BILL NUMBER: SB 946 ENROLLED
BILL TEXT
PASSED THE SENATE SEPTEMBER 9, 2011
PASSED THE ASSEMBLY SEPTEMBER 9, 2011
AMENDED IN ASSEMBLY SEPTEMBER 9, 2011
AMENDED IN ASSEMBLY SEPTEMBER 6, 2011
AMENDED IN ASSEMBLY SEPTEMBER 2, 2011
AMENDED IN SENATE MAY 10, 2011
INTRODUCED BY Senators Steinberg and Evans
(Principal coauthor: Senator Alquist)
(Principal coauthor: Assembly Member Beall)
(Coauthors: Senators Corbett, DeSaulnier, Leno, Lieu, Liu,
Padilla, Pavley, and Wolk)
(Coauthors: Assembly Members Ammiano, Butler, Dickinson, Eng,
Fong, Mitchell, Portantino, Williams, and Yamada)
MARCH 31, 2011
An act to amend Section 121022 of, to add Section 1374.74 to, and
to add and repeal Section 1374.73 of, the Health and Safety Code, to
add and repeal Sections 10144.51 and 10144.52 of the Insurance Code,
and to amend Sections 5705, 5708, 5710, 5716, 5724, and 5750.1 of the
Welfare and Institutions Code, relating to health.
LEGISLATIVE COUNSEL'S DIGEST
SB 946, Steinberg. Health care coverage: mental illness: pervasive
developmental disorder or autism: public health.
Existing law provides for the licensure and regulation of health
care service plans by the Department of Managed Health Care. A
willful violation of these provisions is a crime. Existing law
provides for the regulation of health insurers by the Department of
Insurance. Existing law requires health care service plan contracts
and health insurance policies to provide benefits for specified
conditions, including certain mental health conditions.
This bill, effective July 1, 2012, would require those health care
service plan contracts and health insurance policies, except as
specified, to provide coverage for behavioral health treatment, as
defined, for pervasive developmental disorder or autism. The bill
would provide, however, that no benefits are required to be provided
that exceed the essential health benefits that will be required under
specified federal law. Because a violation of these provisions with
respect to health care service plans would be a crime, the bill would
impose a state-mandated local program.
These provisions would be inoperative July 1, 2014, and repealed
on January 1, 2015.
The bill would require the Department of Managed Health Care, in
conjunction with the Department of Insurance, to convene an Autism
Advisory Task Force by February 1, 2012, to provide assistance to the
department on topics related to behavioral health treatment and to
develop recommendations relating to the education, training, and
experience requirements to secure licensure from the state. The bill
would require the department to submit a report of the Task Force to
the Governor and specified members of the Legislature by December 31,
2012.
Existing law establishes various communicable disease prevention
and control programs. Existing law requires the State Department of
Public Health to establish a list of reportable diseases and
conditions and requires health care providers and laboratories to
report cases of HIV infection to the local health officer using
patient names and sets guidelines regarding these reports. Existing
law requires the local health officers to report unduplicated HIV
cases by name to the department.
This bill would authorize the department to revise the HIV
reporting form without the adoption of a regulation, as specified.
Under the Bronzan-McCorquodale Act, the State Department of Mental
Health administers the provision of funds to counties for community
mental health services programs. Existing law also permits counties
to receive, under certain circumstances, Medi-Cal reimbursement for
mental health services. Under existing law, negotiated net amounts or
rates are used as the cost of services in contracts between the
state and the county and between the county and a subprovider of
services. Existing law establishes the method for computing
negotiated rates. Existing law prohibits the charges for the care and
treatment of each patient receiving service from a county mental
health program from exceeding the actual or negotiated cost of the
services.
This bill would only allow the use of negotiated net amounts as
the cost of services in a contract between the state and a county and
the county and a subprovider of services, and would eliminate the
use of negotiated rates. The bill would also specify that the charges
for the care and treatment of each patient receiving a service from
a county mental health program shall not exceed the actual cost of
the service.
