BILL ANALYSIS Ó
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: SB 1273
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|AUTHOR: |Moorlach |
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|VERSION: |March 28, 2016 |
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|HEARING DATE: |April 13, 2016 | | |
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|CONSULTANT: |Reyes Diaz |
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SUBJECT : Crisis stabilization units: funding
SUMMARY : Allows a county to use its Mental Health Services Fund monies
for crisis intervention, crisis stabilization, crisis
residential treatment, rehabilitative mental health services,
and mobile crisis support teams, as specified.
Existing law:
1)Establishes the Mental Health Services Act (MHSA), enacted by
voters in 2004 as Proposition 63, which provides funds to
counties to expand services and develop innovative programs
and integrated service plans for mentally ill children,
adults, and seniors through a one percent income tax on
personal income above $1 million.
2)Requires each county mental health program to prepare and
submit a three-year program and expenditure plan, with annual
updates, adopted by the county board of supervisors, to the
Mental Health Services Oversight and Accountability Commission
within 30 days after adoption. Requires the plan to include,
among other things, programs for services to adults and
seniors.
This bill: Allows a county, when included in its three-year
program and expenditure plan, to use its Mental Health Services
Fund monies for crisis intervention, crisis stabilization,
crisis residential treatment, rehabilitative mental health
services, and mobile crisis support teams, including personnel
and the purchase or lease of equipment, such as vehicles.
FISCAL
EFFECT : This bill has not been analyzed by a fiscal committee.
SB 1273 (Moorlach) Page 2 of ?
COMMENTS :
1)Author's statement. According to the author, California is
facing a mental health crisis, as there is not enough
infrastructure dedicated for the rapid assessment and
stabilization of individuals in psychiatric crisis. As a
result, individuals in mental health crisis are often
transported to local emergency rooms (ERs) that are high
stress, chaotic environments designed for split-second
lifesaving decision-making, rather than thoughtful therapeutic
treatment. Patients are often boarded in the ERs against their
will while waiting for assessment or transfer to a psychiatric
bed. The boarding of psychiatric patients in the ERs also
results in lost access to beds for patients with medical
emergencies. When ERs are full, ambulances are diverted and
patients leave the waiting rooms without being seen by a
physician. Because law enforcement officers are often the
first responders, the hours spent in the ER represents
out-of-service time from the field. These issues are
significant public health and safety issues in California. SB
1273 clarifies that counties can direct local MHSA funds to
outpatient crisis stabilization services. Additional
outpatient resources will support rapid patient stabilization
while preserving ER access for medical emergencies and
minimizing out-of-service time for law enforcement.
2)MHSA. The MHSA provides funding for programs within five
components:
a) Community Services and Supports (CSS): provides
direct mental health services to the severely and
seriously mentally ill, such as mental health treatment,
cost of health care treatment, and housing supports. CSS
requires counties to direct the majority of its funds to
full-service partnerships, which are county-coordinated
plans, in collaboration with the client and the family to
provide the full spectrum of community services and
utilize a "whatever it takes" approach to providing
services. Such services include peer support and crisis
intervention services, and non-mental health services and
supports, such as food, clothing, housing, and the cost
of medical treatment;
b) Prevention and Early Intervention: provides services
to mental health clients in order to help prevent mental
illness from becoming severe and disabling;
SB 1273 (Moorlach) Page 3 of ?
c) Innovation: provides services and approaches that
are creative, in an effort to address mental health
clients' persistent issues, such as improving services
for underserved or unserved populations within the
community;
d) Capital Facilities and Technological Needs: creates
additional county infrastructure, such as additional
clinics and facilities, and/or development of a
technological infrastructure for the mental health
system, such as electronic health records for mental
health services; and,
e) Workforce Education and Training: provides training
for existing county mental health employees, outreach and
recruitment to increase employment in the mental health
system, and financial incentives to recruit or retain
employees within the public mental health system.
3)Crisis stabilization. "Crisis stabilization (CS)" is defined
in Title 9, California Code of Regulations (CCR), Division 1,
Chapter 11, Section 1810.210 as a service lasting less than 24
hours, to or on behalf of a beneficiary for a condition that
requires more timely response than a regularly scheduled
visit. Service activities include, but are not limited to, one
or more of the following: assessment, collateral, and therapy.
