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	<ns0:Description>
		<ns0:Id>20250SB__081296AMD</ns0:Id>
		<ns0:VersionNum>96</ns0:VersionNum>
		<ns0:History>
			<ns0:Action>
				<ns0:ActionText>INTRODUCED</ns0:ActionText>
				<ns0:ActionDate>2025-02-21</ns0:ActionDate>
			</ns0:Action>
			<ns0:Action>
				<ns0:ActionText>AMENDED_SENATE</ns0:ActionText>
				<ns0:ActionDate>2025-04-08</ns0:ActionDate>
			</ns0:Action>
			<ns0:Action>
				<ns0:ActionText>AMENDED_SENATE</ns0:ActionText>
				<ns0:ActionDate>2025-05-05</ns0:ActionDate>
			</ns0:Action>
			<ns0:Action>
				<ns0:ActionText>AMENDED_ASSEMBLY</ns0:ActionText>
				<ns0:ActionDate>2025-07-17</ns0:ActionDate>
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		<ns0:LegislativeInfo>
			<ns0:SessionYear>2025</ns0:SessionYear>
			<ns0:SessionNum>0</ns0:SessionNum>
			<ns0:MeasureType>SB</ns0:MeasureType>
			<ns0:MeasureNum>812</ns0:MeasureNum>
			<ns0:MeasureState>AMD</ns0:MeasureState>
		</ns0:LegislativeInfo>
		<ns0:AuthorText authorType="LEAD_AUTHOR">Introduced by Senator Allen</ns0:AuthorText>
		<ns0:AuthorText authorType="PRINCIPAL_COAUTHOR_OPPOSITE">(Principal coauthor: Assembly Member Muratsuchi)</ns0:AuthorText>
		<ns0:AuthorText authorType="COAUTHOR_ORIGINATING">(Coauthor: Senator Rubio)</ns0:AuthorText>
		<ns0:Authors>
			<ns0:Legislator>
				<ns0:Contribution>LEAD_AUTHOR</ns0:Contribution>
				<ns0:House>SENATE</ns0:House>
				<ns0:Name>Allen</ns0:Name>
			</ns0:Legislator>
			<ns0:Legislator>
				<ns0:Contribution>PRINCIPAL_COAUTHOR</ns0:Contribution>
				<ns0:House>ASSEMBLY</ns0:House>
				<ns0:Name>Muratsuchi</ns0:Name>
			</ns0:Legislator>
			<ns0:Legislator>
				<ns0:Contribution>COAUTHOR</ns0:Contribution>
				<ns0:House>SENATE</ns0:House>
				<ns0:Name>Rubio</ns0:Name>
			</ns0:Legislator>
		</ns0:Authors>
		<ns0:Title> An act to amend Section 1374.722 of the Health and Safety Code, to amend Section 10144.53 of the Insurance Code, and to amend Section 5961.4 of the Welfare and Institutions Code, relating to health care coverage. </ns0:Title>
		<ns0:RelatingClause>health care coverage</ns0:RelatingClause>
		<ns0:GeneralSubject>
			<ns0:Subject>Qualified youth drop-in center health care coverage.</ns0:Subject>
		</ns0:GeneralSubject>
		<ns0:DigestText>
			<html:p>Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care and makes a willful violation of the act a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law requires a health care service plan contract or health insurance policy issued, amended, renewed, or delivered on or after January 1, 2024, that provides coverage for medically necessary treatment of mental health and substance use disorders to cover the provision of those services to an individual 25 years of age or younger when delivered at a schoolsite.</html:p>
			<html:p>This bill would expand the definition of schoolsite to
			 additionally require a contract or policy that provides coverage for medically necessary treatment of mental health and substance use disorders to cover the provision of those services to an individual 25 years of age or younger when delivered at a qualified youth drop-in center. Because a violation of this requirement relative to health care service plans would be a crime, the bill would create a state-mandated local program.</html:p>
			<html:p>Existing law provides for the Medi-Cal program, administered by the State Department of Health Care Services and under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Existing law requires a Medi-Cal managed care plan or Medi-Cal behavioral health delivery system to reimburse providers of medically necessary outpatient mental health or substance use disorder treatment provided at a schoolsite to a student 25 years of age
			 or younger who is an enrollee of the plan or delivery system, as specified.</html:p>
			<html:p>Because of the expansion of the definition of schoolsite to include qualified youth drop-in centers, this bill would expand the above-described reimbursement requirement to those services when provided at a qualified youth drop-in center, as specified.</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 no reimbursement is required by this act for a specified reason.</html:p>
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		<ns0:DigestKey>