Existing law establishes the Medi-Cal program, administered by the
State Department of Health Care Services, under which basic health
care services are provided to qualified low-income persons. The
Medi-Cal program is, in part, governed and funded by federal Medicaid
provisions. Under existing law, the State Department of Health Care
Services promulgates regulations for determining reimbursement of
Short-Doyle mental health services allowable under the Medi-Cal
program. Existing law requires the State Department of Mental Health
and the State Department of Health Care Services to jointly develop a
ratesetting methodology for use in the Short-Doyle Medi-Cal system
that maximizes federal funding and utilizes, as much as practicable,
federal Medicare reimbursement principles. Existing law requires that
this ratesetting methodology contain incentives relating to economy
and efficiency.
The bill would delete the requirement that the ratesetting
methodology in the Short-Doyle Medi-Cal system include incentives
relating to economy and efficiency.
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 no reimbursement is required by this
act for a specified reason.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 1374.73 is added to the Health and Safety Code,
to read:
1374.73. (a) (1) Every health care service plan contract that
provides hospital, medical, or surgical coverage shall also provide
coverage for behavioral health treatment for pervasive developmental
disorder or autism no later than July 1, 2012. The coverage shall be
provided in the same manner and shall be subject to the same
requirements as provided in Section 1374.72.
(2) Notwithstanding paragraph (1), as of the date that proposed
final rulemaking for essential health benefits is issued, this
section does not require any benefits to be provided that exceed the
essential health benefits that all health plans will be required by
federal regulations to provide under Section 1302(b) of the federal
Patient Protection and Affordable Care Act (Public Law 111-148), as
amended by the federal Health Care and Education Reconciliation Act
of 2010 (Public Law 111-152).
(3) This section shall not affect services for which an individual
is eligible pursuant to Division 4.5 (commencing with Section 4500)
of the Welfare and Institutions Code or Title 14 (commencing with
Section 95000) of the Government Code.
(4) This section shall not affect or reduce any obligation to
provide services under an individualized education program, as
defined in Section 56032 of the Education Code, or an individualized
service plan, as described in Section 5600.4 of the Welfare and
Institutions Code, or under the Individuals with Disabilities
Education Act (20 U.S.C. Sec. 1400, et seq.) and its implementing
regulations.
(b) Every health care service plan subject to this section shall
maintain an adequate network that includes qualified autism service
providers who supervise and employ qualified autism service
professionals or paraprofessionals who provide and administer
behavioral health treatment. Nothing shall prevent a health care
service plan from selectively contracting with providers within these
requirements.
(c) For the purposes of this section, the following definitions
shall apply:
(1) "Behavioral health treatment" means professional services and
treatment programs, including applied behavior analysis and
evidence-based behavior intervention programs, that develop or
restore, to the maximum extent practicable, the functioning of an
individual with pervasive developmental disorder or autism and that
meet all of the following criteria:
(A) The treatment is prescribed by a physician and surgeon
licensed pursuant to Chapter 5 (commencing with Section 2000) of, or
is developed by a psychologist licensed pursuant to Chapter 6.6
(commencing with Section 2900) of, Division 2 of the Business and
Professions Code.
(B) The treatment is provided under a treatment plan prescribed by
a qualified autism service provider and is administered by one of
the following:
(i) A qualified autism service provider.
(ii) A qualified autism service professional supervised and
employed by the qualified autism service provider.
(iii) A qualified autism service paraprofessional supervised and
employed by a qualified autism service provider.
(C) The treatment plan has measurable goals over a specific
timeline that is developed and approved by the qualified autism
service provider for the specific patient being treated. The
treatment plan shall be reviewed no less than once every six months
by the qualified autism service provider and modified whenever
appropriate, and shall be consistent with Section 4686.2 of the
Welfare and Institutions Code pursuant to which the qualified autism
service provider does all of the following:
(i) Describes the patient's behavioral health impairments to be
treated.
(ii) Designs an intervention plan that includes the service type,
number of hours, and parent participation needed to achieve the plan'
s goal and objectives, and the frequency at which the patient's
progress is evaluated and reported.
(iii) Provides intervention plans that utilize evidence-based
practices, with demonstrated clinical efficacy in treating pervasive
developmental disorder or autism.
(iv) Discontinues intensive behavioral intervention services when
the treatment goals and objectives are achieved or no longer
appropriate.
(D) The treatment plan is not used for purposes of providing or
for the reimbursement of respite, day care, or educational services
and is not used to reimburse a parent for participating in the
treatment program. The treatment plan shall be made available to the
health care service plan upon request.
