BILL ANALYSIS Ó
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: AB 38
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|AUTHOR: |Eggman |
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|VERSION: |June 13, 2016 |
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|HEARING DATE: |June 22, 2016 | | |
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|CONSULTANT: |Teri Boughton |
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SUBJECT : Mental Health Early Diagnosis and PreventiveTreatment
Program
SUMMARY : Establishes the Early Diagnosis and Preventive Treatment pilot
program at the Department of Health Care Services to utilize
integrated systems of care for persons with severe mental
illness and children with severe emotional disturbance who have
private health benefit coverage.
Existing law:
1)Establishes the Medi-Cal program, administered by the
Department of Health Care Services (DHCS), under which
qualified low-income persons receive health care benefits.
2)Establishes, under the terms of a federal Medicaid waiver, a
managed care program providing Medi-Cal specialty mental
health services for eligible low-income persons administered
through local county mental health plans under contract with
DHCS.
3)Requires county mental health plans to provide specialty
mental health services to eligible Medi-Cal beneficiaries,
including both adults and children.
4)Establishes the Department of Managed Health Care to regulate
health plans and the California Department of Insurance to
regulate health insurers.
5)Establishes as California's essential health benefits
benchmark the Kaiser Small Group Health Maintenance
Organization plan, existing California mandates, and the
following 10 federal Affordable Care Act mandated benefits:
a) Ambulatory patient services;
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b) Emergency services;
c) Hospitalization;
d) Maternity and newborn care;
e) Mental health and substance use disorder
services, including behavioral health treatment;
f) Prescription drugs;
g) Rehabilitative and habilitative services and
devices;
h) Laboratory services;
i) Preventive and wellness services and chronic
disease management; and,
j) Pediatric services, including oral and
vision care.
6)Requires every health plan contract that provides hospital,
medical, or surgical coverage and health insurance policy to
also provide coverage for behavioral health treatment for
pervasive developmental disorder or autism no later than July
1, 2012. Requires the coverage to be provided in the same
manner and to be subject to the same requirements as provided
in California's mental health parity law.
7)Establishes the Mental Health Services Act (MHSA), enacted by
voters in 2004 as Proposition 63, which provides funds to
counties to expand services and develop innovative programs
and integrated service plans for mentally ill children,
adults, and seniors through a one percent income tax on
personal income above $1 million to be deposited to the Mental
Health Services Fund (MHSF).
8)Establishes the Mental Health Services Oversight and
Accountability Commission (OAC) to oversee the implementation
of the MHSA.
9)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
OAC within 30 days after adoption. Requires the plan to
include, among other things, programs for services to adults
and seniors.
This bill:
1)Establishes the Early Diagnosis and Preventive Treatment
(EDAPT) pilot program within DHCS to utilize integrated
systems of care to provide early interventions, assessment,
AB 38 (Eggman) Page 3 of ?
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)Requires DHCS to use funds appropriated by the Legislature to
provide reimbursement to the 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
services.
3)Permits DHCS to solicit and accept funds from private,
federal, or other sources to use for purposes of this program.
4)Prohibits these funds from being used to pay for services
normally covered by the patient's private health benefit plan
and requires that the funds only be used to augment private
health benefit plan coverage to provide the patient with the
full range of necessary services.
5)Defines "EDAPT program" as the EDAPT program provided at the
Davis campus of the University of California.
6)Defines "private health benefit plan" as 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.
7)Requires an evaluation if the University of California, Davis
accepts money for this purpose in the fourth year after the
program is established but not later than January 1, 2022.
Requires the evaluation to include:
a) 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;
b) The number of patients with private health
benefit plans served by the EDAPT pilot program in the
12 months prior to implementation of the pilot
program;
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c) The number of patients with private health
benefit plans served by the EDAPT pilot program;
d) The number of patients in the program who are
considered stabilized, as a percentage of patients
served;
e) The number of patients needing services beyond
those provided in the program and the nature of those
services; and,
f) Any other information the university deems
necessary.
8)Sunsets this bill's provisions on January 1, 2022.
FISCAL
EFFECT : This bill has not been analyzed by a fiscal committee.
