Accountability and transparency are critical to transforming California’s mental health and substance use disorder systems. While access to care for everyone in the state is critically important, we must ensure that the care provided is high quality resulting in improved outcomes for those receiving it. As such,, this year, the Steinberg Institute is focused on ensuring that our care systems are focused on outcomes. As unprecedented investments are made in behavioral health, it’s more important than ever.
At the same time, an opportunity exists to modernize the foundational act that provides billions for mental health services across the state. Authored by our founder Darrell Steinberg and the late Rusty Selix, the Mental Health Services Act (MHSA) of 2004 reshaped how services were paid for and delivered in California.
In March, Governor Gavin Newsom proposed modernizing the MHSA to better align with current needs. The proposal calls for prioritizing these funds to serve people with the most acute behavioral health issues, focusing on housing and “Full Service Partnerships” for the most seriously ill and allowing MHSA to be used for people with substance use disorders.
Our founder joined the Governor in San Diego for the announcement. As the co-author of the Mental Health Services Act, he applauded the proposed reforms.
This year we are sponsoring Assembly Bill 459 (Haney), establishing the California Behavioral Health Outcomes and Accountability Review program (CBH-OAR). AB 459 takes a critical step forward to hold our behavioral health systems accountable for serving and improving the life outcomes of Californians living with mental illnesses and substance use disorders. The bill does so by requiring counties and health plans to set ambitious systems goals and the state to monitor and publicly report their progress.
Our Primary Legislation
Our mental health and substance use care system is broken, leaving thousands in dire straits to fend for themselves, facing impossible circumstances with few resources. Our fragmented and underfunded behavioral health systems are not adequately focused on outcomes, resulting in needless human suffering, institutionalization, homelessness, incarceration, and death.
Over the past decade California’s budget for behavioral health services has more than doubled, yet we have no evidence of improved outcomes associated with this increased investment. Recent initiatives such as the California Youth Behavioral Health Initiative, CARE Court, CalAIM, SB 855 and the new 988 crisis line have brought much-needed reforms to the behavioral health system. In addition, almost $4 billion in new investments have been made in additional behavioral health facilities and housing. It’s now critical that our systems of care are held accountable to ensure the effectiveness of these initiatives.
AB 459 seeks to create a data-informed and community-driven continuous quality improvement framework for California’s public and private mental health and substance use care systems. The bill requires counties and health plans to set ambitious goals and the state to monitor and publicly report their progress. This legislation is modeled after the Child Welfare Indicators Project and Cal-OAR, which have demonstrated approaches that improve systems without penalizing them.
It has been 60 years since President John F. Kennedy signed the Community Mental Health Act, a promise of dignity and recovery for people with mental illness, supported with community-based treatment instead of institutionalization. Unfortunately, as a society, we have failed to deliver on those promises, continuing the systemic discrimination against people living with mental health and substance use disorders. Measurable goals, increased collaboration, and customizable approaches are necessary to ensure all Californians have access to quality behavioral health care.
Our 2023 Legislative Package
Would require plans or insurers to annually audit and delete inaccurate listings from its provider directories. Starting January 1, 2024, this bill would require a provider directory to be at least 60% accurate with increasing annual benchmarks until 95% accuracy is achieved on or before January 1, 2027. Additionally, this bill would subject plans and insurers to administrative penalties if the plan or insurer has not met the prescribed benchmarks. This bill would also require a plan or insurer to delete a provider from its directory by July 1, 2024, if the plan or insurer has not financially compensated the provider.
This bill would require plans or insurers to provide information about in-network providers to enrollees or insureds upon request. Finally, this bill would limit the cost-sharing amounts an enrollee is required to pay for services from those providers under specified circumstances.
This bill is sponsored by Health Access California.
AB 280 provides a clear definition of what constitutes solitary confinement across all facilities, sets limits on how it can be used, and provides examples of alternatives to solitary confinement when individuals need to be housed individually. Additionally, this bill ends the use of solitary confinement for designated populations, including people who are pregnant, 60 years of age or older, or have serious disabilities.
This bill tackles the lack of regulation on the use of solitary confinement in detention facilities in California in existing law.