(2) "Pervasive developmental disorder or autism" shall have the
same meaning and interpretation as used in Section 1374.72.
(3) "Qualified autism service provider" means either of the
following:
(A) A person, entity, or group that is certified by a national
entity, such as the Behavior Analyst Certification Board, that is
accredited by the National Commission for Certifying Agencies, and
who designs, supervises, or provides treatment for pervasive
developmental disorder or autism, provided the services are within
the experience and competence of the person, entity, or group that is
nationally certified.
(B) A person licensed as a physician and surgeon, physical
therapist, occupational therapist, psychologist, marriage and family
therapist, educational psychologist, clinical social worker,
professional clinical counselor, speech-language pathologist, or
audiologist pursuant to Division 2 (commencing with Section 500) of
the Business and Professions Code, who designs, supervises, or
provides treatment for pervasive developmental disorder or autism,
provided the services are within the experience and competence of the
licensee.
(4) "Qualified autism service professional" means an individual
who meets all of the following criteria:
(A) Provides behavioral health treatment.
(B) Is employed and supervised by a qualified autism service
provider.
(C) Provides treatment pursuant to a treatment plan developed and
approved by the qualified autism service provider.
(D) Is a behavioral service provider approved as a vendor by a
California regional center to provide services as an Associate
Behavior Analyst, Behavior Analyst, Behavior Management Assistant,
Behavior Management Consultant, or Behavior Management Program as
defined in Section 54342 of Title 17 of the California Code of
Regulations.
(E) Has training and experience in providing services for
pervasive developmental disorder or autism pursuant to Division 4.5
(commencing with Section 4500) of the Welfare and Institutions Code
or Title 14 (commencing with Section 95000) of the Government Code.
(5) "Qualified autism service paraprofessional" means an
unlicensed and uncertified individual who meets all of the following
criteria:
(A) Is employed and supervised by a qualified autism service
provider.
(B) Provides treatment and implements services pursuant to a
treatment plan developed and approved by the qualified autism service
provider.
(C) Meets the criteria set forth in the regulations adopted
pursuant to Section 4686.3 of the Welfare and Institutions Code.
(D) Has adequate education, training, and experience, as certified
by a qualified autism service provider.
(d) This section shall not apply to the following:
(1) A specialized health care service plan that does not deliver
mental health or behavioral health services to enrollees.
(2) A health care service plan contract in the Medi-Cal program
(Chapter 7 (commencing with Section 14000) of Part 3 of Division 9 of
the Welfare and Institutions Code).
(3) A health care service plan contract in the Healthy Families
Program (Part 6.2 (commencing with Section 12693) of Division 2 of
the Insurance Code).
(4) A health care benefit plan or contract entered into with the
Board of Administration of the Public Employees' Retirement System
pursuant to the Public Employees' Medical and Hospital Care Act (Part
5 (commencing with Section 22750) of Division 5 of Title 2 of the
Government Code).
(e) Nothing in this section shall be construed to limit the
obligation to provide services under Section 1374.72.
(f) As provided in Section 1374.72 and in paragraph (1) of
subdivision (a), in the provision of benefits required by this
section, a health care service plan may utilize case management,
network providers, utilization review techniques, prior
authorization, copayments, or other cost sharing.
(g) This section shall become inoperative on July 1, 2014, and, as
of January 1, 2015, is repealed, unless a later enacted statute,
that becomes operative on or before January 1, 2015, deletes or
extends the dates on which it becomes inoperative and is repealed.
SEC. 2. Section 1374.74 is added to the Health and Safety Code, to
read:
1374.74. (a) The department, in consultation with the Department
of Insurance, shall convene an Autism Advisory Task Force by February
1, 2012, in collaboration with other agencies, departments,
advocates, autism experts, health plan and health insurer
representatives, and other entities and stakeholders that it deems
appropriate. The Autism Advisory Task Force shall develop
recommendations regarding behavioral health treatment that is
medically necessary for the treatment of individuals with autism or
pervasive developmental disorder. The Autism Advisory Task Force
shall address at the following:
(1) Interventions that have been scientifically validated and have
demonstrated clinical efficacy.
(2) Interventions that have measurable treatment outcomes.
(3) Patient selection, monitoring, and duration of therapy.
