BILL ANALYSIS                                                                                                                                                                                                    Ó



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          CONCURRENCE IN SENATE AMENDMENTS


          AB  
          168 (Maienschein)


          As Amended  August 17, 2016


          Majority vote


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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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