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| 1 | + | Amended IN Assembly June 23, 2022 Amended IN Senate May 02, 2022 Amended IN Senate April 18, 2022 Amended IN Senate March 10, 2022 CALIFORNIA LEGISLATURE 20212022 REGULAR SESSION Senate Bill No. 970Introduced by Senator Eggman(Principal coauthor: Senator Stern)(Principal coauthors: Assembly Members Carrillo, Friedman, and Quirk-Silva)(Coauthor: Senator Glazer)February 10, 2022An act to add Section 5846.5 to the Welfare and Institutions Code, relating to mental health.LEGISLATIVE COUNSEL'S DIGESTSB 970, as amended, Eggman. Mental Health Services Act.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 Mental Health Services Fund (MHSF), a continuously appropriated fund, to fund various county mental health programs, including childrens mental health care, adult and older adult mental health care, prevention and early intervention programs, and innovative programs.This bill would require the California Health and Human Services Agency, by July 1, 2025, to establish the California MHSA Outcomes and Accountability Review (MHSA-OAR), consisting of performance indicators, county self-assessments, and county MHSA improvement plans, to facilitate a local accountability system that fosters continuous quality improvement in county programs funded by the MHSA and in the collection and dissemination by the agency of best practices in service delivery. The bill would require the agency to convene a workgroup, as specified, to establish a workplan by which the MHSA-OAR shall be conducted, including a process for qualitative peer reviews of counties MHSA services and uniform elements for the county MHSA system improvement plans. The bill would require the agency to establish specific process measures and uniform elements for the county MHSA improvement plans and updates. The bill would require the counties to execute and fulfill components of its MHSA system improvement plan that can be accomplished with existing resources. The bill would require the agency to report to the Legislature, on an annual basis, a report that summarizes county performance on the established process and outcome measures during the reporting period, analyzes county performance trends over time, and makes findings and recommendations for common MHSA services improvements identified in the county MHSA self-assessments and county MHSA system improvement plans. By imposing new requirements on counties, this bill would impose a state-mandated local program.This bill would require the agency to request the University of California to enter into a contract with the state to provide specified services, including preparing an analysis of how data pertaining to the provision of mental health services and client outcomes collected by the counties and provided to the state may be used to demonstrate the impact of services funded by the MHSF on life outcomes. The bill would require the analysis to be delivered to the agency, the Legislature, and the workgroup on or before July 1, 2024.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.Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: YES Bill TextThe people of the State of California do enact as follows:SECTION 1. Section 5846.5 is added to the Welfare and Institutions Code, to read:5846.5. (a) This section shall be known, and may be cited as, the Mental Health Services Act (MHSA) Outcomes and Accountability Review Act of 2022.(b) The California Health and Human Services Agency shall establish, by July 1, 2025, the California MHSA Outcomes and Accountability Review (MHSA-OAR) to facilitate a local accountability system that fosters continuous quality improvement in county programs funded by the MHSA and in the collection and dissemination by the agency of best practices in service delivery. The MHSA-OAR shall cover MHSA-funded services provided to current and former recipients and shall include the programmatic elements that each county offers as part of its MHSA service array, as well as any local program components, and shall consist of performance indicators, a county MHSA self-assessment process, and a county MHSA system improvement plan.(c) (1) (A) On or before October 1, 2023, the agency shall convene a workgroup comprised of representatives from the State Department of Health Care Services, the Mental Health Services Oversight and Accountability Commission, county behavioral health agencies, legislative staff, interested behavioral health advocacy and research organizations, current and former MHSA service recipients, organizations that represent county behavioral health agencies and county boards of supervisors, nonprofit community-based organizations, researchers, people with lived experience, county behavioral health agency partners, and any other entities or individuals that the agency deems necessary. The workgroup shall establish a workplan by which the MHSA-OAR shall be conducted, including a process for qualitative peer reviews of counties MHSA services.(B) The agency shall report annually to the Subcommittee on Health and Human Services of the Senate Committee on Budget and Fiscal Review and the Subcommittee on Health and Human Services of the Assembly Committee on Budget during the budget process with an update on the schedule for development of, and future changes to, the MHSA-OAR.(2) At a minimum, in establishing the work plan, the workgroup shall consider existing MHSA performance indicators being measured, additional, alternative, or additional and alternative process and outcome indicators to be measured, development of uniform elements of the county MHSA self-assessment and the county MHSA system improvement plans, timelines for implementation, recommendations for reducing the existing MHSA services data reporting burden, recommendations for financial incentives to counties for achievement on performance measures, and an analysis of the county and state workload associated with implementation of the requirements of this section.(3) The workgroup shall develop the uniform elements for the county MHSA system improvement plans required in paragraph (3) of subdivision (d). The agency, in consultation with the workgroup, shall develop the uniform elements of the updates to those plans, as required pursuant to subparagraph (D) of paragraph (3) of subdivision (d).(d) The MHSA-OAR shall consist of the following three components: performance indicators, a county MHSA self-assessment, and a county MHSA system improvement plan.(1) (A) The MHSA-OAR performance indicators shall be consistent with programmatic goals for the MHSA, and shall include both process and outcome measures. These measures shall be established in order to provide baseline and ongoing information about how the state and counties are performing over time and to inform and guide each county behavioral health agencys MHSA self-assessment and MHSA system improvement plan.(i) Process measures shall include measures of participant engagement, MHSA service delivery, and participation. Specific process measures shall be established by the agency, in consultation with the workgroup, and may include measures of engagement as shown by improvement in program participation, timeliness of service provision, rates of utilization of program components, and referrals and utilization of services.(ii) Outcome measures shall be determined based on the recommendations included in the analysis prepared by the University of California pursuant to subdivision (g), if the University of California enters into the contract described in subdivision (g).(B) Performance indicator data available in existing county data systems shall be collected by counties and provided to the agency, and performance indicator data available in existing state agency data systems shall be collected by the agency and provided to the counties. These data shall be reported in a manner, and on a schedule, determined by the agency, in consultation with the workgroup, but no less frequently than semiannually.(C) (i) During the first five-year MHSA-OAR cycle, performance indicator data reported by each county, shall be used to establish both county and statewide baselines for each of the process measures. After the first review cycle, the agency, in consultation with the workgroup, shall establish standard target thresholds for each of the process measures established by the workgroup.(ii) The agency, in consultation with the workgroup, shall develop a process for resolving any disputes regarding the establishment of standard process thresholds pursuant to clause (i).(D) For subsequent reviews, and based upon availability of additional data through interagency data-sharing agreements, the workgroup shall convene, as necessary, to consider whether to establish additional performance indicators that support the programmatic goals for the MHSA. Additional performance indicators established shall also be subject to the process described in subparagraph (C) and shall include consideration of when data on the additional performance indicators would be available for reporting, if not already available.(E) If, during subsequent reviews, there is sufficient reason to establish statewide performance standards for one or more outcome measures, the agency, in consultation with the workgroup, may establish those standards for each of the agreed-upon outcome measures.(2) (A) The county MHSA self-assessment component of the MHSA-OAR, as established by the workgroup, shall require the county behavioral health agencies to assess their performance on the established process and outcome measures that comprise the performance indicators, identify the strengths and weaknesses in their current practice and resource deployment, identify and describe how local operational decisions and systemic factors affect program outcomes, and consider areas of focus that may be included in the county MHSA system improvement plan, as described in paragraph (3). The county MHSA self-assessment process shall be designed to identify areas of best practices for replication and for system improvement at the county level, and shall guide the development of the county MHSA system improvement plan.(B) (i) The county MHSA self-assessment process shall be completed every five years by the county, in consultation and collaboration with local stakeholders, and submitted to the agency.(ii) Local stakeholders shall include county behavioral health directors, supervisors, and caseworkers; current and former MHSA service recipients; and county behavioral health agency partners. To the extent possible and relevant, local stakeholders shall also include representatives of tribal organizations and the local behavioral health board. Additional specific county behavioral health agency partners shall be determined by the county and may include, but are not limited to, adult education providers, providers of services for survivors of domestic violence, the local housing continuum of care, county human service departments, county drug and alcohol programs, community-based service providers, and organizations that represent MHSA recipients, as appropriate.