(4) Qualifications, training, and supervision of providers.
(5) Adequate networks of providers.
(b) The Autism Advisory Task Force shall also develop
recommendations regarding the education, training, and experience
requirements that unlicensed individuals providing autism services
shall meet in order to secure a license from the state.
(c) The department shall submit a report of the Autism Advisory
Task Force to the Governor, the President pro Tempore of the Senate,
the Speaker of the Assembly, and the Senate and Assembly Committees
on Health by December 31, 2012, on which date the task force shall
cease to exist.
SEC. 3. Section 121022 of the Health and Safety Code is amended to
read:
121022. (a) To ensure knowledge of current trends in the HIV
epidemic and to ensure that California remains competitive for
federal HIV and AIDS funding, health care providers and laboratories
shall report cases of HIV infection to the local health officer using
patient names on a form developed by the department. Local health
officers shall report unduplicated HIV cases by name to the
department on a form developed by the department.
(b) (1) Health care providers and local health officers shall
submit cases of HIV infection pursuant to subdivision (a) by courier
service, United States Postal Service express mail or registered
mail, other traceable mail, person-to-person transfer, facsimile, or
electronically by a secure and confidential electronic reporting
system established by the department.
(2) This subdivision shall be implemented using the existing
resources of the department.
(c) The department and local health officers shall ensure
continued reasonable access to anonymous HIV testing through
alternative testing sites, as established by Section 120890, and in
consultation with HIV planning groups and affected stakeholders,
including representatives of persons living with HIV and health
officers.
(d) The department shall promulgate emergency regulations to
conform the relevant provisions of Article 3.5 (commencing with
Section 2641.5) of Chapter 4 of Division 1 of Title 17 of the
California Code of Regulations, consistent with this chapter, by
April 17, 2007. Notwithstanding the Administrative Procedure Act
(Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3
of Title 2 of the Government Code), if the department revises the
form used for reporting pursuant to subdivision (a) after
consideration of the reporting guidelines published by the federal
Centers for Disease Control and Prevention, the revised form shall be
implemented without being adopted as a regulation, and shall be
filed with the Secretary of State and printed in Title 17 of the
California Code of Regulations.
(e) Pursuant to Section 121025, reported cases of HIV infection
shall not be disclosed, discoverable, or compelled to be produced in
any civil, criminal, administrative, or other proceeding.
(f) State and local health department employees and contractors
shall be required to sign confidentiality agreements developed by the
department that include information related to the penalties for a
breach of confidentiality and the procedures for reporting a breach
of confidentiality, prior to accessing confidential HIV-related
public health records. Those agreements shall be reviewed annually by
either the department or the appropriate local health department.
(g) No person shall disclose identifying information reported
pursuant to subdivision (a) to the federal government, including, but
not limited to, any agency, employee, agent, contractor, or anyone
else acting on behalf of the federal government, except as permitted
under subdivision (b) of Section 121025.
(h) (1) Any potential or actual breach of confidentiality of
HIV-related public health records shall be investigated by the local
health officer, in coordination with the department, when
appropriate. The local health officer shall immediately report any
evidence of an actual breach of confidentiality of HIV-related public
health records at a city or county level to the department and the
appropriate law enforcement agency.
(2) The department shall investigate any potential or actual
breach of confidentiality of HIV-related public health records at the
state level, and shall report any evidence of such a breach of
confidentiality to an appropriate law enforcement agency.
(i) Any willful, negligent, or malicious disclosure of cases of
HIV infection reported pursuant to subdivision (a) shall be subject
to the penalties prescribed in Section 121025.
(j) Nothing in this section shall be construed to limit other
remedies and protections available under state or federal law.
SEC. 4. Section 10144.51 is added to the Insurance Code, to read:
10144.51. (a) (1) Every health insurance policy shall also
provide coverage for behavioral health treatment for pervasive
developmental disorder or autism no later than July 1, 2012. The
coverage shall be provided in the same manner and shall be subject to
the same requirements as provided in Section 10144.5.
(2) Notwithstanding paragraph (1), as of the date that proposed
final rulemaking for essential health benefits is issued, this
section does not require any benefits to be provided that exceed the
essential health benefits that all health insurers will be required
by federal regulations to provide under Section 1302(b) of the
federal Patient Protection and Affordable Care Act (Public Law
111-148), as amended by the federal Health Care and Education
Reconciliation Act of 2010 (Public Law 111-152).
