BILL ANALYSIS Ó
AB 2679
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Date of Hearing: April 29, 2014
ASSEMBLY COMMITTEE ON HEALTH
Richard Pan, Chair
AB 2679 (Logue) - As Introduced: February 21, 2014
SUBJECT : County mental health services: baseline reports.
SUMMARY : Requires the Department of Health Care Services (DHCS)
to develop a baseline report of system quality and access to
services in each county's mental health plan. Specifically,
this bill :
1)Requires DHCS, in cooperation with county mental health
directors and appropriate state and county officials, to
develop a baseline report of system quality and access to
services in each county's mental health plan. Requires the
baseline report to include documentation of services funded by
all revenue sources, including county overmatch and any other
sources.
2)Requires, on or before July 1, 2015, the state to issue
requirements for each county to establish a baseline report on
its county mental health plan. Requires these reports to
include specified data, including number of clients served,
service priorities, staff-to-client ratios, a description of
certain programs, data about county jail populations, suicide
rates, and law enforcement involvement, and use of funds
towards treatment in locked facilities.
3)Requires each county to submit a baseline report on the
efficacy of the county's mental health care plan, including
county-operated programs and county-contracted services, and
requires DHCS to report to the Legislature. Requires reports
in 2016 and 2020.
EXISTING LAW :
1)Makes DHCS responsible for administration of law governing the
state's community mental health systems and for all statewide
mental health planning, research, evaluation and quality
assurance functions. Includes among these functions
implementation of a system of required performance reporting
by local mental health programs.
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2)Establishes the Mental Health Services Act (MHSA), which
imposes a 1% income tax on personal income in excess of $1
million to provide for local mental health services.
3)Establishes the Mental Health Services Oversight and
Accountability Commission to oversee various mental health
programs. Among many other duties, authorizes the Commission
to obtain data and information from DHCS, the Office of
Statewide Health Planning and Development, or other state or
local entities that receive MHSA funds, for oversight,
review, training and technical assistance, accountability, and
evaluation of projects and programs supported with MHSA
funds.
4)Requires counties to annually adopt and submit to DHCS a
proposed annual performance contract for mental health
services in the county.
5)Provides for appointment of local mental health boards by
county boards of supervisors. Requires each local mental
health board to submit an annual report to the county on the
needs and performance of the county's mental health system.
6)Creates the California Mental Health Planning Council for
purposes of fulfilling mental health planning requirements
mandated by federal law.
7)Requires each local mental health board to review and comment
on the county's performance outcome data and communicate its
findings to the California Mental Health Planning Council.
8)Requires DHCS to establish a Performance Outcome Committee and
consult with the Committee, the California Mental Health
Planning Council, the Mental Health Services Oversight and
Accountability Commission, and the California Health and Human
Services Agency, to develop uniform definitions and formats
for a statewide, nonduplicative client-based information
system that meets federal mental health grant requirements and
state and federal Medicaid reporting requirements, as well as
any other state requirements established by law.
9)Requires the data system to include performance measures for
evaluating client outcomes and cost effectiveness of mental
health services, including a consideration of outcome measures
in the following areas:
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a) Numbers of persons in identified target populations
served;
b) Estimated number of persons in identified target
populations in need of services;
c) Treatment plan development for members of the target
population served;
d) Treatment plan goals met;
e) Stabilization of living arrangements;
f) Reduction of law enforcement involvement and jail
bookings;
g) Increase in employment or education activities;
h) Percentage of resources used to serve children and older
adults;
i) Number of patients' rights advocates and their duties;
j) Quality assurance activities for services, including
peer review and medication management; and,
aa) Identification of special projects, incentives, and
prevention programs.
10)Requires counties to annually report data on these
performance measures to the local mental health board and to
DHCS.
11)Requires DHCS to annually make available to the Legislature,
no later than March 15, data on county performance.
