Existing law authorizes the State Department of Health Care Services to, subject to an appropriation, establish a Behavioral Health Continuum Infrastructure Program. Existing law authorizes the department, pursuant to this program, to award competitive grants to qualified entities to construct, acquire, and rehabilitate real estate assets or to invest in needed mobile crisis infrastructure to expand the community continuum of behavioral health treatment resources to build or expand the capacity of various treatment and rehabilitation options for persons with behavioral health disorders, as specified.

This bill would authorize the department, in awarding the above-described grants, to give preference to qualified entities that are intending to place their projects in specified facilities or properties. The bill would appropriate $1,000,000,000 from the General Fund to the department for the purpose of implementing the Behavioral Health Continuum Infrastructure Program, for encumbrance during the 202324 to 202526, inclusive, fiscal years.

SENATE COMMITTEE ON

Senator Anthony Portantino, Chair

2023 - 2024 Regular Session

SB 65 (Ochoa Bogh) - Behavioral Health Continuum Infrastructure Program

Bill Summary:

SB 65 would permit the Department of Health Care Services (DHCS), in awarding Behavioral Health Continuum Infrastructure Program (BHCIP) grants, to give a preference to qualified entities that are intending to place their projects in specified facilities or properties. The bill would appropriate $1 billion from the General Fund, for encumbrance during the 2023-24 to 2025-26 fiscal years, to DHCS for the purpose of implementing the BHCIP.

Fiscal Impact:

One-time cost of $1 billion General Fund, for encumbrance during the 2023-24 to 2025-26 fiscal years, for BHCIP grants.

Background:

Current law establishes the BHCIP for the purpose of awarding competitive grants to qualified entities, as specified, to construct, acquire, and rehabilitate real estate assets or to invest in needed mobile crisis infrastructure to expand the community continuum of behavioral health treatment resources to build new capacity or expand existing capacity for short-term crisis stabilization; acute and subacute care; crisis residential; community-based mental health residential; substance use disorder residential; peer respite; mobile crisis; community and outpatient behavioral health services; and other clinically enriched longer term treatment and rehabilitation options for persons with behavioral health disorders in the least restrictive and least costly setting.

According to the Governor’s proposed budget, a total of $1.2 billion has been awarded to date under the BHCIP, and $480 million General Fund is scheduled to be awarded in 2022-23. The budget proposes to delay the last round of funding of $480.7 million General Fund to $240.4 million in 2024-25 and $240.3 million in 2025-26.

Proposed Law:

SB 65 would permit DHCS, in awarding BHCIP grants, to give a preference to qualified entities that are intending to place their projects in any of the following facilities or properties:

a) Recently closed hospitals;

b) Recently closed skilled nursing facilities;

c) Unused city, county, or state properties;

d) Facilities that are co-located or near state or local housing program sites; and,

e) Recently closed or unused city or county jail facilities.

The bill would appropriate $1 billion from the General Fund, for encumbrance during the 2023-24 to 2025-26 fiscal years, to DHCS for the purpose of implementing the BHCIP.

Related Legislation:

SB 1298 (Ochoa Bogh, 2022) was substantially similar to this bill. SB 1298 was held on the suspense file in this committee.

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SENATE COMMITTEE ON HEALTH

Senator Dr. Susan Talamantes Eggman, Chair

BILL NO: SB 65

SUBJECT: Behavioral Health Continuum Infrastructure Program

SUMMARY:

Permits the Department of Health Care Services (DHCS), in awarding Behavioral Health Continuum Infrastructure Program (BHCIP) grants, to give a preference to qualified entities that are intending to place their projects in specified facilities or properties. Appropriates $1 billion, for encumbrance during the 2023-24 to 2025-26 fiscal years, to DHCS for the purpose of implementing the BHCIP.

Existing law:

1. Permits DHCS to establish the BHCIP for the purpose of awarding competitive grants to qualified entities, as specified, to construct, acquire, and rehabilitate real estate assets or to invest in needed mobile crisis infrastructure to expand the community continuum of behavioral health treatment resources to build new capacity or expand existing capacity for short-term crisis stabilization; acute and subacute care; crisis residential; community-based mental health residential; substance use disorder (SUD) residential; peer respite; mobile crisis; community and outpatient behavioral health services; and other clinically enriched longer term treatment and rehabilitation options for persons with behavioral health disorders in the least restrictive and least costly setting. [WIC §5960, et seq.]
2. Sunsets the BHCIP on January 1, 2027. [WIC §5960.45]
3. Requires DHCS to license and regulate residential alcoholism or drug abuse (or SUD) recovery or treatment facilities (RTFs). [HSC §11834.02, et seq.]
4. Defines “psychiatric health facilities” as a facility licensed by DHCS, that provide 24-hour inpatient care for people with mental health disorders that includes, but is not limited to, the following basic services: psychiatry; clinical psychology; psychiatric nursing; social work; rehabilitation drug administration; and, appropriate food services for those persons whose physical health needs can be met in an affiliated hospital or in outpatient settings. [HSC §1250.2 and WIC §4080]
5. Requires mental health rehabilitation centers (MHRCs) to be licensed only by DHCS subsequent to application by counties, county contract providers, or other organizations. Requires DHCS to conduct annual licensing inspections of MHRCs. [WIC §5675]
6. Requires the California Department of Public Health (CDPH) to license and regulate health facilities, including general acute care hospitals, acute psychiatric hospitals, and skilled nursing facilities. [HSC §1250, et. seq.]
7. Requires the Department of Social Services (CDSS) to license community care facilities, including any facility, place, or building that is maintained and operated to provide nonmedical residential care, day treatment, adult day care, or foster family agency services for children, adults, or children and adults, including, but not limited to, the physically handicapped, mentally impaired, incompetent persons, and abused or neglected children, and may include crisis residential services. [HSC §1501, et seq.]

