Bill Text: CA SB970 | 2021-2022 | Regular Session | Amended

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

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Bill Title: Mental Health Services Act.

Spectrum: Partisan Bill (Democrat 7-0)

Status: (Engrossed - Dead) 2022-08-23 - Ordered to third reading. [SB970 Detail]

Download: California-2021-SB970-Amended.html

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Amended  IN  Senate  April 18, 2022

Amended  IN  Senate  March 10, 2022

CALIFORNIA LEGISLATURE— 2021–2022 REGULAR SESSION

Senate Bill

No. 970

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Introduced by Senator Eggman
(Principal coauthor: Senator Stern)
(Principal coauthors: Assembly Members Carrillo, Friedman, and Quirk-Silva)
(Coauthor: Senator Glazer)

February 10, 2022

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An act to amend Sections 5651, 5847, 5848, 5891, and 5891.5, and 5892 of, and to add Section 5846.5 to, the Welfare and Institutions Code, relating to mental health, and making an appropriation therefor. health.

LEGISLATIVE COUNSEL'S DIGEST

SB 970, as amended, Eggman. Mental Health Services Act.

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 Mental Health Services Fund (MHSF), a continuously appropriated fund, to fund various county mental health programs, including children’s mental health care, adult and older adult mental health care, prevention and early intervention programs, and innovative programs. Existing law authorizes the MHSA to be amended by a ²/₃ vote of each house of the Legislature if the amendments are consistent with, and further the intent of, the MHSA.

The MHSA requires a certain percentage of funds in the MHSF to be used by the counties for specified purposes, including requiring 20% of all unexpended and unreserved funds on deposit in the MHSF each month to be distributed to the counties and used for prevention and early intervention programs and requiring 5% of the total funding for each county mental health program for children’s mental health care, adult and older adult mental health care, and prevention and early intervention to be utilized for innovative programs, as specified.

This bill would amend the MHSA by eliminating those percentage funding requirements commencing with the 2024–25 fiscal year. By changing the purposes for which the funds in the MHSF may be used, the bill would make an appropriation.

The MHSA establishes the Mental Health Services Oversight and Accountability Commission and requires the counties to prepare and submit a 3-year program and expenditure plan, and annual updates, as specified, to the commission and the department.

This bill would amend the MHSA by, instead, requiring the counties to prepare and submit 5-year program and expenditure plans, and annual updates, as specified.

This bill would require the California Health and Human Services Agency, by July 1, 2024, 2025, to establish the California MHSA Outcomes and Accountability Review (MHSA-OAR), consisting of performance indicators, county self-assessments, and county MHSA improvement plans, to facilitate a local accountability system that fosters continuous quality improvement in county programs funded by the MHSA and in the collection and dissemination by the department of best practices in service delivery. The bill would require the agency to convene a workgroup, as specified, to establish a workplan by which the MHSA-OAR shall be conducted, including a process for qualitative peer reviews of counties’ MHSA services and uniform elements for the county MHSA system improvement plans. The bill would require the agency to establish specific process measures and uniform elements for the county MHSA improvement plans and updates. The bill would require the counties to execute and fulfil fulfill components of its MHSA system improvement plan that can be accomplished with existing resources. The bill would require the agency to report to the Legislature, on an annual basis, a report that summarizes county performance on the established process and outcome measures during the reporting period, analyzes county performance trends over time, and makes findings and recommendations for common MHSA services improvements identified in the county MHSA self-assessments and county MHSA system improvement plans. 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 specified services, including preparing an analysis of how data pertaining to the provision of mental health services and client outcomes collected by the counties and provided to the state may be used to demonstrate the impact of services funded by the MHSF 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, 2024.

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: 2/3   Appropriation: YESNO   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 5651 of the Welfare and Institutions Code is amended to read:

5651.

 (a) Counties shall comply with the terms of the county mental health services performance contract.

(b) The county mental health services performance contract shall include all of the following provisions:

(1) That the county shall comply with the expenditure requirements of Section 17608.05.

(2) That the county shall provide services to persons receiving involuntary treatment as required by Part 1 (commencing with Section 5000) and Part 1.5 (commencing with Section 5585).

(3) That the county shall comply with all requirements necessary for Medi-Cal reimbursement for mental health treatment services and case management programs provided to Medi-Cal eligible individuals, including, but not limited to, the provisions set forth in Chapter 3 (commencing with Section 5700), and that the county shall submit cost reports and other data to the department in the form and manner determined by the State Department of Health Care Services.

