BILL ANALYSIS �
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|SENATE RULES COMMITTEE | SB 1136|
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THIRD READING
Bill No: SB 1136
Author: Steinberg (D)
Amended: 4/16/12
Vote: 21
SENATE HEALTH COMMITTEE : 9-0, 4/25/12
AYES: Hernandez, Harman, Alquist, Anderson, Blakeslee, De
Le�n, DeSaulnier, Rubio, Wolk
SENATE APPROPRIATIONS COMMITTEE : 7-0, 5/24/12
AYES: Kehoe, Walters, Alquist, Dutton, Lieu, Price,
Steinberg
SUBJECT : Health: mental health: Mental Health Services
Act
SOURCE : Author
DIGEST : This bill makes many changes to the Mental
Health Services Act (Proposition 63 of 2004) to clarify
existing law, codify existing practice, or reorganize state
activities.
ANALYSIS :
Deputy Director of Mental Health and Substance Use Disorder
Services in the Department of Health Care Services (DHCS)
Existing law requires the Governor, with the consent of the
Senate, to appoint the Director of the Department of Mental
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Health (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 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.
Changes to Human Resources, Education and Training Programs
provisions of the Mental Health Services Act (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.
This bill:
1.Shifts state MHSA workforce education and training
administrative functions from DMH to the Office of
Statewide Health Planning and Development (OSHPD).
2.Requires OSHPD to work in coordination with the
California Mental Health Planning Council in identifying
the currently required statewide needs for each
professional and occupation category, and would require
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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.
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:
To increase access to underserved groups;
To increase the quality of services, including
better outcomes;
To promote interagency collaboration; and
To increase access to services.
1.Requires county mental health programs to receive funds
for their innovation programs upon approval by the
Oversight and Accountability Commission (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:
Increase access to underserved groups,
Increase the quality of services, including
measurable outcomes,
Promote interagency and community
collaboration, or
Increase access to services; and
A. Support innovative approaches by doing one of the
following:
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Introducing new mental health practices or
approaches, including, but not limited to,
prevention and early intervention,
Making a change to an existing mental health
practice or approach, including, but not limited to,
adaptation for a new setting or community, or
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.
Prevention and Early Intervention (PEI) programs in MHSA
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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.
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 California
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Mental Health Planning 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
5. 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.
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
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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 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.
1.Requires DHCS to annually inform CMHDA and OAC of the
methodology used for revenue allocation to the counties.
2.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.
3.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.
4.Requires program and expenditure plans to be developed in
consultation with providers of alcohol and drug services
and health care organizations.
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5.Deletes the requirement that DMH establish requirements
for the content of plans.
6.Requires the performance outcomes for services to be
established jointly by DHCS and OAC, in collaboration
with CMHDA, instead of DMH under 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.
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
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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.
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.
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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.
Background
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.
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 (Assembly Budget
Committee), 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 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
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for state administration from five 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.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: No
According to the Senate Appropriations Committee, ongoing
cost of $200,000 per year to establish a new Deputy
Director position (including staff support) in the
Department of Health Care Services (Mental Health Services
Fund).
SUPPORT : (Verified 5/23/12)
California Council of Community Mental Health Agencies
Disabilities Rights in California
Mental Health America of California
ARGUMENTS IN 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.
CTW:nl 5/25/12 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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