5848.5.
(a) The Legislature finds and declares all of the following:(1) California has realigned public community mental health services to counties and it is imperative that sufficient community-based resources be available to meet the mental health needs of eligible individuals.
(2) Increasing access to effective outpatient and crisis stabilization services provides an opportunity to reduce costs associated with expensive inpatient and emergency room care and to better meet the needs of individuals with mental health disorders in the least restrictive manner possible.
(3) Almost one-fifth of people with mental health disorders visit a hospital emergency room at least once per year. If an adequate array of crisis services is not available, it leaves an individual with little choice but to access an emergency room for assistance and, potentially, an unnecessary inpatient hospitalization.
(4) Recent reports have called attention to a continuing problem of inappropriate and unnecessary utilization of hospital emergency rooms in California due to limited community-based services for individuals in psychological distress and acute psychiatric crisis. Hospitals report that 70 percent of people taken to emergency rooms for psychiatric evaluation can be stabilized and transferred to a less intensive level of crisis care. Law enforcement personnel report that their personnel need to stay with people in the emergency
room waiting area until a placement is found, and that less intensive levels of care tend not to be available.
(5) Comprehensive public and private partnerships at both local and regional levels, including across physical health services, mental health, substance use disorder, law enforcement, social services, and related supports, are necessary to develop and maintain high quality, patient-centered, and cost-effective care for individuals with mental health disorders that facilitates their recovery and leads towards wellness.
(6) The recovery of individuals with mental health disorders is important for all levels of government, business, and the local community.
(b) This section shall be known, and may be cited, as the
Investment in Mental Health Wellness Act of 2013. The objectives of this section are to do all of the following:
(1) Expand access to early intervention and treatment services to improve the client experience, achieve recovery and wellness, and reduce costs.
(2) Expand the continuum of services to address crisis intervention, crisis stabilization, and crisis residential treatment needs that are wellness, resiliency, and recovery oriented.
(3) Add at least 25 mobile crisis support teams and at least 2,000 crisis stabilization and crisis residential treatment beds to bolster capacity at the local level to improve access to mental health crisis services and address unmet mental health care needs.
(4) Add at least 600 triage personnel to provide intensive case management and linkage to services for individuals with mental health care disorders at various points of access, such as at designated community-based service points, homeless shelters, and clinics.
(5) Reduce unnecessary hospitalizations and inpatient days by appropriately utilizing community-based services and improving access to timely assistance.
(6) Reduce recidivism and mitigate unnecessary expenditures of local law enforcement.
(7) Provide local communities with increased financial resources to leverage additional public and private funding sources to achieve improved networks of
care for individuals with mental health disorders.
(8) Provide a complete continuum of crisis services for children and youth 21 years of age and under regardless of where they live in the state. The funds included in the Budget Act of 2016 for the purpose of developing the continuum of mental health crisis services for children and youth 21 years of age and under shall be for the following objectives:
(A) Provide a continuum of crisis services for children and youth 21 years of age and under regardless of where they live in the state.
(B) Provide for early intervention and treatment services to improve the client experience, achieve recovery and wellness, and reduce costs.
(C) Expand the continuum of community-based services to address crisis intervention, crisis stabilization, and crisis residential treatment needs that are wellness-, resiliency-, and
recovery-oriented.
(D) Add at least 200 mobile crisis support teams.
(E) Add at least 120 crisis stabilization services and beds and crisis residential treatment beds to increase capacity at the local level to improve access to mental health crisis services and address unmet mental health care needs.
(F) Add triage personnel to provide intensive case management and linkage to services for individuals with mental health care disorders at various points of access, such as at designated community-based service points, homeless shelters, schools, and clinics.
(G) Expand family respite care to help families and sustain caregiver health and
well-being.
(H) Expand family supportive training and related services designed to help families participate in the planning process, access services, and navigate programs.
(I) Reduce unnecessary hospitalizations and inpatient days by appropriately utilizing community-based services.
(J) Reduce recidivism and mitigate unnecessary expenditures of local law enforcement.
