Amended in Assembly April 6, 2016

Amended in Assembly March 18, 2016

California Legislature—2015–16 Regular Session

Assembly BillNo. 1764


Introduced by Assembly Member Waldron

February 3, 2016


An act to amend Sectionbegin delete 5348 of the Welfare and Institutionsend deletebegin insert 127660 of the Health and Safetyend insert Code, relating tobegin delete mental health.end deletebegin insert health care coverage.end insert

LEGISLATIVE COUNSEL’S DIGEST

AB 1764, as amended, Waldron. begin deleteMental health services: assisted outpatient treatment. end deletebegin insertCalifornia Health Benefit Review Program: financial impacts.end insert

begin insert

Existing law, until July 1, 2017, requests the University of California to establish the California Health Benefit Review Program to assess, among other things, legislation that proposes to mandate or repeal a mandated benefit or service, as defined. Existing law requests the University of California to prepare a written analysis with relevant data on public health, medical, financial, and other impacts of that legislation, as specified.

end insert
begin insert

Existing law requests the University of California to provide the analysis to the appropriate policy and fiscal committees of the Legislature, as specified, and to submit a report to the Governor and the Legislature regarding the implementation of these provisions by January 1, 2017. Existing law establishes the Health Care Benefits Fund in the State Treasury to effectively support the University of California and its work in implementing these provisions.

end insert
begin insert

This bill would additionally request the University of California to include in its analysis, as part of the financial impacts of the above legislation, relevant data on the impact of coverage or repeal of coverage of the benefit or service on anticipated costs or savings estimated upon implementation for the 2 subsequent state fiscal years and, if applicable, for the 5 subsequent state fiscal years, as specified.

end insert
begin delete

Existing law, the Assisted Outpatient Treatment Demonstration Project Act of 2002, known as Laura’s Law, until January 1, 2017, grants each county the authority to offer certain assisted outpatient treatment services for its residents by adopting a resolution or through the county budget process and by making a finding that no mental health program, as specified, may be reduced as a result of implementation. Under that law, participating counties are required to offer prescribed assisted outpatient treatment services, including, among other things, a service planning and delivery process and a mental health personal services coordinator, as specified. Existing law authorizes participating counties to pay for the services provided from moneys distributed to the counties from various continuously appropriated funds, including the Mental Health Services Fund when included in a county plan, as specified.

end delete
begin delete

Existing law authorizes designated persons to request the county behavioral health director to file a petition in the superior court for an order for assisted outpatient treatment, for an initial period not to exceed 6 months, for a person who meets specified criteria. Existing law requires the county behavioral health director to investigate the appropriateness of filing the petition. Existing law also provides specified rights to a person who is the subject of the petition. Existing law requires participating counties to also offer the services described above on a voluntary basis.

end delete
begin delete

This bill would authorize participating counties to agree to act jointly to offer, or to contract with each other to offer, assisted outpatient treatment services pursuant to these provisions, subject to the approval of the State Department of Health Care Services. The bill would provide that the agreement may include all or a portion of those services and would require a county that is a party to the agreement to separately offer required services that are not included in the agreement.

end delete

Vote: majority. Appropriation: no. Fiscal committee: yes. 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 insertSection 127660 of the end insertbegin insertHealth and Safety Codeend insertbegin insert is
2amended to read:end insert

3

127660.  

(a) The Legislature hereby requests the University of
4California to establish the California Health Benefit Review
5Program to assess legislation proposing to mandate a benefit or
6service, as defined in subdivision (d), and legislation proposing to
7repeal a mandated benefit or service, as defined in subdivision (e),
8and to prepare a written analysis with relevant data on the
9following:

10(1) Public health impacts, including, but not limited to, all of
11the following:

12(A) The impact on the health of the community, including the
13reduction of communicable disease and the benefits of prevention
14such as those provided by childhood immunizations and prenatal
15care.

16(B) The impact on the health of the community, including
17diseases and conditions where disparities in outcomes associated
18with the social determinants of health as well as gender, race,
19sexual orientation, or gender identity are established in
20peer-reviewed scientific and medical literature.

21(C) The extent to which the benefit or service reduces premature
22death and the economic loss associated with disease.

