CMHDA Legislative Report

1. CMHDA Legislative Report Legislative Committee Meeting 8/13/08

2. AB 1780 (Galgiani) – EPSDT Administrative Procedures/Processes • Sponsor: Department of Mental Health. Required as part of the budget trailer bill language in the 2007-08 budget. • CMHDA Position: Support if Amended. • CSAC: Support if Amended. • Status: Passed out of Senate Appropriations Committee 8-7-08. • Adds to current Specialty Mental Health Managed Care statute (W&I Section 5778 et seq) current administrative structure for EPSDT. • Includes current risk sharing arrangement between state and counties. • Funding Source: 50% SGF/Medi-Cal Managed Care Allocation – 50% local match. 10% above EPSDT baseline for growth is county share of cost. • Appropriations Analysis: No direct GF impact for the California Department of Mental Health (DMH) to continue oversight of and auditing within the EPSDT Program.

3. AB 3083 (Assembly Veterans Committee) – Mental Health Services – Veterans • Sponsor: Assembly Veterans Affairs Committee • CMHDA Position: Support as Amended • CSAC: Support as Amended • Status: Passed unanimously out of Senate Appropriations Committee 8-7-08 • Requires county mental health departments to provide services to veterans, to the extent that those services are available to other adults and to the extent resources are available. • Latest amendments add bipolar disorder and PTSD to target population criteria. “Combat related PTSD” was amended out of the bill (at CMHDA’s request). • Additional amendments delete the requirement that county mental health assist veterans in accessing other services, and replaces this provision that county mental health authorities will assist in linking veterans to other services. • Funding Source: Realignment; MHSA; and requires DHCS and DMH to seek funds through Medi-Cal and all other funding sources (e.g. grants) • Senate Appropriations Analysis: $200,000 state administrative costs.

4. SB 292 (Wiggins) – AB 3632 – Out of State For Profit Providers • Sponsor: CMHDA • CMHDA Position: Sponsored • CSAC and CWDA: Support • Status: HELD IN ASSEMBLY APPROPRIATIONS 8-07-08. • Would align state law with federal law by allowing counties to be reimbursed for AB 3632 services in for-profit out-of-state residential facilities. • Specifies that reimbursement for services are not subject to dispute by State Controller’s Office. • Specifies that county reimbursement shall not exceed the cost of services provided; no other placement option is available; DMH, in collaboration with CMHDA, will annually review and report to the Legislature the number of children placed out of state in “for profit” facilities and the average length of stay; and, the number of children placed out of state that are foster youth or wards of the court. • July 2 amendments include the following stipulations: 1) the child was placed in a for-profit facility as a result of a due process hearing and an OAL judge/hearing officer’s decision required the placement and allows for a for-profit placement if no other nonprofit or publicly licensed residential facility can be found; the placement is agreed upon by written mediation or settlement agreement; and the IEP team agrees with the placement after a thorough search is conducted and no other placement options can be found. • Funding Source: federal IDEA; categorical funding (SGF); SB 90 claims • Assembly Appropriations Analysis: Costs “could exceed several million dollars.”

5. SB 1349 (Cox)Prompt Payment • Sponsor: Regional Council of Rural Counties • CMHDA Position: Support • CSAC: Support. • Status: Held in Assembly Appropriations Committee Suspense File. • Requires the State Controller to reimburse cities and counties for Medi-Cal specialty mental health services within 90 days after DMH receives a claim. • Requires DMH to pay interest for non-payment after 90 days. • Latest amendments require the Controller to request the Director of Finance to include any amounts necessary to satisfy the claim in a request to a deficiency appropriation. Specifies that interest shall not accrue against the department’s budget for periods when the funding to the department is insufficient to pay the claim. • Funding Source: Medi-Cal (State General Fund) • Assembly Appropriations Analysis: Assembly Appropriations Analysis: Major annual GF interest costs of $1.7 million to $3.5 million to DMH depending on magnitude of late reimbursements paid in FFS claims.

6. AB 1951 (Hayashi)Mental Health: Capital Facilities • Sponsor: CCCMHA • CSAC Position: Support (???) • *CMHDA Position: ???? (Issues have been raised by County Counsels Association about need for legislation, and precedent it would set) • Status: Senate Third Reading • Provides specific authority that DMH says it needs in order to allow counties to contract with non-governmental providers in the development of much-needed recovery-oriented community facilities consistent with the MHSA. • Proposed amendments (that would be even more prescriptive) caused Legislative Counsel to opine that it would need a 2/3 vote. * CMHDA has asked DMH and the Administration to reconsider its position on the need for the legislation given the new County Counsels Association opinion.

