HomeMy WebLinkAboutMINUTES - 06221999 - C52-C56 TO: BOARD OF S1v PERN71SORS Al. Contra
FROM: PHIL BATCHELOR, COUNTY ADMINISTRATOR
Costa
County
DATE: r''rr•..,._;
Mune 14, 1999 <>
SUBJECT.
LEGISLATION: SE 1154 (Speier)
SPECIFIC REQUEST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION
RECOMMENDATION:
ADOPT a position in SUPPORT of SB 1154 by Senator Jackie Speier which would
enact the California Breast and Gynecological Cancer Treatment Program for low
income women.
BACKGROUND:
The Board's 1999 Legislative Program includes the following item:
"19. Support efforts to increase funding for breast cancer
awareness, public education, and treatment. (Supported
AE 40 on 115199, and SB 193 on 3/23199)„
SB 1154 has been introduced by Senator Speier. As amended Jude 3, 1999, SB
1154 would do the following:
1. Establish a California Breast and Gynecological Cancer Treatment Program.
2. Make all women 10 years of age or over eligible who are diagnosed with
breast or gynecological cancer and have an income below 300% of the
Federal poverty level, who are not eligible for Medicare, no cont Medi-Cal,
have no other insurance coverage for breast or gynecological cancer or have
insurance that requires a deductible of more than $1,000 for breast or
gynecological cancer treatment.
CONTINUED ON ATTACHMENT: YES SIGNATURE:
RECOMMENDATION OF COUNTY ADMINISTRATOR -RECOMMENDATION OF BOARD COMMITTEE
APPROVE OTHER
r"
'LGNATURE Sj:
ACTION OF BOARD ON June 22, 1399 APPROVED AS RECOMMENDED x� OTHER
MOTE OF SUPERVISORS
I HEREBY CERTIFY THAT THIS IS A TRUE
UNANIMOUS _ ) AND CORRECT COPY OF AN ACTION TAKEN
AYES: NOES: AND ENTERED ON THE MINUTES OF THE BOARD
ABSENT: ABSTAIN: OF SUPERVISORS ON THE DATE SHOWN.
See Page 2 ATTESTED— June 22, 1999
Contact PHIL BATCHELOR.,CLERK OF THE BOARD OF
O` SUPERVISORS AND COUNTY ADIV.?NiSTRATOR
BY
DEPUTY
ACALL
............. ........................ .....
3. Establish a presumptive eligibility period during which the woman can receive
treatment while eligibility is being determined.
4. Provide for 24 months of treatment for each diagnosed condition.
5. Provide for an extension of the 24 month period when medically required.
6. Provide that funding is dependent upon an annual appropriation by the
Legislature.
7. Require an advisory committee of specified composition to advise the
Managed Risk Medical Insurance Board regarding the Program.
In view of the fact that SB 1154 appears to be consistent with the Board's adopted
Legislative Program, it is recommended that the Board indicate its support for SB
1154.
cc: County Administrator
Health Services Director
Public Health Director
Senator Jackie Speier
8th Senate District
Room 2032 State Capitol
Sacramento, CA 95814
Les Spahnn; beim, Noack, Kelly & Spahnn
1121 L Street, Suite 100
Sacramento, CA 95814
-2-
AMENDED IN SENATE JUNE 3, 1999
AMENDED LN SENATE APRIL 19, 1999
SENATE BILL No. 1154
Introduced by Senator Speier
February 26, 1999
An act to add Article 1.5 (commencing with Section 104160)
to Chapter 2 of Fart 1 of Division 103 of the Health and Safety
Code, and to add Section 14021.8 to the Welfare and
Institutions Code, relating to cancer,
LEGISLATIVE GOL'hSM:S DIGEST
SB 1154, as amended, Speier. Breast and gynecological
cancers treatment services.
Existing law establishes the Breast Cancer Control Program
that provides early breast cancer detection services for
uninsured and underinsured women.
This bill would enact the California Breast and
Gynecological Cancer Treatment Program to be
administered by the
:Managed Bask Medical Insurance Board. This bili , eeld
meets eerfain et4wria to ereafe the treatment program. This
bill would describe the treatment services to be provided, and
would establish eligibility criteria and require that a
presumptive eligibility period apply to individuals seeking
services, as described. This bill would authorize each program
participant to receive up to 24 months of comprehensive
97
I
i
SB 1154 —2—
medical
--2medical care coverage for each newly diagnosed condition,
and would allow extension of this coverage in certain
circumstances.
This bill would require the ,
eemirAt+ee appointed by speeified x
board to establish an advisory council to perform certain
functions relating to implementation of the
program.
flenprefif erganitafi n ' meos ee sari-eriteria—iv--ereai e
$16,000,000
Fund to the depfftment fer the pwpeses of these pregraffis.
.Existing law provides for the Medi-Cal program,
administered by the department, which provides health care
services for certain low-income individuals.
This bill would require the department to provide breast
and cervical cancer treatment under the Medi-Cal program,
but only if certain federal law is enacted.
Vote: 43 majority. Appropriation: yft no. Fiscal committee:
yes. State-mandated local program: no.
The people of the State of California do enact as follows:
1 SECTION 1. Article 1.5 (commencing with ,section
2 104160) is added to Chapter 2 of Part 1 of Division 103 of
3 the Health and Safety Code, to read:
4
5 Article 1.5. Universal Breast and Gynecological
6 Cancer Treatment Act
7
S 104160. (a) The California Breast and Gynecological
9 Cancer Treatment Program is hereby created. The
10 program shall be administered by theState - partm
11 deal`°- S.ryiee Managed Risk Medical Insurance
12 Board.
13 (b) For purposes of this article, the following
14 definitions shall apply:
97
-3— SB 1154
1 (1) "Covered conditions" means breast and
2 gynecological cancer.
3 (2) "Breast cancer" includes primary, recurrent, and
4 metastatic (with a primary diagnosis of breast
5 carcinoma) cancers of the breast, whether infiltrating or
6 in sitar.
7 (3) GytteeelegieeA ea er "Gynecological cancer"
8 includes all primary, recurrent, and metastatic (with a
9 primary diagnosis of gynecological origin) cancers of the
10 cervix, ovaries, endometrium, or uterus, whether
11 infiltrating or in situ, as well as cervical dysplasia.
12 (4) "Berard" means the Managed Risk Medical
13 Insurance Board
14 (c) The program shall be open to all California
15 residents diagnosed with breast or gynecological cancer
16 (positive pathology), 18 years of age or older with income
17 below 300 percent of the federal poverty level who are
18 not eligible for Medicare, not eligible for no-cost
19 Medi-Cal, and have no other insurance coverage for
20 breast or cervical cancer treatment or have insurance
21 coverage that requires more than a one thousand dollar
22 ($1,000) deductible or copayment per year for breast or
23 gynecological cancer treatment.
24 (d) There shall be a presumptive eligibility period.
25 The presumptive eligibility period shall begin on the date
26 that a qualified entity determines, on the basis of
27 preliminary information, that the individual is eligible to
28 participate in the program, and shall end on the day that
29 a determination is made with respect to the eligibility of
30 the individual for services within the program, or, in the
31 case of an individual who does not file an application by
32 the last day of the month following the month during
33 which the entity determined presumptive eligibility, on
34 the last day of that following month. For purposes of this
35 subdivision, "qualified entity" means any entity that is
36 eligible for payments by the program established by this
37 article, that provides breast or gynecological
38 cancer-related treatment services, and is determined by
39 the program to be capable of making presumptive
97
I
SB 1154 —4-
1
41 eligibility determinations pursuant to paragraph (1) of
2 subdivision(f) of Section 104163.
3 (e) Each program participant may receive up to 24
4 months of comprehensive medical care coverage for each
5 newly diagnosed covered condition. In the event of
6 treatment needs beyond 24 months, coverage may be
7 extended with medical review under the direction of the
g — )tmeil board.
9 (f) Services to be covered by the program shall include
10 all services provided as benefits under Medi-Cal, plus
11 additional services including, but not limited to, hospice,
12 nutritional counseling, home health, reconstruction,
13 prosthesis, pain management, and other ancillary
14 services as needed, arising from treatment and
15 complications as determined by the eeetteil
16 board.
1 e (g) To the extent California Law requires, whether at
18 present or in the future, health care service plans or
19 disability insurers that provide hospital, medical, or
20 surgical coverage to .provide access to clinical trials for
21 patients, the program shall cover participation in
22 approved clinical trials.
23 104161. The deparenent board shall only implement
24 this article during fiscal years in which the Legislature has
25 appropriated funds to the depw4men board for the
26 purpose of this article. The dent board may
27 expend no more than 5 percent of funds appropriated to
28 it for purposes of the program in any fiscal year for
29 administrative costs of the program..
30
31
32
33 pfagrem modeled after the exisfiitg Breast Gmteer Fund
34
35
36 seeeeg9fit! of it similar pmgraffi far at le"t
37 eee ef the eevered eendifiens, epermed en a statewide
38 ievei, serving a pepelatien ef at least 4 909 pa4erttq.
97
--- SB 1154
r1 9
2 tie 4.LT,s« Febmary- S Cb 2f1f- o9 in fieeeid;—�.ee,'...—
'4L. tL
3 wing preeedtwe—
7
10
f{9 ,
CF' 44_a Gc.""'LF1the"""members�'CTX.' 2T1'e
11
13 eeitditiea.
14
15
16 media are used te seliek aeffl and interest
17 ei4 and R eefthwt
r r r+ s
18
20 .
21
22
23 (,.. e
24 104162. For purposes of administering the program,
25 the board may utilize a purchasing pool model,
26 purchasing credits, and supplemental coverage to
27 provide comprehensive health coverage for eligible
28 program participants.
29 104163. (a) The board shall establish an advisory
30 council to advise the board. The chair of the advisory
31 council shall be appointed and commence the
32 performance o,f his or her duties by April 1, 2000.
33 (b) The advisory council shall consist of at least 17 and
34 no more than 19 voting members representing a range of
35 expertise and experience, and 3 ex officio nonvoting
36 members, as follows:
37 (1) At least five members who are breast and
38 gynecological cancer survivors or advocates representing
39 an organization that actively participates in cancer
40 advocacy or women's health advocacy.
97
SB 1154 —6-
1
-6-1 (2) At least five members who are clinicians treating
2 breast and gynecological cancer patients, including one
3 whose practice includes clinical trials.
4 (3) At least two members who are county health
5 officers, one from an urban area and one from a rural area,
6 each representing different California regions.
7 (4) At least three members from the Breast Cancer
8 Early ]Detection Program, one of whom is a patient care
9 coordinator, and one each representing the north, south,
10 and central California regions,
11 (5) At least two members who are program
12 participants.
13 (6) One ex officio, nonvoting member from the
14 Cancer Detection Section of the California Department
15 of Health Services.
16 (7) Two ex officio, nonvoting members, one from the
17 Breast Cancer Research Program and one from the
18 Cancer Research Program.
19 (c) If more than 17 voting members are appointed to
20 the governing council, it is the intent of the Legislature
21 that the proportional representation among the voting
22 members remain substantially the same as set forth in
23 subdivision(b).
24 (d) Members of the governing council shall serve
25 without compensation, but may receive reimbursement
26 for travel and other necessary expenses actually incurred
27 in the performance of their official duties.
28 (e) Terms of membership on the governing council
29 shall be staggered in such a way as to maintain a full
30 council while ensuring a reasonable degree of continuity
31 of expertise and a consistency of direction. 'Terms shall be
32 no longer than three years.
33 (f) The eetteeil advisory council shall elect
34 its chair from among its members.
35 ('g) The advisory council shall do all of the following:
36 (.l) Advise the board regarding all policies,
37 regulations, operations, and implementation of the
38 programa.
gr
I
-7— SB 1154
1 (2) Consider all decisions of the ward and respond in
2 writing when the board rejects the advice of the advisory
3 council.
4 (3) Meet at least quarterly, unless deemed
5 unnecessary by the chair.
b (h) Members of the advisory council shall be
7 reimbursed for all necessary travel expenses associated
8 with the activities of the council. .Members of the advisory
9 council who represent the program participants may
10 receive per thein compensation if these members are
11 otherwise economically unable to meet council
12 responsibilities.
13 104164. The board may do all of the following
14 consistent with the standards set forth in this article:
15 fH–
1€a (a) (1) Determine the eligibility criteria for
17 applicants for program participation. The eewteRsh�
18
19 (2) .direct the development of a simple application
20 and application ,
21 process.
22 (3) Determine the qualification mechanism for
23 entities to be authorized to determine presumptive
24 eligibility.
25
26
27
28
29
30
+31 d
year at a -The Soy
32 eetineil shall3 SrepeA eft the
33 eppfeyed 149t of eaveted serviees,
34 .
35
36
37
3
g eeYered eeft4ifiea.
97
SB 1154 —8-
1
2
3 (3) Researeh and vftL-M of Persons diagnosed
4
5
6 deliyery systeffis,
7 ircirria". ;; �.�itt+�,irs .trlara.na
(j d 3
Q (4) Approve ,
and
9 (c) Approve plan rates, and establish program
10 contribution and copayment amounts for individuals
11 covered by the programa
12 f-S-)-
13 (d) Provide medical coverage for individuals with the
14 covered conditions or contract with a participating health
15 plan or plans to provide or administer medical coverage
16 for individuals with the covered conditions.
17
18 (c) Set rates for reimbursement for services, and
19 authorize expenditures from the fund to pay program
20 expenses, as necessary.
21
22 Contract for administration of the program or any
23 portion thereof with any public agency, including any
224
5 age of state government, or with any private entity.
26 (g) Adopt rules and regulations to carry out the
27 purposes of this article.
28 (.c*-
29 (h) Exercise all powers reasonably necessary to carry
30 out the powers and responsibilities expressly granted or
31 imposed upon it under this article.
32 0 -
33 (i) Can an annual basis, evaluate, or contract for the
34 evaluation of, the program,
35 eeardiftatiee and outreach services required under
36 Section 104165, and report on the satisfaction rate of
37 patients and providers, the efficiency and efficacy of
38 services provided, and any continued barriers to
39 achieving comprehensive coverage for all eligible
40 individuals.
97
I
-9— SB 1154
1 (44-)-
2 (j) Establish procedures for filling vacancies on the
3 advisory council.
4 104464 -en
5 1€4155. No more than 10 percent of the funds
6 appropriated for treatment services covered by this
7 article shad be
10
Mer
ll
12
13 eeer-diftatieft wand — r"
14
15
16
1'
18 efte of the eeyered eenditiefts, epefated eft
1y
20 —urseam to
r21
G2
,23 r
Bremf
24
25 preyiden,
26
27 p pert:
2
29
30
31
32 x
33 x
34
35
36 4%e a9sistaftee may
37
38 d9
39
40
97
l
SB 1154 —10
1 ;
2 .
3
4 el sobseribersr
Y
6 designated
� Program
proyiders, and eo7wmniv� partners to patient e—are
10
11
y12 hem .
13
14 not - ,
15 stibseribef,
16 ' y
17 plans and eeer&nating treatment and seppeq* gerviee
18
19 !
2te
21 essin
22
23 for regeletien efforts.
