Assembly Bill Archives - Mental Health America of California

AB 2711 (Ramos) Services Before Suspensions – Support

March 18, 2024

The Honorable James C. Ramos
State Assembly
1021 O Street, Suite 8310
Sacramento, CA 95814

Re: Support for AB 2711 (Ramos)

Dear Assemblymember Ramos:

The California Youth Empowerment Network (CAYEN) is pleased to sponsor AB 2711 (Ramos), legislation aimed at implementing a public health strategy to assist youth with substance use needs. This legislation prioritizes keeping youth engaged in their education, establishes a community support system, and facilitates access to behavioral health services and resources.

The California Youth Empowerment Network (CAYEN) is a youth-led statewide network comprised of TAY Action Teams and CAYEN Board members which engages, empowers and represents Transitional Age Youth (TAY), ages 15-26, in mental health advocacy on issues that directly affect TAY. Since CAYEN’s inception in 2006, CAYEN has taken many forms of action to empower TAY in their personal lives and spark progressive change in public policy.

The I AM Collaborative, a subprogram of CAYEN, empowers LGBTQIA+ and BIPOC TAY to advocate for substance use prevention through social change campaigns and multimedia advocacy art in Sacramento and Los Angeles. The culmination of their advocacy efforts influenced the language incorporated in AB 2711. A resounding consensus among youth emphasized the significance of integrating harm reduction strategies into our spectrum of care and enhancing accessibility to behavioral health services. The current use of suspension and expulsion to address substance use is punitive in nature and is in direct conflict with what youth are asking for.

Below you’ll see testimony from youth in our program. We have removed the youth’s name to protect their identity.

“I hope to see workshops/counseling events that directly work with individuals who suffer from a substance

use disorder. I feel that viewing their situation through a lens of empathy and care provides more help to their situation than simply punishing them for indulging in something they are not allowed to. Additionally, many of my friends who do use substances have had trouble with their families and home life, so it only makes sense

to approach their situations with compassion and hope for their healing.”
– San Diego Youth, 18 years old

“My school does not discuss substance use very much or the supports in place for substance use, which does not allow students to feel safe to get support.”
– San Diego Youth, 16 years old

Currently, under California Education Code §48900, school officials possess the discretion to determine whether to suspend or expel a student for drug use and/or possession on school grounds. However, a standardized protocol for offering support to youth and addressing the root causes of their substance use is lacking. Moreover, administrative discretion has resulted in a disproportionate impact on certain demographics: more than 59 percent of drug-related suspensions involve boys, over 83 percent affect socioeconomically disadvantaged students, and approximately 82 percent involve youth of color.[1] These suspensions deprive youth of valuable instructional time, thereby heightening the risk of academic disengagement, dropout, and involvement in the juvenile justice system.[2] Education policies such as these predicated on the belief that abstinence works have failed to provide the youth the proper services and supports.

AB 2711 would require schools to use a public health framework before employing suspension and expulsion policies. By implementing this approach, this bill will help stem drug use and addiction, ensuring all students receive the help they want and need, remain in school, graduate, and thrive. For these reasons, we support AB 2711. If you have any questions, or if CAYEN can provide assistance on this bill or any other behavioral health legislation, please do not hesitate to contact me at dthirakul@mhac.org.

Sincerely,

Danny Thirakul

Public Policy Coordinator

[1] Children Now Analysis of California Department of Education Suspension and Expulsion Data, 2021-22.

[2] The Civil Rights Project 2018

AB 2711 (Ramos) Request for Signature

September 9^th 2024

The Honorable Gavin Newsom
Governor of California
1021 O Street, Suite 9000
Sacramento, CA 95814

Subject: Request for Signature: Assembly Bill 2711 (Ramos)

Dear Governor Newsom,

We, the undersigned organizations, respectfully request your signature on AB 2711 (Ramos), legislation aimed at increasing access to behavioral health services and support for youth facing substance use challenges. This bill seeks to prohibit the suspension of students who voluntarily disclose their use of a controlled substance, alcohol, or any intoxicant to seek help.

By 11th grade, nearly a quarter of California teens actively use alcohol and drugs. The substances most abused by youth are alcohol and marijuana, which have lasting harmful effects. Alcohol use during adolescence increases the likelihood of alcohol dependence in adulthood, and excessive alcohol consumption can have long-term health consequences including liver disease, cardiovascular disease, and cancer. Marijuana use is linked to adverse health effects such as respiratory problems, anxiety attacks, cognitive difficulties, coordination loss, and poor academic performance.

Unfortunately, under current California Education Code, there are no protections for youth who seek help for drug use to be protected from suspensions and/or expulsions once they disclose. The California Youth Empowerment Network surveyed California youth ages 15 to 26 and found that 55% have been prevented from or punished for attempting to seek help with their alcohol, tobacco, or substance use. Among those, 43% of youth cited fear of getting in trouble or fear of classmates’ opinions as a reason for not seeking help, 42% indicated a lack of support at home or school, 14% reported their school had little to no services available, and 9% were unaware of any services at all.