Services are required to be provided on-site at a licensed
24-hour health care facility or hospital-based outpatient
program or a provider site certified by the Department of
Health Care Services or a Mental Health Plan. All
beneficiaries receiving CS are required to receive an
assessment of their physical and mental health. Physicians are
required to be on-call at all times for the provision of CS
services that only a physician can provide. At a minimum, CS
staffing requirements include one registered nurse,
psychiatric technician, or licensed vocational nurse on-site
at all times beneficiaries are present. A ratio of one
licensed mental health or waivered/registered professional
on-site for each four beneficiaries or other patients
receiving CS at any given time is required. If CS services are
co-located with other specialty mental health services,
persons providing CS must be separate and distinct from
persons providing other services.
4)Related legislation. AB 2017 (McCarty), would establish the
College Mental Health Services Trust Account, and appropriate
an unspecified amount annually to that account from the Mental
SB 1273 (Moorlach) Page 4 of ?
Health Services Fund to create a grant program for public
community colleges, colleges, and universities to improve
access to mental health services on campus. Requires campuses
that have been awarded grants annually to report on the use of
grant funds. AB 2017 is pending in the Assembly Committee on
Higher Education.
5)Prior legislation. SB 82 (Committee on Budget and Fiscal
Review, Chapter 34, Statutes of 2013), made a one-time
appropriation of $500,000 from the General Fund to the
California Health Facilities Financing Authority to implement
grant programs to support the development, capital, equipment
acquisition, and applicable program startup or expansion costs
to increase capacity for client assistance and services for
individuals with mental health disorders, including the
services contained in this bill.
SB 585 (Steinberg, Chapter 288, Statutes of 2013), allows
counties, when included in their plans, to use Mental Health
Services Fund monies for Assisted Outpatient Treatment, known
as "Laura's Law," if a county elects to participate in and
implement Laura's Law.
6)Support. Supporters argue that there are currently a limited
number of tools available for first responders and
practitioners to address mental illness encountered in the
community, and that there is a glaring lack of treatment and
placement options for those with mental illness. Supporters
state that this bill will provide greater flexibility and
provide a better system of care for the mentally ill and the
health care system, as well as improve access to mental health
services through the expansion of available CS services. The
California Psychiatric Association (CPA) states that the MHSA
does not clearly indicate that funds may be used for the
purposes contained in this bill, which it also does not
clearly indicate that the purposes are unauthorized; CPA
believes clarification is necessary.
7)Letter of concern. The Citizens Commission of Human Rights
(CCHR) has concerns about the use of MHSA money to fund mental
health programs, and believes those services should be funded
from existing county and state revenue sources. CCHR believes
that the state would be better served if MHSA funds were used
instead to fund alternate, non-drug-based and voluntary
services to help the mentally ill.
SB 1273 (Moorlach) Page 5 of ?
8)Opposition. The California Association of Mental Health
Peer-Run Organizations (CAMHPRO) opposes the February 18,
2016, version of this bill based on its provision to allow
MHSA funds to be used for CS services, including temporary
commitment. CAMHPRO states that to use MHSA funding for
temporary commitment is in direct conflict with the intent of
the MHSA to treat the whole person using client-centered,
family focused, community-based, integrated services that are
voluntary and based on the recovery model.
9)Policy question. Background information provided by the
author's office states that Orange County is unclear about
whether MHSA funds may be used for the services contained in
this bill and has issued a legal opinion that MHSA funds are
restricted from being used for crisis stabilization services.
However, MHSA CCS regulations (Title 9, CCR, Division 1,
Chapter 14, Section 3630) allow for MHSA funds to be used for
crisis intervention and CS. Upon further investigation by
Committee staff, the issue some counties face, including
Orange, is uncertainty about whether MHSA funds can be used
for CS services for an individual who is receiving the
services voluntarily when the facility co-locates services for
individuals who are receiving services involuntarily. CS
regulations make reference to services that are co-located,
and require separation and distinction of services that are
co-located. Additionally, the Department of Health Care
Services indicates that there is no policy barring the
co-location of services. Given this, it is unclear if this
bill is needed.
SUPPORT AND OPPOSITION :
Support: California Chapter of the American College of
Emergency Physicians
California Psychiatric Association
California State Sheriffs' Association
Orange County Board of Supervisors
Orange County Sheriff-Coroner Sandra Hutchens
St. Joseph Hoag Health
St. Joseph Hospital in Orange
St. Jude Medical Center in Fullerton
Tenet Health
One individual
SB 1273 (Moorlach) Page 6 of ?
Oppose: California Association of Mental Health Peer-Run
Organizations (previous version)
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