Amended in Senate June 12, 2013

California Legislature—2013–14 Regular Session

Assembly Bill No. 87

Introduced by Committee on Budget (Blumenfield (Chair), Bloom, Bonilla, begin insert Campos, end insert Chesbro, Daly, Dickinson, Gordon, Jones-Sawyer, Mitchell, Mullin, Muratsuchi, Nazarian, begin delete Rendon, end delete begin insert Skinner, end insert Stone, and Ting)

January 10, 2013

An act begin delete relating to the Budget Act of 2013 end delete begin insert to amend Section 5892 of, and to add Part 3.8 (commencing with Section 5848.5) to Division 5 of, the Welfare and Institutions Code, relating to mental health, and making an appropriation therefor, to take effect immediately, bill related to the budget end insert .

LEGISLATIVE COUNSEL’S DIGEST

AB 87, as amended, Committee on Budget. begin delete Budget Act of 2013. end delete begin insert Investment in Mental Health Wellness Act of 2013. end insert

begin insert

The California Health Facilities Financing Authority Act authorizes the California Health Facilities Financing Authority (authority) to make loans from the continuously appropriated California Health Facilities Financing Authority Fund to participating health institutions for financing or refinancing the acquisition, construction, or remodeling of health facilities.

end insert begin insert

Existing law, the Mental Health Services Act, an initiative measure enacted by the voters as Proposition 63 at the November 2, 2004, statewide general election, establishes the continuously appropriated Mental Health Services Fund to fund various county mental health programs. The act, as originally enacted, limited state administrative costs to implement duties pursuant to the programs to 5% of the total of annual revenues received for the fund. Existing law limits state administrative costs to 3.5%. Existing law establishes the Mental Health Services Oversight and Accountability Commission (commission) to oversee the administration of various parts of the Mental Health Services Act. The act provides that it may be amended by the Legislature by a 2⁄3 vote of each house as long as the amendment is consistent with and furthers the intent of the act, and that the Legislature may also clarify procedures and terms of the act by majority vote.

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This bill would restore the limit on state administrative costs to 5%.

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This bill would establish the Investment in Mental Health Wellness Act of 2013. The bill would provide that funds appropriated by the Legislature to the authority for the purposes of the act be made available to selected counties or counties acting jointly, except as otherwise provided, and used to increase capacity for client assistance and services in crisis intervention, crisis stabilization, crisis residential treatment, rehabilitative mental health services, and mobile crisis support teams. The bill would require the authority to develop and to consider specified selection criteria for awarding grants, as prescribed. The bill would require the authority to provide prescribed reports to the fiscal and policy committees of the Legislature on May 1, 2014, and May 1, 2015. The bill would provide that funds appropriated by the Legislature to the commission for the purposes of the act be allocated to selected counties, counties acting jointly, or city mental health departments, as determined by the commission through a selection process, for triage personnel to provide intensive case management and linkage to services for individuals with mental health disorders. The bill would authorize triage personnel to provide targeted case management services face to face, by telephone, or by telehealth. The bill would require the commission to consider specified selection criteria for awarding grants, and require the commission to provide a prescribed report to the fiscal and policy committees of the Legislature by March 1, 2014. The bill would prohibit funds awarded by the authority or commission from being used to supplant existing financial and resource commitments of the grantee.

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The bill would appropriate $500,000 from the General Fund to the California Health Facilities Financing Authority for these purposes.

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This bill would declare that it is to take effect immediately as a bill providing for appropriations related to the Budget Bill.

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This bill would express the intent of the Legislature to enact statutory changes relating to the Budget Act of 2013.

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Vote: majority. Appropriation:  begin delete no end delete begin insert yes end insert . Fiscal committee:  begin delete no end delete begin insert yes end insert . State-mandated local program: no.

