California Legislature—2013–14 Regular Session

Assembly Bill No. 1367

Introduced by Assembly Member Mansoor

(Coauthors: Assembly Members Achadjian, Allen, Conway, Beth Gaines, Gorell, Hagman, Harkey, and Morrell)

February 22, 2013

An act to amend Sections 5813.5, 5840, 5890, and 5892 of the Welfare and Institutions Code, relating to mental health, and making an appropriation therefor.

LEGISLATIVE COUNSEL’S DIGEST

AB 1367, as introduced, Mansoor. Mental health: Mental Health Services Fund.

Existing law, known as Laura’s Law, until January 1, 2017, regulates designated assisted outpatient treatment services, which a county may choose to provide for its residents. In a county where assisted outpatient treatment services are available, a person is authorized to receive specified mental health services pursuant to an order if requisite criteria are met, as specified. Under that law, participating counties are required to provide prescribed assisted outpatient services, including a service planning and delivery process that provides for services that are client-directed and employ psychosocial rehabilitation and recovery principles.

Existing law contains provisions governing the operation and financing of community mental health services for the mentally disordered in every county through locally administered and locally controlled community mental health programs. Existing law, the Mental Health Services Act, an initiative measure enacted by the voters as Proposition 63 at the November 2, 2004, statewide general election, funds a system of county mental health plans for the provision of mental health services, as specified. The act provides that it may be amended by the Legislature by a 2⁄3 vote of each house as long as the amendment is consistent with and furthers the intent of the act, and that the Legislature may also clarify procedures and terms of the act by majority vote.

The act establishes the Mental Health Services Fund, continuously appropriated to and administered by the State Department of Health Care Services, to fund specified county mental health programs, including prevention and early intervention programs, which include outreach, and programs implemented under the Adult and Older Adult Mental Health System of Care Act. The Adult and Older Adult Mental Health System of Care Act establishes services standards that require, among other things, that a service planning and delivery process provides for services that are client-directed and employ psychosocial rehabilitation and recovery principles.

This bill would declare that it is consistent with and furthers the intent of the Mental Health Services Act. This bill would clarify that services provided under Laura’s Law may be provided pursuant to the Mental Health Services Act. This bill would provide that outreach under prevention and early intervention programs may include the provision of funds to school districts, county offices of education, and charter schools for the purposes of obtaining and providing training to identify students with mental health issues that may result in a threat to themselves or others. By allocating moneys in the Mental Health Services Fund for new purposes, this bill would make an appropriation.

This bill would delete obsolete provisions and make other conforming changes.

Because the bill would amend Proposition 63, it would require a 2⁄3 vote of the Legislature.

Vote: ²⁄₃. Appropriation: yes. Fiscal committee: yes. State-mandated local program: no.

The people of the State of California do enact as follows:

SECTION 1.  

The Legislature hereby finds and declares that
the provisions of this act are consistent with, and further the intent
of, the Mental Health Services Act.

SEC. 2.  

Section 5813.5 of the Welfare and Institutions Code
is amended to read:

5813.5.  

Subject to the availability of funds from the Mental
Health Services Fund, the state shall distribute funds for the
provision of services under Sections begin insert 5347, 5348, end insert 5801, 5802, and
5806 to county mental health programs. Services shall be available
to adults and seniors with severe illnesses who meet the eligibility
criteria in subdivisions (b) and (c) of Section 5600.3. For purposes
of begin delete this act end delete begin insert the Mental Health Services Act end insert , seniors means older
adult persons identified in begin delete Part 3 (commencing with Section 5800)
of end delete this begin delete division end delete begin insert part end insert .

(a) Funding shall be provided at sufficient levels to ensure that
counties can provide each adult and senior served pursuant to this
part with the medically necessary mental health services,
medications, and supportive services set forth in the applicable
treatment plan.

(b) The funding shall only cover the portions of those costs of
services that cannot be paid for with other funds including other
mental health funds, public and private insurance, and other local,
state, and federal funds.

(c) Each county mental health programs plan shall provide for
services in accordance with the system of care for adults and
seniors who meet the eligibility criteria in subdivisions (b) and (c)
of Section 5600.3.

(d) Planning for services shall be consistent with the philosophy,
principles, and practices of the Recovery Vision for mental health
consumers:

(1) To promote concepts key to the recovery for individuals
who have mental illness: hope, personal empowerment, respect,
social connections, self-responsibility, and self-determination.

(2) To promote consumer-operated services as a way to support
recovery.

(3) To reflect the cultural, ethnic, and racial diversity of mental
health consumers.

(4) To plan for each consumer’s individual needs.