12)Requires DHCS to consult with the Quality Improvement
Committee, which includes representatives of the California
Mental Health Planning Council, local mental health
departments, consumers and families of consumers, and other
stakeholders, to establish and measure indicators of access
and quality for the purpose of continuously improving
California's public mental health system. Requires inclusion
of indicators for structure, access, appropriateness, and cost
effectiveness of care, and outcomes.
13)Requires the California Mental Health Planning Council to
annually review performance outcome data as follows: a) review
and approve the performance outcome measures; b) review mental
health program performance based on performance outcome data
and other reports from the State Department of Health Care
Services and other sources; c) report findings and
recommendations on programs' performance annually to the
Legislature and DHCS; and d) identify successful and failing
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programs.
14)Requires county mental health systems, in consultation with
the California Mental Health Directors Association, DHCS, the
Mental Health Services Oversight and Accountability
Commission, the California Mental Health Planning Council, and
the California Health and Human Services Agency, to provide
reports and data to meet the information needs of the state.
15)Requires a county, whenever it makes a substantial change in
its allocation of mental health funds among services,
facilities, programs, and providers, to document that it based
its decision on the most cost-effective use of available
resources to maximize overall client outcomes, and provide
this documentation to DHCS.
FISCAL EFFECT : This bill has not yet been analyzed by a fiscal
committee.
COMMENTS :
1)PURPOSE OF THIS BILL . This bill was introduced in response to
a 2013 audit by the Bureau of State Audits (BSA) entitled
"Mental Health Services Act: The State's Oversight Has
Provided Little Assurance of the Act's Effectiveness, and Some
Counties Can Improve Measurement of Their Program
Performance." The author of this bill notes the audit found
that, although the MHSA funded many programs and served
numerous individuals, the Department of Mental Health (DMH)
and the Mental Health Services Oversight and Accountability
Commission did not provide the oversight needed to demonstrate
whether the MHSA is effective. This bill seeks to provide the
necessary oversight to ensure that the funds generated through
the MHSA are being used effectively.
2)BACKGROUND . California has a decentralized public mental
health system with most direct services provided through the
county mental health system. Counties have the primary
funding and programmatic responsibility for the majority of
local mental health programs. Specifically, counties are
responsible for: a) all mental health treatment services
provided to low-income, uninsured individuals with severe
mental illness; b) Medi-Cal Specialty Mental Health Services
for adults and children; c) mental health treatment services
for individuals enrolled in other programs, including special
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education and CalWORKs; and d) programs specifically
associated with the MHSA.
a) Medi-Cal Specialty Mental Health Services Program.
California provides Medi-Cal specialty mental health
services under a waiver that includes outpatient specialty
mental health services, such as clinic outpatient
providers, psychiatrists, psychologists, some nursing
services, and psychiatric inpatient hospital services.
Children's specialty mental health services are provided
under the federal requirements of the Early and Periodic
Screening, Diagnosis, and Treatment (EPSDT) benefit for
persons under age 21. County mental health plans are the
responsible entity that ensures specialty mental health
services are provided, and Medi-Cal enrollees must obtain
their specialty mental health services through the county.
b) MHSA. Proposition 63 of 2004 enacted the MHSA, which
imposes a 1% income tax on personal income in excess of $1
million. The purpose of the MHSA is to expand mental
health services to children, youth, adults and older adults
who have severe mental illnesses or severe mental health
disorders and whose service needs are not being met through
other funding sources. Under MHSA, counties that receive
funds must have a three-year plan developed with
significant local stakeholder input and involvement. The
MHSA requires each plan to cover the following five
components: a) Community Services and Supports for Adults
and Children's System of Care; b) Prevention and Early
Intervention; c) Innovation; d) Workforce Education and
Training; and, e) Capital Facilities and Technological
Needs. MHSA revenues for Fiscal Year 2014-15 are projected
to be about $1.6 billion.
