BILL ANALYSIS                                                                                                                                                                                                    Ó



          SENATE COMMITTEE ON HEALTH
                          Senator Ed Hernandez, O.D., Chair

          BILL NO:                    SB 804    
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          |AUTHOR:        |Committee on Health                            |
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          |VERSION:       |March 26, 2015                                 |
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          |HEARING DATE:  |April 29, 2015 |               |               |
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          |CONSULTANT:    |Juan Reyes                                     |
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           SUBJECT  :  Health

           SUMMARY  :  Updates obsolete references to county mental health directors  
          and county drug and alcohol program administrators to instead  
          reference county behavioral health directors and/or the County  
          Behavioral Health Directors Association. Requires the Department  
          of Health Care Services to report to the Legislature with  
          quarterly updates on caseload, estimated expenditures, and  
          related program monitoring data for the Every Woman Counts  
          Program. Deletes additional references to non-profit hospital  
          service plans not included in last year's committee bill.  
          Technical clean-up to ensure individuals that can prove their  
          homeless status are not subject to any fee when requesting a  
          certified record of live birth. Extends indefinitely the sunset  
          date of the California Office of Health Information Integrity.
          
          Existing law:
          1.Regulates provision of programs and services relating to  
            mental health and alcohol and drug abuse at the state and  
            local levels. 

          2.Requires the State Department of Health Care Services (DHCS),  
            no later than January 10 and concurrently with the May  
            Revision of the annual budget, to provide the fiscal  
            committees of the Legislature with an estimate package for the  
            Every Woman Counts (EWC) Program for early detection of breast  
            and cervical cancer.

          3.Establishes the State Department of Public Health (DPH) and  
            sets forth its powers and duties, including, but not limited  
            to, duties as State Registrar relating to the uniform  
            administration of provisions relating to vital records and  
            health statistics.







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          4.Requires, on or after July 1, 2015, each local registrar or  
            county recorder to issue, without a fee, a certified record of  
            live birth to any person who can verify his or her status as a  
            homeless person or a homeless child or youth, as defined.

          5.Permits the Office of Health Information Integrity (CalOHII)  
            to assume statewide leadership, coordination, policy  
            formulation, direction, and oversight responsibilities for  
            HIPAA implementation, and exercises full authority relative to  
            state entities to establish policy, provide direction to state  
            entities, monitor progress, and report on implementation  
            efforts.

          6.Repeals CalOHII on June 30, 2016.

          This bill:
          1.Replaces obsolete references relevant in existing law to the  
            California Mental Health Directors Association (CMHDA) and the  
            County Alcohol and Drug Program Administrators' Association of  
            California (CADPAAC) to instead reference the County  
            Behavioral Health Directors' Association of California  
            (CBHDAC) to reflect the merging of the two organizations.

          2.Replaces references to county mental health directors and  
            county alcohol and drug program administrators to instead  
            reference the county behavioral health directors.

          3.Requires DHCS to provide the appropriate policy and fiscal  
            committees of the Legislature with quarterly updates on  
            caseload, estimated expenditures, and related program  
            monitoring data for the EWC program.

          4.Clarifies that a person can verify his or her status as a  
            homeless person or a homeless child or youth, in addition to  
            verification provided by a homeless services provider, is to  
            be issued a certified record of live birth, as specified,  
            without an issuance fee or any other associated fee.

          5.Deletes sunset date for CalOHII.

          6.Deletes obsolete references to nonprofit hospital service  
            plans in three provisions of Medi-Cal law.









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           FISCAL  
          EFFECT  :  This bill has not been analyzed by a fiscal committee.
           
          COMMENTS  :
          1.Author's statement.  According to the author, this bill makes  
            a number of technical and clarifying changes to existing law  
            and other substantive changes:

            Last year, the Legislature decided, unanimously, to assist  
            individuals enduring difficult times in their efforts to get  
            back on their feet by not subjecting homeless persons or  
            homeless youth to a fee when requesting a certified record of  
            live birth. Nearly every government program or social service,  
            programs that these individuals so desperately need, require  
            some form of identification, including a birth certificate.  
            This bill will further clarify that homeless individuals are  
            not subject to any surprise fees as they seek the  
            documentation needed to access social services programs.

            This bill will also extend the sunset date of the California  
            Office of Health Information Integrity (CalOHII) indefinitely.  
            CalOHII has focused on making confidential health information  
            available in the most secure ways and the sunset date has  
            continued to be extended. At a time when confidentiality,  
            particularly of personal health information, is paramount, the  
            work done by CalOHII will be needed in the immediate and  
            distant future.
            
          2.County Behavioral Health Directors Association of California.  
            As of 2004, California administered its alcohol, drug and  
            mental health programs in two separate agencies, the  
            now-defunct Department of Alcohol and Drug Programs (ADP) and  
            the Department of Mental Health (DMH). The California  
            Performance Review published in its 2004 report a set of  
            recommendations for developing a more efficient and effective  
            government. One of the recommendations included consolidating  
            the management of the behavioral health programs to improve  
            coordination of county administered services to persons  
            suffering from both mental illness and substance use  
            disorders. Ultimately, ADP was folded into DHCS and some  
            functions of DMH were also folded into DHCS while others were  
            incorporated into the newly formed Department of State  
            Hospitals.  Similarly, on July 1, 2014 the CMHDA and the  
            CADPAAC became the CBHDAC to also reflect the need to  








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            integrate mental health and drug and alcohol use services. 

