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SB-408 Foster youth with complex needs: regional health teams.(2023-2024)



Current Version: 07/13/23 - Amended Assembly

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SB408:v95#DOCUMENT

Amended  IN  Assembly  July 13, 2023
Amended  IN  Senate  May 18, 2023
Amended  IN  Senate  May 03, 2023
Amended  IN  Senate  March 14, 2023

CALIFORNIA LEGISLATURE— 2023–2024 REGULAR SESSION

Senate Bill
No. 408

Introduced by Senator Ashby
(Coauthor: Assembly Member Bonta)

February 09, 2023

An act to add Chapter 4.5 (commencing with Section 5425) to Part 1 of Division 5 of the Welfare and Institutions Code, relating to foster youth.


LEGISLATIVE COUNSEL'S DIGEST


SB 408, as amended, Ashby. Foster youth with complex needs: regional health teams.
Existing law generally provides for the placement of foster youth in various placement settings, and governs the provision of child welfare services, which is defined to mean public social services that are directed toward the accomplishment of specified purposes, including protecting and promoting the welfare of all children, preventing the unnecessary separation of children from their families, and restoring to their families children who have been removed. Existing federal law, the Family First Prevention Services Act of 2018, among other things, provides states with an option to use federal funds under Title IV of the federal Social Security Act to provide mental health and substance abuse prevention and treatment services and in-home parent skill-based programs to a child who is a candidate for foster care or a child in foster care who is a pregnant or parenting foster youth, as specified.
This bill would require the State Department of Health Care Services, in consultation with the State Department of Social Services, to establish up to 10 regional health teams throughout the state, to serve foster youth and youth who may be at risk of entering foster care. The bill would require the department to submit a state plan amendment to the federal Centers for Medicare and Medicaid Services no later than July 1, 2024, to implement the Medicaid Health Home State Plan Option, as specified, in establishing the regional health teams. The bill would require the department to coordinate with the State Department of Social Services and the State Department of Developmental Services, and to convene and engage specified stakeholders, to develop the regional health teams.
The bill would make regional health teams available to children and youth and any adult caregiver or other adult connected with the child or youth under 26 years of age, who are experiencing severe mental illness, emotional disturbance, substance use, intellectual or developmental disability, or special health care needs or chronic health issues, or any combination of those conditions. The bill would specify the required membership of the regional health teams, including, but not limited to, a physician, a licensed clinical social worker, and a public health nurse. The duties of the regional health team would include, but not be limited to, receiving and responding to referrals received from staff from county child welfare agencies, county probation departments, regional centers, and others, developing a person-centered care plan, and coordinating and providing access to delivering various categories of care and services.
The bill would require the department to fund up to provide grants, upon appropriation, to create the necessary startup infrastructure for 10 health teams that are geographically situated to support access to services equitably throughout the state, as specified. The bill would require the regional health teams to be funded by the department pursuant to a competitive procurement process. The bill would declare the intent of the Legislature that the health home state plan option begin no later than December 1, 2024, subject to the receipt of any required federal approvals or waivers. as specified.
The bill would condition implementation of these provisions on the availability of federal financial participation and receipt of any necessary federal approvals. The bill would authorize the department to implement these provisions through all-county letters or similar instructions.
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 counties are experiencing a crisis of foster youth with severe trauma and complex, unmet needs who are simply overwhelming county child welfare and probation agencies, regional centers, schools, and behavioral health providers.
(b) Foster youth with complex needs are often served by multiple other systems who also struggle with providing timely and appropriate services due to lack of funding and antiquated processes that are not conducive to meeting children’s immediate needs, particularly for foster children experiencing a “trauma crisis.”
(c) Services to this population are currently delayed, lacking, and disjointed, resulting in foster youth often experiencing frequent placement changes because no single provider or entity can meet their needs. This results in a cycle of multiple placement moves, frequent changes in service providers and caregivers, and unnecessary stays in hospital settings and unlicensed settings. These experiences lead to poor outcomes for youth and exacerbate their trauma.
(d) While some efforts have been made at the state level to provide additional supports and assess the gaps and service needs, immediate action is necessary to provide a trauma-informed, patient- and youth-centered approach to addressing the individualized needs of foster youth with complex needs.
(e) Foster children and their families have experienced trauma that requires a coordinated, multisystem approach to achieve positive outcomes and to build on and leverage existing efforts, such as trauma-informed systems of care, pursuant to AB 2083 (Chapter 815 of the Statutes of 2018), and California Advancing and Innovating Medi-Cal (CalAIM).
(f) Some foster youth who have experienced significant trauma, coupled with other intensive needs that cross multiple systems, and their families require a targeted approach to service provision that involves a coordinated effort across systems to meet their very unique needs.
(g) California can take advantage of tools and enhanced funding available through the federal Medicaid program to help better coordinate care and provide targeted services to foster youth with intensive needs. These needs include mental and physical health needs, developmental services, and other services that address their broad needs through care managers to help reduce hospitalizations or placement into restrictive institutional settings.

SEC. 2.

 Chapter 4.5 (commencing with Section 5425) is added to Part 1 of Division 5 of the Welfare and Institutions Code, to read:
CHAPTER  4.5. Regional Health Teams

5425.
 (a) The department, State Department of Health Care Services (department), in consultation with the State Department of Social Services, shall establish up to 10 regional health teams throughout the state to serve foster youth and youth who may be at risk of entering foster care. care, as described in Section 5426. In establishing the regional health teams, the department shall submit a state plan amendment to the federal Centers for Medicare and Medicaid Services no later than July 1, 2024, to implement the Medicaid Health Home State Plan Option, pursuant to Section 1945 of the federal Social Security Act, as added by Section 2703 of the federal Patient Protection and Affordable Care Act.
(b) The department shall coordinate with the State Department of Social Services and the State Department of Developmental Services and shall convene and engage stakeholders, including, but not limited to, the County Welfare Directors Association of California, the Chief Probation Officers of California, the County Behavioral Health Directors Association of California, the Association of Regional Center Agencies, interested counties, and other stakeholders, as deemed appropriate, to develop the regional health teams.

