California 2019-2020 Regular Session

California Assembly Bill AB166 Compare Versions

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1-Enrolled September 16, 2019 Passed IN Senate September 10, 2019 Passed IN Assembly September 11, 2019 Amended IN Senate September 06, 2019 Amended IN Senate August 30, 2019 Amended IN Senate June 24, 2019 Amended IN Assembly April 30, 2019 Amended IN Assembly March 07, 2019 CALIFORNIA LEGISLATURE 20192020 REGULAR SESSION Assembly Bill No. 166Introduced by Assembly Member Gabriel(Coauthor: Assembly Member Chiu)(Coauthor: Senator Portantino)January 07, 2019 An act to add Section 14134.3 to the Welfare and Institutions Code, relating to Medi-Cal.LEGISLATIVE COUNSEL'S DIGESTAB 166, Gabriel. Medi-Cal: violence preventive services.Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and 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 law establishes a schedule of benefits under the Medi-Cal program, including various mental health services. Existing federal law authorizes, at the option of the state, preventive services, as defined, that are recommended by a physician or other licensed practitioner of the healing arts.This bill would require the department to establish, no later than January 1, 2021, a violence intervention pilot program at a minimum of 9 sites, including at least one site in 9 specified counties, and would require the department to consult with identified stakeholders, such as professionals in the community violence intervention field, for purposes of establishing the pilot program. The bill would require the department to provide violence preventive services that are rendered by a qualified violence prevention professional to a Medi-Cal beneficiary who meets identified criteria, including that the beneficiary has received medical treatment for a violent injury. The bill would require the department to approve one or more training and certification programs for violence prevention professionals, and would require an entity that employs or contracts with a qualified violence prevention professional to maintain specified documentation on, and to ensure compliance by, that professional.The bill would require the department to seek any federal approvals necessary to implement these requirements, and would condition the departments implementation of these provisions to the extent that federal financial participation is available and not otherwise jeopardized, and any necessary federal approvals have been obtained.The bill would make its provisions inoperative 5 calendar years following the date upon which violence preventive services are able to be provided and billed pursuant to the bill, as specified. The bill would require the department to issue, at least one calendar year prior to the inoperative date, a report to the Legislature on the implementation of the violence intervention pilot program, and the demonstrated impact of violence preventive services.Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: NO Bill TextThe people of the State of California do enact as follows:SECTION 1. Section 14134.3 is added to the Welfare and Institutions Code, immediately following Section 14134.25, to read:14134.3. (a) (1) The Legislature finds that people who have been violently injured are substantially more likely to be violently reinjured, and to engage in behaviors, as part of a cycle of community violence, trauma, and retaliation, that also substantially increase their own risk of violent reinjury.(2) It is the intent of the Legislature that the State Department of Health Care Services develop and implement services targeted at reducing injury recidivism among violently injured Medi-Cal beneficiaries, and provide direct reimbursement to qualified violence prevention professionals for violence preventive services in accordance with this section.(b) No later than January 1, 2021, the department shall establish a violence intervention pilot program that is hospital-based or hospital-linked. The pilot program shall be established at a minimum of nine sites, and at least one site shall be located in each of the following counties:(1) Alameda.(2) Contra Costa.(3) Los Angeles.(4) Monterey.(5) Sacramento.(6) San Bernardino.(7) San Francisco.(8) Santa Clara.(9) Ventura.(c) For the purposes of establishing the pilot program, the department shall consult with stakeholders, including, but not limited to, professionals in the community violence intervention field, hospital-linked and hospital-based violence intervention programs, and health care professionals working with hospital-linked and hospital-based violence intervention programs.(d) Under the pilot program, the department shall provide violence preventive services that are rendered by a qualified violence prevention professional to a Medi-Cal beneficiary who meets both of the following conditions:(1) The beneficiary has received medical treatment for a violent injury, including, but not limited to, a gunshot wound, stabbing injury, or any other form of violent injury.(2) A licensed health care provider has determined that the beneficiary is at elevated risk of violent reinjury or retaliation and has referred the beneficiary to participate in a violence preventive services program.(e) Violence preventive services, as defined in paragraph (3) of subdivision (o), that are provided by a qualified violence prevention professional through the Medi-Cal program shall be offered to an eligible Medi-Cal beneficiary for a minimum of three months and a maximum of 12 months. These services shall be rendered within and outside the clinical setting, and shall include all of the following components:(1) Care coordination to support the recovery of a violently injured patient.(2) Home and community visitation after discharge to provide patient education, neighborhood mapping of community resources, referrals for substance abuse, behavioral health, or any additional risk reduction resources to support injury recovery and reduce injury recidivism.(3) Peer support services, including, but not limited to, mentorship, conflict mediation, and crisis intervention.(f) A qualified violence prevention professional, as defined in paragraph (2) of subdivision (o), shall meet all of the following conditions:(1) Possesses at least six months of full-time equivalent experience in providing violence preventive services through employment, volunteer work, or as part of an internship experience.(2) Has successfully completed an accredited training and certification program for violence prevention professionals, in accordance with subdivision (g), or has been certified as a violence prevention professional by the National Network of Hospital-Based Violence Intervention Programs prior to January 1, 2021.(3) Successfully completes at least four hours of continuing education annually in the field of violence preventive services.(4) Satisfies any other requirements necessary to maintain certification as a violence prevention professional.(g) The department shall approve one or more training and certification programs for violence prevention professionals, which shall include at least 35 hours of training that collectively addresses all of the following:(1) The profound effects of trauma and violence and the basics of trauma-informed care.(2) Violence prevention strategies, including, but not limited to, conflict mediation and retaliation prevention related to community violence.(3) Care coordination and patient support practices.(4) Patient privacy and the federal Health Insurance Portability and Accountability Act of 1996.(h) An entity that employs or contracts with a qualified violence prevention professional to provide violence preventive services shall do both of the following:(1) Maintain documentation that the qualified violence prevention professional has met all of the conditions described in subdivision (f).(2) Ensure that the qualified violence prevention professional is providing violence preventive services consistent with the requirements specified in subdivision (e).(i) The department shall seek any federal approvals necessary to implement this section, including, but not limited to, any state plan amendments or federal waivers by the federal Centers for Medicare and Medicaid Services.(j) This section shall be implemented only to the extent that federal financial participation is available and not otherwise jeopardized, and any necessary federal approvals have been obtained.(k) This section does not alter the scope of practice for any health care professional nor authorizes the delivery of health care services in a setting or in a manner that is not authorized under any provision of the Business and Professions Code or the Health and Safety Code.(l) At least one calendar year prior to the inoperative date of this section pursuant to subdivision (m), the department shall issue a report to the Legislature, in compliance with Section 9795 of the Government Code, on the implementation of the violence intervention pilot program established under this section, and the demonstrated impact of violence preventive services. The report shall, at a minimum, include all of the following:(1) The number of individuals receiving violence preventive services pursuant to this section.(2) The number of individuals providing violence preventive services pursuant to this section.(3) Expenditures, in aggregate and per person, in providing services pursuant to this section.(4) A description of the types of services provided and the locations where those services were provided.(5) The number and types of accrediting bodies for violence preventive services and the number and names of violence preventive services training programs providing training pursuant to this section.(6) An analysis on whether violence intervention sites implemented pursuant to this section have reduced the incidence of risk factors for violent injury and reinjury among individuals receiving violence preventive services. The analysis shall consider all of the following:(A) Data available from the Medi-Cal program related to claims and other available data sources on the incidence of violent injury and reinjury among individuals receiving violence preventive services.(B) Data and analysis from published, peer-reviewed evaluations of violence intervention sites implemented pursuant to this section.(7) A comparison of the outcomes of the violence intervention pilot program implemented pursuant to this section to the outcomes of other substantially similar violence preventive service programs that have been published in peer-reviewed evaluations.(8) Recommendations on how to improve implementation of the pilot program established under this section, including all of the following information:(A) A description of any administrative barriers or other challenges identified by stakeholders.(B) Recommendations on legislative or policy changes needed, if any, to promote effective utilization of violence preventive services in the population served by the Medi-Cal program.(C) Recommendations on whether to expand the Medi-Cal schedule of benefits to include violence preventive services, and, if those services are a benefit under the Medi-Cal program, recommendations on which delivery system, such as fee-for-service or managed care, including a Medi-Cal managed care health plan or county mental health plan, should provide those services.(m) This section shall become inoperative five calendar years following the date upon which violence preventive services described in this section are able to be provided and billed pursuant to this section.(n) The department shall post on its internet website the date upon which violence preventive services described in this section are able to be provided and billed pursuant to this section.(o) The following definitions apply for purposes of this section:(1) Prevention professional has the same meaning as defined by the National Uniform Claim Committee (NUCC) under NUCC Code Number 405300000X or its successor.(2) Qualified violence prevention professional means a prevention professional who renders violence preventive services.(3) Violence preventive services means evidence-based, trauma-informed, supportive, culturally responsive, and nonpsychotherapeutic services provided by a prevention professional, who works in collaboration with other care providers and community partners, for the purpose of promoting improved health outcomes and positive behavioral change, preventing injury recidivism, and reducing the likelihood that violently injured individuals will commit or promote violence themselves.
