SB 773: Medi-Cal managed care: behavioral health services.
- Session Year: 2021-2022
- House: Senate
- Latest Version Date: 2021-03-10
Existing law establishes the Medi-Cal program, administered by the State Department of Health Care Services, under which health care services, such as behavioral health treatment services, are provided to qualified, low-income persons by various health care delivery systems, including managed care. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Existing law imposes requirements on Medi-Cal managed care plans, including standards on network adequacy, alternative access, and minimum loss ratios.
This bill would, commencing with the January 1, 2022, rating period, and through December 31, 2024, require the department to make incentive payments to qualifying Medi-Cal managed care plans that meet predefined goals and metrics associated with targeted interventions, rendered by school-affiliated behavioral health providers, that increase access to preventive, early intervention, and behavioral health services for children enrolled in kindergarten and grades 1 to 12, inclusive, at those schools. The bill would require the department to consult with certain stakeholders on the development of interventions, goals, and metrics, to determine the amount of incentive payments, and to seek any necessary federal approvals.
The bill would condition the issuance of incentive payments on compliance with specified federal requirements and the availability of federal financial participation. Alternatively, if federal approval is not obtained, the bill would authorize the department to make incentive payments on a state-only funding basis, but only to the extent the department determines that federal financial participation for the Medi-Cal program is not otherwise jeopardized.
Existing law, the Mental Health Student Services Act, requires the Mental Health Services Oversight and Accountability Commission to award grants to county mental health and behavioral health department to fund partnerships between educational and county mental health entities, as specified.This bill would make technical, nonsubstantive changes to those provisions.Existing law, the Mental Health Student Services Act, requires the Mental Health Services Oversight and Accountability Commission to award grants to county mental health and behavioral health department to fund partnerships between educational and county mental health entities, as specified.
This bill would make technical, nonsubstantive changes to those provisions.
(a)Commencing with the January 1, 2022, rating period, and through December 31, 2024, the department shall make incentive payments to qualifying Medi-Cal managed care plans that meet predefined goals and metrics, as developed pursuant to subdivision (b), associated with targeted interventions, rendered by school-affiliated behavioral health providers, that increase access to preventive, early intervention, and behavioral health services for children enrolled in kindergarten and grades 1 to 12, inclusive, at those schools.
(b)The department, in consultation with Medi-Cal managed care plans, county behavioral health departments, schools, and other affected stakeholders, shall develop the interventions, goals, and metrics used to determine a Medi-Cal managed care plans eligibility to receive the incentive payments described in this section.
(c)(1)For each rating period during which the department implements incentive payments, the department shall determine the amount of incentive payment earned by each qualifying Medi-Cal managed care plan.
(2)An incentive payment that is eligible for federal financial participation pursuant to subdivision (d) shall be made in accordance with the requirements for incentive arrangements, as specified in Section 438.6(b)(2) of Title 42 of the Code of Federal Regulations and any associated federal guidance.
(d)The department shall seek any necessary federal approvals to claim federal financial participation for the incentive payments to qualifying Medi-Cal managed care plans, as described in this section. If federal approval is obtained for one or more rating periods, the department shall implement this section only to the extent that federal financial participation is available in that applicable rating period. If federal approval is not obtained for one or more rating periods, the department may make incentive payments to qualifying Medi-Cal managed care plans as described in this section on a state-only funding basis during the applicable rating period, but only to the extent the department determines that federal financial participation for the Medi-Cal program is not otherwise jeopardized as a result.
(e)Incentive payments made pursuant to this section shall be used to supplement and not supplant existing payments to Medi-Cal managed care plans.
(f)For purposes of this section, the following definitions apply:
(1)Comprehensive risk contract has the same meaning as set forth in Section 438.2 of Title 42 of the Code of Federal Regulations.
(2)Medi-Cal managed care plan means an individual, organization, or entity that enters into a comprehensive risk contract with the department to provide covered full-scope health care services to enrolled Medi-Cal beneficiaries pursuant to this chapter or Chapter 8 (commencing with Section 14200).
