BILL ANALYSIS �
SENATE COMMITTEE ON BUDGET AND FISCAL REVIEW
Mark Leno, Chair
Bill No: AB 1469
Author: Committee on Budget
As Amended: June 25, 2012
Consultant: Michelle Baass
Fiscal: Yes
Hearing Date: June 25, 2012
Subject: Budget Act of 2012
Summary: This is the Omnibus Mental Health Trailer Bill
for 2012-13. It provides for a comprehensive restructuring
of community-based mental health services at both the State
and local levels and is necessary to effectuate the 2011
Realignment legislation. It makes the following key
changes.
Transfers Functions from Department of Mental Health to
Other State Departments . This bill eliminates and modifies
most duties of the department since its being restructured
into the Department of State Hospitals whose functions and
duties are articulated in AB 1470 trailer bill legislation.
This bill transfers most remaining State administrative
functions for community-based mental health to the
Department of Health Care Services effective July 1, 2012,
including Medi-Cal Specialty Mental Health services.
Licensing and Certification Functions. Under existing law,
the Department of Mental Health (DMH) is responsible for
assuring compliance related to facility licensing and
program certification of a range of 24-hour psychiatric and
rehabilitation care facilities. The programs subject to
licensure and certification by DMH are: Mental Health
Rehabilitation Centers (MHRCs); Psychiatric Health
Facilities (PHFs); Skilled Nursing Facilities with Special
Treatment Programs (SNFs/STPs); Community Residential
Treatment Systems (CRTS) -- also known as Social
Rehabilitation Programs (SRPs); and Community Treatment
Facilities (CTFs).
This bill transfers licensing and certification
responsibilities to other departments due to the
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elimination of the DMH. The Department of Social Services
will assume responsibilities for licensing of MHRCs and
PHFs. The Department of Health Care Services will assume
responsibilities for certification of SNFs with Special
Treatment Programs, CRTS/SRPs, and Community Treatment
Facilities.
Recasts State and Local Specialty Mental Health Services
provided through Medi-Cal. Under existing law, County
Mental Health Plans administer Medi-Cal Specialty Mental
Health Program services at the local level, including the
Early and Periodic Screening, Diagnosis and Treatment
Program. This arrangement operates under its own
distinctive federal Medicaid Waiver which is administered
by the Department of Health Care Services.
This bill modifies statute by making the following key
changes to these provisions of law:
Provides for the DHCS to contract with Mental
Health Plans, who may include individual counties,
counties acting jointly, or an organization or
non-governmental entity determined by the DHCS to meet
mental health plan standards. It provides that if a
county decides not to contract with the DHCS, or is
unable to meet standards set by the DHCS, the county
is to inform the department. Further, the DHCS shall
ensure that specialty mental health services are
provided to Medi-Cal beneficiaries and the DHCS may
contract as specified in order to provide this
assurance of service delivery.
In addition, if a county does not contract with the
State for specialty mental health services, then the
DHCS shall work with the DOF and State Controller to
sequester funds from any county that is unable or
unwilling to contract as specified.
If a county does not contract with the State, the
DHCS shall notify the DOF, the fiscal and policy
committees of the Legislature and the Controller of
the amounts to be sequestered from specified
Realignment accounts.
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Mental Health Plans shall be financially
responsible for ensuring access and a minimum required
scope of benefits and services to Medi-Cal
beneficiaries who are residents of that county
regardless of where the beneficiary resides. The same
definition of medical necessity is to be used and the
minimum scope of benefits offered by each Mental
Health Plan must be the same, except to the extent
that prior federal approval is received and is
consistent with state and federal laws.
Specifies that Mental Health Plans shall provide
Medi-Cal Specialty Mental Health services to eligible
Medi-Cal beneficiaries, including both adults and
children, including services provided under the Early
and Periodic Screening, Diagnosis and Treatment
Program (EPSDT).
Expresses the intent of the Legislature to
establish a standard set of guidelines that governs
the provision of Medi-Cal Specialty Mental Health
Services at the local level, consistent with federal
law and consistent with guidelines established by the
DHCS. It further is the intent that Mental Health
Plans be developed and implemented regardless of
whether other systems of Medi-Cal managed care are
implemented and that Sections 14681 to 14685,
inclusive, shall not be construed to mandate the
participation of counties in Medi-Cal managed mental
health plans.
Declares that Section 14685 of Welfare and
Institutions Code, regarding a county's first right of
refusal to serve as a mental health plan, be repealed
on November 7, 2012 if Section 36 has been added to
Article XIII of the California Constitution as of that
date.
