Amended
IN
Senate
August 23, 2024 |
Amended
IN
Assembly
March 18, 2024 |
Introduced by Assembly Member Weber |
February 06, 2024 |
(a)This section governs standards for the mental health program approval for short-term residential therapeutic programs, which is required under subdivision (c) of Section 1562.01 of the Health and Safety Code.
(b)All short-term residential therapeutic programs that serve children who have either been assessed as meeting the medical necessity criteria for Medi-Cal specialty mental health services, as provided for in Section 1830.205 or 1830.210 of Title 9 of the California Code of Regulations, or who have been assessed and diagnosed with serious emotional disturbance, as defined in subdivision (a) of Section 5600.3, shall obtain and have in good standing a mental health program
approval and a Medi-Cal mental health certification, as described in Section 11462.01, issued by the State Department of Health Care Services or a county mental health plan to which the department has delegated approval authority. This approval, which is required pursuant to subdivision (c) of Section 1562.01 of the Health and Safety Code, is a condition for receiving an Aid to Families with Dependent Children-Foster Care rate pursuant to Section 11462.01.
(c)(1)A short-term residential therapeutic program shall not directly provide specialty mental health services without a current mental health program approval. A licensed short-term residential therapeutic program that has not obtained a program approval shall provide children in its care access to appropriate mental health services.
(2)County mental health plans shall ensure that Medi-Cal specialty mental health services, including, but not limited to, services under the Early and Periodic Screening, Diagnosis and Treatment benefit, are provided to all Medi-Cal beneficiaries served by short-term residential therapeutic programs who meet medical necessity criteria, as provided for in Section 1830.205 or 1830.210 of Title 9 of the California Code of Regulations.
(d)(1)The State Department of Health Care Services or a county mental health plan to which the department has delegated mental health program approval authority shall approve or deny mental health program approval requests within 45 days of receiving a request. The State Department of Health Care Services or a county mental
health plan to which the department has delegated mental health program approval authority shall issue each mental health program approval for a period of one year, except for approvals granted pursuant to paragraph (2) and provisional approvals granted pursuant to regulations promulgated under subdivision (e), and shall specify the effective date of the approval. Approved entities shall meet all program standards to be reapproved.
(2)(A)Between January 1, 2017, and December 31, 2017, the State Department of Health Care Services, or a county mental health plan to which the department has delegated mental health program approval authority, shall approve or deny a mental health program approval request within 90 days of receipt.
(B)Between January 1, 2017, and December 31, 2017, the State Department of Health Care Services, or a county mental health plan to which the department has delegated mental health program approval authority, may issue a mental health program approval for a period of less than one year.
(e)(1)The State Department of Health Care Services and the county mental health plans to which the department has delegated mental health program approval authority may enforce the mental health program approval standards by taking any of the following actions against a noncompliant short-term residential therapeutic program:
(A)Suspend or revoke a mental health program approval.
(B)Impose monetary penalties.
(C)Place a mental health program on probation.
(D)Require a mental health program to prepare and comply with a corrective action plan.
(2)The State Department of Health Care Services and the county mental health plans to which the department has delegated mental health program approval authority shall provide short-term residential therapeutic programs with due process protections when taking any of the actions described in paragraph (1).
(f)The State Department of Health Care Services, in consultation with the State Department of Social Services, shall promulgate regulations regarding program standards, oversight, enforcement, issuance of mental
health program approvals, including provisional approvals that are effective for a period of less than one year, and due process protections related to the mental health program approval process for short-term residential therapeutic programs.
(g)(1)Except for mental health program approval of short-term residential therapeutic programs operated by a county, the State Department of Health Care Services may, upon the request of a county, delegate to that county mental health plan the mental health program approval of short-term residential therapeutic programs within its borders.
(2)Any county to which mental health program approval is delegated pursuant to paragraph (1) shall be responsible for the oversight and enforcement of program standards and the provision of due process for approved and denied entities.
(h)The State Department of Health Care Services or a county mental health plan to which the department has delegated mental health program approval authority shall notify the State Department of Social Services immediately upon the termination of any mental health program approval issued in accordance with subdivisions (b) and (d).
