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AB-512 Medi-Cal: specialty mental health services.(2019-2020)

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Date Published: 07/03/2019 09:00 PM
AB512:v94#DOCUMENT

Amended  IN  Senate  July 03, 2019
Amended  IN  Senate  June 27, 2019
Amended  IN  Assembly  May 16, 2019
Amended  IN  Assembly  April 02, 2019
Amended  IN  Assembly  March 14, 2019

CALIFORNIA LEGISLATURE— 2019–2020 REGULAR SESSION

Assembly Bill
No. 512


Introduced by Assembly Member Ting
(Coauthors: Assembly Members Boerner Horvath, Eduardo Garcia, and Reyes)
(Coauthor: Senator Portantino)

February 13, 2019


An act to amend Sections 14684 and 14717.5 of the Welfare and Institutions Code, relating to Medi-Cal.


LEGISLATIVE COUNSEL'S DIGEST


AB 512, as amended, Ting. 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 health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Existing law requires the department to implement managed mental health care for Medi-Cal beneficiaries through contracts with mental health plans, and requires mental health plans to be governed by various guidelines, including a requirement that a mental health plan assess the cultural competency needs of the program. Existing law requires mental health plan reviews to be conducted by an external quality review organization (EQRO) on an annual basis, and requires those reviews to include specific data for Medi-Cal eligible minor and nonminor dependents in foster care, such as the number of Medi-Cal eligible minor and nonminor dependents in foster care served each year.
This bill would require each mental health plan to prepare a cultural competency assessment plan to address specified matters, including mental health disparities in access, utilization, and outcomes by various categories, such as race, ethnicity, and immigration status. The bill would require a mental health plan to convene a committee for the purpose of reviewing and approving the cultural competency assessment plan, to annually update its cultural competency plan and progress, to post this material on its internet website, and to submit its cultural competency assessment plan to the department every 3 years for technical assistance and implementation feedback. The bill would require the department to develop at least 8 statewide mental health disparities reduction targets, to post the cultural competency assessment plan submitted by each mental health plan to its internet website, and to consult with the Office of Health Equity and the office of the state Surgeon General to review and implement county assessments and statewide performance on mental health disparities reductions. The bill would require the department to direct the EQRO to develop a protocol for monitoring performance of each mental health plan, and to report on statewide mental health disparities reduction targets and identified matters, including statewide progress related to the mental health disparities reduction targets. The bill would require the EQRO to publish specified information in the annual detailed technical report, such as recommendations for statewide strategies to reduce mental health disparities. The bill would require the mental health plan to meet specified mental health disparities reduction targets or make year-over-year improvements toward meeting the targets. The bill would require the department to promulgate, by January 1, 2021, regulations to implement these provisions.
Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   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) Mental health is a vital aspect of an individual’s overall well-being.
(b) Disparities in access to mental health services vary across demographic groups, including race, age, gender, income level, and immigration status.
(c) Immigrant communities across California have experienced heightened levels of stress and anxiety in light of today’s political climate, which has resulted in reduced utilization of state administered assistance programs and reduced incidence of crime reporting by communities of color.
(d) Disparities in mental health services can be reduced or eliminated by addressing barriers to the mental health care system and improving outreach strategies.
(e) Investing in mental health services that are culturally and linguistically appropriate are crucial in identifying, preventing, and alleviating mental health conditions for historically disenfranchised groups, such as communities of color, the lesbian, gay, bisexual, and transgender community, and the undocumented.
(f) Early detection and intervention for mental health conditions among vulnerable communities is inherent to overall community wellness and safety.

SEC. 2.

 Section 14684 of the Welfare and Institutions Code is amended to read:

