(1)Existing law establishes the Office of Health Equity within the State Department of Public Health for the purposes of aligning state resources, decisionmaking, and programs to accomplish various goals relating to health, and requires the office to perform various duties specifically relating to vulnerable communities, as defined. Existing law requires the office to establish a comprehensive, cross-sectoral strategic plan to eliminate health and mental health disparities and inequities and to seek input from the public on the plan through an inclusive public stakeholder process.

This bill would include individuals who have experienced trauma related to genocide in the definition of vulnerable communities and would require representatives from vulnerable communities to be represented in the public stakeholder process for developing the offices plan to eliminate health and mental health disparities.

(2)Existing law requires the State Department of Health Care Services to provide, to the extent resources are available, technical assistance, through its own staff, or by contract, to county mental health programs and other local mental health agencies in the areas of program operations, research, evaluation, demonstration, or quality assurance projects. Existing law requires the department, to this end, to utilize a meaningful decisionmaking process that includes, among others, stakeholders as determined by the department.

This bill would require the department to include specified stakeholders from vulnerable communities in this process, including diverse racial, ethnic, cultural, and LGBTQQ communities, communities that experience trauma related to genocide, womens health advocates, mental health advocates, health and mental health providers, community-based organizations and advocates, academic institutions, local public health departments, local government entities, and low-income and vulnerable consumers.

(1)Existing law establishes the Office of Health Equity within the State Department of Public Health for the purposes of aligning state resources, decisionmaking, and programs to accomplish various goals relating to health, and requires the office to perform various duties specifically relating to vulnerable communities, as defined. Existing law requires the office to establish a comprehensive, cross-sectoral strategic plan to eliminate health and mental health disparities and inequities and to seek input from the public on the plan through an inclusive public stakeholder process.

This bill would include individuals who have experienced trauma related to genocide in the definition of vulnerable communities and would require representatives from vulnerable communities to be represented in the public stakeholder process for developing the offices plan to eliminate health and mental health disparities.

(2)Existing law requires the State Department of Health Care Services to provide, to the extent resources are available, technical assistance, through its own staff, or by contract, to county mental health programs and other local mental health agencies in the areas of program operations, research, evaluation, demonstration, or quality assurance projects. Existing law requires the department, to this end, to utilize a meaningful decisionmaking process that includes, among others, stakeholders as determined by the department.

This bill would require the department to include specified stakeholders from vulnerable communities in this process, including diverse racial, ethnic, cultural, and LGBTQQ communities, communities that experience trauma related to genocide, womens health advocates, mental health advocates, health and mental health providers, community-based organizations and advocates, academic institutions, local public health departments, local government entities, and low-income and vulnerable consumers.

(1)Existing law establishes the Office of Health Equity within the State Department of Public Health for the purposes of aligning state resources, decisionmaking, and programs to accomplish various goals relating to health, and requires the office to perform various duties specifically relating to vulnerable communities, as defined. Existing law requires the office to establish a comprehensive, cross-sectoral strategic plan to eliminate health and mental health disparities and inequities and to seek input from the public on the plan through an inclusive public stakeholder process.

This bill would include individuals who have experienced trauma related to genocide in the definition of vulnerable communities. communities and would require representatives from vulnerable communities to be represented in the public stakeholder process for developing the offices plan to eliminate health and mental health disparities.

(2)Existing law requires the State Department of Health Care Services to provide, to the extent resources are available, technical assistance, through its own staff, or by contract, to county mental health programs and other local mental health agencies in the areas of program operations, research, evaluation, demonstration, or quality assurance projects. Existing law requires the department, to this end, to utilize a meaningful decisionmaking process that includes, among others, stakeholders as determined by the department.

This bill would require the department to include specified stakeholders from vulnerable communities in this process, including diverse racial, ethnic, cultural, and LGBTQQ communities, communities that experience trauma related to genocide, womens health advocates, mental health advocates, health and mental health providers, community-based organizations and advocates, academic institutions, local public health departments, local government entities, and low-income and vulnerable consumers.

(1)Existing law establishes the Office of Statewide Health Planning and Development and requires the office to prepare a Health Manpower Plan for California to establish standards for, and determine the adequacy of, policies relating to health care practitioners, including physicians, nurses, and dentists, to serve the needs of the state.

This bill would require the office to prepare a Mental Health Manpower Plan to assess include the needs and services available to serve the mental health needs of Californians, especially those in vulnerable communities, as defined, in the Health Manpower Plan.

(2)Existing law establishes the Office of Health Equity within the State Department of Public Health for the purposes of aligning state resources, decisionmaking, and programs to accomplish various goals relating to health, and requires the office to perform various duties specifically relating to vulnerable communities, as defined.

This bill would include individuals who have experienced trauma related to genocide in the definition of vulnerable communities.

(3)Existing law requires the State Department of Health Care Services to provide, to the extent resources are available, technical assistance, through its own staff, or by contract, to county mental health programs and other local mental health agencies in the areas of program operations, research, evaluation, demonstration, or quality assurance projects. Existing law requires the department, to this end, to utilize a meaningful decisionmaking process that includes, among others, stakeholders as determined by the department.

This bill would require the department to include specified stakeholders from vulnerable communities in this process, including diverse racial, ethnic, cultural, and LGBTQQ communities, communities that experience trauma related to genocide, womens health advocates, mental health advocates, health and mental health providers, community-based organizations and advocates, academic institutions, local public health departments, local government entities, and low-income and vulnerable consumers.

(2)Existing law establishes the Office of Health Equity within the State Department of Public Health for the purposes of aligning state resources, decisionmaking, and programs to accomplish various goals relating to health, and requires the office to perform various duties specifically relating to multicultural health vulnerable communities, as defined.

This bill would make a technical, nonsubstantive change to these provisions include individuals who have experienced trauma related to genocide in the definition of vulnerable communities.

Existing law establishes the Office of Health Equity within the State Department of Public Health for the purposes of aligning state resources, decisionmaking, and programs to accomplish various goals relating to health, and requires the office to perform various duties specifically relating to multicultural health.

This bill would make a technical, nonsubstantive change to these provisions.

 VETO  

Bill No: SB 291

Author: Lara (D), et al.

Amended: 9/4/15

Vote: 21

SENATE HEALTH COMMITTEE: 7-0, 4/22/15

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

NO VOTE RECORDED: Hall, Nielsen

SENATE APPROPRIATIONS COMMITTEE: 7-0, 5/28/15

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

SENATE FLOOR: 36-1, 6/1/15

AYES: Allen, Anderson, Bates, Beall, Berryhill, Block, Cannella, De León, Gaines, Galgiani, Glazer, Hall, Hancock, Hernandez, Hertzberg, Hill, Hueso, Huff, Jackson, Lara, Leno, Leyva, Liu, McGuire, Mendoza, Mitchell, Monning, Morrell, Nguyen, Pan, Pavley, Roth, Stone, Vidak, Wieckowski, Wolk

NOES: Moorlach

NO VOTE RECORDED: Fuller, Nielsen, Runner

SENATE FLOOR: 37-1, 9/10/15

AYES: Allen, Anderson, Bates, Beall, Berryhill, Block, Cannella, De León, Fuller, Gaines, Galgiani, Glazer, Hall, Hancock, Hernandez, Hertzberg, Hill, Huff, Jackson, Lara, Leno, Leyva, Liu, McGuire, Mendoza, Mitchell, Monning, Morrell, Nguyen, Pan, Pavley, Roth, Runner, Stone, Vidak, Wieckowski, Wolk

NOES: Moorlach

NO VOTE RECORDED: Hueso, Nielsen

ASSEMBLY FLOOR: 80-0, 9/9/15 - See last page for vote

SUBJECT: Public health: vulnerable communities

SOURCE: Cambodian Advocacy Collaborative

DIGEST: This bill expands the definition of “vulnerable communities,” as specified, and requires the Department of Health Care Services (DHCS) to include stakeholders in vulnerable communities, as specified, in its meaningful decision making process for purposes of providing technical assistance to specified entities.

ANALYSIS:

Existing law:

1. Establishes the Office of Health Equity (OHE) within the Department of Public Health (DPH) to align state resources, decision making, and programs to establish various goals relating to health. Requires OHE to perform various duties relating to vulnerable communities.

2. Defines “vulnerable communities” as, but not limited to:

1. Women;

2. racial or ethnic groups;

3. low-income individuals and families;

4. individuals who are and have been incarcerated;

5. individuals with disabilities;

6. individuals with mental health conditions;

7. children, youth and young adults, and seniors,

8. immigrants and refugees;

9. individuals who are limited-English proficient;

10. lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQQ) communities; or,

11. combinations of these populations.

3. Requires DHCS to provide, to the extent resources are available, technical assistance to county mental health programs and other local mental health agencies, through DHCS staff or by contract, in the areas of program operations, research, evaluation, demonstration, or quality assurance projects. Requires DHCS to utilize a meaningful decision making process that includes local mental health directors and representatives of local mental health boards, as well as other stakeholders as determined by DHCS.

This bill:

1. Expands the definition of “vulnerable communities” to include individuals who have experienced trauma related to genocide.

