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2024 State Legislation

Access to Treatment

SB 1300 (Cortese): Health facility closure: public noticing for inpatient psychiatric and maternity services – Sponsor 

Extends the public notice requirement when a health facility eliminates a supplemental service, currently 90 days prior to elimination of the service, to instead be 120 days when it involves the closure of either inpatient psychiatric services or maternity services.

This bill responds to the state’s mental health and maternity deserts crises by increasing accountability, transparency, and mitigating the impact to the health of the community. 

AB 2501 (Bonta): Psychology interjurisdictional compact – Support  

Interstate Psychological Practice

Asks state to sign on to an interstate compact to allow:

1. Psychologists from other states to treat Californians via telepsychology; and/ or
2. temporary in-person, face-to-face psychological practice

More than half the country has already signed up for this.

Psychs who want to practice must:

1. Get authorizations to practice interjurisdictional telepsychology
2. Get temporary authorization to practice for temporary in-person face-to-face practice   

AB 2700 (Gabriel): Emergency medical services: alternate destinations – Support

Aims to connect individuals in behavioral health crises with appropriate care facilities such as crisis stabilization units and sobering centers, rather than defaulting to emergency departments, which may not be equipped to provide the specialized care needed for these situations.

The bill requires a systematic survey and analysis of facilities across each county that can serve as alternative destinations for individuals in crisis. This will help local emergency services agencies develop informed plans that cater to the specific needs and resources of their communities.   

SB 999 (Cortese): Health coverage: mental health and substance use disorders – Support 

Health Care Review Integrity and Transparency Standards

Ensures that health care and disability insurers adhere to stringent standards for utilization review, aiming to match the expertise of reviewers with that of treating doctors, enhance access to care authorization processes, and clarify the reasons behind treatment denials.

Requires a health plan and a disability insurer to ensure compliance with specific requirements for utilization review, including:

1. Decisions must be made by a health care professional who has the same kind of expertise and qualifications as the doctor who asked for the treatment. i.e. the person making the decision should have the same level of education, training, and experience in the specific area of health care that’s being discussed, and they should also have any certifications that are needed to prove they are experts in that area.

2. Maintaining telephone access during business hours for a provider to request authorization for care

3. If a plan decides not to approve treatment, they must explain why to both the doctor treating the patient and the patient themselves. This explanation must include which medical guidelines they looked at to make their decision and a detailed reason why the patient’s situation didn’t match these guidelines for approval.    

SB 1017 (Eggman): Available facilities for impatient and residential mental health or substance use disorder treatment – Co-Sponsor  

This is a re-introduction of bed registry dashboard bill (SB 363), which NAMI-CA co-sponsored last year.

Requires the DHCS, in consultation with DPH & DSS to establish a solution that monitors psychiatric, substance use disorder, and community mental health bed openings, to be updated and maintained as changes in availability occur in order to streamline communication and reduce patient waiting time for placement in appropriate beds. 

AB 3077 (Hart): Criminal procedure: borderline personality disorder – Support  

Current law allows for those diagnosed with PTSD, schizophrenia and schizoaffective disorder to be eligible for IST. The exclusion of BPD is not data driven, perpetuates harmful stigma about the disorder, and limits access to mental health treatment.

The exclusion of BPD from the list of eligible psychiatric diagnosis that are eligible for a determination of IST and the dismissal of penalty enhancements is not data driven, perpetuates harmful stigma about the disorder, and limits access to the necessary rehabilitative mental health treatment that both helps individuals recover their mental health and protect public safety.

The overwhelming consensus among scholars is that BPD is treatable, and psychotherapy is the first-line intervention for BPD. People with BPD deserve the judicial options that are currently available to people with other mental health diagnoses.  

SB 1397 (Eggman): Behavioral health services coverage – Support  

Parity: Seeks to ensure that county behavioral health agencies are reimbursed by plans for services provided under Full-service Partnerships (FSPs) to insured individuals under private insurance plans.

Under this bill, health plans would be required to reimburse county behavioral health agencies either at the contracted rate or the fee-for-service or case reimbursement rate paid in the Medi-Cal specialty behavioral health program, whichever is higher.

