BILL ANALYSIS Ó
SB 1273
Page 1
Date of Hearing: June 14, 2016
ASSEMBLY COMMITTEE ON HEALTH
Jim Wood, Chair
SB
1273 (Moorlach) - As Amended April 19, 2016
SENATE VOTE: 38-0
SUBJECT: Crisis stabilization units: funding.
SUMMARY: Clarifies that Mental Health Services Act (MHSA) funds
may be used for the provision of outpatient crisis stabilization
services (CSS) to individuals who are voluntarily receiving
those services, even when facilities colocate services to
individuals who are receiving services involuntarily.
EXISTING LAW:
1)Establishes the MHSA (through Proposition 63), enacted in in
2004 to provide funds to counties to expand services, develop
innovative programs, and develop integrated service plans for
mentally ill children, adults, and seniors through a 1% income
tax on personal income above $1 million.
2)Establishes the Mental Health Oversight and Accountability
Commission (Commission) to oversee the implementation of MHSA,
made up of 16 members appointed by the Governor, President pro
Tempore of the Senate, Speaker of the Assembly, and others, as
SB 1273
Page 2
specified.
3)Specifies that the MHSA can only be amended by a two-thirds
vote of both houses of the Legislature and only as long as the
amendment is consistent with and furthers the intent of the
MHSA. Permits provisions clarifying the procedures and terms
of the MHSA to be added by a majority vote of the Legislature.
4)Requires the Department of Health Care Services (DHCS) to
develop and implement mental health plans for Medi-Cal
beneficiaries.
5)Requires mental health plans, whether administered by public
or private entities, to be governed by specified guidelines,
including the provision of culturally competent and
age-appropriate services, to the extent feasible.
6)Requires a mental health plan to assess the cultural
competency needs of the program and to include a process to
accommodate the significant needs with reasonable timeliness.
FISCAL EFFECT: None.
COMMENTS:
1)PURPOSE OF THIS BILL. According to the author, this bill
clarifies that counties can direct local MHSA funds to
outpatient CSS that colocate voluntary and involuntary
patients. The author argues that California is facing a mental
health crisis and lacks 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
SB 1273
Page 3
thoughtful therapeutic treatment. The author states that
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 the 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. The author
concludes that 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)BACKGROUND.
a) Proposition 63. Proposition 63 was passed by voters in
November 2004. The MHSA imposes a 1% income tax on
personal income in excess of $1 million and creates the 16
member Commission charged with overseeing the
implementation of MHSA. The 2015-16 Governor's Budget
projected that $1.776 billion would be deposited into the
Mental Health Services Fund (MHSF) in fiscal year 2015-16.
The MHSA addresses a broad continuum of prevention, early
intervention, and service needs as well as providing
funding for infrastructure, technology, and training needs
for the community mental health system. In addition to
local programs, the MHSA authorizes up to 5% of revenues
for state administration. These include administrative
functions performed by a variety of state entities such as
the DHCS and Office of Statewide Health Planning and
Development. It also funds evaluation of the MHSA by the
Commission.
SB 1273
Page 4
i) Commission. MHSA requires each county mental health
department to prepare and submit a three-year plan to
DHCS that must be updated each year and approved by DHCS
after review and comment by the Commission. In their
three-year plans, counties are required to include a list
of all programs for which MHSA funding is being requested
and that identifies how the funds will be spent and which
populations will be served. Counties must submit their
plans for approval to the Commission before the counties
may spend certain categories of funding.
ii) Funding. The MHSA provides funding for programs
within five components:
(1) Community Services and Supports: 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. Regulations require counties to direct the
majority of its Community Services and Supports funds
to Full-Service Partnerships (FSPs). FSPs are county
coordinated plans, in collaboration with the client
and the family to provide a full spectrum of community
services. These services consist of mental health
services and supports, such as peer support and crisis
intervention services; and, non-mental health services
and supports, such as food, clothing, housing, and the
cost of medical treatment. Currently the County of
Stanislaus, and the City/County of San Francisco
provide CSS as part of their FSP;
SB 1273
Page 5
(2) Prevention and Early Intervention: Provides
services to mental health clients in order to help
prevent mental illness from becoming severe and
disabling;
(3) 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;
(4) 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,
(5) 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.
b) 2016 "No Place Like Home" Initiative. On January 4,
2016, the California State Senate announced a proposed
legislative package intended to use $2 billion of
Proposition 63 bond funds and leverage additional dollars
from other local, state, and federal funding for purposes
of providing housing for chronically homeless persons with
SB 1273
Page 6
mental illness. The initiative includes proposals to
construct permanent supportive housing for chronically
homeless persons with mental illness, provide $200 million
over four years in shorter-term, rent subsidies while the
permanent housing is constructed or rehabilitated, and
support for special housing programs that will assist
families that are part of the child welfare system or are
enrolled in California Work Opportunity and Responsibility
to Kids Housing Support Program.
c) Crisis stabilization (CS). California Code of
Regulations (regulations) defines CS 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. 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 DHCS 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 colocated with other specialty mental health
services, persons providing CS must be separate and
distinct from persons providing other services.
d) Voluntary vs. Involuntary. Regulations regarding the
implementation of MHSA state that programs and/or services
provided with MHSA funds shall be designed for voluntary
SB 1273
Page 7
participation and that no person shall be denied access
based solely on his/her previous voluntary or involuntary
legal status. However, state laws amending MHSA have
permitted funds to be used for services related to Assisted
Outpatient Treatment (AOT), which is an involuntary
program.
