BILL ANALYSIS Ó SENATE COMMITTEE ON HEALTH Senator Ed Hernandez, O.D., Chair BILL NO: SB 291 --------------------------------------------------------------- |AUTHOR: |Lara | |---------------+-----------------------------------------------| |VERSION: |April 6, 2015 | --------------------------------------------------------------- --------------------------------------------------------------- |HEARING DATE: |April 22, 2015 | | | --------------------------------------------------------------- --------------------------------------------------------------- |CONSULTANT: |Reyes Diaz | --------------------------------------------------------------- SUBJECT : Mental health: vulnerable communities SUMMARY : Requires the Office of Statewide Health Planning and Development to prepare a Mental Health Manpower Plan for the state to assess the needs and available services to meet the mental health needs of Californians, specifically those in vulnerable communities. Expands the definition of "vulnerable communities," as specified; Requires the Department of Health Care Services to include stakeholders in vulnerable communities, as specified, in its meaningful decision making process for purposes of providing technical assistance to specified entities. Existing law: 1.Establishes the Office of Statewide Health Planning and Development (OSHPD) to, among other duties, collect data and disseminate information about the state's health care infrastructure. Requires OSHPD to prepare a Health Manpower Plan for the state to establish standards for and determine the adequacy of policies relating to health care practitioners to serve the needs of the state. 2.Establishes the Office of Health Equity (OHE) within the Department of Public Health (DPH) to align state resources, decision making, and programs to establish various goals relating to health. Requires OHE to perform various duties relating to vulnerable communities. 3.Defines "vulnerable communities" as, but not limited to: a. Women; b. racial or ethnic groups; c. low-income individuals and families; SB 291 (Lara) Page 2 of ? d. individuals who are and have been incarcerated; e. individuals with disabilities; f. individuals with mental health conditions; g. children, youth and young adults, and seniors, h. immigrants and refugees; i. individuals who are limited-English proficient; j. lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQQ) communities; or, aa. combinations of these populations. 4.Requires the Department of Health Care Services (DHCS) to provide, to the extent resources are available, technical assistance to county mental health programs and other local mental health agencies, through DHCS staff or by contract, in the areas of program operations, research, evaluation, demonstration, or quality assurance projects. Requires DHCS to utilize a meaningful decision making process that includes local mental health directors and representatives of local mental health boards, as well as other stakeholders as determined by DHCS. This bill: 1.Requires OSHPD to prepare a Mental Health Manpower Plan for the state to assess the needs and services available to meet the mental health needs of Californians, especially those in vulnerable communities. Requires the plan to consist of at least the following elements: a. Establishment of appropriate standards for determining the adequacy of supply in the state of psychologists, psychiatrists, counselors, and other mental health personnel who may be able to treat groups in vulnerable communities; b. Determination of appropriate standards for the adequacy of supply of the categories in (a.) above; c. Determination of the adequacy of the current and future supply of personnel in (a.) above, taking into account the sources of supply for that personnel in the state, the magnitude of immigration of personnel to the state, and the likelihood of the continuing immigration; d. Determination of the adequacy of supply of SB 291 (Lara) Page 3 of ? specialties within each category of health personnel in (a.) above; and, e. Recommendations concerning changes in programs, mental health manpower policies, and licensing statutes needed to meet the state's need for mental health personnel to serve vulnerable communities. 2.Expands the definition of "vulnerable communities" to include individuals who have experienced trauma related to genocide. 3.Requires DHCS to include stakeholders in vulnerable communities in its meaningful decision making process, for purpose of providing technical assistance, including: a. diverse racial, ethnic, cultural, and LGBTQQ communities; b. communities that experience trauma related to genocide; c. women's health advocates; d. mental health advocates; e. health and mental health providers; f. community-based organizations and advocates; g. academic institutions; h. local public health departments; i. local government entities; and, j. low-income and vulnerable consumers. FISCAL EFFECT : This bill has not been analyzed by a fiscal committee. COMMENTS : 1.Author's statement. According to the author, OSHPD, OHE, DHCS, and other state and local entities have been charged with carrying out various mental health initiatives, yet barriers remain. In particular the Cambodian-American population, which has the largest population in California, still suffers from the effects of the Cambodian Genocide that occurred between 1975 and 1979. Their mental health challenges are multigenerational, extending past the elders who were refugees to the youth who are born in the U.S. Unfortunately, the Cambodian community is lumped together, if recognized at all, under the Asian Pacific-Islander category by departments. The current system, where groups are collapsed together in a broad category, disenfranchises people who suffer from trauma SB 291 (Lara) Page 4 of ? related to genocide. These individuals have unique challenges that cannot be generalized by any other category and, therefore, should be separately assessed. In the absence of laws that highlight this group as a vulnerable population, smaller community and non-profit organizations that serve these individuals are often unable to access funding under the current system. In the interest of continuing the state's goal towards advancing mental health care access, SB 291 will improve institutional access for Californians who have experienced trauma related to genocide by improving stakeholder engagement, service delivery, and ultimately access to mental health services. 