Oversight And Accountability - Community Mental Health Services - CA Welfare And Institutions

Section § 5845

This law establishes the Behavioral Health Services Oversight and Accountability Commission to drive improvements in California's behavioral health system through research and assessments. It replaces a former advisory committee and is composed of 27 voting members with diverse backgrounds in health, government, and community services. The Governor appoints some members, focusing on those with personal or family experience with mental health and substance use disorders.

Members serve three-year terms without pay but are reimbursed for expenses, and the commission is managed by an Executive Director. The commission's duties include holding public meetings, employing necessary staff, establishing advisory committees, entering into contracts, and collaborating with various state agencies.

Key functions of the commission involve providing technical assistance to counties, advising the Governor and Legislature, and promoting strategies to reduce mental health stigma. The commission also seeks to enhance workplace mental health standards and will issue a report on promising behavioral health practices by 2030.

This law will be active on January 1, 2025, contingent upon voter-approved amendments to the Mental Health Services Act in 2024.

(a) The Behavioral Health Services Oversight and Accountability Commission is hereby established to promote transformational change in California’s behavioral health system through research, evaluation and tracking outcomes, and other strategies to assess and report progress. The commission shall use this information and analyses to inform the commission’s grant making, identify key policy issues and emerging best practices, provide technical assistance and training, promote high-quality programs implemented, and advise the Governor and the Legislature, pursuant to the Behavioral Health Services Act and related components of California’s behavioral health system. For this purpose, the commission shall collaborate with the California Health and Human Services Agency, its departments and other state entities.

(b)

(1) The commission shall replace the advisory committee established pursuant to Section 5814.

(2) The commission shall consist of 27 voting members as follows:

(A) The Attorney General or the Attorney General’s designee.

(B) The Superintendent of Public Instruction or the Superintendent’s designee.

(C) The Chairperson of the Senate Committee on Health, the Chairperson of the Senate Committee on Human Services, or another member of the Senate selected by the President pro Tempore of the Senate, or their designee.

(D) The Chairperson of the Assembly Committee on Health, the Chairperson of the Assembly Committee on Human Services, or another Member of the Assembly selected by the Speaker of the Assembly, or their designee.

(E)

(i) The following individuals, all appointed by the Governor:

(I) Two persons who have or have had a mental health disorder.

(II) Two persons who have or have had a substance use disorder.

(III) A family member of an adult or older adult who has or has had a mental health disorder.

(IV) One person who is 25 years of age or younger and has or has had a mental health disorder, substance use disorder, or cooccurring disorder.

(V) A family member of an adult or older adult who has or has had a substance use disorder.

(VI) A family member of a child or youth who has or has had a mental health disorder.

(VII) A family member of a child or youth who has or has had a substance use disorder.

(VIII) A current or former county behavioral health director.

(IX) A physician specializing in substance use disorder treatment, including the provision of medications for addiction treatment.

(X) A mental health professional.

(XI) A professional with expertise in housing and homelessness.

(XII) A county sheriff.

(XIII) A superintendent of a school district.

(XIV) A representative of a labor organization.

(XV) A representative of an employer with less than 500 employees.

(XVI) A representative of an employer with more than 500 employees.

(XVII) A representative of a health care service plan or insurer.

(XVIII) A representative of an aging or disability organization.

(XIX) A person with knowledge and experience in community-defined evidence practices and reducing behavioral health disparities.

(XX) A representative of a children and youth organization.

(XXI) A veteran or a representative of a veterans organization.

(ii) In making appointments, the Governor shall seek individuals who have had personal or family experience with mental illness or substance use disorder.

(c) Members shall serve without compensation but shall be reimbursed for all actual and necessary expenses incurred in the performance of their duties.

(d) The term of each member shall be three years, to be staggered so that approximately one-third of the appointments expire in each year.

(e)

(1) The commission shall have an Executive Director.

(2) The Executive Director will be responsible for management over the administrative, fiscal, and program performance of the commission.

(3) The Executive Director shall be selected by the commission.

(4) The commission may delegate to the Executive Director any power, duty, purpose, function, or jurisdiction that the commission may lawfully delegate, including the authority to enter into and sign contracts on behalf of the commission. The Executive Director may redelegate any of those powers, duties, purposes, functions, or jurisdictions to the Executive Director’s designee, unless by statute, or rule or regulation, the Executive Director is expressly required to act personally.

(f) In carrying out its duties and responsibilities, the commission may do all of the following:

(1)

(A) Meet at least once each quarter at a time and location convenient to the public as it may deem appropriate.