1+Amended IN Senate September 06, 2019 Amended IN Senate August 30, 2019 Amended IN Senate June 24, 2019 Amended IN Assembly April 30, 2019 Amended IN Assembly March 07, 2019 CALIFORNIA LEGISLATURE 20192020 REGULAR SESSION Assembly Bill No. 166Introduced by Assembly Member Gabriel(Coauthor: Assembly Member Chiu)(Coauthor: Senator Portantino)January 07, 2019 An act to add Section 14134.3 to the Welfare and Institutions Code, relating to Medi-Cal.LEGISLATIVE COUNSEL'S DIGESTAB 166, as amended, Gabriel. Medi-Cal: violence preventive services.Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and 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 law establishes a schedule of benefits under the Medi-Cal program, including various mental health services. Existing federal law authorizes, at the option of the state, preventive services, as defined, that are recommended by a physician or other licensed practitioner of the healing arts.This bill would require the department to establish, no later than January 1, 2021, a violence intervention pilot program at a minimum of 9 sites, including at least one site in 9 specified counties, and would require the department to consult with identified stakeholders, such as professionals in the community violence intervention field, for purposes of establishing the pilot program. The bill would require the department to provide violence preventive services that are rendered by a qualified violence prevention professional to a Medi-Cal beneficiary who meets identified criteria, including that the beneficiary has received medical treatment for a violent injury. The bill would require the department to approve one or more training and certification programs for violence prevention professionals, and would require an entity that employs or contracts with a qualified violence prevention professional to maintain specified documentation on, and to ensure compliance by, that professional.The bill would require the department to seek any federal approvals necessary to implement these requirements, and would condition the departments implementation of these provisions to the extent that federal financial participation is available and not otherwise jeopardized, and any necessary federal approvals have been obtained.The bill would make its provisions inoperative 5 calendar years following the date upon which violence preventive services are able to be provided and billed pursuant to the bill, as specified. The bill would require the department to issue, at least one calendar year prior to the inoperative date, a report to the Legislature on the implementation of the violence intervention pilot program, and the demonstrated impact of violence preventive services.Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: NO Bill TextThe people of the State of California do enact as follows:SECTION 1. Section 14134.3 is added to the Welfare and Institutions Code, immediately following Section 14134.25, to read:14134.3. (a) (1) The Legislature finds that people who have been violently injured are substantially more likely to be violently reinjured, and to engage in behaviors, as part of a cycle of community violence, trauma, and retaliation, that also substantially increase their own risk of violent reinjury.(2) It is the intent of the Legislature that the State Department of Health Care Services develop and implement services targeted at reducing injury recidivism among violently injured Medi-Cal beneficiaries, and provide direct reimbursement to qualified violence prevention professionals for violence preventive services in accordance with this section.(b) No later than January 1, 2021, the department shall establish a violence intervention pilot program that is hospital-based or hospital-linked. The pilot program shall be established at a minimum of nine sites, and at least one site shall be located in each of the following counties:(1) Alameda.(2) Contra Costa.(3) Los Angeles.(4) Monterey.(5) Sacramento.(6) San Bernardino.(7) San Francisco.(8) Santa Clara.(9) Ventura.(c) For the purposes of establishing the pilot program, the department shall consult with stakeholders, including, but not limited to, professionals in the community violence intervention field, hospital-linked and hospital-based violence intervention programs, and health care professionals working with hospital-linked and hospital-based violence intervention programs.(d) Under the pilot program, the department shall provide violence preventive services that are rendered by a qualified violence prevention professional to a Medi-Cal beneficiary who meets both of the following conditions:(1) The beneficiary has received medical treatment for a violent injury, including, but not limited to, a gunshot wound, stabbing injury, or any other form of violent injury.(2) A licensed health care provider has determined that the beneficiary is at elevated risk of violent reinjury or retaliation and has referred the beneficiary to participate in a violence preventive services program.(e) Violence preventive services, as defined in paragraph (3) of subdivision (o), that are provided by a qualified violence prevention professional through the Medi-Cal program shall be offered to an eligible Medi-Cal beneficiary for a minimum of three months and a maximum of 12 months. These services shall be rendered within and outside the clinical setting, and shall include all of the following components:(1) Targeted case management and care Care coordination to support the recovery of a violently injured patient.(2) Home and community visitation after discharge to provide patient education, neighborhood mapping of community resources, referrals or screenings for substance abuse, behavioral health, or any additional risk reduction resources to support injury recovery and reduce injury recidivism.(3) Peer support services, including, but not limited to, counseling, mentorship, conflict mediation, and crisis intervention.(f) A qualified violence prevention professional, as defined in paragraph (2) of subdivision (o), shall meet all of the following conditions:(1) Possesses at least six months of full-time equivalent experience in providing violence preventive services through employment, volunteer work, or as part of an internship experience.(2) Has successfully completed an accredited training and certification program for violence prevention professionals, in accordance with subdivision (g), or has been certified as a violence prevention professional by the National Network of Hospital-Based Violence Intervention Programs prior to January 1, 2021.(3) Successfully completes at least four hours of continuing education annually in the field of violence preventive services.(4) Satisfies any other requirements necessary to maintain certification as a violence prevention professional.(g) The department shall approve one or more training and certification programs for violence prevention professionals, which shall include at least 35 hours of training that collectively addresses all of the following:(1) The profound effects of trauma and violence and the basics of trauma-informed care.(2) Violence prevention strategies, including, but not limited to, conflict mediation and retaliation prevention related to community violence.(3) Case management and advocacy Care coordination and patient support practices.(4) Patient privacy and the federal Health Insurance Portability and Accountability Act of 1996.(h) An entity that employs or contracts with a qualified violence prevention professional to provide violence preventive services shall do both of the following:(1) Maintain documentation that the qualified violence prevention professional has met all of the conditions described in subdivision (f).(2) Ensure that the qualified violence prevention professional is providing violence preventive services consistent with the requirements specified in subdivision (e).(i) The department shall seek any federal approvals necessary to implement this section, including, but not limited to, any state plan amendments or federal waivers by the federal Centers for Medicare and Medicaid Services.(j) This section shall be implemented only to the extent that federal financial participation is available and not otherwise jeopardized, and any necessary federal approvals have been obtained.(k) This section does not alter the scope of practice for any health care professional nor authorizes the delivery of health care services in a setting or in a manner that is not authorized under any provision of the Business and Professions Code or the Health and Safety Code.(l) At least one calendar year prior to the inoperative date of this section pursuant to subdivision (m), the 0;">(A) Data available from the Medi-Cal program related to claims and other available data sources on the incidence of violent injury and reinjury among individuals receiving violence preventive services.(B) Data and analysis from published, peer-reviewed evaluations of violence intervention sites implemented pursuant to this section.(7) A comparison of the outcomes of the violence intervention pilot program implemented pursuant to this section to the outcomes of other substantially similar violence preventive service programs that have been published in peer-reviewed evaluations.(8) Recommendations on how to improve implementation of the pilot program established under this section, including all of the following information:(A) A description of any administrative barriers or other challenges identified by stakeholders.(B) Recommendations on legislative or policy changes needed, if any, to promote effective utilization of violence preventive services in the population served by the Medi-Cal program.(C) Recommendations on whether to expand the Medi-Cal schedule of benefits to include violence preventive services, and, if those services are a benefit under the Medi-Cal program, recommendations on which delivery system, such as fee-for-service or managed care, including a Medi-Cal managed care health plan or county mental health plan, should provide those services.(m) This section shall become inoperative five calendar years following the date upon which violence preventive services described in this section are able to be provided and billed pursuant to this section.(n) The department shall post on its internet website the date upon which violence preventive services described in this section are able to be provided and billed pursuant to this section.(o) The following definitions apply for purposes of this section:(1) Prevention professional has the same meaning as defined by the National Uniform Claim Committee (NUCC) under NUCC Code Number 405300000X or its successor.(2) Qualified violence prevention professional means a prevention professional who renders violence preventive services.(3) Violence preventive services means evidence-based, trauma-informed, supportive, culturally responsive, and nonpsychotherapeutic services provided by a prevention professional, who works in collaboration with other care providers and community partners, for the purpose of promoting improved health outcomes and positive behavioral change, preventing injury recidivism, and reducing the likelihood that violently injured individuals will commit or promote violence themselves.
22
3- Enrolled September 16, 2019 Passed IN Senate September 10, 2019 Passed IN Assembly September 11, 2019 Amended IN Senate September 06, 2019 Amended IN Senate August 30, 2019 Amended IN Senate June 24, 2019 Amended IN Assembly April 30, 2019 Amended IN Assembly March 07, 2019 CALIFORNIA LEGISLATURE 20192020 REGULAR SESSION Assembly Bill No. 166Introduced by Assembly Member Gabriel(Coauthor: Assembly Member Chiu)(Coauthor: Senator Portantino)January 07, 2019 An act to add Section 14134.3 to the Welfare and Institutions Code, relating to Medi-Cal.LEGISLATIVE COUNSEL'S DIGESTAB 166, Gabriel. Medi-Cal: violence preventive services.Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and 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 law establishes a schedule of benefits under the Medi-Cal program, including various mental health services. Existing federal law authorizes, at the option of the state, preventive services, as defined, that are recommended by a physician or other licensed practitioner of the healing arts.This bill would require the department to establish, no later than January 1, 2021, a violence intervention pilot program at a minimum of 9 sites, including at least one site in 9 specified counties, and would require the department to consult with identified stakeholders, such as professionals in the community violence intervention field, for purposes of establishing the pilot program. The bill would require the department to provide violence preventive services that are rendered by a qualified violence prevention professional to a Medi-Cal beneficiary who meets identified criteria, including that the beneficiary has received medical treatment for a violent injury. The bill would require the department to approve one or more training and certification programs for violence prevention professionals, and would require an entity that employs or contracts with a qualified violence prevention professional to maintain specified documentation on, and to ensure compliance by, that professional.The bill would require the department to seek any federal approvals necessary to implement these requirements, and would condition the departments implementation of these provisions to the extent that federal financial participation is available and not otherwise jeopardized, and any necessary federal approvals have been obtained.The bill would make its provisions inoperative 5 calendar years following the date upon which violence preventive services are able to be provided and billed pursuant to the bill, as specified. The bill would require the department to issue, at least one calendar year prior to the inoperative date, a report to the Legislature on the implementation of the violence intervention pilot program, and the demonstrated impact of violence preventive services.Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: NO
3+ Amended IN Senate September 06, 2019 Amended IN Senate August 30, 2019 Amended IN Senate June 24, 2019 Amended IN Assembly April 30, 2019 Amended IN Assembly March 07, 2019 CALIFORNIA LEGISLATURE 20192020 REGULAR SESSION Assembly Bill No. 166Introduced by Assembly Member Gabriel(Coauthor: Assembly Member Chiu)(Coauthor: Senator Portantino)January 07, 2019 An act to add Section 14134.3 to the Welfare and Institutions Code, relating to Medi-Cal.LEGISLATIVE COUNSEL'S DIGESTAB 166, as amended, Gabriel. Medi-Cal: violence preventive services.Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and 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 law establishes a schedule of benefits under the Medi-Cal program, including various mental health services. Existing federal law authorizes, at the option of the state, preventive services, as defined, that are recommended by a physician or other licensed practitioner of the healing arts.This bill would require the department to establish, no later than January 1, 2021, a violence intervention pilot program at a minimum of 9 sites, including at least one site in 9 specified counties, and would require the department to consult with identified stakeholders, such as professionals in the community violence intervention field, for purposes of establishing the pilot program. The bill would require the department to provide violence preventive services that are rendered by a qualified violence prevention professional to a Medi-Cal beneficiary who meets identified criteria, including that the beneficiary has received medical treatment for a violent injury. The bill would require the department to approve one or more training and certification programs for violence prevention professionals, and would require an entity that employs or contracts with a qualified violence prevention professional to maintain specified documentation on, and to ensure compliance by, that professional.The bill would require the department to seek any federal approvals necessary to implement these requirements, and would condition the departments implementation of these provisions to the extent that federal financial participation is available and not otherwise jeopardized, and any necessary federal approvals have been obtained.The bill would make its provisions inoperative 5 calendar years following the date upon which violence preventive services are able to be provided and billed pursuant to the bill, as specified. The bill would require the department to issue, at least one calendar year prior to the inoperative date, a report to the Legislature on the implementation of the violence intervention pilot program, and the demonstrated impact of violence preventive services.Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: NO
44
5- Enrolled September 16, 2019 Passed IN Senate September 10, 2019 Passed IN Assembly September 11, 2019 Amended IN Senate September 06, 2019 Amended IN Senate August 30, 2019 Amended IN Senate June 24, 2019 Amended IN Assembly April 30, 2019 Amended IN Assembly March 07, 2019
5+ Amended IN Senate September 06, 2019 Amended IN Senate August 30, 2019 Amended IN Senate June 24, 2019 Amended IN Assembly April 30, 2019 Amended IN Assembly March 07, 2019
66
7-Enrolled September 16, 2019
8-Passed IN Senate September 10, 2019
9-Passed IN Assembly September 11, 2019
107 Amended IN Senate September 06, 2019
118 Amended IN Senate August 30, 2019
129 Amended IN Senate June 24, 2019
1310 Amended IN Assembly April 30, 2019
1411 Amended IN Assembly March 07, 2019
1512
1613 CALIFORNIA LEGISLATURE 20192020 REGULAR SESSION
1714
1815 Assembly Bill
1916
2017 No. 166
2118
2219 Introduced by Assembly Member Gabriel(Coauthor: Assembly Member Chiu)(Coauthor: Senator Portantino)January 07, 2019
2320
2421 Introduced by Assembly Member Gabriel(Coauthor: Assembly Member Chiu)(Coauthor: Senator Portantino)
2522 January 07, 2019
2623
2724 An act to add Section 14134.3 to the Welfare and Institutions Code, relating to Medi-Cal.
2825
2926 LEGISLATIVE COUNSEL'S DIGEST
3027
3128 ## LEGISLATIVE COUNSEL'S DIGEST
3229
33-AB 166, Gabriel. Medi-Cal: violence preventive services.
30+AB 166, as amended, Gabriel. Medi-Cal: violence preventive services.
3431
3532 Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and 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 law establishes a schedule of benefits under the Medi-Cal program, including various mental health services. Existing federal law authorizes, at the option of the state, preventive services, as defined, that are recommended by a physician or other licensed practitioner of the healing arts.This bill would require the department to establish, no later than January 1, 2021, a violence intervention pilot program at a minimum of 9 sites, including at least one site in 9 specified counties, and would require the department to consult with identified stakeholders, such as professionals in the community violence intervention field, for purposes of establishing the pilot program. The bill would require the department to provide violence preventive services that are rendered by a qualified violence prevention professional to a Medi-Cal beneficiary who meets identified criteria, including that the beneficiary has received medical treatment for a violent injury. The bill would require the department to approve one or more training and certification programs for violence prevention professionals, and would require an entity that employs or contracts with a qualified violence prevention professional to maintain specified documentation on, and to ensure compliance by, that professional.The bill would require the department to seek any federal approvals necessary to implement these requirements, and would condition the departments implementation of these provisions to the extent that federal financial participation is available and not otherwise jeopardized, and any necessary federal approvals have been obtained.The bill would make its provisions inoperative 5 calendar years following the date upon which violence preventive services are able to be provided and billed pursuant to the bill, as specified. The bill would require the department to issue, at least one calendar year prior to the inoperative date, a report to the Legislature on the implementation of the violence intervention pilot program, and the demonstrated impact of violence preventive services.
