This week, the Legislature returned to Sacramento and kicked off a series of hearings related to the Health Special Session. The Senate convened two hearings, one to explore the managed care organization (MCO) tax and the other to hear a series of tobacco legislation introduced during the special session. The Assembly also convened two hearings, one to discuss community developmental services funding and the other focused on the Medi-Cal program.

Both the Senate and Assembly discussed the two MCO tax structures – the flat tax and the tiered tax structure. Members heard from the Department of Health Care Services, the Legislative Analyst’s Office and key stakeholders from the health field. No actions were taken in these hearings, but, as noted below, the Senate did take action on the tobacco measures.

Tobacco Legislation

As previously mentioned, the Senate Public Health and Developmental Services Committee heard a series of tobacco legislation which was introduced at the beginning of the special session. All six bills were passed by the Committee and are now headed to the Senate Appropriations Committee. The Assembly will take up their identical bills next week. CSAC has taken a SUPPORT position on two of the bills, both of which we supported during the regular session.

SBX2 5 (Leno) – SUPPORT
As Introduced on July 16, 2015

SBX2 5, as introduced by Senator Leno, would add e-cigarettes to existing tobacco products definitions. CSAC supported Senator Leno’s SB 140, which was identical to SBX2 5. SB 140 died in the Assembly Governmental Organizations Committee after committee members added hostile amendments to the bill, forcing Senator Leno to abandon the bill during the regular session. The Senate Public Health and Developmental Services Committee passed the bill on a 9-3 vote on August 19. It now goes to the Senate Appropriations Committee.

SBX2 7 (Hernandez) – SUPPORT
As Introduced on July 16, 2015

SBX2 7, by Senator Ed Hernandez, would increase the age of sale for tobacco products to 21. CSAC supported the SB 151 during the regular session, which mirrors this bill and was also authored by Senator Hernandez. SB 151 also died in the Assembly Governmental Organizations Committee due to strong opposition from the tobacco industry. The Senate Public Health and Developmental Services Committee passed the bill on a 9-3 vote on August 19. It now goes to the Senate Appropriations Committee.

End of Life

Another bill, ABX2 15 by Assembly Member Susan Eggman, was reintroduced in this special session. ABX2 15 would enact the End of Life Option Act, which would authorize a terminally ill adult to request a prescription to assist in ending their life. During the regular session, Senator Wolk introduced an identical bill, SB 128, which did not pass out of the Assembly Health Committee.

The Administration does not believe the Special Session is the appropriate vehicle to introduce this bill. However, Assembly Member Eggman believes this bill is about providing care and that patient care is a vital aspect of the Special Session. CSAC does not have a position on this legislation.

Senator McGuire Requests Audit on Child Welfare and Behavioral Health Systems

Senator Mike McGuire submitted a letter to the Joint Legislative Audit Committee requesting an audit of the state and county Child Welfare and Behavioral Health systems. The Senator wants the audit to focus on the roles of state and county agencies in addition to the monitoring of psychotropic medication, supports and oversight for foster youth. The Senate Health Committee, chaired by Senator McGuire, has convened several hearings on the issue of psychotropic medications. Senator McGuire’s letter requesting the audit can be viewed here.

CMS approves Drug Medi-Cal Waiver

The Centers for Medicare and Medicaid Services approved California’s Drug Medi-Cal Organized Delivery System (DMC-ODS) Waiver on August 13. California is the first in the nation to receive approval for a waiver of this type. The DMC-ODS was approved for a five-year demonstration term.

The Department of Health Care Services posted both the approval letter from CMS and Special Terms and Conditions. CSAC will be releasing a summary of the waiver soon.

California Submits Behavioral Health Clinic Planning Grant

The Department of Health Care Services submitted California’s application for the Substance Abuse and Mental Health Services Administration’s Certified Community Behavioral Health Clinic Planning Grant. California is requesting $1.9 million to develop and establish Certified Community Behavioral Health Clinics. A copy of California’s application is posted on the DHCS website.

Medi-Cal Demonstration Bills

Both Waiver bills – SB 36 (Hernandez) and AB 72 (Bonta) – were passed out of the Appropriations Committees and are headed to the Senate and Assembly floors respectively. Both bills are currently serving as the legislative vehicles to implement the Department of Health Care Services’ (DHCS) application to the federal Centers for Medicare and Medicaid Services for California’s successor Section 1115 Medicaid Waiver.

