BILL NUMBER: AB 38 AMENDED
BILL TEXT
AMENDED IN SENATE MAY 18, 2016
AMENDED IN ASSEMBLY MARCH 23, 2015
INTRODUCED BY Assembly Member Eggman
DECEMBER 1, 2014
An act to add and repeal Section 1367.020 of the
Health and Safety Code, relating to the California
State University. mental health.
LEGISLATIVE COUNSEL'S DIGEST
AB 38, as amended, Eggman. California State University:
Legislative Analyst's Office: initial analysis to assess need for new
campus. Mental Health Delivery Demonstration Project:
Early Diagnosis and Psychosis Treatment Program.
Existing law, the Knox-Keene Health Care Service Plan Act of 1975,
provides for the licensure and regulation of health care service
plans by the Department of Managed Health Care. Existing law requires
health care service plans to meet specified criteria. Existing law
makes a willful violation of that act a crime.
This bill would, commencing July 1, 2017, authorize health care
service plans that offer health care services within the greater
Sacramento area to require enrollees seeking services for a mental
health condition to participate in a Mental Health Delivery
Demonstration Project through an Early Diagnosis and Psychosis
Treatment (EDAPT) program, as defined. The bill would require plans
that choose to participate to develop clinical guidelines for
enrollees and to make those guidelines available as part of their
evidence of coverage and to primary care providers and specialty
mental health providers in their contracted network. The bill would
allow an enrollee to opt out of the EDAPT program if a psychiatrist
notifies the plan that the enrollee is under his or her care. These
provisions would be repealed on January 1, 2020. Because a willful
violation of these provisions would be a crime, this bill would
impose a state-mandated local program.
The California Constitution requires the state to reimburse local
agencies and school districts for certain costs mandated by the
state. Statutory provisions establish procedures for making that
reimbursement.
This bill would provide that no reimbursement is required by this
act for a specified reason.
Existing law establishes the California State University, under
the administration of the Trustees of the California State
University, as one of the segments of public postsecondary education
in this state. The university comprises 23 independent campuses.
This bill would require the Legislative Analyst's Office to
conduct an initial analysis to assess the need for a new campus of
the university. The bill would specify data to be included in the
analysis, to the extent that applicable data is available. The bill
would require the university to provide whatever data is needed to
meet the requirements of this bill to the Legislative Analyst's
Office upon that office's request. The bill would require the
Legislative Analyst's Office to submit a report containing this
analysis to the Legislature and Department of Finance on or before
January 1, 2017.
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no yes .
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. (a) The Legislature finds and declares
all of the following:
(1) Despite the importance of and emphasis on mental health
parity, management of mental illness within a system of care is far
more difficult than most types of physical illness. There are
significant differences between the delivery systems for the Medi-Cal
population and the delivery systems for those covered by private
insurance, and there are unique problems associated with each system.
While changes are needed in both, there is an immediate need to look
for ways to better serve the insured population.
(2) The limited number of providers, the lack of facilities for
treatment, and the difficulties of arranging for and coordinating
ancillary services have made it extremely difficult for health
insurers to meet the needs of enrollees facing significant mental
health issues.
(3) Attempts to develop truly accessible provider networks that
can link with the array of administrative and ancillary services that
the mentally ill need to manage their disease and to improve will
take an investment of time and resources.
(4) Systems of care known as Early Diagnosis and Psychosis
Treatment (EDAPT) programs may hold the key to these problems. These
integrated systems of care provide early intervention, assessment,
diagnosis, a treatment plan, and the services necessary to implement
that plan. EDAPT programs have interdisciplinary teams of physicians,
clinicians, advocates, and staff that coordinate care on an
outpatient basis.
(5) EDAPT programs do not yet exist in sufficient number to allow
them to meet the provider network requirements health insurers must
meet. While it is possible under existing law for health insurers to
contract with existing EDAPT programs, there are a number of
regulatory and practical issues that stand in the way of directing
patients to them so that the patients' conditions can be effectively
managed. If insurers could designate an EDAPT program as an exclusive
provider for their enrollees, an assessment can be made of the
overall efficacy of the model.
