ARTICLE 5.9. Medi-Cal Managed Care Plan Mental Health Benefits [14189 - 14190.2]
( Article 5.9 added by Stats. 2013, 1st Ex. Sess., Ch. 4, Sec. 30. )
Medi-Cal managed care plans shall provide mental health benefits covered in the state plan excluding those benefits provided by county mental health plans under the Specialty Mental Health Services Waiver. The department may require the managed care plans to cover mental health pharmacy benefits to the extent provided in the contracts between the department and the Medi-Cal managed care plans.
(Added by Stats. 2013, 1st Ex. Sess., Ch. 4, Sec. 30. (SB 1 1x) Effective September 30, 2013.)
(a) The department shall convene an advisory group to receive feedback on the changes, modifications, and operational timeframes regarding the implementation of pharmacy benefits offered in the Medi-Cal program. This advisory group shall be composed of organizations and entities such as hospitals, clinics, health plans, and consumer advocates.
(b) The department, through this advisory group as well as through other existing stakeholder meetings, shall provide regular updates on the pharmacy transition that include the following:
(1) A description of the changes in the division of responsibilities between the department and managed care plans as a result of a transition of the
outpatient pharmacy benefit to fee-for-service.
(2) A description of anticipated changes, if any, to beneficiary access to prescription medications.
(c) The department shall include in the Governor’s proposed budget the fiscal assumptions for the transition of the outpatient pharmacy benefit to a fee-for-service benefit.
(Added by Stats. 2019, Ch. 38, Sec. 51. (SB 78) Effective June 27, 2019.)
(a) Subject to subdivision (b), and no later than January 1, 2025, a Medi-Cal managed care plan shall conduct annual outreach and education for its enrollees, based on a plan that the Medi-Cal managed care plan develops and submits to the department upon the department’s approval of the Medi-Cal managed care plan’s Population Needs Assessment, regarding the mental health benefits that are covered by the Medi-Cal managed care plan pursuant to Section 14189 and paragraph (1) of subdivision (b) of Section 14184.402.
(1) The outreach and education plan shall be informed by the Medi-Cal managed care plan’s stakeholder engagement, including the community advisory committee established by the Medi-Cal managed care
plan, and by local stakeholders representing diverse racial and ethnic communities.
(2) The outreach and education plan shall be informed by the Medi-Cal managed care plan’s Population Needs Assessment and an assessment of utilization of covered mental health benefits by race, ethnicity, language, age, sexual orientation, gender identity, and disability, and shall ensure that materials and messaging are appropriate for the diversity of the plan enrollee membership. The Medi-Cal managed care plan shall submit the utilization assessment to the department.
(3) The outreach and education plan shall meet cultural and linguistic appropriateness standards,
in alignment with the National Standards for Culturally and Linguistically Appropriate Services, shall incorporate best practices in stigma reduction, and shall provide multiple points of contact for enrollees to access mental health benefits.
(b) (1) The department shall review the new or updated outreach and education plan submitted by each Medi-Cal managed care plan as described in this section and shall approve or modify the plan within 180 calendar days since submission, to ensure appropriate local stakeholder engagement, alignment with the Population Needs Assessment, and cultural and linguistic
appropriateness.
(2) Implementation of a Medi-Cal managed care plan’s outreach and education plan described in this section shall be subject to approval by the department pursuant to paragraph (1).
(3) Each Medi-Cal managed care plan shall publicly post, on its internet website and in an accessible manner, its approved outreach and education plan and its utilization assessment described in paragraph (2) of subdivision (a), excluding any personally identifiable information.
(c) The department shall consult with stakeholders
representative of diverse racial and ethnic communities, including, but not limited to, consumer advocates, mental health stigma reduction experts, community-based organizations, and Medi-Cal managed care plan stakeholders, to develop the standards by which outreach and education plans will be reviewed and approved.
(d) Approval standards may include, but are not limited to, any of the following:
(1) Outreach and education methods that include, but are not limited to, online outreach, mail, telephone, partnerships with community-based organizations, partnerships with primary care providers, and use of navigators, community health workers, and other providers trained to conduct outreach and education.
