BILL ANALYSIS Ó
AB 741
Page 1
Date of Hearing: April 21, 2015
ASSEMBLY COMMITTEE ON HEALTH
Rob Bonta, Chair
AB 741
Williams - As Amended April 15, 2015
SUBJECT: Medi-Cal: comprehensive mental health crisis
services.
SUMMARY: Requires Medi-Cal reimbursement for comprehensive
mental health crisis services, including crisis intervention,
crisis stabilization, crisis residential treatment,
rehabilitative mental health services, and mobile crisis support
teams for children and youth. Specifically, this bill:
1)Expands the definition of "social rehabilitation facility" to
include residential facilities that provide treatment for
individuals in a mental health crisis in addition to treatment
to individuals recovering from mental illness.
2)Expands allowable services provided by a social rehabilitation
facility to include children and adolescents, in addition to
adults.
3)Adds specified services to the schedule of reimbursable
Medi-Cal benefits.
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4)Requires the Department of Health Care Services (DHCS) to seek
approval of any necessary state plan amendments necessary for
implementation.
5)Specifies that federal financial participation must be
available and that any necessary federal approvals must be
obtained before these provisions can be implemented.
EXISTING LAW:
1)Establishes in federal law the Medicaid program to provide
comprehensive health benefits to low income persons.
2)Establishes the Medi-Cal program as California's Medicaid
program.
3)Establishes specified Medi-Cal benefits, some required by
federal law, and other benefits which are optional under
federal law.
4)Defines "social rehabilitation facility" as any residential
facility that provides social rehabilitation services in a
group setting up to 18 months to adults recovering from mental
illness who temporarily need assistance, guidance, or
counseling.
FISCAL EFFECT: This bill has not yet been analyzed by a fiscal
committee.
COMMENTS:
1)PURPOSE OF THIS BILL. According to the author, the objective
for mental health services, guided by the federal Olmstead
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Act, is to provide treatment in the least restrictive setting
possible. The overarching goal of existing programs is to
keep youth experiencing a mental health crisis in calm,
familiar environments where their mental health needs can be
met. Currently, an estimated three out of every four children
in the U.S. that need mental health services, do not receive
them. Nearly 20% of high school students in California
consider suicide at some point in their lives and more than
10% actually attempt it. With 47 out of 58 counties lacking
any child/adolescent psychiatric hospital inpatient beds for
children under 12 (and fewer than 70 beds statewide), the need
for children's crisis residential services could not be more
acute. Among the benefits already included in the State
Mental Health Plan are: crisis intervention; crisis
stabilization; crisis residential treatment services; and the
Early and Periodic Screening, Diagnostic and Treatment (EPSDT)
supplemental Specialty Mental Health Services. Without a
licensing category specific to children's crisis residential
programs, however, this critically needed service - both in
lieu of inpatient care and as a step down from inpatient care
- is missing from the continuum of care.
The author provides an example of the status quo. A nine
year-old child is experiencing increased behavioral and
emotional symptoms which include persistent suicidal and
homicidal thoughts. Outpatient services available within the
family's county are not able to meet the child's increased
needs. The only immediately available intervention is
psychiatric hospitalization. The child experiences six
hospital stays in three weeks, all at facilities at least
three to five hours away from home. As the client returns
home, the lack of crisis services increase the risk of a yet
another hospitalization.
2)BACKGROUND. California has a decentralized public mental
health system with most direct services provided through the
county mental health system. Counties (i.e., county mental
health plans) have the primary funding and programmatic
responsibility for the majority of local mental health
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programs. The state is required to meet certain federal
requirements, including those set forth by Medicaid's child
health component, known as the EPSDT program. EPSDT is a
Medi-Cal benefit for individuals under the age of 21 who have
full-scope Medi-Cal eligibility. Federal law - including
statutes, regulations, and guidelines - requires that Medi-Cal
cover a very comprehensive set of benefits and services for
children, different from adult benefits. EPSDT provides
eligible children access to a range of mental health services
that include, but are not limited to:
a) Mental health assessment;
b) Therapy;
c) Rehabilitation;
d) Mental health services;
e) Medication support services;
f) Day rehabilitation;
g) Day treatment intensive;
h) Crisis intervention/stabilization;
i) Targeted case management;
j) Therapeutic behavioral services.
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3)CRISIS RESIDENTIAL PROGRAMS. According to a 2010 report by
the California Mental Health Planning Council, crisis
residential programs are a lower-cost, community-based
treatment option in home-like settings that help reduce
emergency department visits and divert hospitalization and
incarcerations. These programs include peer-run programs such
as crisis respites that offer safer, trauma-informed
alternatives to psychiatric emergency units, or other locked
facilities. The report indicates that crisis residential
programs reduce unnecessary stays in psychiatric hospitals,
reduce the number and expense of emergency room visits, and
divert inappropriate incarcerations while producing the same
or superior outcomes to those of institutionalized care. The
report states that, as the costs for inpatient treatment
continue to rise, the need to expand an appropriate array of
acute treatment settings becomes more urgent, and state and
county mental health systems should encourage and support
alternatives to costly institutionalization and improve the
continuum of care to better serve individuals experiencing an
acute psychiatric episode.
