Bill Text: CA AB1764 | 2015-2016 | Regular Session | Amended

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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Bill Title: California Health Benefit Review Program: financial impacts.

Spectrum: Partisan Bill (Republican 1-0)

Status: (Failed) 2016-11-30 - From committee without further action. [AB1764 Detail]

Download: California-2015-AB1764-Amended.html

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BILL NUMBER: AB 1764	AMENDED
	BILL TEXT

	AMENDED IN ASSEMBLY  APRIL 6, 2016
	AMENDED IN ASSEMBLY  MARCH 18, 2016

INTRODUCED BY   Assembly Member Waldron

                        FEBRUARY 3, 2016

   An act to amend Section  5348 of the Welfare and
Institutions   127660 of the Health and Safety 
Code, relating to  mental health.   health care
coverage. 


	LEGISLATIVE COUNSEL'S DIGEST


   AB 1764, as amended, Waldron.  Mental health services:
assisted outpatient treatment.   California Health
Benefit Review Program: financial impacts.  
   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.  
   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.  
   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.  
   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. 

   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.  

   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. 
   Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

   SECTION 1.    Section 127660 of the   Health
and Safety Code   is amended to read: 
   127660.  (a) The Legislature hereby requests the University of
California to establish the California Health Benefit Review Program
to assess legislation proposing to mandate a benefit or service, as
defined in subdivision (d), and legislation proposing to repeal a
mandated benefit or service, as defined in subdivision (e), and to
prepare a written analysis with relevant data on the following:
   (1) Public health impacts, including, but not limited to, all of
the following:
   (A) The impact on the health of the community, including the
reduction of communicable disease and the benefits of prevention such
as those provided by childhood immunizations and prenatal care.
   (B) The impact on the health of the community, including diseases
and conditions where disparities in outcomes associated with the
social determinants of health as well as gender, race, sexual
orientation, or gender identity are established in peer-reviewed
scientific and medical literature.
   (C) The extent to which the benefit or service reduces premature
death and the economic loss associated with disease.
   (2) Medical impacts, including, but not limited to, all of the
following:
   (A) The extent to which the benefit or service is generally
recognized by the medical community as being effective in the
screening, diagnosis, or treatment of a condition or disease, as
demonstrated by a review of scientific and peer-reviewed medical
literature.
   (B) The extent to which the benefit or service is generally
available and utilized by treating physicians.
   (C) The contribution of the benefit or service to the health
status of the population, including the results of any research
demonstrating the efficacy of the benefit or service compared to
alternatives, including not providing the benefit or service.
   (D) The extent to which mandating or repealing the benefits or
services would not diminish or eliminate access to currently
available health care benefits or services.
   (3) Financial impacts, including, but not limited to, all of the
following:
   (A) The extent to which the coverage or repeal of coverage will
increase or decrease the benefit or cost of the benefit or service.
   (B) The extent to which the coverage or repeal of coverage will
increase the utilization of the benefit or service, or will be a
substitute for, or affect the cost of, alternative benefits or
services.
   (C) The extent to which the coverage or repeal of coverage will
increase or decrease the administrative expenses of health care
service plans and health insurers and the premium and expenses of
subscribers, enrollees, and policyholders.
   (D) The impact of this coverage or repeal of coverage on the total
cost of health care. 
   (E) The impact of this coverage or repeal of coverage on
anticipated costs or savings estimated upon implementation for the
following periods:  
   (i) The two subsequent state fiscal years.  
   (ii) If applicable, the five subsequent state fiscal years through
a longer-range estimate.  
   (E) 
   (F)  The potential cost or savings to the private sector,
including the impact on small employers as defined in paragraph (1)
of subdivision (l) of Section 1357, the Public Employees' Retirement
System, other retirement systems funded by the state or by a local
government, individuals purchasing individual health insurance, and
publicly funded state health insurance programs, including the
Medi-Cal program and the Healthy Families Program. 
   (F) 
    (G)  The extent to which costs resulting from lack of
coverage or repeal of coverage are or would be shifted to other
payers, including both public and private entities. 
   (G) 
    (H)  The extent to which mandating or repealing the
proposed benefit or service would not diminish or eliminate access to
currently available health care benefits or services. 
   (H) 
    (I)  The extent to which the benefit or service is
generally utilized by a significant portion of the population.

