AB 253
Page 1
Date of Hearing: April 28, 2015
ASSEMBLY COMMITTEE ON HEALTH
Rob Bonta, Chair
ABPCA Bill Id:AB 253
Author:(Roger Hernández) – As Amended Ver:March 26, 2015
SUBJECT: Mental health.
SUMMARY: Makes specified changes to the Mental Health Services Act (MHSA), the Veterans Housing and Homeless Prevention (VHHP) Bond Act of 2014, and the Medi-Cal mental health plan requirements. Specifically, this bill:
1) Requires the California Housing Finance Agency (CalHFA), the Department of Housing and Community Development (HCD), and the Department of Veterans Affairs (CalVet) to give a preference to applicants for VHHP funding for supportive housing projects when the applicant can demonstrate a multiyear commitment of MHSA funding for the applicant’s project funding plan.
2) Requires the Governor to appoint two additional members to the Mental Health Services Oversight and Accountability Commission (Commission) including:
a) A person with knowledge and experience in reducing mental health disparities; and,
b) A veteran with knowledge about veteran’s mental health issues.
3) Requires the Department of Health Care Services (DHCS) to submit the cultural competence plan component for Medi-Cal beneficiaries received by each mental health plan to the Legislature within 30 days of DHCS receiving the plan.
EXISTING LAW:
1) Establishes the MHSA, enacted by voters in 2004 as Proposition 63, to provide funds to counties to expand services, develop innovative programs, and integrated service plans for mentally ill children, adults, and seniors through a 1% income tax on personal income above $1 million.
2) Establishes the Commission to oversee the implementation of MHSA and provides for the following membership requirements for the Commission, appointed by the Governor unless otherwise specified:
a) The Attorney General and his or her designee;
b) The Superintendent of Public Instruction or his or her designee;
c) A member of the Senate selected by the President pro Tempore of the Senate;
d) A member of the Assembly selected by the Speaker of the Assembly;
e) Two persons with a severe mental illness;
f) A family member of an adult or senior with a severe mental illness;
g) A family member of a child who has or has had a severe mental illness;
h) A physician specializing in alcohol and drug treatment;
i) A mental health professional;
j) A county sheriff;
k) A superintendent of a school district;
l) A representative of a labor organization;
m) A representative of an employer with less than 500 employees;
n) A representative of an employer with more than 500 employees; and,
o) A representative of a health care services plan or insurer.
3) Specifies that the MHSA can only be amended by a two-thirds vote of both houses of the Legislature and only as long as the amendment is consistent with and furthers the intent of the MHSA. Permits provisions clarifying the procedures and terms of the MHSA to be added by majority vote.
4) Establishes the VHHP, an initiative measure enacted by the voters in 2014 as Proposition 41, authorizing $600 million in bonds for the acquisition, construction, rehabilitation, and preservation of affordable multifamily supportive housing, affordable multifamily transitional housing, or related facilities for veterans and their families.
5) Requires CalHFA, HCD, and CalVet to work collaboratively to carry out the duties and functions of the VHHP.
6) Provides that DHCS is responsible for the development and implementation of mental health plans for Medi-Cal beneficiaries.
7) Requires mental health plans, whether administered by public or private entities, to be governed by specified guidelines, including providing for culturally competent and age-appropriate services, to the extent feasible.
8) Requires a mental health plan to assess the cultural competency needs of the program and to include a process to accommodate the significant needs with reasonable timeliness.
FISCAL EFFECT: This bill has not yet been analyzed by a fiscal committee.
COMMENTS:
1) PURPOSE OF THIS BILL. According to the author, state and local governments must continue to partner together to further the successes of Proposition 63, especially as it pertains to helping veterans and reducing mental health disparities among California’s diverse communities. Currently, the Commission lacks representation by experts on the challenges that veterans face and reducing mental health disparities.
The author notes that the State must create opportunities to better leverage the investment of Proposition 63 with other voter approved funding sources that share the same policy mission and goals. According to the author, this is especially important as Proposition 41 projects are usually in need of gap financing and service dollars to successfully implement the projects. This concept is similar to how the California Tax Credit Allocation Committee provides competitive scoring and first-priority under the non-profit set-aside for projects with MHSA funds.
The author concludes that it is important that the data and plans submitted by counties to the state regarding their efforts to plan and deliver culturally competent services is shared with the Legislature.
2) BACKGROUND.
a) MHSA. Proposition 63 was passed by voters in November 2004. The MHSA imposes a 1% income tax on personal income in excess of $1 million and creates a 16 member Commission charged with overseeing the implementation of MHSA.
i) Commission. MHSA requires each county mental health department to prepare and submit a three-year plan to DHCS that must be updated each year and approved by DHCS after review and comment by the Commission. In their three-year plans, counties are required to include a list of all programs for which MHSA funding is being requested and that identifies how the funds will be spent and which populations will be served. Counties must submit their plans for approval to the Commission before the counties may spend certain categories of funding.
ii) Funding. The MHSA provides funding for programs within five components:
(1) Community Services and Supports: Provides direct mental health services to the severely and seriously mentally ill, such as mental health treatment, cost of health care treatment, and housing supports. Regulation requires counties to direct the majority of its Community Services and Supports funds to Full‑Service Partnerships (FSPs). FSPs are county coordinated plans, in collaboration with the client and the family to provide the full spectrum of community services. These services consist of mental health services and supports, such as peer support and crisis intervention services; and non‑mental health services and supports, such as food, clothing, housing, and the cost of medical treatment;
(2) Prevention and Early Intervention: Provides services to mental health clients in order to help prevent mental illness from becoming severe and disabling;
(3) Innovation: Provides services and approaches that are creative in an effort to address mental health clients’ persistent issues, such as improving services for underserved or unserved populations within the community;
(4) Capital Facilities and Technological Needs: Creates additional county infrastructure such as additional clinics and facilities and/or development of a technological infrastructure for the mental health system, such as electronic health records for mental health services; and,
(5) Workforce Education and Training: Provides training for existing county mental health employees, outreach and recruitment to increase employment in the mental health system, and financial incentives to recruit or retain employees within the public mental health system.
b) Prop 41. Proposition 41 established the VHHP after its passage in the 2014 primary election. The VHHP restructures $600 million of the $900 million in bonds approved by the voters for the CalVet Home Loan Program in 2008 and uses them instead to fund the acquisition, construction, rehabilitation, and preservation of affordable multifamily supportive housing, affordable multifamily transitional housing, or related facilities for veterans and their families.