(K) Provide local communities with increased financial resources to leverage additional public and private funding sources to achieve improved networks of care for children and youth 21 years of age and under with mental health disorders.
(c) Through appropriations provided in the annual Budget Act for this purpose, it is the intent of the Legislature to authorize the California Health Facilities Financing Authority, hereafter referred to as the authority, and the Mental Health Services Oversight and Accountability Commission, hereafter referred to as the commission, to administer competitive selection processes as provided in this section for capital capacity and program expansion to increase capacity for mobile crisis support, crisis intervention, crisis stabilization services, crisis residential treatment, and specified personnel resources.
(d) Funds appropriated by the Legislature to the authority for purposes of this section shall be made available to selected
counties, or counties acting jointly. The authority may, at its discretion, also give consideration to private nonprofit corporations and public agencies in an area or region of the state if a county, or counties acting jointly, affirmatively supports this designation and collaboration in lieu of a county government directly receiving grant funds.
(1) Grant awards made by the authority shall be used to expand local resources for the development, capital, equipment acquisition, and applicable program startup or expansion costs to increase capacity for client assistance and services in the following areas:
(A) Crisis intervention, as authorized by Sections 14021.4, 14680, and 14684.
(B) Crisis stabilization, as
authorized by Sections 14021.4, 14680, and 14684.
(C) Crisis residential treatment, as authorized by Sections 14021.4, 14680, and 14684 and as provided at a children’s crisis residential program, as defined in Section 1502 of the Health and Safety Code.
(D) Rehabilitative mental health services, as authorized by Sections 14021.4, 14680, and 14684.
(E) Mobile crisis support teams, including personnel and equipment, such as the purchase of vehicles.
(2) The authority shall develop selection criteria to expand local resources, including those described in paragraph (1), and processes for awarding grants after consulting with representatives and interested
stakeholders from the mental health community, including, but not limited to, the County Behavioral Health Directors Association of California, service providers, consumer organizations, and other appropriate interests, such as health care providers and law enforcement, as determined by the authority. The authority shall ensure that grants result in cost-effective expansion of the number of community-based crisis resources in regions and communities selected for funding. The authority shall also take into account at least the following criteria and factors when selecting recipients of grants and determining the amount of grant awards:
(A) Description of need, including, at a minimum, a comprehensive description of the project, community need, population to be served, linkage with other public systems of health and mental health
care, linkage with local law enforcement, social services, and related assistance, as applicable, and a description of the request for funding.
(B) Ability to serve the target population, which includes individuals eligible for Medi-Cal and individuals eligible for county health and mental health services.
(C) Geographic areas or regions of the state to be eligible for grant awards, which may include rural, suburban, and urban areas, and may include use of the five regional designations utilized by the County Behavioral Health Directors Association of California.
(D) Level of community engagement and commitment to project completion.
(E) Financial support that, in
addition to a grant that may be awarded by the authority, will be sufficient to complete and operate the project for which the grant from the authority is awarded.
(F) Ability to provide additional funding support to the project, including public or private funding, federal tax credits and grants, foundation support, and other collaborative efforts.
(G) Memorandum of understanding among project partners, if applicable.
(H) Information regarding the legal status of the collaborating partners, if applicable.
(I) Ability to measure key outcomes, including improved access to services, health and mental health outcomes, and cost benefit of the project.
(3) The authority shall determine maximum grants awards, which shall take into consideration the number of projects awarded to the grantee, as described in paragraph (1), and shall reflect reasonable costs for the project and geographic region. The authority may allocate a grant in increments contingent upon the phases of a project.
(4) Funds awarded by the authority pursuant to this section may be used to supplement, but not to supplant, existing financial and resource commitments of the grantee or any other member of a collaborative effort that has been awarded a grant.
(5) All projects that are awarded grants by the authority shall be completed within a reasonable period of time, to be determined by the authority.
Funds shall not be released by the authority until the applicant demonstrates project readiness to the authority’s satisfaction. If the authority determines that a grant recipient has failed to complete the project under the terms specified in awarding the grant, the authority may require remedies, including the return of all or a portion of the grant.