2. Requires DHCS to include stakeholders in vulnerable communities in its meaningful decision making process, for purpose of providing technical assistance, including:

1. diverse racial, ethnic, cultural, and LGBTQQ communities;

2. communities that experience trauma related to genocide;

3. women’s health advocates;

4. mental health advocates;

5. health and mental health providers;

6. community-based organizations and advocates;

7. academic institutions;

8. local public health departments;

9. local government entities; and,

10. low-income and vulnerable consumers.

Comments

1. Author’s statement. According to the author, the Office of Statewide Health Planning and Development, OHE, DHCS, and other state and local entities have been charged with carrying out various mental health initiatives, yet barriers remain. In particular the Cambodian-American population, which has the largest population in California, still suffers from the effects of the Cambodian Genocide that occurred between 1975 and 1979. Their mental health challenges are multigenerational, extending past the elders who were refugees to the youth who are born in the U.S. Unfortunately, the Cambodian community is lumped together, if recognized at all, under the Asian Pacific-Islander category by departments. The current system, where groups are collapsed together in a broad category, disenfranchises people who suffer from trauma related to genocide. These individuals have unique challenges that cannot be generalized by any other category and, therefore, should be separately assessed. In the absence of laws that highlight this group as a vulnerable population, smaller community and non-profit organizations that serve these individuals are often unable to access funding under the current system. In the interest of continuing the state’s goal towards advancing mental health care access, SB 291 will improve institutional access for Californians who have experienced trauma related to genocide by improving stakeholder engagement, service delivery, and ultimately access to mental health services.

2. Health care disparities. According to the Health Services Research Community of the National Institutes of Health, health care disparities refer to differences in access to or availability of facilities and services. Health status disparities refer to the variation in rates of disease occurrence and disabilities between socioeconomic and/or geographically defined population groups. Health disparities have been measured between those of a different race, ethnicity, gender, sexual orientation, age, ability, religion, socioeconomic status, language proficiency, and geographic location. Many racial and ethnic minorities, people with disabilities, and LGBTQQ communities face unique health challenges, have reduced access to health care and insurance, and often have poorer health throughout their lives. For example, research suggests LGBTQQ people and families may face significant challenges associated with health disparities in insurance coverage and access to health care services.

3. Behavioral health evidence-based/best practice service provision lacking in the state? The Technical Assistance Collaborative/Human Services Research Institute’s final report in February 2012, California Mental Health and Substance Use System Needs Assessment, notes that the percent of individuals reported to be receiving an evidence-based practice service was low: only one percent in 2010, down from two percent in 2009. It also notes that there is a variability among counties in the use and training of staff in state-of-the-art and evidence-based and recovery-oriented treatment; there is a need to address better preparation of physical health providers to engage and treat people with behavioral health needs; and there is still disproportionate access to behavioral health services on the part of certain ethnic populations—compounded by the relative lack of cultural and linguistic capacity among providers and practitioners in the state.

4. Let’s Get Healthy Task Force. In May 2012, Governor Jerry Brown established the Let’s Get Healthy California Task Force (Task Force) to develop a 10-year plan for improving the health of Californians, controlling health care costs, promoting personal responsibility for individual health, and advancing health equity. The Executive Order directed the Task Force to issue a report with recommendations for how the state can make progress toward becoming the healthiest state in the nation over the next decade. In the report, issued in December 2012, the Task Force developed an overarching framework, identifying six goals, organized under two strategic directions: Health Across the Lifespan and Pathways to Health. The report states that the framework makes clear that health equity should be fully integrated across the entire effort.

5. DHCS. DHCS recently indicated that, beginning in Fiscal Year 2015-2016, it will stratify quality measures by demographic factors. Their goal is to focus quality improvement efforts to eliminate heath disparities and improve quality overall. DHCS is in the process of identifying initial measures to conduct this analysis. Another demographic analysis currently conducted by DHCS is the use of managed care plan grievances and appeals data. DHCS is able to determine if an over-prevalence of grievances and/or appeals exists among a specific demographic group. DHCS has previously collected race and/or ethnicity data when conducting the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. This survey is a measure of Medi-Cal beneficiary satisfaction. DHCS reports they will continue to conduct this analysis by race and/or ethnicity and use the CAHPS survey to collect additional demographic factors.

6. Covered California. Covered California has stated that one of its missions is to reduce health disparities, and that it recognizes the diverse cultural, language, economic, educational, and health status needs of those they serve. Their ongoing outreach initiatives include efforts to enroll underserved beneficiaries. Covered California runs the Community Outreach Network, which partners with local organizations across the state to provide information, resources, and training. Community Outreach Network partners include organizations devoted to serving at-risk (vulnerable) populations, including immigrants, African Americans, Asians and Asian sub-populations, LGBTQQ, Mexican Americans, Native Americans, and HIV and AIDS patients. Partners distribute materials, provide outreach and enrollment assistance, and are compensated by Covered California for each application that leads to a purchase. Covered California has also awarded $43 million in grants to organizations that have trusted relationships with culturally and linguistically diverse uninsured markets.

FISCAL EFFECT: Appropriation: No Fiscal Com.: Yes Local: No

According to Assembly Appropriations Committee, negligible state fiscal impact.

SUPPORT: (Verified 11/13/15)

Cambodian Advocacy Collaborative (source)

African Communities Public Health Coalition

Asian Americans Advancing Justice – Los Angeles

Asian American Pacific Islander Health Research Group

Asian Pacific Environmental Network

Building Health Communities: Long Beach

Cambodian Americans for Rural Education Foundation

Cambodian Association of America

Center for the Pacific Asian Family

Children’s Defense Fund California

Families in Good Health

Institute for Multicultural Counseling and Education Services

Los Angeles Lesbian, Gay, Bisexual, Transgender Center

Khmer Parent Association

Khmer Girls in Action

Kingdom Causes Long Beach

Mental Health America’s Homeless Innovations Project

Santa Clara County Board of Supervisors

Southeast Asia Resource Action Center

U.S. Representative Alan Lowenthal

Vietnamese Youth Development Center

OPPOSITION: (Verified 11/13/15)

None received

ARGUMENTS IN SUPPORT: Supporters of this bill argue that there continues to be barriers to accessing mental health services, especially for the Cambodian community, which still suffers from effects of genocide that occurred between the years of 1975 and 1979. They further argue that because many Asian subpopulations get lumped together as Asian Pacific-Islander, groups that have experienced trauma related to genocide are disenfranchised, particularly because of unique challenges. Supporters cite mounting research that shows trauma/stress affects brain development, as well as physical and mental health.

GOVERNOR'S VETO MESSAGE:

I am returning Senate Bill 291 without my signature.

This bill would amend the definition of "vulnerable communities" for the Office of Health Equity in the California Department of Public Health to include individuals who have experienced trauma related to genocide. The bill would also require the Department of Public Health as well as the Department of Health Care Services to involve these communities in their stakeholder work.

The definition of "vulnerable communities" already includes people with mental health conditions, immigrants and refugees. No additional authority is necessary to ensure that both of these departments continue to consider the needs of all those who have suffered trauma related to genocide.

ASSEMBLY FLOOR: 80-0, 9/9/15

AYES: Achadjian, Alejo, Travis Allen, 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, Perea, Quirk, Rendon, Ridley-Thomas, Rodriguez, Salas, Santiago, Steinorth, Mark Stone, Thurmond, Ting, Wagner, Waldron, Weber, Wilk, Williams, Wood, Atkins

Prepared by: Reyes Diaz / HEALTH /

11/13/15 16:03:38

**** END ****

SENATE THIRD READING

STR Bill Id:SB 291

Author:(Lara)

As Amended Ver:September 4, 2015

Majority vote

SENATE VOTE: 36-1

SUMMARY: Amends the definition of vulnerable communities to include individuals who have experienced trauma related to genocide; requires the Department of Health Care Services (DHCS) to include stakeholders in vulnerable communities, as defined, in its decision making process, to promote effective and efficient quality mental health services; and, requires the Office of Health Equity (OHE) to include representatives from vulnerable communities amongst the stakeholders they seek input from when developing and updating their strategic plan on eliminating health disparities.

FISCAL EFFECT: According to the Assembly Appropriations Committee, negligible state fiscal impact.

COMMENTS: According to the author, in the last decade, the Legislature has sought to expand access to mental health care. OHE and DHCS, among other state and local entities, have been charged with carrying out various mental health initiatives. Yet barriers to mental health care remain and community and non-profit organizations that serve individuals suffering from trauma related to genocide struggle to access programs and services administered by these departments. The author states, in particular the Cambodian-American population still suffers from the effects of the Cambodian Genocide that occurred between 1975 to 1979 and their mental health challenges are multigenerational, extending beyond the elders who were refugees to the youth who are United States born citizens. The author concludes, in the interest of continuing the state's goal towards advancing mental health care access, this bill will improve institutional access for Californians who have experienced with trauma related to genocide by improving stakeholder engagement, service delivery, and ultimately access to mental health services.

Health disparities. According to the federal Centers for Disease Control and Prevention, health disparities are preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by socially disadvantaged populations. Populations can be defined by factors such as race or ethnicity, gender, education or income, disability, geographic location (e.g., rural or urban), or sexual orientation. Health disparities are inequitable and are directly related to the historical and current unequal distribution of social, political, economic, and environmental resources.

