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Summary of “The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008″

Purpose. The Mental Health Parity Act of 2008 will end health insurance benefits inequity between mental health/substance use disorders and medical/surgical benefits for group health plans with more than 50 employees. When the law is enacted, 113 million people across the country will have the right to non-discriminatory mental health coverage, including 82 million individuals enrolled in self-funded plans (regulated under ERISA), who cannot be assisted by State parity laws.

The Parity Requirement. The bill amends the Mental Health Parity Act of 1996 to require that a group health plan of 50 or more employees (or coverage offered in connection with such a plan)-that provides both medical and surgical benefits and mental health or substance use benefits-to ensure that financial requirements and treatment limitations applicable to mental health/substance use disorder benefits are no more restrictive than those requirements and limitations placed on medical/surgical benefits.

• Equity coverage will apply to all financial requirements, including deductibles, copayments, coinsurance, and out-of-pocket expenses, and to all treatment limitations, including frequency of treatment, number of visits, days of coverage, or other similar limits.

• The bill builds on the current 1996 parity law, which already requires parity coverage for annual and lifetime dollar limits.

• Mental health and substance use disorder benefits are defined broadly to mean benefits with respect to services for mental health conditions and substance use disorders, as defined under the terms of the plan and in accordance with applicable Federal and State law.

• A plan may not apply separate cost sharing requirements or treatment limitations to mental health and substance use disorder benefits.

• If a plan offers two or more benefit packages, the requirements of this Act will be applied separately to each package.

• As under the current Federal parity law, mental health or substance use benefit coverage is not mandated. However, if a plan offers such coverage, it must be provided at parity in accordance with this Act.

Out-Of-Network Benefits. A group health plan (or coverage) that provides out-of-network coverage for medical/surgical benefits must also provide out-of-network coverage, at parity, for mental health/substance use disorder benefits.

Benefits Management and Transparency. As under the 1996 Mental Health Parity Act, a group health plan (or coverage) may manage the benefits under the terms and conditions of the plan. A plan will make mental health/substance use disorder medical necessity criteria available to current or potential participants, beneficiaries or providers upon request.  A plan must also make reasons for payment denials available to participants or beneficiaries on request or as otherwise required.

Preservation of State Law. The current HIPAA preemption standard applies.  This standard is extremely protective of State law.  Only a State law that “prevents the application” of this Act will be preempted which means that stronger State parity and other consumer protection laws remain in place.

Small Employer Exemption. As with the current 1996 Federal parity law, small employers of 50 or fewer employees are exempt from the requirements of the Act. State parity laws will continue to apply to these employers, as well as to individual plans.

Cost Exemption. If a group health plan (or coverage) experiences an increase in actual total costs with respect to medical/surgical and mental health/substance use benefits of 1% (2% in the first plan year that this Act is applicable), the plan can be exempted from the law.

• An employer may elect to continue parity coverage regardless of this cost increase.

• The exemption shall apply for one plan year.

• A qualified actuary (member of American Academy of Actuaries) shall determine and prepare a written report regarding a plan’s cost increase after a plan has complied with the Act for the first six months of the plan year involved.

• A plan shall promptly and timely notify the Department of Labor (if self-funded) or the Department of Health and Human Services (if fully-insured), the appropriate State agencies, and participants and beneficiaries when it elects an exemption. Plan notification to Labor or HHS is confidential and will provide a description of covered lives in the plan and the actual costs for which the exemption is sought.

• Labor or HHS (as appropriate) and State agencies may audit a plan to determine compliance with the Act when the plan has elected an exemption.

Compliance Report. By 2012 and every two years after, the Labor Secretary shall submit to Congress a report on group health plan (or coverage) compliance with this Act. The report will include the results of any compliance audits or surveys, and if necessary, an analysis of reasons for any failures to comply with the law.