2.Health care disparities. According to the Health Services Research Community of the National Institutes of Health, health care disparities refer to differences in access to or availability of facilities and services. Health status disparities refer to the variation in rates of disease occurrence and disabilities between socioeconomic and/or geographically defined population groups. Health disparities have been measured between those of a different race, ethnicity, gender, sexual orientation, age, ability, religion, socioeconomic status, language proficiency, and geographic location. Many racial and ethnic minorities, people with disabilities, and LGBTQQ communities face unique health challenges, have reduced access to health care and insurance, and often have poorer health throughout their lives. For example, research suggests LGBTQQ people and families may face significant challenges associated with health disparities in insurance coverage and access to health care services. 3.Behavioral health evidence-based/best practice service provision lacking in the state? The Technical Assistance Collaborative/Human Services Research Institute's final report in February 2012, California Mental Health and Substance Use System Needs Assessment, notes that the percent of individuals reported to be receiving an evidence-based practice service was low: only one percent in 2010, down from two percent in 2009. It also notes that there is a variability among counties in the use and training of staff in state-of-the-art and evidence-based and recovery-oriented treatment; there is a need to address better preparation of physical health providers to engage and treat people with behavioral health needs; and there is still disproportionate access to behavioral health services on the part of certain ethnic SB 291 (Lara) Page 5 of ? populations-compounded by the relative lack of cultural and linguistic capacity among providers and practitioners in the state. 4.Let's Get Healthy Task Force. In May 2012, Governor Jerry Brown established the Let's Get Healthy California Task Force (Task Force) to develop a 10-year plan for improving the health of Californians, controlling health care costs, promoting personal responsibility for individual health, and advancing health equity. The Executive Order directed the Task Force to issue a report with recommendations for how the state can make progress toward becoming the healthiest state in the nation over the next decade. In the report, issued in December 2012, the Task Force developed an overarching framework, identifying six goals, organized under two strategic directions: Health Across the Lifespan and Pathways to Health. The Report states that the framework makes clear that health equity should be fully integrated across the entire effort. 5.State's current efforts. According to OSHPD's Web site, the passage of Proposition 63, the Mental Health Services Act (MHSA), provided a unique opportunity with funding to increase staffing and other resources that support public mental health programs, increase access to much-needed services, and monitor progress toward statewide goals for serving children, transition age youth, adults and older adults, and their families. California's public mental health system has suffered from a shortage of public mental health workers, maldistribution of certain public mental health occupational classifications, a recognized lack of diversity in the workforce, and underrepresentation of professionals with consumer and family member experience, and of racial, ethnic, and cultural communities in the provision of services and support. To address the public mental health workforce issues, the MHSA included a component for Mental Health Workforce Education and Training (WET) programs. In 2008, the former Department of Mental Health developed the first WET Development Five-Year Plan, which covered the period April 2008 to April 2013 and provided vision, values, and mission for state and local implementation of WET programs. In July 2012, the MHSA WET programs were transferred to OSHPD, which assumed the responsibility of administering the WET programs and developing the second MHSA WET Five-Year Plan. OSHPD, with advice from stakeholders and approval by the California Mental Health Planning Council, developed the second MHSA WET SB 291 (Lara) Page 6 of ? Five-Year Plan, which covers the period of April 2014 to April 2019 and provides a framework on strategies that state, local government, community partners, education and training institutions, and other stakeholders can enact to further public mental health workforce, education, and training efforts. DHCS DHCS recently indicated that, beginning in Fiscal Year 2015-2016, it will stratify quality measures by demographic factors. Their goal is to focus quality improvement efforts to eliminate heath disparities and improve quality overall. DHCS is in the process of identifying initial measures to conduct this analysis. Another demographic analysis currently conducted by DHCS is the use of managed care plan grievances and appeals data. DHCS is able to determine if an over-prevalence of grievances and/or appeals exists among a specific demographic group. DHCS has previously collected race and/or ethnicity data when conducting the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. This survey is a measure of Medi-Cal beneficiary satisfaction. DHCS reports they will continue to conduct this analysis by race and/or ethnicity and use the CAHPS survey to collect additional demographic factors. Covered California Covered California has stated that one of its missions is to reduce health disparities, and that it recognizes the diverse cultural, language, economic, educational, and health status needs of those they serve. Their ongoing outreach initiatives include efforts to enroll underserved beneficiaries. Covered California runs the Community Outreach Network, which partners with local organizations across the state to provide information, resources, and training. Community Outreach Network partners include organizations devoted to serving at-risk (vulnerable) populations, including immigrants, African Americans, Asians and Asian sub-populations, LGBTQQ, Mexican Americans, Native Americans, and HIV and AIDS patients. Partners distribute materials, provide outreach and enrollment assistance, and are compensated by Covered California for each application that leads to a purchase. Covered California has also awarded $43 million in grants to organizations that have trusted relationships with culturally and linguistically diverse uninsured markets. SB 291 (Lara) Page 7 of ? 