BILL ANALYSIS �
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: SB 1136
AUTHOR: Steinberg
AMENDED: April 16, 2012
HEARING DATE: April 25, 2012
CONSULTANT: Bain
SUBJECT : Health: mental health: Mental Health Services Act.
SUMMARY : Transfers Mental Health Service Act (MHSA) functions
from Department of Mental Health (DMH) to the Department of
Health Care Services (DHCS) and the Office of Statewide Health
Planning and Development (OSHPD). Requires county mental health
program and expenditure plans to be adopted by the county board
of supervisors and submitted to the Mental Health Services
Oversight and Accountability Commission (OAC), and requires
county plans to be certified by the county mental health
director and the county auditor controller as complying with the
MHSA. Authorizes the OAC, in collaboration with DHCS and in
consultation with specified entities, to work in designing a
comprehensive joint plan for a coordinated evaluation of client
outcomes in the community-based mental health system, and
requires the Health and Human Services Agency (Agency) to lead
this comprehensive joint plan effort. Permits prevention and
early intervention funds to be used to broaden the provision of
community-based mental health services, and codifies Innovation
Program project requirements. Authorizes the appointment,
subject to Senate confirmation, of a Deputy Director of Mental
Health and Substance Use Disorder Services within DHCS.
Overview
This bill makes changes to the MHSA enacted through voter
approval of Proposition 63 of the November 2, 2004, ballot.
Proposition 63 levied an additional tax at the rate of 1 percent
on that portion of a taxpayer's taxable income in excess of $1
million to fund county mental health programs. Revenue from the
tax and interest from the tax levied by the MHSA are projected
to be $1.117 billion in 2012-13.
There have been significant changes to the MHSA and state
funding and administration of mental health programs enacted
through health budget trailer bills in 2011. In addition, there
are significant changes proposed by the Administration as part
of the 2012-13 budget.
Continued---
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Due to the state's fiscal condition, in March 2011, the
Legislature enacted a one-time funding shift of Proposition 63
funds, and made several permanent changes to the MHSA. For the
2011-12 fiscal year only, AB 100 (Committee on Budget), Chapter
5, Statutes of 2011, amended the MHSA to allocate, on a one-time
basis, $861 million in MHSA funds to counties to support the
Early and Periodic Screening, Diagnosis, and Treatment (EPSDT)
Program, Medi-Cal Specialty Mental Health Managed Care, and
mental health services provided to special education students.
In addition to the one-time funding shift of MHSA funding, AB
100 also made changes to MHSA administration, including reducing
the percentage amount available from MHSA revenues for state
administration from 5 percent to 3.5 percent, requiring monthly
distributions from the MHSA Fund, having the state (instead of
DMH) administer the MHSA Fund, and having the OAC provide
technical assistance to counties. When AB 100 was enacted, it
was assumed follow-up legislation would be enacted to address
several issues left unresolved by that measure.
This year, the 2012-13 proposed Governor's January Budget
creates the Department of State Hospitals, eliminates DMH, and
transfers community mental health programs and functions to six
departments and entities.
The author indicates the purpose of this bill is to clarify
local and state responsibilities as well as procedures and terms
of the MHSA which are necessary due to restructuring of the
public mental health system at both the local and state levels
which began last year. Further, the author indicates this
legislation is necessary to clarify the MHSA in light of the
issues left temporarily unresolved by AB 100, and is intended to
be in lieu of the MHSA-related provisions of the trailer bill
language submitted as part of the Governor's 2012-13 Budget
proposal.
Deputy Director of Mental Health and Substance Use Disorder
Services in DHCS
Existing law : Requires the Governor, with the consent of the
Senate, to appoint the Director of DMH. Existing law authorizes
the Governor, upon recommendation of the director, to appoint a
Chief Deputy Director of DMH who is required to hold office at
the pleasure of the Governor.
This bill : Authorizes the Governor or the Director of DHCS to
appoint, subject to Senate confirmation, a Deputy Director of
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Mental Health and Substance Use Disorder Services within DHCS.
This bill requires the salary for the Deputy Director to be
fixed in accordance with law.
The author indicates that the reason for this change is that the
merger of community-based mental health services, including
Medi-Cal Specialty Mental Health Managed Care, the EPSDT
Program, and MHSA services into DHCS is a substantial
undertaking. To ensure accountability to the public and the
Legislature, the author makes this position subject to Senate
confirmation.