(3) This section shall not affect services for which an individual
is eligible pursuant to Division 4.5 (commencing with Section 4500)
of the Welfare and Institutions Code or Title 14 (commencing with
Section 95000) of the Government Code.
(4) This section shall not affect or reduce any obligation to
provide services under an individualized education program, as
defined in Section 56032 of the Education Code, or an individualized
service plan, as described in Section 5600.4 of the Welfare and
Institutions Code, or under the Individuals with Disabilities
Education Act (20 U.S.C. Sec. 1400, et seq.) and its implementing
regulations.
(b) Pursuant to Article 6 (commencing with Section 2240.1) of
Title 10 of the California Code of Regulations, every health insurer
subject to this section shall maintain an adequate network that
includes qualified autism service providers who supervise and employ
qualified autism service professionals or paraprofessionals who
provide and administer behavioral health treatment. Nothing shall
prevent a health insurer from selectively contracting with providers
within these requirements.
(c) For the purposes of this section, the following definitions
shall apply:
(1) "Behavioral health treatment" means professional services and
treatment programs, including applied behavior analysis and
evidence-based behavior intervention programs, that develop or
restore, to the maximum extent practicable, the functioning of an
individual with pervasive developmental disorder or autism, and that
meet all of the following criteria:
(A) The treatment is prescribed by a physician and surgeon
licensed pursuant to Chapter 5 (commencing with Section 2000) of, or
is developed by a psychologist licensed pursuant to Chapter 6.6
(commencing with Section 2900) of, Division 2 of the Business and
Professions Code.
(B) The treatment is provided under a treatment plan prescribed by
a qualified autism service provider and is administered by one of
the following:
(i) A qualified autism service provider.
(ii) A qualified autism service professional supervised and
employed by the qualified autism service provider.
(iii) A qualified autism service paraprofessional supervised and
employed by a qualified autism service provider.
(C) The treatment plan has measurable goals over a specific
timeline that is developed and approved by the qualified autism
service provider for the specific patient being treated. The
treatment plan shall be reviewed no less than once every six months
by the qualified autism service provider and modified whenever
appropriate, and shall be consistent with Section 4686.2 of the
Welfare and Institutions Code pursuant to which the qualified autism
service provider does all of the following:
(i) Describes the patient's behavioral health impairments to be
treated.
(ii) Designs an intervention plan that includes the service type,
number of hours, and parent participation needed to achieve the plan'
s goal and objectives, and the frequency at which the patient's
progress is evaluated and reported.
(iii) Provides intervention plans that utilize evidence-based
practices, with demonstrated clinical efficacy in treating pervasive
developmental disorder or autism.
(iv) Discontinues intensive behavioral intervention services when
the treatment goals and objectives are achieved or no longer
appropriate.
(D) The treatment plan is not used for purposes of providing or
for the reimbursement of respite, day care, or educational services
and is not used to reimburse a parent for participating in the
treatment program. The treatment plan shall be made available to the
insurer upon request.
(2) "Pervasive developmental disorder or autism" shall have the
same meaning and interpretation as used in Section 10144.5.
(3) "Qualified autism service provider" means either of the
following:
(A) A person, entity, or group that is certified by a national
entity, such as the Behavior Analyst Certification Board, that is
accredited by the National Commission for Certifying Agencies, and
who designs, supervises, or provides treatment for pervasive
developmental disorder or autism, provided the services are within
the experience and competence of the person, entity, or group that is
nationally certified.
(B) A person licensed as a physician and surgeon, physical
therapist, occupational therapist, psychologist, marriage and family
therapist, educational psychologist, clinical social worker,
professional clinical counselor, speech-language pathologist, or
audiologist pursuant to Division 2 (commencing with Section 500) of
the Business and Professions Code, who designs, supervises, or
provides treatment for pervasive developmental disorder or autism,
provided the services are within the experience and competence of the
licensee.
(4) "Qualified autism service professional" means an individual
who meets all of the following criteria:
(A) Provides behavioral health treatment.
(B) Is employed and supervised by a qualified autism service
provider.
(C) Provides treatment pursuant to a treatment plan developed and
approved by the qualified autism service provider.
