BILL ANALYSIS Ó
AB 847
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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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|ASSEMBLY: | 74-0 |May 22, 2015 |SENATE: |39-0 |March 10, 2016 |
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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