The people of the State of California do enact as follows:

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begin insert SECTION 1. end insert   

end insert

begin insert Part 3.8 (commencing with Section 5848.5) is
added to Division 5 of the end insert begin insert Welfare and Institutions Code end insert begin insert , to read: end insert

begin insert

 

PART  begin insert 3.8. end insert   COMMUNITY-BASED SERVICES

 

begin insert 5848.5. end insert   

(a) The Legislature finds and declares all of the
following:

(1) California has realigned public community mental health
services to counties and it is imperative that sufficient
community-based resources be available to meet the mental health
needs of eligible individuals.

(2) Increasing access to effective outpatient and crisis
stabilization services provides an opportunity to reduce costs
associated with expensive inpatient and emergency room care and
to better meet the needs of individuals with mental health disorders
in the least restrictive manner possible.

(3) Almost one-fifth of people with mental health disorders visit
a hospital emergency room at least once per year. If an adequate
array of crisis services is not available, it leaves an individual
with little choice but to access an emergency room for assistance
and, potentially, an unnecessary inpatient hospitalization.

(4) Recent reports have called attention to a continuing problem
of inappropriate and unnecessary utilization of hospital emergency
rooms in California due to limited community-based services for
individuals in psychological distress and acute psychiatric crisis.
Hospitals report that 70 percent of people taken to emergency
rooms for psychiatric evacuation can be stabilized and transferred
to a less intensive level of crisis care. Law enforcement personnel
report that their personnel need to stay with people in the
emergency room waiting area until a placement is found, and that
less intensive levels of care tend not to be available.

(5) Comprehensive public and private partnerships at both local
and regional levels, including across physical health services,
mental health, substance use disorder, law enforcement, social
services, and related supports, are necessary to develop and
maintain high quality, patient-centered, and cost-effective care
for individuals with mental health disorders that facilitates their
recovery and leads towards wellness.

(6) The recovery of individuals with mental health disorders is
important for all levels of government, business, and the local
community.

(b) This section shall be known, and may be cited, as the
Investment in Mental Health Wellness Act of 2013. The objectives
of this section are to do all of the following:

(1) Expand access to early intervention and treatment services
to improve the client experience, achieve recovery and wellness,
and reduce costs.

(2) Expand the continuum of services to address crisis
intervention, crisis stabilization, and crisis residential treatment
needs that are wellness, resiliency, and recovery oriented.

(3) Add at least 25 mobile crisis support teams and at least
2,000 crisis stabilization and crisis residential treatment beds to
bolster capacity at the local level to improve access to mental
health crisis services and address unmet mental health care needs.

(4) Add at least 600 triage personnel to provide intensive case
management and linkage to services for individuals with mental
health care disorders at various points of access, such as at
designated community-based service points, homeless shelters,
and clinics.

(5) Reduce unnecessary hospitalizations and inpatient days by
appropriately utilizing community-based services and improving
access to timely assistance.

(6) Reduce recidivism and mitigate unnecessary expenditures
of local law enforcement.

(7) Provide local communities with increased financial
resources to leverage additional public and private funding sources
to achieve improved networks of care for individuals with mental
health disorders.

(c) Through appropriations provided in the annual Budget Act
for this purpose, it is the intent of the Legislature to authorize the
California Health Facilities Financing Authority, hereafter referred
to as the authority, and the Mental Health Services Oversight and
Accountability Commission, hereafter referred to as the
commission, to administer competitive selection processes as
provided in this section for capital capacity and program expansion
to increase capacity for mobile crisis support, crisis intervention,
crisis stabilization services, crisis residential treatment, and
specified personnel resources.

(d) Funds appropriated by the Legislature to the authority for
the purposes of this section shall be made available to selected
counties, or counties acting jointly. The authority may, at its
discretion, also give consideration to private nonprofit
corporations and public agencies in an area or region of the state
if a county, or counties acting jointly, affirmatively supports this
designation and collaboration in lieu of a county government
directly receiving grant funds.

(1) Grant awards made by the authority shall be used to expand
local resources for the development, capital, equipment acquisition,
and applicable program startup or expansion costs to increase
capacity for client assistance and services in the following areas:

(A) Crisis intervention, as authorized by Sections 14021.4,
14680, and 14684.

(B) Crisis stabilization, as authorized by Sections 14021.4,
14680, and 14684.

