NEWSLETTER
Volume 3, Issue 13 - March 31, 2023
Legislation
SB 43 (Eggman) Advances in the Legislature
CSAP's co-sponsored SB 43 (Eggman), which proposes to rewrite California's definition of grave disability, passed through the Senate Health Committee Wednesday afternoon on a 12-0 vote. CSAP Government Affairs Committee (GAC) member Aaron Meyer (SDPS) was one of the two lead witnesses on the bill along with a representative of the National Alliance on Mental Illness (NAMI). You may view the bill presentation by visiting here Senate Health Committee (3/29/23) and advancing to 52:46 on the recording. You may also view SYASL staff notes from the hearing here. Next stop, the Senate Judiciary Committee. 
CSAP Adopts New Bill Positions
Monday night, the Governmental Affairs Committee recommended that CSAP adopt the following bill positions. The CSAP Board is expected to concur as follows:
Support:
AB 456 (Maienschein) Public postsecondary education: campus mental health hotlines
AB 492 (Pellerin) Medi-Cal: reproductive and behavioral health integration pilot programs
AB 564 (Villapudua) Medi-Cal enrollment
AB 1001 (Haney) Health facilities: behavioral health emergency services
AB 1085 (Maienshein) Medi-Cal: housing support services
SB 65 (Ochoa Bogh) Behavioral Health Continuum Infrastructure Program
SB 282 (Eggman) Medi-Cal: federally qualified health centers and rural health clinics
Watch:
AB 459 (Haney) California Behavioral Health Outcomes and Accountability Review
Oppose:
AB 616 (Rodriguez) Medical Group Financial Transparency Act
AB 1316 (Irwin) Emergency services: psychiatric emergency medical conditions
You may view a list of CSAP's tracked legislation, including hearing information, here.
Prescribing
APA Submits Comments to the Drug Enforcement Administration (DEA)
The APA has submitted comments to the DEA on the two proposed rules around telemedicine prescribing of controlled substances (Telemedicine Prescribing of Controlled Substances When the Practitioner and the Patient Have Not Had a Prior In-Person Medical Evaluation & Expansion of Induction of Buprenorphine via Telemedicine Encounter). You may view the letters below.
APA letter to DEA - Telemedicine Prescribing
APA letter to DEA - Expansion of Induction of Buprenorphine via Telemedicine Encounter
Want to comment? There's still time today to do so. It doesn't have to be a treatise, just how this proposed rule could impact you and your patients.
Governor Proposes Mental Health Bond and Changes to the Mental Health Services Act
More details have been released regarding the Administration’s plans to modernize the Mental Health Services Act (MHSA) and to seek bond funding to support behavioral health treatment capacity. The Administration is planning for a November 2024 ballot measure that will include three primary elements:
Address the current shortage of nearly 6,000 behavioral health treatment beds through a $3 to $5 billion general obligation bond to fund behavioral health care expansion in distinct community residential settings:
- Multi-property: unlocked and community-based, campus-like settings with robust onsite supportive services.
- Cottage style: smaller residential settings with access to existing community benefits and services.
- Home-like: Permanent Supporting Housing and Scattered Site Housing, which would include home-like or single units to integrate individuals into the community and offer long-term housing stability.
- Veterans: Some unspecified portion of the bond funds would be used to address housing for homeless veterans.
Propose reforms to the Mental Health Services Act (MHSA) of 2004 to:
- Redirect up to 30 percent annually to pay for housing and other community-based residential solutions and serve as an ongoing source of funding for new and existing housing and residential settings, with a focus on homeless individuals.
- Recast local categorical funding buckets and focus 35% of funding on Full-Service Partnerships and other services for the most seriously ill.
- Require counties to bill Medi-Cal first, prior to MHSA, for reimbursable services.
- Expand target population to include those with substance use disorders.
- Make various changes to county accountability and overall transparency, including (1) paring back the Three-Year County Plan, (2) reducing the “prudent reserve” (from 33% to 20% for large counties and 25% for small counties), and (3) moving the Mental Health Services Oversight Act Oversight and Accountability Commission (MHSAOAC) under CalHHS.
Seek reforms to stabilize and strengthen core behavioral health systems:
- Align behavioral health benefits across all health plans.
- Increase accountability for services provided and outcomes achieved through increased reporting by county behavioral health plans.