6.Related legislation. SB 315 (Monning and Hernandez), creates the California Health Access Model Program Two Account within the California Health Facilities Financing Authority Fund for purposes of administering a second competitive grant selection process, in accordance with existing grant provisions, to fund one or more projects designed to demonstrate specified new or enhanced cost-effective methods of delivering quality health care services to improve access to quality health care for vulnerable populations or communities, or both. SB 315 is set for hearing in the Senate Health Committee on April 29, 2015. AB 176 (Bonta), adds DPH to the list of agencies that are required to use additional separate collection categories and other tabulations, and to take additional actions, including posting the demographic data collected on its Internet Web site. Requires the updating of the reporting categories for future decennial censuses. Requires, on or after July 1, 2016, whenever DPH, DHCS, or the Department of Managed Health Care collects ancestry or ethnic origin demographic data of persons for a report that includes specified categories of information, that entity to use the additional separate collection categories and other tabulations for specified Asian groups and Pacific Island groups, and to post the demographic data on its Internet Web site. Requires, on and after July 1, 2016, the Board of Governors of the California Community Colleges, the Trustees of the California State University, and the Regents of the University of California, whenever those entities collect ancestry or ethnic origin demographic data of students for a report that includes student admission, enrollment, completion, or graduation rates, to use specified collection and tabulation categories for Asian, Native Hawaiian, and Pacific Islander groups. Requires each entity specified above to make the demographic data publicly available on the entity's Internet Web site and requires the updating of the reporting categories for each decennial census. AB 176 is scheduled for hearing in the Assembly Health Committee on April 21, 2015. 7.Prior legislation. AB 411 (Pan), of 2013, would have required DHCS, when entering into a new contract with an External Quality Review Organization (EQRO) for the purpose of performing work associated with Medi-Cal managed care programs, to include in the terms of the new contract a requirement that, upon approval of the contract, the EQRO stratify all patient-specific Healthcare Effectiveness Data SB 291 (Lara) Page 8 of ? and Information Set measures, or their External Accountability Set performance measure equivalent, by certain characteristics, including geographic area and primary language. AB 411 would have required DHCS to publicly report this analysis on its Internet Web site. AB 411 would have provided that its provisions only be implemented to the extent that funding is available. AB 411 was vetoed by the Governor who stated that nothing in current law prevents DHCS from requiring EQROs to provide more detailed data by geography, race, ethnicity, or other demographic attribute. He concluded that if DHCS saw a need or benefit that justifies the costs of procuring this additional data, he was confident that they would procure it. AB 209 (Pan), of 2013, would have required DHCS to develop and implement a plan that includes specified components to monitor, evaluate, and improve the quality, accessibility, and utilization of health care and dental services provided through Medi-Cal managed care. This bill would have required DHCS to hold public meetings to report on performance measures, utilization levels, quality and access standards, network adequacy, fiscal solvency, and evaluation standards with regard to all Medi-Cal managed care services and to invite public comments. This bill would have also required DHCS to appoint an advisory committee for the purpose of making recommendations to improve quality and access in the delivery of Medi-Cal managed care services. AB 209 died in the Senate on the third reading file. 8.Support. Supporters of this bill argue that there continues to be barriers to accessing mental health services, especially for the Cambodian community, which still suffers from effects of genocide that occurred between the years of 1975 and 1979. They further argue that because many Asian subpopulations get lumped together as Asian Pacific-Islander, groups that have experienced trauma related to genocide are disenfranchised, particularly because of unique challenges. Supporters cite mounting research that shows trauma/stress affects brain development, as well as physical and mental health. 9.Technical amendment. In current law, OSHPD is already required to develop a Health Manpower Plan for the state. The author may wish to amend this bill to require OSHPD to include in its current responsibility an element for addressing the mental health needs of vulnerable communities, which will include SB 291 (Lara) Page 9 of ? communities that experience trauma related to genocide in its expanded definition. SUPPORT AND OPPOSITION : Support: Cambodian Advocacy Collaborative (sponsor) Families in Good Health Khmer Parent Association Los Angeles Lesbian, Gay, Bisexual, Transgender Center Oppose: None received. -- END --