SB 508

Bill Subjects

Abstract

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 and makes a willful violation of the act a crime. Existing law also provides for the regulation of health insurers by the Department of Insurance. Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income persons receive health care benefits. The Medi-Cal program is, in part, governed and funded by federal Medicaid Program provisions. Existing law provides that specified services, including targeted case management services for children with an individual education plan or an individualized family service plan, provided by local educational agencies (LEAs) , are covered Medi-Cal benefits, and authorizes an LEA to bill for those services. Existing law requires the department to perform various activities with respect to the billing option for services provided by LEAs. Existing law authorizes a school district to require the parent or legal guardian of a pupil to keep current at the pupil's school of attendance certain emergency information. This bill would authorize an LEA to have an appropriate mental health professional provide brief initial interventions at a school campus when necessary for all referred pupils, including pupils with a health care service plan, health insurance, or coverage through a Medi-Cal managed care plan, but not those covered by a county mental health plan. For pupils with coverage through a health care service plan, health insurance, or Medi-Cal managed care plan, the bill would require the mental health professional to contact the plan or insurer to facilitate a referral to the plan's provider for the brief initial intervention services, when appropriate and available, and would allow the mental health professional to complete the brief intervention services if the plan or insurer is unable to offer the pupil an appointment with a network provider within 48 hours for an urgent care appointment or within 15 business days for a nonurgent appointment. If the plan or insurer is unable to offer the pupil mental health services beyond the brief initial intervention services, the bill would authorize the plan or insurer to negotiate with the LEA for a single case agreement to determine reimbursement for additional services, subject to specified reimbursement requirements. The bill would also require a health care service plan, health insurer, or Medi-Cal managed care plan that is required to provide coverage for medically necessary treatment of mental health disorders to enter into a contract with all LEAs in which 15 percent or more of the pupils enrolled are insured by the plan or insurer, as specified, and would authorize the LEA to bill for mental health disorder services provided if the plan or insurer fails to enter into a contract with the LEA, as specified. The bill would require the State Department of Health Care Services, the Department of Insurance, the Department of Managed Health Care, and the State Department of Education to develop a model contract for use by LEAs, health care service plans, and health insurers when implementing these provisions. Because a violation of this provision with respect to a health care service plan would be a crime, and by imposing new duties on LEAs with respect to entering into contracts with, and facilitating referrals to, health care service plans and health insurers, the bill would impose a state-mandated local program. The bill would include telehealth as an approved modality for the Medi-Cal program for the specified services provided by an LEA. The bill would authorize a school district to require the parent or legal guardian of a pupil also to keep current at the pupil's school of attendance information on the pupil's health care service plan, health insurance, or Medi-Cal managed care plan provider, if applicable. 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 with regard to certain mandates no reimbursement is required by this act for a specified reason. With regard to any other mandates, this bill would provide that, if the Commission on State Mandates determines that the bill contains costs so mandated by the state, reimbursement for those costs shall be made pursuant to the statutory provisions noted above.