The proposals are still in development, and the Administration will be seeking input on how various mechanisms are structured.
Learn More:
- CalHHS Website: More information about the Administration’s policy objectives
- Policy Brief: Understanding California’s Recent Behavioral Health Reform Efforts
- Fact Sheet: Modernizing Our Behavioral Health System
Another interesting development on this front? State wants Medicaid to cover 6 months of rent.
Sacramento and Solano Counties - Update
We continue to highlight this issue. This week, the Sacramento Bee editorialized, "Praying...someone doesn't die": State Must End Rift With Counties in which they concluded "Sacramento and Solano Counties must receive broad financial and administrative support from the state of California and from the Department of Health Care Services if this transition is to be successful. Anything less is a dereliction of duty to mentally ill patients who rely on the state for their care. Thousands of lives are on the line." You can read the entire editorial here.
Parity / Wit vs UBH
Wit vs United Behavioral Health: The Fight Continues
We want to revisit this item as the Mental Health & Autism Insurance Project recently did a great summary of where things are on it:
"...this class action has garnered a huge amount of attention in the mental health, substance abuse, and legal communities. To recap, in this case, Federal Magistrate Joseph Spero issued a 100 plus page ruling against United Health Care for using overly restrictive guidelines to determine medical necessity for mental health residential, intensive outpatient, and outpatient treatments for their members. Magistrate Spero found that United developed their own guidelines for financial interests, and put these interests before those of their consumers." Read more.
2023 CSAP Virtual Lobby Day - Save the Date!
CSAP will be hosting a virtual Lobby Day on Friday, April 21, between 8:30am-1:30pm. So far we have three confirmed speakers: Senators Eggman and Wiener, and Assemblymember Jackson.
More information to come! Please save some time on this upcoming Friday (4/21) to interact with the legislators affecting California's mental health and substance use-related public policy. These Zooms will be open to ALL members of California's five District Branches of the American Psychiatric Association.
CMA
CMA Data Exchange Explainer Series #2 - Data Exchange Policy and Legal Environment
Starting January 31, 2023, the California Health and Human Services Agency (CHHS) is launching the CHHS Data Exchange Framework. Over the next three years, this Framework will require all physician practices in this state to exchange data with other practices, health plans, hospitals, and others. To help physicians prepare for this change, CMA has partnered with CHHS to develop the “CMA Data Exchange Explainer Series.” This series of webinars will walk practices through the various considerations in implementing robust data exchange. This is the second webinar in the series.
Data Exchange Explainer Series:
Register here.
Fed / APA Update
State Funding Opportunity for Collaborative Care Model (CoCM) Funds
APA’s Division of Policy, Programs, and Partnerships held a Zoom meeting March 29 to discuss DB strategies for applying for state funding for CoCM funds. You may view the slides from the meeting here.
As you may be aware, the collaborative care model (CoCM) bill passed as part of the omnibus in December. That legislation authorized an extension of an existing SAMHSA integrated care program, called the Promoting Integration of Primary and Behavioral Health Care Program, to provide funding to states to work with primary care settings to implement the CoCM.
The grant announcement for states to apply for funding was released on March 23rd with the following information:
- applications are due on May 22, 2023
- eligible entities include: states or an appropriate state agency (e.g., state mental health authority, the single state agency for substance abuse services, the State Medicaid agency, or the state health department),
- grants are for up to $2 million with an estimated number of 14 awards given,
- there are two different tracks for these awards: Track 1 awards go to the states to coordinate with community mental health centers, and community health centers to integrate mental health into their programs, and Track 2 awards go to states to partner with primary care practices/providers to implement the CoCM, and
- at least two of these awards will be made to applicants who propose to implement the CoCM, i.e. Track 2.
With the CoCM awards being a new opportunity, APA would like to encourage as many states as possible to show interest. If you have connections with your state mental health agencies, APA asks that you reach out to them to encourage their application for “Track 2” (CoCM) of this new funding opportunity.
State Updates
Grant Opportunities and Opportunities for Public Comment
For SYASL's latest compilation of draft behavioral health regulations and grant opportunities, see here.
Workforce
The CA Alliance and the Catalyst Center are have released a report on the workforce challenges in youth behavioral health. View here.
Worth a Read
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