Bill Text: CA AB38 | 2015-2016 | Regular Session | Chaptered
Bill Title: Mental health: Early Diagnosis and Preventive Treatment
Sponsorship: Partisan Bill (Democrat 1)
Status: (Passed) 2016-09-24 - Chaptered by Secretary of State - Chapter 547, Statutes of 2016. [AB38 Detail]
Download: California-2015-AB38-Chaptered.html
BILL NUMBER: AB 38 CHAPTERED
BILL TEXT
CHAPTER 547
FILED WITH SECRETARY OF STATE SEPTEMBER 24, 2016
APPROVED BY GOVERNOR SEPTEMBER 24, 2016
PASSED THE SENATE AUGUST 29, 2016
PASSED THE ASSEMBLY AUGUST 31, 2016
AMENDED IN SENATE AUGUST 19, 2016
AMENDED IN SENATE JUNE 13, 2016
AMENDED IN SENATE MAY 18, 2016
AMENDED IN ASSEMBLY MARCH 23, 2015
INTRODUCED BY Assembly Member Eggman
DECEMBER 1, 2014
An act to add and repeal Part 6 (commencing with Section 5950) of
Division 5 of the Welfare and Institutions Code, relating to mental
health, and making an appropriation therefor.
LEGISLATIVE COUNSEL'S DIGEST
AB 38, Eggman. Mental health: Early Diagnosis and Preventive
Treatment Program.
Existing law, the Bronzan-McCorquodale Act, sets out a system of
community mental health care services provided by counties and
administered by the State Department of Health Care Services.
This bill would establish the Early Diagnosis and Preventive
Treatment (EDAPT) Program Fund in the State Treasury to provide
funding to the Regents of the University of California for the
purpose of providing reimbursement to an EDAPT program that would
utilize integrated systems of care to provide early intervention,
assessment, diagnosis, a treatment plan, and necessary services for
individuals with severe mental illness and children with severe
emotional disturbance, as specified. The bill would authorize moneys
from private or other sources to be deposited into the fund and used
for purposes of the bill. The bill would require, when the Department
of Finance has determined that the total amount of the moneys in the
fund has reached or exceeded $1,200,000, the Controller to
distribute all of the moneys in the fund to the Regents of the
University of California for the purpose of providing reimbursement
to an EDAPT program for services provided to persons who are referred
to that program, but whose private health benefit plan, as defined,
does not cover the full range of required services, thereby making an
appropriation. The bill would require the Regents of the University
of California, if the regents accept the money, or if the regents
accept federal funding distributed by the State Department of Health
Care Services for the purpose of supporting an EDAPT program, as
specified, to report, on or after January 1, 2022, but prior to
January 1, 2023, specified information to the health committees of
both houses of the Legislature. The bill would repeal the program as
of January 1, 2023.
Appropriation: yes.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. (a) The Legislature finds and declares all of the
following:
(1) There are approximately 1.2 million adult Californians who
suffer from severe mental illness and over 700,000 children in
California who deal with severe emotional disturbance.
(2) Despite the importance of and emphasis on mental health
parity, management of mental illness within a system of care is far
more difficult than most types of physical illness. There are
significant differences between the delivery systems for the Medi-Cal
population and the delivery systems for those covered by private
insurance, and there are unique problems associated with each system.
While changes are needed in both, there is an immediate need to look
for ways to better serve the insured population.
(3) The limited number of providers, the lack of facilities for
treatment, and the difficulties of arranging for and coordinating
ancillary services have made it extremely difficult for health
insurers to meet the needs of enrollees facing significant mental
health issues.
(4) Attempts to develop truly accessible provider networks that
can link with the array of administrative and ancillary services that
the mentally ill need to manage their disease and to improve will
take an investment of time and resources.
(5) Systems of care known as Early Diagnosis and Preventive
Treatment (EDAPT) programs may hold the key to these problems. These
integrated systems of care provide early intervention, assessment,
diagnosis, a treatment plan, and the services necessary to implement
that plan. EDAPT programs have interdisciplinary teams of physicians,
clinicians, advocates, and staff that coordinate care on an
outpatient basis.
