Amended in Assembly June 12, 2013

Senate BillNo. 82


Introduced by Committee on Budget and Fiscal Review

January 10, 2013


begin deleteAn act relating to the Budget Act of 2013. end deletebegin insertAn act 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

SB 82, as amended, Committee on Budget and Fiscal Review. begin deleteBudget Act of 2013. end deletebegin insertInvestment in Mental Health Wellness Act of 2013.end insert

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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.

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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 The act, as originally enacted, limited state administrative costs to implement duties pursuant to the programs to 5% of the total of annual revenues received for the fund.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 23 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 deleteno end deletebegin insertyesend insert. Fiscal committee: begin deleteno end deletebegin insertyesend insert. State-mandated local program: no.

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

P3    1begin insert

begin insertSECTION 1.end insert  

end insert

begin insertPart 3.8 (commencing with Section 5848.5) is
2added to Division 5 of the end insert
begin insertWelfare and Institutions Codeend insertbegin insert, to read:end insert

begin insert

3 

4PART begin insert3.8.end insert  COMMUNITY-BASED SERVICES

5

 

6

begin insert5848.5.end insert  

(a) The Legislature finds and declares all of the
7following:

8(1) California has realigned public community mental health
9services to counties and it is imperative that sufficient
10community-based resources be available to meet the mental health
11needs of eligible individuals.

12(2) Increasing access to effective outpatient and crisis
13stabilization services provides an opportunity to reduce costs
14associated with expensive inpatient and emergency room care and
15to better meet the needs of individuals with mental health disorders
16in the least restrictive manner possible.

17(3) Almost one-fifth of people with mental health disorders visit
18a hospital emergency room at least once per year. If an adequate
19array of crisis services is not available, it leaves an individual
20with little choice but to access an emergency room for assistance
21and, potentially, an unnecessary inpatient hospitalization.

22(4) Recent reports have called attention to a continuing problem
23of inappropriate and unnecessary utilization of hospital emergency
24rooms in California due to limited community-based services for
25individuals in psychological distress and acute psychiatric crisis.
26Hospitals report that 70 percent of people taken to emergency
27rooms for psychiatric evacuation can be stabilized and transferred
28to a less intensive level of crisis care. Law enforcement personnel
29report that their personnel need to stay with people in the
30emergency room waiting area until a placement is found, and that
31less intensive levels of care tend not to be available.

32(5) Comprehensive public and private partnerships at both local
33and regional levels, including across physical health services,
34mental health, substance use disorder, law enforcement, social
35services, and related supports, are necessary to develop and
36maintain high quality, patient-centered, and cost-effective care
37for individuals with mental health disorders that facilitates their
38recovery and leads towards wellness.

P4    1(6) The recovery of individuals with mental health disorders is
2important for all levels of government, business, and the local
3community.

4(b) This section shall be known, and may be cited, as the
5Investment in Mental Health Wellness Act of 2013. The objectives
6of this section are to do all of the following:

7(1) Expand access to early intervention and treatment services
8to improve the client experience, achieve recovery and wellness,
9and reduce costs.

10(2) Expand the continuum of services to address crisis
11intervention, crisis stabilization, and crisis residential treatment
12needs that are wellness, resiliency, and recovery oriented.

13(3) Add at least 25 mobile crisis support teams and at least
142,000 crisis stabilization and crisis residential treatment beds to
15bolster capacity at the local level to improve access to mental
16health crisis services and address unmet mental health care needs.

17(4) Add at least 600 triage personnel to provide intensive case
18management and linkage to services for individuals with mental
19health care disorders at various points of access, such as at
20designated community-based service points, homeless shelters,
21and clinics.

22(5) Reduce unnecessary hospitalizations and inpatient days by
23appropriately utilizing community-based services and improving
24access to timely assistance.

25(6) Reduce recidivism and mitigate unnecessary expenditures
26of local law enforcement.

27(7) Provide local communities with increased financial
28resources to leverage additional public and private funding sources
29to achieve improved networks of care for individuals with mental
30health disorders.

31(c) Through appropriations provided in the annual Budget Act
32for this purpose, it is the intent of the Legislature to authorize the
33California Health Facilities Financing Authority, hereafter referred
34to as the authority, and the Mental Health Services Oversight and
35Accountability Commission, hereafter referred to as the
36commission, to administer competitive selection processes as
37provided in this section for capital capacity and program expansion
38to increase capacity for mobile crisis support, crisis intervention,
39crisis stabilization services, crisis residential treatment, and
40specified personnel resources.