			<ns0:VoteRequired>MAJORITY</ns0:VoteRequired>
			<ns0:Appropriation>NO</ns0:Appropriation>
			<ns0:FiscalCommittee>YES</ns0:FiscalCommittee>
			<ns0:LocalProgram>YES</ns0:LocalProgram>
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			<ns0:ImmediateEffect>NO</ns0:ImmediateEffect>
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				<ns0:Urgency>NO</ns0:Urgency>
				<ns0:TaxLevy>NO</ns0:TaxLevy>
				<ns0:Election>NO</ns0:Election>
				<ns0:UsualCurrentExpenses>NO</ns0:UsualCurrentExpenses>
				<ns0:BudgetBill>NO</ns0:BudgetBill>
				<ns0:Prop25TrailerBill>NO</ns0:Prop25TrailerBill>
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	</ns0:Description>
	<ns0:Bill id="bill">
		<ns0:Preamble>The people of the State of California do enact as follows:</ns0:Preamble>
		<ns0:BillSection id="id_9D0A1409-F708-4F33-9D51-0C2D621C0B4F">
			<ns0:Num>SECTION 1.</ns0:Num>
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				Section 1374.722 of the 
				<ns0:DocName>Health and Safety Code</ns0:DocName>
				 is amended to read:
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				<ns0:LawSection id="id_8C50CF47-787D-47A6-A20A-277FA1BF7D9F">
					<ns0:Num>1374.722.</ns0:Num>
					<ns0:LawSectionVersion id="id_1F3AE243-7F9D-4227-9184-E1DEEE4D4186">
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							<html:p>
								(a)
								<html:span class="EnSpace"/>
								(1)
								<html:span class="EnSpace"/>
								A health care service plan contract issued, amended, renewed, or delivered on or after January 1, 2024, that is required to provide coverage for medically necessary treatment of mental health and substance use disorders pursuant to Sections 1374.72, 1374.721, and 1374.73 shall cover the provision of the services identified in the fee-for-service reimbursement schedule published by the State Department of Health Care Services, as described in subparagraph (B) of paragraph (5) of subdivision (c), when those services are delivered at schoolsites
						pursuant to this section, regardless of the network status of the local educational agency, institution of higher
						education, or health care provider.
							</html:p>
							<html:p>
								(2)
								<html:span class="EnSpace"/>
								This section does not relieve a local educational agency or institution of higher education from requirements to accommodate or provide services to students with disabilities pursuant to any applicable state and federal law, including, but not limited to, the federal Individuals with Disabilities Education Act (20 U.S.C. Sec. 1400 et seq.), Part 30 (commencing with Section 56000) of Division 4 of Title 2 of the Education Code, Chapter 26.5 (commencing with Section 7570) of Division 7 of Title 1 of the Government Code, and Chapter 3 (commencing with Section 3000) of Division 1 of Title 5 of the California Code of Regulations.
							</html:p>
							<html:p>
								(b)
								<html:span class="EnSpace"/>
								The following definitions apply for purposes of this section:
							</html:p>
							<html:p>
								(1)
								<html:span class="EnSpace"/>
								“Health care provider” has the same meaning as defined in paragraph (4) of subdivision (a) of Section 1374.72 and paragraph (5) of subdivision (c) of Section 1374.73.
							</html:p>
							<html:p>
								(2)
								<html:span class="EnSpace"/>
								“Institution of higher education” means the California Community Colleges, the California State University, or the University of California.
							</html:p>
							<html:p>
								(3)
								<html:span class="EnSpace"/>
								“Local educational agency” means a school district, county office of education, charter school, the California Schools for the Deaf, and the California School for the Blind.
							</html:p>
							<html:p>
								(4)
								<html:span class="EnSpace"/>
								“Medically necessary treatment of a mental health or substance use disorder” has the same meaning as defined in paragraph (3) of subdivision (a) of Section 1374.72.
							</html:p>
							<html:p>
								(5)
								<html:span class="EnSpace"/>
								“Mental health and substance use disorder” has the same meaning as defined in paragraph (2) of subdivision (a) of Section 1374.72.