(6) A grantee that receives a grant from the authority under this section shall commit to using that capital capacity and program expansion project, such as the mobile crisis team, crisis stabilization unit, or crisis residential treatment program, for the duration of the expected life of the project.
(7) The authority may consult with a technical assistance entity, as described in paragraph (5) of subdivision (a) of Section 4061, for
purposes of implementing this section.
(8) The authority may adopt emergency regulations relating to the grants for the capital capacity and program expansion projects described in this section, including emergency regulations that define eligible costs and determine minimum and maximum grant amounts.
(9) The authority shall provide reports to the fiscal and policy committees of the Legislature on or before May 1, 2014, and on or before May 1, 2015, on the progress of implementation that include, but are not limited to, the following:
(A) A description of each project awarded funding.
(B) The amount of each grant issued.
(C) A description of other sources of funding for each project.
(D) The total amount of grants issued.
(E) A description of project operation and implementation, including who is being served.
(10) A recipient of a grant provided pursuant to paragraph (1) shall adhere to all applicable laws relating to scope of practice, licensure, certification, staffing, and building codes.
(e) Of the funds specified in paragraph (8) of subdivision (b), it is the intent of the Legislature to authorize the authority and the commission to administer competitive selection processes as provided in this section for capital capacity and program expansion to increase capacity
for mobile crisis support, crisis intervention, crisis stabilization services, crisis residential treatment, family respite care, family supportive training and related services, and triage personnel resources for children and youth 21 years of age and under.
(f) Funds appropriated by the Legislature to the authority to address crisis services for children and youth 21 years of age and under for the purposes of this section shall be made available to selected counties or counties acting jointly. The authority may, at its discretion, also give consideration to private nonprofit corporations and public agencies in an area or region of the state if a county, or counties acting jointly, affirmatively support this designation and collaboration in lieu of a county government directly receiving grant funds.
(1) Grant awards made by the authority shall be used to expand local resources for the development, capital, equipment acquisition, and applicable program startup or expansion costs to increase capacity for client assistance and crisis services for children and youth 21 years of age and under in the following areas:
(A) Crisis intervention, as authorized by Sections 14021.4, 14680, and 14684.
(B) Crisis stabilization, as authorized by Sections 14021.4, 14680, and 14684.
(C) Crisis residential treatment, as authorized by Sections 14021.4, 14680, and 14684 14684,
and as provided at a children’s crisis residential program, as defined in Section 1502 of the Health and Safety Code.
(D) Mobile crisis support teams, including the purchase of equipment and vehicles.
(E) Family respite care.
(2) The authority shall develop selection criteria to expand local resources, including those described in paragraph (1), and processes for awarding grants after consulting with representatives and interested stakeholders from the mental health community, including, but not limited to, county mental health directors, service providers, consumer organizations, and other appropriate interests, such as health care providers and law enforcement, as determined by the authority.
The authority shall ensure that grants result in cost-effective expansion of the number of community-based crisis resources in regions and communities selected for funding. The authority shall also take into account at least the following criteria and factors when selecting recipients of grants and determining the amount of grant awards:
(A) Description of need, including, at a minimum, a comprehensive description of the project, community need, population to be served, linkage with other public systems of health and mental health care, linkage with local law enforcement, social services, and related assistance, as applicable, and a description of the request for funding.
(B) Ability to serve the target population, which includes individuals eligible for Medi-Cal and
individuals eligible for county health and mental health services.
(C) Geographic areas or regions of the state to be eligible for grant awards, which may include rural, suburban, and urban areas, and may include use of the five regional designations utilized by the County Behavioral Health Directors Association of California.
(D) Level of community engagement and commitment to project completion.
(E) Financial support that, in addition to a grant that may be awarded by the authority, will be sufficient to complete and operate the project for which the grant from the authority is awarded.
(F) Ability to provide additional funding support to the project, including
public or private funding, federal tax credits and grants, foundation support, and other collaborative efforts.
(G) Memorandum of understanding among project partners, if applicable.
(H) Information regarding the legal status of the collaborating partners, if applicable.