24
25
26
27
28 apprepriate to the subseriber.
23 (B) Pmient eare eeerdinafien staff may be in the
30
3335
32 geegraphiea4 areas where
33 stibgeriber velurne is low or when other eensiderations
34 allocated ,for the purposes of
35 outreach services.
36 SEC. 2. Section 14021.8 is added to the Welfare and
37 Institutions Code, to read;
38 14021.8. (a) The State Department of Health
39 Services shall provide breast and cervical cancer
40 treatment services under the Medi-Cal program to all
97
I
SB 1154
1 persons specifically eligible for those services under Title
2 XIX of the Social Security Act, to the extent that federal.
3 financial participation is available.
4 (b) For purposes of this section, "breast and cervical
5 cancer treatment services" shall be those services defined
6 as such in Title XIX of the Social Security Act.
7 (c) This section shall be implemented only upon the
S passage of federal legislation that authorizes the provision
9 of breast and cervical cancer treatment services to
10 specified persons under Title XIX of the Social Security
11 Act.
12 (d) if this section is implemented, the director shall do
13 both of the following.
14 (1) Execute a declaration, that shall be retained on file
15 by the director, stating that the condition set forth in
16 subdivision (c) requiring implementation of this section
17 has occurred.
18 (2) Adopt regulations to .implement this section.
19 Notwithstanding Chapter 3.5 (commencing with Section
20 11340) of Part 1 of Division 3 of Title 2 of the Government
21 Code, the adoption of the regulations shall be deemed to
22 be an emergency and necessary for the immediate
23 preservation of the public peace, health and safety, or
24 general welfare. The director shall transmit these
25 emergency regulations directly to the Secretary of State
26 for filing and the regulations shall become effective
27 immediately upon. filing. Upon completion of the formal
28 regulation adoption process and prior to the expiration of
29 the 120-day duration period of emergency regulations,
30 the director shall transmit directly to the Secretary of
31 State for filing the adapted regulations, the rulemaking
32 file; and the certification of compliance as required by
33 subdivision (e) of Section 11346.1 of the Government
34 Cade.
35 (e) This section shall not be construed to limit the
36 treatment program described in Article 1.5
37 (commencing with Section 104160) of Chapter 2 of Part
38 1 of Division 103 of the Health and Safety Code to provide
39 only supplementary services for those individuals who
40 qualify for services under this section, nor to prohibit that
97
I
SB 1154 d-- 1
1 program from continuing to operate with regard to
2 covered conditions not included in this section..
3 SEC. 3. 1t is the intent of the Legislature that hospitals
4 and clinics operated by the University of California
5 should participate in this program.
+p ($15,009,000)
a
p�
11
12 .
0
97
TO: BOARD OF SUPERVISORS
t
Contra
FROM: PHIL BATCHELOR, COUNTY ADMINISTRATOR os
ta
,lane 17, 1999 County
DATE:
SUBJECT: LEGISLATION: AB 34 (Steinberg)
SPECIFIC REQUEST(S)OR RECOMMIENDAT€ON(S)&BACKGROUND AND JUSTIFICATION
RECOMMENDATION:
ADOPT a position in SUPPORT of AB 34 by Assemblyman Darrell Steinberg of
Sacramento which would fund an expansion of mental health services to seriously
and persistently mentally ill adults.
BACKGROUND:
The Mental Health Director, Donna Wigand, reports that AB 34 will fund needed
expansions to services for seriously and persistently mentally ill adults. Older adults
are of particular concern to Contra Costa County since services to them have been
reduced in recent years. In addition, we are finding it increasinglydifficult to serve
low-income individuals who are not Medi-Cal eligible, another situation that AB 34
will remedy. It will also support many components of the Mentally Ill Offender Crime
Redaction Local Plan developed recently in conjunction with the Sheriff's Office and
Probation Department. This will mean funds to obtain and maintain housing thus
reducing criminal justice system involvement and costs. AB 34 appropriates $12
million in 1999-2000 and $41 million in 2000-2001 for these programs.
AB 34 has passed the Assembly and is currently in the Senate Health & Human
Services Committee. The Mental Health Director recommends that the Board
indicate its support for AB 34.
CONTINUED C4?ed AT?AC#iid?oNT: YES SIGNATURE:
r
RECOMMEN3ATION O�COUN -Y AO-M,N:STRATOR -RECOMMENDATION OF BOARD COMMITTEE
APPROVE OTHER
A�;W
SIGNATURES : , 4'k
ACTION OFF BOARD ON June 22 9999 APPROVED AS RECOMMIENDED —X)L OTHER
VOTE OF SUPERVISORS
I HEREBY CERTIFY THAT THIS IS A TRUE
!X UNANIMOUS{ASSENT "' ) AND CORRECT COPY OF AN ACTION TAKEN
AYES: -- NOES: AND ENTERED ON THE MINUTES OF THE BOARD
ABSENT: ABSTAIN: OF SUPERVISORS ON THE DATE SHOWN.
County Administrator
Health Services Director ATTESTED June 2 2 1999
Contact: Mental Health Director PHIL BATCHELOR,CLERK of THE BQA9D of
cc: Assemblyman Darrell Steinberg su�EFIVISOla AND coin i Y ADMI T BATOR
Room 2176 State Capitol
Sacramento, CA 95614
Les Spahnn; Heim,Noack, Kelly&Sp ahnn
1121 L Street,suite 190 B DEPUTY
Sacramento, CA 95814
AB 34 Assembly Bill- Bill Analysis Page 1 of 5
AB 34
Page _
ASSEMBLY THIRD READING
AB 34 (Steinberg)
As Amended June 1, 1999
2/3 vote. Urgency
HEALTH _-- 14-0 APPROPRIATIONS 17-4
j.Ayes: €Gallegos, Baugh, €Ayes: €Migden, Cedilio,-Davis, ®�
€ Janestad, Bates, Corbett, jPescetti, Hertzberg,
3 €Firebaugh, Kuehl, i Kuehl, Maldonado, Papan,
€ €Steinberg, Strickland, €Romero, Shelley,
€ €Thomson, Vincent, Wayne, € iSteisberg, Thomson,
€Wildman, Zettel € ;Wesson, Wiggins, Wright,
€ € Aettel, Aroner I
----------------------------------+-----+----------_---__-----_---_--
€ €Nays: Brewer, Ashburn, Battin, E
€ € IRunner €
€ i !-----------------------------------------------------------------
I
SUMMARY Revises county mental health service standards to
include access to integrated services, and establishes fiscal
incentives for counties to engage in outreach to mentally ill
persons. Specifically, this bill .
1)Revises county mental health service standards to be developed
by the Department of Mental Health (DMH) , to include
coordination and access to medication, substance abuse
services, supportive housing, veterans' services and
vocational rehabilitation services.
2)Requires, as funds become available, the three demonstration
projects established in the Adult and Older Adult Mental
Health System of Care Act to be expanded to counties with
significant populations of homeless mentally ill persons.
3)Hstablishes Tour-year planning and outreach grants to
counties, provides for increased funding reflecting the number
of adults receiving mental health services for at least four
months in a six-month period.
4)Requires outreach grants to be sufficient to provide mental
health services, medications, alcohol and drug services,
housing assistance, vocational rehabilitation_, financial
management assistance and stipends to attract and retain
AB 34
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AB 34 Assembly Bill -Bill Analysis Page 2 of 5
professionals to provide services.
5)Permits an outreach grant to be renewed if the county
demonstrates to DMH that the services are successfully
reducing mental health reeds and reducing law enforcement,
criminal justice system, and state corrections expenditures on
severely mentally ill persons.
6)Permits grant reductions based upon benchmarks for a 20% or
larger reduction in incarceration rates over the four-year
grant. Permits DME: to approve grant renewal if the benchmark
is unmet and the county is stabilizing more mentally ill and
reducing homelessness, achieving the maximum feasible
reduction in incarceration, or meeting other performance
criteria specified in the county contract.
7) Permits subsequent funding to be limited, or for conditions
for improvement to be imposed upon a county that received a
grant, but did not reduce criminal justice expenditures or
greet other performance benchmarks as a result. Requires DMH to
provide annual oversight of grants for compliance with
contract standards.
8)Requires the DME: Director to establish an advisory committee
to provide advice regarding the development of grant award
criteria, and to identify performance measures for evaluating
the effectiveness of grants. The committee shall include, but
not be limited to, representatives from veterans' services
programs, law enforcement, county and private mental health
providers, the Board. of Corrections, the Department of Alcohol
and Drug Programs, substance abuse service providers, the
Department of Rehabilitation, and providers of employment
services. Requires criteria for grant awards to include, but
not be limited to:
a) A strategic plan for providing outreach, prevention,
intervention, and evaluation in a cost appropriate manner;
b) A description of the population to be served, ability to
administer an effective service program., and the degree to
which local agencies and advocates will support program
efforts, and
W Mechanisms to award grants in a manner that supports
better county performance, by restricting grants based on
AB 34
------------ Page 3
the extent to which the current number of people receiving
extensive menta'_ health services with funds provided other
than through this part in the county are significantly
below those of other comparable counties, and by rewarding
counties that are able to provide mental health services to
more people with other resources.
9)Requires local strategy committees composed of, but not
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AB 34.Assembly Bill-Bill Analysis Page 3 of 5
limited to representatives of local government and providers
of housing assistance, mental health services, outreach for
mental health services, veterans' services, law enforcement,
substance abuse services and employment services.
10?Requires the local strategy committee to develop a
comprehensive plan to from the basis for a performance-based
contract with DMH. Requires the plan to identify specified
outcome and performance measures identified by DMH and the
local committee.
!_)Permits grant amounts to be increased to reward counties that
are providing mental health services to significantly more
mentally ill adults with funds other than state
appropriations, relative to other comparable counties.
Permits grant amounts to be decreased to penalize counties
serving a number of severely mentally ill adults significantly
below that of comparable counties.
.2)Permits outreach grants to be renewed, if the county
demonstrates to DMH that the outreach services are
successfully bringing into treatment the number of persons
projected in the contract. Permits contracts to be modified
as necessary.
13)Requires, beginning on or before November 1, 2001, and
annually thereafter, the Director to report to the Legislature
about the impact of grants in reducing incarceration of
mentally ill persons, and to make recommendations regarding
improving county performance and state mental health policies.
14)Appropriates $12 million from the General Fund during the
current (1999-2000) fiscal, year to DMH. Requires $500, 000 to
be allocated for training, $500, 000 to be allocated for
homeless outreach training for counties, to be offered through
an organization with significant success with homeless
outreach programs. Requires $9 million to be allocated for
0
AB 34
--- — Pace 4
county planning grants.
15)Appropriates $41 million to DMH from the General Fund for the
2000-2001 fiscal year. Requires, of the amounts appropriated
each year, $500, 000 to be allocated to DMH for administrative
purposes.
16)Expresses legislative intent that the future funding be
allocated to counties based on the amount due under the
applicable county's contract, according to net increases in
the number of persons served in the prior fiscal year,
adjusted by the amount the county's prior fiscal year
allocation was greater or ,less than the amount required to
fund the county's actual increase in number of persons served.
If the total amount of allocations due to all counties would
exceed the previous year's appropriation by more than $50
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AB 34 Assembly Bill-Bill Analysis Page 4 of 5
million, each county shall receive a percentage of a $50
million increase over the previous year's appropriation.
EXISTING LAIC .
l) Requires counties to relieve and support poor, indigent and
incapacitated persons, when such persons are not supported
and relieved by relatives, friends, or other public or
private institutions.
2) Establishes three mental health care demonstration projects
in the Adult and Older Adult mental Health System of Care
Act.
FISCAL EFFECT According to the Assembly Appropriations
Committee analysis, the bill appropriates $12 million General
:Fund in 1999-2000, and $41 million in 2000-2001. in addition,
this bili expresses intent to provide state funding, with annual
increases not to exceed $50 million annually.
— COMMENTS a The author is proposing this bill to reduce
homelessness of people with severe mental illnesses. The author
notes that the mentally ill frequently become disoriented and
unable to recognize the need for medical assistance. When
medical care is not sought, a cycle of hospitalization, return
to the streets, arrest, and return to homelessness ensues. This
bill is sponsored by the Mental health Association in
California.
AB 34
-- – Page 5
AB 3777 (Wright) , Chapter 982, Statutes of 1988, authorized two
types of pilot programs for delivering mental health services to
seriously mentally ill adults. a system of care model, which has
been piloted in Ventura County, and the integrated service
agencies (TSA) model, piloted in Stanislaus and Los Angeles
Counties. These programs have helped clients become functional
through coordinated services to address multiple problems, such
as mental illness, substance abuse and homelessness. SB 659
(Wright) , Chapter 153, Statutes of 1996, reauthorized the
demonstration projects, and required DMH to issue requests for
proposals for additional projects in any year in which the state
provides funds for that purpose.
The California Council of Community :Mental. Health Agencies
(CCCMHA) argues that the only way to step the cycle of
homelessness due to untreated illness is to provide incentive
funding for county programs. The Los Angeles County Sheriff's
Department believes this ;Dili will provide resources to keep
mentally ill patients from weighing down our criminal justice
system. The California dental Health Planning Council argues
that this bill will reverse a pattern of underfunding that has
continued since deinstitutionalization of the mentally ill in
the early 1970's.
http://v,rww.leginfo.ca.gov/pub/bill/asm/ab-00.../ab34—cfa 19990603_022833—asrn_#1oor.htni 6/16/99
AB 34 Assembly Bill -Bill Analysis Page 5 of 5
Analysis Prepared by Ann Blackwood I :HEALTH / (916) 319-2097
FN
0001584
http://www.leginfo.ca.gov/pub/bill/asm/ab_00.../ab-34—cfa-19990603-022833—asm—floor.htm 6/16/99
AMENDED IN ASSEMBLY JUNE 1, 1999
AMENDED IN ASSEMBLY APRIL 26, 1999
AMENDED IN ASSEMBLY APRIL,5, 1999
AMENDED IN ASSEMBLY MARCH 4, 1999
AMENDED IN ASSEMBLY FEBRUARY"4, 1999
CALIFORNIA LEGISLATURE--1999--2(!tl(?REGULAR SESSION
ASSEMBLY BILL No. 34
Introduced by Assembly Members Steinberg and Baugh
(Coauthors; Assembly Members Alquist, Calderon, Cedillo,
Gallegos, Hertzberg, Honda, Jackson, Keeley, Kuehl,
Lowenthal, .Mazzoni, Romero, Strom-Martin, Thomson,
and Washington)
(Coauthors: Senators Alpert, Baca, Chesbro, Johnston,
Perata, and Solis)
December 7, 1998
An act to amend Sections 5802, 5806, and 5814 of the Welfare
and Institutions Code, relating to mental health, aft4 making
an appropriation therefor, and declaring the urgency thereof,
to take effect immediately.
LEGISLATIVE COUNSEL'S NICEST
AB 34, as amended, Steinberg. Mental health funding:
local grants.
Existing law provides for the allocation of state funds to
counties for mental health programs.
94
r—
AB 34 —2 This bill would make various statements of legislative
findings and intent regarding the need to provide sufficient
funds to counties for adult mental health and related services.
