Amended in Assembly July 16, 2015

Amended in Senate April 28, 2015

Amended in Senate April 6, 2015

Senate Bill No. 291

Introduced by Senator Lara

February 23, 2015

An act to amend begin delete Sections 127750 and end delete begin insert Section end insert 131019.5 of the Health and Safety Code, and to amend Section 4060 of the Welfare and Institutions Code, relating to begin delete mental end delete begin insert public end insert health.

LEGISLATIVE COUNSEL’S DIGEST

SB 291, as amended, Lara. begin delete Mental end delete begin insert Public end insert health: vulnerable communities.

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(1) Existing law establishes the Office of Statewide Health Planning and Development and requires the office to prepare a Health Manpower Plan for California to establish standards for, and determine the adequacy of, policies relating to health care practitioners, including physicians, nurses, and dentists, to serve the needs of the state.

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This bill would require the office to include the mental health needs of vulnerable communities, as defined, in the Health Manpower Plan.

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(2)

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begin insert (1) end insert  Existing law establishes the Office of Health Equity within the State Department of Public Health for the purposes of aligning state resources, decisionmaking, and programs to accomplish various goals relating to health, and requires the office to perform various duties specifically relating to vulnerable communities, as defined. begin insert Existing law requires the office to establish a comprehensive, cross-sectoral strategic plan to eliminate health and mental health disparities and inequities and to seek input from the public on the plan through an inclusive public stakeholder process. end insert

This bill would include individuals who have experienced trauma related to genocide in the definition of vulnerable begin delete communities. end delete begin insert communities and would require representatives from vulnerable communities to be represented in the public stakeholder process for developing the office’s plan to eliminate health and mental health disparities. end insert

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(3)

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begin insert (2) end insert  Existing law requires the State Department of Health Care Services to provide, to the extent resources are available, technical assistance, through its own staff, or by contract, to county mental health programs and other local mental health agencies in the areas of program operations, research, evaluation, demonstration, or quality assurance projects. Existing law requires the department, to this end, to utilize a meaningful decisionmaking process that includes, among others, stakeholders as determined by the department.

This bill would require the department to include specified stakeholders from vulnerable communities in this process, including diverse racial, ethnic, cultural, and LGBTQQ communities, communities that experience trauma related to genocide, women’s health advocates, mental health advocates, health and mental health providers, community-based organizations and advocates, academic institutions, local public health departments, local government entities, and low-income and vulnerable consumers.

Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: no.

The people of the State of California do enact as follows:

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SECTION 1.  

Section 127750 of the Health and Safety Code
is amended to read:

127750.  

The office shall prepare a Health Manpower Plan for
California. The plan shall consist of at least the following elements:

(a)  The establishment of appropriate standards for determining
the adequacy of supply in California of at least each of the
following categories of health personnel: physicians, midlevel
medical practitioners (physician’s assistants and nurse
practitioners); nurses; dentists; midlevel dental practitioners (dental
nurses and dental hygienists); optometrists; optometry assistants;
pharmacists; and pharmacy technicians.

(b)  A determination of appropriate standards for the adequacy
of supply of the categories in subdivision (a) shall be made by
taking into account all of the following: current levels of demand
for health services in California; the capacity of each category of
personnel in subdivision (a) to provide health services; the extent
to which midlevel practitioners and assistants can substitute their
services for those of other personnel; the likely impact of the
implementation of a national health insurance program on the
demand for health services in California; professionally developed
standards for the adequacy of the supply of health personnel; and
assumptions concerning the future organization of health care
services in California.

(c)  A determination of the adequacy of the current and future
supply of health personnel by category in subdivision (a) taking
into account the sources of supply for such personnel in California,
the magnitude of immigration of personnel to California, and the
likelihood of the immigration continuing.

(d)  A determination of the adequacy of the supply of specialties
within each category of health personnel in subdivision (a). The
determination shall be made, based upon standards of appropriate
supply to speciality developed, in accordance with subdivision
(b).

(e)  Recommendations concerning changes in health manpower
policies, licensing statutes, and programs needed to meet the state’s
need for health personnel.

