BILL ANALYSIS Ó
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: SB 291
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|AUTHOR: |Lara |
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|VERSION: |April 6, 2015 |
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|HEARING DATE: |April 22, 2015 | | |
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|CONSULTANT: |Reyes Diaz |
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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;
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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
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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
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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
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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
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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.
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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
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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
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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.
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