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AB-552 Integrated School-Based Behavioral Health Partnership Program.(2021-2022)

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Date Published: 04/05/2021 09:00 PM
AB552:v98#DOCUMENT

Amended  IN  Assembly  April 05, 2021

CALIFORNIA LEGISLATURE— 2021–2022 REGULAR SESSION

Assembly Bill
No. 552


Introduced by Assembly Member Quirk-Silva

February 10, 2021


An act to add Article 3 (commencing with Section 49440) to Chapter 9 of Part 27 of Division 4 of Title 2 of the Education Code, relating to pupil health.


LEGISLATIVE COUNSEL'S DIGEST


AB 552, as amended, Quirk-Silva. Integrated School-Based Behavioral Health Partnership Program.
Existing law requires the governing board of any school district to give diligent care to the health and physical development of pupils and authorizes the governing board of a school district to employ properly certified persons for the work.
The School-based Early Mental Health Intervention and Prevention Services for Children Act of 1991 authorizes the Director of Health Care Services, in consultation with the Superintendent of Public Instruction, to award matching grants to local educational agencies to pay the state share of the costs of providing school-based early mental health intervention and prevention services to eligible pupils at schoolsites of eligible pupils, subject to the availability of funding each year. Existing law establishes the Mental Health Student Services Act as a mental health partnership competitive grant program for the purpose of establishing mental health partnerships between a county’s mental health or behavioral health departments and school districts, charter schools, and the county office of education within the county, as provided.
This bill would establish the Integrated School-Based Behavioral Health Partnership Program to provide prevention and early intervention for, and access to, behavioral health services for pupils. The bill would authorize a county behavioral health agency and the governing board or governing body of a local educational agency to agree to collaborate on conducting a needs assessment on the need for school-based mental health and substance use disorder services, and implement an integrated school-based behavioral health partnership program, to develop a memorandum of understanding outlining the requirements for the partnership program, and to enter into a contract for mental health or substance use disorder services.
As part of a partnership program, the bill would require a county behavioral health agency to provide, through its own staff or through its network of contracted community-based organizations, one or more behavioral health professionals that meet specified contract, licensing, and supervision requirements requirements, and who have a valid, current satisfactory background check, to serve pupils with serious emotional disturbances or substance use disorders, or who are at risk of developing a serious behavioral health condition. The bill would require a local educational agency to provide school-based locations, including space at schools, appropriate for the delivery of behavioral health services, and would additionally authorize these services to be provided through telehealth or through appropriate referral. The bill would establish processes for delivering services services, and would specify the types of services services, including prevention, intervention, and intensive intervention services, as specified, that may be provided pursuant to the partnership program. The bill would require the local educational agency and county behavioral health agency to develop a process related to serving pupils with private insurance, including a process to seek reimbursement from private insurers for behavioral health services provided to a pupil.
The bill would require the partnership program to annually report specified information to the State Department of Health Care Services and the Mental Health Services Oversight and Accountability Commission, and would require the commission, in collaboration with the department, to report that information to the Legislature every three 3 years, as specified.
The bill would authorize a partnership program to provide services to individuals with exceptional needs, including services required by the pupil’s individualized education program, as specified.
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) In any given year, the percentage of young people with behavioral health disorders is estimated to be between 14 and 20 percent.
(b) One-half of all mental illness develops by 14 years of age and three quarters three-quarters by 24 years of age. Among adolescents and adults with substance use disorders, 90 percent began using substances before 18 years of age. Early intervention and prevention of behavioral health conditions are critical to the success of an individual’s health, educational goals, and social relationships.
(c) Pupils with emotional disturbances have the highest increase in absenteeism and dropout rates when compared to any other disability, according to studies.
(d) In 2017, a child in the United States was 10.1 times more likely to be seen by an out-of-network provider than a primary care office visit, which is more than twice the disparity seen for adults, according to a Milliman report.
(e) Under health parity law, services treating behavioral health conditions at the onset to prevent these conditions from becoming more serious should be part of every health plan’s benefits. Because of the importance of early intervention for children, private health plans do or should cover these services for children.
(f) Schools have been identified as a crucial place to provide behavioral health services and improve access to services for pupils, including for pupils in underserved communities, but also for pupils who are privately insured.
(g) According to recent research, the COVID-19 pandemic is affecting the mental health of children and adolescents causing an increase in depression, anxiety, and risky substance use. As children and youth return to schools, there will be a growing need for school-based behavioral health services to address the emotional harm caused by the COVID-19 pandemic.
(h) Beginning in April 2020, the proportion of children’s mental health-related emergency department visits among all pediatric emergency department visits increased and remained elevated through October 2020. Compared with 2019, the proportion of mental health-related visits for children 5 to 11 years of age, inclusive, and 12 to 17 years of age, inclusive, increased in 2020 by approximately 24 percent and 31 percent, respectively.

