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AB-898 Early and Periodic Screening, Diagnostic, and Treatment services: behavioral health.(2019-2020)

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Date Published: 06/13/2019 09:00 PM
AB898:v97#DOCUMENT

Amended  IN  Senate  June 13, 2019
Amended  IN  Assembly  March 28, 2019

CALIFORNIA LEGISLATURE— 2019–2020 REGULAR SESSION

Assembly Bill
No. 898

Introduced by Assembly Member Wicks

February 20, 2019

An act to add and repeal Section 14132.191 of the Welfare and Institutions Code, relating to Medi-Cal.


LEGISLATIVE COUNSEL'S DIGEST


AB 898, as amended, Wicks. Early and Periodic Screening Diagnosis, Screening, Diagnostic, and Treatment services: behavioral health.
Existing law provides for the California Health and Human Services Agency, which includes the State Department of Health Care Services, the State Department of Developmental Services, and the Department of Managed Health Care. Under existing law, various state and local agencies are responsible for providing or arranging for the provisions of behavioral health services to adults and children in the state.
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, including Early and Periodic Screening, Diagnosis, Diagnostic, and Treatment (EPSDT) services, which encompass screening services, vision services, and other necessary services to correct or ameliorate defects and physical and mental illnesses and conditions discovered by the screening services, whether or not the services are covered under the state plan, for any individual under 21 years of age. The Medi-Cal program is, in part, governed and funded by federal Medicaid Program provisions.
This bill would require, by March 30, 2020, and monthly thereafter, the California Health and Human Services Agency, under the oversight of the Governor, to convene require the California Health and Human Services Agency, under the oversight of the Secretary of California Health and Human Services or their designee, to convene, by March 30, 2020, and monthly thereafter, the Children’s Behavioral Health Action Team, which would consist of no fewer than 30 individuals, including the Director of Health Care Services, Director of Social Services, the Director of Managed Health Care, and representatives from community-based behavioral health agencies, to maximize the Medi-Cal program’s investment in the social, emotional, and developmental health and well-being of children in California who receive EPSDT services and health care through the Medi-Cal program. The bill would require the Action Team to develop and report specified findings and recommendations, including identifying opportunities for the state to better ensure that Medi-Cal eligible children receive behavioral health services, to prepare a final implementation plan, to distribute the reports and plan to specified entities, including the Legislature and the public, and to disband upon the submission of the plan.
Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: NO  

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


SECTION 1.

 (a) The Legislature hereby finds and declares all of the following:
(1) Research demonstrates that poverty, early childhood adversity, and social isolation contribute to short short- and long-term behavioral health consequences across the life course. Those consequences manifest in developmental delays, mental and physical health impairments, inadequate school readiness and educational attainment, and increased risk for substance use and abuse. In California, nearly one-half of all children live in or near poverty and more than 60 percent have experienced as at least one adverse childhood event. For California’s children, the risks for behavioral health consequences are profound. Furthermore, structural racism and geographic isolation too often place ameliorating resources beyond the reach of children in California. Preventative and proactive behavioral health supports, strategies, and interventions that empower children, youth, and families are necessary to promote the social and emotional well-being of California’s children.
(2) Federal Medicaid program provisions governing the Early and Periodic Screening, Diagnostic, and Treatment services require that Medi-Cal beneficiaries under 21 years of age receive developmental and other necessary screenings, and an array of health and mental health services, which are targeted to address conditions that impede healthy development. Estimates suggest that 22 percent of low-income children meet diagnostic criteria for a behavioral health disorder that negatively impacts their health and well-being. These estimates do not include children whose behavioral health needs may diverge from strict diagnostic criteria, which may be more common among certain populations of low-income children. Nevertheless, currently in California, less than 5 percent of eligible children receive mental health services under the Medi-Cal program, and fewer than 3 percent receive ongoing clinical treatment. Urgent action is needed to improve health equity, promote healthy development for all children in California, and maximize the Medi-Cal program’s investment in the social, emotional, and developmental health and well-being of children, youth, and families.
(3) While the rate of Medi-Cal beneficiaries under 21 years of age who access behavioral health services has declined by 11 percent over the past six years, the acuity of behavioral health needs among children has increased significantly. Since 2007, in California, the rate of behavioral health-related hospitalizations for youth has increased 50 percent. The rate of self-reported mental health needs among California adolescents has increased by 61 percent since 2005. Nationally, between 2006 and 2011, inpatient visits for suicide, suicidal ideation, and self-injury increased by 104 percent for children one to 17 years of age, inclusive, and by 151 percent for children 10 to 14 years of age, inclusive.
(4) Untreated behavioral health needs can lead to lifelong challenges in social and emotional development, academic achievement, and physical health. Given that early childhood is a critical window for brain and emotional development, and 50 percent of all chronic mental health problems begin by 14 years of age, and 75 percent by 25 years of age, childhood and adolescence is a critical time for identifying and addressing behavioral needs before more costly and restrictive interventions are required.
(5) In order to comprehensively improve child well-being, it is necessary to identify available federal, state, and local revenue sources to provide behavioral health supports that overcome service barriers for children who meet medical necessity under current diagnostic criteria, and to address service barriers driven by structural racism and multigenerational poverty. Currently, youth of color in California disproportionately receive punitive and restrictive interventions that contribute to further distress and displace them from vital social and emotional supports. For example, youth of color are overrepresented in the juvenile justice system and are suspended from school at higher rates than their white White peers at every school age.
(6) Under existing law, financing and administrative burdens contribute to a children’s behavioral health system that is fragmented and ill-equipped to comprehensively offer the support children, youth, and families deserve to achieve social, emotional, and developmental health and well-being.
(b) It is therefore the intent of the Legislature to improve health equity and promote healthy development for all children in California, and to fully maximize the Medi-Cal program’s investment in the social, emotional, and developmental health and well-being of children, youth, and families.

