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