(i)The State Department of Social Services shall notify the State Department of Health Care Services and, if applicable, a county to which the department has delegated mental health program approval authority, immediately upon the revocation of any license issued pursuant to Chapter 3 (commencing with Section 1500) of Division 2 of the Health and Safety Code.
(j)Revocation of a license or a mental health program approval or failure to meet the requirements of subdivision (c) of Section 1562.01 of the Health and Safety Code shall be a basis for rate termination.
The State Department of Health Care Services shall establish service standards that ensure that members of the target population are identified, and services provided to assist them to live independently, work, and reach their potential as productive citizens. The department shall provide annual oversight of grants issued pursuant to this part for compliance with these standards. These standards shall include, but are not limited to, all of the following:
(a)A service planning and delivery process that is target population based and includes the following:
(1)Determination of the numbers of clients 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.
(2)Plans for services, including outreach to families who have an adult child experiencing a serious mental health condition 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 also shall contain evaluation strategies, that shall consider cultural, linguistic, gender, age, and special needs of minorities 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 due to 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 experiencing 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.
(3)Provision for services to meet the needs of target population clients who are physically disabled.
(4)Provision for services to meet the special needs of older adults.
(5)Provision for family support and consultation services, parenting support and consultation services, and peer support or self-help group support, where appropriate for the individual.
(6)Provision for services to be client-directed and that employ psychosocial rehabilitation and recovery principles.
(7)Provision for psychiatric and psychological services that are integrated with other services and for psychiatric and psychological collaboration in overall service planning.
(8)Provision for services specifically directed to young adults 25 years of age or younger who have a serious mental illness and 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 due to age.
(9)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.
(10)Provision for housing for clients that is immediate, transitional, permanent, or all of these.
(11)Provision for clients who have been experiencing 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.
(12)Provision for services for veterans.
(b)A 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 that the client receives those services that are agreed to in the personal services plan. A client shall participate in the development of the client’s personal services plan, and responsible staff shall consult with the designated conservator, if one has been appointed, and, with the consent of the client, consult with the family and other significant persons as appropriate.
(c)The individual personal services plan shall ensure that members of the target population involved in the system of care receive age-appropriate, gender-appropriate, and culturally appropriate services or appropriate services based on any characteristic listed or
defined in Section 11135 of the Government Code, to the extent feasible, that are designed to enable recipients to:
(1)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.
(2)Engage in the highest level of work or productive activity appropriate to their abilities and experience.
(3)Create and maintain a support system consisting of friends, family, and participation in community activities.
(4)Access an appropriate level of academic education or vocational training.
(5)Obtain an adequate income.
(6)Self-manage their illness and exert as much control as possible over both the day-to-day and long-term decisions that affect their lives.
(7)Access necessary physical health care and maintain the best possible physical health.
(8)Reduce or eliminate serious antisocial or criminal behavior and thereby reduce or eliminate their contact with the criminal justice system.
(9)Reduce or eliminate the distress caused by the symptoms of mental illness.
(10)Have freedom from dangerous addictive substances.
(d)The individual personal services plan shall describe the service array that meets the requirements of subdivision (c), and to the extent applicable to the individual, the requirements of subdivision (a).
(a)The State Department of Health Care Services, in coordination with counties, shall establish a program designed to prevent mental illness from becoming severe and disabling. The program shall emphasize improving timely access to services for underserved populations.
(b)The program shall include the following components:
(1)Outreach to families, employers, primary care health care providers, and others to recognize the early signs of potentially severe and disabling mental illnesses.
(2)Access and linkage to medically necessary care provided by county mental health programs for children with severe mental illness, as defined in Section 5600.3, and for adults and seniors with severe mental illness, as defined in Section 5600.3, as early in the onset of these conditions as practicable.
(3)Reduction in stigma associated with either being diagnosed with a mental illness or seeking mental health services.
(4)Reduction in discrimination against people with mental illness.
(c)The program shall include mental health services similar to those provided under other programs that are effective in preventing mental illnesses from becoming severe, and shall also include components similar to programs that have been successful in reducing the
duration of untreated severe mental illnesses and assisting people in quickly regaining productive lives.
