CMHDA Budget and Legislative Report

1. CMHDA Budget and Legislative Report Legislative Committee/GB Meeting 5/14/08

2. Budget Update2008-09 Budget Year Proposals • SMA COLA. Proposed reduction of 5% to the SMA, which would result in an additional reduction of $10.7 million SGF in the FY 08-09 budget year. Senate and Assembly Budget Subcommittees held this item open. • Day Treatment. This proposal would require a six month reauthorization of day treatment services, for a proposed savings of $19.4 million in the budget year. Senate and Assembly Budget Subcommittees held this item open. • Managed Care Allocation. Proposes a 10% SGF reduction ($23.8 million) to the Medi-Cal Specialty Mental Health Managed Care allocation to counties. Senate and Assembly Budget Subcommittees held this item open.

3. Budget Update2008-09 Budget Year Proposals • CTF Supplemental Rate. Proposes elimination of the state supplemental rate for Community Treatment Facilities ($1.2 million) in the budget year. Senate and Assembly Budget Subcommittees held this item open. • DMH Headquarters. Reduce the administrative budget of DMH in both the current year and the budget year by 10%, for a total of$722,000 in the current year, and $1,948,000 in the budget year. Senate and Assembly Budget Subcommittees approved this proposal. • State Hospital Beds. Charge counties the full cost of state hospital civil commitment beds. Estimated SGF Savings: 9.8 million. Senate Budget Subcommittee approved; Assembly Budget Subcommittee left open.

4. AB 1405 MazeJuveniles: Joint Assessments: Confidential Information • Sponsor: Author (DSS is working with author) • CMHDA Position: Recommend Support. CSAC: Pending. CWDA: Support • Status: Senate Judiciary Committee. No hearing date set. • Prohibits any statements, admissions, confessions, or incriminating information obtained from, a minor during the course of a screening or assessment from being admitted into evidence or used in any juvenile, criminal or civil hearing. • Keyed Fiscal: No • Funding Source: CWS and Probation • Appropriations Analysis: Not Available

5. AB 1486 (Calderon)Licensed Professional Counselors • Sponsor: California Coalition for Counselor Licensure • CMHDA Position: Recommend ???. CSAC: Watch • Senate Business and Professions Committee. No hearing date set. • Allows for the licensure of professional counselors under the BBS, effective Oct. 1, 2009. • Permits licensees to perform psychotherapy and assessments. • Assessment does not include assessment of personality, intelligence tests, neuropsychological test, or using three or more tests to determine psychosis, dementia, amnesia, cognitive impairment, or criminal behavior. • Requires referral to other licensed health care providers when issues identified are beyond their scope of practice. • Must possess a master’s or doctoral degree. • 3000 licensure hours. Adds 4 members to BBS Board. • Keyed Fiscal: Yes • Funding Source: LPC fees • Appropriations Analysis: Not Available

6. AB 1825 (Beall) Developmental Disabilities: Dispute Resolution • Sponsor: Association of Regional Center Agencies • CMHDA Position: Recommend Support if Amended. CSAC: Not tracking. • Status: Senate Human Services Committee. No hearing date set. • Creates a dispute resolution process when there is a disagreement over which entity is to deliver or pay for a specific type, frequency or duration of services contained in an individualized family service plan. • Only applies to children under six years of age. • Allows regional center to submit a written notification of failure to the generic agency provide the service and request a dispute resolution. • Defines “generic agency” to mean any agency which has a legal responsibility to serve all members of the general public and is receiving public funds to provide services. • Requires both parties to meet within 15 days. If dispute is not resolved in 10 days after the meeting, each party is required to submit its rationale to the Office of Administrative Hearings within 30 days of the meeting. • Keyed Fiscal: Yes • Funding Source: DSS Identified in bill; May impact AB 3632; MC EPSDT • Appropriations Analysis: No net fiscal impact.