(D) Is a behavioral service provider approved as a vendor by a
California regional center to provide services as an Associate
Behavior Analyst, Behavior Analyst, Behavior Management Assistant,
Behavior Management Consultant, or Behavior Management Program as
defined in Section 54342 of Title 17 of the California Code of
Regulations.
(E) Has training and experience in providing services for
pervasive developmental disorder or autism pursuant to Division 4.5
(commencing with Section 4500) of the Welfare and Institutions Code
or Title 14 (commencing with Section 95000) of the Government Code.
(5) "Qualified autism service paraprofessional" means an
unlicensed and uncertified individual who meets all of the following
criteria:
(A) Is employed and supervised by a qualified autism service
provider.
(B) Provides treatment and implements services pursuant to a
treatment plan developed and approved by the qualified autism service
provider.
(C) Meets the criteria set forth in the regulations adopted
pursuant to Section 4686.3 of the Welfare and Institutions Code.
(D) Has adequate education, training, and experience, as certified
by a qualified autism service provider.
(d) This section shall not apply to the following:
(1) A specialized health insurance policy that does not cover
mental health or behavioral health services or an accident only,
specified disease, hospital indemnity, or Medicare supplement policy.
(2) A health insurance policy in the Medi-Cal program (Chapter 7
(commencing with Section 14000) of Part 3 of Division 9 of the
Welfare and Institutions Code).
(3) A health insurance policy in the Healthy Families Program
(Part 6.2 (commencing with Section 12693) of Division 2 of the
Insurance Code).
(4) A health care benefit plan or policy entered into with the
Board of Administration of the Public Employees' Retirement System
pursuant to the Public Employees' Medical and Hospital Care Act (Part
5 (commencing with Section 22750) of Division 5 of Title 2 of the
Government Code).
(e) Nothing in this section shall be construed to limit the
obligation to provide services under Section 10144.5.
(f) As provided in Section 10144.5 and in paragraph (1) of
subdivision (a), in the provision of benefits required by this
section, a health insurer may utilize case management, network
providers, utilization review techniques, prior authorization,
copayments, or other cost sharing.
(g) This section shall become inoperative on July 1, 2014, and, as
of January 1, 2015, is repealed, unless a later enacted statute,
that becomes operative on or before January 1, 2015, deletes or
extends the dates on which it becomes inoperative and is repealed.
SEC. 5. Section 10144.52 is added to the Insurance Code, to read:
10144.52. (a) For purposes of this part, the terms "provider,"
"professional provider," "network provider," "mental health provider,"
and "mental health professional" shall include the term "qualified
autism service provider," as defined in subdivision (c) of Section
10144.51.
(b) This section shall become inoperative on July 1, 2014, and, as
of January 1, 2015, is repealed, unless a later enacted statute,
that becomes operative on or before January 1, 2015, deletes or
extends the dates on which it becomes inoperative and is repealed.
SEC. 6. Section 5705 of the Welfare and Institutions Code is
amended to read:
5705. (a) It is the intent of the Legislature that the use of
negotiated net amounts, as provided in this section, be given
preference in contracts for services under this division.
(b) Negotiated net amounts may be used as the cost of services in
contracts between the state and the county or contracts between the
county and a subprovider of services, or both. A negotiated net
amount shall be determined by calculating the total budget for
services for a program or a component of a program, less the amount
of projected revenue. All participating government funding sources,
except for the Medi-Cal program (Chapter 7 (commencing with Section
14000) of Part 3 of Division 9), shall be bound to that amount as the
cost of providing all or part of the total county mental health
program as described in the county performance contract for each
fiscal year, to the extent that the governmental funding source
participates in funding the county mental health programs. Where the
State Department of Health Care Services promulgates regulations for
determining reimbursement of Short-Doyle mental health services
allowable under the Medi-Cal program, those regulations shall be
controlling as to the rates for reimbursement of Short-Doyle mental
health services allowable under the Medi-Cal program and rendered to
Medi-Cal beneficiaries. Providers under this subdivision shall report
to the State Department of Mental Health and local mental health
programs any information required by the State Department of Mental
Health in accordance with procedures established by the Director of
Mental Health.
