BILL ANALYSIS                                                                                                                                                                                                    



                                                                     AB 847


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          Date of Hearing:  April 28, 2015


                            ASSEMBLY COMMITTEE ON HEALTH


                                  Rob Bonta, Chair


          AB 847  
          (Mullin) - As Amended March 26, 2015


          SUBJECT:  Mental health:  community-based services.


          SUMMARY:  Requires the Department of Health Care Services (DHCS)  
          to apply to the federal Secretary of Health and Human Services  
          (HHS Secretary) for the planning grant awarded for the purpose  
          of developing proposals to participate in demonstration programs  
          to improve mental health services furnished by certified  
          community behavioral health clinics to Medi-Cal beneficiaries. 


          EXISTING FEDERAL LAW:  


          1)Federal law authorizes the Patient Protection and Affordable  
            Care Act (ACA) to increase access to health care through a  
            number of measures, including expanding Medicaid eligibility,  
            subsidizing insurance premiums, and setting aside funds for  
            health promotion and disease prevention, among others. 

          2)Federal law authorizes the Protecting Access to Medicare Act  
            (H.R. 4302) to establish 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, and provides $25 million that will be available to  








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            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 MHPs under contract with the state.

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


          COMMENTS:  


          1)PURPOSE OF THIS BILL.  According to the author, the federal  
            Protecting Access to Medicare Act would enable successful  
            states to nearly double federal funds to support community  
            mental health and alcohol and drug services with no additional  
            state or county cost. The law currently allows for eight  
            states to be selected for two years to have the federal share  
            of costs increased for outpatient mental health and alcohol  
            and drug services increased from the current level of 50% to  
            at least 65%.  The author states that this would mostly affect  
            people who are disabled due to a severe mental illness.  If  
            successful, this would have a value to California of about $2  
            billion. It would significantly help California's counties get  
            more people, who are homeless due to untreated mental illness,  
            off the streets, out of hospitals and jails and into  
            treatment. The author concludes that it would also likely  








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            generate additional savings to Medi-Cal from reduced physical  
            health hospitalizations.


          2)BACKGROUND.  


             a)   Protecting Access to Medicare Act.  On March 31, 2014,  
               Congress passed the Protecting Access to Medicare Act (H.R.  
               4302), which included a demonstration program aimed at  
               increasing Americans' access to community mental health and  
               substance use treatment services while improving Medicaid  
               reimbursement for these services. This legislation:



               i)     Creates criteria for CCBHCs as entities designed to  
                 serve 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 HHS Secretary is  
                 directed to establish a process for selecting states to  
                 participate in a two year pilot program;



               ii)    Provides $25 million that will be available to  
                 states as planning grants to develop applications to  
                 participate in the two year pilot.  Only states that have  
                 received a planning grant will be eligible to apply to  
                 participate in the pilot;



               iii)   Stipulates that eight states will be selected to  
                 participate in the two year pilot program.  The match  
                 rate for CCBHC services is either the Enhanced Federal  
                 Medical Assistance Program (FMAP) /Children's Health  








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                 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; and,



               iv)    Requires participating states to develop a  
                 Prospective Payment System for reimbursing CCBHCs for  
                 required services provided by these entities.



             b)   Program Timeline.



               i)     September 1, 2015:  Deadline for the HHS Secretary  
                 to publish: criteria for a clinic to be certified by a  
                 State as a certified community behavioral health clinic;  
                 and, guidance for states on the establishment of a  
                 prospective payment system for certified clinics  
                 participating in the demonstration program.
               


               ii)    January 1, 2016:  Deadline for the HHS Secretary to  
                 award planning grants to states for the purpose of  
                 developing proposals to participate in the demonstration  
                 program.



               iii)   September 1, 2017:  Deadline for the HHS Secretary  
                 to select the states that will participate in the  
                 demonstration program. Only states that have received a  
                 planning grant are eligible to participate.  The states  
                 will be selected through a competitive application  
                 process and must represent a diverse selection of  








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                 geographic areas, including rural and underserved areas.

             c)   Certified Community Behavioral Health Clinics.  The  
               Substance Abuse and Mental Health Services Administration  
               (SAMHSA) is currently in the process of determining what  
               the eligibility criteria will be for the CCBHC. The CCBHC  
               demonstration program and Prospective Payment System are  
               designed to work within the scope of State Medicaid Plans  
               and to apply specifically to individuals who are Medicaid  
               enrollees.  The statute also requires that the CCBHCs not  
               refuse service to any person based either on ability to pay  
               or residence. According to SAMHSA, 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.   
               Further, while the statute is clear that the CCBHCs are to  
               provide services to all who seek help, it is anticipated  
               that the CCBHCs will prove particularly valuable for  
               individuals with serious mental illness, children and  
               adolescents with serious emotional disturbance and those  
               with co-occurring mental health, substance use and/or  
               physical health disorders.  Finally, the statute directs  
               that the care provided be "patient-centered."  It is  
               expected that CCBHCs will offer care that is  
               person-centered and family-centered in accordance with the  
               requirements of the Affordable Care Act. 
          3)SUPPORT.  The Steinberg Institute, sponsor of this bill,  
            states in support that this bill directs DHCS to develop and  
            submit a proposal to compete to become one of the eight  
            designated states to receive significantly enhanced federal  
            mental health funds under the Excellence in Mental Health Act  
            - enacted as Section 223 of the Protecting Access to Medicare  
            Act of 2014.  This federal law would enable selected states to  
            nearly double federal funds to support community mental health  
            and alcohol and drug services with no additional state or  
            county cost.  The law currently allows eight states to have  
            the federal share of costs increased for outpatient mental  








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            health and alcohol and drug services increased from the  
            current level of 50% to at least 65% over a two year period of  
            time.  If DHCS is successful, this would bring an additional  
            $2 billion in funding to California, which would significantly  
            impact California's ability to ensure that those who are  
            homeless, due to untreated mental illness, get off the  
            streets, out of hospitals and jails, and into treatment.   
            Participating in the Act would also likely generate additional  
            savings to Medi-Cal from reduced physical health  
            hospitalizations.


          4)RELATED LEGISLATION.  This bill is substantially similar to AB  
            861 (Maienschein) and is currently pending in the Assembly  
            Health Committee.


          5)PREVIOUS LEGISLATION.  AB 2287 (Monning) of 2010 required the  
            California Health and Human Services Agency (CHHSA) to direct  
            the appropriate state departments within the agency to apply  
            for Community Transformation Grants under the ACA.  This bill  
            died in Senate Appropriations Committee.


          6)AMENDMENTS.  The Committee is adopting amendments to add an  
            urgency clause to the bill to ensure the provisions of this  
            bill go into immediate effect upon enactment.


          REGISTERED SUPPORT / OPPOSITION:




          Support


          The Steinberg Institute (sponsor)









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          California Coalition for Mental Health
          California Council of Community Mental Health Agencies
          Disability Rights California
          Mental Health America of California




          Opposition


          None on file.




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