							</html:p>
							<html:p>
								(6)
								<html:span class="EnSpace"/>
								”Qualified youth drop-in center” means a center to which all of the following apply: 
							</html:p>
							<html:p>
								(A)
								<html:span class="EnSpace"/>
								The center provides behavioral health and wellness services to youth up to 25 years of age, inclusive, or to a subset of youth who are between 12 and 25 years of age, inclusive.
							</html:p>
							<html:p>
								(B)
								<html:span class="EnSpace"/>
								The center provides at least one or more additional youth services, including, but not limited to, health services, services to support youth education and employment, and services to
						assist families to support youth.
							</html:p>
							<html:p>
								(C)
								<html:span class="EnSpace"/>
								The center has the capacity to provide services before and after school hours.
							</html:p>
							<html:p>
								(D)
								<html:span class="EnSpace"/>
								The center has been designated by or embedded with a local educational agency or institution of higher education for the purposes of this section.
							</html:p>
							<html:p>
								(E)
								<html:span class="EnSpace"/>
								The center has a physical location and offers face-to-face services.
							</html:p>
							<html:p>
								(F)
								<html:span class="EnSpace"/>
								The center is operated by a nonprofit entity, local government agency, or a federally recognized Indian tribe, tribal organization, urban Indian organization, or other tribal entity as designated by the department.
							</html:p>
							<html:p>
								 (7)
								<html:span class="EnSpace"/>
								“Schoolsite” means a facility or location used for public
						kindergarten, elementary, secondary, or postsecondary purposes. “Schoolsite” also includes a location not owned or operated by a public school, or public school district, if the school or school district provides or arranges for the provision of medically necessary treatment of a mental health or substance use disorder to its students at that location, including off-campus clinics, mobile counseling services, qualified youth drop-in centers, and similar locations.
							</html:p>
							<html:p>
								(8)
								<html:span class="EnSpace"/>
								“Utilization review” has the same meaning as defined in paragraph (3) of subdivision (f) of Section 1374.721.
							</html:p>
							<html:p>
								(c)
								<html:span class="EnSpace"/>
								If a local educational
						agency or institution of higher education provides or arranges for the provision of treatment of a mental health or substance use disorder services subject to this section by a health care provider for an individual 25 years of age or younger at a schoolsite, the student’s health care service plan shall reimburse the local educational
						agency or institution of higher education for those services. If an affiliated provider is designated by a local education agency or institution of higher education to directly submit claims and receive reimbursement for fee schedule services, a student’s health care service plan shall reimburse an affiliated provider directly.
							</html:p>
							<html:p>
								(1)
								<html:span class="EnSpace"/>
								A health care service plan shall not require prior authorization for services provided pursuant to this section.
							</html:p>
							<html:p>
								(2)
								<html:span class="EnSpace"/>
								A health care
						service plan may conduct a postclaim review to determine appropriate payment of the claim. Payment for services subject to this section may be denied only if the health care service plan reasonably determines that the services were provided to a student not enrolled in the health plan, were never performed, or were not provided by a health care provider appropriately licensed or authorized to provide the services.
							</html:p>
							<html:p>
								(3)
								<html:span class="EnSpace"/>
								Notwithstanding paragraph (1), a health plan may require prior authorization for services as authorized by the department pursuant to subdivision (d).
							</html:p>
							<html:p>
								(4)
								<html:span class="EnSpace"/>
								A local educational agency, community college district, the California State University system, or the Regents of the University of California may consolidate claims for purposes of submitting the claims to a
						health care service plan.
							</html:p>
							<html:p>
								(5)
								<html:span class="EnSpace"/>
								A health care service plan shall provide reimbursement for services provided to students pursuant to this section at the greater of either of the following amounts:
							</html:p>
							<html:p>
								(A)
								<html:span class="EnSpace"/>
								The health plan’s contracted rate with the local educational
						agency, institution of higher education, or health care provider, if any.
							</html:p>
							<html:p>
								(B)
								<html:span class="EnSpace"/>
								The fee-for-service reimbursement rate published by the State Department of Health Care Services for the same or similar services provided in an outpatient setting, pursuant to Section 5961.4 of the Welfare and Institutions Code.
							</html:p>
							<html:p>
								(6)
								<html:span class="EnSpace"/>
								A health care service plan shall provide reimbursement for services provided pursuant to this section in compliance with the requirements for timely payment of claims, as required by this chapter.
							</html:p>
							<html:p>
								(7)
								<html:span class="EnSpace"/>
								Services provided pursuant to this section shall not be subject to copayment, coinsurance, deductible, or any other form of cost sharing.
