Bill Text: CA AB552 | 2021-2022 | Regular Session | Enrolled
Bill Title: Integrated School-Based Behavioral Health Partnership Program.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Vetoed) 2022-09-19 - Vetoed by Governor. [AB552 Detail]
Download: California-2021-AB552-Enrolled.html
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Enrolled
August 26, 2022 |
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Passed
IN
Senate
August 23, 2022 |
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Passed
IN
Assembly
August 24, 2022 |
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Amended
IN
Senate
June 20, 2022 |
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Amended
IN
Senate
June 02, 2022 |
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Amended
IN
Assembly
January 27, 2022 |
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Amended
IN
Assembly
January 24, 2022 |
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Amended
IN
Assembly
April 05, 2021 |
CALIFORNIA LEGISLATURE—
2021–2022 REGULAR SESSION
Assembly Bill
No. 552
| Introduced by Assembly Member Quirk-Silva |
February 10, 2021 |
An act to add Article 3 (commencing with Section 49440) to Chapter 9 of Part 27 of Division 4 of Title 2 of the Education Code, relating to pupil health.
LEGISLATIVE COUNSEL'S DIGEST
AB 552, Quirk-Silva.
Integrated School-Based Behavioral Health Partnership Program.
Existing law requires the governing board of any school district to give diligent care to the health and physical development of pupils and authorizes the governing board of a school district to employ properly certified persons for the work.
The School-based Early Mental Health Intervention and Prevention Services for Children Act of 1991 authorizes the Director of Health Care Services, in consultation with the Superintendent of Public Instruction, to award matching grants to local educational agencies to pay the state share of the costs of providing school-based early mental health intervention and prevention services to eligible pupils at schoolsites of eligible pupils, subject to the availability of funding each year.
This bill would authorize the Integrated School-Based Behavioral Health Partnership
Program, which the bill would establish, to provide prevention and early intervention for, and access to, behavioral health services for pupils. The bill would authorize a county behavioral health agency and the governing board or body of a local educational agency to agree to collaborate on conducting a needs assessment on the need for school-based mental health and substance use disorder services, to implement an integrated school-based behavioral health partnership program, and to develop a memorandum of understanding outlining the requirements for the partnership program. The bill would encourage the county behavioral health agency and the local educational agency, when appropriate, to enter into a contract for mental health or substance use disorder services.
As part of a partnership program, the bill would require a county behavioral health agency to provide, through its own staff or through its network of contracted community-based organizations, one or more
behavioral health professionals that meet specified contract, licensing, and supervision requirements, and who have a valid, current satisfactory background check, to serve pupils with serious emotional disturbances or substance use disorders, or who are at risk of developing a serious behavioral health condition. The bill would require a local educational agency to provide school-based locations, including space at schools, appropriate for the delivery of behavioral health services, and would additionally authorize these services to be provided through telehealth or through appropriate referral. The bill would require parents and guardians to be notified of, and contacted for information related to, these services by local educational agencies, as provided. The bill would establish processes for delivering services, and would specify the types of services, including prevention, intervention, and brief initial intervention services, as specified, that may be provided pursuant to the partnership program. The
bill would require the local educational agency and county behavioral health agency to develop a process related to serving pupils with private coverage, including a process to seek reimbursement from private insurers for behavioral health services provided to a pupil. The bill would require the memorandum of understanding of the partnership program to specify, among other things, how a pupil will be served if a pupil has coverage from a health plan or insurer that is not regulated by the state, or if the parent or guardian cannot afford the cost sharing required under their health plan contract or health insurance policy.
The bill would require the partnership program to annually report specified information to the State Department of Health Care Services and the Mental Health Services Oversight and Accountability Commission, and would require the commission, in collaboration with the department, to report that information to the Legislature every 3 years, as
specified. The bill would also require the partnership program to annually report specified pupil referral information to the Department of Managed Health Care and the Department of Insurance, as provided.
The bill would authorize a partnership program to provide services to individuals with exceptional needs, including services required by the pupil’s individualized education program, as specified.
Digest Key
Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: NOBill Text
The people of the State of California do enact as follows:
SECTION 1.
The Legislature finds and declares all of the following:(a) In any given year, the percentage of young people with behavioral health disorders is estimated to be between 14 and 20 percent.
