SR-106-040 (4)
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SEP 2 8 2004
CCS:JH:F:\HSD\SHARE\COMMISSIONS-ADVISORY BOARDS\DC\Staff Reports\Prop 63 092804.doc
Council Meeting: September 28, 2004 Santa Monica, California
TO:
Mayor and City Council
FROM:
City Staff
SUBJECT: Transmission of Letter from Disabilities Commission Requesting the City
Council Support Proposition 63, Mental Health Services Act
Introduction
The Disabilities Commission is requesting that the City Council take action to support
Proposition 63, the Mental Health Services Act. Prop. 63 will appear on the November
2004 ballot.
Backaround
Briefly, Prop. 63:
· Imposes an additional 1 % surcharge on individual taxable income over $1
million to provide dedicated funding for expansion of mental health services and
programs.
. Prohibits current funding for mental health programs from being reduced
because of funding from the new tax.
. Provides funds to counties to expand services and develop innovative
programs and integrated service programs for mentally ill children, adults and
seniors.
. Requires the state to develop mental health service programs including
prevention, early intervention, education and training programs.
. Creates a new commission to approve certain county programs and
expend itu res.
SEP 2 8 2004
1
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BudaetlFinanciallmpact
The recommendation presented in this report does not have any budget or financial
impact.
Recommendation
The Disabilities Commission recommends that the City Council supports Proposition 63
and directs staff to take appropriate action to communicate the support of the measure.
Prepared by:
Janet Hand, Sr. Admin. Analyst, Human Services Division
Community and Cultural Services Department, for the Disabilities
Commission
Attachments:
I - Letter from the Disabilities Commission
II - Text of Proposition 63
2
ATTACHMENT I
August 30, 2004
Honorable Richard Bloom, Mayor
City Council Members
City of Santa Monica
1685 Main Street
Santa Monica CA 90401
Dear Mr. Mayor and City Council Members;
The Disabilities Commission respectfully asks the City Council to consider our
request to support Proposition 63, the Mental Health Services Act, which will appear
on the ballot for the November 2, 2004 general election. Prop. 63 will expand
mental health care programs for children and adults, persons currently disabled by
mental illness, persons showing signs of mental illness in need of prevention
services, and to families and caregivers of those affected.
Funding from the state and county for mental health care has not kept pace with the
needs at the local level. The budget for community mental health programs is the
first to be cut whenever monies are short. State hospitals were once the placement
of choice out of necessity. In 1963 when Aid to the Totally Disabled became
available for the first time to the mentally ill, patients had income to live outside of
institutions. Mostly to cut costs, State hospitals were shuttered. In 1967-68,3,700
state jobs were eliminated due to closures. (L.A. County Department of Mental
Health, First 40 Years: The Story of Public Mental Health.)
Mental illness is the leading cause of disability in the world (World Health
Organization). In the U.S., one in four individuals will be affected by a serious
mental disorder in their lifetime. In Service Area 5 (Westside) the L.A. County
Department of Mental Health has one directly operated clinic, Edelman Westside
Mental Health Center, and 19 contract agencies. Of the 2,400 clients seen annually
at Edelman MHC, 870 (27.6%) are Santa Monica residents. Six of the 19 contract
agencies are in Santa Monica and at least four others located outside of the city also
serve large numbers of Santa Monica residents. One of these agencies, Westside
Center for Independent Living, has a Community Services Specialist based in Santa
Monica whose clients are comprised primarily of people with mental disabilities.
Approximately 630 Santa Monica residents are seen also or unduplicated at four of
the Santa Monica contract agencies. These are Center for Healthy Aging, Step Up
on Second, St. John's Child and Family Center and St. Joseph Center. At the
opec Access Center, 60% of the clients (1,800 people) in FY 03-04 had a mental
disability. OPCC's Daybreak Center and Shelter served 628 women who are
homeless and mentally ill, a 21 % increase from the previous year.
In the 2000 census, there were a total of 24,224 people in Santa Monica who
reported having a disability. Of the 652 Santa Monica residents aged 5-15 years
with a disability, 53% reported havjng a mental limitation (Adrian Overton, RAND
Corp., Santa Monica Community Profile 2003). For all age groups (age 5 years and
up), the incidence of mental limitation was reported to be 15% or 3,687.
In California, community resources for treatment and support are primarily funded by
county Departments of Mental Health (DMH), which, in turn, are primarily funded
with State and some federal dollars. In June, the Los Angeles County Board of
Supervisors cut $28.6 million from the county DMH budget for this fiscal year in
response to cuts in the state DMH budget and the Los Angeles County budget. This
has resulted in service cuts at both county DMH facilities and private non-profit
agencies. Countywide, DMH is restricting treatment for 35,000 patients without
health insurance. In the Santa Monica area, Didi Hirsch Community Mental Health
Center is closing its Venice office, forcing 220 clients to transfer to one of the
center's two other locations. In DMH Service Area 5 (Westside), 2,500 uninsured
clients (30%) will have their services terminated because of the cut in the L.A.
County DMH budget.
Prop. 63 specifies that services be provided through an "integrated services" model,
which addresses the person as a whole. Integrated services include outreach,
medical care, short and long-term housing, prescription drugs, vocational training,
and access to client-run services. In treating both housed high utilizers of mental
health services and people with a chronic mental disability who are homeless, this
model has proved, in statewide pilot and permanent programs, to be highly
successful, as well as to reduce costs. In Santa Monica, there are approximately
1,037 people who are homeless on any given night. Approximately one-third sleep
in shelters or utilize similar programs and the rest live on the street. Sixty-two
percent served by the Santa Monica system in FY 03-04 reported having a disability;
the majority of these are psychological.
To fund expanded community services, Prop. 63 calls for a 1 % surcharge on income
over $1 million per year. The County of Los Angeles may realize as much as $100
million the first year. Statewide, 50,000 more adults would be eligible for benefits.
