Bill Text: CA AB2242 | 2021-2022 | Regular Session | Amended
NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Mental health services.
Spectrum: Partisan Bill (Democrat 5-0)
Status: (Passed) 2022-09-30 - Chaptered by Secretary of State - Chapter 867, Statutes of 2022. [AB2242 Detail]
Download: California-2021-AB2242-Amended.html
An individual shall not be discharged from a hold unless a A care coordination plan shall be developed by, at a minimum, the individual, the facility, the county behavioral health department, the health care payer, if different from the county, and any other individuals designated by the individual as appropriate is established.
appropriate, and shall be provided to the individual before their discharge. The care coordination plan shall include a first followup appointment with an appropriate behavioral health professional. The appointment information shall be provided to the individual before their release, but in release. In no event may the individual be involuntarily held based on the requirements of this subdivision beyond when they would otherwise
qualify for release. All care and treatment after release shall be voluntary. include include, at a minimum, the County Behavioral Health Directors Association of California, the California Hospital Association, Medi-Cal managed care plans, private insurance plans, other organizations representing the various facilities where individuals may be detained under temporary
holds or a conservatorship, and other appropriate entities or agencies as determined by the department. department, and advocacy organizations representing those who have been involuntarily detained or conserved, as well as individuals who have been detained or conserved.
Bill Title: Mental health services.
Spectrum: Partisan Bill (Democrat 5-0)
Status: (Passed) 2022-09-30 - Chaptered by Secretary of State - Chapter 867, Statutes of 2022. [AB2242 Detail]
Download: California-2021-AB2242-Amended.html
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Amended
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Assembly
April 21, 2022 |
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Amended
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April 18, 2022 |
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Amended
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Assembly
March 24, 2022 |
CALIFORNIA LEGISLATURE—
2021–2022 REGULAR SESSION
Assembly Bill
No. 2242
| Introduced by Assembly Member Santiago |
February 16, 2022 |
An act to amend Sections 5152 and 5361 of, and to add Sections 5014, 5257.5, 5402.5, and 5899.3 to, the Welfare and Institutions Code, relating to mental health.
LEGISLATIVE COUNSEL'S DIGEST
AB 2242, as amended, Santiago.
Mental health services.
(1) Existing law, the Lanterman-Petris-Short Act (the Act), authorizes the involuntary commitment and treatment of persons with specified mental health disorders for the protection of the persons so committed. Under the act, if a person, as a result of a mental health disorder, is a danger to others, or to themselves, or is gravely disabled, the person may, upon probable cause, be taken into custody by a peace officer, a member of the attending staff of an evaluation facility, designated members of a mobile crisis team, or another designated professional person, and placed in a facility designated by the county and approved by the State Department of Social Services as a facility for 72-hour treatment and evaluation. The act also authorizes a conservator of the person, of the estate, or of both, to be appointed for a person who is gravely disabled as a result of a
mental health disorder.
This bill, on or before July 1, 2023, would require the State Department of State Hospitals Health Care Services to convene a stakeholder group of entities, including the County Behavioral Health Directors Association of California and the California Hospital Association, among others, to create a model care coordination plan to be followed when discharging those held under temporary holds or a conservatorship. The bill would require the model care coordination plan and process to outline who would be on the care team and how the communication would occur to coordinate care. Among other components. The
components, the bill would require the model care coordination plan to require that an individual exiting a temporary hold or a conservatorship be provided with a detailed treatment plan that includes a scheduled first appointment with a behavioral health professional. The bill would declare the intent of the Legislature that counties and hospitals implement the care coordination plan by February 1, 2024.
This bill would prohibit an individual from being discharged from a hold, or from being released after being detained for evaluation and treatment,
until a care coordination plan has been established for the individual, as specified. The bill would also prohibit a conservatee from being discharged until a care coordination plan has been established. require that a care coordination plan be developed, as specified, and provided to an individual before being discharged from a hold, or from being released after being detained for evaluation and treatment. The bill would also require a care coordination plan to be developed and provided to a conservatee prior to their release. The bill would require the county, county behavioral health department,
among others, to participate in designing an individual’s care coordination plan. By placing additional duties on counties, the bill would impose a state-mandated local program. The bill would require a behavioral health professional to whom a person released from hold or a conservatorship is referred for services to make a good faith effort to contact the referred individual no less than 3 times, either by email, telephone, mail, or in-person outreach. outreach, as specified.
(2) Existing law, the Mental Health Services Act (MHSA), an initiative measure enacted by the voters as Proposition 63 at the November 2, 2004, statewide general election, establishes the continuously appropriated Mental Health Services Fund to fund various county mental
health programs. The MHSA also established the Mental Health Services Oversight and Accountability Commission to oversee the administration of various parts of the act.
