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AB-166 Medi-Cal: violence preventive services.(2019-2020)

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Date Published: 06/24/2019 02:00 PM
AB166:v96#DOCUMENT

Amended  IN  Senate  June 24, 2019
Amended  IN  Assembly  April 30, 2019
Amended  IN  Assembly  March 07, 2019

CALIFORNIA LEGISLATURE— 2019–2020 REGULAR SESSION

Assembly Bill
No. 166


Introduced by Assembly Member Gabriel
(Coauthor: Assembly Member Chiu)
(Coauthor: Senator Portantino)

January 07, 2019


An act to add Section 14134.3 to the Welfare and Institutions Code, relating to Medi-Cal.


LEGISLATIVE COUNSEL'S DIGEST


AB 166, as amended, Gabriel. Medi-Cal: violence preventive services.
Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and 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 establishes a schedule of benefits under the Medi-Cal program, including various mental health services. Existing federal law authorizes, at the option of the state, preventive services, as defined, that are recommended by a physician or other licensed practitioner of the healing arts.

This bill would, no later than July 1, 2020, make violence preventive services provided by a qualified violence prevention professional, as defined, a covered benefit within the Medi-Cal fee-for-service and managed care delivery systems, subject to utilization controls. The bill would make the benefit available to a Medi-Cal beneficiary who has received medical treatment for a violent injury and for whom a licensed health care provider has determined that the beneficiary is at elevated risk of violent reinjury or retaliation and has referred the beneficiary to participate in a violence preventive services program.

The bill would require the department to approve at least one governmental or nongovernmental accrediting body with expertise in violence preventive services to review and approve training and certification programs. The bill would require an entity that employs or contracts with a qualified violence prevention professional to maintain specified documentation on, and to ensure compliance by, that professional.

This bill would require the department to establish, no later than January 1, 2021, a violence intervention pilot program at a minimum of 8 sites, including at least one site in 8 specified counties, and would require the department to consult with identified stakeholders, such as professionals in the community violence intervention field, for purposes of establishing the pilot program. The bill would require the department to provide violence preventive services that are rendered by a qualified violence prevention professional to a Medi-Cal beneficiary who meets identified criteria, including that the beneficiary has received medical treatment for a violent injury. The bill would require the department to approve one or more training and certification programs for violence prevention professionals, and would require an entity that employs or contracts with a qualified violence prevention professional to maintain specified documentation on, and to ensure compliance by, that professional.
The bill would require the department to seek any federal approvals necessary to implement these provisions. The bill would be implemented only to these requirements, and would condition the department’s implementation of these provisions to the extent that federal financial participation is available and not otherwise jeopardized, and any necessary federal approvals have been obtained.
The bill would make its provisions inoperative 5 calendar years following the date upon which violence preventive services are able to be provided and billed pursuant to the bill, as specified. The bill would, at least one calendar year prior to the inoperative date, require the department to contract for an evaluation of the implementation and impact of these provisions. The bill would, prior to the inoperative date, require the department to post the evaluation results on its internet website and to submit a report, with specified information, to the relevant fiscal and policy committees of the Legislature.
Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: NO  

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


SECTION 1.

 Section 14134.3 is added to the Welfare and Institutions Code, immediately following Section 14134.25, to read:

14134.3.
 (a) (1) The Legislature finds that people who have been violently injured are substantially more likely to be violently reinjured, and to engage in behaviors, as part of a cycle of community violence, trauma, and retaliation, that also substantially increase their own risk of violent reinjury.
(2) It is the intent of the Legislature that the State Department of Health Care Services develop and implement services targeted at reducing injury recidivism among violently injured Medi-Cal beneficiaries, and provide direct reimbursement to qualified violence prevention professionals for violence preventive services in accordance with this section.

