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AB-1058 Medi-Cal: specialty mental health services and substance use disorder treatment.(2019-2020)

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Date Published: 04/22/2019 09:00 PM
AB1058:v96#DOCUMENT

Amended  IN  Assembly  April 22, 2019
Amended  IN  Assembly  April 11, 2019
Amended  IN  Assembly  March 18, 2019

CALIFORNIA LEGISLATURE— 2019–2020 REGULAR SESSION

Assembly Bill No. 1058


Introduced by Assembly Member Salas

February 21, 2019


An act to add and repeal Article 3.3 (commencing with Section 14124.30) of Chapter 7 of Part 3 of Division 9 Section 14021.54 of the Welfare and Institutions Code, relating to Medi-Cal.


LEGISLATIVE COUNSEL'S DIGEST


AB 1058, as amended, Salas. Medi-Cal: specialty mental health services and substance use disorder treatment.
Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, 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 provides for various benefits under the Medi-Cal program, including mental health services and substance use disorder treatment and mental health services that are delivered through the Medi-Cal Specialty Mental Health Services program and the Drug Medi-Cal Treatment Program, respectively. Program, the Drug Medi-Cal organized delivery system, and the Medi-Cal Specialty Mental Health Services Program.

This bill would establish county-administered pilot projects in up to nine counties in the state to identify and test strategies for delivering integrated behavioral health services to Medi-Cal beneficiaries with cooccurring substance use disorders and mental health conditions who access services through the Drug Medi-Cal Treatment Program, the Drug Medi-Cal organized delivery system, and the Medi-Cal Specialty Mental Health Services program. The bill would require pilot project participants to meet specified requirements, including that the county has implemented the Drug Medi-Cal organized delivery system. The bill would require a selection committee consisting of representatives from the department and the County Behavioral Health Directors Association to select pilot counties to administer a county pilot project for a 4-year period. The bill would require a pilot project participant to perform specified tasks, such as developing a county-specific pilot implementation plan, and satisfying quality assurance and quality improvement requirements as established in state-county contracts for the Drug Medi-Cal organized delivery system and the Medi-Cal Specialty Mental Health Services program. The bill would require the department to perform specified tasks related to the pilot program, including approving each county’s pilot implementation plan, posting these plans on the department’s internet website, and preparing a final pilot project evaluation report for the Legislature. The bill would authorize the department to implement these requirements by various instructions, including plan letters, to enter into contracts for procuring qualified consultant services, and to seek funding from federal agencies, foundations, or other nongovernmental sources.

This bill would require the department to engage, commencing no later than January 15, 2020, in a stakeholder process to develop recommendations for addressing legal and administrative barriers to the delivery of integrated behavioral health services for Medi-Cal beneficiaries with cooccurring substance use disorders and mental health conditions who access services through the Drug Medi-Cal Treatment Program, the Drug Medi-Cal organized delivery system, and the Medi-Cal Specialty Mental Health Services Program. The bill would require the stakeholder group to include specified individuals, such as behavioral health subject-matter experts and representatives from county behavioral health departments, and would require the stakeholder group to complete various tasks, including reviewing departmental policies and procedures on the department’s implementation and operation of administrative and oversight responsibilities for the 3 programs and reporting recommendations to the Legislature by September 15, 2020. The bill would repeal these provisions on January 1, 2021.
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 hereby finds and declares all of the following:
(a) Eight and one-half percent of Californians over 12 years of age have a substance use disorder, and more than 15 percent of adults have a mental health condition.
(b) More than 30 percent of the population that receives mental health services for severe and persistent mental illness through the Medi-Cal Specialty Mental Health Services program Program in California have cooccurring substance use disorders.
(c) Substance use disorders and mental health conditions that are untreated may lead to chronic physical health problems, increased rates of emergency room visits, higher risk for homelessness, unemployment, and justice-system involvement, and trauma, suicide, or premature death.
(d) Nearly every California county has merged the administration of publicly funded substance use disorder treatment and specialty mental health services into integrated behavioral health systems. Care for both conditions is now typically managed using the same administrative infrastructure within the county and an overlapping workforce.
(e) Nonetheless, reimbursement, county contracts with the state, documentation and reporting, oversight and other administrative requirements for the Drug Medi-Cal Treatment Program Program, the Drug Medi-Cal organized delivery system and the Medi-Cal Specialty Mental Health Services program remain bifurcated Program remain trifurcated under state law.
(f) The rigidly separate benefit structures for these two closely-related Medi-Cal programs produce inefficiencies and create administrative barriers to the provision of integrated substance use disorder treatment and mental health services for Californians with cooccurring conditions and who receive health care through the Medi-Cal program.
(g) It is in the interest of Californians in need of behavioral health services, and of the state as a whole, to develop integrated behavioral health programs that can effectively meet the needs of individuals with cooccurring substance use disorders and mental health conditions.
SEC. 2.Article 3.3 (commencing with Section 14124.30) is added to Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions Code, to read:
3.3.County Behavioral Health Integration Pilot Program Act of 2019
14124.30.