Changes to Human Resources, Education and Training Programs
provisions of the MHSA
Existing law :
1. Requires, through MHSA, county mental health program to
submit to DMH a needs assessment identifying its shortages in
each professional and other occupational category in order to
increase the supply of professional staff and other staff that
county mental health programs anticipate they will require in
order to provide the increase in services projected to serve
additional individuals and families.
2. Requires DMH to identify the total statewide needs for
each professional and other occupational category and to
develop a five-year education and training development plan.
Requires subsequent plans to be adopted every five years.
3. Requires each five-year plan to be reviewed and approved
by the California Mental Health Planning Council (Council).
This bill :
1.Shifts state MHSA workforce education and training
administrative functions from DMH to OSHPD.
2.Requires OSHPD to work in coordination with the California
Mental Health Planning Council (Council) in identifying the
currently required statewide needs for each professional and
occupation category, and would require the statewide needs
assessment to use county needs assessment information.
3.Establishes April 1, 2014 as the due date for the next
five-year plan.
The author indicates the purpose of the above-described
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provision is to clarify provisions regarding workforce
development and planning by linking the county needs assessment
information with the five-year plan, while continuing the
existing role of the Council in this effort. The author argues
linking the county needs assessment to the five-year plan will
assist in ensuring that the workforce information provided by
the counties is utilized more comprehensively by the state.
Additionally, this bill also identifies the due date of the next
five-year plan (April 1, 2014), and designates OSHPD to lead
this effort. The author states the existing five-year plan is in
effect until 2013, and it has typically taken a year for
counties to provide their local assessment of need and for the
state to analyze this information and then produce a final
report. The author concludes designating OSHPD as the lead state
entity in this effort in lieu of the DMH is consistent with the
Governor's proposal.
Innovative Programs under MHSA
Existing law :
1.Requires, through the MHSA, county mental health programs to
develop plans for Innovative Programs to be funded under the
MHSA. Requires the Innovative Programs to have the following
purposes:
a. To increase access to underserved groups;
b. To increase the quality of services, including better
outcomes;
c. To promote interagency collaboration; and
d. To increase access to services.
1. Requires county mental health programs to receive funds
for their innovation programs upon approval by the OAC.
This bill :
1. Requires all projects included in the innovative program
portion of the county plan to meet the following requirements:
a. Address one of the following purposes as its primary
purpose:
i. Increase access to underserved groups,
ii. Increase the quality of services, including
measurable outcomes,
iii. Promote interagency and community
collaboration, or
iv. Increase access to services; and
b. Support innovative approaches by doing one of the
following:
i. Introducing new mental health practices or
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approaches, including, but not limited to, prevention
and early intervention,
ii. Making a change to an existing mental health
practice or approach, including, but not limited to,
adaptation for a new setting or community, or
iii. Introducing a new application to the mental
health system of a promising community-driven practice
or an approach that has been successful in non-mental
health contexts or settings.
1.Permits an innovative project to affect virtually any aspect
of mental health practices or assess a new or changed
application of a promising approach to solving persistent,
seemingly intractable mental health challenges, including, but
not limited to, any of the following:
a. Administrative, governance, and organizational
practices, processes, or procedures;
b. Advocacy;
c. Education and training for service providers, including
nontraditional mental health practitioners;
d. Outreach, capacity building, and community development;
e. System development;
f. Public education efforts;
g. Research; and
h. Services and interventions, including prevention, early
intervention, and treatment.
1.Requires, if an innovative project has proven successful and
county chooses to continue it, the project work plan to
transition to another category of funding as appropriate.
2.Requires county health programs to expend funds (rather than
receive funds under existing law) for their innovation
programs upon approval by the OAC.
The author indicates the purpose of these provisions is to
clarify the framework for content of projects to be included in
Innovative Programs, which increases the ability for oversight
by the public and the Legislature. The author states this
framework reflects guidelines adopted by the OAC. The purpose of
placing these requirements in statute is to increase the
public's knowledge of these provisions, to enable all involved
entities, including the Legislature, OAC, counties, and local
communities to actively engage in how to utilize these programs
within the community mental health service system and to
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increase accountability regarding the expenditure of these funds
by having statute more clearly reflect what should be included
in the projects. In addition, this bill also authorizes counties
to expend funds for Innovative Programs upon approval by the OAC
to streamline the expenditure of funds. Previously, the counties
would only receive an allocation of funds from the OAC.