14684.
 Notwithstanding any other state law, and to the extent permitted by federal law, a mental health plan, whether administered by public or private entities, shall be governed by the following guidelines:
(a) State and federal Medi-Cal funds identified for the diagnosis and treatment of mental illness shall be used solely for those purposes. Administrative costs incurred by a county for activities necessary for the administration of the mental health plan shall be clearly identified and reimbursed in a manner consistent with federal Medicaid requirements and the approved Medicaid state plan and waivers. Administrative requirements shall be based on and limited to federal Medicaid requirements and the approved Medicaid state plan and waivers, and shall not impose costs exceeding funds available for that purpose.
(b) The development of a mental health plan shall include a public planning process that includes a significant role for Medi-Cal beneficiaries, family members, mental health advocates, providers, and public and private contract agencies.
(c) A mental health plan shall include appropriate standards relating to quality, access, and coordination of services within a managed system of care, and costs established under the plan, and shall provide opportunities for existing Medi-Cal providers to continue to provide services under the mental health plan, as long as the providers meet those standards.
(d) Continuity of care for current recipients of services shall be ensured in the transition to managed mental health care.
(e) Medi-Cal covered specialty mental health services shall be provided in the beneficiary’s home community, or as close as possible to the beneficiary’s home community. Pursuant to the objectives of the rehabilitation option described in subdivision (a) of Section 14021.4, mental health services may be provided in a facility, a home, or other community-based site.
(f) Medi-Cal beneficiaries whose mental or emotional condition results or has resulted in functional impairment, as defined by the department, shall be eligible for covered specialty mental health services. Emphasis shall be placed on adults with serious and persistent mental illness and children with serious emotional disturbances, as defined by the department.
(g) A mental health plan shall provide specialty mental health services to eligible Medi-Cal beneficiaries, including both adults and children. Specialty mental health services include Early and Periodic Screening, Diagnosis, and Treatment Services to eligible Medi-Cal beneficiaries under 21 years of age pursuant to Section 1396d(a)(4) of Title 42 of the United States Code.
(h) A mental health plan shall include a mechanism for monitoring the effectiveness of, and evaluating accessibility and quality of, services available. The plan shall utilize and be based upon state-adopted performance outcome measures and shall include review of individual service plan procedures and practices, a beneficiary satisfaction component, and a grievance system for beneficiaries and providers.
(i) A mental health plan shall provide for culturally competent and age-appropriate services, to the extent feasible. A mental health plan shall assess the cultural competency needs of the program, and prepare a cultural competency assessment plan, as specified in this subdivision. A mental health plan shall include, as part of the quality assurance program required by Section 14725, a process to accommodate the significant needs with reasonable timeliness. The department shall provide demographic data and technical assistance. Performance outcome measures shall include a reliable method of measuring and reporting the extent to which services are culturally competent and age-appropriate.
(1) (A) The cultural competency assessment plan shall address, but not be limited to, all of the following:
(i) Mental health disparities in access, utilization, and outcomes by race, ethnicity, primary language, sexual orientation, gender identity, age, disability status, income level, and immigration status, to the extent data is available.
(ii) Annual statewide performance targets for reducing mental health disparities in access, utilization, and outcomes, as determined by the department pursuant to subparagraph (C) of paragraph (6). A mental health plan may include additional performance targets, as appropriate.
(iii) Designated strategies for reaching performance targets, including the mental health plan’s rationale for each strategy.
(iv) The mental health plan’s performance on prior performance targets.
(v) The mental health plan’s strategies for addressing trauma and developing trauma-informing services.
(vi) The process for community input, including a list of community entities participating.
(B) (i) For purposes of developing the cultural competency assessment plan, a mental health plan shall utilize available data and may solicit information from Medi-Cal beneficiaries who receive specialty mental health services from the mental health plan and recipients of other county mental health services.
(ii) Data reported pursuant to this section shall be collected, maintained, and kept confidential in a manner consistent with Sections 14100.2 and 17852, 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.
(2) A mental health plan shall convene a committee, through open invitation to relevant stakeholders, including, but not limited to, agency and department representatives, consumer advocates, consumers, mental health disparities reduction experts, and providers, for the purpose of reviewing and approving the cultural competency assessment plan. The committee shall convene monthly either in person or through electronic means, and meetings shall be open and accessible to the public.
(3) (A) A mental health plan shall annually update its cultural competency assessment plan, in coordination with the committee, to reflect population changes, and shall include in the annual update a report on its progress toward achieving performance targets.
(B) A mental health plan shall post the material described in subparagraph (A) on its internet website.
(4) A mental health plan shall submit the cultural competency assessment plan to the department every three years for technical assistance and implementation feedback. The department, within 30 days of its receipt of this material, shall post the cultural competency assessment plan submitted by each plan to its internet website.
(5) (A) The department shall consult with the Office of Health Equity and the office of the state Surgeon General for purposes of reviewing county assessments and statewide performance on mental health disparities reduction.
(B) The review specified in subparagraph (A) shall include an assessment about the extent to which strategies utilize both evidence-based and community-defined best practices, and shall address documented mental health disparities, including progress in meeting performance targets.
(6) (A) The department shall direct an external quality review organization, as described in Section 14717.5, to develop and implement a protocol for monitoring performance on established mental health disparities reduction targets for each mental health plan.
(B) In developing and implementing this protocol, the department shall consult with mental health plans, consumer advocates, consumers, experts in mental health disparities reduction, and providers.
(C) The department shall develop, in consultation with stakeholders mental health plans, stakeholders, and the Office of Health Equity, at least eight statewide mental health disparities reduction targets and shall require each mental health plan to meet the specified mental health disparities reduction targets or make year-over-year improvements toward meeting the targets. The mental health disparities reduction targets shall include access and outcomes targets, and shall consider, at a minimum, metrics addressing mental health disparities on the basis of race, ethnicity, primary language, sexual orientation, gender identity, age, disability status, income level, immigration status, other factors, or a combination of factors.
(j) By January 1, 2021, the department shall adopt regulations to implement this section in accordance with the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code).
(k) For purposes of this section, “mental health disparities” means inequitable differences in risk of illness, access to services, utilization of services, and health outcomes experienced by individuals or groups based on age, race, ethnicity, gender identity, sexual orientation, immigration status, primary language, disability status, income level, and other factors, or a combination of these factors. factors, to the extent data is available.

SEC. 3.