GAO Study. GAO will conduct a study that analyzes the specific rates, patterns and trends in coverage, any exclusion of specific mental health and substance use diagnoses by health plans, and the impact of this Act on such coverage and costs. GAO will provide a report to Congress within three years (and an additional report after five years) on the results of the study.

Consumer Assistance. The Labor Secretary, in cooperation with the HHS and Treasury Secretaries, shall publish and disseminate guidance and information for plans, participants and beneficiaries, applicable State agencies, and the National Association of Insurance Commissioners concerning the requirements of this Act. This information will include assistance with questions and how participants and beneficiaries can obtain assistance from State consumer and insurance agencies.

Enforcement. As under the 1996 law, Labor, HHS, and Treasury will continue to coordinate enforcement of the Federal mental health parity requirements and are required to issue regulations to carry out changes made in this Act not later then one year after the enactment date. Treasury may continue to impose an excise tax on any plan for failure to comply with the requirements of the Act.

Effective Date. The Act will apply to plans beginning in the first plan coverage year that is one year after the date of enactment.  For most plans, this will mean the effective date begins on January 1, 2010. Plans maintained under collective bargaining agreements ratified before the enactment date are not subject to the Act until they terminate (or until January 1, 2009, if this is a later date). The current 1996 parity act requirements for annual and lifetime dollar limits remain in effect for all plans, while the annual sunset in the 1996 parity act is eliminated, effective January 1, 2009.

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To all Mental Health Advocates:

The September 30, 2008 Sub-Committee Meeting for MHSA PEI is the last opportunity for all stakeholders to be part of the planning of process of the expenditure of $26 Million for PEI programs in Orange County.   Please respond to this email and RSVP to the MHSA office, 714-667-5620 if you will attend even if for only part of the day.

PEI County Plans will address all age groups…

HOWEVER, a MINIMUM of 51% of the overall County PEI budget must be dedicated to individuals who are between the ages of 0-25

“50% of all lifetime mental health disorders start by age 14 and 75% start by age 24″

PEI Funding should be used to PREVENT mental health problems or to intervene EARLY with relatively “short-duration” and “low-intensity”

“To facilitate accessing supports at the earliest possible signs of mental health problems and concerns, PEI builds capacity for providing mental health early intervention services at sites where people go for other routine activities (e.g., health, education, community organizations).” (DMH PEI Guidelines Sept. 2007, page 2)

Janice DeLoof - NAMI OC Government Affairs Committee

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CA Court Rejects Bid to Halt Medi-Cal Payment Cuts
See NAMI-OC Call to Action and complete details on Current Advocacy Page 

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Government Affairs Report - July 2008
Edited by: Janice DeLoof,  NAMI OC Government Affairs Committee
Email: namioc.leg@gmail.com

Medi-Cal Rates Restored: The Conference Committee on a split vote (Democrats “yes” and Republicans “no”) approved the rate restoration of provider rates (10% reduction in governors budget) which had been agreed to in the Special Session.

HUGS-OC note: Related article http://www.signonsandiego.com/news/state/20080709-9999-1n9budget.html

1. Mental Health Budget - OC Board of Supervisors

• $ 3.1 Million approved for inpatient psych beds for indigents!  Doubles Bed capacity for indigents from 13 beds to 27 beds.
• $ 4 Million reduction, in OC 08/09 FY Budget - No Behavioral Health Staffing reductions but 10 % reductions affected contracted staff positions.

Note:  $ 3 Million cut in OC 07/08 FY Budget - Services for 800 Clients affected, no staff layoffs, but some the staff were assigned to fill current open vacancies existing within the agency.
 
2. Federal Deficit Reduction Act of May 2008 affecting patients at Royal Skilled Nursing Facility.

Must show proof of citizenship such as a Live Birth Data Base Certificate or a Passport.

Required documentation to prove identification and citizenship is proving challenging for any new application for Medi-Cal. Right now, it is only impacting Royale TRC, but may have implications for patients attempting to get benefits and then services at all levels of care.  County has hope that Royale TRC may get an exemption from the FDR Act.

