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<ns0:ActionText>INTRODUCED</ns0:ActionText>
<ns0:ActionDate>2026-02-20</ns0:ActionDate>
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<ns0:ActionDate>2026-03-19</ns0:ActionDate>
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<ns0:AuthorText authorType="LEAD_AUTHOR">Introduced by Assembly Member Addis</ns0:AuthorText>
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<ns0:Name>Addis</ns0:Name>
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<ns0:Title> An act to add Section 5961.41 to the Welfare and Institutions Code, relating to behavioral health.</ns0:Title>
<ns0:RelatingClause>behavioral health</ns0:RelatingClause>
<ns0:GeneralSubject>
<ns0:Subject>Statewide Fee Schedule Pilot Program.</ns0:Subject>
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<html:p>Existing law establishes the Children and Youth Behavioral Health Initiative, administered by the California Health and Human Services Agency and its departments, as applicable. Under existing law, the purpose of the initiative is to transform the state’s behavioral health system into an innovative ecosystem in which all children and youth 25 years of age and younger, regardless of payer, are screened, supported, and served for emerging and existing behavioral health needs.</html:p>
<html:p>Existing law requires, as a part of the initiative, the State Department of Health Care Services to develop and maintain a school-linked statewide fee schedule for outpatient mental health or substance use disorder treatment provided to a student who is 25 years of age or younger at a
schoolsite. Existing law requires providers of medically necessary schoolsite services to be reimbursed by health care service plans, insurers, and Medi-Cal managed care plans, at a minimum, at the fee schedule rate or rates, regardless of network provider status. </html:p>
<html:p>This bill would establish the Statewide Fee Schedule Pilot Program. The bill would require the pilot lead, the Monterey County Office of Education, in coordination with the State Department of Health Care Services, to, no later than April 1, 2027, select 25 entities to participate in the pilot program and prioritize certain applicants, including, among others, applicants who will increase the number of transition-age youth receiving behavioral health services. The bill would require the pilot lead, starting no later than April 1, 2027, and ending no earlier than July 1, 2030, to provide intensive
technical assistance and support to the participating entities in participating in the school-linked statewide fee schedule, including technical assistance and support with specified activities, including, among others, providing training and coaching for behavioral health service providers related to documentation of services, proper coding and noting procedures, obtaining required consents, applicable privacy laws and disclosure requirements, and referral protocols. The bill would require the pilot lead to submit a progress report by January 1, 2028, and submit a summative report by January 1, 2031, regarding the pilot program to the appropriate policy and fiscal committees of the Legislature. The bill would require the State Department of Education, upon appropriation and subject to the terms of the appropriation, allocate funds the pilot lead to administer the pilot program. By requiring the Monterey County Office of Education to serve as the pilot lead, this bill would impose a state-mandated local
program.</html:p>
<html:p>The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.</html:p>
<html:p>This bill would provide that, if the Commission on State Mandates determines that the bill contains costs mandated by the state, reimbursement for those costs shall be made pursuant to the statutory provisions noted above.</html:p>
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<ns0:Preamble>The people of the State of California do enact as follows:</ns0:Preamble>
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<ns0:Num>SECTION 1.</ns0:Num>
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Section 5961.41 is added to the
<ns0:DocName>Welfare and Institutions Code</ns0:DocName>
,
<ns0:Positioning>immediately following Section 5961.4</ns0:Positioning>
, to read:
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<html:p>
(a)
<html:span class="EnSpace"/>
The Statewide Fee Schedule Pilot Program is hereby established for all for the following purposes:
</html:p>
<html:p>
(1)
<html:span class="EnSpace"/>
To address inconsistent access to the statewide fee schedule, established pursuant to Section 5961.4, caused by the limited capacity and expertise of small and rural schools, early learning and care providers, and institutions of higher education serving transition-age youth in billing for behavioral health claims.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
To increase the number of behavioral health services provided to children who are 0 to 5 years of age, students attending small and rural schools, and transition-age youth.
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
To reduce the
burden of participating in the school-linked statewide fee schedule for entities providing behavioral health services to under-served communities and groups.
</html:p>
<html:p>
(b)
<html:span class="EnSpace"/>
(1)
<html:span class="EnSpace"/>
No later than April 1, 2027, the pilot lead, in coordination with the State Department of Health Care Services, shall select 25 entities to participate in the pilot program for up to three years. When selecting pilot participants, the pilot lead shall prioritize applicants who will do one or more of the following:
</html:p>
<html:p>
(A)
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Increase the number of children 0 to 5 years of age receiving behavioral health services.