This bill, to the extent permitted under state and federal law and consistent with the Mental Health Services Act
MHSA and for the purposes of the above-mentioned provisions of the Lanterman-Petris-Short Act, would clarify that counties may pay for the services authorized in those provisions using funds from the Mental Health Services Fund when included in county plans, as specified, and would also authorize counties to pay for those services with specified funds from the Local Revenue Fund and the Local Revenue Fund 2011. The bill would require the State Department of Health Care Services to, on or before July 1, 2023, issue guidance specifying which services authorized under the Lanterman-Petris-Short Act may be paid by counties with funds from the Mental Health Services Fund.
This bill would require the commission to develop, implement, and oversee a public and comprehensive framework for tracking and reporting spending on mental health programs and services from all major fund sources and of program- and service-level and statewide outcome
data, as specified. The bill would require counties to report to the commission its expenses in specific categories, including, but not limited to, inpatient care or intensive outpatient services, as well as their unspent funding from all major funding sources. By imposing new reporting requirements on counties, this bill would impose a state-mandated local program.
(3) The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that, if the Commission on State Mandates determines that the bill contains costs mandated by the state, reimbursement for those costs shall be made pursuant to the statutory provisions noted above.
Digest Key
Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: YESBill Text
The people of the State of California do enact as follows:
SECTION 1.
Section 5014 is added to the Welfare and Institutions Code, to read:5014.
(a) To the extent otherwise permitted under state and federal law and consistent with the Mental Health Services Act, all of the following apply for purposes of Article 1 (commencing with Section 5150) and Article 4 (commencing with Section 5250) of Chapter 2 and Chapter 3 (commencing with Section 5350):(1) Counties may pay for the provision of services using funds distributed to the counties from the Mental Health Subaccount, the Mental Health Equity Subaccount, and the Vehicle License Collection Account of the Local Revenue Fund, funds from the Mental Health Account and the Behavioral Health Subaccount within the Support Services Account of the Local Revenue Fund 2011,
funds from the Mental Health Services Fund when included in county plans pursuant to Section 5847, and any other funds from which the Controller makes distributions to the counties for those purposes.
(2) A person shall not be denied access to services funded by the Mental Health Services Fund based solely on the person’s voluntary or involuntary legal status.
(3) Counties shall not use funds from the Mental Health Services Fund to pay for more than one cumulative year of acute or subacute care services provided to a person under a conservatorship established pursuant to Section 5350 for each established conservatorship, including any succeeding periods of conservatorship.
(b) On or before July 1, 2023, the State
Department of Health Care Services shall issue guidance specifying which services authorized under Article 1 (commencing with Section 5150) and Article 4 (commencing with Section 5250) of Chapter 2 and Chapter 3 (commencing with Section 5350) may be paid by counties with funds from the Mental Health Services Fund.
SEC. 2.
Section 5152 of the Welfare and Institutions Code is amended to read:5152.
(a) A person admitted to a facility for 72-hour treatment and evaluation under the provisions of this article shall receive an evaluation as soon as possible after the person is admitted and shall receive whatever treatment and care the person’s condition requires for the full period that they are held. The person shall be released before 72 hours have elapsed only if the psychiatrist directly responsible for the person’s treatment believes, as a result of the psychiatrist’s personal observations, that the person no longer requires evaluation or treatment. However, in those situations in which both a psychiatrist and psychologist have personally evaluated or examined a person who is placed under a 72-hour hold and there is a collaborative treatment relationship between the psychiatrist and psychologist, either the psychiatrist or psychologist may authorize the release of the person from the hold, but only after they have consulted with one another. In the event of a clinical or professional disagreement regarding the early release of a person who has been placed under a 72-hour hold, the hold shall be maintained unless the facility’s medical director overrules the decision of the psychiatrist or psychologist opposing the release. Both the psychiatrist and psychologist shall enter their findings, concerns, or objections into the person’s medical record. If any other professional person who is authorized to release the person believes the person should be released before 72 hours have elapsed, and the psychiatrist directly responsible for the person’s treatment objects, the matter shall be referred to the medical director of the facility for the final decision. However, if the medical director is not a psychiatrist, the medical director shall appoint a designee who is a psychiatrist. If the matter is referred, the person shall be released before 72 hours have elapsed only if the psychiatrist making the final decision believes, as a result of the psychiatrist’s personal observations, that the person no longer requires evaluation or treatment.(b) A person who has been detained for evaluation and treatment shall be released, referred for further care and treatment on a voluntary basis, or certified for intensive treatment, or a conservator or temporary conservator shall be appointed pursuant to this part as required.
