Existing law, the Mental Health Services Act (MHSA), an initiative measure enacted by the voters as Proposition 63 at the November 2, 2004, statewide general election, establishes the Mental Health Services Oversight and Accountability Commission. Existing law requires the State Department of Health Care Services, in consultation with the Mental Health Services Oversight and Accountability Commission and the County Behavioral Health Directors Association of California, to develop and administer instructions for the Annual Mental Health Services Act Revenue and Expenditure Report, which gathers specified information on mental health spending as a result of the MHSA, including the expenditures of funds distributed to each county.

This bill would require the department, based on the Annual Mental Health Services Act Revenue and Expenditure Report, to compile information, in total and by county on an annual basis, that includes, among other things, the total amount of MHSA revenue, the amount of MHSA money received and expended for each specified component of the MHSA program, and the amount of MHSA money spent on program administration. The bill would require the department to make the collected information available to the Legislature and the public on its Internet Web site no later than July 1, 2018, and annually thereafter.

Existing law, the Mental Health Services Act (MHSA), an initiative measure enacted by the voters as Proposition 63 at the November 2, 2004, statewide general election, establishes the Mental Health Services Oversight and Accountability Commission. Existing law requires the State Department of Health Care Services, in consultation with the Mental Health Services Oversight and Accountability Commission and the County Behavioral Health Directors Association of California, to develop and administer instructions for the Annual Mental Health Services Act Revenue and Expenditure Report, which gathers specified information on mental health spending as a result of the MHSA, including the expenditures of funds distributed to each county.

This bill would require the department, based on the Annual Mental Health Services Act Revenue and Expenditure Report, to compile information, in total and by county on an annual basis, that includes, among other things, the total amount of MHSA revenue, the amount of MHSA money received and expended for each specified component of the MHSA program, and the amount of MHSA money spent on program administration. The bill would require the department to make the collected information available to the Legislature and the public on its Internet Web site no later than July 1, 2018, and annually thereafter.

Existing law, the Mental Health Services Act (MHSA), an initiative measure enacted by the voters as Proposition 63 at the November 2, 2004, statewide general election, establishes the Mental Health Services Oversight and Accountability Commission. The act Existing law requires the State Department of Health Care Services, in consultation with the Mental Health Services Oversight and Accountability Commission and the County Behavioral Health Directors Association of California, to develop and administer instructions for the Annual Mental Health Services Act Revenue and Expenditure Report, which gathers specified information on mental health spending as a result of the MHSA, including the expenditures of funds distributed to each county.

This bill would require the department, based on the Annual Mental Health Services Act Revenue and Expenditure Report, to compile information, in total and by county on an annual basis basis, that includes includes, among other things, the total amount of MHSA revenue, a county-by-county comparison of fund expenditure plans and annual updates, and a county-by-county comparison of the purposes for which MHSA funds were expended and to send that information to the commission. The bill would require the commission to make the information available to the public on the commissions Internet Web site and to update the Internet Web site annually. the amount of MHSA money received and expended for each specified component of the MHSA program, and the amount of MHSA money spent on program administration. The bill would require the department to make the collected information available to the Legislature and the public on its Internet Web site no later than July 1, 2018, and annually thereafter.

Existing law, the Mental Health Services Act (MHSA), an initiative measure enacted by the voters as Proposition 63 at the November 2, 2004, statewide general election, establishes the Mental Health Services Oversight and Accountability Commission. The act requires the State Department of Health Care Services, in consultation with the Mental Health Services Oversight and Accountability Commission and the County Behavioral Health Directors Association of California, to develop and administer instructions for the Annual Mental Health Services Act Revenue and Expenditure Report, which gathers specified information on mental health spending as a result of the MHSA, including the expenditures of funds distributed to each county.

This bill would require the department, based on the Annual Mental Health Services Act Revenue and Expenditure Report, to compile information on an annual basis that includes the total amount of MHSA revenue, a county-by-county comparison of fund expenditure plans and annual updates, and a county-by-county comparison of the purposes for which MHSA funds were expended and to send that information to the commission. The bill would require the commission to make the information available to the public on the commissions Internet Web site and to update the Internet Web site annually.

GOVERNOR'S VETO

GV Bill Id:AB 2279

Author:(Cooley)

As Enrolled Ver:August 30, 2016

2/3 vote

Original Committee Reference: HEALTH

SUMMARY: Requires the Department of Health Care Services (DHCS) to develop and administer instructions for the compilation of revenue and expenditure information related to the Mental Health Services Act (MHSA) by counties, in consultation with the Mental Health Services Oversight and Accountability Commission and the County Behavioral Health Directors Association of California, as specified, and permits DHCS to withhold MHSA funds from counties that do not submit the Annual MHSA Report until the reports are submitted.

FISCAL EFFECT: According to the Senate Appropriations Committee, ongoing costs of $240,000 per year to compile information submitted by counties, create comparisons of county-by-county expenditures, and develop the required reports by DHCS.

COMMENTS: According to the author, counties are required to report information to DHCS annually about local programs, expenditure plans and how MHSA funds were spent. While some counties make annual reports available to the public on their own Web sites, currently there is no complete state-wide financial picture of how much MHSA revenue is generated annually. The author argues that the absence of a single repository for this information makes it difficult for taxpayers, mental health advocates, and consumers to see which mental health programs are available and how MHSA funds are spent county-by-county and state-wide. This information would make it easier for providers to identify best practices and for consumers to compare services to identify programs that best address their needs.

