Amended in Senate August 19, 2016

Amended in Senate June 13, 2016

Amended in Senate May 18, 2016

Amended in Assembly March 23, 2015

California Legislature—2015–16 Regular Session

Assembly Bill No. 38

Introduced by Assembly Member Eggman

December 1, 2014

An act to add and repeal Part 6 (commencing with Section 5950) of Division 5 of the Welfare and Institutions Code, relating to mental begin delete health. end delete begin insert health, and making an appropriation therefor. end insert

LEGISLATIVE COUNSEL’S DIGEST

AB 38, as amended, Eggman. Mental health: Early Diagnosis and Preventive Treatment Program.

Existing law, the Bronzan-McCorquodale Act, sets out a system of community mental health care services provided by counties and administered by the State Department of Health Care Services.

This bill would establish the begin delete EDAPT pilot program in the department to end delete begin insert Early Diagnosis and Preventive Treatment (EDAPT) Program Fund in the State Treasury to provide funding to the Regents of the University of California for the purpose of providing reimbursement to an EDAPT program that would end insert utilize integrated systems of care to provide early intervention, assessment, diagnosis, a treatment plan, and necessary services for individuals with severe mental illness and children with severe emotional disturbance, as specified. begin insert The bill would authorize moneys from private or other sources to be deposited into the fund and used for purposes of the bill. end insert The bill would begin delete require the department to use funds appropriated for this purpose by the Legislature to provide end delete begin insert require, when the Department of Finance has determined that the total amount of the moneys in the fund has reached or exceeded $1,200,000, the Controller to distribute all of the moneys in the fund to the Regents of the University of California for the purpose of providing end insert reimbursement to begin delete the end delete begin insert an end insert EDAPT program for services provided to persons who are referred to that program, but whose private health benefit plan, as defined, does not cover the full range of required begin delete services. end delete begin insert services, thereby making an appropr end insert begin insert iation. end insert The bill would require the begin delete University of California, Davis, if they accept money from the program, in the 4th year after the program is established but no later than January 1, 2022, to report end delete begin insert Regents of the University of California, if the regents accept the money, or if the regents accept federal funding distributed by the State Department of Health Care Services for the purpose of supporting end insert begin insert an EDAPT program, as specified, to report, on or after January 1, 2022, but prior to January 1, 2023, end insert specified information to the health committees of both houses of the Legislature. The bill would repeal the program as of January 1, begin delete 2022. end delete begin insert 2023. end insert

Vote: majority. Appropriation:  begin delete no end delete begin insert yes end insert . Fiscal committee: yes. State-mandated local program: no.

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

SECTION 1.  

(a) The Legislature finds and declares all of the
following:

(1) There are approximately 1.2 million adult Californians who
suffer from severe mental illness and over 700,000 children in
California who deal with severe emotional disturbance.

(2) 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.

(3) 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.

(4) 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.

(5) Systems of care known as Early Diagnosis and Preventive
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.

(6) EDAPT programs do not yet exist in sufficient begin delete number end delete
begin insert numbers end insert 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
begin delete can end delete begin insert could end insert be made of the overall efficacy of the model.

(b) Therefore, it is the intent of the Legislature to begin delete establish a
demonstration project to allow health insurers to opt in to utilizing
the full range of EDAPT services to preserve the functioning of
the insurers’ enrollees in need of these services. end delete begin insert provide funding
to augment private health benefit plan coverage in order to provide
patients with the full range of necessary EDAPT services. end insert

SEC. 2.  

Part 6 (commencing with Section 5950) is added to
Division 5 of the Welfare and Institutions Code, to read:

 

PART 6.  EDAPT begin insert Funding end insert Pilot Program

 

5950.  

