SB 296: Medi-Cal: specialty mental health services: documentation requirements.

Session Year: 2015-2016
House: Senate

Version:

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, including specialty mental health services. The Medi-Cal program is, in part, governed and funded by federal Medicaid Program provisions. In order to facilitate the receipt of medically necessary specialty mental health services by a foster child who is placed outside of his or her county of original jurisdiction, existing law requires the department to create a standardized set of documentation standards and forms. The department is responsible for conducting investigations and audits of claims and reimbursements for expenditures for specialty mental health services provided by mental health plans to Medi-Cal eligible individuals.

This bill would require the department, in consultation with specified stakeholders, to develop a single set of service billing documentation requirements for the provision of specialty mental health services by January 1, 2017, for use commencing July 1, 2017, and would require the department to update the billing documentation requirements no less than every 2 years. The bill would generally prohibit counties from requiring additional billing documentation requirements for Medi-Cal specialty mental health services that go beyond the billing documentation requirements developed by the department.

This bill would limit the scope of the service billing documentation requirements the department may apply when conducting an audit of Medi-Cal specialty mental health services to criteria that is clearly and explicitly set forth in specified state regulations, letters, and directives, federal Medicaid terms and conditions, and the Medicaid state plan. The bill would require the department to allow counties and county contract providers of behavioral health services to incorporate by reference any information in a patients existing case record in subsequent documentation and would prohibit the department from requiring any unchanged information in a patients existing case record to be copied or reentered into specified treatment documents, unless required by a federal directive. The bill would require the department to consider further revisions to its service billing documentation requirements, and to prepare, in consultation with counties, providers, and other stakeholders, and submit to the Legislature, a proposal to accomplish those objectives, as specified.

Discussed in Hearing