CALIFORNIA LEGISLATURE    2021   2022 REGULAR SESSION

Senate Bill
No. 508


Introduced by Senator Stern

February  17,  2021


An act to amend Section 49408 of the Education Code, to add Sections 1374.722 and 1374.723 to the Health and Safety Code, to add Sections 10144.53 and 10144.54 to the Insurance Code, and to amend Section 14132.06 of, and to add Section 14197.15 to, the Welfare and Institutions Code, and relating to mental health.


LEGISLATIVE COUNSEL'S DIGEST


SB 508, as introduced, Stern. Mental health coverage: school-based services.
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 allow 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 meet the existing time and geographic access standards. If the plan or insurer is unable to meet the time and geographic standards for delivery of mental health services beyond the brief initial intervention services, the bill would require 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 and substance abuse disorders to enter into a memorandum of understanding (MOU) 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 and substance use disorder services provided if the plan or insurer fails to enter into an MOU with the LEA, as specified. 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 MOUs with 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.
Vote: MAJORITY     Appropriation: NO     Fiscal Committee: YES     Local Program: YES    

The people of the State of California do enact as follows:


SECTION 1.

 Section 49408 of the Education Code is amended to read:

49408.
 For the protection of a pupil   s health and welfare, the governing board of a school district may require the parent or legal guardian of a pupil to keep current at the pupil   s school of attendance, emergency information including the home address and telephone number, business address and telephone number of the parents or guardian, and the name, address and telephone number of a relative or friend who is authorized to care for the pupil in any emergency situation if the parent or legal guardian cannot be reached. reached, and information on the pupil   s health care service plan, health insurance, or Medi-Cal managed care plan provider, if applicable.

SEC. 2.

 Section 1374.722 is added to the Health and Safety Code, immediately following Section 1374.721, to read:

1374.722.
 (a)  The Legislature finds and declares all of the following:
(1)  All health care service plans are required to provide coverage for the diagnosis and medically necessary treatment of mental health and substance use disorders under the same terms and conditions applied to other medical conditions, as defined in state and federal law, including Sections 1374.72 and 1374.721 of this code and the federal Mental Health Parity and Addiction Equity Act of 2008 (Public Law 110-343).
(2)  Suicide rates in California increased by 225 percent between 1999 and 2016 for children 10 to 14 years of age.
(3)  Thirty-seven percent of students with a mental health condition 14 years of age and older drop out of school. Pupils with emotional disturbances have the highest increase in absenteeism and dropout rates when compared to any other disability.
(4)  Seventy percent of youth arrested each year have a mental health disorder.
(5)  None of the health care service plans in California provide covered children with adequate access to in-network mental health providers.
(6)  Meanwhile, children are 21 times more likely to get the health and mental health services they need if services are provided on a school campus. School-based services increase access to qualified mental health care professionals and decrease the stigma around receiving mental health services.
(7)  By failing to meet the mental health needs of children, health care service plans are passing the responsibility and cost of medically necessary mental health services on to local educational agencies (LEAs) in violation of their obligations under state and federal law.
(b)  To ensure timely access to behavioral health interventions at the earliest onset of a behavioral health condition, an appropriate mental health professional as described in Sections 49422 and 49424 of the Education Code and Chapters 13 (commencing with Section 4980), 14 (commencing with Section 4991), and 16 (commencing with Section 4999.10) of Division 2 of the Business and Professions Code, may provide brief initial interventions when necessary for all referred pupils, including pupils who are enrollees of a health care service plan contract.
(c)  Brief initial interventions, for purposes of this article, consist of Medi-Cal covered behavioral health services that are essential health benefits, as defined in state and federal law, including Section 1300.67.005 of Title 28 of the California Code of Regulations, Sections 1374.72 and 1374.721, and the federal Mental Health Parity and Addiction Equity Act of 2008 (Public Law 110-343), and include, but are not limited to, mental health and substance use disorder services specified in California   s essential health benefits benchmark plan.
(d)  (1)  For pupils who are enrollees of a health care service plan contract, the mental health professional or their designee may contact the plan upon initiating the brief initial intervention services described in subdivision (b) to facilitate a referral to the health care service plan   s network providers, as appropriate and consistent with professionally recognized standards of practice, and in consultation with the pupil and their parent or guardian, in compliance with all applicable state and federal laws protecting a pupil   s right to privacy and parental rights.
(2)  If a health care service plan is unable to meet timely and geographic access standards for care delivery required by state law, as defined by Section 1300.67.2.2 and Section 1300.51 of Title 28 of the California Code of Regulations, the mental health professional may complete the brief initial intervention services. If a health care service plan cannot meet timely access standards for care delivery for mental health services beyond the brief initial intervention services, the health care service plan and the LEA shall negotiate a single case agreement to determine reimbursement for additional services.
(A)  A health care service plan shall reimburse services provided to pupils by the mental health professional at the rate required by state and federal law for noncontracted providers.
(B)  A health care service plan shall meet requirements for the timely payment of claims for a contracted provider. If the health care service plan disputes the services provided or the amount, the health care service plan may submit a dispute to the Department of Managed Health Care, but shall still comply with requirements for timely payment, including for services or amounts in dispute.
(3)  If a health care service plan can meet timely and geographic access standards for care delivery required by state law, as defined by Section 1300.67.2.2 and Section 1300.51 of Title 28 of the California Code of Regulations, the mental health professional shall make a referral to the plan   s provider.
(d)  Pursuant to subdivision (h) of Section 1374.72, a health care service plan shall not limit benefits or reimbursement for medically necessary services provided pursuant to this section on the basis that those services should be or could be covered by a public entitlement program, including, but not limited to, special education or an individualized education program, Medi-Cal, Medicare, Supplemental Security Income, or Social Security Disability Insurance.
(e)  A health care service plan is encouraged to contract with LEAs to serve pupils who are receiving mental health services pursuant to this section.
(f)  This section does not apply to a contract with a county mental health plan contracted with the State Department of Health Care Services pursuant to Chapter 8.9 (commencing with Section 14700) of Part 3 of Division 9 of the Welfare and Institutions Code.