(B) 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 clerical, legal, and technical assistance, as necessary.

(3) The commission shall administer its operations separate and apart from the State Department of Health Care Services and the California Health and Human Services Agency.

(4) Establish technical advisory committees, such as a committee of consumers and family members, and a reducing disparities committee focusing on demographic, geographic, and other communities. The commission may provide pertinent information gained from those committees to relevant state agencies and departments, including, but not limited to, the California Health and Humans Services Agency and its departments.

(5) 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 authority expressly granted to an officer or employee of state government.

(6) Enter into contracts.

(7) Make reasonable requests for data and information to the State Department of Health Care Services, the Department of Health Care Access and Information, the State Department of Public Health, or other state and local entities that receive Behavioral Health Services Act funds. These entities shall respond in a timely manner and provide information and data in their possession that the commission deems necessary for the purposes of carrying out its responsibilities.

(8) Participate in the joint state-county decisionmaking process, as described in Section 4061, for training, technical assistance, and regulatory resources to meet the mission and goals of the state’s mental health system.

(9) Identify best practices to overcome stigma and discrimination, in consultation with the State Department of Public Health.

(10) 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 or substance use disorder.

(11) If the commission identifies a critical issue related to the performance of a county mental health program, it may refer the issue to the State Department of Health Care Services pursuant to Section 5655 or 5963.04.

(12) Provide technical assistance to counties on implementation planning, training, and capacity building investments as defined by the State Department of Health Care Services and in consultation with the County Behavioral Health Directors Association of California. Technical assistance may also include innovative behavioral health models of care and innovative promising practices pursuant to subparagraph (A) of paragraph (4) of subdivision (a) of Section 5892. Technical assistance may also include compiling and publishing a list of innovative behavioral health models of care programs and promising practices for each of the programs set forth in subparagraphs (1), (2), and (3) of subdivision (a) of Section 5892.

(13) Work in collaboration with the State Department of Health Care Services to define the parameters of a report that includes recommendations for improving and standardizing promising practices across the state based on the technical assistance provided to counties as specified in paragraph (12). The commission shall prepare and publish the report on its internet website. In formulating this report, the commission shall prioritize the perspectives of the California behavioral health community through a robust public engagement process with a focus on priority populations and diverse communities.

(14) Establish a framework and voluntary standard for mental health in the workplace that serves to reduce mental health stigma, increase public, employee, and employer awareness of the recovery goals of the Mental Health Services Act, and provide guidance to California’s employer community to put in place strategies and programs, as determined by the commission, to support the mental health and wellness of employees. The commission shall consult with the Labor and Workforce Development Agency or its designee to develop the standard.

(g)

(1) The commission shall work in collaboration with the State Department of Health Care Services and the California Behavioral Health Planning Council, and in consultation with the County Behavioral Health Directors Association of California, to write a report that includes recommendations for improving and standardizing promising practices for Behavioral Health Services Act programs.

(2) The commission shall complete the report and provide a written report on its internet website no later than January 1, 2030, and every three years thereafter.

(h) For purposes of this section, “substance use disorder” shall have the meaning as defined in subdivision (c) of Section 5891.5.

(i) This section shall become operative on January 1, 2025, if amendments to the Mental Health Services Act are approved by the voters at the March 5, 2024, statewide primary election.

Behavioral Health Services Oversight Accountability Commission mental health disorders substance use disorder public meetings Executive Director commission membership technical assistance Governor appointments advising legislature behavioral health system improvement stigma reduction workplace mental health reporting and recommendations Mental Health Services Act amendments

(Amended (as added by Stats. 2023, Ch. 790, Sec. 58) by Stats. 2024, Ch. 40, Sec. 41. (SB 159) Effective June 29, 2024. Operative January 1, 2025, by its own provisions.)

Section § 5845.1

This law establishes the Behavioral Health Services Act Innovation Partnership Fund, which is meant to support grants for innovative mental health and substance use disorder programs. The fund can receive money from private donations, federal and state grants, and interest earned. The grants, distributed by the Behavioral Health Services Oversight and Accountability Commission, aim to improve services for underserved, low-income, and other affected communities while meeting state mental health goals.

The commission must consult with relevant state health agencies to determine how funds are used, especially if directed toward prevention or workforce innovation. A report on the funded initiatives' effectiveness is required to be submitted to the Legislature every three years starting in 2030, highlighting how they meet the goals of serving targeted populations and improving services.

(a)

(1) The Behavioral Health Services Act Innovation Partnership Fund is hereby created in the State Treasury.