The initiative will directly raise approximately $700 million dollars per year for mental
health services in California by year three. With this additional revenue, California
would also qualify for additional federal funds, raising the annual total to more than
$1 billion. To oversee spending, the initiative creates a Citizens' Oversight and
Accountability Commission to annually review each county's expenditure plan's
compliance with the initiative.
The public need for mental health treatment is significant and is growing. On the
Westside, the county Dept. of Mental Health serves 7,500 clients. Based on the
prevalence of under-reporting, stigma and lack of insurance coverage for mental
health, thousands more undoubtedly go without treatment.
When individuals go untreated, the costs to the person and to society are
staggering. Child abuse, homelessness, unemployment, and criminal behavior and
associated conduct burden our jails, schools, hospital emergency rooms and board
and care homes. By contrast, mental health treatment works. The price is
significant, but it is effective and cost efficient in the long run.
To summarize, Prop. 63 imposes an additional surcharge on taxable income over
$1 million. Increased revenues will allow for expansion of services to mentally ill
children, adults and seniors; facilities improvement; and education and training
programs. Prop. 63 prohibits current funding for mental health services from being
reduced and would supplement, not replace, FY 03-04 state budget expenditure
levels. The initiative also creates a commission to approve certain county programs
and expenditures. (Please see the attached full text of the initiative.)
A summary of the estimate by the Legislative Analyst and Director of Finance of the
fiscal impact on state and local governments shows:
· Additional revenues of approximately $250 million in 2004-05, $680 million
in 2005-06, $700 million in 2006-07, and increasing amounts annually
thereafter, with expected comparable increases in program expenditures by
the state and counties.
· Unknown savings to the state and local agencies potentially amounting to
hundreds of millions of dollars annually on a statewide basis from reduced
costs for state prison and county jail operations, medical care, homeless
shelters, and social services programs.
Proposition 63 is currently endorsed by more than 150 agencies, local governments,
professional associations and professionals and 25 individual state senators and
assembly members, including:
· California Medical Association
· California Police Chiefs Association
. Board of Supervisors of the City and County of San Francisco
. Sacramento, Oakland, and Santa Barbara City Councils
. Boards of Supervisors of San Mateo, Marin, Santa Clara and Santa Barbara
Counties
. State Senator Sheila Kuehl
Since its formation in 2002, the Disabilities Commission has pledged an ongoing
commitment to mental health in our community. The funds generated by Prop. 63
are greatly needed and will directly benefit the residents of Santa Monica. On behalf
of the Disabilities Commission, I urge you to join the many organizations, local and
regional governments, non-profit agencies and individuals and support Prop. 63, the
Mental Health Services Act. Your consideration is appreciated. Thank you.
Sincerely,
Christofer Arroyo, Chair
Attachment II
MENTAL HEALTH SERVICES ACT
SECTION 1. Title
This Act shall be known and may be cited as the "Mental Health Services Act."
SECTION 2. Findings and Declarations
The People of the State of California hereby find and declare all of the following:
(a) Mental illnesses are extremely common; they affect almost every family in
California. They affect people from every background and occur at any age. In
any year, between 5% and 7% of adults have a serious mental illness as do a
similar percentage of children N between 5% and 9%. Therefore, more than two
million children, adults and seniors in California are affected by a potentially
disabling mental illness every year. People who become disabled by mental
illness deserve the same guarantee of care already extended to those who face
other kinds of disabilities.
(b) Failure to provide timely treatment can destroy individuals and families. No
parent should have to give up custody of a child and no adult or senior should
have to become disabled or homeless to get mental health services as too often
happens now. No individual or family should have to suffer inadequate or
insufficient treatment due to language or cultural barriers to care. Lives can be
devastated and families can be financially ruined by the costs of care. Yet, for too
many Californians with mental illness, the mental health services and supports
they need remain fragmented, disconnected and often inadequate, frustrating the
opportunity for recovery.
(c) Untreated mental illness is the leading cause of disability and suicide and
imposes high costs on state and local government. Many people left untreated or
with insufficient care see th'eir mental illness worsen. Children left untreated often
become unable to learn or participate in a normal school environment. Adults
lose their ability to work and be independent; many become homeless and are
subject to frequent hospitalizations or jail. State and county governments are
forced to pay billions of dollars each year in emergency medical care, long-term
nursing home care, unemployment, housing, and law enforcement, including
juvenile justice, jail and prison costs.
(d) In a cost cutting move 30 years ago, California drastically cut back its
services in state hospitals for people with severe mental illness. Thousands
ended up on the streets homeless and incapable of caring for themselves. Today
thousands of suffering people remain on our streets because they are afflicted
with untreated severe mental illness. We can and should offer these people the
care they need to lead more productive lives.
(e) With effective treatment and support, recovery from mental illness is
feasible for most people. The State of California has developed effective models
of providing services to children, adults and seniors with serious mental illness. A
recent innovative approach, begun under Assembly Bill 34 in 1999, was
recognized in 2003 as a model program by the President's Commission on
Mental Health. This program combines prevention services with a full range of
integrated services to treat the whole person, with the goal of self-sufficiency for
those who may have otherwise faced homelessness or dependence on the state
for years to come. Other innovations address services to other underserved
populations such as traumatized youth and isolated seniors. These successful
programs, including prevention, emphasize client-centered, family focused and
community-based services that are culturally and linguistically competent and are
provided in an integrated services system.
(f) By expanding programs that have demonstrated their effectiveness,
California can save lives and money. Early diagnosis and adequate treatment
provided in an integrated service system is very effective; and by preventing
disability, it also saves money. Cutting mental health services wastes lives and
costs more. California can do a better job saving lives and saving money by
making a firm commitment to providing timely, adequate mental health services.
