrative requirements for the Drug Medi-Cal Treatment Program and the Medi-Cal Specialty Mental Health Services program remain bifurcated under state law.
(f) The rigidly separate benefit structures for these two closely-related Medi-Cal programs produce inefficiencies and create administrative barriers to the provision of integrated substance use disorder treatment and mental health services for Californians with co-occurring conditions and who receive health care through the Medi-Cal program.
(g) It is in the interest of Californians in need of behavioral health services, and of the state as a whole, to develop integrated behavioral health programs that can effectively meet the needs of individuals with co-occurring substance use disorders and mental health conditions.

SEC. 2.

 Article 3.3 (commencing with Section 14124.30) is added to Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions Code, to read:
Article  3.3. County Behavioral Health Integration Pilot Program Act of 2019

14124.30.
 (a) This act shall be known, and may be cited, as the County Behavioral Health Integration Pilot Program Act of 2019.
(b) It is the intent of the Legislature to establish the County Behavioral Health Integration Pilot Program to identify and test strategies for integrating the administration and financing of the Drug Medi-Cal Treatment Program, the Drug Medi-Cal organized delivery system, and the Medi-Cal Specialty Mental Health Services program in nine county-administered pilot projects in the state.

14124.31.
 (a) The goals of the County Behavioral Health Integration Pilot Program shall be to:
(1) Develop, test, and evaluate new models for providing integrated behavioral health services to Medi-Cal beneficiaries with co-occurring substance use disorders and mental health conditions.
(2) Provide high-quality, integrated behavioral health services that meet the unique needs of Medi-Cal beneficiaries with co-occurring substance use disorders and mental health conditions in a clinically appropriate manner.
(3) Utilize a formal evaluation process and specific performance outcome measures to demonstrate evidence of all of the following:
(A) Access to treatment for substance use disorder treatment and specialty mental health services at rates that are comparable to or higher than those in nonpilot counties.
(B) Increased quality of care.
(C) Program costs that are no higher on average than those for comparable services provided by the Drug Medi-Cal Treatment Program and the Medi-Cal Specialty Mental Health Services program and that are delivered in nonpilot project counties.
(4) Identify any necessary changes to the Drug Medi-Cal Treatment Program, the Drug Medi-Cal organized delivery system, and the Medi-Cal Specialty Mental Health Services program that would be required to facilitate the provision of integrated services and to expand the pilot program statewide.
(b) The County Behavioral Health Integration Pilot Program shall be implemented over a five-year period, with at least four years of active implementation and service delivery.
(c) No later than one year from the date that this article is effective, selected pilot counties shall implement their programs by commencing the pilot activities specified in their county implementation plan, as described in subdivision (c) of Section 14124.33. In the year prior to program implementation, counties willing to commit to the pilot shall elect to participate in the pilot, the department and the County Behavioral Health Directors Association shall select pilot participants, and the department shall approve county implementation plans.
(d) Each pilot program shall conclude four years from its original implementation date.

14124.32.
 (a) An eligible pilot participant shall include any county behavioral health program that has implemented the Drug Medi-Cal organized delivery system, as authorized in the California Medi-Cal 2020 Demonstration pursuant to Article 5.5 (commencing with Section 14184) or a successor demonstration or waiver, as applicable, prior to its County Behavioral Health Integration Pilot implementation date.
(b) (1) A selection committee, which shall consist of an equal number of representatives from the department and the County Behavioral Health Directors Association, shall select the pilot participants. The selection committee shall select nine counties as follows:
(A) Three counties shall have a population in excess of 1,000,000 residents.
(B) Three counties shall have a population between 200,000 and 1,000,000 residents.
(C) Three counties shall have a population less than 200,000 residents.
(2) If less than two counties in one of these three population-based categories is willing to commit to the pilot program, the department and the County Behavioral Health Directors Association may select additional participants from another population category to ensure that nine county-administered pilot projects are established.
(3) Selection criteria shall include, at a minimum, all of the following:
(A) Geographic distribution of pilot counties.
(B) County readiness to provide integrated behavioral health services, as demonstrated by the presence of existing programs specifically targeted to Medi-Cal beneficiaries with co-occurring substance use and mental health conditions.
(c) This article does not prohibit the department, in consultation with the County Behavioral Health Directors Association, from establishing a two-stage selection process by which local pilot project sites are selected on a preliminary basis and final selection of local pilot project sites are contingent upon the county completion of, and departmental approval of, a county implementation plan, as described in subdivision (c) of Section 14124.33.