Co-sponsors of the bill include Immigrant Defense Advocates, NextGen California, Disability Rights California, California Collaborative for Immigrant Justice, Prison Law Office, and Underground Scholars, UC Berkeley.
AB 663 allows mobile pharmacies to provide medications for Opioid Use Disorder (OUD) treatment. This change would help expand local efforts to prevent overdose deaths and improve access to healthcare for some of our most vulnerable populations.
This bill serves as an expansion to passed legislation SB 872 (Dodd, 2022), which allowed local jurisdictions to operate mobile pharmacies and provide prescription medications, including to persons experiencing homelessness.
The bill is sponsored by the City and County of San Francisco.
AB 1339 revises the definition of disability to include people receiving Medication-assisted treatment (MAT) and prohibits housing providers who accept state funding from discriminating against individuals on MAT. It clarifies that providers accepting State funding cannot discriminate against individuals on MAT treatment because it is directly tied to a protected disability. For contractors that violate the law, it requires contract administrators to place contracts in breach, including canceling their contracts.
This bill aims at aligning California’s definition and protection of individuals with disabilities with those of the Federal Law, where discrimination based on disabilities is strictly prohibited.
The bill is sponsored by California Association of Alcohol and Drug Program Executives.
AB 799 requires the State to take a more direct leadership role in working with local jurisdictions collaboratively to set homeless reduction targets. Additionally, the bill sets consequences for failing to meet goals, including the potential for HHAP funds to be reallocated to another entity within the same region. Furthermore, the bill streamlines administrative burdens on local systems, while ensuring that more detailed information is made public to improve transparency and oversight. Lastly, the bill requires investments in balanced homeless response systems that promote equitable housing outcomes while maintaining flexible eligible uses.
This bill tackles the lack of accountability and inconsistent funding in the existing law, which has caused the failure of homelessness response systems to fully meet the challenges of rising housing costs and insufficient supply.
Co-sponsors of the bill include Bring California Home Coalition, Corporation for Supportive Housing, Housing California, John Burton Advocates for Youth, National Alliance to End Homelessness , and the Regional Task Force on Homelessness – San Diego.
AB 1029 amends the current Health Care Decisions Law and the form for Advance Health Care Directives to allow an individual to appoint a separate agent for mental health decision making. This bill also creates a new section within the Advance Health Care Directives form specifically for mental health care planning.
Though California’s statutory template for an Advance Health Care Directive form includes healthrelated information, it does not include questions related specifically to mental health care; this bill aims to alleviate such a situation.
Co-sponsors include Mental Health America of California and Disability Rights California.
AB 1437 would revise the current process for Medi-Cal patients to receive medications for serious mental illness in an effort to provide greater support to patients. This bill would prevent requiring prior authorization for drugs prescribed to Medi-Cal patients for the treatment of serious mental illness. This would apply to any individual who is 18 years of age or older who is not under the transition jurisdiction of the juvenile court.
Additionally, the bill would require automatic approval for prescribed drugs with the intent to treat serious mental illness if there is a record of a pad claim that documents a diagnosis of serious mental illness within 365 days before the date of prescription with the same age and jurisdiction conditions mentioned earlier.
This bill is co-sponsored by California Access Coalition, Alliance for Patient Access, and Psychiatric Physicians Alliance of California
SB 10 expands statewide prevention and education efforts to combat the skyrocketing overdoses and fentanyl-related deaths that have plagued youth statewide. It seeks to provide necessary intervention, increase accessibility to resources and provide valuable education and training services to protect our youth from fentanyl poisoning and overdoses.
This bill addresses the fact that Fentanyl is responsible for more deaths among youth than all other drugs combined. This drug can be found in fake and counterfeit pills that are sold through social media or e-commerce platforms, making them available to youth. Across America, the Drug Enforcement Agency has noted a considerable rise in the amount of fake and counterfeit pills containing a deadly dose of fentanyl – nearly a 502 percent increase since 2019.
This bill would prohibit limiting or excluding coverage, dosage, or dosage form of a drug that is prescribed for off-label use if the drug had been previously covered for a chronic medical condition or cancer, regardless of whether the drug, dose, or dosage form is on the plan’s or insurer’s formulary. Finally, the bill would prohibit a service plan contract or health insurance policy from requiring additional cost not already imposed for a drug that was previously approved for coverage.
