14714.

 (a) (1) Except as otherwise specified in this chapter, a contract entered into pursuant to this chapter shall include a provision that the mental health plan contractor shall bear the financial risk for the cost of providing medically necessary specialty mental health services to Medi-Cal beneficiaries.

(2) If the mental health plan is not administered by a county, the mental health plan shall not transfer the obligation for any specialty mental health services to Medi-Cal beneficiaries to the county. The mental health plan may purchase services from the county. The mental health plan shall establish mutually agreed-upon protocols with the county that clearly establish conditions under which beneficiaries may obtain non-Medi-Cal reimbursable services from the county. Additionally, the plan shall establish mutually agreed-upon protocols with the county for the conditions of transfer of beneficiaries who have lost Medi-Cal eligibility to the county for care under Part 2 (commencing with Section 5600), Part 3 (commencing with Section 5800), and Part 4 (commencing with Section 5850) of Division 5.

(3) The mental health plan shall be financially responsible for ensuring access and a minimum required scope of benefits and services, consistent with state and federal requirements, to Medi-Cal beneficiaries who are residents of that county regardless of where the beneficiary resides, except as provided for in Section 14717.1 or 14717.2. The department shall require that the same definition of medical necessity be used, and the minimum scope of benefits offered by each mental health plan be the same, except to the extent that prior federal approval is received and is consistent with state and federal laws.

(b) (1) Any contract entered into pursuant to this chapter may be renewed if the mental health plan continues to meet the requirements of this chapter, regulations promulgated pursuant to this chapter, and the terms and conditions of the contract. Failure to meet these requirements shall be cause for nonrenewal of the contract. The department may base the decision to renew on timely completion of a mutually agreed-upon plan of correction of any deficiencies, submissions of required information in a timely manner, or other conditions of the contract.

(2) If the contract is not renewed based on the reasons specified in paragraph (1), the department shall notify the Department of Finance, the fiscal and policy committees of the Legislature, and the Controller of the amounts to be sequestered from the Mental Health Subaccount, the Mental Health Equity Account, and the Vehicle License Fee Collection Account of the Local Revenue Fund and the Mental Health Account and the Behavioral Health Subaccount of the Local Revenue Fund 2011, and the Controller shall sequester those funds in the Behavioral Health Subaccount pursuant to Section 30027.10 of the Government Code. Upon this sequestration, the department shall use the funds in accordance with Section 30027.10 of the Government Code.

(c) (1) The obligations of the mental health plan shall be changed only by contract or contract amendment.

(2) Notwithstanding paragraph (1), the mental health plan shall comply with federal and state requirements, including the applicable sections of the state plan and waiver.

(3) A change may be made during a contract term or at the time of contract renewal, when there is a change in obligations required by federal or state law, or when required by a change in the interpretation or implementation of any law or regulation.

(4) To the extent permitted by federal law, either the department or the mental health plan may request that contract negotiations be reopened during the course of a contract due to substantial changes in the cost of covered benefits that result from an unanticipated event.

(d) The department shall immediately terminate a contract when the director finds that there is an immediate threat to the health and safety of Medi-Cal beneficiaries. Termination of the contract for other reasons shall be subject to reasonable notice of the department’s intent to take that action and notification to affected beneficiaries. The plan may request a hearing by the Office of Administrative Hearings and Appeals.

(e) A mental health plan may terminate its contract in accordance with the contract. The mental health plan shall provide written notice to the department at least 180 days before the termination or nonrenewal of the contract.

(f) Upon the request of the director, the Director of the Department of Managed Health Care may exempt a mental health plan from the Knox-Keene Health Care Service Plan Act of 1975 (Chapter 2.2 (commencing with Section 1340) of Division 2 of the Health and Safety Code). These exemptions may be subject to conditions the director deems appropriate. This section does not impair or diminish the authority of the Director of the Department of Managed Health Care under the Knox-Keene Health Care Service Plan Act of 1975, nor does it reduce or otherwise limit the obligation of a mental health plan contractor licensed as a health care service plan to comply with the requirements of the Knox-Keene Health Care Service Plan Act of 1975, and the rules of the Director of the Department of Managed Health Care promulgated under the Knox-Keene Health Care Service Plan Act of 1975. The director, in consultation with the Director of the Department of Managed Health Care, shall analyze the appropriateness of licensure or application of applicable standards of the Knox-Keene Health Care Service Plan Act of 1975.