(e) The plan for each county mental health program shall
indicate, subject to the availability of funds as determined by Part
4.5 (commencing with Section 5890) of this division, and other
funds available for mental health services, adults and seniors with
a severe mental illness being served by this program are either
receiving services from this program or have a mental illness that
is not sufficiently severe to require the level of services required
of this program.

(f) Each county plan and annual update pursuant to Section
5847 shall consider ways to provide services similar to those
established pursuant to the Mentally Ill Offender Crime Reduction
Grant Program. Funds shall not be used to pay for persons
incarcerated in state prison or parolees from state prisons.

(g) The department shall contract for services with county
mental health programs pursuant to Section 5897. After begin delete the
effective date of this section end delete begin insert January 1, 2005, end insert the term begin delete grants
referred to end delete begin insert “grant” as used end insert in Sections 5814 and 5814.5 begin delete shall refer
to such contracts end delete begin insert means a contract described in this subdivision end insert .

SEC. 3.  

Section 5840 of the Welfare and Institutions Code is
amended to read:

5840.  

(a) The State Department of Health Care Services, in
coordination with counties, shall establish a program designed to
prevent mental illnesses from becoming severe and disabling. The
program shall emphasize improving timely access to services for
underserved populations.

(b) The program shall include the following components:

(1) Outreach to families, employers, primary care health care
providers, begin insert school districts, county offices of education, charter
schools, end insert and others to recognize the early signs of potentially severe
and disabling mental illnesses. begin insert This may include the provision of
funds to school districts, county offices of education, and charter
schools for the purposes of obtaining and providing training to
identify students with mental health issues that may result in a
threat to themselves or others in order to provide for timely
intervention. end insert

(2) Access and linkage to medically necessary care provided
by county mental health programs for children with severe mental
illness, as defined in Section 5600.3, and for adults and seniors
with severe mental illness, as defined in Section 5600.3, as early
in the onset of these conditions as practicable.

(3) Reduction in stigma associated with either being diagnosed
with a mental illness or seeking mental health services.

(4) Reduction in discrimination against people with mental
illness.

(c) The program shall include mental health services similar to
those provided under other programs effective in preventing mental
illnesses from becoming severe, and shall also include components
similar to programs that have been successful in reducing the
duration of untreated severe mental illnesses and assisting people
in quickly regaining productive lives.

(d) The program shall emphasize strategies to reduce the
following negative outcomes that may result from untreated mental
illness:

(1) Suicide.

(2) Incarcerations.

(3) School failure or dropout.

(4) Unemployment.

(5) Prolonged suffering.

(6) Homelessness.

(7) Removal of children from their homes.

(e) Prevention and early intervention funds may be used to
broaden the provision of community-based mental health services
by adding prevention and early intervention services or activities
to these services.

(f) In consultation with mental health stakeholders, and
consistent with guidelines from the Mental Health Services
Oversight and Accountability Commission, pursuant to Section
5846, the department shall revise the program elements in Section
5840 applicable to all county mental health programs in future
years to reflect what is learned about the most effective prevention
and intervention programs for children, adults, and seniors.

SEC. 4.  

Section 5890 of the Welfare and Institutions Code is
amended to read:

5890.  

(a) The Mental Health Services Fund is hereby created
in the State Treasury. The fund shall be administered by the state.
Notwithstanding Section 13340 of the Government Code, all
moneys in the fund are, except as provided in subdivision (d) of
Section 5892, continuously appropriated, without regard to fiscal
years, for the purpose of funding the following programs and other
related activities as designated by other provisions of this division:

(1) Part 3 (commencing with Section 5800), the Adult and Older
Adult begin insert Mental Health end insert System of Care Act.

(2) Part 3.2 (commencing with Section 5830), Innovative
Programs.

(3) Part 3.6 (commencing with Section 5840), Prevention and
Early Intervention Programs.

(4) Part 4 (commencing with Section 5850), the Children’s
Mental Health Services Act.

begin insert

(5) Article 9 (commencing with Section 5345) of Chapter 2 of
Part 1, Laura’s Law.

end insert

(b) Nothing in the establishment of this fund, nor any other
provisions of the act establishing it or the programs funded shall
be construed to modify the obligation of health care service plans
and disability insurance policies to provide coverage for mental
health services, including those services required under Section
1374.72 of the Health and Safety Code and Section 10144.5 of the
Insurance Code, related to mental health parity. Nothing in this
act shall be construed to modify the oversight duties of the
Department of Managed Health Care or the duties of the
Department of Insurance with respect to enforcing these obligations
of plans and insurance policies.

(c) Nothing in this act shall be construed to modify or reduce
the existing authority or responsibility of the State Department of
Health Care Services.