The bill covers services delivered under the Full-Service Partnership model, which include a broad spectrum of community services necessary to achieve the goals identified in the individual’s service plan. This includes not only direct mental health services but also supports for co-occurring conditions such as substance abuse, housing, and more.

The bill enhances the funding framework for mental health services, ensuring that county agencies are adequately reimbursed and that insured individuals receive necessary care without undue financial burden.

Fresno County reports that they receive less than 1% of the cost of the care for those privately insured individuals.   

 

Public Safety  

AB 2882 (McCarty) California Community Corrections performance incentives – Support  

Enhances the planning and reporting processes within the community corrections system, particularly focusing on the needs of incarcerated individuals requiring mental health care.

Enhanced Stakeholder Inclusion: Adds a representative of a community-based organization with experience in providing behavioral health treatment and a representative from a Medi-Cal managed care plan to the local Community Corrections Partnership (CCP).

Improved Planning and Goal Setting: Each county’s CCP must now include the heads of the county’s departments of social services, mental health, and substance abuse programs in its executive committee, ensuring a more comprehensive approach to community corrections. The bill requires each county to set specific goals for reducing recidivism, daily jail populations, jail bookings, and average length of stay while increasing connections to behavioral health care services.

Accountability and Transparency: Mandates the creation of an annual County Community Corrections Outcomes, Accountability, and Transparency report, which includes detailed tracking and reporting on public safety funding and its outcomes. This report must cover various metrics such as the use of funds, administrative costs, behavioral health calls for services, and the number of people connected to community-based treatment upon release.

Public Dashboard: The bill requires the development of a public dashboard that displays county goals and the spending and outcomes data, enhancing transparency and allowing for the comparison of data across counties.   

 AB 2142 (Haney): Prisons: mental health – Support  

Incarcerated Individuals Mental Health Access and Rehabilitation Pilot Program

1. Pilot Program Setup: Mandates the creation of a pilot program at two or more CDCR institutions, including institutions housing individuals of each gender. The program is designed to explore the benefits of providing mental health therapy to inmates who are not classified for such treatment under current CDCR programs.

2. Mental Health Therapy Access: Participants in the pilot program will have access to mental health therapy, either through virtual means like telepsychiatry or through in-person sessions with licensed or registered mental health providers. Therapy sessions are to be confidential and will be offered at least twice per month, lasting a minimum of 50 minutes each.

3. Eligibility Criteria: The program excludes individuals already receiving mental health care under the Correctional Clinical Case Management System, Enhanced Outpatient Program, Psychiatric Inpatient Programs, or Mental Health Crisis Bed.

4. Post-Release Information: Upon release, participants will be provided information about community-based treatment programs to help facilitate their reintegration. 

 SB 1025 (Eggman): Pretrial diversion for veterans – Support

Expands pretrial diversion to include non-serious felonies (i.e. murder & sex crimes not eligible) for veterans suffering from service-related issues like PTSD, traumatic brain injuries, or substance abuse.

The pretrial diversion program would use existing resources that are available to current or former members of the military to address and treat those suffering from sexual trauma, traumatic brain injury, PTSD, SUD, or mental health problems as a result of military service.

2. Conditions of Eligibility: To be eligible for diversion under the expanded provisions, veterans must not be accused of severe felonies such as murder, certain sex offenses, or crimes involving children. The inclusion criteria focus on supporting veterans whose criminal behavior may be linked to service-related health issues.

Positive results: the San Francisco Veterans Justice Court has informed us that most of the participants in their court have open felony charges and over 85% of veterans who graduate from their program have not been arrested again.  

 

Housing

SB 1082 (Eggman): Augmented residential care facilities – Support  

RCFE/ARF Facility Reimbursement Rates: Seeks to address the chronically low reimbursement rates that adult residential facilities (ARFs) and residential care facilities for the elderly (RCFEs) encounter.

Requires the Department of Health Care services (DHCS), in partnership with the Department of Social Services’ Community Care Licensing Division to develop and implement an Augmented Residential Care Facility plan that addresses community care facility needs of Californian’s with serious mental illness who require 24-hour non- medical care and augmented supports in a homelike setting.