(g) To provide an equitable way to fund these expanded services while
protecting other vital state services from being cut, very high-income individuals
should pay an additional one percent of that portion of their annual income that
exceeds one million dollars ($1,000,000). About 1/10 of one percent of
Californians have incomes in excess of one million dollars ($1,000,000). They
have an average pre-tax income of nearly five million dollars ($5,000,000). The
additional tax paid pursuant to this represents only a small fraction of the amount
of tax reduction they are realizing through recent changes in the federal income
tax law and only a small portion of what they save on property taxes by living in
California as compared to the property taxes they would be paying on multi-
million dollar homes in other states.
SECTION 3. Purpose and Intent.
The People of the State of California hereby declare their purpose and intent in
enacting this Act to be as follows:
(a) To define serious mental illness among children, adults and seniors as a
condition deserving priority attention, including prevention and early intervention
services and medical and supportive care.
(b) To reduce the long-term adverse impact on individuals, families and state
and local budgets resulting from untreated serious mental illness.
(c) To expand the kinds of successful, innovative service programs for
children, adults and seniors begun in California, including culturally and
linguistically competent approaches for underserved populations. These
programs have already demonstrated their effectiveness in providing outreach
and integrated services, including medically necessary psychiatric services, and
other services, to individuals most severely affected by or at risk of serious
mental illness.
(d) To provide state and local funds to adequately meet the needs of all
children and adults who can be identified and enrolled in programs under this
measure. State funds shall be available to provide services that are not already
covered by federally sponsored programs or by individuals' or families' insurance
programs.
(e) To ensure that all funds are expended in the most cost effective manner
and services are provided in accordance with recommended best practices
subject to local and state oversight to ensure accountability to taxpayers and to
the public.
SECTION 4. Part 3.6 (commencing with Section 5840) is added to Division 5 of
the Welfare and Institutions Code, to read:
PART 3.6 PREVENTION AND EARLY INTERVENTION PROGRAMS
5840. (a) The Department of Mental Health shall establish a program
designed to prevent mental illnesses from becoming severe and disabling. The
program shall emphasize improving timely access to services for underserved
populations.
(b) The program shall include the following components:
(1) Outreach to families, employers, primary care health care
providers, and others to recognize the early signs of potentially severe and
disabling mental illnesses.
(2) Access and linkage to medically necessary care provided by
county mental health programs for children with severe mental illness, as defined
in Section 5600.3, and for adults and seniors with severe mental illness, as
defined in Section 5600.3, as early in the onset of these conditions as
practicable.
(3) Reduction in stigma associated with either being diagnosed with a mental
illness or seeking mental health services.
(4) Reduction in discrimination against people with mental illness.
(c) The program shall include mental health services similar to those
provided under other programs effective in preventing mental illnesses from
becoming severe, and shall also include components similar to programs that
have been successful in reducing the duration of untreated severe mental
illnesses and assisting people in quickly regaining productive lives.
(d) The program shall emphasize strategies to reduce the following
negative outcomes that may result from untreated mental illness:
(1) Suicide.
(2) Incarcerations.
(3) School failure or dropout.
(4) Unemployment.
(5) Prolonged suffering.
(6) Homelessness.
(7) Removal of children from their homes.
(e) In consultation with mental health stakeholders, the department shall revise
the program elements in Section 5840 applicable to all county mental health
programs in future years to reflect what is learned about the most effective
prevention and intervention programs for children, adults, and seniors.
5840.2 (a) The department shall contract for the provision of services
pursuant to this part with each county mental health program in the manner set
forth in Section 5897.
SECTION 5. Article 11 (commencing with Section 5878.1) is added to Chapter
1 of Part 4 of Division 5 of the Welfare and Institutions Code, to read:
Article 11. Services for Children with Severe Mental Illness.
5878.1 (a) It is the intent of this article to establish programs that assure
services will be provided to severely mentally ill children as defined in Section
5878.2 and that they be part of the children's system of care established
pursuant to this Part. It is the intent of this Act that services provided under this
Chapter to severely mentally ill children are accountable, developed in
partnership with youth and their families, culturally competent, and individualized
to the strengths and needs of each child and their family.
(b) Nothing in this Act shall be construed to authorize any services
to be provided to a minor without the consent of the child's parent or legal
guardian beyond those already authorized by existing statute.
5878.2 For purposes of this article, severely mentally ill children means
minors under the age of 18 who meet the criteria set forth in subdivision (a) of
Section 5600.3.
5878.3 (a) Subject to the availability of funds as determined pursuant to
Part 4.5, county mental health programs shall offer services to severely mentally
ill children for whom services under any other public or private insurance or other
mental health or entitlement program is inadequate or unavailable. Other
entitlement programs include but are not limited to mental health services
available pursuant to MediCal, child welfare, and special education programs.
The funding shall cover only those portions of care that cannot be paid for with
public or private insurance, other mental health funds or other entitlement
programs.
(b) Funding shall be at sufficient levels to ensure that counties can
provide each child served all of the necessary services set forth in the applicable
treatment plan developed in accordance with this Part, including services where
appropriate and necessary to prevent an out of home placement, such as
services pursuant to Chapter 4 of Part 6 of Division 9 (commencing with Section
18250).
(c) The Department of Mental Health shall contract with county
mental health programs for the provision of services under this article in the
manner set forth in Section 5897.
SECTION 6. Section 18257 is added to the Welfare and Institutions Code to read
as follows:
18257. (a) The Department of Social Services shall seek applicable federal
approval to make the maximum number of children being served through such
programs eligible for federal financial participation and amend any applicable
state regulations to the extent necessary to eliminate any limitations on the
numbers of children who can participate in these programs.
(b) Funds from the Mental Health Services Fund shall be made available to
the Department of Social Services for technical assistance to counties in
establishing and administering projects. Funding shall include reasonable and
necessary administrative costs in establishing and administering a project
pursuant to this chapter and shall be sufficient to create an incentive for all
counties to seek to establish programs pursuant to this chapter.