23(2) Medical impacts, including, but not limited to, all of the
24following:

25(A) The extent to which the benefit or service is generally
26recognized by the medical community as being effective in the
27screening, diagnosis, or treatment of a condition or disease, as
28demonstrated by a review of scientific and peer-reviewed medical
29literature.

30(B) The extent to which the benefit or service is generally
31available and utilized by treating physicians.

32(C) The contribution of the benefit or service to the health status
33of the population, including the results of any research
34demonstrating the efficacy of the benefit or service compared to
35alternatives, including not providing the benefit or service.

36(D) The extent to which mandating or repealing the benefits or
37services would not diminish or eliminate access to currently
38available health care benefits or services.

P4    1(3) Financial impacts, including, but not limited to, all of the
2following:

3(A) The extent to which the coverage or repeal of coverage will
4increase or decrease the benefit or cost of the benefit or service.

5(B) The extent to which the coverage or repeal of coverage will
6increase the utilization of the benefit or service, or will be a
7substitute for, or affect the cost of, alternative benefits or services.

8(C) The extent to which the coverage or repeal of coverage will
9increase or decrease the administrative expenses of health care
10service plans and health insurers and the premium and expenses
11of subscribers, enrollees, and policyholders.

12(D) The impact of this coverage or repeal of coverage on the
13total cost of health care.

begin insert

14
(E) The impact of this coverage or repeal of coverage on
15anticipated costs or savings estimated upon implementation for
16the following periods:

end insert
begin insert

17
(i) The two subsequent state fiscal years.

end insert
begin insert

18
(ii) If applicable, the five subsequent state fiscal years through
19a longer-range estimate.

end insert
begin delete

20(E)

end delete

21begin insert(F)end insert The potential cost or savings to the private sector, including
22the impact on small employers as defined in paragraph (1) of
23subdivision (l) of Section 1357, the Public Employees’ Retirement
24System, other retirement systems funded by the state or by a local
25government, individuals purchasing individual health insurance,
26and publicly funded state health insurance programs, including
27the Medi-Cal program and the Healthy Families Program.

begin delete

28(F)

end delete

29begin insert(G)end insert The extent to which costs resulting from lack of coverage
30or repeal of coverage are or would be shifted to other payers,
31including both public and private entities.

begin delete

32(G)

end delete

33begin insert(H)end insert The extent to which mandating or repealing the proposed
34benefit or service would not diminish or eliminate access to
35currently available health care benefits or services.

begin delete

36(H)

end delete

37begin insert(I)end insert The extent to which the benefit or service is generally utilized
38by a significant portion of the population.

begin delete

39(I)

end delete

P5    1begin insert(J)end insert The extent to which health care coverage for the benefit or
2service is already generally available.

begin delete

3(J)

end delete

4begin insert(K)end insert The level of public demand for health care coverage for the
5benefit or service, including the level of interest of collective
6bargaining agents in negotiating privately for inclusion of this
7coverage in group contracts, and the extent to which the mandated
8benefit or service is covered by self-funded employer groups.

begin delete

9(K)

end delete

10begin insert(L)end insert In assessing and preparing a written analysis of the financial
11impact of legislation proposing to mandate a benefit or service and
12legislation proposing to repeal a mandated benefit or service
13pursuant to this paragraph, the Legislature requests the University
14of California to use a certified actuary or other person with relevant
15knowledge and expertise to determine the financial impact.

16(4) The impact on essential health benefits, as defined in Section
171367.005 of this code and Section 10112.27 of the Insurance Code,
18and the impact on the California Health Benefit Exchange.

19(b) The Legislature further requests that the California Health
20Benefit Review Program assess legislation that impacts health
21insurance benefit design, cost sharing, premiums, and other health
22insurance topics.

23(c) The Legislature requests that the University of California
24provide every analysis to the appropriate policy and fiscal
25committees of the Legislature not later than 60 days, or in a manner
26and pursuant to a timeline agreed to by the Legislature and the
27California Health Benefit Review Program, after receiving a request
28made pursuant to Section 127661. In addition, the Legislature
29requests that the university post every analysis on the Internet and
30make every analysis available to the public upon request.

31(d) As used in this section, “legislation proposing to mandate a
32benefit or service” means a proposed statute that requires a health
33care service plan or a health insurer, or both, to do any of the
34following:

35(1) Permit a person insured or covered under the policy or
36contract to obtain health care treatment or services from a particular
37type of health care provider.