(4) That the local mental health advisory board has reviewed and approved procedures ensuring citizen and professional involvement at all stages of the planning process pursuant to Section 5604.2.

(5) That the county shall comply with all provisions and requirements in law pertaining to patient rights.

(6) That the county shall comply with all requirements in federal law and regulation, and all agreements, certifications, assurances, and policy letters, pertaining to federally funded mental health programs, including, but not limited to, the Projects for Assistance in Transition from Homelessness grant and Community Mental Health Services Block Grant programs.

(7) That the county shall provide all data and information set forth in Sections 5610 and 5664.

(8) That the county, if it elects to provide the services described in Chapter 2.5 (commencing with Section 5670), shall comply with guidelines established for program initiatives outlined in that chapter.

(9) That the county shall comply with all applicable laws and regulations for all services delivered, including all laws, regulations, and guidelines of the Mental Health Services Act.

(10) The State Department of Health Care Services’ ability to monitor the county’s five-year program and expenditure plan and annual update pursuant to Section 5847.

(11) Other information determined to be necessary by the director, to the extent this requirement does not substantially increase county costs.

(c) The State Department of Health Care Services may include contract provisions for other federal grants or county mental health programs in this performance contract.

SEC. 2.

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

5846.5.

 (a) This section shall be known, and may be cited as, the Mental Health Services Act (MHSA) Outcomes and Accountability Review Act of 2022.

(b) The California Health and Human Services Agency shall establish, by July 1, 2024, 2025, the California MHSA Outcomes and Accountability Review (MHSA-OAR) to facilitate a local accountability system that fosters continuous quality improvement in county programs funded by the MHSA and in the collection and dissemination by the department of best practices in service delivery. The MHSA-OAR shall cover MHSA-funded services provided to current and former recipients and shall include the programmatic elements that each county offers as part of its MHSA service array, as well as any local program components, and shall consist of performance indicators, a county MHSA self-assessment process, and a county MHSA system improvement plan.

(c) (1) (A) On or before October 1, 2023, the agency shall convene a workgroup comprised of representatives from the State Department of Health Care Services, the Mental Health Services Oversight and Accountability Commission, county behavioral health agencies, legislative staff, interested behavioral health advocacy and research organizations, current and former MHSA service recipients, organizations that represent county behavioral health agencies and county boards of supervisors, researchers, people with lived experience, county behavioral health agency partners, and any other entities or individuals that the department deems necessary. The workgroup shall establish a workplan by which the MHSA-OAR shall be conducted, including a process for qualitative peer reviews of counties’ MHSA services.

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

(2) At a minimum, in establishing the work plan, the workgroup shall consider existing MHSA performance indicators being measured, additional, alternative, or additional and alternative process and outcome indicators to be measured, development of uniform elements of the county MHSA self-assessment and the county MHSA system improvement plans, timelines for implementation, recommendations for reducing the existing MHSA services data reporting burden, recommendations for financial incentives to counties for achievement on performance measures, and an analysis of 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 MHSA system improvement plans required in paragraph (3) of subdivision (d). The agency, in consultation with the workgroup, shall develop the uniform elements of the updates to those plans, as required pursuant to subparagraph (D) of paragraph (3) of subdivision (d).

(d) The MHSA-OAR shall consist of the following three components: performance indicators, a county MHSA self-assessment, and a county MHSA system improvement plan.

(1) (A) The MHSA-OAR performance indicators shall be consistent with programmatic goals for the MHSA, and shall include both process and outcome measures. These measures shall be established in order to provide baseline and ongoing information about how the state and counties are performing over time and to inform and guide each county behavioral health agency’s MHSA self-assessment and MHSA system improvement plan.

(i) Process measures shall include measures of participant engagement, MHSA 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.

(ii)Outcome measures shall include measures of the reduction of the negative outcomes described in subdivision (d) of Section 5840, which 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 may include other indicators of well-being as determined by the agency, in consultation with the workgroup.

(ii) Outcome measures shall be determined based on the recommendations included in the analysis prepared by the University of California pursuant to subdivision (g), if the University of California enters into the contract described in subdivision (g).

