ARTICLE 2. Establishing New County Systems of Care [5803 - 5809]
( Article 2 added by Stats. 1996, Ch. 153, Sec. 2. )
(a) The State Department of Health Care Services 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
Health Care Services 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.
(Amended by Stats. 2012, Ch. 34, Sec. 186. (SB 1009) Effective June 27, 2012.)
(a) The State Department of Health Care Services 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.
(b) 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.
(Amended by Stats. 2023, Ch. 790, Sec. 35. (SB 326) Effective April 17, 2024. Approved in Proposition 1 at the March 5, 2024, election. Operative January 1, 2025, pursuant to Sec. 117 of Proposition 1. Inoperative July 1, 2026, by its own provisions. Repealed as of January 1, 2027, by its own provisions. See later operative version added by Sec. 36 of Stats. 2023, Ch. 790.)
(a) The State Department of Health Care Services shall require counties to use funds distributed pursuant to subdivision (c) of Section 5891 for eligible adults and older adults, as defined in Section 5892, to develop a comprehensive array of services, as defined in Sections 5600.6 and 5600.7, and substance use disorder treatment services, as defined in Section
5891.5.
(b) A county may include services to address first episode psychosis.
(c) This section shall become operative on July 1, 2026, if amendments to the Mental Health Services Act are approved by the voters at the March 5, 2024, statewide primary election.
(Repealed (in Sec. 35) and added by Stats. 2023, Ch. 790, Sec. 36. (SB 326) Effective April 17, 2024. Approved in Proposition 1 at the March 5, 2024, election. Operative July 1, 2026, by its own provisions.)
The State Department of Health Care Services shall establish service standards that ensure 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. The department shall provide annual oversight of grants issued pursuant to this part for compliance with these standards. These standards shall include, but are not limited to, all of the following:
(a) A service planning and delivery 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 sheriff, the police chief, the probation officer, the mental health board, contract agencies, and family, client, ethnic, and citizen constituency groups as determined by the director.
(2) Plans for services, including outreach to families who have an adult child experiencing a serious mental health condition living with them, design of mental health services, coordination and access to medications, psychiatric and psychological services, substance use disorder services, supportive housing or other
housing assistance, vocational rehabilitation, and veterans’ services. Plans also shall contain evaluation strategies that shall consider cultural, linguistic, gender, age, and special needs of minorities in the target populations. Provision shall be made for a workforce with the cultural background and linguistic skills necessary to remove barriers to mental health services due to limited-English-speaking ability and cultural differences. Recipients of outreach services may include families, the public, primary care physicians, and others who are likely to come into contact with individuals who may be experiencing an untreated severe mental illness who would be likely to become homeless if the illness continued to be untreated for a substantial period of time. Outreach to adults may include adults
voluntarily or involuntarily hospitalized as a result of a severe mental illness.
(3) Provision 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 for the individual.
(6) Provision for services to be client-directed and that employ psychosocial rehabilitation and recovery principles.
(7) Provision for psychiatric and psychological services that are integrated with other services and for psychiatric and psychological
collaboration in overall service planning.
(8) Provision for services specifically directed to
young adults 25 years of age or younger who have a serious mental illness and are homeless or at significant risk of becoming homeless. These provisions may include continuation of services that still would be received through other funds had eligibility not been terminated due to age.
(9) Services reflecting special needs of women from diverse cultural backgrounds, including supportive housing that accepts children, personal services coordinator therapeutic treatment, and substance treatment programs that address gender-specific trauma and abuse in the lives of persons with mental illness, and vocational rehabilitation programs that offer job training programs free of gender bias and sensitive to the needs of women.
(10) Provision for housing for clients
that is immediate, transitional, permanent, or all of these.
(11) Provision for clients who have been experiencing an untreated severe mental illness for less than one year, and who do not require the full range of services but are at risk of becoming homeless unless a comprehensive individual and family support services plan is implemented. These clients shall be served in a manner that is designed to meet their needs.
(12) Provision for services for veterans.
(b) A client shall have a clearly designated mental health personal services coordinator who may be part of a multidisciplinary treatment team who is
responsible for providing or
ensuring 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 that the client receives those services that are agreed to in the personal services plan. A client shall participate in the development of their personal services plan, and responsible staff shall consult with the designated conservator, if one has been appointed, and, with the consent of the client, consult with the family and other significant persons as appropriate.
(c) The individual personal services plan shall ensure that members of the target population involved in the system of care receive age-appropriate, gender-appropriate, and culturally appropriate services or appropriate services based on any characteristic
listed or defined in Section 11135 of the Government Code, to the extent feasible, that are designed to enable recipients to:
(1) Live in the most independent, least restrictive housing feasible in the local community, and for clients with children, to live in a supportive housing environment that strives for reunification with their children or assists clients in maintaining custody of their children as is appropriate.