(b) One-half of all mental illness develops by 14 years of age and three-quarters by 24 years of age. Among adolescents and adults with substance use disorders, 90 percent began using substances before 18 years of age. Early intervention and prevention of behavioral health conditions are critical to the success of an individual’s health, educational goals, and social relationships.
(c) Pupils with emotional disturbances
have the highest increase in absenteeism and dropout rates when compared to any other disability, according to studies.
(d) In 2017, a child in the United States was 10.1 times more likely to be seen by an out-of-network provider than a primary care office visit, which is more than twice the disparity seen for adults, according to a Milliman report.
(e) Under health parity law, services treating behavioral health conditions at the onset to prevent these conditions from becoming more serious should be part of every health plan’s benefits. Because of the importance of early intervention for children, private health plans do or should cover these services for children.
(f) Schools have been identified as a crucial place to provide behavioral health services and improve access to services for pupils, including for pupils
in underserved communities, but also for pupils who are privately insured.
(g) According to recent research, the COVID-19 pandemic is affecting the mental health of children and adolescents causing an increase in depression, anxiety, and risky substance use. As children and youth return to schools, there will be a growing need for school-based behavioral health services to address the emotional harm caused by the COVID-19 pandemic.
(h) Beginning in April 2020, the proportion of children’s mental health-related emergency department visits among all pediatric emergency department visits increased and remained elevated through October 2020. Compared with 2019, the proportion of mental health-related visits for children 5 to 11 years of age, inclusive, and 12 to 17 years of age, inclusive, increased in 2020 by approximately 24 percent and 31 percent, respectively.
SEC. 2.
Article 3 (commencing with Section 49440) is added to Chapter 9 of Part 27 of Division 4 of Title 2 of the Education Code, to read:Article 3. Integrated School-Based Behavioral Health Partnership Program
49440.
For purposes of this article, the following definitions apply:(a) “At risk of developing a serious behavioral health condition” shall be defined by the applicable county behavioral health agency and local educational agency pursuant to the partnership program described in Section 49440.2.
(b) “Brief initial intervention” means select Medi-Cal specialty mental health services and substance use disorder services that would be appropriately provided at a school-based location or through telehealth, including assessments, plan developments, therapy, substance use counseling, rehabilitation, collateral services, medication support services, therapeutic behavioral services, case management, recovery
services, and intensive care coordination.
(c) “Local educational agency” means a school district, county office of education, or charter school.
(d) “Participating entity” means a community-based organization or another provider or entity, including a local educational agency, that has contracted with a county behavioral health agency to provide services described in subdivision (b) and participate in the partnership program pursuant to this article.
(e) “Partnership program” means an integrated school-based behavioral health partnership program established by a county behavioral health agency and the governing board or governing body of a local educational agency pursuant to this article. A partnership program may include one or more participating entities.
(f) “Private insurer” means a health insurer offering policies of health insurance, as defined in subdivision (b) of Section 106 of the Insurance Code.
(g) “Private plan” means a health care service plan licensed pursuant to the Knox-Keene Health Care Service Plan Act of 1975 (Article 1 (commencing with Section 1340) of Chapter 2.2 of Division 2 of the Health and Safety Code).
(h) “Privately covered pupil” means a pupil with comprehensive health coverage that is not coverage provided through the Medi-Cal program, including, but not limited to, the Optional Targeted Low-Income Children’s Program, and the County Health Initiative Matching Fund Program, and is coverage provided through a plan licensed pursuant to the Knox-Keene Health Care Service Plan Act of 1975 (Article 1 (commencing with Section 1340) of Chapter 2.2 of Division 2 of the Health and Safety Code) or a
health insurer offering policies of health insurance, as defined in subdivision (b) of Section 106 of the Insurance Code.
49440.1.
The Integrated School-Based Behavioral Health Partnership Program is hereby authorized to provide prevention and early intervention for, and access to, behavioral health services for pupils with serious emotional disturbances or substance use disorders, or who are at risk of developing a serious behavioral health condition.49440.2.
A county behavioral health agency and the governing board or governing body of a local educational agency may agree to collaborate on conducting a needs assessment on the need for school-based mental health and substance use disorder services, and implement an integrated school-based behavioral health partnership program pursuant to this article, and may develop a memorandum of understanding outlining the requirements for the partnership program, as provided in this article. Multiple local educational agencies within a single county may join to form a partnership program with the county behavioral health agency. The county behavioral health agency and the local educational agency are encouraged, when appropriate, to formalize the memorandum of understanding and enter into a contract for the provision of mental health or substance use disorder services.49440.3.
