BILL ANALYSIS Ó
AB 168
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Date of Hearing: January 12, 2016
ASSEMBLY COMMITTEE ON HEALTH
Rob Bonta, Chair
AB 168
(Maienschein) - As Amended January 4, 2016
SUBJECT: Mental health: community-based services.
SUMMARY: Requires the Department of Health Care Services (DHCS)
to develop and submit a proposal to participate in a
demonstration project authorized under the U.S. Protecting
Access to Medicare Act of 2014 to improve mental health services
provided by certified community behavioral health clinics to
Medi-Cal beneficiaries. Requires DHCS to work with counties and
other stakeholders to identify unmet needs for the covered
services and estimate the number of individuals who will need
housing services. Requires the grant application to include
plans for counties to redirect a portion of the funds that are
currently used to match federal funds but will not be needed for
that purpose during the grant period to provide increased
housing opportunities for individuals with severe mental
illnesses.
EXISTING FEDERAL LAW:
1)Authorizes the Patient Protection and Affordable Care Act
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(ACA) to increase access to health care through an expansion
of Medicaid (Medi-Cal in California) eligibility, subsidizing
insurance premiums, and setting aside funds for health
promotion and disease prevention, among others.
2)Authorizes the Protecting Access to Medicare Act (H.R. 4302)
to establish an eight-state demonstration project that creates
criteria for "Certified Community Behavioral Health Clinics"
(CCBHCs), entities designed to serve individuals with serious
mental illnesses and substance use disorders.
3)Provides $25 million that will be available to states as
planning grants to develop applications to participate in the
two-year pilot.
EXISTING STATE LAW:
1)Establishes the Medi-Cal program, administered by DHCS, which
provides comprehensive health benefits to low-income children,
their parents or caretaker relatives, pregnant women, elderly,
blind or disabled persons, nursing home residents, and
refugees who meet specified eligibility criteria.
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
the state.
FISCAL EFFECT: This bill has not yet been analyzed by a fiscal
committee.
1)PURPOSE OF THIS BILL. According to the author, federal law
enables successful states to nearly double federal funds to
support community mental health and alcohol and drug services
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with no additional costs to the state or county. These
additional funds will significantly help California's counties
serve more people who are homeless due to an untreated mental
illness and get them off the streets, out of hospitals and
jails, and into treatment. The author states that if
California is successful in its bid for the additional
funding, it would benefit the state to the tune of about $2
billion. The savings to the counties will free up Proposition
63 funds and other county mental health funds that are now
expended on hospital care. The author concludes that those
savings can then be redirected to supportive housing efforts
which will help make the effects of these dollars more
permanent.
2)BACKGROUND.
a) Certified Community Behavioral Health Clinics. On March
31, 2014, Congress passed the Protecting Access to Medicare
Act, which included $25 million for a two year, eight state
demonstration program aimed at increasing Americans' access
to community mental health and substance use treatment
services while improving Medicaid reimbursement for these
services. The Act established criteria for CCBHCs when
serving individuals with serious mental illnesses and
substance use disorders that provide intensive,
person-centered, multidisciplinary, evidence-based
screening, assessment, diagnostics, treatment, prevention,
and wellness services. The U.S. Health and Human Services
(HHS) Secretary is directed to establish a process for
selecting states to participate in this pilot. The Act
establishes the match rate for CCBHC services as either the
Enhanced Federal Medical Assistance Program
(FMAP)/Children's Health Insurance Program rate or, for
newly eligible "expansion" Medicaid beneficiaries, the
current FMAP for that population - which is 100% now and
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moves down to 90% by 2020. Participating states must
develop a prospective payment system for reimbursing CCBHCs
for required services provided by these entities.
The Substance Abuse and Mental Health Services Administration
(SAMHSA) is currently in the process of determining what
the eligibility criteria will be for the CCBHCs. CCBHCs
cannot refuse service to any person based either on ability
to pay or residence. This requirement, together with the
fact that improving access to and the quality of health
care for the Medicaid population may also positively affect
the health of others, means that the CCBHC demonstration
program may have long-lasting and beneficial effects beyond
the realm of Medicaid enrollees.
Authorized under Section 223 of the Protecting Access to
Medicare Act of 2014, the planning grants are part of a
comprehensive effort to integrate behavioral health with
physical health care, utilize evidence-based practices on a
more consistent basis, and improve access to high quality
care. The planning grants will be used to support states
to certify community behavioral health clinics, solicit
input from stakeholders, establish prospective payment
systems for demonstration reimbursable services, and
prepare an application to participate in the demonstration
program.
