Article
1. Legislative Findings and Intent
5801.
(a)
A system of care for adults and older adults with severe mental illness results in the highest benefit to the client, family, and community while ensuring that the public sector meets its legal responsibility and fiscal liability at the lowest possible cost.
(b)
The underlying philosophy for these systems of care includes the following:
(1)
Mental health care is a basic human service.
(2)
Seriously mentally disordered adults and older adults are citizens of a community with all the rights, privileges, opportunities, and responsibilities accorded other citizens.
(3)
Seriously mentally disordered adults and older adults usually have multiple disorders and disabling conditions and should have the highest priority among adults for mental health services.
(4)
Seriously mentally disordered adults and older adults should have an interagency network of services with multiple points of access and be assigned a single person or team to be responsible for all treatment, case management, and community support services.
(5)
The client should be fully informed and volunteer for all treatment provided, unless danger to self or others or grave disability requires temporary involuntary treatment.
(6)
Clients and families should directly participate in making decisions about services and resource allocations that affect their lives.
(7)
People in local communities are the most knowledgeable regarding their particular environments, issues, service gaps and strengths, and opportunities.
(8)
Mental health services should be responsive to the unique characteristics of people with mental disorders including age, gender, minority and ethnic status, and the effect of multiple disorders.
(9)
For the majority of seriously mentally disordered adults and older adults, treatment is best provided in the client’s natural setting in the community. Treatment, case management, and community support services should be designed to prevent inappropriate removal from the natural environment to more restrictive and costly placements.
(10)
Mental health systems of care shall have measurable goals and be fully accountable by providing measures of client outcomes and cost of services.
(11)
State and county government agencies each have responsibilities and fiscal liabilities for seriously mentally disordered adults and seniors.
5802.
(a)
The Legislature finds that a mental health system of care for adults and older adults with severe and persistent mental illness is vital for the success of mental health managed care in California. Specifically:
(1)
A comprehensive and coordinated system of care includes community-based treatment, case management, and interagency system components required by adults and older adults with severe and persistent mental illness.
(2)
Mentally ill adults and older adults receive service from many different state and county agencies, particularly criminal justice, employment, housing, public welfare, health, and mental health. In a system of care these agencies collaborate in order to deliver integrated and cost-effective programs.
(3)
The management of the risk for persons with severe mental illness and related financial risks is important for all levels of government, business, and the community.
(4)
System of care services which ensure culturally competent care for persons with severe mental illness in the most appropriate, least restrictive level of care are necessary to achieve the desired performance outcomes.
(5)
Mental health service providers need to increase accountability and further develop methods to measure progress towards client outcome goals and cost-effectiveness as required by a system of care.
(b)
The Legislature further finds that the integrated service agency model developed in Los Angeles and Stanislaus Counties and the countywide systems model developed in Ventura County, beginning in the 1989–90 fiscal year through the implementation of Chapter 982 of the Statutes of 1988, provides models for managing care for adults and older adults with severe mental illness that are vital to the implementation and success of the mental health managed care plan in California, and have successfully met the performance outcomes required by the Legislature.
(c)
The Legislature also finds that the system components established in these three programs can be replicated and expanded to additional clients in order to provide greater benefit to adults and older adults with severe and persistent mental illness at a lower cost in California.
(d)
Therefore, using the guidelines developed under the demonstration projects implemented under the adult system of care legislation in 1989, it is the intent of the Legislature to accomplish the following:
(1)
Encourage each county to implement a system of care as described in this legislation for the delivery of mental health services to seriously mentally disordered adults and older adults.
(2)
To promote system of care accountability for performance outcomes which enable adults with severe mental illness to reduce symptoms which impair their ability to live independently, work, maintain community supports, care for their children, stay in good health, not abuse drugs or alcohol, and not commit crimes.
(3)
Maintain funding for the existing programs developed in Los Angeles, Stanislaus, and Ventura Counties as models and technical assistance resources for future expansion of system of care programs to other counties as funding becomes available.
Article
2. Establishing New County Systems of Care
5803.
(a)
The State Department of Mental Health shall issue a request for proposals to develop system of care programs no later than October 1 in any year in which the state budget provides new funds to expand the system of care provided for in this chapter. The request for proposals shall include the following:
(1)
Proposals may be submitted as a regional system of care by counties acting jointly, independent countywide proposals, and proposals to serve discrete geographic areas within counties or for a specific integrated services agency team. Nothing in the request for proposal shall be construed to restrict a county from contracting for part or all services included in the demonstration project proposal.
(2)
The department shall establish reporting requirements for direct and indirect costs, and these requirements may be included in the request for proposals.
(3)
The department shall require that proposals identify resources necessary to measure client and cost outcome and interagency collaboration. Proposal guidelines shall clearly require identification of procedures to document outcomes.
(4)
Proposals must be approved by the board of supervisors and the local mental health board or commission.
(b)
The director shall prepare a method for rating proposals to assure objectivity and selection of the best qualified applications. New proposals shall be selected with consideration of regional balance across the state.