							</html:p>
							<html:p>
								(8)
								<html:span class="EnSpace"/>
								An individual or entity shall not bill the enrollee or subscriber, nor seek reimbursement from the enrollee or subscriber, for services provided pursuant to this section.
							</html:p>
							<html:p>
								(d)
								<html:span class="EnSpace"/>
								No later than December 31, 2023, the director shall issue guidance to health care service plans regarding compliance with this section. This guidance shall not be subject to the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code). Any guidance issued pursuant to this subdivision shall be effective only until the director adopts regulations pursuant to the Administrative Procedure Act.
							</html:p>
							<html:p>
								(e)
								<html:span class="EnSpace"/>
								This section does not apply to contracts entered into pursuant to Chapter 7 (commencing with Section 14000) or Chapter 8 (commencing
						with Section 14200) of Part 3 of Division 9 of the Welfare and Institutions Code, between the State Department of Health Care Services and a health care service plan for enrolled Medi-Cal beneficiaries.
							</html:p>
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		</ns0:BillSection>
		<ns0:BillSection id="id_AD8DD6B5-A19D-4C75-B47C-4FDCA6C9AA9A">
			<ns0:Num>SEC. 2.</ns0:Num>
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				Section 10144.53 of the 
				<ns0:DocName>Insurance Code</ns0:DocName>
				 is amended to read:
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				<ns0:LawSection id="id_95A9C463-8029-4782-80C9-203FED99FAA2">
					<ns0:Num>10144.53.</ns0:Num>
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							<html:p>
								(a)
								<html:span class="EnSpace"/>
								(1)
								<html:span class="EnSpace"/>
								A disability insurance policy issued, amended, renewed, or delivered on or after January 1, 2024, that is required to provide coverage for medically necessary treatment of mental health and substance use disorders pursuant to Sections 10144.5, 10144.51, and 10144.52 shall cover the provision of the services identified in the fee-for-service reimbursement schedule published by the State Department of Health Care Services, as described in subparagraph (B) of paragraph (5) of subdivision (c), when those services are delivered at schoolsites pursuant to this section, regardless of the network status of
						the local educational agency, institution of higher
						education, or health care provider.
							</html:p>
							<html:p>
								(2)
								<html:span class="EnSpace"/>
								This section does not relieve a local educational agency or institution of higher education from requirements to accommodate or provide services to students with disabilities pursuant to any applicable state and federal law, including, but not limited to, the federal Individuals with Disabilities Education Act (20 U.S.C. Sec. 1400 et seq.), Part 30 (commencing with Section 56000) of Division 4 of Title 2 of the Education Code, Chapter 26.5 (commencing with Section 7570) of Division 7 of Title 1 of the Government Code, and Chapter 3 (commencing with Section 3000) of Division 1 of Title 5 of the California Code of Regulations.
							</html:p>
							<html:p>
								(b)
								<html:span class="EnSpace"/>
								The following definitions apply for purposes of this section:
							</html:p>
							<html:p>
								(1)
								<html:span class="EnSpace"/>
								“Health care provider” has the same meaning as defined in paragraph (4) of subdivision (a) of Section 10144.5 and paragraph (5) of subdivision (c) of Section 10144.51.
							</html:p>
							<html:p>
								(2)
								<html:span class="EnSpace"/>
								“Institution of higher education” means the California Community Colleges, the California State University, or the University of California.
							</html:p>
							<html:p>
								(3)
								<html:span class="EnSpace"/>
								“Local educational agency” means a school district, county office of education, charter school, the California Schools for the Deaf, and the California School for the Blind.
							</html:p>
							<html:p>
								(4)
								<html:span class="EnSpace"/>
								“Medically necessary treatment of a mental health or substance use disorder” has the same meaning as defined in paragraph (3) of subdivision (a) of Section 10144.5.
							</html:p>
							<html:p>
								(5)
								<html:span class="EnSpace"/>
								“Mental health and substance use disorders” has the same meaning as defined in paragraph (2) of subdivision (a) of Section 10144.5.
							</html:p>
							<html:p>
								(6)
								<html:span class="EnSpace"/>
								”Qualified youth drop-in center” means a center to which all of the following apply:
							</html:p>
							<html:p>
								(A)
								<html:span class="EnSpace"/>
								The center provides behavioral health and wellness services to youth up to 25 years of age, inclusive, or to a subset of youth who are between 12 and 25 years of age, inclusive.
