Bill Text: CA SB964 | 2021-2022 | Regular Session | Amended

NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Behavioral health.

Spectrum: Moderate Partisan Bill (Democrat 9-2)

Status: (Vetoed) 2022-09-27 - In Senate. Consideration of Governor's veto pending. [SB964 Detail]

Download: California-2021-SB964-Amended.html

Amended  IN  Senate  May 19, 2022
Amended  IN  Senate  April 18, 2022
Amended  IN  Senate  April 04, 2022

CALIFORNIA LEGISLATURE— 2021–2022 REGULAR SESSION

Senate Bill
No. 964

Introduced by Senator Wiener
(Principal coauthors: Senators Caballero and Stern)
(Coauthors: Senators Dodd and Rubio)
(Coauthors: Assembly Members Bauer-Kahan, Gipson, Gray, Lackey, Levine, and Waldron)

February 09, 2022

An act to add Section 66024.3 to the Education Code, to add Chapter 1 (commencing with Section 127800) to Part 3 of Division 107 of, to repeal Section 127815 of, and to repeal the heading of Chapter 1 (commencing with former Section 127750) of Part 3 of Division 107 of, the Health and Safety Code, and to amend Sections 14045.12, 14045.13, and 14105.29 of, 14045.12 and 14045.13 of, to repeal Section 14045.14 of, and to repeal and add Sections 14045.18 and 14045.19 of, the Welfare and Institutions Code, relating to behavioral health.


LEGISLATIVE COUNSEL'S DIGEST


SB 964, as amended, Wiener. Behavioral health.
(1) Existing law, the Donahoe Higher Education Act, sets forth the missions and functions of the 3 segments comprising the state’s public postsecondary education system. These segments are the University of California, administered by the Regents of the University of California, the California State University, administered by the Trustees of the California State University, and the California Community Colleges, administered by the Board of Governors of the California Community Colleges. Provisions of the act apply to the University of California only to the extent that the regents act, by resolution, to make the provisions applicable.
This bill would amend the act to require the California Community Colleges and the California State University, and to request the University of California, to develop 2 accelerated programs of study related to degrees in social work. The bill would require one program to offer a concurrent bachelor’s and master’s of social work program that would allow students to combine their last one or 2 years of undergraduate study in social work with their graduate study in social work in order to complete both programs at an accelerated rate. The bill would require the 2nd program to offer an accelerated academic program in which students with experience as peer support specialists, registered or certified alcohol or other drug counselors, community health workers, or psychiatric technicians could receive their associate’s degree, as well as a bachelor’s and master’s degree in social work. The bill would require both programs to require a student to take a course on working with the severely mentally ill, with a focus on working in the public behavioral health system.
(2) Existing law establishes the Department of Health Care Access and Information and authorizes the department, among other things, to award competitive grants to entities and individuals it deems qualified to expand the supply of behavioral health counselors, coaches, peer supports, and other allied health care providers serving children and youth.
This bill would establish the Behavioral Health Workforce Preservation and Restoration Fund as a fund in the state treasury, State Treasury, to be administered by the department, for the purpose of stabilizing the current licensed, certified, or registered clinical behavioral health workforce. The bill would authorize moneys from the fund to be used, upon appropriation by the Legislature, to provide hiring or performance-based bonuses, salary augmentation, overtime pay, or hazard pay to licensed, certified, or registered professionals working in the behavioral health sector. The bill would also require the department to establish a stipend program, in addition to and separate from the fund, for students pursuing a master’s degree in social work with a specialized focus on public behavioral health. Under the bill, a student would be eligible for a stipend of $18,500 per year for up to 2 calendar years if specified conditions are met.
This bill would require the department to develop an online jobs board on which licensed public, private, and nonprofit behavioral health providers and facilities in the state may post job openings for behavioral health workers. The bill would also require the department to request the University of California to enter into a contract with the department to prepare a report for the Legislature, on or before January 1, 2024, that provides a landscape analysis of the current behavioral health workforce and the state’s behavioral health workforce needs, and makes recommendations on how to address the state’s behavioral health workforce shortage.
(3) Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income persons receive health care benefits. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Existing law establishes a schedule of benefits under the Medi-Cal program and provides for various services, including behavioral and mental health services that are rendered by Medi-Cal enrolled providers.
Existing law requires the department, by July 1, 2022, to establish statewide requirements for counties to use in developing certification programs for the certification of peer support specialists, as specified. Existing law authorizes a county, or an agency that represents a county, to develop a peer support specialist certification program and certification fee schedule, both of which are subject to department approval.
This bill would repeal those provisions authorizing a county to develop a peer support specialist certification program and instead would require the department, by July 1, 2023, to provide for a statewide certification for peer support specialists. The bill would require the department to amend the Medicaid state plan to include a certified peer support specialist as a provider type for purposes of the Medi-Cal program and to include peer support specialist services as a distinct service type under the Medi-Cal program. The bill would require Medi-Cal reimbursement for peer support specialist services to be implemented only if, and to the extent that, federal financial participation is available and the department obtains all necessary federal approvals.