(B) Performance indicator data available in existing county data systems shall be collected by counties 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. These 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 five-year MHSA-OAR cycle, performance indicator data reported by each county, shall be used to establish both county and statewide baselines for each of the process measures. After the first review cycle, the agency shall, in consultation with the workgroup, establish standard target thresholds for each of the process measures established by the workgroup.

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

(D) For subsequent reviews, and based upon availability of additional data through interagency data-sharing agreements, the workgroup shall convene, as necessary, to consider whether to establish additional performance indicators that support the programmatic goals for the MHSA. Additional performance indicators established shall also be subject to the process described in subparagraph (C) and shall include consideration of when data on the additional performance indicators would 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, in consultation with the workgroup, establish those standards for each of the agreed-upon outcome measures.

(2) (A) The county MHSA self-assessment component of the MHSA-OAR, as established by the workgroup, shall require the county behavioral health agencies to assess their performance on the established process and outcome measures that comprise the performance indicators, identify the strengths and weaknesses in their current practice and resource deployment, identify and describe how local operational decisions and systemic factors affect program outcomes, and consider areas of focus that may be included in the county MHSA system improvement plan, as described in paragraph (3). The county MHSA self-assessment process shall be designed to identify areas of best practices for replication and for system improvement at the county level, and shall guide the development of the county MHSA system improvement plan.

(B) (i) The county MHSA self-assessment process shall be completed every five years by the county, in consultation and collaboration with local stakeholders, and submitted to the agency.

(ii) Local stakeholders shall include county behavioral health directors, supervisors, and caseworkers; current and former MHSA service recipients; and county behavioral health agency partners. To the extent possible and relevant, local stakeholders shall also include representatives of tribal organizations and the local behavioral health board. 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 service departments, county drug and alcohol programs, community-based service providers, and organizations that represent MHSA recipients, as appropriate.

(3) (A) (i) The county MHSA system improvement plan shall, at a minimum, describe how the county will improve its MHSA program performance in strategic focus areas based upon information learned through the county MHSA self-assessment process. The county MHSA system improvement plan shall include the uniform elements established by the workgroup pursuant to paragraph (3) of subdivision (c).

(ii) The county MHSA system improvement plan shall be completed every five years by the county, approved in public session by the county’s board of supervisors or, as applicable, chief elected official, and be submitted to the agency.

(B) The county MHSA system improvement plan shall include an MHSA services peer review element, the purpose of which shall be to provide additional insight and technical assistance by peer counties.

(C) Strategic focus areas for the county MHSA system improvement plan shall be determined by the county, informed by the county MHSA self-assessment process, as described in paragraph (2), with targets for improvement based upon what is learned in the county MHSA self-assessment process.

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

(e) (1) The agency shall receive, review, and, based on its determination of whether the county MHSA system improvement plan meets the required elements, certify as complete all county-submitted performance indicator data, county MHSA self-assessments, county MHSA system improvement plans, and annual progress reports, and shall identify and promote the replication of best practices in MHSA service delivery to achieve the established process and outcome measures.

(2) The agency shall monitor, on an ongoing basis, county performance on the measures developed pursuant to subdivision (d).

(3)The agency shall make data collected pursuant to this section publicly available on its internet website.

(4)

(3) The agency shall, on an annual basis, submit a report to the Legislature that summarizes county performance on the established process and outcome measures during the reporting period, analyzes county performance trends over time, and makes findings and recommendations for common MHSA services improvements identified in the county MHSA self-assessments and county MHSA system improvement plans, including information on common statutory, regulatory, or fiscal barriers identified as inhibiting system improvements and any recommendations to overcome those barriers.

(5)

(4) (A) The agency shall provide or shall, in partnership with the University of California, if the contract is executed pursuant to subdivision (g), facilitate the provision of technical assistance to county behavioral health agencies as part of the peer review that supports the county’s selected areas for improvement, as described in its system improvement plan.

(B) If, in the course of its review of county MHSA system improvement plans and annual updates, or, in the course of its review of regularly submitted performance indicator data, the agency determines that a county is consistently failing to make progress toward its strategic focus areas for improvement or is consistently failing to meet the process measure standard target thresholds established pursuant to subparagraph (C) of paragraph (1) of subdivision (d), the agency shall engage the county in a process of targeted technical assistance and support to address and resolve the identified shortcomings.