							</html:p>
							<html:p>
								(B)
								<html:span class="EnSpace"/>
								The center provides at least one or more additional youth services, including, but not limited to, health services, services to support youth education and employment, and services to assist families to support youth.
							</html:p>
							<html:p>
								(C)
								<html:span class="EnSpace"/>
								The center has the capacity to provide services before and after school hours.
							</html:p>
							<html:p>
								(D)
								<html:span class="EnSpace"/>
								The center has been designated by or embedded with a local educational agency or institution of higher education for the purposes of this section.
							</html:p>
							<html:p>
								(E)
								<html:span class="EnSpace"/>
								The center has a physical location and offers face-to-face services.
							</html:p>
							<html:p>
								(F)
								<html:span class="EnSpace"/>
								The center is operated by a nonprofit entity, local government agency, or a federally recognized Indian tribe, tribal organization, urban Indian organization, or other tribal entity as designated by the department.
							</html:p>
							<html:p>
								(7)
								<html:span class="EnSpace"/>
								“Schoolsite” means a facility or location used for public kindergarten, elementary, secondary, or postsecondary purposes. “Schoolsite” also includes a location not owned or operated by a public school, or public school district if the school or school district
						provides or arranges for the provision of medically necessary treatment of a mental health or substance use disorder to its students at that location, including off-campus clinics, mobile counseling services,
						qualified youth drop-in centers, and similar locations.
							</html:p>
							<html:p>
								(8)
								<html:span class="EnSpace"/>
								“Utilization review” has the same meaning as defined in paragraph (3) of subdivision (f) of Section 10144.52.
							</html:p>
							<html:p>
								(c)
								<html:span class="EnSpace"/>
								If a local educational agency or
						institution of higher education provides or arranges for the provision of treatment of a mental health or substance use disorder services subject to this section by a health care provider at a schoolsite for an individual 25 years of age or younger, the student’s disability insurer shall reimburse the local educational agency or institution of higher
						education for those services. If an affiliated provider is designated by a local education agency or institution of higher education to directly submit claims and receive reimbursement for fee schedule services, a student’s disability insurer shall reimburse an affiliated provider directly.
							</html:p>
							<html:p>
								(1)
								<html:span class="EnSpace"/>
								A disability insurer shall not require prior authorization for services provided pursuant to this section.
							</html:p>
							<html:p>
								(2)
								<html:span class="EnSpace"/>
								A disability insurer may conduct a postclaim review to determine appropriate payment of the claim. Payment for services subject to this section may be denied only if the disability insurer reasonably determines that the services were provided to a student not covered by the
						insurer, were never performed, or were not provided by a health care provider appropriately licensed or authorized to provide the services.
							</html:p>
							<html:p>
								(3)
								<html:span class="EnSpace"/>
								Notwithstanding paragraph (1), a disability insurer may require prior authorization for services as authorized by the commissioner, pursuant to subdivision (d).
							</html:p>
							<html:p>
								(4)
								<html:span class="EnSpace"/>
								A local educational agency, community college district, the California State University system, or the Regents of the University of California may consolidate claims for purposes of submission to a disability insurer.
							</html:p>
							<html:p>
								(5)
								<html:span class="EnSpace"/>
								A disability insurer shall provide reimbursement for services provided to students pursuant to this section at the greater of either of the following amounts:
							</html:p>
							<html:p>
								(A)
								<html:span class="EnSpace"/>
								The disability insurer’s contracted rate with the local educational agency, institution of higher education, or health care provider, if any.
							</html:p>
							<html:p>
								(B)
								<html:span class="EnSpace"/>
								The fee-for-service reimbursement rate published by the State Department of Health Care Services for the same or similar services provided in an outpatient setting, pursuant to Section 5961.4 of the Welfare and Institutions Code.
							</html:p>
							<html:p>
								(6)
								<html:span class="EnSpace"/>
								A disability insurer shall provide reimbursement for services provided pursuant to this section in compliance with the requirements for timely payment of claims as required by this chapter.
							</html:p>
							<html:p>
								(7)
								<html:span class="EnSpace"/>
								Services provided pursuant to this section shall not be subject to copayment,
						coinsurance, deductible, or any other form of cost
						sharing.