3.  Alcohol and Drug Abuse Services (ADAS) Consolidated in Clinics with BHS Mental Health Services

Now one door through which clients can receive treatment services regardless of their diagnosis.

4.  Ask OC Legislators to support SB 292, Author Wiggins

Subject:  Authorizes payments issued by county welfare departments for 24-hour out-of-home care provided on behalf of any seriously emotionally disturbed child who has been placed out-of-home pursuant to an individualized education program to be made to a for-profit out-of-state privately owned residential facility that meets applicable licensing requirements if specified conditions are met.    Click on Legislation for more info on the bill at:  http://orange.networkofcare.org

5. MHSA: Sub-Committee Meeting for Prevention and Early Intervention

July 21 and July 30.  1 to 4:30 pm. Holiday Inn, Grand Ballroom 2726 S. Grand Ave, Santa Ana, CA 92705.  Questions: 714-667-5620

6. Mental Health Board & Public Hearing on the Capital Facilities and Technological Needs Component Proposal, Thursday July 10.   The meeting location and time will be as follows: Hall of Administration, Planning Commission Hearing Room, 10 Civic Center Plaza, (333 West Santa Ana Blvd.), Santa Ana, CA 92701.

Mental Health Board Study Meeting, July 10:  8:00 a.m. - 9:00 a.m. Public Hearing: 9:00 a.m. - 11:00 a.m.

Government Affairs Alert:  Contact Legislators

California Budget is being negotiated in the Budget Conference Committee and will be brought to the assembly and senate for a vote.

Medi-Cal Rates Restored:  The Conference Committee on a split vote (Democrats “yes” and Republicans “no”) approved restoration of the 10% reduction in provider rates which had been agreed to in the Special Session.  Since the reductions have already gone into place as of July 1, the effective date of the restoration would be September 1, 2008.  Rates were also restored for California Children’s Services (CCS) and Child Health and Disability Prevention Program (CHDP) providers and managed care plans.   Medi-Cal pharmacy and long-term care rates were partially restored to a 5% reduction.  Total General Fund impact of the rate restorations is in the neighborhood of $360 million.

Legislators need to hear that Cuts to Mental Health COST more than the cuts will save!

Phone or fax: Senator Don Perata, President Pro Tempore of the Senate, Phone: (916) 651-4009
Fax:  (916) 327-1997 Senator Dave Cogdill, Minority Leader of Senate, Phone: (916) 651-4014, Fax: (916) 327-3523, Karen Bass, Speaker of the Assembly (916) 319-2047, Mike Villines, Ph: (916) 319-2029, Fax: (916) 319-2129

Get contact information for your legislator at: http://www.leginfo.ca.gov/yourleg.html

Tell your legislators:  Cuts to MH will actually COST the state and counties if client/patients discontinue treatment.

Oppose Elimination of MediCal Optional Benefits.  The eliminated optional benefits include incontinence creams and washes, acupuncture, adult dental, audiology, optometry, optical, chiropractic, podiatry, psychology, and speech therapy. The elimination of these optional benefits will mean the loss of access to these services through the Medi-Cal program.

The Assembly and Senate needs to support avoidance of the 10% cutback all state programs face in the current budget crisis including:

• The SSI/SSP COLA Suspension, the 10% Provider Rate Reduction
• The reduction of Medi-Cal services for full scope Medi-Cal beneficiaries ages 0 -21 in the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) program.

A California Budget Project summary outlines major differences among the Governor’s May Revision of his proposed 2008-09 Budget and the Assembly and Senate spending plans.  On June 12, the Budget Conference Committee began reconciling differences between the Assembly and Senate Budget Committees’ spending plans. Web site:  http://www.cbp.org/

Below is a press release put out by Assembly member Karen Bass (D-Los Angeles) in June, 2008:

1) The plan provides $2.3 billion more for K-14 education than the Governor’s plan, backfilling all proposed base cuts and providing a 1.6 percent cost-of-living increase.

