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AB-1175 Medi-Cal: mental health services.(2019-2020)

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Date Published: 08/12/2019 02:00 PM
AB1175:v91#DOCUMENT

Amended  IN  Senate  August 12, 2019
Amended  IN  Senate  July 08, 2019
Amended  IN  Senate  June 24, 2019
Amended  IN  Assembly  May 16, 2019
Amended  IN  Assembly  April 23, 2019
Amended  IN  Assembly  April 02, 2019
Amended  IN  Assembly  April 01, 2019
Amended  IN  Assembly  March 18, 2019

CALIFORNIA LEGISLATURE— 2019–2020 REGULAR SESSION

Assembly Bill
No. 1175


Introduced by Assembly Member Wood

February 21, 2019


An act to amend Sections 14707.7 and 14715 of, and to add Sections 14197.06, 14197.08, 14197.09, and 14715.5 to, the Welfare and Institutions Code, relating to Medi-Cal.


LEGISLATIVE COUNSEL'S DIGEST


AB 1175, as amended, Wood. Medi-Cal: mental health 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, including specialty mental health services and nonspecialty mental health 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 county mental health plans. Under existing law, the county mental health plans are responsible for providing specialty mental health services to enrollees, and Medi-Cal managed care health plans deliver nonspecialty mental health services to enrollees. Existing law requires county mental health plans and Medi-Cal managed care health plans to be governed by various guidelines, including network adequacy standards and a requirement that an external quality review organization (EQRO) annually review these plans. Existing law requires the department to consult with stakeholders, including subject matter experts who represent providers, to inform the updates to the performance outcomes reports for specialty mental health services. Existing law requires the department to ensure that contracts for county mental health plans and the Medi-Cal managed care health plans include a process for screening, referral, and coordination with necessary services, and to require a county mental health plan that provides Medi-Cal specialty mental health services to enter into a memorandum of understanding (MOU) with a Medi-Cal managed care health plan that provides Medi-Cal health services to some of the same Medi-Cal recipients served by the county mental health plan. Existing regulations provide for a dispute resolution process to be used to resolve matters between a Medi-Cal managed care health plan and a county mental plan.
This bill would require the department, as part of its consultation with stakeholders stakeholders, including Medi-Cal managed care plans, concerning updates to the performance outcomes reports for specialty mental health services, to include additional components in those reports, including information on language access. The bill would require the department, commencing January 1, 2021, and annually thereafter, to update the performance dashboard to include the Healthcare Effectiveness Data and Information Set measures and Consumer Assessment of Healthcare Providers and Systems measures. The access, and would make other changes to the consultation requirements. The bill would require the department to select performance measures that enable a comparison of Medi-Cal managed care plan performance relating to individuals who are either receiving or not receiving specialty mental health services from a county mental health plan, and would require the department to include the selected measures on the performance dashboard.
The bill would require each county mental health plan and Medi-Cal managed care health plan, commencing January February 1, 2021, to annually track and report specified county-specific information on referrals to other plans and how soon those referred services were rendered. The bill would require the department to require the EQRO to report, by specified dates, various information concerning the county mental health plan and the Medi-Cal managed care health plan, such as the average expenditure per individual provided mental health services and provider usage of electronic health record systems.
This bill would require a county mental health plan and a Medi-Cal managed care health plan to provide continuity of care to a Medi-Cal enrollee who receives either specialty or nonspecialty mental health services from a respective plan by ensuring that an enrollee may access all of their mental health services-related care from one provider and through one plan if specified requirements are met, including that the enrollee has an ongoing relationship with that provider. The bill would require the plans to inform enrollees of their rights to avail themselves to continuity of care in the beneficiary handbook.
This bill would require a county mental health plan and a Medi-Cal managed care health plan to provide, on a monthly basis, to the respective Medi-Cal managed care health plan and county mental health plan a list that identifies specified information, including the contact information of the patient and provider, relating to the members of the respective plans who are receiving, or have received, any specialty mental health services. The bill would require the department to consult with specified subject matter experts, including Medi-Cal beneficiary advocates, to develop implementing guidance to assist plans in meeting these requirements. The bill would require the department to implement, by July 1, 2020, these provisions by any of various means, including plan letters, and to that direct county mental health plans and Medi-Cal managed care health plans to exchange the required information.
This bill would require the department to require that the MOU include additional components, including care coordination protocols between a county mental health plan and a Medi-Cal managed care health plan. plan, for contracts entered into, amended, modified, extended, or renewed on or after January 1, 2021. The bill would require the department to annually evaluate the implementation of the MOU and related protocol and policies, and to report to the Legislature on specified matters, including the findings of the review and identifying the timeframes for these plans to achieve compliance with these provisions by January 1, 2021. The bill would require a county mental health plan and Medi-Cal managed care health plan that are unable to resolve a dispute to submit a request for resolution to the department, and to ensure that there is no delay in the provision of medically necessary services pending the resolution of the dispute. The bill would require the department to issue a written decision to the plans within 30 calendar days from receipt of the request.
Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: NO  