Note that the current federal supplemental security income rate of approximately $1,398 a month per individual with a serious mental illness is inadequate, yet small ARFs and RCFEs rely on this for their primary and often only source of revenue.

Operators are paid $44 a day for each resident with serious mental illness, versus about $191 to $391 a day per person with developmental disabilities — a discrepancy that advocates have said must be fixed if the lower-funded board and care homes are to survive.

For individuals with Intellectual or Developmental Disabilities (IDD) there is a tiered structure of funding available to small community care facilities that is facilitated through DDS, the 21 Regional Centers, DSS’ Community Care Licensing and DHCS.

The 1915 (c) waiver for IDD has a tiered rates range from $1,398 to $12,715 per month per consumer with IDD.

Includes a rate structure that facilitates Medi-Cal matching for individuals with SMI who are on Supplemental Security Income who need 24/7 care and housing.

 

Crisis Services

 AB 1788 (Quirk-Silva): Mental health multidisciplinary personnel team – Support  

Expansion of Multidisciplinary Personnel Teams (MPTs) for Behavioral Health

Enables counties to establish Behavioral Health MPTs. Promotes collaboration across service providers and government agencies. MPT members can share confidential information as per existing privacy laws, strictly to facilitate the identification and treatment of behavioral health issues. Information sharing is confined to team members to ensure care continuity, adhering to state and federal privacy laws (including HIPAA).

While the bill does not specifically restrict family engagement with MPTs, all information shared between teams still must adhere to current state and federal privacy laws.   

 

Children and Youth

AB 2466 (Carrillo, Wendy): Cedi-Cal managed care: network adequacy standards- Support

Focus is on ensuring that enrollees receive timely access to healthcare services. Under this bill, MCPs would be out of compliance if less than 85% of their doctors get appointments on time.

The State Auditor found that health plans were largely unable to meet the state’s 48-hour urgent appointment standard. The median wait time was actually 13 days across Medi-Cal managed care plans.

Additionally, DHCS hasn’t set any minimum threshold for how many providers a health plan must have for services with timely access standards.
   

AB 2556 (Jackson): Behavioral health and wellness screenings: notice – Support

Mandates that health care service plans and insurers provide legal guardians of youths aged 10 to 18 with notifications about the benefits of behavioral health and wellness screenings every two years.

These screenings aim to identify indicators or symptoms of behavioral health issues such as depression or anxiety. The bill specifies that notifications can be delivered through the preferred method of the guardian, whether by hard copy, mail, in person, or electronically via text message or email. The intent is to enhance early identification and intervention for behavioral health issues among young people.  

 ACR 167 (Carrillo, Juan) Student Mental Health Awareness Week in California – Support  

 

SB 1318 (Wahab): Pupil health: suicide prevention policies  

Student Mental Health Emergency Protocol Enhancement

Mandates local educational agencies (LEAs) adopt specific mental health crisis intervention protocols. This legislation aims to ensure that during a mental health crisis, students are managed primarily by qualified school mental health professionals rather than law enforcement.

Adoption of Protocols: LEAs must adopt a mental health crisis intervention protocol that details the processes for deploying staff and external agencies during a student’s mental health crisis.

Prioritization of Mental Health Professionals: The protocols are to emphasize the use of school mental health professionals over law enforcement in managing crises, except where a student’s life is in imminent danger.

Training and Resources: If no school mental health professionals are available, the protocol should identify school employees who have received relevant training or community-based organizations that can intervene.

Parental Notification: It includes a process for notifying the parents or guardians of the student involved in the crisis, considering the safety of the student regarding such notification.   

 

LPS

AB 2154 (Berman): Mental health: involuntary treatment – Support  

 Patients’ Rights Handbook for Family Members

Mandates that any facility where a person is involuntarily detained must give a copy of the Patients’ Rights Handbook, prepared by DHCS, to a family member of the detained individual. The definition of “family member” in this context is broad:

(1) The spouse or domestic partner of the person.
(2) An adult child of the person.
(3) A parent or legal guardian of the person.
(4) A grandparent of the person.
(5) An adult sibling of the person.
(6) An adult grandchild of the person.
(7) An adult relative or close personal friend who has demonstrated special care and concern for the person and is familiar with the person’s personal values and beliefs to the extent known.