							</html:p>
							<html:p>
								(8)
								<html:span class="EnSpace"/>
								An individual or entity shall not bill the policyholder or insured, nor seek reimbursement from the policyholder or insured, for services provided pursuant to this section.
							</html:p>
							<html:p>
								(d)
								<html:span class="EnSpace"/>
								The commissioner shall issue guidance to disability insurers regarding compliance with this section, as well as requirements necessary to comply with Section 5961.4 of the Welfare and Institutions Code. This guidance shall not be subject to the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code). Guidance issued pursuant to this subdivision shall be effective only until the commissioner adopts regulations pursuant to the Administrative Procedure Act.
							</html:p>
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		<ns0:BillSection id="id_739E1D91-48EC-4C95-B590-678CBAA97A45">
			<ns0:Num>SEC. 3.</ns0:Num>
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				Section 5961.4 of the 
				<ns0:DocName>Welfare and Institutions Code</ns0:DocName>
				 is amended to read:
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				<ns0:LawSection id="id_32C741A9-B198-47AF-82AC-357F83EBF5B3">
					<ns0:Num>5961.4.</ns0:Num>
					<ns0:LawSectionVersion id="id_33135EE7-8373-4DB3-8499-310A0670989F">
						<ns0:Content>
							<html:p>
								(a)
								<html:span class="EnSpace"/>
								As a component of the initiative, the State Department of Health Care Services shall develop and maintain a school-linked statewide fee schedule for outpatient mental health or substance use disorder treatment provided to a student 25 years of age or younger at a schoolsite.
							</html:p>
							<html:p>
								(b)
								<html:span class="EnSpace"/>
								The department shall develop and maintain a school-linked statewide provider network of schoolsite behavioral health counselors.
							</html:p>
							<html:p>
								(c)
								<html:span class="EnSpace"/>
								(1)
								<html:span class="EnSpace"/>
								Subject to subdivision (h), each Medi-Cal managed care plan and Medi-Cal behavioral health delivery system, as applicable, shall reimburse providers of medically necessary outpatient mental
						health or substance use disorder treatment provided at a schoolsite to a student 25 years of age or younger who is an enrollee of the plan or delivery system, in accordance with paragraph (2), but only to the extent the Medi-Cal managed care plan or Medi-Cal behavioral delivery system is financially responsible for those schoolsite services under its approved managed care contract with the department.
							</html:p>
							<html:p>
								(2)
								<html:span class="EnSpace"/>
								Providers of medically necessary schoolsite services described in this section shall be reimbursed,
						at a minimum, at the fee schedule rate or rates developed pursuant to subdivision (a), regardless of network provider status.
							</html:p>
							<html:p>
								(d)
								<html:span class="EnSpace"/>
								(1)
								<html:span class="EnSpace"/>
								The department may contract with an entity to administer the school-linked statewide behavioral health provider network in accordance with this subdivision.
							</html:p>
							<html:p>
								(2)
								<html:span class="EnSpace"/>
								The entity that administers the school-linked statewide behavioral health provider network shall do all of the following:
							</html:p>
							<html:p>
								(A)
								<html:span class="EnSpace"/>
								Create and administer a process for enrolling and credentialing all eligible practitioners and providers seeking to provide medically necessary schoolsite services described
						in this section.
							</html:p>
							<html:p>
								(B)
								<html:span class="EnSpace"/>
								Create and administer a process for the submission and reimbursement of claims eligible to be reimbursed pursuant to this section, which may include resolving disputes related to the school-linked statewide all-payer fee schedule and administering fee collection pursuant to subdivision (g).
							</html:p>
							<html:p>
								(C)
								<html:span class="EnSpace"/>
								Create and administer a mechanism for the sharing of data between the entity contracted pursuant to this subdivision and a health care service plan, insurer, or Medi-Cal managed care plan that covers medically necessary schoolsite services subject to the school-linked statewide all-payer fee schedule that is necessary to facilitate timely claims processing,
						payment, and reporting, avoid duplication of claims, allow for tracking of grievance remediation, and to facilitate coordination of care and continuity of care for enrollees.
							</html:p>
							<html:p>
								(e)
								<html:span class="EnSpace"/>
								A provider or practitioner of medically necessary schoolsite services participating in the school-linked statewide behavioral health provider network described in this section shall do all of the following:
							</html:p>
							<html:p>
								(1)
								<html:span class="EnSpace"/>
								Comply with all administrative requirements necessary to be enrolled and credentialed, as applicable, by the entity that administers the school-linked statewide behavioral health provider network.
