BILL ANALYSIS Ó
AB 1133
Page 1
Date of Hearing: April 21, 2015
ASSEMBLY COMMITTEE ON HEALTH
Rob Bonta, Chair
AB 1133
Achadjian - As Amended April 15, 2015
SUBJECT: School-based early mental health intervention and
prevention services support program.
SUMMARY: Establishes a four year pilot program, the
School-Based Early Mental Health Intervention and Prevention
Services Support Program (EMHI Support Program), to provide
outreach, free regional training, and technical assistance for
local educational agencies in providing mental health services
at school sites. Specifically, this bill:
1)Makes findings and recommendations relative to the importance
of mental health services for students and to the funding
history of the EMHI Support Program.
2)Requires the State Public Health Officer, in consultation with
the Superintendent of Public Instruction (SPI) and the
Director of the Department of Health Care Services (DHCS), to
establish a four-year pilot program to encourage and support
local decisions to provide funding for the eligible support
services.
AB 1133
Page 2
3)Requires the Department of Public Health (DPH) to provide
outreach to local education agencies (LEAs) and county mental
health agencies to inform them of the program.
4)Requires DPH to provide free regional training on eligible
support services, including intervention and prevention
services, parent involvement, teacher and staff conferences
and training, referral to outside resources, and use of
paraprofessional staff, counselors, and social workers.
5)Requires DPH to also provide free regional training on how the
support services can help fulfill state priorities described
by the local control funding formula and local control and
accountability plans and how educational, mental health, and
other funds subject to local control can be used to finance
the eligible support services, as specified.
6)Requires the department to provide technical assistance to
LEAs that provide or seek to provide eligible services defined
in this section. Technical assistance includes assistance in
designing programs, training staff, conducting evaluations,
and leveraging funds that are subject to local control.
7)Requires the DPH to select and support school sites as
follows:
a) Requires, during the first 18 months of the program, DPH
to support, strengthen, and expand the provision of
AB 1133
Page 3
eligible services at 30 school sites that received funding
pursuant to the previously established School-Based EMHI
and Prevention Services Matching Grant Program and have
continued to provide eligible support services: and,
b) Requires the department, during the second 18 months of
the program, to select 30 new school sites that are not
providing eligible support services but that demonstrate
the willingness and capacity to participate in the program.
Requires DPH to work with these school sites to deliver
eligible support services.
1)Requires the DPH to prioritize geographic diversity, program
effectiveness, program efficiency, and long-term program
sustainability.
2)Requires the DPH to submit an interim report to the
Legislature at the end of the second year of the pilot program
and to complete an evaluation at the end of the four year
pilot and submit it to the Legislature.
3)Expands the definition of eligible students to include
students who attend a preschool program at a publicly funded
elementary school or who attends a publicly funded elementary
school and who is in kindergarten, transitional kindergarten,
or in grades one through three.
4)Sunsets the program on January 1, 2021.
AB 1133
Page 4
EXISTING LAW:
1)Establishes the School-based EMHI Services for Children Act of
1991, and authorizes DHCS, in consultation with the SPI, to
provide matching grants to LEAs to pay the state share of the
costs of providing school-based EMHI services to eligible
students, subject to the availability of funding each year.
2)Provides for the Medi-Cal program, administered by DHCS, under
which eligible low-income individuals receive health care
services subject to state and federal laws and funding.
3)Establishes the Medi-Cal Early and Periodic Screening,
Diagnostic and Treatment (EPSDT) program for eligible
individuals up to age 21 pursuant to state and federal law.
4)Defines a LEA as a school district, a county office of
education, a nonprofit charter school participating as a
member of a special education local plan area, or a special
education local plan area and allows LEAs to provide and bill
for Medi-Cal services provided to students receiving special
education services on Medi-Cal (generally, special education
students).
FISCAL EFFECT: This bill has not yet been analyzed by a fiscal
committee.
COMMENTS:
1)PURPOSE OF THIS BILL. According to the author, this bill
AB 1133
Page 5
would authorize the provision of non-financial supports to
help LEAs maximize the use of funds that are under local
control for EMHI programs. The new school financing formula
permitting local school entities more discretion in how they
spend their funds, known as the Local Control Funding permits
LEAs to divert funds into early mental health programs for
students. The pilot program established by this bill would be
one option for LEAs to use to provide health services to
pupils. These supports would include outreach to local
decision-makers; free regional trainings on eligible services
to fulfill state and locally defined educational priorities,
available funding sources and relevant state and local
non-financial resources; and technical assistance to LEAs that
provide or seek eligible services. The author states that the
earlier these children are connected to services, the more
successful they might become later in life.
2)BACKGROUND. There are a number of different funding
mechanisms currently available for school districts and LEAs
to provide health care services to pupils, as discussed in
more detail below. Between 1991 and 2011, the state
Department of Mental Health (DMH) also operated a previous
version of the Early Mental Health Initiative, which provided
schools with approximately $15 million annually to serve
children in kindergarten through third grade with mild and
moderate mental health problems. With the transfer of
responsibilities from the DMH to DHCS in 2012, this program
was shifted to local education departments. Many counties also
fund on-campus mental health services to non-special education
students through EPSDT and Mental Health Services Act-funded
early prevention programs.
a) School-Based Mental Health Services. Schools are a main
provider of mental health services for children in
California. The federal Individuals with Disabilities
Education Act (IDEA) was adopted in 1975 to guarantee
AB 1133
Page 6
children with disabilities a right to public education in
the least restrictive setting. In California, the federal
IDEA mandate to provide special education services is
administered by local school districts and local education
agencies. Special education students may be eligible for
health care services, including mental health services, in
specific IDEA disability categories. Mental health services
provided to special education students include counseling
and guidance, psychological services, parental counseling
and training, and residential placement, among others.