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

(g) 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) Prepare an analysis of how data pertaining to the provision of mental health services and client outcomes collected by the counties and provided to the state may be used to demonstrate the impact of services funded by the Mental Health Services Fund on life outcomes. The analysis shall be delivered to the agency, the Legislature, and the workgroup established pursuant to subparagraph (A) of paragraph (1) of subdivision (c) on or before July 1, 2024, and shall include both of the following:

(i) Recommendations of what outcomes should be used to measure the impact of the Mental Health Services Act. Recommended life outcome measures shall include measures of the reduction of the negative outcomes described in subdivision (d) of Section 5840, which 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.

(ii) An estimate of how much an impact funding from the Mental Health Service Fund can have on each recommended outcome.

(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 to report the status of county process and outcome indicators as described in this section.

(3) Consult with the agency to provide technical assistance to county behavioral health agencies as described in subparagraph (A) of paragraph (4) of subdivision (e).

SEC. 3.

 Section 5847 of the Welfare and Institutions Code is amended to read:

5847.

 (a) Each county mental health program shall prepare and submit a five-year program and expenditure plan, and annual updates, adopted by the county board of supervisors, to the Mental Health Services Oversight and Accountability Commission and the State Department of Health Care Services within 30 days after adoption.

(b) The five-year program and expenditure plan shall be based on available unspent funds and estimated revenue allocations provided by the state and in accordance with established stakeholder engagement and planning requirements, as required in Section 5848. The five-year program and expenditure plan and annual updates shall include all of the following:

(1) A program for prevention and early intervention in accordance with Part 3.6 (commencing with Section 5840).

(2) A program for services to children in accordance with Part 4 (commencing with Section 5850), to include a program pursuant to Chapter 4 (commencing with Section 18250) of Part 6 of Division 9 or provide substantial evidence that it is not feasible to establish a wraparound program in that county.

(3) A program for services to adults and seniors in accordance with Part 3 (commencing with Section 5800).

(4) A program for innovations in accordance with Part 3.2 (commencing with Section 5830).

(5) A program for technological needs and capital facilities needed to provide services pursuant to Part 3 (commencing with Section 5800), Part 3.6 (commencing with Section 5840), and Part 4 (commencing with Section 5850). All plans for proposed facilities with restrictive settings shall demonstrate that the needs of the people to be served cannot be met in a less restrictive or more integrated setting, such as permanent supportive housing.

(6) Identification of shortages in personnel to provide services pursuant to the above programs and the additional assistance needed from the education and training programs established pursuant to Part 3.1 (commencing with Section 5820).

(7) Establishment and maintenance of a prudent reserve to ensure the county program will continue to be able to serve children, adults, and seniors that it is currently serving pursuant to Part 3 (commencing with Section 5800), the Adult and Older Adult Mental Health System of Care Act, Part 3.6 (commencing with Section 5840), Prevention and Early Intervention Programs, and Part 4 (commencing with Section 5850), the Children’s Mental Health Services Act, during years in which revenues for the Mental Health Services Fund are below recent averages adjusted by changes in the state population and the California Consumer Price Index.

(8) Certification by the county behavioral health director, which ensures that the county has complied with all pertinent regulations, laws, and statutes of the Mental Health Services Act, including stakeholder participation and nonsupplantation requirements.

(9) Certification by the county behavioral health director and by the county auditor-controller that the county has complied with any fiscal accountability requirements as directed by the State Department of Health Care Services, and that all expenditures are consistent with the requirements of the Mental Health Services Act.

(c) The programs established pursuant to paragraphs (2) and (3) of subdivision (b) shall include services to address the needs of transition age youth 16 to 25 years of age. In implementing this subdivision, county mental health programs shall consider the needs of transition age foster youth.

(d) Each year, the State Department of Health Care Services shall inform the County Behavioral Health Directors Association of California and the Mental Health Services Oversight and Accountability Commission of the methodology used for revenue allocation to the counties.

(e) Each county mental health program shall prepare expenditure plans pursuant to Part 3 (commencing with Section 5800) for adults and seniors, Part 3.2 (commencing with Section 5830) for innovative programs, Part 3.6 (commencing with Section 5840) for prevention and early intervention programs, and Part 4 (commencing with Section 5850) for services for children, and updates to the plans developed pursuant to this section. Each expenditure update shall indicate the number of children, adults, and seniors to be served pursuant to Part 3 (commencing with Section 5800), and Part 4 (commencing with Section 5850), and the cost per person. The expenditure update shall include utilization of unspent funds allocated in the previous year and the proposed expenditure for the same purpose.