2)The plan upholds the safety net for children by rejecting the Governor’s cuts to children’s services and foster care, CalWORKS grant reductions that hurt kids, the SSI/SSP federal COLA, Medi-Cal optional services, and the proposal to drop the salary for in-home support service workers to minimum wage.

3) The Assembly Democrats’ plan also restores most of the Medi-Cal cuts made in February

4) Proposed cuts have been partially restored to Medi-Cal provider rates (cuts were passed in February, but don’t take effect until July), and partially restored to mass transit, which are devastating to working Californians as ridership soars and gasoline prices skyrocket.

5) Assembly Democrats will also be making some extremely painful cuts that hurt real people. For example, the plan incorporates the suspension of the CalWORKS and SSI/SSP cost-of-living increases, and accepts the Governor’s “summary parole” proposal.

6) Assembly Democrats have modified the Governor’s lottery proposal, putting kids first and Wall Street second. The revised proposal secures the lottery, but excludes education funds so there are no risks to schools; funds from the securitization will be placed in a new “Debt Retirement Fund,” much of which will be used to pay down the debt. This fund will help us pay off budgetary debts several years earlier than the Governor’s plan and helps avoid out-year deficits created by borrowing. These debt payments include economic recovery bonds, transportation loans, education loans, local government mandates, and general obligation debt. Under our plan, most of these debts would be paid off anywhere from 3 to 10 years faster than they would under the Governor’s plan.

Note: Senate plan rejects the lottery bond sale proposals.  Senate plan includes:

• Dental services: Adopts an annual dental coverage limit of $1,500.
• Approves: California Work Opportunity and Responsibility to Kids (CalWORKs) Program
• Suspends October 2008 state COLA, but rejects proposal to suspend June 2009 state COLA. 

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17 June 2008

Our sympathy is extended to the Howard Black family.   The son of Howard and Natalye Black was killed in a car accident on Sunday returning from a Father’s Day Gathering. 
 
Helen Cameron, Director of HOMES Inc. wrote the following in an email:  “Howard and Natalye have been courageous advocates for our mentally ill residents for decades and we are so sad to hear of their loss.  Their son Brian was a mentor for so many others in recent years. We join their extended family in mourning his sudden passing.”
 
Services will be held Thursday, June 19 at 11:00 AM at:  University Synagogue, 3400 Michelson Drive, Irvine, CA 92612

On the corner of Michelson Drive and Harvard. ~~ Coming south on the 405, exit at Jamboree, turn right onto Jamboree, then left onto Michelson. ~~ Coming North on the 405, exit at Culver, turn left onto Culver, then turn right on Michelson.
http://www.universitysynagogue.org/

Janice DeLoof
NAMI OC Government Affairs Committee

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To OC Mental Health Advocates:
 
NAMI OC and MHA Mental Health advocates are pictured in the attached photos in Sacramento for Mental Health Advocacy/Disability Day Thursday, May 15.  NAMI OC and MHA advocates meet with Senator Correa and the aides of our the other OC Legislators to NOT make cuts to mental health funding in the FY 2008/09 CA state budget.   It was proclaimed to all of the OC legislators, “Cuts to Mental Health cost more!”

In the Senate Chambers at the podium with MHA tribute above on the screen:

Left to right:  Jeff Thrash, MHA Director,  Jenny Monge, NAMI OC “In Our Own Voice” leader, Janice DeLoof, Janice DeLoof, Chair, NAMI OC Government Affairs Committee, Sarah Niemer, NAMI OC Government Affairs Committee, Senator Lou Correa (not pictured, Robert Reid, MHA consumer member.)

The MHA Bell was placed in the Senate chambers as a tribute to MHA on their 50th year anniversary.

With MHA Bell, Left to right:   Jenny Monge, NAMI OC “In Our Own Voice” leader, Sarah Niemer, NAMI OC Government Affairs Committee, MHA Director Jeff Thrash,  Janice DeLoof, Chair, NAMI OC Government Affairs Committee.  Thank you to the Senator Correa for the opportunity to have this photo taken.

