Bill Text: CA SB1019 | 2021-2022 | Regular Session | Chaptered

California Senate Bill 1019 (Prior Session Legislation)

Bill Title: Medi-Cal managed care plans: mental health benefits.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Passed) 2022-09-30 - Chaptered by Secretary of State. Chapter 879, Statutes of 2022. [SB1019 Detail]

Download: California-2021-SB1019-Chaptered.html

Senate Bill No. 1019

CHAPTER 879

An act to add Sections 14190.1 and 14190.2 to the Welfare and Institutions Code, relating to Medi-Cal.

[ Approved by Governor September 30, 2022. Filed with Secretary of State September 30, 2022. ]

LEGISLATIVE COUNSEL'S DIGEST

SB 1019, Gonzalez. Medi-Cal managed care plans: mental health benefits.

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 through various delivery systems, including fee-for-service and managed care. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions.

Existing law requires a Medi-Cal managed care plan to provide mental health benefits covered in the state plan, excluding those benefits provided by county mental health plans under the Specialty Mental Health Services Waiver. Under existing law, nonspecialty mental health services covered by a Medi-Cal managed care plan include, among other things, individual and group mental health evaluation and treatment, psychological testing, and psychiatric consultation, as specified.

This bill would require a Medi-Cal managed care plan, no later than January 1, 2025, to conduct annual outreach and education for its enrollees, based on a plan that the Medi-Cal managed care plan develops and submits to the department, as specified, regarding the mental health benefits that are covered by the Medi-Cal managed care plan. The bill would require a Medi-Cal managed care plan to also conduct annual outreach and education, based on a plan that it develops, to inform primary care providers regarding those mental health benefits.

The bill would require that the outreach and education plan for the enrollees be informed by stakeholder engagement, the Medi-Cal managed care plan’s Population Needs Assessment, and a utilization assessment, as specified, and that the plan meet cultural and linguistic appropriateness standards and incorporate best practices in stigma reduction. The bill would require the department to review the new or updated outreach and education plan and to approve or modify it within 180 calendar days since submission to ensure specified conditions are met, and to consult with stakeholders to develop the standards for the review and approval. The bill would condition implementation of the outreach and education plan on the department’s approval. The bill would require each Medi-Cal managed care plan to publicly post, on its internet website and in an accessible manner, its approved outreach and education plan and its utilization assessment, as specified.

The bill would require the department, once every 3 years, to assess enrollee experience with mental health benefits covered by Medi-Cal managed care plans, as specified. The bill would require the department, no later than January 1, 2025, to adopt survey tools and methodologies relating to the assessment of consumer experience, including best practice methods for data collection and reporting, as specified.

The bill would require the department to publish reports, commencing with a report in April 2026 and once every 3 years thereafter, on its internet website on consumer experience with mental health benefits covered by Medi-Cal managed care plans. The bill would require the reports to include plan-by-plan data, provide granularity for subpopulations, address inequities based on key demographic factors, and provide recommendations, as specified.

The bill would authorize the department to implement these provisions through all-county letters or similar guidance, until any necessary regulations are adopted. The bill would authorize the department to enter into exclusive or nonexclusive contracts, or amend existing contracts, on a bid or negotiated basis, with specified contracting-related exemptions.

Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: NO

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

SECTION 1.

Section 14190.1 is added to the Welfare and Institutions Code, to read:

14190.1.

(a) Subject to subdivision (b), and no later than January 1, 2025, a Medi-Cal managed care plan shall conduct annual outreach and education for its enrollees, based on a plan that the Medi-Cal managed care plan develops and submits to the department upon the department’s approval of the Medi-Cal managed care plan’s Population Needs Assessment, regarding the mental health benefits that are covered by the Medi-Cal managed care plan pursuant to Section 14189 and paragraph (1) of subdivision (b) of Section 14184.402.

(1) The outreach and education plan shall be informed by the Medi-Cal managed care plan’s stakeholder engagement, including the community advisory committee established by the Medi-Cal managed care plan, and by local stakeholders representing diverse racial and ethnic communities.

(2) The outreach and education plan shall be informed by the Medi-Cal managed care plan’s Population Needs Assessment and an assessment of utilization of covered mental health benefits by race, ethnicity, language, age, sexual orientation, gender identity, and disability, and shall ensure that materials and messaging are appropriate for the diversity of the plan enrollee membership. The Medi-Cal managed care plan shall submit the utilization assessment to the department.

(3) The outreach and education plan shall meet cultural and linguistic appropriateness standards, in alignment with the National Standards for Culturally and Linguistically Appropriate Services, shall incorporate best practices in stigma reduction, and shall provide multiple points of contact for enrollees to access mental health benefits.