(d)The program shall emphasize strategies to reduce the following negative outcomes that may result from untreated mental illness:
(1)Suicide.
(2)Incarcerations.
(3)School failure or dropout.
(4)Unemployment.
(5)Worsening of symptoms and the condition over time.
(6)Homelessness.
(7)Removal of children from their homes.
(e)Prevention and early intervention funds may be used to broaden the provision of community-based mental health services by adding prevention and early intervention services or activities to these services, including prevention and early intervention strategies that address mental health needs, substance misuse or substance use disorders, or needs relating to cooccurring mental health and substance use services.
(f)In consultation with mental health stakeholders, and consistent with regulations from the Mental Health Services Oversight and Accountability Commission, pursuant to Section 5846, the department shall revise the program elements in Section 5840 applicable to all county mental health
programs in future years to reflect what is learned about the most effective prevention and intervention programs for children, adults, and older adults.
(a)The commission shall adopt regulations for programs and expenditures pursuant to Part 3.2 (commencing with Section 5830), for innovative programs, and Part 3.6 (commencing with Section 5840), for prevention and early intervention.
(b)Any regulation adopted by the department pursuant to Section 5898 shall be consistent with the commission’s regulations.
(c)The commission may provide technical assistance to any county mental health plan as needed to address concerns or recommendations of the commission or when local programs could benefit from technical assistance for improvement of their plans.
(d)The commission shall ensure that the perspective and participation of diverse community members reflective of California’s diverse populations, persons experiencing a severe mental health condition, and family members of persons experiencing a severe mental health condition is a significant factor in the commission’s decisions and recommendations.
The State Department of Health Care Services, in consultation with the Mental Health Services Oversight and Accountability Commission, shall review those counties that have been awarded funds to implement a comprehensive system for the delivery of mental health services to children with serious emotional disturbance and to their families or foster families to determine compliance with either of the following:
(a)The total estimated cost avoidance in all of the following categories shall equal or exceed the applications for funding award moneys:
(1)Group home costs paid by Aid to Families with Dependent Children-Foster Care (AFDC-FC) program.
(2)Children and adolescent state hospital and acute inpatient programs.
(3)Nonpublic school residential placement costs.
(4)Juvenile justice reincarcerations.
(5)Other short- and long-term savings in public funds resulting from the applications for funding award moneys.
(b)If the department determines that the total cost avoidance listed in subdivision (a) does not equal or exceed applications for funding award amounts, the department shall determine that the county that has been awarded funding shall achieve substantial
compliance with all of the following goals:
(1)Total cost avoidance in the categories listed in subdivision (a) to exceed 50 percent of the applications for funding award moneys.
(2)A 20-percent reduction in out-of-county ordered placements of juvenile justice wards and social service dependents.
(3)A statistically significant reduction in the rate of recidivism by juvenile offenders.
(4)A 25-percent reduction in the rate of state hospitalization of minors from placements of special education pupils.
(5)A 10-percent reduction in out-of-county nonpublic school residential placements of special education pupils.
(6)Allow at least 50 percent of children at risk of imminent placement served by the intensive in-home crisis treatment programs, which are wholly or partially funded by applications for funding award moneys, to remain at home at least six months.
(7)Statistically significant improvement in school attendance and academic performance of special education pupils with serious emotional disturbance treated in day treatment programs which are wholly or partially funded by applications for funding award moneys.
(8)Statistically significant increases in services provided in nonclinic settings among agencies.
(9)Increase in ethnic minority and gender access to services proportionate to the percentage of these groups in the county’s school-age population.
(a)It is the intent of this article to establish programs that ensure services will be provided to children with serious emotional disturbance, as defined in Section 5878.2, and that they be part of the children’s system of care established pursuant to this part. It is the intent of this act that services provided under this chapter to
children with serious emotional disturbance are accountable, developed in partnership with youth and their families, culturally competent, and individualized to the strengths and needs of each child and the child’s family.
(b)This act does not authorize any services to be provided to a minor without the consent of the minor’s parent or legal guardian beyond those already authorized by existing statute.
For purposes of this article, a child with serious emotional disturbance means a minor under 18 years of age who meets the criteria set forth in subdivision (a) of Section 5600.3.
