MHAC Priority Legislation

MHAC Position: Support

Author: Arambula

Date: 04/18/2024

Existing law establishes the Early Psychosis Intervention Plus (EPI Plus) Program to encompass early psychosis and mood disorder detection and intervention. Existing law establishes the Early Psychosis and Mood Disorder Detection and Intervention Fund and makes the moneys in the fund available, upon appropriation, to the Mental Health Services Oversight and Accountability Commission. Existing law authorizes the commission to allocate moneys from that fund to provide grants to create or expand existing capacity for early psychosis and mood disorder detection and intervention services and supports.This bill would require the Mental Health Services Oversight and Accountability Commission to consult with the State Department of Health Care Services and related state departments and entities, create a strategic plan to achieve specific goals, including improving the understanding of psychosis, as specified, and, no later than July 1, 2025, submit that strategic plan to the relevant policy and fiscal committees of the Legislature. The bill would require the State Department of Health Care Services to seek to partner with the University of California to develop a plan to establish a Center for Practice Innovations the Center for Mental Health Wellness and Innovations to, among other things, promote the widespread availability of evidence-based practices to improve behavioral health services. If the center is established, the bill would require the State Department of Health Care Services, no later than July 1, 2025, to submit the plan to create the center to the relevant policy and fiscal committees of the Legislature.

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MHAC Position: Support

Author: Carrillo

Date: 04/18/2024

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. Existing law authorizes the Director of Health Care Services to terminate a contract or impose sanctions if the director finds that a Medi-Cal managed care plan fails to comply with contract requirements, state or federal law or regulations, or the state plan or approved waivers, or for other good cause.Existing law establishes, until January 1, 2026, certain time and distance and appointment time standards for specified Medi-Cal managed care covered services, consistent with federal regulations relating to network adequacy standards, to ensure that those services are available and accessible to enrollees of Medi-Cal managed care plans in a timely manner, as specified.Under this bill, a Medi-Cal managed care plan would be deemed to be not in compliance with the appointment time standards if either (1) fewer than 85% of the network providers had an appointment available within the standards or (2) the department receives information establishing that the plan was unable to deliver timely, available, or accessible health care services to enrollees, as specified. Under the bill, failure to comply with the appointment time standard may result in contract termination or the issuance of sanctions as described above.Existing law requires a Medi-Cal managed care plan to submit a request for alternative access standards if the plan cannot meet the time or distance standards. Under existing law, a plan is not required to submit a previously approved request on an annual basis, unless the plan requires modifications to its request. Existing law requires the plan to submit this previously approved request at least every 3 years for review and approval when the plan is required to demonstrate compliance with time or distance standards.This bill would instead require a plan that has a previously approved alternative access standard to submit a renewal request on an annual basis, explaining which efforts the plan has made in the previous 12 months to mitigate or eliminate circumstances that justify the use of an alternative access standard, as specified. The bill would require the department to consider the reasonableness and effectiveness of the mitigating efforts as part of the renewal decision.Existing law requires a Medi-Cal managed care plan to demonstrate, annually and upon request by the department, how the plan arranged for the delivery of Medi-Cal covered services to Medi-Cal enrollees, with a report measuring compliance, as specified. Existing law requires the department to annually evaluate a plan’s compliance with the standards and to annually publish a report.This bill would, effective for contract periods commencing on or after July 1, 2025, require the plan’s and department’s reports to include certain information and require the department’s evaluation to be performed using a direct testing method, as specified. Under the bill, failure to comply with these provisions may result in contract termination or the issuance of sanctions.Existing law, as part of the federally required external quality review organization (EQRO) review of Medi-Cal managed care plans, requires the EQRO designated by the department to compile certain data, by plan and by county, for the purpose of informing the status of implementation of the above-described standards.This bill would require that the data include, effective for contract periods commencing on or after July 1, 2025, the number of requests for alternative access standards, categorized by new and returning patients, and the number of allowable exceptions for the appointment time standards, categorized by urgent and nonurgent appointment types and by new and returning patients.Under existing law, in lieu of contract termination, the director has the power and authority to require or impose a plan of correction and issue one or more of specified sanctions against a contractor for findings of noncompliance or good cause.This bill would require the department to monitor any plan of correction imposed by the director, with progress reported publicly no less than annually for the duration of the plan of correction.Existing law authorizes the director to impose monetary sanctions based on any of specified circumstances, including, among others, a contractor’s failure to comply with network adequacy standards, failure to submit timely and accurate network provider data, or failure to timely and accurately process grievances or appeals.This bill would set forth definitions for the terms of “timely” and “accurate network provider data.”

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MHAC Position: Support

Author: Salas

Date: 08/25/2022

Status: Vetoed

Behavioral Health Internship Grant Program: This bill would, subject to an appropriation, require the Department of Health Care Access and Information to develop and administer a grant program to allocate funding in the form of stipends, for students in behavioral health fields of study and practice, who are participating in unpaid internships or completing unpaid licensure hours at FQHCs. The bill would require the department, when making grants, to consider mental health professional shortage areas and underrepresented groups in the behavioral health workforce.

