Volume 2, Issue 48 - December 2, 2022
New York Will Involuntarily Hospitalize More Mentally Ill People
The week began with the City of New York announcing that more seriously mentally ill residents will be transported to area hospitals for psychiatric evaluations without their consent under a directive Mayor Eric Adams issued Tuesday.
"Emergency workers are already empowered to hold dangerously violent individuals. But the directive expands the interpretation of that policy to include more people whose inability to care for themselves places them in more subtle forms of danger.
The mayor and his aides did not precisely define those “basic needs” or say how city workers would determine whether they were being met. Deputy Mayor Anne Williams-Isom said the determinations would be made “case by case.”
Police officers, firefighters and Department of Health workers will be able to hold such individuals after the city workers undergo imminent training sessions — a plan that civil rights activists immediately took issue with." Read more here.
On the heels of this announcement, editorial boards in California asked whether California should follow suit. See: "Bold moves to help the homeless mentally ill", here.
"We let blind, mentally ill homeless man die in Vacaville"
The same day, James Mark Rippee, who was blind, severely mentally ill, homeless — and unhelped, despite all the years that his sisters spent trying to change that — died.
"You could say, as doctors at Fairfield North Bay Medical Center did, that he died of multiple organ failure after an untreated urinary tract infection caused sepsis. Or you could say that the cause was really the 1987 motorcycle accident that took his sight and part of his frontal lobe more than half a lifetime ago, when he was 24. Over the next few years, his brain injury robbed him of his sanity and safety, too.
You could consider some corner of accountability for the entrepreneur who had lately been charging him $600 a month to let him sleep in his backyard, along with other homeless people, though no one knows who left Mark at a Vacaville ER unable to breathe at 2:30 on Saturday morning, long after he should have received medical care.
Or you could say that he died because we just didn’t care enough whether he kept on living." Read more here.
Senator Eggman to Begin Again Regarding Definition of Grave Disability
The 2023-24 state legislative session will begin next Monday, 12/5. Senator Eggman may introduce her next attempt to rewrite California's definition of grave disability. The latest attempt, which will be co-sponsored by CSAP, will most likely be based on the definition that is already in state law and used by the California Department of Corrections and Rehabilitation. You can view this definition here.
Governmental Affairs Committee
Medicare Rate Reduction in 2023
Several members asked if CSAP could weigh in with the California Congressional Delegation regarding a possible 8.5% reduction in Medicare reimbursements. You may view a letter, which AMA spearheaded and APA signed onto, here. CSAP's Governmental Affairs Committee (GAC) and Board discussed this at their meetings last night. The GAC recommended, and the Board concurred, that a version of this letter be sent. Thanks to those of you who contacted CSAP regarding this issue.
Fentanyl / Narcan
As a follow up to a previous newsletter, Senator Cortese will for sure introduce legislation to "expand statewide prevention and education efforts to combat the skyrocketing overdoses and fentanyl-related deaths that have plagued youth statewide." You may view a fact sheet on the proposed legislation here.
Governor Newsom joined local and state leaders virtually for a convening of the first cohort of counties that will implement CARE Court. You may also view the full press release here. Here are some quotes from key players in this ongoing discussion:
“CARE Court means new hope for thousands of Californians with untreated mental health and substance abuse issues,” said Governor Newsom. “Today, our work begins to turn promise into practice. While we watch other places in America move swiftly towards more involuntary hospitalization, in California, we’re doing it the right way – community based care, a focus on housing, and accountability for everyone involved.”
“We are committed to developing a process that is person-centered and addresses the needs of those we are serving, instead of the bureaucratic structures of government,” CalHHS Secretary Dr. Mark Ghaly reminded the counties. “We will continue to work collaboratively, with a focus on equity, to support the successful implementation of the CARE Act. The hard work of implementation begins now, and I look forward to rolling up our sleeves with you to continue to build on our partnership as we work together to deliver on the promises at the heart of the CARE Act.”