(g) The department shall provide oversight to the mental health plans to ensure quality, access, cost efficiency, and compliance with data and reporting requirements. At a minimum, the department shall monitor, through a method independent of any agency of the mental health plan contractor, the level and quality of services provided, expenditures pursuant to the contract, and conformity with federal and state law.

(h) County employees implementing or administering a mental health plan act in a discretionary capacity when they determine whether or not to admit a person for care or to provide any level of care pursuant to this chapter.

(i) If a county discontinues operations as the mental health plan, the department shall approve any new mental health plan. The new mental health plan shall give reasonable consideration to affiliation with nonprofit community mental health agencies that were under contract with the county and that meet the mental health plan’s quality and cost efficiency standards.

(j) This chapter does not modify, alter, or increase the obligations of counties as otherwise limited and defined in Chapter 3 (commencing with Section 5700) of Part 2 of Division 5. The county’s maximum obligation for services to persons ineligible for Medi-Cal shall be no more than the amount of funds remaining in the mental health subaccount pursuant to Sections 17600, 17601, 17604, 17605, and 17609 after fulfilling the Medi-Cal contract obligations.

14717.1.

 (a) (1) It is the intent of the Legislature to ensure that foster youth who are placed outside of their county of original jurisdiction are able to access specialty mental health services in a timely manner, consistent with their individual strengths and needs and the requirements of federal Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services.

(2) It is the further intent of the Legislature to overcome any barriers to care that may result when responsibility for providing or arranging for specialty mental health services to foster youth who are placed outside of their county of original jurisdiction is retained by the county of original jurisdiction.

(b) In order to facilitate the receipt of medically necessary specialty mental health services by a foster youth who is placed outside of their county of original jurisdiction, the California Health and Human Services Agency shall coordinate with the department and the State Department of Social Services to take all of the following actions on or before July 1, 2017:

(1) The department shall issue policy guidance on the conditions for, and exceptions to, presumptive transfer, as described in subdivisions (c) and (d), in consultation with the State Department of Social Services and with the input of stakeholders that include the County Welfare Directors Association of California, the Chief Probation Officers of California, the County Behavioral Health Directors Association of California, provider representatives, and family and youth advocates.

(2) Policy guidance concerning the conditions for, and exceptions to, presumptive transfer shall ensure all of the following:

(A) The transfer of responsibility improves access to specialty mental health care services consistent with the mental health needs of the foster youth.

(B) Presumptive transfer does not disrupt the continuity of care.

(C) Conditions and exceptions are applied consistently statewide, giving due consideration to the varying capabilities of small, medium, and large counties.

(D) Presumptive transfer can be waived only with an individualized determination that an exception applies.

(E) A party to the case who disagrees with the presumptive transfer individualized exception determination made by the county placing agency pursuant to subdivision (d) is afforded an opportunity to request judicial review before a transfer or exception being finalized.

(F) There is a procedure for expedited transfer within 48 hours of placement of the youth outside of the county of original jurisdiction.

(c) For purposes of this section, “presumptive transfer” means that absent any exceptions as established pursuant to this section, responsibility for providing or arranging for specialty mental health services shall promptly transfer from the county of original jurisdiction to the county in which the foster youth resides, under either of the following conditions:

(1) A foster youth is placed in a county other than the county of original jurisdiction on or after July 1, 2017.

