BILL ANALYSIS Ó
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|eSENATE RULES COMMITTEE | AB 861|
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THIRD READING
Bill No: AB 861
Author: Maienschein (R)
Amended: 5/12/15 in Assembly
Vote: 21
SENATE HEALTH COMMITTEE: 9-0, 6/17/15
AYES: Hernandez, Nguyen, Hall, Mitchell, Monning, Nielsen,
Pan, Roth, Wolk
SENATE APPROPRIATIONS COMMITTEE: 7-0, 8/27/15
AYES: Lara, Bates, Beall, Hill, Leyva, 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 submit an application for a specified federal
competitive grant for purposes of improving mental health
services to Medi-Cal beneficiaries, as specified. This bill
requires DHCS to work with counties and stakeholders, as
specified, to identify the unmet need for covered services and
to estimate the number of individuals who need housing
assistance. This bill requires the competitive grant proposal to
include plans for counties to redirect current funds, as
specified, to provide housing for those with severe mental
illnesses.
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ANALYSIS:
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 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, if it is awarded the planning grant for the
purpose of improving mental health services furnished by
CCBHCs to Medi-Cal beneficiaries, to submit an application for
the subsequent competitive grant competition to be selected as
a participating state in the demonstration program authorized
under PAMA.
2)Requires DHCS, in planning to develop its proposal for the
competitive grant, to work with counties and other
stakeholders to identify the unmet need for the covered
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services and to estimate the number of individuals who will
need housing assistance.
3)Requires the competitive grant proposal to include plans for
counties to redirect a portion of current funds, which would
be made available during the demonstration program, to provide
increased housing opportunities for individuals with severe
mental illness.
Comments
1)Author's statement. According to the author, in 2014, Congress
enacted PAMA, under which up to eight states will be selected
to have their federal share of costs for outpatient behavioral
health care for individuals with severe mental illnesses or
serious emotional disturbances increased to be equivalent to
the enhanced federal matching rate for the Children's Health
Insurance Program (CHIP). The federal law would enable
successful states to nearly double federal funds to support
community mental health and Substance Use Disorder (SUD)
services with no additional costs to the state or county.
These are extremely important funds that California could use
to serve some its most vulnerable populations.
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. Department of 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
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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
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)National data on mental illness and homelessness. In the
"Current Statistics on the Prevalence and Characteristics of
People Experiencing Homelessness in the United States," last
updated in July 2011 by SAMHSA, data from 2010 shows that,
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nationally, on a given night 407,966 individuals were homeless
in shelters, transitional housing programs, or on the streets
(not including those who were sleeping at the homes of family
or friends), and 109,812 individuals were chronically homeless
(a one percent decrease from the previous year). Of these
individuals, 26.2% had a severe mental illness, and 34.7% of
adults had chronic SUDs. Over the course of that year, data
shows that a total of 1,593,150 individuals experienced
homelessness.
Related Legislation
AB 847 (Mullin) requires DHCS to apply to the Secretary of the
USHHS for the PAMA federal planning grant for the purpose of
developing proposals to improve mental health services provided
by CCBHCs to Medi-Cal beneficiaries. AB 847 is pending in the
Senate Appropriations Committee.
AB 745 (Chau) requires the Governor to appoint an additional
member to the Mental Health Services Oversight and
Accountability Commission in existing law who has experience
providing supportive housing to people with a severe mental
illness. AB 745 is on Third Reading on the Senate Floor.
AB 253 (Roger Hernández) makes specified changes to the Mental
Health Services Act (MHSA), the Veterans Housing and Homeless
Prevention Bond Act of 2014, and mental health plan
requirements. AB 253 is pending in the Senate Transportation and
Housing Committee.
Prior Legislation
AB 1929 (Chau, Chapter 674, Statutes of 2014) allows county
mental health departments to deposit MHSA funding with the
California Housing Finance Agency (CalHFA), as specified, and
allows CalHFA to use those funds for special housing needs for
those with mental illness. Requires counties to dedicate funds
to provide housing assistance to those with serious mental
illness who are homeless or to the mentally ill at risk of being
homeless.
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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 the Senate
Appropriations Committee.
FISCAL EFFECT: Appropriation: No Fiscal
Com.:YesLocal: No
According to the Senate Appropriations Committee, one-time costs
likely from $1 million to $2 million to develop an application
for the demonstration grant program by DHCS (federal funds).
SUPPORT: (Verified8/31/15)
The Steinberg Institute (source)
California Chapter of the American College of Emergency
Physicians
Disability Rights California
Easter Seals
Western Center on Law and Poverty
OPPOSITION: (Verified8/31/15)
None received
ARGUMENTS IN SUPPORT: Supporters of this bill, including
behavioral health and disability advocates, argue that the
savings to counties will free up MHSA funds and other county
mental health funds that are now expended on hospital care. The
Western Center on Law and Poverty states that homeless people
often visit emergency departments for conditions that could be
controlled and contained if the people had access to safe
housing.
ASSEMBLY FLOOR: 74-0, 5/22/15
AYES: Achadjian, Travis Allen, Baker, Bigelow, Bloom, Bonilla,
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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 /
8/31/15 12:50:21
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