(3) (A) (i) The county MHSA system improvement plan shall, at a minimum, describe how the county will improve its MHSA program performance in strategic focus areas based upon information learned through the county MHSA self-assessment process. The county MHSA system improvement plan shall include the uniform elements established by the workgroup pursuant to paragraph (3) of subdivision (c).(ii) The county MHSA system improvement plan shall be completed every five years by the county, approved in public session by the countys board of supervisors or, as applicable, chief elected official, and be submitted to the agency.(B) The county MHSA system improvement plan shall include an MHSA services peer review element, the purpose of which shall be to provide additional insight and technical assistance by peer counties.(C) Strategic focus areas for the county MHSA system improvement plan shall be determined by the county, informed by the county MHSA self-assessment process, as described in paragraph (2), with targets for improvement based upon what is learned in the county MHSA self-assessment process.(D) The county behavioral health agency shall complete an annual progress report on the status of its system improvement plan and shall submit these reports to the agency.(e) (1) The agency shall receive, review, and, based on its determination of whether the county MHSA system improvement plan meets the required elements, certify as complete all county-submitted performance indicator data, county MHSA self-assessments, county MHSA system improvement plans, and annual progress reports, and shall identify and promote the replication of best practices in MHSA service delivery to achieve the established process and outcome measures.(2) The agency shall monitor, on an ongoing basis, county performance on the measures developed pursuant to subdivision (d).(3) The agency shall, on an annual basis, submit a report to the Legislature that summarizes county performance on the established process and outcome measures during the reporting period, analyzes county performance trends over time, and makes findings and recommendations for common MHSA services improvements identified in the county MHSA self-assessments and county MHSA system improvement plans, including information on common statutory, regulatory, or fiscal barriers identified as inhibiting system improvements and any recommendations to overcome those barriers.(4) (A) The agency shall, in partnership with the University of California, if the contract is executed pursuant to subdivision (g), facilitate the provision of technical assistance to county behavioral health agencies as part of the peer review that supports the countys selected areas for improvement, as described in its system improvement plan.(B) If, in the course of its review of county MHSA system improvement plans and annual updates, or, in the course of its review of regularly submitted performance indicator data, the agency determines that a county is consistently failing to make progress toward its strategic focus areas for improvement or is consistently failing to meet the process measure standard target thresholds established pursuant to subparagraph (C) of paragraph (1) of subdivision (d), the agency shall engage the county in a process of targeted technical assistance and support to address and resolve the identified shortcomings.(f) A county shall execute and fulfill components of its MHSA system improvement plan that can be accomplished with existing resources.(g) The agency shall request the University of California to enter into a contract with the state to provide all of the following services:(1) (A) Prepare an analysis of how data pertaining to the provision of mental health services and client outcomes collected by the counties and provided to the state may be used to demonstrate the impact of services funded by the Mental Health Services Fund on life outcomes. The analysis shall be delivered to the agency, the Legislature, and the workgroup established pursuant to subparagraph (A) of paragraph (1) of subdivision (c) on or before July 1, 2024, and shall include both of the following:(i) Recommendations of what outcomes should be used to measure the impact of the Mental Health Services Act. Recommended life outcome measures shall include measures of the reduction of the negative outcomes described in subdivision (d) of Section 5840, which address prevention and early intervention strategies for mental illness, and measures of employment, educational attainment, program exits and program reentries, adherence to treatment plans, attainment of housing, reduction in contacts with law enforcement, reduction in hospitalizations, and reductions in homelessness.(ii) An estimate of how much an impact funding from the Mental Health Service Services Fund can have on each recommended outcome.(B) The analysis required to be delivered to the Legislature pursuant to subparagraph (A) shall be submitted in compliance with Section 9795 of the Government Code.(2) Create and maintain a dashboard modeled after the California Child Welfare Indicators Project to publicly report the data collected by counties and to report the status of county process and outcome indicators as described in this section.(3) Consult with the agency to provide technical assistance to county behavioral health agencies as described in subparagraph (A) of paragraph (4) of subdivision (e).SEC. 2. 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. | |
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| 3 | + | Amended IN Assembly June 23, 2022 Amended IN Senate May 02, 2022 Amended IN Senate April 18, 2022 Amended IN Senate March 10, 2022 CALIFORNIA LEGISLATURE 20212022 REGULAR SESSION Senate Bill No. 970Introduced by Senator Eggman(Principal coauthor: Senator Stern)(Principal coauthors: Assembly Members Carrillo, Friedman, and Quirk-Silva)(Coauthor: Senator Glazer)February 10, 2022An act to add Section 5846.5 to the Welfare and Institutions Code, relating to mental health.LEGISLATIVE COUNSEL'S DIGESTSB 970, as amended, Eggman. Mental Health Services Act.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 Mental Health Services Fund (MHSF), a continuously appropriated fund, to fund various county mental health programs, including childrens mental health care, adult and older adult mental health care, prevention and early intervention programs, and innovative programs.This bill would require the California Health and Human Services Agency, by July 1, 2025, to establish the California MHSA Outcomes and Accountability Review (MHSA-OAR), consisting of performance indicators, county self-assessments, and county MHSA improvement plans, to facilitate a local accountability system that fosters continuous quality improvement in county programs funded by the MHSA and in the collection and dissemination by the agency of best practices in service delivery. The bill would require the agency to convene a workgroup, as specified, to establish a workplan by which the MHSA-OAR shall be conducted, including a process for qualitative peer reviews of counties MHSA services and uniform elements for the county MHSA system improvement plans. The bill would require the agency to establish specific process measures and uniform elements for the county MHSA improvement plans and updates. The bill would require the counties to execute and fulfill components of its MHSA system improvement plan that can be accomplished with existing resources. The bill would require the agency to report to the Legislature, on an annual basis, a report that summarizes county performance on the established process and outcome measures during the reporting period, analyzes county performance trends over time, and makes findings and recommendations for common MHSA services improvements identified in the county MHSA self-assessments and county MHSA system improvement plans. By imposing new requirements on counties, this bill would impose a state-mandated local program.This bill would require the agency to request the University of California to enter into a contract with the state to provide specified services, including preparing an analysis of how data pertaining to the provision of mental health services and client outcomes collected by the counties and provided to the state may be used to demonstrate the impact of services funded by the MHSF on life outcomes. The bill would require the analysis to be delivered to the agency, the Legislature, and the workgroup on or before July 1, 2024.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.Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: YES | |
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| 5 | - | ||
| 5 | + | Amended IN Assembly June 23, 2022 Amended IN Senate May 02, 2022 Amended IN Senate April 18, 2022 Amended IN Senate March 10, 2022 | |
| 6 | 6 | ||
| 7 | - | Amended IN Assembly August 23, 2022 | |
| 8 | 7 | Amended IN Assembly June 23, 2022 | |
| 9 | 8 | Amended IN Senate May 02, 2022 | |
| 10 | 9 | Amended IN Senate April 18, 2022 | |
| 11 | 10 | Amended IN Senate March 10, 2022 | |
| 12 | 11 | ||
| 13 | 12 | CALIFORNIA LEGISLATURE 20212022 REGULAR SESSION | |
| 14 | 13 | ||
| 15 | 14 | Senate Bill | |
| 16 | 15 | ||
| 17 | 16 | No. 970 | |
| 18 | 17 | ||
| 19 | - | Introduced by Senator Eggman(Principal coauthor: Senator Stern)(Principal coauthors: Assembly Members Carrillo, Friedman, and Quirk-Silva)(Coauthor: Senator Glazer) | |
| 18 | + | Introduced by Senator Eggman(Principal coauthor: Senator Stern)(Principal coauthors: Assembly Members Carrillo, Friedman, and Quirk-Silva)(Coauthor: Senator Glazer)February 10, 2022 | |
| 20 | 19 | ||
| 21 | - | Introduced by Senator Eggman(Principal coauthor: Senator Stern)(Principal coauthors: Assembly Members Carrillo, Friedman, and Quirk-Silva)(Coauthor: Senator Glazer) | |
| 20 | + | Introduced by Senator Eggman(Principal coauthor: Senator Stern)(Principal coauthors: Assembly Members Carrillo, Friedman, and Quirk-Silva)(Coauthor: Senator Glazer) | |
| 22 | 21 | February 10, 2022 | |
| 23 | 22 | ||
| 24 | 23 | An act to add Section 5846.5 to the Welfare and Institutions Code, relating to mental health. | |
| 25 | 24 | ||
| 26 | 25 | LEGISLATIVE COUNSEL'S DIGEST | |
| 27 | 26 | ||
| 28 | 27 | ## LEGISLATIVE COUNSEL'S DIGEST | |
| 29 | 28 | ||
| 30 | 29 | SB 970, as amended, Eggman. Mental Health Services Act. | |
| 31 | 30 | ||