(2) A foster youth who resides in a county other than the county of original jurisdiction after June 30, 2017, and is not receiving specialty mental health services consistent with their mental health needs, requests transfer of responsibility. A foster youth who resided in a county other than the county of original jurisdiction after June 30, 2017, and who continues to reside outside the county of original jurisdiction after December 31, 2017, shall have jurisdiction transferred no later than the youth’s first regularly scheduled status review hearing conducted pursuant to Section 366 in the 2018 calendar year unless an exception described under subdivision (d) applies.

(d) (1) On a case-by-case basis, and when consistent with the medical rights of youth in foster care, presumptive transfer may be waived and the responsibility for the provision of specialty mental health services shall remain with the county of original jurisdiction if any of the exceptions described in paragraph (5) exist.

(2) A request for waiver in a manner established by the department may be made by the foster youth, the person or agency that is responsible for making mental health care decisions on behalf of the foster youth, the county probation agency or the child welfare services agency with responsibility for the care and placement of the youth, or any other interested party who owes a legal duty to the youth involving the youth’s health or welfare, as defined by the department.

(3) The county probation agency or the child welfare services agency with responsibility for the care and placement of the youth, in consultation with the youth and their parent, the youth and family team if one exists, and other professionals who serve the youth as appropriate, is responsible for determining whether waiver of the presumptive transfer is appropriate pursuant to the conditions and exceptions established under this section. The person who requested the exception, along with any other parties to the case, shall receive notice of the county agency’s determination.

(4) The individual who requested the exception or any other party to the case who disagrees with the determination made by the county agency pursuant to paragraph (3) may request judicial review before the county’s determination becoming final. The court may set the matter for hearing and may confirm or deny the transfer of jurisdiction or application of an exception based on the best interest of the youth.

(5) Presumptive transfer may be waived under any of the following exceptions:

(A) It is determined that the transfer would disrupt continuity of care or delay access to services provided to the foster youth.

(B) It is determined that the transfer would interfere with family reunification efforts documented in the individual case plan.

(C) The foster youth’s placement in a county other than the county of original jurisdiction is expected to last less than six months.

(D) The foster youth’s residence is within 30 minutes of travel time to the youth’s established specialty mental health care provider in the county of original jurisdiction.

(6) A waiver processed based on an exception to presumptive transfer shall be contingent upon the mental health plan in the county of original jurisdiction demonstrating an existing contract with a specialty mental health care provider, or the ability to enter into a contract, single case agreement, or other service payment mechanism within 30 days of the waiver decision, and the ability to deliver timely specialty mental health services directly to the foster youth. That information shall be documented in the youth’s case plan.

(7) A request for waiver, the exceptions claimed as the basis for the request, a determination whether a waiver is determined to be appropriate under this section, and any objections to the determination shall be documented in the foster youth’s case plan pursuant to Section 16501.1.

(e) If the mental health plan in the county of original jurisdiction has completed an assessment of needed services for the foster youth, the mental health plan in the county in which the foster youth resides shall accept that assessment. The mental health plan in the county in which the foster youth resides may conduct additional assessments if the foster youth’s needs change or an updated assessment is needed to determine the youth’s needs and identify the needed treatment and services to address those needs.

(f) Upon presumptive transfer, the mental health plan in the county in which the foster youth resides shall assume responsibility for the authorization and provision of specialty mental health services and payments for services. The foster youth transferred to the mental health plan in the county in which the foster youth resides shall be considered part of the county of residence caseload for claiming purposes from the Behavioral Health Subaccount and the Behavioral Health Services Growth Special Account, both created pursuant to Section 30025 of the Government Code.

(g) The State Department of Social Services and the department shall adopt regulations by July 1, 2019, to implement this section. 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 State Department of Social Services and the department may implement and administer the changes made by this legislation through all-county letters, information notices, or similar written instructions until regulations are adopted.

(h) (1) If the department determines it is necessary, it shall seek approval from the United States Department of Health and Human Services, federal Centers for Medicare and Medicaid Services before implementing this section.

(2) If the department makes the determination that it is necessary to seek federal approval pursuant to paragraph (1), the department shall make an official request for approval from the federal government no later than January 1, 2017.

