Today's Law As Amended


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SB-508 Mental health coverage: school-based services.(2021-2022)



As Amends the Law Today


SECTION 1.

 Section 49408 of the Education Code is amended to read:

49408.
 For the protection of a pupil’s health and welfare, the governing board of a school district may require the parent or legal guardian of a pupil to keep current at the pupil’s school of attendance, emergency information including the home address and telephone number, business address and telephone number of the parents or guardian, and  the name, address address,  and telephone number of a relative or friend who is authorized to care for the pupil in any emergency situation if the parent or legal guardian cannot be reached. reached, and information on the pupil’s health care service plan, health insurance, or Medi-Cal managed care plan provider, if applicable. The governing board of a school district may require the parent or legal guardian of a pupil to update this information if it changes during the school year. 

SEC. 2.

 Section 1374.722 is added to the Health and Safety Code, immediately following Section 1374.721, to read:

1374.722.
 (a) The Legislature finds and declares all of the following:
(1) All health care service plans are required to provide coverage for the diagnosis and medically necessary treatment of mental health disorders under the same terms and conditions applied to other medical conditions, as defined in state and federal law, including Sections 1374.72 and 1374.721 of this code and the federal Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (Public Law 110-343).
(2) Suicide rates in California increased by 225 percent between 1999 and 2016 for children 10 to 14 years of age.
(3) Thirty-seven percent of students with a mental health condition 14 years of age and older drop out of school. Pupils with emotional disturbances have the highest increase in absenteeism and dropout rates when compared to any other disability.
(4) Seventy percent of youth arrested each year have a mental health disorder.
(5) There is a shortage of qualified children’s mental health professionals in California. As a result, health care service plans struggle to provide covered children with adequate access to in-network mental health providers.
(6) Meanwhile, children are 21 times more likely to get the health and mental health services they need if services are provided on a school campus. School-based services increase access to qualified mental health care professionals and decrease the stigma around receiving mental health services.
(7) Local educational agencies (LEAs) frequently bear the cost of providing students with medically necessary mental health interventions and services.
(b) To ensure timely access to behavioral health interventions at the earliest onset of a behavioral health condition, an appropriate mental health professional, as described in Sections 49422 and 49424 of the Education Code and Chapters 6.6 (commencing with Section 2900), 13 (commencing with Section 4980), 14 (commencing with Section 4991), and 16 (commencing with Section 4999.10) of Division 2 of the Business and Professions Code, may provide brief initial interventions when necessary for all referred pupils, including pupils who are enrollees of a health care service plan contract.
(c) (1) Brief initial interventions, for purposes of this article, consist of behavioral health services, as described in paragraph (2), that are essential health benefits, as defined in state and federal law, including Section 1300.67.005 of Title 28 of the California Code of Regulations, Sections 1374.72 and 1374.721, and the federal Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (Public Law 110-343), and include, but are not limited to, mental health disorder services specified in California’s essential health benefits benchmark plan.
(2) Covered behavioral health services include preventive, diagnostic, therapeutic, and rehabilitative services as described in Section 51309 and subdivision (b) of Section 51360 of Title 22 of the California Code of Regulations.
(d) (1) For pupils who are enrollees of a health care service plan contract, the mental health professional or their designee shall contact the plan upon initiating the brief initial intervention services described in subdivision (b) to facilitate a referral to the health care service plan’s network providers, as appropriate and consistent with professionally recognized standards of practice, and in consultation with the pupil and their parent or guardian, in compliance with all applicable state and federal laws protecting a pupil’s right to privacy and right to consent, including Section 6924 of, and subdivision (b) of Section 6929 of, the Family Code, Sections 123110 and 123115 of this code, and Sections 56.10 and 56.11 of the Civil Code, and parental rights, including Section 164.502 of Title 45 of the Code of Federal Regulations.
(2) If a health care service plan is unable to offer the pupil an appointment with a network provider within 48 hours for an urgent care appointment or within 15 business days for a nonurgent appointment, the mental health professional may complete the brief initial intervention services. If a health care service plan cannot offer the pupil mental health services beyond the brief initial intervention services, the health care service plan and the LEA may negotiate a single case agreement to determine reimbursement for additional services.
(A) Absent a single case agreement, a health care service plan shall reimburse the local educational agency for services provided to pupils at the same rate that is provided to local educational agencies participating in the LEA Medi-Cal Billing Option program identified in Section 14115.8 of the Welfare and Institutions Code.
(B) A health care service plan shall meet requirements for the timely payment of claims for a contracted provider. If the health care service plan disputes the services provided or the amount, the health care service plan may submit a dispute to the Department of Managed Health Care, but shall still comply with requirements for timely payment, including for services or amounts in dispute.
(3) If a health care service plan can offer the pupil an appointment with a network provider within 48 hours for an urgent care appointment or within 15 business days for a nonurgent appointment, the mental health professional shall make a referral to the plan’s provider.
(d) Pursuant to subdivision (h) of Section 1374.72, a health care service plan shall not limit benefits or reimbursement for medically necessary services provided pursuant to this section on the basis that those services should be or could be covered by a public entitlement program, including, but not limited to, special education or an individualized education program, Medi-Cal, Medicare, Supplemental Security Income, or Social Security Disability Insurance.
(e) A health care service plan is encouraged to contract with LEAs to serve pupils who are receiving mental health services pursuant to this section.
(f) This section does not apply to a contract with a county mental health plan contracted with the State Department of Health Care Services pursuant to Chapter 8.9 (commencing with Section 14700) of Part 3 of Division 9 of the Welfare and Institutions Code.
(g) The billing provisions of this section do not apply if the mental health professional providing the brief initial intervention services is employed by an LEA that has executed a contract pursuant to Section 1374.723 with a pupil’s health care service plan.