| 32 | - | 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 Mental Health Services Fund (MHSF), a continuously appropriated fund, to fund various county mental health programs, including childrens mental health care, adult and older adult mental health care, prevention and early intervention programs, and innovative programs.This bill would require the California Health and Human Services Agency, by July 1, 2025, to establish the California MHSA Outcomes and Accountability Review (MHSA-OAR), consisting of performance indicators, county self-assessments, and county MHSA improvement plans, to facilitate a local accountability system that fosters continuous quality improvement in county programs funded by the MHSA and in the collection and dissemination by the agency of best practices in service delivery. The bill would require the agency to convene a workgroup, as specified, to establish a workplan by which the MHSA-OAR shall be conducted, including a process for qualitative peer reviews | |
| 31 | + | 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 Mental Health Services Fund (MHSF), a continuously appropriated fund, to fund various county mental health programs, including childrens mental health care, adult and older adult mental health care, prevention and early intervention programs, and innovative programs.This bill would require the California Health and Human Services Agency, by July 1, 2025, to establish the California MHSA Outcomes and Accountability Review (MHSA-OAR), consisting of performance indicators, county self-assessments, and county MHSA improvement plans, to facilitate a local accountability system that fosters continuous quality improvement in county programs funded by the MHSA and in the collection and dissemination by the agency of best practices in service delivery. The bill would require the agency to convene a workgroup, as specified, to establish a workplan by which the MHSA-OAR shall be conducted, including a process for qualitative peer reviews of counties MHSA services and uniform elements for the county MHSA system improvement plans. The bill would require the agency to establish specific process measures and uniform elements for the county MHSA improvement plans and updates. The bill would require the counties to execute and fulfill components of its MHSA system improvement plan that can be accomplished with existing resources. The bill would require the agency to report to the Legislature, on an annual basis, a report that summarizes county performance on the established process and outcome measures during the reporting period, analyzes county performance trends over time, and makes findings and recommendations for common MHSA services improvements identified in the county MHSA self-assessments and county MHSA system improvement plans. By imposing new requirements on counties, this bill would impose a state-mandated local program.This bill would require the agency to request the University of California to enter into a contract with the state to provide specified services, including preparing an analysis of how data pertaining to the provision of mental health services and client outcomes collected by the counties and provided to the state may be used to demonstrate the impact of services funded by the MHSF on life outcomes. The bill would require the analysis to be delivered to the agency, the Legislature, and the workgroup on or before July 1, 2024.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. | |
| 33 | 32 | ||
| 34 | 33 | 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 Mental Health Services Fund (MHSF), a continuously appropriated fund, to fund various county mental health programs, including childrens mental health care, adult and older adult mental health care, prevention and early intervention programs, and innovative programs. | |
| 35 | 34 | ||
| 36 | - | This bill would require the California Health and Human Services Agency, by July 1, 2025, to establish the California MHSA Outcomes and Accountability Review (MHSA-OAR), consisting of performance indicators, county self-assessments, and county MHSA improvement plans, to facilitate a local accountability system that fosters continuous quality improvement in county programs funded by the MHSA and in the collection and dissemination by the agency of best practices in service delivery. The bill would require the agency to convene a workgroup, as specified, to establish a workplan by which the MHSA-OAR shall be conducted, including a process for qualitative peer reviews | |
| 35 | + | This bill would require the California Health and Human Services Agency, by July 1, 2025, to establish the California MHSA Outcomes and Accountability Review (MHSA-OAR), consisting of performance indicators, county self-assessments, and county MHSA improvement plans, to facilitate a local accountability system that fosters continuous quality improvement in county programs funded by the MHSA and in the collection and dissemination by the agency of best practices in service delivery. The bill would require the agency to convene a workgroup, as specified, to establish a workplan by which the MHSA-OAR shall be conducted, including a process for qualitative peer reviews of counties MHSA services and uniform elements for the county MHSA system improvement plans. The bill would require the agency to establish specific process measures and uniform elements for the county MHSA improvement plans and updates. The bill would require the counties to execute and fulfill components of its MHSA system improvement plan that can be accomplished with existing resources. The bill would require the agency to report to the Legislature, on an annual basis, a report that summarizes county performance on the established process and outcome measures during the reporting period, analyzes county performance trends over time, and makes findings and recommendations for common MHSA services improvements identified in the county MHSA self-assessments and county MHSA system improvement plans. By imposing new requirements on counties, this bill would impose a state-mandated local program. | |
| 37 | 36 | ||
| 38 | 37 | This bill would require the agency to request the University of California to enter into a contract with the state to provide specified services, including preparing an analysis of how data pertaining to the provision of mental health services and client outcomes collected by the counties and provided to the state may be used to demonstrate the impact of services funded by the MHSF on life outcomes. The bill would require the analysis to be delivered to the agency, the Legislature, and the workgroup on or before July 1, 2024. | |
| 39 | 38 | ||
| 40 | 39 | 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. | |
| 41 | 40 | ||
| 42 | 41 | 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. | |
| 43 | 42 | ||
| 44 | 43 | ## Digest Key | |
| 45 | 44 | ||
| 46 | 45 | ## Bill Text | |
| 47 | 46 | ||
| 48 | - | The people of the State of California do enact as follows:SECTION 1. Section 5846.5 is added to the Welfare and Institutions Code, to read:5846.5. (a) This section shall be known, and may be cited as, the Mental Health Services Act (MHSA) Outcomes and Accountability Review Act of 2022.(b) The California Health and Human Services Agency shall establish, by July 1, 2025, the California MHSA Outcomes and Accountability Review (MHSA-OAR) to facilitate a local accountability system that fosters continuous quality improvement in county programs funded by the MHSA and in the collection and dissemination by the agency of best practices in service delivery. The MHSA-OAR shall cover MHSA-funded services provided to current and former recipients and shall include the programmatic elements that each county offers as part of its MHSA service array, as well as any local program components, and shall consist of performance indicators, | |
| 47 | + | The people of the State of California do enact as follows:SECTION 1. Section 5846.5 is added to the Welfare and Institutions Code, to read:5846.5. (a) This section shall be known, and may be cited as, the Mental Health Services Act (MHSA) Outcomes and Accountability Review Act of 2022.(b) The California Health and Human Services Agency shall establish, by July 1, 2025, the California MHSA Outcomes and Accountability Review (MHSA-OAR) to facilitate a local accountability system that fosters continuous quality improvement in county programs funded by the MHSA and in the collection and dissemination by the agency of best practices in service delivery. The MHSA-OAR shall cover MHSA-funded services provided to current and former recipients and shall include the programmatic elements that each county offers as part of its MHSA service array, as well as any local program components, and shall consist of performance indicators, a county MHSA self-assessment process, and a county MHSA system improvement plan.(c) (1) (A) On or before October 1, 2023, the agency shall convene a workgroup comprised of representatives from the State Department of Health Care Services, the Mental Health Services Oversight and Accountability Commission, county behavioral health agencies, legislative staff, interested behavioral health advocacy and research organizations, current and former MHSA service recipients, organizations that represent county behavioral health agencies and county boards of supervisors, nonprofit community-based organizations, researchers, people with lived experience, county behavioral health agency partners, and any other entities or individuals that the agency deems necessary. The workgroup shall establish a workplan by which the MHSA-OAR shall be conducted, including a process for qualitative peer reviews of counties MHSA services.(B) The agency shall report annually to the Subcommittee on Health and Human Services of the Senate Committee on Budget and Fiscal Review and the Subcommittee on Health and Human Services of the Assembly Committee on Budget during the budget process with an update on the schedule for development of, and future changes to, the MHSA-OAR.(2) At a minimum, in establishing the work plan, the workgroup shall consider existing MHSA performance indicators being measured, additional, alternative, or additional and alternative process and outcome indicators to be measured, development of uniform elements of the county MHSA self-assessment and the county MHSA system improvement plans, timelines for implementation, recommendations for reducing the existing MHSA services data reporting burden, recommendations for financial incentives to counties for achievement on performance measures, and an analysis of the county and state workload associated with implementation of the requirements of this section.(3) The workgroup shall develop the uniform elements for the county MHSA system improvement plans required in paragraph (3) of subdivision (d). The agency, in consultation with the workgroup, shall develop the uniform elements of the updates to those plans, as required pursuant to subparagraph (D) of paragraph (3) of subdivision (d).(d) The MHSA-OAR shall consist of the following three components: performance indicators, a county MHSA self-assessment, and a county MHSA system improvement plan.