NEWSLETTER
Volume 3, Issue 16 - April 21, 2023
CSAP Advocacy Day
CSAP held a virtual lobby day today. Participants heard from Senators Susan Eggman and Scott Wiener, Assemblymember Corey Jackson, and Stephanie Welch, Deputy Secretary of Behavioral Health with the California Health and Human Services Agency. All four discussions were interactive and informative - and all five District Branches were represented (as was APA!). There will be more opportunities like this later in 2023, i.e., CSAP will not restrict itself to just one day of advocating directly with Sacramento policymakers. Here's a screen shot from the Zoom with Senator Eggman (third row, far left). We hope more of you can join future opportunities like this!
Senator Eggman and her team briefed us on discussions over SB 43 with the Senate Judiciary Committee in preparation for the hearing on April 25. While there have been concerns from the committee about packaging the grave disability redefinition with the hearsay language, Senator Eggman's team was able to convey the way these issues can be intricately woven and both critical to making real progress.
Both Senators Eggman and Weiner, heard our concerns regarding the current lack of support for secure mental health beds in the Mental Health Services Act (MHSA) realignment. We expressed that the need for secure beds has been dire and will only grow with passage of SB 43. They both expressed their understanding and commitment to providing adequate placements for our most vulnerable patients. Both Senators are aware of the barriers to care imposed by the IMD exclusion. They learned from us about the strict diagnostic limitations imposed on MediCal payments which are consistently used to deny paying for our patient's care. They directed their staff to work with us on this issue.
Senator Weiner confirmed his commitment to mental health parity with all health care and will consider adding language regarding mental health care in SB 770 which will allow California to position itself to establish a unified healthcare financing.
Deputy Secretary of Health and Human Services, Stephanie Welch provided an overview of the 988 Mental Health Continuum of Care report that will be coming out soon. Also, her office is hard at work putting together the specifics regarding Governor Newsom's MHSA realignment. In addition to designating funds for supportive housing, this realignment is intended to improve fiscal accountability of the counties, establish more consistent utilization of evidence-based practices, and aid counties in pulling down MediCal funds more appropriately.
Assemblymember Jackson is the chair of the Assembly Human Services Committee and recently established a Select Committee on Mental Health. His goal with this committee is to focus on rapid changes that could drastically improve the lives of our patients now. For instance, he is working on lowering barriers to receiving MH care at FQHCs by allowing for multiple encounters on the same day and removing pre-authorization requirements for emergency mental health services. Importantly, he learned about the stimulant shortage and psychotropic medication prescribing issues affecting our patients and is going to work with us to take immediate action in contacting federal agencies. In addition, he heard our suggestions and said he would direct staff to invite CSAP to speak at an upcoming Select Committee hearing. Within hours of this commitment, staff followed up with CSAP with an invitation to provide a panelist in the hearing, which will be May 2nd from 10 a.m. to Noon. CSAP will participate in the "Perspectives From the Field" panel. FYI, Cal-ACAP has also been invited to speak on another panel the same day. Stay tuned for more!
Legislation
CSAP sponsored AB 29 (Gabriel) Firearms: California Do Not Sell List is now on the Assembly Appropriations Suspense file. The Suspense File is for any bill with an annual cost of more than $150,000 (any fund). Suspense File bills are all considered at one hearing after the state budget has been prepared and the committee has a better sense of available revenue. No testimony is presented – author or witness – at the Suspense File hearing. The Senate and the Assembly will hold their first of two Suspense File hearings on Thursday May 18. With the state budget predicted to be in a deficit this year, SYASL expects more bills may be held on suspense this year than have been the last two years when the state was enjoying a surplus of funds, hopefully AB 29 will not be one of them.
SB 43 (Eggman) as mentioned above, SB 43 is set for hearing in the Senate Judiciary Committee on April 25. CSAP's Governmental Affairs Committee Chairwoman Dr. Emily Wood will be testifying on behalf CSAP. FYI, the California Behavioral Health Directors Association (CBHDA) recently changed its position on SB 43 from Oppose to Concerns. You may view their new letter here.
SB 363 (Eggman), the real time bed database bill, will be heard in the Senate Appropriations Committee on April 24.
SB 372 and SB 373 (Menjivar) passed out of the Senate Judiciary Committee this week and are heading to the Appropriations Committee. Paul Yoder of SYASL was one of the two lead witnesses on SB 372. Regarding SB 373, there has been an unfortunate turn of events that we will expand on next week.
This week, the CSAP Governmental Affairs Committee recommended, and the Board concurred, on new bill positions as follows:
AB 360 (Gipson) Excited delirium - Support
AB 1110 (Arambula) Public health: adverse childhood experience (Fact sheet) - Support
AB 1282 (Lowenthal) Mental Health: impacts of social media - Support
AB 1450 (Jackson) Universal screenings; ACES - Support
AB 1557 (Flora) Pharmacy: electronic prescriptions (Fact sheet) - Support
AB 1697 (Schiavo) E-signatures for Medical Information Sharing (Fact sheet) - Support
SB 524 (Caballero) Pharmacists: testing and treatment (Fact Sheet) - Oppose
You may view a list of all of CSAP's tracked legislation here.
Fentanyl
Governor Announces Public Safety Partnership in SF
In a new partnership with the City of San Francisco, Governor Newsom is directing California Highway Patrol and California National Guard to identify personnel and resources to assist the city in combatting fentanyl trafficking — strengthening law enforcement presence and public safety. Read more here.