SEC. 3.

 Section 1374.723 is added to the Health and Safety Code, immediately following Section 1374.722, to read:

1374.723.
 (a) A health care service plan that is required to provide coverage for the medically necessary treatment of mental health disorders pursuant to Sections 1374.72 and 1374.721 and the federal Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (Public Law 110-343), shall enter into a contract with a local educational agency (LEA) if 15 percent or more of the pupils enrolled are covered by the health care service plan. The contract shall describe the terms under which the health care service plan will coordinate with the LEA to provide diagnosis and medically necessary treatment of mental health disorders to pupils who are plan enrollees in one or more of the following ways:
(1) Pursuant to Section 1374.722, a health care service plan shall reimburse at the same rate that is provided to LEAs participating in the LEA Medi-Cal Billing Option program identified in Section 14115.8 of the Welfare and Institutions Code if, upon referral, the health care service plan is unable to offer the pupil an appointment with a network provider within 48 hours for an urgent care appointment or within 15 business days for a nonurgent appointment.
(2) A health care service plan shall designate and provide, through in-network providers or through a contracted community-based organization, one or more mental health professionals that shall provide services on the school campus at intervals that are sufficient to ensure that all pupils who are plan enrollees receive access to diagnosis and medically necessary mental health services. A health care service plan provider may use telehealth, as defined in Section 49429 of the Education Code, to facilitate the diagnosis, consultation, treatment, education, care management, and self-management of a pupil’s health care while the pupil is on the school campus and the health care provider is at a distant location.
(3) A health care service plan shall designate and provide, through in-network providers or through a contracted community-based organization, one or more mental health professionals that shall provide services within a 30 mile radius of the school campus where the referred pupil is enrolled. A health care service plan shall ensure that there are sufficient mental health professionals so that all pupils who are plan enrollees receive access to diagnosis and medically necessary mental health services within 48 hours for an urgent care appointment or within 15 business days for a nonurgent appointment.
(4) A health care service plan and the LEA shall agree upon an annual payment from the health care service plan to the LEA that will be used to fund one or more school mental health professional positions.
(5) A health care service plan shall designate one or more mental health professionals employed by the LEA as an in-network provider.
(b) (1) No later than March 1, 2022, and each subsequent year thereafter, an LEA shall calculate the percent of enrolled pupils that are plan enrollees for each health care service plan. If 15 percent or more of students are enrollees of a particular health care service plan, the LEA shall notify the health care service plan and inform them of the requirements under this section.
(2) A health care service plan shall have 30 business days to respond to the LEA’s notice. If a health care service plan fails to respond and begin negotiations on a contract within 30 business days, the LEA may inform the health care service plan that it intends to bill the health care service plan for services provided to pupils who are plan enrollees pursuant to Section 1374.722.
(3) A health care service plan and an LEA shall have no more than 90 business days after March 1 to reach agreement on the contract required by this section. If an agreement cannot be reached within 90 business days, the parties may mutually agree to extend the deadline by up to 90 additional business days. If the parties fail to reach an agreement, the LEA may continue to bill the health care service plan for services provided to pupils who are plan enrollees pursuant to Section 1374.722.
(4) If a health care service plan and an LEA have executed a contract pursuant to this section, the LEA shall not bill the health care service plan for services pursuant to Section 1374.722 for the duration of the contract.
(c) (1) One or more LEAs may enter into a joint partnership agreement with the county office of education for the purposes of meeting the obligations under this section. A health care service plan is required to enter into only one contract with the LEAs in a joint partnership agreement.
(2) The LEAs in a joint partnership agreement may combine their enrollment numbers to calculate the percent of enrolled pupils who are enrollees of each health care service plan.
(d) The State Department of Health Care Services, the Department of Insurance, the Department of Managed Health Care, and the State Department of Education shall develop a model contract for use by LEAs, health care service plans, and health insurers when implementing the requirements of this section or Section 10144.54 of the Insurance Code.