(C) Crisis residential treatment, as authorized by Sections
14021.4, 14680, and 14684.

(D) Rehabilitative mental health services, as authorized by
Sections 14021.4, 14680, and 14684.

(E) Mobile crisis support teams, including personnel and
equipment, such as the purchase of vehicles.

(2) The authority shall develop selection criteria to expand local
resources, including those described in paragraph (1), and
processes for awarding grants after consulting with representatives
and interested stakeholders from the mental health community,
including, but not limited to, county mental health directors, service
providers, consumer organizations, and other appropriate interests,
such as health care providers and law enforcement, as determined
by the authority. The authority shall ensure that grants result in
cost-effective expansion of the number of community-based crisis
resources in regions and communities selected for funding. The
authority shall also take into account at least the following criteria
and factors when selecting recipients of grants and determining
the amount of grant awards:

(A) Description of need, including, at a minimum, a
comprehensive description of the project, community need,
population to be served, linkage with other public systems of health
and mental health care, linkage with local law enforcement, social
services, and related assistance, as applicable, and a description
of the request for funding.

(B) Ability to serve the target population, which includes
individuals eligible for Medi-Cal and individuals eligible for county
health and mental health services.

(C) Geographic areas or regions of the state to be eligible for
grant awards, which may include rural, suburban, and urban
areas, and may include use of the five regional designations utilized
by the California Mental Health Directors Association.

(D) Level of community engagement and commitment to project
completion.

(E) Financial support that, in addition to a grant that may be
awarded by the authority, will be sufficient to complete and operate
the project for which the grant from the authority is awarded.

(F) Ability to provide additional funding support to the project,
including public or private funding, federal tax credits and grants,
foundation support, and other collaborative efforts.

(G) Memorandum of understanding among project partners, if
applicable.

(H) Information regarding the legal status of the collaborating
partners, if applicable.

(I) Ability to measure key outcomes, including improved access
to services, health and mental health outcomes, and cost benefit
of the project.

(3) The authority shall determine maximum grants awards,
which shall take into consideration the number of projects awarded
to the grantee, as described in paragraph (1), and shall reflect
reasonable costs for the project and geographic region. The
authority may allocate a grant in increments contingent upon the
phases of a project.

(4) Funds awarded by the authority pursuant to this section
may be used to supplement, but not to supplant, existing financial
and resource commitments of the grantee or any other member of
a collaborative effort that has been awarded a grant.

(5) All projects that are awarded grants by the authority shall
be completed within a reasonable period of time, to be determined
by the authority. Funds shall not be released by the authority until
the applicant demonstrates project readiness to the authority’s
satisfaction. If the authority determines that a grant recipient has
failed to complete the project under the terms specified in awarding
the grant, the authority may require remedies, including the return
of all or a portion of the grant.

(6) A grantee that receives a grant from the authority under this
section shall commit to using that capital capacity and program
expansion project, such as the mobile crisis team, crisis
stabilization unit, or crisis residential treatment program, for the
duration of the expected life of the project.

(7) The authority may consult with a technical assistance entity,
as described in paragraph (5) of subdivision (a) of Section 4061
of the Welfare and Institutions Code, for the purposes of
implementing this section.

(8) The authority may adopt emergency regulations relating to
the grants for the capital capacity and program expansion projects
described in this section, including emergency regulations that
define eligible costs and determine minimum and maximum grant
amounts.

(9) The authority shall provide reports to the fiscal and policy
committees of the Legislature on or before May 1, 2014, and or
before May 1, 2015, on the progress of implementation, that
includes, but are not limited to, the following:

(A) A description of each project awarded funding.

(B) The amount of each grant issued.

(C) A description of other sources of funding for each project.

(D) The total amount of grants issued.

(E) A description of project operation and implementation,
including who is being served.

(10) A recipient of a grant provided pursuant to paragraph (1)
shall adhere to all applicable laws relating to scope of practice,
licensure, certification, staffing, and building codes.