By removing the consequence of suspension, we hope to encourage more students to speak to school officials about their struggles. This bill would allow students to disclose their use of a controlled substance, alcohol, or intoxicant to seek help through services or support without the fear of suspension solely for that disclosure. By implementing this approach, AB 2711 (Ramos) will help reduce drug use and addiction, ensuring all students receive the help they need, remain in school, graduate, and thrive. For these reasons, we support AB 2711 (Ramos) and ask for your signature.

Sincerely,

Danny Thirakul Public Policy Coordinator California Youth Empowerment Network	Heidi Strunk President and CEO Mental Health America of California
Karen Vicari Director of Public Policy L.I.V.E	Gregory Cramer Senior Legislative Advocate Disability Rights California
Deborah Starkey Chairperson California Behavioral Health Planning Council	Lynn Rivas Executive Director California Association for Mental Health Peer Run Organizations
Angelica Garcia-Guerrero Deputy Director of Operations Project Return Peer Support Network	Gabrielle Tilley Associate Director of Policy and Partnerships The L.A. Trust for Children’s Health
Carmen-Nicole Cox Director of Government Affairs ACLU California Action	Dana Paycao Senior Policy Coordinator National Center for Youth Law
Stacie Hiramoto Director Racial & Ethnic Mental Health Disparities Coalition	Clare Cortright Policy Director Cal Voices
Sandy Rives LEAD Coordinator Transitions Mental Health Association	Nazeehah Khan Policy Director Californians for Justice
Isabella D’Alacio Senior Policy Associate Voices for Progress	Imari S Nuyen-Kariotis President California Peer Watch
Damon Johnson Executive Director Black Men Speak, Inc.	April Smith Community Manager Resiliency in the Valley
Mira Green LEAD Coordinator Assistant Lived Experience Advocacy Development	Daniela Dominguez Founder & Chief Executive Officer On the Margins
Jose Ramos Founder/President Impulse Group/AIDS Healthcare Foundation	Steve Kang Director of External Affairs Koreatown Youth & Community Center (KYCC)
Emily Wu Truong Peer Programs Facilitator NAMI Glendale

AB 2711 (RAMOS) CAYEN Co-Sponsor – Support

August 16, 2024

The Honorable Josh Newman
Chair, Senate Education Committee
1021 O Street, Room 6740
Sacramento, CA 95814

Subject: Co-Sponsor Support for Assembly Bill 2711 (Ramos)

Dear Senator Newman,

The California Youth Empowerment Network (CAYEN) is proud to co-sponsor AB 2711 (Ramos), legislation designed to increase access to behavioral health services and support for youth facing substance use challenges. This bill aims to protect students who voluntarily disclose their use of controlled substances, alcohol, or any intoxicant to seek help by prohibiting their suspension for such disclosures.

CAYEN is a youth-led, statewide network comprised of TAY Action Teams and Board members that engages, empowers, and represents Transitional Age Youth (TAY), ages 15-26, in mental health advocacy on issues directly impacting them. Since its inception in 2006, CAYEN has been at the forefront of empowering TAY in their personal lives and driving progressive change in public policy. We are committed to addressing the issue of substance use among youth and the profound impact our education system has on providing a safe and supportive environment to facilitate access to care.

By the 11th grade, nearly a quarter of California teens actively use alcohol and drugs, with alcohol and marijuana being the most commonly abused substances. The long-term effects of these substances are significant, ranging from increased risk of dependence in adulthood to serious health conditions such as liver disease, cardiovascular disease, cancer, and cognitive difficulties.

Currently, California Education Code lacks protections for youth who seek help for substance use. Our statewide survey of California youth ages 15 to 26 revealed that 55% reported being prevented from or punished for attempting to seek help with their alcohol, tobacco, or substance use. Among those respondents, 43% cited fear of getting in trouble or being judged by classmates as a deterrent, 42% indicated a lack of support at home or school, 14% noted their school had limited or no services available, and 9% were unaware of any available services.

By removing the threat of suspension, AB 2711 (Ramos) aims to create a safer environment for students to seek assistance from school officials. This bill allows students to disclose their substance use and seek help without fear of suspension, ultimately helping to reduce drug use and addiction. Ensuring students receive the help they need will contribute to higher graduation rates and better long-term outcomes. For these reasons, we strongly support AB 2711 (Ramos). If CAYEN can assist with this bill or any other behavioral health legislation, please feel free to contact me at dthirakul@mhac.org.

Sincerely,

Danny Thirakul
Public Policy Coordinator

Mental Health Coalition Comments to California Department of Insurance on Proposed SB 855 and AB 988 Rules

July 9, 2024

California Department of Insurance
Attn: Sarah Sullivan, Attorney III
Health Equity and Access Office
300 Capitol Mall, Suite 1700
Sacramento, CA 95814

Via email CDIRegulations@insurance.ca.gov

Re: Mental Health and Substance Use Disorder Coverage Requirements, Article 15.2 (commencing with section 2652.1) of Subchapter 3 of Chapter 5 of Title 10 of the California Code of Regulations, pursuant to the authority granted by Insurance Code sections 10144.4, 10144.5, 10144.51, 10144.52, 10144.53, and 10144.57

