BILL NUMBER: SB 664	INTRODUCED
	BILL TEXT


INTRODUCED BY   Senator Yee
   (Coauthor: Senator Wolk)

                        FEBRUARY 22, 2013

   An act to amend Sections 5348, 5349, 5813.5, and 5892 of the
Welfare and Institutions Code, relating to mental health, and making
an appropriation therefor.


	LEGISLATIVE COUNSEL'S DIGEST


   SB 664, as introduced, Yee. Mental health: Laura's Law: 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. To implement the
program, the county board of supervisors is required to, by
resolution, authorize the program and make a finding that no
voluntary mental health program serving adults, and no children's
mental health program, may be reduced as a result of the program's
implementation. In a county where assisted outpatient treatment
services are available, a person is authorized to receive specific
mental health services pursuant to an order if requisite criteria are
met, as specified. Under that law, a participating county is
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.
   This bill would no longer require a county to authorize the
program by resolution and make those findings to implement the
program. This bill would authorize a county to limit the number of
persons to whom it provides assisted outpatient treatment services.
   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 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 programs funded under the
Adult and Older Adult Mental Health System of Care Act. The Adult and
Older Adult Mental Health System of Care Act establishes service
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. The
act authorizes the Legislature to clarify procedures and terms of the
act by majority vote.
    This bill would make an appropriation by clarifying that mental
health services provided under Laura's Law may be provided pursuant
to the procedures established by the Mental Health Services Act. This
bill would make other conforming changes and delete obsolete
provisions.
   Vote: majority. Appropriation: yes. Fiscal committee: yes.
State-mandated local program: no.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

