BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | SB 1466|
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THIRD READING
Bill No: SB 1466
Author: Mitchell (D)
Amended: 5/31/16
Vote: 21
SENATE HEALTH COMMITTEE: 9-0, 4/6/16
AYES: Hernandez, Nguyen, Hall, Mitchell, Monning, Nielsen,
Pan, Roth, Wolk
SENATE HUMAN SERVICES COMMITTEE: 5-0, 4/12/16
AYES: McGuire, Berryhill, Hancock, Liu, Nguyen
SENATE APPROPRIATIONS COMMITTEE: 7-0, 5/27/16
AYES: Lara, Bates, Beall, Hill, McGuire, Mendoza, Nielsen
SUBJECT: Early and Periodic Screening, Diagnosis, and
Treatment Program: trauma screening
SOURCE: Californians for Safety and Justice
Youth Law Center
DIGEST: This bill requires screening services provided under
the Early and Periodic Screening, Diagnosis, and Treatment
Program (EPSDT) to include screening for trauma, as defined, at
all screenings. Requires a child who is removed from the custody
or care of his or her parent or legal guardian to be assessed by
the county mental health plan for specialty mental health
services.
ANALYSIS:
Existing law:
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1)Establishes the Medi-Cal program, administered by the
Department of Health Care Services (DHCS), under which
qualified low-income individuals receive health care services.
2)Establishes a schedule of benefits under the Medi-Cal program,
which includes EPSDT for any individual under 21 years of age,
consistent with federal Medicaid requirements. Defines,
through regulation, "screening services" for purposes of EPSDT
to mean:
a) An initial, periodic, or additional health assessment of
a Medi-Cal eligible individual under 21 years of age
provided in accordance with the requirements of the Child
Health and Disability Prevention (CHDP) program;
b) A health assessment, examination, or evaluation of a
Medi-Cal eligible individual under 21 years of age by a
licensed health care professional acting within his or her
scope of practice, at intervals other than the CHDP
intervals, to determine the existence of physical or mental
illnesses or conditions; or
c) Any other encounter with a licensed health care
professional that results in the determination of the
existence of a suspected illness or condition or a change
or complication in a condition for a Medi-Cal eligible
person under 21 years of age.
3)Requires mental health plans to provide specialty mental
health services to eligible Medi-Cal beneficiaries, including
both adults and children. Includes EPSDT within the scope of
specialty mental health services for eligible Medi-Cal
beneficiaries under the age of 21 pursuant to federal Medicaid
law.
4)Requires DHCS, in collaboration with the California Health and
Human Services Agency, and in consultation with the Mental
Health Services Oversight and Accountability Commission, to
create a plan for a performance outcome system for EPSDT
mental health services provided to eligible Medi-Cal
beneficiaries under the age of 21
This bill:
1)Requires, consistent with federal law, screening services
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provided under the EPSDT benefit to include screening for
trauma at all screenings.
2)Defines "trauma," as any physiological response to an event,
series of events, or set of circumstances that is experienced
by an individual as physically or emotionally harmful or life
threatening and that has lasting adverse effects on the
individual's functional and mental, physical, social,
emotional, or spiritual well-being.
3)Requires a child who is removed from the custody or care of
his or her parent or legal guardian pursuant to specified
provisions of existing law to be assessed by the county mental
health plan for specialty mental health services.
Comments
1)Author's statement. According to the author, adverse
childhood experiences (ACEs) are potentially traumatic events
that can have negative, lasting effects on health and
well-being. These experiences range from physical, emotional,
or sexual abuse to parental divorce or the incarceration of a
parent or guardian. A growing body of research has sought to
quantify the prevalence of adverse childhood experiences and
illuminate their connection with negative behavioral and
health outcomes, such as obesity, alcoholism, and depression,
later in life.