SEC. 2.

 Article 3 (commencing with Section 49440) is added to Chapter 9 of Part 27 of Division 4 of Title 2 of the Education Code, to read:
Article  3. Integrated School-Based Behavioral Health Partnership Program

49440.
 For purposes of this article, the following definitions apply:
(a) “At risk of developing a serious behavioral health condition” shall be defined by the applicable county behavioral health agency and local educational agency pursuant to the partnership program described in Section 49440.2.
(b) “Brief initial intervention” means Medi-Cal covered behavioral health services, as described in paragraph (c), that are a subset of essential health benefits, as defined in state and federal law, including Section 1300.67.005 of Title 28 of the California Code of Regulations, or any successor regulation, the federal Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (Public Law 110-343), and Senate Bill 855 (Chapter 151 of the Statutes of 2020).
(c) “Intervention” and “intensive intervention services,” means services” mean select Medi-Cal specialty mental health services and substance use disorder services that would be appropriately provided at a school-based location or through telehealth, including assessments, plan developments, therapy, substance use counseling, rehabilitation, collateral services, medication support services, therapeutic behavioral services, case management, recovery services, and intensive care coordination.
(d) “Local educational agency” means a school district, county office of education, or charter school.
(e) “Participating entity” means a community-based organization or other entity, including a local educational agency, that has contracted with a county behavioral health agency to provide services and participate in the partnership program pursuant to this article.
(f) “Partnership program” means an integrated school-based behavioral health partnership program established by a county behavioral health agency and the governing board or governing body of a local educational agency pursuant to this article. A partnership program may include one or more participating entities.
(g) “Privately insured pupil” means a pupil with comprehensive health coverage that is not run by the state or federal government.

49440.1.
 The Integrated School-Based Behavioral Health Partnership Program is hereby established to provide prevention and early intervention for, and access to, behavioral health services for pupils with serious emotional disturbances or substance use disorders, or who are at risk of developing a serious behavioral health condition.

49440.2.
 A county behavioral health agency and the governing board or governing body of a local educational agency may agree to collaborate on conducting a needs assessment on the need for school-based mental health and substance use disorder services, and implement an integrated school-based behavioral health partnership program pursuant to this article, and may develop a memorandum of understanding outlining the requirements for the partnership program, as provided in this article. Multiple local educational agencies within a single county may join to form a partnership program with the county behavioral health agency. The county behavioral health agency and the local educational agency are encouraged, when appropriate, to formalize the memorandum of understanding and enter into a contract for the provision of mental health or substance use disorder services.

