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AB-43 Mental health.(2019-2020)

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Date Published: 06/24/2019 02:00 PM
AB43:v96#DOCUMENT

Amended  IN  Senate  June 24, 2019
Amended  IN  Assembly  May 16, 2019
Amended  IN  Assembly  March 25, 2019

CALIFORNIA LEGISLATURE— 2019–2020 REGULAR SESSION

Assembly Bill
No. 43


Introduced by Assembly Member Gloria

December 03, 2018


An act to amend Sections 5813.5, 5830, 5845, 5847, and 5848 of, and to add Sections 5845.2 and 5845.3 to, the Welfare and Institutions Code, relating to mental health.


LEGISLATIVE COUNSEL'S DIGEST


AB 43, as amended, Gloria. Mental health.
Existing law, the Mental Health Services Act (MHSA), an initiative measure enacted by the voters as Proposition 63 at the November 2, 2004, statewide general election, establishes the continuously appropriated Mental Health Services Fund to fund various county mental health programs. The MHSA established the Mental Health Services Oversight and Accountability Commission, which is funded with moneys from the Mental Health Services Fund and which is required to review county plans relating to mental health services and to create specified reports on the use of MHSA moneys. Existing law requires counties to create plans for innovative programs, funds for which may be expanded upon approval by the Mental Health Services Oversight and Accountability Commission.
Existing law authorizes the act to be amended by a 2/3 vote of each house of the Legislature if the amendments are consistent with, and further the intent of, the act. Existing law authorizes the Legislature to add provisions to the act to clarify procedures and terms of the act by majority vote.
This bill would clarify that the planning process for innovative programs is to be completed in collaboration with stakeholders and is to comply with open meetings laws.
This bill would require the commission, in consultation with specified state, local, and private entities, to develop a strategy for the collection, organization, and public reporting of information on mental health funding, mental health programs, services, and strategies, funded by the Mental Health Services Act or other sources, and mental health outcomes, as specified. By authorizing a new use of MHSA moneys, this bill would amend the act. By requiring additional actions from local agencies, this bill would impose a state-mandated local program. The bill would require the commission to make the information available as prescribed to the public and policymakers. The bill would authorize the commission, subject to available funding, to develop an innovation challenge and utilize one or more hackathons, open coding initiatives, or other approaches to an effective strategy to collect, display, and make publicly available relevant information to support the intent of these provisions.
This bill would require the State Department of Health Care Services, the Department of Finance, the Controller, and any other state agency, to provide the commission with the information necessary to support the implementation of the reporting requirements. The bill would require an agency that cannot provide information to the commission as needed, to provide a written explanation to the commission and the relevant policy committees of the Senate and the Assembly explaining why the information cannot be provided and what authority, resources, or policy and practice changes are needed to accomplish the reporting goals. The bill would require the commission to make recommendations to the Governor and the Legislature relating to the adequacy of various reporting requirements.
Existing law requires each county mental health program to prepare and submit a 3-year program and expenditure plan, and annual updates, as specified, to the commission and the State Department of Health Care Services within 30 days after adoption. Existing law requires counties to demonstrate a partnership with constituents and stakeholders throughout the planning process that includes meaningful stakeholder involvement on mental health policy, program planning, and implementation, monitoring, quality improvement, evaluation, and budget allocations.
This bill would require the 3-year plans to include certification by the county behavioral health director that the county has undertaken a rigorous community planning process with meaningful stakeholder involvement and would clarify that every meeting at which planning activities are undertaken for those plans is required to comply with open meeting laws. The bill would define the term “meaningful stakeholder involvement” for these purposes to include stakeholder input at all stages of the planning process, stakeholder training, training of county employees in involving stakeholders in the planning process, and the provision of services and incentives to promote stakeholder involvement, including, but not limited to, payment for transportation, transportation and childcare, and other payments or processes to promote access to direct participation in the planning process. By requiring new duties of the county behavioral health director, this bill would impose a state-mandated local program.
The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that, if the Commission on State Mandates determines that the bill contains costs mandated by the state, reimbursement for those costs shall be made pursuant to the statutory provisions noted above.
Vote: 2/3   Appropriation: NO   Fiscal Committee: YES   Local Program: YES  

The people of the State of California do enact as follows:


SECTION 1.