3)BSA AUDIT . In its audit of the state's oversight of MHSA
activities, BSA found that DMH, which was responsible for
administering law related to community mental health programs
through June 2012, made poor use of the statutory protections
that ensure transparency and accountability of spending in the
state's public mental health system. The audit report found
that DMH did not base its monitoring of county MHSA programs
on performance contracts, but instead used an agreement that
offered little specificity as to the steps a county should
take to assure compliance with the MHSA. The audit further
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found that DMH did not provide clear and consistent guidance
to counties on how to evaluate and assess the outcomes of
their MHSA activities.
The audit made several recommendations, mostly focused on urging
DHCS and counties to use performance contracts to achieve
effective oversight and accountability. The audit report made
one recommendation to the Legislature, which is to clarify
that DHCS can withhold certain funds from a noncompliant
county.
4)SUPPORT . The California Chapter of the American College of
Emergency Physicians (California ACEP) argues that this bill,
by establishing baseline measures for county mental health
programs, will help increase access to mental health services.
California ACEP states emergency physicians know firsthand
the difficulties facing patients in need of psychiatric care,
and those patients without access to adequate mental health
services often find themselves in the emergency department.
5)SUPPORT IF AMENDED . The California Mental Health Directors
Association (CMHDA) with a position of "support if amended,"
writes that while it supports transparency and accountability
in the public mental health system, amendments are needed to
ensure that meaningful information without excessive
regulation or bureaucracy is reported. CMHDA asserts counties
already report vast amounts of information to the state and
suggests that this bill creates duplicative requirements.
CMHDA requests that this bill be amended to require DHCS to
publish a report that makes use of the extensive information
already reported and collected, with the aim of achieving a
transformative, transparent, and useful measuring tool that
empowers policy makers and the public.
6)RELATED LEGISLATION .
a) SB 82 (Committee on Budget), Chapter 20, Statutes of
2013, the Investment in Mental Health Wellness Act of 2013,
was a trailer bill for the 2013-14 Budget Act. SB 82
includes, among its other provisions, $206 million ($142
million General Fund one-time) for a major investment in
mental health services, including additional residential
treatment capacity, crisis treatment teams, and triage
personnel.
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b) SB 585 (Steinberg) clarifies that MHSA funds and
various County Realignment accounts may be used to provide
mental health services under the Assisted Outpatient
Treatment Demonstration Project Act of 2002, or Laura's
Law, and allows counties to opt to implement Laura's Law
through the county budget process. SB 585 is pending in
the Assembly Appropriations Committee.
7)PREVIOUS LEGISLATION .
a) SB 1006 (Committee on Budget and Fiscal Review), Chapter
34, Statutes of 2012, provides for a comprehensive
restructuring of community-based mental health services at
both the state and local levels and makes changes necessary
to effectuate the 2011 Realignment. Among other changes,
requires DHCS to create a plan for a performance outcome
system for EPSDT mental health services provided to
eligible Medi-Cal beneficiaries under the age of 21.
b) AB 1288 (Bronzan and McCorquodale), Chapter 89, Statutes
of 1991, realigned financial responsibility for various
state programs, including the state's mental health
programs, to local governments.
8)SUGGESTED AMENDMENT . Given the already extensive requirements
for counties and the state to report performance data, the
additional reporting requirements in this bill may
unnecessarily divert needed resources from the provision of
needed mental health services. Instead, to achieve the
author's stated goal and to make the currently reported
information more useful, the author may wish to remove the new
reporting requirements in this bill and instead: a) require
DHCS's currently required annual report to the Legislature on
county mental health performance data to be posted on the DHCS
Website; and b) require the California Mental Health Planning
Council's annual report to review mental health program
performance in each county and be posted on the web.
REGISTERED SUPPORT / OPPOSITION :
Support
California Chapter of the American College of Emergency
Physicians
AB 2679
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Opposition
None on file.
Analysis Prepared by : Ben Russell / HEALTH / (916) 319-2097