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 the 16 member Commission charged with overseeing the implementation of MHSA. The 2015-16 Governor's Budget projected that $1.776 billion would be deposited into the Mental Health Services Fund in fiscal year (FY) 2015-16. The MHSA addresses a broad continuum of prevention, early intervention and service needs as well as provided funding for infrastructure, technology and training needs for the community mental health system. In addition to local programs, the MHSA authorizes up to 5% of revenues for state administration. These include administrative functions performed by a variety of state entities such as the DHCS and Office of Statewide Health Planning and Development (OSHPD). It also funds evaluation of the MHSA by the Commission, which was established by the MHSA.

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.

The most recently available MHSA Report discusses expenditures for FY 2015-16 and is available on the DHCS website, but not on the Commission Web site. The MHSA Report includes an explanation of estimated revenues, general MHSA Fund expenditures to counties in the aggregate and to OSHPD, and a detailed summary of how the funds set aside for program administration were allocated to 14 different state agencies and departments.

The National Association of Social Workers – California Chapter supports this legislation because it will increase transparency regarding how MHSA funds are spent. California Chapter of the American College of Emergency Physicians states that without adequate analysis of the effectiveness of MHSA programs, there is no guarantee that people with mental illness are receiving adequate treatment. County-by-county comparisons of MHSA program would be an important step toward determining the most effective programs and increasing access to mental health services. The Steinberg Institute states, in support, that the current lack of timely and accessible reporting does not align with the principles set forth in Prop 63.

There is no known opposition to this bill.

GOVERNOR'S VETO MESSAGE:

I am returning Assembly Bill 2279 without my signature.

This bill requires the Department of Health Care Services to annually compile and publicly report financial data and program information from counties on their Mental Health Services Act expenditures.

The department is already in the process of collecting and posting county revenue and expenditure reports as well as updated three year program expenditure plans, which will provide much of the information outlined in this bill. I encourage the Legislature and interested stakeholders to continue to work with the department to identify useful information that can be integrated into the existing reports to improve transparency and accountability in the use of these funds.

Analysis Prepared by: Paula Villescaz / HEALTH / (916) 319-2097 FN: 0005050

CONCURRENCE IN SENATE AMENDMENTS

CSA1 Bill Id:AB 2279

Author:(Cooley)

As Amended Ver:August 15, 2016

Majority vote

Original Committee Reference: HEALTH

SUMMARY: Requires the Department of Health Care Services (DHCS) to annually compile county revenue and expenditure information related to the Mental Health Services Act (MHSA) based on the existing Annual Mental Health Services Act Revenue and Expenditure Report (Annual MHSA Report) and requires the information compiled to be made available by DHCS to the Mental Health Services Oversight and Accountability Commission (MHSOAC), and requires the Commission to make the information publicly available online.

The Senate amendments

1. Require DHCS to develop and administer instructions for the compilation of information for the Annual MHSA Report by counties, in consultation with the MHSOAC and the County Behavioral Health Directors Association of California and require the instructions to include county certification of the accuracy of the report.
2. Require the Annual MHSA Report to be submitted electronically to DHCS and to the MHSOAC and require DHCS to annually post each county's report on its website in a timely manner.
3. Specify that the purpose of the Annual MHSA Report is to identify the expenditures of MHSA funds that were distributed to each county, quantify the amount of additional funds generated for the mental health system, and determine reversion amounts, if applicable, from prior fiscal year distributions.
4. Specify that the intent of the Annual MHSA Report is to provide information that allows for the evaluation of children's systems of care, prevention and early intervention strategies, innovative projects, workforce education and training, adults and older adults systems of care, and capital facilities and technology needs.
5. Require DHCS, no later than nine months after the end of each fiscal year, based on the Annual MHSA Report, to collect and publicly report, by county level, the total revenue received from MHSA and the amount of MHSA funds received for each individual components of the act, as specified. Require this information to be reported for each fiscal year, include statewide totals, and to be updated annually.
6. Permit counties to submit to DHCS information about programs that address homelessness, criminal justice diversion or related programs, suicide prevention, school-based mental health programs designed to reduce school failure, employment or other programs intended to reduce unemployment, and other information as specified.
7. Require DHCS to compile the information collected from counties or other local mental health agencies to promote public understanding of MHSA funds that are distributed statewide and for each county, as well as how those funds are spent and what funds remain available for expenditure.
8. Require DHCS to consolidate reporting requirements when feasible and to propose to the appropriate policy committees of the Legislature strategies to refine and consolidate reporting requirements.
9. Require DHCS to make information related to the Annual MHSA Report available on its internet website no later than July 1, 2018.
10. Permit DHCS to withhold MHSA funds from counties that do not submit the Annual MHSA Report until the reports are submitted.

FISCAL EFFECT: According to the Senate Appropriations Committee, ongoing costs of $240,000 per year to compile information submitted by counties, create comparisons of county-by-county expenditures, and develop the required reports by DHCS.

COMMENTS: According to the author, counties are required to report information to DHCS annually about local programs, expenditure plans and how MHSA funds were spent. While some counties make annual reports available to the public on their own Web sites, currently there is no complete state-wide financial picture of how much MHSA revenue is generated annually. The author argues that the absence of a single repository for this information makes it difficult for taxpayers, mental health advocates, and consumers to see which mental health programs are available and how MHSA funds are spent county-by-county and state-wide. This information would make it easier for providers to identify best practices and for consumers to compare services to identify programs that best address their needs.

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 the 16 member Commission charged with overseeing the implementation of MHSA. The 2015-16 Governor's Budget projected that $1.776 billion would be deposited into the Mental Health Services Fund in fiscal year (FY) 2015-16. The MHSA addresses a broad continuum of prevention, early intervention and service needs as well as provided funding for infrastructure, technology and training needs for the community mental health system. In addition to local programs, the MHSA authorizes up to 5% of revenues for state administration. These include administrative functions performed by a variety of state entities such as the DHCS and Office of Statewide Health Planning and Development (OSHPD). It also funds evaluation of the MHSA by the Commission, which was established by the MHSA.