3633
3734 Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and 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 law establishes a schedule of benefits under the Medi-Cal program, including various mental health services. Existing federal law authorizes, at the option of the state, preventive services, as defined, that are recommended by a physician or other licensed practitioner of the healing arts.
3835
3936 This bill would require the department to establish, no later than January 1, 2021, a violence intervention pilot program at a minimum of 9 sites, including at least one site in 9 specified counties, and would require the department to consult with identified stakeholders, such as professionals in the community violence intervention field, for purposes of establishing the pilot program. The bill would require the department to provide violence preventive services that are rendered by a qualified violence prevention professional to a Medi-Cal beneficiary who meets identified criteria, including that the beneficiary has received medical treatment for a violent injury. The bill would require the department to approve one or more training and certification programs for violence prevention professionals, and would require an entity that employs or contracts with a qualified violence prevention professional to maintain specified documentation on, and to ensure compliance by, that professional.
4037
4138 The bill would require the department to seek any federal approvals necessary to implement these requirements, and would condition the departments implementation of these provisions to the extent that federal financial participation is available and not otherwise jeopardized, and any necessary federal approvals have been obtained.
4239
4340 The bill would make its provisions inoperative 5 calendar years following the date upon which violence preventive services are able to be provided and billed pursuant to the bill, as specified. The bill would require the department to issue, at least one calendar year prior to the inoperative date, a report to the Legislature on the implementation of the violence intervention pilot program, and the demonstrated impact of violence preventive services.
4441
4542 ## Digest Key
4643
4744 ## Bill Text
4845
49-The people of the State of California do enact as follows:SECTION 1. Section 14134.3 is added to the Welfare and Institutions Code, immediately following Section 14134.25, to read:14134.3. (a) (1) The Legislature finds that people who have been violently injured are substantially more likely to be violently reinjured, and to engage in behaviors, as part of a cycle of community violence, trauma, and retaliation, that also substantially increase their own risk of violent reinjury.(2) It is the intent of the Legislature that the State Department of Health Care Services develop and implement services targeted at reducing injury recidivism among violently injured Medi-Cal beneficiaries, and provide direct reimbursement to qualified violence prevention professionals for violence preventive services in accordance with this section.(b) No later than January 1, 2021, the department shall establish a violence intervention pilot program that is hospital-based or hospital-linked. The pilot program shall be established at a minimum of nine sites, and at least one site shall be located in each of the following counties:(1) Alameda.(2) Contra Costa.(3) Los Angeles.(4) Monterey.(5) Sacramento.(6) San Bernardino.(7) San Francisco.(8) Santa Clara.(9) Ventura.(c) For the purposes of establishing the pilot program, the department shall consult with stakeholders, including, but not limited to, professionals in the community violence intervention field, hospital-linked and hospital-based violence intervention programs, and health care professionals working with hospital-linked and hospital-based violence intervention programs.(d) Under the pilot program, the department shall provide violence preventive services that are rendered by a qualified violence prevention professional to a Medi-Cal beneficiary who meets both of the following conditions:(1) The beneficiary has received medical treatment for a violent injury, including, but not limited to, a gunshot wound, stabbing injury, or any other form of violent injury.(2) A licensed health care provider has determined that the beneficiary is at elevated risk of violent reinjury or retaliation and has referred the beneficiary to participate in a violence preventive services program.(e) Violence preventive services, as defined in paragraph (3) of subdivision (o), that are provided by a qualified violence prevention professional through the Medi-Cal program shall be offered to an eligible Medi-Cal beneficiary for a minimum of three months and a maximum of 12 months. These services shall be rendered within and outside the clinical setting, and shall include all of the following components:(1) Care coordination to support the recovery of a violently injured patient.(2) Home and community visitation after discharge to provide patient education, neighborhood mapping of community resources, referrals for substance abuse, behavioral health, or any additional risk reduction resources to support injury recovery and reduce injury recidivism.(3) Peer support services, including, but not limited to, mentorship, conflict mediation, and crisis intervention.(f) A qualified violence prevention professional, as defined in paragraph (2) of subdivision (o), shall meet all of the following conditions:(1) Possesses at least six months of full-time equivalent experience in providing violence preventive services through employment, volunteer work, or as part of an internship experience.(2) Has successfully completed an accredited training and certification program for violence prevention professionals, in accordance with subdivision (g), or has been certified as a violence prevention professional by the National Network of Hospital-Based Violence Intervention Programs prior to January 1, 2021.(3) Successfully completes at least four hours of continuing education annually in the field of violence preventive services.(4) Satisfies any other requirements necessary to maintain certification as a violence prevention professional.(g) The department shall approve one or more training and certification programs for violence prevention professionals, which shall include at least 35 hours of training that collectively addresses all of the following:(1) The profound effects of trauma and violence and the basics of trauma-informed care.(2) Violence prevention strategies, including, but not limited to, conflict mediation and retaliation prevention related to community violence.(3) Care coordination and patient support practices.(4) Patient privacy and the federal Health Insurance Portability and Accountability Act of 1996.(h) An entity that employs or contracts with a qualified violence prevention professional to provide violence preventive services shall do both of the following:(1) Maintain documentation that the qualified violence prevention professional has met all of the conditions described in subdivision (f).(2) Ensure that the qualified violence prevention professional is providing violence preventive services consistent with the requirements specified in subdivision (e).(i) The department shall seek any federal approvals necessary to implement this section, including, but not limited to, any state plan amendments or federal waivers by the federal Centers for Medicare and Medicaid Services.(j) This section shall be implemented only to the extent that federal financial participation is available and not otherwise jeopardized, and any necessary federal approvals have been obtained.(k) This section does not alter the scope of practice for any health care professional nor authorizes the delivery of health care services in a setting or in a manner that is not authorized under any provision of the Business and Professions Code or the Health and Safety Code.(l) At least one calendar year prior to the inoperative date of this section pursuant to subdivision (m), the department shall issue a report to the Legislature, in compliance with Section 9795 of the Government Code, on the implementation of the violence intervention pilot program established under this section, and the demonstrated impact of violence preventive services. The report shall, at a minimum, include all of the following:(1) The number of individuals receiving violence preventive services pursuant to this section.(2) The number of individuals providing violence preventive services pursuant to this section.(3) Expenditures, in aggregate and per person, in providing services pursuant to this section.(4) A description of the types of services provided and the locations where those services were provided.(5) The number and types of accrediting bodies for violence preventive services and the number and names of violence preventive services training programs providing training pursuant to this section.(6) An analysis on whether violence intervention sites implemented pursuant to this section have reduced the incidence of risk factors for violent injury and reinjury among individuals receiving violence preventive services. The analysis shall consider all of the following:(A) Data available from the Medi-Cal program related to claims and other available data sources on the incidence of violent injury and reinjury among individuals receiving violence preventive services.(B) Data and analysis from published, peer-reviewed evaluations of violence intervention sites implemented pursuant to this section.(7) A comparison of the outcomes of the violence intervention pilot program implemented pursuant to this section to the outcomes of other substantially similar violence preventive service programs that have been published in peer-reviewed evaluations.(8) Recommendations on how to improve implementation of the pilot program established under this section, including all of the following information:(A) A description of any administrative barriers or other challenges identified by stakeholders.(B) Recommendations on legislative or policy changes needed, if any, to promote effective utilization of violence preventive services in the population served by the Medi-Cal program.(C) Recommendations on whether to expand the Medi-Cal schedule of benefits to include violence preventive services, and, if those services are a benefit under the Medi-Cal program, recommendations on which delivery system, such as fee-for-service or managed care, including a Medi-Cal managed care health plan or county mental health plan, should provide those services.(m) This section shall become inoperative five calendar years following the date upon which violence preventive services described in this section are able to be provided and billed pursuant to this section.(n) The department shall post on its internet website the date upon which violence preventive services described in this section are able to be provided and billed pursuant to this section.(o) The following definitions apply for purposes of this section:(1) Prevention professional has the same meaning as defined by the National Uniform Claim Committee (NUCC) under NUCC Code Number 405300000X or its successor.(2) Qualified violence prevention professional means a prevention professional who renders violence preventive services.(3) Violence preventive services means evidence-based, trauma-informed, supportive, culturally responsive, and nonpsychotherapeutic services provided by a prevention professional, who works in collaboration with other care providers and community partners, for the purpose of promoting improved health outcomes and positive behavioral change, preventing injury recidivism, and reducing the likelihood that violently injured individuals will commit or promote violence themselves.
46+The people of the State of California do enact as follows:SECTION 1. Section 14134.3 is added to the Welfare and Institutions Code, immediately following Section 14134.25, to read:14134.3. (a) (1) The Legislature finds that people who have been violently injured are substantially more likely to be violently reinjured, and to engage in behaviors, as part of a cycle of community violence, trauma, and retaliation, that also substantially increase their own risk of violent reinjury.(2) It is the intent of the Legislature that the State Department of Health Care Services develop and implement services targeted at reducing injury recidivism among violently injured Medi-Cal beneficiaries, and provide direct reimbursement to qualified violence prevention professionals for violence preventive services in accordance with this section.(b) No later than January 1, 2021, the department shall establish a violence intervention pilot program that is hospital-based or hospital-linked. The pilot program shall be established at a minimum of nine sites, and at least one site shall be located in each of the following counties:(1) Alameda.(2) Contra Costa.(3) Los Angeles.(4) Monterey.(5) Sacramento.(6) San Bernardino.(7) San Francisco.(8) Santa Clara.(9) Ventura.(c) For the purposes of establishing the pilot program, the department shall consult with stakeholders, including, but not limited to, professionals in the community violence intervention field, hospital-linked and hospital-based violence intervention programs, and health care professionals working with hospital-linked and hospital-based violence intervention programs.(d) Under the pilot program, the department shall provide violence preventive services that are rendered by a qualified violence prevention professional to a Medi-Cal beneficiary who meets both of the following conditions:(1) The beneficiary has received medical treatment for a violent injury, including, but not limited to, a gunshot wound, stabbing injury, or any other form of violent injury.(2) A licensed health care provider has determined that the beneficiary is at elevated risk of violent reinjury or retaliation and has referred the beneficiary to participate in a violence preventive services program.(e) Violence preventive services, as defined in paragraph (3) of subdivision (o), that are provided by a qualified violence prevention professional through the Medi-Cal program shall be offered to an eligible Medi-Cal beneficiary for a minimum of three months and a maximum of 12 months. These services shall be rendered within and outside the clinical setting, and shall include all of the following components:(1) Targeted case management and care Care coordination to support the recovery of a violently injured patient.(2) Home and community visitation after discharge to provide patient education, neighborhood mapping of community resources, referrals or screenings for substance abuse, behavioral health, or any additional risk reduction resources to support injury recovery and reduce injury recidivism.(3) Peer support services, including, but not limited to, counseling, mentorship, conflict mediation, and crisis intervention.(f) A qualified violence prevention professional, as defined in paragraph (2) of subdivision (o), shall meet all of the following conditions:(1) Possesses at least six months of full-time equivalent experience in providing violence preventive services through employment, volunteer work, or as part of an internship experience.(2) Has successfully completed an accredited training and certification program for violence prevention professionals, in accordance with subdivision (g), or has been certified as a violence prevention professional by the National Network of Hospital-Based Violence Intervention Programs prior to January 1, 2021.(3) Successfully completes at least four hours of continuing education annually in the field of violence preventive services.(4) Satisfies any other requirements necessary to maintain certification as a violence prevention professional.(g) The department shall approve one or more training and certification programs for violence prevention professionals, which shall include at least 35 hours of training that collectively addresses all of the following:(1) The profound effects of trauma and violence and the basics of trauma-informed care.(2) Violence prevention strategies, including, but not limited to, conflict mediation and retaliation prevention related to community violence.(3) Case management and advocacy Care coordination and patient support practices.(4) Patient privacy and the federal Health Insurance Portability and Accountability Act of 1996.(h) An entity that employs or contracts with a qualified violence prevention professional to provide violence preventive services shall do both of the following:(1) Maintain documentation that the qualified violence prevention professional has met all of the conditions described in subdivision (f).(2) Ensure that the qualified violence prevention professional is providing violence preventive services consistent with the requirements specified in subdivision (e).(i) The department shall seek any federal approvals necessary to implement this section, including, but not limited to, any state plan amendments or federal waivers by the federal Centers for Medicare and Medicaid Services.(j) This section shall be implemented only to the extent that federal financial participation is available and not otherwise jeopardized, and any necessary federal approvals have been obtained.(k) This section does not alter the scope of practice for any health care professional nor authorizes the delivery of health care services in a setting or in a manner that is not authorized under any provision of the Business and Professions Code or the Health and Safety Code.(l) At least one calendar year prior to the inoperative date of this section pursuant to subdivision (m), the 0;">(A) Data available from the Medi-Cal program related to claims and other available data sources on the incidence of violent injury and reinjury among individuals receiving violence preventive services.(B) Data and analysis from published, peer-reviewed evaluations of violence intervention sites implemented pursuant to this section.(7) A comparison of the outcomes of the violence intervention pilot program implemented pursuant to this section to the outcomes of other substantially similar violence preventive service programs that have been published in peer-reviewed evaluations.(8) Recommendations on how to improve implementation of the pilot program established under this section, including all of the following information:(A) A description of any administrative barriers or other challenges identified by stakeholders.(B) Recommendations on legislative or policy changes needed, if any, to promote effective utilization of violence preventive services in the population served by the Medi-Cal program.(C) Recommendations on whether to expand the Medi-Cal schedule of benefits to include violence preventive services, and, if those services are a benefit under the Medi-Cal program, recommendations on which delivery system, such as fee-for-service or managed care, including a Medi-Cal managed care health plan or county mental health plan, should provide those services.(m) This section shall become inoperative five calendar years following the date upon which violence preventive services described in this section are able to be provided and billed pursuant to this section.(n) The department shall post on its internet website the date upon which violence preventive services described in this section are able to be provided and billed pursuant to this section.(o) The following definitions apply for purposes of this section:(1) Prevention professional has the same meaning as defined by the National Uniform Claim Committee (NUCC) under NUCC Code Number 405300000X or its successor.(2) Qualified violence prevention professional means a prevention professional who renders violence preventive services.(3) Violence preventive services means evidence-based, trauma-informed, supportive, culturally responsive, and nonpsychotherapeutic services provided by a prevention professional, who works in collaboration with other care providers and community partners, for the purpose of promoting improved health outcomes and positive behavioral change, preventing injury recidivism, and reducing the likelihood that violently injured individuals will commit or promote violence themselves.