(1) (A) The MHSA-OAR performance indicators shall be consistent with programmatic goals for the MHSA, and shall include both process and outcome measures. These measures shall be established in order to provide baseline and ongoing information about how the state and counties are performing over time and to inform and guide each county behavioral health agencys MHSA self-assessment and MHSA system improvement plan.(i) Process measures shall include measures of participant engagement, MHSA service delivery, and participation. Specific process measures shall be established by the agency, in consultation with the workgroup, and may include measures of engagement as shown by improvement in program participation, timeliness of service provision, rates of utilization of program components, and referrals and utilization of services.(ii) Outcome measures shall be determined based on the recommendations included in the analysis prepared by the University of California pursuant to subdivision (g), if the University of California enters into the contract described in subdivision (g).(B) Performance indicator data available in existing county data systems shall be collected by counties and provided to the agency, and performance indicator data available in existing state agency data systems shall be collected by the agency and provided to the counties. These data shall be reported in a manner, and on a schedule, determined by the agency, in consultation with the workgroup, but no less frequently than semiannually.(C) (i) During the first five-year MHSA-OAR cycle, performance indicator data reported by each county, shall be used to establish both county and statewide baselines for each of the process measures. After the first review cycle, the agency, in consultation with the workgroup, shall establish standard target thresholds for each of the process measures established by the workgroup.(ii) The agency, in consultation with the workgroup, shall develop a process for resolving any disputes regarding the establishment of standard process thresholds pursuant to clause (i).(D) For subsequent reviews, and based upon availability of additional data through interagency data-sharing agreements, the workgroup shall convene, as necessary, to consider whether to establish additional performance indicators that support the programmatic goals for the MHSA. Additional performance indicators established shall also be subject to the process described in subparagraph (C) and shall include consideration of when data on the additional performance indicators would be available for reporting, if not already available.(E) If, during subsequent reviews, there is sufficient reason to establish statewide performance standards for one or more outcome measures, the agency, in consultation with the workgroup, may establish those standards for each of the agreed-upon outcome measures.(2) (A) The county MHSA self-assessment component of the MHSA-OAR, as established by the workgroup, shall require the county behavioral health agencies to assess their performance on the established process and outcome measures that comprise the performance indicators, identify the strengths and weaknesses in their current practice and resource deployment, identify and describe how local operational decisions and systemic factors affect program outcomes, and consider areas of focus that may be included in the county MHSA system improvement plan, as described in paragraph (3). The county MHSA self-assessment process shall be designed to identify areas of best practices for replication and for system improvement at the county level, and shall guide the development of the county MHSA system improvement plan.(B) (i) The county MHSA self-assessment process shall be completed every five years by the county, in consultation and collaboration with local stakeholders, and submitted to the agency.(ii) Local stakeholders shall include county behavioral health directors, supervisors, and caseworkers; current and former MHSA service recipients; and county behavioral health agency partners. To the extent possible and relevant, local stakeholders shall also include representatives of tribal organizations and the local behavioral health board. Additional specific county behavioral health agency partners shall be determined by the county and may include, but are not limited to, adult education providers, providers of services for survivors of domestic violence, the local housing continuum of care, county human service departments, county drug and alcohol programs, community-based service providers, and organizations that represent MHSA recipients, as appropriate.(3) (A) (i) The county MHSA system improvement plan shall, at a minimum, describe how the county will improve its MHSA program performance in strategic focus areas based upon information learned through the county MHSA self-assessment process. The county MHSA system improvement plan shall include the uniform elements established by the workgroup pursuant to paragraph (3) of subdivision (c).(ii) The county MHSA system improvement plan shall be completed every five years by the county, approved in public session by the countys board of supervisors or, as applicable, chief elected official, and be submitted to the agency.(B) The county MHSA system improvement plan shall include an MHSA services peer review element, the purpose of which shall be to provide additional insight and technical assistance by peer counties.(C) Strategic focus areas for the county MHSA system improvement plan shall be determined by the county, informed by the county MHSA self-assessment process, as described in paragraph (2), with targets for improvement based upon what is learned in the county MHSA self-assessment process.(D) The county behavioral health agency shall complete an annual progress report on the status of its system improvement plan and shall submit these reports to the agency.(e) (1) The agency shall receive, review, and, based on its determination of whether the county MHSA system improvement plan meets the required elements, certify as complete all county-submitted performance indicator data, county MHSA self-assessments, county MHSA system improvement plans, and annual progress reports, and shall identify and promote the replication of best practices in MHSA service delivery to achieve the established process and outcome measures.(2) The agency shall monitor, on an ongoing basis, county performance on the measures developed pursuant to subdivision (d).(3) The agency shall, on an annual basis, submit a report to the Legislature that summarizes county performance on the established process and outcome measures during the reporting period, analyzes county performance trends over time, and makes findings and recommendations for common MHSA services improvements identified in the county MHSA self-assessments and county MHSA system improvement plans, including information on common statutory, regulatory, or fiscal barriers identified as inhibiting system improvements and any recommendations to overcome those barriers.(4) (A) The agency shall, in partnership with the University of California, if the contract is executed pursuant to subdivision (g), facilitate the provision of technical assistance to county behavioral health agencies as part of the peer review that supports the countys selected areas for improvement, as described in its system improvement plan.(B) If, in the course of its review of county MHSA system improvement plans and annual updates, or, in the course of its review of regularly submitted performance indicator data, the agency determines that a county is consistently failing to make progress toward its strategic focus areas for improvement or is consistently failing to meet the process measure standard target thresholds established pursuant to subparagraph (C) of paragraph (1) of subdivision (d), the agency shall engage the county in a process of targeted technical assistance and support to address and resolve the identified shortcomings.(f) A county shall execute and fulfill components of its MHSA system improvement plan that can be accomplished with existing resources.(g) The agency shall request the University of California to enter into a contract with the state to provide all of the following services:(1) (A) Prepare an analysis of how data pertaining to the provision of mental health services and client outcomes collected by the counties and provided to the state may be used to demonstrate the impact of services funded by the Mental Health Services Fund on life outcomes. The analysis shall be delivered to the agency, the Legislature, and the workgroup established pursuant to subparagraph (A) of paragraph (1) of subdivision (c) on or before July 1, 2024, and shall include both of the following:(i) Recommendations of what outcomes should be used to measure the impact of the Mental Health Services Act. Recommended life outcome measures shall include measures of the reduction of the negative outcomes described in subdivision (d) of Section 5840, which address prevention and early intervention strategies for mental illness, and measures of employment, educational attainment, program exits and program reentries, adherence to treatment plans, attainment of housing, reduction in contacts with law enforcement, reduction in hospitalizations, and reductions in homelessness.(ii) An estimate of how much an impact funding from the Mental Health Service Services Fund can have on each recommended outcome.(B) The analysis required to be delivered to the Legislature pursuant to subparagraph (A) shall be submitted in compliance with Section 9795 of the Government Code.(2) Create and maintain a dashboard modeled after the California Child Welfare Indicators Project to publicly report the data collected by counties and to report the status of county process and outcome indicators as described in this section.(3) Consult with the agency to provide technical assistance to county behavioral health agencies as described in subparagraph (A) of paragraph (4) of subdivision (e).SEC. 2. 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. | |
| 49 | 48 | ||
| 50 | 49 | The people of the State of California do enact as follows: | |
| 51 | 50 | ||
| 52 | 51 | ## The people of the State of California do enact as follows: | |
| 53 | 52 | ||
| 54 | - | SECTION 1. Section 5846.5 is added to the Welfare and Institutions Code, to read:5846.5. (a) This section shall be known, and may be cited as, the Mental Health Services Act (MHSA) Outcomes and Accountability Review Act of 2022.(b) The California Health and Human Services Agency shall establish, by July 1, 2025, the California MHSA Outcomes and Accountability Review (MHSA-OAR) to facilitate a local accountability system that fosters continuous quality improvement in county programs funded by the MHSA and in the collection and dissemination by the agency of best practices in service delivery. The MHSA-OAR shall cover MHSA-funded services provided to current and former recipients and shall include the programmatic elements that each county offers as part of its MHSA service array, as well as any local program components, and shall consist of performance indicators, | |
