Today's Law As Amended


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AB-586 Pupil health: health and mental health services: School Health Demonstration Project.(2021-2022)



As Amends the Law Today


SECTION 1.
 The Legislature finds and declares all of the following:
(a) Approximately 6,100,000 children, nearly 60 percent of all children in California, are enrolled in Medi-Cal.
(b) Only 5 percent of low-income children currently access the mental health services they are entitled to in California. Of those pupils who receive mental health services, many receive those services at school.
(c) Local educational agencies often lack the capacity to develop partnerships to access Medi-Cal funding and support school-based health and mental health services. The current Medi-Cal program tends to be administratively burdensome for local educational agencies.
(d) California schools draw down significantly less in reimbursements for Medicaid services than other states.
(e) Beginning in April 2020 when the COVID-19 pandemic led to school closures, the proportion of children’s mental health-related emergency department visits among all pediatric emergency visits increased and remained elevated through October 2020. Compared with 2019, the proportion of mental health-related visits for children 5 to 11 years of age and 12 to 17 years of age increased approximately 24 percent and 31 percent, respectively.
(f) In order to address this exacerbated issue, schools need significant support to build the infrastructure and capacity necessary to provide comprehensive health and mental health services for vulnerable youth.
(g) By leveraging available Medi-Cal funding for eligible pupils, and identifying additional revenue sources, schools will be better positioned to support the social, emotional, and mental health needs of their pupils.

SEC. 2.

 Section 49427.1 is added to the Education Code, to read:

49427.1.
 (a) Subject to an appropriation for this purpose, there is hereby established the School Health Demonstration Project, a pilot project to expand comprehensive health and mental health services to public school pupils by providing local educational agencies with intensive assistance and support to build the capacity for long-term sustainability by leveraging multiple funding streams. For these purposes, the project is intended to provide training and technical assistance on the requirements for health care provider participation in the Medi-Cal program pursuant to Article 1.3 (commencing with Section 14043) of Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions Code to enable local educational agencies to participate in, contract with, and conduct billing and claiming in the Medi-Cal program through all of the following:
(1) The Local Educational Agency Medi-Cal Billing Option Program.
(2) The School-Based Medi-Cal Administrative Activities Program.
(3) Contracting or entering into a memorandum of understanding with Medi-Cal managed care plans as a participating Medi-Cal managed care plan contracting provider.
(4) Contracting or entering into a memorandum of understanding with county mental health plans for specialty mental health services through the Early and Periodic Screening, Diagnostic and Treatment program.
(5) Contracting with community-based providers to deliver health and mental health services to pupils in school through contracts with Medi-Cal managed care plans or county mental health plans.
(6) Employment of classified and certificated staff to provide health and mental health services to pupils at schoolsites.
(b) On or before March 1, 2022, the Superintendent, in consultation with the state board and the State Department of Health Care Services, shall select up to three organizations to serve as technical assistance teams for purposes of the pilot project. Organizations selected to serve as technical assistance teams may be one or more local educational agencies, a county agency, a community-based organization, or consortia with extensive experience in special education, school finance, Medicaid billing, commercial health insurance, and data analysis. The technical assistance teams are intended to provide hands-on, intensive support for a two-year period to the local educational agencies selected to be pilot participants to create capacity for those local educational agencies to become self-sustaining by securing federal reimbursement and other funding streams for health and mental health services provided to pupils. In selecting the technical assistance teams, consideration shall be given to demonstrated expertise, including, but not limited to, the following:
(1) Knowledge of the process to submit claims through the Local Educational Agency Medi-Cal Billing Option Program, the School-Based Medi-Cal Administrative Activities Program, and drawing down federal reimbursement for Medi-Cal services.
(2) The knowledge and capacity to provide direct, hands-on assistance and support to selected local educational agencies in securing federal reimbursement for health and mental health services provided to pupils, and identifying additional sources of funding through programs identified in subdivision (a).
(3) Experience working with the department, the State Department of Health Care Services, county health departments, county behavioral health departments, Medi-Cal managed care plans, private health care service plans and health insurers, and the Mental Health Services Oversight and Accountability Commission.
(c) On or before May 1, 2022, the department, in consultation with the State Department of Health Care Services, shall select up to 10 local educational agencies to serve as pilot participants for a period of two years. In selecting local educational agencies to serve as pilot participants, consideration shall be given to all of the following factors:
(1) Demonstrated need for health and mental health services for pupils.
(2) Commitment of the local educational agency’s leadership to expand health and mental health services for all pupils.
(3) Willingness to reinvest increased reimbursements gained through the pilot project into direct health and mental health services for pupils.
(4) Unduplicated pupil count.
(5) Geographic diversity of the state.
(6)  Mix of urban, suburban, and rural.
(d) A local educational agency selected to serve as a pilot participant pursuant to subdivision (c) shall receive up to five hundred thousand dollars ($500,000) per year for each of the two years it participates in the pilot project. Funds shall be used for contracting with one of the technical assistance teams identified by the department pursuant to subdivision (b), and may also be used for, but are not limited to being used for, any of the following:
(1) Staffing, including the hiring of support staff responsible for Medi-Cal and other insurance billing.
(2) Professional development and participation in professional learning networks related to pupil health and mental health.
(3) Conducting outreach to pupils and families.
(4) Data analysis and reporting.
(e) The technical assistance teams selected pursuant to subdivision (b) shall, under the direction of the department, work with each pilot participant to do all of the following:
(1) Conduct an analysis of all of the following related to the local educational agency:
(A) The need for health and mental health services for pupils.
(B) The current capacity within the local educational agency to meet those needs.
(C) Current participation in the programs identified in paragraphs (1) and (2) of subdivision (a).
(D) The barriers to participating in the programs identified in paragraphs (1) and (2) of subdivision (a).
(E) Any existing partnerships with county agencies or community-based agencies to provide health and mental health services to pupils.
(2) Work with local educational agency staff to establish or expand the expertise necessary to maximize federal reimbursement revenue through an analysis of past claims and review eligible school expenditures to ensure maximum usage of potential Medi-Cal reimbursements, including the Early and Periodic Screening, Diagnostic, and Treatment services provided to eligible pupils.
(3) Facilitate the exploration of opportunities to collaborate with county mental health plans, Medi-Cal managed care plans, and private health care service plans and health insurers to establish partnerships through memoranda of understanding or other means to coordinate the funding and provision of health and mental health services to pupils.
(4) Complete, and provide to the department, a final report at the conclusion of the pilot project with data on any increases in the level of health and mental health services provided to pupils in the local educational agency, increased funding secured, plans for ongoing sustainability of health and mental health services beyond the pilot project period, and recommendations on maximizing federal reimbursement and other revenue streams to provide effective health and mental health services to pupils.
(f) (1) The department, in consultation with the State Department of Health Care Services, participating local educational agencies, and the technical assistance teams established pursuant to subdivision (b) shall prepare and submit to the relevant policy and fiscal committees of the Legislature on or before January 1, 2025, or six months after the final local educational agency has ended its service as a pilot participant, whichever comes first, a final report of the pilot programs established pursuant to this section. The report shall include, but not be limited to, all the following:
(A) Best practices developed by local educational agencies that ensure every pupil receives an uninterrupted continuum of care services.
(B) Program requirements and support services needed for the Local Educational Agency Medi-Cal Billing Option Program, the School-based Medi-Cal Administrative Activities Program, and medically necessary federal Early and Periodic Screening, Diagnostic, and Treatment benefits, to ensure ease of use and access for local educational agencies.
(C) Total dollars drawn down from federal sources by local educational agencies participating in the pilot project.
(D) The number of pupils receiving health and mental health services by participating local educational agencies throughout the course of the pilot project, including breakdowns by subgroups.
(E) Recommendations for expanding the program statewide, including an estimate of the cost of fully funding an ongoing technical assistance and support program on a statewide basis.
(F) Recommendations on specific changes needed to state regulations or statute, the need for approval of amendments to the state Medicaid plan or federal waivers, changes to implementation of federal regulations, changes to state agency support and oversight, and associated staffing or funding needed to implement recommendations.
(2) A report to be submitted pursuant to paragraph (1) shall be submitted in compliance with Section 9795 of the Government Code.
(g) The department shall coordinate and collaborate with expert lead agencies identified pursuant to Section 52073.1, special education resource leads identified pursuant to Section 52073.2, the State Department of Health Care Services, and the Mental Health Services Oversight and Accountability Commission, in developing a statewide system of support for school-based health and mental health services.
(h) The department, in consultation with the technical assistance teams, the State Department of Health Care Services, and the Mental Health Services Oversight and Accountability Commission, shall prepare materials for use by local educational agencies in developing the capacity to effectively secure sustainable funding for the delivery of comprehensive health and mental health services to pupils.
(i) The State Department of Health Care Services shall seek federal financial participation for the activities conducted pursuant to this section.
(j) This section does not authorize the displacement of classified or certificated staff employed by the local educational agency to provide health and mental health services to pupils.
(k) The following definitions apply to this section:
(1) “County mental health plan” means an entity authorized pursuant to Article 5 (commencing with Section 14680) of Chapter 8.8 of Part 3 of Division 9 of the Welfare and Institutions Code.
(2) “Medi-Cal managed care plan” means an individual, organization, or entity that enters into a contract with the department to provide services to enrolled Medi-Cal beneficiaries pursuant to any of the following:
(A) Article 2.7 (commencing with Section 14087.3) of Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions Code, excluding dental managed care programs developed pursuant to Section 14087.46 of the Welfare and Institutions Code.
(B) Article 2.8 (commencing with Section 14087.5), Article 2.81 (commencing with Section 14087.96), Article 2.82 (commencing with Section 14087.98), Article 2.9 (commencing with Section 14088), or Article 2.91 (commencing with Section 14089) of Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions Code.
(C) Chapter 8 (commencing with Section 14200) of Part 3 of Division 9 of the Welfare and Institutions Code, excluding dental managed care plans.
(D) Chapter 3 (commencing with Section 101675) of Part 4 of Division 101 of the Health and Safety Code.