SECTION 1.Section 5886 of the Welfare and Institutions Code is amended to read:5886.(a)The Mental Health Student Services Act is hereby established as a mental health partnership competitive grant program for the purpose of establishing mental health partnerships between a countys mental health or behavioral health departments and school districts, charter schools, and the county office of education within the county.(b)The Mental Health Services Oversight and Accountability Commission shall award grants to county mental health or behavioral health departments to fund partnerships between educational and county mental health entities.(1)County, city, or multicounty mental health or behavioral health departments, or a consortium of those entities, including multicounty partnerships, may, in partnership with one or more school districts and at least one of the following educational entities located within the county, apply for a grant to fund activities of the partnership:(A)The county office of education.(B)A charter school.(2)An educational entity may be designated as the lead agency at the request of the county, city, or multicounty department, or consortium, and authorized to submit the application. The county, city, or multicounty department, or consortium, shall be the grantee and receive grant funds awarded pursuant to this section, even if an educational entity is designated as the lead agency and submits the application pursuant to this paragraph.(c)The commission shall establish criteria for the grant program, including the allocation of grant funds pursuant to this section, and shall require that applicants comply with, at a minimum, all of the following requirements:(1)That all school districts, charter schools, and the county office of education have been invited to participate in the partnership, to the extent possible.(2)That applicants include with their application a plan developed and approved in collaboration with participating educational entity partners and that includes a letter of intent, a memorandum of understanding, or other evidence of support or approval by the governing boards of all partners.(3)That plans address all of the following goals:(A)Preventing mental illnesses from becoming severe and disabling.(B)Improving timely access to services for underserved populations.(C)Providing outreach to families, employers, primary care health care providers, and others to recognize the early signs of potentially severe and disabling mental illnesses.(D)Reducing the stigma associated with the diagnosis of a mental illness or seeking mental health services.(E)Reducing discrimination against people with mental illness.(F)Preventing negative outcomes in the targeted population, including, but not limited to:(i)Suicide and attempted suicide.(ii)Incarceration.(iii)School failure or dropout.(iv)Unemployment.(v)Prolonged suffering.(vi)Homelessness.(vii)Removal of children from their homes.(viii)Involuntary mental health detentions.(4)That the plan includes a description of the following:(A)The need for mental health services for children and youth, including campus-based mental health services, as well as potential gaps in local service connections.(B)The proposed use of funds, which shall include, at a minimum, that funds will be used to provide personnel or peer support.(C)How the funds will be used to facilitate linkage and access to ongoing and sustained services, including, but not limited to, objectives and anticipated outcomes.(D)The partnerships ability to do all of the following:(i)Obtain federal Medicaid or other reimbursement, including Early and Periodic Screening, Diagnostic, and Treatment funds, when applicable, or to leverage other funds, when feasible.(ii)Collect information on the health insurance carrier for each child or youth, with the permission of the child or youths parent, to allow the partnership to seek reimbursement for mental health services provided to children and youth, where applicable.(iii)Engage a health care service plan or a health insurer in the mental health partnership, when applicable, and to the extent mutually agreed to by the partnership and the plan or insurer.(iv)Administer an effective service program and the degree to which mental health providers and educational entities will support and collaborate to accomplish the goals of the effort.(v)Connect children and youth to a source of ongoing mental health services, including, but not limited to, through Medi-Cal, specialty mental health plans, county mental health programs, or private health coverage.(vi)Continue to provide services and activities under this program after grant funding has been expended.(d)Grants awarded pursuant to this section shall be used to provide support services that include, at a minimum, all of the following:(1)Services provided on school campuses, to the extent practicable.(2)Suicide prevention services.(3)Drop-out prevention services.(4)Outreach to high-risk youth and young adults, including, but not limited to, foster youth, youth who identify as lesbian, gay, bisexual, transgender, or queer, and youth who have been expelled or suspended from school.(5)Placement assistance and development of a service plan that can be sustained over time for students in need of ongoing services.(e)Funding may also be used to provide other prevention, early intervention, and direct services, including, but not limited to, hiring qualified mental health personnel, professional development for school staff on trauma-informed and evidence-based mental health practices, and other strategies that respond to the mental health needs of children and youth, as determined by the commission.(f)The commission shall determine the amount of grants and shall take into consideration the level of need and the number of schoolage youth in participating educational entities when determining grant amounts.(g)The commission may establish incentives to provide matching funds by awarding additional grant funds to partnerships that do so.(h)Partnerships currently receiving grants from the Investment in Mental Health Wellness Act of 2013 (Part 3.8 (commencing with Section 5848.5)) may receive a grant under this section for the expansion of services funded by that grant or for the inclusion of additional educational entity partners within the mental health partnership.(i)Grants awarded pursuant to this section may be used to supplement, but not supplant, existing financial and resource commitments of the county, city, or multi-county mental health or behavioral health departments, or a consortium of those entities, or educational entities that receive a grant.(j)(1)The commission shall develop metrics and a system to measure and publicly report on the performance outcomes of services provided using the grants.(2)(A)The commission shall provide a status report to the fiscal and policy committees of the Legislature on the progress of implementation of this section no later than March 1, 2022. The report shall address, at a minimum, all of the following:(i)Successful strategies.(ii)Identified needs for additional services.(iii)Lessons learned.(iv)Numbers of, and demographic information for, the schoolage children and youth served.(v)Available data on outcomes, including, but not limited to, linkages to ongoing services and success in meeting the goals identified in paragraph (3) of subdivision (c).(B)A report to be submitted pursuant to this paragraph shall be submitted in compliance with Section 9795 of the Government Code.(k)This section does not require the use of funds allocated for the purpose of satisfying the minimum funding obligation under Section 8 of Article XVI of the California Constitution for the partnerships established by this section.(l)The commission may enter into exclusive or nonexclusive contracts, or amend existing contracts, on a bid or negotiated basis in order to implement this section. Contracts entered into or amended pursuant to this subdivision are 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.(m)This section shall be implemented only to the extent moneys are appropriated in the annual Budget Act or another statute for purposes of this section.(a)The Mental Health Student Services Act is hereby established as a mental health partnership competitive grant program for the purpose of establishing mental health partnerships between a countys mental health or behavioral health departments and school districts, charter schools, and the county office of education within the county.