(6) EDAPT programs do not yet exist in sufficient numbers to allow
them to meet the provider network requirements health insurers must
meet. While it is possible under existing law for health insurers to
contract with existing EDAPT programs, there are a number of
regulatory and practical issues that stand in the way of directing
patients to them so that the patients' conditions can be effectively
managed. If insurers could designate an EDAPT program as an exclusive
provider for their enrollees, an assessment could be made of the
overall efficacy of the model.
(b) Therefore, it is the intent of the Legislature to provide
funding to augment private health benefit plan coverage in order to
provide patients with the full range of necessary EDAPT services.
SEC. 2. Part 6 (commencing with Section 5950) is added to Division
5 of the Welfare and Institutions Code, to read:
PART 6. EDAPT Funding Pilot Program
5950. (a) There is hereby established the Early Diagnosis and
Preventive Treatment (EDAPT) Program Fund within the State Treasury.
Moneys from private or other sources may be deposited into the fund
and used for purposes of this part. General Fund moneys shall not be
deposited into the fund.
(b) When the Department of Finance has determined that the total
amount of the moneys in the fund established pursuant to subdivision
(a) has reached or exceeded one million two hundred thousand dollars
($1,200,000), the Controller shall distribute all of the moneys in
the fund to the Regents of the University of California for the
purpose of providing reimbursement to an EDAPT program for services
provided to persons who are referred to that program, but whose
private health benefit plan does not cover the full range of required
services.
(c) Funds distributed pursuant to this part shall not be used to
pay for services normally covered by the patient's private health
benefit plan and shall only be used to augment private health benefit
plan coverage to provide the patient with the full range of
necessary services.
(d) For purposes of this part, the following definitions shall
apply:
(1) "EDAPT program" means an Early Diagnosis and Preventive
Treatment program and refers to a program that utilizes integrated
systems of care to provide early intervention, assessment, diagnosis,
a treatment plan, and necessary services for individuals with severe
mental illness and children with severe emotional disturbance using
an interdisciplinary team of physicians, clinicians, advocates, and
staff who coordinate care on an outpatient basis.
(2) "Private health benefit plan" means a program or entity that
provides, arranges, pays for, or reimburses the cost of health
benefits, but does not include coverage provided through the Medi-Cal
system.
5951. (a) If the Regents of the University of California accept
moneys from the fund established pursuant to this part, or accept
federal funds distributed by the State Department of Health Care
Services as described in subdivision (b), the regents shall report,
on or after January 1, 2022, but prior to January 1, 2023, to the
health committees of both houses of the Legislature all of the
following:
(1) Evidence as to whether the early psychosis approach reduces
the duration of untreated psychosis, reduces the severity of
symptoms, improves relapse rates, decreases the use of inpatient care
in comparison to standard care, supports educational and career
progress, and reduces the cost of treatment in comparison to standard
treatment methodologies.
(2) The number of patients with private health benefit plans
served by an EDAPT program in the 12 months prior to the
implementation of this part.
(3) The number of patients with private health benefit plans
served by an EDAPT program that has received funding pursuant to this
part.
(4) The number of patients participating in an EDAPT program that
has received funding pursuant to this part who are considered
stabilized, as a percentage of patients served.
(5) The number of patients participating in an EDAPT program that
has received funding pursuant to this part who need services beyond
those provided in the program and the nature of those services.
(6) Any other information the regents deem necessary.
(b) If the State Department of Health Care Services distributes
federal funds to the Regents of the University of California for the
purpose of supporting an EDAPT program, the regents shall issue the
report described in subdivision (a), to the extent permitted by
federal law.
(c) A report to be submitted pursuant to this section shall be
submitted in compliance with Section 9795 of the Government Code.
5952. This part shall remain in effect only until January 1,
2023, and as of that date is repealed, unless a later enacted
statute, that is enacted before January 1, 2023, deletes or extends
that date.