(f) A county mental health program shall include an allocation of funds from a reserve established pursuant to paragraph (7) of subdivision (b) for services pursuant to paragraphs (2) and (3) of subdivision (b) in years in which the allocation of funds for services pursuant to subdivision (e) are not adequate to continue to serve the same number of individuals as the county had been serving in the previous fiscal year.

(g) The department shall post on its internet website the five-year program and expenditure plans submitted by every county pursuant to subdivision (a) in a timely manner.

(h) (1) Notwithstanding subdivision (a), a county that is unable to complete and submit a three-year program and expenditure plan or annual update for the 2020–21 or 2021–22 fiscal years due to the COVID-19 Public Health Emergency may extend the effective timeframe of its currently approved three-year plan or annual update to include the 2020–21 and 2021–22 fiscal years. The county shall submit a three-year program and expenditure plan or annual update to the Mental Health Services Oversight and Accountability Commission and the State Department of Health Care Services by July 1, 2022.

(2) For purposes of this subdivision, “COVID-19 Public Health Emergency” means the federal Public Health Emergency declaration made pursuant to Section 247d of Title 42 of the United States Code on January 30, 2020, entitled “Determination that a Public Health Emergency Exists Nationwide as the Result of the 2019 Novel Coronavirus,” and any renewal of that declaration.

(i) Notwithstanding paragraph (7) of subdivision (b) and subdivision (f), a county may, during the 2020–21 and 2021–22 fiscal years, use funds from its prudent reserve for prevention and early intervention programs created in accordance with Part 3.6 (commencing with Section 5840) and for services to persons with severe mental illnesses pursuant to Part 4 (commencing with Section 5850) for the children’s system of care and Part 3 (commencing with Section 5800) for the adult and older adult system of care. These services may include housing assistance, as defined in Section 5892.5, to the target population specified in Section 5600.3.

(j) Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department, without taking any further regulatory action, may implement, interpret, or make specific subdivisions (h) and (i) of this section and subdivision (i) of Section 5892 by means of all-county letters or other similar instructions.

SEC. 4.

 Section 5848 of the Welfare and Institutions Code is amended to read:

5848.

 (a) Each five-year program and expenditure plan and update shall be developed with local stakeholders, including adults and seniors with severe mental illness, families of children, adults, and seniors with severe mental illness, providers of services, law enforcement agencies, education, social services agencies, veterans, representatives from veterans organizations, providers of alcohol and drug services, health care organizations, and other important interests. Counties shall demonstrate a partnership with constituents and stakeholders throughout the process that includes meaningful stakeholder involvement on mental health policy, program planning, and implementation, monitoring, quality improvement, evaluation, and budget allocations. A draft plan and update shall be prepared and circulated for review and comment for at least 30 days to representatives of stakeholder interests and any interested party who has requested a copy of the draft plans.

(b) The mental health board established pursuant to Section 5604 shall conduct a public hearing on the draft five-year program and expenditure plan and annual updates at the close of the 30-day comment period required by subdivision (a). Each adopted five-year program and expenditure plan and update shall include any substantive written recommendations for revisions. The adopted five-year program and expenditure plan or update shall summarize and analyze the recommended revisions. The mental health board shall review the adopted plan or update and make recommendations to the local mental health agency or local behavioral health agency, as applicable, for revisions. The local mental health agency or local behavioral health agency, as applicable, shall provide an annual report of written explanations to the local governing body and the State Department of Health Care Services for any substantive recommendations made by the local mental health board that are not included in the final plan or update.

(c) The plans shall include reports on the achievement of performance outcomes for services pursuant to Part 3 (commencing with Section 5800), Part 3.6 (commencing with Section 5840), and Part 4 (commencing with Section 5850) funded by the Mental Health Services Fund and established jointly by the State Department of Health Care Services and the Mental Health Services Oversight and Accountability Commission, in collaboration with the County Behavioral Health Directors Association of California.

(d) Mental health services provided pursuant to Part 3 (commencing with Section 5800) and Part 4 (commencing with Section 5850) shall be included in the review of program performance by the California Behavioral Health Planning Council required by paragraph (2) of subdivision (c) of Section 5772 and in the local mental health board’s review and comment on the performance outcome data required by paragraph (7) of subdivision (a) of Section 5604.2.

