Amended in Assembly March 18, 2016

California Legislature—2015–16 Regular Session

Assembly Bill No. 1576

Introduced by Assembly Member Eggman

January 4, 2016

An act begin insert to add and repeal Section 1367.020 of the Health and Safety Code, end insert relating to begin delete pupil end delete begin insert mental end insert health.

LEGISLATIVE COUNSEL’S DIGEST

AB 1576, as amended, Eggman. begin delete Pupil health: school-based mental health services. end delete begin insert Mental Health Delivery Demonstration Project: Early Diagnosis and Psychosis Treatment Program. end insert

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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 requires health care service plans to meet specified criteria. Existing law makes a willful violation of that act a crime.

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This bill would, commencing July 1, 2017, authorize health care service plans that offer health care services within the greater Sacramento area to require enrollees seeking services for a mental health condition to participate in a Mental Health Delivery Demonstration Project through an Early Diagnosis and Psychosis Treatment (EDAPT) program, as defined. The bill would require plans that choose to participate to develop clinical guidelines for enrollees and to make those guidelines available as part of their evidence of coverage and to primary care providers and specialty mental health providers in their contracted network. The bill would allow an enrollee to opt out of the EDAPT program if a psychiatrist notifies the plan that the enrollee is under his or her care. These provisions would be repealed on January 1, 2020. Because a willful violation of these provisions would be a crime, this bill would impose a state-mandated local program.

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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.

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This bill would provide that no reimbursement is required by this act for a specified reason.

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Existing law establishes a system of public elementary and secondary schools in this state, and provides for the establishment of school districts and other local educational agencies to operate these schools and provide instruction to pupils.

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This bill would declare the intent of the Legislature to enact future legislation that would utilize school-based mental health services to address the mental health needs of children in the state.

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Vote: majority. Appropriation: no. Fiscal committee:  begin delete no end delete begin insert yes end insert . State-mandated local program:  begin delete no end delete begin insert yes end insert .

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

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begin insert SECTION 1. end insert   

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begin insert (a) end insert begin insert   end insert begin insert The Legislature finds and declares all of the
following: end insert

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(1) Despite the importance of and emphasis on mental health
parity, management of mental illness within a system of care is
far more difficult than most types of physical illness. There are
significant differences between the delivery systems for the
Medi-Cal population and the delivery systems for those covered
by private insurance, and there are unique problems associated
with each system. While changes are needed in both, there is an
immediate need to look for ways to better serve the insured
population.

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(2) The limited number of providers, the lack of facilities for
treatment, and the difficulties of arranging for and coordinating
ancillary services have made it extremely difficult for health
insurers to meet the needs of enrollees facing significant mental
health issues.

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(3) Attempts to develop truly accessible provider networks that
can link with the array of administrative and ancillary services
that the mentally ill need to manage their disease and to improve
will take an investment of time and resources.

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(4) Systems of care known as Early Diagnosis and Psychosis
Treatment (EDAPT) programs may hold the key to these problems.
These integrated systems of care provide early intervention,
assessment, diagnosis, a treatment plan, and the services necessary
to implement that plan. EDAPT programs have interdisciplinary
teams of physicians, clinicians, advocates, and staff that coordinate
care on an outpatient basis.

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(5) EDAPT programs do not yet exist in sufficient number to
allow them to meet the provider network requirements health
insurers must meet. While it is possible under existing law for
health insurers to contract with existing EDAPT programs, there
are a number of regulatory and practical issues that stand in the
way of directing patients to them so that the patients’ conditions
can be effectively managed. If insurers could designate an EDAPT
program as an exclusive provider for their enrollees, an assessment
can be made of the overall efficacy of the model.

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(b) Therefore, it is the intent of the Legislature to establish a
demonstration project or projects in geographic areas of the state
where EDAPT programs exist to allow health insurers to opt in
to utilizing the EDAPT programs as exclusive provider networks
for the insurers’ enrollees in need of these services.

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begin insert SEC. 2. end insert   

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begin insert Section 1367.020 is added to the end insert begin insert Health and Safety
Code end insert begin insert , to read: end insert

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begin insert 1367.020. end insert   

(a) Notwithstanding any other law, commencing
July 1, 2017, a health care service plan that offers health care
services on an individual or group basis in the greater Sacramento
area may require enrollees seeking services for a mental health
condition to participate in a Mental Health Delivery Demonstration
Project through an Early Diagnosis and Psychosis Treatment
Program.

(b) If a plan chooses to require its enrollees to participate in
the project, it shall develop clinical guidelines for those enrollees
and make those guidelines available as part of its evidence of
coverage. The plan shall also make those guidelines available to
all primary care providers and specialty mental health providers
in its contracted network.

(c) An enrollee directed to a Mental Health Delivery
Demonstration Project site for services shall be able to opt out of
those services if a psychiatrist notifies the plan that the enrollee
is under his or her care.

(d) For purposes of this section, “Early Diagnosis and Psychosis
Treatment Program” means a mental health service program that
provides early intervention, diagnosis, treatment, and necessary
support through interdisciplinary teams of physicians, mental
health professionals, social workers, and advocates on an
outpatient basis and through a single point of entry.

(e) This section shall remain in effect only until January 1, 2020,
and as of that date is repealed, unless a later enacted statute, that
is enacted before January 1, 2020, deletes or extends that date.

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begin insert SEC. 3. end insert   

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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.

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SECTION 1.  

(a) The Legislature finds and declares both of
the following:

(1) California supplies only one social worker for every 12,000
pupils.

(2) Seventy percent of children in California with mental health
needs receive no treatment.

(b) It is therefore the intent of the Legislature to enact future
legislation that would utilize school-based mental health services
to address this need.

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