5047
5148 The people of the State of California do enact as follows:
5249
5350 ## The people of the State of California do enact as follows:
5451
55-SECTION 1. Section 14134.3 is added to the Welfare and Institutions Code, immediately following Section 14134.25, to read:14134.3. (a) (1) The Legislature finds that people who have been violently injured are substantially more likely to be violently reinjured, and to engage in behaviors, as part of a cycle of community violence, trauma, and retaliation, that also substantially increase their own risk of violent reinjury.(2) It is the intent of the Legislature that the State Department of Health Care Services develop and implement services targeted at reducing injury recidivism among violently injured Medi-Cal beneficiaries, and provide direct reimbursement to qualified violence prevention professionals for violence preventive services in accordance with this section.(b) No later than January 1, 2021, the department shall establish a violence intervention pilot program that is hospital-based or hospital-linked. The pilot program shall be established at a minimum of nine sites, and at least one site shall be located in each of the following counties:(1) Alameda.(2) Contra Costa.(3) Los Angeles.(4) Monterey.(5) Sacramento.(6) San Bernardino.(7) San Francisco.(8) Santa Clara.(9) Ventura.(c) For the purposes of establishing the pilot program, the department shall consult with stakeholders, including, but not limited to, professionals in the community violence intervention field, hospital-linked and hospital-based violence intervention programs, and health care professionals working with hospital-linked and hospital-based violence intervention programs.(d) Under the pilot program, the department shall provide violence preventive services that are rendered by a qualified violence prevention professional to a Medi-Cal beneficiary who meets both of the following conditions:(1) The beneficiary has received medical treatment for a violent injury, including, but not limited to, a gunshot wound, stabbing injury, or any other form of violent injury.(2) A licensed health care provider has determined that the beneficiary is at elevated risk of violent reinjury or retaliation and has referred the beneficiary to participate in a violence preventive services program.(e) Violence preventive services, as defined in paragraph (3) of subdivision (o), that are provided by a qualified violence prevention professional through the Medi-Cal program shall be offered to an eligible Medi-Cal beneficiary for a minimum of three months and a maximum of 12 months. These services shall be rendered within and outside the clinical setting, and shall include all of the following components:(1) Care coordination to support the recovery of a violently injured patient.(2) Home and community visitation after discharge to provide patient education, neighborhood mapping of community resources, referrals for substance abuse, behavioral health, or any additional risk reduction resources to support injury recovery and reduce injury recidivism.(3) Peer support services, including, but not limited to, mentorship, conflict mediation, and crisis intervention.(f) A qualified violence prevention professional, as defined in paragraph (2) of subdivision (o), shall meet all of the following conditions:(1) Possesses at least six months of full-time equivalent experience in providing violence preventive services through employment, volunteer work, or as part of an internship experience.(2) Has successfully completed an accredited training and certification program for violence prevention professionals, in accordance with subdivision (g), or has been certified as a violence prevention professional by the National Network of Hospital-Based Violence Intervention Programs prior to January 1, 2021.(3) Successfully completes at least four hours of continuing education annually in the field of violence preventive services.(4) Satisfies any other requirements necessary to maintain certification as a violence prevention professional.(g) The department shall approve one or more training and certification programs for violence prevention professionals, which shall include at least 35 hours of training that collectively addresses all of the following:(1) The profound effects of trauma and violence and the basics of trauma-informed care.(2) Violence prevention strategies, including, but not limited to, conflict mediation and retaliation prevention related to community violence.(3) Care coordination and patient support practices.(4) Patient privacy and the federal Health Insurance Portability and Accountability Act of 1996.(h) An entity that employs or contracts with a qualified violence prevention professional to provide violence preventive services shall do both of the following:(1) Maintain documentation that the qualified violence prevention professional has met all of the conditions described in subdivision (f).(2) Ensure that the qualified violence prevention professional is providing violence preventive services consistent with the requirements specified in subdivision (e).(i) The department shall seek any federal approvals necessary to implement this section, including, but not limited to, any state plan amendments or federal waivers by the federal Centers for Medicare and Medicaid Services.(j) This section shall be implemented only to the extent that federal financial participation is available and not otherwise jeopardized, and any necessary federal approvals have been obtained.(k) This section does not alter the scope of practice for any health care professional nor authorizes the delivery of health care services in a setting or in a manner that is not authorized under any provision of the Business and Professions Code or the Health and Safety Code.(l) At least one calendar year prior to the inoperative date of this section pursuant to subdivision (m), the department shall issue a report to the Legislature, in compliance with Section 9795 of the Government Code, on the implementation of the violence intervention pilot program established under this section, and the demonstrated impact of violence preventive services. The report shall, at a minimum, include all of the following:(1) The number of individuals receiving violence preventive services pursuant to this section.(2) The number of individuals providing violence preventive services pursuant to this section.(3) Expenditures, in aggregate and per person, in providing services pursuant to this section.(4) A description of the types of services provided and the locations where those services were provided.(5) The number and types of accrediting bodies for violence preventive services and the number and names of violence preventive services training programs providing training pursuant to this section.(6) An analysis on whether violence intervention sites implemented pursuant to this section have reduced the incidence of risk factors for violent injury and reinjury among individuals receiving violence preventive services. The analysis shall consider all of the following:(A) Data available from the Medi-Cal program related to claims and other available data sources on the incidence of violent injury and reinjury among individuals receiving violence preventive services.(B) Data and analysis from published, peer-reviewed evaluations of violence intervention sites implemented pursuant to this section.(7) A comparison of the outcomes of the violence intervention pilot program implemented pursuant to this section to the outcomes of other substantially similar violence preventive service programs that have been published in peer-reviewed evaluations.(8) Recommendations on how to improve implementation of the pilot program established under this section, including all of the following information:(A) A description of any administrative barriers or other challenges identified by stakeholders.(B) Recommendations on legislative or policy changes needed, if any, to promote effective utilization of violence preventive services in the population served by the Medi-Cal program.(C) Recommendations on whether to expand the Medi-Cal schedule of benefits to include violence preventive services, and, if those services are a benefit under the Medi-Cal program, recommendations on which delivery system, such as fee-for-service or managed care, including a Medi-Cal managed care health plan or county mental health plan, should provide those services.(m) This section shall become inoperative five calendar years following the date upon which violence preventive services described in this section are able to be provided and billed pursuant to this section.(n) The department shall post on its internet website the date upon which violence preventive services described in this section are able to be provided and billed pursuant to this section.(o) The following definitions apply for purposes of this section:(1) Prevention professional has the same meaning as defined by the National Uniform Claim Committee (NUCC) under NUCC Code Number 405300000X or its successor.(2) Qualified violence prevention professional means a prevention professional who renders violence preventive services.(3) Violence preventive services means evidence-based, trauma-informed, supportive, culturally responsive, and nonpsychotherapeutic services provided by a prevention professional, who works in collaboration with other care providers and community partners, for the purpose of promoting improved health outcomes and positive behavioral change, preventing injury recidivism, and reducing the likelihood that violently injured individuals will commit or promote violence themselves.
52+SECTION 1. Section 14134.3 is added to the Welfare and Institutions Code, immediately following Section 14134.25, to read:14134.3. (a) (1) The Legislature finds that people who have been violently injured are substantially more likely to be violently reinjured, and to engage in behaviors, as part of a cycle of community violence, trauma, and retaliation, that also substantially increase their own risk of violent reinjury.(2) It is the intent of the Legislature that the State Department of Health Care Services develop and implement services targeted at reducing injury recidivism among violently injured Medi-Cal beneficiaries, and provide direct reimbursement to qualified violence prevention professionals for violence preventive services in accordance with this section.(b) No later than January 1, 2021, the department shall establish a violence intervention pilot program that is hospital-based or hospital-linked. The pilot program shall be established at a minimum of nine sites, and at least one site shall be located in each of the following counties:(1) Alameda.(2) Contra Costa.(3) Los Angeles.(4) Monterey.(5) Sacramento.(6) San Bernardino.(7) San Francisco.(8) Santa Clara.(9) Ventura.(c) For the purposes of establishing the pilot program, the department shall consult with stakeholders, including, but not limited to, professionals in the community violence intervention field, hospital-linked and hospital-based violence intervention programs, and health care professionals working with hospital-linked and hospital-based violence intervention programs.(d) Under the pilot program, the department shall provide violence preventive services that are rendered by a qualified violence prevention professional to a Medi-Cal beneficiary who meets both of the following conditions:(1) The beneficiary has received medical treatment for a violent injury, including, but not limited to, a gunshot wound, stabbing injury, or any other form of violent injury.(2) A licensed health care provider has determined that the beneficiary is at elevated risk of violent reinjury or retaliation and has referred the beneficiary to participate in a violence preventive services program.(e) Violence preventive services, as defined in paragraph (3) of subdivision (o), that are provided by a qualified violence prevention professional through the Medi-Cal program shall be offered to an eligible Medi-Cal beneficiary for a minimum of three months and a maximum of 12 months. These services shall be rendered within and outside the clinical setting, and shall include all of the following components:(1) Targeted case management and care Care coordination to support the recovery of a violently injured patient.(2) Home and community visitation after discharge to provide patient education, neighborhood mapping of community resources, referrals or screenings for substance abuse, behavioral health, or any additional risk reduction resources to support injury recovery and reduce injury recidivism.(3) Peer support services, including, but not limited to, counseling, mentorship, conflict mediation, and crisis intervention.(f) A qualified violence prevention professional, as defined in paragraph (2) of subdivision (o), shall meet all of the following conditions:(1) Possesses at least six months of full-time equivalent experience in providing violence preventive services through employment, volunteer work, or as part of an internship experience.(2) Has successfully completed an accredited training and certification program for violence prevention professionals, in accordance with subdivision (g), or has been certified as a violence prevention professional by the National Network of Hospital-Based Violence Intervention Programs prior to January 1, 2021.(3) Successfully completes at least four hours of continuing education annually in the field of violence preventive services.(4) Satisfies any other requirements necessary to maintain certification as a violence prevention professional.(g) The department shall approve one or more training and certification programs for violence prevention professionals, which shall include at least 35 hours of training that collectively addresses all of the following:(1) The profound effects of trauma and violence and the basics of trauma-informed care.(2) Violence prevention strategies, including, but not limited to, conflict mediation and retaliation prevention related to community violence.(3) Case management and advocacy Care coordination and patient support practices.(4) Patient privacy and the federal Health Insurance Portability and Accountability Act of 1996.(h) An entity that employs or contracts with a qualified violence prevention professional to provide violence preventive services shall do both of the following:(1) Maintain documentation that the qualified violence prevention professional has met all of the conditions described in subdivision (f).(2) Ensure that the qualified violence prevention professional is providing violence preventive services consistent with the requirements specified in subdivision (e).(i) The department shall seek any federal approvals necessary to implement this section, including, but not limited to, any state plan amendments or federal waivers by the federal Centers for Medicare and Medicaid Services.(j) This section shall be implemented only to the extent that federal financial participation is available and not otherwise jeopardized, and any necessary federal approvals have been obtained.(k) This section does not alter the scope of practice for any health care professional nor authorizes the delivery of health care services in a setting or in a manner that is not authorized under any provision of the Business and Professions Code or the Health and Safety Code.(l) At least one calendar year prior to the inoperative date of this section pursuant to subdivision (m), the 0;">(A) Data available from the Medi-Cal program related to claims and other available data sources on the incidence of violent injury and reinjury among individuals receiving violence preventive services.(B) Data and analysis from published, peer-reviewed evaluations of violence intervention sites implemented pursuant to this section.(7) A comparison of the outcomes of the violence intervention pilot program implemented pursuant to this section to the outcomes of other substantially similar violence preventive service programs that have been published in peer-reviewed evaluations.(8) Recommendations on how to improve implementation of the pilot program established under this section, including all of the following information:(A) A description of any administrative barriers or other challenges identified by stakeholders.(B) Recommendations on legislative or policy changes needed, if any, to promote effective utilization of violence preventive services in the population served by the Medi-Cal program.(C) Recommendations on whether to expand the Medi-Cal schedule of benefits to include violence preventive services, and, if those services are a benefit under the Medi-Cal program, recommendations on which delivery system, such as fee-for-service or managed care, including a Medi-Cal managed care health plan or county mental health plan, should provide those services.(m) This section shall become inoperative five calendar years following the date upon which violence preventive services described in this section are able to be provided and billed pursuant to this section.(n) The department shall post on its internet website the date upon which violence preventive services described in this section are able to be provided and billed pursuant to this section.(o) The following definitions apply for purposes of this section:(1) Prevention professional has the same meaning as defined by the National Uniform Claim Committee (NUCC) under NUCC Code Number 405300000X or its successor.(2) Qualified violence prevention professional means a prevention professional who renders violence preventive services.(3) Violence preventive services means evidence-based, trauma-informed, supportive, culturally responsive, and nonpsychotherapeutic services provided by a prevention professional, who works in collaboration with other care providers and community partners, for the purpose of promoting improved health outcomes and positive behavioral change, preventing injury recidivism, and reducing the likelihood that violently injured individuals will commit or promote violence themselves.