Existing law requires the State Department of Mental
Health to establish service standards relating to mental health
services. These standards are required to include, among
other things, plans for services and evaluation strategies.
This bill would also require these standards to include
coordination and access to related medications, substance
abuse services, housing assistance, vocational
rehabilitation, and veterans' services.
The bill would also provide for the award, by the
department, of planning grants, outreach grants, and service
expansion grants to counties for adult mental health
programs.
The bill would appropriate funds to provide planning
grants, outreach grants, and expansion grants for counties
with significant populations of homeless mentally ill persons
through the 2000-01 fiscal year.
This bill would declare that it is to take effect immediately
as an urgency statute.
Vote: 2/3. Appropriation: yes. Fiscal committee: yes.
State-mandated local programa no.
The people of the State of California do enact as follows:
1 SECTION 1. The Legislature finds and declares all of
2 the following:
3 (a) Recent estimates indicate that there are 50,000
4 homeless severely mentally ill Californians, including
5 10,000 to 20,000 homeless mentally ill veterans.
6 (b) Presently there are no financial incentives for
7 counties to provide outreach to homeless mentally ill
8 adults to increase the number of people they serve with
9 severe mental illness.
10 (b�-
11 (c) County dollars are generally fixed, so that
12 treatment of a higher than expected number of Medi-Cal
13 recipients, who are entitled to treatment by the county,
94
-3— AB 34
1 reduces the amount of funds available to serve other
2 individuals.
3
4 (d) Counties should be provided an amount of funds
5 to establish systems of care for severely mentally ill adults,
6 and provide mental health services and related
7 medications, substance abuse services, housing assistance,
8 vocational rehabilitation, and other nonmedical
9 programs necessary to stabilize homeless mentally ill
10 persons, get them into regular treatment or access to
11 veterans' services, and off the streets.
12 (d--
13 (e) When people who suffer from severe mental
14 illness do not have access to the services they require they
15 frequently wind up in the criminal justice system.
16 However, those who receive extensive community
17 treatment are ev much less frequently
18 incarcerated. The Department of Corrections is
19 expending $400 million annually for the incarceration and
20 treatment of people suffering from severe mental illness.
21 In addition, the Department of Corrections and the
22 criminal justice system are responsible for the placement
23 of more than 3,000 of the total of approximately 4,500
24 persons in the state mental hospitals, for an additional
25 annual state cost of over$300 million.
26 �
27 (f) People suffering from severe mental illness receive
28 sentences that are sift tifftes frequently longer than those
29 received by others convicted of the same crimes.
30 {4--
31 (g) There arethat insufficient
32 funds car programs to ensure that people suffering from
33 severe mental illness can receive the treatment they
34 needs
35 -)-
36 (h) Increasing funding for an adult mental health
37 system of care will result
38 in significantly reduced Department of Corrections,
39 criminal justice system, and local law enforcement
40 expenditures for people with severe mental illness.
94
AB 34 —4-
1
4--
1 SEC. 2. Section 5802 of the `welfare and Institutions
2 Code is amended to read:
3 58032. (a) The Legislature finds that a mental health
4 system of care for adults and alder adults with severe and
5 persistent mental illness is vital for the sueeess of mefft-1
6 llh fttmed successful management of mental hearth
7 care in California. Specifically:
8 (1) A comprehensive and coordinated system of care
9 includes community-Lased treatment, outreach services
10 and other early intervention strategies, case
11 management, and interagency system components
12 required by adults and older adults with severe and
13 persistent mental illness.
14 (2) Mentally ill adults and older adults receive service
15 from many different state and county agencies,
16 particularly criminal justice, employment, housing=
17 public welfare, health, and mental health. In a system of
18 care these agencies collaborate in order to deliver
19 integrated and cost-effective programs.
20
21
22 (3) The recovery of persons with severe mental illness
23 and their financial means are important for all levels of
24 government, business, and the community.
25 (4) System of care services which ensure culturally
26 competent care for persons with severe mental illness in
27 the most appropriate, least restrictive level of care are
28 necessary to achieve the desired performance outcomes.
29 (5) Mental health service providers need to increase
30 accountability and further develop methods to measure
31 progress towards client outcome goals and cost
32 effectiveness as required by a system of case.
33 (b) The Legislature further finds that the integrated
34 service agency model developed. in Los Angeles and
35 Stanislaus Counties and the countywide systems model
36 developed in Ventura County, beginning in the 1989-90
37 fiscal year through the implementation of Chapter 982 of
38 the Statutes of 1988,6--fides provide models for
39 managing care for adults and older adults with severe
40 menu illness that are -Yita4 to the implemeftw6an etfid
94
-p-5-- AB 34
2 C i r o, aftd have, and have successfully met the
3 performance outcomes required by the Legislature,
4 (c) The Legislature also finds that the system
6
7 pie components established in adult systems o,f care
8 are of valve in ,providing greater benefit to adults and
9 older adults with severe and persistent mental illness at
10 a louver cast in California.
ll (d) Therefore, using the guidelines and principles
12 developed under the demonstration projects
13 implemented under the adult system of care legislation
14 in 1989, it is the intent of the Legislature to accomplish the
15 following.
16 (1) Encourage each county to implement a system of
17 care as described in this legislation for the delivery of
18 mental health services to seriously mentally disordered
19 adults and older adults.
20 (2) To promote system of care accountability for
21 performance outcomes which enable adults with severe
22 mental illness to reduce symptoms which impair their
23 ability to live independently, work, maintain community
24 supports, care for their children, stay in good health, not
25 abase drugs or alcohol, and not commit crimes.
26 (3) Maintain funding for the existing programs
27 developed in Los Angeles, stanislaus, and Ventura
28 Counties as models and technical assistance resources for
29 future expansion of system of care programs to other
30 counties as funding becomes available.
31 (4) Provide sufficient funds for counties to establish
32 outreach programs and to provide mental health services
33 and related medications, substance abuse services,
34 supportive housing or other housing assistance,
35 vocational rehabilitation, and other nonmedical
36 programs necessary to stabilize homeless mentally ill
37 persons or mentally ill persons at risk of being homeless,
38 get them off the street, and into treatment and recovery,
39 or to provide access to veterans' services that will also
40 provide for treatment and recovery,
94
AB 34 —6-
1 SEC. 3. Section 5806 of the Welfare and Institutions
2 Code is amended to read:
3 5806. The State Department of Mental Health shall
4 establish service standards that ensure that members of
5 the target population are identified, and services
6 provided to assist them to live independently, work, and
7 reach their potential as productive citizens. The
8 department shall provide annual oversight of grants
9 issued pursuant to this part for compliance with these
10 standards. These standards include but are not limited to:
11 (a) A service planning process that is target
12 population based and includes the following:
13 (1) Determination of the numbers of clients to be
14 served and the programs and services that will be
15 provided to meet their needs. The local director of
16 mental health shall consult with the sheriff, the police
17 chief, the probation officer, the mental health board,
18 contract agencies, and family, client, ethnic and citizen
19 constituency groups as determined by the director.
20 (2) Plans for services including outreach, design of
21 mental health services, coordination and access to
22 medications, substance abuse services, housing assistance,
23 supportive housing or other and . .t:..na ehabi,:a..iet
24 vocational rehabilitation, and veterans' services. Plans
25 shall also contain evaluation strategies, which shall
26 consider cultural, linguistic, gender, age, and special
27 needs of minorities in the target populations. Provision
28 shall be made for staff with the cultural background and
29 linguistic skills necessary to remove barriers to mental
30 health services due to limited English speaking ability
31 and cultural differences.
32 (3) Provisions for services to meet the needs of target
33 population clients who are physically disabled.
34 (4) Provision for services to meet the special needs of
35 older adults.
36 (5) Provision for family support and consultation
37 services, parenting support and consultation services, and
38 peer support or self-help group support, where
39 appropriate.
94
-7— AB 34
1 (b) Each client shall have either a clearly designated
2 meatal health case manager or a multidisciplinary
3 treatment team who is responsible for providing or
4, assuring needed services. Responsibilities include
5 complete assessment of the client's needs, development
6 of the client's personal services plan, linkage with all
7 appropriate community services, monitoring of the
8 quality and followthrough of services, and necessary
9 advocacy to ensure each client receives those services
10 which are agreed to in the personal services plan. Each
11 client shall participate in the development of his or her
12 personal services plan, and responsible staff shall consult
13 with the designated conservator and, with the consent of
14 the client, consult with the family and other significant
15 persons as appropriate.
16 (c) The individual personal services plan shall ensure
17 that members of the target population involved in the
18 system of care receive age, gender, and culturally
19 appropriate services, to the extent feasible, that are
20 designed to enable recipients to:
21 (1) Live in the most independent, least restrictive
22 housing feasible in the local community.
23 (2) Engage in the highest level of work or productive
24 activity appropriate to their abilities and experience.
25 (3) Create and maintain a support system consisting of
26 friends, family, and participation in community activities.
27 (4) Access an appropriate level of academic education
28 or vocational training.
29 (5) Obtain an adequate income.
30 (6) Self-manage their illness and exert as much control
31 as possible over both the clay-to-day and long-term
32 decisions which affect their lives.
33 (7) Access necessary physical health care and
34 maintain the best possible physical health.
35 (8) Reduce or eliminate antisocial or criminal
36 behavior and thereby reduce or eliminate their contact
37 with the criminal justice system.
38 (9) Reduce or eliminate the distress caused by the
39 symptoms of mental illness.
94
AB 34 —8-
1
-8--
1 (1€1) Reduce or eliminate the harmful effects of alcohol
2 and substance abuse.
3 SEC. 4. section. 5814 of the Welfare and Institutions
4 Code is amended to read:
5 5814. (a) (.l) This part shall be implemented only to
6 the extent that funds are appropriated for purposes of this
7 part. To the extent that funds are made available, the first
8 priority shall go to maintain funding for the existing
9 programs developed in Los Angeles, Stanislaus, and
10 Ventura Counties.
11 (2) The director shall establish a methodology for
12 awarding grants under this part consistent with the
13 legislative intent expressed in Section . 802, and in
14 consultation with the advisory committee established in
15 this subdivision.
16 (3) The director shall establish an advisory committee
17 for the purpose of providing advice regarding the
18 development of criteria for the award of grants, and the
19 identification of specific performance measures for
20 evaluating the effectiveness of grants. The committee
21 shall include, but not be limited to, representatives from
22 state, county, and community veterans' services and
23 disabled veterans outreach programs, supportive housing
24 and other housing assistance programs, law enforcement,
25 county mental health and private providers of local
26 mental health services and mental health outreach
27 services, the Board of Corrections, the State Department
28 of Alcohol and Drug Programs, local substance abuse
29 services providers, the Department of Rehabilitation,
34 and providers of local employment services. The criteria
31 for the award of grants shall include, but not be limited
32 to, all of the following:
33 (A) A description of a comprehensive strategic plan
34 for providing outreach, prevention, intervention, and
35 evaluation in a cost appropriate manner corresponding to
36 the criteria specified in subparagraph (C) of paragraph
37 (.l)of subdivision (b).
38 (B) A description of the local population to be served,
39 ability to administer an effective service program, and
94
._.9...._ AB 34
1 the degree to which local agencies and advocates will
2 support and collaborate with program.efforts.
3 (C) Memoranda of understanding for referral and
4 coordination with county probation program parolees
5 and all severely mentally ill individuals being released
6 from custody of the Sheriff, the .Department of the Youth
7 Authority, or the .Department of Corrections.
8 Memoranda of understanding with local housing and
9 redevelopment agencies and other programs to provide
10 housing assistance and other appropriate interagency
11 coordination.
12 (D) Mechanisms to award grants in a manner that
13 supports better performance by counties by restricting
14 the availability and level of grants for counties based on
15 the extent to which the current number of people
16 receiving extensive community mental health services
17 with funds provided other than through this part in the
18 county are significantly below those of other comparably
19 sized counties with comparable resources, and by
20 rewarding counties who are able to provide extensive
21 community mental health services to more people within
22 other available resources.
23 (b) As funds become available, this program shall be
24 expanded to provide gaining and funding for counties
25 with significant populations of homeless mentally ill
26 persons , which may include the
27 following types of grants:
28 (1) P4miting Strategic planning grants for new
29 aunties to create, and for existing system of care counties
30 to expand, an adult system of care that meets the
31 requirements of this part.
32 {
33 (A) Strategic planning grants shall require a strategy
34 committee composed of, but not limited to,
35 representatives of the local government and private
36 providers of housing assistance, mental health services,
37 outreach for mental health services, veterans' services,
38 outreach to disabled veterans, law enforcement,
39 substance abuse services and employment services. An
40 existing local committee may be utilized to serve as this
94
AB 34 _10—
I
10-
1 strategy committee if it includes or is expanded to include
2 the required representation.
3 (B) The strategy committee shall develop a
4 comprehensive plan for providing services pursuant to
5 this part. The strategic plan shall be suitable to form the
6 basis for a performance-based contract with the
7 department.
8 (C) The strategic plan shall identify specific outcome
9 and performance measures and annual reporting that
10 will allow the department to evaluate, at a minimum, the
11 effectiveness of the strategies in providing successful
12 outreach and reducing homelessness, and involvement
13 with local law enforcement, and other measures
14 identified by both the department and the strategy
15 committee. The outcome and performance measures
16 shall include, but not be limited to all of the following.
17 (i) The number of persons served, and of those, the
18 number who are able to maintain housing, and the
19 number who receive extensive community mental health
20 services for at least four months in a six-month period.
21 (ii) The number of persons with contacts with local
22 law enforcement and the extent to which local and state
23 incarceration has been reduced.
24 (iii) The number of persons able to demonstrate an
25 increase in stability of income including competitive
26 employment.
27 (2) pour-year outreach service grants in accordance
28 with a contract between the state and approved counties
29 that reflects the number of anticipated contacts with
30 people who are homeless or at risk of homelessness, and
31 the number of those who are severely mentally ill and
32 who are likely to be successfully referred for treatment
33 and will remain in treatment until successfully
34 discharged.
35 (3) (A) Four-year service expansion grants in
36 accordance with a contract between the state and
37 approved counties that provides a formula for annual
38 increased funding reflecting net increases in the total
39 annual number of severely mentally ill adults, as
40 described in Section 5600.3, who receive extensive
94
AB 34
1 community mental health services in at least four
2 eeeseeutiye wh months in a six-month period. As
3 used in this section, "receiving extensive community
4 mental health services" mans having a case manager as
5 described in subdivision (b) of Section 5806, having an
6 individual personal service plan as described in
7 subdivision ('c) of Section 5806, and receiving service
8 pursuant to that plan in four months of a six-month
9 period.
10 (B) The formula incentive funding provided pursuant
11 to subparagraph (A) shall be sufficient to provide mental
12 health services, medically necessary medications to treat
13 severe mental illnesses, alcohol and drug services,
14 supportive housing and other housing assistance,
15 vocational rehabilitation, money management assistance
16 for accessing other health care and obtaining federal.