(a) A county behavioral health agency shall designate and provide, through its own staff or through its network of contracted participating entities, one or more behavioral health professionals that meet the licensing and supervision requirements of one or more of the classifications listed in subdivision (b) to serve pupils with serious emotional disturbances or substance use disorders, or who are at risk of developing a serious behavioral health condition, pursuant to the partnership program.(b) The county behavioral health agency, to secure Medicaid federal matching funds for school-based services, shall require any behavioral health professional who provides mental health or substance use disorder services pursuant
to a partnership program to contract with the health agency to provide those services and to hold an active license or credential with one or more of the following classifications:
(1) A licensed clinical social worker or registered associate social worker, as described in Section 4996.18 of the Business and Professions Code.
(2) A licensed marriage and family therapist (MFT) or MFT associate, as described in subdivision (b) of Section 4980.03 of the Business and Professions Code.
(3) A licensed professional clinical counselor (LPCC) or LPCC associate, as described in subdivision (f) of Section 4999.12 of the Business and Professions Code.
(4) A licensed clinical psychologist, psychological intern, psychological registrant, psychological trainee, or
other supervised individual permitted to provide psychological services pursuant to Chapter 6.6 (commencing with Section 2900) of Division 2 of the Business and Professions Code.
(5) A licensed psychiatrist or psychiatric resident.
(6) A licensed psychiatric mental health nurse practitioner.
(7) A physician specialist in substance use disorder treatment.
(8) An individual who holds a services credential with a specialization in pupil personnel services as described in Section 44266 that authorizes the individual to perform school counseling, school psychology, or school social work.
(9) An individual who holds a services credential with specialization in health for school nurse, as
described in Section 44267.5.
(10) A licensed educational psychologist, as defined in Chapter 13.5 (commencing with Section 4989.10) of Division 2 of the Business and Professions Code.
(11) Any other licensed behavioral health professional practicing within the scope of their license and providing behavioral health services who is deemed appropriate by the partnership program and who meets any applicable Medi-Cal requirements.
(c) (1) Other trained county behavioral health professionals, including clinical interns or trainees, certified peer specialists, and registered or certified substance use disorder counselors, may participate as providers in the partnership program so long as these professionals are supervised pursuant to existing Medi-Cal requirements for any intervention services
provided on schoolsites.
(2) All behavioral health professionals who participate in the partnership program shall have a valid, current satisfactory background check.
49440.4.
(a) The local educational agency shall provide school-based locations, including space at schools, appropriate for the delivery of behavioral health services.(b) The county behavioral health agency and participating entities, as appropriate, shall collaborate with the local educational agency to establish hours of service at mutually agreed upon school-based locations or a process for ensuring timely interventions when needed, or both.
(c) The partnership program shall identify if mental health services or substance use disorder services, or both, will be delivered at the school-based location or through telehealth, or both. If the partnership program determines that only
mental health services or only substance use disorder services shall be provided at the school-based location, the partnership program shall develop a plan for each pupil who has been identified as needing behavioral health services that are not offered at the school-based location. The plan shall include appropriate referral for services not offered at the school-based location.
(d) Behavioral health services may be provided at locations that are not at the school-based location for purposes of accommodating the individual needs of a pupil.
(e) If necessary and appropriate, as determined in consultation with the parent or guardian of the pupil being served and in compliance with state and federal law protecting the pupil’s right to privacy and parental rights, Medi-Cal covered behavioral health services may continue to be delivered at the school-based location beyond the delivery
of brief initial interventions.
49440.5.
(a) The local educational agency, county behavioral health agency, and any participating entity shall jointly develop a referral process to support school personnel in making appropriate referrals to the designated behavioral health professional.(b) The local educational agency shall notify parents and guardians, as part of the notification required pursuant to Section 48980, of the prevention and early intervention for, and access to, behavioral health services offered for pupils pursuant to this article. The notification shall, consistent with Section 124260 of the Health and Safety Code, include a form on which a parent or guardian may indicate that they do not consent to their child receiving those services and to, consistent with
Section 124260 of the Health and Safety Code, opt out their child, if the child is under 12 years of age, from receiving prevention and early intervention for, and access to, behavioral health services offered pursuant to this article by submitting the completed form to the local educational agency. If a pupil for whom a form has been submitted is later identified as needing behavioral health services, this shall not preclude the local education agency from reaching out to the parent or guardian to seek consent for services.
