BILL ANALYSIS Ó
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: AB 2279
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|AUTHOR: |Cooley |
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|VERSION: |June 13, 2016 |
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|HEARING DATE: |June 22, 2016 | | |
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|CONSULTANT: |Reyes Diaz |
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SUBJECT : Mental Health Services Act: county-by-county spending
reports
SUMMARY : Requires the Department of Health Care Services, in
consultation with specified entities, to collect and publicly
report specified information related to Mental Health Services
Act revenue and expenditures, based on the current annual
reporting requirement.
Existing law:
1)Establishes the Mental Health Services Act (MHSA), enacted by
voters in 2004 as Proposition 63, which provides funds to
counties to expand services and develop innovative programs
and integrated service plans for mentally ill children,
adults, and seniors through a one percent income tax on
personal income above $1 million to be deposited to the Mental
Health Services Fund (MHSF), administered by the Department of
Health Care Services (DHCS).
2)Establishes the Mental Health Services Oversight and
Accountability Commission (OAC) to oversee the implementation
of the MHSA.
3)Requires each county mental health program to prepare and
submit a three-year program and expenditure plan, with annual
updates, adopted by the county board of supervisors, to the
OAC within 30 days after adoption. Requires the plan to
include, among other things, programs for services to adults
and seniors.
4)Requires DHCS, in consultation with the OAC and the County
Behavioral Health Directors Association of California, to
develop and administer instructions for the Annual MHSA
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Revenue and Expenditure Report, including identifying the
expenditure of funds, quantifying the amount of additional
funds generated for the mental health system, identifying
unexpended funds and interest earned on funds, and determining
reversion amounts from prior fiscal year distributions.
This bill:
1)Requires DHCS, based on the Annual MHSA Revenue and
Expenditures Report, to collect and publicly report, no later
than nine months after the end of each fiscal year, the
following information, by statewide total and by individual
county:
a) Total revenue received from the MHSA;
b) The amount of MHSA funds received by counties
for each of the following components:
i) Community services and supports;
ii) Prevention and early intervention;
iii) Innovation;
iv) Housing that is not funded under i)
above;
v) Workforce education and training
not funded under i) above;
vi) Capital facilities and
technological needs not funded under i) above;
and,
vii) Other mental health services not
reflected in i) through vi) above;
c) MHSA revenues expended in the prior fiscal
year;
d) The amount of MHSA funds expended by counties
for each of the components in b) above;
e) Funds held in prudent reserve by each county;
f) Distribution from the counties' prudent
reserves;
g) For the most recent fiscal year, the amount of
MHSA funds for each component listed in b) above; and,
h) MHSA funds subject to reversion and funds that
have reverted.
2)Requires the information specified in 1) above to be reported
for each fiscal year and to include statewide totals. Requires
the information to be updated annually, including necessary
revisions. Requires annual reports to include fiscal
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information for a period of not less than 10 fiscal years, as
specified.
3)Requires DHCS also to report publicly annual county program
expenditures for program administration, research and
evaluation, and funds used to support joint powers authorities
and other statewide entities. Requires a county to provide an
explanation if it cannot supply some or all of this
information, and to provide a timeframe for making the
information available. Requires DHCS to work with counties and
other specified entities to determine how best to make this
information available.
4)Allows counties to submit to DHCS information about programs
that address areas that include, but are not limited to,
homelessness, criminal justice diversion, suicide prevention,
school-based mental health programs, programs to reduce
unemployment, stigma reduction, and programs targeted to meet
the needs of populations, including veterans; Lesbian, Gay,
Bisexual, Transgender, Queer, and Questioning; children and
transition-age youth; and adults and older adults.
5)Requires DHCS to compile the information required in 1)
through 4) above to promote public understanding of MHSA funds
that are distributed to each county, as well as how the funds
are spent and what funds remain available for expenditure.
Requires DHCS to consult with the OAC, the State Controller's
Office, the Department of Finance, counties, other local
mental health agencies, and any other agency required to
implement the provisions in this bill.
6)Requires DHCS to consolidate reporting requirements when
feasible and to propose to the appropriate policy committees
of the Legislature strategies to refine and consolidate
reporting requirements.
7)Requires DHCS to make the information available to the
Legislature and the public on its Internet Web site no later
than July 1, 2018, and annually thereafter.
FISCAL
EFFECT : According to the Assembly Appropriations Committee,
costs to DHCS are expected to be minor and absorbable.