5653
5754 SECTION 1. Section 14134.3 is added to the Welfare and Institutions Code, immediately following Section 14134.25, to read:
5855
5956 ### SECTION 1.
6057
61-14134.3. (a) (1) The Legislature finds that people who have been violently injured are substantially more likely to be violently reinjured, and to engage in behaviors, as part of a cycle of community violence, trauma, and retaliation, that also substantially increase their own risk of violent reinjury.(2) It is the intent of the Legislature that the State Department of Health Care Services develop and implement services targeted at reducing injury recidivism among violently injured Medi-Cal beneficiaries, and provide direct reimbursement to qualified violence prevention professionals for violence preventive services in accordance with this section.(b) No later than January 1, 2021, the department shall establish a violence intervention pilot program that is hospital-based or hospital-linked. The pilot program shall be established at a minimum of nine sites, and at least one site shall be located in each of the following counties:(1) Alameda.(2) Contra Costa.(3) Los Angeles.(4) Monterey.(5) Sacramento.(6) San Bernardino.(7) San Francisco.(8) Santa Clara.(9) Ventura.(c) For the purposes of establishing the pilot program, the department shall consult with stakeholders, including, but not limited to, professionals in the community violence intervention field, hospital-linked and hospital-based violence intervention programs, and health care professionals working with hospital-linked and hospital-based violence intervention programs.(d) Under the pilot program, the department shall provide violence preventive services that are rendered by a qualified violence prevention professional to a Medi-Cal beneficiary who meets both of the following conditions:(1) The beneficiary has received medical treatment for a violent injury, including, but not limited to, a gunshot wound, stabbing injury, or any other form of violent injury.(2) A licensed health care provider has determined that the beneficiary is at elevated risk of violent reinjury or retaliation and has referred the beneficiary to participate in a violence preventive services program.(e) Violence preventive services, as defined in paragraph (3) of subdivision (o), that are provided by a qualified violence prevention professional through the Medi-Cal program shall be offered to an eligible Medi-Cal beneficiary for a minimum of three months and a maximum of 12 months. These services shall be rendered within and outside the clinical setting, and shall include all of the following components:(1) Care coordination to support the recovery of a violently injured patient.(2) Home and community visitation after discharge to provide patient education, neighborhood mapping of community resources, referrals for substance abuse, behavioral health, or any additional risk reduction resources to support injury recovery and reduce injury recidivism.(3) Peer support services, including, but not limited to, mentorship, conflict mediation, and crisis intervention.(f) A qualified violence prevention professional, as defined in paragraph (2) of subdivision (o), shall meet all of the following conditions:(1) Possesses at least six months of full-time equivalent experience in providing violence preventive services through employment, volunteer work, or as part of an internship experience.(2) Has successfully completed an accredited training and certification program for violence prevention professionals, in accordance with subdivision (g), or has been certified as a violence prevention professional by the National Network of Hospital-Based Violence Intervention Programs prior to January 1, 2021.(3) Successfully completes at least four hours of continuing education annually in the field of violence preventive services.(4) Satisfies any other requirements necessary to maintain certification as a violence prevention professional.(g) The department shall approve one or more training and certification programs for violence prevention professionals, which shall include at least 35 hours of training that collectively addresses all of the following:(1) The profound effects of trauma and violence and the basics of trauma-informed care.(2) Violence prevention strategies, including, but not limited to, conflict mediation and retaliation prevention related to community violence.(3) Care coordination and patient support practices.(4) Patient privacy and the federal Health Insurance Portability and Accountability Act of 1996.(h) An entity that employs or contracts with a qualified violence prevention professional to provide violence preventive services shall do both of the following:(1) Maintain documentation that the qualified violence prevention professional has met all of the conditions described in subdivision (f).(2) Ensure that the qualified violence prevention professional is providing violence preventive services consistent with the requirements specified in subdivision (e).(i) The department shall seek any federal approvals necessary to implement this section, including, but not limited to, any state plan amendments or federal waivers by the federal Centers for Medicare and Medicaid Services.(j) This section shall be implemented only to the extent that federal financial participation is available and not otherwise jeopardized, and any necessary federal approvals have been obtained.(k) This section does not alter the scope of practice for any health care professional nor authorizes the delivery of health care services in a setting or in a manner that is not authorized under any provision of the Business and Professions Code or the Health and Safety Code.(l) At least one calendar year prior to the inoperative date of this section pursuant to subdivision (m), the department shall issue a report to the Legislature, in compliance with Section 9795 of the Government Code, on the implementation of the violence intervention pilot program established under this section, and the demonstrated impact of violence preventive services. The report shall, at a minimum, include all of the following:(1) The number of individuals receiving violence preventive services pursuant to this section.(2) The number of individuals providing violence preventive services pursuant to this section.(3) Expenditures, in aggregate and per person, in providing services pursuant to this section.(4) A description of the types of services provided and the locations where those services were provided.(5) The number and types of accrediting bodies for violence preventive services and the number and names of violence preventive services training programs providing training pursuant to this section.(6) An analysis on whether violence intervention sites implemented pursuant to this section have reduced the incidence of risk factors for violent injury and reinjury among individuals receiving violence preventive services. The analysis shall consider all of the following:(A) Data available from the Medi-Cal program related to claims and other available data sources on the incidence of violent injury and reinjury among individuals receiving violence preventive services.(B) Data and analysis from published, peer-reviewed evaluations of violence intervention sites implemented pursuant to this section.(7) A comparison of the outcomes of the violence intervention pilot program implemented pursuant to this section to the outcomes of other substantially similar violence preventive service programs that have been published in peer-reviewed evaluations.(8) Recommendations on how to improve implementation of the pilot program established under this section, including all of the following information:(A) A description of any administrative barriers or other challenges identified by stakeholders.(B) Recommendations on legislative or policy changes needed, if any, to promote effective utilization of violence preventive services in the population served by the Medi-Cal program.(C) Recommendations on whether to expand the Medi-Cal schedule of benefits to include violence preventive services, and, if those services are a benefit under the Medi-Cal program, recommendations on which delivery system, such as fee-for-service or managed care, including a Medi-Cal managed care health plan or county mental health plan, should provide those services.(m) This section shall become inoperative five calendar years following the date upon which violence preventive services described in this section are able to be provided and billed pursuant to this section.(n) The department shall post on its internet website the date upon which violence preventive services described in this section are able to be provided and billed pursuant to this section.(o) The following definitions apply for purposes of this section:(1) Prevention professional has the same meaning as defined by the National Uniform Claim Committee (NUCC) under NUCC Code Number 405300000X or its successor.(2) Qualified violence prevention professional means a prevention professional who renders violence preventive services.(3) Violence preventive services means evidence-based, trauma-informed, supportive, culturally responsive, and nonpsychotherapeutic services provided by a prevention professional, who works in collaboration with other care providers and community partners, for the purpose of promoting improved health outcomes and positive behavioral change, preventing injury recidivism, and reducing the likelihood that violently injured individuals will commit or promote violence themselves.