This bill:

1. Permits DHCS, in awarding BHCIP grants, to give a preference to qualified entities that are intending to place their projects in any of the following facilities or properties:
2. Recently closed hospitals;
3. Recently closed skilled nursing facilities;
4. Unused city, county, or state properties;
5. Facilities that are co-located or near state or local housing program sites; and,
6. Recently closed or unused city or county jail facilities.
7. Defines “recently closed hospitals” as those that have been closed for at least two years.
8. Appropriates $1 billion, for encumbrance during the 2023-24 to 2025-26 fiscal years, to DHCS for the purpose of implementing the BHCIP.

FISCAL EFFECT:

This bill has not been analyzed by a fiscal committee.

COMMENTS:

1. Author’s statement. According to the author, to fully close the mental health bed deficit, this bill will appropriate $1 billion from the General Fund annually for the next three fiscal years to continue building out essential mental health bed capacity across the entire spectrum of need. California faces a behavioral health continuum infrastructure deficit with significant variations between regions and levels of care. For example, while researchers recommend that California have 24.6 inpatient beds per 100,000 adults for subacute (or long-term) psychiatric patients, regional estimates ranged from 7.4 to 31.8 beds per 100,000 adults, with a particular deficit in the Los Angeles, San Francisco Bay, Inland Empire, and North State regions. These four regions require more than 2,000 additional beds—more than a quarter of all additional beds needed throughout the state. We have been failing our mentally ill populations for many years, and it is time that we make significant ongoing investments toward getting these populations the care they need. This bill will make a real tangible investment toward addressing this severe lack of mental health treatment capacity, which has been woefully inadequate for decades.
2. BHCIP. DHCS was authorized through 2021 legislation to establish BHCIP and award $2.2 billion to construct, acquire, and expand properties, as well as invest in mobile crisis infrastructure related to behavioral health. In partnership with Advocates for Human Potential, Inc., DHCS is releasing these funds through six grant rounds targeting various gaps in the state’s behavioral health facility infrastructure. This infrastructure funding, alongside significant new state and federal investments in homelessness, health care delivery reform, and the social safety net, will help address historic gaps in the behavioral health and long-term care continuum to meet growing demand for services and supports across the lifespan. These investments are intended to ensure care can be provided in the least restrictive settings by creating a wide range of options, including outpatient alternatives, urgent care, peer respite, wellness centers, and social rehabilitation models. A variety of care placements can provide a vital off-ramp from intensive behavioral health service settings and transition individuals, including the most vulnerable and those experiencing homelessness, to community living.

To date, the first four grant rounds have been awarded in the following areas:

• Mobile Crisis: $205 million ($55 million SAMHSA grant funding) to county, city, or tribal entity behavioral health authorities to implement new and enhanced crisis care mobile units (November 2021 and February 2022);
• County and Tribal Planning Grants: $16 million for counties and tribal entities to expand planning efforts in their communities or regions for the acquisition and expansion of behavioral health infrastructure statewide. Action plans may involve the construction, acquisition, or rehabilitation of behavioral health facilities (January and April 2022);
• Launch Ready: $518.5 million to counties, cities, tribal entities, nonprofit organizations, for-profit organizations, and other private organizations, including private real estate developers, to expand community capacity for serving the behavioral health population, with a requirement to commit to serving Medi-Cal beneficiaries (June 2022); and,
• Children & Youth: $480.5 million in projects to expand the behavioral health continuum of treatment and service resources in settings that serve Californians ages 25 and younger, including pregnant and postpartum women and their children, and transition-age youth, along with their families (October 2022).