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PRIOR
VOTES :
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|Assembly Floor: |80 - 0 |
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|Assembly Appropriations Committee: |20 - 0 |
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|Assembly Health Committee: |18 - 0 |
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COMMENTS :
1)Author's statement. According to the author, the Centers for
Disease Control and Prevention and the National Institute of
Mental Health report that 4.2% of Americans ages 18 and older
suffer from serious mental illness and 26.2% suffer from a
diagnosable mental disorder. In 2004, the California voters
passed the MHSA, which aimed to address serious mental
illness, create prevention and intervention programs, and spur
innovation to identify best practices to treat and prevent
mental illness. The MHSA created a revenue source to fund
programs and determined that local and state oversight was
necessary to ensure accountability to the public. Currently,
there is no single repository with county-by-county and
state-wide information about how MHSA funds are spent. The
lack of information made available to the public makes it
difficult for consumers to compare services to identify
programs that best address their needs, for county programs to
identify best practices, and to ensure effective oversight and
accountability to the public. AB 2279 requires that the total
amount of revenue generated by the MHSA, a county-by-county
comparison of fund expenditure plans, and comparison of how
MHSA funds were spent be made available in one place in an
easy to understand format. Easy access to this information can
facilitate enhanced research and modeling, promote best
practices, enhance transparency, and allow consumers to more
easily identify programs that best address their needs.
2)MHSA. The MHSA provides funding for programs within five
components:
a) Community Services and Supports (CSS): provides
direct mental health services to the severely and
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seriously mentally ill, such as mental health treatment,
cost of health care treatment, and housing supports. CSS
requires counties to direct the majority of its funds to
full-service partnerships, which are county-coordinated
plans, in collaboration with the client and the family to
provide the full spectrum of community services and
utilize a "whatever it takes" approach to providing
services. Such services include peer support and crisis
intervention services, and non-mental health services and
supports, such as food, clothing, housing, and the cost
of medical treatment;
b) Prevention and Early Intervention (PEI): provides
services to mental health clients in order to help
prevent mental illness from becoming severe and
disabling, emphasizing improving timely access to
services for underserved populations. PEI programs are
also required to emphasize strategies to reduce negative
outcomes resulting from untreated mental illness,
including suicide, school failure or dropout,
incarcerations, and unemployment;
c) 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. Innovation is funded by 5% from CSS and 5%
from PEI funds;
d) 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,
e) 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.
The 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 OAC. Some counties make annual reports
available to the public on their own Web sites while others do
not. In their three-year plans, counties are required to
include a list of all programs for which MHSA funding is being
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requested and identify how the funds will be spent and what
populations will be served. Counties must submit their plans
for approval to the OAC before the counties may spend certain
categories of funding.
3)Related legislation. SB 1273 (Moorlach), would clarify that
counties may use MHSF moneys for services when co-located with
involuntary services. SB 1273 is set to be heard in the
Assembly Health Committee on June 28, 2016.
AB 2017 (McCarty), would establish the College Mental Health
Services Program Act, as specified, until January 1, 2022,
with dedicated funding from the MHSF. Requires DHCS to create
a grant program for specified colleges to provide required
improved access to mental health services, as specified. AB
2017 is set to be heard in this committee on June 22, 2016.
AB 847 (Mullin, Chapter 6, Statutes of 2016), requires DHCS to
develop a proposal for the United States Secretary of Health
and Human Services to be selected as a participating state in
the time-limited demonstration program for mental health
services to be provided by certified community behavioral
health clinics to Medi-Cal beneficiaries. Appropriates $1
million from the MHSA for DHCS to develop the proposal.
4)Prior legislation. SB 585 (Steinberg, Chapter 288, Statutes of
2013), allows counties, when included in their plans, to use
MHSF moneys for Assisted Outpatient Treatment, known as
"Laura's Law," if a county elects to participate in and
implement Laura's Law.
5)Support. Supporters of this bill argue that, while the MHSA
has helped to fund a mental health system that has been sorely
underfunded for many years, there has been a lack of
transparency in county MHSA spending reports, which are not
consistently made available to the public either by the
counties themselves or DHCS. Supporters also state that there
is no single repository for MHSA revenue and expenditure
reporting, leaving the general public and mental health care
advocates unable to access this information. Supporters argue
that this bill will enhance transparency about MHSA funds and
promote better outcomes, facilitate program improvement, and
enhance accountability to the public.
SUPPORT AND OPPOSITION :
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Support: California Chapter of the American College of
Emergency Physicians
California Council of Community Behavioral Health
Agencies
California Hospital Association
California Youth Empowerment Network
Little Hoover Commission
Mental Health America of California
National Association of Social Workers, California
Chapter
The Steinberg Institute
United Advocates for Children and Families
Oppose: None received
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