BILL ANALYSIS Ó SENATE COMMITTEE ON HUMAN SERVICES Senator McGuire, Chair 2015 - 2016 Regular Bill No: AB 2568 ----------------------------------------------------------------- |Author: |Atkins | ----------------------------------------------------------------- |----------+-----------------------+-----------+-----------------| |Version: |June 13, 2016 |Hearing |June 28, 2016 | | | |Date: | | |----------+-----------------------+-----------+-----------------| |Urgency: |No |Fiscal: |No | ---------------------------------------------------------------- ----------------------------------------------------------------- |Consultant|Mareva Brown | |: | | ----------------------------------------------------------------- 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)) AB 2568 (Atkins) Page 2 of ? 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) AB 2568 (Atkins) Page 3 of ? 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 of ? 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. AB 2568 (Atkins) Page 5 of ? 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 AB 2568 (Atkins) Page 6 of ? 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 | AB 2568 (Atkins) Page 7 of ? | 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 AB 2568 (Atkins) Page 8 of ? 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. AB 2568 (Atkins) Page 9 of ? 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. AB 2568 (Atkins) Page 10 of ? (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 AB 2568 (Atkins) Page 11 of ? 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 ----------------------------------------------------------------- |Assembly Floor: |79 - | | |0 | |-----------------------------------------------------------+-----| |Assembly Appropriations Committee: | | |-----------------------------------------------------------+-----| |Assembly Human Services Committee: |6 - | | |0 | | | | ----------------------------------------------------------------- POSITIONS Support: County of San Diego (Sponsor) Urban Counties of California California State Association of Counties Oppose: None. -- END -- AB 2568 (Atkins) Page 12 of ?