(a)This act shall be known, and may be cited, as the County Behavioral Health Integration Pilot Program Act of 2019.

(b)It is the intent of the Legislature to establish county-administered pilot projects in up to nine counties in the state to identify and test strategies for delivering integrated behavioral health services to Medi-Cal beneficiaries with cooccurring substance use disorders and mental health conditions who access services through the Drug Medi-Cal Treatment Program, the Drug Medi-Cal organized delivery system, and the Medi-Cal Specialty Mental Health Services program.

14124.31.

(a)The goals of the pilot projects shall be to:

(1)Develop, test, and evaluate new models for providing integrated behavioral health services to Medi-Cal beneficiaries with cooccurring substance use disorders and mental health conditions.

(2)Provide high-quality, integrated behavioral health services that meet the unique needs of Medi-Cal beneficiaries with cooccurring substance use disorders and mental health conditions in a clinically appropriate manner.

(3)Utilize a formal evaluation process and specific performance outcome measures to demonstrate evidence of all of the following:

(A)Access to treatment for substance use disorder treatment and specialty mental health services at rates that are comparable to or higher than those in nonpilot counties.

(B)Increased quality of care.

(C)Program costs that are no higher on average than those for comparable services provided by the Drug Medi-Cal Treatment Program and the Medi-Cal Specialty Mental Health Services program and that are delivered in nonpilot project counties.

(4)Identify any necessary changes to the Drug Medi-Cal Treatment Program, the Drug Medi-Cal organized delivery system, and the Medi-Cal Specialty Mental Health Services program that would be required to facilitate the provision of integrated services and to expand implementation of integrated treatment models statewide.

(b)The pilot projects shall be implemented over a five-year period, with at least four years of active implementation and service delivery.

(c)No later than one year from the date that this article is effective, selected pilot counties shall implement their programs by commencing the pilot activities specified in their county implementation plan, as described in subdivision (c) of Section 14124.33. In the year prior to program implementation, counties willing to commit to the pilot shall elect to participate in the pilot, the department and the County Behavioral Health Directors Association shall select pilot participants, and the department shall approve county implementation plans.

(d)Each pilot program shall conclude four years from its original implementation date.

14124.32.

(a)An eligible pilot participant shall include any county behavioral health program that has implemented the Drug Medi-Cal organized delivery system, as authorized in the California Medi-Cal 2020 Demonstration pursuant to Article 5.5 (commencing with Section 14184) or a successor demonstration or waiver, as applicable, prior to its pilot project implementation date.

(b)(1)A selection committee, which shall consist of an equal number of representatives from the department and the County Behavioral Health Directors Association, shall select the pilot participants. The selection committee shall select up to nine counties as follows:

(A)Three counties shall have a population in excess of 1,000,000 residents.

(B)Three counties shall have a population between 200,000 and 1,000,000 residents.

(C)Three counties shall have a population less than 200,000 residents.

(2)If fewer than three counties in one of these three population-based categories is willing to commit to the pilot program, the department and the County Behavioral Health Directors Association may select additional participants from another population category to authorize the establishment of up to nine county-administered pilot projects.

(3)Selection criteria shall include, at a minimum, all of the following:

(A)Geographic distribution of pilot counties.

(B)Use of evidence-based or promising practices for providing dual diagnosis services, including the colocation of substance use disorder treatment and mental health services, the use of a single treatment team, case management to help address “whole person” health needs and social determinants of health, and the integration of medication services with psychosocial services.

(C)County readiness to provide integrated behavioral health services, as demonstrated by the presence of existing programs specifically targeted to Medi-Cal beneficiaries with cooccurring substance use and mental health conditions.

(c)This article does not prohibit the department, in consultation with the County Behavioral Health Directors Association, from establishing a two-stage selection process by which local pilot project sites are selected on a preliminary basis and final selection of local pilot project sites are contingent upon the county completion of, and departmental approval of, a county implementation plan, as described in subdivision (c) of Section 14124.33.