We appreciate the opportunity to comment on California Department of Insurance’s Notice of Proposed Action for the Department’s Mental Health and Substance Use Disorder Parity in Health Insurance Rulemaking (REG-2021-00008) dated May 24, 2024, to implement Senate Bill 855 (Wiener, Chapter 151, 2020) and Assembly Bill 988 (Bauer-Kahan, Chapter 747, 2022). We are grateful for the Department’s engagement with us on numerous issues related to the drafted regulations. The Department’s proposed Rule lessens the possibility that disability insurers will exploit ambiguities to inappropriately limit insureds’ access to mental health and substance use disorder (MHSUD) care
We encourage this comprehensive Rulemaking to be finalized as soon as possible and offer support for the following key provisions, as currently drafted:

● Use of nonprofit professional association utilization review criteria and gap-filling criteria aligned with generally accepted standards of care (GASC). The exclusive use of nonprofit professional association criteria, unmodified, is essential to ensuring that insureds receive the appropriate intensity and duration of services to meet their specific needs in a manner consistent with generally accepted standards of care. The proposed Rule clearly states that it is the responsibility of disability insurers to use nonprofit professional association utilization review criteria in a manner established or approved by the association and to document how the plan is meeting these requirements.

We also support the Department’s development of gap-filling criteria for use when there are not established nonprofit professional association utilization review criteria for a MHSUD condition or service. All criteria, including gap-filling criteria, should be consistent with GASC to ensure that every MHSUD condition is measured against appropriate clinical standards. These standards are squarely in-line with the intent and letter of the law.

● Obligation of health insurers to arrange and pay for out-of-network care and insureds’ rights to arranging out-of-network coverage, including requirements that insurers must be required to enter into an agreement with out-of-network providers when geographic and timely access standards are not met. We support the Department’s specificity on obligations of insurers in arranging out-of-network care, including:

○ The insurer’s obligation to identify and secure out-of-network health care providers or facilities within time and distance standards;
○ The insured’s right to timely authorization of out-of-network services;
○ The insured’s right to in-network cost-sharing for out-of-network benefits when an insurer fails to secure in-network care;
○ Where appointments/admissions are not available within 90 calendar days, that an insured shall be allowed to schedule the appointment/admission beyond this timeframe;
○ The insurer’s explicit responsibility to cover the entire course of medically necessary treatment;
○ Transitioning an insured to an in-network provider or facility should involve “clear and convincing evidence” that such a transition is in the best interest of the patient, and not for the convenience or cost-savings of the insurer.

● Explicit coverage requirements for crisis services, including those accessed through 988, including mandates that emergency crisis services be covered:

○ without medical necessity reviews;
○ without prior authorization;
○ without regard to provider network status; and
○ that insureds are subject to only in-network cost sharing on these claims.

● Requirements that utilization reviewers have appropriate qualifications. We support the Department’s inclusion of qualifications and standards for utilization reviewers conducting reviews on MHSUD claims. Utilization reviewers should have proper training and experience in the field of behavioral health care that is under review. We further appreciate the Department’s specificity on qualifications for SUD reviews, a field in which the practice of unqualified utilization reviewers results in disproportionately high denials for SUD care. We encourage the Department to consider adding such specificity for other specialty areas with high rates of denials, such as eating disorder care, gender affirming care, and treatment for autism spectrum disorders.

● Ensuring continuity of care by requiring insurers to bear the burden of demonstrating by clear and convincing evidence that ongoing MHSUD services arranged out-of-network (due to network inadequacy) are interrupted only in accordance with generally accepted standards of care. The Department’s explicit requirements that an insurer reimburse for the entire course of treatment is aligned with the intent of the law and the clinical standards for MHSUDs.

● Formal education programs, including requiring insurers to sponsor a formal education program created by relevant nonprofit professional associations. Ensuring insurers are using relevant nonprofit professional association trainings, as available, ensures alignment and proper use of clinical review criteria in the manner in which the clinical association intended. Such trainings should include targeted outreach and be made available to both in and out-of-network providers and facilities, as well as members.

● Transparency in utilization review and training, by requiring insurers make education materials, trainings, and utilization review criteria available to network providers, group policyholders, insureds and their authorized representatives, and out-of-network providers.

● Definition of health care provider that is aligned with statute and inclusive of often-denied providers such as associates and trainees. Providers continue to report claim denials when associates appropriately provide medically necessary services under existing laws. Aligning the definition of health care provider with how it is defined in statute makes unambiguous that the use of associate providers is permitted under the statute.

While the above-mentioned components of Rulemaking offer strong protections for insureds seeking MHSUD care, we provide the following comments to further bolster insureds’ rights and lessen their burden in obtaining medically necessary MHSUD care. We hope the Department will consider the following comments for inclusion in its Final Rulemaking.

● Coverage requirements for frequently denied care. While we appreciate the proposed Rule’s clarity on the exclusive use of nonprofit professional association utilization review criteria, we encourage the Department to consider listing coverage requirements for frequently denied services and levels of care.

● Frequency and duration of treatment reviews. 28 CCR 1300.74.721(d) states that “a health plan shall not conduct repeated utilization review of a case at intervals more frequent than those prescribed or recommended by the relevant nonprofit professional association criteria or guidelines.” We encourage the Department to adopt similar language limiting the frequency and duration of treatment reviews, to align with the statute’s definition of medically necessary treatments that are “clinically appropriate in terms of type, frequency, extent, site, and duration.”