(4)Existing law, to the extent permitted by federal law, requires Medi-Cal payments to be made to designated public hospitals and their affiliated government entities in recognition of the Medi-Cal managed care share of graduate medical education costs. Under existing law, the payments consist of specified components, including direct graduate medical education payments made in recognition and support of the direct costs incurred in the operation of graduate medical education programs, including, among other things, allocated overhead costs incurred for interns and residents in medicine, osteopathy, dentistry, podiatry, nursing, and allied health and paramedical programs.

This bill would also specifically authorize those payments for allocated overhead costs incurred for interns and residents in behavioral health programs.

Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: NO  

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


SECTION 1.

 This act shall be known as the Behavioral Health Workforce Revitalization Act.

SEC. 2.

 Section 66024.3 is added to the Education Code, to read:

66024.3.
 (a) The California Community Colleges and the California State University shall, and the University of California is requested to, develop both of the following accelerated programs of study related to degrees in social work:
(1) A concurrent bachelor’s and master’s of social work program that will allow students to combine their last one or two years of undergraduate study in social work with their graduate study in social work in order to complete both programs at an accelerated rate. The program shall require a student to take a course on working with the severely mentally ill, with a focus on working in the public behavioral health system.
(2) An accelerated academic program in which students with experience as peer support specialists, registered or certified alcohol or other drug counselors, community health workers, or psychiatric technicians may receive their associate’s degree, as well as a bachelor’s and master’s degree in social work. The program shall require a student to take a course on working with the severely mentally ill, with a focus on working in the public behavioral health system. The program shall be designed to be completed by a student who is working full-time and may include online, part-time, and night class options.
(b) For purposes of this section, “behavioral health” refers to both mental health and substance use disorder.

SEC. 3.

 The heading of Chapter 1 (commencing with former Section 127750) of Part 3 of Division 107 of the Health and Safety Code is repealed.

SEC. 4.

 Chapter 1 (commencing with Section 127800) is added to Part 3 of Division 107 of the Health and Safety Code, to read:
CHAPTER  1. Behavioral Health Workforce

127800.
 (a) The Behavioral Health Workforce Preservation and Restoration Fund is hereby established as a fund in the state treasury, State Treasury, to be administered by the department, for the purpose of stabilizing the current licensed, certified, or registered clinical behavioral health workforce.
(b) Moneys from the fund may be used, upon appropriation by the Legislature, to provide hiring or performance-based bonuses, salary augmentation, overtime pay, or hazard pay to licensed, certified, or registered professionals working in the behavioral health sector. Funding shall be prioritized to retain or recruit licensed staff for facilities and programs at risk of closure due to a shortage of licensed staff.
(c) For purposes of this chapter, “behavioral health” refers to both mental health and substance use disorder.

127805.
 (a) In addition to, and separate from, the Behavioral Health Workforce Preservation and Restoration Fund established by Section 127800, the department shall establish a stipend program for students pursuing a master’s degree in social work with a specialized focus on public behavioral health.
(b) Under the program, a student shall be eligible for a stipend of eighteen thousand five hundred dollars ($18,500) per year for up to two calendar years. A stipend recipient shall be required to complete two calendar years of continuous and satisfactory full-time employment with a public behavioral health agency or a contracted provider.

