Currrent as of February 4, 2022
Senate Bill No. 773
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Introduced by Senator Roth |
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An act to add Section 14197.6 to the Welfare and Institutions Code, relating to Medi-Cal.
LEGISLATIVE COUNSEL’S DIGEST
SB 773, as amended, Roth. Medi-Cal managed care: behavioral health services.
Existing law establishes the Medi-Cal program, administered by the State Department of Health Care Services, under which health care services, such as behavioral health treatment services, are provided to qualified, low-income persons by various health care delivery systems, including managed care. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Existing law imposes requirements on Medi-Cal managed care plans, including standards on network adequacy, alternative access, and minimum loss ratios.
This bill would, commencing with the January 1, 2022, rating period, and through December 31, 2024, require the department to make incentive payments to qualifying Medi-Cal managed care plans that meet predefined goals and metrics associated with targeted interventions, rendered by school-affiliated behavioral health providers, that increase access to preventive, early intervention, and behavioral health services for children enrolled in kindergarten and grades 1 to 12, inclusive, at those schools. The bill would require the department to consult with certain stakeholders on the development of interventions, goals, and metrics, to determine the amount of incentive payments, and to seek any necessary federal approvals.
The bill would condition the issuance of incentive payments on compliance with specified federal requirements and the availability of federal financial participation. Alternatively, if federal approval is not obtained, the bill would authorize the department to make incentive payments on a state-only funding basis, but only to the extent the department determines that federal financial participation for the Medi-Cal program is not otherwise jeopardized.
Vote: majority Appropriation: no Fiscal Committee: yes Local Program: no
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1.
Section 14197.6 is added to the Welfare and Institutions Code, to read:
14197.6.
(a) Commencing with the January 1, 2022, rating period, and through December 31, 2024, the department shall make incentive payments to qualifying Medi-Cal managed care plans that meet predefined goals and metrics, as developed pursuant to subdivision (b), associated with targeted interventions, rendered by school-affiliated behavioral health providers, that increase access to preventive, early intervention, and behavioral health services for children enrolled in kindergarten and grades 1 to 12, inclusive, at those schools.
(b) The department, in consultation with Medi-Cal managed care plans, county behavioral health departments, schools, and other affected stakeholders, shall develop the interventions, goals, and metrics used to determine a Medi-Cal managed care plan’s eligibility to receive the incentive payments described in this section.
(c) (1) For each rating period during which the department implements incentive payments, the department shall determine the amount of incentive payment earned by each qualifying Medi-Cal managed care plan.
(2) An incentive payment that is eligible for federal financial participation pursuant to subdivision (d) shall be made in accordance with the requirements for incentive arrangements, as specified in Section 438.6(b)(2) of Title 42 of the Code of Federal Regulations and any associated federal guidance.
(d) The department shall seek any necessary federal approvals to claim federal financial participation for the incentive payments to qualifying Medi-Cal managed care plans, as described in this section. If federal approval is obtained for one or more rating periods, the department shall implement this section only to the extent that federal financial participation is available in that applicable rating period. If federal approval is not obtained for one or more rating periods, the department may make incentive payments to qualifying Medi-Cal managed care plans as described in this section on a state-only funding basis during the applicable rating period, but only to the extent the department determines that federal financial participation for the Medi-Cal program is not otherwise jeopardized as a result.
(e) Incentive payments made pursuant to this section shall be used to supplement and not supplant existing payments to Medi-Cal managed care plans.
(f) For purposes of this section, the following definitions apply:
(1) “Comprehensive risk contract” has the same meaning as set forth in Section 438.2 of Title 42 of the Code of Federal Regulations.
(2) “Medi-Cal managed care plan” means an individual, organization, or entity that enters into a comprehensive risk contract with the department to provide covered full-scope health care services to enrolled Medi-Cal beneficiaries pursuant to this chapter or Chapter 8 (commencing with Section 14200).
SB 773