Write or call your Orange County Legislators regarding some of the Budget issues we addressed:

Oppose Elimination of MediCal Optional Benefits - reduce in 2007-08 by $20.2 million

($10 million General Fund) and 2008-09 by $268.2 million ($134 million General Fund) by reducing the number of optional benefits provided for adults over the age of twenty-one who are not in a nursing facility. The eliminated optional benefits include incontinence creams and washes, acupuncture, adult dental, audiology, optometry, optical, chiropractic, podiatry, psychology, and speech therapy. The elimination of these optional benefits will mean the loss of access to these services through the Medi-Cal program. The Senate needs to support avoidance of the 10% cutback all state programs face in the current budget crisis including:

The SSI/SSP COLA Suspension, the 10% Provider Rate Reduction

The reduction of Medi-Cal services for full scope Medi-Cal beneficiaries ages 0 -21 in the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) program.  

These cuts will actually cost the state and counties if client/patients discontinue treatment.

The ability of CA counties to deliver mental health services is threatened by the slow reimbursement from the state to deliver mental health services. The Legislators need take out the10% reductions of state programs including the 10% reduction to county mental health plans for managing the Medi-Cal specialty MH Managed Care program.   These reductions could drive counties out of the MH care business.  
 
Janice DeLoof
NAMI OC Government Affairs Committee

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Government Affairs Committee Report for May 19, 2008
 
1. AOT in Orange County:  A meeting of Government partners in Pasadena delayed to early July.    Pacific Clinics in Pasadena provides the services for the AOT program in LA County, now called Wraparound Assisted Treatment (WAT) Program.
 
2.  Senate Bill 1606 (2008) put on Suspense but still hope in the assembly.
 
SB 1606 authored by Senator Leland Yee (D-San Francisco/San Mateo) originally was meant to facilitate the use and efficiency of California’s law for assisted outpatient treatment (AOT.   Now a bill to study how to best care for people with severe mental illnesses who do not meet California’s commitment criteria yet are nonetheless incapacitated by symptoms and incapable of accessing available treatment.
 
3. MHSA (Prop 63) in Orange County:
 
a. Mental Health Board MHSA Workforce Education and Training Hearing May 8 resulted in unanimous approval for the plan.  Copy of plan is to be placed in the NAMI OC library.  NAMI OC Family to Family and Provider Education programs mentioned in the plan. 
 
b. An Ed/Stakeholder meeting will be held in Lake Forest at Saddleback Church on PEI of MHSA on May 28, 7-8:30 PM.   Participate in the Planning for New MHSA (Prop 63) Prevention and Early Intervention Programs for At-Risk Children, Adults and Older Adults
 
Saddleback Church, 1 Saddleback Pkwy, Rm. 303, Lake Forest, CA  92630

Speaker:  Alan Albright, MFT,  OC Health Care Agency,  Behavioral Health, MHSA  PEI Coordinator

For Directions:  (North of El Toro Rd. on Saddleback Pkwy or Portolla Exit of 241 toll road)
 http://www.saddlebackfamily.com/contact/index.html and click on directions or call the church at 949.609.8000

RSVP: NAMI OC Support Group Facilitator at Saddleback Church: Nan Ibarra (949) 922-3425
 
The next phase of the Mental Health Service Act (MHSA) Prevention and Early Intervention (PEI) and Community and Organizational Surveys are available at  http://ochealthinfo.com/mhsa/pei/survey/. 
 
c. Community Services & Supports 2007 Implementation Progress Report is available for public review and comment from April 25, 2008 to May 25, 2008.  http://ochealthinfo.com/mhsa/css/index.htm
 
d. Capital Facilities and Technological Needs Component Three-Year Plan and Expenditure Plan Guidelines    http://ochealthinfo.com/mhsa/cft/
 
e. The Mental Health Training program for Police Officers (MHSA CIT Training) The next Round Table discussion on curriculum development for Golden West College course is May 28th from 9-11 at 600 West Santa Ana Blvd, Suite 510, Santa Ana, CA. 
 
