AB 1576: Mental Health Delivery Demonstration Project: Early Diagnosis and Psychosis Treatment Program.
- Session Year: 2015-2016
- House: Assembly
- Latest Version Date: 2016-03-18
Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care. Existing law requires health care service plans to meet specified criteria. Existing law makes a willful violation of that act a crime.
This bill would, commencing July 1, 2017, authorize health care service plans that offer health care services within the greater Sacramento area to require enrollees seeking services for a mental health condition to participate in a Mental Health Delivery Demonstration Project through an Early Diagnosis and Psychosis Treatment (EDAPT) program, as defined. The bill would require plans that choose to participate to develop clinical guidelines for enrollees and to make those guidelines available as part of their evidence of coverage and to primary care providers and specialty mental health providers in their contracted network. The bill would allow an enrollee to opt out of the EDAPT program if a psychiatrist notifies the plan that the enrollee is under his or her care. These provisions would be repealed on January 1, 2020. Because a willful violation of these provisions would be a crime, this bill would impose a state-mandated local program.
The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.
Existing law establishes a system of public elementary and secondary schools in this state, and provides for the establishment of school districts and other local educational agencies to operate these schools and provide instruction to pupils.
This bill would declare the intent of the Legislature to enact future legislation that would utilize school-based mental health services to address the mental health needs of children in the state.
Existing law establishes a system of public elementary and secondary schools in this state, and provides for the establishment of school districts and other local educational agencies to operate these schools and provide instruction to pupils.
This bill would declare the intent of the Legislature to enact future legislation that would utilize school-based mental health services to address the mental health needs of children in the state.
(a)The Legislature finds and declares all of the following:
(1)Despite the importance of and emphasis on mental health parity, management of mental illness within a system of care is far more difficult than most types of physical illness. There are significant differences between the delivery systems for the Medi-Cal population and the delivery systems for those covered by private insurance, and there are unique problems associated with each system. While changes are needed in both, there is an immediate need to look for ways to better serve the insured population.
(2)The limited number of providers, the lack of facilities for treatment, and the difficulties of arranging for and coordinating ancillary services have made it extremely difficult for health insurers to meet the needs of enrollees facing significant mental health issues.
(3)Attempts to develop truly accessible provider networks that can link with the array of administrative and ancillary services that the mentally ill need to manage their disease and to improve will take an investment of time and resources.
(4)Systems of care known as Early Diagnosis and Psychosis Treatment (EDAPT) programs may hold the key to these problems. These integrated systems of care provide early intervention, assessment, diagnosis, a treatment plan, and the services necessary to implement that plan. EDAPT programs have interdisciplinary teams of physicians, clinicians, advocates, and staff that coordinate care on an outpatient basis.
(5)EDAPT programs do not yet exist in sufficient number to allow them to meet the provider network requirements health insurers must meet. While it is possible under existing law for health insurers to contract with existing EDAPT programs, there are a number of regulatory and practical issues that stand in the way of directing patients to them so that the patients conditions can be effectively managed. If insurers could designate an EDAPT program as an exclusive provider for their enrollees, an assessment can be made of the overall efficacy of the model.
(b)Therefore, it is the intent of the Legislature to establish a demonstration project or projects in geographic areas of the state where EDAPT programs exist to allow health insurers to opt in to utilizing the EDAPT programs as exclusive provider networks for the insurers enrollees in need of these services.
SEC. 2.Section 1367.020 is added to the Health and Safety Code, to read:1367.020.(a)Notwithstanding any other law, commencing July 1, 2017, a health care service plan that offers health care services on an individual or group basis in the greater Sacramento area may require enrollees seeking services for a mental health condition to participate in a Mental Health Delivery Demonstration Project through an Early Diagnosis and Psychosis Treatment Program.
(b)If a plan chooses to require its enrollees to participate in the project, it shall develop clinical guidelines for those enrollees and make those guidelines available as part of its evidence of coverage. The plan shall also make those guidelines available to all primary care providers and specialty mental health providers in its contracted network.
(c)An enrollee directed to a Mental Health Delivery Demonstration Project site for services shall be able to opt out of those services if a psychiatrist notifies the plan that the enrollee is under his or her care.
(d)For purposes of this section, Early Diagnosis and Psychosis Treatment Program means a mental health service program that provides early intervention, diagnosis, treatment, and necessary support through interdisciplinary teams of physicians, mental health professionals, social workers, and advocates on an outpatient basis and through a single point of entry.
(e)This section shall remain in effect only until January 1, 2020, and as of that date is repealed, unless a later enacted statute, that is enacted before January 1, 2020, deletes or extends that date.
SEC. 3.No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution.
SECTION 1.(a)The Legislature finds and declares both of the following:
(1)California supplies only one social worker for every 12,000 pupils.
(2)Seventy percent of children in California with mental health needs receive no treatment.
(b)It is therefore the intent of the Legislature to enact future legislation that would utilize school-based mental health services to address this need.
(a)The Legislature finds and declares both of the following:
(1)California supplies only one social worker for every 12,000 pupils.
(2)Seventy percent of children in California with mental health needs receive no treatment.
(b)It is therefore the intent of the Legislature to enact future legislation that would utilize school-based mental health services to address this need.
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Date
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Status
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|---|---|
| Jan 4, 2016 | Read first time. To print. |
| Jan 5, 2016 | From printer. May be heard in committee February 4. |
| Mar 17, 2016 | Referred to Com. on HEALTH. |
| Mar 18, 2016 | From committee chair, with author's amendments: Amend, and re-refer to Com. on HEALTH. Read second time and amended. |
| Mar 28, 2016 | Re-referred to Com. on HEALTH. |
| Apr 12, 2016 | In committee: Set, first hearing. Hearing canceled at the request of author. |
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