BILL ANALYSIS Ó
SENATE COMMITTEE ON HUMAN SERVICES
Senator McGuire, Chair
2015 - 2016 Regular
Bill No: AB 2568
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|Author: |Atkins |
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|Version: |June 13, 2016 |Hearing |June 28, 2016 |
| | |Date: | |
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|Urgency: |No |Fiscal: |No |
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|Consultant|Mareva Brown |
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Subject: Integrated health and human services program
SUMMARY
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.
ABSTRACT
Existing law:
1) Authorizes the counties of Humboldt, Mendocino and
Alameda, and any additional county or counties, as
determined by the Secretary of California Health and Human
Services, 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, as
specified. (WIC 18986.86)
2) Permits the integrated program to implement and evaluate
a system of universal intake for those seeking services;
provide multiple services for families through an
integrated, coordinated service plan, as appropriate;
implement a coordinated management system to support
clients; and implement and evaluate a system of
accountability, among other items. (WIC 18986.86 (b))
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3) Prohibits creation of an integrated county health and
human services system if it will result in a loss of
federal funding to either the state or the county and
prohibits the programs from generating any increased
General Fund expenditures. (WIC 18986.86 (e))
4) Requires a participating county, in consultation with
the appropriate state departments, as designated by the
Secretary of Health and Human Services, to develop outcomes
and performance measures specific to the project prior to
the implementation of the pilot program. Implementation of
a pilot program pursuant to this chapter shall occur no
later than January 1, 2009. (WIC 18986.87(a))
5) Requires a participating county to evaluate its program
with the participation of the appropriate state
departments, as designated by the Secretary of Health and
Human Services, and prepare interim and final evaluations
and submit them to the Governor or the Governor's designee
and the appropriate policy committees of the Legislature.
The interim report shall be submitted not later than six
months following the third year of the implementation of
the program. The final report shall be submitted not later
than July 1, 2008. Requires each participating county to
provide for the evaluation of the program. (WIC
18986.87(b))(WIC 18986.87 (c))
6) Permits the county of San Mateo to apply for a waiver of
state regulations pertaining to single agency operations
and auditing requirements that hinder the coordination of
human services, and specifies issues the county must
address in the application. (WIC 18989)
7) Permits Placer County, with the assistance of the
appropriate state departments, to implement a program to
deliver integrated and comprehensive county health and
human services, and requires the county evaluate specific
innovations, including universal intake and a coordinated
plan with one caseworker for multiple family services.
Additionally, specifies the types of services that may be
integrated and requires that the integration not result in
a loss of federal funding. (WIC 18986.6)
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8) Establishes, under provisions implementing the 2011
Realignment, the Support Services Account. Establishes,
within the Support Services Account, the Protective
Services Subaccount, the Behavioral Health Subaccount, and
the County Intervention Support Services Subaccount, among
others. (GOV 30025)
9) Permits, under implementation of the 2011 Realignment,
each county to reallocate money between subaccounts in the
Support Services Account, provided that the reallocation
may not exceed 10 percent of the amount deposited in the
immediately preceding fiscal year in the subaccount in the
Support Services Account with the lowest balance. Requires
the reallocation is considered at a publicly noticed
meeting and is based on the most cost-effective use of
available resources to maximize client outcomes. (WIC 30025
(f)(4)(A))
10) Exempts a county authorized to operate an integrated and
comprehensive county health and human services system, as
defined, from the 10 percent limit on reallocation of money
between the Protective Services Subaccount and the
Behavioral Health Subaccount, as specified. (WIC 30025
(f)(4)(B))
This bill:
1) Authorizes the County of San Diego, upon approval of the
county board of supervisors, to operate an integrated and
comprehensive health and human services system,
notwithstanding a statutorily required pilot implementation
date of 2009, and a report to the Legislature due in 2008.
FISCAL IMPACT
This bill has been keyed non fiscal by Legislative Counsel.
BACKGROUND AND DISCUSSION
Purpose of the bill:
According to the author, the county of San Diego has had an
integrated and comprehensive health and human services system
since 1996, when the county Board of Supervisors approved
AB 2568 (Atkins) Page 4
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merging "five local organizations into a single super-agency."
Those agencies include the former departments of Health
Services, Social Services, Veterans Services, Area Agency on
Aging and the commission on Children Youth and Family. Two years
after its merger, the Public Administrator and Public Guardian
was integrated into the Health and Human Services Agency.
The author states that while the Health and Human Services
Agency has the ability to create a streamlined and effective
client-focused delivery of health and social services in San
Diego County, it is does not share the authorization of a
handful of counties that have been statutorily designated to
implement an integrated and comprehensive health and human
services system, subject to certain limitations.