 Section 5813.5 of the Welfare and Institutions Code is amended to read:

5813.5.
 Subject to the availability of funds from the Mental Health Services Fund, the state shall distribute funds for the provision of services under Sections 5801, 5802, and 5806 to county mental health programs. Services shall be available to adults and seniors with severe illnesses who meet the eligibility criteria in subdivisions (b) and (c) of Section 5600.3. For purposes of this act, seniors means older adult persons identified in Part 3 (commencing with Section 5800) of this division.
(a) Funding shall be provided at sufficient levels to ensure that counties can provide each adult and senior served pursuant to this part with the medically necessary mental health services, medications, and supportive services set forth in the applicable treatment plan.
(b) The funding shall only cover the portions of those costs of services that cannot be paid for with other funds, including other mental health funds, public and private insurance, and other local, state, and federal funds.
(c) Each county mental health program’s plan shall provide for services in accordance with the system of care for adults and seniors who meet the eligibility criteria in subdivisions (b) and (c) of Section 5600.3.
(d) Planning for services shall be consistent with the philosophy, principles, and practices of the Recovery Vision for mental health consumers:
(1) To promote concepts key to the recovery for individuals who have mental illness: hope, personal empowerment, respect, social connections, self-responsibility, and self-determination.
(2) To promote consumer-operated services as a way to support recovery.
(3) To reflect the cultural, ethnic, and racial diversity of mental health consumers.
(4) To plan for each consumer’s individual needs.
(5) To ensure that planning for services is client driven.
(e) The plan for each county mental health program shall indicate, subject to the availability of funds as determined by Part 4.5 (commencing with Section 5890) of this division, and other funds available for mental health services, adults and seniors with a severe mental illness being served by this program are either receiving services from this program or have a mental illness that is not sufficiently severe to require the level of services required of this program.
(f) Each county plan and annual update pursuant to Section 5847 shall consider ways to provide services similar to those established pursuant to the Mentally Ill Offender Crime Reduction Grant Program. Funds shall not be used to pay for persons incarcerated in state prison or parolees from state prisons. When included in county plans pursuant to Section 5847, funds may be used for the provision of mental health services under Sections 5347 and 5348 in counties that elect to participate in the Assisted Outpatient Treatment Demonstration Project Act of 2002 (Article 9 (commencing with Section 5345) of Chapter 2 of Part 1).
(g) The department shall contract for services with county mental health programs pursuant to Section 5897. After the effective date of this section, the term grants referred to in Sections 5814 and 5814.5 shall refer to such contracts.

SEC. 2.

 Section 5830 of the Welfare and Institutions Code is amended to read:

5830.
 County mental health programs shall develop plans for innovative programs to be funded pursuant to paragraph (6) of subdivision (a) of Section 5892.
(a) The innovative programs shall have the following purposes:
(1) To increase access to underserved groups.
(2) To increase the quality of services, including better outcomes.
(3) To promote interagency collaboration.
(4) To increase access to services, including, but not limited to, services provided through permanent supportive housing.
(b) All projects included in the innovative program portion of the county plan shall meet the following requirements:
(1) Address one of the following purposes as its primary purpose:
(A) Increase access to underserved groups, which may include providing access through the provision of permanent supportive housing.
(B) Increase the quality of services, including measurable outcomes.
(C) Promote interagency and community collaboration.
(D) Increase access to services, which may include providing access through the provision of permanent supportive housing.
(2) Support innovative approaches by doing one of the following:
(A) Introducing new mental health practices or approaches, including, but not limited to, prevention and early intervention.
(B) Making a change to an existing mental health practice or approach, including, but not limited to, adaptation for a new setting or community.
(C) Introducing a new application to the mental health system of a promising community-driven practice or an approach that has been successful in nonmental health contexts or settings.
(D) Participating in a housing program designed to stabilize a person’s living situation while also providing supportive services on site.
(c) An innovative project may affect virtually any aspect of mental health practices or assess a new or changed application of a promising approach to solving persistent, seemingly intractable mental health challenges, including, but not limited to, any of the following:
(1) Administrative, governance, and organizational practices, processes, or procedures.
(2) Advocacy.
(3) Education and training for service providers, including nontraditional mental health practitioners.
(4) Outreach, capacity building, and community development.
(5) System development.
(6) Public education efforts.
(7) Research. If research is chosen for an innovative project, the county mental health program shall consider, but is not required to implement, research of the brain and its physical and biochemical processes that may have broad applications, but that have specific potential for understanding, treating, and managing mental illness, including, but not limited to, research through the Cal-BRAIN program pursuant to Section 92986 of the Education Code or other collaborative, public-private initiatives designed to map the dynamics of neuron activity.
(8) Services and interventions, including prevention, early intervention, and treatment.
(9) Permanent supportive housing development.
(d) If an innovative project has proven to be successful and a county chooses to continue it, the project workplan shall transition to another category of funding as appropriate.
(e) The county shall develop the plans in collaboration with stakeholders as part of the community program planning process required by Section 5848 and in accordance with open meeting laws.
(f) County mental health programs shall expend funds for their innovation programs upon approval by the Mental Health Services Oversight and Accountability Commission.