(a)Subject to the availability of funds as determined pursuant to Part 4.5 (commencing with Section 5890) of this division, county mental health programs shall offer services to children with serious emotional disturbance for whom services under any other public or private insurance or other mental health or entitlement program is inadequate or unavailable. Other entitlement programs
include, but are not limited to, mental health services available pursuant to Medi-Cal, child welfare, and special education programs. The funding shall cover only those portions of care that cannot be paid for with public or private insurance, other mental health funds or other entitlement programs.
(b)Funding shall be at sufficient levels to ensure that counties can provide each child served all of the necessary services set forth in the applicable treatment plan developed in accordance with this part, including services where appropriate and necessary to prevent an out of home placement, such as services pursuant to Chapter 4 (commencing with Section 18250) of Part 6 of Division 9.
(c)The State Department of Health Care Services shall contract with county mental health programs for the provision of services under this article in the manner set forth in Section 5897.
(a)The Mental Health Student Services Act is hereby established as a mental health partnership grant program for the purpose of establishing mental health partnerships between a county’s mental health or behavioral health departments and school districts, charter schools, and the county office of education within the county.
(b)The Mental Health Services Oversight and Accountability Commission shall award grants to county mental health or behavioral health departments to fund partnerships between educational and county mental health entities. Subject to an appropriation for this purpose, commencing with the 2021–22 fiscal year, the commission shall award a grant under this section
to a county mental health or behavioral health department or another lead agency, as identified by the partnership within each county that meets the requirements of this section.
(1)County, city, or multicounty mental health or behavioral health departments, or a consortium of those entities, including multicounty partnerships, may, in partnership with one or more school districts and at least one of the following educational entities located within the county, apply for a grant to fund activities of the partnership:
(A)The county office of education.
(B)A charter school.
(2)An educational entity may be designated as the lead agency at the request of the county, city, or multicounty department, or consortium, and authorized to submit the application. The county, city, or multicounty department, or consortium, shall be the grantee and receive any grant funds awarded pursuant to this section even if an educational entity is designated as the lead agency and submits the application pursuant to this paragraph.
(c)The commission shall establish criteria for awarding funds under the grant program, including the allocation of grant funds pursuant to this section, and shall require that applicants comply with, at a minimum, all of the following requirements:
(1)That all school districts, charter schools, and the county office of education have been invited to participate in the partnership, to the extent possible.
(2)That an applicant include with their application a plan developed and approved in collaboration with participating educational entity partners and that include a letter of intent, a memorandum of understanding, or other evidence of support or approval by the governing boards of all partners.
(3)That plans address all of the following goals:
(A)Preventing mental illnesses from becoming severe and disabling.
(B)Improving timely access to services for underserved populations.
(C)Providing outreach to families, employers, primary care health care providers, and others to recognize the early signs of potentially severe and disabling mental illnesses.
(D)Reducing the stigma associated with the diagnosis of a mental illness or seeking mental health services.
(E)Reducing discrimination against people with mental illness.
(F)Preventing negative outcomes in the targeted population, including, but not limited to:
(i)Suicide and attempted suicide.
(ii)Incarceration.
(iii)School failure or dropout.
(iv)Unemployment.
(v)Worsening of symptoms and the condition over time.
(vi)Homelessness.
(vii)Removal of a child from their home.
(viii)Involuntary mental health detentions.
(4)That the plan includes a description of the following:
(A)The need for mental health services for children and youth, including campus-based mental health services, as well as potential gaps in local service connections.
(B)The proposed use of funds, which shall include, at a minimum, that funds will be used to provide personnel or peer support.
(C)How the funds will be used to facilitate linkage and access to ongoing and sustained services, including, but not limited to, objectives and anticipated outcomes.
(D)How the partnership will collaborate with preschool and childcare providers, or other early childhood service organizations, to ensure the mental health needs of children are met before and after they transition to a school setting.
(E)The partnership’s ability to do all of the following:
(i)Obtain federal Medicaid or other reimbursement, including Early and Periodic Screening, Diagnostic, and Treatment funds, when applicable, or to leverage other funds, when feasible.
