BILL ANALYSIS Ó
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: AB 847
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|AUTHOR: |Mullin |
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|VERSION: |April 30, 2015 |
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|HEARING DATE: |June 17, 2015 | | |
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|CONSULTANT: |Reyes Diaz |
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SUBJECT : Mental health: community-based services.
SUMMARY : Requires the Department of Health Care Services to apply to
the Secretary of the U.S. Health and Human Services for a
specified federal planning grant for the purpose of developing
proposals to improve mental health services provided by
certified community behavioral health clinics to Medi-Cal
beneficiaries. Contains an urgency clause that will make this
bill effective upon enactment
Existing law:
Federal law
1)Enacts 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.
Authorizes, in Section 223 of the Protecting Access to
Medicare Act (PAMA) of 2014 (P.L. 113-93), a two-year
demonstration program, to include up to eight states, that
creates criteria for by certified community behavioral health
clinics (CCBHCs) and provides planning grants to develop
applications to participate in the demonstration program.
State law
2)Establishes the Medi-Cal program, administered by the
Department of Health Care Services (DHCS), under which
qualified low-income persons receive health care benefits. The
Medi-Cal program is, in part, governed and funded by the
federal Medicaid provisions.
3)Establishes, under the terms of a federal Medicaid waiver, a
AB 847 (Mullin) Page 2 of ?
managed care program providing Medi-Cal specialty mental
health services for eligible low-income persons administered
through local county mental health plans under contract with
DHCS.
This bill:
1)Requires DHCS to apply for planning grants available pursuant
to PAMA for purposes of developing proposals to participate in
the demonstration program to improve mental health services
provided by CCBHCs to Medi-Cal beneficiaries.
2)Contains an urgency clause that will make this bill effective
upon enactment.
FISCAL
EFFECT : According to the Assembly Appropriations Committee,
this bill includes administrative costs to DHCS estimated at
under $100,000 (General Fund/federal) to apply for the planning
grant. This is subject to uncertainty, as the grant application
has not yet been released. If this grant is received, federal
planning grant funds would pay for the development of the
demonstration program grant.
PRIOR
VOTES :
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|Assembly Floor: |74 - 0 |
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|Assembly Appropriations Committee: |17 - 0 |
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|Assembly Health Committee: |19 - 0 |
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COMMENTS :
1)Author's statement. According to the author, the federal
Excellence in Mental Health Act will enable successful states
to nearly double federal funds to support community mental
health and substance use disorder (SUD) services with no
additional state or county cost. The law currently allows for
up to eight states to be selected for two years to have the
federal matching funds increased for outpatient mental health
and SUD services from the current level of 50% to be
AB 847 (Mullin) Page 3 of ?
equivalent to the enhanced federal matching rate for the
Children's Health Insurance Program (CHIP). This would mostly
affect people who are disabled due to a severe mental illness.
If California is successful in its application for the
increased funding, this would have a value of about $2 billion
and would significantly help California's counties get more
people who are homeless due to untreated mental illness off
the streets and out of hospitals and jails and into treatment.
It would also likely generate additional savings to Medi-Cal
from reduced physical health hospitalizations for this
population.
2)Background. Federal law authorizes PAMA to establish a
demonstration program, to include up to eight states, that
creates criteria for CCBHCs, which are facilities designed to
serve individuals with serious mental illnesses and SUDs. PAMA
provides nearly $25 million that will be available to states
as planning grants to develop applications. PAMA also directs
the Secretary of the U.S. Health and Human Services (USHHS) to
award planning grants to states for the development of
demonstration proposals by January 1, 2016, and to select
states to participate in the demonstration program by
September 1, 2017. Section 223 of PAMA authorizes the USHHS
to:
a) Establish criteria that states will use to certify
CCBHCs for a two-year demonstration program;
b) Provide guidance on the development of a Prospective
Payment System (PPS) for payment of services provided by
CCBHCs;
c) Award grants to states for planning purposes to
develop proposals to participate in the demonstration
program;
d) Select up to eight states to participate in the
demonstration program;
e) Pay states participating in the demonstration
program federal matching funds equivalent to the standard
CHIP matching rate for services provided to currently
enrolled Medicaid beneficiaries; and,
f) Evaluate the program and prepare annual reports to
Congress.
As indicated on the Substance Abuse and Mental Health Services
Administration's (SAMHSA) Web site, states may submit
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applications for the planning grants through August 5, 2015.
According to DHCS, the department will apply for the planning
grants.
1)CCBHCs. SAMHSA is currently in the process of determining what
the eligibility criteria will be for states to certify CCBHCs.
The CCBHC demonstration program and the PPS are designed to
work within the scope of State Medicaid Plans and to apply
only to individuals who are Medicaid enrollees. According to
SAMHSA, this demonstration program provides an opportunity for
states to improve the behavioral health of their residents by
providing community-based mental health and SUD treatment, and
by helping to further integrate behavioral health with
physical health care, utilize evidence-based practices on a
more consistent basis, and improve access to high quality
care. According to SAMHSA, populations to be served are adults
with serious mental illness, children with serious emotional
disturbance, and those with long term and serious SUDs, as
well as others with mental illness and SUDs.
2)Related legislation. AB 861 (Maienschein), would require DHCS
to submit an application for a subsequent grant under PAMA, if
it applies for and is awarded the PAMA planning grant, and
requires DHCS to work with counties and stakeholders to
identify the unmet need for covered services and to estimate
the number of individuals who need housing assistance. AB 861
also requires the competitive grant proposal to include plans
for counties to redirect current funds to provide housing for
those with severe mental illnesses. AB 861 is set for hearing
in the Senate Health Committee on June 17, 2015.
3)Prior legislation. AB 2287 (Monning, 2010), would have
required the California Health and Human Services Agency to
direct the appropriate state departments within the agency to
apply for community transformation grants under the ACA. AB
2287 died in Senate Appropriations Committee.
4)Support. Supporters of this bill, which include health,
behavioral health, and disability rights advocates, argue that
PAMA enables selected states to nearly double federal funds to
support community mental health and SUD services. They argue
that the added funding is an important complement to the
current behavioral health care funding and will significantly
expand the number of people in need that could be served. The
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California Chapter of the American College of Emergency
Physicians (California ACEP) states that a 2012 study in the
Annals of Emergency Medicine found that patients having
psychiatric emergencies wait approximately 42 percent longer
in the emergency department than other emergency patients.
Therefore, California ACEP supports this bill because it has
the potential to help improve access to MH services provided
to Medi-Cal patients at CCBHCs.
SUPPORT AND OPPOSITION :
Support: The Steinberg Institute (sponsor)
American Association for Marriage and Family Therapy,
California Division
California Chapter of the American College of
Emergency Physicians
California Coalition for Mental Health
California Council of Community Mental Health Agencies
California Primary Care Association
California Youth Empowerment Network
Disability Rights California
Mental Health America of California
Oppose: None received.
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