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.

The most recently available MHSA Report discusses expenditures for FY 2015-16 and is available on the DHCS website, but not on the Commission Web site. The MHSA Report includes an explanation of estimated revenues, general MHSA Fund expenditures to counties in the aggregate and to OSHPD, and a detailed summary of how the funds set aside for program administration were allocated to 14 different state agencies and departments.

The National Association of Social Workers – California Chapter supports this legislation because it will increase transparency regarding how MHSA funds are spent. California Chapter of the American College of Emergency Physicians states that without adequate analysis of the effectiveness of MHSA programs, there is no guarantee that people with mental illness are receiving adequate treatment. County-by-county comparisons of MHSA program would be an important step toward determining the most effective programs and increasing access to mental health services. The Steinberg Institute states, in support, that the current lack of timely and accessible reporting does not align with the principles set forth in Proposition 63.

There is no known opposition to this bill.

Analysis Prepared by: Paula Villescaz / HEALTH / (916) 319-2097 FN: 0004164

 THIRD READING  

Bill No: AB 2279

Author:

:

Vote:

SENATE HEALTH COMMITTEE: 9-0, 6/22/16

AYES: Hernandez, Nguyen, Hall, Mitchell, Monning, Nielsen, Pan, Roth, Wolk

SENATE APPROPRIATIONS COMMITTEE: 7-0, 8/11/16

AYES: Lara, Bates, Beall, Hill, McGuire, Mendoza, Nielsen

ASSEMBLY FLOOR: 80-0, 5/31/16 - See last page for vote

SUBJECT:

SOURCE: Author

DIGEST: This bill requires the Department of Health Care Services, in consultation with specified entities, to collect and publicly report specified information related to Mental Health Services Act revenue and expenditures, based on the current annual reporting requirement.

ANALYSIS:

Existing law:

1. Establishes the Mental Health Services Act (MHSA), enacted by voters in 2004 as Proposition 63, which provides funds to counties to expand services and develop innovative programs and integrated service plans for mentally ill children, adults, and seniors through a one percent income tax on personal income above $1 million to be deposited to the Mental Health Services Fund (MHSF), administered by the Department of Health Care Services (DHCS).
2. Establishes the Mental Health Services Oversight and Accountability Commission (OAC) to oversee the implementation of the MHSA.
3. Requires each county mental health program to prepare and submit a three-year program and expenditure plan, with annual updates, adopted by the county board of supervisors, to the OAC within 30 days after adoption. Requires the plan to include, among other things, programs for services to adults and seniors.
4. Requires DHCS, in consultation with the OAC and the County Behavioral Health Directors Association of California, to develop and administer instructions for the Annual MHSA Revenue and Expenditure Report, including identifying the expenditure of funds, quantifying the amount of additional funds generated for the mental health system, identifying unexpended funds and interest earned on funds, and determining reversion amounts from prior fiscal year distributions.

This bill:

1. Requires DHCS, based on the Annual MHSA Revenue and Expenditures Report, to collect and publicly report, no later than nine months after the end of each fiscal year, the following information, by statewide total and by individual county:
   1. Total revenue received from the MHSA;
   2. The amount of MHSA funds received by counties for each of the following components:
      1. Community services and supports;
      2. Prevention and early intervention;
      3. Innovation;
      4. Housing that is not funded under i) above;
      5. Workforce education and training not funded under i) above;
      6. Capital facilities and technological needs not funded under i) above; and,
      7. Other mental health services not reflected in i) through vi) above, inclusive.
   3. MHSA revenues expended in the prior fiscal year;
   4. The amount of MHSA funds expended by counties for each of the components in b) above;
   5. Funds held in prudent reserve by each county;
   6. Distributions from the counties’ prudent reserves;
   7. For the most recent fiscal year, the amount of unspent MHSA funds for each component listed in b) above; and,
   8. MHSA funds subject to reversion and funds that have reverted.
2. Requires the information specified in 1) above to be reported for each fiscal year and to include statewide totals. Requires the information to be updated annually, including necessary revisions, as specified. Requires annual reports to include fiscal information for a period of not less than 10 fiscal years, as specified.
3. Requires DHCS also to report publicly annual county program expenditures for program administration, research and evaluation, and funds used to support joint powers authorities and other statewide entities. Requires a county to provide an explanation if it cannot supply some or all of this information, and to provide a timeframe for making the information available. Requires DHCS to work with counties and other specified entities to determine how best to make this information available, as specified.
4. Allows counties to submit to DHCS information about programs that address areas that include, but are not limited to, homelessness, criminal justice diversion, suicide prevention, school-based mental health programs, programs to reduce unemployment, stigma reduction, and programs targeted to meet the needs of populations, including veterans; Lesbian, Gay, Bisexual, Transgender, Queer, and Questioning; children and transition-age youth; and adults and older adults.
5. Requires DHCS to compile the information required in 1) through 4) above to promote public understanding of MHSA funds that are distributed statewide to each county, as well as how the funds are spent and what funds remain available for expenditure. Requires DHCS to consult with the OAC, the State Controller’s Office, the Department of Finance, counties, other local mental health agencies, and any other agency required to implement the provisions in this bill.
6. Requires DHCS to consolidate reporting requirements when feasible and to propose to the appropriate policy committees of the Legislature strategies to refine and consolidate reporting requirements.
7. Requires DHCS to make the information available to the Legislature and the public on its Internet Web site no later than July 1, 2018, and annually thereafter.