(i) This section shall be implemented only if, and to the extent that, federal financial participation under Title XIX of the federal Social Security Act (42 U.S.C. Sec. 1396 et seq.) is available and all necessary federal approvals have been obtained.

(j) Upon the implementation of the requirements set forth in Section 14717.2, this section shall not apply to a foster youth or probation-involved youth who is placed in a community treatment facility, group home, or a short-term residential therapeutic program, as defined in paragraphs (8), (13), and (18), respectively, of subdivision (a) of Section 1502 of the Health and Safety Code, outside of the youth’s county of original jurisdiction.

14717.2.

 (a) (1)  It is the intent of the Legislature to ensure that foster youth placed in congregate care settings outside of their county of original jurisdiction are able to access specialty mental health services in a timely manner, consistent with their individual strengths and needs and the requirements of federal Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services.

(2) The Legislature finds that because group home or short-term residential therapeutic program (STRTP) placements are intended to be short-term and community treatment facility placements are intended to be time-limited based on medical necessity, the responsibility for the provision of or arrangement for specialty mental health services for a foster youth before placement and upon return from the temporary placement are vested with the county of original jurisdiction.

(3) The Legislature finds that the placement of a youth in a group home, community treatment facility, or STRTP outside of the county of original jurisdiction should not disrupt continuity of care or adversely impact timely payment to the provider of specialty mental health services.

(b) Foster youth placed in a community treatment facility, group home, or a short-term residential therapeutic program, as defined in paragraphs (8), (13), and (18), respectively, of subdivision (a) of Section 1502 of the Health and Safety Code, shall not be presumptively transferred, as described in Section 14717.1, unless an exception is invoked pursuant to this subdivision.

(1) A request to invoke an exception in a manner established by the department in consultation with stakeholders may be made by the foster youth, the person or agency that is responsible for making mental health care decisions on behalf of the foster youth, the county probation agency or the child welfare services agency with responsibility for the care and placement of the foster youth, or any other interested party who owes a legal duty to the foster youth involving the youth’s health or welfare, as defined by the department.

(2) The county probation agency or the child welfare services agency with responsibility for the care and placement of the foster youth, with input from the child and family team if one exists, and in consultation with the foster youth and their parent, and other professionals who serve the youth as appropriate, is responsible for determining whether invoking the exception is appropriate pursuant to the conditions and exceptions established under this section. The person or entity that requested the exception, along with any other parties to the case, shall receive notice of the county agency’s determination.

(3) The individual or entity that requested the exception or any other party to the case who disagrees with the determination made by the county agency pursuant to paragraph (2) may request judicial review before the county’s determination becomes final. The court may set the matter for hearing and may confirm or deny the transfer of jurisdiction or application of an exception based on the best interest of the foster youth.

(4) An exception may be invoked, and presumptive transfer applied, for either of the following reasons:

(A) The foster youth’s case plan includes a transition to a home-based setting in the county of residence or within the same geographic region.

(B) The mental health plan in the county of residence requests presumptive transfer to directly serve the youth, and continued oversight and ensuring consistency of services can be provided through the members of the youth’s treatment team.

(c) (1) To support service delivery, continuity of care, and timely payment, the placing agency shall provide notification to the mental health plans in the county of original jurisdiction and the county of residence before placing a foster youth out of county in a community treatment facility, group home, or a short-term residential therapeutic program. The county may complete the notification through email. The State Department of Social Services shall maintain and update a contact list of county mental health plans on its internet website. If notification before placement is not possible, the placing agency shall notify the mental health plans in the county of original jurisdiction and the county of residence no later than three business days after making the out-of-county placement.

(2) To support service delivery, continuity of care, and timely payment, the community treatment facility, group home, or short-term residential therapeutic program that accepts an out-of-county placement may also notify the mental health plan in the county of original jurisdiction and the mental health plan in the county of residence about the out-of-county placement in their group home, facility, or program.

(3) Timely payment timeframes outlined in Section 14717.25 shall not begin until mental health plans are notified of the placement by either the placing agency or the placement provider.