(e) Funds appropriated by the Legislature to the commission
for the purposes of this section shall be allocated for triage
personnel to provide intensive case management and linkage to
services for individuals with mental health disorders at various
points of access. These funds shall be made available to selected
counties, counties acting jointly, or city mental health departments,
as determined by the commission through a selection process. It
is the intent of the Legislature for these funds to be allocated in
an efficient manner to encourage early intervention and receipt
of needed services for individuals with mental health disorders,
and to assist in navigating the local service sector to improve
efficiencies and the delivery of services.

(1) Triage personnel may provide targeted case management
services face to face, by telephone, or by telehealth with the
individual in need of assistance or his or her significant support
person, and may be provided anywhere in the community. These
service activities may include, but are not limited to, the following:

(A) Communication, coordination, and referral.

(B) Monitoring service delivery to ensure the individual accesses
and receives services.

(C) Monitoring the individual’s progress.

(D) Providing placement service assistance and service plan
development.

(2) The commission shall take into account at least the following
criteria and factors when selecting recipients and determining the
amount of grant awards for triage personnel as follows:

(A) Description of need, including potential gaps in local service
connections.

(B) Description of funding request, including personnel and use
of peer support.

(C) Description of how triage personnel will be used to facilitate
linkage and access to services, including objectives and anticipated
outcomes.

(D) Ability to obtain federal Medicaid reimbursement, when
applicable.

(E) Ability to administer an effective service program and the
degree to which local agencies and service providers will support
and collaborate with the triage personnel effort.

(F) Geographic areas or regions of the state to be eligible for
grant awards, which shall include rural, suburban, and urban
areas, and may include use of the five regional designations utilized
by the California Mental Health Directors Association.

(3) The commission shall determine maximum grant awards,
and shall take into consideration the level of need, population to
be served, and related criteria, as described in paragraph (2), and
shall reflect reasonable costs.

(4) Funds awarded by the commission for purposes of this
section may be used to supplement, but not supplant, existing
financial and resource commitments of the county, counties acting
jointly, or city mental health department that received the grant.

(5) Notwithstanding any other law, a county, counties acting
jointly, or city mental health department that receives an award
of funds for the purpose of supporting triage personnel pursuant
to this subdivision is not required to provide a matching
contribution of local funds.

(6) Notwithstanding any other law, the commission, without
taking any further regulatory action, may implement, interpret, or
make specific this section by means of informational letters,
bulletins, or similar instructions.

(7) The commission shall provide a status report to the fiscal
and policy committees of the Legislature on the progress of
implementation no later than March 1, 2014.

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begin insert

begin insert SEC. 2. end insert   

end insert

begin insert Section 5892 of the end insert begin insert Welfare and Institutions Code end insert begin insert is
amended to read: end insert

5892.  

(a) In order to promote efficient implementation of this
act, the county shall use funds distributed from the Mental Health
Services Fund as follows:

(1) In 2005-06, 2006-07, and in 2007-08 10 percent shall be
placed in a trust fund to be expended for education and training
programs pursuant to Part 3.1.

(2) In 2005-06, 2006-07 and in 2007-08 10 percent for capital
facilities and technological needs distributed to counties in
accordance with a formula developed in consultation with the
California Mental Health Directors Association to implement plans
developed pursuant to Section 5847.

(3) Twenty percent of funds distributed to the counties pursuant
to subdivision (c) of Section 5891 shall be used for prevention and
early intervention programs in accordance with Part 3.6
(commencing with Section 5840) of this division.

(4) The expenditure for prevention and early intervention may
be increased in any county in which the department determines
that the increase will decrease the need and cost for additional
services to severely mentally ill persons in that county by an
amount at least commensurate with the proposed increase.

(5) The balance of funds shall be distributed to county mental
health programs for services to persons with severe mental illnesses
pursuant to Part 4 (commencing with Section 5850), for the
children’s system of care and Part 3 (commencing with Section
5800), for the adult and older adult system of care.

(6) Five percent of the total funding for each county mental
health program for Part 3 (commencing with Section 5800), Part
3.6 (commencing with Section 5840), and Part 4 (commencing
with Section 5850) of this division, shall be utilized for innovative
programs in accordance with Sections 5830, 5847, and 5848.