SB 1184 (Eggman): Mental health: involuntary treatment: antipsychotic medication – Support  

 Continuous Care for Involuntary Mental Health Treatment

Seeks to extend the effectiveness of a determination of a person’s incapacity to refuse treatment with antipsychotic medication during multiple periods of involuntary detention.

Currently, such determinations are required to be reevaluated and possibly renewed at the end of each specific period of involuntary detention under existing California law (the Lanterman-Petris-Short Act).

The bill aims to streamline the process by allowing a single determination to cover all involuntary detention periods unless the person’s capacity is restored sooner or a court orders otherwise.

This change is intended to prevent interruptions in medication treatment that can occur due to the need for repeated judicial hearings (known as Riese hearings) as the patient moves from one phase of detention to another. This is particularly relevant when transitioning from a 14-day hold to a 30-day hold and beyond.   

SB 1238 (Eggman): Lanterman-Petris-Short Act: designated facilities – Support  

 Expands the definition of facilities under the LPS Act to include those that can treat severe substance use disorders, allowing more types of facilities, such as skilled nursing facilities and mental health rehabilitation centers, to be designated for the evaluation and treatment of such disorders.

Last year, NAMI-CA co-sponsored SB 43, which modernized the definition of “gravely disabled” in two ways:

1) SB 43 added severe substance abuse disorders, or co-occurring mental health and severe substance use disorders, to the list of conditions a person could be suffering and be gravely disabled.
2) SB 43 expanded the list of limitations the mental health, substance abuse, or co-occurring mental health and substance abuse disorder, or chronic alcoholism, could cause to render a person gravely disabled, to include the person’s basic personal needs for personal safety or medical care.

At the time SB 43 was signed, many stakeholders raised concerns about SB 43’s expansion of the “gravely disabled” definition on the grounds that the LPS system was already overburdened and over capacity, and that there is no system of care in California to involuntarily treat persons suffering from severe substance abuse disorders. According to the Senate Health Committee’s analysis of this bill, all but two counties have indicated that they would take advantage of SB 43’s delayed implementation option, in part due to a lack of clarity over whether designated facilities are authorized to treat patients with a primary or standalone substance use disorder.

This bill closes the gap in care left by SB 43 by requiring DHCS to authorize facilities to accept patients with standalone severe substance abuse disorders and to provide for reimbursement for the treatment of standalone severe substance abuse disorders. It also permits DHCS to implement the provisions of this bill (but not the LPS Act as a whole) through bulletins or other means without going through a formal rulemaking process until it adopts formal regulations.   

 

Suicide Prevention and Crisis 

ACR 174 (Grayson): Firefighter Suicide Awareness and Prevention Stand Down Week – Support  

SCR 114 (Sevarto): Suicide Prevention Week in California – Support  

 

NAMI CA Official Position on the CARE Court — Support

Dear Governor Newsom:

NAMI-CA is in support of the Administration’s CARE Court framework, which intends to deliver services to Californians with a serious mental illness or substance use disorder who too often languish – suffering in homelessness or incarceration – without the treatment they desperately need.

NAMI-CA is the statewide affiliate of the country’s largest mental health advocacy organization, the National Alliance on Mental Illness. Our over 110,000 active advocates and 58 affiliates include many people living with serious mental illnesses, their families, and supporters. NAMI-CA advocates on their behalf, providing education and support to its members and the broader community.

NAMI-CA believes that all people should have the right to make their own decisions about medical treatment. However, we are aware that there are individuals with serious mental illnesses who have very high complex needs, at times, due to their illness, lack insight or good judgment about their need for medical treatment. In cases like this, a higher level of care may be necessary, but must be the last resort. Our members have been calling for reform for their loved ones for years.