17 income and housing support, accessing veterans' services,
18 and stipends to attract and retain sufficient numbers of
19 qualified professionals as necessary to provide the
20 necessary levels of these services. These grants shall,
21 however, pay for only the portion of the costs of those
22 services not likely to be provided by federal funds or
23 other state funds. The amount of the grants may be
24 increased to reward counties that are providing extensive
25 community mental health services to significantly more
26 severely mentally ill adults, with funds other than those
27 provided pursuant to this part, relative to other
28 comparable counties based on size, location, and
29 resources, and may be decreased to penalize counties,
30 and in some cases make theta ineligible for participation
31 in these grants, if the numbers of severely mentally ill
32 adults to wham a county is providing extensive
33 community mental health services relative to its size,
34 location, and resources is significantly below that of other
35 comparable counties.
36 (C) Grants provided pursuant to subparagraph (A)
37 shall include provisions measuring the base level of the
38 number of people suffering from severe mental illness
39 who are arrested and serve in jail, prison, or a state
40 hospital as a result of their arrest in the applicable county,
94
AB 34 -- 12
1 and measuring how the grant and increased mental
2 health services provided by the grant reduces the portion
3 of criminal justice system resources required to be
4 expended on people with severe mental. illness. Grants
5 shall also include a projection of the number of persons to
6 be served annually. Beginning in the 20012-03 fiscal year,
7 funding shall be based upon each county's successful
8 demonstration that the county has served the number of
9 adults projected for the prior fiscal year.
10 (D) Four-year outreach grants, provided pursuant to
11 paragraph (2), may be renewed upon their expiration
12 provided that the applicant county demonstrates to the
13 satisfaction of the department that the outreach services
14 are successfully reaching and bringing into treatment the
15 numbers of persons projected in the contract. The
16 contract may be modified as necessary based upon the
17 results being achieved, bath in the outreach program and
18 in the program expansion grant.
19 (E) Four-year program expansion grants provided
20 pursuant to subparagraph (A) may be renewed upon
21 their expiration, provided that the applicant county
22 demonstrates to the satisfaction of the department that
23 the services provided are successfully reducing the
24 unmet mental health need and providing for reduction in
25 the amount of law enforcement, criminal justice system,
26 and state corrections expenditures that would otherwise
27 be expended upon persons with severe mental illness
28 from the applicable county in accordance with a process
29 included in the grant for measuring these reductions and
30 setting forth benchmarks for reducing the expenditures
31 as mental health expenditures increase, and for meeting
32 other performance objectives established in the contract.
33 The benchmarks for reduction in incarceration rates shall.
34 require each county to reduce incarceration rates by 20
35 percent or more over the four-year period. In reviewing
36 a county program for renewal of a grant, the department
37 may approve the renewal even if the perf-efmeftee
38 befi-ehm.ftrk is —user reduction in incarceration rates
39 does not meet the required performance, if the
40 department finds that the county program is meeting
94
I
- 13— AB 34
1 other performance benchmarks established in the
2 contract, and is successfully stabilizing more people with
3 severe mental illness, improving the community by
4 reducing homelessness, and achieving the maximum
5 feasible reduction in incarceration of people with severe
6 mental illness,
fl;)-
8 (F) In any county in which the director determines
9 the program has not resulted in a reduction of criminal
10 ,justice expenditures or is not meeting other performance
11 benchmarks in accordance with the previous four-year
12 grant, the director may limit the funds available for a
13 continuation of the grant, or an expansion of the grant, or
14 impose other conditions upon the grant in order to
15 improve the performance of the county in reducing the
16 incarceration of people suffering from severe mental
17 illness.
18 )--
19 (G) On or before November 1, 2001, and annually
20 thereafter, the director shall report to the Legislature
21 regarding the impact of grants funded pursuant to this
22 section in reducing the incarceration of people suffering
23 from severe mental illness, and make recommendations
24 to the Legislature regarding how counties can improve
25 their performance and whether state policies regarding
26 severe mental illness should be changed. The director
27 may establish standards and a reporting format for county
28 reports to the director on annual progress toward
29 attaining expansion grant,goals.
30
31
32
33 ft4equ= te meef t1te tteed,
34
35 irt the 2094 08 fisee4 year &td subsequent ftsea4 years MAAF
36
37 g g ,
provided
38
39 ,
94
AB 34 — 14-
1
- 14--1 (c) Contracts awarded pursuant to this part shall be
2 exempt from the Public Contract Code and the state
3 administrative manual and shall not be subject to the
4 approval of the Department of General Services.
5 (d) .Notwithstanding any other provision of law, funds
6 awarded to counties pursuant to this part and .Fart 4
7 (commencing with Section 5850) shall not require a local
8 match in funds. However,, counties shall demonstrate a
9 maintenance of effort in adult and childrens mental
10 health services.
11 (e) No county shall reduce existing system-of-care or
12 .roman-McCorquodale service funds provided under
13 this part and Part 4 (commencing with Section 5850) if
14 adult or childrens system-of-care funds are accepted by
15 the county.
16 SEC. 5. (a) The sum of +tee twelve million dollars
17 33,9 9,000) ($12,000,000) is hereby appropriated from
18 the general. Fund to the State Department of Mental
19 Health. Five hundred thousand dollars ($500,000) shall be
20 allocated for training, by or through the programs
21 established pursuant to subdivision (a) of Section 5814 of
22 the Welfare and Institutions Code. Five hundred
23 thousand dollars ($500,000) shall be allocated for training
24 to counties in homeless outreach to be offered through an
25 organization with significant success with homeless
26 outreach programs, and two million dollars ($2,000,000)
27 shall be allocated for grants to counties for
28 implementation of paragraph (1) of subdivision (b) of
29 Section 5814 of the Welfare and Institutions Code during
30 the 1999-2000 fiscal year. Nine million dollars ($9,000,000)
31 shall be allocated for implementation of paragraphs (2)
2 and (3) of subdivision (b) of .Section 5814 of the Welfare
33 and Institutions Code for grants to counties that enter
34 into contracts to establish or expand their programs on or
35 before April 1, 2000.
36 (b) The stun of , forty
37 one million dollars ($41,000,000) is hereby appropriated
38 from. the General. Fund for the 2000-01 fiscal year to the
39 State Department of Mental Health for implementation
94
- 15— AB 34
1 of paragraph (2) of subdivision (b) of Section 5814 of the
2 Welfare and Institutions Code.
3 k- ) � -=nei to e3keeed-oft hefl—dre weft dellars
4 100,000,0()0) is hereb tted for the 2001-02
r'vn1 !
Fund to the
,Lft
�Lz OL
paragraph
10 ($150,009,000, is
11 , 11 r.� �V LLL�...... t eny d 4 t�. C t 4
yA L�
12 Department -of Mented Health for ex
13 Pof subeft (b) ef Seetion 1.14e�
14 iAMl V iL1244 11ZLL,LefIR Code.
15 " ee' ed- Y' s
16 , is hereby a"rrepfiftted fer the 2003--94
1$
1 div zsjaft r of-geetr��4� e
20f a
ye 1L41V t4d1YJ.lALs7 Lt Li1L.LeftsT,�ed yam.
r1
)r the
22
23 200406 fiseal year the --R. � t r d--tV--t--e —fate
24 Depafuftettt of
paragraph4ZLF oft Of25
2Jys6)� Welfare and Ristitutie... G d .
(9 J4AlA 11VL
28 3 ; is hereby appreprioed fef
29 fi seal year frem - ~ e-n Rand fe thetam
31
32
33
34daliffs ,
35 -2006 -
je- and an -equal aftiount is hereby
36
37 &em the Genere4 Fund te the State Department -of
3
39 sem ---(b)-epee iee`-3 14of the
40
94
AB 34 —16-
1
16--1
2 (c) The State Department of Mental Health shall
3 allocate to counties, from the amount appropriated
4 pursuant to subdivision (a), for the first year of initial
5 grants to counties, the amount projected by each county
6 that would be required to fund first-year costs pursuant
7 to paragraph (2) of subdivision. (b) of Section 5814 of the
8 Welfare and Institutions Code. If the total of the
3 projected first-year casts of all counties exceeds the
10 maximum appropriation, each county shall receive a
It percentage of the maximum appropriation equal to that
12 county's percentage of the total projected costs for all
13 counties.
14 �
15 (d) It is the intent of the Legislature that the amounts
16 appropriated to the State Department of Mental Health;
17 , iftelesivez, for the second and all
18 subsequent fiscal years of Binding for expansion of the
19 county mental health programs pursuant to Section 5814
20 of the Welfare and Institutions Code, shall be allocated. to
21 counties 'based on the actual amounts due under the
22 contract with the applicable county for the actual. net
23 increases in the number of persons served during the
24 prior fiscal year, adjusted by the amount that the
25 allocation to the county in the prior fiscal year was greater
26 or less than the amount required to fund the county for
27 the actual increase in number of persons served. If the
28 total amount of the allocations due to all counties would
29 exceed the allewable appmpAft6en previous
30 year's appropriation by more than fifty million dollars
31 ($50,000,0001 for that year, each county shall receive a
32 percentage of t--niftimufn a fifty million dollar
33 ($50,000,000) increase over the previous year's
34 appropriation equal to that county's percentage of the
35 total costs for all counties for that year.
36 to eettefies are redueed, th The balance of each county's
37 costs fftery shall be paid to that county in the following
38 fiscal year to the extent funds are available.
39 (e) Of the amounts appropriated each year, ,five
40 hundred thousand dollars ($500,000) shrill be allocated to
94
-17— AB 34
1 departmental support for administrative casts associated
with the programs described in this section.
3 SEC. 6. This act is an urgency statute necessary for
4 the immediate preservation of the public peace, health,
S or safety within the meaning of Article IV of the
6 Constitution and shall go into immediate effect. The facts
7 constituting the necessity are:
b In order for the State Department of trental Health to
9 have the program established and grants awarded within
10 the time frames set forth in this act, and to ensure that the
11 state is able to begin promptly achieving reductions in
12 incarceration and homelessness in accordance with this
13 measure, it is essential that this act take effect
14 immediately.
0
94
1
0
To: BOARD OF SUPERVISORS Contra
FROM: Costa
PHIL BATCHELOR, COUNTY ADMINISTRATOR
Count
Jane 17, 1999
SUBJECT:
LEGISLATION: AB 88 (Thomson)
SPECIFIC REQUEST(S)OR PECOia9M5NDATION(S)&BACKGROUND AND JUSTIFICATION
RECOMMENDATION
ADOPT a position in SUPPORT of AB 88 by Assemblywoman Helen Thomson of
Davis which would require health service plans to provide coverage for severe
mental illnesses, and for the serious emotional disturbances of achild under the
same rates, terms, and conditions applied to other medical conditions.
BACKGROUND:
The Mental Health Director, Donna Wigand, reports that AB 88 will require health
service plans to contract to provide coverage for the diagnosis and treatment of
mental illness under the same rates, terms and conditions applied to other medical
conditions and specifically states that children with severe emotional disturbances
are covered under the same terms. This bill will benefit mentally ill adults,
emotionally disturbed children, and publicly funded mental health systems. Among
other benefits, parity in insurance coverage for the treatment of serious mental
illness or emotional disturbances will allow covered individuals and families to
receive needed treatment in the private sector, preserving public resources for those
who have no insurance coverage.
AB 88 has passed the Assembly and is currently awaiting a committee assignment
in the Senate. The Mental Health Director recommends that the Board indicate its
support for AB 88.
CONTINUED ON ATTACHMENT: YES SIGNATURE: o�
RECOMMENDATION OF COt,'N-Y AD,VfiNISTRATOR RECOMMENDATION OF BOARD COMMITTEE
APPROVE OTHER
S#GNAT L#"rddlS
ACTION OF BOARD ON June 22, 19 9
APPROVED AS RECOMNIENOED OTHER
VOTE OF SUPERVISORS
I HEREBY CERTIFY THAT THIS IS A TRUE
X UNANIMOUS(ABSENT _ ® - ® ) AND CORRECT COPY OF AN ACTION TAKEN
AYES:__ NOES: AND ENTERED ON THE MINUTES OF THE BOARD
ABSENT: _ ABSTAIN: OF SUPERVISORS ON THE DATE SHOWN.
County Administrator ATTESTED June 22 , 1999
Contacts Health Services Director PHIL BATCHELOR,CLERK OF THE BOARD Or
cc: Mental Health Director SUP RWSORS AND COUNTY ADMINISTRATOR
Assemblywoman Helen Thomson
Moore 4140 State Capitol
Sacramento,CA 95814
Les Spahnn;Heim, Noack, Kelly&Spahnn B DEPUTY
1121 L Street,Suite 100
Sacramento,CA 95814
AB 88 Assembly Bill- Bill Analysis Mage 1 of 4
AB 88
pace 1
ASSEMBLY THIRD READING
AB 88 (Thomson)
As An-ended February 24, 1.999
Majority vote
HEALTH _ 10.-3 � APPROPRIATIONS 14.-6
-----------------------------------------------------------------
#Ayes. Gallegos, Aanestad, ;Ayes. #Migden, Cedill.o, Davis,
( ;Corbett, Firebau.gh, i {:Hertzberg, Kuehl, Papan,
# !Kuehl, Steinberg, I #Romero, Shelley,
3
1-Thomson, Cedill.o, Mayne, ISteinberg, Thomson,
# #Wildman ( #Wesson, Wiggins, Wright, i
? # # IAroner
-----------------------------------------------------------------
#Nays. IBaugh, Bates, Strickland JNays: IBrewer, Ashburn, Battin, I
I # # #Pescetti, Maldonado, I
f # I #Runner I
( I 1
-
SUMMARY .--Requires a health care service plan (health plan)
contract or disability insurance policy to provide coverage for
severe :rental illnesses, and for the serious emotional
disturbances of a child. Specifically, this :bill
1)Reauires every health plan or disability insurer contract
issued, amended, or renewed on or after January 1, 2000, that
provides hospital, medical-, or surgical coverage, to provide
coverage for diagnosis and medically necessary treatment-- of
severe mental illnesses and for the serious emotional
disturbances of a child.
2)Defin.es `severe mental illnesses" as including.
a) Schizophrenia,
:b) Schizoaffective disorder,
C) Bipolar disorder (manic depressiveness) :
d) Major depressive disorders;
C'
AB 88
�J Page 2
e) Panic disorder;
http://www.leginfo.ca.gov/pub/bill/asm/ab-00.../ab88 cfa 19990601-101239 asm €loor.btm 6/16/99
AB 88 Assembly Bill-Bill Analysis Nge 2 of 4
°f) Obsessive-compulsive disorder;
g) Pervasive developmental disorder or autism;
h) Anorexia nervosa and,
i) Bulimia nervosa.
3) Refines "serious emotional disturbances of a child" as one or
more mental disorders, other than substance abuse or
developmental disability, identified in the Diagnostic and
Statistical. Manual. of Mental Disorders.
4)Requires severe mental illness benefits to include outpatient
and inpatient services, hospital services, and prescription
drugs if a plan contract or insurance policy otherwise covers
prescription drugs.
5)Requires terms for maximum lifetime benefits, copayments and
deductibles to be applied equally to all benefits under a plan
contract or insurance policy.
