14707.7.
(a) It is the intent of the Legislature to build upon performance outcomes system reports the department has developed pursuant to Section 14707.5 and the Special Terms and Conditions of the Medi-Cal Specialty Mental Health Services Waiver, as approved pursuant to Section 1915(b) of the federal Social Security Act (42 U.S.C. Sec. 1396n(b)), in order to provide data to inform strategies to increase access to mental health services and to reduce mental health disparities.(b) (1) Commencing no later than January 15, 2018, and as needed thereafter, the department shall consult with stakeholders, including, but not limited to, subject matter experts who represent
providers, consumer advocates, consumers, family members, counties, Medi-Cal managed care plans, and the Legislature, to inform the updates to the performance outcomes reports for specialty mental health that the department developed pursuant to Section 14707.5 and the Special Terms and Conditions of the Medi-Cal Specialty Mental Health Services Waiver. The stakeholder consultation shall continuously inform the development of performance outcome and disparities reduction measures.
(2) In building upon the performance outcomes reports for specialty mental health services, the department shall also consider all of the following objectives, among others:
(A) High-quality,
culturally and linguistically competent, and accessible specialty mental health services for all eligible beneficiaries, consistent with federal law.
(B) Strategies to reduce mental health disparities.
(C) Strategies to reduce suicide rates, and to reduce the amount of populations with low treatment prevalence rates.
(3) The performance outcomes reports for specialty mental health services shall also consider the Special Terms and Conditions of the Medi-Cal Specialty Mental Health Services Waiver, as approved pursuant to Section 1915(b) of the federal Social Security Act (42 U.S.C. Sec. 1396n(b)) and the Medicaid Managed Care Quality Rating System.
(4) In
order to identify mental health disparities, at a minimum, the performance outcomes reports for specialty mental health services shall be produced using existing data collected by the state, stratified by both the statewide and county levels in the following areas:
(A) Access, such as timely access to services, including waiting time to assessment and waiting time to first appointment.
(B) Language capacity and language access.
(C) Quality, including outcomes and patient experience.
(D) Utilization by service type and penetration.
(E) Grievance and appeals.
(5) (A) Data required pursuant to paragraph (4) shall be stratified by age, sex, gender identity, race, ethnicity, primary language, sexual orientation, and any other data elements for which there is peer-reviewed evidence to assess performance outcomes related to mental health disparities.
(B) The department shall not report any demographic data under
paragraph (4) or this paragraph that would permit identification of individuals.
(6) (A) The department shall publish the performance outcomes reports based on available data for specialty mental health services described in this section on the department’s internet website by December 31, 2018. The department shall also provide the performance outcomes reports to the Legislature by December 31, 2018.
(B) Commencing January 1, 2019, and annually thereafter, the department shall update the performance outcomes reports for specialty mental health services and shall post the updated reports on the department’s internet website.
(7) Commencing January 1, 2019, the department shall
consult, as needed, with the stakeholders specified in paragraph (1) to do both of the following:
(A) Incorporate additional components into the performance outcomes reports, stratified by statewide, county, county- or department-approved reporting unit, and plan levels, including, but not limited to, components concerning the reduction of mental health disparities, such as timely access to services, language access, and quality and utilization measures, relating to mental health services obtained through Medi-Cal managed care plans.
(B) Make recommendations for statewide quality improvement and efforts to
reduce mental health disparities based on information reported in the performance outcomes reports.
(8) Upon completion of the activities specified in paragraph (7), the department shall consult with stakeholders on an as-needed basis.
(c)Commencing January 1, 2021, and annually thereafter, the department shall update the performance dashboard to include the Healthcare Effectiveness Data and Information Set measures and Consumer Assessment of Healthcare Providers and Systems measures, as reported by Medi-Cal managed care health plans, stratified by individuals who are diagnosed with severe mental illness.
(c) (1) It is the intent of the Legislature to monitor the performance of Medi-Cal managed care plans in providing medically necessary covered services to Medi-Cal beneficiaries who are adults with a serious mental illness and children and adolescents with a serious emotional disturbance.
(2) By January 1, 2021, and as needed thereafter, the department, in consultation with county mental health plans, Medi-Cal managed care plans, and advocates for Medi-Cal beneficiaries, shall select performance measures that enable a comparison of the following:
(A) Medi-Cal managed care plan performance in treating individuals who are enrolled in that managed care plan to individuals who are enrolled in that managed care plan and who are also receiving specialty mental health services from a county mental health
plan.
(B) The performance of each Medi-Cal managed care plan in the performance measures described in subparagraph (A), as compared to other plans.
(3) In selecting the measures, the department shall include measures that are based on administrative and clinical data, and not solely based on encounter data. The department shall also consider co-morbidities that result in lower life expectancies for adults with a serious mental illness and children and adolescents with a serious emotional disturbance.
(4) By January 1, 2022, and annually thereafter, the department shall report the measures selected pursuant to paragraph (2) on the Medi-Cal managed care plan performance dashboard.
(d) (1) Commencing January
February 1, 2021, and annually thereafter, each county mental health plan and each Medi-Cal managed care health
plan shall track and report to the department all of the following information, information regarding individuals referred from one plan to the other plan, stratified by county county- or department-approved reporting unit, if county level data is
are unavailable:
(A) The number of referrals from one plan to the other plan.
(B) The mean and median time from the date of first contact with the plan to request services made by or on behalf of the enrollee to the date of first offer of any mental health service covered by the plan.
(C) The number and percentage of requests for appointment assistance made by enrollees to the respective plan for mental health service that resulted in the enrollee being offered the requested service within the timeframes for offering an appointment for urgent and nonurgent mental health services established pursuant to subdivision (d) of Section 14197.
(2) The department shall make the information described in paragraph (1) publicly available on its internet website.
(e) Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may implement, interpret, or make specific this subdivision by means of all-county letters, plan letters, plan or provider bulletins, or similar instructions, without taking regulatory action.