BILL ANALYSIS Ó AB 2568 Page 1 Date of Hearing: April 26, 2016 ASSEMBLY COMMITTEE ON HUMAN SERVICES Susan Bonilla, Chair AB 2568 (Atkins) - As Introduced February 19, 2016 SUBJECT: Integrated health and human services program SUMMARY: Authorizes the County of San Diego to, upon approval of the county board of supervisors, operate an integrated and comprehensive health and human services system. EXISTING LAW: 1)Permits Humboldt County, Mendocino County, Alameda County, and any additional county or counties, as determined by the Secretary of the California Health and Human Services Agency, as specified, to implement a program, upon approval of the county board of supervisors, for the funding and delivery of services and benefits through an integrated and comprehensive county health and human services system. (WIC 18986.86) 2)Places a number of requirements on participating counties regarding their county integrated health and human services programs, including, but not limited to: a) Observing disclosure and privacy requirements related to AB 2568 Page 2 medical information, as specified; b) Including programs or services only to the extent that federal funding will not be reduced, and/or General Fund expenditures will not be increased, as a result; c) Seeking federal approval of the program as may be needed to ensure funding and allow for the integrated provision of services, as specified; and d) Utilizing any and all state general and county funds that the county is legally allocated or entitled to receive and further, maximizing federal matching funds. FISCAL EFFECT: Unknown. COMMENTS: County integrated health and human services programs: In 1996 and 1997, respectively, California authorized Placer and Solano Counties to operate integrated health and human services pilot projects via AB 1846 (Leslie), Chapter 899, Statutes of 1996, and AB 866 (Thomson), Chapter 265, Statutes of 1997. A similar program was adopted for Humboldt, Mendocino, and Alameda counties in 1999 by AB 1259 (Strom-Martin), Chapter 705, Statutes of 1999. Subsequent legislation extended the sunset date (AB 1881 (Berg), Chapter 655, Statutes of 2004) and later made the programs permanent by repealing the sunset (AB 315 (Berg), Chapter 264, Statutes of 2007). AB 1881 also allowed additional counties to be included if approved by the Secretary of the Health and Human Services Agency. AB 2568 Page 3 County integrated health and human services programs cover a wide range of health and human services, including adoption, child welfare, foster care, drug and alcohol, mental health, eligibility determination, public health, housing and medically indigent health care. These programs employ a variety of assessment and service-delivery methods, including universal intake, coordinated service plans, and integrated case management and reporting. These programs enable information to be shared between programs; however, limitations are placed on the disclosure of medical information without authorization of the client, and memoranda of understanding must be developed between affected agencies. Regarding AB 315 (Berg), Assembly Member Berg stated that, "by consolidating such services, counties are able to demonstrate cost savings and increase efficiency while providing quality services?. In an era where health and human services are targeted to be cut, innovation and cost savings are key to maintaining an adequate level of service to those in need." San Diego County health and human services: According to the author's office, the County of San Diego Health and Human Services Agency has utilized an integrated agency approach to offering Behavioral Services and Protective Services since 1996, when the San Diego County Board of Supervisors approved the merging of five local organizations into a single super-agency composed of the former Department of Health Services, Department of Social Services, Department of Veteran Services, Area Agency on Aging, and the Commission on Children Youth and Family. According to the author, this Agency has authority over a broad array of services including those dealing with aging and independence services, behavioral health, child welfare, public health, and self-sufficiency services, and, "bringing these many services together into one comprehensive system has enabled a more streamlined and effective client-focused delivery of health and social services in San Diego County for almost two decades." AB 2568 Page 4 Need for this bill: This bill seeks to officially designate San Diego County's utilization of an integrated approach to offering Behavioral Services and Protective Services in order to allow for greater flexibility between the two accounts. According to the author, "Existing law authorizes the Counties of Humboldt, Mendocino and Alameda to implement a program for the funding and delivery of services and benefits through an integrated and comprehensive county health and human services system, subject to certain limitations. [This bill] would authorize the County of San Diego, upon approval of the County Board of Supervisors, to operate an integrated and comprehensive health and human services system." Staff comments: As currently written, this bill differs from other statutorily authorized integration efforts by not including details such as requiring county compliance with disclosure and privacy requirements related to medical information, placing a prohibition on the inclusion of programs that will reduce federal funding or increase General Fund expenditures, and requiring counties to seek federal approval of the program, as specified. Part of this difference arguably results from the fact that the agency in San Diego County already employs an integrated model, whereas previous efforts were constructed after enactment. However, should this bill move forward, the author may wish to consider including San Diego County in already-existing provisions of law regarding other counties' integrated health and human services programs, thereby reducing confusion and, more importantly, avoiding disparate treatment of various county programs by ensuring that all programs are held to the same standards and requirements. AB 2568 Page 5 PRIOR LEGISLATION: AB 315 (Berg), Chapter 264, Statutes of 2007, eliminated the January 1, 2009, repeal date for the Humboldt, Mendocino, and Alameda County integrated health and human services programs. AB 1881 (Berg), Chapter 655, Statutes of 2004, extended the sunset for the Humboldt, Mendocino, and Alameda County integrated health and human services programs to January 1, 2009, and authorized additional counties to participate in the program if approved by the Secretary of the Health and Human Services Agency. AB 1259 (Strom-Martin), Chapter 705, Statutes of 1999, established the Humboldt, Mendocino, and Alameda County integrated health and human services programs, with a sunset date of January 1, 2005. AB 866 (Thomson), Chapter 265, Statutes of 1997, required Solano County to implement an integrated health and human services pilot program, with a sunset date of July 1, 2002. AB 1846 (Leslie), Chapter 899, Statutes of 1996, required Placer County to implement an integrated health and human services pilot program, with a sunset date of July 1, 2001. REGISTERED SUPPORT / OPPOSITION: Support AB 2568 Page 6 County of San Diego - sponsor Opposition None on file. Analysis Prepared by:Daphne Hunt / HUM. S. / (916) 319-2089