(e) The department shall annually post on its internet website a summary of the performance outcomes reports submitted by counties if clearly and separately identified by counties as the achievement of performance outcomes pursuant to subdivision (c).

(f) For purposes of this section, “substantive recommendations made by the local mental health board” means any recommendation that is brought before the board and approved by a majority vote of the membership present at a public hearing of the local mental health board that has established its quorum.

SEC. 5.

 Section 5891 of the Welfare and Institutions Code is amended to read:

5891.

 (a) The funding established pursuant to this act shall be utilized to expand mental health services. Except as provided in subdivision (j) of Section 5892 due to the state’s fiscal crisis, these funds shall not be used to supplant existing state or county funds utilized to provide mental health services. The state shall continue to provide financial support for mental health programs with not less than the same entitlements, amounts of allocations from the General Fund or from the Local Revenue Fund 2011 in the State Treasury, and formula distributions of dedicated funds as provided in the last fiscal year which ended prior to the effective date of this act. The state shall not make any change to the structure of financing mental health services, which increases a county’s share of costs or financial risk for mental health services unless the state includes adequate funding to fully compensate for the increased costs or financial risk. These funds shall only be used to pay for the programs authorized in Sections 5890 and 5892. These funds may not be used to pay for any other program. These funds may not be loaned to the General Fund or any other fund of the state, or a county general fund or any other county fund for any purpose other than those authorized by Sections 5890 and 5892.

(b) (1) Notwithstanding subdivision (a), and except as provided in paragraph (2), the Controller may use the funds created pursuant to this part for loans to the General Fund as provided in Sections 16310 and 16381 of the Government Code. Any such loan shall be repaid from the General Fund with interest computed at 110 percent of the Pooled Money Investment Account rate, with interest commencing to accrue on the date the loan is made from the fund. This subdivision does not authorize any transfer that would interfere with the carrying out of the object for which these funds were created.

(2) This subdivision does not apply to the Supportive Housing Program Subaccount created by subdivision (f) of Section 5890 or any moneys paid by the California Health Facilities Financing Authority to the Department of Housing and Community Development as a service fee pursuant to a service contract authorized by Section 5849.35.

(c) Commencing July 1, 2012, on or before the 15th day of each month, pursuant to a methodology provided by the State Department of Health Care Services, the Controller shall distribute to each Local Mental Health Service Fund established by counties pursuant to subdivision (f) of Section 5892, all unexpended and unreserved funds on deposit as of the last day of the prior month in the Mental Health Services Fund, established pursuant to Section 5890, for the provision of programs and other related activities set forth in Part 3 (commencing with Section 5800), Part 3.2 (commencing with Section 5830), Part 3.6 (commencing with Section 5840), Part 3.9 (commencing with Section 5849.1), and Part 4 (commencing with Section 5850).

(d) Counties shall base their expenditures on the county mental health program’s five-year program and expenditure plan or annual update, as required by Section 5847. This subdivision shall not affect subdivision (a) or (b).

SEC. 6.

 Section 5891.5 of the Welfare and Institutions Code is amended to read:

5891.5.

 (a) (1) The programs in paragraphs (1) to (3), inclusive, and paragraph (5) of subdivision (a) of Section 5890 may include substance use disorder treatment for children, adults, and older adults with cooccurring mental health and substance use disorders who are eligible to receive mental health services pursuant to those programs. The MHSA includes persons with a serious mental disorder and a diagnosis of substance abuse in the definition of persons who are eligible for MHSA services in Sections 5878.2 and 5813.5, which reference paragraph (2) of subdivision (b) of Section 5600.3.

(2) Provision of substance use disorder services pursuant to this section shall comply with all applicable requirements of the Mental Health Services Act.

(3) Treatment of cooccurring mental health and substance use disorders shall be identified in a county’s five-year program and expenditure plan or annual update, as required by Section 5847.

(b) (1) When a person being treated for cooccurring mental health and substance use disorders pursuant to subdivision (a) is determined to not need the mental health services that are eligible for funding pursuant to the MHSA, the county shall refer the person receiving treatment to substance use disorder treatment services in a timely manner.

(2) Funding established pursuant to the MHSA may be used to assess whether a person has cooccurring mental health and substance use disorders and to treat a person who is preliminarily assessed to have cooccurring mental health and substance use disorders, even when the person is later determined not to be eligible for services provided with funding established pursuant to the MHSA.