38(2) Offer or provide coverage for the screening, diagnosis, or
39treatment of a particular disease or condition.

P6    1(3) Offer or provide coverage of a particular type of health care
2treatment or service, or of medical equipment, medical supplies,
3or drugs used in connection with a health care treatment or service.

4(e) As used in this section, “legislation proposing to repeal a
5mandated benefit or service” means a proposed statute that, if
6enacted, would become operative on or after January 1, 2008, and
7would repeal an existing requirement that a health care service
8plan or a health insurer, or both, do any of the following:

9(1) Permit a person insured or covered under the policy or
10contract to obtain health care treatment or services from a particular
11type of health care provider.

12(2) Offer or provide coverage for the screening, diagnosis, or
13treatment of a particular disease or condition.

14(3) Offer or provide coverage of a particular type of health care
15treatment or service, or of medical equipment, medical supplies,
16or drugs used in connection with a health care treatment or service.

begin delete
17

SECTION 1.  

Section 5348 of the Welfare and Institutions Code
18 is amended to read:

19

5348.  

(a) For purposes of subdivision (e) of Section 5346, a
20county that chooses to provide assisted outpatient treatment
21services pursuant to this article shall offer assisted outpatient
22treatment services including, but not limited to, all of the following:

23(1) Community-based, mobile, multidisciplinary, highly trained
24mental health teams that use high staff-to-client ratios of no more
25than 10 clients per team member for those subject to court-ordered
26services pursuant to Section 5346.

27(2) A service planning and delivery process that includes the
28following:

29(A) Determination of the numbers of persons to be served and
30the programs and services that will be provided to meet their needs.
31The local director of mental health shall consult with the sheriff,
32the police chief, the probation officer, the mental health board,
33contract agencies, and family, client, ethnic, and citizen
34constituency groups as determined by the director.

35(B) Plans for services, including outreach to families whose
36severely mentally ill adult is living with them, design of mental
37health services, coordination and access to medications, psychiatric
38and psychological services, substance abuse services, supportive
39housing or other housing assistance, vocational rehabilitation, and
40veterans’ services. Plans shall also contain evaluation strategies,
P7    1which shall consider cultural, linguistic, gender, age, and special
2needs of minorities and those based on any characteristic listed or
3defined in Section 11135 of the Government Code in the target
4populations. Provision shall be made for staff with the cultural
5 background and linguistic skills necessary to remove barriers to
6mental health services as a result of having
7limited-English-speaking ability and cultural differences.
8Recipients of outreach services may include families, the public,
9primary care physicians, and others who are likely to come into
10contact with individuals who may be suffering from an untreated
11severe mental illness who would be likely to become homeless if
12the illness continued to be untreated for a substantial period of
13time. Outreach to adults may include adults voluntarily or
14involuntarily hospitalized as a result of a severe mental illness.

15(C) Provision for services to meet the needs of persons who are
16physically disabled.

17(D) Provision for services to meet the special needs of older
18adults.

19(E) Provision for family support and consultation services,
20parenting support and consultation services, and peer support or
21self-help group support, where appropriate.

22(F) Provision for services to be client-directed and that employ
23psychosocial rehabilitation and recovery principles.

24(G) Provision for psychiatric and psychological services that
25are integrated with other services and for psychiatric and
26psychological collaboration in overall service planning.

27(H) Provision for services specifically directed to seriously
28mentally ill young adults 25 years of age or younger who are
29homeless or at significant risk of becoming homeless. These
30provisions may include continuation of services that still would
31be received through other funds had eligibility not been terminated
32as a result of age.

33(I) Services reflecting special needs of women from diverse
34cultural backgrounds, including supportive housing that accepts
35children, personal services coordinator therapeutic treatment, and
36substance treatment programs that address gender-specific trauma
37and abuse in the lives of persons with mental illness, and vocational
38rehabilitation programs that offer job training programs free of
39gender bias and sensitive to the needs of women.

P8    1(J) Provision for housing for clients that is immediate,
2transitional, permanent, or all of these.

3(K) Provision for clients who have been suffering from an
4untreated severe mental illness for less than one year, and who do
5not require the full range of services, but are at risk of becoming
6homeless unless a comprehensive individual and family support
7services plan is implemented. These clients shall be served in a
8manner that is designed to meet their needs.