(b) In any year after 2007-08, programs for services pursuant
to Part 3 (commencing with Section 5800), and Part 4
(commencing with Section 5850) of this division may include
funds for technological needs and capital facilities, human resource
needs, and a prudent reserve to ensure services do not have to be
significantly reduced in years in which revenues are below the
average of previous years. The total allocation for purposes
authorized by this subdivision shall not exceed 20 percent of the
average amount of funds allocated to that county for the previous
five years pursuant to this section.

(c) The allocations pursuant to subdivisions (a) and (b) shall
include funding for annual planning costs pursuant to Section 5848.
The total of these costs shall not exceed 5 percent of the total of
annual revenues received for the fund. The planning costs shall
include funds for county mental health programs to pay for the
costs of consumers, family members, and other stakeholders to
participate in the planning process and for the planning and
implementation required for private provider contracts to be
significantly expanded to provide additional services pursuant to
Part 3 (commencing with Section 5800), and Part 4 (commencing
with Section 5850) of this division.

(d) Prior to making the allocations pursuant to subdivisions (a),
(b), and (c), funds shall be reserved for the costs for the State
Department of Health Care Services, the California Mental Health
Planning Council, the Office of Statewide Health Planning and
Development, the Mental Health Services Oversight and
Accountability Commission, the State Department of Public Health,
and any other state agency to implement all duties pursuant to the
programs set forth in this section. These costs shall not exceed begin delete 3.5 end delete
begin insert 5 end insert percent of the total of annual revenues received for the fund. The
administrative costs shall include funds to assist consumers and
family members to ensure the appropriate state and county agencies
give full consideration to concerns about quality, structure of
service delivery, or access to services. The amounts allocated for
administration shall include amounts sufficient to ensure adequate
research and evaluation regarding the effectiveness of services
being provided and achievement of the outcome measures set forth
in Part 3 (commencing with Section 5800), Part 3.6 (commencing
with Section 5840), and Part 4 (commencing with Section 5850)
of this division. The amount of funds available for the purposes
of this subdivision in any fiscal year shall be subject to
appropriation in the annual Budget Act.

(e) In 2004-05 funds shall be allocated as follows:

(1)  Forty-five percent for education and training pursuant to
Part 3.1 (commencing with Section 5820) of this division.

(2)  Forty-five percent for capital facilities and technology needs
in the manner specified by paragraph (2) of subdivision (a).

(3)  Five percent for local planning in the manner specified in
subdivision (c).

(4) Five percent for state implementation in the manner specified
in subdivision (d).

(f) Each county shall place all funds received from the State
Mental Health Services Fund in a local Mental Health Services
Fund. The Local Mental Health Services Fund balance shall be
invested consistent with other county funds and the interest earned
on the investments shall be transferred into the fund. The earnings
on investment of these funds shall be available for distribution
from the fund in future years.

(g) All expenditures for county mental health programs shall
be consistent with a currently approved plan or update pursuant
to Section 5847.

(h) Other than funds placed in a reserve in accordance with an
approved plan, any funds allocated to a county which have not
been spent for their authorized purpose within three years shall
revert to the state to be deposited into the fund and available for
other counties in future years, provided however, that funds for
capital facilities, technological needs, or education and training
may be retained for up to 10 years before reverting to the fund.

(i) If there are still additional revenues available in the fund
after the Mental Health Services Oversight and Accountability
Commission has determined there are prudent reserves and no
unmet needs for any of the programs funded pursuant to this
section, including all purposes of the Prevention and Early
Intervention Program, the commission shall develop a plan for
expenditures of these revenues to further the purposes of this act
and the Legislature may appropriate these funds for any purpose
consistent with the commission’s adopted plan which furthers the
purposes of this act.