“Cities and counties are truly on the frontlines of the state’s behavioral health crisis, and the officials who gathered yesterday are eager to get to work on this challenge,” said San Diego Mayor Todd Gloria. “I’m proud San Diego is in the inaugural group that will be implementing CARE Court, and have every confidence that the folks who convened yesterday have the ability and experience to make this program work to help Californians who are struggling with mental health.”
“I’m incredibly grateful to everyone participating in this initial effort to implement the CARE Act in California,” said Senator Umberg. “This is not an individual effort, but a collective approach that includes local leaders, health care professionals, county administrators, and especially the families in need of help for their loved ones. We are turning this effort over to the implementers – the people on the ground who will do the hard work to make this framework a reality.”
“I want to commend this initial group of counties for their willingness to partner and take bold new steps forward to address this challenge, because we know that the status quo has not worked and it’s time to try something dramatically new.” Said Senator Eggman “I want to thank the Governor and my colleagues in the Legislature for helping to create a new onramp into a system that we know is fragmented at best. Through this effort, we will create services that are streamlined and will provide greater accountability across the board.”
“CARE will provide more tools for families to get timely and robust treatment and support services for those living with the most serious mental health challenges,” said Anita Fisher, Advocate and former Education Director at NAMI-San Diego. “I work with families all of the time who have to wait until their loved one is incarcerated or institutionalized to get the help they need. The CARE Act has the power to change that for those who need help the most.”
New Health Laws 2023: Are You Ready?
The California Medical Association published a summary of the most significant new health laws of interest to physicians. You can review it here.
Realignment Growth Estimates Released - Increases for County MH
The Department of Finance finalized the calculations for 1991 Realignment 2021-22 growth. You may view the specific caseload growth county amounts that will be provided and details of the schedule that will be used to provide general growth to the health, mental health, child poverty, and family supplemental support subaccounts here. Caseload growth amounts are based on the county-by-county calculation that examines year-over-year expenditures for the eligible programs. For general growth, the State Controller’s Office should process the payments soon and county amounts will then be available here. There is a significant amount of additional monies going to the counties for these purposes.
Patient Bill of Rights?
Consumer Watchdog held a press event this week to discuss “The need to reform the Medical Board of California’s failed oversight of dangerous doctors,” and called on the board “...to support Patient Bill of Rights legislation as part of the upcoming ‘sunset review’ of the board’s performance by the legislature,” say the legislation includes “a consumer right to input in the enforcement process,” “improved transparency” and “adequate discipline for serious offenders.” More to come on this. SYASL will be watching for any such bill.
Quarterly Board Meeting
The Medical Board held its quarterly meeting this week. You may view SYASL staff notes and materials below. The Board's discussion included follow up actions they will take in response to recently enacted legislation.
Item 11 A
Item 11 B
SYASL Staff Notes
APA / Federal Update
What Happens When the Public Health Emergency Ends? Telepsychiatry and Hybrid Practice Post-PHE
Since March 2020, psychiatrists have been practicing under flexibilities granted by state and federal governments. These flexibilities, made possible through the declaration of the Public Health Emergency (PHE), were intended to allow access to care during the PHE. The PHE will end at some point and along with it, these flexibilities. Join the Committee on Telepsychiatry and Committee on Mental Health Information Technology for an interactive session to learn more about the rules and regulations that will be back in place and to discuss what is needed in your practice to operate successfully in a hybrid environment.
Psychiatrists have been practicing for two and a half years in an environment regulated by temporary waivers. These waivers have changed the way patients are receiving care and the way psychiatrists are providing care. APA members will have an opportunity to learn about changes once the PHE ends, and how they can continue to practice in a way that meets the needs of their patients and within the rules and regulations of practice.
The event will take place on January 11, 2023, at 1:00 PM in Eastern Time (US and Canada). You may register here.