58+14134.3. (a) (1) The Legislature finds that people who have been violently injured are substantially more likely to be violently reinjured, and to engage in behaviors, as part of a cycle of community violence, trauma, and retaliation, that also substantially increase their own risk of violent reinjury.(2) It is the intent of the Legislature that the State Department of Health Care Services develop and implement services targeted at reducing injury recidivism among violently injured Medi-Cal beneficiaries, and provide direct reimbursement to qualified violence prevention professionals for violence preventive services in accordance with this section.(b) No later than January 1, 2021, the department shall establish a violence intervention pilot program that is hospital-based or hospital-linked. The pilot program shall be established at a minimum of nine sites, and at least one site shall be located in each of the following counties:(1) Alameda.(2) Contra Costa.(3) Los Angeles.(4) Monterey.(5) Sacramento.(6) San Bernardino.(7) San Francisco.(8) Santa Clara.(9) Ventura.(c) For the purposes of establishing the pilot program, the department shall consult with stakeholders, including, but not limited to, professionals in the community violence intervention field, hospital-linked and hospital-based violence intervention programs, and health care professionals working with hospital-linked and hospital-based violence intervention programs.(d) Under the pilot program, the department shall provide violence preventive services that are rendered by a qualified violence prevention professional to a Medi-Cal beneficiary who meets both of the following conditions:(1) The beneficiary has received medical treatment for a violent injury, including, but not limited to, a gunshot wound, stabbing injury, or any other form of violent injury.(2) A licensed health care provider has determined that the beneficiary is at elevated risk of violent reinjury or retaliation and has referred the beneficiary to participate in a violence preventive services program.(e) Violence preventive services, as defined in paragraph (3) of subdivision (o), that are provided by a qualified violence prevention professional through the Medi-Cal program shall be offered to an eligible Medi-Cal beneficiary for a minimum of three months and a maximum of 12 months. These services shall be rendered within and outside the clinical setting, and shall include all of the following components:(1) Targeted case management and care Care coordination to support the recovery of a violently injured patient.(2) Home and community visitation after discharge to provide patient education, neighborhood mapping of community resources, referrals or screenings for substance abuse, behavioral health, or any additional risk reduction resources to support injury recovery and reduce injury recidivism.(3) Peer support services, including, but not limited to, counseling, mentorship, conflict mediation, and crisis intervention.(f) A qualified violence prevention professional, as defined in paragraph (2) of subdivision (o), shall meet all of the following conditions:(1) Possesses at least six months of full-time equivalent experience in providing violence preventive services through employment, volunteer work, or as part of an internship experience.(2) Has successfully completed an accredited training and certification program for violence prevention professionals, in accordance with subdivision (g), or has been certified as a violence prevention professional by the National Network of Hospital-Based Violence Intervention Programs prior to January 1, 2021.(3) Successfully completes at least four hours of continuing education annually in the field of violence preventive services.(4) Satisfies any other requirements necessary to maintain certification as a violence prevention professional.(g) The department shall approve one or more training and certification programs for violence prevention professionals, which shall include at least 35 hours of training that collectively addresses all of the following:(1) The profound effects of trauma and violence and the basics of trauma-informed care.(2) Violence prevention strategies, including, but not limited to, conflict mediation and retaliation prevention related to community violence.(3) Case management and advocacy Care coordination and patient support practices.(4) Patient privacy and the federal Health Insurance Portability and Accountability Act of 1996.(h) An entity that employs or contracts with a qualified violence prevention professional to provide violence preventive services shall do both of the following:(1) Maintain documentation that the qualified violence prevention professional has met all of the conditions described in subdivision (f).(2) Ensure that the qualified violence prevention professional is providing violence preventive services consistent with the requirements specified in subdivision (e).(i) The department shall seek any federal approvals necessary to implement this section, including, but not limited to, any state plan amendments or federal waivers by the federal Centers for Medicare and Medicaid Services.(j) This section shall be implemented only to the extent that federal financial participation is available and not otherwise jeopardized, and any necessary federal approvals have been obtained.(k) This section does not alter the scope of practice for any health care professional nor authorizes the delivery of health care services in a setting or in a manner that is not authorized under any provision of the Business and Professions Code or the Health and Safety Code.(l) At least one calendar year prior to the inoperative date of this section pursuant to subdivision (m), the 0;">(A) Data available from the Medi-Cal program related to claims and other available data sources on the incidence of violent injury and reinjury among individuals receiving violence preventive services.(B) Data and analysis from published, peer-reviewed evaluations of violence intervention sites implemented pursuant to this section.(7) A comparison of the outcomes of the violence intervention pilot program implemented pursuant to this section to the outcomes of other substantially similar violence preventive service programs that have been published in peer-reviewed evaluations.(8) Recommendations on how to improve implementation of the pilot program established under this section, including all of the following information:(A) A description of any administrative barriers or other challenges identified by stakeholders.(B) Recommendations on legislative or policy changes needed, if any, to promote effective utilization of violence preventive services in the population served by the Medi-Cal program.(C) Recommendations on whether to expand the Medi-Cal schedule of benefits to include violence preventive services, and, if those services are a benefit under the Medi-Cal program, recommendations on which delivery system, such as fee-for-service or managed care, including a Medi-Cal managed care health plan or county mental health plan, should provide those services.(m) This section shall become inoperative five calendar years following the date upon which violence preventive services described in this section are able to be provided and billed pursuant to this section.(n) The department shall post on its internet website the date upon which violence preventive services described in this section are able to be provided and billed pursuant to this section.(o) The following definitions apply for purposes of this section:(1) Prevention professional has the same meaning as defined by the National Uniform Claim Committee (NUCC) under NUCC Code Number 405300000X or its successor.(2) Qualified violence prevention professional means a prevention professional who renders violence preventive services.(3) Violence preventive services means evidence-based, trauma-informed, supportive, culturally responsive, and nonpsychotherapeutic services provided by a prevention professional, who works in collaboration with other care providers and community partners, for the purpose of promoting improved health outcomes and positive behavioral change, preventing injury recidivism, and reducing the likelihood that violently injured individuals will commit or promote violence themselves.
6259
63-14134.3. (a) (1) The Legislature finds that people who have been violently injured are substantially more likely to be violently reinjured, and to engage in behaviors, as part of a cycle of community violence, trauma, and retaliation, that also substantially increase their own risk of violent reinjury.(2) It is the intent of the Legislature that the State Department of Health Care Services develop and implement services targeted at reducing injury recidivism among violently injured Medi-Cal beneficiaries, and provide direct reimbursement to qualified violence prevention professionals for violence preventive services in accordance with this section.(b) No later than January 1, 2021, the department shall establish a violence intervention pilot program that is hospital-based or hospital-linked. The pilot program shall be established at a minimum of nine sites, and at least one site shall be located in each of the following counties:(1) Alameda.(2) Contra Costa.(3) Los Angeles.(4) Monterey.(5) Sacramento.(6) San Bernardino.(7) San Francisco.(8) Santa Clara.(9) Ventura.(c) For the purposes of establishing the pilot program, the department shall consult with stakeholders, including, but not limited to, professionals in the community violence intervention field, hospital-linked and hospital-based violence intervention programs, and health care professionals working with hospital-linked and hospital-based violence intervention programs.(d) Under the pilot program, the department shall provide violence preventive services that are rendered by a qualified violence prevention professional to a Medi-Cal beneficiary who meets both of the following conditions:(1) The beneficiary has received medical treatment for a violent injury, including, but not limited to, a gunshot wound, stabbing injury, or any other form of violent injury.(2) A licensed health care provider has determined that the beneficiary is at elevated risk of violent reinjury or retaliation and has referred the beneficiary to participate in a violence preventive services program.(e) Violence preventive services, as defined in paragraph (3) of subdivision (o), that are provided by a qualified violence prevention professional through the Medi-Cal program shall be offered to an eligible Medi-Cal beneficiary for a minimum of three months and a maximum of 12 months. These services shall be rendered within and outside the clinical setting, and shall include all of the following components:(1) Care coordination to support the recovery of a violently injured patient.(2) Home and community visitation after discharge to provide patient education, neighborhood mapping of community resources, referrals for substance abuse, behavioral health, or any additional risk reduction resources to support injury recovery and reduce injury recidivism.(3) Peer support services, including, but not limited to, mentorship, conflict mediation, and crisis intervention.(f) A qualified violence prevention professional, as defined in paragraph (2) of subdivision (o), shall meet all of the following conditions:(1) Possesses at least six months of full-time equivalent experience in providing violence preventive services through employment, volunteer work, or as part of an internship experience.(2) Has successfully completed an accredited training and certification program for violence prevention professionals, in accordance with subdivision (g), or has been certified as a violence prevention professional by the National Network of Hospital-Based Violence Intervention Programs prior to January 1, 2021.(3) Successfully completes at least four hours of continuing education annually in the field of violence preventive services.(4) Satisfies any other requirements necessary to maintain certification as a violence prevention professional.(g) The department shall approve one or more training and certification programs for violence prevention professionals, which shall include at least 35 hours of training that collectively addresses all of the following:(1) The profound effects of trauma and violence and the basics of trauma-informed care.(2) Violence prevention strategies, including, but not limited to, conflict mediation and retaliation prevention related to community violence.(3) Care coordination and patient support practices.(4) Patient privacy and the federal Health Insurance Portability and Accountability Act of 1996.(h) An entity that employs or contracts with a qualified violence prevention professional to provide violence preventive services shall do both of the following:(1) Maintain documentation that the qualified violence prevention professional has met all of the conditions described in subdivision (f).(2) Ensure that the qualified violence prevention professional is providing violence preventive services consistent with the requirements specified in subdivision (e).(i) The department shall seek any federal approvals necessary to implement this section, including, but not limited to, any state plan amendments or federal waivers by the federal Centers for Medicare and Medicaid Services.(j) This section shall be implemented only to the extent that federal financial participation is available and not otherwise jeopardized, and any necessary federal approvals have been obtained.(k) This section does not alter the scope of practice for any health care professional nor authorizes the delivery of health care services in a setting or in a manner that is not authorized under any provision of the Business and Professions Code or the Health and Safety Code.(l) At least one calendar year prior to the inoperative date of this section pursuant to subdivision (m), the department shall issue a report to the Legislature, in compliance with Section 9795 of the Government Code, on the implementation of the violence intervention pilot program established under this section, and the demonstrated impact of violence preventive services. The report shall, at a minimum, include all of the following:(1) The number of individuals receiving violence preventive services pursuant to this section.(2) The number of individuals providing violence preventive services pursuant to this section.(3) Expenditures, in aggregate and per person, in providing services pursuant to this section.(4) A description of the types of services provided and the locations where those services were provided.(5) The number and types of accrediting bodies for violence preventive services and the number and names of violence preventive services training programs providing training pursuant to this section.(6) An analysis on whether violence intervention sites implemented pursuant to this section have reduced the incidence of risk factors for violent injury and reinjury among individuals receiving violence preventive services. The analysis shall consider all of the following:(A) Data available from the Medi-Cal program related to claims and other available data sources on the incidence of violent injury and reinjury among individuals receiving violence preventive services.(B) Data and analysis from published, peer-reviewed evaluations of violence intervention sites implemented pursuant to this section.(7) A comparison of the outcomes of the violence intervention pilot program implemented pursuant to this section to the outcomes of other substantially similar violence preventive service programs that have been published in peer-reviewed evaluations.(8) Recommendations on how to improve implementation of the pilot program established under this section, including all of the following information:(A) A description of any administrative barriers or other challenges identified by stakeholders.(B) Recommendations on legislative or policy changes needed, if any, to promote effective utilization of violence preventive services in the population served by the Medi-Cal program.(C) Recommendations on whether to expand the Medi-Cal schedule of benefits to include violence preventive services, and, if those services are a benefit under the Medi-Cal program, recommendations on which delivery system, such as fee-for-service or managed care, including a Medi-Cal managed care health plan or county mental health plan, should provide those services.(m) This section shall become inoperative five calendar years following the date upon which violence preventive services described in this section are able to be provided and billed pursuant to this section.(n) The department shall post on its internet website the date upon which violence preventive services described in this section are able to be provided and billed pursuant to this section.(o) The following definitions apply for purposes of this section:(1) Prevention professional has the same meaning as defined by the National Uniform Claim Committee (NUCC) under NUCC Code Number 405300000X or its successor.(2) Qualified violence prevention professional means a prevention professional who renders violence preventive services.(3) Violence preventive services means evidence-based, trauma-informed, supportive, culturally responsive, and nonpsychotherapeutic services provided by a prevention professional, who works in collaboration with other care providers and community partners, for the purpose of promoting improved health outcomes and positive behavioral change, preventing injury recidivism, and reducing the likelihood that violently injured individuals will commit or promote violence themselves.