Prevention and Early Intervention (PEI) programs in MHSA
Existing law : Requires DMH to establish a PEI program designed
to prevent mental illnesses from becoming severe and disabling;
requires the PEI program to emphasize improving timely access to
services for underserved populations; and requires the program
to include specified components.
This bill :
1.Transfers state administration of PEI from DMH to DHCS.
2.Permits PEI funds to be used to broaden the provision of
community-based mental health services by adding PEI services
or activities to these services.
3.Requires DHCS, instead of DMH in existing law, to revise
program elements applicable to all county mental health
programs, and requires DHCS to do so consistent with OAC
guidelines.
The author indicates this change requires DHCS, in coordination
with the counties, to establish PEI programs, which assist in
facilitating a stronger partnership at both the state and local
levels and strengthens the role of the counties in ensuring a
consistent, statewide program for PEI. The author also states
that this bill clarifies that PEI funds can be used to
strengthen existing community-based mental health programs by
adding PEI services or activities to these existing programs.
This purpose of this change is to provide counties with greater
clarity in how they choose to structure local mental health
services. The author states the proposed change also reinforces
the role of the OAC by acknowledging their existing involvement
with PEI Program oversight by stating that any DHCS revisions to
PEI Programs must be consistent with OAC guidelines.
The author states OAC has established guidelines but existing
statute does not directly spell out this fundamental aspect. The
intent of these changes is to strengthen and acknowledge the
partnership of the DHCS, counties and OAC in overseeing and
administering these important PEI programs.
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Mental Health Services Oversight and Accountability Commission
Existing law : Establishes OAC to oversee the Adult and Older
Adult Mental Health System of Care Act, Human Resources,
Education, and Training Programs, Innovative Programs, PEI
Programs, and the Children's Mental Health Services Act. The OAC
consists of 16 voting members, and it has the authority to hire
staff within the funding allocated. The OAC is required to
administer its operations separate and apart from DMH.
This bill : Replaces references to DMH to DHCS, and provides new
authority for OAC, as follows to:
1. Assist in providing technical assistance to accomplish the
purposes of MHSA, the Adult and Older Adult Mental Health
System of Care Act and the Children's Mental Health Services
Act, in collaboration with DHCS and in consultation with the
California Mental Health Directors Association (CMHDA);
2. Work in collaboration with DHCS and the Council, and in
consultation with CMHDA, in designing a comprehensive joint
plan for a coordinated evaluation of client outcomes in the
community-based mental health system, as defined. Requires
Agency to lead this comprehensive joint plan effort;
3. Use data obtained from DHSC and OSHPD for training,
technical assistance and accountability;
4. Develop strategies to overcome discrimination (in addition
to stigma in existing law); and
Requires OAC to ensure the perspective and participation of
individuals at-risk for severe mental illness, in addition to
individuals suffering from severe mental illness and their
family members.
The author states this bill continues and expands the ongoing
role of the OAC in several ways. First, it acknowledges the need
for the OAC to continue to provide technical assistance
regarding the MHSA, which is now even more crucial as the
community mental health system evolves with the 2011 Realignment
and pending federal health care reform. Second, it allows the
OAC to obtain data from the DHCS and OSHPD as these entities are
performing new functions involving the MHSA. Third, this bill
authorizes the OAC to be actively involved in designing a joint
plan for evaluation of the community-based mental health system.
The author states the OAC is presently conducting evaluations of
selected community-mental health system components and needs to
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be involved in an overall framework, particularly because of its
MHSA expertise. Further, this bill includes the OAC as a joint
partner in the establishment of performance outcomes, in
collaboration with CMHDA. The author argues the independence,
oversight and expertise of the OAC needs to continue and is a
key component of the success of the MHSA.
This bill also authorizes the design of a comprehensive joint
plan for a coordinated evaluation of client outcomes in the
community-based mental health system. The purpose of this change
is to utilize the leadership role of Agency to focus existing
evaluation efforts and to plan for additional future efforts so
that a shared evaluation framework can be identified and used.
This will facilitate the identification and use of valid and
reliable data for evaluation efforts and will enable all
involved entities to share resources when applicable and share
programmatic expertise more readily.