SEC. 4.

 Section 10144.53 is added to the Insurance Code, to read:

10144.53.
 (a) To ensure timely access to behavioral health interventions at the earliest onset of a behavioral health condition, an appropriate mental health professional, as described in Sections 49422 and 49424 of the Education Code and Chapters 6.6 (commencing with Section 2900), 13 (commencing with Section 4980), 14 (commencing with Section 4991), and 16 (commencing with Section 4999.10) of Division 2 of the Business and Professions Code may provide brief initial interventions when necessary for all referred pupils, including pupils who are insureds of a health insurance policy.
(b) (1) Brief initial interventions, for purposes of this article, consist of behavioral health services, as described in paragraph (2), that are essential health benefits, as defined in state and federal law, including Section 1300.67.005 of Title 28 of the California Code of Regulations, Sections 10144.5 and 10144.52 of this code, and the federal Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (Public Law 110-343), and include, but are not limited to, mental health disorder services specified in California’s essential health benefits benchmark plan.
(2) Covered behavioral health services include preventive, diagnostic, therapeutic, and rehabilitative services as described in Section 51309 and subdivision (b) of Section 51360 of Title 22 of the California Code of Regulations.
(c) (1) For pupils who are insureds of a health insurance policy, the mental health professional or their designee shall contact the health insurer upon initiating the brief initial intervention services described in subdivision (a) to facilitate a referral to the insurer’s network providers, as appropriate and consistent with professionally recognized standards of practice, and in consultation with the pupil and their parent or guardian, in compliance with all applicable state and federal laws protecting a pupil’s right to privacy and right to consent, including Section 6924 of, and subdivision (b) of Section 6929 of, the Family Code, Sections 123110 and 123115 of the Health and Safety Code, and Sections 56.10 and 56.11 of the Civil Code, and parental rights, including Section 164.502 of Title 45 of the Code of Federal Regulations.
(2) If a health insurer is unable to offer the pupil an appointment with a network provider within 48 hours for an urgent care appointment or within 15 business days for a nonurgent appointment, the mental health professional may complete the brief initial intervention services. If an insurer cannot offer the pupil mental health services beyond the brief initial intervention services, the insurer and the LEA may negotiate a single case agreement to determine reimbursement for additional services.
(A) Absent a single case agreement, a health insurer shall reimburse the local educational agency for services provided to pupils at the same rate that is provided to local educational agencies participating in the LEA Medi-Cal Billing Option program identified in Section 14115.8 of the Welfare and Institutions Code.
(B) A health insurer shall meet requirements for the timely payment of claims for a contracted provider. If a health insurer disputes the services provided or the amount, an insurer may submit a dispute to the Department of Insurance, but shall still comply with requirements for timely payment, including for services or amounts in dispute.
(3) If a health insurer can offer the pupil an appointment with a network provider within 48 hours for an urgent care appointment or within 15 business days for a nonurgent appointment, the mental health professional shall make a referral to the insurer’s provider.
(c) Pursuant to subdivision (h) of Section 10144.5, a health insurer shall not limit benefits or reimbursement for medically necessary services provided pursuant to this section on the basis that those services should be, or could be, covered by a public entitlement program, including, but not limited to, special education or an individualized education program, Medi-Cal, Medicare, Supplemental Security Income, or Social Security Disability Insurance.
(d) A health insurer is encouraged to contract with LEAs to serve pupils who are receiving mental health services pursuant to this section.
(e) This section does not apply to a contract with a county mental health plan contracted with the State Department of Health Care Services pursuant to Chapter 8.9 (commencing with Section 14700) of Part 3 of Division 9 of the Welfare and Institutions Code.
(f) The billing provisions of this section do not apply if the mental health professional providing the brief initial intervention services is employed by an LEA that has executed a contract pursuant to Section 10144.54 with a pupil’s health insurer.