b) County Mental Health Plans (MHPs). Prior to 2011,
special education students who had a severe emotional
disturbance condition documented in their individual
education plans (IEPs) were referred by their schools to
county mental health agencies for treatment. In 2011, the
Legislature repealed the state mandate on county mental
health agencies to provide IDEA-related mental health
services and shifted this financial responsibility to the
California Department of Education. LEAs and local county
MHPs were required to develop new agreements defining
agency responsibilities that reflected the changes in state
law. MHPs remain responsible for providing EPSDT services
for students who are Medi-Cal beneficiaries with
IDEA-related individualized education, if they meet medical
necessity criteria.
c) School Billing for Medicaid Administrative Activities
(SMAA). The SMAA program reimburses school districts for
the federal share (50%) of the certain costs for
administering the Medi-Cal program. Those activities
include: outreach and referral; facilitating the Medi-Cal
application; arranging non-emergency/non-medical
transportation; program planning and policy development;
and, claims coordination. SMAA funds were typically
reimbursed directly to school districts for services
already provided. Approximately half a billion dollars in
AB 1133
Page 7
reimbursable funds has not been paid to California school
districts in the last five years. This funding would have
gone towards the administration of and claiming of similar
services that the School-Based EMHI Support Program seeks
to provide. Materials provided by the supporters of this
bill state that in the past school districts have relied on
a combination of Medical Administrative Activities (MAA)
funding and LEA funding to provide health services to
students.
d) EPSDT. EPSDT is a federally mandated Medi-Cal benefit
for individuals up to the age of 21 who have full-scope
Medi-Cal eligibility. This benefit allows for periodic
screenings to determine health care needs and based upon
the identified health care need and diagnosis, treatment
services are provided. EPSDT services include all services
otherwise covered by Medi-Cal and EPSDT beneficiaries can
receive additional medically necessary services. EPSDT
mental health services are Medi-Cal services that correct
or improve mental health problems that have been determined
by a physician, psychologist, counselor, social worker,or
other health or social services provider. EPSDT provides
eligible children access to a range of mental health
services that include, but are not limited to:
i) Mental health assessment;
ii) Collateral contracts;
iii) Therapy;
iv) Rehabilitation;
AB 1133
Page 8
v) Mental health services;
vi) Medication support services;
vii) Day rehabilitation; day treatment intensive;
viii) Crisis intervention/stabilization;
ix) Targeted case management; and,
x) Therapeutic behavioral services.
3)SUPPORT. Children Now and Time for Kids, sponsors of this
bill, state that state that the rationale for creating the
EMHI program in 1991 still resonates today: "It is in
California's best interest, both in economic and human terms,
to identify and treat minor difficulties that our children are
experiencing before those difficulties become major barriers
to later success." For 20 years, the EMHI Matching Grant
Program was the solution: a highly successful program that
provided matching grants to LEAs to provide school-based
mental health supports to young pupils experiencing mild to
moderate school adjustment difficulties such as isolation,
anxiety, and bullying.
The California Medical Association and others state in support
that this bill would build on the success of the EMHI program
by authorizing the provision of non-financial supports to help
LEAs maximize the use of funds that are under local control
for EMHI programs. These supports would include: a) outreach
to local decision-makers; b) free regional trainings on
eligible services, the potential for these services to fulfill
AB 1133
Page 9
state and locally-defined educational priorities, available
funding sources, and relevant state and local non-financial
resources; and, c) technical assistance to LEAs. The proposed
program would benefit young children from preschool through
third grade with evidence-based and developmentally
appropriate services and be both cost effective and consistent
with the principles of local control.
Supporters of the bill including the Steinberg Institute and
Autism Deserves Equal Coverage, write in support, state that
it would create a prevention and early intervention pilot
program to help students from preschool to third grade through
the delivery of EMHI services, which have a long track record
of success in California.
4)RELATED LEGISLATION. AB 1025 (Thurmond) requires CDE to
establish a three-year pilot program to encourage inclusive
practices that integrate mental health, special education, and
school climate interventions following a multitiered
framework. AB 1025 is pending in the Assembly Education
Committee.
REGISTERED SUPPORT / OPPOSITION:
Support
Children Now (sponsor)
Time for Kids, Inc. (sponsor)
AB 1133
Page 10
Abriendo Puertas/Opening Doors
Autism Deserves Equal Coverage
Benicia Unified School District
Brighter Beginnings
California Alliance of Child and Family Services
California Association of School Psychologists
California Coverage and Health Initiatives
California Black Health Network
California Medical Association
Center Joint Unified School District
Chico Unified School District
Children's Defense Fund, California
Committee for Children
Compton Unified School District
Discovery Counseling Center
AB 1133
Page 11
Early Edge California
Epilepsy California
Evergreen Elementary School
Family Voices of California
Half Moon Bay Brewing
Julian Pathways Center for Family, Schools, and Community
Partnerships
Lucile Packard Children's Hospital Stanford
Magnolia School District
Rowland Unified School District Family Resource Center
Sanger Unified School District
San Leandro Unified School District
Steinberg Institute
United Ways of California
Several individuals
AB 1133
Page 12
Opposition
California Right to Life Committee, Inc..
Analysis Prepared by:Paula Villescaz / HEALTH / (916) 319-2097