Bill Text: CA AB459 | 2023-2024 | Regular Session | Amended

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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Bill Title: Contracts against public policy: personal or professional services: digital replicas.

Spectrum: Partisan Bill (Democrat 2-0)

Status: (Engrossed) 2023-09-14 - Re-referred to Com. on RLS. [AB459 Detail]

Download: California-2023-AB459-Amended.html

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Amended  IN  Assembly  April 13, 2023

Amended  IN  Assembly  March 23, 2023

Amended  IN  Assembly  March 16, 2023

CALIFORNIA LEGISLATURE— 2023–2024 REGULAR SESSION

Assembly Bill

No. 459

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Introduced by Assembly Member Haney

February 06, 2023

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An act to add Section 5846.5 to the Welfare and Institutions Code, relating to behavioral health.

LEGISLATIVE COUNSEL'S DIGEST

AB 459, as amended, Haney. California Behavioral Health Outcomes and Accountability Review.

Existing law, the Bronzan-McCorquodale Act, contains provisions governing the operation and financing of community mental health services for persons with mental disorders in every county through locally administered and locally controlled community mental health programs.

Existing law, the Mental Health Services Act (MHSA), an initiative measure enacted by the voters as Proposition 63 in the November 2, 2004, statewide general election, establishes the continuously appropriated Mental Health Services Fund to fund various county mental health programs, including prevention and early intervention programs.

This bill would require the California Health and Human Services Agency, by July 1, 2026, to establish the California Behavioral Health Outcomes and Accountability Review (CBH-OAR), consisting of performance indicators, county self-assessments, and county and health plan improvement plans, to facilitate an accountability system that fosters continuous quality improvement in county and commercial behavioral health services and in the collection and dissemination of best practices in service delivery by the agency. The bill would require the agency to convene a workgroup, as specified, to establish a workplan by which the CBH-OAR shall be conducted. The bill would require the agency to establish specific process measures and uniform elements for the county and health plan improvement plan updates. The bill would require the agency to report to the Legislature, as specified. By imposing new requirements on counties, this bill would impose a state-mandated local program.

This bill would require the agency to request the University of California to enter into a contract with the state to provide specific services, including preparing an analysis of how data pertaining to the provision of behavioral health services and client outcomes collected by the counties and health plans may be used to demonstrate the impact of services on life outcomes. The bill would require the analysis to be delivered to the agency, the Legislature, and the workgroup on or before July 1, 2026.

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: YES  

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Bill Text

The people of the State of California do enact as follows:

SECTION 1.

 Section 5846.5 is added to the Welfare and Institutions Code, to read:

5846.5.

 (a) (1)The California Health and Human Services Agency shall establish, by July 1, 2026, the California Behavioral Health Outcomes and Accountability Review (CBH-OAR) to facilitate an accountability system that fosters continuous quality improvement in county and commercial behavioral health services and in the collection and dissemination by the agency of best practices in service delivery. The CBH-OAR shall cover county recipients and shall include the programmatic elements that each county and health plan offers as part of its behavioral health care service array, and shall consist of performance indicators, including specific processes and outcome measures, a county and health plan system needs assessment process, and a county and health plan system improvement plan.

(2)For purposes of this section, “behavioral health services” includes mental health and substance use disorder services being provided by or arranged by either of the following:

(A)A county behavioral health agency funded through county general funds, 1991 Realignment and 2011 Realignment funds, federal Substance Abuse and Mental Health Services Administration grants, Mental Health Services Act funds, and other sources of local, state, or federal funding dedicated to county behavioral health services.

(B)Health plans, including both public and private health plans.

(b) (1) (A) (i) On or before October 1, 2024, the agency shall convene a workgroup composed of representatives from all of the following:

(I) The State Department of Health Care Services.

(II) The Mental Health Services Oversight and Accountability Commission.

(III) The Department of Managed Health Care.

(IV) The Department of Insurance.

(V) The University of California.

(VI) County behavioral health agencies.

(VII) Health plans.

(VIII) Legislative staff.

(IX) Interested behavioral health advocacy and research organizations.

(X) Consumers.

(XI) Organizations that represent county behavioral health agencies and county boards of supervisors.

(XII) Nonprofit community-based organizations.

(XIII) Researchers.

(XIV) Other entities or individuals that the agency deems necessary.

(ii) The workgroup shall establish a workplan by which the CBH-OAR shall be conducted.

(B) The agency shall report annually to the Senate Budget Subcommittee on Health and Human Services and the Assembly Budget Subcommittee on Health and Human Services during the budget process with an update on the schedule for, development of, and future changes to, the CBH-OAR.

(2) In establishing the work plan, the workgroup shall, at minimum, do all of the following:

(A) Consider existing performance indicators being measured.

(B) Consider or develop additional, alternative, or additional and alternative performance indicators to be measured.