7. AB 2352 (Fuentes)Confidential Information • Sponsor: LA County District Attorney’s Office • CMHDA Position: Recommend: ???. CSAC: Watch. CWDA: Support • Status: Senate Health Committee. Scheduled to be heard on 6/11/08. • Permits the release of information to a county social worker, probation officer, or any other person who is legally authorized to have custody or care of a dependent or ward. • Information can only be used for the purpose of coordinating health care services and medical treatment, including mental health treatment. • Information disclosed may not be admitted into evidence in any criminal or delinquency proceeding against a minor. • Keyed Fiscal: Yes • Funding Source: CWS, Probation • Appropriations Analysis: Cites no direct fiscal impact

8. AB 2614 (Houston)State Hospitals – NGRIs and ISTs • Sponsor: NAMI • CMHDA Position: Recommend Support. CSAC: Watch • Status: Assembly Appropriations Committee—Suspense File. Will be taken up with other suspense items. • Removes financial liability to the patient, their family or their estate, if the person was committed to a state hospital as a result of a “not guilty by reason of insanity” or “incompetent to stand trial.” • Keyed Fiscal: Yes • Funding Source: Families currently. Bill does not specify replacement of funds. • Appropriations Analysis: Cites GF fund losses of $1 million to $3 million.

9. SB 1593 (Alquist) -- Health Care Coverage: Childrens’ Health Initiatives • Sponsor: Author and Steinberg, Torlakson and Ridley-Thomas • CMHDA Position: Recommend Support. CSAC: Pending • Status: Senate Health. Will be heard 6/11/08. • Requires the joint development of a timely transition for children receiving health care coverage through a children’s health initiative into Healthy Families or Medi-Cal. • Would establish auto-enrollment to ensure that children are transferred without a disruption of coverage. • Would identify funds currently obligated to local children’s health initiatives for the provision of coverage to children that would be transitioned into Medi-Cal or Healthy Families. • Creates the Children’s Health Care Fund which would be administered by MRMIB. • Keyed Fiscal: Yes • Funding Source: Medi-Cal; SCHIP; local county match • Appropriations Analysis: April 28 analysis, prior to recent amendments, cites DHCS administrative costs of $250,000.

10. 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 Assembly Appropriations. Will be heard next on Senate Floor. • 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. • Keyed Fiscal: yes • 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.

11. AB 3083 (Assembly Veterans Committee) – Mental Health Services – Veterans • Sponsor: Assembly Veterans Committee • CMHDA Position: Oppose Unless Amended (consider changing to “support if amended”)? CSAC: Oppose Unless Amended. • Status: Assembly Appropriations Committee; to be heard May 14. • Requires county mental health departments to provide services to veterans to the extent that those services are not being provided by another entity. • Adds PTSD to target population criteria. • Amends MHSA to include veterans as one of the local stakeholders that counties must include for their MHSA plans. • Keyed Fiscal: yes. • Funding Source: Realignment; MHSA; and requires DHCS and DMH to seek funds through Medi-Cal and all other funding sources (e.g. grants) • Appropriations Analysis: Not available

12. SB 292 (Wiggins) – AB 3632 – Out of State, For Profit Providers • Sponsor: CMHDA • CMHDA Position: Sponsored. Support. CSAC and CWDA support. • Status: Senate Human Services Committee. Not yet set for hearing. • Aligns state law with federal law by allowing counties to be reimbursed for AB 3632 services in for-profit in-state or out-of-state residential facilities. • Specifies that reimbursement for services are not subject to dispute by State Controller’s Office. • Keyed Fiscal: Yes • Funding Source: federal IDEA; categorical funding (SGF); SB 90 claims • Appropriations Analysis: Not available at this time

13. SB 1349 (Cox)Prompt Payment • Sponsor: Regional Council of Rural Counties • CMHDA Position: Support. CSAC: Support. • Status: Passed Senate. Assembly Health Committee. Hearing date not yet set. • 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 accrual of interest for non-payment after 90 days. • Keyed Fiscal: Yes • Funding Source: Medi-Cal (State General Fund) • Appropriations Analysis: Minor costs. Cites the OSAE report stating that recent increases in submitted claims have pushed the system beyond capacity, subjected DMH to potential liability (in December of 2007) of up to $33 million and left almost one half of the of the 15 million annual claims beyond the 90 day standard.

14. AB 2861 (Hayashi)Mental Health Services • Sponsor: CHA • CMHDA: Support. CSAC: Neutral • Status: Scheduled to be heard in Assembly Appropriations on 5/14/08. • Requires a health care service plan or an insurer that provides coverage for emergency health care services to reimburse providers for prestabilization emergency mental health services provided to its enrollees or insureds without prior authorization in specified circumstances. • Keyed Fiscal: Yes • Funding Source: Funds from subscriber contributions for enrollee plans. • Appropriations Analysis: Not available • Spoke with CHA re: amendment to include PHFs. CHA will be amending bill and will include PHFs.

