BILL ANALYSIS                                                                                                                                                                                                    Ó






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          |SENATE RULES COMMITTEE            |                        AB 847|
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                                   THIRD READING 


          Bill No:  AB 847
          Author:   Mullin (D) and Ridley-Thomas (D)
          Amended:  2/22/16 in Senate
          Vote:     27  - Urgency

           SENATE HEALTH COMMITTEE:  9-0, 6/17/15
           AYES:  Hernandez, Nguyen, Hall, Mitchell, Monning, Nielsen,  
            Pan, Roth, Wolk

           SENATE APPROPRIATIONS COMMITTEE:  7-0, 3/7/16
           AYES:  Lara, Bates, Beall, De León, Hill, Mendoza, Nielsen

           ASSEMBLY FLOOR:  74-0, 5/22/15 (Consent) - See last page for  
            vote

           SUBJECT:   Mental health:  community-based services


          SOURCE:    The Steinberg Institute

          DIGEST:  This bill requires the Department of Health Care  
          Services (DHCS) to develop a proposal for the United States  
          Secretary of Health and Human Services (USSHHS) for selection as  
          a participating state in a time-limited demonstration program,  
          as specified, to improve mental health services provided by  
          specified entities to Medi-Cal beneficiaries. Requires DHCS to  
          use funds awarded to the state, as specified, to pay for costs  
          that will support this effort. Appropriates $1 million of Mental  
          Health Services Fund monies to support DHCS's proposal to the  
          USSHHS.

          ANALYSIS:
          








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          Existing 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.

          2)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 certified community behavioral health  
            clinics (CCBHCs) and provides planning grants to states to  
            develop applications to participate in the demonstration  
            program. 

          Existing state law:

          1)Establishes the Medi-Cal program, administered by 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.

          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 mental health plans under contract with  
            DHCS.

          This bill:

          1)Requires DHCS to develop a proposal for the USSHHS for  
            selection as a participating state in the time-limited  
            demonstration program authorized under PAMA in order to  
            improve mental health services provided by CCBHCs to Medi-Cal  
            beneficiaries.

          2)Requires DHCS to use the funds awarded to the state by the  
            USSHHS, for purposes of the PAMA demonstration program, to pay  
            any costs that will support the development of a competitive  
            proposal, including, but not limited to, establishing  
            actuarially sound rates and providing technical assistance to  
            counties.








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          3)Appropriates $1 million from the Mental Health Services Fund  
            to DHCS for the purpose of developing the proposal to the  
            USSHHS for the demonstration program.














































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          Comments

          1)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 substance  
            use disorders (SUDs). PAMA provides nearly $25 million that  
            will be available to states as planning grants to develop  
            applications. PAMA also directs the USSHHS 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 USSHHS 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.

          2)CCBHCs. The federal Substance Abuse and Mental Health Services  
            Administration (SAMHSA) developed eligibility criteria for  
            states to certify CCBHCs, based on a review of selected state  
            Medicaid Plans, standards for Federally Qualified Health  
            Centers and Medicaid Health Homes, and quality measures  
            currently in use by states. According to SAMHSA's Web site,  
            the criteria are intended to extend quality and to improve  
            outcomes of the behavioral health care system within the  
            authorities of state regulations, statutes, and state Medicaid  
            Plans; establish a basic level of services at which the CCBHCs  
            should, at a minimum, operate; and allow states the  
            flexibility in determining how to implement the criteria in a  
            manner best addressing the needs of the population being  







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            served. The criteria are designed to encourage states and  
            CCBHCs to further develop their abilities to offer behavioral  
            health services that comport with current best practices.  
            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.

          Prior Legislation
          
          AB 861 (Maienschein, 2015), was substantially similar to this  
          bill. AB 861 was vetoed by Governor Brown, who stated that the  
          bill was premature because the state had not been awarded any  
          federal grants or approved as one of the eight participating  
          states for the demonstration program.

          FISCAL EFFECT:   Appropriation:    Yes         Fiscal  
          Com.:YesLocal:   No

          According to the Senate Appropriations Committee, one-time costs  
          of $1.9 million for DHCS to develop a proposal (federal funds  
          and Mental Health Services Act Fund). DHCS indicates that the  
          total cost to prepare the proposal is $1.9 million. DHCS has  
          received a $900,000 planning grant from the federal government.  
          The $1 million appropriation in the bill will allow DHCS to  
          complete the administrative work needed to prepare the proposal  
          for participation in the demonstration program.


          SUPPORT:  (Verified  3/8/16)


          The Steinberg Institute (source)
          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








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          OPPOSITION:  (Verified  3/8/16)


          None received

          ASSEMBLY FLOOR:  74-0, 5/22/15
          AYES:  Achadjian, Travis Allen, Baker, Bigelow, Bloom, Bonilla,  
            Bonta, Brough, Brown, Burke, Calderon, Campos, Chang, Chau,  
            Chávez, Chiu, Chu, Cooley, Cooper, Dababneh, Dahle, Daly,  
            Dodd, Eggman, Frazier, Beth Gaines, Gallagher, Cristina  
            Garcia, Eduardo Garcia, Gatto, Gipson, Gomez, Gonzalez,  
            Gordon, Gray, Grove, Hadley, Harper, Roger Hernández, Holden,  
            Irwin, Jones-Sawyer, Kim, Lackey, Levine, Linder, Lopez, Low,  
            Maienschein, Mathis, Mayes, McCarty, Medina, Melendez, Mullin,  
            Nazarian, Obernolte, Patterson, Perea, Quirk, Rendon,  
            Ridley-Thomas, Rodriguez, Salas, Santiago, Steinorth, Mark  
            Stone, Thurmond, Ting, Wagner, Wilk, Williams, Wood, Atkins
          NO VOTE RECORDED:  Alejo, Jones, O'Donnell, Olsen, Waldron,  
            Weber

          Prepared by:Reyes Diaz / HEALTH / 
          3/9/16 14:42:24


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