● Out-of-state provider coverage for out-of-network care. While we support the Department’s specificity on insureds’ rights to out-of-network coverage, we request further specificity that insureds’ rights to arranging out-of-network care are not limited to in-state providers once a plan has failed to arrange for in-network coverage. The state has limited facilities appropriate for certain populations. For example, there is a shortage of longer-term residential facilities as well as high quality programs that can address needs of specific populations; the state’s Department of Education has responded well to this issue by creating a list of out-of-state schools that can additionally serve special youth populations under IEP. Out of state status should not be a disqualifying issue for receiving medically necessary MHSUD care if appropriate care cannot be found in-state.

● Inclusion of nonprofit clinical criteria for eating disorder care. The REDC Level of Care Criteria are the most detailed, up to date, clinical level of care guidelines for eating disorder care. These criteria define eating disorder levels of care and criteria for admission for each level of care and were vetted across clinical and research evidence as well as across the eating disorders field to gain clinical consensus. We encourage the Department to list these criteria as part of its allowed nonprofit clinical criteria.

● Instituting reporting requirements to track compliance including yearly insurer reporting requirements on timely access and out-of-network referrals. Regular data collection efforts will allow the Department to proactively identify compliance issues without relying on trends in insured complaints to understand violations of these laws.

● Distributing department-produced educational materials on SB 855 and AB 988 to insureds including know-your-rights materials. We additionally encourage the Department to add a requirement that health plans provide insureds with copies of these Department-produced materials to better ensure insureds receive such information, as well as including them in the Evidence of Coverage manual.

● Requiring plans to incorporate the list of services into their evidences of coverage. While we appreciate the requirements in the proposed rules related to evidences of coverage, we believe more should be required of plans in order to ensure that enrollees get access to necessary information regarding covered services. CDI should require plans to include a list of all the services outlined in Section 2562.05 in their evidences of coverage and to explain that all of those services are covered when meeting the medical necessity criteria. In addition, plans should be required to add a statement emphasizing that the list is not exhaustive and that other MHSUD services not listed in the evidence of coverage are covered when medically necessary.

● Allowed health care providers. Health plans and insurers often disallow certain eligible providers from providing and billing services; associates, trainees, and autism providers, for example, are frequently not considered eligible providers, despite their clear inclusion in statute, resulting in continued denials for claims for medically necessary MHSUD care under current law. We support the Department’s definition of “health care provider” and believe it is clearly inclusive of these often-denied providers. To ensure adherence to the statute, we request that the Department include clarifying language that confirms listed providers cannot be denied reimbursement for MHSUD services rendered on the basis of their provider status (as associates, trainees, etc.).

● Issuing Notices/Bulletins/General Counsel opinion letters upon adoption of final Rules regarding particular areas of enforcement concern.

We encourage the consideration of our above-stated comments and the swift promulgation of comprehensive regulations. Once again, we thank you for considering our comments and considerations for finalization of the proposed Rules. As always, our organizations stand ready to assist you in any way we can.

If you have any questions, please contact Lauren Finke (lauren@thekennedyforum.org). For matters requiring physical or printed communication, please send to 1121 L Street, Sacramento, California 95814 suite #300.

Sincerely,

Adrienne Shilton
California Alliance of Child and Family Services

Robb Layne
California Association of Alcohol and Drug Program Executives, Inc

Joy Alafia
California Association of Marriage and Family Therapists

Chad Costello
California Association of Social Rehabilitation Agencies

Tyler Rinde
California Psychological Association

Paul Yoder
California State Association of Psychiatrists

Danny Thirakul
California Youth Empowerment Network

Alison Ivie
Eating Disorders Coalition
REDC

Karen Fessel
Mental Health & Autism Insurance Project

Heidi Strunk
Mental Health America of California

Jessica Cruz, MPA/HS
National Alliance on Mental Illness

Héctor Hernández-Delgado
National Health Law Program

Benjamin Eichert
NUHW

Randall Hagar
Psychiatric Physicians Alliance of California

John Drebinger III
Steinberg Institute

Lauren Finke
The Kennedy Forum

CC:
Ricardo Lara, Stesha Hodges, Department of Insurance
Senator Scott Wiener
Assemblymember Bauer-Kahan

AB 2352 (Irwin) Mental health and psychiatric advance directives – Oppose unless amended

April 5, 2024

The Honorable Ash Kalra
Chair, Judiciary Committee
California State Assembly
1020 N Street, Suite 104
Sacramento, CA 95814

RE: AB 2352 (IRWIN) as Amended March 21, 2024 – OPPOSE UNLESS AMENDED

Dear Chair Kalra:

Disability Rights California (DRC) is California’s federally mandated protection and advocacy agency, working to advance and protect the rights of Californians with disabilities. Mental Health America of California (MHAC) is a peer-run organization leading the state in behavioral health public policy and advocacy since 1957. MHAC works to encourage hope, wellness and recovery from mental health and substance use disorders through voluntary services, delivered locally with compassion and respect for everyone’s dignity and autonomy.

