BILL ANALYSIS �
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UNFINISHED BUSINESS
Bill No: SB 1009
Author: Senate Budget and Fiscal Review Committee
Amended: 6/25/12
Vote: 21
PRIOR VOTES NOT RELEVANT
ASSEMBLY FLOOR : Not available
SUBJECT : Budget Act of 2012: Mental Health
SOURCE : Author
DIGEST : 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.
Assembly Amendments delete the Senate version of the bill
and insert the above language.
ANALYSIS :
1. Transfers Functions from Department of Mental Health
(DMH) to Other State Departments . This bill eliminates
and modifies most duties of the DPH since its being
restructured into the Department of State Hospitals
whose functions and duties are articulated in AB 1470
(Assembly Budget Committee, 2012) trailer bill
CONTINUED
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legislation. This bill transfers most remaining State
administrative functions for community-based mental
health to the Department of Health Care Services (DHCS)
effective July 1, 2012, including Medi-Cal Specialty
Mental Health services.
2. Licensing and Certification Functions. Under existing
law, 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
elimination of the DMH. The Department of Social
Services will assume responsibilities for licensing of
MHRCs and PHFs. The DHCS will assume responsibilities
for certification of SNFs with Special Treatment
Programs, CRTS/SRPs, and Community Treatment Facilities.
3. 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 DHCS.
This bill modifies statute by making the following key
changes to these provisions of law:
A. 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
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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 DHCS. 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 Department of Finance
(DOF) and State Controller (Controller) to
sequester funds from any county that is unable or
unwilling to contract as specified.
B. 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.
C. 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.
D. 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.
E. 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
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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.
F. 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.
G. 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 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
Early and Periodic Screening, Diagnosis and
Treatment Program 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 Early and Periodic Screening,
Diagnosis and Treatment Program EPSDT mental health
outcomes by no later than October 1, 2013.
H. 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.
I. Provides for counties to set aside funds for
self-insurance, audit settlement, and statewide
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program risk-pools. The counties shall assume all
responsibility and liability for administration of
these mechanisms.
J. 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.
K. 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.
L. 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. This is to include a separate
presentation of data and methodology to forecast
trends in the provision of Early and Periodic
Screening, Diagnosis and Treatment Program services
to estimate annual Early and Periodic Screening,
Diagnosis and Treatment Program related costs and
other information.
M. 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.
N. Modifies federal audit exceptions against the
state regarding federal funds expended by counties
in order to conform to AB 1480 (Assembly Budget
Committee, 2012) regarding the Realignment
superstructure and specifies which Realignment
accounts can be used for this purpose.
O. Provides for specified Realignment accounts to
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be used for certified public expenditures to be
consistent with federal Medicaid requirements.
4. 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 (Assembly Budget Committee,
2012) regarding the Realignment superstructure.
5. Other Conforming Provisions and Changes. This bill also
makes other conforming changes including the following:
A. Provides for broader stakeholder discussions in
the development of standards and guidelines for
local quality assurance activities as specified in
the Welfare and Institutions Code Section 14725.
B. 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 (Assembly
Budget Committee 2012), the Omnibus Health trailer
bill where applicable.
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C. Continues the performance contracting process as
a conforming action to AB 1467, the Omnibus Health
trailer bill.
D. Recasts the Patient Rights Program by utilizing
a joint contracting process between the DHCS and
new Department of State Hospitals.
E. Modernizes terminology in the statute by using
the reference "individuals with mental illness" in
lieu of terms such as "chronically mentally
disordered patients".
F. Provides the DHCS with regulation authority
where applicable.
G. Updates certain reporting requirements for the
DHCS and the Department of State Hospitals.
H. Deletes un-operative provisions of statute that
are not in effect or would become effective in the
future.
FISCAL EFFECT : Appropriation: Yes Fiscal Com.: Yes
Local: No
According to the Senate Budget and Fiscal Review Committee,
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.
DLW:d 6/25/12 Senate Floor Analyses
SUPPORT/OPPOSITION: NONE RECEIVED
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