BILL ANALYSIS Ó
AB 861
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Date of Hearing: April 28, 2015
ASSEMBLY COMMITTEE ON HEALTH
Rob Bonta, Chair
AB 861
(Maienschein) - 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.
Specifically, this bill:
1)Requires DHCS to submit an application for the subsequent
competitive grant competition to be selected as a
participating state in the demonstration program.
2)Requires DHCS to, in planning to develop its proposal for the
competitive grant, work with counties and other stakeholders
to identify the unmet need for the covered services and to
estimate the number of individuals who will need housing
assistance.
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3)Requires the competitive grant proposal to include plans for
counties to redirect a portion of the funds that are currently
used to match federal funds but will not be needed for that
purpose during the grant period to provide increased housing
opportunities for individuals with severe mental illnesses.
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
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.
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FISCAL EFFECT: This bill has not yet been analyzed by a fiscal
committee.
COMMENTS:
1)PURPOSE OF THIS BILL. According to the author, federal law
enables successful states to nearly double federal funds to
support community mental health and alcohol and drug services
with no additional costs to the state or county. These
additional funds will significantly help California's counties
serve more people who are homeless due to an untreated mental
illness and get them off the streets, out of hospitals and
jails, and into treatment. The author states that if
California is successful in its bid for the additional
funding, it would benefit the state to the tune of about $2
billion. The savings to the counties will free up Proposition
63 funds and other county mental health funds that are now
expended on hospital care. The author concludes that those
savings can then be redirected to supportive housing efforts
which will help make the effects of these dollars more
permanent.
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:
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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
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;
iv) Requires participating states to develop a
prospective payment system for reimbursing CCBHCs for
required services provided by these entities.
b) Program Timeline.
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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; and,
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
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 CCBHCs. 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
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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 expected 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.
3)SUPPORT. Disability Rights California (DRC), supporters of
the bill, state that this bill would require DHCS to apply for
a planning grant and work with counties and other stakeholders
in developing its proposal. DRC state that this bill would
also require the proposal to include plans for increasing
housing opportunities for individuals with severe mental
health disabilities. Housing is one of the most needed
options people with mental health disabilities need. DRC
concludes that while this grant is to plan rather than develop
housing options at least it brings counties closer to
developing housing options for people.
4)RELATED LEGISLATION. AB 847 (Mullin) is substantially similar
to this bill 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 to direct the
appropriate state departments within the agency to apply for
Community Transformation Grants under the ACA. This bill died
in the Senate Appropriations Committee.
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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
Disability Rights California
Steinberg Institute
Western Center on Law & Poverty
Opposition
None on file.
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Analysis Prepared by:Paula Villescaz / HEALTH / (916) 319-2097