Disparities in data collection. According to a 2010 Asian and Pacific Islander American Health Forum Report, in California, data available for Asian Americans (AA) and Native Hawaiians/Pacific Islanders (NHPI) lag far behind data on other racial/ethnic groups. In addition, aggregated AA and NHPI data fail to capture the diversity and differences across subgroups. For example, in the 1980s and 1990s, aggregated AA and NHPI data showed that the group had the lowest incidence of breast cancer across races and ethnicities, which helped lead to a belief that Asian women had significantly lower rates of breast cancer. However, subsequent studies showed that Native Hawaiian women had a very high incidence of breast cancer, second only to white women, whereas Korean women had a very low incidence. The high risk for Native Hawaiians was hidden by the aggregation of data. Asian subpopulations also have varying socioeconomic statuses, which is an important predictor of health access. The Asian & Pacific Islander American Health Forum stated in the report that support for new primary data collection and longitudinal studies are needed to fully capture the diverse social and health assets and needs faced by all the AA and NHPI communities.

DHCS efforts. In March of this year the Senate and Assembly Health Committees held a joint hearing regarding health disparities in California. At that time DHCS informed the Senate and Assembly Health Committees that it will soon stratify quality measures by demographic factors. Their goal is to focus quality improvement efforts to eliminate heath disparities and improve quality overall. DHCS is in the process of identifying initial measures to conduct this analysis.

Another demographic analysis currently conducted by DHCS is the use of managed care plan grievances and appeals data. DHCS is able to determine if an over-prevalence of grievances and/or appeals exists among a specific demographic group. DHCS has previously collected race and/or ethnicity data when conducting the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. This survey is a measure of Medi-Cal beneficiary satisfaction. DHCS reports they will continue to conduct this analysis by race and/or ethnicity and use the CAHPS survey to collect additional demographic factors.

Families in Good Health (FGH) supports this bill stating, in the last 20 years or so there has been a tremendous amount of research done on how trauma and stress affects brain development and physical and mental health. FGH notes the Cambodian community with its own unique challenges is lumped together, if recognized at all, under the Asian and Pacific Islander (API) category by state departments, and this aggregation of identity does not reveal the real health conditions of the Cambodians in California.

The California Immigrant Policy Center supports this bill because it will improve institutional access for community and non-profit organizations that service individuals who suffer from trauma related to genocide.

There is no opposition to this bill.

Analysis Prepared by: Lara Flynn / HEALTH / (916) 319-2097 FN: 0002089

 UNFINISHED BUSINESS  

Bill No: SB 291

Author: Lara (D), et al.

Amended: 9/4/15

Vote: 21

SENATE HEALTH COMMITTEE: 7-0, 4/22/15

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

NO VOTE RECORDED: Hall, Nielsen

SENATE APPROPRIATIONS COMMITTEE: 7-0, 5/28/15

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

SENATE FLOOR: 36-1, 6/1/15

AYES: Allen, Anderson, Bates, Beall, Berryhill, Block, Cannella, De León, Gaines, Galgiani, Glazer, Hall, Hancock, Hernandez, Hertzberg, Hill, Hueso, Huff, Jackson, Lara, Leno, Leyva, Liu, McGuire, Mendoza, Mitchell, Monning, Morrell, Nguyen, Pan, Pavley, Roth, Stone, Vidak, Wieckowski, Wolk

NOES: Moorlach

NO VOTE RECORDED: Fuller, Nielsen, Runner

ASSEMBLY FLOOR: 80-0, 9/9/15 - See last page for vote

SUBJECT: Public health: vulnerable communities

SOURCE: Cambodian Advocacy Collaborative

DIGEST: This bill expands the definition of “vulnerable communities,” as specified, and requires the Department of Health Care Services (DHCS) to include stakeholders in vulnerable communities, as specified, in its meaningful decision making process for purposes of providing technical assistance to specified entities.

Assembly Amendments delete the requirement for the Office of Statewide Health Planning and Development (OSHPD) to prepare a Mental Health Manpower Plan for the state to assess the needs and available services to meet the mental health needs of Californians, specifically those in vulnerable communities.

ANALYSIS:

Existing law:

1. Establishes the Office of Health Equity (OHE) within the Department of Public Health (DPH) to align state resources, decision making, and programs to establish various goals relating to health. Requires OHE to perform various duties relating to vulnerable communities.

2. Defines “vulnerable communities” as, but not limited to:

1. Women;

2. racial or ethnic groups;

3. low-income individuals and families;

4. individuals who are and have been incarcerated;

5. individuals with disabilities;

6. individuals with mental health conditions;

7. children, youth and young adults, and seniors,

8. immigrants and refugees;

9. individuals who are limited-English proficient;

10. lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQQ) communities; or,

11. combinations of these populations.

3. Requires DHCS to provide, to the extent resources are available, technical assistance to county mental health programs and other local mental health agencies, through DHCS staff or by contract, in the areas of program operations, research, evaluation, demonstration, or quality assurance projects. Requires DHCS to utilize a meaningful decision making process that includes local mental health directors and representatives of local mental health boards, as well as other stakeholders as determined by DHCS.

This bill:

1. Expands the definition of “vulnerable communities” to include individuals who have experienced trauma related to genocide.

2. Requires DHCS to include stakeholders in vulnerable communities in its meaningful decision making process, for purpose of providing technical assistance, including:

1. diverse racial, ethnic, cultural, and LGBTQQ communities;

2. communities that experience trauma related to genocide;

3. women’s health advocates;

4. mental health advocates;

5. health and mental health providers;

6. community-based organizations and advocates;

7. academic institutions;

8. local public health departments;

9. local government entities; and,

10. low-income and vulnerable consumers.

Comments

1. Author’s statement. According to the author, OSHPD, OHE, DHCS, and other state and local entities have been charged with carrying out various mental health initiatives, yet barriers remain. In particular the Cambodian-American population, which has the largest population in California, still suffers from the effects of the Cambodian Genocide that occurred between 1975 and 1979. Their mental health challenges are multigenerational, extending past the elders who were refugees to the youth who are born in the U.S. Unfortunately, the Cambodian community is lumped together, if recognized at all, under the Asian Pacific-Islander category by departments. The current system, where groups are collapsed together in a broad category, disenfranchises people who suffer from trauma related to genocide. These individuals have unique challenges that cannot be generalized by any other category and, therefore, should be separately assessed. In the absence of laws that highlight this group as a vulnerable population, smaller community and non-profit organizations that serve these individuals are often unable to access funding under the current system. In the interest of continuing the state’s goal towards advancing mental health care access, SB 291 will improve institutional access for Californians who have experienced trauma related to genocide by improving stakeholder engagement, service delivery, and ultimately access to mental health services.

2. Health care disparities. According to the Health Services Research Community of the National Institutes of Health, health care disparities refer to differences in access to or availability of facilities and services. Health status disparities refer to the variation in rates of disease occurrence and disabilities between socioeconomic and/or geographically defined population groups. Health disparities have been measured between those of a different race, ethnicity, gender, sexual orientation, age, ability, religion, socioeconomic status, language proficiency, and geographic location. Many racial and ethnic minorities, people with disabilities, and LGBTQQ communities face unique health challenges, have reduced access to health care and insurance, and often have poorer health throughout their lives. For example, research suggests LGBTQQ people and families may face significant challenges associated with health disparities in insurance coverage and access to health care services.

3. Behavioral health evidence-based/best practice service provision lacking in the state? The Technical Assistance Collaborative/Human Services Research Institute’s final report in February 2012, California Mental Health and Substance Use System Needs Assessment, notes that the percent of individuals reported to be receiving an evidence-based practice service was low: only one percent in 2010, down from two percent in 2009. It also notes that there is a variability among counties in the use and training of staff in state-of-the-art and evidence-based and recovery-oriented treatment; there is a need to address better preparation of physical health providers to engage and treat people with behavioral health needs; and there is still disproportionate access to behavioral health services on the part of certain ethnic populations—compounded by the relative lack of cultural and linguistic capacity among providers and practitioners in the state.

4. Let’s Get Healthy Task Force. In May 2012, Governor Jerry Brown established the Let’s Get Healthy California Task Force (Task Force) to develop a 10-year plan for improving the health of Californians, controlling health care costs, promoting personal responsibility for individual health, and advancing health equity. The Executive Order directed the Task Force to issue a report with recommendations for how the state can make progress toward becoming the healthiest state in the nation over the next decade. In the report, issued in December 2012, the Task Force developed an overarching framework, identifying six goals, organized under two strategic directions: Health Across the Lifespan and Pathways to Health. The report states that the framework makes clear that health equity should be fully integrated across the entire effort.

5. DHCS. DHCS recently indicated that, beginning in Fiscal Year 2015-2016, it will stratify quality measures by demographic factors. Their goal is to focus quality improvement efforts to eliminate heath disparities and improve quality overall. DHCS is in the process of identifying initial measures to conduct this analysis. Another demographic analysis currently conducted by DHCS is the use of managed care plan grievances and appeals data. DHCS is able to determine if an over-prevalence of grievances and/or appeals exists among a specific demographic group. DHCS has previously collected race and/or ethnicity data when conducting the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. This survey is a measure of Medi-Cal beneficiary satisfaction. DHCS reports they will continue to conduct this analysis by race and/or ethnicity and use the CAHPS survey to collect additional demographic factors.