(C) Develop uniform elements of the county and health plan system needs assessment process and the county and health plan system improvement plans.

(D) Develop timelines for implementation.

(E) Make recommendations for reducing the existing services data reporting burden.

(F) Make recommendations for financial incentives to counties for achievement on performance measures.

(G) Analyze the county and state workload associated with implementation of the requirements of this section.

(3) The workgroup shall develop the uniform elements for the county and health plan system improvement plans required in subparagraph (C) of paragraph (2). The agency, in consultation with the workgroup, shall develop the uniform elements of the updates to those plans as required pursuant to subparagraph (C) of paragraph (2).

(4) On or after July 1, 2027, the workgroup may, at the discretion of the agency, be disbanded or incorporated into existing advisory bodies.

(c) (1) The CBH-OAR shall consist of the following three components: performance indicators, including specific processes and outcome measures, a county and health plan system needs assessment process, and a county and health plan system improvement plan.

(2) (A) (i) The CBH-OAR performance indicators shall include both process and outcome measures. These measures shall be established to provide baseline and ongoing information about how the state, counties, and health plans are performing over time and to inform and guide each county behavioral health agency’s and health plan’s system needs assessment process and system improvement plan.

(ii) Process measures shall include measures of participant engagement, service delivery, and participation. Specific process measures shall be established by the agency, in consultation with the workgroup, and may include measures of engagement as shown by improvement in program participation, timeliness of service provision, rates of utilization of program components, and referrals and utilization of services.

(iii) If the University of California enters into the contract described in subdivision (f), outcome measures shall be determined based on the recommendations included in the analysis prepared by the University of California pursuant to subdivision (f).

(B) To the extent permitted by existing state and federal privacy laws, performance indicator data available in existing county and health plan data systems shall be collected by counties and health plans and provided to the agency, and performance indicator data available in existing state agency data systems shall be collected by the agency and provided to the counties and health plans. This data shall be reported in a manner and on a schedule determined by the agency, in consultation with the workgroup, but no less frequently than semiannually.

(C) (i) During the first three-year CBH-OAR cycle, performance indicator data reported by each county and health plan shall be used to establish both county and statewide baselines for each performance indicator. The data reported in the first year of the first CBH-OAR cycle shall serve as the county and statewide baselines. After the first review cycle, the agency shall establish standard target thresholds for each performance indicator established by the workgroup.

(ii) The agency, in consultation with the workgroup, shall develop a process for resolving disputes regarding the establishment of standard target thresholds pursuant to clause (i).

(D) (i) For subsequent reviews, based upon availability of additional data through data sharing agreements, the agency shall consider whether to establish additional performance indicators to advance the intent of this section.

(ii) Additional performance indicators shall also be subject to the process described in subparagraph (C) and shall include consideration of when data on the additional performance indicators will be available for reporting, if not already available.

(E) If, during subsequent reviews, there is sufficient reason to establish statewide performance standards for one or more outcome measures, the agency may establish those standards for each of the agreed-upon outcome measures.

(3) (A) (i) The county and health plan system needs assessment process component of the CBH-OAR, as established by the workgroup, shall require county behavioral health agencies and health plans to assess their performance on the established performance indicators, identify the strengths and weaknesses in their current practice and resource deployment, and identify and describe how operational decisions and systemic factors affect program outcomes as described in paragraph (4).

(ii) The county and health plan system needs assessment process shall be designed to identify areas of best practices for replication and for system improvement and shall guide the development of the county and health plan system improvement plan.

(B) (i) The county and health plan system needs assessment process shall be completed by the county and health plans, in consultation and collaboration with stakeholders, and submitted to the agency every three years.

(ii) (I) Counties shall convene local stakeholders, including, but not limited to, all of the following:

(ia) County behavioral health directors, supervisors, and caseworkers.

(ib) Consumers and family members of consumers.

(ic) Health plans operating in the county.

(id) Hospitals.

(ie) Local educational agencies.

(if) Law enforcement.

(ig) Child welfare agencies.

(ih) County-contracted providers.

(ii) Other county behavioral health agency partners.

(II) To the extent possible and relevant, local stakeholders shall also include representatives from tribal organizations and the local behavioral health board.

(III) Additional specific county behavioral health agency partners shall be determined by the county and may include, but are not limited to, adult education providers, providers of services for survivors of domestic violence, the local housing continuum of care, county human services departments, county drug and alcohol programs, and community-based service providers, as appropriate.

(iii) Health plans shall convene stakeholders, including, but not limited to, providers, hospitals, enrollees who are or have received behavioral health services in that system, parents of child enrollees who are or have received behavioral health services in that system, and a representative sample of county behavioral health departments from their service area.

(4) (A) The county and health plan system improvement plan shall include the uniform elements established by the workgroup pursuant to subparagraph (C) of paragraph (2) of subdivision (b).