P5    1(d) Funds appropriated by the Legislature to the authority for
2the purposes of this section shall be made available to selected
3counties, or counties acting jointly. The authority may, at its
4discretion, also give consideration to private nonprofit
5corporations and public agencies in an area or region of the state
6if a county, or counties acting jointly, affirmatively supports this
7designation and collaboration in lieu of a county government
8directly receiving grant funds.

9(1) Grant awards made by the authority shall be used to expand
10local resources for the development, capital, equipment acquisition,
11and applicable program startup or expansion costs to increase
12capacity for client assistance and services in the following areas:

13(A) Crisis intervention, as authorized by Sections 14021.4,
1414680, and 14684.

15(B) Crisis stabilization, as authorized by Sections 14021.4,
1614680, and 14684.

17(C) Crisis residential treatment, as authorized by Sections
1814021.4, 14680, and 14684.

19(D) Rehabilitative mental health services, as authorized by
20Sections 14021.4, 14680, and 14684.

21(E) Mobile crisis support teams, including personnel and
22equipment, such as the purchase of vehicles.

23(2) The authority shall develop selection criteria to expand local
24resources, including those described in paragraph (1), and
25processes for awarding grants after consulting with representatives
26and interested stakeholders from the mental health community,
27including, but not limited to, county mental health directors, service
28providers, consumer organizations, and other appropriate interests,
29such as health care providers and law enforcement, as determined
30by the authority. The authority shall ensure that grants result in
31cost-effective expansion of the number of community-based crisis
32resources in regions and communities selected for funding. The
33authority shall also take into account at least the following criteria
34and factors when selecting recipients of grants and determining
35the amount of grant awards:

36(A) Description of need, including, at a minimum, a
37comprehensive description of the project, community need,
38population to be served, linkage with other public systems of health
39and mental health care, linkage with local law enforcement, social
P6    1services, and related assistance, as applicable, and a description
2of the request for funding.

3(B) Ability to serve the target population, which includes
4individuals eligible for Medi-Cal and individuals eligible for county
5health and mental health services.

6(C) Geographic areas or regions of the state to be eligible for
7grant awards, which may include rural, suburban, and urban
8areas, and may include use of the five regional designations utilized
9by the California Mental Health Directors Association.

10(D) Level of community engagement and commitment to project
11completion.

12(E) Financial support that, in addition to a grant that may be
13awarded by the authority, will be sufficient to complete and operate
14the project for which the grant from the authority is awarded.

15(F) Ability to provide additional funding support to the project,
16including public or private funding, federal tax credits and grants,
17foundation support, and other collaborative efforts.

18(G) Memorandum of understanding among project partners, if
19applicable.

20(H) Information regarding the legal status of the collaborating
21partners, if applicable.

22(I) Ability to measure key outcomes, including improved access
23to services, health and mental health outcomes, and cost benefit
24of the project.

25(3) The authority shall determine maximum grants awards,
26which shall take into consideration the number of projects awarded
27to the grantee, as described in paragraph (1), and shall reflect
28reasonable costs for the project and geographic region. The
29authority may allocate a grant in increments contingent upon the
30phases of a project.

31(4) Funds awarded by the authority pursuant to this section
32may be used to supplement, but not to supplant, existing financial
33and resource commitments of the grantee or any other member of
34a collaborative effort that has been awarded a grant.

35(5) All projects that are awarded grants by the authority shall
36be completed within a reasonable period of time, to be determined
37by the authority. Funds shall not be released by the authority until
38the applicant demonstrates project readiness to the authority’s
39satisfaction. If the authority determines that a grant recipient has
40failed to complete the project under the terms specified in awarding
P7    1the grant, the authority may require remedies, including the return
2of all or a portion of the grant.

3(6) A grantee that receives a grant from the authority under this
4section shall commit to using that capital capacity and program
5expansion project, such as the mobile crisis team, crisis
6stabilization unit, or crisis residential treatment program, for the
7duration of the expected life of the project.

8(7) The authority may consult with a technical assistance entity,
9as described in paragraph (5) of subdivision (a) of Section 4061
10of the Welfare and Institutions Code, for the purposes of
11implementing this section.

12(8) The authority may adopt emergency regulations relating to
13the grants for the capital capacity and program expansion projects
14described in this section, including emergency regulations that
15define eligible costs and determine minimum and maximum grant
16amounts.