60+14134.3. (a) (1) The Legislature finds that people who have been violently injured are substantially more likely to be violently reinjured, and to engage in behaviors, as part of a cycle of community violence, trauma, and retaliation, that also substantially increase their own risk of violent reinjury.(2) It is the intent of the Legislature that the State Department of Health Care Services develop and implement services targeted at reducing injury recidivism among violently injured Medi-Cal beneficiaries, and provide direct reimbursement to qualified violence prevention professionals for violence preventive services in accordance with this section.(b) No later than January 1, 2021, the department shall establish a violence intervention pilot program that is hospital-based or hospital-linked. The pilot program shall be established at a minimum of nine sites, and at least one site shall be located in each of the following counties:(1) Alameda.(2) Contra Costa.(3) Los Angeles.(4) Monterey.(5) Sacramento.(6) San Bernardino.(7) San Francisco.(8) Santa Clara.(9) Ventura.(c) For the purposes of establishing the pilot program, the department shall consult with stakeholders, including, but not limited to, professionals in the community violence intervention field, hospital-linked and hospital-based violence intervention programs, and health care professionals working with hospital-linked and hospital-based violence intervention programs.(d) Under the pilot program, the department shall provide violence preventive services that are rendered by a qualified violence prevention professional to a Medi-Cal beneficiary who meets both of the following conditions:(1) The beneficiary has received medical treatment for a violent injury, including, but not limited to, a gunshot wound, stabbing injury, or any other form of violent injury.(2) A licensed health care provider has determined that the beneficiary is at elevated risk of violent reinjury or retaliation and has referred the beneficiary to participate in a violence preventive services program.(e) Violence preventive services, as defined in paragraph (3) of subdivision (o), that are provided by a qualified violence prevention professional through the Medi-Cal program shall be offered to an eligible Medi-Cal beneficiary for a minimum of three months and a maximum of 12 months. These services shall be rendered within and outside the clinical setting, and shall include all of the following components:(1) Targeted case management and care Care coordination to support the recovery of a violently injured patient.(2) Home and community visitation after discharge to provide patient education, neighborhood mapping of community resources, referrals or screenings for substance abuse, behavioral health, or any additional risk reduction resources to support injury recovery and reduce injury recidivism.(3) Peer support services, including, but not limited to, counseling, mentorship, conflict mediation, and crisis intervention.(f) A qualified violence prevention professional, as defined in paragraph (2) of subdivision (o), shall meet all of the following conditions:(1) Possesses at least six months of full-time equivalent experience in providing violence preventive services through employment, volunteer work, or as part of an internship experience.(2) Has successfully completed an accredited training and certification program for violence prevention professionals, in accordance with subdivision (g), or has been certified as a violence prevention professional by the National Network of Hospital-Based Violence Intervention Programs prior to January 1, 2021.(3) Successfully completes at least four hours of continuing education annually in the field of violence preventive services.(4) Satisfies any other requirements necessary to maintain certification as a violence prevention professional.(g) The department shall approve one or more training and certification programs for violence prevention professionals, which shall include at least 35 hours of training that collectively addresses all of the following:(1) The profound effects of trauma and violence and the basics of trauma-informed care.(2) Violence prevention strategies, including, but not limited to, conflict mediation and retaliation prevention related to community violence.(3) Case management and advocacy Care coordination and patient support practices.(4) Patient privacy and the federal Health Insurance Portability and Accountability Act of 1996.(h) An entity that employs or contracts with a qualified violence prevention professional to provide violence preventive services shall do both of the following:(1) Maintain documentation that the qualified violence prevention professional has met all of the conditions described in subdivision (f).(2) Ensure that the qualified violence prevention professional is providing violence preventive services consistent with the requirements specified in subdivision (e).(i) The department shall seek any federal approvals necessary to implement this section, including, but not limited to, any state plan amendments or federal waivers by the federal Centers for Medicare and Medicaid Services.(j) This section shall be implemented only to the extent that federal financial participation is available and not otherwise jeopardized, and any necessary federal approvals have been obtained.(k) This section does not alter the scope of practice for any health care professional nor authorizes the delivery of health care services in a setting or in a manner that is not authorized under any provision of the Business and Professions Code or the Health and Safety Code.(l) At least one calendar year prior to the inoperative date of this section pursuant to subdivision (m), the 0;">(A) Data available from the Medi-Cal program related to claims and other available data sources on the incidence of violent injury and reinjury among individuals receiving violence preventive services.(B) Data and analysis from published, peer-reviewed evaluations of violence intervention sites implemented pursuant to this section.(7) A comparison of the outcomes of the violence intervention pilot program implemented pursuant to this section to the outcomes of other substantially similar violence preventive service programs that have been published in peer-reviewed evaluations.(8) Recommendations on how to improve implementation of the pilot program established under this section, including all of the following information:(A) A description of any administrative barriers or other challenges identified by stakeholders.(B) Recommendations on legislative or policy changes needed, if any, to promote effective utilization of violence preventive services in the population served by the Medi-Cal program.(C) Recommendations on whether to expand the Medi-Cal schedule of benefits to include violence preventive services, and, if those services are a benefit under the Medi-Cal program, recommendations on which delivery system, such as fee-for-service or managed care, including a Medi-Cal managed care health plan or county mental health plan, should provide those services.(m) This section shall become inoperative five calendar years following the date upon which violence preventive services described in this section are able to be provided and billed pursuant to this section.(n) The department shall post on its internet website the date upon which violence preventive services described in this section are able to be provided and billed pursuant to this section.(o) The following definitions apply for purposes of this section:(1) Prevention professional has the same meaning as defined by the National Uniform Claim Committee (NUCC) under NUCC Code Number 405300000X or its successor.(2) Qualified violence prevention professional means a prevention professional who renders violence preventive services.(3) Violence preventive services means evidence-based, trauma-informed, supportive, culturally responsive, and nonpsychotherapeutic services provided by a prevention professional, who works in collaboration with other care providers and community partners, for the purpose of promoting improved health outcomes and positive behavioral change, preventing injury recidivism, and reducing the likelihood that violently injured individuals will commit or promote violence themselves.
6461
65-14134.3. (a) (1) The Legislature finds that people who have been violently injured are substantially more likely to be violently reinjured, and to engage in behaviors, as part of a cycle of community violence, trauma, and retaliation, that also substantially increase their own risk of violent reinjury.(2) It is the intent of the Legislature that the State Department of Health Care Services develop and implement services targeted at reducing injury recidivism among violently injured Medi-Cal beneficiaries, and provide direct reimbursement to qualified violence prevention professionals for violence preventive services in accordance with this section.(b) No later than January 1, 2021, the department shall establish a violence intervention pilot program that is hospital-based or hospital-linked. The pilot program shall be established at a minimum of nine sites, and at least one site shall be located in each of the following counties:(1) Alameda.(2) Contra Costa.(3) Los Angeles.(4) Monterey.(5) Sacramento.(6) San Bernardino.(7) San Francisco.(8) Santa Clara.(9) Ventura.(c) For the purposes of establishing the pilot program, the department shall consult with stakeholders, including, but not limited to, professionals in the community violence intervention field, hospital-linked and hospital-based violence intervention programs, and health care professionals working with hospital-linked and hospital-based violence intervention programs.(d) Under the pilot program, the department shall provide violence preventive services that are rendered by a qualified violence prevention professional to a Medi-Cal beneficiary who meets both of the following conditions:(1) The beneficiary has received medical treatment for a violent injury, including, but not limited to, a gunshot wound, stabbing injury, or any other form of violent injury.(2) A licensed health care provider has determined that the beneficiary is at elevated risk of violent reinjury or retaliation and has referred the beneficiary to participate in a violence preventive services program.(e) Violence preventive services, as defined in paragraph (3) of subdivision (o), that are provided by a qualified violence prevention professional through the Medi-Cal program shall be offered to an eligible Medi-Cal beneficiary for a minimum of three months and a maximum of 12 months. These services shall be rendered within and outside the clinical setting, and shall include all of the following components:(1) Care coordination to support the recovery of a violently injured patient.(2) Home and community visitation after discharge to provide patient education, neighborhood mapping of community resources, referrals for substance abuse, behavioral health, or any additional risk reduction resources to support injury recovery and reduce injury recidivism.(3) Peer support services, including, but not limited to, mentorship, conflict mediation, and crisis intervention.(f) A qualified violence prevention professional, as defined in paragraph (2) of subdivision (o), shall meet all of the following conditions:(1) Possesses at least six months of full-time equivalent experience in providing violence preventive services through employment, volunteer work, or as part of an internship experience.(2) Has successfully completed an accredited training and certification program for violence prevention professionals, in accordance with subdivision (g), or has been certified as a violence prevention professional by the National Network of Hospital-Based Violence Intervention Programs prior to January 1, 2021.(3) Successfully completes at least four hours of continuing education annually in the field of violence preventive services.(4) Satisfies any other requirements necessary to maintain certification as a violence prevention professional.(g) The department shall approve one or more training and certification programs for violence prevention professionals, which shall include at least 35 hours of training that collectively addresses all of the following:(1) The profound effects of trauma and violence and the basics of trauma-informed care.(2) Violence prevention strategies, including, but not limited to, conflict mediation and retaliation prevention related to community violence.(3) Care coordination and patient support practices.(4) Patient privacy and the federal Health Insurance Portability and Accountability Act of 1996.(h) An entity that employs or contracts with a qualified violence prevention professional to provide violence preventive services shall do both of the following:(1) Maintain documentation that the qualified violence prevention professional has met all of the conditions described in subdivision (f).(2) Ensure that the qualified violence prevention professional is providing violence preventive services consistent with the requirements specified in subdivision (e).(i) The department shall seek any federal approvals necessary to implement this section, including, but not limited to, any state plan amendments or federal waivers by the federal Centers for Medicare and Medicaid Services.(j) This section shall be implemented only to the extent that federal financial participation is available and not otherwise jeopardized, and any necessary federal approvals have been obtained.(k) This section does not alter the scope of practice for any health care professional nor authorizes the delivery of health care services in a setting or in a manner that is not authorized under any provision of the Business and Professions Code or the Health and Safety Code.(l) At least one calendar year prior to the inoperative date of this section pursuant to subdivision (m), the department shall issue a report to the Legislature, in compliance with Section 9795 of the Government Code, on the implementation of the violence intervention pilot program established under this section, and the demonstrated impact of violence preventive services. The report shall, at a minimum, include all of the following:(1) The number of individuals receiving violence preventive services pursuant to this section.(2) The number of individuals providing violence preventive services pursuant to this section.(3) Expenditures, in aggregate and per person, in providing services pursuant to this section.(4) A description of the types of services provided and the locations where those services were provided.(5) The number and types of accrediting bodies for violence preventive services and the number and names of violence preventive services training programs providing training pursuant to this section.(6) An analysis on whether violence intervention sites implemented pursuant to this section have reduced the incidence of risk factors for violent injury and reinjury among individuals receiving violence preventive services. The analysis shall consider all of the following:(A) Data available from the Medi-Cal program related to claims and other available data sources on the incidence of violent injury and reinjury among individuals receiving violence preventive services.(B) Data and analysis from published, peer-reviewed evaluations of violence intervention sites implemented pursuant to this section.(7) A comparison of the outcomes of the violence intervention pilot program implemented pursuant to this section to the outcomes of other substantially similar violence preventive service programs that have been published in peer-reviewed evaluations.(8) Recommendations on how to improve implementation of the pilot program established under this section, including all of the following information:(A) A description of any administrative barriers or other challenges identified by stakeholders.(B) Recommendations on legislative or policy changes needed, if any, to promote effective utilization of violence preventive services in the population served by the Medi-Cal program.(C) Recommendations on whether to expand the Medi-Cal schedule of benefits to include violence preventive services, and, if those services are a benefit under the Medi-Cal program, recommendations on which delivery system, such as fee-for-service or managed care, including a Medi-Cal managed care health plan or county mental health plan, should provide those services.(m) This section shall become inoperative five calendar years following the date upon which violence preventive services described in this section are able to be provided and billed pursuant to this section.(n) The department shall post on its internet website the date upon which violence preventive services described in this section are able to be provided and billed pursuant to this section.(o) The following definitions apply for purposes of this section:(1) Prevention professional has the same meaning as defined by the National Uniform Claim Committee (NUCC) under NUCC Code Number 405300000X or its successor.(2) Qualified violence prevention professional means a prevention professional who renders violence preventive services.(3) Violence preventive services means evidence-based, trauma-informed, supportive, culturally responsive, and nonpsychotherapeutic services provided by a prevention professional, who works in collaboration with other care providers and community partners, for the purpose of promoting improved health outcomes and positive behavioral change, preventing injury recidivism, and reducing the likelihood that violently injured individuals will commit or promote violence themselves.
