November 18, 2021

Governor Newsom met the October 10 deadline to take action on measures approved by the Legislature and delivered to his desk. To keep counties informed of new laws that impact them, CSAC will be publishing a series of articles to spotlight those laws in each policy area. This week, the Health and Human Services policy area provides information on new laws affecting local health, behavioral health and social services programs and services.

The new laws listed below become effective January 1, 2022 unless otherwise noted.

Behavioral Health

AB 134 (Assembly Committee on Budget): Mental Health Services Act: county program and expenditure plans. This budget bill includes important Mental Health Services Act (MHSA) flexibilities strongly supported by CSAC, including:

• Suspending the reversion of unspent MHSA funds required to be reverted as of July 1, 2019, or July 1, 2020, until July 1, 2021.
• Authorizing a county to extend the effective timeframe of expenditures or annual updates to the MHSA three-year program and expenditure plans to include the 2020-21 and 2021-22 fiscal years if the county was unable to complete and submit the plan or update due to the COVID-19 Public Health Emergency.
• Requiring counties to submit the three-year program and expenditure plan or annual update to the Mental Health Services Oversight and Accountability Commission and the Department of Health Care Services (DHCS) by July 1, 2022, rather than July 1, 2021.
• Allowing counties, during the 2020-21 and 2021-22 fiscal years, to use funds from MHSA prudent reserves for mental health expenditures to children and adults, including for housing assistance.
• Authorizing counties to determine allocations of MHSA funds within the Community Services and Supports and Prevention and Early Intervention categories for the 2020-21 and 2021-22 fiscal years.

AB 451 (Arambula): Health care facilities: treatment of psychiatric emergency medical conditions. This bill requires non-county owned and operated psychiatric units within a general acute care hospital, acute psychiatric hospitals, and psychiatric health facilities (PHF) to treat any patients who present with an emergency psychiatric condition, regardless of whether the facility has an emergency department. County-owned facilities were initially included in the bill, but after CSAC and the County Behavioral Health Directors Association raised concerns about non-Medicaid patients crowding out Medicaid patients, Assembly Member Arambula agreed to exempt county facilities.

AB 638 (Quirk-Silva): Mental Health Services Act: early intervention and prevention programs. This bill makes a small revision to the Mental Health Services Act (MHSA) to allow counties to use Prevention and Early Intervention (PEI) funds for strategies that address substance misuse or substance use disorders (SUDs), or needs relating to co-occurring mental health and substance use.

AB 1344 (Arambula): State Department of Public Health: needle and syringe exchange services. This bill, on which CSAC was neutral, establishes an exemption from the California Environmental Quality Act (CEQA) for needle and syringe exchange program application submissions, authorizations, and operations authorized pursuant to the Clean Needle and Syringe Exchange Program within the California Department of Public Health (CDPH).

As of August 2021, CDPH has authorized syringe services programs in 19 counties since 2011. These include programs offered by clinics, health departments, and community-based organizations in Alameda, San Diego, Kern, Riverside, Santa Cruz, Humboldt, Sacramento, Inyo, El Dorado, Kings, Mono, Lake, Merced, Plumas, San Joaquin, Siskiyou, and Yuba/Sutter Counties.

SB 14 (Portantino): Pupil health: school employee and pupil training: excused absences: youth mental and behavioral health. This bill allows behavioral health to serve as an illness for purposes of an excused absence for grades Kindergarten through 12. It also requires the California Department of Education to identify an evidence-based and evidence-informed training program for local educational agencies to address youth behavioral health, including staff and pupil training.

SB 221 (Wiener): Health care coverage: timely access to care. Requires Medi-Cal Managed Care plans, as of July 1, 2022, to provide a follow-up appointment for non-physician mental health and/or substance use services within 10 business days of an initial appointment. The bill does not limit the number of visits within 10 days nor require an appointment every 10 days for those in treatment for ongoing mental health or substance use conditions. 

Public Health

ACR 30 (Medina): COVID-19 Victims and Survivors Memorial Day.  This Assembly Concurrent Resolution recognizes the first Monday in March as COVID-19 Victims and Survivors Memorial Day.

SB 380 (Eggman): End of life. This measure makes several changes to the state’s existing End of Life Option Act (EOLA), including:

• Extending the sunset date from January 1, 2026, to January 1, 2031;
• Allowing a patient to make a second oral request a minimum of 48 hours from the first request for medical aid in dying;
• Eliminating the final attestation form prior to self-administering the aid-in-dying medication;
• Requiring health care providers who elect not to participate in EOLA to inform a patient and transfer records to another health care provider.

SB 395 (Caballero): Excise tax: electronic cigarettes: Health Careers Opportunity Grant Program: Small and Rural Hospital Relief Program. CSAC strongly supported SB 395 which will impose an additional 12.5 percent excise tax on all electronic cigarette products sold in the state. Portions of the new funding will support local county First 5 Commissions and local health jurisdictions. It requires retailers to collect the tax at the time of sale and permits them to retain up to 1 percent of the revenue for administrative purposes. Additionally, the bill establishes the Health Careers Opportunity Grant Program to support access by underrepresented students from disadvantaged backgrounds to postsecondary health profession programs.