(B) (i) The county and health plan system improvement plan shall be completed every three years by the county and health plan.

(ii) A county’s system improvement plan shall be approved in public session by the county’s board of supervisors or chief elected official, as applicable, and be submitted to the agency. Prior to being presented to the county’s board of supervisors or chief elected official, as applicable, for approval, the county’s system improvement plan shall be presented to the local behavioral health board or equivalent body. A health plan’s system improvement plan shall be approved by its board of directors.

(C) (i) A county’s system improvement plan shall include a services peer review element, conducted by peer counties, the purpose of which is to provide additional insight, including collaborative training on best practices and technical assistance by peer counties.

(ii) Health plans are not required to participate in a peer review process.

(D) The county behavioral health agency or health plan shall complete an annual progress report on the status of its system improvement plan and shall submit these reports to the agency.

(d) (1) (A) The agency shall receive, review, and, based on its determination of whether the county or health plan system improvement plan meets the required elements, certify as complete all submitted performance indicator data, county and health plans’ self-assessments, county and health plan system improvement plans, and annual progress reports.

(B) The agency shall identify and promote the replication of best practices in service delivery to achieve the established process and outcome measures.

(C) The agency shall monitor, on an ongoing basis, county performance on the performance indicators developed pursuant to subdivision (c).

(D) The agency may assign the duties outlined in paragraphs (A) to (C), inclusive, to the State Department of Health Care Services, the Department of Managed Health Care, and the Department of Insurance, as appropriate.

(2) The agency shall, on an annual basis, beginning July 1, 2026, submit a report to the Legislature that summarizes county or health plan performance on the established performance indicators during the reporting period, analyzes county performance trends over time, and makes findings and recommendations for common service improvements identified in the county and health plan system assessments and system improvement plans, including information on common statutory, regulatory, or fiscal barriers identified as inhibiting system improvements and recommendations to overcome those barriers.

(3) (A) (i) If the contract is executed pursuant to subdivision (f), the agency shall, in partnership with the University of California, facilitate the provision of technical assistance to county behavioral health agencies and health plans that supports the county’s or health plan’s selected areas for improvement as described in its system improvement plan.

(ii) The agency and the University of California shall not be considered peers in the county peer review element, and their role shall be limited to providing technical assistance.

(B) If the agency determines, in the course of its review of county and health plan system improvement plans and annual updates or in the course of its review of regularly submitted performance indicator data, that a county or health plan is consistently failing to meet the performance indicator standard target thresholds established pursuant to subparagraph (C) of paragraph (2) of subdivision (c), the agency shall engage the county or health plan in a process of targeted technical assistance and support to address and resolve the identified shortcomings.

(e) A county shall execute and fulfill components of its system improvement plan that can be accomplished with existing resources.

(f) The agency shall request the University of California to enter into a contract with the state to provide all of the following services:

(1) (A) (i) Prepare an analysis of how data pertaining to the provision of behavioral health services and client outcomes collected by the counties and health plans and provided to the state may be used to demonstrate the impact of services on life outcomes.

(ii) The analysis shall be delivered to the agency, the Legislature, and the workgroup established pursuant to subparagraph (A) of paragraph (1) of subdivision (b) on or before July 1, 2026, and shall include recommended life outcome measures and measures of the reduction of the negative outcomes described in subdivision (d) of Section 5840 that address prevention and early intervention strategies for mental illness and measures of employment, educational attainment, program exits and program reentries, adherence to treatment plans, attainment of housing, reduction in contacts with law enforcement, reduction in hospitalizations, and reductions in homelessness.

(B) The analysis required to be delivered to the Legislature pursuant to subparagraph (A) shall be submitted in compliance with Section 9795 of the Government Code.

(2) Create and maintain a dashboard modeled after the California Child Welfare Indicators Project to publicly report the data collected by counties and health plans and to report the status of performance indicators as described in this section.

(3) Consult with the agency to provide technical assistance to county behavioral health agencies and health plans as described in subparagraph (A) of paragraph (3) of subdivision (d).

(g) For purposes of this section:

(1) “Behavioral health services” includes mental health and substance use disorder services being provided by or arranged by either of the following:

(A) A county behavioral health agency funded through county general funds, 1991 Realignment and 2011 Realignment funds, federal Substance Abuse and Mental Health Services Administration block grants, Mental Health Services Act funds, and other sources of local, state, or federal funding dedicated to county behavioral health services.

(B) Health plans, including both public and private health plans.

(2) “Health plan” means a health care service plan regulated by the Department of Managed Health Care or a disability insurer regulated by the Department of Insurance.

SEC. 2.

 If the Commission on State Mandates determines that this act contains costs mandated by the state, reimbursement to local agencies and school districts for those costs shall be made pursuant to Part 7 (commencing with Section 17500) of Division 4 of Title 2 of the Government Code.