(d) The State Department of Health Care Services shall seek
approval of all applicable federal Medicaid approvals to maximize
the availability of federal funds and eligibility of participating
children, adults, and seniors for medically necessary care.

(e) Share of costs for services pursuant to Part 3 (commencing
with Section 5800), and Part 4 (commencing with Section 5850)
of this division, shall be determined in accordance with the
Uniform Method for Determining Ability to Pay applicable to
other publicly funded mental health services, unless this Uniform
Method is replaced by another method of determining co-payments,
in which case the new method applicable to other mental health
services shall be applicable to services pursuant to Part 3
(commencing with Section 5800), and Part 4 (commencing with
Section 5850) of this division.

SEC. 5.  

Section 5892 of the Welfare and Institutions Code is
amended to read:

5892.  

(a) In order to promote efficient implementation of begin delete this
act end delete begin insert the Mental Health Services Act end insert , the county shall use funds
distributed from the Mental Health Services Fund as follows:

(1) In 2005-06, 2006-07, and in 2007-08 10 percent shall be
placed in a trust fund to be expended for education and training
programs pursuant to Part 3.1 begin insert (commencing with Section 5820) end insert .

(2) In 2005-06, 2006-07 and in 2007-08 10 percent for capital
facilities and technological needs distributed to counties in
accordance with a formula developed in consultation with the
California Mental Health Directors Association to implement plans
developed pursuant to Section 5847.

(3) Twenty percent of funds distributed to the counties pursuant
to subdivision (c) of Section 5891 shall be used for prevention and
early intervention programs in accordance with Part 3.6
(commencing with Section 5840) begin delete of this division end delete .

(4) The expenditure for prevention and early intervention may
be increased in any county in which the department determines
that the increase will decrease the need and cost for additional
services to severely mentally ill persons in that county by an
amount at least commensurate with the proposed increase.

(5) The balance of funds shall be distributed to county mental
health programs for services to persons with severe mental illnesses
pursuant to Part 4 (commencing with Section 5850), for the
children’s system of begin delete care and end delete begin insert care, end insert Part 3 (commencing with
Section 5800), for the adult and older adult system of begin delete care end delete begin insert care,
and Article 9 (commencing with Section 5345) of Chapter 2 of
Part 1 end insert .

(6) Five percent of the total funding for each county mental
health program for Part 3 (commencing with Section 5800), Part
3.6 (commencing with Section 5840), and Part 4 (commencing
with Section 5850) of this division, shall be utilized for innovative
programs in accordance with Sections 5830, 5847, and 5848.

(b) In any year after 2007-08, programs for services pursuant
to Part 3 (commencing with Section 5800), and Part 4
(commencing with Section 5850) of this division may include
funds for technological needs and capital facilities, human resource
needs, and a prudent reserve to ensure services do not have to be
significantly reduced in years in which revenues are below the
average of previous years. The total allocation for purposes
authorized by this subdivision shall not exceed 20 percent of the
average amount of funds allocated to that county for the previous
five years pursuant to this section.

(c) The allocations pursuant to subdivisions (a) and (b) shall
include funding for annual planning costs pursuant to Section 5848.
The total of these costs shall not exceed 5 percent of the total of
annual revenues received for the fund. The planning costs shall
include funds for county mental health programs to pay for the
costs of consumers, family members, and other stakeholders to
participate in the planning process and for the planning and
implementation required for private provider contracts to be
significantly expanded to provide additional services pursuant to
Part 3 (commencing with Section 5800), and Part 4 (commencing
with Section 5850) of this division.

(d) Prior to making the allocations pursuant to subdivisions (a),
(b), and (c), funds shall be reserved for the costs for the State
Department of Health Care Services, the California Mental Health
Planning Council, the Office of Statewide Health Planning and
Development, the Mental Health Services Oversight and
Accountability Commission, the State Department of Public Health,
and any other state agency to implement all duties pursuant to the
programs set forth in this section. These costs shall not exceed 3.5
percent of the total of annual revenues received for the fund. The
administrative costs shall include funds to assist consumers and
family members to ensure the appropriate state and county agencies
give full consideration to concerns about quality, structure of
service delivery, or access to services. The amounts allocated for
administration shall include amounts sufficient to ensure adequate
research and evaluation regarding the effectiveness of services
being provided and achievement of the outcome measures set forth
in Part 3 (commencing with Section 5800), Part 3.6 (commencing
with Section 5840), and Part 4 (commencing with Section 5850)
of this division. The amount of funds available for the purposes
of this subdivision in any fiscal year shall be subject to
appropriation in the annual Budget Act.