On October 19, 2015, the SAMHSA, in conjunction with the
Centers for Medicare and Medicaid Services (CMS) and the
Assistant Secretary of Planning and Evaluation (ASPE),
awarded a total of $22.9 million in planning grants for
CCBHCs. Planning grants were awarded to 24 states,
including California, to support efforts to improve
behavioral health of their citizens by providing
community-based mental health and substance use disorder
treatment. California received a planning grant that
totaled just under $1 million.
b) Proposition 63. Proposition 63 was passed by voters in
November 2004. The Mental Health Services Act (MHSA)
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imposes a 1% income tax on personal income in excess of $1
million and creates a 16 member Commission charged with
overseeing the implementation of MHSA.
i) Commission. MHSA requires each county mental health
department to prepare and submit a three-year plan to
DHCS that must be updated each year and approved by DHCS
after review and comment by the Commission. In their
three-year plans, counties are required to include a list
of all programs for which MHSA funding is being requested
and that identifies how the funds will be spent and which
populations will be served. Counties must submit their
plans for approval to the Commission before the counties
may spend certain categories of funding.
ii) Funding. The MHSA provides funding for programs
within five components:
(1) Community Services and Supports: Provides
direct mental health services to the severely and
seriously mentally ill, such as mental health
treatment, cost of health care treatment, and housing
supports. Regulation requires counties to direct the
majority of its Community Services and Supports funds
to FullService Partnerships (FSPs). FSPs are county
coordinated plans, in collaboration with the client
and the family to provide the full spectrum of
community services. These services consist of mental
health services and supports, such as peer support and
c(2) risis intervention services; and nonmental
health services and supports, such as food, clothing,
housing, and the cost of medical treatment;
(3) Prevention and Early Intervention: Provides
services to mental health clients in order to help
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prevent mental illness from becoming severe and
disabling;
(4) 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;
(5) 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,
(6) 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.
c) 2016 "No Place Like Home" Initiative. On January 4,
2016 the California State Senate announced a proposed
legislative package intended to re-purposes $2 billion of
Proposition 63 bond funds and leverage additional dollars
from other local, state, and federal funding for purposes
of providing housing for chronically homeless persons with
mental illness. The initiative includes proposals to
construct permanent supportive housing for chronically
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homeless persons with mental illness, provide $200 million
over four years in shorter-term, rent subsidies while the
permanent housing is constructed or rehabilitated and
support for special housing programs that will assist
families that are part of the child welfare system or are
enrolled in California Work Opportunity and Responsibility
to Kids (CalWORKs) Housing Support Program.
3)RELATED LEGISLATION. AB 847 (Mullin) is substantially similar
to this bill and is currently pending in the Senate
Appropriations Committee.
4)PREVIOUS LEGISLATION.
a) AB 2287 (Monning) of 2010 would have required the
California Health and Human Services Agency to direct the
appropriate state departments within the agency to apply
for Community Transformation Grants under the ACA. AB 2287
died in the Senate Appropriations Committee.
b) AB 861 (Maienschein) of 2015 would have required the
DHCS to apply to the HHS Secretary for the planning grant
awarded for the purpose of developing proposals to
participate in demonstration programs to improve mental
health services furnished by certified community behavioral
health clinics to Medi-Cal beneficiaries. AB 861 was
vetoed by Governor Brown. The Governor's veto message
stated, "This bill would require the Department of Health
Care Services to mandate counties, as a condition of
participation in a federal behavioral health demonstration
program, to redirect a portion of any local savings to
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increasing housing opportunities for individuals with
severe mental illness. The department has not been awarded
the federal grant nor approved as one of eight states to
participate in the federal demonstration program. As such,
this bill is premature."
5)Committee Comments. This bill is substantially similar to AB
861 (Maienschein) of 2015, which was vetoed, as noted in the
veto message above, as being "premature". California has
since applied for and been awarded the initial CCBHC planning
grant, however it has not been awarded the eight-state
demonstration grant, of which this bill is requiring DHCS to
submit a proposal for.
REGISTERED SUPPORT / OPPOSITION:
Support
None on file.
Opposition
None on file.
Analysis Prepared by:Paula Villescaz / HEALTH / (916) 319-2097
AB 168
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