California Senate Bill SB1161 Amended / Bill

 BILL NUMBER: SB 1161AMENDED BILL TEXT AMENDED IN SENATE APRIL 29, 2014 AMENDED IN SENATE APRIL 10, 2014 AMENDED IN SENATE APRIL 2, 2014 INTRODUCED BY Senator Beall FEBRUARY 20, 2014 An act to add Section 14124.27 to the Welfare and Institutions Code, relating to Medi-Cal. LEGISLATIVE COUNSEL'S DIGEST SB 1161, as amended, Beall. Drug Medi-Cal. Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid Program provisions. Existing federal law prohibits federal financial participation for care or services provided to patients in an institution for mental diseases (IMD). Existing law establishes the Drug Medi-Cal Treatment Program (Drug Medi-Cal) under which the department is authorized to enter into contracts with counties for various drug treatment services for Medi-Cal recipients, or is required to directly arrange for these services if a county elects not to do so. This bill would require the department to seek a specified waiver of the IMD exclusion under Drug Medi-Cal to provide short-term residential treatment in facilities with a bed capacity in excess of 16 beds and short-term inpatient medical detoxification in a hospital setting. Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: no. THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS: SECTION 1. (a) The Legislature finds and declares all of the following: (1) The federal Patient Protection and Affordable Care Act (PPACA) (Public Law 111-148), as amended by the federal Health Care and Education Reconciliation Act of 2010 (Public Law 111-152), offers previously uninsured Californians unprecedented access to health services, including mental health and substance use disorder services. (2) In 2013, the Legislature passed Assembly Bill 1 and Senate Bill 1 in the 2013-14 First Extraordinary Session, which expanded Medi-Cal coverage to low-income adults with incomes at or below 138 percent of the federal poverty level who were not previously eligible, established the Medi-Cal benefit package for this expansion population, and required the Medi-Cal program to cover  essential health benefits contained in PPACA, which are now included in the state plan.   additional mental health and substance use disorder services.  (3)  It is estimated that 250,000 Californians newly eligible for Medi-Cal are in need of, or are seeking, substance use disorder treatment.   An   estimated 1.2 million people enrolled in the Medi-Cal program have substance use treatment needs.  (4) Substance use disorder treatment often requires medical detoxification and residential treatment services, services that have been  approved under   included in  California's Medi-Cal expansion under PPACA. (5) The federal exclusion for institutions for mental diseases (IMD) only permits residential care for substance use disorder in facilities with 16 beds or fewer and medical detoxification only in a general acute hospital, making both services inaccessible to Medi-Cal and Drug Medi-Cal beneficiaries. (6) Capacity for both medical detoxification and residential treatment is severely limited in California in settings in compliance with the federal exclusion for IMD.  (7) Medical detoxification in a general acute care hospital is, by far, the most expensive method to provide detoxification treatment.   (8)   (   7)  According to a letter from the Director of Health Care Services to the federal Centers for Medicare and Medicaid Services, only 21 percent of California's beds are in facilities with a capacity of 16 and under. Furthermore, other than 11 perinatal programs, there are no Drug Medi-Cal licensed residential substance use disorder facilities in California. Therefore, California is severely limited in providing the expanded substance use disorder residential treatment benefits as provided for by the Medi-Cal expansion.  (9)   (   8)  The Commonwealth of Massachusetts successfully included IMD expenditure authority in its Section 1115 waiver. California has a similar need for IMD expenditure authority.  (10) The State Department of Health Care Services has the authority, subject to federal approval, to seek a Section 1115 waiver.  (b) It is the intent of the Legislature to expeditiously expand statewide capacity for mental health and substance use disorder treatment services for all Californians  newly  eligible for health care services under  the expansion of  Medi-Cal  eligibility who are in need of or currently seeking treatment. SEC. 2. Section 14124.27 is added to the Welfare and Institutions Code, immediately following Section 14124.26, to read: 14124.27. (a) The department shall seek a waiver of federal law under Section 1115 of the federal Social Security Act (42 U.S.C. Sec. 1315) to receive federal financial participation under the Drug Medi-Cal program in accordance with this section. (b) The department shall seek a waiver of the institution for mental diseases (IMD) exclusion in Section 1396d(a)(29)(B) of Title 42 of the United States Code to provide short-term residential treatment in facilities with bed capacities in excess of 16 beds  , 30 to 90 days maximum, with an average length of stay of 60 days,  and short-term inpatient medical detoxification in a hospital setting, including, but not limited to, free-standing acute psychiatric and chemical dependency recovery hospitals. (c) This section shall be implemented only to the extent federal approval is obtained and to the extent that federal financial participation is available.