(b)The Mental Health Services Oversight and Accountability Commission shall award grants to county mental health or behavioral health departments to fund partnerships between educational and county mental health entities.
(1)County, city, or multicounty mental health or behavioral health departments, or a consortium of those entities, including multicounty partnerships, may, in partnership with one or more school districts and at least one of the following educational entities located within the county, apply for a grant to fund activities of the partnership:
(A)The county office of education.
(B)A charter school.
(2)An educational entity may be designated as the lead agency at the request of the county, city, or multicounty department, or consortium, and authorized to submit the application. The county, city, or multicounty department, or consortium, shall be the grantee and receive any grant funds awarded pursuant to this section section, even if an educational entity is designated as the lead agency and submits the application pursuant to this paragraph.
(c)The commission shall establish criteria for the grant program, including the allocation of grant funds pursuant to this section, and shall require that applicants comply with, at a minimum, all of the following requirements:
(1)That all school districts, charter schools, and the county office of education have been invited to participate in the partnership, to the extent possible.
(2)That applicants include with their application a plan developed and approved in collaboration with participating educational entity partners and that include includes a letter of intent, a memorandum of understanding, or other evidence of support or approval by the governing boards of all partners.
(3)That plans address all of the following goals:
(A)Preventing mental illnesses from becoming severe and disabling.
(B)Improving timely access to services for underserved populations.
(C)Providing outreach to families, employers, primary care health care providers, and others to recognize the early signs of potentially severe and disabling mental illnesses.
(D)Reducing the stigma associated with the diagnosis of a mental illness or seeking mental health services.
(E)Reducing discrimination against people with mental illness.
(F)Preventing negative outcomes in the targeted population, including, but not limited to:
(i)Suicide and attempted suicide.
(ii)Incarceration.
(iii)School failure or dropout.
(iv)Unemployment.
(v)Prolonged suffering.
(vi)Homelessness.
(vii)Removal of children from their homes.
(viii)Involuntary mental health detentions.
(4)That the plan includes a description of the following:
(A)The need for mental health services for children and youth, including campus-based mental health services, as well as potential gaps in local service connections.
(B)The proposed use of funds, which shall include, at a minimum, that funds will be used to provide personnel or peer support.
(C)How the funds will be used to facilitate linkage and access to ongoing and sustained services, including, but not limited to, objectives and anticipated outcomes.
(D)The partnerships ability to do all of the following:
(i)Obtain federal Medicaid or other reimbursement, including Early and Periodic Screening, Diagnostic, and Treatment funds, when applicable, or to leverage other funds, when feasible.
(ii)Collect information on the health insurance carrier for each child or youth, with the permission of the child or youths parent, to allow the partnership to seek reimbursement for mental health services provided to children and youth, where applicable.
(iii)Engage a health care service plan or a health insurer in the mental health partnership, when applicable, and to the extent mutually agreed to by the partnership and the plan or insurer.
(iv)Administer an effective service program and the degree to which mental health providers and educational entities will support and collaborate to accomplish the goals of the effort.
(v)Connect children and youth to a source of ongoing mental health services, including, but not limited to, through Medi-Cal, specialty mental health plans, county mental health programs, or private health coverage.
(vi)Continue to provide services and activities under this program after grant funding has been expended.
