BILL ANALYSIS Ó ----------------------------------------------------------------- |SENATE RULES COMMITTEE | SB 1273| |Office of Senate Floor Analyses | | |(916) 651-1520 Fax: (916) | | |327-4478 | | ----------------------------------------------------------------- THIRD READING Bill No: SB 1273 Author: Moorlach (R) Amended: 4/19/16 Vote: 21 SENATE HEALTH COMMITTEE: 8-0, 4/13/16 AYES: Hernandez, Nguyen, Hall, Mitchell, Nielsen, Pan, Roth, Wolk NO VOTE RECORDED: Monning SUBJECT: Crisis stabilization units: funding SOURCE: Author DIGEST: This bill allows a county to use its Mental Health Services Fund moneys for outpatient crisis stabilization services to individuals who are voluntarily receiving those services, even when facilities co-locate services to individuals who are involuntarily receiving services. ANALYSIS: 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 SB 1273 Page 2 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 to use its Mental Health Services Fund moneys for outpatient crisis stabilization services to individuals who are voluntarily receiving those services, even when facilities co-locate services to individuals who are involuntarily receiving services. 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. This bill 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: SB 1273 Page 3 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; 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, SB 1273 Page 4 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)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. 5)Policy question. Background information provided by the author's office states that Orange County is unclear about SB 1273 Page 5 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 CSS 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 Senate Health 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, there is no indication that the Department of Health Care Services has a policy barring the co-location of services. Given this, it is unclear if this bill is needed. Related/Prior Legislation AB 2017 (McCarty, 2016) establishes the College Mental Health Services Trust Account, and appropriates an unspecified amount annually to that account from the Mental 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 currently in the Assembly Appropriations Committee. 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. FISCAL EFFECT: Appropriation: No Fiscal Com.:NoLocal: No SUPPORT: (Verified4/20/16) SB 1273 Page 6 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 OPPOSITION: (Verified4/20/16) None receivedARGUMENTS IN 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. Prepared by:Reyes Diaz / HEALTH / 4/20/16 16:34:48 SB 1273 Page 7 **** END ****