17(9) The authority shall provide reports to the fiscal and policy
18committees of the Legislature on or before May 1, 2014, and or
19before May 1, 2015, on the progress of implementation, that
20includes, but are not limited to, the following:

21(A) A description of each project awarded funding.

22(B) The amount of each grant issued.

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

24(D) The total amount of grants issued.

25(E) A description of project operation and implementation,
26including who is being served.

27(10) A recipient of a grant provided pursuant to paragraph (1)
28shall adhere to all applicable laws relating to scope of practice,
29licensure, certification, staffing, and building codes.

30(e) Funds appropriated by the Legislature to the commission
31for the purposes of this section shall be allocated for triage
32personnel to provide intensive case management and linkage to
33services for individuals with mental health disorders at various
34points of access. These funds shall be made available to selected
35counties, counties acting jointly, or city mental health departments,
36as determined by the commission through a selection process. It
37is the intent of the Legislature for these funds to be allocated in
38an efficient manner to encourage early intervention and receipt
39of needed services for individuals with mental health disorders,
P8    1and to assist in navigating the local service sector to improve
2efficiencies and the delivery of services.

3(1) Triage personnel may provide targeted case management
4services face to face, by telephone, or by telehealth with the
5individual in need of assistance or his or her significant support
6person, and may be provided anywhere in the community. These
7service activities may include, but are not limited to, the following:

8(A) Communication, coordination, and referral.

9(B) Monitoring service delivery to ensure the individual accesses
10and receives services.

11(C) Monitoring the individual’s progress.

12(D) Providing placement service assistance and service plan
13development.

14(2) The commission shall take into account at least the following
15 criteria and factors when selecting recipients and determining the
16amount of grant awards for triage personnel as follows:

17(A) Description of need, including potential gaps in local service
18connections.

19(B) Description of funding request, including personnel and use
20of peer support.

21(C) Description of how triage personnel will be used to facilitate
22linkage and access to services, including objectives and anticipated
23outcomes.

24(D) Ability to obtain federal Medicaid reimbursement, when
25applicable.

26(E) Ability to administer an effective service program and the
27degree to which local agencies and service providers will support
28and collaborate with the triage personnel effort.

29(F) Geographic areas or regions of the state to be eligible for
30grant awards, which shall include rural, suburban, and urban
31areas, and may include use of the five regional designations utilized
32by the California Mental Health Directors Association.

33(3) The commission shall determine maximum grant awards,
34and shall take into consideration the level of need, population to
35be served, and related criteria, as described in paragraph (2), and
36shall reflect reasonable costs.

37(4) Funds awarded by the commission for purposes of this
38section may be used to supplement, but not supplant, existing
39financial and resource commitments of the county, counties acting
40jointly, or city mental health department that received the grant.

P9    1(5) Notwithstanding any other law, a county, counties acting
2jointly, or city mental health department that receives an award
3of funds for the purpose of supporting triage personnel pursuant
4to this subdivision is not required to provide a matching
5contribution of local funds.

6(6) Notwithstanding any other law, the commission, without
7taking any further regulatory action, may implement, interpret, or
8make specific this section by means of informational letters,
9bulletins, or similar instructions.

10(7) The commission shall provide a status report to the fiscal
11and policy committees of the Legislature on the progress of
12implementation no later than March 1, 2014.

end insert
13begin insert

begin insertSEC. 2.end insert  

end insert

begin insertSection 5892 of the end insertbegin insertWelfare and Institutions Codeend insertbegin insert is
14amended to read:end insert

15

5892.  

(a) In order to promote efficient implementation of this
16act, the county shall use funds distributed from the Mental Health
17Services Fund as follows:

18(1) In 2005-06, 2006-07, and in 2007-08 10 percent shall be
19placed in a trust fund to be expended for education and training
20programs pursuant to Part 3.1.

21(2) In 2005-06, 2006-07 and in 2007-08 10 percent for capital
22facilities and technological needs distributed to counties in
23accordance with a formula developed in consultation with the
24California Mental Health Directors Association to implement plans
25developed pursuant to Section 5847.

26(3) Twenty percent of funds distributed to the counties pursuant
27to subdivision (c) of Section 5891 shall be used for prevention and
28early intervention programs in accordance with Part 3.6
29(commencing with Section 5840) of this division.

30(4) The expenditure for prevention and early intervention may
31be increased in any county in which the department determines
32that the increase will decrease the need and cost for additional
33services to severely mentally ill persons in that county by an
34amount at least commensurate with the proposed increase.

