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AB-254 Local Educational Agency Behavioral Health Integration Pilot Program.(2017-2018)

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Date Published: 06/28/2017 09:00 PM
AB254:v94#DOCUMENT

Amended  IN  Senate  June 28, 2017
Amended  IN  Assembly  May 30, 2017
Amended  IN  Assembly  May 03, 2017
Amended  IN  Assembly  April 17, 2017
Amended  IN  Assembly  March 23, 2017

CALIFORNIA LEGISLATURE— 2017–2018 REGULAR SESSION

Assembly Bill No. 254


Introduced by Assembly Member Thurmond

January 31, 2017


An act to add Article 2.986 (commencing with Section 14094.25) to Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions Code, relating to health care services, and making an appropriation therefor.


LEGISLATIVE COUNSEL'S DIGEST


AB 254, as amended, Thurmond. Local Educational Agency Behavioral Health Integration Pilot Program.
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 by, and funded pursuant to, federal Medicaid program provisions. Existing law provides that specified services provided by local educational agencies (LEAs) are covered Medi-Cal benefits, including, but not limited to, mental health evaluations, mental health education, and mental health and counseling services. Existing law provides that an LEA may be reimbursed for the provision of those benefits on a fee-for-service basis through the Medi-Cal billing option for LEAs.
This bill would require the department to establish the Local Educational Agency Behavioral Health Integration Pilot Program for the purpose of improving the behavioral health outcomes of students through a whole person care approach that is accomplished by providing funding to an eligible participant for the provision by improving the delivery of direct behavioral health services, as defined. The bill would require the department to encourage eligible participants to participate in the program, to provide technical assistance to eligible participants, to develop a request for a proposals process to determine funding allocation, and to formulate any necessary Medi-Cal State Plan amendments, and award grants pursuant to these provisions. The bill would require an LEA receiving funding through the program to use funds received to undertake specified activities in support of the program, including, among others, providing, or building capacity for the provision of, direct behavioral health services to all students with a demonstrated need, with a concerted effort toward improving the delivery of underutilized services to students enrolled in the Medi-Cal program. The bill would authorize an LEA to provide direct behavioral health services through direct employment of health care providers, or by contracting, as specified, with health care providers or school health centers, as defined. The bill would provide for implementation of the program to the extent that any necessary federal approvals have been obtained. The bill would require the department, upon termination of the program and depletion of appropriated funds, to report to the Legislature, as specified, on the outcomes of the program and the need for funding school-based health services and their connection to early behavioral health outcomes. The bill would make related legislative findings and declarations.
Existing law, the Mental Health Services Act (MHSA), an initiative measure enacted by the voters as Proposition 63 at the November 2, 2004, statewide general election, funds a system of county mental health plans for the provision of mental health services, as specified. The MHSA provides that it may be amended by the Legislature by a 2/3 vote of each house as long as the amendment is consistent with and furthers the intent of the MHSA. Existing law establishes the Mental Health Services Fund (MHSF), continuously appropriated to and administered by the department, to fund specified county mental health programs, including prevention and early intervention programs and programs implemented under the Adult and Older Adult Mental Health System of Care Act. The MHSA authorizes the payment of administrative costs of the state from the fund in an amount not greater than 5% of the annual total deposited in the fund and otherwise specifies the distribution of moneys in the fund.
To implement the pilot program, this bill would appropriate $15 $10 million per year for the fiscal years from the 2018–19 fiscal year through and including the 2021–22 fiscal year to the department, subject to availability, from the MHSF moneys reserved for administrative costs described above. The bill would provide that funds not fully expended in a single fiscal year shall be available for the purpose of implementing this article in any one, or across one or more of, subsequent fiscal years, as specified. The bill would require the program to operate for 4 years from the date of that appropriation. By changing the use of the reserved administrative funds from that approved by the voters, the bill would amend the MHSA.
Vote: 2/3   Appropriation: YES   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)Health is a state of complete physical, mental, and social well-being.

(b)Physical health and behavioral health are inextricably tied together. Persons with poor behavioral health are at risk of developing chronic physical conditions, and poor physical health is associated with behavioral health concerns.

(c)Comprehensive health care, which is health care that integrates both physical and behavioral health, best addresses a person’s whole needs.

(d)Schools are an important resource for the provision of both physical and behavioral health, as they are at the center of communities, and a place that parents know and trust.

(e)School-based health improves student academic achievement, increases attendance, reduces dropout rates, improves behavior, and promotes parent engagement.

(f)Increasing school-based comprehensive health care is one of the best ways to improve overall student outcomes.

SEC. 2.SECTION 1.