(d)This article does not require services sites that provide services under the Drug Medi-Cal Treatment Program, the Drug Medi-Cal organized delivery system, and the Medi-Cal Specialty Mental Health Services program to participate in the pilot project by providing colocated substance use disorder treatment and mental health services. A county that administers a pilot project shall identify all participating service sites, in addition to any subcontracted providers, offering services at those sites under the pilot project.

14124.33.

A county that administers a pilot project pursuant to this article shall be responsible, at a minimum, for all of the following:

(a)Guaranteeing that substance use disorder treatment and mental health services provided pursuant to the pilot program are equivalent to benefits available under the Drug Medi-Cal organized delivery system and the Medi-Cal Specialty Mental Health Services program. Any modifications to medical necessity or service eligibility criteria proposed under the pilot program shall be approved by the department and shall not hinder an individual’s access to covered services.

(b)Continuing to meet quality assurance and quality improvement requirements equivalent to those outlined in existing state-county contracts for the Drug Medi-Cal organized delivery system and the Medi-Cal Specialty Mental Health Services program.

(c)(1)Developing, preparing, and submitting to the department an implementation plan that describes the integrated service delivery strategies that the county intends to test and the actions the county will take during the course of the pilot period.

(2)An implementation plan may address a phased-in implementation of pilot activities, with a timeline that accounts for the phased-in development of specific strategies to mitigate administrative barriers to integrated service delivery, in partnership with the department as described in Section 14124.34.

(d)(1)Implementing the pilot project by providing integrated substance use disorder treatment and specialty mental health services that are funded by the Medi-Cal program at a minimum of one service site located within the borders of the county.

(2)A county may, but is not required to, select to implement integrated services at multiple service delivery sites within the county.

(e)Identifying all participating service sites, in addition to any subcontracted providers, offering services at those sites under the pilot project.

(f)Submitting required reports on pilot activities and performance outcomes data specified in the evaluation plan developed by the department pursuant to subdivision (e) of Section 14124.34.

14124.34.

For purposes of administering the pilot projects, the department shall be responsible, at a minimum, for all of the following:

(a)Reviewing and approving each county’s pilot implementation plan, and posting these plans on the department’s internet website.

(b)Working with pilot counties and representatives of the County Behavioral Health Directors Association to identify and address administrative barriers to integrated service delivery under the current, bifurcated administrative structure of the Drug Medi-Cal organized delivery system and the Medi-Cal Specialty Mental Health Services program. By the first day of the fourth year of the five-year pilot period, and contingent upon any necessary changes in state law or regulation or any necessary federal approvals, the department shall authorize counties to implement programmatic changes to the Drug Medi-Cal Treatment Program, the Drug Medi-Cal organized delivery system, and the Medi-Cal Specialty Mental Health Services program to address all of the following:

(1)Billing and claiming requirements of the programs to allow more flexible reimbursement for the Medi-Cal benefits related to substance use disorder treatment and specialty mental health services that are provided to Medi-Cal beneficiaries with dual diagnoses.

(2)Streamlining and integrating requirements for Medi-Cal program and site certifications, quality assurance, quality improvement, treatment planning and documentation, and data reporting for substance use disorder treatment and mental health services provided pursuant to the Medi-Cal program.

(3)Promoting best practices for obtaining client consent to share personal health information within an integrated behavioral health program for treatment purposes.

(c)Seeking any changes to state law or regulation, as may be necessary, for full implementation of the pilot program.

(d)Seeking necessary federal approval, including a Medicaid waiver, for implementation of the pilot program.

(e)Collaborating with pilot counties and the County Behavioral Health Directors Association to develop a program evaluation plan and a set of performance outcomes measures for purposes of evaluating the pilot program.

(f)Collecting data and reports from pilot counties as specified in the evaluation plan.

(g)(1)Submitting to the Legislature, no more than six months after the last pilot project concludes, a final pilot evaluation report that includes recommendations for statewide implementation of specific integration strategies and any policy changes that are needed to meet the goals of the pilot program throughout the state as a statewide expansion effort.

(2)A report to be submitted pursuant to subdivision (g) and paragraph (1) and shall be submitted in compliance with Section 9795 of the Government Code.

14124.35.

(a)Notwithstanding the rulemaking provisions of 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 article by means of all-county letters, plan letters, plan or provider bulletins, or similar instructions.

(b)The department may contract with qualified consultants to provide technical assistance to pilot counties, to carry out the departmental responsibilities specified in Section 14124.34, or for any other purpose that furthers the goals of the County Behavioral Health Integration Pilot Program.