5426.
 (a) Regional health teams shall be available to children and youth and any adult caregivers or other adults connected with the child or youth under 26 years of age, who are experiencing severe mental illness, emotional disturbance, substance use, intellectual or developmental disability, or special health care needs or chronic health issues, or any combination of the listed conditions, and subject to identification and referral as described pursuant to subdivision (d). For purposes of this chapter, “severe mental illness and emotional disturbance” means an organic disorder of the brain or a clinically significant disorder of thought, mood, perception, orientation, memory, or behavior, that seriously limits a person’s capacity to function in primary aspects of daily living, such as personal relations, living arrangements, work, school, and recreation.
(b) Regional health teams shall be physician led and shall be composed of, at a minimum, the following members:
(1) A physician. physician, including a psychiatrist.
(2) A licensed clinical social worker. worker or psychologist.
(3) A public health nurse.
(4) A nutritionist or dietitian.
(5) An occupational therapist.
(6) A community health worker.
(7) A peer support specialist.
(8) A training coordinator.
(9) Additional behavioral health staff as appropriate.
(c) All team members shall be responsible for ensuring that care is person centered, culturally competent, and linguistically capable.
(d) Regional health teams shall perform the following activities, which may be delivered at a facility or through mobile services in home or other community-based settings where the youth and child or youth and the family are located:
(1) Receive and respond to referrals received from staff from county child welfare, county probation departments, regional centers, and others as deemed appropriate by the local county system of care, as defined pursuant to described in Section 16521.6.
(2) (A) Develop a person-centered care plan for each individual that coordinates and integrates all of their clinical and nonclinical health care-related needs and services.
(B) Regional health teams shall include, as part of their services under this chapter, all of the following:

(2)

(i) Provide quality-driven, cost-effective, culturally appropriate, and person- and family-centered health home services.

(3)

(ii) Coordinate and provide access to deliver high-quality health care services informed by evidence-based clinical practice guidelines.

(4)

(iii) Coordinate and provide access to deliver preventive and health promotion services, including prevention of mental illness and substance use disorders.

(5)

(iv) Coordinate and provide access to deliver mental health and substance abuse services. If the child or youth already has a mental health provider, the regional health team shall attempt to engage with that provider in order to exchange relevant information and provide guidance to the treating mental health provider, upon the agreement of the individual served or their medical rights holder.

(6)

(v) Coordinate and provide access to deliver comprehensive care management, care coordination, and transitional care across settings. For purposes of this chapter, “transitional care” means appropriate followup from inpatient to other settings, such as participation in discharge planning and facilitating transfer from a pediatric to an adult system of health care.

(7)

(vi) Coordinate and provide access to deliver chronic disease management, including self-management support to individuals and their families.

(8)

(vii) Coordinate and provide access to deliver individual and family supports, including linkage to community, social support, and recovery services.

(9)Coordinate and provide access to long-term care supports and services.

(viii) Develop transition plans with individuals and their families.
(e) Regional health teams shall implement each of the following strategies to support their delivery of services:

(10)

(1) Promote evidence-based medicine and utilize patient engagement strategies in the implementation of client plans.

(11)Develop a person-centered care plan for each individual that coordinates and integrates all of their clinical and nonclinical, health care-related needs and services.

(12)

(2) Demonstrate a capacity to use health information technology to link services, facilitate communication among team members and between the health team and individual and family caregivers, as well as the placing agency, and provide feedback regarding practices, as feasible and appropriate.

(13)

(3) Establish a continuous quality improvement program, and collect and report on data that permit an evaluation of increased coordination of care and chronic disease management on individual-level clinical outcomes, experience-of-care outcomes, and quality-of-care outcomes at the population level.

(14)

(4) Conduct staff training within the regional health team and with other service providers to improve direct care and patient outcomes.

(e)

(f) Screening and referral for regional health team services shall be determined pursuant to guidelines developed by the local system of care team pursuant to Section 16521.6 in the county or counties served by the regional health team, with priority to current foster youth and those at risk of entering foster care.

(f)The department shall fund up to

(g) Subject to an appropriation made by the Legislature for this purpose, the department shall provide grants to create the necessary startup infrastructure for 10 health teams that shall be geographically situated to support access to services equitably throughout the state. Regional health teams shall be funded by the department pursuant to a competitive procurement process. Eligible entities shall include county behavioral health plans, community health centers, hospital-based physician groups, or others as determined by the department.

(g)

(h) The department, in consultation with the stakeholders identified in subdivision (b) of Section 5425, shall establish do both of the following:
(1) Establish performance and outcome measures to be tracked by regional health teams and the intervals at which these teams are required to report information related to those measures to the department. The department shall post the results of these performance and outcome measures on its internet website on at least an annual basis.
(2) Develop a payment methodology, including, but not limited to, fee-for-service or per-member per-month (PMPM) payment structures that may include tiered payment rates that take into account the intensity of services provided by regional health teams pursuant to this chapter.

(h)

(i) It is the intent of the Legislature that the health home state plan option established pursuant to this section begin no later than December 1, 2024, subject to the receipt of any required federal approvals or waivers. waivers, in accordance with Section 5427.

5427.
 (a) This chapter shall be implemented only to the extent that federal financial participation is available and any necessary federal approvals have been obtained.
(b) 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 chapter by means of all-county letters, plan letters, plan or provider bulletins, or similar instructions, without taking any further regulatory action.