We reluctantly submit this letter in opposition to AB 2352 (Irwin). We support psychiatric advance directives (PADs) and proudly sponsored AB 1029 (Pellerin), Chapter 171, Statutes of 2023, to promote their use. We understand from the author’s office that AB 2352 is intended to further the work of a seven-county Innovation Project sponsored by the Mental Health Services Oversight and Accountability Commission. DRC has been working with the project team and along with MHAC we suggest the bill be substantially amended to focus exclusively on what we understand to be the bill’s intent: create a legal framework to facilitate the testing and use of a digital platform which, in turn, will hopefully further promote the use of PADs.

BACKGROUND ON ADVANCE HEALTH CARE DIRECTIVES AND PADS

Many people are familiar with an Advance Health Care Directive, (AHCD) a legal document executed by a person in anticipation of medical decisions that may need to be made when the person lacks capacity to make those decisions. One example is a person facing surgery who wants to be sure their loved ones and health care providers know their treatment preferences if something unexpected occurs. An AHCD often, but not always, includes designation of an agent with power of attorney to make decisions.

A PAD is a type of AHCD. It may be a standalone document, or it may be included as part of an overall AHCD. A PAD specifies a person’s preferences regarding mental health treatment in the event of a future mental health crisis. This may include information about medications known to be effective, an individual’s preferences for emergency care, and more. PADs are demonstrated to reduce the need for coercive interventions during mental health crises and increase participants’ feelings of autonomy, self-determination and empowerment.¹

PADs can also improve mental health outcomes by facilitating conversations between mental health providers and an individual in mental health crisis. When psychological distress results in a mental health crisis, a person may be subjected to involuntary treatment, which can be traumatizing and demoralizing, and ultimately less effective than voluntary care, in part because treating providers lack knowledge about which services or treatments are likely to be most effective for an individual.

AB 2352 GOES FAR BEYOND CREATING THE NECESSARY FRAMEWORK FOR TESTING PADS

In numerous instances, AB 2352 goes far beyond what is needed to test a digital platform for PADs. In so doing, the bill pushes mental health policy away from the original intent of PADs.

AB 2352 increases the use of PADs in CARE Court. These sections should all be stricken from the bill.

We opposed CARE Court when it was enacted two years ago.² Among the reasons we sponsored AB 1029 last year was the surprise inclusion of PADs in CARE Court. Welfare and Institutions Code Section 5971 specifies the “graduation plan” in CARE Court may include a PAD. Because we believe CARE Court to be coercive, and because coercion has no place in a PAD, AB 1029 made sure PADs would fall under the Health Care Decisions law, which governs AHCDs. AB 2352 authorizes a CARE plan to include a PAD. The CARE plan is created early in a respondent’s CARE Court journey. Whether or not “graduation” is coercive, surely a CARE plan imposed on a respondent meets that definition. In addition, if a PAD is part of a CARE plan, how is the respondent’s right to privacy protected? Further, the bill contemplates the use of a health care advocate for PADs but with respect to CARE Court, appears to require (but at a minimum permits) that same health care advocate to also serve as the individual’s CARE supporter. This expansion of the health care advocate’s duties into CARE Court dramatically changes the duties of the advocate and risks changing the advocate’s role from neutral to coercive.

AB 2352 attempts to update California law post Proposition 1 by replacing “mental health” with “behavioral health” in numerous instances. These changes have unintended consequences. They should be removed from AB 2352 and considered in a separate bill that carefully and thoughtfully updates the law.

Proposition 1, passed by voters on March 5, 2024, renames the Mental Health Services Act (MHSA) as the Behavioral Health Services Act (BHSA). Prop 1 also renames the Mental Health Services Oversight and Accountability Commission (MHSOAC) as the Behavioral Health Services Oversight and Accountability Commission (BHSOAC). Beyond these changes, there is no wholesale substitution of “behavioral health” for “mental health” in the many sections of law amended by Proposition 1 containing the term “mental health.”

“Behavioral Health” is a broad term with many different definitions, but it generally refers to substance use disorders and mental health disorders of any severity. Some state laws and programs apply to mental health, some apply to mental health with co-occurring substance use disorders, and some apply to standalone “mild to moderate” substance use disorder or “severe” substance use disorder. The term “behavioral health” is not interchangeable with the term “mental health.” By replacing “mental health” with “behavioral health,” throughout statute, even beyond those code sections amended by Proposition 1, AB 2352 makes expansive changes to current law. At best these are unintended consequences, but they are problematic all the same. Below are some examples.

• AB 2352 substantially expands Assisted Outpatient Treatment

By changing “mental health” to “behavioral health” in the state’s Assisted Outpatient Treatment (AOT) law, the bill applies AOT to any person “suffering from a behavioral health illness.” AOT does not currently apply to people with a standalone SUD; any SUD must be co-occurring with mental illness. By applying AOT to standalone SUD, this proposed change opens the door to involuntary treatment for large numbers of Californians not currently eligible for AOT. Furthermore, this same section of the bill refers to Health & Safety Code Section 5600.3(b)(2) and (3) for the definition of “behavioral health illness,” but “behavioral health illness” is not defined in those paragraphs. This raises serious concerns, because if “behavioral health illness” is later defined within the Health &Safety Code, this definition would likely impact a vast number of other code sections in untold ways. Changes to current law this significant deserve careful consideration and public debate; they should not be dropped into a piece of legislation that may not receive a lot of scrutiny because it is viewed as simple code cleanup.