(2) Engage in the highest level of work or productive activity appropriate to their abilities and experience.
(3) Create and maintain a support system consisting of friends, family, and participation in community activities.
(4) Access an appropriate level of academic education or vocational training.
(5) Obtain an adequate income.
(6) Self-manage their illness and exert as much control as possible over both the day-to-day and long-term decisions that affect their lives.
(7) Access necessary physical health care and maintain the best possible physical health.
(8) Reduce or eliminate serious antisocial or criminal behavior and thereby reduce or eliminate their contact with the criminal justice system.
(9) Reduce or eliminate the distress caused by the symptoms of mental illness.
(10) Have freedom from dangerous addictive substances.
(d) The individual personal
services plan shall describe the service array that meets the requirements of subdivision (c) and, to the extent applicable to the individual, the requirements of subdivision (a).
(e) 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.
(Amended (as amended by Stats. 2023, Ch. 790, Sec. 37) by Stats. 2024, Ch. 948, Sec. 44.5. (AB 2119) Effective January 1, 2025. Inoperative July 1, 2026, by its own provisions. Repealed as of January 1, 2027, by its own provisions. See later operative version, as amended by Sec. 45 of Stats. 2024, Ch. 948.)
(a) The State Department of Health Care Services shall establish service standards so that adults and older adults in the target population are identified and receive needed and appropriate services from qualified staff in the least restrictive environment to assist them to live independently, work, and thrive in their communities. This section shall not apply to services covered by the Medi-Cal program and services covered by a health care service plan or other insurance coverage. These standards shall include, but are not limited to, all of the following:
(1) For services funded pursuant to subdivision (a) of Section 5892, the county may consult with the stakeholders listed in paragraph (1) of subdivision (a) of Section 5963.03.
(2) (A) Outreach to adults with a serious mental illness or a substance use disorder to provide coordination and access to behavioral health services, medications, housing interventions pursuant to Section 5830, supportive services, as defined in subdivision (g) of Section 5887, and veterans’ services.
(B) Service planning shall include evaluation strategies that consider cultural, linguistic, gender, age, and special needs of the target populations.
(C) Provision shall be made for a workforce with the cultural background and linguistic skills necessary to remove barriers to mental health services and substance use disorder treatment services due to limited-English-speaking ability and cultural differences.
(D) Recipients of outreach
services may include families, the public, primary care physicians, hospitals, including emergency departments, behavioral health urgent care, and others who are likely to come into contact with individuals who may be
experiencing either an untreated serious mental illness or substance use disorder, or both, who would likely become homeless or incarcerated if the illness continued to be untreated for a substantial period of time.
(E) Outreach to adults may include adults voluntarily or involuntarily hospitalized as a result of a serious mental illness.
(3) Provision for services for populations with identified disparities in behavioral health outcomes.
(4) Provision for full participation of the family in all aspects of assessment, service planning, and treatment, including, but not limited to, family support and consultation services, parenting support and consultation services, and peer support or self-help group support, where appropriate and when supported by the individual.
(5) Treatment for clients who have been
experiencing an untreated serious mental illness or substance use disorder, or both, for less than one year and who do not require the full range of services but are at risk of becoming homeless or incarcerated unless comprehensive individual and family support services are provided consistent with the planning process specified in subdivision (d). This includes services that are available and designed to meet their needs, including housing for clients that is immediate, transitional, permanent, or all of these services.
(6) (A) Provision for services to be client-directed and to employ psychosocial rehabilitation and recovery principles.
(B) Services may be integrated with other services and may include psychiatric and psychological collaboration in overall service planning.
(7) Provision for services specifically directed to young adults 25 years of age or younger with either a serious mental illness or substance use disorder, or both, who are chronically homeless, experiencing homelessness or are at risk of homelessness, as defined in subdivision (j) of Section 5892, or experiencing first episode psychosis. These provisions may include continuation of services that still would be received through other funds had eligibility not been terminated due to age.
(8) Provision for services for frequent users of behavioral health urgent care, crisis stabilization units, and hospitals or emergency room services as the primary resource for mental health and substance use disorder treatment.
(9) Provision for services to meet the special needs of clients who are physically disabled, clients who are
intellectually or developmentally disabled, veterans, or persons of American Indian or Alaska Native descent.
(10) Provision for services to meet the special needs of women from diverse cultural backgrounds, including supportive housing that accepts children and youth, personal services coordinators, therapeutic treatment, and substance use disorder treatment programs that address gender-specific trauma and abuse in the lives of persons with either a serious mental illness or a substance use disorder, or both, and vocational rehabilitation programs that offer job training programs free of gender bias and sensitive to the needs of women.
