BILL NUMBER: AB 38 AMENDED
BILL TEXT
AMENDED IN SENATE AUGUST 19, 2016
AMENDED IN SENATE JUNE 13, 2016
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 Part 6 (commencing with Section 5950) of
Division 5 of the Welfare and Institutions Code, relating to mental
health. health, and making an appropriation
therefor.
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 EDAPT pilot program in the
department to 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 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. The bill would authorize moneys from
private or other sources to be deposited into the fund and used for
purposes of the bill. The bill would require the
department to use funds appropriated for this purpose by the
Legislature to provide 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 distri
bute all of the moneys in the fund to the Regents of the
University of California for the purpose of providing
reimbursement to the an 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 services. services,
thereby making an appropr iation. The bill would
require the 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
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 an EDAPT program, as specified, to report, on
or after January 1, 2022, but prior to January 1, 2023,
specified information to the health committees of both houses of the
Legislature. The bill would repeal the program as of January 1,
2022. 2023.
Vote: majority. Appropriation: no yes
. 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 number
numbers 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 could be
made of the overall efficacy of the model.
(b) Therefore, it is the intent of the Legislature to
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.
provide funding to augment private health benefit plan
coverage in order to provide patients with the full range of nec
essary EDAPT services.
SEC. 2. Part 6 (commencing with Section 5950) is added to Division
5 of the Welfare and Institutions Code, to read:
PART 6. EDAPT Funding Pilot Program
5950. (a) There is hereby established the EDAPT pilot
program Early Diagnosis and
Preventive Treatment (EDAPT) Program Fund within the
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.
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.
(b) (1) The
department shall use funds appropriated for this purpose by the
Legislature to provide 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
reimbursement to the an 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.
(2) The department may solicit and accept funds from private,
federal, or other sources to use for purposes of this program.
(c) Funds provided distributed
pursuant to this program part 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" means the Early Diagnosis and
Preventive Treatment program provided at the Davis campus of the
University of California. 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.
(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.
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
5951. (a) 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, 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 the EDAPT pilot an EDAPT
program in the 12 months prior to the implementation of the
pilot program. this part.
(3) The number of patients with private health benefit plans
served by the EDAPT pilot program. an EDAPT
program that has received funding pursuant to this part.
(4) The number of patients in the program
participating in an EDAPT program that has received funding pursuant
to this part who are considered stabilized, as a percentage of
patients served.
(5) The number of patients needing
participating in an EDAPT program that has received funding pursuant
to this part who need services beyond those provided in the
program and the nature of those services.
(6) Any other information the university deems
regents deem necessary.
(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.
(b)
( c) 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,
2022, 2023, and as of that date is
repealed, unless a later enacted statute, that is enacted before
January 1, 2022, 2023, deletes or
extends that date.