(c)
The State Department of Mental Health shall fund counties with integrated service agencies or countywide systems of care funded under Chapter 982 of the Statutes of 1988, operating at the time of passage of this part. Those programs shall be funded under the provisions paragraph (2) of subdivision (a) of Section 5700 and shall be subject to all of the requirements and sanctions of this part.
5804.
(a)
The State Department of Mental Health shall include funding under this part in the county’s performance contracts required under Section 5650 for existing and new counties selected under this part to develop an integrated service agency component or a countywide or regional system of care. The contracts required pursuant to this part shall be exempt from the requirements of the Public Contract Code and the State Administrative Manual and shall be exempt from approval by the Department of General Services.
(b)
Projects funded under this part, or continued under the provisions of subdivision (b) of Section 5802, shall be considered an ongoing program of service delivery as long as the county and any of its contractors meet client and cost outcomes as required in the annual performance contract established by the department.
(c)
The department may terminate contracts funded under this part when the department determines that the county has failed to meet client and cost outcomes as required in the performance contract or are no longer able to operate programs under the provisions of this part.
(d)
Counties and their contractors shall provide the department with all information needed to evaluate the financial and program performance of participating projects.
5805.
The State Department of Mental Health shall require counties to use available state and matching funds for the client target population as defined in Section 5600.3 to develop a comprehensive array of services as defined in Sections 5600.6 and 5600.7.
5806.
The State Department of Mental Health shall establish service standards that assure that members of the target population are identified, and services provided to assist them to live independently, work, and reach their potential as productive citizens. These standards include but are not limited to:
(a)
A service planning process that is target population based and includes the following:
(1)
Determination of the numbers of clients to be served and the programs and services that will be provided to meet their needs. The local director of mental health shall consult with the mental health board, contract agencies, family, client, ethnic and citizen constituency groups as determined by the director.
(2)
Plans for services including outreach, services design, and evaluation strategies shall consider cultural, linguistic, gender, age, and special needs of minorities in the target populations. Provision shall be made for staff with the cultural background and linguistic skills necessary to remove barriers to mental health services due to limited English speaking ability and cultural differences.
(3)
Provisions for services to meet the needs of target population clients who are physically disabled.
(4)
Provision for services to meet the special needs of older adults.
(5)
Provision for family support and consultation services, parenting support and consultation services, and peer support or self-help group support, where appropriate.
(b)
Each client shall have either a clearly designated mental health case manager or a multidisciplinary treatment team who is responsible for providing or assuring needed services. Responsibilities include complete assessment of the client’s needs, development of the client’s personal services plan, linkage with all appropriate community services, monitoring of the quality and followthrough of services, and necessary advocacy to ensure each client receives those services which are agreed to in the personal services plan. Each client shall participate in the development of his or her personal services plan, and responsible staff shall consult with the designated conservator and, with the consent of the client, consult with the family and other significant persons as appropriate.
(c)
The individual personal services plan shall assure that members of the target population involved in the system of care receive services which are designed to:
(1)
Reduce the disabling symptoms of mental illness.
(2)
Live in the most normal housing feasible in the local community.
(3)
Have an adequate income and an appropriate level of work or vocational training.
(4)
Are in good health.
(5)
Have a support system, with friendships and participation in community activities.
(6)
Have freedom from dangerous, addictive substances.
(7)
Maintain socially responsible behavior.
(8)
Obtain an appropriate level of education and learning.
(9)
Receive culturally appropriate services.
(10)
Receive gender and age appropriate services.
5807.
(a)
The State Department of Mental Health shall require counties which receive funding to develop interagency collaboration with shared responsibilities for services under this part and achievement of the client and cost outcome goals and interagency collaboration goals specified.
(b)
Collaborative activities shall include:
(1)
Identification of those agencies that have a significant joint responsibility for the target population and ensuring collaboration on planning for services to that population.
(2)
Identification of gaps in services to members of the target population, development of policies to assure service effectiveness and continuity, and setting priorities for interagency services.
(3)
Implementation of public and private collaborative programs whenever possible to better serve the target population.
(4)
Provision of interagency case management services to coordinate resources to target population members who are using the services of more than one agency.
5808.
In order to reduce the state and county cost of a mental health system of care, participating counties shall collect reimbursement for services from clients which shall be the same as patient fees established pursuant to Section 5710, fees paid by private or public third-party payers, federal financial participation for medicaid or Medicare services, and other financial sources when available.
5809.
The State Department of Mental Health shall continue to work with participating counties and other interested parties to refine and establish client and cost outcome and interagency collaboration goals including the expected level of attainment with participating system of care counties. These outcome measures should include specific objectives addressing the following goals:
(a)
Client benefit outcomes.
(b)
Client and family member satisfaction.
(c)
System of care access.
(d)
Cost savings, cost avoidance, and cost-effectiveness outcomes that measure short-term or long-term cost savings and cost avoidance achieved in public sector expenditures to the target population.