Special Session on Health Care

Today, the 2nd Extraordinary Session Senate Public Health and Developmental Services Committee convened an informational hearing. Members of the Committee include Senators Ed Hernandez (Chair), Mike Morell (Vice Chair), Joel Anderson, Jim Beall, Isadore Hall, Mark Leno, Mike McGuire, Holly Mitchell, Bill Monning, John Moorlach, Jim Nielson, Richard Pan and Lois Wolk.

During the hearing, the Governor’s Administration provided a brief walk-though of the history of managed care taxes in California and further described the guidance issued to California by the Centers for Medicare and Medicaid Services (CMS). In 2014, CMS deemed the MCO tax in California along with other states’ to be out of compliant with federal rules citing it was not a broad based tax and instead only taxed Medi-Cal plans. Further CMS highlighted California’s MCO tax did not create “winners” and “losers” – Medi-Cal health plans net even. CMS gave states until the end of their next legislative Session to make changes to their current MCO tax structures. 

Moving forward, the Administration’s goals for creating the new tax are to: 1) generate $1.1B in General Fund revenue; 2) have the least impact on health plans; and 3) be consistent with Federal guidelines and have “winners” and “losers”. The Administration’s proposal would create a tiered tax structure based on cumulative enrollment per quarter. However, the LAO questions the use of enrollment per quarter stating that commercial plans would be taxed at a higher rate. 

In addition to the discussion around the MCO tax, the Committee also heard from the Legislative Analyst’s Office (LAO) on the issue of provider rates, the In-Home Supportive Services (IHSS) Program and Developmental Services (DDS) Programs. The Hearing agenda and summaries of the LAO’s analysis can be found here. 

CSAC remains engaged and will provide updates as key issues are addressed throughout the remainder of the Special Session.

The hearing agenda and materials can be found at http://shea.senate.ca.gov/informationalhearings.

CMS Approves Specialty Mental Health Waiver Renewal

Last Friday, the Centers for Medicare and Medicaid Services approved California’s Section 1915(b) Medi-Cal Specialty Mental Health Services Waiver Renewal. CMS granted California a five-year renewal term which covers July 1, 2015 – June 30, 2020. The 1915(b) Specialty Mental Health Waiver will continue the way California’s mental health programs comprised of 54 County-run health plans and a wide array of community based Mental Health services, including outpatient and psych inpatient services.

Governor Signs Vaccination Bill

This week, Governor Brown signed SB 277, co-authored by Senators Richard Pan and Ben Allen, into law. SB 277 eliminates the personal belief exemption for existing required immunizations in order to attend private (K-12) schools and daycare facilities. Further, SB 277 allows physicians to consider family medical history for medical exemptions.

CSAC supported SB 277 – along with CSAC affiliate, the County Health Executives of California – and wishes to thank the Governor for signing this measure into law. 

Conservatorship

AB 193 (Maienschein) – OPPOSE 
As Amended on May 28, 2015 

AB 193, by Assembly Member Brian Maienschein, would authorize a Probate Court judge to recommend a Lanterman-Petris-Short Act (LPS) conservatorship to the county officer providing conservatorship investigations if the court determines, based on evidence and the opinion of a medical professional, that a person for whom a probate conservatorship has been established may be gravely disabled and is unwilling to accept, or is incapable of accepting, treatment voluntarily and is thus eligible for a LPS conservatorship. 

Essentially, AB 193 assumes that because a Probate conservatorship has been established a person should 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. Throughout this process there must be sufficient evidence to hold the person involuntary and the ability for the person to fight these holds and the administration of psychiatric medication against their will. 

Despite the continued opposition of CSAC and CSAC affiliates – the Urban Counties Caucus and the County Behavioral Health Directors Association – the measure was passed unanimously by the Assembly Judiciary Committee and is awaiting a hearing in the Assembly Appropriations Committee. CSAC urges individual counties to send letters of opposition to AB 193, which infringes upon the due process afforded by the LPS Act. 
Psychotropic Medications

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 double referred to both the Assembly Judiciary and Assembly Human Services Committees. This week, the Assembly Judiciary Committee unanimously passed SB 238. The measure is scheduled to be heard by the Assembly Human Services Committee on July 14.