SEC. 3.

 Section 1374.723 is added to the Health and Safety Code, immediately following Section 1374.722, to read:

1374.723.
 (a)  A health care service plan that is required to provide coverage for the medically necessary treatment of mental health and substance abuse disorders pursuant to Sections 1374.72 and 1374.721 shall enter into a memorandum of understanding (MOU) with all local educational agencies (LEAs) if 15 percent or more of the pupils enrolled are covered by the health care service plan. The MOU shall describe the terms under which the health care service plan will coordinate with the LEA to provide diagnosis and medically necessary treatment of mental health and substance use disorders to pupils who are plan enrollees in one or more of the following ways:
(1)  Pursuant to Section 1374.722, a health care service plan shall reimburse for the mental health services provided to pupils who are plan enrollees at the rate required by state and federal law for noncontracted providers if, upon referral, the health care service plan is unable to meet timely and geographic access standards for care delivery required by state law, as defined by Section 1300.67.2.2 and Section 1300.51 of Title 28 of the California Code of Regulations.
(2)  A health care service plan shall designate and provide, through in-network providers or through a contracted community-based organization, one or more mental health professionals that shall provide services on the school campus at intervals that are sufficient to ensure that all pupils who are plan enrollees receive access to diagnosis and medically necessary treatment of mental health and substance use disorders. A health care service plan provider may use telehealth, as defined in Section 49429 of the Education Code, to facilitate the diagnosis, consultation, treatment, education, care management, and self-management of a pupil   s health care while the pupil is on the school campus and the health care provider is at a distant location.
(3)  A health care service plan shall designate and provide, through in-network providers or through a contracted community-based organization, one or more mental health professionals that shall provide services within a one mile radius of the school campus where the referred pupil is enrolled. A health care service plan shall ensure that there are sufficient mental health professionals so that all pupils who are plan enrollees receive access to diagnosis and medically necessary treatment of mental health and substance use disorders in accordance with the timely and geographic access standards for care delivery required by state law, as defined by Section 1300.67.2.2 and Section 1300.51 of Title 28 of the California Code of Regulations.
(4)  A health care services plan and the LEA shall agree upon an annual capitated reimbursement rate payment based on the number of pupils who are enrolled at the LEA and are enrollees of the health care service plan. To determine the amount of the annual capitation payment, the LEA, in compliance with all applicable state and federal laws protecting a pupil   s right to privacy and parental rights, shall annually inform a health care service plan of the number of pupils who are enrolled at the LEA and are enrollees of the health care service plan.
(b)  (1)  No later than March 1, 2022, and each subsequent year thereafter, an LEA shall calculate the percent of enrolled pupils that are plan enrollees for each health care service plan. If more than 15 percent of students are enrollees of a particular health care service plan, the LEA shall notify the health care service plan and inform them of the requirements under this section.
(2)  A health care service plan shall have 30 business days to respond to the LEA   s notice. If a health care service plan fails to respond and begin negotiations on an MOU within 30 business days, the LEA may inform the health care service plan that it intends to bill the health care service plan for services provided to pupils who are plan enrollees pursuant to Section 1374.722.
(3)  A health care service plan and an LEA shall have no more than 90 business days after March 1 to reach agreement on the MOU required by this section. If an agreement cannot be reached within 90 business days, the parties may mutually agree to extend the deadline by no more than 30 additional business days. If the parties fail to reach an agreement, the LEA may continue to bill the health care service plan for services provided to pupils who are plan enrollees pursuant to Section 1374.722.
(c)  (1)  One or more LEAs may enter into a joint partnership agreement with the county office of education for the purposes of meeting the obligations under this section. A health care service plan is required to enter into only one MOU with the LEAs in a joint partnership agreement.
(2)  The LEAs in a joint partnership agreement may combine their enrollment numbers to calculate the percent of enrolled pupils who are enrollees of each health care service plan.

SEC. 4.

 Section 10144.53 is added to the Insurance Code, to read:

10144.53.
 (a)