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Volume 2, Issue 46 - November 18, 2022

Establishing a Right to Care in California

Should Housing, Mental Health and Substance Use Services Be a Right in California?

The Steinberg Institute and its founder, Darrell Steinberg, has invited CSAP to participate in a conversation about what it would take in California to make mental health and substance use services an entitlement for all those who need care. 

The Steinberg Institute states, “Over the course of the previous eight legislative sessions here in California we have been honored to work with several of you on some of our most ambitious efforts.  As we continue to seek solutions to an ever growing crisis, we would like to spend uninterrupted time with you to hear your thoughts as we begin crafting legislation to establish such a right to mental health and substance use care for all Californians.

We believe that establishing a legally enforceable right to care will fundamentally shift the state's approach to mental health by compelling  proactive effort to ensure access to a comprehensive set of services and supports. We propose establishing a mandatory minimum set of services accessible to all regardless of insurance type or place of residence that the state would be responsible for guaranteeing, accompanied by a legal remedy to hold the state accountable. 

In an article published in Cal Matters on homelessness in August of this year, our founder put a fine point on the need to define the obligations of our city, county, and state governments to ensure needed services are provided. 

“Despite successes along the way, unprecedented resources from Gov. Newsom and the Legislature, and heroic providers who have helped thousands navigate their way out of homelessness, the fundamental problem remains the same. The law describes no timetables, production requirements or even individualized obligations to help. There is no requirement for cities and counties — very different systems with different historic roles and responsibilities — to work together to solve the problem.”

Some of the key questions we’d like to talk with you about include:
  • What should the minimum set of services be as part of a right to care?  Are there models we can look to as we establish what this standard set of services should include?
  • For Medicaid services, do you see any gaps or implementation challenges in CalAIM that could be addressed through legislation to support a right to care?
  • What barriers do you experience in trying to deliver services to people who need care in California?” 

Will funding be on the table in this discussion? CSAP’s advocates at SYASL have already inquired and the response has been yes it can. 2023 is already shaping up to be another lively year for mental health and substance use legislation in California.

AB 890 Regulations

The Board of Registered Nursing met this week and discussed the AB 890 regulations. You can view the agenda here, and SYASL staff notes here. The newly adopted regulations clarify that the clinical practice experience required to become a 103 or 104 NP must be completed in the five years prior to the date the NP applies for the new certification. Also, clinical practice experience must be in direct patient care in the category the NP seeks certification. However, the nursing board has chosen to recognize work experience completed prior to passage of the regulations, despite the fact that this clinical experience was not directly in preparation for independent practice.

CSAP and SYASL have been hard at work – sometimes alone, sometimes in cooperation with other like-minded organizations in California – helping doctors and practices work through various billing / reimbursement issues with the health plans. CSAP’s relationship with the State Department of Managed Health Care (DMHC) is producing results. Two specifics that CSAP has recently become aware of:
  • TINs (tax identification numbers; “Tax IDs”) getting flagged such that every single note sent by a practice is getting audited. For one practice this has led to the denial of about 1,500 charges going back to July 2021. When charges are denied, the plans merely say, “insufficient documentation” and administrative staff have to get on the phone to figure out what is happening. In some cases, this practice even included start and stop time and were still denied. 
  • Enrollees being forced to go back in-network after out-of-network services were arranged (due to lack of initial timely access to in-network care), forcing interruptions in a course of treatment. Reminder: SB 855 requires plans to arrange out-of-network services at in-network cost-sharing if in-network services aren't available within timely access and distance standards. These cases involve psychotherapy where plans are attempting to force enrollees back in-network after therapy has just begun out-of-network. DMHC had indicated they wouldn't allow plans to just interrupt a course of treatment in this manner. 
If you have similar experiences, please notify Paul Yoder at SYASL immediately: SYASL is having almost daily conversations with the DMHC progress is being made. If you can help with additional examples in these instances or any others, please do!
CARE Court 

You may view draft instructions for counties from Judicial Counsel here. We have learned the Probate and Mental Health Advisory Committee will have significant influence over CARE court forms and implementation. You may also find court forms here
Certified Community Behavioral Health Clinics  

Last night, the CSAP Governmental Affairs Committee (GAC) considered whether to urge California to apply for Certified Community Behavioral Health Clinic Planning Grants. A Certified Community Behavioral Health Clinic (CCBHC) model is designed to ensure access to coordinated comprehensive behavioral health care. CCBHCs are required to serve anyone who requests care for mental health or substance use, regardless of their ability to pay, place of residence, or age - including developmentally appropriate care for children and youth. CCBHCs must meet standards for the range of services they provide, and they are required to get people into care quickly. An important feature of the CCBHC model is that it requires crisis services that are available 24 hours a day, 7 days a week. CCBHCs are required to provide a comprehensive array of behavioral health services so that people who need care are not caught trying to piece together the behavioral health support they need across multiple providers. In addition, CCBHCs must provide care coordination to help people navigate behavioral health care, physical health care, social services, and the other systems they are involved in. CCBHCs can be supported through the CCBHC Medicaid Demonstration, through SAMHSA administered CCBHC Expansion (CCBHC-E) Grants, or through independent state programs. CCBHCs have demonstrated increased hiring and retention of medical directors, psychiatrists, and child and adolescent psychiatrists, as well as other vital behavioral health care staff with subsequent decreases in appointment wait times, especially for underserved populations. The GAC voted to recommend that CSAP send a letter urging the State to apply. The Board concurred. You may view more information on CCBHCs here
Funding Opportunities  