 Section 14717.5 of the Welfare and Institutions Code is amended to read:

14717.5.
 (a) A mental health plan review shall be conducted annually by an external quality review organization (EQRO) pursuant to Section 438.350 et seq. of Title 42 of the Code of Federal Regulations. Commencing July 1, 2018, the review shall include specific data for Medi-Cal eligible minor and nonminor dependents in foster care, including all of the following:
(1) The number of Medi-Cal eligible minor and nonminor dependents in foster care served each year.
(2) Details on the types of mental health services provided to children, including prevention and treatment services. The types of services may include, but are not limited to, screenings, assessments, home-based mental health services, outpatient services, day treatment services or inpatient services, psychiatric hospitalizations, crisis interventions, case management, and psychotropic medication support services.
(3) Access to, and timeliness of, mental health services, as described in Sections 1300.67.2, 1300.67.2.1, and 1300.67.2.2 of Title 28 of the California Code of Regulations and consistent with Section 438.206 of Title 42 of the Code of Federal Regulations, available to Medi-Cal eligible minor and nonminor dependents in foster care.
(4) Quality of mental health services available to Medi-Cal eligible minor and nonminor dependents in foster care.
(5) Translation and interpretation services, consistent with Section 438.10(c)(4) and (5) of Title 42 of the Code of Federal Regulations and Section 1810.410 of Title 9 of the California Code of Regulations, available to Medi-Cal eligible minor and nonminor dependents in foster care.
(6) Performance data for Medi-Cal eligible minor and nonminor dependents in foster care.
(7) Utilization data for Medi-Cal eligible minor and nonminor dependents in foster care.
(8) Medication monitoring consistent with the child welfare psychotropic medication measures developed by the State Department of Social Services and any Healthcare Effectiveness Data and Information Set (HEDIS) measures related to psychotropic medications, including, but not limited to, the following:
(A) Follow-Up Care for Children Prescribed Attention Deficit Hyperactivity Disorder Medication (HEDIS ADD).
(B) Use of Multiple Concurrent Antipsychotics in Children and Adolescents (HEDIS APC).
(C) Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics (HEDIS APP).
(D) Metabolic Monitoring for Children and Adolescents on Antipsychotics (HEDIS APM).
(b) (1) The department shall post the EQRO data disaggregated by Medi-Cal eligible minor and nonminor dependents in foster care on the department’s internet website in a manner that is publicly accessible.
(2) The department shall review the EQRO data for Medi-Cal eligible minor and nonminor dependents in foster care.
(3) If the EQRO identifies deficiencies in a mental health plan’s ability to serve Medi-Cal eligible minor and nonminor dependents in foster care, the department shall notify the mental health plan in writing of identified deficiencies.
(4) The mental health plan shall provide a written corrective action plan to the department within 60 days of receiving the notice required pursuant to paragraph (3). The department shall notify the mental health plan of approval of the corrective action plan or shall request changes, if necessary, within 30 days after receipt of the corrective action plan. Final corrective action plans shall be made publicly available by, at minimum, posting on the department’s internet website.
(c) To the extent possible, the department shall, in connection with its duty to implement Section 14707.5, share with county boards of supervisors data to assist in the development of mental health service plans, such as data described in Section 438.350 et seq. of Title 42 of the Code of Federal Regulations, subdivision (c) of Section 16501.4, and paragraph (1) of subdivision (a) of Section 1538.8 of the Health and Safety Code.
(d) The department shall annually share performance outcome system data with county boards of supervisors for the purpose of informing mental health service plans. Performance outcome system data shared with county boards of supervisors shall include, but not be limited to, the following disaggregated data for Medi-Cal eligible minor and nonminor dependents in foster care:
(1) The number of youth receiving specialty mental health services.
(2) The racial distribution of youth receiving specialty mental health services.
(3) The gender distribution of youth receiving specialty mental health services.
(4) The number of youth, by race, with one or more specialty mental health service visits.
(5) The number of youth, by race, with five or more specialty mental health service visits.
(6) Utilization data for intensive home services, intensive care coordination, case management, therapeutic behavioral services, medication support services, crisis intervention, crisis stabilization, full-day intensive treatment, full-day treatment, full-day rehabilitation, and hospital inpatient days.
(7) A unique count of youth receiving specialty mental health services who are arriving, exiting, and continuing with services.
(e) The department shall ensure that the performance outcome system data metrics include disaggregated data for Medi-Cal eligible minor and nonminor dependents in foster care, and the data shall be in a format that can be analyzed.
(f) (1) Commencing January 1, 2020, the EQRO shall ensure that the annual review that it performs of each mental health plan, as specified in subdivision (a), includes a report on progress related to the statewide mental health disparities reduction targets established pursuant to subparagraph (C) of paragraph (6) of subdivision (i) of Section 14684.
(2) The EQRO shall publish statewide progress related to the statewide mental health disparities reduction targets both of the following in the annual detailed technical report as required by Section 438.364 of Title 42 of the Code of Federal Regulations. Regulations:
(A) Information related to statewide progress on statewide mental health disparities reduction targets.
(B) Recommendations for statewide strategies to reduce mental health disparities.