BILL ANALYSIS Ó
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