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AB-2464 Project ECHO (registered trademark) Grant Program.(2019-2020)

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Date Published: 05/05/2020 09:00 PM
AB2464:v98#DOCUMENT

Amended  IN  Assembly  May 05, 2020

CALIFORNIA LEGISLATURE— 2019–2020 REGULAR SESSION

Assembly Bill
No. 2464


Introduced by Assembly Member Aguiar-Curry

February 19, 2020


An act to add and repeal Article 5.3 (commencing with Section 124000) to of Chapter 3 of Part 2 of Division 106 of the Health and Safety Code, relating to public health.


LEGISLATIVE COUNSEL'S DIGEST


AB 2464, as amended, Aguiar-Curry. Statewide pediatric behavioral telehealth networks. Project ECHO (registered trademark) Grant Program.
Existing law establishes within state government the California Health and Human Services Agency. Existing law also establishes various public health programs programs, including grant programs, throughout the state for purposes of promoting maternal, child, and adolescent health.

This bill would establish a grant program for purposes of establishing and funding a statewide pediatric behavioral telehealth network, subject to a competitive grant process. The California Health and Human Services Agency shall implement the grant program. The bill would require funding made available for these purposes to be expended to build the clinical infrastructure to support 10 telehealth hubs, as defined, throughout the state. The bill would make children’s hospitals and community-based behavioral health providers, as defined, eligible to participate in the grant program. The bill would require program applicants to demonstrate the ability to, among other things, direct telemedicine services from a hub to the patients of primary care providers.

This bill would require the agency, upon appropriation by the Legislature, to establish, develop, implement, and administer the Project ECHO (registered trademark) Grant Program. Under the grant program, the bill would require participating children’s hospitals to establish one year-long pediatric behavioral health teleECHO (trademark) clinics for specified individuals, including primary care clinicians and educators, to help them develop expertise and tools to better serve the youth that they work with by addressing their mental health needs stemming from the coronavirus pandemic. The bill would require the agency to ensure that the grant program includes a maximum of 8 grants that support pediatric behavioral health teleECHO (trademark) clinics to be administered and operated by an eligible children’s hospital, and that grant funding be made available, at a minimum, to participants for specified purposes, such as recruiting efforts and funding salaries and fringe benefits for pediatric behavioral health teleECHO (trademark) clinic personnel. The bill would require a pediatric behavioral health teleECHO (trademark) clinic to target specified audiences, including school-based health care personnel who serve kindergarten and grades 1 to 12, inclusive, and would require a participant to perform prescribed duties, such as preparing a report that evaluates the grant program. The bill would repeal these provisions on January 1, 2026.
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)California, along with many other states, is suffering from a lack of access to specialized mental health professionals, especially access to child psychiatrists. This shortage comes at a time when the prevalence of mental health issues in children and teens has risen at an alarming rate. According to the American Academy of Pediatrics, the number of child psychiatrists in the nation has increased over the past 10 years by 21 percent, from 8.01 to 9.75 per 100,000 children. However, 70 percent of the counties in the nation still have no child psychiatrists and many of these tend to be counties that are predominantly low income.

(b)While the American Academy of Child and Adolescent Psychiatry recommends 47 child psychiatrists per 100,000 children, California has only 13. Currently, less than 5 percent of children enrolled in Medi-Cal receive even a single mental health treatment and only 3 percent receive ongoing clinical behavioral health treatment. Many California children, whether covered by Medi-Cal or private insurance, can wait months or longer to obtain needed behavioral health care.

(c)While efforts should continue to train, recruit, and retain more specialty mental health providers in California, training new providers will take time and some underserved areas of the state will likely never recruit a sufficient number of behavioral health providers to meet the needs of their local populations. In addition, many children and adolescents whose mental health needs could be effectively managed in a primary care setting currently go untreated until their conditions deteriorate because their primary care providers lack the training and resources to adequately meet the mental health needs of their patients.

(d)Accordingly, California must undertake a multifaceted approach to make better use of the limited supply of specialty mental health providers in the state by deploying them strategically using telehealth and provider-to-provider consultation services to address the unmet need for pediatric behavioral health services across the state.

SECTION 1.