6. Covered California. Covered California has stated that one of its missions is to reduce health disparities, and that it recognizes the diverse cultural, language, economic, educational, and health status needs of those they serve. Their ongoing outreach initiatives include efforts to enroll underserved beneficiaries. Covered California runs the Community Outreach Network, which partners with local organizations across the state to provide information, resources, and training. Community Outreach Network partners include organizations devoted to serving at-risk (vulnerable) populations, including immigrants, African Americans, Asians and Asian sub-populations, LGBTQQ, Mexican Americans, Native Americans, and HIV and AIDS patients. Partners distribute materials, provide outreach and enrollment assistance, and are compensated by Covered California for each application that leads to a purchase. Covered California has also awarded $43 million in grants to organizations that have trusted relationships with culturally and linguistically diverse uninsured markets.

FISCAL EFFECT: Appropriation: No Fiscal Com.: Yes Local: No

According to Assembly Appropriations Committee, negligible state fiscal impact.

SUPPORT: (Verified 9/9/15)

Cambodian Advocacy Collaborative (source)

African Communities Public Health Coalition

Asian Americans Advancing Justice – Los Angeles

Asian American Pacific Islander Health Research Group

Asian Pacific Environmental Network

Building Health Communities: Long Beach

Cambodian Americans for Rural Education Foundation

Cambodian Association of America

Center for the Pacific Asian Family

Children’s Defense Fund California

Families in Good Health

Institute for Multicultural Counseling and Education Services

Los Angeles Lesbian, Gay, Bisexual, Transgender Center

Khmer Parent Association

Khmer Girls in Action

Kingdom Causes Long Beach

Mental Health America’s Homeless Innovations Project

Santa Clara County Board of Supervisors

Southeast Asia Resource Action Center

U.S. Representative Alan Lowenthal

Vietnamese Youth Development Center

OPPOSITION: (Verified 9/9/15)

None received

ARGUMENTS IN SUPPORT: Supporters of this bill argue that there continues to be barriers to accessing mental health services, especially for the Cambodian community, which still suffers from effects of genocide that occurred between the years of 1975 and 1979. They further argue that because many Asian subpopulations get lumped together as Asian Pacific-Islander, groups that have experienced trauma related to genocide are disenfranchised, particularly because of unique challenges. Supporters cite mounting research that shows trauma/stress affects brain development, as well as physical and mental health.

ASSEMBLY FLOOR: 80-0, 9/9/15

AYES: Achadjian, Alejo, Travis Allen, 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, Perea, Quirk, Rendon, Ridley-Thomas, Rodriguez, Salas, Santiago, Steinorth, Mark Stone, Thurmond, Ting, Wagner, Waldron, Weber, Wilk, Williams, Wood, Atkins

Prepared by: Reyes Diaz / HEALTH /

9/9/15 19:24:53

**** END ****

SENATE THIRD READING

STR Bill Id:SB 291

Author:(Lara)

As Amended Ver:July 16, 2015

Majority vote

SENATE VOTE: 36-1

SUMMARY: Amends the definition of vulnerable communities to include individuals who have experienced trauma related to genocide; requires the Department of Health Care Services (DHCS) to include stakeholders in vulnerable communities, as defined, in its decision making process, to promote effective and efficient quality mental health services; and, requires the Office of Health Equity (OHE) to include representatives from vulnerable communities amongst the stakeholders they seek input from when developing and updating their strategic plan on eliminating health disparities.

FISCAL EFFECT: According to the Assembly Appropriations Committee, negligible state fiscal impact.

COMMENTS: According to the author, in the last decade, the Legislature has sought to expand access to mental health care. OHE, and DHCS, among other state and local entities, have been charged with carrying out various mental health initiatives. Yet barriers to mental health care remain and community and non-profit organizations that serve individuals suffering from trauma related to genocide struggle to access programs and services administered by these departments. The author states, in particular the Cambodian-American population still suffers from the effects of the Cambodian Genocide that occurred between 1975 to 1979 and their mental health challenges are multigenerational, extending beyond the elders who were refugees to the youth who are United States born citizens. The author concludes, in the interest of continuing the state's goal towards advancing mental health care access, this bill will improve institutional access for Californians who have experienced with trauma related to genocide by improving stakeholder engagement, service delivery, and ultimately access to mental health services.

Health disparities. According to the federal Centers for Disease Control and Prevention, health disparities are preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by socially disadvantaged populations. Populations can be defined by factors such as race or ethnicity, gender, education or income, disability, geographic location (e.g., rural or urban), or sexual orientation. Health disparities are inequitable and are directly related to the historical and current unequal distribution of social, political, economic, and environmental resources.

Disparities in data collection. According to a 2010 Asian and Pacific Islander American Health Forum Report, in California, data available for Asian Americans (AA) and Native Hawaiians/Pacific Islanders (NHPI) lag far behind data on other racial/ethnic groups. In addition, aggregated AA and NHPI data fail to capture the diversity and differences across subgroups. For example, in the 1980s and 1990s, aggregated AA and NHPI data showed that the group had the lowest incidence of breast cancer across races and ethnicities, which helped lead to a belief that Asian women had significantly lower rates of breast cancer. However, subsequent studies showed that Native Hawaiian women had a very high incidence of breast cancer, second only to white women, whereas Korean women had a very low incidence. The high risk for Native Hawaiians was hidden by the aggregation of data. Asian subpopulations also have varying socioeconomic statuses, which is an important predictor of health access. The Asian & Pacific Islander American Health Forum stated in the report that support for new primary data collection and longitudinal studies are needed to fully capture the diverse social and health assets and needs faced by all the AA and NHPI communities.

DHCS efforts. In March of this year the Senate and Assembly Health Committees held a joint hearing regarding health disparities in California. At that time DHCS informed the Senate and Assembly Health Committees that it will soon stratify quality measures by demographic factors. Their goal is to focus quality improvement efforts to eliminate heath disparities and improve quality overall. DHCS is in the process of identifying initial measures to conduct this analysis.

Another demographic analysis currently conducted by DHCS is the use of managed care plan grievances and appeals data. DHCS is able to determine if an over-prevalence of grievances and/or appeals exists among a specific demographic group. DHCS has previously collected race and/or ethnicity data when conducting the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. This survey is a measure of Medi-Cal beneficiary satisfaction. DHCS reports they will continue to conduct this analysis by race and/or ethnicity and use the CAHPS survey to collect additional demographic factors.

Families in Good Health (FGH) supports this bill stating, in the last 20 years or so there has been a tremendous amount of research done on how trauma and stress affects brain development and physical and mental health. FGH notes the Cambodian community with its own unique challenges is lumped together, if recognized at all, under the Asian and Pacific Islander (API) category by state departments, and this aggregation of identity does not reveal the real health conditions of the Cambodians in California.

The California Immigrant Policy Center supports this bill because it will improve institutional access for community and non-profit organizations that service individuals who suffer from trauma related to genocide.

There is no opposition to this bill.

Analysis Prepared by: Lara Flynn / HEALTH / (916) 319-2097 FN: 0001517

Date of Hearing: August 19, 2015

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Jimmy Gomez, Chair

SBPCA Bill Id:SB 291

Author:(Lara) – As Amended Ver:July 16, 2015

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

SUMMARY:

This bill:

1. Amends the definition of vulnerable communities to include individuals who have experienced trauma related to genocide, for purposes of the California Department of Public Health (CDPH) Office of Health Equity (OHE)'s health disparity initiatives.

2. Requires the Department of Health Care Services (DHCS) to include stakeholders in vulnerable communities, as defined, in its decision making process, to promote effective and efficient quality mental health services.

FISCAL EFFECT:

Negligible state fiscal impact.

COMMENTS:

1. Purpose. According to the author, in the last decade, the Legislature has sought to expand access to mental health care. OHE and DHCS, among other state and local entities, have been charged with carrying out various mental health initiatives. Yet barriers to mental health care remain, and community and non-profit organizations that serve individuals suffering from trauma related to genocide struggle to access programs and services administered by these departments. The author states the Cambodian-American population still suffers from the effects of the Cambodian Genocide that occurred between 1975-1979 and their mental health challenges are multigenerational, extending beyond the elders who were refugees to the youth who are U.S. born citizens. This bill attempts to include those groups in the definition of "vulnerable communities," for purposes of including this unique type of trauma in the state's mental health initiatives.

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

Date of Hearing: July 14, 2015

ASSEMBLY COMMITTEE ON HEALTH

Rob Bonta, Chair

SBPCA Bill Id:SB 291

Author:(Lara) – As Amended Ver:April 28, 2015

SENATE VOTE: 36-1

SUBJECT: Mental health: vulnerable communities.

SUMMARY: Requires the Office of Statewide Health Planning and Development (OSHPD) to create a Workforce Needs Assessment to assess the mental health needs of vulnerable communities; amends the definition of vulnerable communities to include individuals who have experienced trauma related to genocide; and, requires the Department of Health Care Services (DHCS) to include stakeholders in vulnerable communities, as defined, in its decision making process, to promote effective and efficient quality mental health services.

EXISTING LAW:

1. Establishes OSHPD to collect data and disseminate information about the state's health care infrastructure. Requires OSHPD to prepare a Health Manpower Plan (HMP) to evaluate the supply of health care practitioners; including, physicians; physicians assistants; nurse practitioners; nurses; dentists, dental nurses and hygienists; optometrists and optometry assistants; and, pharmacists and pharmacy technicians.