(I) Ability to measure key outcomes, including utilization of services, health and mental health outcomes, and cost benefit of the project.
(3) The authority shall determine maximum grant awards, which shall take into consideration the number of projects awarded to the grantee, as described in paragraph (1), and shall reflect reasonable costs for the project, geographic region, and target
ages. The authority may allocate a grant in increments contingent upon the phases of a project.
(4) Funds awarded by the authority pursuant to this section may be used to supplement, but not to supplant, existing financial and resource commitments of the grantee or any other member of a collaborative effort that has been awarded a grant.
(5) All projects that are awarded grants by the authority shall be completed within a reasonable period of time, to be determined by the authority. Funds shall not be released by the authority until the applicant demonstrates project readiness to the authority’s satisfaction. If the authority determines that a grant recipient has failed to complete the project under the terms specified in awarding the grant, the authority may require
remedies, including the return of all, or a portion, of the grant.
(6) A grantee that receives a grant from the authority under this section shall commit to using that capital capacity and program expansion project, such as the mobile crisis team, crisis stabilization unit, family respite care, or crisis residential treatment program, for the duration of the expected life of the project.
(7) The authority may consult with a technical assistance entity, as described in paragraph (5) of subdivision (a) of Section 4061, for the purposes of implementing this section.
(8) The authority may adopt emergency regulations relating to the grants for the capital capacity and program expansion projects described in this section, including
emergency regulations that define eligible costs and determine minimum and maximum grant amounts.
(9) The authority shall provide reports to the fiscal and policy committees of the Legislature on or before January 10, 2018, and annually thereafter, on the progress of implementation that include, but are not limited to, the following:
(A) A description of each project awarded funding.
(B) The amount of each grant issued.
(C) A description of other sources of funding for each project.
(D) The total amount of grants issued.
(E) A description
of project operation and implementation, including who is being served.
(10) A recipient of a grant provided pursuant to paragraph (1) shall adhere to all applicable laws relating to scope of practice, licensure, certification, staffing, and building codes.
(g) Funds appropriated by the Legislature to the commission for purposes of this section shall be allocated for triage personnel to provide intensive case management and linkage to services for individuals with mental health disorders at various points of access. These funds shall be made available to selected counties, counties acting jointly, or city mental health departments, as determined by the commission through a selection process. It is the intent of the Legislature for these funds to be allocated in an efficient manner to
encourage early intervention and receipt of needed services for individuals with mental health disorders, and to assist in navigating the local service sector to improve efficiencies and the delivery of services.
(1) Triage personnel may provide targeted case management services face to face, face-to-face, by telephone, or by telehealth with the individual in need of assistance or the individual’s significant support person, and may be provided anywhere in the community. These service activities may include, but are not limited to, the following:
(A) Communication, coordination, and referral.
(B) Monitoring service delivery to ensure the individual accesses and receives services.
(C) Monitoring the individual’s progress.
(D) Providing placement service assistance and service plan development.
(2) The commission shall take into account at least the following criteria and factors when selecting recipients and determining the amount of grant awards for triage personnel as follows:
(A) Description of need, including potential gaps in local service connections.
(B) Description of funding request, including personnel and use of
peer support.
(C) Description of how triage personnel will be used to facilitate linkage and access to services, including objectives and anticipated outcomes.
(D) Ability to obtain federal Medicaid reimbursement, when applicable.
(E) Ability to administer an effective service program and the degree to which local agencies and service providers will support and collaborate with the triage personnel effort.
(F) Geographic areas or regions of the state to be eligible for grant awards, which shall include rural, suburban, and urban areas, and may include use of the five regional designations utilized by the County Behavioral Health Directors Association of
California.
(3) The commission shall determine maximum grant awards, and shall take into consideration the level of need, population to be served, and related criteria, as described in paragraph (2), and shall reflect reasonable costs.
(4) Funds awarded by the commission for purposes of this section may be used to supplement, but not supplant, existing financial and resource commitments of the county, counties acting jointly, or city mental health department that received the grant.
(5) Notwithstanding any other law, a county, counties acting jointly, or city mental health department that receives an award of funds for the purpose of supporting triage personnel pursuant to this subdivision is not required to provide a
matching contribution of local funds.