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
Increase the number of transition-age youth 16 to 25 years of age receiving behavioral health services.
</html:p>
<html:p>
(C)
<html:span class="EnSpace"/>
Increase the number of children and youth enrolled in
small school districts, as defined in Section 17078.35 of the Education Code, that receive behavioral health services.
</html:p>
<html:p>
(D)
<html:span class="EnSpace"/>
Increase the number and amount of statewide fee schedule reimbursements.
</html:p>
<html:p>
(E)
<html:span class="EnSpace"/>
Increase the number and amount of statewide fee schedule reimbursements being utilized to support community schools established pursuant to Section 8902 of the Education Code.
</html:p>
<html:p>
(F)
<html:span class="EnSpace"/>
Provide diverse representation of communities and geographic areas throughout the state.
</html:p>
<html:p>
(G)
<html:span class="EnSpace"/>
Operate in communities with higher proportions of unduplicated students, as defined in subdivision (b) of Section 42238.02 of the Education Code.
</html:p>
<html:p>
(H)
<html:span class="EnSpace"/>
Ensure behavioral health service providers have past experience, and
specialize in, serving children and youth of the age that the entity intends to serve.
</html:p>
<html:p>
(2)
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The pilot lead shall create and publish a brief application for entities interested in participating in the pilot program by February 1, 2027. The application shall request, at a minimum, all of the following information:
</html:p>
<html:p>
(A)
<html:span class="EnSpace"/>
The number and age of children and youth currently enrolled at the entity.
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
The number and age of children and youth currently receiving behavioral health services from the entity or an affiliated provider that the entity has designated.
</html:p>
<html:p>
(C)
<html:span class="EnSpace"/>
The number and qualifications of behavioral health service providers, including affiliated providers, currently offering behavioral health services to children and youth enrolled at the entity.
</html:p>
<html:p>
(D)
<html:span class="EnSpace"/>
The entity’s interest in, and capacity to, increase behavioral health services to children and youth in their community.
</html:p>
<html:p>
(E)
<html:span class="EnSpace"/>
The entity’s current ability to meet the minimum qualifications required to participate in the school-linked statewide behavioral health provider network, established pursuant to Section 5961.4, and the completed fee schedule cohort readiness application created by the State Department of Health Care Services.
</html:p>
<html:p>
(c)
<html:span class="EnSpace"/>
Starting no later than April 1, 2027, and ending no earlier than July 1, 2030, the pilot lead shall provide intensive technical assistance and support to the entities participating in the statewide fee schedule pilot program, including, but not limited to, technical assistance and support with the following activities:
</html:p>
<html:p>
(1)
<html:span class="EnSpace"/>
Obtaining national provider identification numbers and completing the statewide fee schedule credentialing process for all employees and affiliated providers that will offer services within scope of services covered by the statewide fee schedule.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
Obtaining an easy to navigate and integrate electronic health records system that is made available to all pilot participants, at no charge, for documentation and submission of claims.
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
Assistance in determining the applicability of privacy laws, including, but not limited to, the Family Educational Rights and Privacy Act (FERPA) and the Health Insurance Portability and Accountability Act (HIPAA), to each participating entity. This may include legal and technology supports necessary to adopt the policies, documents, and forms required by applicable privacy laws, including, but not limited to, all of the
following:
</html:p>
<html:p>
(A)
<html:span class="EnSpace"/>
Consent forms, including forms to consent to services, consent to billing, consent to information sharing, and minor consent to outpatient mental health services, required pursuant to state law.
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
Notice of privacy practices documents that address the right to withhold consent, the right to withdraw consent, the right to request records, and how confidential information may be shared and utilized.
</html:p>
<html:p>
(C)
<html:span class="EnSpace"/>
Data governance policies designating each entity as HIPAA-governed, FERPA-governed or a hybrid entity.
</html:p>
<html:p>
(D)
<html:span class="EnSpace"/>
Data maintenance protocols and guidance documents for providers and administrators defining how and where to document and store information to ensure compliance with applicable privacy laws and release of information requirements,
avoid unintentional disclosure of confidential information, and protect the privacy of individuals consenting to service.
</html:p>
<html:p>
(E)
<html:span class="EnSpace"/>
Other applicable forms and protocols, including, but not limited to, authorizations for ordering and referring physicians, referral protocols, and protocols regarding maintenance of documentation for audit purposes.