127810.
 The department shall develop an online jobs board on which licensed public, private, and nonprofit behavioral health providers and facilities in the state may post job openings for behavioral health workers, including, but not limited to, psychiatrists, clinical psychologists, psychologists, licensed marriage and family therapists, licensed professional clinical counselors, licensed clinical social workers, psychiatric mental health clinical nurse specialists, psychiatric technicians, peer support specialists, and community health workers.

127815.
 (a) The department shall request the University of California to enter into a contract with the department to prepare a report providing a landscape analysis of the current behavioral health workforce and the state’s behavioral health workforce needs, and to make recommendations on how to address the state’s behavioral health workforce shortage. The report shall be delivered to the Legislature on or before January 1, 2024, and shall include all of the following:
(1) An analysis of the public, private, and nonprofit behavioral health workforce.
(2) An analysis that includes both licensed and nonlicensed behavioral health workers, including but not limited to, psychiatrists, clinical psychologists, psychologists, licensed marriage and family therapists, licensed professional clinical counselors, licensed clinical social workers, psychiatric mental health clinical nurse specialists, psychiatric technicians, peer support specialists, and community health workers.
(3) A demographic analysis of the workforce, including information on race, ethnicity, sexual orientation, gender identity, age, geographic location, languages spoken, lived experience with one’s own mental illness or substance use disorder or that of a family member, and disability status. Information regarding health history shall be treated as confidential and shall only be collected on a voluntary basis. Only deidentified and aggregated health information shall be included in the report.
(4) An analysis of the number, type, and location of workers needed to meet California’s behavioral health care needs.
(5) Short, medium, and long-term recommendations on how to increase the state’s behavioral health workforce to meet the current and growing demand.
(6) An analysis of the scope of practice laws for behavioral health workers, as well as health plan hiring guidelines and practices for different behavioral health certification and license types. Recommendations shall aim to ensure that an individual receiving a behavioral health certification or license is able to practice up to their full potential while maintaining a high quality of care.
(7) An analysis of license requirements, including out-of-state license application requirements, and clinical training requirements for behavioral health professionals. The analysis shall compare the state’s license and training requirements for behavioral health professionals to licensing and training requirements in other states and make recommendations.
(8) An analysis of requirements for renewing the license of a behavioral health professional who has an expired license, including, but not limited to, an individual on extended parental, family, or medical leave, or a retiree. Recommendations may include, but are not limited to, requiring competency exams, continuing education requirements, or other competency demonstrations.
(b) The report required to be submitted to the Legislature pursuant to this section shall be submitted in compliance with Section 9795 of the Government Code.
(c) This section shall remain in effect only until January 1, 2028, and as of that date is repealed.

SEC. 5.

 Section 14045.12 of the Welfare and Institutions Code is amended to read:

14045.12.
 For purposes of this article, the following definitions apply:
(a) “Certification” means the activities related to the verification that an individual has met all of the requirements under this article and that the individual may provide peer support specialist services pursuant to this article.
(b) “Certified” means all federal and state requirements have been satisfied by an individual who is seeking designation under this article, including completion of curriculum and training requirements, testing, and agreement to uphold and abide by the code of ethics.
(c) “Code of ethics” means the standards to which a peer support specialist is required to adhere.
(d) “Core competencies” means the foundational and essential knowledge, skills, and abilities required for peer specialists.
(e) “Cultural competence” means a set of congruent behaviors, attitudes, and policies that come together in a system or agency that enables that system or agency to work effectively in cross-cultural situations. A culturally competent system of care acknowledges and incorporates, at all levels, the importance of language and culture, intersecting identities, assessment of cross-cultural relations, knowledge and acceptance of dynamics of cultural differences, expansion of cultural knowledge, and adaptation of services to meet culturally unique needs to provide services in a culturally competent manner.
(f) “Department” means the State Department of Health Care Services.
(g) “Peer support specialist” means an individual who is 18 years of age or older, who has self-identified as having lived experience with the process of recovery from mental illness, substance use disorder, or both, either as a consumer of these services or as the parent or family member of the consumer, and who has been granted certification as a peer support specialist pursuant to this article.
(h) “Peer support specialist services” means culturally competent services that promote engagement, socialization, recovery, self-sufficiency, self-advocacy, development of natural supports, and identification of strengths. Peer support specialist services include, but are not limited to, prevention services, support, coaching, facilitation, or education that is individualized and is conducted by a certified peer support specialist.
(i) “Recovery” means a process of change through which an individual improves their health and wellness, lives a self-directed life, and strives to reach their full potential. This process of change recognizes cultural diversity and inclusion, and honors the different routes to resilience and recovery based on the individual and their cultural community.