4.   Bill: AB 1486 - Author: Calderon C : Bill killed in April SENATE Committee on BUSINESS, PROFESSIONS & ECONOMIC DEVELOPMENT meeting April 9 in Sacramento.   Another form of the bill that requires medication training for licensed professional counselors may return in the next legislative session. 
 
5.  Western Med and College Hospital have made extra beds available to the county.

These beds will make up for loss of adult psychiatric treatment care ending at Huntington Beach Hospital and La Palma Hospitals.  Only Geriatric psychiatric treatment on a voluntary basis will be offered at the hospitals if the Adult units are closed.
 
6.  Mental Health Advocacy/ Disability Capitol ACTION Day 2008, Thursday, May 15 in Sacramento. 
 
All OC representatives offices in Sacramento were visited by NAMI OC members, Janice DeLoof, family member, Jenny Monge, consumer and Sarah Niemer, family member, and/or Jeff Thrash, Dir. of OC MHA who lead another OC team with Robert Reid, consumer on Mental Health Advocacy/ Disability Capitol ACTION Day 2008, Thursday, May 15.  Members addressed the following budget issues and bills:

CA Governor’s 2008-09 state budget and CA Bills regarding Mental Health
 
The Governor’s May Revise is out.  The Governor’s 2008-09 state budget seeks to eliminate a $ 17 Billion deficit in one year.  Of this amount, $6 Billion is new since January due to lower revenues.In general all of the major proposals by the Governor made in January to balance the budget are still being proposed with the exception of suspending proposition 98, the early release of prisoners and closing of state parks. This shifts more of the burden to health and human services and $3.4 billion in reductions is proposed. 
 
Cuts to Mental Health COST more than the cuts will save!
 
OC legislators are asked to oppose Elimination of MediCal Optional Benefits - reduced in 2007-08 by $20.2 million ($10 million General Fund) and 2008-09 by $268.2 million ($134 million General Fund) by reducing the number of optional benefits provided for adults over the age of twenty-one who are not in a nursing facility.
 
The eliminated optional benefits include incontinence creams and washes, acupuncture, adult dental, audiology, optometry, optical, chiropractic, podiatry, psychology, and speech therapy. The elimination of these optional benefits will mean the loss of access to these services through the Medi-Cal program. The Senate needs to support avoidance of the 10% cutback all state programs face in the current budget crisis including:

The SSI/SSP COLA Suspension, the 10% Provider Rate Reduction

The reduction of Medi-Cal services for full scope Medi-Cal beneficiaries ages 0 -21 in the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) program.

These cuts will actually cost the state and counties if client/patients discontinue treatment.
 
The ability of CA counties to deliver mental health services is threatened by the slow reimbursement from the state to deliver mental health services.
 
The Legislators need take out the 10% reductions of state programs including the 10% reduction to county mental health plans for managing the Medi-Cal specialty MH Managed Care program.   These reductions could drive counties out of the MH care business.
 
Sen. Dave Cox (R-Fair Oaks) has introduced SB 1349 a bill requiring timely reimbursement of mental health services claims to local governments. SB 1349 would require the State Controller’s Office to reimburse local governments for mental health services within 90 days of the receipt of a reimbursement claim by the Department of Mental Health. The measure also requires interest to be paid on late payments. 
 
On 06/10/2008 the bill will go to the ASSEMBLY Committee on HEALTH.  Most counties support as this would help keep them in the business of providing mental health services.  Without Dept of MH support, which they have not given, the governor may not sign the bill. NAMI CA does not yet have a position on this bill on their web site. 
 
Important mental health bills include SB 1651, Steinberg and Romero Mentally ill offenders bill, which provides for more counties to develop Mental Health Courts,  AB 1945 & SB 1553 (both parity bills).
 