Comments:

1. Author’s statement. According to the author, the Centers for Disease Control and Prevention and the National Institute of Mental Health report that 4.2% of Americans ages 18 and older suffer from serious mental illness and 26.2% suffer from a diagnosable mental disorder. In 2004, the California voters passed the MHSA, which aimed to address serious mental illness, create prevention and intervention programs, and spur innovation to identify best practices to treat and prevent mental illness. The MHSA created a revenue source to fund programs and determined that local and state oversight was necessary to ensure accountability to the public. Currently, there is no single repository with county-by-county and state-wide information about how MHSA funds are spent. The lack of information made available to the public makes it difficult for consumers to compare services to identify programs that best address their needs, for county programs to identify best practices, and to ensure effective oversight and accountability to the public. AB 2279 requires that the total amount of revenue generated by the MHSA, a county-by-county comparison of fund expenditure plans, and comparison of how MHSA funds were spent be made available in one place in an easy to understand format. Easy access to this information can facilitate enhanced research and modeling, promote best practices, enhance transparency, and allow consumers to more easily identify programs that best address their needs.
2. MHSA. The MHSA provides funding for programs within five components:
   1. Community Services and Supports (CSS): 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. CSS requires counties to direct the majority of its funds to full-service partnerships, which are county-coordinated plans, in collaboration with the client and the family to provide the full spectrum of community services and utilize a “whatever it takes” approach to providing services. Such services include 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 (PEI): provides services to mental health clients in order to help prevent mental illness from becoming severe and disabling, emphasizing improving timely access to services for underserved populations. PEI programs are also required to emphasize strategies to reduce negative outcomes resulting from untreated mental illness, including suicide, school failure or dropout, incarcerations, and unemployment;
   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. Innovation is funded by 5% from CSS and 5% from PEI funds;
   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.

The 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 OAC. Some counties make annual reports available to the public on their own Web sites while others do not. In their three-year plans, counties are required to include a list of all programs for which MHSA funding is being requested and identify how the funds will be spent and what populations will be served. Counties must submit their plans for approval to the OAC before the counties may spend certain categories of funding.

Related/Prior Legislation

SB 1273 (Moorlach, 2016) clarifies that counties may use MHSF moneys for services when co-located with involuntary services.

AB 2017 (McCarty, 2016) establishes the College Mental Health Services Program Act, as specified, until January 1, 2022, with dedicated funding from the MHSF. Requires DHCS to create a grant program for specified colleges to provide required improved access to mental health services, as specified.

AB 847 (Mullin, Chapter 6, Statutes of 2016) required DHCS to develop a proposal for the United States Secretary of Health and Human Services to be selected as a participating state in the time-limited demonstration program for mental health services to be provided by certified community behavioral health clinics to Medi-Cal beneficiaries. Appropriated $1 million from the MHSA for DHCS to develop the proposal.

SB 585 (Steinberg, Chapter 288, Statutes of 2013), allowed counties, when included in their plans, to use MHSF moneys for Assisted Outpatient Treatment, known as “Laura’s Law,” if a county elects to participate in and implement Laura’s Law.

FISCAL EFFECT: Appropriation: Fiscal Com.: Local:

According to the Senate Appropriations Committee, there are ongoing costs to DHCS of $240,000 per year to compile information submitted by counties, create comparisons of county-by-county expenditures, and develop the required reports (Mental Health Services Act Fund).

SUPPORT: (Verified 8/12/16)

California Chapter of the American College of Emergency Physicians

California Council of Community Behavioral Health Agencies

California Hospital Association

California Youth Empowerment Network

Little Hoover Commission

Mental Health America of California

Mental Health Services Oversight and Accountability Commission

National Association of Social Workers, California Chapter

The Steinberg Institute

United Advocates for Children and Families

OPPOSITION: (Verified 8/12/16)

None received

ARGUMENTS IN SUPPORT: Supporters of this bill argue that, while the MHSA has helped to fund a mental health system that has been sorely underfunded for many years, there has been a lack of transparency in county MHSA spending reports, which are not consistently made available to the public either by the counties themselves or DHCS. Supporters also state that there is no single repository for MHSA revenue and expenditure reporting, leaving the general public and mental health care advocates unable to access this information. Supporters argue that this bill will enhance transparency about MHSA funds and promote better outcomes, facilitate program improvement, and enhance accountability to the public.

ASSEMBLY FLOOR: 80-0, 5/31/16

AYES: Achadjian, Alejo, Travis Allen, Arambula, Atkins, Baker, Bigelow, Bloom, Bonilla, Bonta, Brough, Brown, Burke, Calderon, Campos, Chang, Chau, Chávez, Chiu, Chu, Cooley, Cooper, Dababneh, Dahle, Daly, Dodd, Eggman, Frazier, Beth Gaines, Gallagher, Cristina Garcia, Eduardo Garcia, Gatto, Gipson, Gomez, Gonzalez, Gordon, Gray, Grove, Hadley, Harper, Roger Hernández, Holden, Irwin, Jones, Jones-Sawyer, Kim, Lackey, Levine, Linder, Lopez, Low, Maienschein, Mathis, Mayes, McCarty, Medina, Melendez, Mullin, Nazarian, Obernolte, O'Donnell, Olsen, Patterson, Quirk, Ridley-Thomas, Rodriguez, Salas, Santiago, Steinorth, Mark Stone, Thurmond, Ting, Wagner, Waldron, Weber, Wilk, Williams, Wood, Rendon

Prepared by:

8/15/16 19:39:47

**** END ****

SENATE COMMITTEE ON

Senator Ricardo Lara, Chair

2015 - 2016 Regular Session

AB 2279 (Cooley) - Mental Health Services Act: county-by-county spending reports

*********** ANALYSIS ADDENDUM – SUSPENSE FILE ***********

The following information is revised to reflect amendments

adopted by the committee on August 11, 2016

Bill Summary:

AB 2279 would require the Department of Health Care Services to collect and publicly report specified information regarding Mental Health Services Act revenues and expenditures made by counties.