PRIOR
VOTES :
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|Assembly Floor: |Not Relevant |
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|Assembly Appropriations Committee: |Not Relevant |
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|Assembly Higher Education |Not Relevant |
|Committee: | |
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COMMENTS :
1)Author's statement. According to the author, of the 58 counties
in California, only 17 currently provide early detection and
intervention for the prevention of psychosis. While research
conducted throughout the United States and Canada shows that these
programs improve the symptoms and overall outcomes for those
experiencing psychosis, the full bundle of effective services may
not be available to those consumers with private insurance. This
pilot project seeks to fill the gap by providing for the those
ancillary services that are pivotal for the best possible outcome,
while demonstrating for insurance providers the benefits of the
full bundle of services. With the research produced by this pilot
program, more providers may be able to establish early detection
and intervention for psychosis, and improve lives across the
state.
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2)EDAPT program. The program began in 2004 and is a specialty
within the UC Davis Department of Psychiatry. It is a
recovery-based treatment approach that provides services for two
years focusing on reducing and managing symptoms and distress and
improving individuals' ability to achieve success in independent
roles. State-of-the-art clinical assessment tools are used to
evaluate each client to determine the appropriate diagnosis in
order to guide treatment. Assessments of psychosocial functioning
also determine areas where targeted treatment is needed. Regular
and frequent appointments with a psychiatrist are tailored to
control and alleviate symptoms with the fewest amounts of side
effects. Each client has a clinical case manager who helps to
identify the client's unique needs and recovery goals, which will
be used to develop a treatment plan that encourages the client to
build upon their strengths and take an active role in treatment
decisions. Weekly groups for clients and their family members are
designed to provide support and improve understanding of the
illness, develop stress and symptom management techniques, and
enhance communication and problem-solving skills. Psychoeducation
and support are provided to increase understanding about the
illness, improve stress management and communication skills within
the family, and develop problem solving skills. Supported
Education and Employment services are provided as part of a
collaboration with Crossroads Diversified Services, Inc. at an
hourly fee-for-service rate. These services can be provided within
the client's home, school or workplace to improve everyday
functioning and help clients achieve their goals of social,
academic and occupational recovery
The services include all those listed above, and an estimate of cost
from the program is between $12,000-$15,000 per year for each
patient. Of this, roughly 60% is covered by Medi-Cal and the
remainder is covered through MHSA-Prevention and Early
Intervention (PEI) funds through Sacramento County. The program
also provides services to those with private insurance, but does
not receive the MHSA funds to cover the remaining 40% of the
service costs, and these cannot be billed to the insurance, so the
patients are left without, or with high out-of-pocket costs. Of
the roughly 50-60 new cases referred to the program each year,
half have private insurance and half have Medi-Cal. |
3)MHSA. The MHSA provides funding for programs within five
components:
a) Community Services and Supports (CSS): provides
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direct mental health services to the severely and
seriously mentally ill, such as mental health treatment,
cost of health care treatment, and housing supports. CSS
requires counties to direct the majority of its funds to
full-service partnerships, which are county-coordinated
plans, in collaboration with the client and the family to
provide the full spectrum of community services and
utilize a "whatever it takes" approach to providing
services. Such services include peer support and crisis
intervention services, and non-mental health services and
supports, such as food, clothing, housing, and the cost
of medical treatment;
b) PEI: provides services to mental health clients in
order to help prevent mental illness from becoming severe
and disabling, emphasizing improving timely access to
services for underserved populations. PEI programs are
also required to emphasize strategies to reduce negative
outcomes resulting from untreated mental illness,
including suicide, school failure or dropout,
incarcerations, and unemployment;
c) Innovation: provides services and approaches that
are creative in an effort to address mental health
clients' persistent issues, such as improving services
for underserved or unserved populations within the
community. Innovation is funded by 5% from CSS and 5%
from PEI funds;
d) Capital Facilities and Technological Needs: creates
additional county infrastructure, such as additional
clinics and facilities, and/or development of a
technological infrastructure for the mental health
system, such as electronic health records for mental
health services; and,
e) Workforce Education and Training: provides training
for existing county mental health employees, outreach and
recruitment to increase employment in the mental health
system, and financial incentives to recruit or retain
employees within the public mental health system.