(b) Therefore, it is the intent of the Legislature to establish a
demonstration project or projects in geographic areas of the state
where EDAPT programs exist to allow health insurers to opt in to
utilizing the EDAPT programs as exclusive provider networks for the
insurers' enrollees in need of these services.
SEC. 2. Section 1367.020 is added to the
Health and Safety Code , to read:
1367.020. (a) Notwithstanding any other law, commencing July 1,
2017, a health care service plan that offers health care services on
an individual or group basis in the greater Sacramento area may
require enrollees seeking services for a mental health condition to
participate in a Mental Health Delivery Demonstration Project through
an Early Diagnosis and Psychosis Treatment Program.
(b) If a plan chooses to require its enrollees to participate in
the project, it shall develop clinical guidelines for those enrollees
and make those guidelines available as part of its evidence of
coverage. The plan shall also make those guidelines available to all
primary care providers and specialty mental health providers in its
contracted network.
(c) An enrollee directed to a Mental Health Delivery Demonstration
Project site for services shall be able to opt out of those services
if a psychiatrist notifies the plan that the enrollee is under his
or her care.
(d) For purposes of this section, "Early Diagnosis and Psychosis
Treatment Program" means a mental health service program that
provides early intervention, diagnosis, treatment, and necessary
support through interdisciplinary teams of physicians, mental health
professionals, social workers, and advocates on an outpatient basis
and through a single point of entry.
(e) This section shall remain in effect only until January 1,
2020, and as of that date is repealed, unless a later enacted
statute, that is enacted before January 1, 2020, deletes or extends
that date.
SEC. 3. No reimbursement is required by this act
pursuant to Section 6 of Article XIII B of the California
Constitution because the only costs that may be incurred by a local
agency or school district will be incurred because this act creates a
new crime or infraction, eliminates a crime or infraction, or
changes the penalty for a crime or infraction, within the meaning of
Section 17556 of the Government Code, or changes the definition of a
crime within the meaning of Section 6 of Article XIII B of the
California Constitution.
SECTION 1. (a) The Legislature finds and
declares all of the following:
(1) The Master Plan for Higher Education in California established
the following criteria for determining the need for a new public
university campus:
(A) The relative numbers of high school graduates, the location of
existing institutions in the various areas of the state, and the
relation between their capacities and the estimated enrollment in the
area served by each such institution.
(B) The relative numbers of potential students within reasonable
commuting distance of each of the proposed sites.
(2) The need to accommodate students in excess of the physical
capacities of existing community colleges, California State
University (CSU) campuses, and University of California campuses.
(3) The Master Plan designates CSU to draw its freshman class from
the top third of the state's public high school graduates and admit
transfer-prepared applicants with a minimum GPA of 2.0. Most CSU
campuses provide priority admission to local applicants.
(b) The Legislative Analyst's Office shall conduct an initial
analysis to assess the need for a new CSU campus. The analysis shall
consist of the following parts:
(1) An analysis of the need within certain regions for a CSU
campus. This part shall include all of the following to the extent
applicable data are available:
(A) Consideration of enrollment demand based on relative
demographic levels and eligible students for each county. This part
shall include five- to 10-year projections of the college-age
population and public high school graduates. It also shall include
data for the most recent year available on college preparedness,
including the number and share of high school graduates completing
the "A-G" admissions requirements and the number and share of
transfer-prepared community college students.
(B) For each county, data on CSU applications, admissions, and
enrollment for the most recent year available to estimate
college-going rates to CSU.
(C) Data on adult educational attainment by county for the most
recent year available.
(2) An analysis of the physical capacities of existing CSU
campuses, as set forth in their master plans, relative to current
enrollment. This analysis shall identify CSU campuses already at
maximum capacity and those with remaining physical capacity. The
analysis also shall identify which CSU campuses no longer provide
enrollment priority for local applicants.
(c) The CSU shall provide whatever data is needed to meet the
requirements of this section to the Legislative Analyst's Office upon
that office's request. The Legislative Analyst's Office shall submit
a report containing the analysis required by this section to the
Legislature and Department of Finance on or before January 1, 2017.