BILL ANALYSIS Ó
AB 2279
Page 1
Date of Hearing: March 29, 2016
ASSEMBLY COMMITTEE ON HEALTH
Jim Wood, Chair
AB 2279
(Cooley) - As Introduced February 18, 2016
SUBJECT: Mental Health Services Act: county-by-county
spending reports.
SUMMARY: Requires the Department of Health Care Services
(DHCS) to annually compile county revenue and expenditure
information related to the Mental Health Services Act
(MHSA) based on the existing Annual Mental Health Services
Act Revenue and Expenditure Report (MHSA Report).
Specifically, this bill:
1)Requires DHCS to compile information on the following:
a) The total amount of revenue generated by the MHSA;
b) A county-by-county comparison of fund expenditure
plans and updates; and,
c) A county-by-county comparison of the purposes for
which MHSA funds were expended.
AB 2279
Page 2
2)Requires the information compiled in 1) above to be made
available by DHCS to the Mental Health Services Oversight
and Accountability Commission (Commission), and requires
the Commission to make the information publicly available
online.
EXISTING LAW:
1)Establishes the MHSA, enacted by voters in 2004 as
Proposition 63, to provide funds to counties to expand
services, develop innovative programs, and integrated
service plans for mentally ill children, adults, and
seniors through a 1% income tax on personal income above
$1 million.
2)Establishes the Commission to oversee the implementation
of MHSA, made up of 16 individuals appointed by the
Governor unless otherwise specified:
a) The Attorney General or his or her designee;
b) The Superintendent of Public Instruction or his or
her designee;
c) A member of the Senate selected by the President
pro Tempore of the Senate;
d) A member of the Assembly selected by the Speaker of
the Assembly;
e) Two persons with a severe mental illness;
f) A family member of an adult or senior with a severe
AB 2279
Page 3
mental illness;
g) A family member of a child who has or has had a
severe mental illness;
h) A physician specializing in alcohol and drug
treatment;
i) A mental health professional;
j) A county sheriff;
aa) A superintendent of a school district;
bb) A representative of a labor organization;
cc) A representative of an employer with less than 500
employees;
dd) A representative of an employer with more than 500
employees; and,
ee) A representative of a health care services plan or
insurer.
3)Specifies that the MHSA can only be amended by a
two-thirds vote of both houses of the Legislature and
only as long as the amendment is consistent with and
furthers the intent of the MHSA. Permits provisions
clarifying the procedures and terms of the MHSA to be
added by majority vote.
4)Requires DHCS, in consultation with the Commission and
the County Behavioral Health Directors Association of
California, to develop an administer instructions for the
MHSA Report.
AB 2279
Page 4
5)Requires the MHSA Report to be submitted electronically
to DHCS and the Commission.
6)Establishes the purpose of the MHSA Report as follows:
a) Identify the expenditures of MHSA funds that were
distributed to each county;
b) Quantify the amount of additional funds generated
for the mental health system as a result of the MHSA;
c) Identify unexpended funds, and interest earned on
MHSA funds; and,
d) Determine what unspent MHSA funds, if any, are
available prior fiscal year distributions.
7)Establishes that the MHSA Report is intended to provide
information for the evaluation of the following:
a) Children's systems of care;
b) Prevention and early intervention strategies;
c) Innovative projects;
AB 2279
Page 5
d) Adults and older adults systems of care; and,
e) Capital facilities and technology needs.
FISCAL EFFECT: This bill has not yet been analyzed by a
fiscal committee.
COMMENTS:
1)PURPOSE OF THIS BILL. According to the author, counties
are required to report information to DHCS annually about
local programs, expenditure plans and how MHSA funds were
spent. While some counties make annual reports available
to the public on their own Websites, currently there is
no complete state-wide financial picture of how much MHSA
revenue is generated annually. The author argues that
the absence of a single repository for this information
makes it difficult for taxpayers, mental health
advocates, and consumers to see which mental health
programs are available and how MHSA funds are spent
county-by-county and state-wide. This information would
make it easier for providers to identify best practices
and for consumers to compare services to identify
programs that best address their needs.
2)BACKGROUND.
a) Proposition 63. Proposition 63 was passed by
voters in November 2004. The MHSA imposes a 1% income
tax on personal income in excess of $1 million and
AB 2279
Page 6
creates the 16 member Commission charged with
overseeing the implementation of MHSA. The 2015-16
Governor's Budget projected that $1.776 billion would
be deposited into the MHSF in fiscal year (FY)
2015-16. The MHSA addresses a broad continuum of
prevention, early intervention and service needs as
well as provided funding for infrastructure,
technology and training needs for the community mental
health system. In addition to local programs, the
MHSA authorizes up to 5% of revenues for state
administration. These include administrative
functions performed by a variety of state
entities such as the DHCS and Office of
Statewide Health Planning and Development (OSHPD). It
also funds evaluation of the MHSA by the Commission,
which was established by the MHSA.
i) Commission. MHSA requires each county mental
health department to prepare and submit a three-year
plan to DHCS that must be updated each year and
approved by DHCS after review and comment by the
Commission. In their three-year plans, counties are
required to include a list of all programs for which
MHSA funding is being requested and that identifies
how the funds will be spent and which populations
will be served. Counties must submit their plans
for approval to the Commission before the counties
may spend certain categories of funding.