2. Requires the HMP to include such elements as the current levels of demand for services in California; the capacity of the personnel listed in 1) above to provide services; and, the extent to which assistants can substitute their services for those of other personnel. Also requires the HMP to determine the adequacy of the current and future supply of health personnel.

3. Establishes the Office of Health Equity (OHE) within the Department of Public Health (DPH) to help improve the health status of all populations and places, with a priority on eliminating health and mental health disparities and inequities.

4. Defines vulnerable communities as including, but not limited to, women; racial or ethnic groups; low-income individuals and families; individuals who are and have been incarcerated; individuals with disabilities; individuals with mental health conditions; children, youth and young adults, and seniors; immigrants and refugees; individuals who are limited-English proficient; lesbian, gay, bisexual, transgender, queer, and questioning communities; or, combinations of these populations.

5. Requires DHCS to provide technical assistance to county mental health programs and other local mental health agencies. Technical assistance can be for program operations, research, evaluation, demonstration, or quality assurance projects. Requires DHCS to utilize a meaningful decision making process that includes local mental health directors and representatives of local mental health boards, as well as other stakeholders as determined by DHCS.

6. Requires state agencies, boards, and commissions which directly or by contract collect demographic data as to the ancestry or ethnic origin of Californians to use separate collection categories and tabulations for each major Asian and Pacific Islander group, including, but not limited to, Chinese, Japanese, Filipino, Korean, Vietnamese, Asian Indian, Hawaiian, Guamanian, Samoan, Laotian, and Cambodian.

FISCAL EFFECT: According to the Senate Appropriations Committee, one-time costs of $600,000 - $700,000 to develop a needs assessment of workforce training and educational needs to meet the mental health needs of vulnerable communities (California Health Data and Planning Fund). No additional costs are anticipated for the OHE to include individuals who have experienced trauma related to genocide in the Office’s programs for vulnerable communities. No additional costs are anticipated for DHCS to consult with additional stakeholders.

COMMENTS:

1. PURPOSE OF THIS BILL. According to the author, in the last decade, the Legislature has sought to expand access to mental health care. OSHPD, OHE, and DHCS, among other state and local entities, have been charged with carrying out various mental health initiatives. Yet barriers to mental health care remain and community and non-profit organizations that serve individuals suffering from trauma related to genocide struggle to access programs and services administered by these departments. The author states, in particular the Cambodian-American population still suffers from the effects of the Cambodian Genocide that occurred between 1975-1979 and their mental health challenges are multigenerational, extending beyond the elders who were refugees to the youth who are U.S. born citizens.

The author notes the Cambodian community, which has its own unique challenges, is lumped together, if recognized at all, under the Asian Pacific Islander category by the various state departments, and this disenfranchises people who suffer from trauma related to genocide. These individuals have unique challenges that cannot be generalized by any other category and therefore should be separately assessed by state departments. The author concludes, in the interest of continuing the state’s goal towards advancing mental health care access, this bill will improve institutional access for Californians who have experienced with trauma related to genocide by improving stakeholder engagement, service delivery, and ultimately access to mental health services.

2. BACKGROUND.

   1. Health disparities. According to the federal Centers for Disease Control and Prevention, health disparities are preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by socially disadvantaged populations. Populations can be defined by factors such as race or ethnicity, gender, education or income, disability, geographic location (e.g., rural or urban), or sexual orientation. Health disparities are inequitable and are directly related to the historical and current unequal distribution of social, political, economic, and environmental resources.

   2. Disparities in data collection. According to a 2010 Asian and Pacific Islander American Health Forum Report, in California, data available for Asian Americans (AA) and Native Hawaiians/Pacific Islanders (NHPI) lag far behind data on other racial/ethnic groups. In addition, aggregated AA and NHPI data fail to capture the diversity and differences across subgroups.
      
      For example, in the 1980s and 1990s, aggregated AA and NHPI data showed that the group had the lowest incidence of breast cancer across races and ethnicities, which helped lead to a belief that Asian women had significantly lower rates of breast cancer. However, subsequent studies showed that Native Hawaiian women had a very high incidence of breast cancer, second only to white women, whereas Korean women had a very low incidence. The high risk for Native Hawaiians was hidden by the aggregation of data. Asian subpopulations also have varying socioeconomic statuses, which is an important predictor of health access. The Asian & Pacific Islander American Health Forum stated in the report that support for new primary data collection and longitudinal studies are needed to fully capture the diverse social and health assets and needs faced by all the AA and NHPI communities.

   3. Trauma. According to the California Mental Health Planning Council’s 2014 Report on Trauma Informed Care, trauma is a widespread, harmful, and costly public health problem. It occurs as a result of violence, abuse, maltreatment, neglect, loss, disaster, war, and other emotionally harmful experiences. Trauma has no boundaries with regard to age, gender, socioeconomic status, race, ethnicity, geography, or sexual orientation. Traumatic exposures may have only transient effects resulting in no apparent harm; however, traumatic exposures often result in psychological harm, increased rates of mental illness, suicide, risk-taking behaviors, and chronic physical disorders. Exposure to trauma may increase the likelihood of substance abuse and lead to disruptions in daily functioning in educational and employment settings. Trauma is an almost universally shared experience of people receiving treatment for mental illness and substance use disorders, including those served through public systems.
      
      

   4. DHCS efforts. In March of this year the Senate and Assembly Health Committees held a joint hearing regarding health disparities in California. At that time DHCS informed the Committees that it will soon stratify quality measures by demographic factors. Their goal is to focus quality improvement efforts to eliminate heath disparities and improve quality overall. DHCS is in the process of identifying initial measures to conduct this analysis.
      
      

Another demographic analysis currently conducted by DHCS is the use of managed care plan grievances and appeals data. DHCS is able to determine if an over-prevalence of grievances and/or appeals exists among a specific demographic group. DHCS has previously collected race and/or ethnicity data when conducting the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. This survey is a measure of Medi-Cal beneficiary satisfaction. DHCS reports they will continue to conduct this analysis by race and/or ethnicity and use the CAHPS survey to collect additional demographic factors.

3. SUPPORT. Families in Good Health (FGH) supports this bill stating, in the last 20 years or so there has been a tremendous amount of research done on how trauma and stress affects brain development and physical and mental health. FGH notes the Cambodian community with its own unique challenges is lumped together, if recognized at all, under the Asian and Pacific Islander (API) category by state departments, and this aggregation of identity does not reveal the real health conditions of the Cambodians in California.

The California Immigrant Policy Center supports this bill because it will improve institutional access for community and non-profit organizations that service individuals who suffer from trauma related to genocide.

4. RELATED LEGISLATION.

   1. AB 176 (Bonta) places specified requirements regarding the collection of demographic data, by the state's public segments of postsecondary education and by state health-related departments, pertaining to tabulation categories of Native Hawaiian, Asian, and Pacific Islander groups. AB 176 is currently pending on the Senate Floor.

   2. SB 315 (Monning and Ed Hernandez), creates the California Health Access Model Program Two Account within the California Health Facilities Financing Authority Fund to administer a second competitive grant selection process, to fund projects designed to demonstrate specified new or enhanced cost-effective methods of delivering quality health care services to improve access to quality health care for vulnerable populations or communities, or both. SB 315 is pending a hearing in the Assembly Appropriations Committee.
      
      

5. PREVIOUS LEGISLATION.

   1. AB 411 (Pan), of 2013, would have required DHCS, when entering into a new contract with an External Quality Review Organization (EQRO) for the purpose of performing work associated with Medi-Cal managed care programs, to include in the terms of the contract a requirement that the EQRO stratify all patient-specific Healthcare Effectiveness Data and Information Set measures, by certain characteristics, including geographic area and primary language. AB 411 was vetoed by the Governor who stated that nothing in current law prevents DHCS from requiring EQROs to provide more detailed data by geography, race, ethnicity, or other demographic attribute. He concluded that if DHCS saw a need or benefit that justifies the costs of procuring this additional data, he was confident that they would procure it.
      
      

   2. AB 1088 (Eng) Chapter 689, Statutes of 2011, requires the Department of Industrial Relations and the Department of Fair Employment and Housing to collect and tabulate data for each major Asian group.

6. SUGGESTED AMENDMENT. As currently drafted this bill requires OSHPD to develop a mental health workforce needs assessment based on criteria used to develop a HMP from 20 years ago. This bill also amends the definition of vulnerable communities (under the purview of OHE) to include individuals who have experienced trauma related to genocide. Since OHE is statutorily required to create a strategic plan to eliminate health and mental health disparities, the Committee may wish to amend the bill to delete the outdated reference to the OSHPD HMP and instead require OHE to include representatives from vulnerable communities amongst the stakeholders they seek input from when developing and updating the strategic plan.

REGISTERED SUPPORT / OPPOSITION:

Support

Cambodian Advocacy Collaborative (sponsor)
The Honorable Alan Lowenthal, 47^th Congressional District
Asian Pacific Environmental Network

Asian American Pacific Islander Health Research Group
Building Healthy Communities, Long Beach
California Council of Community Mental Health Agencies
California Immigrant Policy Center
California Pan-Ethnic Health Network
California Primary Care Association
Center for the Pacific Asian Family
Children's Defense Fund

Community Clinic Association of Los Angeles County
Families in Good Health
Homeless Innovations Project
Khmer Parent Association
Kingdom Causes, Long Beach
Los Angeles LGBT Center
Mental Health America of California
Pacific Clinics
Santa Clara county Board of Supervisors
Southeast Asia Resource Action Center
United Cambodian Community

Vietnamese Youth Development Center
WISEE Queen Dream Institute
Women in Non-Traditional Employment Roles

Opposition

None on file.