49440.6.
To ensure timely access to behavioral health interventions at the earliest onset of a behavioral health condition, the designated behavioral health professional shall provide brief initial interventions, as defined in subdivision (b) of Section 49440, when necessary for all referred pupils, including uninsured and privately insured pupils, in addition to Medi-Cal beneficiaries.49440.7.
(a) The array of behavioral health services provided pursuant to the partnership program shall be a subset of Medi-Cal covered mental health or substance use disorder services, and shall include prevention, intervention, and, if necessary, brief initial interventions, as defined in subdivision (b) of Section 49440, within a multitiered system of support or other similar framework employed by the local educational agency.(b) Nothing in this article shall be construed to modify, expand, or restrict applicable patient privacy and parental rights.
49440.8.
(a) (1) The local educational agency and county behavioral health agency shall develop a process to collect information on the health coverage for each pupil, with the permission of the pupil’s parent or guardian, to allow the county behavioral health agency or the participating entity to seek reimbursement for behavioral health services provided to the pupil, when applicable. The process shall include informing the participating entity which pupils referred for services have private coverage.(2) The memorandum of understanding of the partnership program shall specify how a privately covered pupil will be served if the parent or guardian does not provide the necessary information on the pupil’s health coverage pursuant
to paragraph (1), if the pupil has coverage from a health plan or insurer that is not regulated by California, or if the parent or guardian cannot afford the cost sharing required under their health plan contract or health insurance policy.
(b) (1) For privately covered pupils, the partnership program shall contact the private plan or insurer before initiating or during an assessment described in subdivision (b) of Section 49440 to determine whether a privately covered pupil needs an urgent or nonurgent appointment and to facilitate a referral to the private plan’s network providers or private insurer’s preferred provider, as appropriate and consistent with professionally recognized standards of practice.
(2) (A) (i) After completing the assessment and contacting the private plan or insurer pursuant to paragraph
(1), if the private plan or insurer is able to offer the pupil enrolled in the private plan or insurer an appointment within 48 hours for an urgent care appointment or within 10 business days for a nonurgent appointment, the designated behavioral health professional shall facilitate the referral to the private plan’s network providers or private insurer’s preferred provider.
(ii) After completing the assessment and contacting the private plan or insurer pursuant to paragraph (1), if the private plan or insurer is unable to offer the pupil enrolled in the plan an appointment with a network provider within 48 hours for an urgent care appointment or within 10 business days for a nonurgent appointment, except as provided in subparagraph (B), the designated behavioral health professional shall continue and complete the brief initial intervention services.
(iii) When a designated
behavioral health professional makes a referral to the network provider of a private plan or a preferred provider of a private insurer, the designated behavioral health professional shall also follow up with the parent or guardian, or pupil, as appropriate, to determine if the pupil was able to attain the services for which they were referred. The partnership program shall keep record of the number of pupils referred to their private coverage and whether these pupils were able to utilize the services for which they were referred until January 1, 2026, and report this information annually to the Department of Managed Health Care and the Department of Insurance, as applicable.
(B) The applicable waiting time for a particular appointment may be extended if the referring or treating licensed behavioral health provider, or the health professional providing triage or screening services, as applicable, acting within the scope of the individual’s
practice and consistent with professionally recognized standards of practice, has determined and noted in the relevant record that a longer waiting time will not have a detrimental impact on the health of the enrollee.
(3) The private plan or insurer shall reimburse for brief initial intervention services provided by the designated behavioral health professional to pupils enrolled with the private plan at the amount a county behavioral health agency would receive for the same services provided to a Medi-Cal beneficiary or as is indicated by Section 1374.722 of the Health and Safety Code and Section 10144.53 of the Insurance Code for a health care service plan contract or insurance policy issued, amended, renewed, or delivered on or after January 1, 2024.