SECTION 7. Section 5813.5 is added to Part 3 of Division 5 of the Welfare and
Institutions Code, to read:
5813.5. Subject to the availability of funds from the Mental Health Services
Fund, the Department of Mental Health shall distribute funds for the provision of
services under Sections 5801, 5802 and 5806 to county mental health programs.
Services shall be available to adults and seniors with severe illnesses who meet
the eligibility criteria in Welfare and Institutions Code Section 5600.3(b) and (c).
For purposes of this act, seniors means older adult persons identified in Part 3.
(a) Funding shall be provided at sufficient levels to ensure that
counties can provide each adult and senior served pursuant to this Part with the
medically necessary mental health services, medications and supportive services
set forth in the applicable treatment plan.
(b) The funding shall only cover the portions of those costs of
services that cannot be paid for with other funds including other mental health
funds, public and private insurance, and other local, state and federal funds.
(c) Each county mental health programs plan shall provide for services in
accordance with the system of care for adults and seniors who meet the eligibility
criteria in Section 5600.3(b) and (c).
(d) Planning for services shall be consistent with the philosophy, principles,
and practices of the Recovery Vision for mental health consumers:
(1) To promote concepts key to the recovery for individuals who
have mental illness: hope, personal empowerment, respect, social connections,
self-responsibility, and self-determination.
(2) To promote consumer-operated services as a way to support
recovery.
(3) To reflect the cultural, ethnic and racial diversity of mental health consumers.
(4) To plan for each consumer's individual needs.
(e) The plan for each county mental health program shall indicate, subject to
the availability of funds as determined by Part 4.5, and other funds available for
mental health services, adults and seniors with a severe mental illness being
served by this program are either receiving services from this program or have a
mental illness that is not sufficiently severe to require the level of services
required of this program.
(f) Each county plan and annual update pursuant to Section 5847 shall
consider ways to provide services similar to those established pursuant to the
Mentally III Offender Crime Reduction Grant Program. Funds shall not be used to
pay for persons incarcerated in state prison or parolees from state prisons.
(g) The department shall contract for services with county mental health
programs pursuant to Section 5897. After the effective date of this section the
term grants referred to in Sections 5814 and 5814.5 shall refer to such contracts.
SECTION 8. Part 3.1 is hereby added to Division 5 of the Welfare and Institutions
Code commencing with Section 5820 to read:
PART 3.1 EDUCATION AND TRAINING PROGRAM
5820. (a) It is the intent of this Part to establish a program with dedicated
funding to remedy the shortage of qualified individuals to provide services to
address severe mental illnesses.
(b) Each county mental health program shall submit to the
department a needs assessment identifying its shortages in each professional
and other occupational category in order to increase the supply of professional
staff and other staff that county mental health programs anticipate they will
require in order to provide the increase in services projected to serve additional
individuals and families pursuant to Parts 3, 3.2, 3.6, and 4 of this Division. For
purposes of this Part, employment in California's public mental health system
includes employment in private organizations providing publicly funded mental
health services.
(c) The department shall identify the total statewide needs for each
professional and other occupational category and develop a five-year education
and training development plan.
(d) Development of the first five-year plan shall commence upon enactment
of the initiative. Subsequent plans shall be adopted every five years.
(e) Each five-year plan shall be reviewed and approved by the California
Mental Health Planning Council.
5821. (a) The Mental Health Planning Council shall advise the Department
of Mental Health on education and training policy development and provide
oversight for the department's education and training plan development.
(b) The Department of Mental Health shall work with the California Mental
Health Planning Council so that council staff is increased appropriately to fulfill its
duties required by Sections 5820 and 5821.
5822. The Department of Mental Health shall include in the five-year
plan:
(a) Expansion plans for the capacity of postsecondary education to meet the
needs of identified mental health occupational shortages.
(b) Expansion plans for the forgiveness and scholarship programs offered in
return for a commitment to employment in California's public mental health
system and make loan forgiveness programs available to current employees of
the mental health system who want to obtain Associate of Arts, Bachelor of Arts,
Masters Degrees, or Doctoral degrees.
(c) Creation of a stipend program modeled after the federal Title IV-E program
for persons enrolled in academic institutions who want to be employed in the
mental health system.
(d) Establishment of regional partnerships among the mental health system and
the educational system to expand outreach to multicultural communities,
increase the diversity of the mental health workforce, to reduce the stigma
associated with mental illness, and to promote the use of web-based
technologies, and distance learning techniques.
(e) Strategies to recruit high school students for mental health occupations,
increasing the prevalence of mental health occupations in high school career
development programs such as health science academies, adult schools, and
regional occupation centers and programs, and increasing the number of human
service academies.
(f) Curriculum to train and retrain staff to provide services in accordance with the
provisions and principles of Parts 3, 3.2, 3.6, and 4.
(g) Promotion of the employment of mental health consumers and family
members in the mental health system.
(h) Promotion of the meaningful inclusion of mental health consumers and family
members and incorporating their viewpoint and experiences in the training and
education programs in subdivisions (a) through (f).
(i) Promotion of the inclusion of cultural competency in the training and
education programs in subdivisions (a) through (f).
5ECTIO~ 9. Part 3.2 Commencing with Section 5830 is added to Division 5 of
the Welfare and Institutions Code to read:
Part 3.2 Innovative Programs
5830. County mental health programs shall develop plans for innovative
programs to be funded pursuant to paragraph (6) of subdivision (a) of Section
5892.
(a) The innovative programs shall have the following purposes:
(1) To increase access to underserved groups.
(2) To increase the quality of services, including better
outcomes.
(3) To promote interagency collaboration.
(4) To increase access to services.
(b) County mental health programs shall receive funds for their
innovation programs upon approval by the Mental Health Oversight and
Accountability Commission.