(d)Grants awarded pursuant to this section shall be used to provide support services that include, at a minimum, all of the following:
(1)Services provided on school campuses, to the extent practicable.
(2)Suicide prevention services.
(3)Drop-out prevention services.
(4)Outreach to high-risk youth and young adults, including, but not limited to, foster youth, youth who identify as lesbian, gay, bisexual, transgender, or queer, and youth who have been expelled or suspended from school.
(5)Placement assistance and development of a service plan that can be sustained over time for students in need of ongoing services.
(e)Funding may also be used to provide other prevention, early intervention, and direct services, including, but not limited to, hiring qualified mental health personnel, professional development for school staff on trauma-informed and evidence-based mental health practices, and other strategies that respond to the mental health needs of children and youth, as determined by the commission.
(f)The commission shall determine the amount of grants and shall take into consideration the level of need and the number of schoolage youth in participating educational entities when determining grant amounts.
(g)The commission may establish incentives to provide matching funds by awarding additional grant funds to partnerships that do so.
(h)Partnerships currently receiving grants from the Investment in Mental Health Wellness Act of 2013 (Part 3.8 (commencing with Section 5848.5)) are eligible to may receive a grant under this section for the expansion of services funded by that grant or for the inclusion of additional educational entity partners within the mental health partnership.
(i)Grants awarded pursuant to this section may be used to supplement, but not supplant, existing financial and resource commitments of the county, city, or multi-county mental health or behavioral health departments, or a consortium of those entities, or educational entities that receive a grant.
(j)(1)The commission shall develop metrics and a system to measure and publicly report on the performance outcomes of services provided using the grants.
(2)(A)The commission shall provide a status report to the fiscal and policy committees of the Legislature on the progress of implementation of this section no later than March 1, 2022. The report shall address, at a minimum, all of the following:
(i)Successful strategies.
(ii)Identified needs for additional services.
(iii)Lessons learned.
(iv)Numbers of, and demographic information for, the schoolage children and youth served.
(v)Available data on outcomes, including, but not limited to, linkages to ongoing services and success in meeting the goals identified in paragraph (3) of subdivision (c).
(B)A report to be submitted pursuant to this paragraph shall be submitted in compliance with Section 9795 of the Government Code.
(k)This section does not require the use of funds allocated for the purpose of satisfying the minimum funding obligation under Section 8 of Article XVI of the California Constitution for the partnerships established by this section.
(l)The commission may enter into exclusive or nonexclusive contracts, or amend existing contracts, on a bid or negotiated basis in order to implement this section. Contracts entered into or amended pursuant to this subdivision are 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.
(m)This section shall be implemented only to the extent moneys are appropriated in the annual Budget Act or another statute for purposes of this section.
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Date
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Status
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| Jul 6, 2021 | July 6 set for first hearing canceled at the request of author. |
| Jun 21, 2021 | Re-referred to Com. on HEALTH pursuant to Assembly Rule 96. |
| Jun 17, 2021 | Re-referred to Com. on RLS. pursuant to Assembly Rule 96. |
| Jun 17, 2021 | Referred to Com. on HEALTH. |
| Jun 2, 2021 | In Assembly. Read first time. Held at Desk. |
| Jun 1, 2021 | Read third time. Passed. (Ayes 39. Noes 0. Page 1348.) Ordered to the Assembly. |
| May 24, 2021 | Ordered to special consent calendar. |
| May 20, 2021 | From committee: Do pass. (Ayes 7. Noes 0. Page 1203.) (May 20). |
| May 14, 2021 | Set for hearing May 20. |
| May 4, 2021 | May 3 hearing: Placed on APPR suspense file. |
| Apr 21, 2021 | Set for hearing May 3. |
| Apr 14, 2021 | From committee: Do pass and re-refer to Com. on APPR. (Ayes 11. Noes 0. Page 795.) (April 14). Re-referred to Com. on APPR. |
| Mar 26, 2021 | Set for hearing April 14. |
| Mar 18, 2021 | Re-referred to Com. on HEALTH. |
| Mar 10, 2021 | From committee with author's amendments. Read second time and amended. Re-referred to Com. on RLS. |
| Mar 3, 2021 | Referred to Com. on RLS. |
| Feb 22, 2021 | Art. IV. Sec. 8(a) of the Constitution dispensed with. |
| Feb 22, 2021 | From printer. May be acted upon on or after March 24. |
| Feb 19, 2021 | Introduced. To Com. on RLS. for assignment. To print. |
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Date
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Description
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Location
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Votes
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| Jun 1, 2021 | Special Consent SB773 | Senate Floor |
Passed |
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Bill Author
