CMHDA

1. CMHDA 2007 Bills of Interest

2. CSACHealth Care Reform Legislation Summary Governor Arnold Schwarzenegger and legislative leaders Assemblymember Fabìan Núñez and Senator Don Perata pooled their ideas and released nearly 200 pages of bill language on October 1. Items NOT included in the bill – it has not been assigned a number or author yet – as of October 5, 2007: • The bill does not contain any type of financing, including employer, physician, or hospital fees • The bill does not mention physician or public hospital rate increases • The bill makes no reference to assigning counties as the employer of record for In-Home Supportive Services (IHSS) workers. • It is clear from the above list that the bill as we know it is a work in progress. It is CSAC’s understanding that the financing piece of any health care reform legislation is being drafted separately from the policy portion, and that the goal of leaders is to place it on the November 2008 ballot as a petition initiative.

3. CSACHealth Care Reform Legislation Summary The bill contains the following: • Implementation: The bill sets July 1, 2010 as the implementation date, contingent on the passage of the financing piece, as well as certifications by the Department of Finance that the “financial resources necessary to implement” exist and the Health and Human Services Agency regarding the plan’s sustainability, solvency, and effects on employers, counties, and the health care coverage market. • County Share of Cost: The bill would require counties to pay 40 percent of the “Medi-Cal Lite” premium costs for Medically Indigent Adults (MIAs) under 100 percent FPL as well as adults under 150 percent FPL who are swept into the new purchasing pool (see New Purchasing Pool below). There would be an as-yet-undefined statutory county-by-county cap on funds paid to the state for health care premiums. The payments would be based on the number of enrollees in each county, and payments would be remitted on a quarterly basis.

4. CSACHealth Care Reform Legislation Summary Program Expansions: Healthy Families • Expands Healthy Families to 300 percent of the Federal Poverty Level (FPL) • Expands Healthy Families to undocumented children Medi-Cal • Expands Medi-Cal to undocumented children • Expands Medi-Cal for parents to 250 percent FPL, with no asset test • Expands Medi-Cal to 19- and 20-year-olds under 250 percent FPL • Creates a new Medi-Cal program for childless adults under 100 percent FPL that offers a more limited and non-retroactive benefit package than regular Medi-Cal (e.g. no dental) and required semi-annual verification • Creates a new Medi-Cal Benchmark Plan for everyone over 100 percent FPL that would be administered by the Managed Risk Medical Insurance Board (MRMIB). New Purchasing Pool Creates three tiers and offers some unsubsidized products such as limited dental and vision care: • 1. Those under 150 percent FPL will pay no premiums or out of pocket costs. • 2. Those from 150 to 250 percent FPL won’t pay premiums greater than 5 percent of their income and have no limit on out of pocket costs. • 3. Those over 250 percent FPL receive no subsidies.

5. CSACHealth Care Reform Legislation Summary • Individual Mandate: The bill sets out an individual mandate with a minimum threshold of coverage, defined as coverage with a deductible of no more than $5,000 and maximum annual out of pocket limits of $7,500 per person and $10,000 per family. • Employer Mandate: Employers who employ two or more employees are required to offer Section 125 Health Care Cafeteria plans. • Hospital Rates: The bill would provide Medicare rates to private hospitals and states that public hospital rates would be purely cost-based (but does not take into account the county share of cost). • Market Reforms: All health plans would be required to meet an 85 percent medical loss ratio (i.e. no more than 15 percent of premium revenue may be used for administrative costs). The bill also contains language for community rating provisions, and sets a parameters for guaranteed issue that would only apply to the two lowest choice plans in a proposed five-tiered coverage model. • Health Incentives: All health plans will be required to offer a Healthy Action and Incentives and Reward Program to encourage education and preventative health care. The bill would also create a framework of Community Makeover Grants to local health departments for preventative health care efforts, but this funding would be contingent on an appropriation in the state budget. The bill would also create the California Diabetes Program, but it too would only become operable through an appropriation in the state budget. • Eligibility: Counties may administer Healthy Families and Purchasing Pool eligibility processes.