(6) Notwithstanding any other law, the commission, without taking any further regulatory action, may implement, interpret, or make specific this section by means of informational letters, bulletins, or similar instructions.
(7) The commission shall provide a status report to the fiscal and policy committees of the Legislature on the progress of implementation no later than March 1, 2014.
(h) Funds appropriated by the Legislature to the commission as described in paragraph (8) of subdivision (b) for the purposes of addressing children’s crisis services shall be allocated to support triage personnel and family supportive training and related services. These funds shall be made
available to selected counties, counties acting jointly, or city mental health departments, as determined by the commission through a selection process. The commission may, at its discretion, also give consideration to private nonprofit corporations and public agencies in an area or region of the state if a county, or counties acting jointly, affirmatively supports this designation and collaboration in lieu of a county government directly receiving grant funds.
(1) These funds may provide for a range of crisis-related services for a child in need of assistance, or the child’s parent, guardian, or caregiver. These service activities may include, but are not limited to, the following:
(A) Intensive coordination of care and services.
(B) Communication, coordination, and referral.
(C) Monitoring service delivery to the child or youth.
(D) Monitoring the child’s progress.
(E) Providing placement service assistance and service plan development.
(F) Crisis or safety planning.
(2) The commission shall take into account at least the following criteria and factors when selecting recipients and determining the amount of grant awards for these funds, as follows:
(A) Description of need, including potential gaps in local service connections.
(B) Description of funding request, including personnel.
(C) Description of how personnel and other services will be used to facilitate linkage and access to services, including objectives and anticipated outcomes.
(D) Ability to obtain federal Medicaid reimbursement, when applicable.
(E) Ability to provide a matching contribution of local funds.
(F) Ability to administer an effective service program and the degree to which local agencies and service providers will support and collaborate with the triage personnel effort.
(G) Geographic areas or
regions of the state to be eligible for grant awards, which shall include rural, suburban, and urban areas, and may include use of the five regional designations utilized by the County Behavioral Health Directors Association of California.
(3) The commission shall determine maximum grant awards, and shall take into consideration the level of need, population to be served, and related criteria, as described in paragraph (2), and shall reflect reasonable costs.
(4) Funds awarded by the commission for purposes of this section may be used to supplement, but not supplant, existing financial and resource commitments of the county, counties acting jointly, or a city mental health department that received the grant.
(5) Notwithstanding any other law, a county, counties acting jointly, or a city mental health department that receives an award of funds for the purpose of this section is not required to provide a matching contribution of local funds.
(6) Notwithstanding any other law, the commission, without taking any further regulatory action, may implement, interpret, or make specific this section by means of informational letters, bulletins, or similar instructions.
(7) The commission may waive requirements in this section for counties with a population of 100,000 or less, if the commission determines it is in the best interest of the state and meets the intent of the law.
(8) The commission shall provide a status report
to the fiscal and policy committees of the Legislature on the progress of implementation no later than January 10, 2018, and annually thereafter.
(i) (1) (A) Except as specified in subparagraph (B), on and after July 1, 2021, when making grant funds appropriated by the Legislature available pursuant to subdivision (g) of this section, the commission shall allocate at least one-half of the funds to local educational agency and mental health partnerships, as described in paragraph (2), through a competitive process. youth services that are
consistent with subdivision (b) and with the priorities of the commission through a competitive process.
(B) The commission may allocate less than one-half of the funds to local educational agency and mental health partnerships
pursuant to subparagraph (A) if there is an inadequate number of qualified applicants entities to receive the funds. The commission may redirect any funds left unallocated pursuant to this paragraph toward youth services that are consistent with subdivision (b) and with the priorities of the commission.
(2) The commission shall align the competitive process with the grant process in Section 5886.
(C)On and after July
1, 2026, if the commission determines that funds are not being allocated pursuant to this subdivision due to a lack of qualified applicants, the commission may redirect any funds left unallocated pursuant to this paragraph for purposes that are consistent with subdivision (b) and with the priorities of the commission.
