Existing law provides counties with broad discretion in the choice of services they utilize to alleviate the alcohol and other drug problems of specific population groups and the community when spending funds allocated to them by the state for that purpose.

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

Date of Hearing: April 18, 2018

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Lorena Gonzalez Fletcher, Chair

ABPCA Bill Id:AB 2328

Author:(Nazarian) – As Amended Ver:March 23, 2018

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

SUMMARY:

This bill requires the Department of Health Care Services (DHCS), in collaboration with counties and providers, to establish regulations regarding intervention and treatment of youth substance use disorders (SUDs) and to establish treatment standards and funding criteria.

It also requires DHCS to report to the Legislature during budget hearings on progress, limits administrative expenses to 5% of program costs, and specifies legislative intent for the department to seek funding through Medi-Cal, federal financial participation, and cannabis tax revenues allocated to youth treatment and prevention.

FISCAL EFFECT:

1. Unknown one-time administrative costs to DHCS to develop regulations and funding criteria, as specified, likely in the low hundreds of thousands of dollars for one to two years (GF).
2. Ongoing significant cost pressure, likely in excess of $10 million, to provide funding through the structure developed by DHCS for youth SUD intervention and treatment programs. (The bill states intent that the programs be funded through a mix of cannabis tax revenues and if available, federal funds).

COMMENTS:

1. Purpose. According to the author, although California counties manage publicly funded treatment programs, they lack systemic guidance and dedicated financial resources to establish a comprehensive set of services for youth with SUDs. This bill is intended to prioritize funding and develop a statewide program to guide this work.
2. Background. In November 2016, voters approved Proposition 64, the Adult Use of Marijuana Act, which legalized the recreational sale and use of cannabis to people over the age of 21. This proposition also levied new excise taxes on the cultivation and retail sale of both adult use cannabis and medical cannabis. Tax revenue is dedicated to specific purposes. The proposition first allocates specified dollar amounts to enumerated programs, then directs 60% of revenue in excess of these allocations to the Youth Education, Prevention, Early Intervention and Treatment Account. This bill requires DHCS to craft a comprehensive structure through which to allocate these funds set aside for youth intervention and treatment, as well as other funds potentially available for the purposes.

DHCS and the Legislative Analyst's Office both indicate cannabis tax revenues will likely not be available to support many components enumerated in the Prop. 64 statute until fiscal year 2019-20.

According to a 2012 statewide report by DHCS, roughly 8% of California youth age 12 to 17 have an SUD, which is similar to the statewide prevalence estimate for adults.

1. Staff Comments. It is reasonable for the state to develop a comprehensive funding approach for available revenues that must be allocated to specific priorities. This bill represents one approach to doing so. This bill's language could be clarified, and the bill would benefit from additional definition of the desired program structure. For instance, the intent is for the state to define a continuum of care and develop a county-based funding program or grant program, but the language only implies this intent and does not state it directly. Also, the bill appears to refer to the Legislature's intent to seek funding through Medi-Cal, which is a program, not a funding source. This could be clarified to state intent to seek federal financial participation for covered services on behalf of Medi-Cal enrollees.

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

Date of Hearing: April 10, 2018

ASSEMBLY COMMITTEE ON HEALTH

Jim Wood, Chair

ABPCA Bill Id:AB 2328

Author:(Nazarian) – As Amended Ver:March 23, 2018

SUBJECT: Youth Substance Use Disorder Treatment and Recovery Program Act of 2018.

SUMMARY: Establishes the Youth Substance Use Disorder (SUD) Treatment and Recovery Program Act of 2018 (Act). Specifically, this bill:

1. Requires the Department of Health Care Services (DHCS), in collaboration with counties and providers of SUD services, to establish regulations regarding community-based nonresidential and residential treatment and recovery programs to intervene and treat the problems of alcohol and drug use among youth under 21 years of age.
2. Requires DHCS, in collaboration with counties and providers of SUD services, to establish through regulation criteria for participation, programmatic requirements, treatment standards, and terms and conditions for funding. Requires the criteria to also include consideration of indicators of drug and alcohol use among youth.
3. Specifies that this bill does not preclude regional approaches to service delivery by counties, including the utilization of community-based nonresidential and residential programs.
4. Requires DHCS, in collaboration with the counties and providers of SUD services, to report to the Legislature, during budget hearings, regarding the status of the implementation of this chapter.
5. Declares the intent of the Legislature that DHCS seek funding for this bill through Medi-Cal, federal financial participation, and through cannabis tax revenues available to DHCS in the Youth Education, Prevention, Early Intervention and Treatment Account (Youth Treatment Account) established pursuant to the Control, Regulate and Tax Adult Use of Marijuana Act (AUMA).
6. Declares that it is further the intent of the Legislature that no more than 5% of funds made available to DHCS for purposes of the Act be expended for purposes of developing regulations, standards, and procedures for implementation.
7. Repeals the Adolescent Alcohol and Drug Treatment and Recovery Program Act of 1998, the provisions of which became inoperative on July 1, 2013.