(b)No later than July 1, 2020, violence preventive services provided by a qualified violence prevention professional are a covered benefit within the Medi-Cal fee-for-service and managed care delivery systems, subject to utilization controls, for a Medi-Cal beneficiary who meets both of the following conditions:

(b)  No later than January 1, 2021, the department shall establish a violence intervention pilot program that is hospital-based or hospital-linked. The pilot program shall be established at a minimum of eight sites, and at least one site shall be located in each of the following counties:
(1) Alameda.
(2) Contra Costa.
(3) Los Angeles.
(4) Monterey.
(5) Sacramento.
(6) San Francisco.
(7) Santa Clara.
(8) Ventura.
(c) For the purposes of establishing the pilot program, the department shall consult with stakeholders, including, but not limited to, professionals in the community violence intervention field, hospital-linked and hospital-based violence intervention programs, and health care professionals working with hospital-linked and hospital-based violence intervention programs.
(d) Under the pilot program, the department shall provide violence preventive services that are rendered by a qualified violence prevention professional to a Medi-Cal beneficiary who meets both of the following conditions:
(1) The beneficiary has received medical treatment for a violent injury, including, but not limited to, a gunshot wound, stabbing injury, or any other form of violent injury.
(2) A licensed health care provider has determined that the beneficiary is at elevated risk of violent reinjury or retaliation and has referred the beneficiary to participate in a violence preventive services program.

(c)For the purposes of this section, the following definitions apply:

(1)“Prevention professional” has the same meaning as defined by the National Uniform Claim Committee (NUCC) under NUCC Code Number 405300000X or its successor.

(2)“Qualified violence prevention professional” means a prevention professional who meets all of the following conditions:

(A)Possesses at least six months of full-time equivalent experience in providing violence preventive services through employment, volunteer work, or as part of an internship experience.

(B)Has successfully completed an accredited training and certification program for violence prevention professionals, in accordance with subdivision (d), or has been certified as a violence prevention professional by the National Network of Hospital-Based Violence Intervention Programs prior to the effective date of this section.

(C)Successfully completes at least four hours of continuing education annually in the field of violence preventive services.

(D)Satisfies any other requirements necessary to maintain certification as a violence prevention professional.

(3)“Violence preventive services” means evidence-based, trauma-informed, supportive, and nonpsychotherapeutic services provided by a prevention professional for the purpose of promoting improved health outcomes and positive behavioral change, preventing injury recidivism, and reducing the likelihood that violently injured individuals will commit or promote violence themselves. Those services may be provided within or outside of a clinical setting and may include the provision of peer support and counseling, mentorship, conflict mediation, crisis intervention, targeted case management, referrals, patient education, or screening services to victims of community violence.

(d)The department shall approve at least one governmental or nongovernmental accrediting body with expertise in violence preventive services to review and approve training and certification programs for violence prevention professionals, if that accrediting body elects to do so. The accrediting body shall approve programs that prepare individuals to provide violence preventive services to victims of community violence, and that include at least 35 hours of training, collectively addressing all of the following:

(e) Violence preventive services, as defined in paragraph (3) of subdivision (o), that are provided by a qualified violence prevention professional through the Medi-Cal program shall be offered to an eligible Medi-Cal beneficiary for a minimum of three months and a maximum of 12 months. These services shall be rendered within and outside the clinical setting, and shall include all of the following components:
(1) Targeted case management and care coordination to support the recovery of a violently injured patient.
(2) Home and community visitation after discharge to provide patient education, neighborhood mapping of community resources, referrals or screenings for substance abuse, behavioral health, or any additional risk reduction resources to support injury recovery and reduce injury recidivism.
(3) Peer support services, including, but not limited to, counseling, mentorship, conflict mediation, and crisis intervention.
(f) A qualified violence prevention professional, as defined in paragraph (2) of subdivision (o), shall meet all of the following conditions:
(1) Possesses at least six months of full-time equivalent experience in providing violence preventive services through employment, volunteer work, or as part of an internship experience.
(2) Has successfully completed an accredited training and certification program for violence prevention professionals, in accordance with subdivision (g), or has been certified as a violence prevention professional by the National Network of Hospital-Based Violence Intervention Programs prior to January 1, 2021.
(3) Successfully completes at least four hours of continuing education annually in the field of violence preventive services.
(4) Satisfies any other requirements necessary to maintain certification as a violence prevention professional.
(g) The department shall approve one or more training and certification programs for violence prevention professionals, which shall include at least 35 hours of training that collectively addresses all of the following:
(1) The profound effects of trauma and violence and the basics of trauma-informed care.
(2) Violence prevention strategies, including, but not limited to, conflict mediation and retaliation prevention related to community violence.
(3) Case management and advocacy practices.
(4) Patient privacy and the federal Health Insurance Portability and Accountability Act of 1996 (HIPAA). 1996.