(e) In 2004-05 funds shall be allocated as follows:

(1) Forty-five percent for education and training pursuant to
Part 3.1 (commencing with Section 5820) of this division.

(2) Forty-five percent for capital facilities and technology needs
in the manner specified by paragraph (2) of subdivision (a).

(3) Five percent for local planning in the manner specified in
subdivision (c).

(4) Five percent for state implementation in the manner specified
in subdivision (d).

(f) Each county shall place all funds received from the State
Mental Health Services Fund in a local Mental Health Services
Fund. The Local Mental Health Services Fund balance shall be
invested consistent with other county funds and the interest earned
on the investments shall be transferred into the fund. The earnings
on investment of these funds shall be available for distribution
from the fund in future years.

(g) All expenditures for county mental health programs shall
be consistent with a currently approved plan or update pursuant
to Section 5847.

(h) Other than funds placed in a reserve in accordance with an
approved plan, any funds allocated to a county which have not
been spent for their authorized purpose within three years shall
revert to the state to be deposited into the fund and available for
other counties in future years, provided however, that funds for
capital facilities, technological needs, or education and training
may be retained for up to 10 years before reverting to the fund.

(i) If there are still additional revenues available in the fund
after the Mental Health Services Oversight and Accountability
Commission has determined there are prudent reserves and no
unmet needs for any of the programs funded pursuant to this
section, including all purposes of the Prevention and Early
Intervention Program, the commission shall develop a plan for
expenditures of these revenues to further the purposes of this act
and the Legislature may appropriate these funds for any purpose
consistent with the commission’s adopted plan which furthers the
purposes of this act.

begin delete

(j) For the 2011-12 fiscal year, General Fund revenues will be
insufficient to fully fund many existing mental health programs,
including Early and Periodic Screening, Diagnosis, and Treatment
(EPSDT), Medi-Cal Specialty Mental Health Managed Care, and
mental health services provided for special education pupils. In
order to adequately fund those programs for the 2011-12 fiscal
year and avoid deeper reductions in programs that serve individuals
with severe mental illness and the most vulnerable, medically
needy citizens of the state, prior to distribution of funds under
paragraphs (1) to (6), inclusive, of subdivision (a), effective July
1, 2011, moneys shall be allocated from the Mental Health Services
Fund to the counties as follows:

(1) Commencing July 1, 2011, one hundred eighty-three million
six hundred thousand dollars ($183,600,000) of the funds available
as of July 1, 2011, in the Mental Health Services Fund, shall be
allocated in a manner consistent with subdivision (c) of Section
5778 and based on a formula determined by the state in
consultation with the California Mental Health Directors
Association to meet the fiscal year 2011-12 General Fund
obligation for Medi-Cal Specialty Mental Health Managed Care.

(2) Upon completion of the allocation in paragraph (1), the
Controller shall distribute to counties ninety-eight million five
hundred eighty-six thousand dollars ($98,586,000) from the Mental
Health Services Fund for mental health services for special
education pupils based on a formula determined by the state in
consultation with the California Mental Health Directors
Association.

(3) Upon completion of the allocation in paragraph (2), the
Controller shall distribute to counties 50 percent of their 2011-12
Mental Health Services Act component allocations consistent with
Sections 5847 and 5891, not to exceed four hundred eighty-eight
million dollars ($488,000,000). This allocation shall commence
beginning August 1, 2011.

(4) Upon completion of the allocation in paragraph (3), and as
revenues are deposited into the Mental Health Services Fund, the
Controller shall distribute five hundred seventy-nine million dollars
($579,000,000) from the Mental Health Services Fund to counties
to meet the General Fund obligation for EPSDT for fiscal year
2011-12. These revenues shall be distributed to counties on a
quarterly basis and based on a formula determined by the state in
consultation with the California Mental Health Directors
Association. These funds shall not be subject to reconciliation or
cost settlement.

(5) The Controller shall distribute to counties the remaining
2011-12 Mental Health Services Act component allocations
consistent with Sections 5847 and 5891, beginning no later than
April 30, 2012. These remaining allocations shall be made on a
monthly basis.

(6) The total one-time allocation from the Mental Health
Services Fund for EPSDT, Medi-Cal Specialty Mental Health
Managed Care, and mental health services provided to special
education pupils as referenced shall not exceed eight hundred
sixty-two million dollars ($862,000,000). Any revenues deposited
in the Mental Health Services Fund in fiscal year 2011-12 that
exceed this obligation shall be distributed to counties for remaining
fiscal year 2011-12 Mental Health Services Act component
allocations, consistent with Sections 5847 and 5891.

(k) Subdivision (j) shall not be subject to repayment.

(l) Subdivision (j) shall become inoperative on July 1, 2012.

end delete