BILL ANALYSIS                                                                                                                                                                                                    Ó



                                                                     AB 253


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          Date of Hearing:   April 28, 2015


                            ASSEMBLY COMMITTEE ON HEALTH


                                  Rob Bonta, Chair


          AB 253  
          (Roger Hernández) - As Amended March 26, 2015


          SUBJECT:  Mental health.


          SUMMARY:  Makes specified changes to the Mental Health Services  
          Act (MHSA), the Veterans Housing and Homeless Prevention (VHHP)  
          Bond Act of 2014, and the Medi-Cal mental health plan  
          requirements.  Specifically, this bill:  


          1)Requires the California Housing Finance Agency (CalHFA), the  
            Department of Housing and Community Development (HCD), and the  
            Department of Veterans Affairs (CalVet) to give a preference  
            to applicants for VHHP funding for supportive housing projects  
            when the applicant can demonstrate a multiyear commitment of  
            MHSA funding for the applicant's project funding plan.


          2)Requires the Governor to appoint two additional members to the  
            Mental Health Services Oversight and Accountability Commission  
            (Commission) including:


             a)   A person with knowledge and experience in reducing  
               mental health disparities; and,










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             b)   A veteran with knowledge about veteran's mental health  
               issues.


          3)Requires the Department of Health Care Services (DHCS) to  
            submit the cultural competence plan component for Medi-Cal  
            beneficiaries received by each mental health plan to the  
            Legislature within 30 days of DHCS receiving the plan.


          EXISTING LAW:  


          1)Establishes the MHSA, enacted by voters in 2004 as Proposition  
            63, to provide funds to counties to expand services, develop  
            innovative programs, and integrated service plans for mentally  
            ill children, adults, and seniors through a 1% income tax on  
            personal income above $1 million.

          2)Establishes the Commission to oversee the implementation of  
            MHSA and provides for the following membership requirements  
            for the Commission, appointed by the Governor unless otherwise  
            specified:

             a)   The Attorney General and his or her designee;
             b)   The Superintendent of Public Instruction or his or her  
               designee;
             c)   A member of the Senate selected by the President pro  
               Tempore of the Senate;
             d)   A member of the Assembly selected by the Speaker of the  
               Assembly;
             e)   Two persons with a severe mental illness;
             f)   A family member of an adult or senior with a severe  
               mental illness;
             g)   A family member of a child who has or has had a severe  
               mental illness;
             h)   A physician specializing in alcohol and drug treatment;
             i)   A mental health professional;
             j)   A county sheriff;








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             aa)  A superintendent of a school district;
             bb)  A representative of a labor organization;
             cc)  A representative of an employer with less than 500  
               employees;
             dd)  A representative of an employer with more than 500  
               employees; and,
             ee)  A representative of a health care services plan or  
               insurer.

          3)Specifies that the MHSA can only be amended by a two-thirds  
            vote of both houses of the Legislature and only as long as the  
            amendment is consistent with and furthers the intent of the  
            MHSA.  Permits provisions clarifying the procedures and terms  
            of the MHSA to be added by majority vote.

          4)Establishes the VHHP, an initiative measure enacted by the  
            voters in 2014 as Proposition 41, authorizing $600 million in  
            bonds for the acquisition, construction, rehabilitation, and  
            preservation of affordable multifamily supportive housing,  
            affordable multifamily transitional housing, or related  
            facilities for veterans and their families.


          5)Requires CalHFA, HCD, and CalVet to work collaboratively to  
            carry out the duties and functions of the VHHP.


          6)Provides that DHCS is responsible for the development and  
            implementation of mental health plans for Medi-Cal  
            beneficiaries.


          7)Requires mental health plans, whether administered by public  
            or private entities, to be governed by specified guidelines,  
            including providing for culturally competent and  
            age-appropriate services, to the extent feasible.


          8)Requires a mental health plan to assess the cultural  








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            competency needs of the program and to include a process to  
            accommodate the significant needs with reasonable timeliness.



          FISCAL EFFECT:  This bill has not yet been analyzed by a fiscal  
          committee. 


          COMMENTS:  


          1)PURPOSE OF THIS BILL.  According to the author, state and  
            local governments must continue to partner together to further  
            the successes of Proposition 63, especially as it pertains to  
            helping veterans and reducing mental health disparities among  
            California's diverse communities.  Currently, the Commission  
            lacks representation by experts on the challenges that  
            veterans face and reducing mental health disparities. 