15. AB 2541 (Bass) Re-entry courts: Deferred Entry of Judgment • Sponsor: San Francisco District Attorney • CMHDA: Watch. CSAC: Pending • Status: Assembly Appropriations Committee – Suspense File. • Creates a pilot program for three counties to develop a deferred entry of judgment re-entry court system 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. • Concerns regarding relative to who is at the table to determine availability/access to mental health or other local resources. • Keyed Fiscal: Yes • Funding Source: Local courts, counties. • Appropriations Analysis: Estimated cost is $5,000 per participant (based on SF model); SGF $400,000 (CDCR estimate).

16. SB 1380 (Steinberg) – Intensive Treatment Foster Care (ITFC) • Sponsor: The Alliance of Children and Family Services • CMHDA Position: Watch with Concerns. CWDA supports. • Status: Passed Senate Floor. In Assembly. • 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. • The most obvious concern is still: How will Counties come up with the 5% match for EPSDT expansion? • Keyed Fiscal: Yes • Funding Source: Title IVE; EPSDT • Appropriations Analysis: Not available

17. SB 1606 (Yee) – Laura’s Law • Sponsor: California Psychiatric Association • CMHDA Position: Watch. • CSAC following CMHDA lead. • Status: Appropriations Committee—Suspense File. • 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. • Keyed Fiscal: Yes • Funding Source: DMH Administrative Budget • Appropriations Analysis: Not available.

18. SB 1651 (Steinberg) – Mentally Ill Offenders • Sponsor: CCCMHA • CMHDA Position: Support. CSAC following CMHDA lead. • Status: Senate Appropriations – Suspense File. • Authorizes superior courts to develop and implement mental health courts. • Creates a pilot program for parolees with a serious mental illness to receive comprehensive mental health and supportive services. • Permits CDCR to contract with either county mental health departments to provide services or CBOs. • Methods for contracting shall promote prompt and flexible use of funds. Each contract shall pay for that portion of services and supports, including hospitalization and medication. • Keyed Fiscal: yes • Funding Source: Various. Courts; CDCR; county mental health funding streams/budgets; DMH • Appropriations Analysis: Mental health courts, Unknown, potentially significant costs.

19. AB 851 (Brownley) Medi-Cal Eligibility • Sponsor: World Institute on Disability • CMHDA Position: Support. CWDA and CSAC support. • Status: Senate Health. Will be heard 6/11/08. • Permits individuals enrolled in the California Working Disabled Program, and who are temporarily not working, to continue to remain in the program for up to 52 weeks. • Earned income for individuals in CWD is considered exempt as long as it is held in separate account. • Deletes September 1, 2008 date for the CWD program. • Keyed Fiscal: Yes • Funding Source: 50% State General Fund; 50% Local Match • Appropriations Analysis: Annual costs of $1 million to $2 million [50% General Fund (GF)] to make the current California Working Disabled program permanent.

20. AB 2055 (Salas)Veterans: Combat Stress Support Team • Sponsor: Author • CMHDA Position: Watch. CSAC: Watch • Status: Passed out of Assembly Veterans Affairs Committee 4/15. Scheduled to be heard next in Assembly Appropriations 5/14/08. • Requires the Military Department to create a Combat Stress Support Team to provide emergency crisis counseling, referral and personal support, combat stress evaluations, and mental health support for state military personnel and their families. • Requires each team to consist of a state psychologist with training in combat-related PTSD. • Keyed Fiscal: Yes • Funding Source: None Found; None Stated • Appropriations Analysis: Not available at this time    

21. AB 2696 (Krekorian)Firearms • Sponsor: Legal Community Against Violence and California Campaign Brady Campaign to Prevent Gun Violence • CMHDA Position: Watch. CSAC Watch. • Status: Senate Health. Will be heard 6/11/08. • Current law requires mental health facilities to report to the Department of Justice the name of individuals that have been admitted to a facility under a 5151; 5152; 5250; 5260; AND 5270.15. • This bill would require these facilities to submit reports in an electronic format as prescribed by the DOJ effective January 1, 2011. • Keyed Fiscal: yes • Funding Source: Special Dealers Record of Sale Fund; local mental health funds (potentially realignment, county general fund if available, other fund sources) • Appropriations Analysis: One-time special fund (Dealers Record of Sale) start-up costs of about $300,000 to DOJ. Significant ongoing local costs, potentially in the hundreds of thousands of dollars, and potentially state-reimbursable, for mental health facilities to report to DOJ via a prescribed electronic format. DOJ estimates it receives about 12,000 reports annually from about 200 facilities.

