2020 Legislative Package

SB 855 (Wiener): Real Mental Health Parity

It’s hard to overstate how important this bill is. Patrick Kennedy, the former Congressman and author of federal parity legislation passed in 2008, says its passage would make California a national leader and set a new standard in the effort to achieve true parity. Our founder, Sacramento Mayor Darrell Steinberg, sees the bill as the “most important mental health bill in many years.”

For decades, people who purchase commercial health insurance or get it through their employers have been frustrated by their inability to get their health plans to cover mental health or substance use treatment. This problem led to the passage of two federal laws – the Mental Health Parity Act of 1996 and the Mental Health Parity and Addiction Equity Act of 2008 – as well as a state law passed in 1999. But these bills had loopholes and didn’t achieve full parity. As a result, people needing mental health and substance use treatment still feel the sting of discrimination and stigma as private health insurers often make it extraordinarily difficult – if not impossible – to get the services they need.

For example, California’s existing law names nine specific types of mental illness, along with serious emotional disturbance in children, and requires commercial insurers to cover them. However, this list excludes a wide range of mental health and substance use disorders including conditions such as post-traumatic stress disorder (PTSD), generalized anxiety disorder, opioid, alcohol and stimulant use disorders, binge eating disorder and traumatic brain injury.  Instead of cherry picking a limited number of conditions, SB 855 expands the law to encompass any treatable mental health or substance use disorder described in the Diagnostic and Statistical Manual of Mental Disorders (DSM).

SB 855 also closes a critical loophole. Under current law, insurance companies are essentially able to determine for themselves whether a recommended mental health treatment is “medically necessary.” SB 855 creates clear standards with a uniform definition of medical necessity tied to generally accepted standards of care.

Last year, before the COVID-19 pandemic hit, 71,000 American died of drug overdoses, a new record, with deaths in California surging 16%. Today, with double-digit unemployment in California as a result of the pandemic, rates of alcohol consumption, substance abuse, and suicide are poised to rise. The need for people to get help for their mental health and substance use disorders has never been greater. This bill can make a huge difference and allow California and its governor to be national leaders on a critically important issue.

Governor Newsom signed this bill into law on September 25, 2020.

SB 803 (Beall): Certification for Peer Support Specialists in Mental Health

California’s burgeoning mental health crisis, visible on its streets and hidden in the homes of newly unemployed workers, is further complicated by a large and growing shortage of mental health professionals of all types. One part of the mental health workforce with the capacity to immediately grow larger and help bring needed support and services to people grappling with mental health problems is peer support specialists.

Peer support specialists are people with “lived experience” who provide vital support to others trying to manage their own mental health challenges. These specialists have struggled with their own mental health and have had experience navigating the social service, mental health or criminal justice systems. Their experience gives them a unique ability to cut through stigma, as well as to understand, empathize and gain the trust and confidence of people going through similar experiences. They are not clinicians, but they can work as part of clinical or support teams and help people get the multifaceted support they need.

The federal Centers for Medicare and Medicaid Services (CMS) have for years recognized the value that peer support specialists provide for mental health recovery. Research has shown that peer support specialists offer a substantial return on investment by reducing emergency room visits and in-patient hospital stays and boosting resilience and recovery.  CMS provides reimbursement for peer services through the Medicaid system to states that build these services into their state Medicaid plans and, most importantly, establish a system for training and certifying these workers. Today, California is one of only two states that has failed to set up a certification program (the other is South Dakota).

SB 803 would finally change that reality by authorizing the state’s Department of Health Care Services to establish a statewide peer support specialist certification and training program, using a core curriculum that defines the skills and competencies required of a peer support specialist.

Creating a certification program will generate relatively minor costs to be offset by certification fees collected by DHCS and the substantial anticipated returns on investment.

We salute Senator Jim Beall, a San Jose Democrat who for years has claimed mental health as a priority, and has worked diligently to strengthen our mental health care system. Termed out of the State Senate in 2020, we know he will continue to find ways to ensure people receive the care they need. 2018 Mental Health Champion

AB 1766 (Bloom) Preserving Board and Care Homes

Adult residential facilities – better known as board-and-care homes — are a vital and rapidly vanishing housing resource for people suffering from severe mental illness or cognitive impairment. These facilities provide a place to live, meals, and other assistance for people who are vulnerable, unable to care for themselves, and at high risk of becoming homeless. Many have been recently discharged from hospitals or prisons or are in a conservatorship. Nearly everyone living in these homes receives federal disability benefits that help pay the cost of their housing and meals.

This vital housing resource is disappearing because many operators, faced with low reimbursement rates, are closing their facilities or converting them to other use. Los Angeles County recently reported a loss of 200 beds in just one year but there is little hard information on the number of these facilities that are still operating across the state. Without this basic information, it is impossible to develop strategies to preserve those that remain.

