Legislative "Halftime" - Many Key Bills Advance Today marks “halftime” in the 2021 legislative year. Each bill introduced this year has either gotten off the floor in its house of origin or become a two-year bill. Halftime won’t last long though – bills are already being set for hearings starting next week in second house policy committees. Over 100 bills being tracked by CSAP have made it from one house over to the other including, but not limited to, the following:
AB 32 (Aguiar-Curry) – Would codify current telehealth flexibilities indefinitely beyond the expiration of the pandemic emergency declaration - SUPPORT
AB 118 (Kamlager-Dove) – Would enact the Community Response Initiative to Strengthen Emergency Systems Acts (CRISES Act) with the goal of making grants to community organizations for the purpose of expanding the participation of community organizations in emergency response for specified vulnerable populations. This bill is paired with a state budget funding request - SUPPORT
AB 852 (Wood) – Would add the new category of nurse practitioners (NPs) who are authorized to practice independently starting January 1, 2023, to provisions of law that include physician and surgeons and other relevant health care licensees, corrects a drafting error related to the conditions when an independent NP must refer to a physician and surgeon, adds the new independent NPs to pharmacy definitions for prescribers, and makes other technical and clarifying changes - OPPOSE UNLESS AMENDED
AB 988 (Bauer-Kahn) – Would establish the 988 Crisis Hotline Center, using the digits "988" in compliance with existing federal law and standards governing the National Suicide Prevention Lifeline. The bill would require the Office of Emergency Services to take specified actions to implement the hotline system, including hiring a director with specified experience and designating a 988-crisis hotline center or centers to provide crisis intervention services and crisis care coordination to individuals accessing the 988. Recently, APA and many other nationwide advocacy organizations sent a letter in support of AB 988 that you can read here - SUPPORT
AB 1178 (Irwin) – Would delete the existing prior authorization requirement for all medications prescribed for the treatment of a serious mental illness for a period of 365 days after the initial prescription - SUPPORT
SB 221 (Wiener) – Would codify timely access standards for non-physician mental or behavioral health providers, add SUD providers, add follow-up appointment standards to current initial appointment standards - SUPPORT
SB 316 (Eggman) – Would approve two billings of Medi-Cal on the same day to allow for a warm mental health handoff while a patient is at a Federally Qualified Health Clinic or Rural Health Clinic - SUPPORT
SB 507 (Eggman) – Would incorporate changes to the Assisted Outpatient Treatment (AOT) statute as suggested in the State Auditor's audit of the LPS Act. Also, would broaden criteria to address serial 5150 and conserved patients, allow telehealth appearances in court, and provide a marker for judges to recognize when a person lacks capacity to refuse medication - SUPPORT
SB 516 (Eggman) – Would add health to the consideration of grave disability allowed to be considered in 5250 hearings - SUPPORT
The latest bill matrix can be found here. If you feel strongly about any of the bills on this list, please contactPaul YoderatSYASL.
State Budget Update Next week, budget related bills will start appearing in print. Negotiations between legislative leadership and the Governor are ongoing. The Legislature is proposing to alter the Governor's historic May Revise mental health proposals in some ways; however, the good news is that they are overwhelmingly on the same page.
The Legislative Budget Committees have approved most of the Governor’s proposal to spend over $1 billion on grants to expand the availability of behavioral health placements, from residential Board and Cares to inpatient psychiatric facilities.
In addition, the Legislature’s package adds $150 million for mobile crisis teams, including $100 million for immediate teams for youth and $50 million for adult-centered teams.
For youth related proposals, the Legislature's take is as follows (yes, it's a lot, but there's a lot being proposed):
2021-22 Children and Youth Behavioral Health Initiative
The Administration proposed $4.4 billion of expenditures over a five year period to transform California’s behavioral health system so that all children and youth age 25 and younger, regardless of payer, are screened, supported, and served for emerging and existing behavioral health needs. These investments build on legislative augmentations and other proposals adopted in the past few years, such as the Mental Health Student Services Act, the Early Psychosis Intervention (EPI) Plus Program, and investments in youth drop-in centers. While the Administration’s proposal provides a welcome allocation of resources for the enormous task of ensuring a full continuum of behavioral health services is available to all children and youth, many of these proposals lack specific detail or require more analysis and consideration. The Legislature would propose the following changes to the Administration’s proposed Children and Youth Behavioral Health Initiative.