Fiscal Impact:

Ongoing costs of $240,000 per year to compile information submitted by counties, create comparisons of county-by-county expenditures, and develop the required reports by the Department of Health Care Services (Mental Health Services Act Fund).

Author Amendments:

Amend the bill to avoid chaptering out changes made in a recently enacted budget trailer bill.

-- END --

SENATE COMMITTEE ON APPROPRIATIONS

Senator Ricardo Lara, Chair

2015 - 2016 Regular Session

AB 2279 (Cooley) - Mental Health Services Act: county-by-county spending reports

This bill meets the criteria for referral to the Suspense File.

Bill Summary:

AB 2279 would require the Department of Health Care Services to collect and publicly report specified information regarding Mental Health Services Act revenues and expenditures made by counties.

Fiscal Impact:

Ongoing costs of $240,000 per year to compile information submitted by counties, create comparisons of county-by-county expenditures, and develop the required reports by the Department of Health Care Services (Mental Health Services Act Fund).

Background:

The Mental Health Services Act (Proposition 63 of 2004) imposes an additional 1% personal income tax on incomes over $1 million. Most of the funding from the Mental Health Services Act is transferred to counties to provide support for mental health services. The Mental Health Services Act limits state administrative spending to 5% of revenues. Counties are required to prepare three-year program and expenditure plans (with annual updates) and to submit those plans to the state. In addition, under direction from the Department of Health Care Services, counties are required to develop annual revenue and expenditure reports.

Proposed Law:

AB 2279 would require the Department of Health Care Services to collect and publicly report specified information regarding Mental Health Services Act revenues and expenditures made by counties.

Specific provisions of the bill would:

• Require the Department of Health Care Services, no later than nine months after the end of each fiscal year, to collect and publicly report specified information by county and statewide;
• Specify the information to be reported, including information broken down by programmatic area, information on administrative expenditures, funds held in reserve, and other topics;
• Require the report made by the Department to include information going back ten years and to provide for a process for making revisions;
• Authorize counties to provide additional information on expenditures based on the purpose of expenditure (e.g. expenditures that address homelessness, suicide prevention, and other issues);
• Require the Department to make the information required in the bill available to the Legislature and the public no later than July 1, 2018 and annually thereafter.

Related Legislation:

AB 2017 (McCarty) would appropriate $40 million per year from the Mental Health Services Act Fund to create a grant program for mental health services at colleges and universities. That bill will be heard in this committee.

Staff Comments:

Under current law, the Department of Health Care Services receives information from counties on their expenditure plans and expenditures. However, the Department does not perform any substantial review of that information or compile the information into any report that would allow comparisons to be made between county programs.

-- END --

SENATE COMMITTEE ON HEALTH

Senator Ed Hernandez, O.D., Chair

BILL NO: AB 2279

SUBJECT: Mental Health Services Act: county-by-county spending reports

SUMMARY:

Requires the Department of Health Care Services, in consultation with specified entities, to collect and publicly report specified information related to Mental Health Services Act revenue and expenditures, based on the current annual reporting requirement.

Existing law:

1. Establishes the Mental Health Services Act (MHSA), enacted by voters in 2004 as Proposition 63, which provides funds to counties to expand services and develop innovative programs and integrated service plans for mentally ill children, adults, and seniors through a one percent income tax on personal income above $1 million to be deposited to the Mental Health Services Fund (MHSF), administered by the Department of Health Care Services (DHCS).
2. Establishes the Mental Health Services Oversight and Accountability Commission (OAC) to oversee the implementation of the MHSA.
3. Requires each county mental health program to prepare and submit a three-year program and expenditure plan, with annual updates, adopted by the county board of supervisors, to the OAC within 30 days after adoption. Requires the plan to include, among other things, programs for services to adults and seniors.
4. Requires DHCS, in consultation with the OAC and the County Behavioral Health Directors Association of California, to develop and administer instructions for the Annual MHSA Revenue and Expenditure Report, including identifying the expenditure of funds, quantifying the amount of additional funds generated for the mental health system, identifying unexpended funds and interest earned on funds, and determining reversion amounts from prior fiscal year distributions.

This bill:

1. Requires DHCS, based on the Annual MHSA Revenue and Expenditures Report, to collect and publicly report, no later than nine months after the end of each fiscal year, the following information, by statewide total and by individual county:
   1. Total revenue received from the MHSA;
   2. The amount of MHSA funds received by counties for each of the following components:
      1. Community services and supports;
      2. Prevention and early intervention;
      3. Innovation;
      4. Housing that is not funded under i) above;
      5. Workforce education and training not funded under i) above;
      6. Capital facilities and technological needs not funded under i) above; and,
      7. Other mental health services not reflected in i) through vi) above;
   3. MHSA revenues expended in the prior fiscal year;
   4. The amount of MHSA funds expended by counties for each of the components in b) above;
   5. Funds held in prudent reserve by each county;
   6. Distribution from the counties’ prudent reserves;
   7. For the most recent fiscal year, the amount of MHSA funds for each component listed in b) above; and,
   8. MHSA funds subject to reversion and funds that have reverted.
2. Requires the information specified in 1) above to be reported for each fiscal year and to include statewide totals. Requires the information to be updated annually, including necessary revisions. Requires annual reports to include fiscal information for a period of not less than 10 fiscal years, as specified.
3. Requires DHCS also to report publicly annual county program expenditures for program administration, research and evaluation, and funds used to support joint powers authorities and other statewide entities. Requires a county to provide an explanation if it cannot supply some or all of this information, and to provide a timeframe for making the information available. Requires DHCS to work with counties and other specified entities to determine how best to make this information available.
4. Allows counties to submit to DHCS information about programs that address areas that include, but are not limited to, homelessness, criminal justice diversion, suicide prevention, school-based mental health programs, programs to reduce unemployment, stigma reduction, and programs targeted to meet the needs of populations, including veterans; Lesbian, Gay, Bisexual, Transgender, Queer, and Questioning; children and transition-age youth; and adults and older adults.
5. Requires DHCS to compile the information required in 1) through 4) above to promote public understanding of MHSA funds that are distributed to each county, as well as how the funds are spent and what funds remain available for expenditure. Requires DHCS to consult with the OAC, the State Controller’s Office, the Department of Finance, counties, other local mental health agencies, and any other agency required to implement the provisions in this bill.
6. Requires DHCS to consolidate reporting requirements when feasible and to propose to the appropriate policy committees of the Legislature strategies to refine and consolidate reporting requirements.
7. Requires DHCS to make the information available to the Legislature and the public on its Internet Web site no later than July 1, 2018, and annually thereafter.

