BILL ANALYSIS                                                                                                                                                                                                    



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          CONCURRENCE IN SENATE AMENDMENTS


          AB  
          847 (Mullin and Ridley-Thomas)


          As Amended  February 22, 2016


          2/3 vote.  Urgency


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          Original Committee Reference:  HEALTH


          SUMMARY:  Requires the Department of Health Care Services (DHCS)  
          to develop a proposal to participate in demonstration programs  
          administered by the federal Secretary of Health and Human  
          Services (HHS Secretary) to improve mental health services  
          furnished by certified community behavioral health clinics to  
          Medi-Cal beneficiaries.


          The Senate amendments appropriate $1 million from the Mental  
          Health Services Fund for the purpose of developing a competitive  
          proposal including, but not limited to, establishing actuarially  
          sound rates and providing technical assistance to counties and  
          add an urgency clause.


          EXISTING FEDERAL LAW:  


          1)Federal law authorizes the Patient Protection and Affordable  








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            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  
            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:  According to the Senate Appropriations  
          Committee, one-time costs of $1.9 million for DHCS to develop a  
          proposal.  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 proposal for participation in the  
          demonstration program.










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


          1)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:


             a)   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;


             b)   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;









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             c)   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 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,


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


          2)Program Timeline.


             a)   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.


             b)   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.


             c)   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 geographic areas,  
               including rural and underserved areas.











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          3)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 ACA.

          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 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.   








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          Participating in the Act would also likely generate additional  
          savings to Medi-Cal from reduced physical health  
          hospitalizations.


          There is no opposition on file.

          Analysis Prepared by:                                             
                          Paula Villescaz / HEALTH / (916) 319-2097  FN:  
          0002655