SEC. 6.

 Section 14045.13 of the Welfare and Institutions Code is amended to read:

14045.13.
 By July 1, 2023, the department shall do all of the following:
(a) Establish a certifying body, either through contract or through an interagency agreement, to provide for the certification activities described in this article.
(b) Provide for a statewide certification for peer support specialists, as contained in federal guidance in State Medicaid Director Letter No. 07-011, issued by the federal Centers for Medicare and Medicaid Services on August 15, 2007.
(c) Define the qualifications, range of responsibilities, practice guidelines, and supervision standards for peer support specialists. The department may utilize best practice materials published by the federal Substance Abuse and Mental Health Services Administration, the United States Department of Veterans Affairs, and related notable experts in the field as a basis for development of these definitions.
(d) Determine curriculum and core competencies required for certification of an individual as a peer support specialist, including curriculum that may be offered in areas of specialization, including, but not limited to, transition-age youth, veterans, gender identity, sexual orientation, and any other areas of specialization identified by the department. Core-competencies-based curriculum shall include, at a minimum, training related to all of the following elements:
(1) The concepts of hope, recovery, and wellness.
(2) The role of advocacy.
(3) The role of consumers and family members.
(4) Psychiatric rehabilitation skills and service delivery, and addiction recovery principles, including defined practices.
(5) Cultural competence training.
(6) Trauma-informed care.
(7) Group facilitation skills.
(8) Self-awareness and self-care.
(9) Cooccurring disorders of mental health and substance use.
(10) Conflict resolution.
(11) Professional boundaries and ethics.
(12) Preparation for employment opportunities, including study and test-taking skills, application and résumé preparation, interviewing, and other potential requirements for employment.
(13) Safety and crisis planning.
(14) Navigation of, and referral to, other services.
(15) Documentation skills and standards.
(16) Confidentiality.
(e) Specify peer support specialist employment training requirements, including core-competencies-based training and specialized training necessary to become certified under this article, and require training to include people with lived experience as consumers and family members.
(f) Establish a code of ethics.
(g) Determine continuing education requirements for biennial certification renewal.
(h) Determine the process for initial certification issuance and biennial certification renewal.
(i) Determine a process for investigation of complaints and corrective action, including suspension and revocation of certification and appeals.
(j) Determine a process for an individual employed as a peer support specialist on January 1, 2023, to obtain certification under this article.
(k) Determine requirements for peer support specialist certification for peer support specialists from out of state.
(l) Seek any federal approvals, related to the statewide certification standards, that it deems necessary to implement this article. For any federal approvals that the department deems necessary related to the statewide certification standards, this article shall be implemented only if and to the extent that the department obtains those federal approvals.

SEC. 7.

 Section 14045.14 of the Welfare and Institutions Code is repealed.

SEC. 8.

 Section 14045.18 of the Welfare and Institutions Code is repealed.

SEC. 9.

 Section 14045.18 is added to the Welfare and Institutions Code, to read:

14045.18.
 (a) The department shall amend its Medicaid state plan to do both of the following:
(1) Include a peer support specialist certified pursuant to this article as a provider type for purposes of this chapter.
(2) Include peer support specialist services as a distinct service type for purposes of this chapter, which may be provided to eligible Medi-Cal beneficiaries who are enrolled in either a Medi-Cal managed care plan or a mental health plan.
(b) The department may seek any federal waivers or other state plan amendments as necessary to implement the certification program provided for under this article.