FISCAL EFFECT:

According to the Assembly Appropriations Committee, costs to DHCS are expected to be minor and absorbable.

PRIOR VOTES:

COMMENTS:

1. Author’s statement. According to the author, the Centers for Disease Control and Prevention and the National Institute of Mental Health report that 4.2% of Americans ages 18 and older suffer from serious mental illness and 26.2% suffer from a diagnosable mental disorder. In 2004, the California voters passed the MHSA, which aimed to address serious mental illness, create prevention and intervention programs, and spur innovation to identify best practices to treat and prevent mental illness. The MHSA created a revenue source to fund programs and determined that local and state oversight was necessary to ensure accountability to the public. Currently, there is no single repository with county-by-county and state-wide information about how MHSA funds are spent. The lack of information made available to the public makes it difficult for consumers to compare services to identify programs that best address their needs, for county programs to identify best practices, and to ensure effective oversight and accountability to the public. AB 2279 requires that the total amount of revenue generated by the MHSA, a county-by-county comparison of fund expenditure plans, and comparison of how MHSA funds were spent be made available in one place in an easy to understand format. Easy access to this information can facilitate enhanced research and modeling, promote best practices, enhance transparency, and allow consumers to more easily identify programs that best address their needs.
2. MHSA. The MHSA provides funding for programs within five components:
   1. Community Services and Supports (CSS): 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. CSS requires counties to direct the majority of its funds to full-service partnerships, which are county-coordinated plans, in collaboration with the client and the family to provide the full spectrum of community services and utilize a “whatever it takes” approach to providing services. Such services include 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 (PEI): provides services to mental health clients in order to help prevent mental illness from becoming severe and disabling, emphasizing improving timely access to services for underserved populations. PEI programs are also required to emphasize strategies to reduce negative outcomes resulting from untreated mental illness, including suicide, school failure or dropout, incarcerations, and unemployment;
   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. Innovation is funded by 5% from CSS and 5% from PEI funds;
   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.

The 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 OAC. Some counties make annual reports available to the public on their own Web sites while others do not. In their three-year plans, counties are required to include a list of all programs for which MHSA funding is being requested and identify how the funds will be spent and what populations will be served. Counties must submit their plans for approval to the OAC before the counties may spend certain categories of funding.

1. Related legislation. SB 1273 (Moorlach), would clarify that counties may use MHSF moneys for services when co-located with involuntary services. SB 1273 is set to be heard in the Assembly Health Committee on June 28, 2016.

AB 2017 (McCarty), would establish the College Mental Health Services Program Act, as specified, until January 1, 2022, with dedicated funding from the MHSF. Requires DHCS to create a grant program for specified colleges to provide required improved access to mental health services, as specified. AB 2017 is set to be heard in this committee on June 22, 2016.

AB 847 (Mullin, Chapter 6, Statutes of 2016), requires DHCS to develop a proposal for the United States Secretary of Health and Human Services to be selected as a participating state in the time-limited demonstration program for mental health services to be provided by certified community behavioral health clinics to Medi-Cal beneficiaries. Appropriates $1 million from the MHSA for DHCS to develop the proposal.

1. Prior legislation. SB 585 (Steinberg, Chapter 288, Statutes of 2013), allows counties, when included in their plans, to use MHSF moneys for Assisted Outpatient Treatment, known as “Laura’s Law,” if a county elects to participate in and implement Laura’s Law.
2. Support. Supporters of this bill argue that, while the MHSA has helped to fund a mental health system that has been sorely underfunded for many years, there has been a lack of transparency in county MHSA spending reports, which are not consistently made available to the public either by the counties themselves or DHCS. Supporters also state that there is no single repository for MHSA revenue and expenditure reporting, leaving the general public and mental health care advocates unable to access this information. Supporters argue that this bill will enhance transparency about MHSA funds and promote better outcomes, facilitate program improvement, and enhance accountability to the public.

SUPPORT AND OPPOSITION:

Support: California Chapter of the American College of Emergency Physicians

California Council of Community Behavioral Health Agencies

California Hospital Association

California Youth Empowerment Network

Little Hoover Commission

Mental Health America of California

National Association of Social Workers, California Chapter

The Steinberg Institute

United Advocates for Children and Families

Oppose: None received

-- END --

ASSEMBLY THIRD READING

ATR Bill Id:AB 2279

Author:(Cooley)

As Introduced Ver:February 18, 2016

Majority vote

SUMMARY: Requires the Department of Health Care Services (DHCS) to annually compile county revenue and expenditure information related to the Mental Health Services Act (MHSA) based on the existing Annual Mental Health Services Act Revenue and Expenditure Report (MHSA Report) and requires the information compiled to be made available by DHCS to the Mental Health Services Oversight and Accountability Commission (Commission), and requires the Commission to make the information publicly available online.