(4) A private plan shall meet requirements for the timely payment of claims established pursuant to Section 1371 of the Health
and Safety Code, and a private insurer shall meet the requirement for timely payment of claims established pursuant to Sections 10123.13 and 10123.147 of the Insurance Code for a contracted provider. If the private plan or insurer disputes the services provided or the amount, the private plan or insurer may submit a dispute to the Department of Managed Health Care or the Department of Insurance, as applicable, but the private plan or insurer shall comply with requirements for timely payment, including for services or amounts in dispute. The Department of Managed Health Care and the Department of Insurance shall have trained staff available to address any disputes arising from the partnership program.
(c) If additional behavioral health services beyond the brief initial intervention services are necessary and appropriate, as determined in consultation with the parent or guardian of the pupil being served, the following shall occur:
(1) If the private plan or insurer can meet timely access standards for care delivery, the designated behavioral health professional shall make a referral to the private plan or insurance provider.
(2) For health care service plan contracts or insurance policies issued, amended, renewed, or delivered before January 1, 2024, if the private plan or insurer cannot meet timely access standards for care delivery, the private plan or insurer and the county behavioral health agency shall negotiate a single case agreement to provide behavioral health services beyond the brief initial intervention services to determine reimbursement for additional services. If an agreement cannot be reached, the private plan or insurer shall report to the Department of Managed Health Care or the Department of Insurance, as applicable, how it will ensure the pupil receives the necessary services in compliance
with state and federal law, including the federal Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (Public Law 110-343) and Senate Bill 855 (Chapter 151 of the Statutes of 2020).
(3) A health care service plan contract or insurance policy issued, amended, renewed, or delivered on or after January 1, 2024, shall reimburse pursuant to Section 1374.722 of the Health and Safety Code and Section 10144.53 of the Insurance Code.
(4) When a designated behavioral health professional makes a referral to the network provider of a private plan or a preferred provider of a private insurer, the designated behavioral health professional shall also follow up with the parent or guardian, or pupil, as appropriate, to determine if the pupil was able to attain the services for which they were referred. The partnership program shall keep record of the number of
pupils referred to their private coverage and whether these pupils were able to utilize the services for which they were referred until January 1, 2026, and report this information annually to the Department of Managed Health Care and the Department of Insurance, as applicable.
(d) Private plans, private insurers, county behavioral health agencies, and participating entities are encouraged to contract to serve pupils who are receiving services from the partnership program.
49440.9.
(a) A partnership program shall annually report to the State Department of Health Care Services and the Mental Health Services Oversight and Accountability Commission, all of the following:(1) A brief description of the partnership program, including the service delivery model.
(2) The financial contribution made by the county behavioral health agency and local educational agency participating in the partnership program.
(3) The definition the partnership program uses to identify pupils “at risk of developing a serious behavioral health condition,” pursuant to Section 49440 and subdivision (a) of Section
49440.3.
(4) The number of school-based locations involved in the partnership program and the percentage of pupils who are Medi-Cal beneficiaries at each school-based location.
(5) The number of pupils served in the last year including demographic data of the pupils’ race, ethnicity, gender, and language.
(6) The number of pupils who receive school-based services beyond the brief initial intervention described in Sections 49440.6 and 49440.7.
(b) The Mental Health Services Oversight and Accountability Commission, in collaboration with the State Department of Health Care Services, shall provide a report to the Legislature on the Integrated School-Based Behavioral Health Partnership Program, based upon the metrics in this section, in compliance with
Section 9795 of the Government Code, every three years, beginning three years after the establishment of a partnership program pursuant to this article.
49441.
(a) A partnership program may provide services to pupils with exceptional needs, including, but not limited to, services required by the pupil’s individualized education program. The partnership program shall clearly delineate responsibilities for any services provided to pupils with exceptional needs that are included in a pupil’s individualized education program, and shall provide services consistent with state and federal law related to pupils with exceptional needs, including, but not limited to, statutes enacted under Chapter 43 of the Statutes of 2011 and the federal Individuals with Disabilities Education Act (20 U.S.C. Sec. 1400 et seq.).(b) (1) This article does not replace current county requirements related to
crisis intervention protocols and the partnership program shall not provide crisis interventions. The county behavioral health agency and local educational agency shall establish processes for timely interventions that identify nonurgent, urgent, and crisis-related circumstances. The process shall include guidelines for when county crisis intervention is needed instead of timely interventions related to urgent or nonurgent needs.
(2) The partnership program shall not create a siloed delivery system. The partnership program shall establish a process to leverage community-based services and other resources, and a process to identify local resources related to crisis intervention protocols and services.
