Budget Actions

This week, the Senate Budget and Fiscal Review Subcommittee No. 3 and the Assembly Budget Subcommittee No. 1 concluded their budget discussions by taking up myriad vote-only items.

Highlights of actions taken by both Subcommittees thus far include:

• County Medi-Cal Administration: Approved the County Welfare Directors Association’s proposal to redirect $95.3 million ($31 Million General Fund) in one-time savings from county CalFresh programs administered by the Department of Social Services. The CalFresh “savings” was due to lower caseload than estimated. CSAC supported the redirection of these administrative funds to supplement the Governor’s May Revision proposal of allocating only $150 million ($48.8 Million General Fund) in 2015-16 for the County Medi-Cal administration costs. With the new proposal, the total estimated county Medi-Cal administration funds (including General Fund and federal funds) is approximately $245 million. The full budget committees in each house must also agree to this proposal.
• Maximum Family Grant: The Senate voted to repeal the MFG rule effective October 1, 2015 ($158 million GF); while the Assembly voted to conform to the Senate’s action.

Additionally, the Senate Budget and Fiscal Review Subcommittee No. 3 took the following actions:

• Continuum of Care Reform: Adopted the Governor’s budget of $9.6 million ($7m GF) to fund the CCR report recommendations.
• Undocumented Immigrants: Expanded Medi-Cal coverage to undocumented immigrants ($40 million GF).
• Medi-Cal Dental: Fully restored the Medi-Cal adult dental benefits ($67.5 million GF) eliminated in the 2009 budget.
• Medi-Cal Dental: Eliminated the AB 97 dental provider payment reductions ($30 million).
• Drug Medi-Cal Residential Treatment Services: Reduced the May Revise estimate by $5 million GF to reflect assumed lags in implementation.
• CSEC: Approved Governor’s May Revision, which redirects $3.25 GF of the 2015-16 county grant money for CSEC activities to meet new federal mandates. CWDA and CSAC are opposed to this proposal. This issue is expected to be taken up by the Conference Committee.
• IHSS Restoration: Approved $228 million GF to restore the 7 percent reduction in IHSS service hours.
• Medi-Cal Cost-of-Living Adjustment: Suspended the county COLA for county eligibility administration in the budget year, but not on a permanent basis.

Meanwhile, the Assembly Budget Subcommittee No. 1 voted to:

• Provide a $30 million GF augmentation in 2015-16 and ongoing for the CalWORKs Housing Support Program, which CSAC supported.
• CSEC: Reversed the Governor’s May Revision proposal to redirect $3.25 GF of the 2015-16 county grant money for CSEC activities to meet new federal mandates. CWDA and CSEC shared our opposition to the Administration’s proposal. This issue is expected to be taken up by the Conference Committee.
• Medi-Cal COLA: Adopted a COLA in January 1, 2016 ($46 m).
• Medi-Cal Benefits: Restored Medi-Cal optional benefits – acupuncture, audiology, incontinence creams/washes, optician/optical lab, podiatry and speech therapy ($15 million).
• Naloxone Grant – Approved $2 million GF for Naloxone Grant Program.

Drug Medi-Cal Organized Delivery System Waiver

The Department of Health Care Services (DHCS) and the Centers of Medicare and Medicaid Services (CMS) continue to negotiate the Special Terms and Conditions (STCs) of the Drug Medi-Cal – Organized Delivery System (DMC-ODS) Waiver amendment to California’s Section 1115 Bridge to Reform Waiver. DHCS initially submitted the STCs to CMS in November 2014, as a result of negotiations, significant changes to the STCs have been made.

Changes include:

