SB874 - Medi-Cal: behavioral health treatment: stakeholder feedback.

Enrolled August 25, 2026 Passed IN Senate August 24, 2026 Passed IN Assembly August 20, 2026 Amended IN Assembly August 13, 2026 Amended IN Assembly July 02, 2026 Amended IN Assembly June 03, 2026 Amended IN Senate April 23, 2026 Amended IN Senate March 17, 2026 CALIFORNIA LEGISLATURE— 2025–2026 REGULAR SESSION Senate Bill No. 874 Introduced by Senator Weber Pierson January 06, 2026 An act to add Section 14132.561 to the Welfare and Institutions Code, relating to Medi-Cal. LEGISLATIVE COUNSEL'S DIGEST SB 874, Weber Pierson. Medi-Cal: behavioral health treatment: stakeholder feedback. 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. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Under existing law, to the extent required by the federal government and effective no sooner than required by the federal government, behavioral health treatment (BHT) is a covered service under the Medi-Cal program for individuals under 21 years of age. This bill would require the department, by July 1, 2027, to ensure that certain individuals providing BHT services under Medi-Cal undergo criminal background checks. The bill would require the department to utilize existing stakeholder forums to seek stakeholder feedback and offer stakeholder comment opportunities to inform changes to coverage and billing policy for BHT services. The bill would encourage the department to affirmatively reach out to specified stakeholders as appropriate based on the topic at issue to ensure adequate feedback. Under the bill, stakeholder feedback would include, among other topics, clinical guidelines for the provision of BHT services, treatment plan requirements, requirements for the provision of center-based services compared to services provided elsewhere, and supervision of unlicensed and uncertified professionals, as specified. The bill would require the department to maintain clear billing and coverage guidance for BHT services, as specified. The bill would require the department, on or before January 1, 2029, to publish on its internet website utilization data for BHT services, a synopsis of changes made as a result of stakeholder feedback, and recommendations for actions necessary to ensure that Medi-Cal reimbursement practices align with federal Medicaid program integrity requirements. Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: NO Bill Text The people of the State of California do enact as follows: SECTION 1. Section 14132.561 is added to the Welfare and Institutions Code, immediately following Section 14132.56, to read: 14132.561. (a) For purposes of this section, “behavioral health treatment” or “BHT” has the same meaning as set forth in Section 14132.56. (b) (1) By July 1, 2027, the department shall ensure that any entity enrolled as a Medi-Cal provider that provides BHT services paid for by the Medi-Cal program conducts, or has a third-party conduct, a state and national criminal background check on its employees who interact with patients. (2) Enrolled Medi-Cal providers shall maintain documentation demonstrating compliance with paragraph (1) and make it available to the department upon request or in the event of a state or federal audit. (c) The department shall utilize existing stakeholder forums to seek stakeholder feedback and offer stakeholder comment opportunities to inform changes to coverage and billing policy for BHT services, including applied behavior analysis and other evidence-based interventions. The department is encouraged to affirmatively reach out to the following stakeholders as appropriate based on the topic at issue to ensure adequate feedback: (1) BHT providers, which may include representatives of trade associations and licensing or certifying bodies, in addition to providers. (2) Providers of other services to children with autism, including, but not limited to, speech and hearing specialists, occupational therapists, psychiatrists, and vision specialists. (3) Managed care plans. (4) Consumers with autism. (5) Consumer advocates for organizations led by individuals with autism and organizations serving families of autistic children. (d) The department may consult with the Department of Managed Health Care or invite that department to participate in any stakeholder forums, for the purposes of coordination with the commercial market. (e) Stakeholder feedback shall include all of the following: (1) Clinical guidelines for the provision of BHT services, including independent clinician assessment for treatment and reauthorization requirements. (2) Treatment plan requirements, including the number of hours in a treatment plan, documentation of an individual’s needs, and how treatment outcomes specific to the individual and the effectiveness of treatment are reviewed. (3) Requirements for the provision of center-based services compared to services provided in the home, school, or otherwise in the child’s natural environment to ensure that only services that qualify as BHT services are billed. (4) Supervision of unlicensed and uncertified professionals, including the number of hours of supervision required, location of the supervisor, and number of unlicensed professionals whom a licensed or board-certified professional may supervise. Consideration shall also be given to how such supervision is monitored. (5) Standardization of Medi-Cal managed care plan documentation requirements, including credentialing. (6) Best practices in prioritizing quality care in contracting with BHT service providers. (7) Feasibility of requiring fingerprint-based criminal background checks of BHT service providers. (f) The department shall maintain clear billing and coverage guidance for BHT services described in Section 14132.56, which shall be consistent with federal Early and Periodic Screening, Diagnostic, and Treatment benefit requirements for individuals under 21 years of age and shall be informed and based on stakeholder feedback. (g) On or before January 1, 2029, the department shall publish on its internet website utilization data for BHT services and a synopsis of the BHT services coverage policy, highlighting any changes made as a result of stakeholder feedback and any applicable recommendations for statutory, regulatory, or administrative actions necessary to ensure that Medi-Cal reimbursement practices align with federal Medicaid program integrity requirements. (h) Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department, without taking any further regulatory action, shall implement, interpret, or make specific this section by means of all-county letters, plan letters, plan or provider bulletins, or similar instructions.