NEWSLETTER 
Volume 3, Issue 14 - April 7, 2023

Legislation

The Legislature will return from Spring Recess on Monday, April 10. Policy committees will be in full swing as legislators work to get their bills heard before the Policy Committee deadline in May. Here is a glance at where CSAP's sponsored and co-sponsored bills are in the legislative process: 

Governor's Proposal to Revamp the MHSA

Webinar Offers Additional Details on Governor’s Proposed 2024 Ballot Measure to Reform MHSA and Expand Behavioral Health and Housing Capacity

On March 29, representatives from the California Health and Human Services Agency (CalHHS) and the Department of Health Care Services (DHCS) hosted a webinar to share more information about the Governor’s plan to pursue a November 2024 ballot measure to modernize the Mental Health Services Act (MHSA) and to seek bond funding to both expand behavioral health treatment capacity as well as offer new housing options with a particular focus on homeless veterans. This webinar included slides. We are grateful to our colleagues with the Urban Counties Caucus who provided this accounting of the webinar:

"In response to a question regarding the characteristics of the new behavioral health facilities conceived under the proposed bond, the state made clear that these would be unlocked, community-based facilities. The intention is to ensure that models from the past (i.e., institutional settings) are not replicated; instead, the state is looking to build out safe, rehabilitative environments that help transition individuals with behavioral health treatment needs from intensive care to other types of settings to allow for time to heal. These will be voluntary, high-quality settings that will prepare a recovery pathway for those in treatment, including transition to permanent supportive housing.

Additionally, when asked to estimate the number of facilities in total and the number of facilities by each setting type (1. Multi-property, campus settings; 2. Cottage settings; and 3. Home settings – i.e., permanent supportive housing or scattered sites) that would be built through bond proceeds, the state indicated it was still giving thought to those questions. State officials consistently hear from communities across the state that they need more behavioral health treatment options, especially to address the needs of those who are transitioning from one level of care to another so that is how the bond – broadly speaking – will be focused.

No specific language – beyond the more detailed outline of the Governor’s proposed ballot measure as presented in the webinar slides – has yet to surface. With a November 2024 ballot timeline, the Administration is not under immediate pressure to unveil a specific statutory approach. We do anticipate that the effort to modernize the MHSA and seek bond funding for treatment and housing capacity will be achieved through the legislative rather than signature gathering process. In the meantime, the Administration appears open to feedback and questions."
 

CARE Court 

The Judicial Council of California (JCC) has released its draft Rules and Forms on CARE. These will be discussed at an upcoming April 13, 2023 meeting, and voted on (finalized) at the JCC's May 11-12 meeting.
 

Assemblymember Akilah Weber Announces Campaign for Senate 

Senator (and pro Tempore of the Senate) Toni Atkins will soon be termed out of the Legislature. It was assumed that San Diego County Supervisor Nathan Fletcher would not only run but be the frontrunner to replace her. However, there has been quite a turn of events on this and it now seems highly unlikely that Fletcher will run. This has prompted Assemblymember Dr. Akilah Weber to announce her intention to run for State Senate District 39 in the March 5, 2024 primary. If she wins, it would make her the only doctor in the Senate. You may read the announcement here. 
 

CMA

DEA Publishes Guidance on New Training Requirements for Prescribers of Controlled Substances

"On March 28, 2023, the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) released recommendations and the U.S. Drug Enforcement Administration (DEA) issued specific guidance on how practitioners can meet the new training requirements for DEA-registered prescribers of controlled substances. 

The new law requires all prescribers of schedule II – V controlled substances to meet a one-time eight-hour training requirement on identifying, treating, and managing patients with opioid or other substance use disorders. Many California-licensed physicians may have already met the new DEA requirements because California requires similar education.

Physicians who are board certified in addiction medicine or addiction psychiatry are exempt from the DEA requirements, as are physicians who received similar training in medical school in the five years prior to June 27, 2023. X-Waiver training also counts. CMA recommends that physicians new to California or new physicians who have yet to complete the California mandated CME ensure that future courses they take meet both California’s 12-hour and DEA’s 8-hour requirements to avoid having to take 20 total hours of CME.

While the California Medical Association (CMA) did not support the new DEA mandate, we worked to ensure that California physicians—who are already required to complete 12 hours of one-time continuing medical education (CME) in pain management and the treatment of terminally ill and dying patients, or the treatment and management of opioid-dependent patients—can use all or some of our  state-mandated CME to satisfy the DEA requirements.

The DEA guidance states that “past trainings on the treatment and management of patients with opioid or other substance use disorders can count towards a practitioner meeting this requirement.” If you received a relevant training from one of the accredited groups listed in the DEA guidance (see page 2)—even if it was completed prior to the enactment of the new law on December 29, 2022—that training can be counted toward the new DEA requirement. 

For more than 20 years, California law has required all licensed physicians to complete a one-time 12-hours of CME in pain management and the treatment of terminally ill and dying patients. These courses must include the risk of addiction associated with the use of Schedule II drugs. In 2019, a new law took effect allowing physicians to also fulfill the pain management CME requirement by completing a one-time CME course of 12 credit hours on the treatment and management of opioid-dependent patients.  (For more information on California’s CME requirements, see the Medical Board of California website.)

Because the California-mandated CME provides education specifically in pain management, opioid use disorders or Schedule II drug addiction risk, CMA believes that some of the California CME that physicians have completed to meet state requirements will also meet the new DEA requirements, as long as it was provided by an accredited organization listed in the DEA guidance. Physicians must determine whether their past accredited training was similar and only need to attest to having completed such education and training on the DEA registration application or renewal form.

The program takes effect on June 27, 2023. Physicians applying for a new DEA registration after June 27, must meet the training requirements upon submission of their application. For physicians who already have a DEA license, you must complete the required training or attest to having completed past training by the next time you renew your DEA license."
 

Fed / APA

APA on the Benefits of Pets

State Updates

CYBHI March 2023 Stakeholder Update

You may view the FW: CYBHI March 2023 Stakeholder Update here. 

Grant Opportunities and Opportunities for Public Comment 

For SYASL's latest compilation of draft behavioral health regulations and grant opportunities, see here. 
 

Workforce 

California’s Department of Health Care Access and Information (HCAI) is issuing more than $150 million in grants to bolster the health care workforce: $117.7 million in grants to support the behavioral health providers at 134 nonprofit Community-Based Organizations (CBOs) across California; and a $33.7 million award to the California Social Work Education Center (CalSWEC), administered by the University of California at Berkeley to 892 students pursuing careers in social work. Read more here. 
 

Worth a Read

• California’s Nutrition Safety Net
• Man ends his life after an AI chatbot 'encouraged' him to sacrifice himself to stop climate change
• The public perception that California’s homelessness crisis is caused by psychiatric emergencies and drug addiction is a false one.
• State has safety net for Medi-Cal enrollees facing loss of benefits 
• As pandemic-era aid ends, millions poised to lose Medicaid 
• California bill to make it easier to place people on psychiatric holds advances
• Mental health funding changes may cut services
• Oregon and California look for answers as homelessness overlaps mental health and addiction
• L.A. County steps up efforts to recruit more mental health workers