SEC. 3.

 Section 5845 of the Welfare and Institutions Code is amended to read:

5845.
 (a) The Mental Health Services Oversight and Accountability Commission is hereby established to oversee Part 3 (commencing with Section 5800), the Adult and Older Adult Mental Health System of Care Act; Part 3.1 (commencing with Section 5820), Human Resources, Education, and Training Programs; Part 3.2 (commencing with Section 5830), Innovative Programs; 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. The commission shall replace the advisory committee established pursuant to Section 5814. The commission shall consist of 16 voting members as follows:
(1) The Attorney General or a designee.
(2) The Superintendent of Public Instruction or a designee.
(3) The Chairpersons of the Senate Health and Human Services Committees or another member of the Senate selected by the President pro Tempore of the Senate.
(4) The Chairperson of the Assembly Committee on Health or another member of the Assembly selected by the Speaker of the Assembly.
(5) Two persons with a severe mental illness, a family member of an adult or senior with a severe mental illness, a family member of a child who has or has had a severe mental illness, a physician specializing in alcohol and drug treatment, a mental health professional, a county sheriff, a superintendent of a school district, a representative of a labor organization, a representative of an employer with less than 500 employees, a representative of an employer with more than 500 employees, and a representative of a health care service plan or insurer, all appointed by the Governor. In making appointments, the Governor shall seek individuals who have had personal or family experience with mental illness. At least one person appointed pursuant to this paragraph shall have a background in auditing.
(b) Members shall serve without compensation, but shall be reimbursed for all actual and necessary expenses incurred in the performance of their duties.
(c) The term of each member shall be three years, to be staggered so that approximately one-third of the appointments expire in each year.
(d) In carrying out its duties and responsibilities, the commission may do all of the following:
(1) Meet at least once each quarter at any time and location convenient to the public as it may deem appropriate. All meetings of the commission shall be open to the public.
(2) Within the limit of funds allocated for these purposes, pursuant to the laws and regulations governing state civil service, employ staff, including any clerical, legal, and technical assistance necessary. 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.
(3) Establish technical advisory committees, such as a committee of consumers and family members.
(4) Employ all other appropriate strategies necessary or convenient to enable it to fully and adequately perform its duties and exercise the powers expressly granted, notwithstanding any authority expressly granted to an officer or employee of state government.
(5) Enter into contracts.
(6) Obtain data and information from the State Department of Health Care Services, the Office of Statewide Health Planning and Development, or other state or local entities that receive Mental Health Services Act funds, for the commission to utilize in its oversight, review, training and technical assistance, accountability, and evaluation capacity regarding projects and programs supported with Mental Health Services Act funds.
(7) Participate in the joint state-county decisionmaking process, as contained in Section 4061, for training, technical assistance, and regulatory resources to meet the mission and goals of the state’s mental health system.
(8) Develop strategies to overcome stigma and discrimination, and accomplish all other objectives of Part 3.2 (commencing with Section 5830), 3.6 (commencing with Section 5840), and the other provisions of the Mental Health Services Act.
(9) 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.
(10) 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.
(11) Assist in providing technical assistance to accomplish the purposes of the Mental Health Services Act, Part 3 (commencing with Section 5800), and Part 4 (commencing with Section 5850) in collaboration with the State Department of Health Care Services and in consultation with the County Behavioral Health Directors Association of California.
(12) 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, in designing a comprehensive joint plan for a coordinated evaluation of client outcomes in the community-based mental health system, including, but not limited to, parts listed in subdivision (a). The California Health and Human Services Agency shall lead this comprehensive joint plan effort.
(13) 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.
(e) (1) Notwithstanding any other statute, regulation, or requirement and subject to paragraph (2), the commission shall have access to data, information, policies, procedures, and practices relative to behavioral health services and programs that are held or maintained by the departments within the California Health and Human Services Agency, the Department of Justice, the State Department of Education, the Employment Development Department, and other state and local agencies, in the electronic format that is currently in use, to comply with the requirements of this part.
(2) In accessing data pursuant to this subdivision, the commission shall comply with all applicable federal and state privacy and confidentiality laws.