(c) A county shall report to the department, in a form and manner determined by the department, both of the following:

(1) The number of people assessed for cooccurring mental health and substance use disorders.

(2) The number of people assessed for cooccurring mental health and substance use disorders who were ultimately determined to have only a substance use disorder without another cooccurring mental health condition.

(d) The department shall by January 1, 2022, and each January 1 thereafter, publish on its internet website a report summarizing county activities pursuant to this section for the prior fiscal year. Data shall be reported statewide and by county or groupings of counties, as necessary to protect the private health information of persons assessed.

(e) (1) 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 plan or county letters, information notices, plan or provider bulletins, or other similar instructions, without taking any further regulatory action.

(2) On or before July 1, 2025, the department shall adopt regulations necessary to implement this section in accordance with the requirements of Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code.

SEC. 7.Section 5892 of the Welfare and Institutions Code is amended to read:

5892.

(a)In order to promote efficient implementation of this act, the county shall use funds distributed from the Mental Health Services Fund as follows:

(1)In the 2005–06, 2006–07, and 2007–08 fiscal years, 10 percent shall be placed in a trust fund to be expended for education and training programs pursuant to Part 3.1 (commencing with Section 5820).

(2)In the 2005–06, 2006–07, and 2007–08 fiscal years, 10 percent for capital facilities and technological needs shall be distributed to counties in accordance with a formula developed in consultation with the County Behavioral Health Directors Association of California to implement plans developed pursuant to Section 5847.

(3)Twenty percent of funds distributed to the counties pursuant to subdivision (c) of Section 5891 shall be used for prevention and early intervention programs in accordance with Part 3.6 (commencing with Section 5840). Commencing with the 2024–25 fiscal year, the percentage requirement in this paragraph shall not apply.

(4)The expenditure for prevention and early intervention may be increased in any county in which the department determines that the increase will decrease the need and cost for additional services to persons with severe mental illness in that county by an amount at least commensurate with the proposed increase.

(5)The balance of funds shall be distributed to county mental health programs for services to persons with severe mental illnesses pursuant to Part 4 (commencing with Section 5850) for the children’s system of care and Part 3 (commencing with Section 5800) for the adult and older adult system of care. These services may include housing assistance, as defined in Section 5892.5, to the target population specified in Section 5600.3.

(6)Five percent of the total funding for each county mental health program for Part 3 (commencing with Section 5800), Part 3.6 (commencing with Section 5840), and Part 4 (commencing with Section 5850), shall be utilized for innovative programs in accordance with Sections 5830, 5847, and 5848. Commencing with the 2024–25 fiscal year, the percentage requirement in this paragraph shall not apply.

(b)(1)In any fiscal year after the 2007–08 fiscal year, programs for services pursuant to Part 3 (commencing with Section 5800) and Part 4 (commencing with Section 5850) may include funds for technological needs and capital facilities, human resource needs, and a prudent reserve to ensure services do not have to be significantly reduced in years in which revenues are below the average of previous years. The total allocation for purposes authorized by this subdivision shall not exceed 20 percent of the average amount of funds allocated to that county for the previous five fiscal years pursuant to this section.

(2)A county shall calculate an amount it establishes as the prudent reserve for its Local Mental Health Services Fund, not to exceed 33 percent of the average community services and support revenue received for the fund in the preceding five years. The county shall reassess the maximum amount of this reserve every five years and certify the reassessment as part of the five-year program and expenditure plan required pursuant to Section 5847.

(3)Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the State Department of Health Care Services may allow counties to determine the percentage of funds to allocate across programs created pursuant to Part 4 (commencing with Section 5850) for the children’s system of care and Part 3 (commencing with Section 5800) for the adult and older adult system of care for the 2020–21 and 2021–22 fiscal years by means of all-county letters or other similar instructions without taking further regulatory action.

(c)The allocations pursuant to subdivisions (a) and (b) shall include funding for annual planning costs pursuant to Section 5848. The total of these costs shall not exceed 5 percent of the total of annual revenues received for the fund. The planning costs shall include funds for county mental health programs to pay for the costs of consumers, family members, and other stakeholders to participate in the planning process and for the planning and implementation required for private provider contracts to be significantly expanded to provide additional services pursuant to Part 3 (commencing with Section 5800) and Part 4 (commencing with Section 5850).

