SB 874: Medi-Cal: behavioral health treatment: stakeholder feedback.

Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and 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.

Under existing law, to the extent required by the federal government and effective no sooner than required by the federal government, behavioral health treatment (BHT) is a covered service under the Medi-Cal program for individuals under 21 years of age.

This bill would require the department, by July 1, 2027, to ensure that certain individuals providing BHT services under Medi-Cal undergo criminal background checks. The bill would require the department to utilize existing stakeholder forums to seek stakeholder feedback and offer stakeholder comment opportunities to inform changes to coverage and billing policy for BHT services. The bill would encourage the department to affirmatively reach out to specified stakeholders as appropriate based on the topic at issue to ensure adequate feedback. Under the bill, stakeholder feedback would include, among other topics, clinical guidelines for the provision of BHT services, treatment plan requirements, requirements for the provision of center-based services compared to services provided elsewhere, and supervision of unlicensed and uncertified professionals, as specified.

The bill would require the department to maintain clear billing and coverage guidance for BHT services, as specified. The bill would require the department, on or before January 1, 2029, to publish on its internet website utilization data for BHT services, a synopsis of changes made as a result of stakeholder feedback, and recommendations for actions necessary to ensure that Medi-Cal reimbursement practices align with federal Medicaid program integrity requirements.