49440.3.
 (a)  A county behavioral health agency shall designate and provide, through its own staff or through its network of contracted participating entities, one or more behavioral health professionals that meet the licensing and supervision requirements of one or more of the classifications listed in subdivision (b) to serve pupils with serious emotional disturbances or substance use disorders, or who are at risk of developing a serious behavioral health condition, pursuant to the partnership program.
(b) The county behavioral health agency, to secure Medicaid federal matching funds for school-based services, shall require any behavioral health professional who provides mental health or substance use disorder services pursuant to a partnership program to contract with the health agency to provide those services and to hold an active license or credential with one or more of the following classifications:
(1) A licensed clinical social worker or registered associate social worker, as described in Section 4996.18 of the Business and Professions Code.
(2) A licensed marriage and family therapist (MFT) or MFT associate, as described in subdivision (b) of Section 4980.03 of the Business and Professions Code.
(3) A licensed professional clinical counselor (LPCC) or LPCC associate, as described in subdivision (f) of Section 4999.12 of the Business and Professions Code.
(4) A licensed clinical psychologist or psychological intern.
(5) A licensed psychiatrist or psychiatric resident.
(6) A licensed psychiatric mental health nurse practitioner.
(7) A physician specialist in substance use disorder treatment.
(8) An individual who holds a services credential with a specialization in pupil personnel services as described in Section 44266 that authorizes the individual to perform school counseling, school psychology, or school social work.
(9) An individual who holds a services credential with specialization in health for school nurse, as described in Section 44267.5.
(10) A licensed educational psychologist, as defined in Chapter 13.5 (commencing with Section 4989.10) of Division 2 of the Business and Professions Code.
(c) (1) A behavioral health professional who meets the contracting and licensing requirements of subdivision (b) may supervise other trained county behavioral health professionals. For purposes of this subdivision, “other trained county behavior health professionals” means health professionals who are subject to supervision requirements under the Medicaid program when providing Medi-Cal reimbursable specialty mental health services and substance use disorder services, including clinical interns or trainees, certified peer specialists, and registered or certified substance use disorder counselors, participating in the partnership program.
(2) All behavioral health professionals who participate in the partnership program shall have a valid, current satisfactory background check.

49440.4.
 (a) The local educational agency shall provide school-based locations, including space at schools, appropriate for the delivery of behavioral health services.
(b) The county behavioral health agency and participating entities, as appropriate, shall collaborate with the local educational agency to establish hours of service at mutually agreed upon school-based locations or a process for ensuring timely interventions when needed, or both. Additional service delivery models that address local needs may be developed under the partnership program.
(c) The partnership program shall identify if mental health services or substance use disorder services, or both, will be delivered at the school-based location or through telehealth. If the partnership program determines that only mental health services or only substance use disorder services shall be provided at the school-based location, the partnership program shall develop a plan for each pupil who has been identified as needing behavioral health services that are not offered at the school-based location. The plan shall include appropriate referral for services not offered at the school-based location.
(d) Except as provided in subdivisions (b) and (c), the choice of timeframe and setting for the delivery of behavioral health services shall be made in consultation with the pupil and the pupil’s parent or guardian guardian, and shall include consideration of the specified needs expressed by the pupil and the pupil’s parent or guardian. Behavioral health services may be provided at locations that are not at the school-based location for purposes of accommodating the individual needs of a pupil.
(e) If necessary and appropriate, as determined in consultation with the parent or guardian of the pupil being served and in compliance with state and federal law protecting the pupil’s right to privacy and parental rights, Medi-Cal covered behavioral health services may continue to be delivered at the school-based location beyond the delivery of brief initial interventions.

49440.5.
 The local educational agency, county behavioral health agency, and any participating entity shall jointly develop a referral process to support school personnel in making appropriate referrals to the designated county behavioral health professional.

49440.6.
 To ensure timely access to behavioral health interventions at the earliest onset of a behavioral health condition, the designated county behavioral health professional shall provide brief initial interventions when necessary for all referred pupils, including uninsured and privately insured pupils, in addition to Medi-Cal beneficiaries.