• American Society of Addiction Medicine (ASAM) Designation – all residential providers must receive an ASAM designation, which will be developed and issued by DHCS.
• Tribal Delivery System: DHCS has added a fifth phase of the DMC-ODS Waiver implementation for DHCS to consult with tribes and tribal 638/urban programs after the approval of the DMC-ODS waiver amendment.
• County Implementation Plan: Under the direction of CMS, the County Implementation Plan will be included in the STCs with minimal changes.
• Evaluation Design: CMS instructed DHCS to place the evaluation design into the STCs.
• Certified Public Expenditures (CPE) Protocol: DHCS included a narrative description of the CPE protocol, per CMS.
• Naloxone: CMS instructed DHCS to add naloxone as a drug covered under the DMC benefit in Narcotic Treatment Program Settings. Naloxone is a life-saving drug used to reverse the effects of opioid overdose.
• Residential Services: Counties will now be required to have three ASAM levels (3.1, 3.3, and 3.5) of residential services available within three years of DMC-ODS participation.
• Additional MOU Requirements: DHCS added additional MOU requirements between counties and managed care plans.
• Integration Plan: CMS has required DHCS to commit to specifying an integration approach by April 1, 2016 and produce a concept design for an integrated care model by October 1, 2016.
• Innovation Accelerator Program: DHCS will participate in the Medicaid Innovation Accelerator Program initiative for reducing substance use disorders.
• Youth Recovery Services: CMS wants DHCS to identify recovery services geared towards youth, as described in the CMS Informational Bulletin “ Coverage of Behavioral Health Services for Youth with Substance Use Disorder ”.
• External Quality Review (EQR): All CMS Waivers require an EQR. The DMS-ODS EQR requirements must be phased in within 12 months of having an approved plan. EQR monitoring visits will begin in January 2016 for Phase One counties, July 2016 in Phase Two counties and by January 2017 for all pilot counties.
• NTP Rate: One original point of contention between counties and the California Opioid Maintenance Providers was who would set the narcotic treatment providers (NTP) rates. The compromise as a result of those negotiations was that DHCS would continue to set the rates for the entire duration of the DMC-ODS.

For additional details regarding the changes to the STCs, please see DHCS’ summary document . DHCS has also posted the updated April 28, 2015 STCs and other materials on their DMC-ODS webpage.

Involuntary Commitment

AB 1300 (Ridley-Thomas) – OPPOSE
As Amended on May 20, 2015

CSAC remains in opposition to Assembly Bill 1300, by Assembly Member Sebastian Ridley-Thomas. This bill makes over 80 technical changes to the Lanterman Petris-Short (LPS) Act (Welfare and Institutions Code Section 5000 et. seq.) – commonly referred to as the 5150 process– concerning involuntary commitment to a mental health institution in California. Sponsored by the California Hospital Association (CHA), AB 1300 would:

• Begin the 72-hour detention period for evaluation and treatment at the time a person is initially detained, which reduces the time a person receives treatment for their mental health crisis.
• Allows hospital emergency room physicians to release a person from a 5150 hold with several immunities protecting them from liability should the person commit harm to themselves or others.
• Creates “county liaisons” who must provide assessments within 30 minutes of the person in crises arriving at the hospital, thereby increasing the workload and needed positions in the county due to potential geographic limitations.

It should be noted that CHA has shopped this bill over the past several years. While we acknowledge that persons can be waiting for long periods of time to receive treatment, we do not believe this bill proposes solutions to that problem and instead releases people without providing treatment. The problem in California is the limited number of psychiatric beds.

CSAC, the County Behavioral Health Directors Association, the National Alliance on Mental Illness – who represent the family members of those suffering from mental illness – and the California Highway Patrol (CHP) are all opposed to AB 1300 and have been meeting with Legislators to explain the impacts of this bill. We encourage counties to formally oppose AB 1300 and to contact their Legislator to express your opposition as well.

IHSS

AB 1436 (Burke) – SUPPORT 
As Amended on May 6, 2015

AB 1436 by Assembly Member Autumn Burke creates an authorized representative structure for the In-Home Supportive Services (IHSS) Program – which enables adults and children who need help with daily living activities remain in their own home rather than being institutionalized. Other county-administered programs, including Medi-Cal, CalWORKs and CalFresh, have statutory or regulator procedures for applicants and recipients to designate an authorized representative to act on their behalf in signing up for the program, receiving services and participating in the appeal process.

AB 1436 would create a statutory authority for an IHSS recipient or applicant to name an authorized representative, which would be completely optional to them.

With no opposition on file, AB 1436 resides on the Assembly Floor’s consent calendar.

Adult Protective Services

SB 196 – SUPPORT
As Amended on May 19, 2015

Senate Bill 196, by Senator Hancock, was recently amended to authorize a county adult protective services agency – but removed the county public conservator from the proposed language – 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, sponsored by the County Welfare Director’s Association of California