6)Exempts specialized health plan contracts and insurance
policies, including Medicare supplement policies, and Medi-Cal
contracts from the requirements of this bill.
___E-_XISTI4Nq requires a hearth plan contract or disability
insurance policy covering hospital, medical or surgical services
to cove:: the diagnosis and treatment of specified physical
conditions.
FISCAL EFFECT . According to the Assembly Appropriations
Committee analysis, the Public Employees Retirement System
indicates a one-half of 1% premium increase that could occur
would result in annual state costs of $1.6 million.
COMMI TS
1)The author intends this bill to prohibit discrimination
against people with biologically-based mental illnesses,
dispel scientifically unsound distinctions between mental and
C
_AB 88
Page 3
physical illnesses, and require equitable mental health
coverage among all plans and insurers to prevent adverse risk
selection..
2)At least 19 states require equitable coverage for mental
illnesses. Benefits range from all mental illnesses, plus
chemical dependency, to covering only selected severe
illnesses. This bill requires equitable coverage for selected
severe mental illnesses.
t#,p //www,le info.ca.gov/p b/bill/as /ab E 0-*/ab_88—cEi 19990601_101239_asni—floor.htni 6/1699
AB 88 Assembly WE-Bill Analysis Nge 3 of 4
3)An April 1998 U.S. Department of Health and Human Services
report indicates that full parity for mental health and
substance abuse in managed care plans would increase premiums
less than 1%.
In 1996, the Congressional Padget Office (CBO) projected
premium increases of 3.2% would result from mental health
parity, and increases of 4% would result from full parity
including chemical dependency coverage. These findings are
disputed by the RAND Corporation, because the CPC projections
"did not incorporate any cost distinction between managed care
or fee-for-service care" and concluded the CBO projections
likely "overestimate the cost effects of parity legislation .
4)The California Alliance for the Mentally Ill (CAM!) , the
sponsor, argues that this bill would benefit employers by
improving worker productivity, reducing homelessness, and
lowering criminal justice costs. The California Psychiatric
Association (CPA) argues that nearly all health plans
discriminate against patients with brain disorders such as
schizophrenia, depression and manic depression. The
California Psychological Association supports this bill in
concept, and is sponsoring SB 468 (Polanco) , which would
require coverage for all mental illnesses.
5)The California Association of Health Plans (CAHP) opposes this
bill unless amended. CARP is urging the author to exclude
individuals and small employers from the coverage requirements
in this mill. The California Network of Mental Health Clients
is opposed to this bill unless amended to exclude coverage of
involuntary treatment. The Citizens Commission on Human Rights
(CCHR) , established by the Church of Scientology to address
AB 88
Page 4
psychiatric violations of human rights, argues this bill will
mandate dubious science, increase the ranks of the uninsured,
and provide a gateway to insurance fraud.
Analysis Prepared by : Ann Blackwood / HEALTH / (916) 319-2097
EDT: 0001253
http-//www.leginfo.ca.gov/ ub/bill/as /ab_00-*/ab_88—cit 19990601_101239 as floor.htm 6/16/99
REQUEST TO PLACE AN ITEM ON THE BOARD OF SUPERVISORS' AGENDA
(Do not use this form for Planning Hearings)
TO: CLERK OF THE BOARD OF SUPERVISORS
FROM: DONNA WIGAND, MENTAL HEALTH DIRECTOR
STAFF MEMBER TO CONTACT FOR ADDITIONAL INFORMATION: (Name &
Telephone Number)
Claude L. Van Marter (5-1002)
REQUESTED BOARD AGENDA DATE: June 22, 1999
IS THERE A CRITICAL DEADLINE FOR BOARD ACTION AND, IF SO, WHAT IS IT:
X NO YES DEADLINE DATE.
THIS IS A NOTICED HEARING: X NO YES
SUGGESTED AGENDA LANGUAGE:
Bill No. Subject Position
AB 88 (Thomson) Requires that mental health services for SUPPORT
children who are seriously emotionally
disturbed be provided by a health plan
on the same basis as treatment for l
other medical conditions. I
THIS ITEM BELONGS IN THE FOLLOWING CATEGORY (Check One)
(See attached for further definition of categories)
CONSENT: No_discussion, no speakers, no opposition.
PRES T ON - Brief: Less than five minutes.
SHORT DISCUSSION: Less than five minutes.
DELIBERATION: Longer than five minutes.
Estimated amount of time required
AMENDED IN ASSEMBLY FEBRUARY 24, 1999
CALIFORNIA LEGISLATURE-1999-2000 REGULAR SESSION
ASSEMBLY BILL No. 8$
Introduced by Assembly Member Thomson
(Principal coauthor: Senator Perata)
(Coauthors. Assembly Members Alquist, Aroner, Cardoza,
Corbett, Davis, , Knox, Kuehl Dickerson, Dutra,
Frusetta, Granlunl, Hertzberg, Jackson, Knox, .Kuehl,
Lempert, Lvngville, Lowenthal, .Machado, Mazzoni,
Migden, Papan, Romero, Scott, Shelley, Steinberg,
Strom-Martin, Villaraigosa, Washington, Wayne, and
Wright)
(Coauthors: Senators Alpert, Chesbro, Of-fiz, Rainey
Escutia, Ortiz, Rainey, Saps, and Vasconcellos)
December 10, 1998
An act to add Section 1374.72 to the Health and Safety Code,
and to add Section 10144.5 to the Insurance Cade, relating to
health care coverage.
LEGISLATIVE COUNSELS DIGEST
AB 88, as amended, Thomson. Health care coverage:
mental illness.
Under existing law, a disability insurer or health care service
plan may not discriminate based on race, color, religion,
national origin., ancestry, marital status, or sexual orientation.
An insurer is also prohibited from refusing to insure a person
or from charging a different premium because of that person's
blindness.
98
AB Sg —2—
This
2—This bill would require a health care service plan contract
or disability insurance policy issued, amended, or renewed on
or after January 1, 2000, to provide coverage for the diagnosis
and medically necessary treatment of severe mental illnesses,
as defined, of a person of any age, and of serious emotional
disturbances of a child, under the same terms and conditions
applied to other medical conditions. The bill would exempt
from the provision relating to a health care service plan
contract, a contract between the State Department of Health
Services and a health care service plan for enrolled Medi-Cal
beneficiaries. The bill would also specify exemptions from the
provision relating to a disability insurance policy.
Because a willful violation of the provisions relating to
health care service plans is a crime, this bill would impose a
state-mandated local program.
The California Constitution requires the state to reimburse
local agencies and school districts for certain costs mandated
by the state. Statutory provisions establish procedures for
making that reimbursement.
This bill would provide that no reimbursement is required
by this act for a specified reason.
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: yes.
The people of the State of California do enact as follows:
1 SECTION 1. (a) The Legislature finds and declares
2 all of the fallowing:
3 (1) Mental illness is real.
4 (2) Mental illness can be reliably diagnosed.
5 (3) Mental illness is treatable.
6 (4) Treatment of mental illness is cost-effective.
7 (b) The Legislature further finds and declares all of
8 the following:
9 (1) There is increasing scientific evidence that severe
10 mental illnesses, such as schizophrenia, bipolar disorders,
11 and major depression, are as effectively treated with
12 medications as other severe illnesses.
99
-3— AB 88
1 (2) Most private health insurance policies provide
2 coverage for mental illness at levels far below coverage
3 for ether physical illnesses.
4 (3) Limitations in coverage for mental illness in
5 private insurance policies have resulted in inadequate
6 treatment for persons with these illnesses.
7 (4) Inadequate treatment causes relapse and untold
8 suffering for individuals with mental illness and their
9 families.
10 (c) The Legislature further finds and declares all of
11 the following.
12 (1) Lack of adequate treatment and services for
13 persons with mental illness has contributed significantly
14 to homelessness, involvement with the criminal. justice
15 system, and other significant social problems experienced
16 by individuals with mental illness and their families.
17 (2) The failure to provide adequate coverage for
18 mental illnesses in private health insurance policies has
19 resulted in significant increased expenditures for state
20 and local governments.
21 (d) The Legislature further finds and declares that
22 other states that have adopted mental illness parity
23 legislation have experienced minimal additional costs if
24 medically necessary services were well managed.
25 SEC. 2. Section 1.374.72 is added to the Health and
26 Safety Code, to read;
27 1374.72. (a) Every health care service plan contract
28 issued, amended, or renewed on or after January 1, 2000,
29 that provides hospital, medical, or surgical coverage shall
30 provide coverage for the diagnosis and. medically
31 necessary treatment of severe mental illnesses of a person
32 of any age, and of serious emotional disturbances of a
33 child, as specified in subdivisions (d) and (e), under the
34 same terms and conditions applied to other medical
35 conditions, as specified in subdivision(c).
36 (b) 'These benefits shall include the following.
37 (1) Outpatient services.
38 (2) Inpatient hospital services.
39 (3) Partial hospital services.
98
AB 88 —4-
1
-4--
1 (4) Prescription drugs, if the plan contract includes
2 coverage for prescription drugs.
3 (c) The terms and conditions applied to the benefits
4 required by this section, that shall be applied equally to
5 all benefits under the plan contract, shall include, but not
6 be limited to, the following:
7 (1) Maximum lifetime benefits.
8 (2) Copayments.
9 (3) Individual and family deductibles.
10 (d) For the purposes of this section, 'severe fne
11 i4neases` "severe mental illnesses" shall include:
12 (1) Schizophrenia.
13 (2) Schizoaffective disorder.
14 (3) Bipolar disorder(manic-depressive illness).
15 (4) Major depressive disorders.
16 (5) Panic disorder.
17 (6) Obsessive-compulsive disorder.
18 (4) Befder4ift
19 ¢8}--
20 (7) Pervasive developmental disorder or autism.
21 (9+-
22 (8) Anorexia Nervosa.
23
24 (9) Bulimia Nervosa.
25 (e) For the purposes of this section, a child suffering
26 from, 'Rei4etts em t. a d h betw e f E child' "serious
27 emotional disturbances of a child" shall be defined as a
28 child who (1) has one or more mental disorders as
29 identified in. the most recent edition of the Diagnostic and
30 Statistical Manual of Mental Disorders, other than a
31 primary substance use disorder or developmental
32 disorder, that result in behavior inappropriate to the
33 child's age according to expected developmental norms,
34 and (2) who meets the criteria in paragraph (2) of
35 subdivision (a) of Section 5600.3 of the Welfare and
36 Institutions Code.
37 (f) This section shall not apply to contracts entered
38 into pursuant to Chapter 7 (commencing with Section
39 14000) or Chapter 8 (commencing with Section 14200) of
40 Division 9 of Dart 3 of the Welfare and Institutions Code,
98
-5— AB 88
1 between the State Department of Health Services and a
2 health care service plan for enrolled Medi-Cal
3 beneficiaries.
4 (g) Nothing in this section shall be construed to
5 prohibit or limit a health care service plan in utilizing case
6 management, managed care, or utilization review in the
7 provision of benefits required in.this section.
8 SEC. 3. Section 10144.5 is added to the Insurance
9 Code, to read:
10 10144.5. (a) Every policy of disability insurance that
11 covers hospital, medical, or surgical expenses in this state
12 that is issued, amended, or renewed on or after January
13 1, 2000, shall provide coverage for the diagnosis and
14 medically necessary treatment of severe mental illnesses
15 of a person of any age, and of serious emotional
16 disturbances of a child, as specified in subdivisions (d)
17 and (e), under the same terms and conditions applied to
18 other medical conditions, as specified in subdivision (c).
19 (b) These benefits shall include the following:
20 (1) Outpatient services.
21 (2) Inpatient hospital services.
22 (3) Partial hospital services.
23 (4) Prescription drags, if the policy or contract
24 includes coverage for prescription drugs.
25 (c) The terms and conditions applied to the benefits
26 required by this section that shall be applied equally to all
27 benefits under the disability insurance policy shall
28 include, but not be limited to, the following:
29 (1) Maximum lifetime benefits.
30 (2) Copayments and coinsurance.
31 (3) Individual and family deductibles.
32 (d) For the purposes of this section, 'severe ffien+e
33 ire "severe mental illnesses" shall include:
34 (1) Schizophrenia.
35 (2) Schizoaffective disorder.
36 (3) Bipolar disorder(manic-depressive illness).
37 (4) Major depressive disorders,
38 (5) Panic disorder.
39 (6) Obsessive-compulsive disorder.
40 .
98
AB 88 —6-
1
6-
1 (-S}-
2 (7) Pervasive developmental disorder or autism.
3 (9)-
4 (8) Anorexia Nervosa.
5 0%-
6 (9) Bulimia Nervosa.
7 (e) For the purposes of this section, a child suffering
Q
V from, 's ist etio a ..b of .-ltil.aE "serious
9 emotional disturbances of a child" shall be defined as a
10 child who (1) has one or more mental disorders as
11 identified in the most recent edition of the Diagnostic and
12 Statistical Manual of Mental Disorders, other than a
13 primary substance use disorder or developmental
14 disorder, that result in behavior inappropriate to the
15 child's age according to expected developmental norms,
16 and (2) who meets the criteria in paragraph (2) of
17 subdivision (a) of Section 5600.3 of the Welfare and
18 Institutions Code.
19 (f) Nothing in this section shall preclude coverage of
20 all or part of mental health services through a separate
21 specialized health care service plan, mental health plan,
22 or mental health field test.
23 (g) Nothing in this section shall be construed to
24 prohibit or limit a disability insurer in utilizing case
25 management, managed care, or utilization review in the
26 provision of benefits required in this section.
27 (h) This section shall not apply to accident-only,
28 specified disease, hospital indemnity, Medicare
29 supplement, dental-only, or vision-only insurance
30 policies.
31 SBC. 4. No reimbursement is required by this act
32 pursuant to Section 6 of Article XIII B of the California
33 Constitution because the only costs that may be incurred
34 by a local agency or school district will be incurred
35 because this act creates a new crime or infraction,
36 eliminates a crime or infraction, or changes the penalty
37 for a crime or infraction, within the meaning of Section
38 17556 of the Government Code, or changes the definition
39 of a crime within the meaning of Section 6 of Article
40 XIII B of the California Constitution.
98
-7— AB 88
1 Seet4sn 17580 of—the--Govemmm
2 Code, unless e4terwise speeified, the previsions of this aet
0
98
TO: BOARD OF SUPERVISORS
Contra
FROW Costs
PHIL BATCHELOR, COUNTY ADMINISTRATOR
County
DATE: 3TA CC;UN'�
June 17, 1999
SUBJECT:
LEGISLATION: SB 468 (Polanco)
SPECIFIC REQUEST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION
RECOMMENDATION:
ADOPT a position in SUPPORT of SB 468 by Senator Richard Polanco of Los
Angeles which would require health service plans to provide coverage for the
diagnosis and treatment of meatal illness under the same rates, terms, and
conditions applied to other medical conditions.
BACKGROUND:
The Mental Health Director, Donna Wigand, reports that SB 468 will require health
service plans to contract to provide coverage for the diagnosis and treatment of
mental illness under the same rates, terms and conditions applied to other medical
conditions. This bill will benefit mentally ill adults, emotionally disturbed children,
and publicly funded mental health systems. Among other benefits, parity in
insurance coverage for the treatment of serious mental illness or emotional
disturbances will allow covered individuals and families to receive needed treatment
in the private sector, preserving public resources for those who have no insurance
coverage.