(c)Contracts entered into pursuant to this article shall be exempt from the requirements of Chapter 1 (commencing with Section 10100) and Chapter 2 (commencing with Section 10290) of Part 2 of Division 2 of the Public Contract Code.

14124.36.

(a)For purposes of implementing the pilot projects, the department may seek funding from federal agencies, foundations, or other nongovernmental sources.

(b)Costs related to the implementation of the pilot projects shall be limited to administrative costs incurred by the department to implement requirements pursuant to this article.

(c)Each county that administers a pilot project shall continue to utilize current behavioral health funding sources, including, but not limited to, the Behavioral Health Subaccount of the Local Revenue Fund 2011 and Medi-Cal funds, such as federal financial participation, to fund substance use disorder treatment and specialty mental health services for Medi-Cal beneficiaries who access integrated behavioral health services under the terms of this pilot program.

14124.37.

This article shall remain in effect only until January 1, 2026, and as of that date is repealed.

SEC. 2.

 Section 14021.54 is added to the Welfare and Institutions Code, to read:

14021.54.
 (a) (1) Commencing no later than January 15, 2020, the department shall engage in a stakeholder process to develop recommendations for addressing legal and administrative barriers to the delivery of integrated behavioral health services for Medi-Cal beneficiaries with cooccurring substance use disorders and mental health conditions who access services through the Drug Medi-Cal Treatment Program, the Drug Medi-Cal organized delivery system, and the Medi-Cal Specialty Mental Health Program.
(2) The stakeholder group shall be comprised of behavioral health subject-matter experts, behavioral health consumers or consumer advocates, providers who render mental health services and substance use disorder treatment, legislative staff members, and representatives from county behavioral health departments, and the County Behavioral Health Directors Association of California.
(b) The stakeholder group shall do all of the following:
(1) Identify administrative duplication, inefficiencies, or impediments to implementing integrated behavioral health services in the Medi-Cal program that exist in law, including state statute and regulation, departmental policy and guidance, such as the Mental Health and Substance Use Disorder Services Information Notices, and California’s Medicaid demonstration project waivers, including related Special Terms and Conditions, as authorized under Sections 1115 or 1915(b) of the federal Social Security Act.
(2) Review departmental policies and procedures on the department’s implementation and operation of administrative and oversight responsibilities for the Drug Medi-Cal Treatment Program, the Drug Medi-Cal organized delivery system, and the Medi-Cal Specialty Mental Health Program, to identify elements of those policies that produce administrative duplication, inefficiencies, or impediments to the implementation of integrated behavioral health services in the Medi-Cal program.
(3) Develop recommendations for changes to state statute and regulation, departmental policy and guidance, such as the Mental Health and Substance Use Disorder Services Information Notices, and the Special Terms and Conditions of California’s Medicaid demonstration project waivers authorized under Sections 1115 or 1915(b) of the federal Social Security Act that would remove identified statutory, regulatory, administrative, or other barriers to the delivery of integrated behavioral health services for Medi-Cal beneficiaries with cooccurring substance use disorders and mental health conditions who access services pursuant to the Medi-Cal program. The stakeholder group shall develop recommendations pursuant to this paragraph that address both of the following:
(A) Changes to requirements for Medi-Cal provider certifications, client assessment, treatment planning and related documentation, quality assurance and quality improvement activities, and data reporting for substance use disorder treatment and mental health services provided pursuant to the Medi-Cal program that would reduce duplication of, and increase the efficiency and effectiveness of, services provided to Medi-Cal beneficiaries with dual diagnoses.
(B) Changes to billing and claiming requirements of the Drug Medi-Cal Treatment Program, the Drug Medi-Cal organized delivery system, and the Medi-Cal Specialty Mental Health Program that would support greater flexibility of provider reimbursement for Medi-Cal benefits related to substance use disorder treatment and specialty mental health services that are rendered to Medi-Cal beneficiaries with dual diagnoses.
(4) Identify recommendations developed through the stakeholder process that may be implemented as components of extensions, renewals, or amendments to any California Medicaid demonstration project waivers as authorized under Sections 1115 or 1915(b) of the federal Social Security Act.
(c) (1) The stakeholder process shall be completed by September 15, 2020. The department shall report, by September 15, 2020, to the relevant policy and fiscal committees of the Legislature the recommendations developed through the stakeholder process.
(2) The report to be submitted pursuant to this subdivision shall be submitted in compliance with Section 9795 of the Government Code.
(d) This section shall remain in effect only until January 1, 2021, and as of that date is repealed.