Along those lines, in this same section, we have concerns that by replacing “mental health professional” with “behavioral health professional”, we inadvertently allow licensed SUD counselors to refer individuals for AOT or determine whether an individual has capacity to consent to psychotropic medication. This should not be permitted.

•AB 2352 expands the LPS “gravely disabled” definition beyond what was enacted last year in SB 43.

The Legislature enacted SB 43 (Eggman), Chapter 637, Statutes of 2023 to, among other things, expand the definition of “gravely disabled” under the Lanterman Petris Short Act (LPS) to include individuals with “severe” SUD. Prior to SB 43, a person with SUD would be considered gravely disabled only in the presence of a co-occurring mental health disorder. The changes proposed by AB 2352, in replacing “mental health” with “behavioral health,” have the effect of expanding SB 43’s expansion to cover ANY substance use disorder, not just a SEVERE substance use disorder.

To add to the confusion of replacing “mental health” with “behavioral health,” section 36 (CARE Court) defines a licensed behavioral health professional as a licensed mental health professional. This makes no sense, and we see no purpose in changing the term “licensed mental health professional” anywhere in code.

Incorrect and confusing definitions and cross-references should be fixed or deleted.

There are many instances in the bill where the use of specific terms would add confusion to the law. This occurs most notably with the creation of a “health care advocate” for PADs. For example, the bill’s two definitions of “PAD” include a “health care advocate,” which appears to be optional in one instance and required in the other. In Section 10 of the bill, amendments to Probate Code Section 4674 require a signature by an ASSIGNED advocate and in Section 6 of the bill, amendments to Probate Code Section 4672 permit the NOMINATION of an advocate.

There are definitions for PAD and “health care advocate” in Section 42 of the bill with proposed amendments to Welfare and Institutions Code Section 21001. Other sections in the bill cross-reference Section 21001, which was added by AB 1663 (Maienschein), Chapter 894, Statutes of 2022. DRC sponsored AB 1663, which reformed probate conservatorships and provided a framework for supported decision making. The changes in AB 2352 are out of step with the statutory structure for supported decision making and appear to be unnecessary and confusing.

The bill establishes different witness requirements for a PAD and an AHCD. There is no identified reason for different requirements. Based on longstanding law, the requirements should remain the same.

Section 9 of the bill amends Probate Code Section 4673 related to legal sufficiency of AHCDs. Under existing law, AHCDs and PADs (which are a type of AHCD) would have the same witness signature requirements, i.e. two witnesses or a notary public. The bill eliminates the ability to use a notary for a PAD and requires only one witness. This makes no sense. There is no reason for a PAD, whether it is standalone or part of a larger AHCD, to have different witness requirements.

AB 2352 SHOULD FOCUS ON WHAT IS NEEDED FOR DIGITAL PADS TO BE TESTED UNDER THE INNOVATION PROJECT. CONFUSING, UNECCESARY AND EXPANSIVE CHANGES TO LAW SHOULD BE ELIMINATED

A PAD is a type of Advance Health Care Directive. It MAY be a standalone document, but this is not required. The bill blurs that point by including specific requirements, duplications and exemptions for PADS as compared to all AHCDs, which makes it seem all PADs will be standalone. This is a mistake. Existing AHCDs with or without an inclusive PAD, and existing standalone PADs, should not need updating because of this bill. For an example of an inclusive AHCD, the Veterans Administration offers a template that includes mental health in an advance directive.

At its heart, the bill seeks to create a framework for digital PADs. That is what the MHSOAC seven-county innovation project is all about. We support that intent but want to be sure everyone understands what a digital PAD is and how it is created, stored and accessed. This bill does not do that. The sponsor is using a proprietary platform in the innovation project. Will that become the standard? With MHSA Innovation funding eliminated by Proposition 1, how will counties sustain the digital platform long term? Will hospitals have to purchase the platform? Will there be competitors? Over the last ten years we have seen the challenges in implementing Electronic Medical Records under the Affordable Care Act. It is about more than digital signatures – it is the content in the platform. The bill needs to do a better job there so that a PAD can be easy to complete and may be accessed by specific entities, i.e. law enforcement and hospitals, when appropriate. Access does not mean all parts of a PAD are accessible to all who need parts of it. It is important to ensure law enforcement and health care providers each have access to only those portions of the PAD relevant for their jobs.

For these reasons, DRC and MHAC respectfully oppose this bill unless it is amended to address our concerns. Please contact us if you have any questions about our position or if I can provide any further information.

Sincerely,

Deb Roth
Senior Legislative Advocate
Disability Rights California

Karen Vicari
Director of Public Policy
Mental Health American of California

cc: Honorable Members, Assembly Judiciary Committee
The Honorable Jacqui Irwin, California State Assembly
The Honorable Gail Pellerin, California State Assembly
Alison Merrilees, Assembly Judiciary Committee
Charmaine Mills, Office of Assemblymember Pellerin

¹ Murray H & Wortzel HS. Psychiatric Advance Directives: Origins, Benefits, Challenges, and Future Directions. Journal of Psychiatric Practice, 2019;25(4):303-0

² SB 1338 (Eggman), Chapter 319, Statutes of 2022.