35(5) The balance of funds shall be distributed to county mental
36health programs for services to persons with severe mental illnesses
37pursuant to Part 4 (commencing with Section 5850), for the
38children’s system of care and Part 3 (commencing with Section
395800), for the adult and older adult system of care.

P10   1(6) Five percent of the total funding for each county mental
2health program for Part 3 (commencing with Section 5800), Part
33.6 (commencing with Section 5840), and Part 4 (commencing
4with Section 5850) of this division, shall be utilized for innovative
5programs in accordance with Sections 5830, 5847, and 5848.

6(b) In any year after 2007-08, programs for services pursuant
7to Part 3 (commencing with Section 5800), and Part 4
8(commencing with Section 5850) of this division may include
9funds for technological needs and capital facilities, human resource
10needs, and a prudent reserve to ensure services do not have to be
11significantly reduced in years in which revenues are below the
12average of previous years. The total allocation for purposes
13authorized by this subdivision shall not exceed 20 percent of the
14average amount of funds allocated to that county for the previous
15five years pursuant to this section.

16(c) The allocations pursuant to subdivisions (a) and (b) shall
17include funding for annual planning costs pursuant to Section 5848.
18The total of these costs shall not exceed 5 percent of the total of
19annual revenues received for the fund. The planning costs shall
20include funds for county mental health programs to pay for the
21costs of consumers, family members, and other stakeholders to
22participate in the planning process and for the planning and
23implementation required for private provider contracts to be
24significantly expanded to provide additional services pursuant to
25Part 3 (commencing with Section 5800), and Part 4 (commencing
26with Section 5850) of this division.

27(d) Prior to making the allocations pursuant to subdivisions (a),
28(b), and (c), funds shall be reserved for the costs for the State
29Department of Health Care Services, the California Mental Health
30Planning Council, the Office of Statewide Health Planning and
31 Development, the Mental Health Services Oversight and
32Accountability Commission, the State Department of Public Health,
33and any other state agency to implement all duties pursuant to the
34programs set forth in this section. These costs shall not exceedbegin delete 3.5end delete
35begin insert 5end insert percent of the total of annual revenues received for the fund. The
36administrative costs shall include funds to assist consumers and
37family members to ensure the appropriate state and county agencies
38give full consideration to concerns about quality, structure of
39service delivery, or access to services. The amounts allocated for
40administration shall include amounts sufficient to ensure adequate
P11   1research and evaluation regarding the effectiveness of services
2being provided and achievement of the outcome measures set forth
3in Part 3 (commencing with Section 5800), Part 3.6 (commencing
4with Section 5840), and Part 4 (commencing with Section 5850)
5of this division. The amount of funds available for the purposes
6of this subdivision in any fiscal year shall be subject to
7appropriation in the annual Budget Act.

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

9(1)  Forty-five percent for education and training pursuant to
10Part 3.1 (commencing with Section 5820) of this division.

11(2)  Forty-five percent for capital facilities and technology needs
12in the manner specified by paragraph (2) of subdivision (a).

13(3)  Five percent for local planning in the manner specified in
14subdivision (c).

15(4) Five percent for state implementation in the manner specified
16in subdivision (d).

17(f) Each county shall place all funds received from the State
18Mental Health Services Fund in a local Mental Health Services
19Fund. The Local Mental Health Services Fund balance shall be
20invested consistent with other county funds and the interest earned
21on the investments shall be transferred into the fund. The earnings
22on investment of these funds shall be available for distribution
23from the fund in future years.

24(g) All expenditures for county mental health programs shall
25be consistent with a currently approved plan or update pursuant
26to Section 5847.

27(h) Other than funds placed in a reserve in accordance with an
28approved plan, any funds allocated to a county which have not
29been spent for their authorized purpose within three years shall
30revert to the state to be deposited into the fund and available for
31other counties in future years, provided however, that funds for
32capital facilities, technological needs, or education and training
33may be retained for up to 10 years before reverting to the fund.

34(i) If there are still additional revenues available in the fund
35after the Mental Health Services Oversight and Accountability
36Commission has determined there are prudent reserves and no
37unmet needs for any of the programs funded pursuant to this
38section, including all purposes of the Prevention and Early
39Intervention Program, the commission shall develop a plan for
40expenditures of these revenues to further the purposes of this act
P12   1and the Legislature may appropriate these funds for any purpose
2consistent with the commission’s adopted plan which furthers the
3purposes of this act.