(f) All of the elements in subdivisions (a) to (e), inclusive, as
appropriate, when addressing workforce education and training
programs and activities and workforce shortages and deficits
identified in the Workforce Needs Assessment for the purposes of
meeting the mental health needs of vulnerable communities, as
defined in subdivision (a) of Section 131019.5.

(g) The Legislature finds and declares that the needs of
vulnerable communities for mental health services are often unique
because of the cultural, linguistic, and experiential circumstances
of these communities and that unique solutions need to be
considered for outreach, removal of the stigma for seeking
assistance, and treatment of individuals in these vulnerable
communities.

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begin delete SEC. 2. end delete
begin insert SECTION 1. end insert   

Section 131019.5 of the Health and Safety Code
is amended to read:

131019.5.  

(a) For purposes of this section, the following
definitions shall apply:

(1) “Determinants of equity” means social, economic,
geographic, political, and physical environmental conditions that
lead to the creation of a fair and just society.

(2) “Health equity” means efforts to ensure that all people have
full and equal access to opportunities that enable them to lead
healthy lives.

(3) “Health and mental health disparities” means differences in
health and mental health status among distinct segments of the
population, including differences that occur by gender, age, race
or ethnicity, sexual orientation, gender identity, education or
income, disability or functional impairment, or geographic location,
or the combination of any of these factors.

(4) “Health and mental health inequities” means disparities in
health or mental health, or the factors that shape health, that are
systemic and avoidable and, therefore, considered unjust or unfair.

(5) “Vulnerable communities” include, but are not limited to,
women, racial or ethnic groups, low-income individuals and
families, individuals who are incarcerated and those who have
been incarcerated, individuals with disabilities, individuals with
mental health conditions, children, youth and young adults, seniors,
immigrants and refugees, individuals who have experienced trauma
related to genocide, individuals who are limited English proficient
(LEP), and lesbian, gay, bisexual, transgender, queer, and
questioning (LGBTQQ) communities, or combinations of these
populations.

(6) “Vulnerable places” means places or communities with
inequities in the social, economic, educational, or physical
environment or environmental health and that have insufficient
resources or capacity to protect and promote the health and
well-being of their residents.

(b) The State Department of Public Health shall establish an
Office of Health Equity for the purposes of aligning state resources,
decisionmaking, and programs to accomplish all of the following:

(1) Achieve the highest level of health and mental health for all
people, with special attention focused on those who have
experienced socioeconomic disadvantage and historical injustice,
including, but not limited to, vulnerable communities; culturally,
linguistically, and geographically isolated communities; and
communities that have experienced trauma related to genocide.

(2) Work collaboratively with the Health in All Policies Task
Force to promote work to prevent injury and illness through
improved social and environmental factors that promote health
and mental health.

(3) Advise and assist other state departments in their mission
to increase access to, and the quality of, culturally and linguistically
competent health and mental health care and services.

(4) Improve the health status of all populations and places, with
a priority on eliminating health and mental health disparities and
inequities.

(c) The duties of the Office of Health Equity shall include all
of the following:

(1) Conducting policy analysis and developing strategic policies
and plans regarding specific issues affecting vulnerable
communities and vulnerable places to increase positive health and
mental health outcomes for vulnerable communities and decrease
health and mental health disparities and inequities. The policies
and plans shall also include strategies to address social and
environmental inequities and improve health and mental health.
The office shall assist other departments in their missions to
increase access to services and supports and improve quality of
care for vulnerable communities.