SEC. 5.

 Section 10144.54 is added to the Insurance Code, to read:

10144.54.
 (a) A health insurer that is required to provide coverage for the medically necessary treatment of mental health disorders pursuant to Sections 10144.5 and 10144.52 and the federal Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (Public Law 110-343), shall enter into a contract with a local educational agency (LEA) if 15 percent or more of the pupils enrolled are insured by the health insurer. The contract shall describe the terms under which an insurer will coordinate with an LEA to provide diagnosis and medically necessary treatment of mental health disorders to insured pupils in one or more of the following ways:
(1) Pursuant to Section 10144.53, a health insurer shall reimburse at the same rate that is provided to LEAs participating in the LEA Medi-Cal Billing Option program identified in Section 14115.8 of the Welfare and Institutions Code if, upon referral, an insurer is unable to offer the pupil an appointment with a network provider within 48 hours for an urgent care appointment or within 15 business days for a nonurgent appointment.
(2) A health insurer shall designate and provide, through in-network providers or through a contracted community-based organization, one or more mental health professionals that shall provide services on the school campus at intervals that are sufficient to ensure that all insured pupils receive access to diagnosis and medically necessary mental health services. An insurer’s provider may use telehealth, as defined in Section 49429 of the Education Code, to facilitate the diagnosis, consultation, treatment, education, care management, and self-management of a pupil’s health care while the pupil is on the school campus and the health care provider is at a distant location.
(3) A health insurer shall designate and provide, through in-network providers or through a contracted community-based organization, one or more mental health professionals that shall provide services within a 30 mile radius of the school campus where the referred pupil is enrolled. An insurer shall ensure that there are sufficient mental health professionals so that all insured pupils receive access to diagnosis and medically necessary mental health services within 48 hours for an urgent care appointment or within 15 business days for a nonurgent appointment.
(4) A health insurer and an LEA shall agree upon an annual payment from the health insurer to the LEA that will be used to fund one or more school mental health professional positions.
(5) A health insurer shall designate one or more mental health professionals employed by the LEA as an in-network provider.
(b) (1) No later than March 1, 2022, and each subsequent year thereafter, an LEA shall calculate the percent of enrolled pupils insured by each health insurer. If 15 percent or more of students are insured by a particular insurer, the LEA shall notify the insurer and inform them of the requirements under this section.
(2) A health insurer shall have 30 business days to respond to an LEA’s notice. If a health insurer fails to respond and begin negotiations on a contract within 30 business days, an LEA may inform the insurer that it intends to bill the insurer for services provided to insured pupils pursuant to Section 10144.53.
(3) A health insurer and an LEA shall have no more than 90 business days after March 1 to reach agreement on the contract required by this section. If an agreement cannot be reached within 90 business days, the parties may mutually agree to extend the deadline by up to 90 additional business days. If the parties fail to reach an agreement, the LEA may continue to bill the insurer for services provided to insured pupils pursuant to Section 10144.53.
(4) If a health insurer and an LEA have executed a contract pursuant to this section, the LEA shall not bill the health insurer for services pursuant to Section 10144.53 for the duration of the contract.
(c) (1) One or more LEAs may enter into a joint partnership agreement with the county office of education for the purposes of meeting the obligations under this section. A health insurer is required to enter into only one contract with the LEAs in a joint partnership agreement.
(2) The LEAs in a joint partnership agreement may combine their enrollment numbers to calculate the percent of enrolled pupils insured by each health insurer.
(d) An LEA and a health insurer may use the model contract developed pursuant to Section 1374.723 of the Health and Safety Code when implementing the requirements of this section.

