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Implementation of the Provisions in Senate Bill SB 785

2. Topics. Overview of Out-of-County Issues Intent of SB 785SB 785 WorkgroupOverview of 785Impact of SB 785 on:Service AuthorizationFoster CareAdoption Assistance Program (AAP)Kinship Guardianship Assistance Payment Program (KinGAP)Standardized Documents and ContractAB 3632. . 3. Over

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Implementation of the Provisions in Senate Bill SB 785

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    1. 1 Implementation of the Provisions in Senate Bill (SB) 785

    2. 2 Topics Overview of Out-of-County Issues Intent of SB 785 SB 785 Workgroup Overview of 785 Impact of SB 785 on: Service Authorization Foster Care Adoption Assistance Program (AAP) Kinship Guardianship Assistance Payment Program (KinGAP) Standardized Documents and Contract AB 3632

    3. 3 Overview of Out-of-County Issues Children in foster care, AAP, and KinGAP, when placed outside their county of origin, have been unable to receive timely access to specialty mental health services. Changes to the law were enacted to improve timely access to specialty mental health care for these children. SB 745 (Chapter 811, Statutes of 2000) added Section 5777.6 to Welfare and Institutions Code (W&IC) requiring local mental health plans (MHPs) to establish a procedure to ensure access to outpatient specialty mental health services for foster care children placed outside their county of origin.

    4. 4 Intent of SB 785 The provisions of SB 785 are intended to facilitate the timely receipt of medically necessary specialty mental health services for foster, AAP, and KinGAP children who are residing outside their county of origin through collaboration between California Department of Mental Health (DMH) and stakeholders in the development of: Standardized contract Standardized documentation procedures and forms Informing materials for foster care providers

    5. 5 SB 785 Workgroup The Stakeholders Workgroup included: California Mental Health Directors Association (CMHDA) County Welfare Directors Association (CWDA) California Alliance of Child and Family Services Child and Family Policy Institute California Institute of Mental Health (CIMH) California Department of Social Services (CDSS) California Department of Mental Health (DMH)

    6. 6 Overview of SB 785 SB 785 (Chapter 469, Statues of 2007) added the following to W&IC : 5777.7-requires: The collaborative efforts of DMH and stakeholders in the development of a standardized contract, authorization procedure, documentation standards and forms, and informing materials for foster care providers. The standardized contract, authorization procedure, and documents be considered complete so that no additional documents are required. Organizational providers already certified by a MHP not require additional certification by the childs county of origin MHP. The standardized contract, or other mechanism of payment, (if a contract is not required) to be completed within 30 days of an approval.

    7. 7 Overview of SB 785 (Continued) 11376-requires: The county of residence of the legal guardian, to be responsible for the provision of specialty mental health services for KinGAP children/youth and the submission of the treatment authorization request (TAR). In accordance with CCR Section, 1830.220(b)(4), the MHP in the childs county of origin is still required to: Make an authorization decision (approve or deny services) within 3 working days following the date of receipt of the service authorization request (SAR), aka TAR, from the public or private provider. Notify the MHP in the childs county of residence and the requesting provider of the authorization decision within 3 working days following the date of receipt of the SAR/TAR. Request additional information, not submitted with the initial request, if necessary, and make an authorization decision within 3 working days from the date the additional information is received, or 14 calendar days from the receipt of the original SAR/TAR, whichever is less.

    8. 8 Overview of SB 785 (Continued) 16125-requires : The county of residence of the adoptive parent to be responsible for the provision of specialty mental health services for adopted children/youth and the submission of the SAR/TAR. In accordance with CCR Section 1830.220(b)(4), the MHP in the childs county of origin is still required to: Make an authorization decision (approve or deny services) within 3 working days following the date of receipt of the SAR/TAR from the public or private provider. Notify the MHP in the childs county of residence and the requesting provider of the authorization decision within 3 working days following the date of receipt of the SAR/TAR. Request additional information, not submitted with the initial request, if necessary, and make an authorization decision within 3 working days from the date the additional information is received, or 14 calendar days from the receipt of the original SAR/TAR, whichever is less.

    9. 9 Impact of SB 785 on Service Authorization: Pursuant to Title 9, CCR Section 1830.220(b)(4), for all Medi-Cal beneficiaries in out-of-county placements, regardless of the payment mechanism, the MHP in the childs county of origin is still required to: Make an authorization decision (approve or deny services) within 3 working days following the date of receipt of the SAR/TAR from the public or private provider. Notify the MHP in the childs county of residence and the requesting provider of the authorization decision within 3 working days following the date of receipt of the SAR/TAR. Request additional information, not submitted with the initial request, if necessary, and make an authorization decision within 3 working days from the date the additional information is received, or 14 calendar days from the receipt of the original SAR/TAR, whichever is less.