Expresses the intent of the Legislature to develop
a performance outcome system for the Early and
Periodic Screening, Diagnosis, and Treatment Program
that will improve outcomes at the individual and
systems levels and will inform fiscal decision making
related to the purchase of services. The DHCS, in
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collaboration with the California Health and Human
Services Agency, and in consultation with the Mental
Health Services Oversight and Accountability
Commission, shall create a plan for a performance
outcome system for EPSDT mental health services. By
no later than September 1, 2012, a stakeholder
advisory committee shall be convened for the purpose
of developing this plan. This bill specifies
objectives for this purpose and requires the DHCS to
provide a plan, including milestones and timelines for
EPSDT mental health outcomes by no later than October
1, 2013.
Requires all Mental Health Plans to comply with
federal laws, regulations, guidelines, standards, and
requirements specified in the State Medicaid Plan,
federal waiver, and mental health plan contract.
Provides for counties to set aside funds for
self-insurance, audit settlement, and statewide
program risk-pools. The counties shall assume all
responsibility and liability for administration of
these mechanisms.
Provides for the DHCS to propose a rulemaking
package consistent with the DHCs' appeals process
(including for Mental Health Plans and subcontractors)
that is in effect on July 1, 2012 by no later than the
end of the 2013-14 fiscal year.
Requires Mental Health Plans to use the DHCS fiscal
intermediary of the Medi-Cal Program for all claims
processing for inpatient psychiatric hospital services
as specified.
Requires the DHCS to consult with the California
Mental Health Directors Association in February and
September of each year to obtain data and methodology
necessary to forecast future fiscal trends in the
provision of Medi-Cal Specialty Mental Health
services, including the Early and Periodic Screening,
Diagnosis and Treatment Program (EPSDT). This is to
include a separate presentation of data and
methodology to forecast trends in the provision of
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EPSDT services to estimate annual EPSDT related costs
and other information.
Requires the DHCS to consult with staff of the
Legislature, counties, providers, and other
stakeholders in the development of State Plan
amendments or federal waivers.
Modifies federal audit exceptions against the state
regarding federal funds expended by counties in order
to conform to AB 1480 regarding the Realignment
superstructure and specifies which Realignment
accounts can be used for this purpose.
Provides for specified Realignment accounts to be
used for certified public expenditures to be
consistent with federal Medicaid requirements.
Further Advances 2011 Realignment. In 1991, legislation
realigned the fiscal and administrative responsibilities
for specialty mental health care. The intent of
realignment was to provide a more stable funding source for
community-based services, to shift program accountability
to the local level, and to make services more
client-centered and family-focused. 1991 Realignment
revenues, funded by an increase in the sales tax and in
vehicle license fees, are collected by the state and
allocated to various accounts and subaccounts in the Local
Revenue Fund. The Mental Health Subaccount is the
principal fund that contains revenues for the provision of
local mental health services. Realignment revenues are
expended by counties to provide specialty mental health
services to low-income individuals not eligible for
Medi-Cal, and it serves as the non-federal match for
Medi-Cal Specialty Mental Health services.
This bill recasts certain technical funding provisions from
1991/92 Realignment, and revises provisions from 2011
Realignment which are consistent with statutory changes
contained in AB 1480 regarding the Realignment
superstructure.
Other Conforming Provisions and Changes. This bill also
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makes other conforming changes including the following:
Provides for broader stakeholder discussions in the
development of standards and guidelines for local
quality assurance activities as specified in Section
14725 of W&I Code.
Adds consultation with California Mental Health
Directors Association, California Mental Health
Planning Council, and the Mental Health Services
Oversight and Accountability Commission to provide for
increased transparency in mental health policymaking
and to conform with AB 1467, the Omnibus Health
trailer bill where applicable.
Continues the performance contracting process as a
conforming action to AB 1467, the Omnibus Health
trailer bill.
Recasts the Patient Rights Program by utilizing a
joint contracting process between the Department of
Health Care Services and new Department of State
Hospitals.
Modernizes terminology in the statute by using the
reference "individuals with mental illness" in lieu of
terms such as "chronically mentally disordered
patients".
Provides the Department of Health Care Services
with regulation authority where applicable.
Updates certain reporting requirements for the
Department of Health Care Services and the Department
of State Hospitals.
Deletes un-operative provisions of statute that are
not in effect or would become effective in the future.
Fiscal Effect: Savings of $20 million special fund in
2011-12 when transition commenced, with ongoing
efficiencies for 2012-13 and future years at both the State
and local levels.
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Support: Unknown
Opposed: Unknown
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