							</html:p>
							<html:p>
								(2)
								<html:span class="EnSpace"/>
								Submit all claims for
						reimbursement for services billed under the school-linked statewide all-payer fee schedule through the entity that administers the school-linked statewide behavioral health provider network.
							</html:p>
							<html:p>
								(3)
								<html:span class="EnSpace"/>
								If a provider or practitioner of medically necessary schoolsite services has, or enters into, a direct agreement established with a health care service plan, insurer, or Medi-Cal managed care plan that covers medically necessary schoolsite services outside of the school-linked statewide all-payer fee schedule, they shall be allowed to bill for services provided directly under the terms of the established agreement.
							</html:p>
							<html:p>
								(f)
								<html:span class="EnSpace"/>
								(1)
								<html:span class="EnSpace"/>
								A health care service plan, insurer, or Medi-Cal managed care plan that covers medically necessary schoolsite services subject to the school-linked statewide all-payer fee schedule, pursuant to Section 1374.722 of the Health and Safety Code, Section 10144.53 of the Insurance Code, and this section, shall comply with all administrative requirements necessary to cover and reimburse those services set forth by the entity that administers the school-linked statewide behavioral health provider network.
							</html:p>
							<html:p>
								(2)
								<html:span class="EnSpace"/>
								If an agreement exists between a health care service plan, insurer, or Medi-Cal managed care plan and a provider or practitioner of medically
						necessary schoolsite
						services outside of the school-linked statewide all-payer fee schedule, the health care service plan, insurer, or Medi-Cal managed care plan shall do all of the following:
							</html:p>
							<html:p>
								(A)
								<html:span class="EnSpace"/>
								At minimum, reimburse the contracted provider or practitioner at the school-linked statewide all-payer fee schedule rates.
							</html:p>
							<html:p>
								(B)
								<html:span class="EnSpace"/>
								Provide to the department data deemed necessary and appropriate for program reporting and compliance purposes.
							</html:p>
							<html:p>
								(C)
								<html:span class="EnSpace"/>
								Comply with all administrative requirements necessary to cover and reimburse medically necessary schoolsite services subject to the school-linked statewide all-payer fee schedule,
						as determined by the department.
							</html:p>
							<html:p>
								(g)
								<html:span class="EnSpace"/>
								(1)
								<html:span class="EnSpace"/>
								The department shall establish and charge a fee to participating health care service plans, insurers, or Medi-Cal managed care plans to cover the reasonable cost of administering the school-linked statewide behavioral health provider network.
							</html:p>
							<html:p>
								(2)
								<html:span class="EnSpace"/>
								The department shall set the fees in an amount that it projects is sufficient to cover all administrative costs incurred by the state associated with implementing this section and consider the assessed volume of claims and providers or practitioners of medically necessary schoolsite services that are credentialed and enrolled by the entity contracted pursuant to subdivision
						(d).
							</html:p>
							<html:p>
								(3)
								<html:span class="EnSpace"/>
								The department shall not assess the fee authorized by this subdivision until the time that the contract between the department and the entity contracted pursuant to subdivision (d) commences.
							</html:p>
							<html:p>
								(4)
								<html:span class="EnSpace"/>
								(A)
								<html:span class="EnSpace"/>
								The department may periodically update the amount and structure of the fees, as necessary, to provide sufficient funding for the purpose specified in this subdivision.
							</html:p>
							<html:p>
								(B)
								<html:span class="EnSpace"/>
								The fees authorized in this paragraph shall be evaluated annually and based on the state’s projected costs for the forthcoming fiscal year.
							</html:p>
							<html:p>
								(C)
								<html:span class="EnSpace"/>
								If the department proposes to increase the fees, it shall notify the Legislature of the proposed increase through the submission of
						the semiannual Medi-Cal estimate provided to the Legislature.
							</html:p>
							<html:p>
								(5)
								<html:span class="EnSpace"/>
								(A)
								<html:span class="EnSpace"/>
								(i)
								<html:span class="EnSpace"/>
								The Behavioral Health Schoolsite Fee Schedule Administration Fund is hereby established in the State Treasury.
							</html:p>
							<html:p>
								(ii)
								<html:span class="EnSpace"/>
								The department shall administer the Behavioral Health Schoolsite Fee Schedule Administration Fund consistent with this subdivision.