Integrated Plans for Prevention, Innovation, and System of Care
Services
Existing law : Requires, through MHSA, each county mental health
program to prepare and submit a three-year plan. The plan must
include specified components dealing with programs for mental
illness.
This bill :
1.Requires county mental health program three-year Integrated
Plans for Prevention, Innovation, and System of Care Services
to be both program and expenditure plans, and requires
counties to submit annual updates to these plans that are
adopted by the county board of supervisors to OAC within 30
days of adoption.
2.Requires the three-year program and expenditure plan to be
based on available unspent funds and estimated revenue
allocations provided by the state and in accordance with
established stakeholder engagement and planning requirements,
and requires the annual updates to include the elements
required in the three-year plans.
3.Requires the three-year program and expenditure plans and
annual updates to additionally include:
a. Certification by the county mental health director,
which ensures that the county has complied with all
pertinent regulations, laws, and statutes of the MHSA,
including stakeholder participation and nonsupplantation
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requirements; and
b. Certification by the county mental health director and
by the county auditor controller that the county has
complied with any fiscal accountability requirements as
directed by DHCS and that all expenditures are consistent
with the requirements of the MHSA.
4.Requires DHCS to annually inform CMHDA and OAC of the
methodology used for revenue allocation to the counties.
5.Repeals the requirement that DMH, in consultation with CMHDA,
OAC and Council, inform counties of the amounts of funds
available for services to children under the Children's Mental
Health Services Act and to adults and seniors under the Adult
and Older Adult Mental Health System of Care Act.
6. Requires county mental health programs to prepare
expenditure plans for Innovative Programs and for PEI
programs, in addition to the expenditure plans required under
existing law.
7. Requires program and expenditure plans to be developed in
consultation with providers of alcohol and drug services and
health care organizations.
8. Deletes the requirement that DMH establish requirements
for the content of plans.
9. Requires the performance outcomes for services to be
established jointly by DHCS and OAC, in collaboration with
CMHDA, instead of DMH under existing law.
The author states that the purpose of the above-described
changes is to modify the integrated plan approval process to
ensure community participation, oversight and accountability, as
follows: first, these provisions clarify that the integrated
three-year plan means a program and expenditure plan, and the
change ensures that the substance of the plan includes both.
Second, it requires a county board of supervisors to adopt the
integrated three-year program and expenditure plan, along with
annual updates to provide local accountability and to streamline
the expenditure of funds so that dollars are directed to
services and supports. State oversight of these plans is also
ensured by requiring the integrated three-year program and
expenditure plans and annual updates to be provided to OAC
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within 30 days after adoption.
To ensure accountability to the provisions of the MHSA, as part
of the county board of supervisors approval process, the author
states this bill requires both the county mental health Director
and county Auditor Controller to certify compliance with key
provisions of MHSA. Specifically, the mental health director
must certify that all pertinent regulations, laws and statutes
of MHSA, including stakeholder participation and
nonsupplantation requirements of MHSA are met, and the county
Auditor Controller must certify that expenditures are consistent
with the requirements of MHSA.
This bill also deletes language from AB 100 regarding the DMH
not issuing guidelines prior to January 1, 2012. The author
states the reason for this deletion is this prohibition is no
longer applicable because DMH is proposed to be abolished as of
June 30, 2012, and because AB 100 lowered the state
administrative expenditure cap from 5 percent of the annual MHSA
revenues to 3.5 percent, so state staff is not available to
issue guidelines.
This bill also modifies existing statute regarding the amount of
funds available for services to children and adults by requiring
DHCS to inform CMHDA and OAC of the methodology used for revenue
allocations to the counties overall in lieu of the amounts of
funds available. The author states this bill simplifies that
process.
Finally, the author states these provisions clarify that
performance outcomes are to be established jointly by DHCS and
OAC in collaboration with the CMHDA, when DMH previously had
this sole responsibility. The author states that including DHCS
and OAC ensures that all MHSA components are addressed in the
performance outcomes, and it is important to recognize the role
of the counties in this process, which is not addressed in
existing law.
Mental Health Services Act Fund
Existing law : Establishes the MHSA Fund in the state Treasury,
and continuously appropriates funds for mental health-related
purposes.
This bill : Includes Innovative Programs within the continuous
appropriation and eliminates the requirement that DHSC consult
with DMH in seeking federal Medicaid approvals.
