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AB-1031 Youth Substance Use Disorder Treatment and Recovery Program Act of 2019.(2019-2020)

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Date Published: 03/25/2019 09:00 PM
AB1031:v98#DOCUMENT

Amended  IN  Assembly  March 25, 2019

CALIFORNIA LEGISLATURE— 2019–2020 REGULAR SESSION

Assembly Bill No. 1031

Introduced by Assembly Member Nazarian
(Coauthors: Assembly Members Quirk-Silva and Waldron)

February 21, 2019

An act to repeal and add Chapter 4 (commencing with Section 11759) of Part 1 of Division 10.5 of the Health and Safety Code, and to amend Section 14059.5 of the Welfare and Institutions Code, relating to alcohol and drug treatment.


LEGISLATIVE COUNSEL'S DIGEST


AB 1031, as amended, Nazarian. Youth Substance Use Disorder Treatment and Recovery Program Act of 2019.
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 medically necessary health care services, including Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) for an individual under 21 years of age, subject to utilization controls and consistent with federal requirements. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions.
Existing law consolidated within the State Department of Health Care Services all substance use disorder functions and programs from the former State Department of Alcohol and Drug Programs.
The existing Adolescent Alcohol and Drug Treatment and Recovery Program Act of 1998, which authorized the department to establish community-based nonresidential and residential recovery programs to intervene and treat the problems of alcohol and other drug use among youth, became inoperative on July 1, 2013.
This bill would repeal those inoperative provisions and would enact the Youth Substance Use Disorder Treatment and Recovery Program Act of 2019, with similar provisions to, in part, require the department, on or before January 1, 2021, to establish community-based nonresidential and residential treatment and recovery programs to intervene and treat the problems of alcohol and drug use among youth under 21 years of age. The bill would additionally require the department, in collaboration with counties and providers of substance use disorder services, to establish through regulation criteria for participation, programmatic requirements, treatment standards, and terms and conditions for funding. The bill would require the criteria to also include consideration of indicators of drug and alcohol use among youth. The bill would require the department’s regulations for these programs to describe a continuum of care to identify, treat, and support recovery from substance misuse for youth under 21 years of age, as specified. The bill would require the department to report to the Legislature during budget hearings regarding the status of the implementation of the program. program, and to annually report to the Legislature specified utilization data. The bill would additionally require the department to update its Medi-Cal billing codes to include specified services, based on whether those services are medically necessary. The bill would make related findings and declarations.
Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: NO  

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


SECTION 1.

 The Legislature finds and declares all of the following:
(a) California families are confronted with challenging problems associated with drug and alcohol use among children and youth under 21 years of age. Families are in desperate need of assistance in the management and treatment of substance use in the youth population.
(b) In 2015–16, the National Survey on Drug Use and Health classified slightly more than 5 percent of California adolescents 12 to 17 years of age, inclusive, as misusing either alcohol or illicit drugs, while substance use disorder (SUD) rates among young adults 18 to 25 years of age, inclusive, were as high as 15 percent.
(c) Multiple studies have established that the developing brains of children and youth are more vulnerable to alcohol and other drug-related problems than those of adults. Most adults suffering from SUDs developed a pattern of alcohol and other drug dependence as adolescents (18 years of age or under) or young adults (19 to 25 years of age, inclusive). Youth with SUDs have high rates of cooccurring mental health disorders, along with other health, social, academic, relational, and legal challenges. Due to these complexities, services for youth require a different approach to drug prevention, early intervention, and treatment of SUDs than that used for adults.
(d) The draft “Youth Services Policy Manual” from the State Department of Health Care Services notes that “... addressing adolescent substance use is a cost-effective, common-sense approach to preventing future challenges in other social service and public health related areas... .”
(e) This act recognizes that federal, state, and local drug control spending assigns low priority to early intervention and treatment of youth SUDs, despite the extensive research that confirms that treatment is the most cost-effective way to address SUDs and drug-related crimes.
(f) In California, the primary strategy for addressing youth substance use and related problems has been placed on the Division of Juvenile Justice, probation departments, and other law enforcement agencies.
(g) California counties, which administer community alcohol and drug prevention and treatment programs, have long been in need of resources to develop youth-specific treatment and early intervention programs for children, adolescents, and young adults who have or are at risk of developing an SUD.

(h)California has very few public sector treatment resources for youth SUDs. Proposition 64, the Control, Regulate and Tax Adult Use of Marijuana Act (AUMA), dedicates a portion of net revenue to drug education, prevention, early intervention, and treatment for youth. One of the stated intents of Proposition 64 is to generate revenue for youth SUD treatment and prevention. Tax revenues allocated to the Youth Education, Prevention, Early Intervention and Treatment Account (Youth Account) could eventually be in the hundreds of millions of dollars annually, according to a fiscal analysis of the measure by the Legislative Analyst’s Office.