ii) Funding. The MHSA provides funding for
programs within five components:
(1) Community Services and Supports:
Provides direct mental health services to the
severely and seriously mentally ill, such as
AB 2279
Page 7
mental health treatment, cost of health care
treatment, and housing supports. Regulation
requires counties to direct the majority of its
Community Services and Supports funds to
FullService Partnerships (FSPs). FSPs are county
coordinated plans, in collaboration with the
client and the family to provide the full
spectrum of community services. These services
consist of mental health services and supports,
such as peer support and c(2)risis intervention
services; and nonmental health services and
supports, such as food, clothing, housing, and
the cost of medical treatment;
(3) Prevention and Early Intervention:
Provides services to mental health clients in
order to help prevent mental illness from
becoming severe and disabling;
(4) Innovation: Provides services and
approaches that are creative in an effort to
address mental health clients' persistent issues,
such as improving services for underserved or
unserved populations within the community;
(5) Capital Facilities and Technological
Needs: Creates additional county infrastructure
such as additional clinics and facilities and/or
development of a technological infrastructure for
the mental health system, such as electronic
health records for mental health services; and,
AB 2279
Page 8
(6) Workforce Education and Training:
Provides training for existing county mental
health employees, outreach and recruitment to
increase employment in the mental health system,
and financial incentives to recruit or retain
employees within the public mental health system.
iii) MHSA Report. The most recently available MHSA
Report discusses expenditures for FY 2015-2016 and
is available on the DHCS website, but not on the
Commission Website. The MHSA Report includes an
explanation of estimated revenues, general MHSA Fund
expenditures to counties in the aggregate and to
OSHPD, and a detailed summary of how the funds set
aside for program administration were allocated to
14 different state agencies and departments.
b) 2016 "No Place Like Home" Initiative. On January
4, 2016 the California State Senate announced a
proposed legislative package intended to re-purposes
$2 billion of Proposition 63 bond funds and leverage
additional dollars from other local, state, and
federal funding for purposes of providing housing for
chronically homeless persons with mental illness. The
initiative includes proposals to construct permanent
supportive housing for chronically homeless persons
with mental illness, provide $200 million over four
years in shorter-term, rent subsidies while the
permanent housing is constructed or rehabilitated and
support for special housing programs that will assist
AB 2279
Page 9
families that are part of the child welfare system or
are enrolled in California Work Opportunity and
Responsibility to Kids Housing Support Program.
3)SUPPORT. The National Association of Social Workers -
California Chapter, supports this legislation because it
will increase transparency regarding how MHSA funds are
spent. California Chapter of the American College of
Emergency Physicians states that without adequate
analysis of the effectiveness of MHSA programs, there is
no guarantee that people with mental illness are
receiving adequate treatment. County-by-county
comparisons of MHSA program would be an important step
toward determining the most effective programs and
increasing access to mental health services. The
Steinberg Institute states, in support, that the current
lack of timely and accessible reporting does not align
with the principles set forth in Prop 63.
4)RELATED LEGISLATION.
a) AB 2017 (McCarty) would establish the College
Mental Health Services Trust Account and would
appropriate funds from the Mental Health Services Fund
(MHSF) to create a grant program for public community
colleges, colleges, and universities to improve access
to mental health services on campus. AB 2017 is
pending in the Assembly Health Committee.
b) AB 847 (Mullin) would require DHCS to develop a
proposal to participate in demonstration programs
administered by the federal Secretary of Health and
AB 2279
Page 10
Human Services (HHS Secretary) to improve mental
health services furnished by certified community
behavioral health clinics to Medi-Cal beneficiaries
and would appropriate $1 million from the MHSF for the
purpose of developing a competitive proposal. AB 847
is pending action on the Governor's desk.
c) SB 1273 (Moorlach) would clarify that the counties
may use MHSF moneys to provide crisis stabilization
services, including temporary commitment. SB 1273 is
pending in the Senate Health Committee.
d) AB 253 (Roger Hernández) would require state
agencies to give a preference to applicants for
funding under the Veterans Housing and Homeless
Prevention Act of 2014 that demonstrate a multiyear
commitment of MHSA funding for the applicant's project
funding plan and would requires the Governor to
appoint two additional members to the Commission with
mental health experience. AB 253 is pending in the
Senate Transportation and Housing Committee.
5)PREVIOUS LEGISLATION.
a) AB 745 (Chau) of 2015 would have required the
Governor to appoint an additional member to the
Commission who has experience providing supportive
housing to persons with a severe mental illness. AB
745 was vetoed, by the Governor stating:
AB 2279
Page 11
"I am returning Assembly Bill 745 without my
signature. This bill would add an additional
member to the Mental Health Services Oversight
and Accountability Commission with experience in
supportive housing. While supportive housing can
help improve the lives of those with serious
mental illness, I believe that the current
commission -- with sixteen members -- is adequate
to the task."
REGISTERED SUPPORT / OPPOSITION:
Support
California Chapter, American College of Emergency
Physicians
California Council of Community Mental health Agencies
California Council of Community Mental Health Agencies
Little Hoover Commission
Mental Health America of California
AB 2279
Page 12
National Association of Social Workers, California Chapter
Steinberg Institute
United Advocates for Children and Families of California
Opposition
None on file.
Analysis Prepared by:Paula Villescaz / HEALTH / (916)
319-2097