BILL ANALYSIS Ó AB 168 Page 1 CONCURRENCE IN SENATE AMENDMENTS AB 168 (Maienschein) As Amended August 17, 2016 Majority vote -------------------------------------------------------------------- |ASSEMBLY: |78-0 |(January 27, |SENATE: |39-0 |(August 22, | | | |2016) | | |2016) | | | | | | | | | | | | | | | -------------------------------------------------------------------- Original Committee Reference: HEALTH SUMMARY: Requires the Department of Health Care Services (DHCS) to develop and submit a proposal to participate in a demonstration project authorized under the United States (U.S.) Protecting Access to Medicare Act of 2014 (H.R. 4302) to improve mental health services provided by certified community behavioral health clinics to Medi-Cal beneficiaries, as specified. The Senate amendments require, if chosen to participate in a federal demonstration project authorized under H.R. 4302, DHCS to provide an update to the Legislature by March 1, 2017, that includes, to the extent that it is available, names of the participating counties, the estimated amount of additional funding each county is expected to receive, identified benefits from the demonstration program funding and planning process, and other information as specified. AB 168 Page 2 EXISTING FEDERAL LAW: 1)Authorizes the Patient Protection and Affordable Care Act 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)Establishes 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. 3)Requires DHCS to develop and submit a proposal to participate in a demonstration project authorized under H.R. 4302 to improve mental health services provided by CCBHCs to Medi-Cal AB 168 Page 3 beneficiaries. FISCAL EFFECT: According to the Senate Appropriations Committee, pursuant to Senate Rule 28.8, negligible state costs. COMMENTS: According to the author, federal law enables successful states to nearly double federal funds to support community mental health and alcohol and drug services 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. On March 31, 2014, Congress passed the Protecting Access to Medicare Act (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 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 moves down to 90% by 2020. Participating states must develop a prospective payment AB 168 Page 4 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 and the Assistant Secretary of Planning and Evaluation, 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. Analysis Prepared by: Paula Villescaz / HEALTH / (916) 319-2097 FN: 0004535 AB 168 Page 5