SECTION 10. Part 3.7 (commencing with Section 5845) is added to Division 5
of the Welfare and Institutions Code to read:
PART 3.7. OVERSIGHT AND ACCOUNTABILITY
5845. (a) The Mental Health Services Oversight and Accountability
Commission is hereby established to oversee Part 3, the Adults and Older Adults
Systems of Care Act; Part 3.1, Human Resources; Part 3.2, Innovative
Programs; Part 3.6, Prevention and Early Intervention Programs; and Part 4, the
Children's Mental Health Services Act. The Commission shall replace the
advisory committee established pursuant to Section 5814. The Commission shall
consist of 16 voting members as follows:
(1) The Attorney General or his or her designee.
(2) The Superintendent of Public Instruction or his or her
designee.
(3) The Chairperson of the Senate Health and Human Services
Committee or another member of the Senate selected by the President pro
Tempore of the Senate.
(4) The Chairperson of the Assembly Health Committee or
another member of the Assembly selected by the Speaker of the Assembly.
(5) Two persons with a severe mental illness, a family member
of an adult or senior with a severe mental illness, a family member of a child who
has or has had a severe mental illness, a physician specializing in alcohol and
drug treatment, a mental health professional, a county Sheriff, a Superintendent
of a school district, a representative of a labor organization, a representative of
an employer with less than 500 employees and a representative of an employer
with more than 500 employees, and a representative of a health care services
plan or insurer, all appointed by the Governor. In making appointments, the
Governor shall seek individuals who have had personal or family experience with
mental illness.
(b) Members shall serve without compensation, but shall be
reimbursed for all actual and necessary expenses incurred in the performance of
their duties.
(c) The term of each member shall be three years, to be staggered
so that approximately one-third of the appointments expire in each year.
(d) In carrying out its duties and responsibilities, the Commission
may do all of the following:
(1) Meet at least once each quarter at any time and location
convenient to the public as it may deem appropriate. All meetings of the
Commission shall be open to the public.
(2) Within the limit of funds allocated for these purposes,
pursuant to the laws and regulations governing state civil service, employ staff,
including any clerical, legal, and technical assistance as may appear necessary.
(3) Establish technical advisory committees such as a
committee of consumers and family members.
(4) Employ all other appropriate strategies necessary or
convenient to enable it to fully and adequately perform its duties and exercise the
powers expressly granted, notwithstanding any authority expressly granted to
any officer or employee of state government.
(5) Develop strategies to overcome stigma and accomplish all
other objectives of Parts 3.2, 3.6 and the other provisions of the Act establishing
this Commission.
(6) At any time, advise the Governor or the Legislature
regarding actions the state may take to improve care and services for people with
mental illness.
(7) If the Commission identifies a critical issue related to the
performance of a county mental health program, it may refer the issue to the
Department of Mental Health pursuant to Section 5655.
5846. (a) The Commission shall annually review and approve each county
mental health program for expenditures pursuant to Parts 3.2 for Innovative
Programs and Part 3.6 for Prevention and Early Intervention.
(b) The department may provide technical assistance to any county
mental health plan as needed to address concerns or recommendations of the
Commission or when local programs could benefit from technical assistance for
improvement of their plans submitted pursuant to Section 5847.
(c) The Commission shall ensure that the perspective and participation
of members and others suffering from severe mental illness and their family
members is a significant factor in all of its decisions and recommendations.
5847. Integrated Plans for Prevention, Innovation and System of Care Services.
(a) Each county mental health program shall prepare and submit a three year
plan which shall be updated at least annually and approved by the department
after review and comment by the Oversight and Accountability Commission. The
plan and update shall include all of the following:
(1) A program for prevention and early intervention in accordance with Part
3.6.
(2) A program for services to children in accordance with Part 4 to include a
program pursuant to Chapter 6 of Part 4 of Division 9 commencing with Section
18250 or provide substantial evidence that it is not feasible to establish a wrap-
around program in that county.
(3) A program for services to adults and seniors in accordance with Part 3.
(4) A program for Innovations in accordance with Part 3.2.
(5) A program for technological needs and capital facilities needed to provide
services pursuant to Parts 3, 3.6 and 4. 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.
(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.
(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 Parts 3 and 4 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.
(b) The department's review and approval of the programs specified in
paragraphs (1) and (4) shall be limited to ensuring the consistency of such
programs with the other portions of the plan and providing review and comment
to the Mental Health Services Oversight and Accountability Commission.
(c) The programs established pursuant to paragraphs (2) and (3) of
subdivision (a) shall include services to address the needs of transition age youth
ages 16 to 25.
(d) Each year the Department of Mental Health shall inform counties of the
amounts of funds available for services to children pursuant to Part 4 and to
adults and seniors pursuant to Part 3. Each county mental health program shall
prepare expenditure plans pursuant to Parts 3 and 4 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 Parts 3 and 4
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.
(e) The department shall evaluate each proposed expenditure plan and
determine the extent to which each county has the capacity to serve the
proposed number of children, adults and seniors pursuant to Parts 3 and 4; the
extent to which there is an unmet need to serve that number of children, adults
and seniors; and determine the amount of available funds; and provide each
county with an allocation from the funds available. The department shall give
greater weight for a county or a population which has been significantly
underserved for several years.
(f) A county mental health program shall include an allocation of funds from a
reserve established pursuant to paragraph (6) of subdivision (a) for services
pursuant to paragraphs (2) and (3) of subdivision (a) in years in which theoallocation of funds for services pursuant to subdivision (c) are not adequate to
continue to serve the same number of individuals as the county had been serving
in the previous fiscal year.
5848. (a) Each 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 and other important
interests. 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 such plans.
(b) The mental health board established pursuant to Section 5604 shall
conduct a public hearing on the draft plan and annual updates at the close of the
30Dday comment period required by subsection (a). Each adopted plan and
update shall include any substantive written recommendations for revisions. The
adopted 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 county mental health department for revisions.