 Article 2.986 (commencing with Section 14094.25) is added to Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions Code, to read:
Article  2.986. Local Educational Agency Behavioral Health Integration Pilot Program

14094.25.
 For the purposes of this chapter, the following definitions shall apply:
(a) “Department” means the State Department of Health Care Services.
(b) “Eligible participant” means either of the following:
(1) A local educational agency (LEA) that does not participate in the Medi-Cal billing option for LEAs authorized pursuant to Section 14132.06.
(2) An LEA that participates in the Medi-Cal billing option for LEAs authorized pursuant to Section 14132.06, but which receives low reimbursement relative to the number of students enrolled in the Medi-Cal program who would be eligible to receive covered services.
(c) “Direct behavioral health services” means those services that the department has identified as reimbursable behavioral health services under the Medi-Cal billing option for LEAs pursuant to Section 14132.06 and behavioral health services that are not covered under the Medi-Cal billing option for LEAs, including, but not limited to, mental health and alcohol and substance abuse service assessments, crisis intervention, counseling, treatment, and referral to a continuum of services, including, but not limited to, emergency psychiatric care, evidence-based mental health or alcohol and substance abuse treatment services, community support programs, inpatient care, and outpatient programs.
(d) “Program” means the Local Educational Agency Behavioral Health Integration Pilot Program established pursuant to this article.
(e) “School health center” means a center or program, located at or near an LEA, that provides age-appropriate health care services at the program site or through referrals.

14094.27.
 (a) The department, in cooperation with the State Department of Education, shall establish the Local Educational Agency Behavioral Health Integration Pilot Program for the purpose of improving the delivery of underutilized direct behavioral health services as part of a whole person care approach. services.
(b) In implementing the program, the department shall do all of the following:
(1) Encourage the participation in the program of eligible participants that are not yet participating in the program.
(2) Provide technical assistance to LEAs that seek to participate in the program or that are eligible participants. For the purposes of this article, technical assistance includes, but is not limited to, identifying public and private funding sources that will assist the LEA in enrolling students in the Medi-Cal program.
(3) Develop a request for proposals process that collects applicant information and determines which proposals shall receive funding. Funding priority shall be given to proposals that ensure coordination with existing health care delivery systems, including, if applicable, Medi-Cal managed care plans, county mental health plans, and primary and behavioral health care providers or their representatives.
(4) Formulate the necessary Medi-Cal State Plan amendments required by subdivisions (a) and (b) of Section 14115.8.
(5) Award grants pursuant to this article.

14094.29.
 (a) An LEA that participates in the program shall do all of the following:
(1) Use funds received through the program to provide, or to build capacity for the provision of, direct behavioral health services to all students with a demonstrated need, with a concerted effort toward improving the delivery of underutilized services to students enrolled in the Medi-Cal program. Funds received through the program shall be used to deliver, or develop capacity to ensure delivery of, new onsite direct behavioral health services not already provided by the LEA.
(2) Maximize enrollment of students eligible for the Medi-Cal program into the Medi-Cal program.
(3) Provide, or ensure the provision of, integrated physical and behavioral health services that are individualized and supportive of students and, where appropriate, their families, to ensure that health, social, or social and behavioral challenges are addressed.
(4) Create a sustainability plan that establishes how the LEA will seek to maximize the use of public funds, including, but not limited to, participation in federal reimbursement programs.
(5) Provide comprehensive professional development opportunities for school employees, including teachers, that enable school employees to recognize and respond to a child’s unique needs that includes the ability to provide referrals to professionals in the school who can provide mental health services. Nothing in this paragraph is intended to require teachers to provide mental health services to students.
(b) An LEA that participates in the program shall participate in the Medi-Cal billing option for LEAs by the time the LEA begins participation in the program.
(c) A reimbursement received through the program for direct behavioral health services provided by the LEA shall be used in accordance with applicable federal laws, regulations, or guidelines.
(d) An LEA participating in the program may provide direct behavioral health services through direct employment of health care providers or by contracting with other health care providers or school health centers for the purpose of supplementing services.

14094.31.
 An LEA that contracts with a health care provider or school health center pursuant to subdivision (d) of Section 14094.29 shall do both of the following:
(a) Create and maintain a mechanism, described in writing, to coordinate services provided to individual students among school staff and school health center staff while maintaining the confidentiality and privacy of health information consistent with applicable state and federal law.
(b) Create and maintain a contract or memorandum of understanding between the LEA, the health care provider or school health center, and any other provider agencies that describes the relationship between the LEA and the school health center, if applicable.

14094.35.
 (a) For the purpose of implementing this article, a sum not to exceed fifteen million dollars ($15,000,000) ten million dollars ($10,000,000) per year is appropriated to the department for each year of the fiscal years from the 2018–19 fiscal year through and including the 2021–22 fiscal year from the Mental Health Services Act funds allocated to the department pursuant to subdivision (d) of Section 5892, subject to the availability of those funds. Funds not fully expended in a single fiscal year shall be available for the purpose of implementing this article in any one, or across one or more of, subsequent fiscal years through and including the 2021–22 fiscal year.
(b) This article shall be implemented only to the extent that any necessary federal approvals have been obtained.
(c)  The program shall operate for four years from the date of the appropriation described in subdivision (a), notwithstanding fiscal years.

14094.37.
 (a) Upon the depletion of funds appropriated for the program and the termination of the program, the department shall submit a report to the Assembly Committees on Appropriations, Education, and Health, and the Senate Committees on Appropriations, Education, and Health, that shall include, but not be limited to, all of the following information:
(1) An evaluation of the need for funding school-based health services and their connection to early behavioral health outcomes.
(2) The impact of the program on student well-being, academic achievement, school engagement, attendance, and other outcome and indicator measures collected by LEAs participating in the program.
(b) Information reported pursuant to subdivision (a) shall be reported in the aggregate and shall not be reported in a manner that would compromise the privacy of any individual student.