NAMI-CA believes that the availability of effective, comprehensive, community- based systems of care for persons suffering from serious mental illnesses will diminish the need for assisted outpatient treatment. Before we reach the stage of last resort, we must fully fund, build and staff our community-based system, so all who need care can access it long before they reach a crisis level.

NAMI-CA urges the state to ensure that any services that are made available through the CARE Court model are also available as voluntary services in the community care continuum. There is currently no statewide standard that specifies that specific services be available to all people in all counties. We can no longer accept a fail-first system composed of partially realized solutions.

NAMI-CA deplores the higher rates of involuntary commitment and incarceration in penal facilities that occurs among communities of color with serious mental illnesses. We are thankful to have an Administration that understands that equity must be a top tenet of policymaking. Recognizing that communities of color and other underrepresented communities often suffer the unintended consequence of the court system serving as their behavioral health delivery system, the Administration must work closely with underrepresented communities to ensure that CARE Courts serve as an example of health equity in action.

NAMI-CA is heartened to see that accountability is one of the pillars of the CARE Court framework. We must hold the system accountable at all delivery points. We cannot take anything for granted in the implementation of a framework, as its effectiveness lies in the words that end up in statute, how it is implemented through the regulatory process, and to how each of our 58 counties will interpret the framework.

Additionally, more can be done to ensure the public (family members and consumers, in particular) and policymakers have the information they need to be assured that public programs treating people with serious mental illness are doing so effectively. In particular, little information is currently collected or shared about one of the most profound roles government plays in the mental health field – involuntary evaluation, treatment, and conservatorship under the LPS Act.

Many questions remain to be answered. What will the court process look like? What does success look like? If an individual has been diverted from legal proceedings, will their record be expunged upon completion of the CARE Court process? Who will qualify as a Supporter? What new resources will be directed to the proposal other than the preexisting federal, homelessness and county funds that were underscored in the framework? NAMI-CA looks forward to working closely with the Administration to implement the promise of the CARE Court framework.

I may be reached at jessica@namica.org or (916) 567-0163. Sincerely,

Jessica Cruz,
MPA/HS
Chief Executive Officer

Cc: Ana J. Matosantos, Cabinet Secretary, Office of Governor Gavin Newsom
Dr. Mark Ghaly, Secretary, California Health and Human Services Agency (CHHS) Stephanie Welch, Deputy Secretary, CHHS
Michelle Baass, Director, DHCS
Dr. Kelly Pfeifer, Deputy Director, Behavioral Health, DHCS
Stephanie Clendenin, Director, DSH
Mary Watanabe, Director, DMHC
Richard Figueroa, Office of the Governor
Tam Ma, Office of the Governor
Marjorie Swartz, Office of the Senate President Pro Tempore
Chris Woods, Office of the Senate President Pro Tempore
Agnes Lee, Office of the Speaker of the Assembly
Jason Sisney, Office of the Speaker of the Assembly
Joe Parra, Senate Republican Fiscal Office

Joe Shinstock, Assembly Republican Fiscal Office Corey Hashida, Legislative Analyst’s Office (LAO) Ben Johnson, LAO

Support NAMI CA This Tax Season

Take Action: Support the NAMI California Sponsored Mental Health Crisis Prevention Tax Contribution Fund – Line 445 on California Form 540.

Support Mental Health & Public Safety

This tax season, help NAMI California strengthen mental health and public safety by contributing to the Mental Health Crisis Prevention Tax Contribution Fund – Line 445 on California Income Tax Form 540. The fund supports an innovative program that provides training, tools, and resources to law enforcement agencies to safely interact with and support individuals experiencing a mental health crisis. According to the U.S. Department of Justice (DOJ), 25% of fatalities and 40% of injuries in officer involved shootings involve a person with a mental illness. NAMI California experts and public safety leaders agree that increased support and education for law enforcement officials is critical to safely engage people living with a mental illness. With these skills, officers can connect people experiencing a mental health crisis to treatment, counseling and other supports aiding in recovery.

Mental health is more important now than ever before. Learn how you can support the NAMI California Sponsored Mental Health Crisis Prevention Tax Contribution Fund >> 

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