BILL ANALYSIS Ó
AB 38
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Date of Hearing: August 30, 2016
ASSEMBLY COMMITTEE ON HEALTH
Jim Wood, Chair
AB 38
(Eggman) - As Amended August 19, 2016
SUBJECT: Mental health: Early Diagnosis and Preventive
Treatment Program
SUMMARY: Establishes the Early Diagnosis and Preventive
Treatment (EDAPT) Program Fund, for the purpose of utilizing
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 Senate amendments delete the Assembly approved version, and
instead:
1)Establish the EDAPT Program Fund within the State Treasury,
which moneys from private or other sources may be deposited
and used for purposes of the EDAPT Program.
2)Define the EDAPT Programs as programs that 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
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severe emotional disturbance using an interdisciplinary team
of physicians, clinicians, advocates, and staff who coordinate
care on an outpatient basis.
3)Require, once the EDAPT Program Fund has reached or exceeded
$1.2 million, the State Controller to distribute all of the
moneys to the Regents of the University of California (UC) for
the purpose of providing reimbursement to 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.
4)Prohibit the EDAPT Program Fund from being used to pay for
services normally covered by the patient's private health
benefit plan. Require the EDAPT Program Fund to be used only
to augment private health benefit plan coverage so that
patients are provided the full range of necessary services.
5)Require, upon acceptance of moneys from the EDAPT Program Fund
by the UC Regents, the UC Regents to report, on or after
January 1, 2022, but before January 1, 2023, to the Health
Committees of both houses of the Legislature information on
the EDAPT Program, as specified.
6)Sunset the EDAPT Program and Program Fund on January 1, 2023.
As passed by the Assembly, this bill required the Legislative
Analyst's Office to conduct an initial analysis to assess the
need for a new campus of the California State University.
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EXISTING LAW:
1)Establishes the Department of Managed Health Care to regulate
health plans and the California Department of Insurance to
regulate health insurers.
2)Establishes as California's essential health benefits
benchmark the Kaiser Small Group Health Maintenance
Organization plan, existing California mandates, and 10
federal Patient Protection and Affordable Care Act mandated
benefits including mental health and behaviorial health
treatment.
3)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. Requires that
coverage to be subject to the same rules that apply under
California's mental health parity law.
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 1% income tax on personal income
above $1 million to be deposited to the Mental Health Services
Fund.
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5)Establishes the Mental Health Services Oversight and
Accountability Commission (OAC) to oversee the implementation
of the MHSA.
6)Requires each county mental health program to prepare and
submit a three-year program and expenditure plan, with annual
updates, to the OAC within 30 days after adoption. Requires
the plan to include programs for services to adults and
seniors.
FISCAL EFFECT: According to the Senate Appropriations
Committee:
1)Ongoing administrative costs likely in the range of $75,000 to
$150,000 per year over the life of the EDAPT program for the
Department of Health Care Services to manage the EDAPT program
and ensure that state funding is used for the allowed uses
(General Fund (GF)).
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 (GF). Currently, the University of
California, Davis (UCD) program admits 50 to 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 UCD program (GF).
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COMMENTS: According to the author, this bill establishes the
framework for the private and federal funding and studying of
the EDAPT pilot program operated by the UC. This bill requires
that UC report to the Legislature on the outcomes and cost
effectiveness of a comprehensive mental health delivery system
and early intervention in psychosis. Currently, the private
health plan system lags far behind the county mental health
system in providing comprehensive mental health care. Data
produced through the UC and backed by the state will demonstrate
to plans that a more robust range of services earlier in
treatment is not only beneficial to those in care, but to the
health plans as well. Rather than asking that the State mandate
that plans cover services, this bill seeks to contribute to the
research necessary for plans to make that decision for
themselves, and provide it to the Legislature if action is
necessary. The author states that the longer we wait for
studies of EDAPT programs, the more Californians dealing with
severe mental illness, along with their families and
communities, will suffer without adequate care.
According to its Website, the UCD EPADT Programs are nationally
recognized as a leading provider of early psychosis care that
utilizes a diverse interdisciplinary team with unique expertise
in the art of assessments and evidence based practices for early
identification and intervention for psychotic disorders. EPADT
programs provide coordinated specialty care in an outpatient
setting that incorporates targeted medication management,
individual, family and group psychosocial interventions, case
management services, and supported education and employment with
the goals of early diagnosis, treatment, and disability
prevention.
This bill, as amended, has not been heard in an Assembly policy
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committee.
The sponsor of this bill, the California Psychiatric Association
(CPA), states that this bill addresses the vast gulf between the
comprehensive array of mental health services available
throughout public mental health system, and the relatively
narrow range of benefits available for privately insured
patients. The problem is that too often people deteriorate
significantly and at length after their first episode of
psychosis. Many will enter the public mental health system
where one of the threshold qualifications is disability so
severe that it interferes with the activities of daily living.
This "hitting bottom" before you can access a comprehensive
array of services is unnecessary and cruel. Ample data from the
National Institute of Mental Health (NIMH) collected for over a
decade demonstrate an array of wrap around services necessary to
stem deterioration before it become severe disability after an
initial psychotic episode.
CPA argues that the participation of managed health care
organizations in programs like EDAPT is any formal way, not only
within California but also nationally, is unknown. The UC
Davis' EADPT program was one of the original NIMH centers
contributing to demonstrate the efficacy of early intervention.
UCD's EDAPT Program accepts privately insured patients, but
reimbursement to the program from private insurance is typically
for a traditional array of services like psychiatrist visits,
medications, and a therapist. Privately insured families then
pay out of pocket for the remainder of the wrap around service
that have been identified as effective by NIMH. With data
demonstrating expensive repeat hospitalizations, as well as
failure at school and/or work, deterioration in social
relationships and alienation from their family, the CPA hopes to
persuade health insurers that spending upfront for wraparound
services not only improves beneficiaries health and mental
health outcomes, but is ultimately less costly.
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The California Hospital Association states that behavioral
health services provided by California's private health
insurance market lags behind that of other medically necessary
care. The traditional model of mental health care in the
private health care services market is to provide appointments
with psychiatrists and other therapists, and enable access to
psychiatric medications. For many people, particularly those
with severe mental illness, this array of services is
insufficient to successfully stabilize and control their
illness. Early intervention programs, such as EDAPT, have shown
potential for improving outcomes for those first experiencing
psychosis. They consolidate the service delivery model and
provide services through a single point of entry, including:
assessment; diagnosis; treatment; and, ancillary services like
outreach, family education and support, and case management.
Unfortunately, the full bundle of EDAPT benefits are not covered
in the private insurance market. Recovering from mental illness
then becomes more difficult for individuals with private
insurance.
The American Academy of Pediatrics, California states that this
bill represents an innovative response to California's mental
health crisis and, in particular, to concerns regarding the
provision of mental health care to the remaining two-thirds of
youth in the U.S. who are undiagnosed and 88% are untreated.
REGISTERED SUPPORT / OPPOSITION:
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Support
California Psychiatric Association (sponsor)
American Academy of Pediatrics, California
California Academy of Physician Assistants
California Hospital Association
National Association of Social Workers
Opposition
None on file.
Analysis Prepared by:Paula Villescaz / HEALTH / (916) 319-2097
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