This bill is sponsored by Crohn’s and Colitis Foundation.
SB 513 provides access to mental health therapy for incarcerated Californians, regardless of security level, sentence length, or mental health classification. Access to therapy will help to rehabilitate incarcerated people and improve California’s recidivism rate. It allows CDCR to increase virtual or in person therapy opportunities to all incarcerated people, to the greatest extent possible. It redefines “mental health therapy” as 50-minute sessions offered up to two times per month by a psychiatrist, psychologist, licensed social worker, or licensed therapist. It also requires CDCR to provide incarcerated people with a mental health appointment within two weeks of the patient requesting care and will ensure patients are seen on schedule, on time, and confidentially.
This bill addresses the existing problem that though incarcerated people technically have access to therapy, their sessions are often as short as 15 minutes, and they are often cycled through different therapists sporadically.
Sponsors include the Anti-Recidivism Coalition and Mental Health of America.
SB 282 would authorize reimbursement for a maximum of 2 visits that take place on the same day at a single site if after the first visit, the patient suffers illness or injury which requires additional diagnosis or treatment, or if the patient had a medical visit and either a dental or mental health visit. Finally, this bill would require the State Department of Health Care Services, by July 1, 2024, to produce a state plan which reflects those provisions to the federal Centers for Medicare and Medicaid Services.
This bill is primarily sponsored by California State Senators Susan Eggman and Mike McGuire.
This bill would require the State Department of Health Care Services to submit a plan amendment no later than January 1, 2024, to enter into a Medicare Part A buy-in agreement with the federal Centers for Medicare and Medicaid Services. Furthermore, the bill would create a state-mandated local program. This bill would allow the state to bypass the SSA requirements and enroll individuals into Medicare Part A at any time. This bill is critical to reducing inequities by streamlining into Medicare Part A through Medi-Cal’s Medicare Beneficiaries program.
This bill is sponsored by Justice in Aging.
SB 363 would establish a real-time, internet-based database to collect, aggregate and display information about beds in specified facilities. The bill would also require the database to include a minimum of specific information relating to contact information, types of treatments appropriate for each bed, and populations served at the facility. Furthermore, the bill would require up-to-date information on the availability of beds to help providers quickly find beds.
This bill is co-sponsored by the California State Association of Psychiatrists.
SB 287 would prohibit social media companies from using algorithms that cause child users to be directly exposed to harmful content. Harmful content may include (1) content or messages that facilitate the purchase of Fentanyl, (2) content or messages that facilitate suicide, or (3) content that cause self-harm, (4) content that may provoke eating disorders, (5) content which cause users to become addicted to the platform. Violations of these provisions would be met with financial penalties. However, social media companies would not be in violation of this bill if they conduct self-audits for harmful content.
This bill is supported by Common Sense Media, Children’s Advocacy Institute, #Halfthestory, Jewish Family and Children’s Services, and American Association of University Women California.
SB 509 would require the California Department of Education to ensure that at least 75% of classified and certified employees on campuses complete a behavioral health training program. This bill would also delete the term “common” from examples included in the current training requirement of youth behavioral health disorders.
This bill is sponsored by the California Council of Community Behavioral Health Agencies.
SB 525 establishes a $25 per hour minimum wage for healthcare workers in California to help retain existing workers and attract additional workers we need to assure quality healthcare for every Californian. Healthcare workers covered include those who provide services in nursing, caregiving, housekeeping, guard duties, clerical, food services, laundry, medical care, and other patient-care related services. Healthcare facilities covered by the bill include hospitals, urgent care centers, ambulatory surgical centers, skilled nursing facilities, Federally-Qualified Health Centers and other primary care clinics, outpatient settings, physician offices, dialysis clinics, behavioral health centers, and integrated healthcare delivery systems.
In light of the increased health care worker crisis in California, this bill seeks to help restore healthcare jobs to the status of a job a person can support a family with, attracting more workers and bolstering efforts to fill the huge shortage of healthcare workers our state is facing.
This bill is sponsored by SEIU.