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The author indicates that the purpose of the continuous
appropriation change is to clarify that Innovative Programs are
also included in the expenditure of funds, and to make
conforming changes to reflect the shift of program
responsibility from DMH to DHCS. The author and OAC indicate the
inclusion of Innovative Programs within the continuous
appropriation is a technical conforming change and reflects
existing practice.
MHSA funding distributions
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|Policy |Existing Law |This Bill |
|Issue | | |
|-----------+--------------------------+--------------------------|
|Controller |Requires the Controller |Requires the Controller's |
|distributio|to distribute all |distribution to be |
|n of MHSA |unexpended and unreserved |pursuant to a methodology |
|funds to |funds on deposit in the |provided by DHCS. |
|Local |state MHSA Fund to each | |
|Mental |Local Mental Health | |
|Health |Services Fund on or | |
|Services |before the 15th day of | |
|Fund |each month. | |
|-----------+--------------------------+--------------------------|
|Funds from |Requires funding |Requires counties to base |
|MHSA |distributions to be based |their expenditures on the |
| |on amounts specified in |county mental health |
| |the county mental health |program's three-year plan |
| |program's three-year plan |or annual update. |
| |or update. | |
|-----------+--------------------------+--------------------------|
|Allocations|Allocate funds from the |Requires counties to use |
| of MHSA |MHSA Fund for specified |funds distributed from |
|funds |purposes. |the MHSA Fund for |
| | |specified purposes. |
|-----------+--------------------------+--------------------------|
|PEI |Permits the allocation |Permits the expenditure |
|allocation |for PEI to increase in |for PEI to increase in |
|increase |any county which DMH |any county which DMH |
|in |determines that the |determines that the |
|counties |increase will decrease |increase will decrease |
| |the need and cost for |the need and cost for |
| |additional services to |additional services to |
| |severely mentally ill |severely mentally ill |
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| |persons in that county by |persons in that county by |
| |an amount at least |an amount at least |
| |commensurate with the |commensurate with the |
| |proposed increase. |proposed increase. |
|-----------+--------------------------+--------------------------|
|State |Permits the statewide |Repeals this provision. |
|allocation |allocation for PEI to be | |
|increase |increased whenever OAC | |
| |determines that all | |
| |counties are receiving | |
| |all necessary funds for | |
| |services to severely | |
| |mentally ill persons and | |
| |have established prudent | |
| |reserves and there are | |
| |additional revenues | |
| |available in the Fund. | |
|-----------+--------------------------+--------------------------|
|Funds |Requires, prior to making |Requires, prior to making |
|reserved |the allocations for |the allocations for WET, |
|for state |workforce, education and |capital facilities and |
|entities. |training (WET), capital |technological needs, PEI |
| |facilities and |and county mental health |
| |technological needs, PEI |programs, funds to be |
| |and county mental health |reserved for the costs |
| |programs, funds to be |for DHCS, Council, OAC, |
| |reserved for the costs |OSHPD, and the Department |
| |for DMH, Council, and OAC |of Public Health (DPH), |
| |to implement all duties |to implement all duties |
| |under these programs. |under these programs. |
| | | |
| |Caps these state |Includes these additional |
| |administrative costs at |state entities within the |
| |3.5 percent of the total |3.5 percent cost cap. |
| |of annual revenues | |
| |received for the Fund. | |
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The purpose of these changes is to clarify that expenditures by
the counties are based on the integrated three-year program and
expenditure plan or annual update and to clarify that the State
Controller distributes funds pursuant to a methodology provided
by the DHCS. The author argues state oversight by the
administrating department is needed to maintain integrity of
MHSA Fund distributions and expenditures. In addition, the
changes clarify that 20 percent of funds distributed to counties
must be used for PEI Programs, and this bill makes technical
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13
corresponding changes which are consistent with MHSA in the
expenditure of PEI funds.
In addition, this bill also adds DHCS, OSHPD, and DPH and any
other state agency to the list of state entities to be funded
and included in the 3.5 percent state administrative cost cap.
The author states this change is consistent with the shift of
responsibilities to DHCS, OSHPD and DPH in performing functions
which previously were conducted by the DMH, and also recognizes
that other state entities (such as Department of Veterans
Affairs) presently utilize MHSA funds for specified services.