49440.7.
 (a) The array of behavioral health services provided pursuant to the partnership program shall be a subset of Medi-Cal covered mental health or substance use disorder services, and shall include prevention, intervention intervention, and, if necessary, intensive intervention services. services, within a multitiered system of support or other similar framework employed by the local educational agency.
(b) At the discretion of the partnership program, services developed using funding from the Mental Health Services Act, enacted by Proposition 63 at the November 2, 2004, statewide general election, as amended, that are appropriate for a school-based setting may be provided under the partnership program. To use this funding, the partnership program shall meet all Mental Health Services Act requirements, including the community program planning process.
(c) Prevention services provided by the partnership program may include, but are not limited to, services that address the priorities described in paragraphs (1) to (4), inclusive, of subdivision (a) of Section 5840.7 of the Welfare and Institutions Code.
(d) Behavioral health interventions provided to pupils through the partnership program shall comply with all applicable state and federal laws protecting a pupil’s right to privacy and parental rights, including Section 6924 and subdivision (b) of Section 6929 of the Family Code.

49440.8.
 (a) (1) The local educational agency and county behavioral health agency, agency shall develop a process to collect information on the health insurance carrier for each pupil, with the permission of the pupil’s parent or guardian, to allow the partnership to seek reimbursement for behavioral health services provided to the pupil, when applicable. The process shall include informing any participating entity which pupils referred for services are privately insured.
(2) The memorandum of understanding of the partnership program shall specify how a privately insured pupil will be served if the parent or guardian does not provide the necessary information on the health insurance carrier pursuant to paragraph (1).
(b) (1) For privately insured pupils, the partnership program shall contact the private plan upon initiating the brief initial intervention services described in Sections 49440.6 and 49440.7 to facilitate a referral to the private plan’s network providers, as appropriate and consistent with professionally recognized standards of practice, and in consultation with the pupil and their parent or guardian, in compliance with all applicable state and federal laws protecting a pupil’s right to privacy and parental rights.
(2) (A) After contacting the private plan pursuant to paragraph (1), if the private plan is unable to offer the pupil enrolled in the plan an appointment with a network provider within 48 hours for an urgent care appointment or within 15 business days for a nonurgent appointment, except as provided in subparagraph (B), the designated behavioral health professional shall continue and complete the brief initial intervention services.
(B) The applicable waiting time for a particular appointment may be extended if the referring or treating licensed behavioral health provider, or the health professional providing triage or screening services, as applicable, acting within the scope of the individual’s practice and consistent with professionally recognized standards of practice, has determined and noted in the relevant record that a longer waiting time will not have a detrimental impact on the health of the enrollee.
(3) The private plan shall reimburse for brief initial intervention services provided by the designated behavioral health professional to pupils enrolled with the private plan at the amount a county behavioral health agency would receive for the same service services provided to a Medi-Cal beneficiary.
(4) A private plan licensed pursuant to the Knox-Keene Health Care Service Plan Act of 1975 (Article 1 commencing (commencing with Section 1340) of Chapter 2.2 of Division 2 of the Health and Safety Code) shall meet requirements for the timely payment of claims established pursuant to Section 1371 of the Health and Safety Code, and a private plan regulated pursuant to the Insurance Code shall meet the requirement for timely payment of claims established pursuant to Sections 10123.13 and 10123.147 of the Insurance Code for a contracted provider. If the private plan disputes the services provided or the amount, the private plan may submit a dispute to the Department of Managed Health Care, but the private plan shall comply with requirements for timely payment, including for services or amounts in dispute. The Department of Managed Health Care shall have trained staff available to address any disputes arising from the partnership program.
(c) If additional behavioral health services beyond the brief initial intervention services are necessary and appropriate, as determined in consultation with the parent or guardian of the pupil being served and in compliance with all applicable state and federal laws protecting a pupil’s right to privacy and parental rights, the following shall occur:
(1) If the private plan can meet timely access standards for care delivery, the designated behavioral health professional shall make a referral to the private plan provider.
(2) If the private plan cannot meet timely access standards for care delivery, the private plan and the county behavioral health agency shall negotiate a single case agreement to provide behavioral health services beyond the brief initial intervention services to determine reimbursement for additional services. If an agreement cannot be reached, the private plan shall report to the Department of Managed Health Care how it will ensure the pupil receives the necessary services in compliance with state and federal law, including the federal Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (Public Law 110-343) and Senate Bill 855 (Chapter 151 of the Statutes of 2020).
(d) Private plans, county behavioral health agencies, and participating entities are encouraged to contract to serve pupils who are receiving services from the partnership program.