SEC. 4.

 Section 5845.2 is added to the Welfare and Institutions Code, to read:

5845.2.
 (a) The commission, in consultation with the State Department of Health Care Services, other state agencies, the County Behavioral Health Directors Association of California, other local agencies, including schools and cities, mental health consumers, family members, providers, organizations, and subject matter experts focused on reducing disparities, serving veterans, and improving outcomes for persons with mental health needs, and others, shall do all of the following:
(1) Develop a strategy for the collection, organization, and public reporting of information on mental health funding, including information on revenues, expenditures, and available unspent funds, from the Mental Health Services Act and other sources of mental health funding.
(2) Develop a strategy for the collection, organization, and public reporting of information on mental health programs, services, and strategies, funded by the Mental Health Services Act or other sources. In developing that strategy, the commission shall strive to make available information on all mental health services that are available to the public, with emphasis on publicly supported programs, but, as determined by the commission, may include information on nonpublic services to the extent that information supports public understanding of the design, sufficiency, and availability of mental health services in California.
(3) Develop a strategy for the collection, organization, and public reporting of information on mental health outcomes, including, but not limited to, the outcomes identified in subdivision (d) of Section 5840.
(b) The commission shall make the information referenced in subdivision (a) available to the public and policymakers in one or more formats, including internet access, in a manner relevant to support public understanding and awareness of the fiscal and mental health resources available and outcomes achieved, statewide and for each county, counties acting jointly, and each city mental health agency. Information shall be made available in a format that allows the public and policymakers to see annual and trend information. In making information available to the public, the commission shall facilitate public access to valid and reliable information that can be viewed, printed, and downloaded consistent with statewide standards for accessing public information.
(c) In making information available, the commission shall strive to include information on persons served and outcomes. That information shall include, to the extent available, detailed demographic information, including, but not limited to, age, race, ethnicity, gender, sexual orientation, language spoken, veteran status, and other characteristics intended to improve public understanding of who is being served by mental health programs, the extent to which California’s mental health system creates access to care, is addressing disparities, and has unmet needs, and the effectiveness of California’s mental health system.
(d) The commission, as it deems necessary, shall consult with experts in gathering, displaying, and disseminating program information or other topics to support the intent of this section. The commission may, subject to available funding, develop an innovation challenge and utilize one or more hackathons, open coding initiatives, or other approaches to an effective strategy to collect, display, and make publicly available relevant information to support the intent of this section.

SEC. 5.