SB 999 (Cortese) Mental Health and Substance Use Disorders Health Coverage – Support

March 18, 2024

The Honorable Dave Cortese
California State Senate
1021 O Street, Suite 6630
Sacramento, CA 95814

RE: Senate Bill 999 (Cortese) — Support

Dear Senator Cortese:

Mental Health America of California (MHAC) is a peer-run organization leading the state in behavioral health public policy and advocacy since 1957. The mission of MHAC is to assist and encourage communities, families and individuals to experience hope, wellness and recovery from mental health and substance use disorder issues through voluntary services that are delivered in their local community with compassion and respect for everyone’s dignity and autonomy. MHAC is pleased to support Senate Bill 999 (Cortese), legislation which would increase access to mental health and substance use disorder care.

SB 999 (Cortese) ensures utilization review determinations are made by a healthcare provider practicing in the relevant clinical specialty with the same level of education and experience as the health care provider requesting the authorization. By ensuring that individuals making the utilization review determination have relevant experience and knowledge as a provider, a more informed decision can be made about the necessity of the request, which can lead to more individuals receiving the care they want and need.

Additionally, this bill requires health plans or insurers to provide direct access and communication between health plans or insurers and health care providers. Increasing access to direct communication reduces the time it takes to conduct a utilization review and increases the delivery of care in a timely manner.

Furthermore, the legislation guarantees certain rights to healthcare providers and health plan enrollees such as the name and credentials of the individual or health care provider performing utilization review, the basis for a denial including citations to the clinical guidelines reviewed, and an analysis of why the health plan enrollee did not meet the clinical criteria. Should a utilization review result in denial, a health plan enrollee can appeal using the provided information, empowering individuals to self-advocate for their care.

For these reasons, we support Senate Bill 999 (Cortese). If you or your staff have any questions, or if Mental Health America of California can be of any assistance on this or any other behavioral health bill, please do not hesitate to contact me at hstrunk@mhac.org, or our Director of Public Policy, Karen Vicari at kvicari@mhacofca.org.

In Community,

Heidi Strunk
President & CEO
Mental Health America of California

AB 3260 (Pellerin) Review and Grievance Protocol – Support

March 29, 2024

The Honorable Mia Bonta
Chair, Assembly Health Committee
1020 N Street, Room 390
Sacramento, CA 95814

Re: AB 3260 (Pellerin) – SUPPORT

Dear Chair Bonta:

The California Youth Empowerment Network (CAYEN) is writing to express our support of AB 3260 (Pellerin), which will improve transparency and provide due process for consumers filing grievances and regulatory complaints concerning access to care, denied health care services, and coverage disputes.

CAYEN is a youth-led statewide network comprised of TAY Action Teams and CAYEN Board members which engages, empowers and represents Transitional Age Youth (TAY), ages 15-26, in mental health advocacy on issues that directly affect TAY. Since CAYEN’s inception in 2006, CAYEN has taken many forms of action to empower TAY in their personal lives and spark progressive change in public policy. We firmly believe that transparency and a more effective due process is essential for ensuring the well-being and rights of all consumers, particularly TAY who are navigating complex mental health systems.

Far too often, when commercially insured patients seek treatment for behavioral health or substance use disorders, health plans exceed required timeframes for approving care requests, fail to provide access to care within legally mandated timelines, or deny requests that should be covered—even when the patient’s condition is urgent. Consumers can seek recourse, but grievance procedures are slow and opaque and frequently result in patients neither receiving timely treatment nor receiving due process when they register complaints. California’s groundbreaking behavioral health parity (SB 855) and timely access laws (SB 221) could address this crisis if consumers were able to more fully enforce them. AB 3260 can empower TAY to do just that.

Unfortunately, health plans do not consistently decide or provide proper notice of decisions concerning claims such as prior authorization based on medical necessity, urgency, and/or access to care, nor do they address grievances within the timeframes and manner specified by law. This leads consumers either to pay out of pocket while waiting for health plans to respond or to go without treatment altogether.

AB 3260 would address these issues by prohibiting health plans and disability insurers from overriding a provider’s designation of a condition as urgent, which can result in improper and dangerous delays in care It would tighten the timelines health plans have to approve/deny requests for care, and trigger an immediate grievance if a health plan fails to respond in a timely manner. If a health plan or disability insurer fails to adjudicate a grievance within mandated timeframes, it would automatically resolve in the patient’s favor. The bill will also expand due process rights to patients and prohibit ex parte communication between departments and parties to regulatory complaints, as well as further harmonize state law with federal law.

AB 3260 improves transparency and due process for consumers to ensure they have recourse when they are denied timely access to the appropriate care they are entitled to receive under the law, by health insurance for which they have already paid. For these reasons, we support AB 3260 (Pellerin), and we respectfully request an “AYE” vote. If you have any questions, or if CAYEN can provide any assistance on this bill or any other behavioral health legislation, please do not hesitate to contact me at dthirakul@mhac.org.

Sincerely,

Danny Thirakul
Public Policy Coordinator

AB 2466 (Carrillo) Timely Access to Behavioral Health Services for Medi-Cal Recipients – Support

April 5, 2024

The Honorable Mia Bonta
Chair, Assembly Health Committee
California State Assembly
1020 N Street, Room 390
Sacramento, CA 95814

Re: Support for AB 2466 (Carrillo)

Dear Chair Bonta:

Mental Health America of California (MHAC) is pleased to support AB 2466 (Carrillo), legislation which would improve timely access to behavioral health services for Medi-Cal recipients by strengthening appointment standards, establishing repercussions for non-compliance, and establishing requirements for data collection and reporting.