(d)Prior to making the allocations pursuant to subdivisions (a), (b), and (c), funds shall be reserved for the costs for the State Department of Health Care Services, the California Behavioral Health Planning Council, the Office of Statewide Health Planning and Development, the Mental Health Services Oversight and Accountability Commission, the State Department of Public Health, and any other state agency to implement all duties pursuant to the programs set forth in this section. These costs shall not exceed 5 percent of the total of annual revenues received for the fund. The administrative costs shall include funds to assist consumers and family members to ensure the appropriate state and county agencies give full consideration to concerns about quality, structure of service delivery, or access to services. The amounts allocated for administration shall include amounts sufficient to ensure adequate research and evaluation regarding the effectiveness of services being provided and achievement of the outcome measures set forth in Part 3 (commencing with Section 5800), Part 3.6 (commencing with Section 5840), and Part 4 (commencing with Section 5850). The amount of funds available for the purposes of this subdivision in any fiscal year is subject to appropriation in the annual Budget Act.

(e)In the 2004–05 fiscal year, funds shall be allocated as follows:

(1)Forty-five percent for education and training pursuant to Part 3.1 (commencing with Section 5820).

(2)Forty-five percent for capital facilities and technology needs in the manner specified by paragraph (2) of subdivision (a).

(3)Five percent for local planning in the manner specified in subdivision (c).

(4)Five percent for state implementation in the manner specified in subdivision (d).

(f)Each county shall place all funds received from the State Mental Health Services Fund in a Local Mental Health Services Fund. The Local Mental Health Services Fund balance shall be invested consistent with other county funds and the interest earned on the investments shall be transferred into the fund. The earnings on investment of these funds shall be available for distribution from the fund in future fiscal years.

(g)All expenditures for county mental health programs shall be consistent with a currently approved plan or update pursuant to Section 5847.

(h)(1)Other than funds placed in a reserve in accordance with an approved plan, any funds allocated to a county that have not been spent for their authorized purpose within three years, and the interest accruing on those funds, shall revert to the state to be deposited into the Reversion Account, hereby established in the fund, and available for other counties in future years, provided, however, that funds, including interest accrued on those funds, for capital facilities, technological needs, or education and training may be retained for up to 10 years before reverting to the Reversion Account.

(2)(A)If a county receives approval from the Mental Health Services Oversight and Accountability Commission of a plan for innovative programs, pursuant to subdivision (e) of Section 5830, the county’s funds identified in that plan for innovative programs shall not revert to the state pursuant to paragraph (1) so long as they are encumbered under the terms of the approved project plan, including any subsequent amendments approved by the commission, or until three years after the date of approval, whichever is later.

(B)Subparagraph (A) applies to all plans for innovative programs that have received commission approval and are in the process at the time of enactment of the act that added this subparagraph, and to all plans that receive commission approval thereafter.

(3)Notwithstanding paragraph (1), funds allocated to a county with a population of less than 200,000 that have not been spent for their authorized purpose within five years shall revert to the state as described in paragraph (1).

(4)(A)Notwithstanding paragraphs (1) and (2), if a county with a population of less than 200,000 receives approval from the Mental Health Services Oversight and Accountability Commission of a plan for innovative programs, pursuant to subdivision (e) of Section 5830, the county’s funds identified in that plan for innovative programs shall not revert to the state pursuant to paragraph (1) so long as they are encumbered under the terms of the approved project plan, including any subsequent amendments approved by the commission, or until five years after the date of approval, whichever is later.

(B)Subparagraph (A) applies to all plans for innovative programs that have received commission approval and are in the process at the time of enactment of the act that added this subparagraph, and to all plans that receive commission approval thereafter.

(i)Notwithstanding subdivision (h) and Section 5892.1, unspent funds allocated to a county, and interest accruing on those funds, which are subject to reversion as of July 1, 2019, and July 1, 2020, shall be subject to reversion on July 1, 2021.

(j)If there are revenues available in the fund after the Mental Health Services Oversight and Accountability Commission has determined there are prudent reserves and no unmet needs for any of the programs funded pursuant to this section, including all purposes of the Prevention and Early Intervention Program, the commission shall develop a plan for expenditures of these revenues to further the purposes of this act and the Legislature may appropriate these funds for any purpose consistent with the commission’s adopted plan that furthers the purposes of this act.

SEC. 8.SEC. 7.

 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.