(j) For the 2011-12 fiscal year, General Fund revenues will be
insufficient to fully fund many existing mental health programs,
including Early and Periodic Screening, Diagnosis, and Treatment
(EPSDT), Medi-Cal Specialty Mental Health Managed Care, and
mental health services provided for special education pupils. In
order to adequately fund those programs for the 2011-12 fiscal
year and avoid deeper reductions in programs that serve individuals
with severe mental illness and the most vulnerable, medically
needy citizens of the state, prior to distribution of funds under
paragraphs (1) to (6), inclusive, of subdivision (a), effective July
1, 2011, moneys shall be allocated from the Mental Health Services
Fund to the counties as follows:

(1) Commencing July 1, 2011, one hundred eighty-three million
six hundred thousand dollars ($183,600,000) of the funds available
as of July 1, 2011, in the Mental Health Services Fund, shall be
allocated in a manner consistent with subdivision (c) of Section
5778 and based on a formula determined by the state in
consultation with the California Mental Health Directors
Association to meet the fiscal year 2011-12 General Fund
obligation for Medi-Cal Specialty Mental Health Managed Care.

(2) Upon completion of the allocation in paragraph (1), the
Controller shall distribute to counties ninety-eight million five
hundred eighty-six thousand dollars ($98,586,000) from the Mental
Health Services Fund for mental health services for special
education pupils based on a formula determined by the state in
consultation with the California Mental Health Directors
Association.

(3) Upon completion of the allocation in paragraph (2), the
Controller shall distribute to counties 50 percent of their 2011-12
Mental Health Services Act component allocations consistent with
Sections 5847 and 5891, not to exceed four hundred eighty-eight
million dollars ($488,000,000). This allocation shall commence
beginning August 1, 2011.

(4) Upon completion of the allocation in paragraph (3), and as
revenues are deposited into the Mental Health Services Fund, the
Controller shall distribute five hundred seventy-nine million dollars
($579,000,000) from the Mental Health Services Fund to counties
to meet the General Fund obligation for EPSDT for fiscal year
2011-12. These revenues shall be distributed to counties on a
quarterly basis and based on a formula determined by the state in
consultation with the California Mental Health Directors
Association. These funds shall not be subject to reconciliation or
cost settlement.

(5) The Controller shall distribute to counties the remaining
2011-12 Mental Health Services Act component allocations
consistent with Sections 5847 and 5891, beginning no later than
April 30, 2012. These remaining allocations shall be made on a
monthly basis.

(6) The total one-time allocation from the Mental Health
Services Fund for EPSDT, Medi-Cal Specialty Mental Health
Managed Care, and mental health services provided to special
education pupils as referenced shall not exceed eight hundred
sixty-two million dollars ($862,000,000). Any revenues deposited
in the Mental Health Services Fund in fiscal year 2011-12 that
exceed this obligation shall be distributed to counties for remaining
fiscal year 2011-12 Mental Health Services Act component
allocations, consistent with Sections 5847 and 5891.

(k) Subdivision (j) shall not be subject to repayment.

(l) Subdivision (j) shall become inoperative on July 1, 2012.

begin insert

begin insert SEC. 3. end insert   

end insert begin insert

For the purpose of the Investment in Mental Health
Wellness Act of 2013, the amount of five hundred thousand dollars
($500,000) is hereby appropriated from the General Fund to the
California Health Facilities Financing Authority to implement
grant programs to support the development, capital, equipment
acquisition, and applicable program startup or expansion costs
to increase capacity for client assistance and services for
individuals with mental health disorders. The authority may
administratively establish positions for this purpose. These funds
shall be available for encumbrance and expenditure until June 30,
2016.

end insert

begin insert

begin insert SEC. 4. end insert   

end insert begin insert

This act is a bill providing for appropriations related
to the Budget Bill within the meaning of subdivision (e) of Section
12 of Article IV of the California Constitution, has been identified
as related to the budget in the Budget Bill, and shall take effect
immediately.

end insert

begin insert

begin insert SEC. 5. end insert   

end insert

begin insert The Legislature finds and declares that this act clarifies
procedures and terms of the Mental Health Services Act within
the meaning of Section 18 of the Mental Health Services Act. end insert

begin delete

SECTION 1.  

It is the intent of the Legislature to enact statutory
changes relating to the Budget Act of 2013.

end delete