9(3) Each client shall have a clearly designated mental health
10personal services coordinator who may be part of a
11multidisciplinary treatment team who is responsible for providing
12or assuring needed services. Responsibilities include complete
13assessment of the client’s needs, development of the client’s
14personal services plan, linkage with all appropriate community
15services, monitoring of the quality and followthrough of services,
16and necessary advocacy to ensure each client receives those
17services that are agreed to in the personal services plan. Each client
18shall participate in the development of his or her personal services
19plan, and responsible staff shall consult with the designated
20conservator, if one has been appointed, and, with the consent of
21the client, shall consult with the family and other significant
22persons as appropriate.

23(4) The individual personal services plan shall ensure that
24persons subject to assisted outpatient treatment programs receive
25age-appropriate, gender-appropriate, and culturally appropriate
26services, to the extent feasible, that are designed to enable
27recipients to:

28(A) Live in the most independent, least restrictive housing
29feasible in the local community, and, for clients with children, to
30live in a supportive housing environment that strives for
31reunification with their children or assists clients in maintaining
32custody of their children as is appropriate.

33(B) Engage in the highest level of work or productive activity
34appropriate to their abilities and experience.

35(C) Create and maintain a support system consisting of friends,
36family, and participation in community activities.

37(D) Access an appropriate level of academic education or
38vocational training.

39(E) Obtain an adequate income.

P9    1(F) Self-manage their illnesses and exert as much control as
2possible over both the day-to-day and long-term decisions that
3affect their lives.

4(G) Access necessary physical health care and maintain the best
5possible physical health.

6(H) Reduce or eliminate serious antisocial or criminal behavior,
7and thereby reduce or eliminate their contact with the criminal
8justice system.

9(I) Reduce or eliminate the distress caused by the symptoms of
10mental illness.

11(J) Have freedom from dangerous addictive substances.

12(5) The individual personal services plan shall describe the
13service array that meets the requirements of paragraph (4), and to
14the extent applicable to the individual, the requirements of
15paragraph (2).

16(b) A county that provides assisted outpatient treatment services
17pursuant to this article also shall offer the same services on a
18voluntary basis.

19(c) Counties that authorize the application of this article pursuant
20to Section 5349 may agree to act jointly to offer, or to contract
21with each other to offer, assisted outpatient treatment services
22pursuant to this article, subject to the approval of the State
23Department of Health Care Services. The agreement may include
24all or a portion of the assisted outpatient treatment services offered
25pursuant to this article. A county that is a party to the agreement
26shall separately offer assisted outpatient treatment services that
27are not included in the agreement, in accordance with this article.

28(d) Involuntary medication shall not be allowed absent a separate
29order by the court pursuant to Sections 5332 to 5336, inclusive.

30(e) A county that operates an assisted outpatient treatment
31program pursuant to this article shall provide data to the State
32Department of Health Care Services and, based on the data, the
33department shall report to the Legislature on or before May 1 of
34each year in which the county provides services pursuant to this
35article. The report shall include, at a minimum, an evaluation of
36the effectiveness of the strategies employed by each program
37operated pursuant to this article in reducing homelessness and
38hospitalization of persons in the program and in reducing
39involvement with local law enforcement by persons in the program.
40The evaluation and report shall also include any other measures
P10   1identified by the department regarding persons in the program and
2all of the following, based on information that is available:

3(1) The number of persons served by the program and, of those,
4the number who are able to maintain housing and the number who
5maintain contact with the treatment system.

6(2) The number of persons in the program with contacts with
7local law enforcement, and the extent to which local and state
8incarceration of persons in the program has been reduced or
9avoided.

10(3) The number of persons in the program participating in
11employment services programs, including competitive employment.

12(4) The days of hospitalization of persons in the program that
13have been reduced or avoided.

14(5) Adherence to prescribed treatment by persons in the program.

15(6) Other indicators of successful engagement, if any, by persons
16in the program.

17(7) Victimization of persons in the program.

18(8) Violent behavior of persons in the program.

19(9) Substance abuse by persons in the program.

20(10) Type, intensity, and frequency of treatment of persons in
21the program.

22(11) Extent to which enforcement mechanisms are used by the
23program, when applicable.

24(12) Social functioning of persons in the program.

25(13) Skills in independent living of persons in the program.

26(14) Satisfaction with program services both by those receiving
27them and by their families, when relevant.

end delete


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