EXISTING LAW:

1. Establishes the Medi-Cal program, administered by DHCS, under which qualified low income individuals receive health care services, including substance abuse services under the Drug Medi-Cal program.
2. Gives DHCS the sole authority to determine the qualifications, including the appropriate skills, education, training, and experience, of personnel working within alcoholism or drug abuse recovery and treatment programs licensed, certified, or funded by DHCS.
3. Defines SUD counselor as a person who is certified as an alcohol or other drug counselor by an approved certifying organization and who provides services or treatment at an adult alcoholism or drug abuse recovery or treatment facility.
4. Gives DHCS the sole authority to license facilities providing 24-hour residential nonmedical services to eligible adults who are recovering from problems related to alcohol or other drug (AOD) misuse or abuse. Requires licensure when at least one of the following services is provided: detoxification; group sessions; individual sessions; educational sessions; or, alcoholism or drug abuse recovery or treatment planning.
5. Establishes, through the voter initiative process, Proposition 64 or the AUMA which permits adults 21 years of age or older to legally grow, possess, and use cannabis for non-medical purposes, as specified.
6. Establishes, through the AUMA, the California Marijuana Tax Fund (Fund), for purposes of depositing taxes collected from the sale and cultivation of marijuana and allocates, after other specified disbursements, 60% of the remaining Fund for the Youth Treatment Account, for programs for youth that are designed to educate about, and to prevent harm from, SUDs.
7. Requires DHCS to enter into interagency agreements with the Department of Public Health (DPH) and the California Department of Education (CDE) to implement and administer programs for youth that are designed to educate about, and to prevent harm from, SUDs.
8. Requires the programs to emphasize accurate education, effective prevention, early intervention, school retention, and timely treatment services for youth, their families, and caregivers, as specified.

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

COMMENTS:

1. PURPOSE OF THIS BILL. According to the author, clinical experts agree that the unique needs of youth with SUDs are most effectively addressed in age-specific treatment settings that offer a continuum of care consisting of outreach, screening, assessment, counseling, residential treatment, family interventions, and recovery support systems. Unfortunately, California has not chosen to invest in a robust system of SUD care for uninsured and Medicaid-eligible youth. Although California counties manage publicly-funded treatment programs, they lack systemic guidance and dedicated financial resources to establish a comprehensive set of services for youth with SUDs. The author states that prioritizing funding and developing a statewide program can provide critical support to existing Medicaid and federal block grant funds. The author concludes that this measure is an important first step to expand public services to meet the needs of youth with SUDs.
2. BACKGROUND.
   1. Proposition (Prop) 64 (AUMA). Prop 64 was passed by the voters in November 2016. As a result of the passage of Prop 64, adults, aged 21 years or older, are allowed to possess and use marijuana for recreational purposes. Prop 64 created two new taxes; a cultivation tax on marijuana plants and flowers and a 15% excise tax on the sale of all marijuana and marijuana products. Prop 64 also exempted from the California state sales tax, sales of medical marijuana or marijuana products. Revenues collected from the new state excise tax and the cultivation tax on growing marijuana will be deposited in a new state account, the Fund. Certain fines on businesses or individuals who violate regulations created by Prop 64 would also be deposited into the Fund. Monies in the Fund will first be used to pay back certain state agencies for any marijuana regulatory costs not covered by license fees. A portion of the monies will then be allocated as follows:
      1. Sixty percent for youth programs including SUD education, prevention, and treatment;
      2. Twenty percent to clean up and prevent environmental damage resulting from the illegal growing of marijuana, and;
      3. Twenty percent for programs designed to reduce driving under the influence of alcohol, marijuana, and other drugs and a grant program designed to reduce any potential negative impacts on public health or safety resulting from the measure.

The 60% for youth programs required in i) above must include the following components:

• • 1. Prevention and early intervention services including outreach, risk survey, and education to youth, families, caregivers, schools, primary care health providers, behavioral health and SUD service providers, community and faith-based organizations, foster care providers, juvenile and family courts, and others to recognize and reduce risks related to substance use, and the early signs of problematic use and of SUDs;
    2. Grants to schools to develop and support student assistance programs, or other similar programs, designed to prevent and reduce substance use, and improve school retention and performance, by supporting students who are at risk of dropping out of school and promoting alternatives to suspension or expulsion that focus on school retention, remediation, and professional care. Requires that schools with higher than average dropout rates be prioritized for grants;
    3. Grants to programs for outreach, education, and treatment for homeless youth and out-of-school youth with SUDs;
    4. Access and linkage to care provided by county behavioral health programs for youth, and their families and caregivers, who have a SUD or who are at risk for developing a SUD;
    5. Youth-focused SUD treatment programs that are culturally and gender competent, trauma-informed, evidence-based and provide a continuum of care that includes screening and assessment (SUD as well as mental health), early intervention, active treatment, family involvement, case management, overdose prevention, prevention of communicable diseases related to substance use, relapse management for substance use and other co-occurring behavioral health disorders, vocational services, literacy services, parenting classes, family therapy and counseling services, medication-assisted treatments, psychiatric medication, and psychotherapy;
    6. Programs to assist individuals, as well as families and friends of drug using young people, to reduce the stigma associated with substance use including being diagnosed with a SUD or seeking SUD services. Includes peer-run outreach and education to reduce stigma, anti-stigma campaigns, and community recovery networks;
    7. Workforce training and wage structures that increase the hiring pool of behavioral health staff with SUD prevention and treatment expertise. Provide ongoing education and coaching that increases substance use treatment providers’ core competencies and trains providers on promising and evidenced-based practices; and,
    8. Construction of community-based youth treatment facilities.
  1. Early and Periodic Screening, Diagnosis, and Treatment (EPSDT). EPSDT services are a benefit of the state’s Medicaid program (Medi-Cal) that provide comprehensive, preventative, diagnostic, and treatment services to eligible children under the age of 21, as specified in Section 1905(r) of the Federal Social Security Act. The EPSDT benefit is designed to ensure that children receive early detection and care, so that health problems are averted or diagnosed and treated as early as possible. EPSDT allows for periodic screenings to determine health care needs and based upon the identified health care need and diagnosis, treatment services are provided. SUD services are outlined in California’s Medicaid State Plan and are available to children and youth as medically necessary. Additionally, under the EPSDT benefit, eligible individuals must be provided periodic screening, such as a well child exam. One required element of this screening is a comprehensive health and developmental history including assessment of physical and mental health development and an age appropriate mental health and substance use health screening. While EPSDT screening services is a federally mandated benefit, data suggests it is not a readily available or accessible benefit to families. According to 2016 data from the Centers for Medicare and Medicaid Services, only half of all eligible children received a screening under the EPSDT program. There is a wide discrepancy between screening figures of children as they get older, with two-thirds of all eligible children ages 0-3 being screened, compared to just one-third of children ages 10-20 being screened; and,
  2. 2016 National Survey on Drug Use and Health. According to information provided by a survey conducted by the Substance Abuse and Mental Health Services Administration and Center for Behavioral Health Statistics and Quality, 20% of Californians between the ages of 12 and 25 have experienced a SUD in the past year, defined as meeting criteria for illicit drug or alcohol dependence or abuse. Additionally, 11%t of survey respondents from California between the ages of 12 and 25 indicated needing but not receiving treatment at an appropriate facility in the past year.

1. SUPPORT. The California Behavioral Health Directors Association (CBHDA), state in support of the measure that clinical experts agree that the unique needs of youth with SUDs are most effectively addressed in age-specific treatment settings that offer a continuum of care consisting of outreach, screening, assessment, counseling, residential treatment, family interventions, and recovery support systems. CBHDA states that unfortunately, California has not invested in a comprehensive set of SUD services for uninsured and Medicaid-eligible youth. Most existing publicly-funded SUD programs in the state were designed to serve the adult population. The criminal justice system has historically been the primary payer for youth SUD care, resulting in uneven, possibly unfair, access. CBHDA notes that under the federal EPSDT benefit, Medicaid-enrolled youth are entitled to age-appropriate care for any identified behavioral health conditions. However, Medicaid service payments alone are insufficient for the capital and overhead costs needed to build new, community-based treatment programs. CBHDA concludes that by identifying potential funding from the Youth Treatment Account established by Proposition 64, this bill effectively addresses this gap in services by providing critical support to existing Medicaid and federal block grant funds.
2. RELATED LEGISLATION.
   1. AB 2804 (Waldron) specifies legislative intent to establish one-year and five-year plans aimed at expanding the SUD treatment workforce in California to aid in the treatment of alcohol and drug abuse. AB 2804 is pending in the Assembly Health Committee.
   2. AB 1135 (Wood) requires DPH and CDE to establish an inclusive public stakeholder process to seek input to determine a disbursement formula for the funds to be distributed by the California Department of Health Care Services for purposes of the Youth Education, Prevention, Early Intervention and Treatment Account established by the AUMA. AB 1135 was held in Assembly Appropriations Committee.
3. PREVIOUS LEGISLATION. AB 1784 (Baca), Chapter 866, Statutes of 1998, established the Adolescent Alcohol and Drug Treatment and Recovery Program which required the then-Department of Alcohol and Drug Programs to establish community-based alcohol and drug recovery youth programs in collaboration with counties and local law enforcement to intervene and treat the problems of alcohol and drugs among youth. The provisions of AB 1784 became inoperative on July 1, 2013.

REGISTERED SUPPORT / OPPOSITION:

Support

California Behavioral Health Directors Association (cosponsor)

Steinberg Institute (cosponsor)

California Council of Community Behavioral Health Agencies

California Psychiatric Association

County Health Executives Association of California

Depression and Bipolar Support Alliance

Western Center on Law and Poverty

Opposition

None on file.

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