Delays in the delivery of services can mean the difference between managing one’s mental health challenges and experiencing a mental health crisis. According to an audit of the Department of Managed Health Care, non-urgent appointments had an average wait time of 23 days, surpassing the standard time frame by nearly two weeks.[1] Urgent appointments saw an average wait time of 13 days, exceeding the standard urgent appointment time frame by 9 days.

AB 2466 (Carillo) aims to address these delays and ensure accountability among Medi-Cal managed health plans. For these reasons we support AB 2566 and ask for your “Aye” vote. If you have any questions, or if MHAC can provide any assistance on this bill or any other behavioral health legislation, please do not hesitate to contact me or our Interim Public Policy Director, Karen Vicari, at kvicari@mhaofca.org.

In Community,

Heidi L. Strunk
President & CEO

[1] Department of Health Care Services and Department of Managed Health Care. Report 2023-115. (n.d.). https://www.auditor.ca.gov/reports/2023-115/index.htm l

AB 2417 (Hoover) Repealing Housing First – Oppose

March 18, 2024

The Honorable Christopher M. Ward
Chair, Assembly Committee on Housing and Community Development
1020 N Street, Room 156
Sacramento, CA 95814

RE: Opposition of AB 2417 (Hoover)

Dear Assemblymember Ward,

Mental Health America of California (MHAC) writes in opposition to AB 2417 (Hoover), legislation that would repeal Housing First policies and the requirement of state agencies and departments to incorporate the core components of Housing First.

MHAC is a peer-run organization leading the state in behavioral health public policy and
advocacy since 1957. The mission of MHAC is to assist and encourage communities, families and individuals to experience hope, wellness and recovery from mental health and substance use disorder issues through voluntary services that are delivered in their local community with compassion and respect for everyone’s dignity and autonomy. Housing First plays a vital role in advancing MHAC’s mission and vision of enhancing individual recovery by safeguarding and emphasizing housing and services for homeless individuals facing behavioral health challenges.

Many unhoused individuals are susceptible to substance use and mental health challenges while living on the streets. An analysis of the U.S. Department of Housing and Urban Development’s Continuum of Care Program found that 25% of unhoused Californian’s have a mental health challenge.[1] As California continues to invest in resources that best support our unhoused community, housing remains the most effective tool in getting people off the street and connected to mental and behavioral health services.

Housing First reduces obstacles for unhoused individuals to access housing assistance and shields them from eviction stemming from their behavioral health issues. These safeguards encompass shielding individuals from housing discrimination, irrespective of their substance use, treatment history, or engagement in services. Additionally, it ensures protection from eviction solely based on alcohol or drug use, without the presence of other lease violations.

It is for these reasons we oppose AB 2417 (Hoover) and ask for your “No” vote. If you have any questions, or if MHAC can provide any assistance on this bill or any other behavioral health legislation, please do not hesitate to contact me or our Interim Public Policy Director, Karen Vicari, at kvicari@mhaofca.org.

In Community,

Heidi L. Strunk
President & CEO

[1] U.S. Department of Housing and Urban Development. (n.d.). CoC Homeless Populations and Subpopulations Reports. Welcome to HUD Exchange – HUD Exchange. https://www.hudexchange.info/programs/coc/coc-homeless-populations-and-subpopulations-reports /

AB 2161 (Arambula) Early Psychosis Intervention Plus Program – Support

May 31, 2024

The Honorable Joaquin Arambula
California State Assembly
1021 O Street, Suite 6130
Sacramento, CA 95814

RE: Support for AB 2161 (Arambula)

Dear Assemblymember Arambula,

Mental Health America of California (MHAC) is pleased to support Assembly Bill 2161, legislation which would require the Behavioral Health Services Oversight and Accountability Commission and the State Department of Health Care Services to create a strategic plan to achieve specific goals, including improving the understanding of psychosis. Additionally, it would seek to partner with the University of California to develop a plan to establish the Center for Mental Health Wellness and Innovations to promote the widespread availability of evidence-based practices to improve behavioral health services.

MHAC is a peer-run organization leading the state in behavioral health public policy and advocacy since 1957. The mission of MHAC is to assist and encourage communities, families and individuals to experience hope, wellness and recovery from mental health and substance use disorder issues through voluntary services that are delivered in their local community with compassion and respect for everyone’s dignity and autonomy. We are proud to support early psychosis and mood disorder detection, enabling the state to invest in voluntary services and support before crises arise.

Early interventions can lead to significant long-term health benefits. Upstream preventative services have demonstrated effectiveness in reducing the need for inpatient care, allowing individuals to remain in their local communities, closer to home. Furthermore, providing resources and services as early as possible helps support children and youth development to better manage their mental health challenges leading to more productive and full lives.

For these reasons we support AB 2161 (Arambula). If you have any questions, or if MHAC can provide any assistance on this bill or any other behavioral health legislation, please do not hesitate to contact me or our Public Policy Director, Karen Vicari, at kvicari@mhaofca.org.

In Community,

Heidi L. Strunk
President & CEO