14124.33.
 A county that administers a pilot project pursuant to this article shall be responsible, at a minimum, for all of the following:
(a) Guaranteeing that substance use disorder treatment and mental health services provided pursuant to the pilot program are equivalent to benefits available under the Drug Medi-Cal organized delivery system and the Medi-Cal Specialty Mental Health Services program. Any modifications to medical necessity or service eligibility criteria proposed under the pilot program shall be approved by the department and shall not hinder an individual's access to covered services.
(b) Continuing to meet quality assurance and quality improvement requirements equivalent to those outlined in existing state-county contracts for the Drug Medi-Cal organized delivery system and the Medi-Cal Specialty Mental Health Services program.
(c) (1) Developing, preparing, and submitting to the department an implementation plan that describes the integrated service delivery strategies that the county intends to test and the actions the county will take during the course of the pilot period.
(2) An implementation plan may address a phased-in implementation of pilot activities, with a timeline that accounts for the phased-in development of specific strategies to mitigate administrative barriers to integrated service delivery, in partnership with the department as described in Section 14124.34.
(d) (1) Implementing the pilot project by providing integrated substance use disorder treatment and specialty mental health services that are funded by the Medi-Cal program at a minimum of one service site located within the borders of the county.
(2) A county may, but is not required to, select to implement integrated services either at multiple sites or systemwide, as to include every site and provider within the county's behavioral health delivery system.
(e) Submitting required reports on pilot activities and performance outcomes data specified in the evaluation plan developed by the department pursuant to subdivision (e) of Section 14124.34.

14124.34.
 For purposes of administering the County Behavioral Health Integration Pilot Program, the department shall be responsible, at a minimum, for all of the following:
(a) Reviewing and approving each county's pilot implementation plan, and posting these plans on the department's internet website.
(b) Working with pilot counties and representatives of the County Behavioral Health Directors Association to identify and address administrative barriers to integrated service delivery under the current, bifurcated administrative structure of the Drug Medi-Cal organized delivery system and the Medi-Cal Specialty Mental Health Services program. By the first day of the fourth year of the five-year pilot period, the department shall authorize counties to implement programmatic changes to the Drug Medi-Cal Treatment Program, the Drug Medi-Cal organized delivery system, and the Medi-Cal Specialty Mental Health Services program to address all of the following:
(1) Integrating or providing dual Medi-Cal program certifications for sites that provide substance use disorder treatment and mental health services under the Drug Medi-Cal organized delivery system and the Medi-Cal Specialty Mental Health Services program, respectively.
(2) Billing and claiming requirements of the programs to allow more flexible reimbursement for the Medi-Cal benefits related to substance use disorder treatment and specialty mental health services that are provided to Medi-Cal beneficiaries with dual diagnoses.
(3) Streamlining and integrating quality assurance, quality improvement, and data reporting requirements for substance use disorder treatment and mental health services provided pursuant to the Medi-Cal program.
(4) Combining state and county contracts for the Drug Medi-Cal organized delivery system and the Medi-Cal Specialty Mental Health Services program.
(5) Promoting best practices for obtaining client consent to share personal health information within an integrated behavioral health program for treatment purposes.
(c) Seeking any changes to state law or regulation, as may be necessary, for full implementation of the pilot program.
(d) Seeking necessary federal approval, including a Medicaid waiver, for implementation of the pilot program.
(e) Collaborating with pilot counties and the County Behavioral Health Directors Association to develop a program evaluation plan and a set of performance outcomes measures for purposes of evaluating the pilot program.
(f) Collecting data and reports from pilot counties as specified in the evaluation plan.
(g) Delivering an annual evaluation report to the Legislature on the results of the pilot program.
(h) (1) Submitting to the Legislature, no more than six months after the last pilot project concludes, a final pilot evaluation report that includes recommendations for statewide implementation of specific integration strategies and any policy changes that are needed to meet the goals of the pilot program throughout the state as a statewide expansion effort.
(2) A report to be submitted pursuant to subdivision (g) and paragraph (1) and shall be submitted in compliance with Section 9795 of the Government Code.

14124.35.
 (a) Notwithstanding the rulemaking provisions of Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may implement, interpret, or make specific this article by means of all-county letters, plan letters, plan or provider bulletins, or similar instructions.
(b) The department may contract with qualified consultants to provide technical assistance to pilot counties, to carry out the departmental responsibilities specified in Section 14124.34, or for any other purpose that furthers the goals of the County Behavioral Health Integration Pilot Program.
(c) Contracts entered into pursuant to this article shall be exempt from the requirements of Chapter 1 (commencing with Section 10100) and Chapter 2 (commencing with Section 10290) of Part 2 of Division 2 of the Public Contract Code.

14124.36.
 (a) For purposes of implementing the County Behavioral Health Integration Pilot Program, the department may seek funding from federal agencies, foundations, or other nongovernmental sources.
(b) Costs related to the implementation of the County Behavioral Health Integration Pilot Program shall be limited to administrative costs incurred by the department to implement requirements pursuant to this article.
(c) Each county that administers a pilot project shall continue to utilize current behavioral health funding sources, including, but not limited to, the Behavioral Health Subaccount of the Local Revenue Fund 2011 and Medi-Cal funds, such as federal financial participation, to fund substance use disorder treatment and specialty mental health services for Medi-Cal beneficiaries who access integrated behavioral health services under the terms of this pilot program.

14124.37.
 This article shall remain in effect only until January 1, 2026, and as of that date is repealed.

SECTION 1.Section 14685 is added to the Welfare and Institutions Code, to read:
14685.

It is the intent of the Legislature to enact legislation to establish a pilot program in several counties to support the integration of specialty mental health services and substance use disorder treatment provided under the Medi-Cal program. The pilot will build upon ongoing efforts underway in many counties. The pilot will seek to reduce barriers to integrated care that remain in the bifurcated delivery systems whereby specialty mental health services and substance use disorder treatment are both separately financed and delivered.