SB 468 has passed the Senate and is currently in the Assembly Health Committee.
The Mental Health Director recommends that the Board indicate its support for SB
468.
CONTINUED ON ATTACH HENT: YES SIGNATURE:':Smodi2z 'A �
REC0PaI0AENDAT€ON OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD CO'a4WTTE£
APPROVE OTHER
SIGNATURE'S,: gt
ACTION OF BOARD ON June 22, 1999 -APPROVED AS RECOMMENDED XX OTHER
VOTE OF SUPERVISORS
I HERBY CERTIFY THAT THIS IS A TRUE
YLX UNANIMOUS(ASSENT - - -- ) AND CORRECT COPY OF AN ACT*N TAKEN
AYES: NOES: AND ENTERED ON THE IVINUTES OF THE BOARD
ASSENT: ABSTAIN: OF SUPERVISORS ON THE DATE SH0WN,
County Administrator ATTESTED June 22 , 1999
Contact: Health Services Director PHIL BATCHELOR,CLERK OF THE B0ARD OF
Mental Health Director
cc: Senator Richard Polanco SUPERVISORS ANr COUNTY AD?V1!N!STa#7OR
Room 313 State Capitol
Sacramento,CA 95814
Les Spahnn; Heim, Noack, Kelly&Spahnn B DEPUTY
1121 L Street,Suite 100
Sacramento, CA 95814
SB 468 Senate Bill- Bill Analysis Wage 1 of 10
------------------------------------------------------------
SENATE RULES COMMITTEE SB 468€
;Office of Senate Floor Analyses €
11520 N Street, Suite 524 €
1 (916) 445-6614 Fax: (916) €
327-4478 #
------------------------------------------------------------
THIRD READING
Bill No: SB 468
Author: Polanco (D) , et al
Amended: 4/27/99
Vote: 21
SENATE HEALTH AND HUMAN SERV. COMMITTEE 6-2, 4/7/99
AYES: Escutia, Figueroa, Hughes, Pol.anco, Solis,
Vascor_cellos
NOES: Morrow, Mountjoy
NOT VOTING: Baynes
SENATE INSURANCE COMMITTEE 6-1, 4/21/99
AYES: Speier, Escutia, Figueroa, Hughes, Schiff, Sher
NOES: Lewis
NOT VOTING: Johnson, Johnston, .Leslie
_SEDATE APPROPRIATIONS COMMITTEE . 8-4, 5/27/99
AYES: Alpert, Bowen, Burton, Escutia, Karnette, McPherson,
Perata, Vasconcellos
DOES: Johnson, Kelley, Leslie, Mountjoy
NOT VOTING: Johnston
SUBJECT Health care coverage: mental illness
SOURCE_: California Psychological Association_
_DIGEST_ This bill seeks parity for health insurance
coverage of mental illness by requiring certain health care
service plans and disability insurance policies to provide
coverage of medically necessary treatment of mental
illness, under the same rates, terms, and conditions as are
CONTINUED
_SB 468
Page
2
http://www.leginfo.ca.gov/pub/bill/sen/sb-045-`/sb_468—cit 19990529_161947_sen floor.htm 6/16/99
SB 468 Senate Bill=IMI Analysis Page 2 of 10
generally applied to other medical conditions.
_ANALYSIS . Current waw contains minimum coverage
requirements for health care insurance plans (health care
service plans) and for disability insurance plans.
This bill requires that, commencing 3uly 1, 2000, health
care service plan contracts and disability insurance
policies that cover hospital, medical or surgical expenses
must also include coverage of the diagnosis and medically
necessary treatment of mental illness. Coverage of mental,
illness would be required to be provided under the same
rates, terms and conditions as the plan generally applies
to other medical conditions; thus, cost sharing, or benefit
limitations, such as lifetime payment limits, inpatient or
outpatient service limits, and co-payments would be the
same for mental illness as for other health conditions.
This mill also specifies that, for those plans and policies
providing hospital, medical or surgical coverage and
prescription drug coverage for other health conditions, the
minimum coverage for mental illness would include inpatient
hospital services, outpatient services and prescription
drugs. For the purposes of this bill, "mental illness"
would be defined as the mental disorders included in the
Diagnostic and Statistical Manual IV or subsequent
editions. Disorders that would be specifically excluded
under this bill include substance arouse disorders and the
"V" codes. in addition, this bill allows health care plans
and disability policies to exclude or limit certain
services including: marital or education services deemed
not medically necessary; and custodial care. Also exempted
from the provisions of this bill would be Medi-Cal
contracts (which already cover mental illness) .
Under this bill, health care service plans or disability
policies could include managed care procedures designed to
limit mental health services to those determined to be
"medically necessary and clinically appropriate", such as
preadmission screening and prior authorization. In
addition, a health care plan or disability policy would not
be prohibited from providing mental health services through
a "carve out" plan, under which a separate agreement with
mental health providers with separate reimbursement rates
SB 468
Page
3
is negotiated. Thus, while a plan could have separate
reimbursement rates for mental health providers, from the
point of view of the patient, this bill requires parity
between limitations on mental health care and other health
care.
The bill specifies that no person suffering from mental
illness covered by the bill shall be denied benefits for
that rental illness because the person also had a disease
h4://www.leginfo.ca.gov/ptdWbHVsviOb 045-`/sb 468 cRt 19990529_16194°7_sen floor.htm 6/16/99
SB 468 Senate Bill_Bill Analysis Page 3 of 10
or condition that is not covered by the bill.
According to the Senate Health and Human Services
Committee:
Mental Health Statistics According to the National
Institute of Mental Health (NIMH) , over the course of a
lifetime, approximately 20% of Americans will experience a
mental disorder or illness. Among the most frequently
experienced mental health disorders are anxiety and
depression. Depression, for example, is estimated by the
National Institute for dental Health to affect 9.5% of the
population each year; treatment is effective in 80% of
cases. A Rand Corporation study estimated a loss of $12
billion in missed work days -nationally each year due to
depression. In recent years, research increasingly has
demonstrated a biological basis for many rental disorders,
often involving neurological abnormalities of the brain.
If a biological basis for a mental disorder is established,
the recommended treatment typically consists of
prescription medications in addition to psychological
counseling or therapy.
Managed Care and Mental Health Under managed care, a
trend of reduced coverage for mental health care has been
observed. According to a report prepared for Congress by
the National Advisory Mental Health Council, in 1-981 58% of
employees with any health insurance also had coverage for
mental health inpatient care comparable to that for other
illnesses. By 1993, only 16% of employees had such
coverage. This has resulted in higher out-of-pocket
expenses for employees for mental heath care than for other
health care. For example, the report stated that an acute
episode resulting in a week of inpatient care followed by
weekly outpatient therapy would cost $3, 892 out of pocket
Ll
SB 468
Page
without mental health parity legislation, versus $866 under
parity.
According to the American Psychological Association,
approximately one-half of health plans limit mental health
treatment by
l.Limiting the number of days of coverage to 20 to 60 days.
2.11imiting the number of outpatient mental health
counseling or consultation visits to 20 to 30 sessions
annually.
3.Imposing lifetime expenditure caps (for example, limiting
mental health expenditure to $50,000 but allowing $1
million caps for lifetime other health expenditures) .
4.Excluding certain mental health conditions from coverage.
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SB 468 Senate Bill-Bili Analysis Page 4 of 10
Purpose of Parity Legislation According to the above
mentioned National Advisory Mental Health Council study,
the purpose of parity legislation under debate in Congress
and in a number of states is to address several goals:
!.Overcome discrimination against persons with mental
illness "based on artificial and scientifically untenable
distinctions between mental and physical disorders.
2.Prevent "adverse selection".
3.Lessen out of pocket expenses for persons with mental
illness.
4.Reduce disability through effective treatment.
5.increase the economic productivity and social
contributions from persons with mental illness.
_Costs of Lack of Coverage As with any non-covered health
condition, out-of-pocket costs for treatment, including
medications, can be a severe financial hardship for
families. Also, as with any serious health condition, lack
of insurance coverage can limit the ability of the affected
individual to be regularly employed and support their
D
SB 468
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5
families. For example, it was estimated that a number of
persons receiving benefits under the CalWORKs program would
require mental health services in preparation to becoming
employed prior to the 5-year time limit (January 1, 2003
for most current recipients) . Thus, for KY 1999-2000, over
$50 million has been allocated for mental health services
for CalWORKs recipients.
Public/Private Cost Shift in general, lack of private
health insurance coverage for mental illness shifts the
cost of treatment for some low income patients to the
public sector, especially state and county government.
Parity legislation is likely to result in an unknown amount
of cost shift from the public to the private sector,
potentially offsetting some of the cost increase to public
employee benefit plans. The National Council study cites
research indicating that for every dollar spent on
treatment of mood disorders between $3 and $9 could be
realized in net economic returns due to employee earnings;
a one-to-one net economic return was reported for less
common and more severe mental illnesses.
federal Law and Report to Congress . Recent federal
legislation, the Domenici--Wellstone parity amendment to the
federal FY 1997 appropriations bill. (H.R. 3666 /P.L.
104-204) , requires group health care plans which contain
some mental illness coverage must not impose more limits on
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Ski 468 Senate Bill-Bill Analysis Page 5 of 10
mental health coverage than are imposed for other health
conditions. However, that legislation did not require
health plans to cover mental illness and applied only to
dans serving 50 or more employees. Subsequent to the
legislation, the federal Senate Appropriations Committee
requested the National Advisory Mental Health^, Council to
report on (1) the cost of providing equitable coverage for
persons with mental illness, and (2) the National Institute
of Mental Health's investigation of mental health coverage
under managed care.
The Council's initial report to Congress states that mental
health parity, adopted in combination with managed care, is
likely to result in Lowered costs and lowered premiums or,
at most, very modest cost increases within the first year
of implementation. The report also notes that while parity
legislation enhances access to mental health services,
SB 468
Page
6
under managed care access can still be restricted if
insurers utilize "behavioral health plans" and aggressive
utilization reviews as "gatekeeping" functions.
Cos s a py Issue Previous debates over legislation in
Congress and in the legislature have prompted conflicting
studies of the cost of providing mental health coverage.
The federal study requested by Congress in 1997 found that
most previous studies failed to account for the impact of
managed care, which can impose cost controls when parity
legislation is enacted.
Supporters of this bill point to a recent Price Waterhouse
study, commissioned by the California Psychological
Association and the American Psychological Association,
that found the cost of a comprehensive mental health parity
requirement (similar to the one included in SH 468) would
increase base medical plan costs by between 1% (for HMOs)
and 3% (for Fee-For-Service plans) . Considering the type
of plans and likely employer responses, the Price
Waterhouse actuarial analysis predicted an average, net
employer contribution cost increase of 94 cents per member
per month. (an average of $3 per family) . In addition, for
small employers, defined as those with 5 employees or less,
the study predicted an increase in cost of $84 per year.
Opponents point to previous studies reporting that for
every 1 percent real increase in health care costs, as many
as 40,000 Californians could lose their insurance coverage
(Barents Croup. study) . In addition, they report a 1998
Wellness Foundation Study found that business with 50
employees or less cite cost as the overwhelming reason for
not providing health coverage.
Full Parity, Spread aealth Care Costs . This bili requires
"full parity" for menta' health, allowing health plans to
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SB 468 Senate Bill w Bill Analysis Paye 6 of 10
restrict mental health only to the extent coverage is also
restricted for other health conditions, rather than
extending coverage only to a limited number of mental
health disorders, Current law allows "adverse selection",
under which health or disability insurers offer :;trental
health coverage in only a few plans, forcing persons or
families needing mental health coverage to enroll in only
those few plans. When the type of mental, disorders covered
SB 468
Page
7
by plans is severely limited, families also are forced to
choose from among the few plans that cover the disorder
found in their family. This has the effect of congregating
those most in need of mental health coverage in those few
plans offering such coverage, thus artificially raising the
average, per person cost of providing mental health
coverage under those plans. According to the sponsors, by
requiring all health plans to provide coverage for a range
of mental illnesses, with the same limitations imposed for
other health conditions, the cost of the benefit will be
spread over the widest number of payors, thus minimizing
the average cost per person.
Related Legislation . A3 88 (Thomson) would also require
health ;clans to cover mental illness but would limit such
coverage to a more narrow range of mental health disorders.
_FISCAL EFFECT Appropriation: No Fiscal Com. : Yes
Local: Yes
According to the Senate Appropriations Committee:
Fiscal Impact (in thousands)
Major Provisions 1999w-2000 2000-0
2001--02 bund
State employee and 3, 000 61000
6,000 General
retiree health benefits 3,000 6, 000
6, 000 various
Healthy Families 188
375 357
General.
375 750 750
federal
-SUPPORT (Verified 5/27/99)
California Psychological Association (source)
American Federation of State, County and Municipal
Employees
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SB 468 Senate Bill-Bill Analysis Page 7 of 14
c�
SFS 468
Page
8
Association of Regional Center Agencies
California Alliance for the Mentally Ill
California Association Health Facilities
California. Council of Community Mental Health Agencies
California Firefighters
California Health Care Association
California Mental Health Directors Association
California Mental Health Planning Council
California Psychiatric Association
California Physicians Croup Council
California Professional Firefighters
California School Employees Association
California State Employees Association
California State Association of Counties
California Teachers Association
Central. Coast Psychological Association
City and County of San Francisco
County of .:dos Angeles
DiDi. Hirsch, Community Mental Health Center
Family Service Council of California
Friends for Survival, Inc.
J'ERICHO
National Association of Social. Workers
San Diego Psychological Association
San Francisco Psychological Association
Santa Barbara County Psychological Association
Santa Clara County
Union of American Physician: and Dentists
United Nurses Association of California.
3 individuals
CPPJSIAION (Verified 5/27/99)
Association of California Life and Health Insurance
Companies
Blue Cross of California
California Association. of Health Plans
California Association of Health Underwriters
California Chamber of Commerce
Californians for Affordable :health Reform
Citizens Commission for Human Rights
.Health Insurance Association of America and New York Life
Printing industries of California
Union of American Physicians and Dentist
C7
SE 468
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9
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B 468 Senate Bill-Bili Analysis f1age 8 of 10
California Network of Mental Health Clients
The following groups were listed in opposition on the
Senate Health and Human Services Committee analysis:
Bamboo Grove Publishers
California Manufacturers Association
Chula Vista Junior High School
Coalition Against Mandated Mental Treatment of California
David Morse & Associates
Dutcher Studio
KNOT Anymore
Leo Hamel and Company, Inc.
Lexis international 'Translations
Peter Heer Video Productions
Precision Design
Precision Systems, Inc.
Smith and Company
ARGUMBNIS IN TUPPORT Supporters of SB 468 argue:
1 .Under managed care, many HMO's are not providing coverage
for mental :health disorders or are imposing severe limits
on coverage.
2.Requiring access to mental health insurance coverage will
reduce financial burdens on families and allow more
prompt, complete treatment of disorders.