Detailed Adjustments to Administration’s Proposal
Mental Health Student Services Act Partnerships Expansion - $200 million Coronavirus Fiscal Recovery Fund (CFRF) one-time (in addition to Administration’s proposed $50 million from Mental Health Services Fund)
The $200 million augmentation to the Mental Health Student Services Act (MHSSA) would allow the Mental Health Services Oversight and Accountability Commission (MHSOAC) to provide non-competitive grants to all counties that did not receive funds in the first round of funding of the program. According to MHSOAC and counties, many of the unsuccessful projects from the first round of MHSSA funding could be implemented in time to provide services for children returning to full-time instruction in the fall, as follows:
$2.5 million, $4 million, or $6 million for counties based on size, with an additional amount for large counties ($12 million per county) and $20 million allocated for Los Angeles. These additional resources would cover all unfunded applications and provide increased support for large counties already participating.
Grants would be non-competitive as funds would be available for all counties. However, counties would still be required to submit an application that meets the MHSSA statutory requirements to the MHSOAC. Counties would be required to submit a letter of intent to apply and complete an application within a specified time frame or funds would be forfeited.
Forfeited funds could be reallocated to counties on a competitive basis to provide additional grants to participating counties.
School-Linked Behavioral Health Partnerships and Capacity
Specify allocations for Administration’s proposed investment of $550 million CFRF over two years ($100 million in 2021-22 and $450 million in 2022-23)
The Administration proposes to invest $550 million CFRF over two years for a competitive grant program to build partnerships, capacity, infrastructure, provider networks, and enhance coordination and partnerships for behavioral health prevention and treatment for children and youth. Eligible entities would be counties, tribal entities, local educational agencies, health care service plans, Medi-Cal managed care plans, community-based organizations, and behavioral health providers.
DHCS would be required to determine the eligibility criteria, grant process, and methodology for distribution.
The Legislature’s action is more specific about the allocations of these funds, including:
$300 million provided exclusively to county behavioral health departments that enter into partnerships with school districts, or county offices of education, to provide behavioral health services for students. Each county would have a specific allocation of the $300 million and would be able to claim its share after submitting an application to the department describing the services it would provide under its partnership agreement. Each county could only claim a proportion of its share equal to the proportion of all students in the county covered by the partnership or partnerships.
$50 million would be allocated to institutions of higher education to support behavioral health services on campus.
$200 million would support a competitive grant program for tribal entities, local educational agencies, community-based organizations, and behavioral health providers to address mental health disparities and provide linguistically and culturally competent services for children, youth, and young adults that lack access to adequate behavioral health care or are otherwise difficult to reach.
Student Behavioral Health Medi-Cal Managed Care Plan Incentives
Approve the Administration’s proposed investment of $400 million ($200 million General Fund and $200 million federal funds) one-time, and modify the terms of participation by plans.
The Administration’s proposal to provide incentive payments to Medi-Cal managed care plans to provide behavioral health services to students is essential to ensuring access to the full continuum of behavioral health services. While county mental health plans provide specialty mental health services, Medi-Cal managed care plans provide services for mild to moderate mental health needs.
However, it is essential that these plans are part of a partnership with county mental health plans and school districts or county offices of education, so care can be comprehensive and coordinated across delivery systems and students do not fall through the cracks.
The Legislature’s action requires Medi-Cal managed care plans, as a condition of participation in the incentive payment program, to enter into three-party partnerships to ensure delivery of the full continuum of behavioral health services to students.
Development and Enhancement of Evidence-Based Behavioral Health Programs
Transfer Administration’s proposed one-time investment of $429 million CFRF in 2022- 23 to MHSOAC o The Administration’s proposal to develop and scale up age appropriate behavioral health evidence based programs is a worthwhile goal, but builds on programs the MHSOAC has been administering for several years. The Administration proposes to prioritize for funding the following:
First break or first episode psychosis programs
Efforts tailored and focused on disproportionately impacted communities and communities of color
Youth drop-in wellness centers
Intensive outpatient programs for youth
Plus program, the youth drop-in centers program, and administers local expenditures of Mental Health Services Act funding for prevention and early intervention. In addition, MHSOAC has attempted to address disproportionately impacted communities and communities of color through its stakeholder contracts. These programs are already in place and could be scaled up with this one-time investment of federal relief funds.