7. AB 2117 (Evans) – Foster Youth: Psychotropic Medication • Sponsor: LA Children’s Law Center • CMHDA Position: Support • CWDA Position: Support • Status: Held in Senate Appropriations Committee 8-07-08 • Would require additional information from a physician upon issuing an order for a foster youth to be prescribed psychotropic medication indicating the reasons for the request, a description of the child's diagnosis and behavior, the child's medical history, the expected results of the medication, and a description of any side effects of the medication. • Requires DMH to develop psychotropic medication information in an age and developmentally appropriate manner. • Requires that a plan is in place for the regular monitoring of the child’s medication plan, the effectiveness of the medication, and any potential side effects. • Permits the court to consider whether any therapeutic services that are clinically indicated are recommended for the child for a period of six months. • Latest amendments wouldl better clarify scope of practice issues governing “health care professional.” Also requires the physician to provide information to the child’s caregiver (and the court) concerning the nature, degree, duration, and probability of side effects and significant risks commonly known by the medical profession. • Senate Appropriations Analysis: If costs to provide services range from $100-$500 per youth, total mandate costs could range from $1,245,000 ($466,875 federal) to $14,525,000 ($5,446,875 federal) annually. • Funding Source: CWS; MC EPSDT; Realignment.

8. AB 2717 (Lieber)Special Education: Due Process Hearing: Burden of Proof • Sponsor: Author • CSAC: Checking • SELPAS: Oppose • CMHDA Position: Oppose • Status: Senate Appropriations Committee. Held in Suspense File 8-07-08 • Would assign the burden of proof in a special education due process hearing to the responsible educational agency, except with regard to the appropriateness of a unilateral parental placement or related services in a case where the parent or guardian is seeking tuition reimbursement for the placement or services. • Specifies that the prima facie case is demonstrated by meeting all of the following elements: a) The child qualifies for special education services; b) An IEP has been created for the child; and, c) The parent or guardian asserts specific facts which, if proven, demonstrate that the IEP failed or would fail to provide the child with a free appropriate public education. • Neither the IDEA nor state law explicitly states which party should bear the burden of proof in due process hearings. • Federal IDEA is silent on the “burden of proof.” • Senate Appropriations Analysis: Assuming the requirement to bear the burden of proof entails increased costs of $5,000 to $10,000 per each student-generated case, increased costs for districts could range from $10 million to $20 million.

9. AB 2541 (Bass) Re-entry Courts: Deferred Entry of Judgment • Sponsor: San Francisco District Attorney • CMHDA: Support as Amended • CSAC: Pending • Status: Passed out of Senate Appropriations Committee 8-07-08. • Permits a superior court to develop a deferred entry of judgment program for non-violent offenders. • Requires that certain criteria be established in order to operate a deferred entry of judgment program, including providing an appropriate level of transitional services such as mental health and/or substance abuse treatment based on available resources. • July 1 amendments included CMHDA language that states, “Local justice agencies as well as county health, mental health, and human services agency representatives to participate with the superior court in developing a plan regarding the scope and availability of resources that will be made available to participants in this program.” • Additional amendments prohibit the use of any information used in an assessment from being admissible in any action or proceeding brought subsequent to the investigation or in any proceeding prior to or subsequent to the granting of a deferred entry of judgment. • July 1 also delete the re-entry court provisions of the bill. • Funding Source: Local courts, counties. • Senate Appropriations Analysis: This bill would result in unknown local costs dependent on the number of participants, local procedures, staffing, and the availability and cost of local treatment and service providers.

10. SB 1415 (Kuehl)Patient Records: Maintenance and Storage • Sponsor: Author • CMHDA Position: Watch • CSAC: Concerns with the bill. • CHEAC: “Watch” position on the bill. • Status: Assembly Third Reading File. • Requires health care providers, including those in mental health, to inform clients that records will be retained for a certain period of time. • Requires these providers to notify clients within 60 days prior to destroying records. • Latest amendments require providers to provide original records to clients prior to the destruction of the records if the client indicates he/she wants the original records. • Provides for penalties and citations for failure to educate/notify client/patient. Psychiatrists have been exempted from the requirements. • Funding Source: Presumably fines and penalties. Anticipated county mental health costs from various funding/program streams. • Assembly Appropriations Analysis: No direct fiscal effect to the state.

11. SB 1380 (Steinberg) Intensive Treatment Foster Care (ITFC) • Sponsor: The Alliance of Children and Family Services • CMHDA Position: Support as Amended • CWDA Position: Support • Status: Assembly Third Reading. • Makes a number of changes to the Intensive Treatment Foster Care program. • Expands ITFC program to include foster youth in level 9 and above group homes for purposes of providing services to children with a “behavioral diagnosis” in foster families. • Provides that social workers would deliver behavioral and crisis services in the home. • Latest amendments add language pertaining to the placement of a child with a serious behavioral problem to include that the placement is approved by the county interagency review team or the county placing agency. • Additional amendments include language that the bill does not change eligibility criteria for EPSDT “benefits or services pursuant to federal law.” • Funding Source: Title IVE; EPSDT • Assembly Appropriations Analysis: Undetermined administrative costs off-set by savings from lower cost placements. Fiscal savings will vary depending on participation and numbers of ITFC placements.