 (a) The Legislature finds and declares all of the following:
(1) California is facing an unprecedented public health crisis as a result of the novel coronavirus (COVID-19) pandemic.
(2) Mental health experts agree that the impacts of the pandemic and statewide stay-at-home orders will have long-lasting impacts on the mental health of all Californians.
(3) A 2013 study from the University of Kentucky, College of Medicine, found that almost one-third of children who experienced isolation or quarantine during the 2002–04 severe acute respiratory syndrome (SARS) pandemic and the 2009 H1N1 flu pandemic demonstrated symptoms that met the overall threshold for post-traumatic stress disorder (PTSD) and showed significantly higher rates of PTSD symptoms of all kinds compared to children who did not experience isolation or quarantine.
(4) The stay-at-home orders that have been issued across California in response to the COVID-19 pandemic are of a much longer duration, and more widespread, than those that were issued during either of these previous pandemics, which suggests that the negative impacts on children’s mental health will also be more severe and widespread.
(5) School district personnel and primary care clinicians are in the best position to implement widespread interventions and mental health supports for children, but many do not have the training or expertise needed to address the mental health needs that children will experience in the coming months and years.
(6) Project ECHO (Extension for Community Healthcare Outcomes) (registered trademark) is an innovative educational model and knowledge-sharing network that allows specialists to share their expertise with health care providers and educators in rural and underserved communities. Project ECHO (registered trademark) serves as a model to help pediatric and adolescent mental health teams share their expertise with primary care clinicians and school personnel who are on the front-line for the purpose of supporting the mental health needs of children and adolescents.
(7) This low-cost and high-impact intervention is accomplished by linking expert interdisciplinary specialist teams with primary care clinicians, other health care professionals, and educators through pediatric behavioral health teleECHO (trademark) clinics. Experts mentor the clinicians and professionals to help them manage their patient cases, clients, and students, as appropriate, and share their expertise through mentoring, guidance, feedback, and didactic education. This enables primary care clinicians and other professionals to develop the skills and knowledge they need to treat their patients, clients, and students, as appropriate, with common and complex conditions in their own communities thereby reducing travel costs, wait times, and avoidable complications.
(8) The ECHO model (trademark) is not a form of telemedicine. The specialist does not assume the care of the patient, client, or student. Rather, the ECHO model (trademark) is a guided practice model under which the primary care physician or professional retains responsibility for managing the patient, client, or student, and the primary care physician or professional operates with increasing independence as their skills and self-efficacy grow.
(b) For purposes of helping primary care clinicians, other health care professionals, including school-based health professionals, and educators meet the mental health needs of children and adolescents stemming from the COVID-19 pandemic, it is the intent of the Legislature to require the California Health and Human Services Agency to establish, develop, implement, and administer a grant program to fund a maximum of eight grants that support pediatric behavioral health teleECHO (trademark) clinics to be administered and operated by eligible children’s hospitals.

SEC. 2.

 Article 5.3 (commencing with Section 124000) is added to Chapter 3 of Part 2 of Division 106 of the Health and Safety Code, to read:
Article  5.3. Pediatric Behavioral Telehealth NetworksProject ECHO (registered trademark) Grant Program
Article  5.3. 

124000.
 For purposes of this article, the following definitions shall apply:
(a) “Children’s Eligible children’s hospital” means any hospital that is identified in Section 10727 or 10728 of the Welfare and Institutions Code. Code, or a children’s hospital that partners with any hospital identified in Section 10727 for purposes of the grant program.

(b)“Community-based behavioral health provider” means any provider with clinical expertise in pediatric behavioral health that has the capacity to serve as a hub in a particular region.

(c)

(b) “Grant program” means the grant program established under this article.

(d)“Hub” means a distinct geographic region of the state for which a participant is authorized to implement the grant program.

(e)“Hub-and-spoke system” means the linking of specialists at a hub to primary care clinicians in local communities pursuant to, among other things, telemedicine and videoconferencing, to facilitate case-based learning, dissemination of best practices, and evaluation of outcomes.

(f)

(c) “Participant” means an applicant that has been approved to implement the grant program in their region. program.

124001.

(a)There is hereby established a grant program for purposes of establishing and funding a statewide pediatric behavioral telehealth network. The network shall be comprised of a hub-and-spoke system, subject to a competitive grant process. The California Health and Human Services Agency shall implement the grant program.