4(j) For the 2011-12 fiscal year, General Fund revenues will be
5insufficient to fully fund many existing mental health programs,
6including Early and Periodic Screening, Diagnosis, and Treatment
7(EPSDT), Medi-Cal Specialty Mental Health Managed Care, and
8mental health services provided for special education pupils. In
9order to adequately fund those programs for the 2011-12 fiscal
10year and avoid deeper reductions in programs that serve individuals
11with severe mental illness and the most vulnerable, medically
12needy citizens of the state, prior to distribution of funds under
13paragraphs (1) to (6), inclusive, of subdivision (a), effective July
141, 2011, moneys shall be allocated from the Mental Health Services
15Fund to the counties as follows:

16(1) Commencing July 1, 2011, one hundred eighty-three million
17six hundred thousand dollars ($183,600,000) of the funds available
18as of July 1, 2011, in the Mental Health Services Fund, shall be
19allocated in a manner consistent with subdivision (c) of Section
205778 and based on a formula determined by the state in
21consultation with the California Mental Health Directors
22Association to meet the fiscal year 2011-12 General Fund
23obligation for Medi-Cal Specialty Mental Health Managed Care.

24(2) Upon completion of the allocation in paragraph (1), the
25Controller shall distribute to counties ninety-eight million five
26hundred eighty-six thousand dollars ($98,586,000) from the Mental
27Health Services Fund for mental health services for special
28education pupils based on a formula determined by the state in
29consultation with the California Mental Health Directors
30Association.

31(3) Upon completion of the allocation in paragraph (2), the
32Controller shall distribute to counties 50 percent of their 2011-12
33Mental Health Services Act component allocations consistent with
34Sections 5847 and 5891, not to exceed four hundred eighty-eight
35million dollars ($488,000,000). This allocation shall commence
36beginning August 1, 2011.

37(4) Upon completion of the allocation in paragraph (3), and as
38revenues are deposited into the Mental Health Services Fund, the
39Controller shall distribute five hundred seventy-nine million dollars
40($579,000,000) from the Mental Health Services Fund to counties
P13   1to meet the General Fund obligation for EPSDT for fiscal year
22011-12. These revenues shall be distributed to counties on a
3quarterly basis and based on a formula determined by the state in
4consultation with the California Mental Health Directors
5Association. These funds shall not be subject to reconciliation or
6cost settlement.

7(5) The Controller shall distribute to counties the remaining
82011-12 Mental Health Services Act component allocations
9consistent with Sections 5847 and 5891, beginning no later than
10April 30, 2012. These remaining allocations shall be made on a
11monthly basis.

12(6) The total one-time allocation from the Mental Health
13Services Fund for EPSDT, Medi-Cal Specialty Mental Health
14Managed Care, and mental health services provided to special
15education pupils as referenced shall not exceed eight hundred
16sixty-two million dollars ($862,000,000). Any revenues deposited
17in the Mental Health Services Fund in fiscal year 2011-12 that
18exceed this obligation shall be distributed to counties for remaining
19fiscal year 2011-12 Mental Health Services Act component
20allocations, consistent with Sections 5847 and 5891.

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

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

23begin insert

begin insertSEC. 3.end insert  

end insert
begin insert

For the purpose of the Investment in Mental Health
24Wellness Act of 2013, the amount of five hundred thousand dollars
25($500,000) is hereby appropriated from the General Fund to the
26California Health Facilities Financing Authority to implement
27grant programs to support the development, capital, equipment
28acquisition, and applicable program startup or expansion costs
29to increase capacity for client assistance and services for
30individuals with mental health disorders. The authority may
31administratively establish positions for this purpose. These funds
32shall be available for encumbrance and expenditure until June 30,
33 2016.

end insert
34begin insert

begin insertSEC. 4.end insert  

end insert
begin insert

This act is a bill providing for appropriations related
35to the Budget Bill within the meaning of subdivision (e) of Section
3612 of Article IV of the California Constitution, has been identified
37as related to the budget in the Budget Bill, and shall take effect
38immediately.

end insert
P14   1begin insert

begin insertSEC. 5.end insert  

end insert
begin insert

The Legislature finds and declares that this act clarifies
2procedures and terms of the Mental Health Services Act within
3the meaning of Section 18 of the Mental Health Services Act.

end insert
begin delete
4

SECTION 1.  

It is the intent of the Legislature to enact statutory
5changes relating to the Budget Act of 2013.

end delete


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