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


SECTION 1.

 Section 14197.06 is added to the Welfare and Institutions Code, to read:

14197.06.
 (a) The department shall require the federally required external quality review organization to report, on or before January 1, 2021, and annually thereafter, on both of the following:
(1) For each Medi-Cal managed care health plan, the average mental health expenditure per plan member that received Medi-Cal covered mental health services from the Medi-Cal managed care plan, identified by the type of mental health service and in the aggregate. plan.
(2) For each county mental health plan, the average expenditure per plan member, from all funds sources, for Medi-Cal covered specialty mental health services that are the responsibility of the county mental health plan, identified by the type of mental health service and in the aggregate.
(b) The department shall require the federally required external quality review organization to report, on or before January 1, 2021, and again on or before January 1, 2023, on all of the following:
(1) For each county mental health plan, the number and percentage of both of the following:
(A) Mental health care providers that are contracted with or employed by the county.
(B) Mental health care providers who have one or more contracts for mental health services with one or more Medi-Cal managed care health plans in the county.
(2) For each Medi-Cal managed care health plan, the number and percentage of contracting mental health care providers in the county who have a contract with the county mental health plan for specialty mental health services.
(3) For each county mental health plan, the number and percentage of mental health care providers that are contracted with or employed by the county who use any of the following:
(A) An electronic health record system.
(B) An electronic health record system or health information exchange that allows the electronic sharing of patient information between the contracted provider and one or more county mental health plans’ electronic health record system.
(C) An electronic health record system or health information exchange that allows the electronic sharing of patient information between the contracted provider and one or more Medi-Cal managed care health plans’ electronic health record systems.
(D) An electronic health record system or health information exchange that allows the electronic sharing of patient information between the contracted provider and one or more Medi-Cal managed care health plans and county mental health plans, and is interoperable with both entities.
(4) For each managed care health plan, the number and percentage of contracting mental health care providers who use any of the following:
(A) An electronic health record system.
(B) An electronic health record system or health information exchange that allows the electronic sharing of patient information between the contracted provider and a county mental health plan’s electronic health record system.
(C) An electronic health record system or health information exchange that allows the electronic sharing of patient information between the contracted provider and the Medi-Cal managed care health plan.
(D) An electronic health record system or health information exchange that allows the electronic sharing of patient information between the contracted provider and both the Medi-Cal managed care health plan and the county mental health plan.

SEC. 2.

 Section 14197.08 is added to the Welfare and Institutions Code, to read:

14197.08.
 (a) In enacting this section, it is the intent of the Legislature to improve the treatment and care coordination of individuals receiving services from both Medi-Cal managed care health plans and county specialty mental health plans.
(b) (1) Effective 60 180 days after the issuance of the guidance required pursuant to subdivision (f), each county mental health plan shall electronically provide, on a monthly basis, and in a standard data format that is mutually agreed upon by the county mental health plan and the Medi-Cal managed care health plan, to the Medi-Cal managed care health plans or plan providing services in that county a list that identifies the members of the respective Medi-Cal managed care health plans provided pursuant to paragraph (2) who are receiving, or have received, any specialty mental health services within that month.
(2) A Medi-Cal managed care health plan shall furnish, on a monthly basis, and in a standard data format that is mutually agreed upon by the Medi-Cal managed care health plan and the county mental health plan, to the county mental health plan a list of its members for purposes of meeting the requirement of paragraph (1).
(c) For purposes of complying with paragraph (1) of subdivision (b), each county mental health plan shall include, as part of the transferred data, all of the following information:
(1) The name of the patient.
(2) The patient’s date of birth.
(3) The patient’s Medi-Cal beneficiary identification number or social security number.
(4) The patient’s current mental health diagnosis.
(5) The patient’s current medication, if known by the plan.
(6) The date of service in the reporting period and services provided.
(7) The patient’s contact information, including residential address and telephone number, if known.
(8) The provider’s contact information, including telephone number, email address, and office address, if known.
(9) Any additional data elements selected by the department, as necessary, for managed care plans to implement, calculate, or monitor quality measures established by the department.
(d) (1) Following the exchange of information between the plans as described in subdivision (b), each Medi-Cal managed care health plan shall electronically provide, on a monthly basis, and in a standard data format that is mutually agreed upon by the Medi-Cal managed care health plan and the county mental health plan, to the county mental health plan both of the following:
(A) A list of those members of the Medi-Cal managed care health plan who are also receiving specialty mental health services from the county mental health plan based on the information provided pursuant to subdivision (b).
(B) The information specified in subdivision (e) relating to those members of the Medi-Cal managed care health plan who are also receiving specialty mental health services from the county mental health plan.
(2) Effective 60 180 days after the issuance of the guidance required pursuant to subdivision (f), each Medi-Cal managed care health plan shall comply with the requirements specified in paragraph (1).
(e) For purposes of complying with paragraph (2) of subdivision (b) and subdivision (d), each Medi-Cal managed care health plan shall include, as part of the transferred data, all of the following information:
(1) The name of the patient.
(2) The patient’s date of birth.
(3) The patient’s Medi-Cal beneficiary identification number or social security number.
(4) The patient’s current physical health diagnosis, including any chronic health conditions, such as diabetes and hypertension.
(5) The patient’s current mental health diagnosis.
(6) The patient’s prescription medication that is known to the Medi-Cal managed care health plan.
(7) The patient’s contact information, including residential address and telephone number, if known.
(8) The name, telephone number, email address, and office address, if known, of the patient’s primary care provider and date of the most recent primary care visit.
(9) Any additional data elements selected by the department, as necessary, for county mental health plans to implement, calculate, or monitor performance measures established by the department.
(f) (1) The department shall consult with subject matter experts who represent county mental health plans, Medi-Cal beneficiary advocates, and Medi-Cal managed care plans to develop implementing guidance to assist county mental health plans and Medi-Cal managed care plans in meeting the requirements of this section. The guidance shall include recommendations for timely health information exchange as required to implement this section in a manner that is compliant with all relevant privacy protections described in subdivision (g).

(f)

(2) Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, by July 1, 2020, the department shall implement, interpret, or make specific this section by means of all-county letters, plan letters, plan or provider bulletins, or similar instructions that direct county mental health plans and Medi-Cal managed care health plans to exchange information consistent with the requirements of this section. section, including the recommendations developed through the stakeholder consultation process described in paragraph (1).
(g) This section shall not be construed to diminish or undermine the privacy protections under the Confidentiality of Medical Information Act (Part 2.6 (commencing with Section 56) of Division 1 of the Civil Code), the Health Insurance Portability and Accountability Act privacy rule (Part 160 and Subparts A and E of Part 164 of Title 45 of the Code of Federal Regulation), or under any other state or federal law.

SEC. 3.

 Section 14197.09 is added to the Welfare and Institutions Code, to read:

14197.09.
 (a) A Medi-Cal managed care health plan shall provide continuity of care to a Medi-Cal enrollee who receives specialty mental health services from a county mental health plan by ensuring that the specialty mental health services provider may also provide nonspecialty mental health services to the enrollee if all of the following requirements are met:
(1) The enrollee has an ongoing relationship with the mental health care provider.
(2) The mental health care provider is willing to accept the Medi-Cal managed care health plan’s rate for the service offered, or the applicable fee-for-service rate, whichever is higher.
(3) The Medi-Cal managed care health plan determines that the mental health care provider meets applicable professional standards and has no disqualifying quality of care issues.
(4) The mental health care provider is a Medi-Cal-approved provider.
(5) The mental health care provider supplies the Medi-Cal managed care plan with all of the relevant treatment information, for the purpose of determining medical necessity, and with the current treatment plan, to the extent authorized under federal and state privacy laws and regulations.
(b) A county mental health plan shall provide continuity of care to a Medi-Cal enrollee who receives nonspecialty mental health services from a Medi-Cal managed care health plan by ensuring that the nonspecialty mental health services provider may also provide specialty mental health services to the enrollee if all of the following requirements are met:
(1) The enrollee has an ongoing relationship with the mental health care provider.
(2) The mental health care provider is willing to accept the county mental health plan’s rate for the service offered, or the applicable Medi-Cal fee-for-service rate, whichever is higher.
(3) The county mental health plan determines that the mental health care provider meets applicable professional standards and has no disqualifying quality of care issues.
(4) The mental health care provider is a Medi-Cal-approved provider.
(5) The mental health care provider supplies the county mental health plan with all of the relevant treatment information, for the purpose of determining medical necessity, and with the current treatment plan, to the extent authorized under federal and state privacy laws and regulations.
(c) Each Medi-Cal managed care plan and county mental health plan shall include, as part of its beneficiary handbook, a description of the rights of an enrollee to continue to receive covered Medi-Cal mental health services with the same mental health care provider.
(d) The covered services specified in this section shall be provided for a period of time necessary to complete a course of treatment and to arrange for a safe transfer to another provider, as determined by the county mental health plan or the Medi-Cal managed care health plan, in consultation with the enrollee and the treating provider, and consistent with good professional practice. Completion of covered services under this section shall not exceed 12 months from the contract termination date or 12 months from the effective date of coverage for a newly covered enrollee.