| 53 | + | SECTION 1. Section 5846.5 is added to the Welfare and Institutions Code, to read:5846.5. (a) This section shall be known, and may be cited as, the Mental Health Services Act (MHSA) Outcomes and Accountability Review Act of 2022.(b) The California Health and Human Services Agency shall establish, by July 1, 2025, the California MHSA Outcomes and Accountability Review (MHSA-OAR) to facilitate a local accountability system that fosters continuous quality improvement in county programs funded by the MHSA and in the collection and dissemination by the agency of best practices in service delivery. The MHSA-OAR shall cover MHSA-funded services provided to current and former recipients and shall include the programmatic elements that each county offers as part of its MHSA service array, as well as any local program components, and shall consist of performance indicators, a county MHSA self-assessment process, and a county MHSA system improvement plan.(c) (1) (A) On or before October 1, 2023, the agency shall convene a workgroup comprised of representatives from the State Department of Health Care Services, the Mental Health Services Oversight and Accountability Commission, county behavioral health agencies, legislative staff, interested behavioral health advocacy and research organizations, current and former MHSA service recipients, organizations that represent county behavioral health agencies and county boards of supervisors, nonprofit community-based organizations, researchers, people with lived experience, county behavioral health agency partners, and any other entities or individuals that the agency deems necessary. The workgroup shall establish a workplan by which the MHSA-OAR shall be conducted, including a process for qualitative peer reviews of counties MHSA services.(B) The agency shall report annually to the Subcommittee on Health and Human Services of the Senate Committee on Budget and Fiscal Review and the Subcommittee on Health and Human Services of the Assembly Committee on Budget during the budget process with an update on the schedule for development of, and future changes to, the MHSA-OAR.(2) At a minimum, in establishing the work plan, the workgroup shall consider existing MHSA performance indicators being measured, additional, alternative, or additional and alternative process and outcome indicators to be measured, development of uniform elements of the county MHSA self-assessment and the county MHSA system improvement plans, timelines for implementation, recommendations for reducing the existing MHSA services data reporting burden, recommendations for financial incentives to counties for achievement on performance measures, and an analysis of the county and state workload associated with implementation of the requirements of this section.(3) The workgroup shall develop the uniform elements for the county MHSA system improvement plans required in paragraph (3) of subdivision (d). The agency, in consultation with the workgroup, shall develop the uniform elements of the updates to those plans, as required pursuant to subparagraph (D) of paragraph (3) of subdivision (d).(d) The MHSA-OAR shall consist of the following three components: performance indicators, a county MHSA self-assessment, and a county MHSA system improvement plan.(1) (A) The MHSA-OAR performance indicators shall be consistent with programmatic goals for the MHSA, and shall include both process and outcome measures. These measures shall be established in order to provide baseline and ongoing information about how the state and counties are performing over time and to inform and guide each county behavioral health agencys MHSA self-assessment and MHSA system improvement plan.(i) Process measures shall include measures of participant engagement, MHSA service delivery, and participation. Specific process measures shall be established by the agency, in consultation with the workgroup, and may include measures of engagement as shown by improvement in program participation, timeliness of service provision, rates of utilization of program components, and referrals and utilization of services.(ii) Outcome measures shall be determined based on the recommendations included in the analysis prepared by the University of California pursuant to subdivision (g), if the University of California enters into the contract described in subdivision (g).(B) Performance indicator data available in existing county data systems shall be collected by counties and provided to the agency, and performance indicator data available in existing state agency data systems shall be collected by the agency and provided to the counties. These data shall be reported in a manner, and on a schedule, determined by the agency, in consultation with the workgroup, but no less frequently than semiannually.(C) (i) During the first five-year MHSA-OAR cycle, performance indicator data reported by each county, shall be used to establish both county and statewide baselines for each of the process measures. After the first review cycle, the agency, in consultation with the workgroup, shall establish standard target thresholds for each of the process measures established by the workgroup.(ii) The agency, in consultation with the workgroup, shall develop a process for resolving any disputes regarding the establishment of standard process thresholds pursuant to clause (i).(D) For subsequent reviews, and based upon availability of additional data through interagency data-sharing agreements, the workgroup shall convene, as necessary, to consider whether to establish additional performance indicators that support the programmatic goals for the MHSA. Additional performance indicators established shall also be subject to the process described in subparagraph (C) and shall include consideration of when data on the additional performance indicators would be available for reporting, if not already available.(E) If, during subsequent reviews, there is sufficient reason to establish statewide performance standards for one or more outcome measures, the agency, in consultation with the workgroup, may establish those standards for each of the agreed-upon outcome measures.(2) (A) The county MHSA self-assessment component of the MHSA-OAR, as established by the workgroup, shall require the county behavioral health agencies to assess their performance on the established process and outcome measures that comprise the performance indicators, identify the strengths and weaknesses in their current practice and resource deployment, identify and describe how local operational decisions and systemic factors affect program outcomes, and consider areas of focus that may be included in the county MHSA system improvement plan, as described in paragraph (3). The county MHSA self-assessment process shall be designed to identify areas of best practices for replication and for system improvement at the county level, and shall guide the development of the county MHSA system improvement plan.(B) (i) The county MHSA self-assessment process shall be completed every five years by the county, in consultation and collaboration with local stakeholders, and submitted to the agency.(ii) Local stakeholders shall include county behavioral health directors, supervisors, and caseworkers; current and former MHSA service recipients; and county behavioral health agency partners. To the extent possible and relevant, local stakeholders shall also include representatives of tribal organizations and the local behavioral health board. Additional specific county behavioral health agency partners shall be determined by the county and may include, but are not limited to, adult education providers, providers of services for survivors of domestic violence, the local housing continuum of care, county human service departments, county drug and alcohol programs, community-based service providers, and organizations that represent MHSA recipients, as appropriate.(3) (A) (i) The county MHSA system improvement plan shall, at a minimum, describe how the county will improve its MHSA program performance in strategic focus areas based upon information learned through the county MHSA self-assessment process. The county MHSA system improvement plan shall include the uniform elements established by the workgroup pursuant to paragraph (3) of subdivision (c).(ii) The county MHSA system improvement plan shall be completed every five years by the county, approved in public session by the countys board of supervisors or, as applicable, chief elected official, and be submitted to the agency.(B) The county MHSA system improvement plan shall include an MHSA services peer review element, the purpose of which shall be to provide additional insight and technical assistance by peer counties.(C) Strategic focus areas for the county MHSA system improvement plan shall be determined by the county, informed by the county MHSA self-assessment process, as described in paragraph (2), with targets for improvement based upon what is learned in the county MHSA self-assessment process.(D) The county behavioral health agency shall complete an annual progress report on the status of its system improvement plan and shall submit these reports to the agency.(e) (1) The agency shall receive, review, and, based on its determination of whether the county MHSA system improvement plan meets the required elements, certify as complete all county-submitted performance indicator data, county MHSA self-assessments, county MHSA system improvement plans, and annual progress reports, and shall identify and promote the replication of best practices in MHSA service delivery to achieve the established process and outcome measures.(2) The agency shall monitor, on an ongoing basis, county performance on the measures developed pursuant to subdivision (d).(3) The agency shall, on an annual basis, submit a report to the Legislature that summarizes county performance on the established process and outcome measures during the reporting period, analyzes county performance trends over time, and makes findings and recommendations for common MHSA services improvements identified in the county MHSA self-assessments and county MHSA system improvement plans, including information on common statutory, regulatory, or fiscal barriers identified as inhibiting system improvements and any recommendations to overcome those barriers.(4) (A) The agency shall, in partnership with the University of California, if the contract is executed pursuant to subdivision (g), facilitate the provision of technical assistance to county behavioral health agencies as part of the peer review that supports the countys selected areas for improvement, as described in its system improvement plan.