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AB 690(Wood)
Improving Access to Behavioral Health
Services in Primary Care
Status: AB 690(Assembly member Wood)
Summary
This bill adds marriage and family therapists
(MFTs) to the list of health care professionals
whose services are reimbursed through MediCal on a per-visit basis to federally qualified
health centers (FQHC) or rural health clinics
(RHCs).
Code
Amends Section 14132.100 of the CA Welfare
and Institutions Code, relating to Medi-Cal
Background
Community clinics and health centers are nonprofit organizations committed to providing
comprehensive, high quality health care to
everyone who walks through their doors, in a
compassionate and culturally sensitive manner.
1 in 7 Californians are served by clinics, equal to
more than 5.6 million patients annually.
According to 2012 OSHPD data, 41.5% of
Community Clinics and Health Centers had
onsite behavioral health visits and behavioral
health services were available onsite at CCHCs in
50 of the 58 California Counties.
Under existing law, psychologists and licensed
clinical social workers (LCSWs) are employed by
RHCs and FQHCs to provide mental health
services and receive reimbursement via a
bundled prospective payment system (PPS) rate
through Medi-Cal. DHCS expanded the role of
MFTs in Medi-Cal in 2014 through State Plan
Amendment 14-012, which allows MFTs to
provide mental health services under Medi-Cal.
However, while a RHC or FQHC can employ an
MFT to provide services, the lack of PPS
reimbursement for the care provided to MediCal patients acts as a disincentive for hiring.
CALIFORNIA PRIMARY CARE ASSOCIATION
web: cpca.org tel: 916.440.8170 fax: 916.440.8172
1231 I Street, Suite 400, Sacramento, California 95814
Why
As part of California’s implementation of the
Patient Protection and Affordable Care Act,
mental health and substance use disorder
services were deemed an essential health
benefit for Medi-Cal managed care health plans.
Along with the expansion of behavioral health
benefits for Medi-Cal members comes the
expansion of the Medi-Cal program itself, with
roughly 32% of the formerly uninsured
population now eligible for coverage as of 2014.
Within the primary care setting, up to 26% of
patients have a psychiatric disorder.1 When left
unaddressed, mental illness can make it difficult
for patients with chronic physical illness to
manage their health care, translating into
significant and costly physical health problems
for both patients and the health care system.
However, according to 2012 DHCS needs
assessment of the Mental Health and Substance
Use System, while there was a relatively high
supply of LCSWs and MFTs in California, only a
fraction of these individuals were working in the
public mental health system.2
Adding MFTs to the list of PPS billable providers
will solve existing gaps in workforce capacity by
providing CCHCs with an adequate source of
funding for their employment, helping to meet
the demand for mental health services in the
public health setting.
Sponsors
California Primary Care Association & California
Association of Marriage and Family Therapists
Contact
Sean South, CPCA
Phone: (916) 440-8170 E-mail: [email protected]
1
Kessler & Stafford, (2008). Primary care is the de facto
mental health system. Collaborative medicine case studies
(9-21). New York, NY: Springer.
2 DHCS, (2012). “California Mental Health and Substance
Use System Needs Assessment Final Report.”