(2) The fund shall be administered by the state for the purposes of funding a grant program administered by the Behavioral Health Services Oversight and Accountability Commission pursuant to this section and subdivision (f) of Section 5892.

(b) All of the following may be paid into the fund:

(1) Any private donation or grant.

(2) Any other federal or state grant.

(3) Any interest that accrues on amounts in the fund and any moneys previously allocated from private donations or grants received by the fund that are subsequently returned to the fund.

(c)

(1) The Behavioral Health Services Oversight and Accountability Commission shall award grants to private, public, and nonprofit partners to promote development of innovative mental health and substance use disorder programs and practices.

(2) The innovative mental health and substance use disorder programs and practices shall be designed for the following purposes:

(A) Improving Behavioral Health Services Act programs and practices funded pursuant to subdivision (a) of Section 5892 for the following groups:

(i) Underserved populations.

(ii) Low-income populations.

(iii) Communities impacted by other behavioral health disparities.

(iv) Other populations, as determined by the Behavioral Health Services Oversight and Accountability Commission.

(B) Meeting statewide Behavioral Health Services Act goals and objectives.

(3) The Behavioral Health Services Oversight and Accountability Commission, in determining the allowable uses of the funds, shall consult with the California Health and Human Services Agency and the State Department of Health Care Services. If the Behavioral Health Services Oversight and Accountability Commission utilizes funding for population-based prevention or workforce innovation grants, the commission shall consult with the State Department of Public Health for population-based prevention innovations and the Department of Health Care Access and Information for workforce innovations.

(d)

(1) The Behavioral Health Services Oversight and Accountability Commission shall submit a report to the Legislature by January 1, 2030, and every three years thereafter. The report shall cover the three-fiscal-year period immediately preceding the date of submission.

(2) The report shall include the practices funded pursuant to this section and the extent to which they accomplished the purposes specified in paragraphs (1), (2), and (3) of subdivision (b).

(3) A report to be submitted pursuant to paragraph (1) shall be submitted in compliance with Section 9795 of the Government Code.

Behavioral Health Services Act Innovation Partnership Fund mental health grants substance use disorder Behavioral Health Services Oversight and Accountability Commission underserved populations low-income support mental health innovation population-based prevention workforce innovation California Health and Human Services Agency State Department of Health Care Services State Department of Public Health grant program behavioral health disparities

(Amended by Stats. 2024, Ch. 40, Sec. 42. (SB 159) Effective June 29, 2024.)

Section § 5845.5

This law lets the commission set up a fellowship program focused on mental health and substance use disorders. The program offers hands-on learning for both consumers and professionals in these fields. Fellows can only participate for one year. The program aligns with the commission's broad goals, aiming to incorporate real-world experiences and improve understanding of mental health and substance use issues. An advisory committee will assist in guiding the program, ensuring it reflects diverse perspectives. The commission can work with other entities to support the program's setup and operation, but it can't result in losing jobs for existing civil service employees. It starts in January 2025, if voters approve changes to the Mental Health Services Act in March 2024.

In addition to the activities authorized under Section 5845, the commission may establish a fellowship program in accordance with this section for the purpose of providing an experiential learning opportunity for mental health or substance use disorder consumers and mental health or substance use disorder professionals.

(a) Participants in the fellowship shall serve on an annual basis and may serve only one term as a fellow.

(b) The fellowship program established under this section shall support the broad goals of the commission and be based upon the following principles:

(1) To enhance opportunities for the work of the commission to reflect the perspective of persons with personal experience and state-of-the-art practices in the mental health and substance use disorder fields.

(2) To strengthen opportunities for the goals of the Behavioral Health Services Act and the work of the commission in promoting those goals and to be accessible and understandable to mental health and substance use disorder individuals, mental health and substance use disorder professionals, and the general public.

(3) To improve opportunities for outreach and engagement with individuals who have a mental health disorder or a substance use disorder and mental health and substance use disorder professionals relating to the work of the commission.

(4) To increase the awareness of mental health and substance use disorder individuals and professionals of the goals of the Behavioral Health Services Act and both of the following:

(A) The role of the state in meeting those goals.

(B) The role of public policy, regulation development, fiscal strategies, use of data, research, and evaluation and communication strategies to improve mental health and substance use disorder outcomes in California.

(c)

(1) The commission shall establish an advisory committee to provide guidance on the fellowship program goals, design, eligibility criteria, application process, and other issues as the commission deems necessary.

(2) The advisory committee shall include persons with personal experience with the mental health and substance use disorder system, mental health and substance use disorder professionals, persons with experience with similar fellowship programs, and others with diverse perspectives who can assist the commission to meet the goals of the fellowship program.