(c) The department shall establish requirements for the content of the
plans. The plans shall include reports on the achievement of performance
outcomes for services pursuant to Parts 3, 3.6 and 4 funded by the Mental Health
Services Fund and established by the department.
(d) Mental health services provided pursuant to Parts 3 and 4 shall be
included in the review of program performance by the California Mental Health
Planning Council required by Section 5772(c)(2) and in the local mental health
board's review and comment on the performance outcome data required by
Section 5604.2(a)(7).
Section 11. Section 5771.1 is added to the Welfare and Institutions Code to
read:
5771.1 The members of the Mental Health Services Oversight and
Accountability Commission established pursuant to Section 5845 are members of
the California Mental Health Planning Council. They serve in an ex officio
capacity when the Council is performing its statutory duties pursuant to Section
5772. Such membership shall not affect the composition requirements for the
Council specified in Section 5771.
SECTION 12. Section 17043 is added to the Revenue and Taxation Code to
read:
17043. (a) For each taxable year beginning on or after January 1, 2005, in
addition to any other taxes imposed by this part, an additional tax shall be
imposed at the rate of 1 % on that portion of a taxpayer's taxable income in
excess of one million dollars ($1,000,000).
(b) For purposes of applying Part 10.2 (commencing with Section
18401), the tax imposed under this section shall be treated as if imposed under
Section 17041.
(c) The following shall not apply to the tax imposed by this section:
(1) The provisions of Section 17039, relating to the allowance of
credits.
(2) The provisions of Section 17041, relating to filing status and
recomputation of the income tax brackets.
(3) The provisions of Section 17045, relating to joint returns.
SECTION 13. Section 19602 of the Revenue and Taxation Code is amended to
read:
19602. Except for amounts collected or accrued under Sections 17935, 17941,
17948, 19532, and 19561, and revenues deposited pursuant to Section 19602.5,
all moneys and remittances received by the Franchise Tax Board as amounts
imposed under Part 1 0 (commencing with Section 17001), and related penalties,
additions to tax, and interest imposed under this part, shall be deposited, after
clearance of remittances, in the State Treasury and credited to the Personal
Income Tax Fund.
SECTION 14. Section 19602.5 is added to the Revenue and Taxation Code to
read:
19602.5 (a) There is in the State Treasury the Mental Health Services Fund
(MHS Fund). The estimated revenue from the additional tax imposed under
Section 17043 for the applicable fiscal year, as determined under subparagraph
(B) of paragraph (3) of subdivision (c), shall be deposited to the MHS Fund on a
monthly basis, subject to an annual adjustment as described in this section.
(b) (1) Beginning with fiscal year 2004-2005 and for each fiscal year
thereafter, the Controller shall deposit on a monthly basis in the MHS Fund an
amount equal to the applicable percentage of net personal income tax receipts
as defined in paragraph (4).
(2) (A) Except as provided in subparagraph (B), the applicable
percentage referred to in paragraph (1) shall be 1.76 percent.
(B) For fiscal year 2004-2005, the applicable percentage shall
be 0.70 percent.
(3) Beginning with fiscal year 2006-2007, monthly deposits to
the MHS Fund pursuant to this subdivision are subject to suspension pursuant to
subdivision (f).
(4) For purposes of this subdivision, Onet personal income tax
receiptsO refers to amounts received by the Franchise Tax Board and the
Employment Development Department under the Personal Income Tax Law, as
reported by the Franchise Tax Board to the Department of Finance pursuant to
law, regulation, procedure, and practice (commonly referred to as the 0102
ReportO) in effect on the effective date of the Act establishin~ this section.
(c) No later than March 1,2006, and each March 18 thereafter, the
Department of Finance, in consultation with the Franchise Tax Board, shall
determine the annual adjustment amount for the following fiscal year.
(1) The Oannual adjustment amountO for any fiscal year shall be
an amount equal to the amount determined by subtracting the Orevenue
adjustment amountO for the applicable revenue adjustment fiscal year, as
determined by the Franchise Tax Board under paragraph (3), from the Otax
liability adjustment amountO for applicable tax liability adjustment tax year, as
determined by the Franchise Tax Board under paragraph (2).
(2) (A) (i) The Otax liability adjustment amountO for a tax year is
equal to the amount determined by subtracting the estimated tax liability increase
from the additional tax imposed under Section 17043 for the applicable year
under subparagraph (B) from the amount of the actual tax liability increase from
the additional tax imposed under Section 17043 for the applicable tax year,
based on the returns filed for that tax year.
(ii) For purposes of the determinations required under
this paragraph, actual tax liability increase from the additional tax means the
increase in tax liability resulting from the tax of 1 % imposed under Section
17043, as reflected on the original returns filed by October 15th of the year after
the close of the applicable tax year.
(iii) The applicable tax year referred to in this paragraph
means the 12-calendar month taxable year beginning on January 1 st of the year
that is two (2) years before the beginning of the fiscal year for which an annual
adjustment amount is calculated.
(B) (i) The estimated tax liability increase from the
additional tax for the following tax years is:
Tax Year Estimated Tax Liability Increase from the
Additional Tax
2005 $ 634 million
2006 $ 672 million
2007 $ 713 million
2008 $ 758 million
(ii) The Oestimated tax liability increase from the additional taxO for the tax year
beginning in 2009 and each tax year thereafter shall be determined by applying
an annual growth rate of seven (7) percent to the Oestimated tax liability increase
from additional taxO of the immediately preceding tax year.
(3) (A) The Orevenue adjustment amountO is equal to the amount
determined by subtracting the Oestimated revenue from the additional taxO for
the applicable fiscal year, as determined under subparagraph (B), from the actual
amount transferred for the applicable fiscal year.