</html:p>
<html:p>
(4)
<html:span class="EnSpace"/>
Providing training and coaching for behavioral health service providers related to documentation of services, proper coding and noting procedures, obtaining required consents, applicable privacy laws and disclosure requirements, and referral protocols, including escalation of services.
</html:p>
<html:p>
(5)
<html:span class="EnSpace"/>
Obtaining and maintaining health plan information for each individual receiving services, including conducting insurance discovery and follow up activities where information is absent.
</html:p>
<html:p>
(6)
<html:span class="EnSpace"/>
Review of all claims prior to submission to ensure services are appropriately coded, documented, and noted, with the goal of increasing the likelihood of submitting a clean claim.
</html:p>
<html:p>
(7)
<html:span class="EnSpace"/>
Submission of claims on the entities’ behalf, including providing assistance to the entity to resolve any potential issues or missing documentation causing the denial of a claim.
</html:p>
<html:p>
(8)
<html:span class="EnSpace"/>
The pilot lead may subcontract with additional experts, as needed, to fulfill the requirements of this subdivision.
</html:p>
<html:p>
(d)
<html:span class="EnSpace"/>
(1)
<html:span class="EnSpace"/>
By January 1, 2028, the pilot lead shall submit a report to the appropriate policy and fiscal committees of the Legislature on the progress of the statewide fee schedule pilot program in achieving the goals described in this section. The report
shall include, but not be limited to, all of the following:
</html:p>
<html:p>
(A)
<html:span class="EnSpace"/>
The number of and name of entities accepted to participate in the pilot program.
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
The number of entities that have completed the minimum qualifications required to participate in the school-linked statewide behavioral health provider network, established pursuant to Section 5961.4, and the fee schedule cohort readiness application created by the State Department of Health Care Services.
</html:p>
<html:p>
(C)
<html:span class="EnSpace"/>
The number of entities participating in the pilot program that have completed training and onboarding with an electronic health records system, and adopted required data sharing policies, privacy notices, and disclosure and release forms.
</html:p>
<html:p>
(D)
<html:span class="EnSpace"/>
The number of behavioral health service providers that have
completed the statewide fee schedule certification process, including obtaining a National Provider Identifier.
</html:p>
<html:p>
(E)
<html:span class="EnSpace"/>
The number of children and youth, disaggregated by age, that have been enrolled in an electronic health records system.
</html:p>
<html:p>
(F)
<html:span class="EnSpace"/>
The percentage of children and youth with verified health plan information in an electronic health records system and completed consent forms.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
No later than January 1, 2031, the pilot lead shall submit a summative report to the appropriate policy and fiscal committees of the Legislature on the success of the statewide fee schedule pilot program in achieving the goals described in this section. The report shall include, but not be limited to, all of the following:
</html:p>
<html:p>
(A)
<html:span class="EnSpace"/>
The number of claims submitted by pilot
participants from small and rural school districts.
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
The number of claims submitted by pilot participants for services provided to children 0 to 5 years of age, inclusive.
</html:p>
<html:p>
(C)
<html:span class="EnSpace"/>
The number of claims submitted by pilot participants for services provided to transition-age youth.
</html:p>
<html:p>
(D)
<html:span class="EnSpace"/>
The total number of claims submitted by pilot participants and the percent of claims that are approved and paid.
</html:p>
<html:p>
(E)
<html:span class="EnSpace"/>
The total value of claims submitted by pilot participants.
</html:p>
<html:p>
(F)
<html:span class="EnSpace"/>
The total number of behavioral health services providers, including affiliated providers, authorized by pilot participants to provide services.
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
A report to be
submitted pursuant to paragraph (1) or (2) shall be submitted in compliance with Section 9795 of the Government Code.
</html:p>
<html:p>
(e)
<html:span class="EnSpace"/>
The State Department of Education shall, upon appropriation by the Legislature and subject to the terms of the appropriation, allocate funds to the Monterey County Office of Education to administer the statewide fee schedule pilot program over a three year period.
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<ns0:Num>SEC. 2.</ns0:Num>
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<html:p>If the Commission on State Mandates determines that this act contains costs mandated by the state, reimbursement to local agencies and school districts for those costs shall be made pursuant to Part 7 (commencing with Section 17500) of Division 4 of Title 2 of the Government Code.</html:p>
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