(ii)Collect information on the health insurance carrier for each child or youth, with the permission of the child or youth’s parent, to allow the partnership to seek reimbursement for mental health services provided to children and youth, where applicable.
(iii)Engage a health care service plan or a health insurer in the mental health partnership, when applicable, and to the extent mutually agreed to by the partnership and the plan or insurer.
(iv)Administer an effective service program and the degree to which mental health providers and educational entities will support and collaborate to accomplish the goals of the effort.
(v)Connect children and youth to a source of ongoing mental health services, including, but not limited to, through Medi-Cal, specialty mental health plans, county mental health programs, or private health coverage.
(vi)Continue to provide services and activities under this program after grant funding has been expended.
(d)Grants awarded pursuant to this section shall be used to provide support services that include, at a minimum, all of the following:
(1)Services provided on school campuses, to the extent practicable.
(2)Suicide prevention services.
(3)Drop-out prevention services.
(4)Outreach to high-risk youth and young adults, including, but not limited to, foster youth, youth who identify as lesbian, gay, bisexual, transgender, or queer, and youth who have been expelled or suspended from school.
(5)Placement assistance and development of a service plan that can be sustained over time for students in need of ongoing services.
(e)Funding may also be used to provide other prevention, early intervention, and direct services, including, but not limited to, hiring qualified mental health personnel, professional development for school staff on trauma-informed and evidence-based mental health practices, and other strategies that respond to the mental health needs of children and youth, as determined by the commission.
(f)The commission shall determine the amount of grants and shall take into consideration the level of need and the number of schoolage youth in participating educational entities when determining grant amounts. In determining the distribution of funds appropriated in the 2021–22 fiscal year, the commission shall take into consideration any previous funding the grantee received under this section.
(g)The commission may establish incentives to provide matching funds by awarding additional grant funds to partnerships that do so.
(h)If the commission is unable to provide a grant to a partnership in a county because of a lack of applicants or because no applicants met the minimum requirements within the timeframes established
by the commission, the commission may redistribute those funds to other eligible grantees.
(i)Partnerships currently receiving grants from the Investment in Mental Health Wellness Act of 2013 (Part 3.8 (commencing with Section 5848.5)) are eligible to receive a grant under this section for the expansion of services funded by that grant or for the inclusion of additional educational entity partners within the mental health partnership.
(j)Grants awarded pursuant to this section may be used to supplement, but not supplant, existing financial and resource commitments of the county, city, or multicounty mental health or behavioral health departments, or a consortium of those entities, or educational entities that receive a grant.
(k)(1)The commission shall develop metrics and a system to measure and publicly report on the performance outcomes of services provided using the grants.
(2)(A)The commission shall provide a status report to the fiscal and policy committees of the Legislature on the progress of implementation of this section no later than March 1, 2022, and provide an updated report no later than March 1, 2024. The reports shall address, at a minimum, all of the following:
(i)Successful strategies.
(ii)Identified needs for additional services.
(iii)Lessons learned.
(iv)Numbers of, and demographic information for, the schoolage children and youth served.
(v)Available data on outcomes, including, but not limited to, linkages to ongoing services and success in meeting the goals identified in paragraph (3) of subdivision (c).
(B)The reports to be submitted pursuant to this paragraph shall be submitted in compliance with Section 9795 of the Government Code.
(l)This section does not require the use of funds allocated for the purpose of satisfying the minimum funding obligation under Section 8 of Article XVI of the California Constitution for the partnerships established by this section.
(m)The commission may
enter into exclusive or nonexclusive contracts, or amend existing contracts, on a bid or negotiated basis in order to implement this section. Contracts entered into or amended pursuant to this subdivision are exempt from Chapter 6 (commencing with Section 14825) of Part 5.5 of Division 3 of Title 2 of the Government Code, Section 19130 of the Government Code, and Part 2 (commencing with Section 10100) of Division 2 of the Public Contract Code, and shall be exempt from the review or approval of any division of the Department of General Services.
(n)This section shall be implemented only to the extent moneys are appropriated in the annual Budget Act or another statute for purposes of this section.
(v)Prolonged suffering.
(vii)Removal of children and youth from their homes.