(B) If, in the course of its review of county MHSA system improvement plans and annual updates, or, in the course of its review of regularly submitted performance indicator data, the agency determines that a county is consistently failing to make progress toward its strategic focus areas for improvement or is consistently failing to meet the process measure standard target thresholds established pursuant to subparagraph (C) of paragraph (1) of subdivision (d), the agency shall engage the county in a process of targeted technical assistance and support to address and resolve the identified shortcomings.(f) A county shall execute and fulfill components of its MHSA system improvement plan that can be accomplished with existing resources.(g) The agency shall request the University of California to enter into a contract with the state to provide all of the following services:(1) (A) Prepare an analysis of how data pertaining to the provision of mental health services and client outcomes collected by the counties and provided to the state may be used to demonstrate the impact of services funded by the Mental Health Services Fund on life outcomes. The analysis shall be delivered to the agency, the Legislature, and the workgroup established pursuant to subparagraph (A) of paragraph (1) of subdivision (c) on or before July 1, 2024, and shall include both of the following:(i) Recommendations of what outcomes should be used to measure the impact of the Mental Health Services Act. Recommended life outcome measures shall include measures of the reduction of the negative outcomes described in subdivision (d) of Section 5840, which address prevention and early intervention strategies for mental illness, and measures of employment, educational attainment, program exits and program reentries, adherence to treatment plans, attainment of housing, reduction in contacts with law enforcement, reduction in hospitalizations, and reductions in homelessness.(ii) An estimate of how much an impact funding from the Mental Health Service Services Fund can have on each recommended outcome.(B) The analysis required to be delivered to the Legislature pursuant to subparagraph (A) shall be submitted in compliance with Section 9795 of the Government Code.(2) Create and maintain a dashboard modeled after the California Child Welfare Indicators Project to publicly report the data collected by counties and to report the status of county process and outcome indicators as described in this section.(3) Consult with the agency to provide technical assistance to county behavioral health agencies as described in subparagraph (A) of paragraph (4) of subdivision (e). | |
| 55 | 54 | ||
| 56 | 55 | SECTION 1. Section 5846.5 is added to the Welfare and Institutions Code, to read: | |
| 57 | 56 | ||
| 58 | 57 | ### SECTION 1. | |
| 59 | 58 | ||
| 60 | - | 5846.5. (a) This section shall be known, and may be cited as, the Mental Health Services Act (MHSA) Outcomes and Accountability Review Act of 2022.(b) The California Health and Human Services Agency shall establish, by July 1, 2025, the California MHSA Outcomes and Accountability Review (MHSA-OAR) to facilitate a local accountability system that fosters continuous quality improvement in county programs funded by the MHSA and in the collection and dissemination by the agency of best practices in service delivery. The MHSA-OAR shall cover MHSA-funded services provided to current and former recipients and shall include the programmatic elements that each county offers as part of its MHSA service array, as well as any local program components, and shall consist of performance indicators | |
| 59 | + | 5846.5. (a) This section shall be known, and may be cited as, the Mental Health Services Act (MHSA) Outcomes and Accountability Review Act of 2022.(b) The California Health and Human Services Agency shall establish, by July 1, 2025, the California MHSA Outcomes and Accountability Review (MHSA-OAR) to facilitate a local accountability system that fosters continuous quality improvement in county programs funded by the MHSA and in the collection and dissemination by the agency of best practices in service delivery. The MHSA-OAR shall cover MHSA-funded services provided to current and former recipients and shall include the programmatic elements that each county offers as part of its MHSA service array, as well as any local program components, and shall consist of performance indicators, a county MHSA self-assessment process, and a county MHSA system improvement plan.(c) (1) (A) On or before October 1, 2023, the agency shall convene a workgroup comprised of representatives from the State Department of Health Care Services, the Mental Health Services Oversight and Accountability Commission, county behavioral health agencies, legislative staff, interested behavioral health advocacy and research organizations, current and former MHSA service recipients, organizations that represent county behavioral health agencies and county boards of supervisors, nonprofit community-based organizations, researchers, people with lived experience, county behavioral health agency partners, and any other entities or individuals that the agency deems necessary. The workgroup shall establish a workplan by which the MHSA-OAR shall be conducted, including a process for qualitative peer reviews of counties MHSA services.(B) The agency shall report annually to the Subcommittee on Health and Human Services of the Senate Committee on Budget and Fiscal Review and the Subcommittee on Health and Human Services of the Assembly Committee on Budget during the budget process with an update on the schedule for development of, and future changes to, the MHSA-OAR.(2) At a minimum, in establishing the work plan, the workgroup shall consider existing MHSA performance indicators being measured, additional, alternative, or additional and alternative process and outcome indicators to be measured, development of uniform elements of the county MHSA self-assessment and the county MHSA system improvement plans, timelines for implementation, recommendations for reducing the existing MHSA services data reporting burden, recommendations for financial incentives to counties for achievement on performance measures, and an analysis of the county and state workload associated with implementation of the requirements of this section.(3) The workgroup shall develop the uniform elements for the county MHSA system improvement plans required in paragraph (3) of subdivision (d). The agency, in consultation with the workgroup, shall develop the uniform elements of the updates to those plans, as required pursuant to subparagraph (D) of paragraph (3) of subdivision (d).(d) The MHSA-OAR shall consist of the following three components: performance indicators, a county MHSA self-assessment, and a county MHSA system improvement plan.(1) (A) The MHSA-OAR performance indicators shall be consistent with programmatic goals for the MHSA, and shall include both process and outcome measures. These measures shall be established in order to provide baseline and ongoing information about how the state and counties are performing over time and to inform and guide each county behavioral health agencys MHSA self-assessment and MHSA system improvement plan.(i) Process measures shall include measures of participant engagement, MHSA service delivery, and participation. Specific process measures shall be established by the agency, in consultation with the workgroup, and may include measures of engagement as shown by improvement in program participation, timeliness of service provision, rates of utilization of program components, and referrals and utilization of services.(ii) Outcome measures shall be determined based on the recommendations included in the analysis prepared by the University of California pursuant to subdivision (g), if the University of California enters into the contract described in subdivision (g).(B) Performance indicator data available in existing county data systems shall be collected by counties and provided to the agency, and performance indicator data available in existing state agency data systems shall be collected by the agency and provided to the counties. These data shall be reported in a manner, and on a schedule, determined by the agency, in consultation with the workgroup, but no less frequently than semiannually.(C) (i) During the first five-year MHSA-OAR cycle, performance indicator data reported by each county, shall be used to establish both county and statewide baselines for each of the process measures. After the first review cycle, the agency, in consultation with the workgroup, shall establish standard target thresholds for each of the process measures established by the workgroup.(ii) The agency, in consultation with the workgroup, shall develop a process for resolving any disputes regarding the establishment of standard process thresholds pursuant to clause (i).(D) For subsequent reviews, and based upon availability of additional data through interagency data-sharing agreements, the workgroup shall convene, as necessary, to consider whether to establish additional performance indicators that support the programmatic goals for the MHSA. Additional performance indicators established shall also be subject to the process described in subparagraph (C) and shall include consideration of when data on the additional performance indicators would be available for reporting, if not already available.(E) If, during subsequent reviews, there is sufficient reason to establish statewide performance standards for one or more outcome measures, the agency, in consultation with the workgroup, may establish those standards for each of the agreed-upon outcome measures.(2) (A) The county MHSA self-assessment component of the MHSA-OAR, as established by the workgroup, shall require the county behavioral health agencies to assess their performance on the established process and outcome measures that comprise the performance indicators, identify the strengths and weaknesses in their current practice and resource deployment, identify and describe how local operational decisions and systemic factors affect program outcomes, and consider areas of focus that may be included in the county MHSA system improvement plan, as described in paragraph (3). The county MHSA self-assessment process shall be designed to identify areas of best practices for replication and for system improvement at the county level, and shall guide the development of the county MHSA system improvement plan.(B) (i) The county MHSA self-assessment process shall be completed every five years by the county, in consultation and collaboration with local stakeholders, and submitted to the agency.(ii) Local stakeholders shall include county behavioral health directors, supervisors, and caseworkers; current and former MHSA service recipients; and county behavioral health agency partners. To the extent possible and relevant, local stakeholders shall also include representatives of tribal organizations and the local behavioral health board. Additional specific county behavioral health agency partners shall be determined by the county and may include, but are not limited to, adult education providers, providers of services for survivors of domestic violence, the local housing continuum of care, county human service departments, county drug and alcohol programs, community-based service providers, and organizations that represent MHSA recipients, as appropriate.