    10. 10 Impact of SB 785 on a Medi-Cal Eligible Child in Foster Care : The MHP in the childs county of origin is responsible for providing or arranging for medically necessary specialty mental health services for children residing outside their county of origin. The MHP may utilize contract providers to fulfill this responsibility. Either a public or private provider may submit a SAR/TAR to the MHP in the childs county of origin. If the MHP in the childs county of origin requires the use of a contract as a payment mechanism, the MHP must use the standardized contract developed by DMH through the stakeholders process. In accordance with W&IC 5777.7(a)(5), the standardized contract or another mechanism of payment must be completed within 30 days of authorizing services for the child. The MHP in the childs county of origin must accept the standardized documents and forms developed by DMH through the stakeholders process.

    11. 11

    12. 12 Impact of SB 785 on a Medi-Cal Eligible Child in AAP : SB 785 transfers the responsibility for the provision of services to the county of residence MHP for the adoptive parent, while keeping the financial responsibility to authorize and pay for services with the county of origin. The MHP in the childs adoptive parents county of residence is required to: Upon verification that a parent resides in the MHPs county, provide medically necessary specialty mental health services to the child in an AAP aid code. Submit the SAR/TAR to the childs county of origin. The county of residence MHP may utilize contract private providers to fulfill its SAR/TAR submission and provision of service responsibilities. Ensure that the MHP and its providers are aware that a child in an AAP aid code living outside his or her county of origin must be served in the same way as a child living in his or her county of origin.

    13. 13 Impact of SB 785 on a Medi-Cal Eligible Child in AAP (Continued) : In accordance with CCR, Section 1830.220(b)(4), the MHP in the childs county of origin is required to: Make an authorization decision (approve or deny services) within 3 working days following the date of receipt of the SAR from the public or private provider. Notify the MHP in the childs county of residence and the requesting provider of the authorization decision within 3 working days following the date of receipt of the SAR/TAR. Request additional information, not submitted with the initial request, if necessary, and make an authorization decision within 3 working days from the date the additional information is received, or 14 calendar days from the receipt of the original SAR/TAR, whichever is less. Make payment arrangements within 30 days of the date that the MHP authorized services. The MHP in the childs county of origin must accept the standardized documents and forms developed by DMH through the stakeholders process The State General Fund (SGF) share of the claim will be sent to the MHP submitting the claim eliminating the need for the MHP in the childs county of origin to develop a reimbursement mechanism for the SGF share.

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    15. 15 Impact of SB 785 on a Medi-Cal Eligible Child in KinGAP : SB 785 transfers the responsibility for the provision of services to the county of residence MHP for the legal guardian, while keeping the financial responsibility to authorize and pay for services with the county of origin. The MHP in the childs legal guardians county of residence is required to: Upon verification that a guardian resides in the MHPs county, provide medically necessary specialty mental health services to the child in a KinGAP aid code. Submit a SAR/ TAR to the childs county of origin. The county of residence MHP may utilize contract private providers to fulfill its SAR/TAR submission and provision of service responsibilities. Ensure that the MHP and its providers are aware that a child in a KinGAP aid code living outside his or her county of origin must be served in the same way as a child living in his or her county of origin.

    16. 16 Impact of SB 785 on a Medi-Cal Eligible Child in KinGAP (Continued): In accordance with CCR, Section 1830.220(b)(4), the MHP in the childs county of origin is required to: Make an authorization decision (approve or deny services) within 3 working days following the date of receipt of the SAR from the public or private provider. Notify the MHP in the childs county of residence and the requesting provider of the authorization decision within 3 working days following the date of receipt of the SAR/TAR. Request additional information, not submitted with the initial request, if necessary, and make an authorization decision within 3 working days from the date the additional information is received, or 14 calendar days from the receipt of the original SAR/TAR, whichever is less. Make payment arrangements within 30 days of the date that the MHP authorized services. The MHP in the childs county of origin must accept the standardized documents and forms developed by DMH through the stakeholders process.

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    18. 18 Summary of AAP and Kin-GAP Out-of-County Placements (with a residential placement)

    19. 19 Organizational Provider Agreement (Contract) Client Assessment Client Plan Service Authorization Request (aka Treatment Authorization Request) Client Assessment Update Progress Notes Day Treatment Intensive Services Progress Notes Day Rehabilitation Services

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    21. 21 AB 3632 Medi-Cal Eligible Child SB 785 does not change existing statute governing the Special Education Pupils Program (AB 3632). County mental health agencies responsibilities, as specified in Sections 7570 et seq. of Chapter 26.5 of the California Government Code and Sections 60000 et seq. of Title 2 of the California Code of Regulations, related to the provision of mental health services to pupils in special education, remain the same. Important note: Pursuant to Section 60040(g) of Title 2 of the CCR, for the purposes of the AB 3632 program If the community mental health service receives a referral for a pupil with a different county of origin, the community mental health service receiving the referral shall forward the referral within one (1) working day to the county of origin, which shall have programmatic and fiscal responsibility for providing or arranging for the provision of necessary services. The procedures prescribed in this subsection shall not delay or impede the referral and assessment process.

    22. 22 Contact DMH County Technical Assistance Section http://www.dmh.ca.gov/Services_and_Programs/Local_ Program_Support/County_Technical_Assistance.asp (The link provides a list of the staff and their assigned counties.)

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