(c) A person who has been detained for evaluation and treatment and subsequently released with referral
for further care and
treatment on a voluntary basis, shall receive, prior to release, a care coordination plan developed by, at a minimum, the individual, the facility, the county behavioral health department, the health care payer, if different from the county, and any other individuals designated by the person as appropriate. The care coordination plan shall include a first followup appointment with an appropriate behavioral health professional. The appointment information shall be provided to the person before their release, but in release. In no event may the person be involuntarily held
detained based on the requirements of this subdivision beyond when they would otherwise qualify for release. All care and treatment after release shall be voluntary.
(d) The behavioral health professional to whom the person has been referred shall make a good faith effort to contact the referred individual no fewer than three times, either by email, telephone, mail, or in-person outreach, whichever method or methods is most likely to reach the individual.
(e) A person designated by the mental health facility shall give to any person who has been detained at that facility for evaluation and treatment and who is receiving medication as a result of their
mental illness, as soon as possible after detention, written and oral information about the probable effects and possible side effects of the medication. The State Department of Health Care Services shall develop and promulgate written materials on the effects of medications, for use by county mental health programs as disseminated or as modified by the county mental health program, addressing the probable effects and the possible side effects of the medication. The following information shall be given orally to the patient:
(1) The nature of the mental illness, or behavior, that is the reason the medication is being given or recommended.
(2) The likelihood of improving or not improving without the medication.
(3) Reasonable alternative treatments available.
(4) (A) The name and type, frequency, amount, and method of dispensing the medication, and the probable length of time the medication will be taken.
(B) The fact that the information has or has not been given shall be indicated in the patient’s chart. If the information has not been given, the designated person shall document in the patient’s chart the justification for not providing the information. A failure to give information about the probable effects and possible side effects of the medication shall not constitute new grounds for release.
(f) The amendments to this section made by Assembly Bill 348 of the 2003–04 Regular Session shall not be
construed to revise or expand the scope of practice of psychologists, as defined in Chapter 6.6 (commencing with Section 2900) of Division 2 of the Business and Professions Code.
SEC. 3.
Section 5257.5 is added to the Welfare and Institutions Code, to read:5257.5.
(a)(b) The service behavioral health professional to whom the individual has been referred shall make a good faith effort to contact the referred individual no fewer than three times, either by email, telephone, mail, or in-person outreach, whichever method or methods is most likely to reach the individual.
SEC. 4.
Section 5361 of the Welfare and Institutions Code is amended to read:5361.
(a) Conservatorship initiated pursuant to this chapter shall automatically terminate one year after the appointment of the conservator by the superior court. The period of service of a temporary conservator shall not be included in the one-year period. When the conservator has been appointed as conservator of the estate, the conservator shall, for a reasonable time, continue to have the authority over the estate that the superior court, on petition by the conservator, deems necessary for (1) the collection of assets or income that accrued during the period of conservatorship, but were uncollected before the date of termination, (2) the payment of expenses that accrued during period of conservatorship and of which the conservator was notified prior to termination, but were unpaid before the date of termination, and (3) the completion of sales of real property when the only act remaining at the date of termination is the actual transfer of title.(b) If, upon the termination of an initial or a succeeding period of conservatorship, the conservator determines that conservatorship is still required, the conservator may petition the superior court for reappointment as conservator for a succeeding one-year period. The petition shall include the opinion of two physicians or licensed psychologists who have a doctoral degree in psychology and at least five years of postgraduate experience in the diagnosis and treatment of emotional and mental disorders that the conservatee is still gravely disabled as a result of mental disorder or impairment by chronic
alcoholism. If the conservator is unable to obtain the opinion of two physicians or psychologists, the conservator shall request that the court appoint them.
(c) (1) A facility in which a conservatee is placed shall release the conservatee at the conservatee’s request when the conservatorship terminates. A petition for reappointment filed by the conservator or a petition for appointment filed by a public guardian shall be transmitted to the facility at least 30 days before the automatic termination date. The facility may detain the conservatee after the end of the termination date only if the conservatorship proceedings have not been completed and the court orders the conservatee to be held until the proceedings have been completed.
(2) Prior to the discharge of a conservatee, a A
care coordination plan shall be developed by, at a minimum, the individual, the facility, the county behavioral health department, the health care payer, if different from the county, and other individuals designated by the individual as appropriate shall be established. appropriate, and shall be provided to the conservatee prior to their release. The care coordination plan shall include a first followup appointment with an appropriate behavioral health professional. The appointment information shall be provided to the individual before the individual is released, but in
released. In no event may the individual be involuntarily held based on the requirements of this paragraph beyond when they would otherwise qualify for release. All care and treatment after release shall be voluntary.