Mobile Crisis Services 

Regarding the new Medi-Cal mobile crisis services benefit, in October 2022, DHCS submitted to the Centers for Medicare and Medicaid Services (CMS) State Plan Amendment (SPA) 22-0043 that establishes mobile crisis services as a new benefit in the Medi-Cal program (SPA 22-0043 is still pending federal approval). Medi-Cal behavioral health delivery systems may begin implementing the mobile crisis services benefit as soon as January 1, 2023, and shall have the benefit fully implemented by December 31, 2023. Mobile crisis services are an integral part of California’s efforts to strengthen the continuum of community-based care for individuals who experience behavioral health crises. DHCS requests stakeholders submit feedback to by 11:59pm PT on Tuesday, November 22nd.

CalAIM Behavioral Health Workgroup

DHCS has released a RFA totaling $51.3 million for the California Hub and Spoke System (CA H&SS) for project activities from January 1, 2023, through June 30, 2024. CA H&SS will improve access to medication-assisted treatment (MAT) for marginalized populations; improve MAT provider infrastructure and expand service hours and appropriate telehealth services; and broaden the concept of the patient population from an individual to include the family to maximize recovery capital, support family resiliency, and destigmatize treatment. Entities may apply to receive up to $1 million annually to fund the prevention, assessment, diagnosis, treatment, and recovery of opioid and substance use disorders. The RFA is posted on the
Advocates for Human Potential website.

Bridge Navigator Program-Final Round of Applications

Due to high demand, there will be one more round of applications for the CalBridge Behavioral Health Navigator Program. Funding is available for an additional 42 hospitals. This program provides funding and technical assistance to support emergency departments to treat substance use disorders and co-occurring mental health conditions. Applications will be processed on a rolling basis, hospitals are encouraged to apply as soon as possible. For more information and to apply, visit the CalBridge webpage. The application deadline is December 15. 
Governor Throws Down on Homelessness

The Governor will meet with local government representatives after this edition of the newsletter goes to press. We will report on the results of the meeting next week. Prior to the meeting, counties and cities got the following message from the State.

"Thank you for applying for the Homeless Housing, Assistance and Prevention Round 3 (HHAP-3) funding. This notice provides an update on our final review of your HHAP-3 application.
Last week, Cal ICH submitted a request for additional information regarding your HHAP-3 Action Plan outcome goals. As we anticipate receipt of your responses, we also request you review and provide a signed copy of the attached document titled, “HHAP-4 Guidance.” This document seeks to build upon our joint efforts through HHAP-3 while committing to more robust goals in HHAP-4.
Upon receipt of your response to the Cal ICH additional information request and a signed copy of this attachment, Cal ICH will move forward and initiate the approval of your HHAP-3 funding award. We appreciate the time and effort that was provided in your HHAP-3 application and look forward to the successful implementation of these resources. If you have any questions, please contact ("

The new form that local governments must fill out can be viewed here. Are counties and cities sharpening the pencils in response? Yes. Will homelessness in California go down more than it would have otherwise before this ruckus? We shall see.



CMA Warns of Dangers in Federal Bill to Expand Scope of Nonphysician Practitioners

In a forceful rebuke, the California Medical Association (CMA) joined the American Medical Association and more than 90 other organizations to voice strong opposition to a bill that could compromise care quality for millions of Medicare and Medicaid patients. Read more

HHS Awards Hundreds of Millions to Expand Mental Health Care Services

Over the past few months, the U.S. Department of Health and Human Services (HHS) has announced hundreds of millions in funding to support and expand mental health services across the country to help address the country’s mental health crisis. Read more

CMA Partners with UC Davis on Free Online CME Course on Preventing Firearm Violence

The CMA has partnered with the University of California, Davis (UC Davis) BulletPoints Project on a free online course to help physicians and other health care providers reduce gun violence. The hour-long on-demand training teaches clinicians how to identify at-risk patients and how to intervene according to the type and level of risk of firearm violence. Read more

APA / Federal Update 

The APA's our federal government relations team is working throughout the lame duck session in Congress in an attempt to get Collaborative Care legislative language attached to a larger legislative vehicle. Both the Senate and the House flipped, leaving a divided government (Senate majority Democrat and House majority Republicans). This is both good and bad; negative legislation will be unlikely to pass, but the same can be said for positive legislation.
In addition, the APA actively working on materials to support the major legislative topics that will likely consume most of next year:
  • Patient safety/scope of practice
  • Prior authorization reform
  • Collaborative Care Model (integrated care)
  • Telehealth
  • Addressing gun violence
  • Mental health workforce
  • Criminalization of medicine
  • Psilocybin and other psychedelics
Lastly, the APA is working on new one-pagers covering workforce, psilocybin, and the criminalization of medicine.


Worth a Read

CSAP is a cooperative effort between the Central California Psychiatric Society, the Northern California Psychiatric Society, the Orange County Psychiatric Society, the San Diego Psychiatric Society, and the Southern California Psychiatric Society.

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