SEC. 2.

 Section 14132.191 is added to the Welfare and Institutions Code, immediately following Section 14132.19, to read:

14132.191.
 (a) With regard to early and periodic screening, diagnosis, diagnostic, and treatment services and behavioral health services that are medically necessary, as described in Subchapter XIX (commencing with Section 1396) of Chapter 7 of Title 22 of the United States Code, Section 14059.5, and subdivision (v) of Section 14132, the California Health and Human Services Agency, under the oversight of the Governor, Secretary of California Health and Human Services or their designee, shall convene the Children’s Behavioral Health Action Team to maximize the Medi-Cal program’s investment in the social, emotional, and developmental health and well-being of children in California who receive their health care through the Medi-Cal program.
(b) The Action Team shall commence its first meeting by March 30, 2020. Thereafter, the Action Team shall meet no less frequently than once per month, at the call of the chair or cochairs, cochair, and at a time and location convenient to the public.
(c) The Action Team shall be composed of no fewer than 30 individuals. All members shall be appointed by the Secretary of California Health and Human Services and shall consist of the following:
(1) At least five individuals with lived experience with behavioral health needs who have received behavioral health services through one or more public social service systems in California, including parents of youth who have received behavioral health services through one or more public social service systems in California.

(2)A staff member of the Governor.

(2) The Secretary of California Health and Human Services or their designee.
(3) The Director of Health Care Services or their designee.
(4) The Director of Social Services or their designee.
(5) The California Surgeon General or their designee.
(6) The Director of Managed Health Care or their designee.
(7) The State Superintendent of Public Instruction or their designee.
(8) The Director of the Department of Corrections or their designee.
(9) The Director of Developmental Services or their designee.
(10) The Director of Public Health or their designee.
(11) The Chair of the Mental Health Services Oversight and Accountability Commission or their designee.
(12) A cochair of the Child Welfare Council or their designee.
(13) The President of the State Board of Education or their designee.

(14)The Director of the County Behavioral Health Directors Association or their designee.

(14) The Chair of the Special Education Local Plan Area Administrators of California or their designee.
(15) The Executive Director of the County Behavioral Health Directors Association of California, or their designee, and one representative each from a small, medium, and large county. The following definitions apply for purposes of this paragraph:
(A) “Small county” means a county that has a population of less than 200,000 residents.
(B) “Medium county” means a county that has a population between 200,000 and 1,000,000 residents.
(C) “Large county” means a county that has a population in excess of 1,000,000 residents.

(15)

(16) The Director of the County Welfare Directors Association of California or their designee.

(16)

(17) The President of the Chief Probation Officers of California or their designee.

(17)

(18) The President of the First 5 Association of California or their designee.

(18)

(19) At least two representatives from community-based behavioral health agencies.

(19)

(20) At least one representative from the juvenile court system.

(20)

(21) At least two additional leaders and representatives of other stakeholder individuals, organizations, or associations with behavioral health, health, education, or children’s services expertise. This may include child or parent advocacy organizations, health consumer advocacy organizations, pediatricians, health care providers, tribal representatives, and others.
(d) (1) The chair of the Action Team shall be a staff member of the Governor with extensive knowledge of the children’s behavioral health system and public social services in California. the Secretary of California Health and Human Services or their designee.
(2) The chair shall appoint a cochair from among the members of the Action Team.

