BILL ANALYSIS Ó
AB 168
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CONCURRENCE IN SENATE AMENDMENTS
AB
168 (Maienschein)
As Amended August 17, 2016
Majority vote
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|ASSEMBLY: |78-0 |(January 27, |SENATE: |39-0 |(August 22, |
| | |2016) | | |2016) |
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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.
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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
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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
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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
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