AB 193 (Maienschein) – OPPOSE
As Amended on July 6, 2015

AB 193, by Assembly Member Brian Mainschein, would authorize a Probate Court judge to recommend a Lanterman-Petris-Short Act (LPS) conservatorship to the county officer providing conservatorship investigations. Essentially, AB 193 assumes that because a Probate conservatorship has been established, a person should also qualify for involuntary mental health treatment or a conservatorship. The LPS Act was created so that individuals could not be indiscriminately placed in involuntary settings without due process, which includes the involuntary hold process and LPS conservatorship. It is a very high bar that is in place to protect the patients, and AB 193 erodes this due process.

AB 193 would also result in significant county General Fund costs due to increased investigations and potentially increased LPS conservatorships. CSAC, along with Los Angeles County, the Urban Counties Caucus and the County Behavioral Health Directors Association, all OPPOSE AB 193, which was placed on the Senate Appropriations Committee’s Suspense File.

AB 1299 (Ridley-Thomas) – SUPPORT IF AMENDED
As Amended on July 16, 2015

AB 1299, by Assembly Member Sebastian Ridley -Thomas, would make changes to how foster children placed outside of their county of original jurisdiction are able to access mental health services. It would require the Department of Health Care Services to issue policy guidance that establishes the presumptive transfer of responsibility for mental health services from the county of original jurisdiction to the foster child’s county of residence.

CSAC has taken a SUPPORT IF AMENDED on AB 1299, as it seeks to ensure foster children receive services mental health services in a timely manner. However, CSAC continues to work with the author’s office and the sponsors – the California Alliance of Child and Family Services – to address county concerns regarding the bill language and implementation. It is unclear as of this writing if the county concerns regarding the July 16 version of the bill will be addressed. AB 1299 was heard in the Senate Appropriations Committee on August 17 and placed on the Committee’s Suspense File.

AB 403 (Stone) – SUPPORT IN CONCEPT
As Amended on July 16, 2015

AB 403, by Assembly Member Mark Stone and sponsored by the Department of Social Services (DSS), reflects DSS’ attempt to reform the continuum of care group home system for foster youth. In January, DSS released their Continuum of Care Report to the Legislature, which outlined a comprehensive approach to improving the experience and outcomes of children and youth in foster care.

AB 403 reclassifies juvenile treatment facilities and the transition from the use of group homes for children in foster care and on probation to the use of short-term residential treatment centers (STRTCs) – defined in the amendments. AB 403 revises foster parent training requirements and provides for the development of Child-Family Teams to inform the process of placement and services to children. Additionally, the bill seeks to develop a new group home rate payment structure to fund placement options for children in foster care.

CSAC, along with our county affiliates – CWDA, CBHDA and CPOC – continue to work closely with the Department of Social Services on this significant measure, including on both the potential fiscal and policy impacts. CSAC continues to maintain a SUPPORT IN CONCEPT position on AB 403, which was placed on the Senate Appropriations Committee’s Suspense File on August 17.

SB 238 (Mitchell) – SUPPORT
As Amended on July 1, 2015

SB 238, sponsored by the County Welfare Directors Association of California and supported by CSAC, seeks to increase communication and training amongst all parties serving foster youth through requiring four key aspects:

1. The Department of Social Services and the Department of Health Care Services to develop monthly data reports that match prescription and claims data with child welfare services records;

2. The development of a system that triggers alerts to child welfare social workers and others serving the child such as attorneys and courts, when medications that could have dangerous interactions with psychotropic medications have been prescribed or when foster youth are prescribed unusual dosages;

3. An update to the JV-220 court form to allow key stakeholders to provide information, feedback and details on the overall mental health and treatment plan for the child; and

4. Training for child welfare social workers, foster children, caregivers and attorneys, Court-Appointed Special Advocates and foster care public health nurses regarding psychotropic medications.

SB 238 was placed on the Assembly Appropriations Committee Suspense File on August 19.

AB 610 (Jones Sawyer) – SUPPORT
As Amended on July 16, 2015

AB 610, by Assembly Member Reginald Jones-Sawyer, would expand an existing pilot program to apply to all child support cases and would authorize the local child support agency to administratively adjust account balances for cases if the agency verifies that the obligator is unable to pay due to incarceration.

The measure was heard by the Senate Appropriations Committee and placed on the Suspense file on August 19.

SB 196 (Hancock) – SUPPORT
As Amended on August 17, 2015

Senate Bill 196, by Senator Hancock, would authorize a county adult protective services agency to file a petition for a protective order on behalf of elder or dependent adults if the adult has been identified as lacking the capacity and a conservatorship is being sought.

Current law authorizes the following persons to seek an order: a conservator or trustee, an attorney-in-fact, a person appointed as a guardian ad litem, or other person legally authorized to seek the order. SB 196 seeks to add a county adult protective services agency as an authorized entity.

CSAC supports SB 196 which was passed by the Assembly Floor and is headed back to the Senate for concurrence.