SEC. 4.

 Section 14707.7 of the Welfare and Institutions Code is amended to read:

14707.7.
 (a) It is the intent of the Legislature to build upon performance outcomes system reports the department has developed pursuant to Section 14707.5 and the Special Terms and Conditions of the Medi-Cal Specialty Mental Health Services Waiver, as approved pursuant to Section 1915(b) of the federal Social Security Act (42 U.S.C. Sec. 1396n(b)), in order to provide data to inform strategies to increase access to mental health services and to reduce mental health disparities.
(b) (1) Commencing no later than January 15, 2018, and as needed thereafter, the department shall consult with stakeholders, including, but not limited to, subject matter experts who represent providers, consumer advocates, consumers, family members, counties, Medi-Cal managed care plans, and the Legislature, to inform the updates to the performance outcomes reports for specialty mental health that the department developed pursuant to Section 14707.5 and the Special Terms and Conditions of the Medi-Cal Specialty Mental Health Services Waiver. The stakeholder consultation shall continuously inform the development of performance outcome and disparities reduction measures.
(2) In building upon the performance outcomes reports for specialty mental health services, the department shall also consider all of the following objectives, among others:
(A) High-quality, culturally and linguistically competent, and accessible specialty mental health services for all eligible beneficiaries, consistent with federal law.
(B) Strategies to reduce mental health disparities.
(C) Strategies to reduce suicide rates, and to reduce the amount of populations with low treatment prevalence rates.
(3) The performance outcomes reports for specialty mental health services shall also consider the Special Terms and Conditions of the Medi-Cal Specialty Mental Health Services Waiver, as approved pursuant to Section 1915(b) of the federal Social Security Act (42 U.S.C. Sec. 1396n(b)) and the Medicaid Managed Care Quality Rating System.
(4) In order to identify mental health disparities, at a minimum, the performance outcomes reports for specialty mental health services shall be produced using existing data collected by the state, stratified by both the statewide and county levels in the following areas:
(A) Access, such as timely access to services, including waiting time to assessment and waiting time to first appointment.
(B) Language capacity and language access.
(C) Quality, including outcomes and patient experience.
(D) Utilization by service type and penetration.
(E) Grievance and appeals.
(5) (A) Data required pursuant to paragraph (4) shall be stratified by age, sex, gender identity, race, ethnicity, primary language, sexual orientation, and any other data elements for which there is peer-reviewed evidence to assess performance outcomes related to mental health disparities.
(B) The department shall not report any demographic data under paragraph (4) or this paragraph that would permit identification of individuals.
(6) (A) The department shall publish the performance outcomes reports based on available data for specialty mental health services described in this section on the department’s internet website by December 31, 2018. The department shall also provide the performance outcomes reports to the Legislature by December 31, 2018.
(B) Commencing January 1, 2019, and annually thereafter, the department shall update the performance outcomes reports for specialty mental health services and shall post the updated reports on the department’s internet website.
(7) Commencing January 1, 2019, the department shall consult, as needed, with the stakeholders specified in paragraph (1) to do both of the following:
(A) Incorporate additional components into the performance outcomes reports, stratified by statewide, county, county- or department-approved reporting unit, and plan levels, including, but not limited to, components concerning the reduction of mental health disparities, such as timely access to services, language access, and quality and utilization measures, relating to mental health services obtained through Medi-Cal managed care plans.
(B) Make recommendations for statewide quality improvement and efforts to reduce mental health disparities based on information reported in the performance outcomes reports.
(8) Upon completion of the activities specified in paragraph (7), the department shall consult with stakeholders on an as-needed basis.