(d) The State Department of Social Services shall verify that notification to the mental health plans in the county of original jurisdiction and the county of residence has been made as outlined in subdivision (c).

(e) (1) An exception may be applied at any point during the foster youth’s placement out of county, and the placing agency shall provide notification to the mental health plan in the county of residence and the county of original jurisdiction within five business days of the exception’s approval or denial pursuant to the process outlined in subdivision (c). When an exception occurs, the mental health plan in the county of residence shall notify the provider and the timely payment timeframes outlined in Section 14717.25 shall commence.

(2) The mental health plan in the county of residence, upon the presumptive transfer, shall assume responsibility for the authorization and provision of mental health services consistent with federal Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) requirements, as defined in Section 1396d(r) of Title 42 of the United States Code, and the payment for services.

(f) A request to invoke an exception, the reasons claimed as the basis for the request, a determination whether an exception is determined to be appropriate under this section, and any objections to the determination shall be documented in the foster youth’s case plan pursuant to Section 16501.1.

(g) The department and the State Department of Social Services shall adopt regulations by July 1, 2022, to implement this section. 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 and the State Department of Social Services may implement and administer this section through all-county letters, information notices, or similar written instructions until regulations are adopted.

(h) (1) If the department determines it is necessary, it shall seek approval from the United States Department of Health and Human Services, federal Centers for Medicare and Medicaid Services before implementing this section.

(2) If the department makes the determination that it is necessary to seek federal approval pursuant to paragraph (1), the department shall make an official request for approval from the federal government no later than January 1, 2022.

(i) This section shall be implemented only if, and to the extent that, federal financial participation under Title XIX of the federal Social Security Act (42 U.S.C. Sec. 1396 et seq.) is available and all necessary federal approvals have been obtained.

14717.25.

 (a)  It is the intent of the Legislature to support timely payment to the provider for services to help ensure foster or probation involved youth placed out of county receive the care and treatment they need.

(b) If a foster or probation involved youth is placed out of county in a group home, community treatment facility, or short-term residential therapeutic program and the youth is not presumptively transferred pursuant to Section 14717.2, the mental health plan in the county of original jurisdiction and the provider of services shall choose one of the following options in order to ensure timely payment:

(1) Utilize an existing contract between the mental health plan in the county of original jurisdiction and the out-of-state out-of-county specialty mental health services provider.

(2) Establish, if no contract exists, but both the mental health plan and the provider agree to establish a comprehensive contract for payment of specialty mental health services for a youth or multiple youths, a comprehensive contract for payment of services within a mutually agreed upon timeframe.

(c) (1) If neither of the options described under paragraphs (1) and (2) of subdivision (b) are available, payment for the specialty mental health services shall be made through an agreement between the mental health plan in the county of residence and the mental health plan in the county of original jurisdiction.

(2) The agreement between these two parties shall require the mental health plan in the county of residence to pay the specialty mental health provider under an existing contract, single case agreement, or other payment mechanism with the specialty mental health provider. Under this circumstance, financial responsibility for the youth remains with the county of original jurisdiction because the youth has not been presumptively transferred.

(3) If no contract exists between the mental health plan in the county of residence and the specialty mental health provider, as described in paragraph (2), and if the mental health plan in the county of residence does not intend to enter a payment agreement with the specialty mental health provider, the county of original jurisdiction shall be responsible for payment and shall establish a contract, single case agreement, or other payment mechanism for payment of specialty mental health services. The two parties shall enter into a contract, single case agreement, or other payment mechanism for payment of services within 30 days. This timeframe shall not begin until the mental health plans in the county of original jurisdiction and the county of residence have been notified of the out-of-state out-of-county placement by either the placing agency or the placement provider.

(d) For short-term residential therapeutic programs (STRTP), starting from the date of placement, the provider shall be paid for the services, as described under the STRTP interim regulations, promulgated by the State Department of Social Services, based on medical necessity and verified, as determined by the mental health assessment, and the terms of the contract or the agreement with the mental health plan in the county of original jurisdiction or the mental health plan in the county of residence, whichever applies. The contract or agreement may expand the scope of reimbursable services.

