BILL ANALYSIS                                                                                                                                                                                                    Ó



                                                                    AB 2568


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          CONCURRENCE IN SENATE AMENDMENTS


          AB  
          2568 (Atkins)


          As Amended  August 17, 2016


          Majority vote


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          |ASSEMBLY:  |79-0  |(May 5, 2016)  |SENATE: |39-0  |(August 22,      |
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          Original Committee Reference:  HUM. S.


          SUMMARY:  Authorizes the County of San Diego to, upon approval  
          of the county board of supervisors and California Health and  
          Human Services Agency, operate an integrated and comprehensive  
          health and human services system, and further, specifies the  
          purview and requirements of this system.


          The Senate amendments:


          1)Authorize the integrated and comprehensive health and human  
            services system to, among other things, both maintain and  
            evaluate a system of administration that integrates and  
            coordinates the management and support of client services, and  
            to maintain a system of reporting and accountability that  
            provides for the combined provision of services without the  
            loss of state or federal funds, as specified.









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          2)Delineate a range of health and human services that the system  
            may include but not be limited to.


          3)Require the county to comply with all applicable state and  
            federal privacy laws that govern medical and social service  
            information, as specified.


          4)Permit programs or services to be included in the system only  
            to the extent that federal funding to either the state or  
            county will not be reduced as a result.


          5)Prohibit the provisions of the bill from authorizing the  
            county to:  discontinue meeting its obligations under current  
            law to provide services, or reduce its accountability for the  
            provision of these services.


          6)Require the county to use any and all state general funds and  
            county funds and to maximize federal matching funds, as  
            specified, and further, prohibit the integration from  
            resulting in increased General Fund expenditures.


          7)Authorize the appropriate state departments to waive  
            regulations regarding the provision of services and method of  
            reporting and accountability, with certain exceptions, as  
            specified.


          8)Require that a reallocation made by a county between the  
            Protective Services Subaccount and the Behavioral Health  
            Subaccount, as specified, be in effect for only the fiscal  
            year in which that reallocation is made and prohibit the  
            reallocation from being a permanent allocation or permanent  
            funding source for any program or services receiving funds  
            from the reallocation.










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          9)Require a county, or city and county, that reallocates funds  
            between the Protective Services Subaccount and the Behavioral  
            Health Subaccount, as specified, to make a report to the  
            Department of Finance and the California Health and Human  
            Services Agency describing the reallocation made for that  
            year.


          10)Require a San Diego County integrated and comprehensive  
            health and human services system to be subject to the approval  
            of the California Health and Human Services Agency, as  
            specified.


          11)Make technical changes.


          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  
               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; 









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             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.  (WIC  
               18986.86)


          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. 


          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  








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          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."


          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  








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          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."


          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.


          Analysis Prepared by:                                             
                          Daphne Hunt / HUM. S. / (916) 319-2089  FN:  
          0004570










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