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MHAC Position: Support

Author: Holden

Date: 04/18/2024

This bill would require the department to prepare a document, and to post it on the department’s internet website, for the purpose of making available resource information for individuals who are released or discharged by a facility after being detained for evaluation and treatment. Under the bill, the information would relate to potential methods for covering any applicable costs resulting from evaluation and treatment services in a manner that eliminates or reduces any share of cost for the individual. The bill would require the document to contain certain information, including information on how the individual, if uninsured or underinsured, might be able to have the services be covered by any applicable public or private programs. The bill would require the document to include a blank section that each county would be required to use for adding county-specific resource information, as specified. The bill would require a county to post the completed document on the county’s internet website. The bill would require the above-described facilities to provide a copy of that document to a detained individual upon their release or discharge by the facility. By creating new duties for counties relating to the document, the bill would impose a state-mandated local program.

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MHAC Position: Support

Author: Pellerin

Date: 04/18/2024

This bill would instead require the records, books, and papers of a health care service plan and other specified entities to be open to inspection by the director, including through electronic means. The bill would require a plan and other specified entities to furnish in electronic media records, books, and papers that are possessed in electronic media and to conduct a diligent review of records, books, and papers and make every effort to furnish those responsive to the director’s request. The bill would require records, books, and papers to be furnished in a format that is digitally searchable, to the greatest extent feasible. The bill would authorize the director to inspect and copy these records, books, and papers, and to seek relief in an administrative law proceeding if, in the director’s determination, a plan or other specified entity fails to fully or timely respond to a duly authorized request for production of records, books, and papers. Because a willful violation of these requirements would be a crime, the bill would impose a state-mandated local program.

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MHAC Position: Support

Author: Pellerin

Date: 04/18/2024

This bill would require that utilization review decisions be made within 72 hours when an enrollee’s condition is urgent, and would make a determination of urgency by a referring or treating health care provider binding on the health care service plan. If a health care service plan fails to make a utilization review decision within the applicable 72-hour or 30-day timeline, the bill would automatically entitle an enrollee to proceed with a grievance. This bill would require a plan’s grievance system to include expedited review of urgent grievances and would make a determination of urgency by a referring or treating health care provider binding on the health care service plan. The bill would require a plan to communicate its final grievance determination within 72 hours of receipt if urgent and 30 days if nonurgent. If a plan fails to make a utilization review decision within the applicable 72-hour or 30-day timeline, the bill would require a grievance to be automatically resolved in favor of the enrollee. This bill would require the department to provide specified correspondence and documents to an enrollee and their representative, if applicable, if the enrollee has submitted a grievance for review under the Independent Medical Review System. The bill would require the department to provide an enrollee and their representative a reasonable opportunity to respond to communications between the department and the plan or the independent review organization before the grievance is adjudicated. The bill would prohibit the department and its independent medical review organization from engaging in ex parte communication with a plan, enrollee, or their representatives during the grievance process. If a grievance is filed internally with an insurer, this bill would require an insurer to communicate its final grievance determination within 72 hours of receipt if urgent and 30 days if nonurgent. Upon notice from the department to a disability insurer that an insured has submitted a grievance to the department, the bill would require an insurer to respond within 24 hours, if directed by the department, regarding an urgent grievance or within 5 calendar days regarding a nonurgent grievance.This bill would require the department to determine whether or not a grievance is urgent unless the insured’s referring or treating provider has already designated the grievance as urgent. The bill would require the department to provide specified correspondence and documents to an insured and their representative, if applicable, if the insured has submitted a grievance for review under the Independent Medical Review System. The bill would require the department to provide an insured and their representative a reasonable opportunity to respond to communications between the department and the insurer or the independent review organization before the grievance is adjudicated. The bill would prohibit the department and its independent medical review organization from engaging in ex parte communication with an insurer, insured, or their representatives during the grievance process, except as specified.

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MHAC Position: Support

Author: Wiener

Date: 04/18/2024

Under SB 294, denials will be filed automatically as grievances with health plans. Life-threatening/urgent denials and unresolved grievances will then be referred to the IMR process, without burdening consumers to fight for care. This bill will also strengthen SB 855, a mental health parity law which requires plans to provide medically necessary mental health treatment.

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MHAC Position: Support

Author: Wiener

Date: 09/30/2022

Status: Passed

Health care service plans: discipline: civil penalties: 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. Existing law authorizes the Director of the Department of Managed Health Care to take disciplinary measures, including the imposition of civil penalties, against a licensee when the director determines that the licensee has committed an act or omission constituting grounds for disciplinary action. Under existing law, these civil penalties generally do not exceed $2500 per violation. Existing law also includes various provisions that assess specific civil and administrative penalties for certain violations. This bill would increase the base amount of the civil penalty to not less than $25,000 per violation, commencing January 1, 2024, which would be adjusted annually. The bill would multiply the amounts of other specified civil and administrative penalties by 4, commencing January 1, 2023 and would annually adjust those penalties. The bill would authorize the director to impose a corrective action plan to require future compliance with the act, under certain circumstances. If a health care service plan fails to comply with the corrective action plan in a timely manner, the bill would require the department to monitor the health care service plan through medical surveys, financial examinations, or other means necessary to ensure timely compliance.