SEC. 6.

 Section 14132.06 of the Welfare and Institutions Code is amended to read:

14132.06.
 (a) Services specified in this section that are provided by a local educational agency are covered Medi-Cal benefits, to the extent federal financial participation is available, and subject to utilization controls and standards adopted by the department, and consistent with Medi-Cal requirements for physician prescription, order, and supervision.
(b) Any provider enrolled on or after January 1, 1993, to provide services pursuant to this section may bill for those services provided on or after January 1, 1993.
(c) This section shall not be interpreted to expand the current category of professional health care practitioners permitted to directly bill the Medi-Cal program.
(d) This section is not intended to increase the scope of practice of any health care  professional providing services under this section or Medi-Cal requirements for physician prescription, order, and supervision.
(e) (1) For the purposes of this section, the local educational agency, as a condition of enrollment to provide services under this section, shall be considered the provider of services. A local educational agency provider, as a condition of enrollment to provide services under this section, shall enter into, and maintain, a contract with the department in accordance with guidelines contained in regulations adopted by the director and published in Title 22 of the California Code of Regulations.
(2) Notwithstanding paragraph (1), a local educational agency providing services pursuant to this section shall utilize current safety net and traditional health care providers, when those providers are accessible to specific schoolsites identified by the local educational agency to participate in this program, rather than adding duplicate capacity.
(f) For the purposes of this section, covered services may include all of the following local educational agency services:
(1) Health and mental health evaluations and health and mental health education.
(2) Medical transportation.
(A) The following provisions shall not apply to medical transportation eligible to be billed under this section:
(i) Section 51323(a)(2)(A) of Title 22 of the California Code of Regulations.
(ii) Section 51323(a)(3)(B) of Title 22 of the California Code of Regulations.
(iii) For students whose medical or physical condition does not require the use of a gurney, Section 51231.1(f) of Title 22 of the California Code of Regulations.
(iv) For students whose medical or physical condition does not require the use of a wheelchair, Section 51231.2(e) of Title 22 of the California Code of Regulations.
(B) (i) Subparagraph (A) shall become inoperative on January 1, 2018, or on the date the director executes a declaration stating that the regulations implementing subparagraph (A) and Section 14115.8 have been updated, whichever is later.
(ii) The department shall post the declaration executed under clause (i) on its Internet Web site  internet website  and transmit a copy of the declaration to the Assembly Committee on Budget and the Senate Committee on Budget and Fiscal Review and the LEA Ad Hoc Workgroup.
(iii) If subparagraph (A) becomes inoperative on January 1, 2018, subparagraph (A) and this subparagraph shall be inoperative on January 1, 2018, unless a later enacted statute enacted before that date, deletes or extends that date.
(iv) If subparagraph (A) becomes inoperative on the date the director executes a declaration as described in clause (i), subparagraph (A) and this subparagraph shall be inoperative on the January 1 immediately following the date subparagraph (A) becomes inoperative, unless a later enacted statute enacted before that date, deletes or extends that date.
(3) Nursing services.
(4) Occupational therapy.
(5) Physical therapy.
(6) Physician services.
(7) Mental health and counseling services.
(8) School health aide services.
(9) Speech pathology services. These services may be provided by either of the following:
(A) A licensed speech pathologist.
(B) A credentialed speech-language pathologist, to the extent authorized by Chapter 5.3 (commencing with Section 2530) of Division 2 of the Business and Professions Code.
(10) Audiology services.
(11) Targeted case management services for children regardless of whether the child has an individualized education plan (IEP) or an individualized family service plan (IFSP).
(g) (1)  Local educational agencies may, but need not, provide any or all of the services specified in subdivision (f).
(2) Notwithstanding any other law, and consistent with federal requirements, telehealth, as defined in Section 2290.5 of the Business and Professions Code, is an approved modality for service delivery under this section, except for services, such as specialized medical transportation services, that preclude a telehealth modality. LEAs may use any appropriate nonpublic-facing remote communication products that meet privacy and security requirements in their delivery of billable telehealth services. The department shall reimburse for covered services provided via telehealth in the same manner and at the same rate as for face-to-face services. The department shall not pay for ancillary costs, such as technical support, transmission charges, and equipment.
(h) For the purposes of this section, “local educational agency” means the governing body of any school district or community college district, the county office of education, a charter school, a state special school, a California State University campus, or a University of California campus.
(i) Notwithstanding any other law, a community college district, a California State University campus, or a University of California campus, consistent with the requirements of this section, may bill for services provided to any student, regardless of age, who is a Medi-Cal recipient.
(j) No later than July 1, 2013, and every year thereafter, the department shall make publicly accessible an annual accounting of all funds collected by the department from federal Medicaid payments allocable to local educational agencies, including, but not limited to, the funds withheld pursuant to subdivision (g) of Section 14115.8. The accounting shall detail amounts withheld from federal Medicaid payments to each participating local educational agency for that year. One-time costs for the development of this accounting shall not exceed two hundred fifty thousand dollars ($250,000).
(k) (1) If the requirements in paragraphs (2) and (4) are satisfied, the department shall seek federal financial participation for covered services that are provided by a local educational agency pursuant to subdivision (a) to a child who is an eligible Medi-Cal beneficiary, regardless of either of the following:
(A) Whether the child has an IEP or an IFSP.
(B) Whether those same services are provided at no charge to the beneficiary or to the community at large.
(2) The local educational agency shall take all reasonable measures to ascertain and pursue claims for payment of covered services specified in this section against legally liable third parties pursuant to Section 1902(a)(25) of the federal Social Security Act (42 U.S.C. Sec. 1396a(a)(25)).
(3) If a legally liable third party receives a claim submitted by a local educational agency pursuant to paragraph (2), the legally liable third party shall either reimburse the claim or issue a notice of denial of noncoverage of services or benefits. If there is no response to a claim submitted to a legally liable third party by a local educational agency within 45 days, the local educational agency may bill the Medi-Cal program pursuant to subdivision (b). The local educational agency shall retain a copy of the claim submitted to the legally liable third party for a period of three years.
(4) This subdivision shall not be implemented until the department obtains any necessary federal approvals.

