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SB-110 Substance use disorder services: contingency management services.(2021-2022)

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Date Published: 09/08/2021 04:00 AM
SB110:v95#DOCUMENT

Enrolled  September 07, 2021
Passed  IN  Senate  September 03, 2021
Passed  IN  Assembly  September 02, 2021
Amended  IN  Assembly  August 30, 2021
Amended  IN  Assembly  July 01, 2021
Amended  IN  Senate  March 15, 2021

CALIFORNIA LEGISLATURE— 2021–2022 REGULAR SESSION

Senate Bill
No. 110


Introduced by Senator Wiener
(Principal coauthor: Assembly Member Chiu)
(Coauthors: Assembly Members Davies and Friedman)

January 06, 2021


An act to amend Section 14021.6 of, and to add Section 14021.38 to, the Welfare and Institutions Code, relating to Medi-Cal.


LEGISLATIVE COUNSEL'S DIGEST


SB 110, Wiener. Substance use disorder services: contingency management services.
Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, and under which qualified low-income individuals receive health care services, including substance use disorder services that are delivered through the Drug Medi-Cal Treatment Program and the Drug Medi-Cal organized delivery system, subject to utilization controls. For purposes of the Drug Medi-Cal Treatment Program, existing law prescribes the maximum allowable rates for services, including individual and group rates for extensive counseling for outpatient drug-free treatment. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions.
This bill would expand substance use disorder services to include contingency management services as an optional benefit under the Drug Medi-Cal organized delivery system, as specified, subject to utilization controls. The bill would require counties that administer the Drug Medi-Cal organized delivery system to submit a plan to the department that demonstrates readiness to implement contingency management services that are provided to eligible Medi-Cal beneficiaries through electronic or in-person means and to consult with stakeholders for purposes of developing that plan. The bill would require the department to review and approve the plan. The bill would require the department to issue guidance on the use of contingency management services for Medi-Cal beneficiaries who access substance use disorder services under the Drug Medi-Cal organized delivery system. The bill would provide that contingency management services are not a rebate, refund, commission preference, patronage dividend, discount, or any other gratuitous consideration. The bill would authorize the department to establish limits on the number and value of incentives available to Medi-Cal beneficiaries who receive contingency management services, and to implement these provisions by various means, including provider bulletin, without taking regulatory action. The bill would condition the implementation of these provisions to the extent permitted by federal law, the availability of federal financial participation, and the department securing federal approval. The bill would require the department to determine maximum allowable rates for contingency management services, 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.

 Section 14021.38 is added to the Welfare and Institutions Code, to read:

14021.38.
 (a) Subject to subdivision (h), substance use disorder services shall include contingency management services as an optional benefit under the Drug Medi-Cal organized delivery system, subject to utilization controls. Contingency management services shall include an incentive structure, including, but not limited to, scaling rewards for continued evidence of specified behaviors or adherence to treatment goals, that rewards participants for specified behaviors, such as negative urinalysis.
(b) (1) Counties shall do both of the following:
(A) Submit a plan to the department that demonstrates readiness to implement contingency management services that are provided to eligible Medi-Cal beneficiaries through electronic and in-person means.
(B) Consult with stakeholders during the development of the plan specified in subparagraph (A).
(2) The plan, as described in subparagraph (A) of paragraph (1), shall be based on criteria set forth by the department. The department shall review and approve that plan if it meets prescribed criteria.
(c) The department, in consultation with stakeholders, shall issue guidance on the use of contingency management services for Medi-Cal beneficiaries who access substance use disorder services under the Drug Medi-Cal organized delivery system.
(d) Contingency management services are not a rebate, refund, commission preference, patronage dividend, discount, or any other gratuitous consideration, as described in Section 51478 of Title 22 of the California Code of Regulations.
(e) The department may establish limits on the number and value of incentives available to Medi-Cal beneficiaries who receive contingency management services.
(f) Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may implement this section by means of a provider bulletin or similar instruction, without taking any further regulatory action.
(g) For purposes of implementing this section, the department shall seek any necessary federal approvals, including approvals of any state plan amendments or federal waivers, by the federal Centers for Medicare and Medicaid Services.
(h) (1) This section shall only be implemented to the extent permitted by federal law.
(2) This section shall be implemented only if, and to the extent that, any necessary federal approvals are obtained and federal financial participation is available and not otherwise jeopardized.

SEC. 2.

 Section 14021.6 of the Welfare and Institutions Code is amended to read:

14021.6.
 (a) For the fiscal years before the 2004–05 fiscal year, and subject to the requirements of federal law, the maximum allowable rates for the Drug Medi-Cal Treatment Program shall be determined by computing the median rate from available cost data by modality from the fiscal year that is two years before the year for which the rate is being established.
(b) (1) For the 2007–08 fiscal year, and subsequent fiscal years, and subject to the requirements of federal law, the maximum allowable rates for the Drug Medi-Cal Treatment Program shall be determined by computing the median rate from the most recently completed cost reports, by specific service codes that are consistent with the federal Health Insurance Portability and Accountability Act of 1996 (42 U.S.C. Sec. 300gg).
(2) For the 2005–06 and 2006–07 fiscal years, if the department determines that reasonably reliable and complete cost report data are available, the methodology specified in this subdivision shall be applied to either or both of those years. If reasonably reliable and complete cost report data are unavailable, the department shall establish rates for either or both of those years based upon the usual, customary, and reasonable charge for the services to be provided, as the department may determine in its discretion. This subdivision does not modify subdivision (h) of Section 14124.24, which requires certain providers to submit performance reports.
(c) Notwithstanding subdivision (a), for the 1996–97 fiscal year, the rates for nonperinatal outpatient methadone maintenance services shall be set at the rate established for the 1995–96 fiscal year.
(d) Notwithstanding subdivision (a), the maximum allowable rate for group outpatient drug free services shall be set on a per person basis. A group shall consist of a minimum of 2 and a maximum of 12 individuals, at least one of which shall be a Medi-Cal eligible beneficiary. For groups consisting of two individuals, if one of the individuals is ineligible for Medi-Cal, the individual who is ineligible for Medi-Cal shall be receiving outpatient drug free services for a substance use disorder diagnosed by a physician.
(e) The department shall develop individual and group rates for extensive counseling for outpatient drug free treatment, based on a 50-minute individual or a 90-minute group hour, not to exceed the total rate established for subdivision (d).
(f) (1) Notwithstanding 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 section by means of bulletins or similar instructions until the time any necessary regulations are adopted. The department shall adopt regulations by July 1, 2020, in accordance with the requirements of Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code. Beginning six months after the effective date of the act that added this paragraph, and notwithstanding Section 10231.5 of the Government Code, the department shall, on a semiannual basis and in compliance with Section 9795 of the Government Code, provide a status report to the Legislature until the regulations have been adopted.
(2) Notwithstanding paragraph (1) and Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may annually establish and update the statewide maximum allowable reimbursement rates specified in this section by means of bulletins or similar instructions.
(g) Bills for services under the Drug Medi-Cal Treatment Program shall be submitted no later than six months from the date of service.
(h) Notwithstanding subdivision (b), the department shall determine maximum allowable rates for contingency management services authorized pursuant to Section 14021.38 based upon, if available and appropriate, any of the following:
(1) The Medi-Cal fee-for-service outpatient rates for the same or similar services.
(2) Cost report data.
(3) Any other data deemed reliable and relevant by the department.