Lead state department for community-based mental health
programs, MHSA regulation development, and services to children
with severe mental illness
Existing law :
1.Requires DMH to implement the mental health services provided
thorough the Adult and Older Adult Mental Health System of
Care, for Innovative Programs, and PEI Programs through
contracts with county mental health programs. Requires DMH to
establish PEI programs to prevent mental illness from becoming
severe and disabling. Requires county mental health programs
to contract with DMH for services to children with severe
mental illness.
2.Requires the state to develop regulations as necessary for DMH
and the OAC or designated state and local agencies to
implement the MHSA.
This bill :
1.Transfers these functions from DMH to DHCS, and allows DHCS
and OSHPD to enter into contracts, instead of DMH in existing
law.
2.Requires DHCS (instead of DMH) to contract with county mental
health programs for the provision of services to children with
severe mental illness.
3.Requires DHCS (instead of the state) in consultation with OAC,
to develop regulations.
The author states this bill maintains the existing performance
contracting requirements as enacted in MHSA. The author states
the Governor's proposed trailer bill legislation eliminates this
requirement, and the author believes it is important to continue
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the performance contracting provisions in order to maintain
appropriate state oversight and the integrity of MHSA. In
addition, this bill makes conforming changes by listing DHCS and
OSHPD, instead of DMH, to reflect the proposed transfer.
The author indicates the purpose of this change shifting
regulatory authority to DHCS (instead of DMH) is to make a
conforming change consistent with the shift to DHCS made by this
bill. In addition, this change requires coordination with OAC
because they have an integral role in MHSA oversight,
specifically of the Innovation Programs and PEI program
provisions.
Annual MHSA Revenue and Expenditure Report
Existing regulations : Require counties to submit to DMH an
Annual MHSA Revenue and Expenditure Report (Report), consisting
of specified components, including administrative expenditures,
program expenditures, and one-time expenditures.
This bill :
1.Requires DHCS, in consultation with OAC and CMHDA, to develop
and administer instructions for the Report.
2.Requires this Report to be submitted electronically to DHCS
and OAC. Requires the purpose of the Report is as follows:
a. Identify the expenditures of MHSA funds that were
distributed to each county;
b. Quantify the amount of additional funds generated for
the mental health system as a result of the MHSA;
c. Identify unexpended funds and interest earned on MHSA
funds; and
d. Determine reversion amounts, if applicable, from prior
fiscal year distributions.
1.Requires this report is intended to provide information that
allows for the evaluation of all of the following:
a. Children's System of Care;
b. PEI strategies;
c. Innovative Programs;
d. Workforce education and training;
e. Community services and supports; and
f. Adult and Older Adult Mental Health System of Care.
The author states counties presently provide DMH and OAC the
Report, and the above language codifies the Report. The author
argues codifying the Report ensures its ongoing nature and
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15
provides for transparency of the funding by individual counties
for both local and state oversight.
Amendments to MHSA
Existing law : Permits amendments to all provisions of MHSA by a
two-thirds vote of the Legislature so long as such amendments
are consistent with and further the intent of MHSA. Existing law
permits the Legislature, by majority vote, to add provisions to
clarify procedures and terms including the procedures for the
collection of the tax surcharge imposed by MHSA.
This bill : Makes legislative finding and declarations that this
bill clarifies procedures and terms of MHSA within the meaning
of MHSA.
The author indicates his office has been in extensive contact
with Legislative Counsel to assist in ensuring that the contents
of this bill meet these MHSA requirements and that a majority
vote of the Legislature is needed for passage of this
legislation.
FISCAL EFFECT : This bill has not been analyzed by a fiscal
committee.
COMMENTS :
1.Author's statement. According to the author, California's
community-based public mental health system is undergoing
significant evolution due to transformative changes resulting
from MHSA, pending implementation of the 2011 Realignment of
Medi-Cal Specialty Mental Health Services, the restructuring
of state administration, and near-term opportunities for
expanded behavioral health coverage under the federal
Affordable Care Act.
These dynamic changes require a fine-tuning of MHSA, which
invigorates the role of the independent OAC, straightens the
framework for Innovative Programs and PEI Programs, reflects
the new responsibilities of DHCS, and establishes a
partnership for designing a strong, outcome-focused evaluation
framework. This legislation is necessary to ensure the
integrity of the MHSA for diverse constituents to be engaged
at the local level for the development and completion of
county-based integrated three-year program and expenditure
plans.
