AB 858(Asm. Wood and Asm. Garcia, E)

Status:

Summary

Requires Medi-Cal reimbursement to Federally Qualified Health Centers and Rural Health Clinics for mental health services provided on the same day as medical services.

Code

Amends Section 14132.100 of the Welfare and Institutions Code

Background

Community-based primary care is often the first line of defense for detection and treatment of mental health issues and is often the first point of contact for identifying and treating individuals who otherwise might face stigma, cultural or other barriers to accessing traditional mental health services. Integrated Behavioral Health Care addresses both the physical and mental health needs of individuals and broadens access to mental health services by bringing behavioral health into the primary care setting.

In order to best provide integrated behavioral health services to patients, many FQHCs and RHCs provide medical and mental health services on the same day, which is the hallmark of the Integrated Behavioral Health Care model. However, Medi-Cal will not reimburse for a patient to see a primary care provider and a mental health provider/behavioral health specialist on the same day. Only one visit is reimbursed in this situation. While California’s State plan amendment and Medi-Cal Provider Manual will permit FQHCs and RHCs to be reimbursed for same-day medical and dental services, mental health services are excluded.

Why

Although many CCHCs have been working toward clinical integration of physical, mental health, and substance abuse services, certain federal, state and local policies do not support the model. In California, for example, community clinics cannot bill Medi-Cal for same day visits for both primary care and mental health encounters, though they can bill for both a medical and dental visit. Medicaid currently pays for a mental health visit on the same day as a medical visit in FQHCs in 32 states, including Washington, Oregon, Nevada and Arizona. California should follow suit in order to further support integration and improved person-centered services.[i]

Fiscal

Florida is the most recent state to change this policy, which they did through adding language in the state budget bill. They found that the cost of providing same day care had minimal to no impact. Part of the argument to the legislative staff was that it didn’t make sense that a patient coming back for service the next day would be paid for at the same cost as it would take for a patient being seen on that same day. (ie. patient comes in Monday for physical and Tuesday for mental, total cost is $300 versus patient comes in for both on the same day…cost is still $300).[ii]