Medi-Cal managed care plans: mental health benefits.

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 through various delivery systems, including fee-for-service and managed care. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Existing law requires a Medi-Cal managed care plan to provide mental health benefits covered in the state plan, excluding those benefits provided by county mental health plans under the Specialty Mental Health Services Waiver. Under existing law, nonspecialty mental health services covered by a Medi-Cal managed care plan include, among other things, individual and group mental health evaluation and treatment, psychological testing, and psychiatric consultation, as specified. This bill would require a Medi-Cal managed care plan, no later than January 1, 2025, to conduct annual outreach and education for its enrollees, based on a plan that the Medi-Cal managed care plan develops and submits to the department, as specified, regarding the mental health benefits that are covered by the Medi-Cal managed care plan. The bill would require a Medi-Cal managed care plan to also conduct annual outreach and education, based on a plan that it develops, to inform primary care providers regarding those mental health benefits. The bill would require that the outreach and education plan for the enrollees be informed by stakeholder engagement, the Medi-Cal managed care plan's Population Needs Assessment, and a utilization assessment, as specified, and that the plan meet cultural and linguistic appropriateness standards and incorporate best practices in stigma reduction. The bill would require the department to review the new or updated outreach and education plan and to approve or modify it within 180 calendar days since submission to ensure specified conditions are met, and to consult with stakeholders to develop the standards for the review and approval. The bill would condition implementation of the outreach and education plan on the department's approval. The bill would require each Medi-Cal managed care plan to publicly post, on its internet website and in an accessible manner, its approved outreach and education plan and its utilization assessment, as specified. The bill would require the department, once every 3 years, to assess enrollee experience with mental health benefits covered by Medi-Cal managed care plans, as specified. The bill would require the department, no later than January 1, 2025, to adopt survey tools and methodologies relating to the assessment of consumer experience, including best practice methods for data collection and reporting, as specified. The bill would require the department to publish reports, commencing with a report in April 2026 and once every 3 years thereafter, on its internet website on consumer experience with mental health benefits covered by Medi-Cal managed care plans. The bill would require the reports to include plan-by-plan data, provide granularity for subpopulations, address inequities based on key demographic factors, and provide recommendations, as specified. The bill would authorize the department to implement these provisions through all-county letters or similar guidance, until any necessary regulations are adopted. The bill would authorize the department to enter into exclusive or nonexclusive contracts, or amend existing contracts, on a bid or negotiated basis, with specified contracting-related exemptions.