Children in foster care have suffered from abuse, neglect or
exploitation, and have suffered secondary trauma as a result
of being removed from their parents. Research clearly shows
that nearly all children associated with Child Welfare systems
have an underlying condition of complex trauma as a result of
an adverse childhood experience. At a minimum this underlying
condition contributes to the poor outcomes - social,
educational and health - for foster children. This bill
requires that existing screenings under EPSDT to include a
trauma screen. Additionally, this bill includes child abuse
and neglect and removal from the home by a child welfare
agency as evidence of trauma.
2)EPSDT. The EPSDT benefit provides comprehensive screening,
diagnostic, treatment, and preventive health care services for
children under age 21 who are enrolled in Medi-Cal, and is key
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to ensuring that children who are eligible for EPSDT services
receive appropriate preventive, dental, mental health,
developmental, and specialty services. Federal Medicaid law
defines the EPSDT benefit to include a comprehensive array of
preventive, diagnostic, and treatment services for low-income
children under age 21. States are required to provide coverage
of any services listed in a section of the federal Medicaid
Act to children who are eligible for EPSDT services when the
services are determined to be medically necessary to correct
or ameliorate any physical or behavioral conditions. The EPSDT
benefit is more robust than the Medi-Cal benefit package
provided to adults and is designed to ensure that eligible
children receive early detection and preventive care in
addition to medically necessary treatment services, so that
health problems are averted or diagnosed and treated as early
as possible.
Medi-Cal managed care plans are required to cover and ensure
the provision of screening, preventive, and medically
necessary diagnostic and treatment services for individuals
under the age of 21 (including EPSDT), except certain services
are "carved out" of the plan. For individuals enrolled in
Medi-Cal managed care, the Medi-Cal managed care is
responsible for "mild to moderate" mental health coverage,
while more severe mental health conditions are "carved out"
and are the responsibility of the county specialty mental
health plan (MHP).
3)Specialty mental health "carve out." The Medi-Cal Specialty
Mental Health Services Program is "carved-out" of the broader
Medi-Cal program and is administered by DHCS under a federal
waiver approved by the Centers for Medicare and Medicaid
Services (CMS). DHCS contracts with an MHP in each county to
provide or arrange for the provision of Medi-Cal specialty
mental health services. All MHPs are county mental health
departments. Specialty mental health services are a Medi-Cal
entitlement services for adults and children that meet medical
necessity criteria, which consist of having a specific covered
diagnosis, functional impairment, and meeting intervention
criteria. MHPs must certify that they incurred a cost before
seeking federal reimbursement through claims to the State.
MHPs are responsible for the non-federal share of Medi-Cal
specialty mental health services. Mental health services for
Medi-Cal beneficiaries who do not meet the criteria for
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specialty mental health services are provided under the
broader Medi-Cal program either through managed care plans (by
primary care providers within their scope of practice) or
fee-for-service (for children exempt from mandatory enrollment
in Medi-Cal managed care). Children's specialty mental health
services are provided under the federal requirements of EPSDT
benefit, which is available to full-scope beneficiaries under
age 21.
DHCS has reported data on the number of children and youth
eligible to receive Medi-Cal services in 2013-14 as slightly
over 6 million. Of these 6 million children, 262,318 received
specialty mental health services, for a penetration rate of
4.4%. The count of children and youth with 5 or more specialty
mental health visits was 201,192, for a penetration rate of
3.3%. The average per beneficiary expenditure for approved
services in 2013-14 was $6,092.
FISCAL EFFECT: Appropriation: No Fiscal
Com.:YesLocal: No
According to the Senate Appropriations Committee:
1)Increased costs in the low millions per year for additional
screening provided to Medi-Cal eligible children (General Fund
[GF] and federal funds). Under current federal and state law,
children enrolled in Medi-Cal are eligible for the Early and
Periodic Screening, Diagnosis, and Treatment (EPSDT) benefit.