6. CSAC Response • CSAC, CMHDA and many other county affiliate organizations have been working on developing a response to this (or any) proposal to impose a county share of cost for financing the expanded coverage. General principles developed so far include: • Any health care reform process must take into account historical, current and future county costs for treating those who are, and those who may remain, uninsured. To this end, counties should not suffer shortfalls from any of the following: • Any share of cost that exceeds county savings resulting from health care reform • Costs resulting from increased demand for county health care services that exceed county savings resulting from health care reform • Collapse of county health care infrastructure resulting from lost revenues due to patient shifts resulting from health care reform

7. AB 900 (Solorio)Prison Construction • Authorizes up to 40,000 new state prison beds. • Authorizes funding for new local jail construction for 13,000 beds. $750 million is appropriated for Phase I construction; $470 million is appropriated for Phase II construction. This appropriation requires a local match of 25%. • Includes provisions for new programs including vocational education, drug treatment, mental health treatment, etc. • Current language specifies that mental health treatment shall be a day treatment model. • Status: Chaptered by Secretary of State - Chapter 7, Statutes of 2007.

8. SB 568 (Wiggins)Criminal Procedure: Mental Competence • Allows for the administration of psychotropic medications to inmates in county jail determined to be incompetent to stand trial (IST) if a psychiatrist determines that the inmate would benefit from such medication. Sell hearing procedures still apply. • Limits medication treatment in these facilities to a maximum of 6 months. • Requires unanimous agreement of the county Board of Supervisors, county mental health director and county sheriff for implementation. • Requires the State Department of Mental Health to report to the Legislature, no later than January 1, 2009, on specified topics relating to treatment of ISTs, including its progress on addressing the shortage of beds for this population. • The bill sunsets on January 1, 2010, unless the Legislature takes action to extend it. • Status: Enrolled to Governor • Position: Support

9. SB 851 (Steinberg)Re-entry Facilities • SB 851 would authorize courts to implement mental health courts for persons with mental illnesses who are suspected of committing a misdemeanor or felony, with locally-established case eligibility criteria. • SB 851 also mandates the California Department of Corrections and Rehabilitation (CDCR) to create a pilot program to provide comprehensive mental health and supportive services to 100 parolees with a serious mental illness in each of three separate parole regions. • Status: Enrolled to Governor • Position: Support

10. AB 423 (Beall)Parity • Requires a health care service plan and health insurance policy issued, amended, or renewed on or after January 1, 2008 to include the diagnosis and treatment of any mental health disorder and/or substance abuse condition as defined in the Diagnostic and Statistical Manual IV (and subsequent text revisions) for a person of any age. DSM IV “v” codes are excluded. • Status: Enrolled to Governor • Position: Support

11. SB 916 (Yee)Acute Psychiatric Hospitals: Patient Detention and Release • Extends civil and criminal immunity to a non-designated hospital and any licensed professional staff of the hospital or any physician and surgeon providing emergency medical services in the hospital for detaining a person, or for the actions of the person after release from the hospital, if certain conditions exist. • Imposes conditions on the release of a person who has been detained for eight hours and extends the time permitted for detention and/or release of that person from eight hours to 24 hours. • Affirms that existing duties of psychotherapists to warn potential victims or law enforcement under Civil Code 43.92 (Tarasoff warning) would not be affected by the bill. • Status: Enrolled to Governor • Position: Support

12. SB 260 (Steinberg)Same Day Medi-Cal Billing • Provides that more than one encounter between a patient and the same health care professional on the same day and at a single location may each be separately reimbursed in specified circumstances. • Also provides that, under specified circumstances, visits with different health care professionals on the same day of service may be billed as separate visits. • Status: Enrolled to Governor • Position: Support

13. AB 509 (Hayashi)Suicide Prevention • This measure would have required the State Department of Mental Health (DMH) to establish the Office of Suicide Prevention (OSP) by January 1, 2009. • However, the author struck a deal with the Governor and withdrew her bill from enrollment. • In exchange for withdrawing the enrollment of the bill, the Governor will create an Office of Suicide Prevention administratively. • Status: Withdrawn from Enrollment by Author • Position: Support