Analysis Prepared by: Lara Flynn / HEALTH / (916) 319-2097

 THIRD READING 

Bill No: SB 291

Author: Lara (D)

Amended: 4/28/15

Vote: 21

SENATE HEALTH COMMITTEE: 7-0, 4/22/15

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

NO VOTE RECORDED: Hall, Nielsen

SENATE APPROPRIATIONS COMMITTEE: 7-0, 5/28/15

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

SUBJECT: Mental health: vulnerable communities

SOURCE: Cambodian Advocacy Collaborative

DIGEST: This bill requires the Office of Statewide Health Planning and Development to include all of the elements in the Health Manpower Plan, as specified, when addressing workforce education and training programs and activities and workforce shortages and deficits to meet the mental health needs of vulnerable communities; expands the definition of “vulnerable communities,” as specified; and requires the Department of Health Care Services to include stakeholders in vulnerable communities, as specified, in its meaningful decision making process for purposes of providing technical assistance to specified entities.

ANALYSIS:

Existing law:

1. Establishes the Office of Statewide Health Planning and Development (OSHPD) to, among other duties, collect data and disseminate information about the state's health care infrastructure. Requires OSHPD to prepare a Health Manpower Plan for the state to establish standards for and determine the adequacy of policies relating to health care practitioners to serve the needs of the state, consisting of at least the following elements:

1. The establishment of appropriate standards for determining the adequacy of supply in California of at least each of the following categories of health personnel: physicians, midlevel medical practitioners (physician’s assistants and nurse practitioners); nurses; dentists; midlevel dental practitioners (dental nurses and dental hygienists); optometrists; optometry assistants; pharmacists; and pharmacy technicians.

2. A determination of appropriate standards for the adequacy of supply of the categories in (a) to be made by taking into account all of the following: current levels of demand for health services in California; the capacity of each category of personnel in (a) to provide health services; the extent to which midlevel practitioners and assistants can substitute their services for those of other personnel; the likely impact of the implementation of a national health insurance program on the demand for health services in California; professionally developed standards for the adequacy of the supply of health personnel; and assumptions concerning the future organization of health care services in California.

3. A determination of the adequacy of the current and future supply of health personnel by category in (a), taking into account the sources of supply for such personnel in California, the magnitude of immigration of personnel to California, and the likelihood of the immigration continuing.

4. A determination of the adequacy of the supply of specialties within each category of health personnel in (a). The determination shall be made, based upon standards of appropriate supply to specialty developed in accordance with (b).

5. Recommendations concerning changes in health manpower policies, licensing statutes, and programs needed to meet the state’s need for health personnel.

2. Establishes the Office of Health Equity (OHE) within the Department of Public Health (DPH) to align state resources, decision making, and programs to establish various goals relating to health. Requires OHE to perform various duties relating to vulnerable communities.

3. Defines “vulnerable communities” as, but not limited to:

1. Women;

2. racial or ethnic groups;

3. low-income individuals and families;

4. individuals who are and have been incarcerated;

5. individuals with disabilities;

6. individuals with mental health conditions;

7. children, youth and young adults, and seniors,

8. immigrants and refugees;

9. individuals who are limited-English proficient;

10. lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQQ) communities; or,

11. combinations of these populations.

4. Requires the Department of Health Care Services (DHCS) to provide, to the extent resources are available, technical assistance to county mental health programs and other local mental health agencies, through DHCS staff or by contract, in the areas of program operations, research, evaluation, demonstration, or quality assurance projects. Requires DHCS to utilize a meaningful decision making process that includes local mental health directors and representatives of local mental health boards, as well as other stakeholders as determined by DHCS.

This bill:

1. Requires OSHPD to include all of the elements in the Health Manpower Plan in 1) above, inclusive, as appropriate, when addressing workforce education and training programs and activities and workforce shortages and deficits identified in the Workforce Needs Assessment for the purposes of meeting the mental health needs of vulnerable communities.

2. Expands the definition of “vulnerable communities” to include individuals who have experienced trauma related to genocide.

3. Requires DHCS to include stakeholders in vulnerable communities in its meaningful decision making process, for purpose of providing technical assistance, including:

1. diverse racial, ethnic, cultural, and LGBTQQ communities;

2. communities that experience trauma related to genocide;

3. women’s health advocates;

4. mental health advocates;

5. health and mental health providers;

6. community-based organizations and advocates;

7. academic institutions;

8. local public health departments;

9. local government entities; and,

10. low-income and vulnerable consumers.

Comments

1. Author’s statement. According to the author, OSHPD, OHE, DHCS, and other state and local entities have been charged with carrying out various mental health initiatives, yet barriers remain. In particular the Cambodian-American population, which has the largest population in California, still suffers from the effects of the Cambodian Genocide that occurred between 1975 and 1979. Their mental health challenges are multigenerational, extending past the elders who were refugees to the youth who are born in the U.S. Unfortunately, the Cambodian community is lumped together, if recognized at all, under the Asian Pacific-Islander category by departments. The current system, where groups are collapsed together in a broad category, disenfranchises people who suffer from trauma related to genocide. These individuals have unique challenges that cannot be generalized by any other category and, therefore, should be separately assessed. In the absence of laws that highlight this group as a vulnerable population, smaller community and non-profit organizations that serve these individuals are often unable to access funding under the current system. In the interest of continuing the state’s goal towards advancing mental health care access, SB 291 will improve institutional access for Californians who have experienced trauma related to genocide by improving stakeholder engagement, service delivery, and ultimately access to mental health services.

2. Health care disparities. According to the Health Services Research Community of the National Institutes of Health, health care disparities refer to differences in access to or availability of facilities and services. Health status disparities refer to the variation in rates of disease occurrence and disabilities between socioeconomic and/or geographically defined population groups. Health disparities have been measured between those of a different race, ethnicity, gender, sexual orientation, age, ability, religion, socioeconomic status, language proficiency, and geographic location. Many racial and ethnic minorities, people with disabilities, and LGBTQQ communities face unique health challenges, have reduced access to health care and insurance, and often have poorer health throughout their lives. For example, research suggests LGBTQQ people and families may face significant challenges associated with health disparities in insurance coverage and access to health care services.

3. Behavioral health evidence-based/best practice service provision lacking in the state? The Technical Assistance Collaborative/Human Services Research Institute’s final report in February 2012, California Mental Health and Substance Use System Needs Assessment, notes that the percent of individuals reported to be receiving an evidence-based practice service was low: only one percent in 2010, down from two percent in 2009. It also notes that there is a variability among counties in the use and training of staff in state-of-the-art and evidence-based and recovery-oriented treatment; there is a need to address better preparation of physical health providers to engage and treat people with behavioral health needs; and there is still disproportionate access to behavioral health services on the part of certain ethnic populations—compounded by the relative lack of cultural and linguistic capacity among providers and practitioners in the state.

4. Let’s Get Healthy Task Force. In May 2012, Governor Jerry Brown established the Let’s Get Healthy California Task Force (Task Force) to develop a 10-year plan for improving the health of Californians, controlling health care costs, promoting personal responsibility for individual health, and advancing health equity. The Executive Order directed the Task Force to issue a report with recommendations for how the state can make progress toward becoming the healthiest state in the nation over the next decade. In the report, issued in December 2012, the Task Force developed an overarching framework, identifying six goals, organized under two strategic directions: Health Across the Lifespan and Pathways to Health. The report states that the framework makes clear that health equity should be fully integrated across the entire effort.

5. State’s current efforts. According to OSHPD’s Web site, the passage of Proposition 63, the Mental Health Services Act (MHSA), provided a unique opportunity with funding to increase staffing and other resources that support public mental health programs, increase access to much-needed services, and monitor progress toward statewide goals for serving children, transition age youth, adults and older adults, and their families. California’s public mental health system has suffered from a shortage of public mental health workers, maldistribution of certain public mental health occupational classifications, a recognized lack of diversity in the workforce, and underrepresentation of professionals with consumer and family member experience, and of racial, ethnic, and cultural communities in the provision of services and support. To address the public mental health workforce issues, the MHSA included a component for Mental Health Workforce Education and Training (WET) programs. In 2008, the former Department of Mental Health developed the first WET Development Five-Year Plan, which covered the period April 2008 to April 2013 and provided vision, values, and mission for state and local implementation of WET programs. In July 2012, the MHSA WET programs were transferred to OSHPD, which assumed the responsibility of administering the WET programs and developing the second MHSA WET Five-Year Plan. OSHPD, with advice from stakeholders and approval by the California Mental Health Planning Council, developed the second MHSA WET Five-Year Plan, which covers the period of April 2014 to April 2019 and provides a framework on strategies that state, local government, community partners, education and training institutions, and other stakeholders can enact to further public mental health workforce, education, and training efforts.