14717.26.

 The department, in collaboration with the State Department of Social Services, shall collect data on the receipt of Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) specialty mental health services by foster youth who are placed outside of their county of original jurisdiction. These data shall be included in the department’s Medi-Cal specialty mental health services performance dashboard, and shall contain, on the state level and for each county, by placement type, all of the following:

(a) The number of foster youth placed out of county.

(b) The number of foster youth placed out of county who receive specialty mental health services.

(c) For foster youth placed out of county who receive specialty mental health services, the number of foster youth for whom the county of original jurisdiction is responsible for providing or arranging for those services, and the number of foster youth for whom the county of residence is responsible for that provision or arrangement.

14717.3.

 (a)   If a foster youth is placed in a congregate care setting outside of their county of original jurisdiction, and the county of jurisdiction retains responsibility for specialty mental health services, the placing agency shall inform, if possible at the time of placement, but no later than three business days from placement, the mental health plans in the county of residence and the county of original jurisdiction.

(b) For foster youth placed in a short-term residential therapeutic program or other congregate care facility outside the county of original jurisdiction pursuant to the mental health program approval, a mental health assessment shall be completed or received by a licensed mental health professional within 10 calendar days of a youth’s admission.

(c) If relying upon a previously completed mental health assessment, that previously completed assessment shall be completed within 60 calendar days before admission and performed by a licensed mental health professional or an otherwise recognized provider of mental health services acting within their scope of practice. An exception of this requirement is authorized in instances in which a licensed mental health professional determines it is more clinically appropriate to complete a more current mental health assessment. The mental health assessment shall include a mental health status examination.

(d) Pursuant to federal law, and regardless if the presumptive transfer is made, foster youth placed out of county shall be entitled to continue their therapeutic relationship with prior treatment providers if chosen by the youth, and any changes to treatment providers shall be made in consultation with the youth in the context of the child and family team, as defined in paragraph (4) of subdivision (a) of Section 16501.

14717.35.

 (a) The mental health plan in the county of jurisdiction shall notify the mental health plan in the county of residence of any third-party service provider if additional information must be obtained directly from the third-party service provider.

(b) The county mental health plan in the county of original jurisdiction shall provide to the mental health plan in the county of residence both of the following:

(1) Contact information for the third-party service provider, if applicable.

(2) Any completed assessment or client plans.

14717.4.

 (a) It is the intent of the Legislature that all eligible youth, including youth in the state’s child welfare system, have timely access to mental health care through the federal Early and Periodic Screening, Diagnostic, and Treatment program. It is further the intent of the Legislature that, in order to fulfill this important responsibility, all mental health plans operating in the state use standardized forms to facilitate efficient and effective provision of mental health services by providers of specialty mental health services to all foster youth, regardless of the county in which the youth live.

(b) The department, in consultation with the State Department of Social Services and stakeholders, and no later than March 1, 2022, shall create standardized forms that shall be used by counties for the purpose of simplifying the notification of out-of-county placements, and presumptive transfers transfers, exceptions, or waivers thereof, including in the case of foster youth placed in home-based care and foster youth placed in congregate care.

(c) The department, no later than June 1, 2022, shall work with the State Department of Social Services to determine the feasibility of automating forms through the child welfare automation data system for use by county child welfare agencies and county mental health plans.

14717.45.

 No later than June 1, 2022, the department shall work in consultation with stakeholders, including, but not limited to, the California Behavioral Health Directors Association, the California State Association of Counties, and the California Alliance of Child and Family Services, among others, to create a standardized contract template for use by a county of original jurisdiction for services provided pursuant to Sections 14717.2 and 14717.25 by an out-of-county community treatment facility, group home, or short-term residential therapeutic program, as defined in paragraphs (8), (13), and (18), respectively, of subdivision (a) of Section 1502 of the Health and Safety Code.