BILL ANALYSIS Ó
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: AB 2679
AUTHOR: Logue
AMENDED: June 17, 2014
HEARING DATE: June 25, 2014
CONSULTANT: Diaz
SUBJECT : County mental health services: baseline reports.
SUMMARY : Requires the Department of Health Care Services and
the California Mental Health Planning Council to make specified
information related to mental health services client outcomes
and cost effectiveness available on their respective Internet
Web sites. Requires a county mental health program to add
information requested by the Mental Health Services Oversight
and Accountability Commission in its three-year program and
expenditure plan. Permits the information to include mental
health program services for adults and seniors, as specified.
Existing law:
1.Makes the Department of Health Care Services (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.
2.Establishes the Mental Health Services Act (MHSA), which
imposes a one percent 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 (MHSOAC) to oversee various mental
health programs. Among many other duties, authorizes MHSOAC 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 DHCS to establish a Performance Outcome Committee and
consult with the Committee, the California Mental Health
Planning Council (CMHPC), the MHSOAC, and the California
Continued---
AB 2679 | Page 2
Health and Human Services Agency, to develop uniform
definitions and formats for a statewide, non-duplicative
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. 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, as guidance only.
5.Requires counties to annually report data on these performance
measures to the local mental health advisory board and to
DHCS. Requires DHCS to annually make available to the
Legislature, no later than March 15, data on county
performance.
6.Creates the CMHPC for purposes of fulfilling mental health
planning requirements mandated by federal law and to review
program performance in delivering mental health services based
on specified data reports, and to report findings and
recommendations on programs' performance annually to the
Legislature, DHCS, and local boards.
7.Requires each county mental health program to prepare and
submit a three-year program and expenditure plan, with annual
updates, adopted by the county board of supervisors, to the
MHSOAC within 30 days after adoption. Requires the plan to
include, among other things, programs for services to adults
and seniors.
This bill:
1.Requires DHCS to make data reported by counties related to
MHSA client outcomes and cost effectiveness of mental health
services available on its Internet Web site.
2.Requires the CMHPC to make its findings and recommendations on
the performance of mental health services programs available
on its Internet Web site.
3.Requires a county mental health program's three-year program
and expenditure plan to include information requested by the
MHSOAC to assist in its oversight of the program for services
to adults and seniors. Permits the information to include
estimates of the number of additional people who meet the
criteria for services pursuant to the Adult and Older Adult
Mental Health System of Care Act and who are not receiving
AB 2679 | Page
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services that meet the criteria in the Act. Requires the
estimates to be based on existing available data and not
include duplicative reporting requirements.
FISCAL EFFECT : According to the Assembly Appropriations
Committee, any costs associated with this legislation are minor
and absorbable.
PRIOR VOTES :
Assembly Health: 19- 0
Assembly Appropriations:17- 0
Assembly Floor: 73- 0
COMMENTS :
1.Author's statement. According to the author, Proposition 63,
known as the MHSA, was approved by voters in 2004 and placed a
one percent tax on incomes over one million dollars to fund
mental health services at the county level. In 2012, the
author along with Senator Steinberg and Assemblyman Nestande
requested a state audit to determine where and how MHSA funds
were being spent. In 2013, the State Auditor's office released
the report, which found that there was a gross lack of
oversight for programs funded through the MHSA. There was very
little evidence to show that the $7.4 billion directed to
county mental health service programs from 2006 through 2012
provided any direct benefit to the state. This bill seeks to
bring needed transparency and accountability to county mental
health services. Counties currently report key information to
DHCS and the CMHPC regarding their county mental health
programs. This bill will require them to compile the data they
receive and provide it on their respective Web sites. This
data is a necessary tool to properly target county spending
and determine if there are any positive changes. The State
Auditor told the Legislature that the audit results could not
ensure that MHSA programs and spending were used effectively
and appropriately. Establishing these added annual reporting
requirements will tell a great deal about current conditions
and enable the state to develop a system to compare those
results with future conditions.
2.State audit. A 2013 audit by the State Auditor, titled "Mental
Health Services Act (MHSA): The State's Oversight Has Provided
Little Assurance of the Act's Effectiveness, and Some Counties
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Can Improve Measurement of Their Program Performance," found
that, although the MHSA funded many programs and served
numerous individuals, the former Department of Mental Health
and the MHSOAC did not provide the oversight needed to
demonstrate whether the MHSA is effective. The report
suggested the state should use performance-based contracts,
conduct comprehensive on-site reviews of MHSA programs,
identify and collect meaningful data, and use the data to
verify and report on performance.
3.Prior legislation. SB 585 (Steinberg), Chapter 288, Statutes
of 2013, clarified 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 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 that included, 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.
SB 1006 (Committee on Budget and Fiscal Review), Chapter 34,
Statutes of 2012, provided for a comprehensive restructuring
of community-based mental health services at both the state
and local levels and made changes necessary to effectuate the
2011 Realignment. Among other changes, required DHCS to
create a plan for a performance outcome system for Early and
Periodic Screening, Diagnosis, and Treatment mental health
services provided to eligible Medi-Cal beneficiaries under the
age of 21.
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.
4.Oppose unless amended. The California Mental Health Directors
Association (CMHDA) argues that the latest amendment on June
17, 2014, which requires county mental health programs'
three-year program and expenditure plans to include
information requested by the MHSOAC (which may include the
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5
estimate of adults and seniors who are eligible for but not
receiving MHSA services) is already available through existing
requirements. CMHDA argues that DHCS provides instructions to
counties for their annual MHSA revenue and expenditure reports
related to this information. CMHDA further argues that simply
counting the number of individuals receiving or not receiving
services does not yield information about the effectiveness
and impact of the MHSA.
5.Amendments. The author may wish to consider the following
committee staff amendments:
a. On page 6, delete lines 33 through 39, inclusive.
b. On page 7, delete lines 1 and 2, inclusive.
SUPPORT AND OPPOSITION :
Support: California American College of Emergency Physicians
(previous version)
California Council of Community Mental Health Agencies
(previous version)
California Mental Health Planning Council (previous
version)
Mental Health America of California (previous version)
Oppose: California Mental Health Directors Association (unless
amended)
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