(d) The commission may enter into an interagency agreement or other contractual agreement with a state, local, or private entity, as determined by the commission, to receive technical assistance or relevant services to support the establishment and implementation of the fellowship program.

(e)

(1) The commission shall ensure that the fellowship program does not cause the displacement of a civil service employee.

(2) For purposes of this subdivision, “displacement” means a layoff, a demotion, an involuntary transfer to a new class, an involuntary transfer to a new location requiring a change of residence, a time base reduction, a change in shift or days off, or a reassignment to another position within the same class and general location.

(f) This section shall become operative on January 1, 2025, if amendments to the Mental Health Services Act are approved by the voters at the March 5, 2024, statewide primary election.

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(Repealed (in Sec. 60) and added by Stats. 2023, Ch. 790, Sec. 61. (SB 326) Effective October 12, 2023. Operative January 1, 2025, by its own provisions.)

Section § 5845.8

This law requires a commission to report every two years to specific California legislative committees about the outcomes of community mental health services provided under a full service partnership model. The first report was due by November 15, 2022, and the commission can also submit progress reports if deemed necessary.

The report should include data on eligible individuals, covering topics like incarceration, housing or homelessness, and healthcare service use, such as hospitalization. It must also analyze why some individuals leave the programs and track their outcomes over the following year. The degree to which those in need access and remain in these services must also be assessed.

Additionally, the commission will highlight any obstacles encountered in gathering necessary data and make recommendations for improving the full service partnerships. The commission must collaborate with the mental health community, including consumers, relatives, and experts, in generating this report.

(a) The commission shall biennially report to the Senate and Assembly Committees on Health, Senate Budget Subcommittee on Health and Human Services, and Assembly Budget Subcommittee on Health and Human Services the outcomes for those receiving community mental health services under a full service partnership model. The initial report shall be submitted no later than November 15, 2022. The commission may also issue a progress report in a year when it is not otherwise due if the commission deems the report to be necessary.

(b) The report shall include, but not be limited to, information regarding persons eligible for full service partnerships, including summary information relating to enrollees and nonenrollees with respect to the community mental health services they receive and their experience with all of the following:

(1) Incarceration or criminalization.

(2) Housing status or homelessness.

(3) Hospitalization, emergency room utilization, and crisis service utilization.

(c) The report shall also include information regarding individuals who separate from a full service partnership, including, but not limited to, analysis of the reasons for separation and, to the extent possible, the community mental health services received and the statuses or experiences of these individuals regarding the outcomes identified in subdivision (b) for a period of 12 months following separation.

(d) The report shall also assess the degree to which the individuals most in need are accessing services and maintaining participation in a full service partnership or other programs providing similar services.

(e) The commission shall report any barriers to receiving the data relevant to completing this report and include recommendations to strengthen California’s use of full service partnerships to reduce incarceration, hospitalization, and homelessness.

(f) In doing this work, the commission shall consult with the California mental health community, including, but not limited to, consumers, relatives of consumers, providers, and other subject matter experts.

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(Added by Stats. 2021, Ch. 544, Sec. 1. (SB 465) Effective January 1, 2022.)

Section § 5847

This law outlines the requirements for county mental health programs in California to submit a three-year program and expenditure plan, along with annual updates, to both the state and the Mental Health Services Oversight and Accountability Commission. These plans should address prevention, early intervention, and services for children, adults, and seniors, as well as innovative programs and technological needs.

Plans must be based on available funds and estimated revenues, and involve community engagement. Counties must also certify compliance with fiscal and stakeholder participation requirements. Special provisions apply for fiscal years affected by the COVID-19 public health emergency, allowing the use of reserve funds for certain mental health programs.

The law also requires addressing personnel shortages and maintaining a reserve to ensure continuous service despite financial fluctuations. Amendments at the state level could make this law inoperative if approved by voters in 2024.

Integrated Plans for Prevention, Innovation, and System of Care Services.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

(h)

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

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

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

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

(k) If amendments to the Mental Health Services Act are approved by the voters at the March 5, 2024, statewide primary election, this section shall become inoperative on July 1, 2026, and as of January 1, 2027, is repealed.

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(Amended (as amended by Stats. 2023, Ch. 790, Sec. 63) by Stats. 2024, Ch. 40, Sec. 43. (SB 159) Effective June 29, 2024. Operative January 1, 2025, pursuant to Sec. 85 of Stats. 2024, Ch. 40. Inoperative July 1, 2026, by its own provisions. Repealed as of January 1, 2027, by its own provisions.)