   (I) 
    (J)  The extent to which health care coverage for the
benefit or service is already generally available. 
   (J) 
    (K)  The level of public demand for health care coverage
for the benefit or service, including the level of interest of
collective bargaining agents in negotiating privately for inclusion
of this coverage in group contracts, and the extent to which the
mandated benefit or service is covered by self-funded employer
groups. 
   (K) 
    (L)  In assessing and preparing a written analysis of
the financial impact of legislation proposing to mandate a benefit or
service and legislation proposing to repeal a mandated benefit or
service pursuant to this paragraph, the Legislature requests the
University of California to use a certified actuary or other person
with relevant knowledge and expertise to determine the financial
impact.
   (4) The impact on essential health benefits, as defined in Section
1367.005 of this code and Section 10112.27 of the Insurance Code,
and the impact on the California Health Benefit Exchange.
   (b) The Legislature further requests that the California Health
Benefit Review Program assess legislation that impacts health
insurance benefit design, cost sharing, premiums, and other health
insurance topics.
   (c) The Legislature requests that the University of California
provide every analysis to the appropriate policy and fiscal
committees of the Legislature not later than 60 days, or in a manner
and pursuant to a timeline agreed to by the Legislature and the
California Health Benefit Review Program, after receiving a request
made pursuant to Section 127661. In addition, the Legislature
requests that the university post every analysis on the Internet and
make every analysis available to the public upon request.
   (d) As used in this section, "legislation proposing to mandate a
benefit or service" means a proposed statute that requires a health
care service plan or a health insurer, or both, to do any of the
following:
   (1) Permit a person insured or covered under the policy or
contract to obtain health care treatment or services from a
particular type of health care provider.
   (2) Offer or provide coverage for the screening, diagnosis, or
treatment of a particular disease or condition.
   (3) Offer or provide coverage of a particular type of health care
treatment or service, or of medical equipment, medical supplies, or
drugs used in connection with a health care treatment or service.
   (e) As used in this section, "legislation proposing to repeal a
mandated benefit or service" means a proposed statute that, if
enacted, would become operative on or after January 1, 2008, and
would repeal an existing requirement that a health care service plan
or a health insurer, or both, do any of the following:
   (1) Permit a person insured or covered under the policy or
contract to obtain health care treatment or services from a
particular type of health care provider.
   (2) Offer or provide coverage for the screening, diagnosis, or
treatment of a particular disease or condition.
   (3) Offer or provide coverage of a particular type of health care
treatment or service, or of medical equipment, medical supplies, or
drugs used in connection with a health care treatment or service.