          3.Every Woman Counts Program.  According to the DHCS website,  
            the EWC program provides free clinical breast exams,  
            mammograms, pelvic exams, and Pap tests to California's  
            underserved women. The mission of  EWC is to save lives by  
            preventing and reducing the devastating effects of cancer for  
            Californians through education, early detection, diagnosis and  
            treatment, and inte
          grated preventive services, with special emphasis on the  
            underserved. In 2010, DPH was required to provide the fiscal  
            committees of the Legislature detailed estimate packages in  
            the Governor's January and May budget proposals each year for  
            the EWC progra4.m. DPH was also required to provide the  
            appropriate policy and fiscal committees of the Legislature  
            with quarterly reports that include all expenditure data  
            available for this program. In 2012, the EWC program was  
            transferred from DPH to DHCS. With the passage of AB 82  
            (Committee on Budget), Chapter 23, Statutes of 2013, DHCS is  
            now required to provide the fiscal committees with similar  
            estimate packages that were once provided by DPH. This bill  
            will require DHCS to provide the appropriate policy and fiscal  
            committees with the quarterly updates for the EWC program that  
            were once provided by DPH.

          5.Vital records.  The base fee for a copy of a birth certificate  
            was $12 and counties were allowed to raise the fee to cover  
            the costs of modernizing vital record operations and improving  
            the collection and analysis of health related birth and death  
            certificate information (costs ranged on average from $23 to  
            $28.) With the enactment of AB 1733 (Quirk-Silva et al.),  
            Chapter 764, Statutes of 2014, beginning on or after July 1,  
            2015, local registrars or county recorders will be required to  
            issue a birth certificate without a fee to homeless persons.

            During a teleconference convened by DPH, which consultants of  
            this committee joined, concerns of language ambiguity were  
            raised about the reference to "a fee."  The intent of AB 1733  
            was clear that no individual, who can prove his or her  
            homeless status, is subject to a fee for requesting a birth  
            certificate. The sponsors of AB 1733 are concerned that, as  
            drafted, a "search fee," separate from an "issuance fee" could  
            be charged. This bill will clarify that a birth certificate  
            will be provided, upon verification of housing status without  








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            any fee to a homeless person or youth.
          
          6.Prior legislation. SB 1465 (Committee on Health), Chapter 442,  
            Statutes of 2014, among other provisions, deleted obsolete  
            references to nonprofit hospital service plans in two  
            provisions of Medi-Cal law.
          
            AB 1733 (Quirk-Silva, Atkins, and Maienschein), Chapter 764,  
            Statutes of 2014, requires each local registrar or county  
            recorder, without  a  fee, to issue a certified record of live  
            birth to any person who can verify his or her status as a  
            homeless person or a homeless child or youth and a homeless  
            services provider that has knowledge of a person's housing  
            status shall verify a person's status for the purposes of  
            exemption from a fee. This bill also requires the Department  
            of Public Health to develop an affidavit attesting to an  
            applicant's status as a homeless person or homeless child or  
            youth and that the affidavit is not complete until signed by  
            both the person making the request for the record and the  
            homeless services provider with knowledge of the person's  
            housing status.

            AB 82 (Committee on Budget), Chapter 23, Statutes of 2013,  
            requires DHCS, no later than January 10 and concurrently with  
            the release of the May Revision, to provide the fiscal  
            committees of the Legislature with an estimate package for the  
            Every Woman Counts Program.

            AB 1467 (Committee on Budget), Chapter 23, Statutes of 2012,  
            extended the sunset on the Office of Health Information and  
            Integrity (CalOHI) to June 30, 2016. This bill also  
            transferred the Every Woman Counts Program, the Prostate  
            Cancer Treatment Program, and the Family Planning Access Care  
            and Treatment Program from the Department of Public Health to  
            the DHCS.

            SB 853 (Committee on Budget and Fiscal Review), Chapter 717,  
            Statutes of 2010, required DPH to include detailed estimate  
            packages in the Governor's January and May budget proposals  
            each year for the Women Infant and Children (WIC) Program,  
            Licensing and Certification Program, and the Every Woman  
            Counts Program. This bill also required DPH to provide the  
            appropriate fiscal and policy committees of the Legislature  
            with quarterly reports that include all expenditure data  








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            available for this program.
            
          7.Support.  The California State Association of Counties (CSAC)  
            states in support that the merging of the organizations CMHDA  
            and CADPAAC is a reflection of the integration of the mental  
            health and substance use disorder agencies at the county level  
            and general understanding that these areas are often  
            interdependent of each other and the people they serve.

          
           SUPPORT AND OPPOSITION  :
          Support:  California State Association of Counties
                    County Behavioral Health Directors Association of  
                    California
                    Housing California
          
          Oppose:   None received.

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