SEC. 10.

 Section 14045.19 of the Welfare and Institutions Code is repealed.

SEC. 11.

 Section 14045.19 is added to the Welfare and Institutions Code, to read:

14045.19.
 Medi-Cal reimbursement for peer support specialist services shall be implemented only if, and to the extent that, federal financial participation under Title XIX of the federal Social Security Act (42 U.S.C. Sec. 1396 et seq.) is available and all necessary federal approvals have been obtained.

SEC. 12.Section 14105.29 of the Welfare and Institutions Code is amended to read:
14105.29.

(a)(1)Subject to subdivision (d), additional Medi-Cal payments shall be made to designated public hospitals and their affiliated government entities, in recognition of the Medi-Cal managed care share of graduate medical education costs. To the extent permissible under federal law, the department shall make these payments directly to the designated public hospitals and their applicable affiliated government entities.

(2)The graduate medical education payments shall consist of the following components:

(A)Direct graduate medical education payments made in recognition and support of the direct costs incurred in the operation of graduate medical education programs, which may include, but are not limited to, salaries, benefits, physician oversight, and allocated overhead costs incurred for interns and residents in medicine, osteopathy, dentistry, podiatry, nursing, allied health and paramedical programs, and behavioral health programs.

(B)Indirect graduate medical education payments made in recognition and support of the increased operating and patient care costs associated with teaching programs.

(3)Graduate medical education payments shall support, recognize, and enhance the role of designated public hospitals and their affiliated government entities in the training of interns, residents, and fellows who are enrolled in accredited medical or dental programs, in advanced practice nursing or other allied health professional programs, or who are pursuing advanced specialty training.

(4)The graduate medical education payments shall be inflation adjusted.

(5)The department shall determine the maximum amount of graduate medical education payments and distribute to participating designated public hospitals and their affiliated government entities, as applicable, in accordance with a methodology developed in consultation with the designated public hospitals.

(6)Interim graduate medical education payments shall be made on a quarterly basis, and reconciled at the end of the fiscal year to determine the final amounts due based on information reported to the department by the designated public hospitals. To the extent practicable, the department shall seek to minimize the administrative burden on participating designated public hospitals associated with reporting and finalizing graduate medical education payments.

(7)Graduate medical education payments provided pursuant to this section shall not supplant amounts that would otherwise be payable by the department to Medi-Cal managed care plans or to designated public hospitals and their affiliated government entities, or by Medi-Cal managed care plans to designated public hospitals and their affiliated government entities. A Medi-Cal managed care plan shall not withhold or otherwise reduce other payments to a designated public hospital or its affiliated government entities as a result of implementation of payment programs pursuant to this section.

(b)Subject to subdivision (d), the department may, in consultation with designated public hospitals, seek federal approval to provide for other forms of graduate medical education payments to designated public hospitals and their affiliated government entities, including payments that reflect the volume of fee-for-service Medi-Cal services or revenue to the extent the fee-for-service payments do not otherwise recognize graduate medical education costs, or incentive payments.

(c)The nonfederal share of payments under this section shall consist of voluntary intergovernmental transfers of funds provided by designated public hospitals or their affiliated government entities, or other eligible public entities, including those described in Section 14164, in accordance with this section. No state General Fund moneys shall be used to fund the nonfederal share of payments under this section.

(1)The Designated Public Hospital (DPH) Graduate Medical Education (GME) Special Fund is hereby established in the State Treasury. Notwithstanding Section 13340 of the Government Code, moneys deposited into the DPH GME Special Fund shall be continuously appropriated, without regard to fiscal year, to the department for the purposes specified in this section. All funds derived pursuant to this section shall be deposited in the State Treasury to the credit of the DPH GME Special Fund.