(3) (A) (i) The county MHSA system improvement plan shall, at a minimum, describe how the county will improve its MHSA program performance in strategic focus areas based upon information learned through the county MHSA self-assessment process. The county MHSA system improvement plan shall include the uniform elements established by the workgroup pursuant to paragraph (3) of subdivision (c).(ii) The county MHSA system improvement plan shall be completed every five years by the county, approved in public session by the countys board of supervisors or, as applicable, chief elected official, and be submitted to the agency.(B) The county MHSA system improvement plan shall include an MHSA services peer review element, the purpose of which shall be to provide additional insight and technical assistance by peer counties.(C) Strategic focus areas for the county MHSA system improvement plan shall be determined by the county, informed by the county MHSA self-assessment process, as described in paragraph (2), with targets for improvement based upon what is learned in the county MHSA self-assessment process.(D) The county behavioral health agency shall complete an annual progress report on the status of its system improvement plan and shall submit these reports to the agency.(e) (1) The agency shall receive, review, and, based on its determination of whether the county MHSA system improvement plan meets the required elements, certify as complete all county-submitted performance indicator data, county MHSA self-assessments, county MHSA system improvement plans, and annual progress reports, and shall identify and promote the replication of best practices in MHSA service delivery to achieve the established process and outcome measures.(2) The agency shall monitor, on an ongoing basis, county performance on the measures developed pursuant to subdivision (d).(3) The agency shall, on an annual basis, submit a report to the Legislature that summarizes county performance on the established process and outcome measures during the reporting period, analyzes county performance trends over time, and makes findings and recommendations for common MHSA services improvements identified in the county MHSA self-assessments and county MHSA system improvement plans, including information on common statutory, regulatory, or fiscal barriers identified as inhibiting system improvements and any recommendations to overcome those barriers.(4) (A) The agency shall, in partnership with the University of California, if the contract is executed pursuant to subdivision (g), facilitate the provision of technical assistance to county behavioral health agencies as part of the peer review that supports the countys selected areas for improvement, as described in its system improvement plan.(B) If, in the course of its review of county MHSA system improvement plans and annual updates, or, in the course of its review of regularly submitted performance indicator data, the agency determines that a county is consistently failing to make progress toward its strategic focus areas for improvement or is consistently failing to meet the process measure standard target thresholds established pursuant to subparagraph (C) of paragraph (1) of subdivision (d), the agency shall engage the county in a process of targeted technical assistance and support to address and resolve the identified shortcomings.(f) A county shall execute and fulfill components of its MHSA system improvement plan that can be accomplished with existing resources.(g) The agency shall request the University of California to enter into a contract with the state to provide all of the following services:(1) (A) Prepare an analysis of how data pertaining to the provision of mental health services and client outcomes collected by the counties and provided to the state may be used to demonstrate the impact of services funded by the Mental Health Services Fund on life outcomes. The analysis shall be delivered to the agency, the Legislature, and the workgroup established pursuant to subparagraph (A) of paragraph (1) of subdivision (c) on or before July 1, 2024, and shall include both of the following:(i) Recommendations of what outcomes should be used to measure the impact of the Mental Health Services Act. Recommended life outcome measures shall include measures of the reduction of the negative outcomes described in subdivision (d) of Section 5840, which address prevention and early intervention strategies for mental illness, and measures of employment, educational attainment, program exits and program reentries, adherence to treatment plans, attainment of housing, reduction in contacts with law enforcement, reduction in hospitalizations, and reductions in homelessness.(ii) An estimate of how much an impact funding from the Mental Health Service Services Fund can have on each recommended outcome.(B) The analysis required to be delivered to the Legislature pursuant to subparagraph (A) shall be submitted in compliance with Section 9795 of the Government Code.(2) Create and maintain a dashboard modeled after the California Child Welfare Indicators Project to publicly report the data collected by counties and to report the status of county process and outcome indicators as described in this section.(3) Consult with the agency to provide technical assistance to county behavioral health agencies as described in subparagraph (A) of paragraph (4) of subdivision (e). | |
| 61 | 60 | ||
| 62 | - | 5846.5. (a) This section shall be known, and may be cited as, the Mental Health Services Act (MHSA) Outcomes and Accountability Review Act of 2022.(b) The California Health and Human Services Agency shall establish, by July 1, 2025, the California MHSA Outcomes and Accountability Review (MHSA-OAR) to facilitate a local accountability system that fosters continuous quality improvement in county programs funded by the MHSA and in the collection and dissemination by the agency of best practices in service delivery. The MHSA-OAR shall cover MHSA-funded services provided to current and former recipients and shall include the programmatic elements that each county offers as part of its MHSA service array, as well as any local program components, and shall consist of performance indicators | |
| 61 | + | 5846.5. (a) This section shall be known, and may be cited as, the Mental Health Services Act (MHSA) Outcomes and Accountability Review Act of 2022.(b) The California Health and Human Services Agency shall establish, by July 1, 2025, the California MHSA Outcomes and Accountability Review (MHSA-OAR) to facilitate a local accountability system that fosters continuous quality improvement in county programs funded by the MHSA and in the collection and dissemination by the agency of best practices in service delivery. The MHSA-OAR shall cover MHSA-funded services provided to current and former recipients and shall include the programmatic elements that each county offers as part of its MHSA service array, as well as any local program components, and shall consist of performance indicators, a county MHSA self-assessment process, and a county MHSA system improvement plan.(c) (1) (A) On or before October 1, 2023, the agency shall convene a workgroup comprised of representatives from the State Department of Health Care Services, the Mental Health Services Oversight and Accountability Commission, county behavioral health agencies, legislative staff, interested behavioral health advocacy and research organizations, current and former MHSA service recipients, organizations that represent county behavioral health agencies and county boards of supervisors, nonprofit community-based organizations, researchers, people with lived experience, county behavioral health agency partners, and any other entities or individuals that the agency deems necessary. The workgroup shall establish a workplan by which the MHSA-OAR shall be conducted, including a process for qualitative peer reviews of counties MHSA services.(B) The agency shall report annually to the Subcommittee on Health and Human Services of the Senate Committee on Budget and Fiscal Review and the Subcommittee on Health and Human Services of the Assembly Committee on Budget during the budget process with an update on the schedule for development of, and future changes to, the MHSA-OAR.(2) At a minimum, in establishing the work plan, the workgroup shall consider existing MHSA performance indicators being measured, additional, alternative, or additional and alternative process and outcome indicators to be measured, development of uniform elements of the county MHSA self-assessment and the county MHSA system improvement plans, timelines for implementation, recommendations for reducing the existing MHSA services data reporting burden, recommendations for financial incentives to counties for achievement on performance measures, and an analysis of the county and state workload associated with implementation of the requirements of this section.(3) The workgroup shall develop the uniform elements for the county MHSA system improvement plans required in paragraph (3) of subdivision (d). The agency, in consultation with the workgroup, shall develop the uniform elements of the updates to those plans, as required pursuant to subparagraph (D) of paragraph (3) of subdivision (d).(d) The MHSA-OAR shall consist of the following three components: performance indicators, a county MHSA self-assessment, and a county MHSA system improvement plan.(1) (A) The MHSA-OAR performance indicators shall be consistent with programmatic goals for the MHSA, and shall include both process and outcome measures. These measures shall be established in order to provide baseline and ongoing information about how the state and counties are performing over time and to inform and guide each county behavioral health agencys MHSA self-assessment and MHSA system improvement plan.(i) Process measures shall include measures of participant engagement, MHSA service delivery, and participation. Specific process measures shall be established by the agency, in consultation with the workgroup, and may include measures of engagement as shown by improvement in program participation, timeliness of service provision, rates of utilization of program components, and referrals and utilization of services.(ii) Outcome measures shall be determined based on the recommendations included in the analysis prepared by the University of California pursuant to subdivision (g), if the University of California enters into the contract described in subdivision (g).