49440.9.
 (a) A partnership program shall annually report to the State Department of Health Care Services and the Mental Health Services Oversight and Accountability Commission, all of the following:
(1) A brief description of the partnership program, including the service delivery model.
(2) The financial contribution made by the county behavioral health agency and local educational agency participating in the partnership program.
(3) The definition the partnership program uses to identify pupils “at risk of developing a serious behavioral health condition,” pursuant to Section 49440 and subdivision (a) of Section 49440.3.
(4) The number of school-based locations involved in the partnership program and the percent of pupils that percentage of pupils who are Medi-Cal beneficiaries at each school-based location.
(5) The number of pupils served in the last year including demographic data of the pupils’ race, ethnicity, gender, and language.
(6) The number of pupils who receive school-based services beyond the brief initial intervention described in Sections 49440.6 and 49440.7.
(7) (A) For partnership programs that provide specialty mental health services, the number of pupils who participate in the program who report functional improvement, as measured by the Child and Adolescent Needs and Strengths (CANS) assessment tool or other evidence-based tools, broken down by those pupils who receive only the brief initial intervention described in Sections 49440.6 and 49440.7 and those that receive additional school-based services.
(B) For partnership programs that provide specialty mental health services, only the relevant components of the CANS assessment tool, as determined by the treating designated behavioral health professional, shall be required to be completed for non-Medi-Cal beneficiaries who receive brief initial interventions.
(8) The percentage of pupils and parents or guardians that report satisfaction with the services provided through the partnership program.
(b) The Mental Health Services Oversight and Accountability Commission, in collaboration with the State Department of Health Care Services, shall provide a report to the Legislature on the Integrated School-Based Behavioral Health Partnership Program, based upon the metrics in this section, in compliance with Section 9795 of the Government Code, every three years, beginning three years after the establishment of a partnership program pursuant to this article.

49441.
 (a) The A partnership program may support, through collaboration and contracting for services, compliance with the local policies, responsibilities, and interventions that are required through individualized education programs described in Chapter 4 (commencing with Section 56300) of Part 30, and shall establish a process that does all of the following: provide services to pupils with exceptional needs, including, but not limited to, services required by the pupil’s individualized education program. The partnership program shall clearly delineate responsibilities for any services provided to pupils with exceptional needs that are included in a pupil’s individualized education program, and shall provide services consistent with state and federal law related to pupils with exceptional needs, including, but not limited to, statutes enacted under Chapter 43 of the Statutes of 2011 and the federal Individuals with Disabilities Education Act (20 U.S.C. Sec 1400 et seq.).

(1)Includes guidance describing the collaborations between local educational agencies and county behavioral health agencies that can support compliance.

(2)Distinguishes the local policies, responsibilities, and interventions that are required through individualized education programs and those relating to special education local plan areas.

(3)Distinguishes through guidance and policies how pupils receive the services required by individualized education programs and special education local plan areas, as well as through the partnership program, when appropriate.

(b) (1) This article does not replace current county requirements related to crisis intervention protocols and the partnership program shall not provide crisis interventions. The county behavioral health agency and local educational agency shall establish processes for timely interventions that identify nonurgent, urgent, and crisis-related circumstances. The process shall include guidelines for when county crisis intervention is needed instead of timely interventions related to urgent or nonurgent needs.
(2) The partnership program shall not create a siloed delivery system. The partnership program shall establish a process to leverage community-based services and other resources, and a process to identify local resources related to crisis intervention protocols and services.