Re: SB 1553: (Lowenthal). To Suspense File and fate determined on about May 22.  If passed, this bill would help make the goal of parity for mental care health services a reality.  Although a mental health parity law was passed nearly ten years ago, health care plans have failed to assure that consumers have timely access to mental health care services.  The Department of Manage Health Care (DMHC) has not been able or willing to assure that the health care plans provide timely access.  DMHC has failed to adopt access regulations, which it was required to do by January 1, 2004.
 
More information on these bills and others regarding mental health is at www.namicalifornia.org and click on legislation for a selected list of current bills about mental health.   The Orange County Network of Care site gives a list of all bills regarding health at http://www.orange.networkofcare.org/mh/home/index.cfm and click on legislation. 
 
Report from the Government Affairs Committee of NAMI Orange County

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Forward from the NAMI OC Government Affairs Committee and addition to the May 19 report:
 
“The Governor’s budget does not rely totally on cuts to balance the budget but forecasts $5 Billion annually through improved lottery operations based upon the premise that California currently nets $88 per capita from its lottery whereas the average among the 10 largest states is $225 per capita.  The Governor proposes to borrow against this revenue source but also proposes that if the revenues are not sufficient there would be a 1 cent increase in the sales tax for up to three years.”   See end of email below for the rest of this quote:

Subject:   Summary of Governor’s May Revise
To:           Mental Health Associates
From:      Rusty Selix
RE:           Summary of Governor’s May Revise

Summary of Governor’s May Revise

The shortfall for 2008-09 is $17 Billion. Of this amount, $6 Billion is new since January due to lower revenues.

In general all of the major proposals by the Governor made in January to balance the budget are still being proposed with the exception of suspending proposition 98, the early release of prisoners and closing of state parks.

This shifts more of the burden to health and human services and $3.4 billion in reductions is proposed.

For mental health there is nothing new.  There are some savings due to smaller caseloads than had been forecast in some programs but no policy changes.

The budget balancing proposals such as taking $20 million from medical managed Care and Reducing the State Maximum Allowance (SMA) are still being proposed. 

The one change not reflected in the budget documents is a shift in thinking regarding EPSDT and Day Treatment.  Instead of a new authorization for day treatment there will instead be a utilization practices care management program established collaboratively between the state counties and providers to evaluate the services provided to the 5500 people who cost over $3000 per month in EPSDT services - sharing data and analyzing these cases to determine if there are potential service duplications or more efficient ways to serve people.  There will be no prior authorizations or audits or new state controls on counties or providers but it is projected that there will be savings in the cost of care for many of these individuals by working together and applying lessons learned.

There are major cuts proposed in MediCal and Social Services that will affect people with mental health needs.  These include the MediCal payments to providers and enrollment restrictions and the optional services such as dental care and psychology. In addition the Governor proposes the elimination of a COLA for SSI/SSP recipients.
The Governor’s budget does not rely totally on cuts to balance the budget but forecasts $5 Billion annually through improved lottery operations based upon the premise that California currently nets $88 per capita from its lottery whereas the average among the 10 largest states is $225 per capita.  The Governor proposes to borrow against this revenue source but also proposes that if the revenues are not sufficient there would be a 1 cent increase in the sales tax for up to three years.  These proposals would have to be approved by voters in November as part of a constitutional amendment that creates a reserve fund whereby revenues above historic averages would not be used to expand programs but instead would go into a reserve fund to ensure that in deficit years there would not have to be program cuts. 

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NAMI OC Government Affairs Report for April 2008
 
1. AOT in Orange County:  A meeting of Government partners to be held the end of May in LA to learn how the program is administrated there before the writing of the OC pilot program will begin. 