(B) (i) The Oestimated revenue from the additional taxO for
the following applicable fiscal years is:
Applicable Estimated Revenue From Additional Tax
Fiscal Year
2004-05 $ 254 million
2005-06 $ 683 million
2006-07 $ 690 million
2007 -08 $ 733 million
(ii) The Oestimated revenue from the additional taxO for applicable fiscal year
2007 -08 and each applicable fiscal year thereafter shall be determined by
applying an annual growth rate of 7 percent to the Oestimated revenue from the
additional taxO of the immediately preceding applicable fiscal year.
(iii) The applicable fiscal year referred to in this paragraph means the fiscal year
that is two (2) years before the fiscal year for which an annual adjustment
amount is calculated.
(d) The Department of Finance shall notify the Legislature and the
Controller of the results of the determinations required under subdivision (c) no
later than ten (10) business days after the determinations are final.
(e) If the annual adjustment amount for a fiscal year is a positive
number, the Controller shall transfer that amount from the General Fund to the
MHS Fund on July 1 of that fiscal year.
(f) If the annual adjustment amount for a fiscal year is a negative
number, the Controller shall suspend monthly transfers to the MHS Fund for that
fiscal year, as otherwise required by paragraph (1) of subdivision (b), until the
total amount of suspended deposits for that fiscal year equals the amount of the
negative annual adjustment amount for that fiscal year.
SECTION 15. Part 4.5 (commencing with Section 5890) is added to Division 5 of
the Welfare and Institutions Code, to read:
PART 4.5. MENTAL HEALTH SERVICES FUND
5890. (a) The Mental Health Services Fund is hereby created in the State
Treasury. The Fund shall be administered by the department of Mental Health.
Notwithstanding Section 13340 of the Government Code, all monies in the Fund
are continuously appropriated to the Department, without regard to fiscal years,
for the purpose of fu"nding the following programs and other related activities as
designated by other provisions of this Division:
(1) Part 3 commencing with Section 5800, the Adult and Older Adult System of
Care Act.
(2) Part 3.6 commencing with Section 5840, Prevention and Early Intervention
Programs.
(3) Part 4 commencing with Section 5850, the Children's Mental Health
Services Act.
(b) Nothing in the establishment of this Fund, nor any other provisions of the
Act establishing it or the programs funded shall be construed to modify the
obligation of health care service plans and disability insurance policies to provide
coverage for mental health services, including those services required under
Section 1374.72 of the Health and Safety Code and Section 10144.5 of the
Insurance Code, related to mental health parity. Nothing in this Act shall be
construed to modify the oversight duties of the Department of Managed Health
Care or the duties of the Department of Insurance with respect to enforcing such
obligations of plans and insurance policies.
(c) Nothing in this Act shall be construed to modify or reduce the existing
authority or responsibility of the Department of Mental Health.
(d) The Department of Health Services, in consultation with the Department of
Mental Health, shall seek approval of all applicable federal Medicaid approvals to
maximize the availability of federal funds and eligibility of participating children,
adults and seniors for medically necessary care.
(e) Share of costs for services pursuant to Parts 3 and 4 shall be
determined in accordance with the Uniform Method for Determining Ability to Pay
applicable to other publicly funded mental health services, unless such Uniform
Method is replaced by another method of determining co-payments, in which
case the new method applicable to other mental health services shall be
applicable to services pursuant to Parts 3 and 4.
5891. The funding established pursuant to this Act shall be utilized to
expand mental health services. 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
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 such increased costs or
financial risk. These funds shall only be used to pay for the programs authorized
in Section 5892. These funds may not be used to pay for any other program.
These funds may not be loaned to the state 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 Section 5892.
5892. (a) In order to promote efficient implementation of this Act allocate
the following portions of funds available in the Mental Health Services Fund in
2005-06 and each year thereafter:
(1) In 2005-06, 2006-07, and in 2007-0810% shall be placed in a trust fund to
be expended for education and training programs pursuant to Part 3.1.
(2) In 2005-06, 2006-07 and in 2007-08 10% for capital facilities and
technological needs distributed to counties in accordance with a formula
developed in consultation with the California Mental Health Directors Association
to implement plans developed pursuant to Section 5847.
(3) 20% for Prevention and Early Intervention Programs distributed to counties in
accordance with a formula developed in consultation with the California Mental
Health Directors Association pursuant to Part 3.6. Each county's allocation of
funds shall be distributed only after its annual program for expenditure of such
funds has been approved by the Oversight and Accountability Commission
established pursuant to Section 5845.
(4) The allocation for Prevention and Early Intervention may be increased in any
county which the department determines that such increase will decrease the
need and cost for additional services to severely mentally ill persons in that
county by an amount at least commensurate with the proposed increase. The
statewide allocation for Prevention and Early Intervention may be increased
whenever the Oversight and Accountability Commission determines that all
counties are receiving all necessary funds for services to severely mentally ill
persons and have established prudent reserves and there are additional
revenues available in the Fund.
(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 for the
Children's System of Care and Part 3, for the Adult and Older Adult System of
Care.
(6) 5% percent of the total funding for each county mental health program for
Parts 3, 3.6 and 4 shall be utilized for Innovative Programs pursuant to an
approved plan required by Section 5830 and such funds may be distributed by
the department only after such programs have been approved by the Oversight
and Accountability Commission established pursuant to Section 5845.
(b) In any year after 2007-08, programs for services pursuant to
Parts 3 and 4 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% of the average amount of funds allocated to that county for
the previous five years pursuant to this Section.
(c) The allocations pursuant to subdivisions (a) and (b) shall include
funding for annual planning costs pursuant to Section 5848. The total of such
costs shall not exceed 5% 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 Parts 3 and 4.
(d) Prior to making the allocations pursuant to subdivisions (a), (b)
and (c), the department shall also provide funds for the costs for itself, the Mental
Health Planning Council and the Oversight and Accountability Commission to
implement all duties pursuant to the programs set forth in this section. Such costs
shall not exceed 5% 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 Parts 3, 3.6 and
4.