FISCAL EFFECT: According to the Assembly Appropriations Committee, costs to DHCS are expected to be minor and absorbable.

COMMENTS: According to the author, counties are required to report information to DHCS annually about local programs, expenditure plans and how MHSA funds were spent. While some counties make annual reports available to the public on their own Web sites, currently there is no complete state-wide financial picture of how much MHSA revenue is generated annually. The author argues that the absence of a single repository for this information makes it difficult for taxpayers, mental health advocates, and consumers to see which mental health programs are available and how MHSA funds are spent county-by-county and state-wide. This information would make it easier for providers to identify best practices and for consumers to compare services to identify programs that best address their needs.

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 the 16 member Commission charged with overseeing the implementation of MHSA. The 2015-16 Governor's Budget projected that $1.776 billion would be deposited into the Mental Health Services Fund in fiscal year (FY) 2015-16. The MHSA addresses a broad continuum of prevention, early intervention and service needs as well as provided funding for infrastructure, technology and training needs for the community mental health system. In addition to local programs, the MHSA authorizes up to 5% of revenues for state administration. These include administrative functions performed by a variety of state entities such as the DHCS and Office of Statewide Health Planning and Development (OSHPD). It also funds evaluation of the MHSA by the Commission, which was established by the MHSA.

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.

The most recently available MHSA Report discusses expenditures for FY 2015-16 and is available on the DHCS website, but not on the Commission Website. The MHSA Report includes an explanation of estimated revenues, general MHSA Fund expenditures to counties in the aggregate and to OSHPD, and a detailed summary of how the funds set aside for program administration were allocated to 14 different state agencies and departments.

The National Association of Social Workers – California Chapter supports this legislation because it will increase transparency regarding how MHSA funds are spent. California Chapter of the American College of Emergency Physicians states that without adequate analysis of the effectiveness of MHSA programs, there is no guarantee that people with mental illness are receiving adequate treatment. County-by-county comparisons of MHSA program would be an important step toward determining the most effective programs and increasing access to mental health services. The Steinberg Institute states, in support, that the current lack of timely and accessible reporting does not align with the principles set forth in Prop 63.

There is no known opposition to this bill.

Analysis Prepared by: Paula Villescaz / HEALTH / (916) 319-2097 FN: 0003230

Date of Hearing: April 6, 2016

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Lorena Gonzalez, Chair

ABPCA Bill Id:AB 2279

Author:(Cooley) – As Introduced Ver:February 18, 2016

Urgency: No State Mandated Local Program: No Reimbursable: No

SUMMARY:

This bill requires the Department of Health Care Services (DHCS) to annually compile county revenue and expenditure information related to the Mental Health Services Act (MHSA) based on the existing annual Mental Health Services Act Revenue and Expenditure Report (MHSA Report) submitted by each county.

FISCAL EFFECT:

Costs to DHCS are expected to be minor and absorbable.

COMMENTS:

1. Purpose. According to the author, counties are required to report information to DHCS annually about local programs, expenditure plans and how MHSA funds were spent. The current information does not provide a complete statewide financial picture of MHSA revenue and expenditures.
2. Background. Proposition 63 (the MHSA) 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 Mental Health Services Oversight and Accountability Commission charged with overseeing the implementation of MHSA. The 2016-17 Governor’s Budget projects $2 billion in MHSA revenues annually for 2015-16 and 2016-17. The MHSA addresses a broad continuum of prevention, early intervention and service needs as well as provided funding for infrastructure, technology and training needs for the community mental health system. Current law requires counties to submit certain reports about expenditures through MHSA.

Analysis Prepared by: Lisa Murawski / APPR. / (916) 319-2081

Date of Hearing: March 29, 2016

ASSEMBLY COMMITTEE ON HEALTH

Jim Wood, Chair

ABPCA Bill Id:AB 2279

Author:(Cooley) – As Introduced Ver:February 18, 2016

SUBJECT: Mental Health Services Act: county-by-county spending reports.

SUMMARY: Requires the Department of Health Care Services (DHCS) to annually compile county revenue and expenditure information related to the Mental Health Services Act (MHSA) based on the existing Annual Mental Health Services Act Revenue and Expenditure Report (MHSA Report). Specifically, this bill:

1. Requires DHCS to compile information on the following:
   1. The total amount of revenue generated by the MHSA;
   2. A county-by-county comparison of fund expenditure plans and updates; and,
   3. A county-by-county comparison of the purposes for which MHSA funds were expended.
2. Requires the information compiled in 1) above to be made available by DHCS to the Mental Health Services Oversight and Accountability Commission (Commission), and requires the Commission to make the information publicly available online.

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, made up of 16 individuals appointed by the Governor unless otherwise specified:
   
   1. The Attorney General or his or her designee;
   2. The Superintendent of Public Instruction or his or her designee;
   3. A member of the Senate selected by the President pro Tempore of the Senate;
   4. A member of the Assembly selected by the Speaker of the Assembly;
   5. Two persons with a severe mental illness;
   6. A family member of an adult or senior with a severe mental illness;
   7. A family member of a child who has or has had a severe mental illness;
   8. A physician specializing in alcohol and drug treatment;
   9. A mental health professional;
   10. A county sheriff;
   11. A superintendent of a school district;
   12. A representative of a labor organization;
   13. A representative of an employer with less than 500 employees;
   14. A representative of an employer with more than 500 employees; and,
   15. 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. Requires DHCS, in consultation with the Commission and the County Behavioral Health Directors Association of California, to develop an administer instructions for the MHSA Report.
5. Requires the MHSA Report to be submitted electronically to DHCS and the Commission.
6. Establishes the purpose of the MHSA Report as follows:
   1. Identify the expenditures of MHSA funds that were distributed to each county;
   2. Quantify the amount of additional funds generated for the mental health system as a result of the MHSA;
   3. Identify unexpended funds, and interest earned on MHSA funds; and,
   4. Determine what unspent MHSA funds, if any, are available prior fiscal year distributions.
7. Establishes that the MHSA Report is intended to provide information for the evaluation of the following:
   1. Children's systems of care;
   2. Prevention and early intervention strategies;
   3. Innovative projects;
   4. Adults and older adults systems of care; and,
   5. Capital facilities and technology needs.