3)SUPPORT. The California State Association of Counties (CSAC),
the County Behavioral Health Directors Association of
California, the Urban Counties of California, and the Rural
Counties Representatives of California state that this bill
would provide counties additional flexibility in the use of
MHSA funds for outpatient CS services by clarifying that
counties may use MHSA funds for outpatient CS services which
are often in high demand.
The California State Sheriffs' Association (CSSA) states that
statutory clarification will allow existing funds to be
utilized to address outpatient mental health care, thereby
easing pressure on hospital ERs. CSSA states that the
frequency with which law enforcement deals with the effects of
mental illness grows by the day. Jail inmates suffer from
mental health issues at alarming rates and there are a limited
number of tools available to first responders and
practitioners to address mental illness encountered in the
community. Proposition 63 expanded county mental health
programs but problems still exist. One glaring deficiency is
the lack of treatment and placement options for persons who
could be a danger to themselves or others.
4)OPPOSITION. Disability Rights California (DRC) states that
this bill could allow MHSA funds to pay for involuntary hold
facilities. Any use of MHSA funds for crisis programs must be
voluntary, further the purpose of MHSA, be used to expand
mental health services and not used to supplant funding from
other sources. DRC argues that a change in the statute may
not be necessary to fund voluntary crisis intervention
programs.
SB 1273
Page 8
5)OPPOSE UNLESS AMENDED. The California Labor Federation (CLF)
states that this bill may result in a negative impact on
counties' long-term services by opening up MHSA resources to
private providers rather than by providing much needed
resources to expand and enhance existing CS services currently
performed by highly skilled county professionals. CLF further
states that introducing private providers to perform these
critical services would result in potential lower quality of
care or private providers cherry picking patients with less
severe conditions while, leaving only the more challenging,
more costly patients to county staff.
6)RELATED LEGISLATION.
a) AB 2017 (McCarty) establishes the College Mental Health
Services Trust Account, and appropriate an unspecified
amount annually to that account from the MHSF 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 Senate.
b) AB 1644 (Bonta) reestablishes the 1991 School-Based
Early Mental Health Intervention and Prevention Services
for Children Act, rename it the Healing from Early
Adversity to Level the Impact of Trauma in Schools Act, to
provide outreach, free regional training, and technical
assistance for local educational agencies in providing
mental health services at school sites. AB 1644 is pending
in the Senate.
SB 1273
Page 9
c) AB 2279 (Cooley) requires DHCS to annually compile
county revenue and expenditure information related to the
MHSA based on the existing Annual MHSA Revenue and
Expenditure Report. AB 2279 is pending in the Senate.
d) SB 1466 (Mitchell) requires screening services provided
by Early and Periodic Screening, Diagnosis, and Treatment
Program to include screening for trauma and would require
any victim of child abuse and neglect or a child removed
from a parent or legal guardian by a child welfare agency
to be screened for trauma. SB 1644 is pending in the
Assembly.
7)PREVIOUS LEGISLATION.
a) AB 847 (Mullin), Chapter 6, Statutes of 2016, requires
DHCS to develop a proposal to participate in demonstration
programs administered by the federal Secretary of Health
and Human Services to improve mental health services
furnished by certified community behavioral health clinics
to Medi-Cal beneficiaries and would appropriate $1 million
from the MHSF for the purpose of developing a competitive
proposal.
b) SB 585 (Steinberg), Chapter 288, Statutes of 2013,
allows counties, when included in their plans, to use MHSF
monies for AOT, known as "Laura's Law," if a county elects
to participate in and implement Laura's Law.
SB 1273
Page 10
8)SUGGESTED AMENDMENT. The Committee may wish to consider an
amendment clarifying that if CS services are provided at a
location where involuntary and voluntary services are
colocated and are currently being provided by collectively
bargained employees, then those services must continue to be
provided as such.
REGISTERED SUPPORT / OPPOSITION:
Support
California Hospital Association
California Chapter of the American College of Emergency
Physicians
California Psychiatric Association
California State Association of Counties
California State Sheriffs' Association
City of Newport Beach
County Behavioral Health Directors Association of California
Emergency Nurses Association
SB 1273
Page 11
Kaiser Permanente
KPC Health
League of California Cities
Orange County Chiefs' & Sheriff's Association
Orange County Department of Education
Orange County Medical Association
Orange County Sheriff's Department
Rural County Representatives of California
Urban Counties of California
Steinberg Institute
St. Joseph Hoag Health
Tenet Health
University of California
SB 1273
Page 12
Opposition
Disability Rights California
Analysis Prepared by:Paula Villescaz / HEALTH / (916)
319-2097