(i)

(h) One of the primary goals of Proposition 64 revenue disbursements from the Youth Account should be to develop 64, the Adult Use of Marijuana Act, was to support a continuum of care for youth SUDs that is based on public health principles. This system of care should provide supportive services for youth that neither stigmatize nor criminalize youth substance use.

(j)Proposition 64 tax revenues will provide the State of California with a unique opportunity to develop a new, community-based continuum of care for the prevention and treatment of youth SUDs.

(k)

(i) In alignment with federal guidance, a youth SUD continuum of care is developmentally relevant. This continuum of care would include screening for early identification and intervention, assessment, outpatient modalities that involve families whenever possible, intensive outpatient treatment, partial hospitalization, medication-assisted treatment, case management, continuing care, recovery services and supports, parent or caregiver support, and residential treatment.

(l)To accomplish these critical goals, Youth Education, Prevention, Early Intervention and Treatment Account funds from Proposition 64 revenue must remain sequestered, independent of preexisting treatment facilities for adults, and directed toward the creation and maintenance of a youth continuum of care developed by the State Department of Health Care Services in collaboration with counties, providers, and other stakeholders.

(j) Under California’s Medicaid State Plan, beneficiaries under 21 years of age are eligible to receive Medicaid services pursuant to the federal mandate to provide Early Periodic Screening, Diagnostic, and Treatment (EPSDT). Under the EPSDT mandate, beneficiaries under 21 years of age are eligible to receive all appropriate and medically necessary services needed to correct and ameliorate health conditions that are coverable under Medicaid authority, including substance use disorder treatment services. Federal EPSDT statutes and regulations require states to furnish all Medicaid coverable, appropriate, and medically necessary services, regardless of whether those services are covered in the state’s Medicaid State Plan.
(k) EPSDT broadens the definition of medical necessity for youth and makes the full SUD benefit package available to all youth under 21 years of age, without any caps or limitations, for any youth under 21 years of age who is assessed as having or is at risk of developing a substance use disorder.

SEC. 2.

 Chapter 4 (commencing with Section 11759) of Part 1 of Division 10.5 of the Health and Safety Code is repealed.

SEC. 3.

 Chapter 4 (commencing with Section 11759) is added to Part 1 of Division 10.5 of the Health and Safety Code, to read:
CHAPTER  4. Substance Use Disorder Treatment for Youth

11759.
 This act shall be known, and may be cited, as the Youth Substance Use Disorder Treatment and Recovery Program Act of 2019.

11759.1.
 On or before January 1, 2021, the department, in collaboration with counties and providers of substance use disorder services, shall establish regulations regarding community-based nonresidential and residential treatment and recovery programs to intervene and treat the problems of alcohol and drug use among youth under 21 years of age.

11759.2.
 The department, in collaboration with counties and providers of substance use disorder services, shall establish through regulation criteria for participation, programmatic requirements, treatment standards, and terms and conditions for funding. The criteria shall also include consideration of indicators of drug and alcohol use among youth.

11759.3.
 (a) The Legislature finds and declares that substance use manifests differently in youth than adults, and that to be effective, youth treatment must be developmentally appropriate, tailored to address the unique psychosocial needs of youth, and distinct from programs designed to treat addiction in adults.
(b) Regulations promulgated under this chapter shall define and describe a comprehensive, evidence-based continuum of care to identify, treat, and support recovery from substance misuse for youth under 21 years of age. The continuum of care shall include, but need not be limited to, the following health care services:
(1) Screening and assessment for substance use and cooccurring mental health conditions.
(2) Collaborative treatment planning between health professionals, youth, and their families, as appropriate.
(3) Outpatient substance use therapies, including substance use education, individual counseling, group counseling, and family therapy.
(4) Intensive outpatient programs.
(5) Partial hospitalization.
(6) Medications for addiction treatment when clinically indicated and offered in combination with counseling and case management.
(7) Residential treatment and detoxification.
(8) Treatment for cooccurring mental health conditions.
(9) Case management that strengthens linkages to other health, wellness, social, and supportive services.
(10) Recovery services and supports for both youth and their families, so youth have access to continuing care outside a treatment environment and family needs are addressed.
(c) The department shall consider encouraging the programs and services offered under the youth continuum of care to:
(1) Provide prevention strategies and early intervention opportunities.
(2) Provide care that is culturally and gender competent and trauma-informed.
(3) Provide nonstigmatizing care in a variety of environments including schools, homes, and other community-based locations.
(4) Prioritize family engagement.
(5) Support academic and work performance.
(6) Be delivered by professionals with expertise in treating substance use disorders in adolescents and young adults.
(7) Address cooccurring mental health conditions.