 Section 5845.3 is added to the Welfare and Institutions Code, to read:

5845.3.
 (a) The State Department of Health Care Services, the Department of Finance, the Controller, and any other state agency, shall provide the commission with information relative to behavioral health services and programs, as determined by the commission, and in their possession, in the electronic format that is currently in use, to support the implementation of this part. If an agency cannot provide information to the commission to meet the goals of this part, the agency shall provide a written explanation to the commission and the relevant policy committees of the Senate and the Assembly explaining why the information cannot be provided and what authority, resources, or policy and practice changes are needed to accomplish the goals of this section.
(b) (1) The commission shall consider whether existing regulatory reporting requirements are adequate, and revise those requirements, on a basis determined by the commission, to support implementation of Section 5845.2.
(2) To support enhanced transparency and outcome accountability, the commission shall assess the adequacy of existing statutory and regulatory data reporting requirements, strategies, and practices, and make recommendations to the Governor and the Legislature for streamlining and strengthening those strategies to reduce costs and improve the use of information to guide program, fiscal, and related decisions.
(c) (1) In developing the strategies required by subdivision (a) of Section 5845.2, the commission shall prepare and report to the relevant policy and fiscal committees of the Legislature on or before January 1, 2021, and periodically thereafter as needed, on its progress in complying with this section, and any funding, personnel, authority, or other resources the commission needs to achieve the intent of this section.
(2) A report submitted pursuant to this paragraph shall be submitted in compliance with Section 9795 of the Government Code.

SEC. 6.

 Section 5847 of the Welfare and Institutions Code is amended to read:

5847.
 (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 Mental 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.
(10) Certification by the county behavioral health director that the county has undertaken a rigorous community planning process with meaningful stakeholder involvement, as defined in Section 5848, and complied with open meeting laws.
(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. 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.

SEC. 7.

 Section 5848 of the Welfare and Institutions Code is amended to read:

5848.
 (a) Each three-year program and expenditure plan and update shall be developed with local stakeholders, including adults and seniors with severe mental illness, families of children, adults, and seniors with severe mental illness, providers of services, law enforcement agencies, education, social services agencies, veterans, representatives from veterans organizations, providers of alcohol and drug services, health care organizations, and other important interests. Counties shall demonstrate a partnership with constituents and stakeholders throughout the process that includes meaningful stakeholder involvement on mental health policy, program planning, and implementation, monitoring, quality improvement, evaluation, and budget allocations. A draft plan and update shall be prepared and circulated for review and comment for at least 30 days to representatives of stakeholder interests and any interested party who has requested a copy of the draft plans.
(b) (1) The mental health board established pursuant to Section 5604 shall conduct a public hearing on the draft three-year program and expenditure plan and annual updates at the close of the 30-day comment period required by subdivision (a). Each adopted three-year program and expenditure plan and update shall include any substantive written recommendations for revisions. The adopted three-year program and expenditure plan or update shall summarize and analyze the recommended revisions. The mental health board shall review the adopted plan or update and make recommendations to the county mental health department for revisions.
(2) Every meeting at which planning activities are undertaken for the three-year program and expenditure plan and update shall be conducted in compliance with open meeting laws.
(c) The plans shall include reports on the achievement of performance outcomes for services pursuant to Part 3 (commencing with Section 5800), Part 3.6 (commencing with Section 5840), and Part 4 (commencing with Section 5850) funded by the Mental Health Services Fund and established jointly by the State Department of Health Care Services and the Mental Health Services Oversight and Accountability Commission, in collaboration with the County Behavioral Health Directors Association of California.
(d) Mental health services provided pursuant to Part 3 (commencing with Section 5800) and Part 4 (commencing with Section 5850) shall be included in the review of program performance by the California Behavioral Health Planning Council required by paragraph (2) of subdivision (c) of Section 5772 and in the local mental health board’s review and comment on the performance outcome data required by paragraph (7) of subdivision (a) of Section 5604.2.
(e) The department shall annually post on its internet website a summary of the performance outcomes reports submitted by counties if clearly and separately identified by counties as the achievement of performance outcomes pursuant to subdivision (c).
(f) For purposes of this section, “meaningful stakeholder involvement” includes stakeholder input at all stages of the planning process, stakeholder training, training of county employees in involving stakeholders in the planning process, and the provision of services and incentives to promote stakeholder involvement, including, but not limited to, payment for transportation, transportation and childcare, and other payments or processes to promote access to direct participation in the planning process.

SEC. 8.

 If the Commission on State Mandates determines that this act contains costs mandated by the state, reimbursement to local agencies and school districts for those costs shall be made pursuant to Part 7 (commencing with Section 17500) of Division 4 of Title 2 of the Government Code.