(2) Establishing a comprehensive, cross-sectoral strategic plan
to eliminate health and mental health disparities and inequities.
The strategies and recommendations developed shall take into
account the needs of vulnerable communities to ensure strategies
are developed throughout the state to eliminate health and mental
health disparities and inequities. This plan shall be developed in
collaboration with the Health in All Policies Task Force. This plan
shall establish goals and benchmarks for specific strategies in order
to measure and track disparities and the effectiveness of these
strategies. This plan shall be updated periodically, but not less than
every two years, to keep abreast of data trends, best practices,
promising practices, and to more effectively focus and direct
necessary resources to mitigate and eliminate disparities and
inequities. This plan shall be included in the report required under
paragraph (1) of subdivision (d). The Office of Health Equity shall
seek input from the public on the plan through an inclusive public
stakeholder begin delete process. end delete begin insert process that includes representatives from
vulnerable communities. end insert

(3) Building upon and informing the work of the Health in All
Policies Task Force in working with state agencies and departments
to consider health in appropriate and relevant aspects of public
policy development to ensure the implementation of goals and
objectives that close the gap in health status. The Office of Health
Equity shall work collaboratively with the Health in All Policies
Task Force to assist state agencies and departments in developing
policies, systems, programs, and environmental change strategies
that have population health impacts in all of the following ways,
within the resources made available:

(A) Develop intervention programs with targeted approaches
to address health and mental health inequities and disparities.

(B) Prioritize building cross-sectoral partnerships within and
across departments and agencies to change policies and practices
to advance health equity.

(C) Work with the advisory committee established pursuant to
subdivision (f) and through stakeholder meetings to provide a
forum to identify and address the complexities of health and mental
health inequities and disparities and the need for multiple,
interrelated, and multisectoral strategies.

(D) Provide technical assistance to state and local agencies and
departments with regard to building organizational capacity, staff
training, and facilitating communication to facilitate strategies to
reduce health and mental health disparities.

(E) Highlight and share evidence-based, evidence-informed,
and community-based practices for reducing health and mental
health disparities and inequities.

(F) Work with local public health departments, county mental
health or behavioral health departments, local social services, and
mental health agencies, and other local agencies that address key
health determinants, including, but not limited to, housing,
transportation, planning, education, parks, and economic
development. The Office of Health Equity shall seek to link local
efforts with statewide efforts.

(4) Consult with community-based organizations and local
governmental agencies to ensure that community perspectives and
input are included in policies and any strategic plans,
recommendations, and implementation activities.

(5) Assist in coordinating projects funded by the state that
pertain to increasing the health and mental health status of
vulnerable communities.

(6) Provide consultation and technical assistance to state
departments and other state and local agencies charged with
providing or purchasing state-funded health and mental health
care, in their respective missions to identify, analyze, and report
disparities and to identify strategies to address health and mental
health disparities.

(7) Provide information and assistance to state and local
departments in coordinating projects within and across state
departments that improve the effectiveness of public health and
mental health services to vulnerable communities and that address
community environments to promote health. This information shall
identify unnecessary duplication of services.

(8) Communicate and disseminate information within the
department and with other state departments to assist in developing
strategies to improve the health and mental health status of persons
in vulnerable communities and to share strategies that address the
social and environmental determinants of health.

(9) Provide consultation and assistance to public and private
entities that are attempting to create innovative responses to
improve the health and mental health status of vulnerable
communities.

(10) Seek additional resources, including in-kind assistance,
federal funding, and foundation support.

(d) In identifying and developing recommendations for strategic
plans, the Office of Health Equity shall, at a minimum, do all of
the following:

(1) Conduct demographic analyses on health and mental health
disparities and inequities. The report shall include, to the extent
feasible, an analysis of the underlying conditions that contribute
to health and well-being. The first report shall be due July 1, 2014.
This information shall be updated periodically, but not less than
every two years, and made available through public dissemination,
including posting on the department’s Internet Web site. The report
shall be developed using primary and secondary sources of
demographic information available to the office, including the
work and data collected by the Health in All Policies Task Force.
Primary sources of demographic information shall be collected
contingent on the receipt of state, federal, or private funds for this
purpose.

(2) Based on the availability of data, including valid data made
available from secondary sources, the report described in paragraph
(1) shall address the following key factors as they relate to health
and mental health disparities and inequities:

(A) Income security such as living wage, earned income tax
credit, and paid leave.

(B) Food security and nutrition such as food stamp eligibility
and enrollment, assessments of food access, and rates of access to
unhealthy food and beverages.

(C) Child development, education, and literacy rates, including
opportunities for early childhood development and parenting
support, rates of graduation compared to dropout rates, college
attainment, and adult literacy.