(e) In 2004-05 funds shall be allocated as follows:
(1) 45% for Education and Training pursuant to Part 3.1.
(2) 45% for Capital Facilities and Technology Needs in the manner specified
by paragraph (2) of subdivision (a).
(3) 5% for Local Planning in the manner specified in Subdivision (c) and
(4) 5% 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 such investments shall be transferred into the
Fund. The earnings on investment of these funds shall be available for
distribution from the Fund in future years.
(g) All expenditures for county mental health programs shall be
consistent with a currently approved plan or update pursuant to Section 5847.
(h) Other than funds placed in a reserve in accordance with an
approved plan, any funds allocated to a county which have not been spent for
their authorized purpose within three years shall revert to the state to be
deposited into the Fund and available for other counties in future years, provided
however, that funds for capital facilities, technological needs or education and
training may be retained for up to ten years before reverting to the Fund.
(i) If there are still additional revenues available in the fund after the
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 such revenues to further
the purposes of this Act and the Legislature may appropriate such funds for any
purpose consistent with the Commission's adopted plan which furthers the
purposes of this act.
5893. (a) In any year in which the funds available exceed the amount
allocated to counties, such funds shall be carried forward to the next fiscal year
to be available for distribution to counties in accordance with Section 5892 in that
fiscal year.
(b) All funds deposited into the Mental Health Services Fund shall be
invested in the same manner in which other state funds are invested. The Fund
shall be increased by its share of the amount earned on investments.
5894. In the event that Parts 3 or 4 are restructured by legislation signed into
law before the adoption of this measure, the funding provided by this measure
shall be distributed in accordance with such legislation; provided, however that
nothing herein shall be construed to reduce the categories of persons entitled to
receive services.
5895. In the event any provisions of Part 3 or Part 4 of this Division are
repealed or modified so the purposes of this Act cannot be accomplished, the
funds in the Mental Health Services Fund shall be administered in accordance
with those sections as they read on January 1, 2004.
5897. (a) Notwithstanding any other provision of state law, the Department
of Mental Health shall implement the mental health services provided by Parts 3,
3.6 and 4 of this Division through contracts with county mental health programs
or counties acting jointly. A contract may be exclusive and may be awarded on a
geographic basis. As used herein a county mental health program includes a city
receiving funds pursuant to Section 5701.5
(b) Two or more counties acting jointly may agree to deliver or
subcontract for the delivery of such mental health services. The agreement may
encompass all or any part of the mental health services provided pursuant to
these parts. Any agreement between counties shall delineate each county's
responsibilities and fiscal liability.
(c) The department shall implement the provisions of Parts 3, 3.2, 3.6
and 4 of this Division through the annual county mental health services
performance contract, as specified in Part 2, Chapter 2, Section 5650 et seq.
(d) When a county mental health program is not in compliance with
its performance contract, the department may request a plan of correction with a
specific time-line to achieve improvements.
(e) Contracts awarded by the Department of Mental Health, the California
Mental Health Planning Council, and the Mental Health Services Oversight and
Accountability Commission pursuant to Parts 3, 3.1, 3.2, 3.6, 3.7, 4, and 4.5 may
be awarded in the same manner in which contracts are awarded pursuant to
Section 5814 and the provisions of subdivisions (g) and (h) of Section 5814 shall
apply to such contracts.
(f) For purposes of Section 5775, the allocation of funds pursuant to Section
5892 which are used to provide services to Medi-Cal beneficiaries shall be
included in calculating anticipated county matching funds and the transfer to the
department of the anticipated county matching funds needed for community
mental health programs.
5898. The department shall develop regulations, as necessary, for the
department or designated local agencies to implement this Act. In 2005, the
director may adopt all regulations pursuant to this Act as emergency regulations
in accordance with Chapter 3.5 (commencing with Section 11340) of Part 1 of
Division 2 of Title 2. For the purpose of the Administrative Procedure Act, the
adoption of regulations, in 2005, shall be deemed an emergency and necessary
for the immediate preservation of the public peace, health and safety, or general
welfare. These regulations shall not be subject to the review and approval of the
Office of Administrative Law and shall not be subject to automatic repeal until
final regulations take effect. Emergency regulations adopted in accordance with
this provision shall not remain in effect for more than a year. The final regulations
shall become effective upon filing with the Secretary of State. Regulations
adopted pursuant to this section shall be developed with the maximum feasible
opportunity for public participation and comments.
SECTION 16
The provisions of this Act shall become effective January 1 of the year following
passage of the Act, and its provisions shall be applied prospectively.
The provisions of this Act are written with the expectation that it will be enacted in
November of 2004. In the event that it is approved by the voters at an election
other than one which occurs during the 2004-05 fiscal year, the provisions of this
act which refer to fiscal year 2005-06 shall be deemed to refer to the first fiscal
year which begins after the effective date of this Act and the provisions of this Act
which refer to other fiscal years shall refer to the year that is the same number of
years after the first fiscal year as that year is in relationship to 2005-06.
SECTION 17
Notwithstanding any other provision of law to the contrary, the department shall
begin implementing the provisions of this Act immediately upon its effective date
and shall have the authority to immediately make any necessary expenditures
and to hire staff for that purpose.
SECTION 18
This Act shall be broadly construed to accomplish its purposes. All of the
provisions of this Act may be amended by a 2/3 vote of the Legislature so long as
such amendments are consistent with and further the intent of this Act. The
Legislature may by majority vote add provisions to clarify procedures and terms
including the procedures for the collection of the tax surcharge imposed by
Section 16.
SECTION 19
If any provision of this Act is held to be unconstitutional or invalid for any reason,
such unconstitutionality or invalidity shall not affect the validity of any other
provision.