BILL ANALYSIS Ó SB 1466 Page 1 SENATE THIRD READING SB 1466 (Mitchell) As Amended August 15, 2016 Majority vote SENATE VOTE: 39-0 ------------------------------------------------------------------ |Committee |Votes|Ayes |Noes | | | | | | | | | | | | | | | | |----------------+-----+----------------------+--------------------| |Health |15-0 |Wood, Maienschein, | | | | |Bonilla, Burke, | | | | |Campos, Chiu, | | | | | | | | | | | | | | |Roger Hernández, | | | | |Lackey, Nazarian, | | | | |Olsen, Patterson, | | | | |Ridley-Thomas, | | | | |Rodriguez, Thurmond, | | | | |Waldron | | | | | | | |----------------+-----+----------------------+--------------------| |Human Services |7-0 |Bonilla, Grove, | | | | |Arambula, Lopez, | | | | |Maienschein, | | | | | | | SB 1466 Page 2 | | | | | | | |Mark Stone, Thurmond | | | | | | | |----------------+-----+----------------------+--------------------| |Appropriations |20-0 |Gonzalez, Bigelow, | | | | |Bloom, Bonilla, | | | | |Bonta, Calderon, | | | | |Chang, Daly, Eggman, | | | | |Gallagher, Eduardo | | | | |Garcia, Holden, | | | | |Jones, Obernolte, | | | | |Quirk, Santiago, | | | | |Wagner, Weber, Wood, | | | | |McCarty | | | | | | | | | | | | ------------------------------------------------------------------ SUMMARY: Requires that screening services provided under the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Program include screening for trauma as consistent with protocols developed by the Department of Health Care Services (DHCS). Establishes trauma to mean an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or threatening and that has lasting adverse effects on the individual's functioning and physical, social, emotional, or spiritual well-being. EXISTING STATE LAW: 1)Establishes the Medi-Cal program, administered by 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 less than 21 years of age, consistent with federal Medicaid requirements. Defines, SB 1466 Page 3 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. Establishes the Mental Health Services Act, enacted by voters in 2004 by Proposition 63, to provide funds to counties to expand SB 1466 Page 4 services, develop innovative programs, and integrated service plans for mentally ill children, adults, and seniors through a 1% income tax on personal income above $1 million. FISCAL EFFECT: According to the Assembly Appropriations Committee, unknown local assistance costs, potentially in the range of $1 million annually, for additional screening services provided to Medi-Cal-eligible children (General Fund (GF)/federal). Staff assumes the state would be responsible for any nonfederal share of costs under this bill based on the requirements of Article XIII, Section 36 of the California Constitution (Proposition 30). Additionally, DHCS and DSS will incur minor staff costs to consult with stakeholders and provide guidance to operationalize the required trauma screening (GF/federal). COMMENTS: According to the author, 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. This bill is needed to ensure that distressed children are appropriately screened for trauma without delay. Under California law, the treatment of children's mental health needs is determined by the severity of the diagnosis. Because we do not currently screen under EPSTD for trauma, we run the risk of delaying treatment to this vulnerable population because of this complicated delivery model. By requiring trauma screening by a designated agency on the front-end, we minimize possible delays in critically-needed treatment. 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 SB 1466 Page 5 one's home, this measure unambiguously establishes that foster children have suffered trauma and should be assessed for appropriate EPSDT services. CSJ argues that 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) states that it serves, in conjunction with its partners in the County Probation Department, over 300 foster children who have experienced abuse or neglect that span the 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.Analysis Prepared by: Paula Villescaz / HEALTH / (916) 319-2097 FN: 0004146 SB 1466 Page 6