  SECTION 1.  Section 5348 of the Welfare and Institutions Code is
amended to read:
   5348.  (a) For purposes of subdivision (e) of Section 5346, a
county that chooses to provide assisted outpatient treatment services
pursuant to this article  may limit the number of persons to
whom it provides assisted outpatient treatment services, and 
shall offer assisted outpatient treatment services including, but not
limited to, all of the following:
   (1) Community-based, mobile, multidisciplinary, highly trained
mental health teams that use high staff-to-client ratios of no more
than 10 clients per team member for those subject to court-ordered
services pursuant to Section 5346.
   (2) A service planning and delivery process that includes the
following:
   (A) Determination of the numbers of persons to be served and the
programs and services that will be provided to meet their needs. The
local director of mental health shall consult with the sheriff, the
police chief, the probation officer, the mental health board,
contract agencies, and family, client, ethnic, and citizen
constituency groups as determined by the director.
   (B) Plans for services, including outreach to families whose
severely mentally ill adult is living with them, design of mental
health services, coordination and access to medications, psychiatric
and psychological services, substance abuse services, supportive
housing or other housing assistance, vocational rehabilitation, and
veterans' services. Plans shall also contain evaluation strategies,
which shall consider cultural, linguistic, gender, age, and special
needs of minorities and those based on any characteristic listed or
defined in Section 11135 of the Government Code in the target
populations. Provision shall be made for staff with the cultural
background and linguistic skills necessary to remove barriers to
mental health services as a result of having limited-English-speaking
ability and cultural differences. Recipients of outreach services
may include families, the public, primary care physicians, and others
who are likely to come into contact with individuals who may be
suffering from an untreated severe mental illness who would be likely
to become homeless if the illness continued to be untreated for a
substantial period of time. Outreach to adults may include adults
voluntarily or involuntarily hospitalized as a result of a severe
mental illness.
   (C) Provision for services to meet the needs of persons who are
physically disabled.
   (D) Provision for services to meet the special needs of older
adults.
   (E) Provision for family support and consultation services,
parenting support and consultation services, and peer support or
self-help group support, where appropriate.
   (F) Provision for services to be client-directed and that employ
psychosocial rehabilitation and recovery principles.
   (G) Provision for psychiatric and psychological services that are
integrated with other services and for psychiatric and psychological
collaboration in overall service planning.
   (H) Provision for services specifically directed to seriously
mentally ill young adults 25 years of age or younger who are homeless
or at significant risk of becoming homeless. These provisions may
include continuation of services that still would be received through
other funds had eligibility not been terminated as a result of age.
   (I) Services reflecting special needs of women from diverse
cultural backgrounds, including supportive housing that accepts
children, personal services coordinator therapeutic treatment, and
substance treatment programs that address gender-specific trauma and
abuse in the lives of persons with mental illness, and vocational
rehabilitation programs that offer job training programs free of
gender bias and sensitive to the needs of women.
   (J) Provision for housing for clients that is immediate,
transitional, permanent, or all of these.
   (K) Provision for clients who have been suffering from an
untreated severe mental illness for less than one year, and who do
not require the full range of services, but are at risk of becoming
homeless unless a comprehensive individual and family support
services plan is implemented. These clients shall be served in a
manner that is designed to meet their needs.
   (3) Each client shall have a clearly designated mental health
personal services coordinator who may be part of a multidisciplinary
treatment team who is responsible for providing or assuring needed
services. Responsibilities include complete assessment of the client'
s needs, development of the client's personal services plan, linkage
with all appropriate community services, monitoring of the quality
and follow  -  through of services, and necessary advocacy
to ensure each client receives those services that are agreed to in
the personal services plan. Each client shall participate in the
development of his or her personal services plan, and responsible
staff shall consult with the designated conservator, if one has been
appointed, and, with the consent of the client, shall consult with
the family and other significant persons as appropriate.
   (4) The individual personal services plan shall ensure that
persons subject to assisted outpatient treatment programs receive
age-appropriate, gender-appropriate, and culturally appropriate
services, to the extent feasible, that are designed to enable
recipients to:
   (A) Live in the most independent, least restrictive housing
feasible in the local community, and, for clients with children, to
live in a supportive housing environment that strives for
reunification with their children or assists clients in maintaining
custody of their children as is appropriate.
   (B) Engage in the highest level of work or productive activity
appropriate to their abilities and experience.
   (C) Create and maintain a support system consisting of friends,
family, and participation in community activities.
   (D) Access an appropriate level of academic education or
vocational training.
   (E) Obtain an adequate income.
   (F) Self-manage their illnesses and exert as much control as
possible over both the day-to-day and long-term decisions that affect
their lives.
   (G) Access necessary physical health care and maintain the best
possible physical health.
   (H) Reduce or eliminate serious antisocial or criminal behavior,
and thereby reduce or eliminate their contact with the criminal
justice system.
   (I) Reduce or eliminate the distress caused by the symptoms of
mental illness.
   (J) Have freedom from dangerous addictive substances.
   (5) The individual personal services plan shall describe the
service array that meets the requirements of paragraph (4), and to
the extent applicable to the individual, the requirements of
paragraph (2).
   (b) A county that provides assisted outpatient treatment services
pursuant to this article also shall offer the same services on a
voluntary basis.
   (c) Involuntary medication shall not be allowed absent a separate
order by the court pursuant to Sections 5332 to 5336, inclusive.
   (d) A county that operates an assisted outpatient treatment
program pursuant to this article shall provide data to the State
Department of Health Care Services and, based on the data, the
department shall report to the Legislature on or before May 1 of each
year in which the county provides services pursuant to this article.
The report shall include, at a minimum, an evaluation of the
effectiveness of the strategies employed by each program operated
pursuant to this article in reducing homelessness and hospitalization
of persons in the program and in reducing involvement with local law
enforcement by persons in the program. The evaluation and report
shall also include any other measures identified by the department
regarding persons in the program and all of the following, based on
information that is available:
   (1) The number of persons served by the program and, of those, the
number who are able to maintain housing and the number who maintain
contact with the treatment system.
   (2) The number of persons in the program with contacts with local
law enforcement, and the extent to which local and state
incarceration of persons in the program has been reduced or avoided.
   (3) The number of persons in the program participating in
employment services programs, including competitive employment.
   (4) The days of hospitalization of persons in the program that
have been reduced or avoided.
   (5) Adherence to prescribed treatment by persons in the program.
   (6) Other indicators of successful engagement, if any, by persons
in the program.
   (7) Victimization of persons in the program.
   (8) Violent behavior of persons in the program.
   (9) Substance abuse by persons in the program.
   (10) Type, intensity, and frequency of treatment of persons in the
program.
   (11) Extent to which enforcement mechanisms are used by the
program, when applicable.
   (12) Social functioning of persons in the program.
   (13) Skills in independent living of persons in the program.
   (14) Satisfaction with program services both by those receiving
them and by their families, when relevant.
  SEC. 2.  Section 5349 of the Welfare and Institutions Code is
amended to read:
   5349.   This article shall be operative in those counties
in which the county board of supervisors, by resolution, authorizes
its application and makes a finding that no voluntary mental health
program serving adults, and no children's mental health program, may
be reduced as a result of the implementation of this article.
 Compliance with this section shall be monitored by the
State Department of Health Care Services as part of its review and
approval of county performance contracts.
  SEC. 3.  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  5347, 5348,  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  this act  the Mental Health
Services Act  , seniors means older adult persons identified in
 Part 3 (commencing with Section 5800) of  this
 division   part  .
   (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.  Funds may be used to
provide persons   with assisted outpatient treatment
services, as defined in Section 5345. 
   (g) The department shall contract for services with county mental
health programs pursuant to Section 5897. After  the
effective date of this section   January 1, 2005, 
the term  grants referred to   "grant" as used
 in Sections 5814 and 5814.5  shall refer to such
contracts   means a contract described in this 
 subdivision  .
  SEC. 4.  Section 5892 of the Welfare and Institutions Code is
amended to read:
   5892.  (a) In order to promote efficient implementation of
 this act   the Mental Health Services Act 
, 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  (commencing with Section 5820) of this
division  .
   (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) of this division.
   (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  care and   care,  Part 3
(commencing with Section 5800), for the adult and older adult system
of  care   care, and Sections 5347 and 5348
 .
   (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. 
   (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.