The author states that "AB 2568 would add the County of San
Diego, upon approval of the board of supervisors, as one of
several counties authorized to operate an integrated and
comprehensive health and human services system."
Integrated Health and Human Services Agencies
Five California counties currently have specific authorization
in statute to create integrated health and human services
agencies.
Humboldt, Mendocino and Alameda authorizations
Welfare and Institutions Code 18986.86 authorizes Humboldt,
Mendocino, and Alameda counties - and any additional county or
counties, as determined by the Secretary of California Health
and Human Services, with the assistance and participation of the
appropriate state departments - 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.
It permits these counties to implement and evaluate specific
innovative components within its agency, including universal
intake, an integrated and coordinate service plan that includes
services across various agencies, coordination of client
management, and integration of various services in a way that
does not cause a loss of state or federal funding, and other
elements.
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Additionally it authorizes the county, in consultation with the
appropriate state departments, as designated by the Secretary of
Health and Human Services, to develop specific goals to achieve
an integrated and comprehensive county health and human services
system. The statute additionally requires information sharing
agreements to protect client privacy, and prohibits a county
with an integrated agency from discontinuing services or
reducing client eligibility. It requires the Secretary of the
state Health and Human Services agency to designate a lead
department to coordinate the state's participation in the
county's program.
San Mateo County
WIC 18989 permits San Mateo County to apply for a state waiver
of regulations that pertain to single agency operations, and to
auditing and accounting requirements that hinder the
coordination of services under an integrated health and human
services agency. The statute specifies that a waiver of
confidentiality requirements pertains only to case management
tasks, and prohibits the waiver from modifying regulations
governing the qualifications of professionals employed in human
services programs.
Additionally, the statute requires the waiver be submitted to
the state Health and Human Services Agency and to identify why
the regulations that are being requested to be waived hinder the
integration of services and how many people would be served
with, and without, the waiver, among other required elements.
Placer County
WIC 18986.6 requires Placer County to implement a program, with
the assistance of appropriate state departments and upon
approval of the county, for the funding and delivery of services
through an integrated health and human services system.
It requires the county to implement and evaluate a universal
intake system, an integrated and coordinated service plan
whereby a single county employee may provide multiple services,
a centralized management and client support system, and other
innovations. The statute also requires Placer County and the
state to jointly seek federal approval of the program, as needed
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to ensure funding, and mandates that programs or services be
included in the program only to the extent that federal funding
to the state or county is not reduced.
2011 Realignment
Legislation that enacted 2011 Realignment shifts more than $6
billion in state revenues and funding responsibilities to local
governments. Revenue from realignment comes from state sales tax
and state and local vehicle license fee.
Realignment establishes various accounts and subaccounts,
including the Support Services Account, which includes the
County Intervention Support Services Subaccount, the Protective
Services Subaccount and the Behavioral Health Subaccount.
Under existing law, counties can annually reallocate money
between subaccounts in the Support Services Account, but the
reallocation cannot exceed 10 percent of the amount deposited in
the immediately preceding fiscal year in the subaccount with the
lowest balance.
SB 1020 (Committee on Budget and Fiscal Review, Chapter 40,
Statutes of 2012), furthered the implementation of the 2011
Realignment. One provision of SB 1020 allowed any county
authorized to operate an integrated and comprehensive county
health and human services system to reallocate money between the
Protective Services Subaccount and the Behavioral Health
Subaccount without being subject to the 10 percent limit in
existing law.
In 2014-15, San Diego County received more than $190 million in
revenue in these two accounts. The chart on the next page
delineates the subaccounts within the Support Services Account.
--------------------------------------------------
| Protective Services | Behavioral Health |
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| Subaccount | Subaccount |
|------------------------+-------------------------|
| Adult protective | Residential perinatal |
| services | drug services and |
| | treatment |
|------------------------+-------------------------|
| Foster care grants and | Drug court operations |
| services | and services |
|------------------------+-------------------------|
|Administrative costs of | Nondrug Medi-Cal |
| foster care services | substance abuse |
| | treatment programs |
|------------------------+-------------------------|
| Child welfare services | Drug Medi-Cal program |
|------------------------+-------------------------|
| Adoptive services | Medi-Cal specialty |
| | mental health services, |
| | including the Early and |
| | Periodic Screening, |
| |Diagnosis, and Treatment |
| | Program and mental |
| | health managed care |
|------------------------+-------------------------|
|Child abuse prevention, | Women and Children's |
| intervention and | Residential Treatment |
| treatment | Services program* |
|------------------------+-------------------------|
|Administrative costs of | |
| family adopting | |
| children with special | |
| needs | |
--------------------------------------------------
* From funds in the Women and
Children's Residential
Treatment Services Special
Account, which is a
subaccount of the Behavioral
Health Account.