(c)Commencing January 1, 2021, and annually thereafter, the department shall update the performance dashboard to include the Healthcare Effectiveness Data and Information Set measures and Consumer Assessment of Healthcare Providers and Systems measures, as reported by Medi-Cal managed care health plans, stratified by individuals who are diagnosed with severe mental illness.

(c) (1) It is the intent of the Legislature to monitor the performance of Medi-Cal managed care plans in providing medically necessary covered services to Medi-Cal beneficiaries who are adults with a serious mental illness and children and adolescents with a serious emotional disturbance.
(2) By January 1, 2021, and as needed thereafter, the department, in consultation with county mental health plans, Medi-Cal managed care plans, and advocates for Medi-Cal beneficiaries, shall select performance measures that enable a comparison of the following:
(A) Medi-Cal managed care plan performance in treating individuals who are enrolled in that managed care plan to individuals who are enrolled in that managed care plan and who are also receiving specialty mental health services from a county mental health plan.
(B) The performance of each Medi-Cal managed care plan in the performance measures described in subparagraph (A), as compared to other plans.
(3) In selecting the measures, the department shall include measures that are based on administrative and clinical data, and not solely based on encounter data. The department shall also consider co-morbidities that result in lower life expectancies for adults with a serious mental illness and children and adolescents with a serious emotional disturbance.
(4) By January 1, 2022, and annually thereafter, the department shall report the measures selected pursuant to paragraph (2) on the Medi-Cal managed care plan performance dashboard.
(d) (1) Commencing January February 1, 2021, and annually thereafter, each county mental health plan and each Medi-Cal managed care health plan shall track and report to the department all of the following information, information regarding individuals referred from one plan to the other plan, stratified by county county- or department-approved reporting unit, if county level data is are unavailable:
(A) The number of referrals from one plan to the other plan.
(B) The mean and median time from the date of first contact with the plan to request services made by or on behalf of the enrollee to the date of first offer of any mental health service covered by the plan.
(C) The number and percentage of requests for appointment assistance made by enrollees to the respective plan for mental health service that resulted in the enrollee being offered the requested service within the timeframes for offering an appointment for urgent and nonurgent mental health services established pursuant to subdivision (d) of Section 14197.
(2) The department shall make the information described in paragraph (1) publicly available on its internet website.
(e) Notwithstanding 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 subdivision by means of all-county letters, plan letters, plan or provider bulletins, or similar instructions, without taking regulatory action.

SEC. 5.

 Section 14715 of the Welfare and Institutions Code is amended to read:

14715.
 (a) (1)The For contracts entered into, amended, modified, extended, or renewed on or after January 1, 2001, both of the following shall apply:
(1) The department shall require a county mental health plan that provides Medi-Cal specialty mental health services to enter into a memorandum of understanding with any Medi-Cal managed care plan that provides Medi-Cal health services to some of the same Medi-Cal recipients served by the county mental health plan. The memorandum of understanding shall comply with applicable regulations, including Section 1810.370 of Title 9 of the California Code of Regulations. regulations.

(2)For purposes of this section, a “Medi-Cal managed care health plan” means any prepaid health plan or Medi-Cal managed care health plan contracting with the department to provide services to enrolled Medi-Cal beneficiaries under Chapter 7 (commencing with Section 14000) or Chapter 8 (commencing with Section 14200), or Part 4 (commencing with Section 101525) of Division 101 of the Health and Safety Code.

(b)

(2) The department shall require the memorandum of understanding to include all both of the following:

(1)

(A) A process and or entity to be designated by the county mental health plan to receive notice of adverse benefit determinations related to requests for mental health services actions, denials, or deferrals from the Medi-Cal managed care health plan, and to provide any additional information requested in the notice in accordance with Section 438.210(d) of Title 42 of the Code of Federal Regulations, and deferral notice as necessary for a medical necessity determination.