(b) (1) The department shall review the new or updated outreach and education plan submitted by each Medi-Cal managed care plan as described in this section and shall approve or modify the plan within 180 calendar days since submission, to ensure appropriate local stakeholder engagement, alignment with the Population Needs Assessment, and cultural and linguistic appropriateness.

(2) Implementation of a Medi-Cal managed care plan’s outreach and education plan described in this section shall be subject to approval by the department pursuant to paragraph (1).

(3) Each Medi-Cal managed care plan shall publicly post, on its internet website and in an accessible manner, its approved outreach and education plan and its utilization assessment described in paragraph (2) of subdivision (a), excluding any personally identifiable information.

(c) The department shall consult with stakeholders representative of diverse racial and ethnic communities, including, but not limited to, consumer advocates, mental health stigma reduction experts, community-based organizations, and Medi-Cal managed care plan stakeholders, to develop the standards by which outreach and education plans will be reviewed and approved.

(d) Approval standards may include, but are not limited to, any of the following:

(1) Outreach and education methods that include, but are not limited to, online outreach, mail, telephone, partnerships with community-based organizations, partnerships with primary care providers, and use of navigators, community health workers, and other providers trained to conduct outreach and education.

(2) Alignment of the culturally and linguistically tailored outreach and education strategies with the National Standards for Culturally and Linguistically Appropriate Services, utilization assessment and Population Needs Assessment.

(3) Inclusion of consumer-friendly information in existing member-facing communication channels, including the Medi-Cal managed care plan’s internet website.

(4) An independent evaluation plan to assess and improve outreach to enrollees related to nonspecialty mental health services upon the department’s approval of a Medi-Cal managed care plan’s Population Needs Assessment.

(e) A Medi-Cal managed care plan shall also conduct annual outreach and education, based on a plan that the Medi-Cal managed care plan develops, to inform primary care providers regarding the mental health benefits covered by the Medi-Cal managed care plan pursuant to Section 14189 and paragraph (1) of subdivision (b) of Section 14184.402.

(f) Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may implement, interpret, or make specific this section, in whole or in part, by means of all-county letters, plan letters, provider bulletins, information notices, or other similar guidance, until any necessary regulations are adopted.

(g) For purposes of implementing this section, the department may enter into exclusive or nonexclusive contracts, or amend existing contracts, on a bid or negotiated basis. Contracts entered into or amended pursuant to this section shall be 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.

SEC. 2.

Section 14190.2 is added to the Welfare and Institutions Code, to read:

14190.2.

(a) Once every three years, the department shall assess enrollee experience with mental health benefits covered by Medi-Cal managed care plans pursuant to Section 14189 and paragraph (1) of subdivision (b) of Section 14184.402.

(b) No later than January 1, 2025, the department shall adopt survey tools and methodologies that shall meet all of the following conditions:

(1) Assess experience with the full range of mental health benefits covered by Medi-Cal managed care plans pursuant to Section 14189 and paragraph (1) of subdivision (b) of Section 14184.402.

(2) Assess consumer experience in various domains, including, but not limited to, receipt of treatment quickly, how well clinicians communicate, cultural competency of providers, communication with the plan and provider, receipt of treatment and information from the plan, including information related to patients’ rights, the treatment plan and options, and the sides effects of medication, perceived improvement, overall rating of counseling and other treatment, and overall rating of the plan.

(3) Assess consumer experience in a manner that utilizes survey best practice methods for data collection and reporting, including, but not limited to, staff training on data collection, the legality and use of data collection, how to work with patients to improve comfort levels in sharing the data, oversampling and collection of self-reported demographic data at the individual encounter level, and the use of data through existing enrollment and renewal processes.

(c) The department shall consider, and may utilize, existing tools in order to ensure alignment with national standards and state health care programs.

(d) (1) The department shall publish reports, commencing with a report in April 2026 and once every three years thereafter, on its internet website on consumer experience with mental health benefits covered by Medi-Cal managed care plans.

(2) The reports shall include plan-by-plan data, provide granularity for subpopulations, and address inequities based on key demographic factors, including, but not limited to, language, race, ethnicity, disability status, sexual orientation, and gender identity, to the extent that survey response rates produce statistically valid results. The reports shall exclude any personally identifiable information.

(3) The reports shall provide recommendations for improving access to mental health benefits covered by Medi-Cal managed care plans.

(e) Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may implement, interpret, or make specific this section, in whole or in part, by means of all-county letters, plan letters, provider bulletins, information notices, or other similar guidance, until any necessary regulations are adopted.

(f) For purposes of implementing this section, the department may enter into exclusive or nonexclusive contracts, or amend existing contracts, on a bid or negotiated basis. Contracts entered into or amended pursuant to this section shall be 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.