(c) Notwithstanding any other provision of this division or
Division 9 (commencing with Section 10000), absent a finding of
fraud, abuse, or failure to achieve contract objectives, no
restrictions, other than any contained in the contract, shall be
placed upon a provider's expenditure pursuant to this section.
SEC. 7. Section 5708 of the Welfare and Institutions Code is
amended to read:
5708. To maintain stability during the transition, counties that
contracted with the department during the 1990-91 fiscal year on a
negotiated net amount basis may continue to use the same funding
mechanism.
SEC. 8. Section 5710 of the Welfare and Institutions Code is
amended to read:
5710. (a) Charges for the care and treatment of each patient
receiving service from a county mental health program shall not
exceed the actual cost thereof as determined or approved by the
Director of Mental Health in accordance with standard accounting
practices. The director may include the amount of expenditures for
capital outlay or the interest thereon, or both, in his or her
determination of actual cost. The responsibility of a patient, his or
her estate, or his or her responsible relatives to pay the charges
and the powers of the director with respect thereto shall be
determined in accordance with Article 4 (commencing with Section
7275) of Chapter 3
of Division 7.
(b) The Director of Mental Health may delegate to each county all
or part of the responsibility for determining the financial liability
of patients to whom services are rendered by a county mental health
program and all or part of the responsibility for determining the
ability of the responsible parties to pay for services to minor
children who are referred by a county for treatment in a state
hospital. Liability shall extend to the estates of patients and to
responsible relatives, including the spouse of an adult patient and
the parents of minor children. The Director of Mental Health may also
delegate all or part of the responsibility for collecting the
charges for patient fees. Counties may decline this responsibility as
it pertains to state hospitals, at their discretion. If this
responsibility is delegated by the director, the director shall
establish and maintain the policies and procedures for making the
determinations and collections. Each county to which the
responsibility is delegated shall comply with the policy and
procedures.
(c) The director shall prepare and adopt a uniform sliding scale
patient fee schedule to be used in all mental health agencies for
services rendered to each patient. In preparing the uniform patient
fee schedule, the director shall take into account the existing
charges for state hospital services and those for community mental
health program services. If the director determines that it is not
practicable to devise a single uniform patient fee schedule
applicable to both state hospital services and services of other
mental health agencies, the director may adopt a separate fee
schedule for the state hospital services which differs from the
uniform patient fee schedule applicable to other mental health
agencies.
SEC. 9. Section 5716 of the Welfare and Institutions Code is
amended to read:
5716. Counties may contract with providers on a negotiated net
amount basis in the same manner as set forth in Section 5705.
SEC. 10. Section 5724 of the Welfare and Institutions Code is
amended to read:
5724. (a) The department and the State Department of Health Care
Services shall jointly develop a new ratesetting methodology for use
in the Short-Doyle Medi-Cal system that maximizes federal funding and
utilizes, as much as practicable, federal medicare reimbursement
principles. The departments shall work with the counties and the
federal Health Care Financing Administration in the development of
the methodology required by this section.
(b) Rates developed through the methodology required by this
section shall apply only to reimbursement for direct client services.
(c) Administrative costs shall be claimed separately and shall be
limited to 15 percent of the total cost of direct client services.
(d) The cost of performing utilization reviews shall be claimed
separately and shall not be included in administrative cost.
(e) The rates established for direct client services pursuant to
this section shall be based on increments of time for all
noninpatient services.
(f) The ratesetting methodology shall not be implemented until it
has received any necessary federal approvals.
SEC. 11. Section 5750.1 of the Welfare and Institutions Code is
amended to read:
5750.1. Notwithstanding Section 5750, a standard, rule, or
policy, not directly the result of a statutory or administrative law
change, adopted by the department or county during the term of an
existing county performance contract shall not apply to the
negotiated net amount terms of that contract under Sections 5705 and
5716, but shall only apply to contracts established after adoption of
the standard, rule, or policy.
SEC. 12. No reimbursement is required by this act pursuant to
Section 6 of Article XIII B of the California Constitution because
the only costs that may be incurred by a local agency or school
district will be incurred because this act creates a new crime or
infraction, eliminates a crime or infraction, or changes the penalty
for a crime or infraction, within the meaning of Section 17556 of the
Government Code, or changes the definition of a crime within the
meaning of Section 6 of Article XIII B of the California
Constitution.