4)Prevention and early intervention (PEI). The 2015-16 fiscal
year (FY) Governor's Budget projected that $1.776 billion
would be deposited into the MHSF, with $320.5 million
dedicated to the PEI component.
According to its Web site, the OAC controls funding approval
for PEI. The goal of PEI is to help counties implement
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services that promote wellness, foster health, and prevent the
suffering that can result from untreated mental illness. The
PEI component requires collaboration with consumers and family
members in the development of PEI projects and programs. In
October 2015, the OAC finalized regulations for the PEI
component, which among other things, requires the Program and
Evaluation Report to describe the evaluation of each PEI
component program and two strategies: access and linkage to
treatment, and improving timely access to services for
underserved populations.
5)Research. Background provided by the author's office includes
a study published in 2008 indicating that clinicians and
researchers in Canada and the United States have established a
number of early intervention programs and research sites on
the early course of psychosis and the prodromal period (period
of initial symptom to full development) that commonly precedes
psychotic disorders. In the United States several programs
were described including EDAPT. The study states that EDAPT
focuses on reduction of long-term disability by fostering
collaboration between a clinical team and an extensive
community network. Researchers from sites in both countries
have formed a consortium to launch the North American Prodrome
Longitudinal Study to gain a better understanding of the
prodromal period of the illness and prediction of conversion
from the prodromal to psychosis. Another study published in
2014 on a program called Family-aided Assertive Community
Treatment (FACT) indicates that FACT is effective in improving
positive, negative, disorganized and general symptoms, Global
Assessment of Functioning, work and school participation and
global outcome in youth at risk for, or experiencing very
early, psychosis.
6)Related legislation. AB 1576 (Eggman) is similar to this
bill. AB 1576 is pending in the Assembly Health Committee.
AB 2017 (McCarty) establishes the College Mental Health
Services Program Act, as specified, until January 1, 2022,
with specified dedicated funding. Requires the Department of
Health Care Services to create a grant program for specified
colleges to provide required services to college students
related to improved access to mental health services and early
identification and intervention programs, and requires grant
awardees to report to specified entities on the use of funds
for programs. AB 2017 is pending in the Senate Health
AB 38 (Eggman) Page 8 of ?
Committee.
7)Support. According to the California Psychiatric Association,
this bill will provide incentives for health plans or insurers
- who typically solely provide access to psychiatrists,
medications and therapy - to provide community education and
outreach, case management and evidence-based education,
vocation, and family support services. In turn, over the four
years of the program, cost savings found in the reduction of
expensive first hospital admissions are expected to
demonstrate that the provision of previously uncovered
benefits can be cost effective. This bill provides for results
to be collected and reported out to the Legislature. In
employing a coordinated specialty care model, the associated
high rates of engagement among individuals who are typically
difficult to engage in treatment will yield further dividends
as measures of occupational and social functioning improve
significantly over time, symptoms decline, and rates of
remission increase. Psychosis will no longer mean an assurance
of severe disability, disrupted education and vocational
goals, strained relationships and untold suffering in the
individual, the family and community. People with psychotic
disorders can be productive contributing citizens.
The California Academy of PAs writes that EDAPT is a promising
model that has shown success in improving health outcomes for
people experiencing mental illness nationally and in other
pilot projects.
8)Policy Questions Comments.
a) It is not clear what role DHCS has other than to
appropriate funds to the UC Davis program to supplement
private insurance payments for privately insured
patients. It is also not clear what specific services
health plans and insurers would be covered with this
funding.
b) Should there be additional eligibility criteria for
those individuals for whom supplemental payments would be
made? The only criteria articulated in this bill are
that the patient's private insurance does not cover the
full cost and the patient has been referred to the
program.
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c) Information on the EDAPT website suggests that
studies of other early psychosis intervention programs
have demonstrated cost savings. However, the author or
sponsor has not provided the committee with an evaluation
with outcome data or a cost impact analysis on this
specific program.
SUPPORT AND OPPOSITION :
Support: California Psychiatric Association (sponsor)
California Hospital Association
California Academy of PAs
National Association of Social Workers, California
Chapter
Oppose: None received
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