APA and Others: Letter to AG Garland and DEA Admin Milgram on Special Registration for Telemedicine
A coalition including the APA sent a letter to Attorney General Garland and Drug Enforcement Agency (DEA) Administrator Milgram regarding the DEA's plan to ensure that patients do not lose access to necessary treatment and medications. In this letter they made several recommendations. You may view the letter here.
Q & A
Q: Most psychiatrists in this area do not take Medicare. I do. A possible 8.5% rate reduction would be a very serious problem and if this occurs I may decide to opt out. This is very important!
A: Per the item above, emails such as this convinced the GAC and Board to consider and approve advocacy with the California Congressional Delegation to oppose such a reduction.
Q: Who was the Assemblyman who sponsored the law requiring all prescriptions be electronically submitted? If you do not use an electronic record, as most of us in private practice do not, it costs us the better part of $1000 per year.
A: AB 2789, authored by Assemblymember Wood, Chairman of the Assembly Health Committee was signed into law in 2018 and required beginning January 1, 2022, most prescriptions issued by a licensed healthcare practitioner to a California pharmacy must be submitted electronically.
Q: Can solo practices group together to buy health insurance or cyber insurance? Or group together for billing to hire a biller?
A: SYASL is speaking with insurance underwriters regarding this and will follow up on this in a future newsletter.
Children and Youth Behavioral Health Initiative
On December 1, as part of the CYBHI, the Department of Health Care Services (DHCS) released a Request for Application (RFA) seeking proposals for the first round of grant funding to expand evidence-based and community-defined evidence practices (EBPs and CDEPs, respectively). For the first round of EBP/CDEP grant funding, DHCS seeks proposals from various individuals, organizations, and agencies to scale parent and caregiver support and training services to parents, caregivers, and children and youth with emerging or existing mental health and/or substance use disorders.
Interested parties are encouraged to apply for funding using this application form by January 31, 2023, at 5 p.m.
On December 7, DHCS will host a public webinar to provide an overview of the RFA and other CYBHI updates. You may register here.
Round 1: Parent and Caregiver Support Programs and Practices
The Behavioral Health Task Force met to hear an update on the State’s Crisis Care Continuum Plan. You may view SYASL staff notes here.
Evidence-Based Practices and Community-Defined Evidence Practices Grant Program
Lunch and Learn
Cal-ACAP Wasserman Education Fund Deadline
The Wasserman Education Fund of CALACAP (WEFC) was created to honor the life of Saul Wasserman, M.D., a Child and Adolescent Psychiatrist who led advocacy efforts in Child and Adolescent Psychiatry for decades. This fund encourages trainees to pursue advocacy and policy in the arena of Child and Adolescent Psychiatry. The WEFC will allocate $500 annually to a Child and Adolescent Psychiatry Fellow from each of the four Regional Organizations (ROCAP) which comprise the CALACAP. We will solicit candidates for this award from the ROCAPs.
The suggested list of advocacy activities / topics may include contact with a legislator or legislative staff, participation in advocacy activities in Sacramento or Washington, D.C., submission of letters to legislator(s) regarding mental health policy or bill(s), use of social media to promote mental health policy issues, participation in statewide or national mental health advocacy activities sponsored by statewide organizations, and/or white paper on anti-racism and mental health.
- Participation in statewide or national advocacy activities in which they have taken part during their training.
- A one-page statement of an important current policy issue related to children’s mental health and the rationale for their selection.
- Complete Wasserman Award Fund Checklist.
- Brief one-paragraph biography of the candidate.
- Submission by December 31st of each year.
Each ROCAP will develop its own process for the selection of its candidate for the award. The ROCAP will then provide the contact information (name, address, training institute) along with the statement from its candidate to the ROCAP’s delegate to CALACAP. Subsequently, a check will be mailed to the successful candidate directly.
Cal-ACAP welcomes you to share this document with your fellow ROCAP Council Members to begin the process of identifying your Member-In-Training who is deserving of this annual award. Cal-ACAP will be accepting applications starting now through December 31, 2022.
Worth a Read