(D) Housing, including access to affordable, safe, and healthy
housing, housing near parks and with access to healthy foods, and
housing that incorporates universal design and visitability features.

(E) Environmental quality, including exposure to toxins in the
air, water, and soil.

(F) Accessible built environments that promote health and
safety, including mixed-used land, active transportation such as
improved pedestrian, bicycle, and automobile safety, parks and
green space, and healthy school siting.

(G) Health care, including accessible disease management
programs, access to affordable, quality health and behavioral health
care, assessment of the health care workforce, and workforce
diversity.

(H) Prevention efforts, including community-based education
and availability of preventive services.

(I) Assessing ongoing discrimination and minority stressors
against individuals and groups in vulnerable communities based
upon race, gender, gender identity, gender expression, ethnicity,
marital status, language, sexual orientation, disability, and other
factors, such as discrimination that is based upon bias and negative
attitudes of health professionals and providers.

(J) Neighborhood safety and collective efficacy, including rates
of violence, increases or decreases in community cohesion, and
collaborative efforts to improve the health and well-being of the
community.

(K) The efforts of the Health in All Policies Task Force,
including monitoring and identifying efforts to include health and
equity in all sectors.

(L) Culturally appropriate and competent services and training
in all sectors, including training to eliminate bias, discrimination,
and mistreatment of persons in vulnerable communities.

(M) Linguistically appropriate and competent services and
training in all sectors, including the availability of information in
alternative formats such as large font, braille, and American Sign
Language.

(N) Accessible, affordable, and appropriate mental health
services.

(3) Consult regularly with representatives of vulnerable
communities, including diverse racial, ethnic, cultural, and
LGBTQQ communities, women’s health advocates, mental health
advocates, health and mental health providers, community-based
organizations and advocates, academic institutions, local public
health departments, local government entities, and low-income
and vulnerable consumers.

(4) Consult regularly with the advisory committee established
by subdivision (f) for input and updates on the policy
recommendations, strategic plans, and status of cross-sectoral
work.

(e) The Office of Health Equity shall be organized as follows:

(1) A Deputy Director shall be appointed by the Governor or
the State Public Health Officer, and is subject to confirmation by
the Senate. The salary for the Deputy Director shall be fixed in
accordance with state law.

(2) The Deputy Director of the Office of Health Equity shall
report to the State Public Health Officer and shall work closely
with the Director of Health Care Services to ensure compliance
with the requirements of the office’s strategic plans, policies, and
implementation activities.

(f) The Office of Health Equity shall establish an advisory
committee to advance the goals of the office and to actively
participate in decisionmaking. The advisory committee shall be
composed of representatives from applicable state agencies and
departments, local health departments, community-based
organizations working to advance health and mental health equity,
vulnerable communities, and stakeholder communities that
represent the diverse demographics of the state. The chair of the
advisory committee shall be a representative from a nonstate entity.
The advisory committee shall be established by no later than
October 1, 2013, and shall meet, at a minimum, on a quarterly
basis. Subcommittees of this advisory committee may be formed
as determined by the chair.

(g) An interagency agreement shall be established between the
State Department of Public Health and the State Department of
Health Care Services to outline the process by which the
departments will jointly work to advance the mission of the Office
of Health Equity, including responsibilities, scope of work, and
necessary resources.

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begin insert SEC. 2. end insert   

Section 4060 of the Welfare and Institutions Code is
amended to read:

4060.  

The State Department of Health Care Services shall, in
order to implement Section 4050, utilize a meaningful
decisionmaking process that includes local mental health directors
and representatives of local mental health boards as well as other
stakeholders in vulnerable communities, including diverse racial,
ethnic, cultural, and LGBTQQ communities, communities that
experience trauma related to genocide, women’s health advocates,
mental health advocates, health and mental health providers,
community-based organizations and advocates, academic
institutions, local public health departments, local government
entities, and low-income and vulnerable consumers. The purpose
of this collaboration shall be to promote effective and efficient
quality mental health services to the residents of the state under
the realigned mental health system.