(2)The DPH GME Special Fund shall consist of moneys that a designated public hospital or affiliated government entity, or other public entity, as applicable, elects to transfer to the department for deposit into the fund, to the extent permitted under Section 433.51 of Title 42 of the Code of Federal Regulations and any other applicable federal Medicaid laws. Moneys derived from these intergovernmental transfers in the DPH GME Special Fund shall be used as the source for the nonfederal share of graduate medical education payments authorized under this section, for reimbursing the department’s administrative costs in implementing this section, and to otherwise support the Medi-Cal program. The timing and amounts of the intergovernmental transfers shall be determined by the department in consultation with the transferring entities. The department shall determine the intergovernmental transfer amounts for each applicable state fiscal year such that they are sufficient to fund the nonfederal share of the associated graduate medical education payments for that year, plus five percent of the aggregate nonfederal share that would be associated with the graduate medical education payments made pursuant to this section in that applicable state fiscal year as if the federal medical assistance percentage were 50 percent. Upon providing any intergovernmental transfer of funds, each transferring entity shall certify that the transferred funds qualify for federal financial participation pursuant to applicable federal Medicaid laws, and in the form and manner as required by the department.

(3)The department shall claim federal financial participation for graduate medical education payments under this section using moneys derived from intergovernmental transfers made pursuant to this section, and deposited in the DPH GME Special Fund to the full extent permitted by law. In the event federal financial participation is not available with respect to a payment under this section and either is not obtained, or results in a recoupment of payments already made, the department shall return any intergovernmental transfer fund amounts associated with the payment for which federal financial participation is not available to the applicable transferring entities within 14 days from the date of the associated recoupment or other determination, as applicable.

(4)Any intergovernmental transfer of funds made pursuant to this section shall be considered voluntary for purposes of all federal and state laws.

(d)(1)This section shall be implemented only to the extent that any necessary federal approvals are obtained and federal financial participation is available and is not otherwise jeopardized.

(2)After consultation with the designated public hospitals, the director may modify the requirements set forth in this section to the extent necessary to meet federal requirements for graduate medical education payments for designated public hospitals and their affiliated government entities or to maximize federal financial participation available under such a program.

(e)(1)The department shall seek any necessary federal approvals from the federal Centers for Medicare and Medicaid Services, through state plan amendments or otherwise, for graduate medical education payments, effective no sooner than January 1, 2017, in accordance with this section.

(2)The department shall consult with the designated public hospitals with regard to the development and implementation, and any subsequent modification, of the payment programs established pursuant to this section.

(3)Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may implement, interpret, or make specific this section by means of all-county letters, plan letters, provider bulletins, or other similar instructions, without taking regulatory action. The department shall timely inform, or provide access to, applicable guidance issued pursuant to this authority to affected designated public hospitals and their affiliated government entities. This guidance shall remain publicly available until all payments made pursuant to this section are finalized.

(f)For purposes of this section, the following definitions apply:

(1)“Designated public hospitals” means those hospitals identified in subdivision (f) of Section 14184.10.

(2)“Designated public hospitals and their affiliated government entities” means those hospitals identified in subdivision (f) of Section 14184.10, and the government entities and agencies with which they are affiliated, inclusive of their affiliated government-operated physician practice groups, affiliated government-operated clinics and other settings that provide clinical training, and affiliated government-operated medical and professional training schools and programs.

LegiScan Search

View Top 50 Searches

Select area of search.
Find an exact bill number.
Search bill text and data. [help]
Reset

LegiScan Trends

View Top 50 National

CA SB988 Freelance Worker Protection Act.
WI SB476 Provision of health services through telehealth by out-of-state providers...
NY A09832 Authorizes towns to adopt, amend or repeal local laws to impose a surcharge...
AZ SB1457 Online instruction; virtual setting; assessments
LA HB827 Provides relative to the sales and use tax rebate on the sale of certain...
MO HB2060 Modifies provisions relating to tobacco product regulations
NE LB692 Adopt the Good Life Transformational Projects Act and change the sales...
AZ HB2297 Commercial buildings; adaptive reuse
NY A04019 Enacts the water bill fairness act; authorizes local water and sewerage...
AZ SB1250 AHCCCS; claims