11759.4.
 Nothing in this chapter shall preclude regional approaches to service delivery by counties, including the utilization of community-based nonresidential and residential programs.

11759.5.
 Notwithstanding the rulemaking provisions of the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code), the department may implement and administer this chapter through all-county information notices or similar written instructions until regulations are adopted.

11759.6.
 (a) The department, in collaboration with the counties and providers of substance use disorder services, shall report to the Legislature, during budget hearings, regarding the status of the implementation of this chapter.
(b) (1) Beginning January 1, 2021, and each year thereafter, the department shall report to the Legislature, and publish on its internet website, the utilization data relevant to services to youth under 21 years of age.
(2) The report required pursuant to this subdivision shall include, but not be limited to, all of the following:
(A) The number of unique Medi-Cal enrollees served.
(B) The number of unique Medi-Cal enrollees screened for substance use disorders.
(C) The number of assessments of youth for substance use disorders.
(D) The number of individual counseling services for youth with substance use disorders.
(E) The number of collateral services for youth with substance use disorders.
(F) The number of family therapy services for youth with substance use disorders.
(G) The number of group sessions for youth with substance use disorders.
(H) The number of intensive outpatient service sessions, meaning sessions lasting 6 to 19 hours, inclusive, provided to youth with substance use disorders.
(I) The number of partial hospitalization sessions, meaning sessions lasting 20 hours or more, provided to youth with substance use disorders.
(J) The number of medication-assisted treatment services to youth with substance use disorders.
(K) The number of case management services provided to youth with substance use disorders.
(L) The number of parent or caregiver support services.
(M) The number of residential service episodes for youth with substance use disorders.
(N) The number of youth provided with inpatient services for treatment of detoxification or withdrawal.
(c) A report to be submitted pursuant to this section shall be submitted in compliance with Section 9795 of the Government Code.

(a)It is the intent of the Legislature that the department seek funding for this chapter through federal financial participation for all services covered by Medi-Cal. The Legislature recommends that the department use additional funding from cannabis tax revenues in the Youth Education, Prevention, Early Intervention and Treatment Account established pursuant to the Control, Regulate and Tax Adult Use of Marijuana Act.

11759.7.
 (a) For the purposes of implementing this chapter, the department may seek funding from federal financial participation for all services covered by Medi-Cal, or from foundations or other nongovernmental sources.
(b) It is further the intent of the Legislature that no more than 4 percent of funds made available to the department pursuant to subdivision (a) be expended for purposes of developing regulations, standards, and procedures to implement this chapter.
(c) Each county that administers this chapter shall continue to use current behavioral health funding sources as applicable, including, but not limited to, the Behavioral Health Subaccount of the Local Revenue Fund 2011 and Drug Medi-Cal funds, including federal financial participation, to fund substance use disorder treatment services for Medi-Cal beneficiaries under 21 years of age who access services under this chapter.

SEC. 4.

 Section 14059.5 of the Welfare and Institutions Code is amended to read:

14059.5.
 (a) For individuals 21 years of age or older, a service is “medically necessary” or a “medical necessity” when it is reasonable and necessary to protect life, to prevent significant illness or significant disability, or to alleviate severe pain.
(b) (1) For individuals under 21 years of age, a service is “medically necessary” or a “medical necessity” if the service meets the standards set forth in Section 1396d(r)(5) of Title 42 of the United States Code.
(2) The department and its contractors shall update any model evidence of coverage documents, beneficiary handbooks, and related material to ensure the medical necessity standard for coverage for individuals under 21 years of age is accurately reflected in all materials.
(3) The department shall update its Medi-Cal billing codes, based upon what is medically necessary for individuals under 21 years of age, to include all of the following:
(A) Screening for early identification and intervention.
(B) Assessment using the American Society of Addiction Medicine criteria.
(C) Residential treatment and withdrawal management.
(D) Outpatient substance use therapies, including substance use education and individual and group counseling.
(E) Family counseling.
(F) Intensive outpatient treatment.
(G) Medications for addiction treatment when clinically indicated.
(H) Case management.
(I) Recovery services and supports.

(3)

(4) 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, shall implement, interpret, and make specific this subdivision by means of all-county letters, plan letters, plan provider bulletins, manuals, plan contract amendments, or similar instructions until regulations are revised or adopted.

(4)

(5) By July 1, 2022, the department shall revise or adopt regulations in accordance with the requirements of Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code.
(c) This section shall not be construed to limit the application of subdivisions (a) and (b) of Section 51184 of Title 22 of the California Code of Regulations.