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 received
ARGUMENTS 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 ****