BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | AB 168|
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THIRD READING
Bill No: AB 168
Author: Maienschein (R)
Amended: 8/17/16 in Senate
Vote: 21
SENATE HEALTH COMMITTEE: 8-0, 6/29/16
AYES: Hernandez, Nguyen, Hall, Mitchell, Monning, Nielsen,
Pan, Roth
NO VOTE RECORDED: Wolk
SENATE APPROPRIATIONS COMMITTEE: Senate Rule 28.8
ASSEMBLY FLOOR: 78-0, 1/27/16 (Consent) - See last page for
vote
SUBJECT: Mental health: community-based services
SOURCE: Author
DIGEST: This bill requires the Department of Health Care
Services, if chosen to participate in a federal demonstration
program, as specified, to provide an update to the Legislature,
as specified, by March 1, 2017.
Senate Floor Amendments on 8/17/16 delete the requirement for
the Department of Health Care Services (DHCS) to submit a report
and instead require DHCS to provide an update to the
Legislature, to the extent that specified information is
available.
ANALYSIS:
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Existing federal law:
1)Enacts the Patient Protection and Affordable Care Act 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.
Existing state law:
1)Establishes the Medi-Cal program, administered by 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.
2)Requires DHCS to develop a proposal for the time-limited
demonstration program.
This bill:
1)Requires DHCS, if it is chosen to participate in the federal
demonstration program, to provide an update to the Legislature
by March 1, 2017, that includes, to the extent the information
is available:
a) Names of the participating counties;
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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.
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 (USSHHS) 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:
1)Establish criteria that states will use to certify CCBHCs for
a two-year demonstration program;
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2)Provide guidance on the development of a Prospective Payment
System for payment of services provided by CCBHCs;
3)Award grants to states for planning purposes to develop
proposals to participate in the demonstration program;
4)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,
5)Evaluate the program and prepare annual reports to Congress.
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 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.
Comments
Author's statement. According to the author, under PAMA, eight
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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 update required by this bill
will keep the Legislature informed and promote 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.
Prior Legislation
AB 847 (Mullin, Chapter 6, Statutes of 2016) requires DHCS to
develop a proposal to the USSHHS 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), which was substantially similar to
this bill, 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.
FISCAL EFFECT: Appropriation: No Fiscal
Com.:YesLocal: No
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SUPPORT: (Verified8/17/16)
California Chapter of the American College of Emergency
Physicians
California Council of Community Behavioral Health Agencies
Jewish Family Service
Mental Health America in California
Western Center on Law and Poverty
OPPOSITION: (Verified8/17/16)
None received
ARGUMENTS IN 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
update required in this bill can inform legislators and other
about ways to expand the innovative approaches that are
developed for the demonstration program.
ASSEMBLY FLOOR: 78-0, 1/27/16
AYES: Achadjian, Alejo, Travis Allen, Baker, Bigelow, Bloom,
Bonilla, Bonta, Brough, Brown, Burke, Calderon, Campos, Chang,
Chau, Chávez, Chiu, Chu, Cooley, Cooper, Dababneh, Dahle,
Daly, Dodd, Eggman, Frazier, Beth Gaines, Gallagher, Cristina
Garcia, Eduardo Garcia, Gatto, Gipson, Gomez, Gonzalez,
Gordon, Gray, Grove, Hadley, Harper, Roger Hernández, Holden,
Irwin, Jones, Jones-Sawyer, Kim, Lackey, Levine, Linder,
Lopez, Low, Maienschein, Mayes, McCarty, Medina, Melendez,
Mullin, Nazarian, Obernolte, O'Donnell, Olsen, Patterson,
Quirk, Rendon, Ridley-Thomas, Rodriguez, Salas, Santiago,
Steinorth, Mark Stone, Thurmond, Ting, Wagner, Waldron, Weber,
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Wilk, Williams, Wood, Atkins
NO VOTE RECORDED: Mathis
Prepared by: Reyes Diaz / HEALTH / (916) 651-4111
8/18/16 16:57:27
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