AB 1766 would require the State Department of Social Services to collect data on the number of people with severe mental illness who live in adult residential facilities and to issue quarterly public reports on the number of facilities and beds that have been lost in the previous quarter. It would also require the department to notify counties of planned closures.

SB 66 (Atkins) Improved Access to Mental Health Services in Primary Care
About 6.5 million people receive primary care, mental health and other services at 1,300 community health centers in California. As many as 40% of patients seen in primary care on any given day also have a mental health condition. Health systems have found that being able to bring a patient from primary care to an on-site mental health specialist on the same day makes it far more likely patients will get the care they need. Current rules prevent providers from being reimbursed for more than one visit in a single day. SB 66 would allow health centers to bill Medi-Cal for two visits if they receive mental health and medical care on the same day. This bill failed passage in the legislature.

SB 331 (Hurtado) Teen Suicide Prevention
Youth suicide has been rising steadily and is now the second leading cause of death among young people aged 15 to 24. In California, almost 20% of all high school students and almost half of LGBTQ students report that they seriously considered attempting suicide in the previous year. Studies show prevention and early intervention efforts can reduce suicide. Santa Clara County has had a concerted suicide prevention effort since 2010, and in 2016 and 2017 suicides there decreased by 11% and 14%. But since 2009, only seven of California’s fifty-eight counties have adopted suicide prevention strategic plans. SB 66 will require all California counties to bring together diverse stakeholders to create and implement strategic suicide prevention plans, with the emphasis on young people. This bill failed passage in the legislature.

SB 803 (Beall): Certification for Peer Support Specialists in Mental Health
Research has shown that “peer support specialists” – people who have had personal experience dealing with and recovering from a mental illness or substance use disorder – are very effective in working with other people experiencing the same thing. Studies suggest peers help reduce costly hospitalizations and hospital days, depression and the myriad of other symptoms affecting clients. They also improve clients’ ability to function, promoting their follow through with all steps on the path to recovery, as well as their resiliency. Peers often serve as the first point of contact for people living with mental illness and can forge connections, inspire trust, and importantly, diminish stigma.The federal government has set up policies that make services provided by peer support specialists eligible for partial reimbursement through the Medicaid program if the peer specialists have been certified by a competent state body. The U.S. Department of Veterans Affairs and 48 states have a certification process in place or in development for mental health peer support specialists, yet California has no such program. SB 803 would direct the Department of Health Care Services to create a statewide peer support specialist certification program, inclusive of core competencies, curriculum, training, supervision standards and certification protocol.  And, importantly, SB 803 would direct the Department to recognize certified peer support specialists as providers eligible to treat patients through the Medi-Cal program. This measure is potentially life saving, cost-saving, and a big potential help for the state’s serious mental health workforce shortage. This bill was signed into law by Governor Newsom.

SB 854 (Beall) Access to Medication Assisted Treatment (MAT) from Private Health Insurers
Eleven medications approved by the FDA for treatment of opioid, alcohol and tobacco use disorders have been found effective, in combination with counseling, at helping people recover. Yet barriers imposed by health insurers limit the ability of patients to get access to medication-assisted treatment (MAT). SB 854 would bar insurers from excluding from coverage FDA-approved medications used to treat substance use disorders or from imposing rules requiring patients to get prior authorization to use MAT or to go through a “step therapy” process before MAT is approved. This bill failed passage in the legislature.

SB 855 (Wiener): Real Mental Health Parity
State and federal laws passed over the past 20 years have sought to provide “parity” and ensure that health insurers cover mental health and substance use treatment on the same basis that they cover medical treatment. Yet weaknesses in the laws have allowed insurers to avoid paying for these kinds of treatment or to enact roadblocks that make it difficult for patients to access needed therapy.SB 855 defines services for mental health and substance use disorders as “medically necessary treatment” that must be covered when recommended by doctors and other treatment professionals, consistent with generally accepted standards. It prohibits insurers from covering only short-term or acute treatment since recovery from mental health and substance use disorders often requires longer-term treatment. If needed services aren’t available from an insurance plan’s network providers, SB 855 requires insurers to reimburse out-of-network coverage at in-network rates. This bill was signed into law by Governor Newsom.

AB 451 (Arambula): Health facilities: Emergency Services and Care
This bill aims to overcome the challenges faced by physicians.  This bill would require psychiatric units within a general acute care hospital, a psychiatric health facility, or an acute psychiatric hospital regardless of whether it maintains an emergency department, to provide emergency care and services to relieve or eliminate a psychiatric emergency medical condition.  The provisions in AB 451 ensure that patients who are in need of more extensive psychiatric emergency care obtain it. This bill failed passage in the legislature.