DHCS. DHCS recently indicated that, beginning in Fiscal Year 2015-2016, it will stratify quality measures by demographic factors. Their goal is to focus quality improvement efforts to eliminate heath disparities and improve quality overall. DHCS is in the process of identifying initial measures to conduct this analysis. Another demographic analysis currently conducted by DHCS is the use of managed care plan grievances and appeals data. DHCS is able to determine if an over-prevalence of grievances and/or appeals exists among a specific demographic group. DHCS has previously collected race and/or ethnicity data when conducting the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. This survey is a measure of Medi-Cal beneficiary satisfaction. DHCS reports they will continue to conduct this analysis by race and/or ethnicity and use the CAHPS survey to collect additional demographic factors.

Covered California. Covered California has stated that one of its missions is to reduce health disparities, and that it recognizes the diverse cultural, language, economic, educational, and health status needs of those they serve. Their ongoing outreach initiatives include efforts to enroll underserved beneficiaries. Covered California runs the Community Outreach Network, which partners with local organizations across the state to provide information, resources, and training. Community Outreach Network partners include organizations devoted to serving at-risk (vulnerable) populations, including immigrants, African Americans, Asians and Asian sub-populations, LGBTQQ, Mexican Americans, Native Americans, and HIV and AIDS patients. Partners distribute materials, provide outreach and enrollment assistance, and are compensated by Covered California for each application that leads to a purchase. Covered California has also awarded $43 million in grants to organizations that have trusted relationships with culturally and linguistically diverse uninsured markets.

FISCAL EFFECT: Appropriation: No Fiscal Com.: Yes Local: No

According to the Senate Appropriations Committee:

• One-time costs of $600,000 - $700,000 to develop a needs assessment of workforce training and educational needs to meet the mental health needs of vulnerable communities (California Health Data and Planning Fund).

• No additional costs are anticipated for the OHE to include individuals who have experienced trauma related to genocide in the OHE programs for vulnerable communities.

• No additional costs are anticipated for the DHCS to consult with additional stakeholders.

SUPPORT: (Verified 5/28/15)

Cambodian Advocacy Collaborative (source)

African Communities Public Health Coalition

Asian Americans Advancing Justice – Los Angeles

Asian American Pacific Islander Health Research Group

Asian Pacific Environmental Network

Building Health Communities: Long Beach

Cambodian Americans for Rural Education Foundation

Cambodian Association of America

Center for the Pacific Asian Family

Children’s Defense Fund California

Families in Good Health

Institute for Multicultural Counseling and Education Services

Los Angeles Lesbian, Gay, Bisexual, Transgender Center

Khmer Parent Association

Khmer Girls in Action

Kingdom Causes Long Beach

Mental Health America’s Homeless Innovations Project

Santa Clara County Board of Supervisors

Southeast Asia Resource Action Center

U.S. Representative Alan Lowenthal

Vietnamese Youth Development Center

OPPOSITION: (Verified 5/28/15)

None received

ARGUMENTS IN SUPPORT: Supporters of this bill argue that there continues to be barriers to accessing mental health services, especially for the Cambodian community, which still suffers from effects of genocide that occurred between the years of 1975 and 1979. They further argue that because many Asian subpopulations get lumped together as Asian Pacific-Islander, groups that have experienced trauma related to genocide are disenfranchised, particularly because of unique challenges. Supporters cite mounting research that shows trauma/stress affects brain development, as well as physical and mental health.

Prepared by: Reyes Diaz / HEALTH /

5/31/15 13:21:32

**** END ****

SENATE COMMITTEE ON APPROPRIATIONS

Senator Ricardo Lara, Chair

2015 - 2016 Regular Session

SB 291 (Lara) - Mental health: vulnerable communities

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

Bill Summary:

SB 291 would require the Office of Statewide Health Planning and Development to address workforce training and education needs to meet the mental health needs of vulnerable communities.

Fiscal Impact:

• One-time costs of $600,000 - $700,000 to develop a needs assessment of workforce training and educational needs to meet the mental health needs of vulnerable communities (California Health Data and Planning Fund).

• No additional costs are anticipated for the Office of Health Equity to include individuals who have experienced trauma related to genocide in the Office’s programs for vulnerable communities.

• No additional costs are anticipated for the Department of Health Care Services to consult with additional stakeholders.

Background:

Under current law, the Office of Statewide Health Planning and Development is required to develop a Health Manpower Plan. The Office previously developed the required plan. There are currently no plans to update the plan.

Proposed Law:

SB 291 would require the Office of Statewide Health Planning and Development to address workforce training and education needs to meet the mental health needs of vulnerable communities as part of its Health Manpower Plan for California.

The bill would require the Office of Health Equity (within the Department of Public Health) to include individuals who have experienced trauma related to genocide in the Office’s programs for vulnerable communities.

The bill would require the Department of Health Care Services to consult with stakeholders in specified vulnerable communities when developing technical assistance to county mental health programs.

Related Legislation:

SB 315 (Monning) would authorize the California Health Facilities Financing Authority to create a grant program to fund projects for delivery of health care services to vulnerable communities. That bill will be heard in this committee.

Staff Comments:

The Office of Statewide Health Planning and Development has previously completed the Health Manpower Plan. Current law does not require the Office to update the plan and it does not have any immediate plans to do so. This analysis assumes that the Office would develop a stand-alone update to the Health Manpower Plan addressing issues specific to the mental health needs of vulnerable communities.

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SENATE COMMITTEE ON HEALTH

Senator Ed Hernandez, O.D., Chair

BILL NO: SB 291

SUBJECT: Mental health: vulnerable communities

SUMMARY:

Requires the Office of Statewide Health Planning and Development to prepare a Mental Health Manpower Plan for the state to assess the needs and available services to meet the mental health needs of Californians, specifically those in vulnerable communities. Expands the definition of “vulnerable communities,” as specified; Requires the Department of Health Care Services to include stakeholders in vulnerable communities, as specified, in its meaningful decision making process for purposes of providing technical assistance to specified entities.

Existing law:

1. Establishes the Office of Statewide Health Planning and Development (OSHPD) to, among other duties, collect data and disseminate information about the state's health care infrastructure. Requires OSHPD to prepare a Health Manpower Plan for the state to establish standards for and determine the adequacy of policies relating to health care practitioners to serve the needs of the state.

2. Establishes the Office of Health Equity (OHE) within the Department of Public Health (DPH) to align state resources, decision making, and programs to establish various goals relating to health. Requires OHE to perform various duties relating to vulnerable communities.

3. Defines “vulnerable communities” as, but not limited to:

1. Women;

2. racial or ethnic groups;

3. low-income individuals and families;

4. individuals who are and have been incarcerated;

5. individuals with disabilities;

6. individuals with mental health conditions;

7. children, youth and young adults, and seniors,

8. immigrants and refugees;

9. individuals who are limited-English proficient;

10. lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQQ) communities; or,

11. combinations of these populations.

4. Requires the Department of Health Care Services (DHCS) to provide, to the extent resources are available, technical assistance to county mental health programs and other local mental health agencies, through DHCS staff or by contract, in the areas of program operations, research, evaluation, demonstration, or quality assurance projects. Requires DHCS to utilize a meaningful decision making process that includes local mental health directors and representatives of local mental health boards, as well as other stakeholders as determined by DHCS.

This bill:

1. Requires OSHPD to prepare a Mental Health Manpower Plan for the state to assess the needs and services available to meet the mental health needs of Californians, especially those in vulnerable communities. Requires the plan to consist of at least the following elements:

1. Establishment of appropriate standards for determining the adequacy of supply in the state of psychologists, psychiatrists, counselors, and other mental health personnel who may be able to treat groups in vulnerable communities;

2. Determination of appropriate standards for the adequacy of supply of the categories in (a.) above;

3. Determination of the adequacy of the current and future supply of personnel in (a.) above, taking into account the sources of supply for that personnel in the state, the magnitude of immigration of personnel to the state, and the likelihood of the continuing immigration;

4. Determination of the adequacy of supply of specialties within each category of health personnel in (a.) above; and,

5. Recommendations concerning changes in programs, mental health manpower policies, and licensing statutes needed to meet the state’s need for mental health personnel to serve vulnerable communities.

2. Expands the definition of “vulnerable communities” to include individuals who have experienced trauma related to genocide.

3. Requires DHCS to include stakeholders in vulnerable communities in its meaningful decision making process, for purpose of providing technical assistance, including:

1. diverse racial, ethnic, cultural, and LGBTQQ communities;

2. communities that experience trauma related to genocide;

3. women’s health advocates;

4. mental health advocates;

5. health and mental health providers;

6. community-based organizations and advocates;

7. academic institutions;

8. local public health departments;

9. local government entities; and,

10. low-income and vulnerable consumers.

FISCAL EFFECT:

This bill has not been analyzed by a fiscal committee.

COMMENTS:

1. Author’s statement. According to the author, OSHPD, OHE, DHCS, and other state and local entities have been charged with carrying out various mental health initiatives, yet barriers remain. In particular the Cambodian-American population, which has the largest population in California, still suffers from the effects of the Cambodian Genocide that occurred between 1975 and 1979. Their mental health challenges are multigenerational, extending past the elders who were refugees to the youth who are born in the U.S. Unfortunately, the Cambodian community is lumped together, if recognized at all, under the Asian Pacific-Islander category by departments. The current system, where groups are collapsed together in a broad category, disenfranchises people who suffer from trauma related to genocide. These individuals have unique challenges that cannot be generalized by any other category and, therefore, should be separately assessed. In the absence of laws that highlight this group as a vulnerable population, smaller community and non-profit organizations that serve these individuals are often unable to access funding under the current system. In the interest of continuing the state’s goal towards advancing mental health care access, SB 291 will improve institutional access for Californians who have experienced trauma related to genocide by improving stakeholder engagement, service delivery, and ultimately access to mental health services.