3.Treating serious disorders of the brain differently from
other disorders is discriminatory, when many mental
disorders are physical in origin and, with recent medical
advances, more treatable than many other physical
disorders that are routinely covered by health plans.
4.Substantial public :savings will result from parity, as
currently treatment for serious mental illness is three
times more likely to be paid for by Medi-Cal or publicly
funded indigent care.
S.Diagnosis and treatment of mental illness is an important
part of a person's overall, health care and cannot be
separated from it.
C�
_SB 468
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6.Discriminatory health insurance policies force persons
with treatable mental illness into lifelong disability
and public dependency.
7.Lack of access to treatment can cause persons to suffer
recurrence of acute mental illness, resulting in
homelessness or involvement with the criminal justice
system, often for non-violent crimes. Parity for mental
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SB 468 Senate Bill a Bill Analysis 'age 9 of 10
health treatment could prevent some mentally ill persons
from becoming victims as well as perpetrators of cri:re,
resulting in government savings due to crime prevention
and reduced placements in state mental hospitals and
correctional facilities.
ARGUMENTS IN OPPOSITION Opponents of SB 468 argue:
1.Reauiring *rental health parity would increase the cost of
health care premiums, which would in turn result in more
Californians losing health insurance coverage entirely
(opponents estimate that for every one percent real
increase in the price of health insurance premiums, up to
40,900 Californians could lose health insurance
coverage) .
2.Approximately 7 million Californians currently have no
health insurance, with the cost of premiums often cited
as the reason.
3.The financial burden of adding mental health parity would
be greatest on small employers, most of whom now offer
only minimal ::ental health coverage--however, large
employers would also be affected as 30% now offer only
minimal coverage and only 20% of large employers
currently offer generous mental health benefits.
4.The definition of :dental illness in SB 468 is broad --
for example, anorexia and bulimia do not create the
functional disorders that other "severe mental illnesses"
do and the physical effects could be covered under
current coverage.
CP:cm 5/29/99 Senate Floor Analyses
SB 468
Page
xA
SUPPORT/OPPOSITION: SEE ABOVE
**** END ****
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AMENDED IN SENATE APRIL 27, 1999
AMENDED IN SENATE APRIL 13, 1999
AMENDED IN SENATE APRIL 5, 199'9
AMENDED IN SENATE MARCH 22, 1999
SENATE BILE No. 468
Introduced by Senators Polanco,Alpert,Figueroa,Ortiz,
and Rainey
(Coauthors: Assembly Members Cardenas, Ducheny,
Firebaugh, Kuehl, Romero, Shelley, and Wildman)
February 17, 1999
An act to add Section 1374.72 to the health and Safety Code,
and to add Section 10144.5 to the Insurance Code, relating to
health care coverage.
I EGISL,ATIVE COUNSEUS DIGEST
SB 468, as amended, Polanco. Health care coverage.
Dental illness.
Under existing law, a disability insurer or health care service
plan may not discriminate based on race, color, religion,
national origin, ancestry, or sexual orientation. An insurer is
also prohibited from refusing to insure a person or from
charging a different premium because of that person's
blindness.
This bill would require a health care service plan contract
or disability insurance policy issued, amended, or renewed on
or after July 1, 2000, to provide coverage for the diagnosis and
medically necessary treatment of mental illness under the
95
C
SB 468 —2—
same
-2—same rates, terms, and conditions as generally applied to other
medical conditions, as specified.. These requirements would
not apply to a contract between the State Department of
Health Services and a health care service plan or a disability
insurer for the benefit of enrolled Medi-Cal beneficiaries.
Because a willful violation of the bill's provisions relating to
health care service plans would be a crime, this bill would
impose a state-mandated local program by creating a new
crime.
The California Constitution requires the state to reimburse
local agencies and school districts for certain costs mandated
by the state. Statutory provisions establish procedures for
making that reimbursement.
This bill would provide that no reimbursement is required
by this act for a specified reason.
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: yes.
The people of the State of California do enact as follows:
1 SECTION 1. Section 1374.72 is added to the Health
2 and Safety Code, to read:
3 1374.72. Every health care service ,plan contract
4 issued, amended, or renewed on or after July 1, 2000, that
5 provides hospital, medical, or surgical coverage shall
6 provide coverage for the diagnosis and medically
7 necessary treatment of mental illness under the same
8 rates, terms, and conditions as generally applied to ether
9 medical conditions.
10 (a) Coverage, at a minimum, shall include all of the
11 following:
12 (1) Inpatient hospital services.
13 (2) Outpatient services.
14 (3) Partial hospital services.
15 (4) Prescription drugs, if the plan contract includes
16 coverage for prescription drugs.
17 (b) "Mental illness" includes mental disorders defined
18 in the Diagnostic and ,Statistical Manual IV or subsequent
19 editions published by the American Psychiatric
20 Association., except those codes defining substance abuse
95
-3— SB 458
1 disorders (291.0 to 292.9, inclusive, and 303.0 to 305.9,
2 inclusive) and the "V" codes.
3 (c) "Rates, terms, and conditions" means any lifetime
4 limits, annual payment limits, episodic limits, inpatient or
5 outpatient service limits, out-of-pocket limits,
6 coinsurance, copayments, or any other cost sharing or
7 benefit limitations, or other limitations that restrict
8 access to services which are medically necessary and
9 clinically appropriate.
10 (d) The commissioner may disapprove any contract
11 that the commissioner determines to be inconsistent with
12 the purposes of this section.
13 (e) Nle4tiftg Subject to conformance to the
14 requirement that the sane rates, terms, and conditions
15 shall apply to amental illness as generally apply to other
16 medical conditions, nothing in this section shall be
17 construed to-provi -for do any of the following:
18 (1) Pfehibi6tig Prohibit a health care service plan
19 from negotiating separate reimbursement rates and
20 service delivery systems for mental illness coverage,
21 including, but not limited to, a mental health carve-out
22 program.
23 (2) Prohibiting Prohibit a health care service plan
24 from managing the provision of benefits through
25 common methods, including, but not limited to,
26 preadmission screening, prior authorization of services,
27 or other mechanisms designed to lime =-
28 ensure that coverage is provided only for those services
29 for mental illness _ 'y fe t p - - t o_ ate_d.,R.ftd
30 that are medically necessary and clinically appropriate.
31 The methods shall not be utilized to deny or limit access
32 to services that are medically necessary and clinically
33 appropriate.
34 (3) Prohibiting Prohibit the use of a case management
35 program for mental illness benefits to evaluate and
36 determine medically necessary and clinically appropriate
37 care and treatment for each patient.
38 (4) Re4rie6ftg Restrict coverage only to those services
39 provided by physicians and surgeons or to alter the scope
40 of practice of any health care professional.
95
SB 468 —4-
1
41 (f) A health care service plan shall not be in violation
2 of this chapter if the plan applies different limits or
3 entirely excludes from coverage any of the following:
4 (1) Marital, family, educational, or training services,
5 unless those services are medically necessary or clinically
6 appropriate.
8 hettse,
9 ef the staff ef my of these eftfities.
10
11 (2) Care that is substantially custodial in nature.
12 (4}
13 (3) Services and supplies that are not medically
14 necessary or clinically appropriate.
15
16 (g) This section does not apply to contracts between
17 the State Department of Health Services and a health
18 care service plan for the benefit of enrolled Medi-Cal
19 beneficiaries that are entered into pursuant to Chapter 7
20 (commencing with Section 14000), or Chapter 8
21 (commencing with Section 14200), of Division 9 of Part
22 3 of the Welfare and Institutions Code.
23 (h) No person suffering from a mental illness covered
24 by this section shall be denied benefits for that mental
25 illness because the person also has a disease or condition
26 that is not covered by this section.
27 SEC. 2. Section 10144.5 is added to the Insurance
28 Code, to read:
29 10144.5. Every policy of disability insurance that
30 covers hospital, medical, or surgical expenses and that is
31 issued, amended, or renewed on or after July 1, 2000, shall
32 provide coverage for the diagnosis and medically
33 necessary treatment of mental illness under the same
34 rates, terms, and conditions as generally applied to other
35 medical conditions.
36 (a) Coverage, at a minimum, shall include all of the
37 following:
38 (1) Inpatient hospital services.
39 (2) Outpatient services.
40 (3) Partial hospital services.
95
— - SB 468
1 (4) Prescription drugs, if the policy includes coverage
2 for prescription drugs.
3 (b) "Mental I(ental illness" includes mental disorders defined
4 in the .�Diagnostic and Statistical Manual IV or subsequent
5 editions published by the American Psychiatric
6 Association, except those codes defining substance abuse
7 disorders (291.0 to 292.9, inclusive, and 303.0 to 305.9,
8 inclusive) and the "V" codes.
9 (c) "Rates, terms, and conditions" means any lifetime
10 limits, annual payment limits, episodic limits, inpatient or
11 outpatient service limits, out-of-pocket limits,
12 coinsurance, copayments, or any other cost sharing or
13 benefit limitations, or other limitations that restrict
14 access to services which are medically necessary and
15 clinically appropriate.
16 (d) The commissioner may disapprove any contract
17 that the commissioner determines to be inconsistent with
18 the purposes of this section..
19 (e) Nedting Subject to conformance to the
20 requirement that the same rates, terms, and conditions
21 shall apply to mental illness as generally apply to other
22 medical conditions, nothing in this section shall be
23 construed provide for do any of the following:
24 (1) Prohibiting Prohibit an insurer from negotiating
25 separate reimbursement rates and service delivery
26 systems for mental illness coverage, including, but not
27 limited to, a mental health carve-out program.
28 (2) Prehibififtg Prohibit an insurer from managing the
29 provision of benefits through common methods,
30 including, but not limited to, preadmission screening,
31 prior authorization of services; or other mechanisms
32 designed t ensure that coverage is
33 provided only for those services for mental illness erAy to
34 that are
35 medically necessary and clinically appropriate. The
36 methods shall not be utilized to deny or limit access to
37 services that are medically necessary and clinically
38 appropriate.
39 ( ) Prei4bittmg .prohibit the use of a case management
40 program for mental illness benefits to evaluate and
95
SB 468 —6-
1 determine medically necessary and clinically appropriate
2 care and treatment for each patient.
3 (4) Restriefing Restrict coverage only to those services
4 provided by physicians and surgeons or to alter the scope
5 of practice of any health care professional.
6 (f) An insurer shall not be in violation of this part if the
7 insurer applies different limits or entirely excludes from
8 coverage any of the following.
9 (1) Marital., family, educational, or training services,
10 unless those services are medically necessary or clinically
11 appropriate.
12
13 Mqttse,
14 of the staff of afly of these entities.
15 (4)
16 (2) Care that is substantially custodial in nature.
17 +
18 (3) Services and supplies that are not medically
19 necessary or clinically appropriate.
20
21 (g) This section does not apply to contracts between
22 the State Department of Health Services and an insurer
23 for the benefit of enrolled Medi-Cal beneficiaries that are
24 entered into pursuant to Chapter 7 (commencing with
25 Section 14000), or Chapter 8 (commencing with Section
26 14200), of Division 9 of Part 3 of the Welfare and
27 Institutions Code.
28 (h) No person suffering from a mental illness covered
29 by this section shall be denied benefits for that mental
30 illness because the person also has a disease or condition
31 that is not covered by this section.
32 SEC. 3. No reimbursement is required by this act
33 pursuant to Section 6 of Article XIII B of the California
34 Constitution because the only costs that may be incurred
35 by a local agency or school district will be incurred
36 because this act creates a new crime or infraction,
37 eliminates a crime or infraction, or changes the penalty
38 for a crime or infraction, within the meaning of Section
39 17556 of the Government Code, or changes the definition
95
-7— SB 468
1 of a crime within the meaning of Section 6 of .Article
2 XIII B of the California Constitution.
0
95
b
TO: BOARD OF SUPERVISORS
Contra
PHIL BATCHELOR, COUNTY ADMINISTRATOR
FROW
Costa
County
DATE. June 17, 1999
SUSJECT:
LEGISLATION: SB 405 (Ortiz)
SPECIFIC REQUEST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION
RECOMMENDATION:
ADOPT a position in SUPPORT of SB 495 by Senator Deborah Ortiz of Sacramento
which would fund a statewide, 24-hour suicide prevention hotline connected to local
agencies.
BACKGROUND:
The Mental Health Director, Donna Wigand, reports that SB 4035 will fund a
statewide, 24-hour suicide prevention hotline connected to such agencies as the
Contra Costa Crisis Center, a large-scale public awareness campaign to de-
stigmatize suicide and increase awareness about what leads someone to
contemplate suicide,pilot training and treatment programs,and statewide databases
of suicide statistics and resource information. There is growing interest in a national
suicide prevention bill. Should that happen, SB 405 will put California in a unique
position to qualify for Federal matching dollars by virtue of already having a
statewide program in place.
SB 4015 has passed the Senate and is currently in the Assembly Health Committee.
The Mental Health Director recommends that the Board indicate its support for SB
405.
CONTINUED ON ATTACHMENT: YES SIGNATURE:
el RECOMMENDATION OF COUNTY ADMINISTRATOR PECOMMENDATICN OF BOARD COMMITTEE
APPROVE OTHER
SIGNATURE S,
ACTION OF BOARD ON APPROVED AS RECOMMENDED XX OTHER
une ,
VOTE OF SUPERVISORS
I HEREBY CERTSFY THAT TH• S IS A TRUE
XX_UNANIMOUS(ABSENT _ __ � AND CORRECT COPY OF AN ACTION TAKEN
AYES: NOES: AND ENTERED ON THE MINUTES OF THE BOARD
ABSENT: ABSTAIN: OF SUPERVISORS ON THE DATE SHOWN.
County Administrator ATTESTED J n n e 22 , 1999
Contact, Health Services Director PHIL BATCHELOR,CLERK OF THE BOARD 0=
��: Mental health Director
Senator Deborah Ortiz SUPERVISORS AND COUNTY ADMINISTRATOR
Room 4032 Mate Capitol ell 'A
Sacramento,CA 95814 ,'
Les Spahnn; Heim, Noack, Kelly&Spahnn BY �� y � DFPUTY
1121 l_Street,suite loo
Sacramento,CA 95814
SB 405 Senate TH-Bi11 Analysis Page 1 of
------------------------------------------------------------
iSENATE PULES COMMITTEE ( SB 4051
€Office of Senate Floor Analyses € i
11020 N Street, Suite 524 € j
€ (916) 445-661.4 Fax: (926) I
€327-4478 € i
------------------------------------------------------------
THIRD READING
Bill No: SB 405
Author: Ortiz (D) , et al
Amended: 5/28/99
Vote: 21
SENATE HEALTH & HUMAN SERV. COMMITTEE 5-2, 4/14/99
AYES: Escutia, Figueroa, Hughes, Solis, Vasconcelios
NOES: Haynes, Mountjoy
NOT VOTING: Morrow, Polanco
SENATE APPROPRIATIONS COMMITTEE 8-4, 5/27/99
AYES: Johnston, Alpert, Bowen., Burton, Escutia, Karnette,
Perata, Vasconcellos
NOES: Kelley, Leslie, McPherson, Mountjoy
NOT VOTING: Johnson
SUBJECT Suicide treatment and prevention_
SOURCE Author
DIGEST This bill establishes a 24-hour central suicide
crisis line that links callers to local suicide prevention
and treatment resources. The bill sunsets June 303, 2004.
