BILL ANALYSIS
Senate Appropriations Committee Fiscal Summary
Senator Christine Kehoe, Chair
543 (Leno)
Hearing Date: 05/28/2009 Amended: 05/13/2009
Consultant: Dan Troy Policy Vote: Judiciary 3-0
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BILL SUMMARY: SB 543 would authorize a minor aged 12 or older
to consent to mental health services or counseling on an
outpatient basis or to residential shelter services, if the
following conditions are satisfied: 1) the minor is mature
enough to participate intelligently in the services; or 2) the
minor presents a danger of serious physical or mental harm to
himself or herself, or the minor is the alleged victim of incest
or child abuse.
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Fiscal Impact (in thousands)
Major Provisions 2009-10 2010-11 2011-12 Fund
Mental health services/ Unknown, likely significant costs
General
minor consent
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STAFF COMMENTS: This bill meets the criteria for referral to the
Suspense File.
Under current law, a minor aged 12 or older may consent on his
or her own for mental health treatment or counseling on an
outpatient basis or to residential shelter services if both of
the following conditions are satisfied:
1) The minor, in the opinion of the attending professional,
is mature enough to participate intelligently in the
service.
2) The minor presents a danger of serious physical or
mental harm to himself or herself, or others, without the
service, or the minor is an alleged victim of incest or
child abuse.
This bill would provide that minors may consent to their own
treatment even if only the first of those conditions is met.
Additionally, the bill would also expand the definition of a
professional person relating to mental health or counseling
services to include licensed clinical social workers and specify
that parental notification is not required when the minor is
receiving outpatient mental health treatment or counseling
services.
There are a variety of mental health programs and services
accessible to minors, with or without parental consent.
Counties have received approximately $7.7 million annually in
lump sum payments (Managed Care) for minor consent costs for the
last 10 years (though the Governor vetoed an amount of funding
identical to minor consent costs in 2008 Budget Act, but did not
specifically identify this program for reduction). There is the
Early and Periodic Screening, Diagnosis, and Treatment (EPSDT),
counties may use realignment funding to provide these services,
and there is also funding available through the Mental Health
Services Act (Proposition 63, approved by
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SB 543 (Leno)
the voters in 2004). In regard to minor consent issues,
counties may also receive reimbursements through the "sensitive
services" option in Medi-Cal.
By lowering the threshold for minors to consent to services on
their own, this bill would likely increase eligibility for
mental health services. In some cases (e.g., managed care), it
may be that counties would be unlikely to receive any more state
funding for these costs, so increases, in these instances,
should be viewed more as cost pressures than as direct costs.
For other programs, increases eligibility would almost certainly
directly in increased state costs (e.g., "sensitive services"
Medi-Cal).
A precise cost estimate is not possible, as appropriate data is
not gathered that details the number of minors requesting or in
need of mental health services that do not meet the criteria
under current law but would meet the criteria under the
provisions of this bill. By removing the "physical or mental
harm" condition for minor consent, this bill would likely expand
the universe of eligible minors significantly, as many minors
would likely be able to meet the "maturity" threshold. As costs
for mental health services average thousands of dollars per
unit, depending on the program and intensity of required
service, it is likely that this bill would result in costs or
cost pressures in the hundreds of thousands of dollars, or even
more.
One issue of concern regarding minor consent that the author's
office has identified is liability on behalf of the service
provider. To the extent the author wishes to eliminate state
costs and pressures, staff suggests amending the bill to limit
the change minor consent to extending toward provider liability,
while leaving the standard as is for purposes of program
eligibility.