2.  Senate Bill 1606 (2008) Setback in the Senate, but Hope in Assembly

SB 1606 authored by Senator Leland Yee (D-San Francisco/San Mateo) originally was meant to facilitate the use and efficiency of California’s law for assisted outpatient treatment (AOT), which provides court-ordered community treatment as a less restrictive and costly alternative to inpatient hospitalization for people incapacitated by the symptoms of severe mental illnesses.

The Senate Health Committee hearing on SB 1606 on April 9 agreed to Senator Leland Yee’s proposal to turn the bill into a study of how to best care for people with severe mental illnesses who do not meet California’s commitment criteria yet are nonetheless incapacitated by symptoms and incapable of accessing available treatment.

The bill now moves to the Assembly.  The original language can be reinserted at any point in the legislative process.  If the language of the original bill is in the Assembly version, the reformed bill would still have to come back to the Senate for approval but not necessarily to the Health Committee.   More information on Laura’s Law is at: www.LaurasLaw.net.

3.  MHSA April 7 Steering Committee meeting:
 
Consensus was for a $1,479,000.00 Recovery Center to serve about 700 clients.  (See attached file)

There was also consensus for two CAT/PERT teams at a cost of $151,000.00 ($151,000.00 for two Crisis Assessment Team and/or Psychiatric Emergency Response Teams (CAT/PERT) in the proposed one year growth funding approved by the OC MHSA Steering Committee in April, 08.) with the rest of the $472,272.00 of remaining Adult funding going to Peer Mentors/Outpatient Support (a new program). An Orange County Centralized Assessment Team (CAT) is now available 24/7 at 866-830-6011 (toll free) More info on PERT Teams at http://www.ocgrandjury.org/pdfs/20070608.pdf

Agendas and Minutes for Steering Committee meetings are available at: http://ochealthinfo.com/mhsa/meetings.html
  
Those present at the preceding Stakeholder meeting voted for Peer Mentors/Outpatient Support and the CAT/PERT teams to give these programs a number 1 and 2 ranking.  Mental Health advocates need to attend MHSA stakeholder meetings and have their voices heard.
 
4.  MHSA Stakeholder Meeting April 22.  Tuesday, April 22, 2008(Definition of Stakeholders: MHSA Stakeholders include MH patients/consumers, family members of someone with a mental illness, providers of mental health services, educational institutions, law enforcement, service providers for each age group, underserved ethnic/linguistic minority populations, and special communities, such as the deaf and hard of hearing.)

5.  A stakeholder meeting for input on  Prevention Early Intervention (PEI) of MHSA by family members to be held at Lake Forest Saddleback Church in May is in the planning stage.    

6.  Great American Write In was held Sat April 5:  Participants were given sample letters on SB 1606 and SSI/SSP COLA Suspension to complete and mail to their legislators in Sacramento.  

7.  Disability Capitol ACTION Day 2008, Thursday, May 15 in Sacramento – More airflight funding for consumers and family members to attend is needed.  Plans are for two family members and two consumers to fly to Sacramento on that day if we get sufficent funding.  

8.   Bill: AB 1486 - Author: Calderon C :   Bill killed in April SENATE Committee on BUSINESS, PROFESSIONS AND ECONOMIC DEVELOPMENT meeting April 9 in Sacramento.   Another form of the bill that requires more intensive medication training of licensed professional counselors may return in the next legislative session.  

Subject:  Provides for the licensure or registration and regulation of licensed professional counselors and interns by the Board of Behavioral Sciences. Adds additional members to the board. Enacts various provisions concerning the practice of licensed professional counselors, interns, and counselor trainees including field training requirements, practice requirements, and enforcement specifications. Adds such counselors to the list of mandated child abuse reporters. Provides civil penalties for violations.

AB 1486 allows psychologists to prescribe psychiatric medications without a medical degree, and without the input of the patient’s primary physician.  This would compromise the quality of care provided to mentally ill patients.

For more information, please also see http://www.calpsych.org/legislation/SB993.pdf of SB 993 which is a bill that is no longer active.

Report edited by: Janice DeLoof, NAMI OC Government Affairs Committee