BILL ANALYSIS Ó
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: AB 168
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|AUTHOR: |Maienschein |
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|VERSION: |June 20, 2016 |
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|HEARING DATE: |June 29, 2016 | | |
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|CONSULTANT: |Reyes Diaz |
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SUBJECT : Mental health: community-based services
SUMMARY : Requires the Department of Health Care Services, if chosen to
participate in a federal demonstration program, as specified, to
report specific information to the Legislature by March 1, 2017.
Existing law:
Federal law
1)Enacts the Patient Protection and Affordable Care Act (ACA) to
increase access to health care through a number of measures,
including expanding Medicaid eligibility, subsidizing
insurance premiums, and setting aside funds for health
promotion and disease prevention.
2)Authorizes, in Section 223 of the Protecting Access to
Medicare Act (PAMA) of 2014 (P.L. 113-93), a time-limited
demonstration program that creates criteria for certified
community behavioral health clinics (CCBHCs) and provides
planning grants to develop applications to participate in the
demonstration program.
State law
3)Establishes the Medi-Cal program, administered by the
Department of Health Care Services (DHCS), under which
qualified low-income individuals receive health care benefits.
The Medi-Cal program is, in part, governed and funded by
federal Medicaid provisions.
This bill:
1)Requires DHCS, if it submits a proposal and is chosen to
participate in the federal demonstration program, to provide a
report to the Legislature by March 1, 2017, that includes:
AB 168 (Maienschein) Page 2 of ?
a) Names of the participating counties;
b) Estimated amount of additional funding each county
is expected to receive;
c) Proposed uses of the additional funds and county
funds no longer required to be used as the federal match;
d) A description of improved partnerships with veterans
organizations, primary care providers, health plans,
educational agencies, and other organizations that the
demonstration program includes; and,
e) Other identified benefits from the demonstration
program funding and planning process, and recommendations
on any components of the demonstration program that could
be extended to other counties.
1)Makes the reporting requirement inoperative on March 1, 2021.
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 Health Committee: |Not relevant |
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COMMENTS :
1)Author's statement. According to the author, under PAMA, eight
states will be selected to have their federal share of costs
increased to 65% for two years for outpatient behavioral
health care for individuals with severe mental illnesses or
serious emotional disturbances. This federal funding would
free up substantial funds in participating counties that are
currently being used to match federal funds. The money that is
currently being used to match federal funds would be available
to be used to meet the mental health service and housing needs
of those individuals who are not currently receiving the
behavioral health care that they need. The report required by
this bill will keep the legislature informed and promote
AB 168 (Maienschein) Page 3 of ?
transparency in regards to how the additional funds will be
used, and how the realized savings could best be utilized to
target the vulnerable population this federal grant is
intended to help. The information will enable the state to
develop better programs to target the needs of these
individuals and utilize funding and other resources in the
most efficient manner.
2)Background. Federal law authorizes PAMA to establish a
demonstration program that creates criteria for CCBHCs, which
are facilities designed to serve individuals with serious
mental illnesses and substance use disorders (SUDs). PAMA
provides nearly $25 million that will be available to states
as planning grants to develop applications. PAMA also directs
the United States Secretary of Health and Human Services
(USHHS) to award planning grants to states for the development
of demonstration program proposals that are due by October 31,
2016, and to select states to participate in the demonstration
program no later than December 31, 2016. Section 223 of PAMA
authorizes the USSHHS to:
a) Establish criteria that states will use to certify
CCBHCs for a two-year demonstration program;
b) Provide guidance on the development of a Prospective
Payment System for payment of services provided by
CCBHCs;
c) Award grants to states for planning purposes to
develop proposals to participate in the demonstration
program;
d) Pay states participating in the demonstration
program federal matching funds equivalent to the standard
Children's Health Insurance Program matching rate for
services provided to currently enrolled Medicaid
beneficiaries; and,
e) Evaluate the program and prepare annual reports to
Congress.
3)CCBHCs. The federal Substance Abuse and Mental Health Services
Administration (SAMHSA) developed eligibility criteria for
states to certify CCBHCs, based on a review of selected state
Medicaid Plans, standards for Federally Qualified Health
Centers and Medicaid Health Homes, and quality measures
currently in use by states. According to SAMHSA's Web site,
the criteria are intended to extend quality and to improve
outcomes of the behavioral health care system within the
AB 168 (Maienschein) Page 4 of ?
authorities of state regulations, statutes, and state Medicaid
Plans; establish a basic level of services at which the CCBHCs
should, at a minimum, operate; and allow states the
flexibility in determining how to implement the criteria in a
manner best addressing the needs of the population being
served. The criteria are designed to encourage states and
CCBHCs to further develop their abilities to offer behavioral
health services that comport with current best practices.
Populations to be served are adults with serious mental
illness, children with serious emotional disturbance, and
those with long-term and serious SUDs, as well as others with
mental illness and SUDs.
4)Prior legislation. AB 847 (Mullin, Chapter 6, Statutes of
2016), requires DHCS to develop a proposal for the United
States Secretary of Health and Human Services to be selected
as a participating state in the time-limited demonstration
program for mental health services to be provided by CCBHCs to
Medi-Cal beneficiaries. Appropriates $1 million from Mental
Health Services Act funds for DHCS to develop the proposal.
AB 861 (Maienschein, 2015), was substantially similar to this
bill. AB 861 was vetoed by Governor Brown, who stated that the
bill was premature because the state had not been awarded any
federal grants or approved as one of the participating states
for the demonstration program.
5)Support. Supporters state that the federal demonstration
program represents state-of-the-art approaches to provide
better care, as well as improved payment models, performance
outcome incentives, care coordination, and additional funding
that can support services not otherwise reimbursable.
Supporters state that 22 counties have expressed letters of
interest to participate in the program, and that the report
required in this bill can inform legislators and other about
ways to expand the innovative approaches that are developed
for the demonstration program.
SUPPORT AND OPPOSITION :
Support: California Chapter of the American College of
Emergency Physicians
California Council of Community Behavioral Health
Agencies
Jewish Family Service
Mental Health America in California
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Oppose: None received
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