  SECTION 1.    Section 5348 of the Welfare and
Institutions Code is amended to read:
   5348.  (a) For purposes of subdivision (e) of Section 5346, a
county that chooses to provide assisted outpatient treatment services
pursuant to this article shall offer assisted outpatient treatment
services including, but not limited to, all of the following:
   (1) Community-based, mobile, multidisciplinary, highly trained
mental health teams that use high staff-to-client ratios of no more
than 10 clients per team member for those subject to court-ordered
services pursuant to Section 5346.
   (2) A service planning and delivery process that includes the
following:
   (A) Determination of the numbers of persons to be served and the
programs and services that will be provided to meet their needs. The
local director of mental health shall consult with the sheriff, the
police chief, the probation officer, the mental health board,
contract agencies, and family, client, ethnic, and citizen
constituency groups as determined by the director.
   (B) Plans for services, including outreach to families whose
severely mentally ill adult is living with them, design of mental
health services, coordination and access to medications, psychiatric
and psychological services, substance abuse services, supportive
housing or other housing assistance, vocational rehabilitation, and
veterans' services. Plans shall also contain evaluation strategies,
which shall consider cultural, linguistic, gender, age, and special
needs of minorities and those based on any characteristic listed or
defined in Section 11135 of the Government Code in the target
populations. Provision shall be made for staff with the cultural
background and linguistic skills necessary to remove barriers to
mental health services as a result of having limited-English-speaking
ability and cultural differences. Recipients of outreach services
may include families, the public, primary care physicians, and others
who are likely to come into contact with individuals who may be
suffering from an untreated severe mental illness who would be likely
to become homeless if the illness continued to be untreated for a
substantial period of time. Outreach to adults may include adults
voluntarily or involuntarily hospitalized as a result of a severe
mental illness.
   (C) Provision for services to meet the needs of persons who are
physically disabled.
   (D) Provision for services to meet the special needs of older
adults.
   (E) Provision for family support and consultation services,
parenting support and consultation services, and peer support or
self-help group support, where appropriate.
   (F) Provision for services to be client-directed and that employ
psychosocial rehabilitation and recovery principles.
   (G) Provision for psychiatric and psychological services that are
integrated with other services and for psychiatric and psychological
collaboration in overall service planning.
   (H) Provision for services specifically directed to seriously
mentally ill young adults 25 years of age or younger who are homeless
or at significant risk of becoming homeless. These provisions may
include continuation of services that still would be received through
other funds had eligibility not been terminated as a result of age.
   (I) Services reflecting special needs of women from diverse
cultural backgrounds, including supportive housing that accepts
children, personal services coordinator therapeutic treatment, and
substance treatment programs that address gender-specific trauma and
abuse in the lives of persons with mental illness, and vocational
rehabilitation programs that offer job training programs free of
gender bias and sensitive to the needs of women.
   (J) Provision for housing for clients that is immediate,
transitional, permanent, or all of these.
   (K) Provision for clients who have been suffering from an
untreated severe mental illness for less than one year, and who do
not require the full range of services, but are at risk of becoming
homeless unless a comprehensive individual and family support
services plan is implemented. These clients shall be served in a
manner that is designed to meet their needs.
   (3) Each client shall have a clearly designated mental health
personal services coordinator who may be part of a multidisciplinary
treatment team who is responsible for providing or assuring needed
services. Responsibilities include complete assessment of the client'
s needs, development of the client's personal services plan, linkage
with all appropriate community services, monitoring of the quality
and followthrough of services, and necessary advocacy to ensure each
client receives those services that are agreed to in the personal
services plan. Each client shall participate in the development of
his or her personal services plan, and responsible staff shall
consult with the designated conservator, if one has been appointed,
and, with the consent of the client, shall consult with the family
and other significant persons as appropriate.
   (4) The individual personal services plan shall ensure that
persons subject to assisted outpatient treatment programs receive
age-appropriate, gender-appropriate, and culturally appropriate
services, to the extent feasible, that are designed to enable
recipients to:
   (A) Live in the most independent, least restrictive housing
feasible in the local community, and, for clients with children, to
live in a supportive housing environment that strives for
reunification with their children or assists clients in maintaining
custody of their children as is appropriate.
   (B) Engage in the highest level of work or productive activity
appropriate to their abilities and experience.
   (C) Create and maintain a support system consisting of friends,
family, and participation in community activities.
   (D) Access an appropriate level of academic education or
vocational training.
   (E) Obtain an adequate income.
   (F) Self-manage their illnesses and exert as much control as
possible over both the day-to-day and long-term decisions that affect
their lives.
   (G) Access necessary physical health care and maintain the best
possible physical health.
   (H) Reduce or eliminate serious antisocial or criminal behavior,
and thereby reduce or eliminate their contact with the criminal
justice system.
   (I) Reduce or eliminate the distress caused by the symptoms of
mental illness.
   (J) Have freedom from dangerous addictive substances.
   (5) The individual personal services plan shall describe the
service array that meets the requirements of paragraph (4), and to
the extent applicable to the individual, the requirements of
paragraph (2).
   (b) A county that provides assisted outpatient treatment services
pursuant to this article also shall offer the same services on a
voluntary basis.
   (c) Counties that authorize the application of this article
pursuant to Section 5349 may agree to act jointly to offer, or to
contract with each other to offer, assisted outpatient treatment
services pursuant to this article, subject to the approval of the
State Department of Health Care Services. The agreement may include
all or a portion of the assisted outpatient treatment services
offered pursuant to this article. A county that is a party to the
agreement shall separately offer assisted outpatient treatment
services that are not included in the agreement, in accordance with
this article.
   (d) Involuntary medication shall not be allowed absent a separate
order by the court pursuant to Sections 5332 to 5336, inclusive.
   (e) A county that operates an assisted outpatient treatment
program pursuant to this article shall provide data to the State
Department of Health Care Services and, based on the data, the
department shall report to the Legislature on or before May 1 of each
year in which the county provides services pursuant to this article.
The report shall include, at a minimum, an evaluation of the
effectiveness of the strategies employed by each program operated
pursuant to this article in reducing homelessness and hospitalization
of persons in the program and in reducing involvement with local law
enforcement by persons in the program. The evaluation and report
shall also include any other measures identified by the department
regarding persons in the program and all of the following, based on
information that is available:
   (1) The number of persons served by the program and, of those, the
number who are able to maintain housing and the number who maintain
contact with the treatment system.
   (2) The number of persons in the program with contacts with local
law enforcement, and the extent to which local and state
incarceration of persons in the program has been reduced or avoided.
   (3) The number of persons in the program participating in
employment services programs, including competitive employment.
   (4) The days of hospitalization of persons in the program that
have been reduced or avoided.
   (5) Adherence to prescribed treatment by persons in the program.
   (6) Other indicators of successful engagement, if any, by persons
in the program.
   (7) Victimization of persons in the program.
   (8) Violent behavior of persons in the program.
   (9) Substance abuse by persons in the program.
   (10) Type, intensity, and frequency of treatment of persons in the
program.
   (11) Extent to which enforcement mechanisms are used by the
program, when applicable.
   (12) Social functioning of persons in the program.
   (13) Skills in independent living of persons in the program.
   (14) Satisfaction with program services both by those receiving
them and by their families, when relevant.