Fentanyl Bill Package
Republicans in both houses of the Legislature raised a ruckus about many public safety related bills, especially ones pertaining to fentanyl, being held in the Assembly Public Safety Committee, which is chaired by Assemblyman Jones-Sawyer. The press had a field day with it. As a result, the Assembly passed a rule waiver to allow the Assembly Public Safety Committee to hold a special hearing to hear the following set of fentanyl-related bills on April 27. You can read and watch more here. We will let you know how this progresses.
AB 33 (Bains) Fentanyl Addiction and Overdose Prevention Task Force
AB 367 (Maienschein) Controlled substances: enhancements
AB 675 (Soria) Controlled substances
AB 955 (Petrie-Norris) Controlled substances
AB 1058 (Patterson) Controlled substances: fentanyl
MHSA Modernization
The California State Association of Counties (CSAC) has released its Board-approved Mental Health Services Act (MHSA) County Priorities, which were developed through the efforts of CSAC’s MHSA Working Group in 2019-2020. You may view them here.
Stay tuned early next week for a Special Edition that will contain a new and lengthy narrative from the Newsom Administration on the Governor's proposal as well as a FAQ.
Sacramento and Solano Counties - the Saga Continues
As we have reported, over the past several years, the Department of Health Care Services has endeavored to transition coverage of Specialty Mental Health Services (SMHS) in Sacramento and Solano Counties from Kaiser Permanente to the counties respective mental health plans by July 1, 2023. In a letter dated March 1, 2023, the Department requested both counties to provide a commitment that they would meet the expected July 1, 2023 transition date by March 15, 2023. The Counties responded with a letter in which they did not commit to the July 1, 2023 transition date. The Counties later verbally informed DHCS they would not meet the July transition date.
Since the two counties are at risk of not meeting their obligations to provide SMHS effective July 1, 2023, Medicaid funds are at risk absent DHCS action to facilitate SMHS provision through alternative arrangements. Pursuant to Government Code section 30027.10, DHCS has notified the Controller and the Department of Finance as to this determination and requested a deposit of $2,921,318.15 from Sacramento and $763,475.20 from Solano Counties’ allocations from the Behavioral Health Subaccount of Realignment into the County Intervention Support Services Subaccount. As authorized by the above referenced statute, this amount is to be used by DHCS to provide SMHS to the affected Medi-Cal members in the respective counties at the level required to fully obtain federal funds for the upcoming coverage period commencing July 1, 2023 through December 31, 2023. DHCS will direct the Controller to deposit additional funds from the Behavioral Health Subaccount into the County Intervention Support Services Subaccount for a future coverage period after December 31, 2023 if the Counties continue to not meet their obligations to provide SMHS.
Please see below notification provided to the Counties, Department of Finance, and Controller.
April 18 DHCS letter to DOC (Solano)
April 18 DHCS Letter to Solano County
April 18 DHCS Letter to Controller (Solano)
April 18 DHCS Letter to DOF (Sacramento)
April 18 DHCS Letter to Sacramento County
April 18 DHCS Letter to Controller (Sacramento)
Sacramento and Solano Counties continue to press their case with the Legislature. We will keep you posted.
Prescribing / DEA
The American Academy of Child and Adolescent Psychiatry (AACAP) and the American Psychiatric Association (APA) sent a joint letter to the DEA to "gain insight about the actions the DEA is taking to improve the nation’s supply of stimulant medications, and to request a time to meet with you or members of your staff to discuss ways to address this situation." You may read the full letter here.
As mentioned above, one of the outcomes from today's advocacy meetings will hopefully be support from key California legislators for corrective and immediate action in Washington D.C.
CARE Court
On Wednesday, the State Supreme Court declined to block Governor Newsom's CARE Act. You can read an article from the San Francisco Chronicle here.
CMA
CMA sponsored prior authorization bill clears Senate Health Committee
The CMA sponsored bill to reform the prior authorization process - supported by CSAP - passed out of Senate Health Committee on April 12. The bill - Senate Bill 598, authored by Senator Nancy Skinner - would require health plans to institute a one-year “gold card” prior authorization exemption for physicians who are practicing within the plan’s criteria 90% of the time. Read more.
Whether or Not to Tap State Reserves to Solve Estimated Budget Problem
California has approximately $25 billion in reserves. Should the reserves be tapped to stave off even worse cuts to programs, and - if so - to what extent, continues to be debated in Sacramento. This week, the State's Legislative Analyst's Office released a short note on this topic: Whether or Not to Tap Reserves to Solve Estimated Budget Problem Emerges as Key Fiscal Decision Facing California’s Legislature.
Grants and Opportunities for Comment
For SYASL's latest compilation of draft behavioral health regulations and grant opportunities, see here.
CALACAP Spring Advocacy Day
You are invited to join CALACAP, Children Now, the National Alliance on Mental Illness (NAMI) of California, and California Alliance of Child and Family Services for their 2023 Children's Mental Health In-Person Spring Advocacy Day on Monday, May 15th, in Sacramento. The meeting is scheduled for 9:30 am to 5:00 pm PDT and will be held at the Secretary of State Offices.
This is a chance to join your fellow mental health community members to discuss important issues with State legislators and their staff. It also serves as a great opportunity to combine your voice with the voices of people from other organizations to support common legislative goals. CALACAP, Children Now, the National Alliance on Mental Illness (NAMI) of California, and California Alliance of Child and Family Services offer $500 reimbursement stipend to medical students, residents and fellows. For questions, please contact CALACAP at 800-549-8495 or info@calacap.org
Worth a Read
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