Related legislation:
SB 1020 (Budget and Fiscal Review, Chapter 40, Statutes of 2012)
created a permanent fund structure for 2011 Realignment, and
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merged specified subaccounts into the Protective Services
Subaccount within the Supportive Services Account.
AB 315 (Berg, Chapter 264, Statutes of 2007) eliminated the
county integrated health and human services program sunset date
of January 1, 2009.
AB 1881 (Berg, Chapter 655, Statutes of 2004), extended the
county integrated health and human services program sunset to
January 1, 2009, and authorized additional counties to
participate in the program if approved by the Secretary of
Health and Human Services Agency.
AB 1259 (Strom-Martin, Chapter 705, Statutes of 1999)
established the county integrated health and human services
program for Humboldt, Mendocino and Alameda Counties, with a
sunset date of January 1, 2005.
AB 866 (Thomson, Chapter 265, Statutes of 1997) required Solano
County to implement a pilot program similar to the county
integrated health and human services program, with a sunset date
for the pilot program of July 1, 2002.
AB 1846 (Leslie, Chapter 899, Statutes of 1996) required Placer
County to implement a pilot program for the funding and delivery
of services and benefits through an integrated and comprehensive
county health and human services system, as specified.
COMMENTS
The author states that this bill will simply add San Diego
County to the other counties authorized to create integrated
health and human services programs. However, the language of
this bill does not require San Diego's program to include the
state oversight or coordination, confidentiality guarantees,
integration of innovative case management practices, prohibition
against reduction in federal funding, or other provisions that
are required for other integrated health and human services
systems in California. In addition to the amendments below, the
California Health and Human Services Agency has indicated it
will be providing the author with technical assistance prior to
a floor vote on this nonfiscal bill that would require
additional reporting of funding transfers and implement other
measures.
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Staff recommends the following amendments:
WIC 18986.89. (a) Notwithstanding the dates provided in
subdivisions (a) and (b) of Section 18986.87, the County of San
Diego may, upon approval of the county board of supervisors,
operate an integrated and comprehensive health and human
services system.
(b) In providing services through an integrated system to
families and individuals, the system may, among other things, do
the following:
(1) Maintain and evaluate a system of administration that
integrates and coordinates the management and support of client
services.
(2) Maintain a system of reporting and accountability that
provides for the combined provision of services without the loss
of state or federal funds provided under current law.
(c) The integrated and comprehensive county health and human
services system may include, but not be limited to, any or all
of the following:
(1) Adoption services.
(2) Child abuse prevention services.
(3) Child welfare services.
(4) Delinquency prevention services.
(5) Drug and alcohol services.
(6) Mental health services.
(7) Eligibility determination.
(8) Employment and training services.
(9) Foster care services.
(10) Health services.
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(11) Public health services.
(12) Housing services.
(13) Medically indigent program services.
(14) Veteran's services
(15) Aging services.
(16) Any other related program as designated by the board of
supervisors.
(d)The county shall comply with all applicable state and federal
privacy laws that govern medical and social service information,
including but not limited to the Confidentiality of Medical
Information Act, the federal Health Insurance portability and
Accountability Act, and Welfare and Institutions Code sections
827, 5328 and 10850.
(e) Programs or services shall be included in the system only to
the extent that federal funding to either the state or the
county will not be reduced as a result of the inclusion of the
services in the project.
(f) This chapter shall not authorize the county to discontinue
meeting its obligations under current law to provide services or
to reduce its accountability for the provision of these
services.
(g) The county shall utilize any and all state general and
county funds that it is legally allocated or entitled to
receive. Through the creation of integrated health and social
services structures, the county shall maximize federal matching
funds. This integration shall not result in increased
expenditures from the General Fund.
(h) The appropriate state departments, as designated by the
Secretary of Health and Human Services, that are assisting,
participating, and cooperating in the program authorized by this
chapter shall have the authority to waive regulations, with the
concurrence of the county, regarding the method of providing
services and the method of reporting and accountability, as may
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be required to meet the goals set forth in subdivision (b).
However, the departments shall not waive regulations pertaining
to privacy and confidentiality of records, civil service merit
systems, or collective bargaining. The departments shall not
waive regulations if the waiver results in a diminished amount
or level of services or benefits to eligible recipients as
compared to the benefits and services that would have been
provided to recipients absent the waiver.
PRIOR VOTES
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|Assembly Floor: |79 - |
| |0 |
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|Assembly Appropriations Committee: | |
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|Assembly Human Services Committee: |6 - |
| |0 |
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POSITIONS
Support:
County of San Diego (Sponsor)
Urban Counties of California
California State Association of Counties
Oppose:
None.
-- END --
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