            The author notes that the State must create opportunities to  
            better leverage the investment of Proposition 63 with other  
            voter approved funding sources that share the same policy  
            mission and goals.  According to the author, this is  
            especially important as Proposition 41 projects are usually in  
            need of gap financing and service dollars to successfully  
            implement the projects.  This concept is similar to how the  
            California Tax Credit Allocation Committee provides  
            competitive scoring and first-priority under the non-profit  
            set-aside for projects with MHSA funds.  





            The author concludes that it is important that the data and  
            plans submitted by counties to the state regarding their  








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            efforts to plan and deliver culturally competent services is  
            shared with the Legislature.


            
          2)BACKGROUND.  


             a)   MHSA.  Proposition 63 was passed by voters in November  
               2004.  The MHSA imposes a 1% income tax on personal income  
               in excess of $1 million and creates a 16 member Commission  
               charged with overseeing the implementation of MHSA.



               i)     Commission.  MHSA requires each county mental health  
                 department to prepare and submit a three-year plan to  
                 DHCS that must be updated each year and approved by DHCS  
                 after review and comment by the Commission.  In their  
                 three-year plans, counties are required to include a list  
                 of all programs for which MHSA funding is being requested  
                 and that identifies how the funds will be spent and which  
                 populations will be served.  Counties must submit their  
                 plans for approval to the Commission before the counties  
                 may spend certain categories of funding.



               ii)    Funding.  The MHSA provides funding for programs  
                 within five components:



                  (1)       Community Services and Supports:  Provides  
                    direct mental health services to the severely and  
                    seriously mentally ill, such as mental health  
                    treatment, cost of health care treatment, and housing  
                    supports.  Regulation requires counties to direct the  
                    majority of its Community Services and Supports funds  








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                    to FullService Partnerships (FSPs).  FSPs are county  
                    coordinated plans, in collaboration with the client  
                    and the family to provide the full spectrum of  
                    community services.  These services consist of mental  
                    health services and supports, such as peer support and  
                    c(2)      risis intervention services; and nonmental  
                    health services and supports, such as food, clothing,  
                    housing, and the cost of medical treatment;



                  (3)       Prevention and Early Intervention:  Provides  
                    services to mental health clients in order to help  
                    prevent mental illness from becoming severe and  
                    disabling;



                  (4)       Innovation:  Provides services and approaches  
                    that are creative in an effort to address mental  
                    health clients' persistent issues, such as improving  
                    services for underserved or unserved populations  
                    within the community;



                  (5)       Capital Facilities and Technological Needs:   
                    Creates additional county infrastructure such as  
                    additional clinics and facilities and/or development  
                    of a technological infrastructure for the mental  
                    health system, such as electronic health records for  
                    mental health services; and,



                  (6)       Workforce Education and Training:  Provides  
                    training for existing county mental health employees,  
                    outreach and recruitment to increase employment in the  
                    mental health system, and financial incentives to  








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                    recruit or retain employees within the public mental  
                    health system.



             b)   Prop 41.  Proposition 41 established the VHHP after its  
               passage in the 2014 primary election.  The VHHP  
               restructures $600 million of the $900 million in bonds  
               approved by the voters for the CalVet Home Loan Program in  
               2008 and uses them instead to fund the acquisition,  
               construction, rehabilitation, and preservation of  
               affordable multifamily supportive housing, affordable  
               multifamily transitional housing, or related facilities for  
               veterans and their families.
               The VHHP tasks HCD with administering the new funding  
               program in collaboration with CalVet and explicitly  
               restricts the use of bond proceeds to those housing units  
               designated for veterans and their families.  The focus of  
               the program is on housing for veterans who are homeless or  
               at risk for homelessness and in need of services such as  
               mental health counseling, substance abuse treatment, job  
               training, and physical therapy to address injuries.  HCD  
               released the first VHHP Program Notice of Funding  
               Availability on February 20, 2015, announcing the  
               availability of approximately $75 million in VHHP funding.   
               The anticipated award date will be in June 2015.





             c)   Mental Health Plan Requirements.  DHCS is responsible  
               for the development and implementation of mental health  
               plans for Medi-Cal beneficiaries.  Mental health plans,  
               whether administered by public or private entities, are  
               governed by specified guidelines, including, but not  
               limited to, how a plan will establish appropriate care  
               standards, how a plan will provide specialty mental health  
               services to eligible adults and children, and other  








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               requirements.  Mental health plans must also assess the  
               cultural competency needs of the program, and must include  
               a process to accommodate the significant needs with  
               reasonable timeliness.  