14. SB 785 (Steinberg)Mental Health Services for Foster Children • Streamlines and expedites some of the current administrative processes for foster youth placed out of county, including the development of uniform provider contracts, documents, and reporting requirements. • Requires mental health plans to approve a standard provider contract or other mechanism of payment if a contract is not required, within 30 days of an approved treatment authorization request. • Establishes clear lines of responsibility between the county of original jurisdiction and the host county to ensure that adopted children or those eligible to receive Adoption Assistance receive services in a timely way. • Provides for accountability and oversight regarding implementation. • Declares legislative intent to create a long-term solution by changing the child’s Medi-Cal code of eligibility in the MEDS file. • Status: Enrolled to Governor • Position: Co-Sponsor

15. BudgetMedi-Cal/EPSDT Late Payments • Allocates $917 million ($454 million SGF) to fund the EPSDT program for the fiscal year 07-08. • Includes $87 million to reimburse counties for costs for fiscal years 2003-04, 2004-05, and 2005-06, which will be paid back over a three-year period. This is the first of three installments that will reimburse counties for the total amount owed of $260 million. • SB 100 (Ducheny), chaptered into law earlier in the summer, contains $59,727,0000 to cover the current year EPSDT deficiency.

16. BudgetDMH Oversight • EPSDT. The FY 2007-08 Budget directs DMH to work with the Legislature to “develop an appropriate administrative structure for the EPSDT program for implementation in the 2008-09 fiscal year, including enacting legislation to codify the administrative structure within the two-year period of the 2007-08 legislative session.” • MHSA. Requires the Department of Finance’s Office of State Audits and Evaluations (OSAE) to review various aspects of DMH’s MHSA planning, development and implementation, including program inefficiencies and improvements for disbursement of funds to counties. • DMH Workplan. Trailer Bill AB 203 requires the department to report to the Legislature on the progress of its “work plan” to “significantly improve the management of the fiscal systems as they pertain to the Medi-Cal program, including the EPSDT program….”

17. BudgetMIOCR • MIOCR was funded last year at $22.3 million each for juvenile and adult mentally ill offenders. • There is no new money for MIOCR in the final 2007-2008 budget, just $30 million total for juvenile and adult MIOCR. • This allows the already-funded programs to finish out their initial 18-month grant period, which ends mid-2008.

18. BudgetJuvenile Justice Realignment Budget Trailer Bill SB 81 realigns the state’s juvenile justice program, cutting the Department of Juvenile Justice’s (DJJ) population by shifting lower-level offenders to counties. • Counties will receive $130,000 per youth primarily through a juvenile justice block grant. Funds are supposed to be spent on a continuum of services for juvenile offenders. • Funding is expected to start with a total of $24 million statewide, increasing to $92 million statewide once fully implemented. Counties must submit a plan to DJJ by January 2008 to get approved. • Appropriates $100 million in construction bond money for new facilities for counties that can no longer send kids to DJJ, particularly for the construction of regional centers in counties that don’t have camps. • $15 million was initially appropriated in SB 81 for planning grants, but the Governor line-item vetoed this amount.

19. Budget5% Medi-Cal Provider Rate Restoration • 5% Medi-Cal Provider Rate Restoration. $12 million was initially included in the Budget Bill by the Budget Conference Committee. However, the Assembly eliminated this funding when it voted on the Budget Bill.

20. Budget AB 3632 • Allocates $69 million in federal IDEA funds and $52 million in categorical funds (identical to last year). • Counties may still be reimbursed for additional costs through the SB 90 mandate claims process.

21. BudgetEarly Mental Health Initiative • Appropriates $15 million in Prop. 98 funds for this evidence-based early intervention program.

22. Budget Prop. 36 • Appropriates $100 million for Prop. 36 along with $20 million for OTP. • This is a $20 million reduction from FY 06-07.

23. BudgetSupplemental Security Income/State Supplementary Payment (SSI/SSP). • Delays the scheduled state SSI/SSP COLA from January 2008 to June 2008.

24. BudgetAB 2034 • AB 2034: $54.9 million in funding was initially included in the Budget Bill, but was line-item vetoed by the Governor. • CMHDA believes this is a violation of the MHSA’s state MOE requirements. • On October 9, 2007, several mental health advocacy organizations sent the Governor and DMH Director Mayberg a “demand” letter, demanding that they restore this funding or a lawsuit will be filed. It is expected that a lawsuit will follow.