NEWSLETTER 
Volume 1, Issue 26 - June 25, 2021

AB 988 Language Reinstated
Assembly Bill 988 (Bauer-Kahan) – The Miles Hall Lifeline and Suicide Prevention Act, was substantively amended on June 22 and is now more like its old self. As you will recall, the bill was essentially a shell of its prior version as it passed the Assembly. The summary of the bill provided by the author's office reads as follows:

Oversight - Amendments clarify oversight and implementation authority to build on existing expertise, reducing redundancies, and improve intergovernmental cooperation. The Office of Emergency Services (OES) will oversee the emergency response components of the 988 system while the Health and Human Services Agency (HHS) will oversee the behavioral health service components. Previously, OES had sole authority of the 988 system. Amendments also added a local implementation body (988 Local Planning Council). The Council, appointed by County Boards of Supervisors, will include consumers and their families, 988 call centers, local behavioral health directors and service providers, first responders, and Indian Tribes. The Council will be responsible for implementing state requirements and guidelines at the county and/or regional levels.

Timeline - To meet both federal deadlines and allow for a thoughtful scaling up of existing behavioral health crisis services, amendments add an implementation timeline. The amendments require that the 988 system be fully implemented statewide within 5 years (January 1, 2027) with intermediate benchmarks.

• Year 1 (2021-22): OES and HHS must each appoint a Director to oversee the 988 system within each of their jurisdictions. The Directors will be responsible for ensuring all of the following goals are met:
  • By July 16, 2022 (the federal go-live date for the 988 number), 988 call centers have the necessary technology to answer calls and that 988 and 911 are interoperable so calls may be transferred as necessary.
  • The 988 user fee is assessed.
  • County Boards of Supervisors appoint a 988 Local Planning Council to implement the system locally. In Year 1, the Council will complete a local landscape analysis of existing behavioral health crisis services.
• Year 2 (2023): OES and HHS must issue a plan outlining how the state will fully implement the bill by January 1, 2027. The plan must also include a path for 988 Local Planning Councils wishing to implement 988 earlier than 2027 to do so.
• Year 4 (2025): The 988 Local Planning Council must prepare a plan to implement the requirements outlined by OES. The Plan must be approved by HHS and OES. If the Council cannot reach consensus on a plan, HHS will determine how the system will be implemented in that county or region.
• Year 5 (2026): No later than January 1, 2027 the bill must be implemented in its entirety.

Law Enforcement Engagement - The amendments to AB 988 provide greater specificity about under what circumstances law enforcement can respond to a behavioral health crisis.

Any call made to 911 pertaining to a clearly articulated suicidal or behavioral health crisis must be transferred to a 988 center unless:

• Someone is in immediate danger (other than the suicidal person), a person is threatening others’ personal safety, or if law enforcement is mandated to investigate a potential crime by federal or state statute; AND
• The situation cannot be reasonably managed without law enforcement.

If a law enforcement response is necessary, a co-responder team made up of law enforcement and behavioral health professionals or a dual mobile crisis team-law enforcement response must be prioritized over independent law enforcement deployment. Law enforcement may only be deployed independently if waiting for a co-responder or mobile crisis team would lead to injury or death.

Anytime behavioral health professionals and law enforcement respond to a behavioral health crisis – whether it be a co-responder team or law enforcement responding in partnership with a mobile crisis team – behavioral health professionals shall have primary jurisdiction over the situation.

If law enforcement other than a co-responder team responds to a behavioral health crisis and it is clear that the situation does not warrant a law enforcement response, they shall request the response of a mobile crisis team.

User Fee Expenditures - In order to ensure the appropriate use of public funds, the amendments specify that the user fee may not be used to fund any service or portion of the 988 system that is otherwise reimbursable by insurance.

The coalition behind AB 988, of which your advocates at SYASL are a vital part, continues to meet and strategize on how to get the bill through not one, but several committees in the State Senate. AB 988 has some difficult committee tests ahead. It was initially referred to three policy committees in the Senate (virtually unheard of); however, we are now hearing that it may "just" have to get through two policy committees in the second house. If you would like to participate in the advocacy for this bill, please contact Paul Yoder and CSAP promises that your skills and passion will be put to good use. You may access the coalition's social media toolkit here.

If AB 988 succeeds, there will most likely be a different test ahead. As reported recently by the Sacramento Bee, "Sacramento County wants more mental health and medical professionals in its jails and on the streets. Here’s the problem: So do schools, hospitals, nonprofits and other municipalities. As a result, county officials are girding for intense competition in the next year as they look to hire enough experienced therapists to staff a new program that will respond to 911 calls involving homeless and mental health crises."
 