Prevention and early intervention services for youtho MHSOAC administers the Early Psychosis Intervention
Behavioral Health Workforce Capacity
Approve Administration’s proposed investments of $426.8 million over five years in workforce capacity, including:
Psychiatry and social workers o Substance use disorder services providers
Behavioral health workforce pipeline
“Earn to Learn” apprenticeship models
Training to serve justice- and system-involved youth
Train New Trainers Psychiatry Fellowship for Primary Care Providers o Peer Training and Placement Programs
Existing Loan Repayment, Scholarship, and Stipend Programs for Behavioral Health
Behavioral Counselors and Coaches
Reduce Administration’s proposed investments of from $428.3 million to $228.3 million for developing behavioral health counselors and coaches.
Reduce allocation for behavioral health counselors and coaches by $200 million.
Reallocate the remaining $228.3 million to expand the resources for other workforce initiatives.
Behavioral Health Services and Supports Platform
Approve positions and other state operations for the Administration’s proposed behavioral health services and supports platform, but reject first-year funding for the system until the project has fulfilled the appropriate requirements in the California Department of Technology’s Project Lifecycle Approval process.
Behavioral Health Continuum Infrastructure Program
Allocate $150 million of $2.455 billion proposal for mobile crisis support teams for youth and adults.
As part of the Administration’s $2.455 billion proposal to support behavioral health continuum infrastructure, the Legislature’s action specifically allocates $150 million to support the development of mobile crisis support teams to address youth and adults in crisis.
$100 million would be allocated for youth and could respond to schools or families with youth experiencing a behavioral health crisis. These funds would be prioritized to ensure availability of these services when children return to full-time instruction in the fall.
$50 million would be allocated for adults and could respond to behavioral health crisis situations that would ordinarily result in an encounter with law enforcement.
Other Components of the Initiative
Approve remaining components of the Administration’s proposal, including:
E-consult services and provider training – $165 million
CalHOPE Student Support Program – $45 million
New Medi-Cal Benefit – Dyadic Services – $800 million
Public Education and Change Campaign – DPH – $100 million
Public Education on ACEs and Trauma – OSG – $25 million
Various State Operations and Other Adjustments – $186.5 million
CSAP / APA Advocacy Training Day As advertised, CSAP and APA held an advocacy training day last night (Thursday, June 3). The event was a smashing success with over 50 registrants, the participation and advice of State Senator Josh Newman, and phenomenal instruction and insight from APA staff and your state advocates atSYASL Inc. Discussions are already underway for another session later this summer with a special emphasis on social media advocacy, which has become much more of a factor in modern day policy-making. Stay tuned for more details. While many OCPS members might be familiar with Senator Newman, below is a short bio for everyone just in case. CSAP looks forward to working with the Senator on mental-health related legislation in the future.
After graduation from Yale University, where he majored in History with a focus on 20th Century politics and government, Josh served as an artillery officer in the United States Army, with duty assignments with a nuclear weapons unit in South Korea and a conventional artillery battalion in the 25th Infantry Division in Hawaii.
In 2012, Josh founded an initiative, ArmedForce2Workforce,to assist young military veterans in the pursuit of rewarding, career-oriented employment following the completion of their own military service and return to the Greater Los Angeles/Orange County area. That work, and his frustration with the lack of progress and support from various levels of government in doing right by the young men and women who had bravely served us during a time of true national need, led to his decision to run for public office.
As a state senator, Josh has successfully guided more than 20 pieces of legislation that supported veteran services and mental health resources, improved local schools, helped businesses create jobs, and protected open space.
CSAP is a cooperative effort between the Northern California Psychiatric Society, the Orange County Psychiatric Society, and the San Diego Psychiatric Society, and is open to all American Psychiatric Association District Branches in California. If your District Branch is not participating, reach out to your leadership and encourage them to join!
