BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | AB 2279|
|Office of Senate Floor Analyses | |
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THIRD READING
Bill No: AB 2279
Author: Cooley (D)
Amended: 8/15/16 in Senate
Vote: 21
SENATE HEALTH COMMITTEE: 9-0, 6/22/16
AYES: Hernandez, Nguyen, Hall, Mitchell, Monning, Nielsen,
Pan, Roth, Wolk
SENATE APPROPRIATIONS COMMITTEE: 7-0, 8/11/16
AYES: Lara, Bates, Beall, Hill, McGuire, Mendoza, Nielsen
ASSEMBLY FLOOR: 80-0, 5/31/16 - See last page for vote
SUBJECT: Mental Health Services Act: county-by-county
spending reports
SOURCE: Author
DIGEST: This bill 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.
ANALYSIS:
Existing law:
1)Establishes the Mental Health Services Act (MHSA), enacted by
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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
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;
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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, inclusive.
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) Distributions from the counties' prudent reserves;
g) For the most recent fiscal year, the amount of unspent
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, as specified. Requires annual reports to include
fiscal 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, as specified.
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
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that are distributed statewide 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.
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.
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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 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
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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
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.
Related/Prior Legislation
SB 1273 (Moorlach, 2016) clarifies that counties may use MHSF
moneys for services when co-located with involuntary services.
AB 2017 (McCarty, 2016) establishes 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 847 (Mullin, Chapter 6, Statutes of 2016) required 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. Appropriated $1 million from the MHSA
for DHCS to develop the proposal.
SB 585 (Steinberg, Chapter 288, Statutes of 2013), allowed
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.
FISCAL EFFECT: Appropriation: No Fiscal
Com.:YesLocal: No
According to the Senate Appropriations Committee, there are
ongoing costs to DHCS of $240,000 per year to compile
information submitted by counties, create comparisons of
county-by-county expenditures, and develop the required reports
(Mental Health Services Act Fund).
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SUPPORT: (Verified8/12/16)
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
Mental Health Services Oversight and Accountability Commission
National Association of Social Workers, California Chapter
The Steinberg Institute
United Advocates for Children and Families
OPPOSITION: (Verified8/12/16)
None received
ARGUMENTS IN 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.
ASSEMBLY FLOOR: 80-0, 5/31/16
AYES: Achadjian, Alejo, Travis Allen, Arambula, Atkins, Baker,
Bigelow, Bloom, Bonilla, 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, Jones-Sawyer, Kim,
Lackey, Levine, Linder, Lopez, Low, Maienschein, Mathis,
Mayes, McCarty, Medina, Melendez, Mullin, Nazarian, Obernolte,
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O'Donnell, Olsen, Patterson, Quirk, Ridley-Thomas, Rodriguez,
Salas, Santiago, Steinorth, Mark Stone, Thurmond, Ting,
Wagner, Waldron, Weber, Wilk, Williams, Wood, Rendon
Prepared by:Reyes Diaz / HEALTH / (916) 651-4111
8/15/16 19:39:47
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