The VHHP tasks HCD with administering the new funding program in collaboration with CalVet and explicitly restricts the use of bond proceeds to those housing units designated for veterans and their families. The focus of the program is on housing for veterans who are homeless or at risk for homelessness and in need of services such as mental health counseling, substance abuse treatment, job training, and physical therapy to address injuries. HCD released the first VHHP Program Notice of Funding Availability on February 20, 2015, announcing the availability of approximately $75 million in VHHP funding. The anticipated award date will be in June 2015.
c) Mental Health Plan Requirements. DHCS is responsible for the development and implementation of mental health plans for Medi-Cal beneficiaries. Mental health plans, whether administered by public or private entities, are governed by specified guidelines, including, but not limited to, how a plan will establish appropriate care standards, how a plan will provide specialty mental health services to eligible adults and children, and other requirements. Mental health plans must also assess the cultural competency needs of the program, and must include a process to accommodate the significant needs with reasonable timeliness.
3) SUPPORT. The Steinberg Institute states in support that this bill would expand the expertise of the Commission to include members experienced in reducing mental health disparities in diverse communities, and who specialize in veterans' mental health issues. This bill would also require agencies that share policy goals of providing veteran housing to give priority to applicants that have stable funding from the MHSA. To improve oversight, this bill would ensure that county agencies share their mental health plan's cultural competency section with the legislature within 30 days of receipt by DHCS. Over 25% of veterans suffer from depression, PTSD, and related illnesses, and 54% of those are African American or Latino. Lack of housing and often homelessness can be the cause, or the result, or mental illness. Increasing the availability of veteran housing, in conjunction with giving veterans a voice on mental health plans, offers the best chance for stability and reduced homelessness. This bill ensures that these essential services are provided to those who have served our country.
4) RELATED LEGISLATION. AB 745 (Chau) requires the Governor to appoint an additional member to the Commission who has experience providing supportive housing to persons with a severe mental illness. AB 745 is currently pending in the Assembly Appropriations Committee.
5) PREVIOUS LEGISLATION. AB 639 (Perez), Chapter 727, Statutes of 2013, establishes the VHHP.
6) DOUBLE REFERRAL. AB 253 was also referred to the Committee on Housing and Community Development and passed on a vote of 4-0 on April 15, 2015.
7) POLICY COMMENTS.
a) Concerns Regarding Implementation. This bill requires the departments administering the VHHP to give a preference to applicants for supportive housing projects who can demonstrate a multiyear commitment of MHSA funding for the applicant’s housing project funding plan. A project would have to be approved first by MHSA, which has requirements built in that it is established as a payer of last resort. This may require projects to demonstrate that they've already been declined for funding from the various grants that the federal Veterans Benefits Administration administers, and it is unclear how funder of last resort can approve a project that, in order to be completed, would require funding approval from another source.
Additionally, projects must be intended to broadly serve individuals with mental health disorders. After a project is approved for MHSA funding, it must then go to VHHP, which has a different set of project requirements. VHHP funds must be used to fund the acquisition, construction, rehabilitation, and preservation of affordable supportive housing; funds are not permitted to be spent on direct services to individuals. The VHHP program funding requirements are evaluated with a scoring rubric, a rubric that already includes consideration of projects that leverage public (federal, state, and local), private, and nonprofit program and fiscal resources and prioritizes projects that combine housing and supportive services, including. While encouraging the use of MHSA funds for VHHP supportive housing services is understandable, the actual implementation may be more onerous and difficult than intended.
b) Mental Health Plan Requirements. This bill requires DHCS to submit the cultural competence plan component of each mental health plan to the Legislature within 30 days of receipt. Mental health plans have a number of requirements as previously discussed. These requirements are separate from the implementation plans that counties must complete to comply with MHSA requirements. It is unclear how requiring DHCS to submit the cultural competency component of the plan to the legislature meets the stated goals of the bill by the author. The committee recommends removing the requirement that the cultural competency plans be submitted to the legislature, and instead require that DHCS post them on a dedicated web page.
c) MHSA Expansion. AB 745, a bill that passed out of the Assembly Health Committee on April 21, 2015, also expands the Commission by one individual. These bills will need to be reconciled later in the legislative process. While adding diversity to the Commission is good, it may become too large for Commissioners to be able to fulfill its initial charge of overseeing the implementation of the MHSA.
REGISTERED SUPPORT / OPPOSITION:
Support
Steinberg Institute (sponsor)
American Legion-Department of California
AMVETS, Department of California
California Association of County Veteran Service Officers
California Association of Veteran Service Agencies
California Military Officer Association of America
California State Commanders Veterans Council
Racial and Ethnic Mental Health Disparities Coalition
VFW- Department of California
Vietnam Veterans of America – California State Council
Opposition
None on file.
Analysis Prepared by: Paula Villescaz / HEALTH / (916) 319-2097