(2)

(3) The chair and cochair shall oversee the responsibilities of the Action Team.
(e) The Action Team may appoint consultants to advise on any of the priorities described in subdivision (g). These consultants may represent any specialized area of expertise, including lived experience with behavioral health needs who have received behavioral health services through one or more public social service systems.
(f) Action Team members shall serve without compensation, with the exception of youth with lived experience with behavioral health needs who have received behavioral health services through one or more public social service systems or their family members. The qualified youth or their family members that serve on the Action Team shall be entitled to compensation for their time and reimbursement for all actual and necessary expenses incurred in the performance of their duties.
(g) (1) The Action Team shall be responsible for developing and reporting findings and recommendations to the Governor, the Legislature, state and local child-serving departments, and the public. The findings and recommendations shall be delivered as an interim report by September 30, 2020, and as a final report no later than March 30, 2021. This report shall include, but not be limited to, findings and recommendations related to the following priorities:
(A) Identifying opportunities for the state to better ensure Medi-Cal eligible children receive behavioral health services through the Medi-Cal program, and to maximize the federal, state, and local funding to pay for the benefits and services needed to uphold California’s commitment to the healthy development of all children.
(B) Identifying opportunities to maximize the scope of available Medicaid program-funded services and supports available to children and families in alignment with federal regulations, including behavioral health strategies and supports that address social, economic, and environmental determinants of health.
(C) Identifying specific mechanisms to include youth and families with lived experience with behavioral health needs who have received services through one or more public social service systems in the design, delivery and evaluation of behavioral health services and strategies, and exploring emerging best practices, including peer provider models.
(D) Assessing the availability and amount of local and state nonfederal revenue across public social service systems that can be used as the nonfederal share of a Medi-Cal program transaction to provide behavioral health services and supports to children.
(E) Developing recommendations for the use of alternative contracts and payment arrangements, such as those related to mental health plans that serve Medi-Cal beneficiaries, that promote and maximize federal funds and collaborative purchasing among public social services to improve access to coordinated and integrated care, including coordination between physical and behavioral health payers.
(F) Identifying the limitations of Medicaid program funding, such as when the Medi-Cal program cannot pay for services or supports, and alternative sources of federal and nonfederal revenue that can be leveraged to provide individual and community-level behavioral health strategies and supports that mitigate the impact of adverse childhood experiences and adverse community experiences.
(2) The requirement for submitting reports imposed under this subdivision is inoperative on March 30, 2025, pursuant to Section 10231.5 of the Government Code.
(3) Reports to be submitted pursuant to this subdivision shall be submitted in compliance with Section 9795 of the Government Code.
(h) (1) By September 30, 2021, the Action Team shall submit a final implementation plan to the Governor, the Legislature, state and local child-serving departments, and the public, detailing implementation strategies related to the recommendations identified in subdivision (g). The implementation plan may identify a range of implementation strategies, but, at a minimum, shall address all of the following:
(A) Legislative action needed to direct state and local child-serving departments to maximize early and periodic screening, diagnosis, diagnostic, and treatment services for eligible children who receive health care under the Medi-Cal program, and any additional gaps in the children’s behavioral health system as identified by the Action Team.
(B) Medicaid State Plan amendments and waivers necessary to implement recommendations, to maximize early and periodic screening, diagnosis, diagnostic, and treatment services for Medi-Cal eligible children, and to address any additional gaps in the children’s behavioral health system, as identified by the Action Team.
(C) Additional appropriations by the Legislature that may be needed to implement Action Team findings, and, if needed, a recommendation to the Department of Finance and legislative budget committees concerning the appropriation.
(2) The final implementation plan to be submitted pursuant to paragraph (1) shall be submitted in compliance with Section 9795 of the Government Code.
(i) All state agencies on the Action Team shall provide data concerning access to, and receipt of, behavioral health services in their respective systems, maintained or contracted for by any state or local department, agency, or court that serves children, youth, and families. The data shall be population-specific for purposes of identifying trends and disparities in access to behavioral health treatment and supports. Information shared shall be subject to state and federal confidentiality laws and regulations.
(j) The Action Team shall disband upon submission of its final implementation plan to the Governor, the Legislature, state and local child-serving departments, and the public.
(k) This section shall remain in effect only until January 1, 2026, and as of that date is repealed.