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

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Date Published: 09/06/2019 12:53 PM
AB166:v94#DOCUMENT

Amended  IN  Senate  September 06, 2019
Amended  IN  Senate  August 30, 2019
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 require the department to establish, no later than January 1, 2021, a violence intervention pilot program at a minimum of 9 sites, including at least one site in 9 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 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 require the department to issue, at least one calendar year prior to the inoperative date, a report to the Legislature on the implementation of the violence intervention pilot program, and the demonstrated impact of violence preventive services.
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 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 nine 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 Bernardino.
(7) San Francisco.
(8) Santa Clara.
(9) 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.
(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 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 Care coordination and patient support practices.
(4) Patient privacy and the federal Health Insurance Portability and Accountability Act of 1996.
(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 subdivision (f).
(2) Ensure that the qualified violence prevention professional is providing violence preventive services consistent with the requirements specified in subdivision (e).
(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.
(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.
(k) This section does not alter the scope of practice for any health care professional 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.
(l) At least one calendar year prior to the inoperative date of this section pursuant to subdivision (m), the department shall issue a report to the Legislature, in compliance with Section 9795 of the Government Code, on the implementation of the violence intervention pilot program established under this section, and the demonstrated impact of violence preventive services. The report shall, at a 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 whether violence intervention sites implemented pursuant to this section have reduced the incidence of risk factors for violent injury and reinjury among individuals receiving violence preventive services. The analysis shall consider all of the following:
(A) Data available from the Medi-Cal program related to claims and other available data sources on the incidence of violent injury and reinjury among individuals receiving violence preventive services.
(B) Data and analysis from published, peer-reviewed evaluations of violence intervention sites implemented pursuant to this section.
(7) A comparison of the outcomes of the violence intervention pilot program implemented pursuant to this section to the outcomes of other substantially similar violence preventive service programs that have been published in peer-reviewed evaluations.
(8) Recommendations on how to improve implementation of the pilot program established under this section, including all of the following information:
(A) A description of any administrative barriers or other challenges identified by stakeholders.
(B) Recommendations on legislative or policy changes needed, if any, to promote effective utilization of violence preventive services in the population served by the Medi-Cal program.
(C) Recommendations on whether to expand the Medi-Cal schedule of benefits to include violence preventive services, and, if those services are a benefit under the Medi-Cal program, recommendations on which delivery system, such as fee-for-service or managed care, including a Medi-Cal managed care health plan or county mental health plan, should provide those services.
(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.
(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.