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AB-1058 Medi-Cal: specialty mental health services and substance use disorder treatment.(2019-2020)

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Date Published: 06/25/2019 09:00 PM
AB1058:v95#DOCUMENT

Amended  IN  Senate  June 25, 2019
Amended  IN  Assembly  April 22, 2019
Amended  IN  Assembly  April 11, 2019
Amended  IN  Assembly  March 18, 2019

CALIFORNIA LEGISLATURE— 2019–2020 REGULAR SESSION

Assembly Bill
No. 1058


Introduced by Assembly Member Salas
(Coauthor: Senator Hurtado)

February 21, 2019


An act to add and repeal Section 14021.54 of the Welfare and Institutions Code, relating to Medi-Cal.


LEGISLATIVE COUNSEL'S DIGEST


AB 1058, as amended, Salas. Medi-Cal: specialty mental health services and substance use disorder treatment.
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 and funded by federal Medicaid program provisions. Existing law provides for various benefits under the Medi-Cal program, including substance use disorder treatment and mental health services that are delivered through the Drug Medi-Cal Treatment Program, the Drug Medi-Cal organized delivery system, and the Medi-Cal Specialty Mental Health Services Program.
This bill would require the department to engage, commencing no later than January 15, 2020, in a stakeholder process to develop recommendations for addressing legal and administrative barriers to the delivery of integrated behavioral health services for Medi-Cal beneficiaries with cooccurring substance use disorders and mental health conditions who access services through the Drug Medi-Cal Treatment Program, the Drug Medi-Cal organized delivery system, and the Medi-Cal Specialty Mental Health Services Program. The bill would require the stakeholder group to include specified individuals, such as behavioral health subject-matter experts and representatives from county behavioral health departments, and would require the stakeholder group to complete various tasks, including reviewing departmental policies and procedures on the department’s implementation and operation of administrative and oversight responsibilities for the 3 programs and reporting recommendations to the Legislature by September 15, 2020. The bill would repeal these provisions on January 1, 2021.
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 hereby finds and declares all of the following:
(a) Eight and one-half percent of Californians over 12 years of age have a substance use disorder, and more than 15 percent of adults have a mental health condition.
(b) More than 30 percent of the population that receives mental health services for severe and persistent mental illness through the Medi-Cal Specialty Mental Health Services Program in California have cooccurring substance use disorders.
(c) Substance use disorders and mental health conditions that are untreated may lead to chronic physical health problems, increased rates of emergency room visits, higher risk for homelessness, unemployment, and justice-system involvement, and trauma, suicide, or premature death.
(d) Nearly every California county has merged the administration of publicly funded substance use disorder treatment and specialty mental health services into integrated behavioral health systems. Care for both conditions is now typically managed using the same administrative infrastructure within the county and an overlapping workforce.
(e) Nonetheless, reimbursement, county contracts with the state, documentation and reporting, oversight and other administrative requirements for the Drug Medi-Cal Treatment Program, the Drug Medi-Cal organized delivery system system, and the Medi-Cal Specialty Mental Health Services Program remain trifurcated under state law.
(f) The rigidly separate benefit structures for these closely-related Medi-Cal programs produce inefficiencies and create administrative barriers to the provision of integrated substance use disorder treatment and mental health services for Californians with cooccurring conditions and who receive health care through the Medi-Cal program.
(g) It is in the interest of Californians in need of behavioral health services, and of the state as a whole, to develop integrated behavioral health programs that can effectively meet the needs of individuals with cooccurring substance use disorders and mental health conditions.

SEC. 2.

 Section 14021.54 is added to the Welfare and Institutions Code, to read:

14021.54.
 (a) (1) Commencing no later than January 15, 2020, the department shall engage in a stakeholder process to develop recommendations for addressing legal and administrative barriers to the delivery of integrated behavioral health services for Medi-Cal beneficiaries with cooccurring substance use disorders and mental health conditions who access services through the Drug Medi-Cal Treatment Program, the Drug Medi-Cal organized delivery system, and the Medi-Cal Specialty Mental Health Program.
(2) The stakeholder group shall be comprised composed of behavioral health subject-matter experts, behavioral health consumers or consumer advocates, providers who render behavioral health providers and representatives who render behavioral health services in primary care settings, including community hospitals, acute psychiatric hospitals, and community health centers, providers who render specialty mental health services and substance use disorder treatment, legislative staff members, and representatives from county behavioral health departments, and the County Behavioral Health Directors Association of California.
(b) The stakeholder group shall do all of the following:
(1) Identify administrative duplication, inefficiencies, or impediments to implementing integrated behavioral health services in the Medi-Cal program that exist in law, including state statute and regulation, departmental policy and guidance, such as the Mental Health and Substance Use Disorder Services Information Notices, and California’s Medicaid demonstration project waivers, including related Special Terms and Conditions, as authorized under Sections 1115 or 1915(b) of the federal Social Security Act.
(2) Review departmental policies and procedures on the department’s implementation and operation of administrative and oversight responsibilities for the Drug Medi-Cal Treatment Program, the Drug Medi-Cal organized delivery system, and the Medi-Cal Specialty Mental Health Program, to identify elements of those policies that produce administrative duplication, inefficiencies, or impediments to the implementation of integrated behavioral health services in the Medi-Cal program.
(3) Develop recommendations for changes to state statute and regulation, departmental policy and guidance, such as the Mental Health and Substance Use Disorder Services Information Notices, and the Special Terms and Conditions of California’s Medicaid demonstration project waivers authorized under Sections 1115 or 1915(b) of the federal Social Security Act that would remove identified statutory, regulatory, administrative, or other barriers to the delivery of integrated behavioral health services for Medi-Cal beneficiaries with cooccurring substance use disorders and mental health conditions who access services pursuant to the Medi-Cal program. The stakeholder group shall develop recommendations pursuant to this paragraph that address both of the following:
(A) Changes to requirements for Medi-Cal provider certifications, client assessment, treatment planning and related documentation, quality assurance and quality improvement activities, and data reporting for substance use disorder treatment and mental health services provided pursuant to the Medi-Cal program that would reduce duplication of, and increase the efficiency and effectiveness of, services provided to Medi-Cal beneficiaries with dual diagnoses.
(B) Changes to billing and claiming requirements of the Drug Medi-Cal Treatment Program, the Drug Medi-Cal organized delivery system, and the Medi-Cal Specialty Mental Health Program that would support greater flexibility of provider reimbursement for Medi-Cal benefits related to substance use disorder treatment and specialty mental health services that are rendered to Medi-Cal beneficiaries with dual diagnoses.
(4) Identify recommendations developed through the stakeholder process that may be implemented as components of extensions, renewals, or amendments to any California Medicaid demonstration project waivers as authorized under Sections 1115 or 1915(b) of the federal Social Security Act.
(c) (1) The stakeholder process shall be completed by September 15, 2020. The department shall report, by September 15, 2020, to the relevant policy and fiscal committees of the Legislature the recommendations developed through the stakeholder process.
(2) The report to be submitted pursuant to this subdivision shall be submitted in compliance with Section 9795 of the Government Code.
(d) This section shall remain in effect only until January 1, 2021, and as of that date is repealed.