BILL ANALYSIS Senate Appropriations Committee Fiscal Summary Senator Christine Kehoe, Chair 543 (Leno) Hearing Date: 05/28/2009 Amended: 05/13/2009 Consultant: Dan Troy Policy Vote: Judiciary 3-0 _________________________________________________________________ ____ BILL SUMMARY: SB 543 would authorize a minor aged 12 or older to consent to mental health services or counseling on an outpatient basis or to residential shelter services, if the following conditions are satisfied: 1) the minor is mature enough to participate intelligently in the services; or 2) the minor presents a danger of serious physical or mental harm to himself or herself, or the minor is the alleged victim of incest or child abuse. _________________________________________________________________ ____ Fiscal Impact (in thousands) Major Provisions 2009-10 2010-11 2011-12 Fund Mental health services/ Unknown, likely significant costs General minor consent _________________________________________________________________ ____ STAFF COMMENTS: This bill meets the criteria for referral to the Suspense File. Under current law, a minor aged 12 or older may consent on his or her own for mental health treatment or counseling on an outpatient basis or to residential shelter services if both of the following conditions are satisfied: 1) The minor, in the opinion of the attending professional, is mature enough to participate intelligently in the service. 2) The minor presents a danger of serious physical or mental harm to himself or herself, or others, without the service, or the minor is an alleged victim of incest or child abuse. This bill would provide that minors may consent to their own treatment even if only the first of those conditions is met. Additionally, the bill would also expand the definition of a professional person relating to mental health or counseling services to include licensed clinical social workers and specify that parental notification is not required when the minor is receiving outpatient mental health treatment or counseling services. There are a variety of mental health programs and services accessible to minors, with or without parental consent. Counties have received approximately $7.7 million annually in lump sum payments (Managed Care) for minor consent costs for the last 10 years (though the Governor vetoed an amount of funding identical to minor consent costs in 2008 Budget Act, but did not specifically identify this program for reduction). There is the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT), counties may use realignment funding to provide these services, and there is also funding available through the Mental Health Services Act (Proposition 63, approved by Page 2 SB 543 (Leno) the voters in 2004). In regard to minor consent issues, counties may also receive reimbursements through the "sensitive services" option in Medi-Cal. By lowering the threshold for minors to consent to services on their own, this bill would likely increase eligibility for mental health services. In some cases (e.g., managed care), it may be that counties would be unlikely to receive any more state funding for these costs, so increases, in these instances, should be viewed more as cost pressures than as direct costs. For other programs, increases eligibility would almost certainly directly in increased state costs (e.g., "sensitive services" Medi-Cal). A precise cost estimate is not possible, as appropriate data is not gathered that details the number of minors requesting or in need of mental health services that do not meet the criteria under current law but would meet the criteria under the provisions of this bill. By removing the "physical or mental harm" condition for minor consent, this bill would likely expand the universe of eligible minors significantly, as many minors would likely be able to meet the "maturity" threshold. As costs for mental health services average thousands of dollars per unit, depending on the program and intensity of required service, it is likely that this bill would result in costs or cost pressures in the hundreds of thousands of dollars, or even more. One issue of concern regarding minor consent that the author's office has identified is liability on behalf of the service provider. To the extent the author wishes to eliminate state costs and pressures, staff suggests amending the bill to limit the change minor consent to extending toward provider liability, while leaving the standard as is for purposes of program eligibility.