22. AB 2828 (Salas) – Veterans’ Substance Abuse and Mental Health Services Fund • Sponsor: Author (and Swords to Plowshares) • CMHDA Position: Support. CSAC: Not tracking • Status: To be heard in Assembly Appropriations on 5/14/08. • Requires the California Department of Veterans Affairs to seek SAMHSA funds for the purposes of contracting with CBOs for mental health and substance abuse services for veterans. • Establishes a new fund in the State Treasury for this purpose. • Keyed Fiscal: Yes • Funding Source: SAMHSA grants • Appropriations Analysis: Not available

23. SB 1415 (Kuehl)Patient Records: Maintenance and Storage • Sponsor: Author • CMHDA Position: Watch. Affiliate Positions: CSAC has concerns with the bill. CHEAC has a “watch” position on the bill. • Status: Senate Floor. • 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. • Keyed Fiscal: No • Funding Source: Anticipated county mental health costs from various funding/program streams • Appropriations Analysis: N/A

24. SB 1470 (Lowenthal) – Homeless Youth Prevention and Assistance Act of 2008 • Sponsor: Author • CMHDA Position: Support. CWDA supports. • Status: Senate Appropriations – Suspense File. • Requires DMH and the Department of Housing and Community Development to consult with a number of state departments, including CalHFA, and other appropriate agencies and stakeholders to develop a homeless youth prevention plan. • The plan would also develop a number of recommendations, including identifying state and federal funding sources that are available to house homeless youth or those at-risk of homelessness. • Keyed Fiscal: yes • Funding Source: DMH and DHCS administrative budgets • Appropriations Analysis: Not available.

25. SB 1738 (Steinberg) – Medi-Cal: Frequent Users Health Care Pilot Program • Sponsor: Department of Health Care Services • CMHDA Position: Support in Concept. CSAC and Urban Counties support. • Status: Senate Appropriations Committee. Suspense File. Set for hearing 5/19/08. • Requires the Department of Health Care Services (DHCS) to create a pilot program, in consultation with stakeholders (CMHDA is included), to provide Medi-Cal services to frequent users of health care services. • “Frequent Users” are defined as meeting two or more risk factors such as chronic health conditions, Axis 1 or Axis 2 diagnoses, inconsistency in following a treatment plan, and/or homelessness. • Requires DHCS to submit any necessary application to CMS for a state plan amendment to implement the pilot project. • The department shall determine the form of the state plan amendment most appropriate to implement the pilot project. • Pilot program will consist of six eligible programs. • Establishes certain criteria for CBOs or government entities to participate in the program. • Keyed Fiscal: yes • Funding Source: Medi-Cal (Waiver to be determined) • Appropriations Analysis: Not available

26. AB 2117 (Evans) – Foster Youth: Psychotropic Medication • Sponsor: LA Children’s Law Center • CMHDA Position: Support. CWDA supports. • Status: Assembly Appropriations – Suspense File. • Requires 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 the Department of Mental Health 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. • Proposed amendments permit the court to consider whether any therapeutic services that are clinically indicated are recommended for the child for a period of six months. • Keyed Fiscal: Yes • Funding Source: CWS; MC EPSDT; realignment • Appropriations Analysis: $2 million in CWS costs for transporting child to court.

27. AB 2667 (Hayashi) Suicide Prevention Lines • Sponsor: Author • CMHDA Position: Oppose. CSAC: Oppose • Status: Assembly Appropriations Committee – Suspense File. • Mandates that all county mental health departments establish a 24-7 suicide prevention hotline. • Requires that county suicide prevention hotlines meet specified criteria established by the Substance Abuse and Mental Health Services Administration funded National Suicide Prevention Lifeline. • Keyed Fiscal: Yes. State Mandate. • Funding Source: County mental health departments; various funding streams (e.g. realignment, MHSA, MC) • Appropriations Analysis: Annual state-reimbursable costs of at least $20 million for counties to comply with the hotline requirements created by this bill.