It provides for both local accountability and necessary state
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oversight of key programmatic and fiscal components of MHSA to
ensure a balanced approach for dollars to be directed to
mental health services as directed by the voters, to ensure a
focus on consumer empowerment in designing services, and to
renew efforts at collectively evaluating client outcomes.
The legislation is necessary to clarify MHSA in light of these
changes, as well as the need to clarify roles and
responsibilities left temporarily unresolved with the
enactment of AB 100.
2.Support. The California Council of Community Mental Health
Agencies and Mental Health America of California write in
support that this bill makes important improvements to MHSA
including the improvement and clarification of state oversight
to achieve the goals of MHSA.
3.Support if amended. CMHDA states that, with a few important
exceptions, this bill clarifies and streamlines administrative
requirements in MHSA, consistent with the state budget adopted
last year, as well as with 2011 Realignment, which moves
decisions closer to the people. CMHDA strongly supports
several provisions of this bill, including the elimination of
unnecessary bureaucracy, a streamlined funding distribution
process, strong local oversight of MHSA planning,
expenditures, and services and an integrated approach to state
and local evaluation, accountability, and data
collection/reporting.
Specifically, CMHDA indicates it supports the provisions of this
bill deleting the requirement that the state establish
requirements for the content of county MHSA plans as MHSA
clearly outlines the required elements of the plan and
updates, and DMH in recent years, has annually released
lengthy guidance to counties for development of local plans
and updates, which have proven administratively burdensome and
cumbersome for local stakeholders to navigate. CMHDA states
the deletion of this unnecessary, additional layer will allow
more effective local program planning for the expenditure of
funds and delivery of critical services. Additionally, CMHDA
supports the bill's provision deleting the current limitation
that statewide PEI allocations can be increased only when OAC
determines counties are receiving all necessary funds for
services for severely mentally ill persons, have established
prudent reserves, and have additional revenues available in
the fund as this deletion will allow for more local
SB 1136 | Page
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flexibility in determining how to expend funds and design
services to meet community needs. CMHDA also supports the
provision of this bill allowing PEI funds to be used to
broaden the provision of community-based mental health
services, the provisions of this bill that further strengthen
local oversight authority by requiring the three-year program
and expenditure plans and updates be adopted by local Boards
of Supervisors and submitted to the OAC, and the provisions of
this bill clarifying the plan submission process for counties
and their stakeholders, while providing for important
oversight by local elected officials. CMHDA states this gives
local stakeholders an important opportunity to work with both
their local mental health boards and boards of supervisors to
ensure an inclusive planning process and appropriate
expenditure of funds.
CMHDA expresses concerns about several provisions of this
bill. First, CMHDA expresses a concern regarding the
requirement in this bill that DHCS annually inform CMHDA and
OAC of the methodology used for revenue allocation to the
counties, and the requirement the State Controller use the
methodology provided by DHCS for revenue allocation to the
counties. CMHDA states the language implies that DHCS will
also determine the methodology, and it requests an amendment
to require CMHDA be consulted in the development of this
methodology.
CMHDA also expresses concern with the required Annual MHSA
Revenue and Expenditure Report contained in this bill, stating
the Report is currently required of counties under DMH
regulations but was not a requirement in the original MHSA.
CMHDA indicates it would prefer that this level of specificity
as to administrative reporting be handled by state agencies
and counties administratively, rather than codified in state
law. CMHDA also seeks to specify the information in the Report
is to be used for evaluation purposes. Third, CMHDA expresses
concern over the codification of the Innovative Programs
language in this bill, stating the language in this bill
places into state law a level of specificity and
micromanagement that concerns counties. CMHDA argues the
codification of guidelines may limit local flexibility and
creativity and asks this provision of the bill be deleted.
CMHDA also suggests placing the provisions of this bill
authorizing a coordinated evaluation of outcomes in the
community-based mental health system be relocated in the bill,
SB 1136 | Page 18
and Council be consulted as part of the development of
performance outcomes.
4.Concerns. The California Psychological Association (CPA)
indicates it has worked with professional schools of
psychology and the California Psychology Internship Council to
secure programming and funding for pre-licensed psychologists
from the MHSA WET funds. CPA states MHSA workforce, education
and training is proposed to be transferred to OSHPD, and CPA
would like to ensure the program and funds continue under the
proposed transfer.
SUPPORT AND OPPOSITION :
Support: California Council of Community Mental Health Agencies
Mental Health America of California
Oppose: None received.
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