ANALYSIS . This bill requires the State Department of
Mental Health to establish and implement, or contract with
an outside agency for the development of, a multicour_ty,
24-your, centralized, seamless suicide crisis line
integrated network.
The bill authorizes existing crisis lines that meet
CONTINUED
0]
SB 405
_ Pane
2
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SB 405 Senate Bi11 o Bill Analysis Page 2 of 4
specifications of the State Department of Mental Health and
the American Association of Suicidology to be included in
this integrated Network.
The bill requires the crisis line to link persons at risk
of committing suicide with local suicide prevention and
treatment resources.
The above provisions sunset June 30, 2004.
The bill states legislative intent to appropriate $600,000
from the General Fund to the department for purposes of
implementing the crisis lire.
According to Senate Health and Human Services Committee
analysis:
The seriousness of suicide
--More people die from suicide than from homicide in the
United States.
--In 1996, suicide was the ninth leading cause of death in
the United States.
--On average, ten Californians complete suicide each day.
--In 1996, 3, 408 people in California died from suicide.
-P-It is estimated that each suicide leaves behind at least
ten family members and friends who are emotionally
devastated and permanently scarred.
Age, Gender, Ethnicity
--In 1996, suicide was the third leading cause of death
among persons 15-24 years of age, following unintentional
injuries and homicide.
--The highest suicide rate in 1996 was for white men over
85 years of age.
--73 of all suicides are committed by white ren.
SB 405
Page
3
--According to the Surgeon General of the United States:
--"Between 1980 and 1995, the rate of Black suicide for
15-19 years-olds more than doubled from a rate of 3.6 per
100,000 to 8.1 per 100,000.
-Region
-- Suicide rates have been consistently higher in Western
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SB 405 Senate rill -Bill Analysis Page 3 of 4
states, 70% higher than in the Northeast. Most western
states have an adjusted suicide rate between 13.4 - 22.2
per 100,000, while many states in the Northeast and Midwest
have rates as low as 0 - 10.9 per 100, 000.
Causes and risk factors
Mental illness:
--"Most suicide results from untreated or undiagnosed
clinical depression." (Suicide Prevention Advocacy
Network)
---"Scientific research has shown that almost all people who
kill themselves have a diagnosable mental or substance
abuse disorder; and the majority have more than one
disorder." (National institute of Mental Health)
Firearms
--Nearly 60% of all suicides are committed with a firearm.
--"Over 90% of the increase in suicide among Black youth is
attributable to the use of firearms." (Surgeon_ General)
Other risk factors:
--Prior suicide attempt, firearm in the home,
incarceration, exposure to the suicidal behavior of
others (family members, peers, media, and entertainment) ,
and family history of mental or substance abuse
disorders, suicide, and violence, including physical or
sexual abase.
United States Surgeon General.
SB 405
Page
4
Last year, recognizing the serious and pervasive problem of
suicide, Davie. Satcher, the U.S. Surgeon General., called
for the development of a rational suicide prevention
strategy and convened a conference of survivors, health
care researchers and providers, policy makers, and
activists to begin developing such a strategy. The
conference produced a document laying the foundation for a
national prevention strategy which focused on: (1)
enhancing access to services and programs; (2) broadening
the public's awareness; and (3) advancing the science of
suicide prevention..
FISCAL EFFECT Appropriation: No Fiscal Com. : Yes
Local: No
States legislative intent to appropriate $600, 000 from the
General Fund .for purposes of implementing the suicide
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SB 405 Senate Bill-Bill Analysis Page 4 of 4
crisis line.
SUPPORT (Verifiers. 4/14/99) (per committee analysis)
(unable to
reverify at time of writing)
California Catholic Conference
California Mental Health Directors Association
Suicide Prevention Advocacy Network
CFasl 5/29/99 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
**** END ****
http://www.leginfo.ca.gov/pub/bill/ser/sb_040-`/sb 405 cti 19990529_180757 sen_floor.htm 6/16/99
AMENDED IN SENATE MAY 28, 1999
A,M, E�'�DED IN SENATE MAY 3, 1999
AMENDED IN SENATE APRIL 7, 1999
AMENDED IN SENATE APRIL 5, 1999
SENATE BILI leo. 405
Introduced by Senator Ortiz
(Coauthor: Senator.Perata)
(Coauthors: Assembly Members Bock, Firebaugh, Mazzoni,
Romero, Strom-Martin, and Thomson)
February 12, 1999
An act to add and repeal Divisiea 109 (eentmeneittg with
,
therefor.E4 beftift and ffla6ftg an Section
4028 of the Welfare and Institutions Code, relating to meatal
health.
LEGISLATIVE COUNSEL'S DIGEST
SB 405, as amended, Ortiz. Suicide treatment and
prevention.
Existing law provides for suicide prevention counseling
services in a variety of contexts.
This bill would establish the---C'empr—ehensiv lifer.i»
--r
establish and impleffient gatelteeper trtAnirtg pilot programs
to pro-vide sttieide preveftAett training to eer+ain
s
paraprefessietteAs9
95
SB 405 —2—
programs,
(2) eefAraet with aft autsideawareness and edtteaki -a on sateide prever�gen and
freatment,
and implement a multicounty
suicide crisis line integrated network, (5) establish a
data on sttieide in California effid speeified reseurees, and (6)
Mareh s s ert en or before s
9 regarding the pilet programs.
These provisions would become inoperative on June 30,
2004, and would be repealed as of January 1, 2005.
The bill would also state the intent of the Legislature
fege&ding -h-e ----d make eeftain legislative findings and
k Ile W1 weuld deelare the intent ef the Legislature to
appropriate from the General Fund $4,800,000 $600,000 to the
State Department of Mental Health for purposes of the bill.
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.
The people of the State of California do enact as�follows:
1 'c8.'�L�?4 1."."' ..,....L "1,�aaf finds nd d. e' is
2 fees:
4
5
7 appYe
8 9 5401 GaRfernians lest their lives to t
7 an average of-nine residents
per day:
14 estimated Fl....,t
10 diefe are betweett 45,W@
11
12 .
14 than their elder GaIiI.-M.-i eeft"fffs. Data indie
15
95
-3— SB 405
1 .
2 14siftg this were likely mare
doleseems, (m 449
r6
jleading eauses of de As,
respeetive4r. Both 44:p8
g p90
1aftdy
11 efted for yeeth. E-videnee is -.1. terms of
12
13j
14
15 es youth sttiei4e affempts and the
16
17
18 progTaffts to identify aftd refer yoWAt a+ risk fe
19 behtwioe
20
21 eoftftrY-fitii,4y estimates that the lives of at least si3t
X22 pefseas related to or eemeet—ed to Wh-o
23
24 ,644
25
26 sttieide.
2/
28
29 .
3£l
3y/1}
32 ediea4 affemiert are less likely to `
33
34
3
36
37
38 Myett, eenwmnity based,
39
40 sttieifle are likely to rise.
95
SB 405 --4—p
Dwitit it 109 With tseoion
f
to rea4,3
4 'xi^r rt. jo"q. c"v® rr7 rREVEn4rv. _ nrD
5 TRE h mMIBNT
6
10 130205. (a) The State Deparwiftf ef M- emal 14
11
12
y �--.'1'c�tk'Fc7feG`t7'Si"t3'LSZ'Ci 7.L IY'C"B'[.'i�.'GYC7'ziasrsc�Z'z'4ztica�ticWsz�
1
14
15 .
y16
(2) Four members by the Sena*GefffffAt*e ott Reles.1
1
190
21
22 of the needs,
23 -or indiyidtials at.
24
2s
26 .
2
2
2
3
31
32
33 tnediee4 eeffflt
34
35
35
37
138 -
3 {
39 se.eebea,
95
-5— SB 405
1
2 '24".5:
3
4 S 9
d
S S
10 laaark
11 (6) Ad-vise the State Deparoft"t of
12 g
13
14 e 0230:
15 "4') Prepare -f-eports that
16Per 14e4th aft the StaW
17
vg 130-220, 1 t
19 140210. (a) 44te State Depar"neat of Hediobt
20 shf4l establish and implement gatekeeper- t4tittiftg pi
21 progrmns pw9ttant te eantreets with eetm6es, ttoWefi
22 5ftsefe the-
iatif4s, and-
23 5
24 pfafessioneAs in the behayiera4 heaM eare,
25 edueation, -4 -religious,
26 g 5
27
2 g
2 5
30 g
31
32 88ffift— to
33
34 g S S
35
36
3.1rN
38 agettey may be5eaeh of
39 iftdiyi4uf4s
40
95
SB 405 —6-
1
61 , ef- it eembiftatieft of e*istifig and pilot
2 programs.
3 (e) Pilot programs established purstte&A te this seefieft
4 shall ...,..rae for three years-.
5
6
7
8 preseribed by the department. The seleetion of
10 mode4s that eart be repReated in other eeniffmitifies,.
11 (e) Gatekeeper training pilot haH build on
12 etiffent krrowledge of exAstiftg,-
13
14
15
16 ,
17 2004-
1$ 130-245. (a) The State Department of Mental 14eaM
19 shed! establish and implemefft evidenee based, preven
20
21
22
23 treatment ef suieidal behaviors.
24 (b) The sttieide treaftr&nt pilet programs established
25 under this seetion shaR operftfe for diree years.
26 (e) The suieide treatment pilot programs shall have -filft'
27 of the feHowiftg geals,.
2$ (1) To ---=-ease ------fing knowledge of _.;a=-___ based,
integrated29 sttiei4e treatment appreaehes that eaft be with30 eetinty health
S
feplieffted by publie and private
31 pregrems, or beth, to address popttla6ens at risk of
32 .
33 (2) To pro4ttee geidebeeks and other material-s
34
35 treatment progrants, the modifieatieft of existing
36 progrants, or beth.
37 (3)– ineltid--erisis eenter eentpertent that servess
38 several .tt.
33 (d) 4he State Department ef Mental Health sha
4{9
95
-7— SB 445
1
2 preserribed by the diThe-- zet4Q�of
3 8pplieants shall SeflGet se,,rey.�✓ide treatment
...4..'I..
4 . �j�
f 7
8 N01. A under
10 shall provide at least 215 pereent eetsh or ia-k4nd fnfttehing
11
12 seeend yeaf 4 the pilot pregram,
13 ease ,�C'P7fe l .y[Iell feeeived
"" " TJ
14 .
15 130-2-20. W The State Department of Menta4 HeaM
16
17
18 sttieide preyetA4en and tre&tment.
19
20 high seh Q fA _w4d.
21
22 ability itt seeiB4 marketing, media adyeeaey, wtd thee
23
24 .
25
2/ pritit, peint of 7 and } and 7 7
28 bef nef lifftited fe, paid platements, free media,
29
30 edueatie
31 1;0226.SECTION I. Section 4028 is added to the Welfare and
33 Institutions Cade, to read:
34 4028. (a) The State Department of Mental Health
35 shall establish and implement, or contract with an outside
36 agency for the development of, a multicounty, 24-hour,
37 centralized, seamless suicide crisis line integrated
38 network.
39 (b) Existing crisis lines that meet specifications of the
40 State Department of Mental Health and the American
95
SB 405 —8-
1
8-
1 Association of Suicidology may be included in this
2 integrated network.
3 (c) The crisis line established under this section shall
4 link persons at risk of committing suicide with local
5 suicide prevention and treatment resources.
6 (d) The er-isis line netwerk shall wilize data available
7 ptffstiant to Seetion 130240-.
10 130240. The State Depaftment ef Health, in
11 eallabera4ett with the State Department ef HeaM
12 Sefyiees, shfdl establish it eentredized Internet based deAft
13
14 eftd fesetffees for- persefts who are at risk of eeffhvpAtfing
15
16
17 .
18
19 puTese,
20
21
22
23
24
25
26 ew4uft6e :
27
2 ,
29
30 established purstiwtf te t4tis divisien.-
31 13024 isioa
32 (d) The crisis line shall maintain appropriate data to
33 evaluate its effectiveness.
34 (e) This section shall become inoperative on June 30,
35 2004, and as of January 1, 2005, is repealed, unless a later
36 enacted statute that is enacted before January 1, 2005,
37 deletes or extends the dates on which it becomes
38 inoperative and is repealed.
39 SEG. 33. It is the intent of the Legislatere tha eAl of the
40 ft4lewingee
ss
-9— SB 405
1 ,
3
4
5 .
6 (b) The State DepWcmen+ of MenteA lie
7
8
10 (e) The programs established by the divisieft b-e
11 eensistent with the pttblie he&M made! proposed by th-e
1 ! and the system-of
13
14
16 (d) The pilot pregframs established ptff&uan+ to the
17 division be sustainable beyeitd the pilot fimdiftg period.
18
19
20 Ll c.CY�7RL if`v_"_7}!4!i [_f c.if[.[�R_RS[�
S"
21
22 eefttraeted pilot pre iders tinder the diyision
24
25 f-evention end treafftnt programs and other wvailable
fiands.
26 SE G. 4. (ft) Gatekeeper training pRot programs
27
28
29
30 8eptember 39, 2004.
31
32
33
34 ,
35 (e) The State Department of Mettta4 llea4th s
36 submit to the I=egislatitre a fi --report .-5ep+effiber 39;
37 2004,
38 regardift the results of the pilot programs
39 Sttieide PfevefAiaa and Treatment Aet of 1999,
95
SB 405 _ 10-
1
10—
2 saf6ty Gede:
3 SEG. R. is the intent ef the begislawre that
4
5
6�p
I % %
for --the pwposes of implementiftg/
18 of the Health and Safiety Gede.
l
10 ($800,000) for- the
11 ; pr
12
13 the Health md Safety Gede.
14
15 ($3,!00,000) far- the purposes of implefneft4ng ft targeted
16
17 Seetien 130220 of the Health aftdSAfPA;OMP
1
19
11 13A
20 netwerk parstiant to At Reft .2-25 Of
21 Safety Goder
224590,9W) fer
23
24
data base per-suaftf to Seetieft 430230 of the 14eakh end-
25
26 ,0W) for the
2
+28
i"Ieftteti6ng Division 109 (e . - with See
29 13020-0) -1 the Health aftd Safety Gede. it is the iftteftt
30
31
32
33 ; ;
34
35
36 e JVa aV a140225 o f the Healthw i Safety
Gede
37
38 eelffif-erenee eensisting of gra-at. a-11-1 fttftded wit
39 Diyisteft 109 (eaffffnetteing with Seetion 139200) of the
44 Health md Safety Gode, members of the Advisery Titsk
95
SB 405
1d ill Preveetieft
2 Seetieft 130225 of the 14 aM and
i
4 SEC 20 It is the intent of the Legislature that six
5 hundred thousand dollars ($601,000) be appropriated
6 from the General Fund to the State Department of
7 Mental Health for the purposes of implementing a suicide
8 crisis lute integrated network pursuant to Section 4025 of
9 the Welfare and Institutions Code.
95