This benefit covers screening for both physical and mental
health issues. By specifically requiring screening for trauma,
the bill is likely to increase the costs to provide screening
services due to additional time spent by providers with
eligible children. It is not clear to what extent children are
already being screened for trauma. It is likely that the
specific requirement in the bill will lead to increased focus
on trauma during screening. For example, if the cost to
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provide trauma screening increased the overall cost of
screening under EPSDT by 5%, the cost would be about $2
million per year.
2)Increased costs of $5 million to $10 million per year to
provide assessments for specialty mental health services by
county mental health plans (GF and federal funds). The bill
would require all children who have been removed from the home
to be assessed by a county mental health plan for specialty
mental health services. There are about 15,000 new foster care
placements per year in the stat. The cost to provide an
assessment for specialty mental health services is around
$500.
3)Likely increase in specialty mental health services in the
hundreds of millions per year (GF and federal funds). Under
the bill, about 6.5 million children are likely to get
additional screening for trauma. Currently, there is a very
low rate of utilization of specialty mental health services by
Medi-Cal eligible children. It is likely that the requirement
for additional screening in the bill will result in a
significant number of children receiving being referred for
specialty mental health services who are not currently
receiving those services. Currently, 4.4% of children receive
specialty mental health services, at an average annual costs
of $6,000. If 5% of the children who are likely to be found to
have experienced trauma under the bill are subsequently found
to be eligible for specialty mental health services, the cost
would be about $500 million per year.
4)Unknown potential future costs savings for Medi-Cal services
(GF, federal funds, local funds). Under the bill, it is likely
that a significant number of Medi-Cal children will be
determined to have experienced trauma and are in need of
mental health services - over and above those who are
currently being identified. By identifying those children, it
is possible that early mental health interventions could
improve those children's long-term prognoses and reduce future
costs, such as psychiatric hospitalizations and other health
care costs associated with trauma (for example health care
services related to alcohol or substance abuse). The extent to
which those would occur is unknown.
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SUPPORT: (Verified5/31/16)
Californians for Safety and Justice (co-source)
Youth Law Center (co-source)
Advokids
Alliance for Children's Rights
California Alliance of Child and Family Services
California Pan-Ethnic Health Network
Children Now
County Welfare Directors Association of California
Fight Crime Invest in Kids California
Futures Without Violence
National Health Law Program
San Luis Obispo County Department of Social Services
Western Center on Law and Poverty
Youth Law Center
OPPOSITION: (Verified5/31/16)
None received
ARGUMENTS IN SUPPORT: Californians for Safety and Justice (CSJ)
writes in support that this bill ensures that medical
professionals conducting already mandated health screenings look
for signs of trauma to ensure that children who have suffered
trauma receive the care they need - care they are legally
entitled to receive. In light of the overwhelming evidence
confirming the traumatic nature of child abuse and neglect and
the secondary trauma of removal from one's home - this measure
unambiguously establishes that foster children have suffered
trauma and should be assessed for appropriate EPSDT services.
CSJ states the State has the legal and moral obligation to act
as the parent of all children in the child welfare system, and
this bill is consistent with long-standing policies that ensure
children in the child welfare system receive the best possible
care that will help them thrive as adults.
The San Luis Obispo County Department of Social Services
(SLOCDSS) writes in support that it serves, in conjunction with
its partners in the County Probation Department, over 300 foster
children who have experienced abuse or neglect that spans the
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spectrum of severity. SLOCDSS states it has encountered
difficulties in ensuring that these children receive the
therapeutic services they need, as mental health providers
debate with one another over the relative severity of the trauma
these children have endured. Too often, these
children-especially those who suffered secondary trauma as a
result of being removed from their caregivers-are shuffled back
and forth between unresponsive systems of care, are denied the
therapy they need to heal from the impacts of trauma and
ultimately suffer the cumulative effects of untreated trauma as
they transition to adulthood.
Prepared by:Scott Bain / HEALTH / (916) 651-4111
5/31/16 20:45:30
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