(3) A behavioral health care professional to whom an individual leaving a facility has been referred shall make a good faith effort to contact the referred individual no less than three times, either by email, telephone, mail, or in-person outreach. outreach,
whichever method or methods are most likely to reach the individual.
SEC. 5.
Section 5402.5 is added to the Welfare and Institutions Code, to read:5402.5.
(a) On or before July 1, 2023, the State Department of Health Care Services shall convene a stakeholder group to create a model care coordination plan to be followed when discharging those held under temporary holds or a conservatorship. The stakeholder group shall(b) The model care coordination plan and process shall outline who will be on the care team and how the communication will occur to coordinate care. It shall specify that the care coordination is a shared responsibility between, at a minimum, the county, the facility, and the health care payer, if different from the county. The model care
coordination plan shall, at a minimum, also address the following:
(1) The roles of each entity to ensure continuity of services and care for all individuals exiting involuntary holds, including how referrals will be made and appointments will be scheduled pursuant to subdivision (d) of Section 5008. This shall include all of the following:
(A) Identification of county resources, programs, and contact information to facilitate referrals for individuals exiting involuntary holds or intensive treatment, including, but not limited to, suicide prevention, substance use disorder treatment, Medi-Cal Enhanced Care Management, Full Service Partnerships, assisted outpatient treatment, early psychosis intervention services, and resources published pursuant to Section 5013.
(B) Hospital aftercare and discharge planning processes pursuant to Sections 1262 and 1262.5 of the Health and Safety Code.
(C) Hospital policies and procedures in compliance with nationally accepted accreditation standards to reduce the risk of suicide, including, but not limited to, screening and assessing patients for suicidal ideation and suicidal risk, developing a safety plan with patients at risk for suicide, and following written policies and procedures addressing the care, counseling, and followup care at discharge for patients at risk for suicide.
(2) A requirement that the care coordination plan for an individual exiting a temporary hold or a conservatorship include a detailed plan that includes a scheduled
first appointment with a behavioral health professional.
(3) County procedures and contact information for the availability of designated persons for the purpose of conducting an assessment pursuant to Section 5150. Designated individuals shall be available on a 24 hours per day, seven days per week basis in order to ensure that individuals are released from the hold as soon after it is determined they no longer require detention as possible. In no event may be the individual be involuntarily held beyond when they would otherwise qualify for release.
(4) County procedures for facilities and professional persons to request designation to perform assessments and evaluations, pursuant to Sections 5151 and
5152.
(5) County procedures and contact information facilities are required to use to obtain an assessment and evaluation of an individual, pursuant to Sections 5151 and 5152.
(6) Defined expectations for information sharing, including notification of and transmittal of applications pursuant to Section 5150 and plans to periodically convene to identify and resolve challenges.
(c) (1) Each county mental health department shall ensure that a care coordination plan that ensures continuity of services and care in the community for all individuals exiting holds or a conservatorship pursuant to this part is established.
(2) It is the intent of
the Legislature that counties and hospitals shall implement the model care coordination plan on or before February 1, 2024.
SEC. 6.
Section 5899.3 is added to the Welfare and Institutions Code, to read:5899.3.
(a) The Mental Health Services Oversight and Accountability Commission shall develop, implement, and oversee a public and comprehensive framework for tracking and reporting spending on mental health programs and services from all major fund sources and of program- and service-level and statewide outcome data. The framework shall, at minimum, do all of the following:(1) Include balances of all major, relevant funding sources, including balances of unspent MHSA funds. Funding shall include specificity about how counties spend funds within the broad MHSA categories, including, but not limited to, how funds support specific types of services such as crisis
intervention or housing programs.
(2) Articulate information about the programs and services counties provide and the populations they serve, statewide and for each county, using those funds.
(3) Report broader outcomes that show the extent to which the state’s entire mental health system is helping people in need.
(b) To develop the framework required in subdivision (a), the commission shall do all of the following:
(1) Consult with state and local mental health authorities to develop and implement the framework.
(2) Consider utilizing available data and information when developing the reporting
framework. The commission may obtain relevant data and information from other state entities for this purpose.
(3) Develop categories of mental health programs and services that are tailored to inform assessments of spending patterns.
(4) Develop statewide measurements of mental health and report publicly about those measurements annually on the commission’s internet website.
(5) Work with counties and other state and local agencies, as necessary, to use the information the commission collects to improve mental health in California.
(c) Each county shall report to the commission its expenses in specific categories, including, but not limited to, inpatient care
or intensive outpatient services, as well as their unspent funding from all major funding sources. Reporting shall be done in a format prescribed by the commission.