AB 890 (Wood) Nurse Practitioners: Scope of Practice AB 890 would enable licensed nurse practitioners to work to the full scope of their license by expanding their ability to treat patients, including those affected by mental health challenges, without a physician’s supervision. Nurse practitioners are registered nurses with extra training who have earned advanced degrees — either a master’s degree or a doctorate. Expanding the role and authority of nurse practitioners will help address the large and growing shortage of primary care physicians in California.  There are currently nearly 28,000 nurse practitioners in California, according to the California Board of Registered Nursing.

Watch Close the Provider Gap President Patti Gurney present Assemblymember Jim Wood with the Nurse Practitioner Advocate of the Year award.

AB 1766 (Bloom): Preserving Board and Care Homes
Adult residential facilities – better known as board-and-care homes — provide housing and care services for people suffering from severe mental illness (SMI) or cognitive impairment. Many have been recently discharged from hospitals or prisons or are in a conservatorship. They provide a critical form of housing and support for people who are vulnerable and unable to care for themselves and are at high risk of becoming homeless or returning to hospitals or incarceration. Yet this vital housing resource is disappearing due to low reimbursement rates coupled with increased costs of labor and property. Los Angeles County recently reported a loss of 200 beds in just one year.AB 1766 would require the State Dept. of Social Services to collect data on the number of people with severe mental illness who live in adult residential facilities and to issue quarterly public reports on the number of facilities and beds that have been lost in the previous quarter. It would also require the Dept. to ensure that counties are notified of planned closings of residential facilities. This bill was signed into law by Governor Newsom.

AB 1845 (Luz Rivas and Chiu) Creating an Office to End Homelessness
Would create, within the Governor’s office, the Office to End Homelessness, to be run by a Secretary on Homelessness appointed by the Governor. The office would be the lead state entity for ending homelessness in California and would coordinate with local, state and federal agencies. The bill was vetoed.

AB 1976 (Eggman) Revises Laura’s Law and makes it permanent
Laura’s Law, first passed in 2002 and since revised, enabled counties to start Assisted Outpatient Treatment (AOT) programs for people with severe mental illness who are deemed likely to deteriorate to the point that they would meet the standard for involuntary commitment if they didn’t get help. Counties that voted to take part in the program had to first offer intensive outpatient treatment on a voluntary basis. If a person declined to take part, the law authorizes county officials to institute a judicial proceeding and allows judges, after a hearing, to order them to receive outpatient treatment.AB 1976 would change several aspects of the program, including these: It would require counties that do not wish to take part to opt out of the program, rather than allowing counties to opt in. It would extend the program beyond 2022, the current sunset date, and make it permanent. And it would allow groups of counties to implement the program together. This bill was signed into law by Governor Newsom.

AB 2054 (Kamlager) Establishes CRISES Act Grant Pilot Program
The bill would create a pilot program called the Community Response Initiative to Strengthen Emergency Systems (CRISES) and give grants of at least $250,000 to community organizations to help them expand community participation in emergency response efforts. This bill was vetoed.

AB 2112 (Ramos) Establishes Office of Suicide Prevention
Would set up an Office of Suicide Prevention in the State Department of Public Health to assess existing efforts, make recommendations and build efforts to reduce suicide in California. This bill was signed into law by Governor Newsom.

AB 2360 (Maienschein) Mental Health Services via Telehealth for Children and New Mothers
Would require health plans to provide mental health consultation services via telehealth for children, pregnant women and postpartum women for up to one year after the birth of their child. This bill was vetoed.

2377 (Chiu) Requiring Public Notice When Board and Care Operators Plan to Close Facilities
Would require operators of board and care facilities to provide 180 days of notice before closing. This bill was signed into law by Governor Newsom.

AB 2589 (Maienschein) Including Board-and-Care Homes in No Place Like Home program
In 2016, Governor Brown signed into law No Place Like Home, a $2 billion bond program championed by the Steinberg Institute. It funds the creation or rehabilitation of permanent supportive housing for chronically homeless people grappling with severe mental illness.AB 2589 would amend the law to expand the definition of permanent supportive housing to include licensed adult residential facilities and residential care facilities for the elderly, commonly known as board-and-care homes. These kinds of facilities are rapidly vanishing because operators do not earn enough money to continue operating them. Making these facilities eligible to be renovated or newly constructed with funding from No Place Like Home will protect and perhaps expand this vital affordable housing resource. This bill failed passage in the legislature.

AB 3242 (Irwin) Allows Evaluations by Telehealth for Persons Considered for Involuntary Commitment
This bill authorizes physicians to use telehealth to examine and assess individuals for the purposes of involuntarily detention under the Lanterman-Petris-Short Act. This bill was signed into law by Governor Newsom.

AB 3269 (Chiu) Creating an Inspector General for Housing and HomelessnessWould create a new position, Inspector General for Housing and Homelessness, and require the state Homeless Coordinating and Financing Council and local governments to develop plans to address homelessness. This bill failed passage in the legislature.