Round 5, Crisis and Behavioral Health Continuum, is currently under consideration as applications were due February 13, 2023. This round will fund $480 million in projects to address significant crisis care gaps in California’s behavioral health infrastructure, with consideration for funding priority to those that provide crisis services to individuals in need. The crisis can be due to mental health issues and/or SUDs. Round 6 has been delayed in accordance with the Governor’s January budget proposal. The $480 million allocated for outstanding needs is expected to be distributed in fiscal year 2024-25 and 2025-26. The Newsom administration estimates that this funding will provide treatment beds for more than 1,000 people at a time, plus behavioral health services for many more. The need to expand mental health bed infrastructure is also needed at the Department of State Hospitals, which has a backlog of hundreds of individuals needing bed space in competency restoration in order to stand trial, in addition to limited space for Lanterman-Petris-Short Act patients who are placed on involuntary detention or conservatorships. Additionally, growing numbers of inmates are waiting for state hospital beds, sometimes for months at a time. In the past five years, the number of California inmates deemed incompetent to stand trial and ordered sent to state hospitals increased 60%. A few decades ago, fewer than half of state hospital patients came from the criminal justice system compared to more than 90% today. When people in psychiatric crisis land in emergency departments (EDs) and jails, it is frequently because they cannot access treatment in the community, even when they ask for it.

1. Treatment beds in California. According to a 2021 RAND report, California requires 50.5 inpatient psychiatric beds per 100,000 adults: 26.0 per 100,000 at the acute level and 24.6 per 100,000 at the subacute level, or 7,945 and 7,518 beds, respectively. At the community residential level, the estimated need is 22.3 beds per 100,000 adults. RAND estimated that California has a total of 5,975 beds at the acute level (19.5 per 100,000 adults) and 4,724 at the subacute level (15.4 per 100,000 adults), excluding state hospital beds. If state hospital beds are included, these figures increase to 7,679 (25.1 per 100,000 adults) and 9,168 beds (29.9 per 100,000 adults), respectively. RAND also observed large regional variation. For example, excluding state hospitals, acute bed capacity ranged from 9.1 beds per 100,000 adults in the Northern San Joaquin Valley to 27.9 beds per 100,000 adults in the Superior county region. For subacute bed capacity, regional estimates ranged from 7.4 to 31.8 beds per 100,000 adults. At the community residential level, RAND estimated that California has a total of 3,872 beds (12.7 per 100,000 adults). California has a shortfall of approximately 1,971 beds at the acute level (6.4 additional beds required per 100,000 adults) and a shortage of 2,796 beds at the subacute level (9.1 additional beds required per 100,000 adults), or 4,767 subacute and acute beds combined, excluding state hospital beds. If state hospitals were included in this estimate, the shortage of acute inpatient beds would shrink to 267, and there would be no observable shortage in beds at the subacute level. Separately, RAND estimated a shortage of 2,963 community-based residential beds.
2. Related legislation. SB 45 (Roth) establishes the California Acute Care Psychiatric Hospital Loan Fund to continuously appropriate moneys in that fund to the California Health Facilities Financing Authority to provide loans to qualifying county or city and county applicants to build or renovate acute care psychiatric hospitals, psychiatric health facilities, or psychiatric units in general acute care hospitals, as defined. SB 45 is set to be heard in this Committee on March 22, 2023.

SB 363 (Eggman) requires DHCS, in consultation with CDPH and CDSS, by January 1, 2025, to develop a real-time, Internet-based database to collect, aggregate, and display information about specified facilities to identify the availability of inpatient and residential mental health or SUD treatment, as specified. SB 363 is set to be heard in this Committee on March 22, 2023.

1. Prior legislation. SB 1154 (Eggman of 2022), AB 682 (Eggman of 2019), AB 1136 (Eggman of 2018), and AB 2743 (Eggman of 2016) were substantially similar to SB 363. SB 1154 was held on the Assembly Appropriations Committee suspense file. AB 682 was held on the Assembly Appropriations Committee suspense file. AB 1136 was held on the Senate Appropriations Committee suspense file. AB 2743 was held on the Assembly Appropriations Committee suspense file.

SB 1298 (Ochoa Bogh of 2022) was identical to this bill. SB 1298 was held on the Senate Appropriations Committee suspense file.

AB 133 (Committee on Budget, Chapter 143, Statutes of 2021) authorized the BHCIP until January 1, 2027.

1. Support. Supporters state that nearly one in seven California adults has a mental illness, and one in 26 has a serious mental illness that makes it difficult to carry out daily activities. These numbers are even more severe when we look at the state’s homeless populations; 42% of people experiencing homelessness in California report a disabling condition, which includes physical, mental, or emotional impairments. Supporters argue that, currently, California only has 55 inpatient psychiatric beds per 100,000 adults, although researchers recommend that the state maintains 60 beds per 100,000 adults. These numbers don’t include the need of psychiatric beds for children, where 42 of 58 counties have no beds for children. Supporters state that this bill will help address the severe lack of mental health treatment capacity in California.

SUPPORT AND OPPOSITION:

Support: Association of California Healthcare Districts

Riverside County Sheriff’s Office

Steinberg Institute

Oppose: None received

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