(2) Alignment
of the culturally and linguistically tailored outreach and education strategies with the National Standards for Culturally and Linguistically Appropriate Services, utilization assessment and Population Needs Assessment.
(3) Inclusion of consumer-friendly information in existing member-facing communication channels, including the Medi-Cal managed care plan’s internet website.
(4) An independent evaluation plan to assess and improve outreach to enrollees related to nonspecialty mental health services upon the department’s approval of a Medi-Cal managed care plan’s Population Needs Assessment.
(e) A Medi-Cal managed care plan shall also conduct annual outreach and education, based on a plan that the Medi-Cal managed
care plan develops, to inform primary care providers regarding the mental health benefits covered by the Medi-Cal managed care plan pursuant to Section 14189 and paragraph (1) of subdivision (b) of Section 14184.402.
(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, interpret, or make specific this
section, in whole or in part, by means of all-county letters, plan letters, provider bulletins, information notices, or other similar guidance, until any necessary regulations are adopted.
(g) For purposes of implementing this section, the department may enter into exclusive or nonexclusive contracts, or amend existing contracts, on a bid or negotiated basis. Contracts entered into or amended pursuant to this section shall be exempt from Chapter 6 (commencing with Section 14825) of Part 5.5 of Division 3 of Title 2 of the Government Code, Section 19130 of the Government Code, and Part 2 (commencing with Section 10100) of Division 2 of the Public Contract Code, and shall be exempt from the review or approval of any division of the
Department of General Services.
(Added by Stats. 2022, Ch. 879, Sec. 1. (SB 1019) Effective January 1, 2023.)
(a) Once every three years, the department shall assess enrollee experience with mental health benefits covered by Medi-Cal managed care plans pursuant to Section 14189 and paragraph (1) of subdivision (b) of Section 14184.402.
(b) No later than January 1, 2025, the department shall adopt survey tools and methodologies that shall meet all of the following conditions:
(1) Assess experience with the full range of mental
health benefits covered by Medi-Cal managed care plans pursuant to Section 14189 and paragraph (1) of subdivision (b) of Section 14184.402.
(2) Assess consumer experience in various domains, including, but not limited to, receipt of treatment quickly, how well clinicians communicate, cultural competency of providers, communication with the plan and provider, receipt of treatment and information from the plan, including information related to patients’ rights, the treatment plan and options, and the sides effects of medication, perceived improvement, overall rating of counseling and other treatment, and overall rating of the plan.
(3) Assess consumer experience in a manner that utilizes survey best practice methods for data collection and reporting, including, but not
limited to, staff training on data collection, the legality and use of data collection, how to work with patients to improve comfort levels in sharing the data, oversampling and collection of self-reported demographic data at the individual encounter level, and the use of data through existing enrollment and renewal processes.
(c) The department shall consider, and may utilize, existing tools in order to ensure alignment with national standards and state health care programs.
(d) (1) The department shall publish reports, commencing with a report in April 2026 and once every three
years thereafter, on its internet website on consumer experience with mental health benefits covered by Medi-Cal managed care plans.
(2) The reports shall include plan-by-plan data, provide granularity for subpopulations, and address inequities based on key demographic factors, including, but not limited to, language, race, ethnicity, disability status, sexual orientation, and gender identity, to the extent that survey response rates produce statistically valid results. The reports shall exclude any personally identifiable information.
(3) The reports shall provide recommendations for improving access to mental health benefits covered by Medi-Cal managed care plans.
(e) 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, in whole or in part, by means of all-county letters, plan letters, provider bulletins, information notices, or other similar guidance, until any necessary regulations are adopted.
(f) For purposes of implementing this section, the department may enter into exclusive or nonexclusive contracts, or amend existing contracts, on a bid or negotiated basis. Contracts entered into or amended pursuant to this section shall be exempt from Chapter 6 (commencing with Section 14825) of Part 5.5 of Division 3 of Title 2 of the Government Code, Section 19130 of the Government Code, and Part 2 (commencing with
Section 10100) of Division 2 of the Public Contract Code, and shall be exempt from the review or approval of any division of the Department of General Services.
(Added by Stats. 2022, Ch. 879, Sec. 2. (SB 1019) Effective January 1, 2023.)