(a) There is hereby established the begin delete EDAPT pilot end delete begin delete program end delete
begin insert Early Diagnosis and Preventive Treatment (EDAPT) Program
Fund end insert within the begin delete State Department of Health Care Services to utilize
integrated systems of care to provide early intervention, assessment,
diagnosis, a treatment plan, and necessary services for individuals
with severe mental illness and children with severe emotional
disturbance using an interdisciplinary team of physicians,
clinicians, advocates, and staff who coordinate care on an outpatient
basis. end delete begin insert State Treasury. Moneys from private or other sources may
be deposited into the fund and used for purposes of this part.
General Fund moneys shall not be deposited into the fund. end insert

(b)  begin delete (1) end delete begin delete   end delete begin delete The department shall use funds appropriated for this
purpose by the Legislature to provide end delete begin insert When the Department of
Finance has determined that the total amount of the moneys in the
fund established pursuant to subdivision (a) has reached or
exceeded one million two hundred thousand dollars ($1,200,000),
the Controller shall distribute all of the moneys in the fund to the
Regents of the University of California for the purpose of providing end insert
reimbursement to begin delete the end delete begin insert an end insert EDAPT program for services provided
to persons who are referred to that program, but whose private
health benefit plan does not cover the full range of required
services.

begin delete

(2) The department may solicit and accept funds from private,
federal, or other sources to use for purposes of this program.

end delete

(c) Funds begin delete provided end delete begin insert distributed end insert pursuant to this begin delete program end delete begin insert part end insert
shall not be used to pay for services normally covered by the
patient’s private health benefit plan and shall only be used to
augment private health benefit plan coverage to provide the patient
with the full range of necessary services.

(d) For purposes of this part, the following definitions shall
apply:

(1) “EDAPT program” begin delete means the Early Diagnosis and
Preventive Treatment program provided at the Davis campus of
the University of California. end delete begin insert means an Early Diagnosis and
Preventive Treatment program and refers to a program that utilizes
integrated systems of care to provide early intervention,
assessment, diagnosis, a treatment plan, and necessary services
for individuals with severe mental illness and children with severe
emotional disturbance using an interdisciplinary team of
physicians, clinicians, advocates, and staff who coordinate care
on an outpatient basis. end insert

(2) “Private health benefit plan” means a program or entity that
provides, arranges, pays for, or reimburses the cost of health
benefits, but does not include coverage provided through the
Medi-Cal system.

begin delete

5951.  

(a) If the University of California, Davis accepts money
from the department through the EDAPT pilot program, in the
fourth year after the program is established but no later than
January 1, 2022, it shall report

end delete

begin insert

begin insert 5951. end insert   

end insert

begin insert (a) end insert begin insert   end insert begin insert If the Regents of the University of California accept
moneys from the fund established pursuant to this part, or accept
federal funds distributed by the State Department of Health Care
Services as described in subdivision (b), the regents shall report,
on or after January 1, 2022, but prior to January 1, 2023, end insert to the
health committees of both houses of the Legislature all of the
following:

(1) Evidence as to whether the early psychosis approach reduces
the duration of untreated psychosis, reduces the severity of
symptoms, improves relapse rates, decreases the use of inpatient
care in comparison to standard care, supports educational and
career progress, and reduces the cost of treatment in comparison
to standard treatment methodologies.

(2) The number of patients with private health benefit plans
served by begin delete the EDAPT pilot end delete begin insert an EDAPT end insert program in the 12 months
prior to the implementation of begin delete the pilot program. end delete begin insert this part. end insert

(3) The number of patients with private health benefit plans
served by begin delete the EDAPT pilot program. end delete begin insert an EDAPT program that has
received funding pursuant to this part. end insert

(4) The number of patients begin delete in the program end delete begin insert participating in an
EDAPT program that has received funding pursuant to this part end insert
who are considered stabilized, as a percentage of patients served.

(5) The number of patients begin delete needing end delete begin insert participating in an EDAPT
program that has received funding pursuant to this part who need end insert
services beyond those provided in the program and the nature of
those services.

(6) Any other information the begin delete university deems end delete begin insert end insert begin insert regents deem end insert
necessary.

begin insert

(b) If the State Department of Health Care Services distributes
federal funds to the Regents of the University of California for the
purpose of supporting an EDAPT program, the regents shall issue
the report described in subdivision (a), to the extent permitted by
federal law.

end insert begin delete

(b)

end delete

begin insert ( end insert begin insert c) end insert  A report to be submitted pursuant to this section shall be
submitted in compliance with Section 9795 of the Government
Code.

5952.  

This part shall remain in effect only until January 1,
begin delete 2022, end delete begin insert 2023, end insert and as of that date is repealed, unless a later enacted
statute, that is enacted before January 1, begin delete 2022, end delete begin insert 2023, end insert deletes or
extends that date.