(e)

(h) An entity that employs or contracts with a qualified violence prevention professional to provide violence preventive services shall do both of the following:
(1) Maintain documentation that the qualified violence prevention professional has met all of the conditions described in paragraph (2) of subdivision (c). subdivision (f).
(2) Ensure that the qualified violence prevention professional is providing violence preventive services consistent with paragraph (3) of subdivision (c). the requirements specified in subdivision (e).

(f)

(i) The department shall seek any federal approvals necessary to implement this section, including, but not limited to, any state plan amendments or federal waivers by the federal Centers for Medicare and Medicaid Services.

(g)

(j) This section shall be implemented only to the extent that federal financial participation is available and not otherwise jeopardized, and any necessary federal approvals have been obtained.

(h)

(k) This section does not alter the scope of practice for any health care professional and does not authorize nor authorizes the delivery of health care services in a setting or in a manner that is not authorized under any provision of the Business and Professions Code or the Health and Safety Code.

(i)

(l) At least one calendar year prior to the inoperative date of this section pursuant to subdivision (j), (m), the department shall contract for an evaluation of the implementation and impact of this section. Prior to the inoperative date of this section, the department shall post the results of the evaluation on its internet website and shall submit a report to the relevant fiscal and policy committees of the Legislature. The report shall, at minimum, include all of the following:
(1) The number of individuals receiving violence preventive services pursuant to this section.
(2) The number of individuals providing violence preventive services pursuant to this section.
(3) Expenditures, in aggregate and per person, in providing services pursuant to this section.
(4) A description of the types of services provided and the locations where those services were provided.
(5) The number and types of accrediting bodies for violence preventive services and the number and names of violence preventive services training programs providing training pursuant to this section.
(6) An analysis on all of the following:

(6)

(A) Whether violence preventive services provided pursuant to this section reduced injury recidivism.

(7)

(B) Whether violence preventive services provided pursuant to this section reduced retaliation, or reduced the likelihood of perpetrating violence.

(8)An analysis regarding whether

(C) Whether violence preventive services should continue to be provided as a fee-for-service benefit, a benefit through a Medi-Cal managed care plan, or a benefit through a county mental health plan.

(j)(1)

(m) This section shall become inoperative five calendar years following the date upon which violence preventive services described in this section are able to be provided and billed pursuant to this section.

(2)

(n) The department shall post on its internet website the date upon which violence preventive services described in this section are able to be provided and billed pursuant to this section.
(o) The following definitions apply for purposes of this section:
(1) “Prevention professional” has the same meaning as defined by the National Uniform Claim Committee (NUCC) under NUCC Code Number 405300000X or its successor.
(2) “Qualified violence prevention professional” means a prevention professional who renders violence preventive services.
(3) “Violence preventive services” means evidence-based, trauma-informed, supportive, culturally responsive, and nonpsychotherapeutic services provided by a prevention professional, who works in collaboration with other care providers and community partners, for the purpose of promoting improved health outcomes and positive behavioral change, preventing injury recidivism, and reducing the likelihood that violently injured individuals will commit or promote violence themselves.