Medi-Cal: mental health.

Existing law provides for the Medi-Cal program, administered by the State Department of Health Care Services, under which qualified low-income persons are provided with health care services, including mental health services. The Medi-Cal program is partially governed and funded under federal Medicaid provisions. Under existing law, the State Department of Mental Health (department) is required to provide specialty mental health services for Medi-Cal recipients through fee-for-service or capitated contracts with mental health plans (MHPs) . The department establishes standards, guidelines, and reimbursement amounts for specialty mental health services based on the federal Medicaid requirements. Existing law requires counties to certify that required matching funds are available prior to the reimbursement of federal funds. This bill, commencing July 1, 2012, would require the standards, guidelines, and reimbursement amounts to be consistent with federal Medicaid requirements, as specified in the approved Medicaid state plan and waivers. The bill would also require counties to certify that certified public expenditures have been incurred prior to reimbursement of federal funds. The bill would, if the reimbursement methodology utilizes federal upper payment limits and the total cost of services exceeds the state maximum rates in effect for the 2011–12 fiscal year, require a county that chooses to claim costs that exceed the state maximum rates with certified public expenditures, to use only local funds, and not state funds, to claim the portion of the costs over the state maximum rates and to enter into and maintain a contract with the department so specifying. Existing law establishes procedures, including reimbursement and claiming procedures, reviews and oversight, and appeal processes for MHPs and MHP subcontractors. The bill, commencing July 1, 2012, also would require claims for reimbursement for service to be submitted by MHPs within the timeframes required by federal Medicaid requirements and the approved Medicaid state plan and waivers. Existing law requires the State Department of Health Care Services and the State Department of Mental Health to jointly develop a new ratesetting methodology for reimbursements for direct client services that meets specified requirements, including that administrative costs be claimed separately and limited to 15% of the total cost of direct client services. This bill, commencing July 1, 2012, would instead require the development of a reimbursement methodology, in consultation with the California Mental Health Directors Association, that is consistent with federal Medicaid requirements and the approved Medicaid state plan and waivers.