62+14134.3. (a) (1) The Legislature finds that people who have been violently injured are substantially more likely to be violently reinjured, and to engage in behaviors, as part of a cycle of community violence, trauma, and retaliation, that also substantially increase their own risk of violent reinjury.(2) It is the intent of the Legislature that the State Department of Health Care Services develop and implement services targeted at reducing injury recidivism among violently injured Medi-Cal beneficiaries, and provide direct reimbursement to qualified violence prevention professionals for violence preventive services in accordance with this section.(b) No later than January 1, 2021, the department shall establish a violence intervention pilot program that is hospital-based or hospital-linked. The pilot program shall be established at a minimum of nine sites, and at least one site shall be located in each of the following counties:(1) Alameda.(2) Contra Costa.(3) Los Angeles.(4) Monterey.(5) Sacramento.(6) San Bernardino.(7) San Francisco.(8) Santa Clara.(9) Ventura.(c) For the purposes of establishing the pilot program, the department shall consult with stakeholders, including, but not limited to, professionals in the community violence intervention field, hospital-linked and hospital-based violence intervention programs, and health care professionals working with hospital-linked and hospital-based violence intervention programs.(d) Under the pilot program, the department shall provide violence preventive services that are rendered by a qualified violence prevention professional to a Medi-Cal beneficiary who meets both of the following conditions:(1) The beneficiary has received medical treatment for a violent injury, including, but not limited to, a gunshot wound, stabbing injury, or any other form of violent injury.(2) A licensed health care provider has determined that the beneficiary is at elevated risk of violent reinjury or retaliation and has referred the beneficiary to participate in a violence preventive services program.(e) Violence preventive services, as defined in paragraph (3) of subdivision (o), that are provided by a qualified violence prevention professional through the Medi-Cal program shall be offered to an eligible Medi-Cal beneficiary for a minimum of three months and a maximum of 12 months. These services shall be rendered within and outside the clinical setting, and shall include all of the following components:(1) Targeted case management and care Care coordination to support the recovery of a violently injured patient.(2) Home and community visitation after discharge to provide patient education, neighborhood mapping of community resources, referrals or screenings for substance abuse, behavioral health, or any additional risk reduction resources to support injury recovery and reduce injury recidivism.(3) Peer support services, including, but not limited to, counseling, mentorship, conflict mediation, and crisis intervention.(f) A qualified violence prevention professional, as defined in paragraph (2) of subdivision (o), shall meet all of the following conditions:(1) Possesses at least six months of full-time equivalent experience in providing violence preventive services through employment, volunteer work, or as part of an internship experience.(2) Has successfully completed an accredited training and certification program for violence prevention professionals, in accordance with subdivision (g), or has been certified as a violence prevention professional by the National Network of Hospital-Based Violence Intervention Programs prior to January 1, 2021.(3) Successfully completes at least four hours of continuing education annually in the field of violence preventive services.(4) Satisfies any other requirements necessary to maintain certification as a violence prevention professional.(g) The department shall approve one or more training and certification programs for violence prevention professionals, which shall include at least 35 hours of training that collectively addresses all of the following:(1) The profound effects of trauma and violence and the basics of trauma-informed care.(2) Violence prevention strategies, including, but not limited to, conflict mediation and retaliation prevention related to community violence.(3) Case management and advocacy Care coordination and patient support practices.(4) Patient privacy and the federal Health Insurance Portability and Accountability Act of 1996.(h) An entity that employs or contracts with a qualified violence prevention professional to provide violence preventive services shall do both of the following:(1) Maintain documentation that the qualified violence prevention professional has met all of the conditions described in subdivision (f).(2) Ensure that the qualified violence prevention professional is providing violence preventive services consistent with the requirements specified in subdivision (e).(i) The department shall seek any federal approvals necessary to implement this section, including, but not limited to, any state plan amendments or federal waivers by the federal Centers for Medicare and Medicaid Services.(j) This section shall be implemented only to the extent that federal financial participation is available and not otherwise jeopardized, and any necessary federal approvals have been obtained.(k) This section does not alter the scope of practice for any health care professional nor authorizes the delivery of health care services in a setting or in a manner that is not authorized under any provision of the Business and Professions Code or the Health and Safety Code.(l) At least one calendar year prior to the inoperative date of this section pursuant to subdivision (m), the 0;">(A) Data available from the Medi-Cal program related to claims and other available data sources on the incidence of violent injury and reinjury among individuals receiving violence preventive services.(B) Data and analysis from published, peer-reviewed evaluations of violence intervention sites implemented pursuant to this section.(7) A comparison of the outcomes of the violence intervention pilot program implemented pursuant to this section to the outcomes of other substantially similar violence preventive service programs that have been published in peer-reviewed evaluations.(8) Recommendations on how to improve implementation of the pilot program established under this section, including all of the following information:(A) A description of any administrative barriers or other challenges identified by stakeholders.(B) Recommendations on legislative or policy changes needed, if any, to promote effective utilization of violence preventive services in the population served by the Medi-Cal program.(C) Recommendations on whether to expand the Medi-Cal schedule of benefits to include violence preventive services, and, if those services are a benefit under the Medi-Cal program, recommendations on which delivery system, such as fee-for-service or managed care, including a Medi-Cal managed care health plan or county mental health plan, should provide those services.(m) This section shall become inoperative five calendar years following the date upon which violence preventive services described in this section are able to be provided and billed pursuant to this section.(n) The department shall post on its internet website the date upon which violence preventive services described in this section are able to be provided and billed pursuant to this section.(o) The following definitions apply for purposes of this section:(1) Prevention professional has the same meaning as defined by the National Uniform Claim Committee (NUCC) under NUCC Code Number 405300000X or its successor.(2) Qualified violence prevention professional means a prevention professional who renders violence preventive services.(3) Violence preventive services means evidence-based, trauma-informed, supportive, culturally responsive, and nonpsychotherapeutic services provided by a prevention professional, who works in collaboration with other care providers and community partners, for the purpose of promoting improved health outcomes and positive behavioral change, preventing injury recidivism, and reducing the likelihood that violently injured individuals will commit or promote violence themselves.
6663
6764
6865
6966 14134.3. (a) (1) The Legislature finds that people who have been violently injured are substantially more likely to be violently reinjured, and to engage in behaviors, as part of a cycle of community violence, trauma, and retaliation, that also substantially increase their own risk of violent reinjury.
7067
7168 (2) It is the intent of the Legislature that the State Department of Health Care Services develop and implement services targeted at reducing injury recidivism among violently injured Medi-Cal beneficiaries, and provide direct reimbursement to qualified violence prevention professionals for violence preventive services in accordance with this section.
7269
7370 (b) No later than January 1, 2021, the department shall establish a violence intervention pilot program that is hospital-based or hospital-linked. The pilot program shall be established at a minimum of nine sites, and at least one site shall be located in each of the following counties:
7471
7572 (1) Alameda.
7673
7774 (2) Contra Costa.
7875
7976 (3) Los Angeles.
8077
8178 (4) Monterey.
8279
8380 (5) Sacramento.
8481
8582 (6) San Bernardino.
8683
8784 (7) San Francisco.
8885
8986 (8) Santa Clara.
9087
9188 (9) Ventura.
9289
9390 (c) For the purposes of establishing the pilot program, the department shall consult with stakeholders, including, but not limited to, professionals in the community violence intervention field, hospital-linked and hospital-based violence intervention programs, and health care professionals working with hospital-linked and hospital-based violence intervention programs.
9491
9592 (d) Under the pilot program, the department shall provide violence preventive services that are rendered by a qualified violence prevention professional to a Medi-Cal beneficiary who meets both of the following conditions:
9693
9794 (1) The beneficiary has received medical treatment for a violent injury, including, but not limited to, a gunshot wound, stabbing injury, or any other form of violent injury.
9895
9996 (2) A licensed health care provider has determined that the beneficiary is at elevated risk of violent reinjury or retaliation and has referred the beneficiary to participate in a violence preventive services program.
10097
10198 (e) Violence preventive services, as defined in paragraph (3) of subdivision (o), that are provided by a qualified violence prevention professional through the Medi-Cal program shall be offered to an eligible Medi-Cal beneficiary for a minimum of three months and a maximum of 12 months. These services shall be rendered within and outside the clinical setting, and shall include all of the following components:
10299
103-(1) Care coordination to support the recovery of a violently injured patient.
100+(1) Targeted case management and care Care coordination to support the recovery of a violently injured patient.
104101
105-(2) Home and community visitation after discharge to provide patient education, neighborhood mapping of community resources, referrals for substance abuse, behavioral health, or any additional risk reduction resources to support injury recovery and reduce injury recidivism.
102+(2) Home and community visitation after discharge to provide patient education, neighborhood mapping of community resources, referrals or screenings for substance abuse, behavioral health, or any additional risk reduction resources to support injury recovery and reduce injury recidivism.
106103
107-(3) Peer support services, including, but not limited to, mentorship, conflict mediation, and crisis intervention.
104+(3) Peer support services, including, but not limited to, counseling, mentorship, conflict mediation, and crisis intervention.
108105
109106 (f) A qualified violence prevention professional, as defined in paragraph (2) of subdivision (o), shall meet all of the following conditions:
110107
111108 (1) Possesses at least six months of full-time equivalent experience in providing violence preventive services through employment, volunteer work, or as part of an internship experience.
112109
113110 (2) Has successfully completed an accredited training and certification program for violence prevention professionals, in accordance with subdivision (g), or has been certified as a violence prevention professional by the National Network of Hospital-Based Violence Intervention Programs prior to January 1, 2021.
114111
115112 (3) Successfully completes at least four hours of continuing education annually in the field of violence preventive services.
116113
117114 (4) Satisfies any other requirements necessary to maintain certification as a violence prevention professional.
118115
119116 (g) The department shall approve one or more training and certification programs for violence prevention professionals, which shall include at least 35 hours of training that collectively addresses all of the following:
120117
121118 (1) The profound effects of trauma and violence and the basics of trauma-informed care.
122119
123120 (2) Violence prevention strategies, including, but not limited to, conflict mediation and retaliation prevention related to community violence.
124121
125-(3) Care coordination and patient support practices.
122+(3) Case management and advocacy Care coordination and patient support practices.
126123
127124 (4) Patient privacy and the federal Health Insurance Portability and Accountability Act of 1996.
128125
129126 (h) An entity that employs or contracts with a qualified violence prevention professional to provide violence preventive services shall do both of the following:
130127
131128 (1) Maintain documentation that the qualified violence prevention professional has met all of the conditions described in subdivision (f).
132129
133130 (2) Ensure that the qualified violence prevention professional is providing violence preventive services consistent with the requirements specified in subdivision (e).
134131
135132 (i) The department shall seek any federal approvals necessary to implement this section, including, but not limited to, any state plan amendments or federal waivers by the federal Centers for Medicare and Medicaid Services.
136133
137134 (j) This section shall be implemented only to the extent that federal financial participation is available and not otherwise jeopardized, and any necessary federal approvals have been obtained.
138135
139136 (k) This section does not alter the scope of practice for any health care professional nor authorizes the delivery of health care services in a setting or in a manner that is not authorized under any provision of the Business and Professions Code or the Health and Safety Code.
140137
141-(l) At least one calendar year prior to the inoperative date of this section pursuant to subdivision (m), the department shall issue a report to the Legislature, in compliance with Section 9795 of the Government Code, on the implementation of the violence intervention pilot program established under this section, and the demonstrated impact of violence preventive services. The report shall, at a minimum, include all of the following:
142-
143-(1) The number of individuals receiving violence preventive services pursuant to this section.
144-
145-(2) The number of individuals providing violence preventive services pursuant to this section.
146-
147-(3) Expenditures, in aggregate and per person, in providing services pursuant to this section.
148-
149-(4) A description of the types of services provided and the locations where those services were provided.
150-
151-(5) The number and types of accrediting bodies for violence preventive services and the number and names of violence preventive services training programs providing training pursuant to this section.
152-
153-(6) An analysis on whether violence intervention sites implemented pursuant to this section have reduced the incidence of risk factors for violent injury and reinjury among individuals receiving violence preventive services. The analysis shall consider all of the following:
154-
155-(A) Data available from the Medi-Cal program related to claims and other available data sources on the incidence of violent injury and reinjury among individuals receiving violence preventive services.
138+(l) At least one calendar year prior to the inoperative date of this section pursuant to subdivision (m), the 0;">(A) Data available from the Medi-Cal program related to claims and other available data sources on the incidence of violent injury and reinjury among individuals receiving violence preventive services.
156139
157140 (B) Data and analysis from published, peer-reviewed evaluations of violence intervention sites implemented pursuant to this section.
158141
159142 (7) A comparison of the outcomes of the violence intervention pilot program implemented pursuant to this section to the outcomes of other substantially similar violence preventive service programs that have been published in peer-reviewed evaluations.
160143
161144 (8) Recommendations on how to improve implementation of the pilot program established under this section, including all of the following information:
162145
163146 (A) A description of any administrative barriers or other challenges identified by stakeholders.
164147
165148 (B) Recommendations on legislative or policy changes needed, if any, to promote effective utilization of violence preventive services in the population served by the Medi-Cal program.
166149
167150 (C) Recommendations on whether to expand the Medi-Cal schedule of benefits to include violence preventive services, and, if those services are a benefit under the Medi-Cal program, recommendations on which delivery system, such as fee-for-service or managed care, including a Medi-Cal managed care health plan or county mental health plan, should provide those services.
168151
169152 (m) This section shall become inoperative five calendar years following the date upon which violence preventive services described in this section are able to be provided and billed pursuant to this section.
170153
171154 (n) The department shall post on its internet website the date upon which violence preventive services described in this section are able to be provided and billed pursuant to this section.
172155
173156 (o) The following definitions apply for purposes of this section:
174157
175158 (1) Prevention professional has the same meaning as defined by the National Uniform Claim Committee (NUCC) under NUCC Code Number 405300000X or its successor.
176159
177160 (2) Qualified violence prevention professional means a prevention professional who renders violence preventive services.
178161
179162 (3) Violence preventive services means evidence-based, trauma-informed, supportive, culturally responsive, and nonpsychotherapeutic services provided by a prevention professional, who works in collaboration with other care providers and community partners, for the purpose of promoting improved health outcomes and positive behavioral change, preventing injury recidivism, and reducing the likelihood that violently injured individuals will commit or promote violence themselves.