(2)The commission, in consultation with the Superintendent of Public Instruction, shall establish criteria for the allocation of funds pursuant to this subdivision. In order to be eligible to receive funding, a partnership shall include one or more local educational agencies and one or more mental health partners. A mental health partner shall be either a county, including a county mental health plan, or a qualified mental health provider operating as part of the county mental health plan network.
(3) Funding allocated pursuant to this subdivision shall be available to support prevention, early intervention, and direct services, including, but not limited to, support for personnel, training, and other strategies that respond to the mental health needs of children and youth, as determined by the commission.
(4) These strategies may include, but are not limited to, the following:
(A) Communication, coordination, and referral.
(B) Monitoring service delivery to ensure the individual accesses and receives services.
(C) Monitoring the individual’s progress.
(D) Providing placement service assistance and service plan development.
(5) Funding allocated pursuant to this subdivision shall be made available to meet the mental health needs of children and youth, including those with an individual education plan, pursuant to the federal Individuals with Disabilities Education Act (20 U.S.C. Sec. 1400 et seq.), or a plan adopted pursuant to Section 504 of the federal Rehabilitation Act of 1973 (29 U.S.C. Sec. 794), as well as other children and youth in need of mental health services.
(6) The commission shall prioritize on-campus and off-campus services for youth, including school-based partnerships and off-campus drop-in centers. The commission shall develop a rubric to determine
grant awards. The rubric shall give priority to both of the following:
(A) Mental health partnerships as described in Section 5886.
(B) Centers that provide integrated mental health, substance use, physical health, social support, and other services for individuals between 12 years of age and 25 years of age, inclusive, and their families.
(6)
(7) In determining grant recipients, the commission, in consultation with the Superintendent of Public Instruction, shall give positive consideration to
each of the following:
(A) Description of 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) Description of the funding request, including personnel and use of peer support.
(C) Description of how the funds will be used to facilitate linkage and access to services, including objectives and anticipated outcomes.
(D) Ability to obtain federal Medicaid or other reimbursement, including Early and Periodic Screening, Diagnosis, and Treatment funds, when applicable, or to leverage other funds, when feasible.
(E)Ability of the LEA to collect information on the health insurance
carrier for each child or youth, with the permission of the parent, to allow the partnership to seek reimbursement for mental health services provided to children and youth, where applicable.
(F)Ability to engage a health care service plan or a health insurer in the LEA and mental health partnership, when applicable, and to the extent mutually agreed to by the LEA and the plan or insurer.
(G)
(E) Ability to administer an effective service program and the degree to which mental health providers
and local educational agencies will support and collaborate to support the goals of the effort.
(H)
(F) Geographic areas or regions of the state to be eligible for funding, which shall include rural, suburban, and urban areas, and may include use of the five regional designations utilized by the County Behavioral Health Directors Association of California.
(7)
(8) The commission, in consultation with the Superintendent of Public Instruction, shall determine maximum funding awards, and shall take into consideration the level of need, population to be served, and related criteria, as described in paragraph (6). (7).
(8)
(9) Funds awarded by the commission for purposes of this subdivision may be used to supplement, but not supplant, existing financial and resource commitments
of the county, counties acting jointly, city mental health departments, qualified mental health agencies, or local education educational agencies that receive funding.
(9)
(10) For the purposes of this subdivision, “local educational agency” or “LEA” means a school district, a county office of education, a nonprofit charter school participating as a member of a special education local plan area, or a special education local plan
area.
(10)
(11) Notwithstanding any other law, the commission, without taking any further regulatory action, may implement, interpret, or make specific this subdivision by means of informational letters, bulletins, or similar instructions.
(11)
(12) The commission shall provide a status
report to the fiscal and policy committees of the Legislature on the progress of implementation no later than March 1, 2022.
(12)
(13) Nothing in this subdivision shall require the use of funds included in the minimum funding obligation under Section 8 of Article XVI of the California Constitution for the partnerships established by this part.
(13)
(14) Implementation of this subdivision shall be subject to an appropriation in the annual Budget Act or any other statute for that purpose.