The revenue generated by the new California Electronic Cigarette Excise Tax Fund is appropriated continuously as follows after a $3 million State General Fund loan to the California Department of Tax and Fee Administration is paid back with the initial revenues:

• 18 percent for tobacco control programs under Proposition 99 (some local health care and prevention grant funding)
• 12 percent for Proposition 10 (state and local First 5 Commissions)
• 48 percent for Proposition 56 Medi-Cal Physicians and Dentists Loan Repayment Act, of which 70 percent is allocated to the physician payment pool and 30% to the dentist payment pool
• 5 percent for the Health Professions Career Opportunity Program administered by the Department of Health Care Access and Information
• 7 percent to the University of California to support the joint program in medical education between the University of California, Merced, and the University of California, San Francisco at Fresno
• 10 percent to the Small and Rural Hospital Relief Fund to assist with seismic safety costs

SB 507 (Eggman): Mental health services: assisted outpatient treatment.

This bill slightly broadens the eligibility for Assisted Outpatient Treatment (AOT) programs, commonly referred to as Laura’s Law programs. First, it allows a person to meet the criteria for AOT without also requiring the person’s condition to be substantially deteriorating. It allows specified individuals to testify at an AOT court hearing via videoconferencing, and permits a court to order AOT for a conservatee if the court determines that the conservatee is the subject of a petition to end the conservatorship, and the person would benefit from AOT to reduce the risk of deteriorating mental health while living independently.

SB 510 (Pan): Health care coverage: COVID-19 cost sharing. This bill requires health plans and insurers to cover the costs associated with COVID-19 testing, immunization, and health care services related to testing during and following the federal public health emergency. It is retroactive to March 4, 2020.

Emergency Medical Services

AB 450 (L. Gonzalez): Paramedic Disciplinary Review Board. This bill remakes the Paramedic Board of California into the Paramedic Disciplinary Review Board as of January 1, 2023. It requires employers to report to the Board a suspension or termination of a paramedic for cause within 72 hours, and allows the Board to act on appeals of the Emergency Medical Services Authority’s (EMSA) final decision to place a license holder on probation, suspend or revoke an EMT-P license, and consider appeals regarding denial of licensure. Finally, the bill specifies that decisions by the Board are not subject to review by the EMSA director and are final and binding.

In-Home Supportive Services

AB 135 (Assembly Committee on Budget): Human services omnibus. This budget trailer bill included the CSAC-led coalition budget proposal to maintain the existing funding mechanisms for IHSS collective bargaining. Without this action, county costs for locally negotiated wage and benefit increases would have nearly doubled on January 1, 2022. This bill maintained the existing sharing ratio of 35% county/65% state for local wage increases up to the cap and the sharing ratio will no longer flip on January 1, 2022. In addition, the ten percent over three years tool that allows counties to secure state participation above the cap will continue. The final language makes it clear that all counties are able to use the tool two times for three-year periods beginning on or after January 1, 2022, no matter how many times a county has utilized the tool prior to that date.

AB 135 also included the IHSS fiscal penalty proposal that CSAC and counties opposed. This means that a county without a collective bargaining agreement could be subject to a 1991 Realignment withholding, but only if a series of four specific conditions are met. The conditions are the same and the penalty language is nearly identical to the 2019 penalty provision, with the penalty amount now being at seven percent of the county’s IHSS MOE. With a strong county advocacy effort, CSAC was able to prevent the penalty from being an ongoing penalty and keep it as a one-time penalty.

Foster Care

AB 153 (Assembly Committee on Budget): Public social services. This budget trailer bill included provisions related to increasing the services and supports that are available to those foster youth with complex needs. AB 153 will establish the Children’s Crisis Continuum Pilot Program. It will be a five-year pilot that would require the creation of several types of crisis stabilization and residential programs, intensive services foster care homes with integrated mental health services, and community-based support services that would be available 24/7. The child welfare trailer bill also requires the California Health and Human Services Agency to submit a plan to develop the services that are needed for those youth whose counties had difficulty providing services and securing placements. Finally, AB 153 prohibits the placement of youth in out-of-state residential facilities as of July 1, 2021, but provides a one-year exemption if certain conditions are met.

AB 640 (Cooley): Extended Foster Care: eligibility redetermination.
CSAC supported AB 640 that will allow counties to establish federal Title IV-E eligibility for many youth who do not currently meet that eligibility as they enter Extended Foster Care. This measure, sponsored by the County Welfare Directors Association, will provide some needed fiscal relief for counties for the Extended Foster Care program, which has not been fully funded as intended when the program was established. The Extended Foster Care program has led to improved outcomes for foster youth up to age 21 and this eligibility redetermination would bring in additional federal resources and be done without any interruption in services or supports to these youth.

Adult Protective Services

AB 636 (Maienschein): Financial abuse of elder or dependent adults
CSAC supported AB 636 which will allow Adult Protective Services (APS) programs to share information with additional entities to help prevent and investigate instances of elder abuse. AB 636 will explicitly allow APS programs to share information with a federal law enforcement agency and local code enforcement agencies under certain circumstances to help investigate instances of abuse and protect the health and safety of elder and dependent adults. This measure will strengthen the APS program so that counties can effectively respond to the increased and complex reports of abuse for this growing population.

Social Services

AB 1326 (Arambula): Public social services: county liaison for higher education. This bill requires each county human services agency to identify a staff liaison as a designated contact person for colleges and universities within the county. The staff liaison would provide information about potential available public social services for college students. The agency would also be responsible for developing protocols for engagement between the staff liaison and campuses.