State Budget Negotiations Still Hanging Fire
State Budget negotiations will, for the time being, wrap up soon. You can expect the new state budget bill to be in print over the weekend along with many budget trailer bills. It appears that the Legislature has agreed to accept the Newsom Administration's revenue estimates. This will mean that the budget could be billions of dollars less than previously approved in AB 128, and programs newly proposed and existing programs proposed for greater funding could end up having funding levels trimmed. What will this mean for children's programs, the continuum of care, telehealth, Medi-Cal, and other proposals? We are still in wait and see mode. 

Right now, what we do know is that the new state budget bills will be SB 129 and AB 129. These bills are identical. At this time, it is unclear which of them will be voted on by June 30. CSAP will send an addendum to this newsletter with more state budget information as it becomes available.

Regarding homelessness, there is three-party (Governor, Senate, Assembly) agreement on AB 832 – which extends the current eviction moratorium through September 30, 2021 – that will ensure California quickly uses the more than $5 billion in federal rental assistance to help the state’s tenants and small landlords and protect vulnerable households from eviction. The agreement widens rental assistance by enhancing current law. Provisions include increasing reimbursement to 100 percent for both rent that is past due and prospective payments for both tenants and landlords. Additionally, the bill ensures rental assistance dollars stay in California by prioritizing cities and counties with unmet needs, and uses the judicial process to ensure tenants and landlords have attempted to obtain rental assistance. Also, very significantly, local governments may get $1 billion each of the next two fiscal years to assist with their operational costs.

Regarding the Administration's LPS proposal, CSAP Vice-Chair Diana Wertz and OCPS GA Chair Alexis Seegan met this past Wednesday with state officials to exchange views. Doctors Wertz and Seegan offered CSAP as a resource going forward. Much work to do here in the weeks and months ahead but a strong relationship was established.
 

AB 890 Update and Call to Action
NPAC is the Nurse Practitioner Advisory Committee established by legislation to create the rules by which AB 890 will be implemented. The CMA has a team which is forcefully advocating for regulations and testing to establish competence of NPs allowed to practice independently, to define boundaries of scope, and to address other items essential to patient safety. CMA is getting significant pushback from NPAC and the Board of Registered Nursing, which have been dismissive of some key CMA concerns. There is an upcoming July 13 meeting that will be an opportunity for other physicians to speak directly to NPAC and reinforce the concerns and recommendations being made by CMA. CMA is hosting an AB 890 Media Training to ensure everyone speaking at the July 13 meeting will be prepared. 
 

AB 890 Media Training
Thursday, July 8 at 6:00-7:00pm
Join Zoom Meeting
https://cmadocs.zoom.us/j/93559299821?pwd=Z0swM0JqTUZmTGt1Q3dVbmhDbEl0dz09
Meeting ID: 935 5929 9821
Passcode: 635496

Some Amended Bills Worth a Look                             
We are entering the time of the legislative year when some bills are completely amended - all of the existing text gets deleted and entirely new text is proposed instead. Lobbyists refer to this as "gutting and amending". Recently, two bills were gutted and amended for new purposes as follows:

AB 1156 (Dr. Akilah Weber) - Would reduce the required months of board-approved postgraduate training required to be issued a physician’s and surgeon’s license to 12 months for graduates of medical schools in the United States and Canada or 24 months for graduates of foreign medical schools other than Canadian medical schools, and make conforming changes.

SB 48 (Limon) - Would, subject to an appropriation by the Legislature for this purpose, expand the schedule of Medi-Cal benefits to include an annual cognitive health assessment for beneficiaries who are 60 years of age or older if they are otherwise ineligible for a similar assessment as part of an annual wellness visit under the Medicare Program. The bill would make a Medi-Cal provider eligible to receive the payment for this benefit only if they comply with certain requirements, including completing cognitive health assessment training. By January 1, 2024, and every 2 years thereafter, the bill would require the department to consolidate and analyze data related to the benefit, and to post information on the utilization and payment of the benefit on its internet website. The bill would authorize the department to implement these provisions by various means, including all-plan letters, without taking regulatory action, and would condition the implementation of these provisions to the extent federal approvals are obtained and federal financial participation is available.

Your GA Committee and Board will review these bills during their next meetings on July 15. The latest bill matrix can be found here. If you feel strongly about any of the bills on this list, please contact Paul Yoder. 
 

Follow Up to the Inaugural DB Legislative Forum
In addition to the Powerpoint provided in last week's Newsletter, APA also provided many other great advocacy tools as follow up. Please see - and utilize whenever possible! - the following: 

1. Telehealth infographic
2. Collaborative Care infographic
3. Education and Training comparison chart
4. Link to Scope of Practice Webinar
   Access Passcode: APA2021!
5. Link to APA State Model Legislation
6. 988 Advocacy Materials  

PBS Launches Series on Mental Illness
Mysteries of Mental Illness explores the story of mental illness in science and society, tracing the evolution of this complex topic from its earliest days to present times. The four-part series examines the dramatic attempts across generations to unravel the mysteries of mental illness and give voice to contemporary Americans across a spectrum of experiences. It premiered June 22 and 23, 2021. For more information and episodes see here.