AB 1688: Community health services: California Mental Health Planning Council, California Children’s Services program, Alameda County pilot program, and Medi-Cal managed care.

(1)Existing law, the Bronzan-McCorquodale Act, contains provisions governing the organization and financing of community mental health services for persons with mental disorders in every county through locally administered and locally controlled community mental health programs. Existing law establishes the California Mental Health Planning Council, consisting of 40 members appointed from both the local and state levels, for the purpose of fulfilling certain mental health planning requirements mandated by federal law. Existing law requires members of the planning council to be appointed in a manner that will ensure that at least ¹/₂ of the members are persons with mental disabilities and family members of, and organizations advocating on behalf of, those persons.

This bill would rename the California Mental Health Planning Council as the California Behavioral Health Planning Council and would make conforming changes. The bill would require the membership of the planning council to also include adults with serious mental illness, including persons who are dually diagnosed with serious mental illness and substance use disorders, and families of, those persons, families of children with emotional disturbance, and representatives from organizations advocating on behalf of persons with mental illness, including persons who are dually diagnosed with mental illness and substance use disorders, and would require the Director of Health Care Services to make appointments from among nominees from various substance use disorder constituency organizations and representatives from mental health or mental health and substance use disorder professional and provider organizations. The bill would revise the planning councils duties to include reviewing, assessing, and making recommendations with respect to substance use disorders, and would make related changes to the planning councils duties to incorporate substance use disorders. The bill would require, if the department determines that Californias Community Mental Health Services Block Grant funding is in jeopardy due to the planning councils noncompliance with a specified federal law, the department to notify and consult with the planning council and would require the planning council to make the changes necessary to comply with federal law.

(2)Existing law establishes 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. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Existing law requires each provider, as defined, of health care services rendered under the Medi-Cal program or any other health care program administered by the department or its agents or contracts to keep and maintain records of specified information, including the beneficiary or person to whom the service was rendered and the date the service was rendered. Existing law requires the provider to retain the records required to be kept and maintained under this provision for a period of 3 years from the date the service was rendered.

This bill would instead require those records to be retained by the provider for a period of 10 years from the final date of the contract period between the plan and the provider, from the date of completion of any audit, or from the date the service was rendered, whichever is later.

(3)Existing law requires the State Department of Health Care Services to develop and prepare one or more reports issued on at least a quarterly basis and make the reports public within 30 days for the purpose of informing the California Health and Human Services Agency, the California Health Benefit Exchange, the Legislature, and the public about the enrollment process for all insurance affordability programs. Existing law further requires the department to collect the data for these reports pursuant to specified administrative procedures.

This bill would instead require these ongoing reports to be issued on at least a biannual basis and to be made public within 90, rather than 30, days. The bill would further require the data within the reports to be aggregated and calculated on at least a quarterly basis. The bill would delete the requirement for the department to collect the data pursuant to the specified administrative procedures.

(4)Existing law provides for the California Childrens Services (CCS) program, which is a statewide program that provides medically necessary services for physically handicapped children whose parents are unable to pay for those services. Existing law authorizes the department to establish, no sooner than July 1, 2017, a Whole Child Model program, under which managed care plans served by a county organized health system or Regional Health Authority in designated counties provide CCS program services to Medi-Cal-eligible CCS children and youth. Existing law requires the department to contract with an independent entity that has experience in performing robust program evaluations to conduct an evaluation to assess Medi-Cal managed care plan performance and the outcomes and experience of CCS-eligible children and youth participating in the Whole Child Model program. Existing law requires the department to provide a report on the results of that evaluation by January 1, 2021.

This bill would instead require the department to provide that report by January 1, 2021, or 3 years from the date when all counties in which the department is authorized to establish the Whole Child Model program are fully operational under the program, whichever is later.

(5)Existing law establishes a program in the County of Alameda in which utilization controls are prohibited from being required when a county hospital-based utilization review committee has been established to determine the level of authorization for payment and a utilization plan has been filed with the department and approved by it.

This bill would repeal those provisions that apply to the program in the County of Alameda.