4)MOBILE CRISIS SUPPORT TEAMS. Mobile crisis support teams can
be utilized to provide crisis intervention, family support,
and Welfare and Institutions Code Section 5150 involuntary
psychiatric evaluations. These teams meet law enforcement in
the field and, among other things, provide diversion into
appropriate treatment arrangements. These teams have been
used in several areas across the state (for example, Sonoma
County's Mobile Support Team and the City of Berkeley's Mobile
Crisis Team). A mobile crisis team typically consists of an
interdisciplinary team of mental health professionals (e.g.,
nurses, social workers, psychiatrists, psychologists, mental
health technicians, addiction specialists, or peer counselors)
that respond to individuals in the community through home
visits or responses to incidents at other locations.
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5)CRISIS STABILIZATION. Crisis stabilization services are those
lasting less than 24 hours for individuals who are in
psychiatric crisis whose needs cannot be accommodated safely
in a residential service setting. Crisis stabilization must
be provided onsite at a 24-hour health facility,
hospital-based outpatient program, or at other certified
provider sites. The goal of the crisis stabilization is to
stabilize the consumer and re-integrate him or her back into
the community quickly. According to various reports, costs
for providing care in a crisis stabilization unit are
significantly lower than inpatient hospitalization.
6)SUPPORT. According to the California Alliance of Child and
Family Services, cosponsors of this bill, and other
supporters, this bill is aimed at addressing a critical
component missing in the continuum of specialty mental health
services for children and youth in California - children's
crisis residential services. This bill creates the needed
licensing category to ensure that counties and their
community-based providers have the ability to develop crisis
residential programs with an appropriate licensing category,
to ensure children and youth have access to mental health
services that are responsive to their individual needs and
strengths in a timely manner, and consistent with the
requirements of the Medi-Cal Early Periodic Screening
Diagnosis and Treatment (EPSDT) and Specialty Mental Health
Services (SMHS) program standards and requirements. There is
no question that a full continuum of care for children and
youth with critical mental health needs is both essential and
required by law. The lack of a licensing component for crisis
residential services, however, is preventing the development
of this much needed program which would provide a
residentially-based acute care option in a less restrictive
environment than inpatient hospitalization and would offer a
more appropriate alternative for children that do not require
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a hospital level of care.
The California Council of Community Mental Health Agencies, also
a cosponsor of the bill, and others in support including the
Steinberg Institute, state that this bill seeks to add to the
schedule of benefits comprehensive mental health crisis
services. This change would address the gaps in our state's
crisis services continuum for children and youth in
California. Supporters argue that crisis care for children is
a significant gap in our current mental health provision, and
this bill will take steps to correct this large deficiency.
The National Association of Social Workers - California
Chapter state in support of the bill that comprehensive mental
health crisis services are currently lacking statewide.
Without these services, children and youth experiencing mental
health crises are forced to use emergency rooms as their only
option for receiving mental health services. In counties
without inpatient hospital beds, children and youth needing
services are forced to try other neighboring counties. This
bill expands mental health services throughout the state,
making it easier for children and youth to receive timely and
comprehensive services.
7)RELATED LEGISLATION. AB 1018 (Cooper) requires DHCS to allow
county mental health plans to contract with LEAs to provide
services for Medi-Cal eligible pupils. AB 1018 is pending in
the Assembly Health Committee.
8)PREVIOUS LEGISLATION. SB 82 (Committee on Budget and Fiscal
Review), Chapter 34, Statutes 2013, established the Investment
in Mental Health Wellness Act of 2013 and authorizes the
California Health Facilities Financing Authority to administer
a program to increase capacity for mobile crisis support,
crisis intervention, crisis stabilization services, crisis
residential treatment, and specified personnel resources.
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REGISTERED SUPPORT / OPPOSITION:
Support
California Alliance of Child and Family Services (co-sponsor)
California Council of Community Mental Health Agencies
(co-sponsor)
California Chapter of the American College of Emergency
Physicians
California Mental Health Advocates for Children and Youth
California Primary Care Association
California Psychiatric Association
California Psychological Association
Casa Pacifica Centers for Children and Families
Crittenton Services for Children and Families
Junior Blind of America
Lincoln Child Center
Mental Health America of California
National Association of Social Workers - California Chapter
Remi Vista, Inc.
Seneca Family of Agencies
Sierra Sacramento Valley Medical Society
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Stars Behavioral Health Group
Steinberg Institute
United Advocates for Children and Families
Opposition
None on file.
Analysis Prepared by:Paula Villescaz / HEALTH / (916) 319-2097