BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | AB 38|
|Office of Senate Floor Analyses | |
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THIRD READING
Bill No: AB 38
Author: Eggman (D)
Amended: 6/13/16 in Senate
Vote: 21
SENATE HEALTH COMMITTEE: 9-0, 6/22/16
AYES: Hernandez, Nguyen, Hall, Mitchell, Monning, Nielsen,
Pan, Roth, Wolk
SENATE APPROPRIATIONS: 7-0, 8/1/16
AYES: Lara, Bates, Beall, Hill, McGuire, Mendoza, Nielsen
ASSEMBLY FLOOR: 70-5, 6/2/15 - See last page for vote
SUBJECT: Mental health: Early Diagnosis and Preventive
Treatment Program
SOURCE: California Psychiatric Association
DIGEST: This bill 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.
ANALYSIS:
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.
Establishes, under the terms of a federal Medicaid waiver, a
managed care program providing Medi-Cal specialty mental
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health services for eligible low-income persons administered
through local county mental health plans under contract with
DHCS.
2)Requires county mental health plans to provide specialty
mental health services to eligible Medi-Cal beneficiaries,
including both adults and children.
3)Establishes the Department of Managed Health Care to regulate
health plans and the California Department of Insurance to
regulate health insurers, and establishes essential health
benefits which include mental health and substance use
disorder services, including behavioral health treatment.
4)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).
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,
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.
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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 (UC),
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;
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.
Comments
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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.
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
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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)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 the 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.
FISCAL EFFECT: Appropriation: No Fiscal
Com.:YesLocal: No
According to Senate Appropriations Committee:
1)Ongoing administrative costs likely in the range of $75,000 to
$150,000 per year over the life of the program for the DHCS to
manage the program and ensure that state funding is used for
the allowed uses (General Fund).
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2)Ongoing program costs of about $400,000 per year to provide
state funding for services and supports not covered by private
health care coverage (General Fund). Currently, the UC Davis
program admits 50-60 new patients each year, patients
generally participate for two years, annual costs are about
$15,000, and roughly 40% of per-capita program costs are not
covered by private insurance.
3)One-time costs likely between $100,000 and $200,000 for an
evaluation of the UC Davis program (General Fund).
SUPPORT: (Verified8/17/16)
California Academy of Physician Assistants
California Hospital Association
California Psychiatric Association
National Association of Social Workers, California Chapter
OPPOSITION: (Verified8/17/16)
None received
ARGUMENTS IN 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
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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.
ASSEMBLY FLOOR: 70-5, 6/2/15
AYES: Achadjian, Alejo, Travis Allen, Baker, Bloom, Bonilla,
Bonta, Brown, Burke, Calderon, Campos, Chang, Chau, Chiu, Chu,
Cooley, Cooper, Dababneh, Dahle, Daly, Dodd, Eggman, Frazier,
Gallagher, Cristina Garcia, Eduardo Garcia, Gatto, Gipson,
Gomez, Gonzalez, Gordon, Gray, Hadley, Roger Hernández,
Holden, Irwin, Jones, Jones-Sawyer, Lackey, Levine, Linder,
Lopez, Low, Maienschein, Mathis, McCarty, Medina, Mullin,
Nazarian, Obernolte, O'Donnell, Olsen, Patterson, Perea,
Quirk, Rendon, Ridley-Thomas, Rodriguez, Salas, Santiago,
Steinorth, Mark Stone, Thurmond, Ting, Wagner, Weber, Wilk,
Williams, Wood, Atkins
NOES: Bigelow, Beth Gaines, Grove, Harper, Kim
NO VOTE RECORDED: Brough, Chávez, Mayes, Melendez, Waldron
Prepared by:Teri Boughton / HEALTH / (916) 651-4111
8/18/16 16:34:39
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