(6)Under existing law, one of the methods by which Medi-Cal services are provided is pursuant to contracts with various types of managed care plans. Existing law, the Waxman-Duffy Prepaid Health Plan Act, authorizes the department to contract with prepaid health plans to provide the benefits authorized under Medi-Cal, providing Medi-Cal beneficiaries the opportunity to enroll as regular subscribers in prepaid health plans, as specified. Existing law requires the Director of Health Care Services to terminate a contract with a prepaid health plan or a Medi-Cal managed health care plan if he or she makes a finding of noncompliance or for other good cause, as described, in accordance with specified procedures, or, in lieu of contract termination, authorizes the director to take one or more specified sanctions, including the imposition of civil penalties, against the contractor for noncompliance. Existing federal regulations set forth the maximum civil monetary penalty that a state may impose depending on the nature of the managed care plans action or failure to act.

The bill would authorize the Director of Health Care Services to impose a civil penalty in specified amounts that are consistent with those federal regulations depending on the nature of the plans action or failure to act, as specified.

Existing law requires the State Department of Health Care Services to monitor the quality of all Medicaid services provided in the state, and specifies that a key component of this monitoring function is the performance of annual, independent, external reviews of the quality of services furnished under each contract with a health maintenance organization, such as a Medi-Cal managed care plan or prepaid health plan.

This bill, effective for the rating period for managed care plan contracts beginning on or after July 1, 2017, would require the department, through its contracts with Medi-Cal managed care plans and prepaid health plans, to require each managed care plan to inform the department whether it has been accredited by a private independent accrediting entity, and would require each managed care plan that has received accreditation by a private independent accrediting agency to authorize the private independent accrediting agency to provide the department with a copy of its most recent accreditation review, as specified. The bill would require the department to make the accreditation status for each contracted entity available on its Internet Web site, and would require the department to update this information at least annually.

(7)Existing law provides for a schedule of benefits under the Medi-Cal program, which, with some exceptions, includes certain dental services that are referred to as the Medi-Cal dental program, or Denti-Cal. Under existing law, one of the methods by which Denti-Cal services are provided is pursuant to contracts with dental managed care plans.

This bill would require, effective for the rating period for contracts with dental managed care plans beginning on or after July 1, 2017, the department to require each dental managed care plan to authorize the department, the federal Centers for Medicare and Medicaid Services, the federal Office of the Inspector General, the federal Comptroller General, and their designees, to inspect and audit, at any time, any records or documents of the managed care entity, or its subcontractors, and to inspect the premises, physical facilities, and equipment where Medicaid-related activities or work is conducted, and would specify that the right to audit under this provision exists for 10 years from the final date of the contract period or from the date of completion of any audit, whichever is later. The bill would require, effective for the rating period for contracts with dental managed care plans beginning on or after July 1, 2017, the department to require each dental managed care plan, and their subcontractors, as applicable, to retain for a period of no less than 10 years certain information, such as enrollee grievance and appeals records, and medical loss ratio reports.

Existing law requires the department to designate an external quality review organization (EQRO) that is required to conduct an external quality review for any dental health plan contracting with the department pursuant to a specified authority. Existing law requires an external quality review (EQR) to include specified information, including performance on the selected performance measures and benchmarks established and updated by the department.

This bill would instead require the EQR to be conducted by a qualified external quality review organization, and would also require the EQR to include information that is consistent with specified federal regulations. The bill would require the department, no later than July 1, 2018, to require that the dental EQRO shall have sufficient information to use in performing its review, and would require the department to require the EQR to comply with specified requirements, including that, for each EQR-related activity, the information gathered for use in the EQR includes the elements described in a specified federal regulation. The bill would require the EQRO to produce and submit to the department an annual EQR technical report in accordance with a specified federal regulation, and would require the department to finalize this report by April 30 of each year. The bill would require the department to post by April 30 of each year the most recent copy of the annual EQR technical report on a specified Internet Web site operated by the department. The bill would require the department to provide, upon request, printed or electronic copies of the EQR results to interested parties, and would require the department to make this information available in alternative formats for persons with disabilities, when requested.

(8)This bill would incorporate additional changes to Section 5845 of the Welfare and Institutions Code proposed by AB 850 and to Section 5892 of the Welfare and Institutions Code proposed by AB 727, to be operative only if this bill is enacted last.