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MHAC Position: Support

Author: Menjivar

Date: 04/22/2024

This bill would require the agency, or an entity designated by the agency, on or before July 1, 2025, to create an internet website where the public can access information and resources to support TGI individuals and their families in accessing trans-inclusive health care and other support services in the state, including, but not limited to, a general description of trans-inclusive health care, information on how to access directories of providers providing gender-affirming services, and resources for victims of hate incidents and hate crimes.The bill would require the agency to consult with specified subject matter experts and the Department of Justice in creating the internet website. The bill would also require the agency, in consultation with subject matter experts, to maintain the website and review the available information and resources to ensure the website is current and updated at reasonable intervals, but no less than once every 6 months.

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MHAC Position: Support

Author: Padilla

Date: 04/26/2024

This bill would require the office, on or before January 1, 2027, to update the State Emergency Plan to include proposed policies and best practices for local government and nongovernmental entities to equitably serve LGBTQ+ communities during an emergency or natural disaster. The bill would require the office to coordinate with specified representatives from LGBTQ+ communities in complying with this requirement and would make related findings and declarations.

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MHAC Position: Support

Author: Cortese

Date: 04/22/2024

This bill would require a health care service plan and a disability insurer, and an entity acting on a plan’s or insurer’s behalf, to ensure compliance with specific requirements for utilization review, including maintaining telephone access during California business hours for a health care provider to request authorization for mental health and substance use disorder care and conducting peer-to-peer discussions regarding specific patient issues related to treatment. Because a willful violation of these provisions by a health care service plan would be a crime, the bill would impose a state-mandated local program.

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MHAC Position: Support

Author: Gonzalez

Date: 09/30/2022

Status: Passed

Medi-Cal managed care plans: Outreach and education: This bill would require a Medi-Cal managed care plan to conduct annual outreach and education to its enrollees regarding the mental health benefits that are covered by the plan, and also to develop annual outreach and education to inform primary care physicians regarding those mental health benefits. The bill would require that the outreach and education efforts be informed by stakeholder engagement and the plan’s population needs assessment, and that the efforts meet cultural and linguistic appropriateness standards and incorporate best practices in stigma reduction. The bill would require DHCS to review and approve annual outreach and education efforts, and to consult with stakeholders to develop the standards for the review and approval. The bill would require DHCS to publish annual reports on its internet website on consumer experience with mental health benefits covered by Medi-Cal managed care plans. The bill would require the department to publish annual reports 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.

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MHAC Position: Support

Author: McGuire

Date: 11/30/2022

Status: Died

Mental health workforce grants: This bill would require the department of Health Care Access and Information, in collaboration with the Superintendent of Public Instruction, to establish a grant program to increase the number of mental health professionals serving children and youth. The bill would require the department to award up to 10,000 grants to postgraduate students over a 3-year period in amounts of up to $25,000 each. The bill would prescribe eligibility requirements for the grants, including that the student be enrolled on or after Jan. 1, 2022 in a California postgraduate program at an accredited school or department of social work or enrolled in a specified master’s or doctoral degree postgraduate program. The bill would require the student to make specified commitments, including a commitment to work with an eligible California-based nonprofit entity or a local educational agency for specified required supervised experience hours and a commitment that, upon completion of the postgraduate program, the student satisfies the requirements to become a registered associate clinical social worker, associate professional clinical counselor, or an associate MFT.

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MHAC Position: Support

Author: Wahab

Date: 04/26/2024

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 provides for the regulation of disability insurers by the Department of Insurance. Existing law requires a health care service plan contract or disability insurance policy issued, amended, or renewed on or after January 1, 2021, to provide coverage for medically necessary treatment of mental health and substance use disorders, as defined, under the same terms and conditions applied to other medical conditions.This bill would require a plan or insurer subject to the above-described coverage requirement, and its delegates, to establish a process to reimburse providers for mental health and substance use disorder treatment services that are integrated with primary care services and provided under a contract or policy issued, amended, or renewed on or after July 1, 2025. Because a willful violation of these provisions by a health care service plan would be a crime, the bill would impose a state-mandated local program.

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MHAC Position: Support

Author: Wahab

Date: 04/18/2024

This bill would add to the Youth Bill of Rights the right to not be deprived of mental health resources, including daily access to counselors, therapists, mentors, or any related services necessary for mental well-being, rehabilitation, and the promotion of positive youth development while detained in a juvenile facility.

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