12. SB 1606 (Yee) – Laura’s Law • Sponsor: California Psychiatric Association • CMHDA Position: Watch. • CSAC: Watch. • Status: Held in Assembly Appropriations Committee Suspense File 8-07-08 • Requires DMH to convene a working group to conduct a study of individuals whose mental health needs are not currently being met because they do not meet assisted outpatient treatment requirements. • Newer amendments would have required DMH to accept private funds to undertake the study. • Funding Source: Private funds/donors per recent amendments.

13. AB 1887 (Beall)Parity • Sponsor: Author • CSAC and CHEAC: Support • CMHDA: Support • Status: Passed out of Senate Appropriations Committee 8-07-08 • Requires Knox-Keene licensed health plans to expand mental health coverage to include the diagnosis and treatment of any mental health condition or disorder as defined in the APA Diagnostic and Statistical Manual IV (DSM IV) (or subsequent editions), including substance abuse conditions. • Builds upon the original California mental health parity legislation, AB 88 (Thomson, Chapter 534, Statutes of 1999), which requires health plans to provide coverage for the diagnosis and medically necessary treatment of severe mental illnesses of a person of any age, and serious emotional disturbances of children, under the same terms and conditions applied to other medical conditions. • Exempts CalPERS • Funding Source: Premiums paid by subscribers. • Senate Appropriations Analysis: $160 k to HFP and Medi-Cal; additional costs to private health insurance market due to increased premiums.

14. AB 2105 (DeSaulnier)Elder and Dependent Adult Abuse • Sponsor: Author • CSAC and CWDA: Support • CMHDA: Support • Status: 8/7/2008 In Assembly. Concurrence in Senate amendments pending. • Beginning July 1, 2009, would expand the category of mandated reporters of suspected financial abuse to include both licensees, as that term is defined under the California Finance Lenders Law and the California Residential Mortgage Lending Act, and employees of licensees engaged in lending or servicing activities, except for those employees involved solely in administrative or clerical practices.

15. AB 2696 (Kerkorian)Firearms Reporting • Sponsor: Legal Community Against Violence • CSAC: No Position • CMHDA: Watch • Status: 8/7/2008 In Assembly. Concurrence in Senate amendments pending. • Would require the Department of Justice to participate in the National Instant Criminal Background Check System, pursuant to the terms of a Memorandum of Understanding between the department and the Federal Bureau of Investigation . • Would require mental health facilities that admit persons on the basis of their being a threat to themselves or others, or for intensive treatment, to report information electronically, by July 1, 2011, to the Department of Justice in regards to those persons.

16. AB 2861 (Hayashi)Psychiatric Emergency Condition • Sponsor: California Hospital Association • CSAC: No Position • CMHDA: Support • Status: 8/7/2008 In Assembly. Concurrence in Senate amendments pending. • Would define psychiatric emergency condition to include admission or transfer to a psychiatric unit within a general acute care hospital or to an acute psychiatric hospital for the purpose of relieving or eliminating a psychiatric emergency condition. • Would allow the transfer to a psychiatric unit within a general acute care hospital or to an acute psychiatric hospital for the purpose of relieving or eliminating a psychiatric emergency condition if, in the opinion of the treating provider, the patient's medical condition is such that, within a reasonable medical probability, the transfer will not create a medical hazard to the person and is needed to provide further treatment for the patient or that a delay in transferring the patient may aggravate the psychiatric emergency condition.

17. SB 1147 (Calderon)Medi-Cal Eligibility: Juvenile Offenders • Sponsor: Youth Law Center • CSAC and CWDA: Support • CMHDA: Support • Status: Assembly Second Reading. • Commencing on the later of January 1, 2010, or the date that all necessary federal approvals are obtained, would require Medi-Cal benefits provided to an individual under 21 years of age who is an inmate of a public institution to be suspended, rather than terminated. • Would require county welfare departments to notify the department within 10 days of receiving information that an individual under 21 years of age on Medi-Cal in the county is or will be an inmate of a public institution. • Would also require DHCS, in consultation with the Chief Probation Officers of California and the County Welfare Directors Association, to establish the protocols and procedures necessary to implement these provisions.

18. SB 1553 (Lowenthal)Health Care Service Plans: Involuntary Admissions • Sponsor: CA Society for Clinical Social Work and CA Association of Marriage and Family Therapists • CSAC: No Position • CMHDA: Support • Status: Assembly Third Reading File • Would prohibit a health care service plan frombasingdecisions on whether to authorize or deny claim reimbursement on whether admission was voluntary or involuntary, or on the method of transportation to the health care facility. • The bill would also require a plan website to include information on accessing mental health services.