(b)Funding made available for the grant program shall be expended to build the clinical infrastructure to support 10 telehealth hubs throughout the state. These hubs shall be established to do all of the following:

(1)Reach out to community-based providers, including pediatricians, family practitioners, and nurse practitioners to educate them about the services that the hub can provide and solicit participation in the hub’s network.

(2)Provide ongoing education to participating providers to build their capacity to identify and manage common pediatric behavioral health conditions, when appropriate, and when to refer to specialty care providers.

(3)Provide case consultation to participating providers to assist them in managing the behavioral health needs of particular patients.

(4)Provide timely telephonic or televideo behavioral health services directly to patients located in rural areas within the hub’s region, as needed.

(c)Participants shall place a priority on working with community providers that predominantly serve low-income populations or those serving in rural or underserved areas of the state.

124002.

(a)The following entities are eligible to apply to be a participant in the grant program:

(1)Children’s hospitals.

(2)Community-based behavioral health providers.

(b)Program applicants shall demonstrate their capacity to provide all of the following services:

(1)Teleconsultations for primary care providers.

(2)Direct telemedicine services from the hub to patients of the primary care providers.

(3)Virtual educational forums with hub to multiple primary care providers to teach everyone using case studies brought by the primary care providers.

(4)In-person education events that meet continuing education requirements for primary care providers and training on how to better address the mental health needs of their patients.

124001.
 (a) (1) Upon appropriation by the Legislature for this purpose, the California Health and Human Services Agency shall establish, develop, implement, and administer the Project ECHO (registered trademark) Grant Program. Under the grant program, participating children’s hospitals shall establish one year-long pediatric behavioral health teleECHO (trademark) clinics for primary care clinicians, other health care professionals, including school-based health professionals, and educators to help them develop expertise and tools to better serve the children and adolescents that they work with by addressing their mental health needs stemming from the coronavirus (COVID-19) pandemic.
(2) The agency shall ensure that the grant program includes a maximum of eight grants that support pediatric behavioral health teleECHO (trademark) clinics to be administered and operated by an eligible children’s hospital. Each one-time grant shall not exceed two hundred twenty-five thousand dollars ($225,000), and one grant shall be available to each eligible children’s hospital to fund a one year-long project. If any funding is available following an initial application period, the agency shall offer a secondary application period to exhaust available funding, subject to the funding limitations described in this paragraph.
(b) The agency shall ensure that grant funding be made available, at a minimum, to participants for all of the following purposes:
(1) Planning and developing curriculum.
(2) Printing and duplication costs.
(3) Recruiting.
(4) Funding all of the following:
(A) Salaries and fringe benefits for pediatric behavioral health teleECHO (trademark) clinic personnel.
(B) Supplies and equipment, including capital and noncapital.
(C) Travel costs associated with Replication Training at the ECHO (registered trademark) Institute and recruitment of pediatric behavioral health teleECHO (trademark) clinic participants.
(D) Facilities and administrative fees.
(E) Consultant fees.
(c) A pediatric behavioral health teleECHO (trademark) clinic shall target one of the following audiences or a subset of that audience:
(1) Primary care providers.
(2) School-based health care personnel who serve kindergarten and grades 1 to 12, inclusive.
(3) School-based mental health personnel who serve kindergarten and grades 1 to 12, inclusive.
(4) School administrators who serve kindergarten and grades 1 to 12, inclusive.
(5) Educators who serve kindergarten and grades 1 to 12, inclusive.
(d) Under the grant program, a participant shall perform specified duties in furtherance of the legislative objectives of this program, as directed by the agency. At a minimum, a participant shall do all of the following:
(1) Prioritize working with community providers and school-based personnel who predominantly serve low-income populations or those serving in rural or underserved areas of the state.
(2) Adhere to the four principles of the ECHO (registered trademark) model in the pediatric behavioral health teleECHO (trademark) clinics, which includes all of the following:
(A) Use technology to leverage scarce resources.
(B) Share best practices to reduce disparity.
(C) Employ case-based learning to master complexity.
(D) Use an internet web-based database to monitor outcomes.
(3) Prepare a report evaluating the grant program upon the conclusion of the one-year program, and submit that report to the agency for review.

124002.
 This article shall remain in effect only until January 1, 2026, and as of that date is repealed.