          3)SUPPORT.  The Steinberg Institute states in support that this  
            bill would expand the expertise of the Commission to include  
            members experienced in reducing mental health disparities in  
            diverse communities, and who specialize in veterans' mental  
            health issues.  This bill would also require agencies that  
            share policy goals of providing veteran housing to give  
            priority to applicants that have stable funding from the MHSA.  
             To improve oversight, this bill would ensure that county  
            agencies share their mental health plan's cultural competency  
            section with the legislature within 30 days of receipt by  
            DHCS.  Over 25% of veterans suffer from depression, PTSD, and  
            related illnesses, and 54% of those are African American or  
            Latino.  Lack of housing and often homelessness can be the  
            cause, or the result, or mental illness.  Increasing the  
            availability of veteran housing, in conjunction with giving  
            veterans a voice on mental health plans, offers the best  
            chance for stability and reduced homelessness.  This bill  
            ensures that these essential services are provided to those  
            who have served our country.  


          4)RELATED LEGISLATION.  AB 745 (Chau) requires the Governor to  
            appoint an additional member to the Commission who has  
            experience providing supportive housing to persons with a  
            severe mental illness.  AB 745 is currently pending in the  
            Assembly Appropriations Committee.


          5)PREVIOUS LEGISLATION.  AB 639 (Perez), Chapter 727, Statutes  
            of 2013, establishes the VHHP.










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          6)DOUBLE REFERRAL.  AB 253 was also referred to the Committee on  
            Housing and Community Development and passed on a vote of 4-0  
            on April 15, 2015.


          7)POLICY COMMENTS.





             a)   Concerns Regarding Implementation.  This bill requires  
               the departments administering the VHHP to give a preference  
               to applicants for supportive housing projects who can  
               demonstrate a multiyear commitment of MHSA funding for the  
               applicant's housing project funding plan.  A project would  
               have to be approved first by MHSA, which has requirements  
               built in that it is established as a payer of last resort.   
               This may require projects to demonstrate that they've  
               already been declined for funding from the various grants  
               that the federal Veterans Benefits Administration  
               administers, and it is unclear how funder of last resort  
               can approve a project that, in order to be completed, would  
               require funding approval from another source.

             Additionally, projects must be intended to broadly serve  
               individuals with mental health disorders.  After a project  
               is approved for MHSA funding, it must then go to VHHP,  
               which has a different set of project requirements.  VHHP  
               funds must be used to fund the acquisition, construction,  
               rehabilitation, and preservation of affordable supportive  
               housing; funds are not permitted to be spent on direct  
               services to individuals.  The VHHP program funding  
               requirements are evaluated with a scoring rubric, a rubric  
               that already includes consideration of projects that  
               leverage public (federal, state, and local), private, and  
               nonprofit program and fiscal resources and prioritizes  
               projects that combine housing and supportive services,  
               including.  While encouraging the use of MHSA funds for  








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               VHHP supportive housing services is understandable, the  
               actual implementation may be more onerous and difficult  
               than intended.



             b)   Mental Health Plan Requirements.  This bill requires  
               DHCS to submit the cultural competence plan component of  
               each mental health plan to the Legislature within 30 days  
               of receipt.  Mental health plans have a number of  
               requirements as previously discussed.  These requirements  
               are separate from the implementation plans that counties  
               must complete to comply with MHSA requirements.  It is  
               unclear how requiring DHCS to submit the cultural  
               competency component of the plan to the legislature meets  
               the stated goals of the bill by the author.  The committee  
               recommends removing the requirement that the cultural  
               competency plans be submitted to the legislature, and  
               instead require that DHCS post them on a dedicated web  
               page.
                 


             c)   MHSA Expansion.  AB 745, a bill that passed out of the  
               Assembly Health Committee on April 21, 2015, also expands  
               the Commission by one individual.  These bills will need to  
               be reconciled later in the legislative process.  While  
               adding diversity to the Commission is good, it may become  
               too large for Commissioners to be able to fulfill its  
               initial charge of overseeing the implementation of the  
               MHSA. 



          REGISTERED SUPPORT / OPPOSITION:












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          Support


          Steinberg Institute (sponsor)
          American Legion-Department of California
          AMVETS, Department of California
          California Association of County Veteran Service Officers
          California Association of Veteran Service Agencies
          California Military Officer Association of America
          California State Commanders Veterans Council
          Racial and Ethnic Mental Health Disparities Coalition
          VFW- Department of California
          Vietnam Veterans of America - California State Council


          Opposition


          None on file.




          Analysis Prepared by:Paula Villescaz / HEALTH / (916) 319-2097