(2)

(B) A requirement that the county mental health plan respond by the close of the business day following the day the notice is received.
(b) For contracts entered into, amended, modified, extended, or renewed on or after January 1, 2021, both of the following shall apply in lieu of the requirements of subdivision (a):
(1) The department shall require a county mental health plan that provides Medi-Cal specialty mental health services to enter into a memorandum of understanding with any Medi-Cal managed care plan that provides Medi-Cal health services to some of the same Medi-Cal recipients served by the county mental health plan. The memorandum of understanding shall comply with applicable regulations, including Section 1810.370 of Title 9 of the California Code of Regulations.
(2) The department shall require the memorandum of understanding to include all of the following:
(A) A process and entity to be designated by the county mental health plan to receive adverse benefit determinations related to requests for mental health services from the Medi-Cal managed care plan, and to provide any additional information requested in the notice in accordance with Section 438.210(d) of Title 42 of the Code of Federal Regulations, and as necessary for a medical necessity determination.
(B) A requirement that the county mental health plan respond by the close of the business day following the day the notice is received.

(3)

(C) A referral protocol between the county mental health plan and the Medi-Cal managed care health plan that refers the enrollee to another plan if it is determined that the enrollee seeks mental health services that are the responsibility of another plan.

(4)

(D) Care coordination protocols between county mental health plans and Medi-Cal managed care health plans that address all of the following:

(A)

(i) Care coordination requirements, as addressed in all-county letters, plan letters, plan or provider bulletins, or similar instructions that are issued by the department.

(B)

(ii) Coordination of care for transportation services, including nonmedical transportation, as specified in subdivision (ad) of Section 14132.

(C)

(iii) Protocols to ensure that enrollees with mental health conditions who also receive services through the Drug Medi-Cal Treatment Program, also known as Drug Medi-Cal, or the Drug Medi-Cal organized delivery system, as authorized under the California Medi-Cal 2020 Demonstration, Number 11-W-00193/9, and as approved by the federal Centers for Medicare and Medicaid Services and described in the Special Terms and Conditions, have access to appropriate and coordinated services.

(5)

(E) A process to review implementation of the memorandum of understanding and related policies and protocols. This process shall, at a minimum, occur on an annual basis.
(F) Protocols for the exchange of data required by Section 14197.08.
(c) (1) The department shall, as part of an existing review process, annually evaluate the implementation of the memoranda of understanding and related protocol and policies for compliance with this section. subdivision (b). This review process shall consider policies and practices from county mental health plans and Medi-Cal managed care health plans, and grievances and appeals related to coordination of care between the plans.
(2) The department shall submit a joint report to Legislature summarizing the findings of this review, describing any corrective action that is required from the county mental health plans or the Medi-Cal managed care health plans, and identifying the timeframes for these plans to achieve compliance with the requirements of this section subdivision (b) by January 1, 2021.
(3) The requirement for submitting a report imposed under paragraph (2) shall be inoperative four years from the date that the report is due, pursuant to Section 10231.5 of the Government Code.
(4) A report to be submitted pursuant to paragraph (3) shall be submitted in compliance with Section 9795 of the Government Code.
(d) The department may sanction a county mental health plan pursuant to subdivision (e) of Section 14712 for failure to comply with this section.

(e)This section applies to contracts entered into, amended, modified, extended, or renewed on or after January 1, 2021.

(e) For purposes of this section, a “Medi-Cal managed care plan” means any prepaid health plan or Medi-Cal managed care plan contracting with the department to provide services to enrolled Medi-Cal beneficiaries under Chapter 7 (commencing with Section 14000) or Chapter 8 (commencing with Section 14200), or Part 4 (commencing with Section 101525) of Division 101 of the Health and Safety Code.

SEC. 6.

 Section 14715.5 is added to the Welfare and Institutions Code, immediately following 14715, to read:

14715.5.
 (a) (1) If a county mental health plan and a Medi-Cal managed care health plan have a dispute, as described in Section 1850.505 of Title 9 of the California Code of Regulations, and are unable to reach a resolution within 15 business days from the initiation of the dispute resolution process, both the county mental health plan and the Medi-Cal managed care health plan shall submit a request for resolution to the department.
(2) The department shall, within 30 calendar days from the receipt of the request, issue a written decision to the county mental health plan and the Medi-Cal managed care health plan.
(b) A dispute between the county mental health plan and the Medi-Cal managed care health plan shall not delay the provision of medically necessary services by the Medi-Cal managed care health plan or the county mental health plan. Pending resolution of the dispute, both plans shall comply with Section 1850.525 of Title 9 of the California Code of Regulations.