FISCAL EFFECT: This bill has not yet been analyzed by a fiscal committee.

COMMENTS:

1. PURPOSE OF THIS BILL. According to the author, counties are required to report information to DHCS annually about local programs, expenditure plans and how MHSA funds were spent. While some counties make annual reports available to the public on their own Websites, currently there is no complete state-wide financial picture of how much MHSA revenue is generated annually. The author argues that the absence of a single repository for this information makes it difficult for taxpayers, mental health advocates, and consumers to see which mental health programs are available and how MHSA funds are spent county-by-county and state-wide. This information would make it easier for providers to identify best practices and for consumers to compare services to identify programs that best address their needs.
2. BACKGROUND.
   1. Proposition 63. 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 the 16 member Commission charged with overseeing the implementation of MHSA. The 2015-16 Governor’s Budget projected that $1.776 billion would be deposited into the MHSF in fiscal year (FY) 2015-16. The MHSA addresses a broad continuum of prevention, early intervention and service needs as well as provided funding for infrastructure, technology and training needs for the community mental health system. In addition to local programs, the MHSA authorizes up to 5% of revenues for state administration. These include administrative functions performed by a variety of state entities such as the DHCS and Office of Statewide Health Planning and Development (OSHPD). It also funds evaluation of the MHSA by the Commission, which was established by the MHSA.
      1. 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.
      2. 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.
      3. MHSA Report. The most recently available MHSA Report discusses expenditures for FY 2015-2016 and is available on the DHCS website, but not on the Commission Website. The MHSA Report includes an explanation of estimated revenues, general MHSA Fund expenditures to counties in the aggregate and to OSHPD, and a detailed summary of how the funds set aside for program administration were allocated to 14 different state agencies and departments.
   2. 2016 "No Place Like Home" Initiative. On January 4, 2016 the California State Senate announced a proposed legislative package intended to re-purposes $2 billion of Proposition 63 bond funds and leverage additional dollars from other local, state, and federal funding for purposes of providing housing for chronically homeless persons with mental illness. The initiative includes proposals to construct permanent supportive housing for chronically homeless persons with mental illness, provide $200 million over four years in shorter-term, rent subsidies while the permanent housing is constructed or rehabilitated and support for special housing programs that will assist families that are part of the child welfare system or are enrolled in California Work Opportunity and Responsibility to Kids Housing Support Program.
3. SUPPORT. The National Association of Social Workers – California Chapter, supports this legislation because it will increase transparency regarding how MHSA funds are spent. California Chapter of the American College of Emergency Physicians states that without adequate analysis of the effectiveness of MHSA programs, there is no guarantee that people with mental illness are receiving adequate treatment. County-by-county comparisons of MHSA program would be an important step toward determining the most effective programs and increasing access to mental health services. The Steinberg Institute states, in support, that the current lack of timely and accessible reporting does not align with the principles set forth in Prop 63.
4. RELATED LEGISLATION.
   1. AB 2017 (McCarty) would establish the College Mental Health Services Trust Account and would appropriate funds from the Mental Health Services Fund (MHSF) to create a grant program for public community colleges, colleges, and universities to improve access to mental health services on campus. AB 2017 is pending in the Assembly Health Committee.
   2. AB 847 (Mullin) would require DHCS to develop a proposal to participate in demonstration programs administered by the federal Secretary of Health and Human Services (HHS Secretary) to improve mental health services furnished by certified community behavioral health clinics to Medi-Cal beneficiaries and would appropriate $1 million from the MHSF for the purpose of developing a competitive proposal. AB 847 is pending action on the Governor's desk.
   3. SB 1273 (Moorlach) would clarify that the counties may use MHSF moneys to provide crisis stabilization services, including temporary commitment. SB 1273 is pending in the Senate Health Committee.
   4. AB 253 (Roger Hernández) would require state agencies to give a preference to applicants for funding under the Veterans Housing and Homeless Prevention Act of 2014 that demonstrate a multiyear commitment of MHSA funding for the applicant’s project funding plan and would requires the Governor to appoint two additional members to the Commission with mental health experience. AB 253 is pending in the Senate Transportation and Housing Committee.
5. PREVIOUS LEGISLATION.
   1. AB 745 (Chau) of 2015 would have required 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 was vetoed, by the Governor stating:

"I am returning Assembly Bill 745 without my signature. This bill would add an additional member to the Mental Health Services Oversight and Accountability Commission with experience in supportive housing. While supportive housing can help improve the lives of those with serious mental illness, I believe that the current commission -- with sixteen members -- is adequate to the task."

REGISTERED SUPPORT / OPPOSITION:

Support

California Chapter, American College of Emergency Physicians

California Council of Community Mental health Agencies

California Council of Community Mental Health Agencies

Little Hoover Commission

Mental Health America of California

National Association of Social Workers, California Chapter

Steinberg Institute

United Advocates for Children and Families of California

Opposition

None on file.

Analysis Prepared by: Paula Villescaz / HEALTH / (916) 319-2097