(b) Each adult or older adult shall have a clearly designated personal services coordinator, or case manager who may be part of a multidisciplinary treatment team who is responsible for providing case management services. The personal services
coordinator may be a person or entity formally designated as primarily responsible for coordinating the services accessed by the client. The client shall be provided information on how to contact their designated person or entity.
(c) A personal services coordinator shall perform all of the following:
(1) Conduct a comprehensive assessment and periodic reassessment of a client’s needs. The assessment shall include all of the following:
(A) Taking the client’s history.
(B) Identifying the individual’s needs, including reviewing available records and gathering information from other sources, including behavioral health service providers, medical providers, family members, social workers, and others needed to form a complete assessment.
(C) Assessing the client’s living arrangements, employment status, and training needs.
(2) Plan for services using information collected through the assessment. The planning process shall do all of the following:
(A) Identify the client’s goals and the behavioral health, supportive, medical, educational, social, prevocational, vocational, rehabilitative, housing, or other community services needed to assist the client to reach their goals.
(B) Include active participation of the client and others in the development of the client’s goals.
(C) Identify a course of action to address the client’s needs.
(D) Address the transition of
care when a client has achieved their goals.
(3) Assist the client in accessing needed behavioral health, supportive, medical, educational, social, prevocational, vocational, rehabilitative, housing, or other community services.
(4) Coordinate the services the county furnishes to the client between settings of care, including appropriate discharge planning for short-term hospital and institutional stays.
(5) Coordinate the services the county furnishes to the client with the services the client receives from managed care organizations, the Medicaid fee-for-service delivery system, other human services agencies, and community and social support providers.
(6) Ensure that, in the course of coordinating care, the client’s privacy is protected in accordance
with all federal and state privacy laws.
(d) The county shall ensure that each provider furnishing services to clients maintains and shares, as appropriate, client health records in accordance with professional standards.
(e) The service planning process shall ensure that adults and older adults receive age-appropriate, gender-appropriate, and culturally appropriate services, or appropriate services based on a characteristic listed or defined in Section 11135 of the Government Code, to the extent feasible, that are designed to enable recipients to:
(1) (A) Live in the most independent, least restrictive housing feasible in the local community and for clients with children and youth, to live in a supportive housing environment that strives for reunification with their children and youth or
assists clients in maintaining custody of their children and youth, as appropriate.
(B) Assist individuals to rejoin or return to a home that had previously been maintained with a family member or in a shared housing environment that is supportive of their recovery and stabilization.
(2) Engage in the highest level of work or productive activity appropriate to their abilities and experience.
(3) Create and maintain a support system consisting of friends, family, and participation in community activities.
(4) Access an appropriate level of academic education or vocational training.
(5) Obtain an adequate income.
(6) Self-manage their illness and exert as much control as possible over both the day-to-day and long-term decisions that affect their lives.
(7) Access necessary physical health care and maintain the best possible physical health.
(8) Reduce or eliminate serious antisocial or criminal behavior and thereby reduce or eliminate their contact with the justice system.
(9) Reduce or eliminate the distress caused by the symptoms of either serious mental illness or substance use disorder, or both.
(10) Utilize trauma-informed approaches to reduce trauma and avoid retraumatization.
(f) (1) (A) The client’s clinical record shall describe the
service array that meets the requirements of subdivisions (c) and (e) and, to the extent applicable to the individual, the requirements of subdivisions (a) and (b).
(B) The State Department of Health Care Services may develop and revise documentation standards for service planning to be consistent with the standards developed pursuant to paragraph (3) of subdivision (h) of Section 14184.402.
(2) Documentation of the service planning process in the client’s clinical record pursuant to paragraph (1) may fulfill the documentation requirements for both the Medi-Cal program and this section.
(g) For purposes of this section, “behavioral health services” shall have the meaning as defined in subdivision (j) of Section 5892.
(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 July 1, 2026, if amendments to the Mental Health Services Act are approved by the voters at the March 5, 2024, statewide primary election.
(Amended (as added by Stats. 2023, Ch. 790, Sec. 38) by Stats. 2024, Ch. 948, Sec. 45. (AB 2119) Effective January 1, 2025. Operative July 1, 2026, by its own provisions.)
(a) The State Department of Health Care Services 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.
(5) Coordination with federal agencies responsible for providing veterans’ services, as well as national, state, and local nonprofit organizations that provide veterans’ services, to maximize the integration of services and to
eliminate duplicative efforts.
(Amended by Stats. 2012, Ch. 34, Sec. 190. (SB 1009) Effective June 27, 2012.)
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 or veterans’ services, and other financial sources when available.
(Amended by Stats. 2008, Ch. 591, Sec. 4. Effective January 1, 2009.)
The State Department of Health Care Services 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.
(Amended by Stats. 2012, Ch. 34, Sec. 191. (SB 1009) Effective June 27, 2012.)