SEC. 7.

 Section 14197.15 is added to the Welfare and Institutions Code, immediately following Section 14197.1, to read:

14197.15.
 (a) A Medi-Cal managed care plan shall comply with the requirements in Sections 1374.722 and 1374.723 of the Health and Safety Code, relating to agreements with local educational agencies (LEAs) for the provision of mental health services to students on school campuses.
(b) Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department, without taking any further regulatory action, may implement, interpret, or make specific this section by means of all-county letters, plan letters, plan or provider bulletins, or similar instructions until the time regulations are adopted.
(c) The department shall seek any federal approvals it deems necessary to implement this section. This section shall be implemented only to the extent that any necessary federal approvals are obtained and federal financial participation is available and is not otherwise jeopardized.
(d) This section does not apply to a contract with a county mental health plan contracted with the State Department of Health Care Services pursuant to Chapter 8.9 (commencing with Section 14700).
SEC. 8.
 No reimbursement is required by this act pursuant to Section 6 of Article XIII B of the California Constitution for certain costs that may be incurred by a local agency or school district because, in that regard, this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIII B of the California Constitution.
However, if the Commission on State Mandates determines that this act contains other costs mandated by the state, reimbursement to local agencies and school districts for those costs shall be made pursuant to Part 7 (commencing with Section 17500) of Division 4 of Title 2 of the Government Code.