2. Health care disparities. According to the Health Services Research Community of the National Institutes of Health, health care disparities refer to differences in access to or availability of facilities and services. Health status disparities refer to the variation in rates of disease occurrence and disabilities between socioeconomic and/or geographically defined population groups. Health disparities have been measured between those of a different race, ethnicity, gender, sexual orientation, age, ability, religion, socioeconomic status, language proficiency, and geographic location. Many racial and ethnic minorities, people with disabilities, and LGBTQQ communities face unique health challenges, have reduced access to health care and insurance, and often have poorer health throughout their lives. For example, research suggests LGBTQQ people and families may face significant challenges associated with health disparities in insurance coverage and access to health care services.

3. Behavioral health evidence-based/best practice service provision lacking in the state? The Technical Assistance Collaborative/Human Services Research Institute’s final report in February 2012, California Mental Health and Substance Use System Needs Assessment, notes that the percent of individuals reported to be receiving an evidence-based practice service was low: only one percent in 2010, down from two percent in 2009. It also notes that there is a variability among counties in the use and training of staff in state-of-the-art and evidence-based and recovery-oriented treatment; there is a need to address better preparation of physical health providers to engage and treat people with behavioral health needs; and there is still disproportionate access to behavioral health services on the part of certain ethnic populations—compounded by the relative lack of cultural and linguistic capacity among providers and practitioners in the state.

4. Let’s Get Healthy Task Force. In May 2012, Governor Jerry Brown established the Let’s Get Healthy California Task Force (Task Force) to develop a 10-year plan for improving the health of Californians, controlling health care costs, promoting personal responsibility for individual health, and advancing health equity. The Executive Order directed the Task Force to issue a report with recommendations for how the state can make progress toward becoming the healthiest state in the nation over the next decade. In the report, issued in December 2012, the Task Force developed an overarching framework, identifying six goals, organized under two strategic directions: Health Across the Lifespan and Pathways to Health. The Report states that the framework makes clear that health equity should be fully integrated across the entire effort.

5. State’s current efforts. According to OSHPD’s Web site, the passage of Proposition 63, the Mental Health Services Act (MHSA), provided a unique opportunity with funding to increase staffing and other resources that support public mental health programs, increase access to much-needed services, and monitor progress toward statewide goals for serving children, transition age youth, adults and older adults, and their families. California’s public mental health system has suffered from a shortage of public mental health workers, maldistribution of certain public mental health occupational classifications, a recognized lack of diversity in the workforce, and underrepresentation of professionals with consumer and family member experience, and of racial, ethnic, and cultural communities in the provision of services and support. To address the public mental health workforce issues, the MHSA included a component for Mental Health Workforce Education and Training (WET) programs. In 2008, the former Department of Mental Health developed the first WET Development Five-Year Plan, which covered the period April 2008 to April 2013 and provided vision, values, and mission for state and local implementation of WET programs. In July 2012, the MHSA WET programs were transferred to OSHPD, which assumed the responsibility of administering the WET programs and developing the second MHSA WET Five-Year Plan. OSHPD, with advice from stakeholders and approval by the California Mental Health Planning Council, developed the second MHSA WET Five-Year Plan, which covers the period of April 2014 to April 2019 and provides a framework on strategies that state, local government, community partners, education and training institutions, and other stakeholders can enact to further public mental health workforce, education, and training efforts.

DHCS

DHCS recently indicated that, beginning in Fiscal Year 2015-2016, it will stratify quality measures by demographic factors. Their goal is to focus quality improvement efforts to eliminate heath disparities and improve quality overall. DHCS is in the process of identifying initial measures to conduct this analysis. Another demographic analysis currently conducted by DHCS is the use of managed care plan grievances and appeals data. DHCS is able to determine if an over-prevalence of grievances and/or appeals exists among a specific demographic group. DHCS has previously collected race and/or ethnicity data when conducting the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. This survey is a measure of Medi-Cal beneficiary satisfaction. DHCS reports they will continue to conduct this analysis by race and/or ethnicity and use the CAHPS survey to collect additional demographic factors.

Covered California

Covered California has stated that one of its missions is to reduce health disparities, and that it recognizes the diverse cultural, language, economic, educational, and health status needs of those they serve. Their ongoing outreach initiatives include efforts to enroll underserved beneficiaries. Covered California runs the Community Outreach Network, which partners with local organizations across the state to provide information, resources, and training. Community Outreach Network partners include organizations devoted to serving at-risk (vulnerable) populations, including immigrants, African Americans, Asians and Asian sub-populations, LGBTQQ, Mexican Americans, Native Americans, and HIV and AIDS patients. Partners distribute materials, provide outreach and enrollment assistance, and are compensated by Covered California for each application that leads to a purchase. Covered California has also awarded $43 million in grants to organizations that have trusted relationships with culturally and linguistically diverse uninsured markets.

6. Related legislation. SB 315 (Monning and Hernandez), creates the California Health Access Model Program Two Account within the California Health Facilities Financing Authority Fund for purposes of administering a second competitive grant selection process, in accordance with existing grant provisions, to fund one or more projects designed to demonstrate specified new or enhanced cost-effective methods of delivering quality health care services to improve access to quality health care for vulnerable populations or communities, or both. SB 315 is set for hearing in the Senate Health Committee on April 29, 2015.

AB 176 (Bonta), adds DPH to the list of agencies that are required to use additional separate collection categories and other tabulations, and to take additional actions, including posting the demographic data collected on its Internet Web site. Requires the updating of the reporting categories for future decennial censuses. Requires, on or after July 1, 2016, whenever DPH, DHCS, or the Department of Managed Health Care collects ancestry or ethnic origin demographic data of persons for a report that includes specified categories of information, that entity to use the additional separate collection categories and other tabulations for specified Asian groups and Pacific Island groups, and to post the demographic data on its Internet Web site. Requires, on and after July 1, 2016, the Board of Governors of the California Community Colleges, the Trustees of the California State University, and the Regents of the University of California, whenever those entities collect ancestry or ethnic origin demographic data of students for a report that includes student admission, enrollment, completion, or graduation rates, to use specified collection and tabulation categories for Asian, Native Hawaiian, and Pacific Islander groups. Requires each entity specified above to make the demographic data publicly available on the entity’s Internet Web site and requires the updating of the reporting categories for each decennial census. AB 176 is scheduled for hearing in the Assembly Health Committee on April 21, 2015.

7. Prior legislation. AB 411 (Pan), of 2013, would have required DHCS, when entering into a new contract with an External Quality Review Organization (EQRO) for the purpose of performing work associated with Medi-Cal managed care programs, to include in the terms of the new contract a requirement that, upon approval of the contract, the EQRO stratify all patient-specific Healthcare Effectiveness Data and Information Set measures, or their External Accountability Set performance measure equivalent, by certain characteristics, including geographic area and primary language. AB 411 would have required DHCS to publicly report this analysis on its Internet Web site. AB 411 would have provided that its provisions only be implemented to the extent that funding is available. AB 411 was vetoed by the Governor who stated that nothing in current law prevents DHCS from requiring EQROs to provide more detailed data by geography, race, ethnicity, or other demographic attribute. He concluded that if DHCS saw a need or benefit that justifies the costs of procuring this additional data, he was confident that they would procure it.

AB 209 (Pan), of 2013, would have required DHCS to develop and implement a plan that includes specified components to monitor, evaluate, and improve the quality, accessibility, and utilization of health care and dental services provided through Medi-Cal managed care. This bill would have required DHCS to hold public meetings to report on performance measures, utilization levels, quality and access standards, network adequacy, fiscal solvency, and evaluation standards with regard to all Medi-Cal managed care services and to invite public comments. This bill would have also required DHCS to appoint an advisory committee for the purpose of making recommendations to improve quality and access in the delivery of Medi-Cal managed care services. AB 209 died in the Senate on the third reading file.

8. Support. Supporters of this bill argue that there continues to be barriers to accessing mental health services, especially for the Cambodian community, which still suffers from effects of genocide that occurred between the years of 1975 and 1979. They further argue that because many Asian subpopulations get lumped together as Asian Pacific-Islander, groups that have experienced trauma related to genocide are disenfranchised, particularly because of unique challenges. Supporters cite mounting research that shows trauma/stress affects brain development, as well as physical and mental health.

9. Technical amendment. In current law, OSHPD is already required to develop a Health Manpower Plan for the state. The author may wish to amend this bill to require OSHPD to include in its current responsibility an element for addressing the mental health needs of vulnerable communities, which will include communities that experience trauma related to genocide in its expanded definition.

SUPPORT AND OPPOSITION:

Support: Cambodian Advocacy Collaborative (sponsor)

Families in Good Health

Khmer Parent Association

Los Angeles Lesbian, Gay, Bisexual, Transgender Center

Oppose: None received.

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