							</html:p>
							<html:p>
								(B)
								<html:span class="EnSpace"/>
								All revenues, less refunds, derived from the fees authorized in this subdivision shall be deposited in the Behavioral Health Schoolsite Fee Schedule Administration Fund.
							</html:p>
							<html:p>
								(C)
								<html:span class="EnSpace"/>
								The moneys in the Behavioral Health Schoolsite Fee Schedule Administration Fund shall be available upon appropriation by the
						Legislature and shall be used only for purposes of this subdivision.
							</html:p>
							<html:p>
								(D)
								<html:span class="EnSpace"/>
								Notwithstanding Section 16305.7 of the Government Code, interest and dividends earned on moneys in the Behavioral Health Schoolsite Fee Schedule Administration Fund shall be retained in the fund and used solely for the purposes specified in this section.
							</html:p>
							<html:p>
								(E)
								<html:span class="EnSpace"/>
								Notwithstanding any other provision of law, the Controller may use moneys in the Behavioral Health Schoolsite Fee Schedule Administration Fund for cashflow loans to the General Fund as provided in Sections 16310 and 16381 of the Government Code.
							</html:p>
							<html:p>
								(F)
								<html:span class="EnSpace"/>
								Funds remaining in the Behavioral Health Schoolsite Fee Schedule Administration Fund at the end of a fiscal year shall be available for use in the
						following fiscal year and taken into consideration in establishment of fees for the subsequent fiscal year.
							</html:p>
							<html:p>
								(h)
								<html:span class="EnSpace"/>
								This section shall be implemented only to the extent that the department obtains any necessary federal approvals, and federal financial participation under the Medi-Cal program is available and not otherwise jeopardized.
							</html:p>
							<html:p>
								(i)
								<html:span class="EnSpace"/>
								This section does not relieve a local educational agency or institution of higher education from requirements to accommodate or provide services to students with disabilities pursuant to any applicable state and federal law, including, but not limited to, the federal Individuals with Disabilities Education Act (20 U.S.C. Sec. 1400 et seq.), Part 30 (commencing with Section 56000) of Division 4 of Title 2 of the Education Code, Chapter 26.5 (commencing
						with Section 7570) of Division 7 of Title 1 of the Government Code, and Chapter 3 (commencing with Section 3000) of Division 1 of Title 5 of the California Code of Regulations.
							</html:p>
							<html:p>
								(j)
								<html:span class="EnSpace"/>
								For purposes of this section, the following definitions shall apply:
							</html:p>
							<html:p>
								(1)
								<html:span class="EnSpace"/>
								“Comprehensive risk contract” has the same meaning as set forth in Section 438.2 of Title 42 of the Code of Federal Regulations.
							</html:p>
							<html:p>
								(2)
								<html:span class="EnSpace"/>
								“Institution of higher education” means the California Community Colleges, the California State University, or the University of California.
							</html:p>
							<html:p>
								(3)
								<html:span class="EnSpace"/>
								“Local
						educational agency” means a school district, county office of education, charter school, the California Schools for the Deaf, and the California School for the Blind.
							</html:p>
							<html:p>
								(4)
								<html:span class="EnSpace"/>
								“Medi-Cal behavioral health delivery system” has the meaning described in subdivision (i) of Section 14184.101.
							</html:p>
							<html:p>
								(5)
								<html:span class="EnSpace"/>
								“Medi-Cal managed care plan” means any individual, organization, or entity that enters into a comprehensive risk contract with the department to provide covered full-scope health care services to enrolled Medi-Cal beneficiaries pursuant to any provision of Chapter 7 (commencing with Section 14000) or Chapter 8 (commencing with Section 14200) of Part 3 of Division 9.
							</html:p>
							<html:p>
								(6)
								<html:span class="EnSpace"/>
								“Schoolsite” has the meaning described in paragraph (7) of subdivision (b) of Section 1374.722 of the Health and Safety Code.
							</html:p>
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		<ns0:BillSection id="id_71F55F6A-F066-4D02-9DD0-48AF4DB860A3">
			<ns0:Num>SEC. 4.</ns0:Num>
			<ns0:Content>
				<html:p>
					No reimbursement is required by this act pursuant to Section 6 of Article XIII
					<html:span class="ThinSpace"/>
					B of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIII
					<html:span class="ThinSpace"/>
					B of the California Constitution.
				</html:p>
			</ns0:Content>
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	</ns0:Bill>
</ns0:MeasureDoc>