(B) Performance indicator data available in existing county data systems shall be collected by counties and provided to the agency, and performance indicator data available in existing state agency data systems shall be collected by the agency and provided to the counties. These data shall be reported in a manner, and on a schedule, determined by the agency, in consultation with the workgroup, but no less frequently than semiannually.(C) (i) During the first five-year MHSA-OAR cycle, performance indicator data reported by each county, shall be used to establish both county and statewide baselines for each of the process measures. After the first review cycle, the agency, in consultation with the workgroup, shall establish standard target thresholds for each of the process measures established by the workgroup.(ii) The agency, in consultation with the workgroup, shall develop a process for resolving any disputes regarding the establishment of standard process thresholds pursuant to clause (i).(D) For subsequent reviews, and based upon availability of additional data through interagency data-sharing agreements, the workgroup shall convene, as necessary, to consider whether to establish additional performance indicators that support the programmatic goals for the MHSA. Additional performance indicators established shall also be subject to the process described in subparagraph (C) and shall include consideration of when data on the additional performance indicators would be available for reporting, if not already available.(E) If, during subsequent reviews, there is sufficient reason to establish statewide performance standards for one or more outcome measures, the agency, in consultation with the workgroup, may establish those standards for each of the agreed-upon outcome measures.(2) (A) The county MHSA self-assessment component of the MHSA-OAR, as established by the workgroup, shall require the county behavioral health agencies to assess their performance on the established process and outcome measures that comprise the performance indicators, identify the strengths and weaknesses in their current practice and resource deployment, identify and describe how local operational decisions and systemic factors affect program outcomes, and consider areas of focus that may be included in the county MHSA system improvement plan, as described in paragraph (3). The county MHSA self-assessment process shall be designed to identify areas of best practices for replication and for system improvement at the county level, and shall guide the development of the county MHSA system improvement plan.(B) (i) The county MHSA self-assessment process shall be completed every five years by the county, in consultation and collaboration with local stakeholders, and submitted to the agency.(ii) Local stakeholders shall include county behavioral health directors, supervisors, and caseworkers; current and former MHSA service recipients; and county behavioral health agency partners. To the extent possible and relevant, local stakeholders shall also include representatives of tribal organizations and the local behavioral health board. Additional specific county behavioral health agency partners shall be determined by the county and may include, but are not limited to, adult education providers, providers of services for survivors of domestic violence, the local housing continuum of care, county human service departments, county drug and alcohol programs, community-based service providers, and organizations that represent MHSA recipients, as appropriate.(3) (A) (i) The county MHSA system improvement plan shall, at a minimum, describe how the county will improve its MHSA program performance in strategic focus areas based upon information learned through the county MHSA self-assessment process. The county MHSA system improvement plan shall include the uniform elements established by the workgroup pursuant to paragraph (3) of subdivision (c).(ii) The county MHSA system improvement plan shall be completed every five years by the county, approved in public session by the countys board of supervisors or, as applicable, chief elected official, and be submitted to the agency.(B) The county MHSA system improvement plan shall include an MHSA services peer review element, the purpose of which shall be to provide additional insight and technical assistance by peer counties.(C) Strategic focus areas for the county MHSA system improvement plan shall be determined by the county, informed by the county MHSA self-assessment process, as described in paragraph (2), with targets for improvement based upon what is learned in the county MHSA self-assessment process.(D) The county behavioral health agency shall complete an annual progress report on the status of its system improvement plan and shall submit these reports to the agency.(e) (1) The agency shall receive, review, and, based on its determination of whether the county MHSA system improvement plan meets the required elements, certify as complete all county-submitted performance indicator data, county MHSA self-assessments, county MHSA system improvement plans, and annual progress reports, and shall identify and promote the replication of best practices in MHSA service delivery to achieve the established process and outcome measures.(2) The agency shall monitor, on an ongoing basis, county performance on the measures developed pursuant to subdivision (d).(3) The agency shall, on an annual basis, submit a report to the Legislature that summarizes county performance on the established process and outcome measures during the reporting period, analyzes county performance trends over time, and makes findings and recommendations for common MHSA services improvements identified in the county MHSA self-assessments and county MHSA system improvement plans, including information on common statutory, regulatory, or fiscal barriers identified as inhibiting system improvements and any recommendations to overcome those barriers.(4) (A) The agency shall, in partnership with the University of California, if the contract is executed pursuant to subdivision (g), facilitate the provision of technical assistance to county behavioral health agencies as part of the peer review that supports the countys selected areas for improvement, as described in its system improvement plan.(B) If, in the course of its review of county MHSA system improvement plans and annual updates, or, in the course of its review of regularly submitted performance indicator data, the agency determines that a county is consistently failing to make progress toward its strategic focus areas for improvement or is consistently failing to meet the process measure standard target thresholds established pursuant to subparagraph (C) of paragraph (1) of subdivision (d), the agency shall engage the county in a process of targeted technical assistance and support to address and resolve the identified shortcomings.(f) A county shall execute and fulfill components of its MHSA system improvement plan that can be accomplished with existing resources.(g) The agency shall request the University of California to enter into a contract with the state to provide all of the following services:(1) (A) Prepare an analysis of how data pertaining to the provision of mental health services and client outcomes collected by the counties and provided to the state may be used to demonstrate the impact of services funded by the Mental Health Services Fund on life outcomes. The analysis shall be delivered to the agency, the Legislature, and the workgroup established pursuant to subparagraph (A) of paragraph (1) of subdivision (c) on or before July 1, 2024, and shall include both of the following:(i) Recommendations of what outcomes should be used to measure the impact of the Mental Health Services Act. Recommended life outcome measures shall include measures of the reduction of the negative outcomes described in subdivision (d) of Section 5840, which address prevention and early intervention strategies for mental illness, and measures of employment, educational attainment, program exits and program reentries, adherence to treatment plans, attainment of housing, reduction in contacts with law enforcement, reduction in hospitalizations, and reductions in homelessness.(ii) An estimate of how much an impact funding from the Mental Health Service Services Fund can have on each recommended outcome.(B) The analysis required to be delivered to the Legislature pursuant to subparagraph (A) shall be submitted in compliance with Section 9795 of the Government Code.(2) Create and maintain a dashboard modeled after the California Child Welfare Indicators Project to publicly report the data collected by counties and to report the status of county process and outcome indicators as described in this section.(3) Consult with the agency to provide technical assistance to county behavioral health agencies as described in subparagraph (A) of paragraph (4) of subdivision (e). | |
| 63 | 62 | ||
| 64 | - | 5846.5. (a) This section shall be known, and may be cited as, the Mental Health Services Act (MHSA) Outcomes and Accountability Review Act of 2022.(b) The California Health and Human Services Agency shall establish, by July 1, 2025, the California MHSA Outcomes and Accountability Review (MHSA-OAR) to facilitate a local accountability system that fosters continuous quality improvement in county programs funded by the MHSA and in the collection and dissemination by the agency of best practices in service delivery. The MHSA-OAR shall cover MHSA-funded services provided to current and former recipients and shall include the programmatic elements that each county offers as part of its MHSA service array, as well as any local program components, and shall consist of performance indicators | |
| 63 | + | 5846.5. (a) This section shall be known, and may be cited as, the Mental Health Services Act (MHSA) Outcomes and Accountability Review Act of 2022.(b) The California Health and Human Services Agency shall establish, by July 1, 2025, the California MHSA Outcomes and Accountability Review (MHSA-OAR) to facilitate a local accountability system that fosters continuous quality improvement in county programs funded by the MHSA and in the collection and dissemination by the agency of best practices in service delivery. The MHSA-OAR shall cover MHSA-funded services provided to current and former recipients and shall include the programmatic elements that each county offers as part of its MHSA service array, as well as any local program components, and shall consist of performance indicators, a county MHSA self-assessment process, and a county MHSA system improvement plan.(c) (1) (A) On or before October 1, 2023, the agency shall convene a workgroup comprised of representatives from the State Department of Health Care Services, the Mental Health Services Oversight and Accountability Commission, county behavioral health agencies, legislative staff, interested behavioral health advocacy and research organizations, current and former MHSA service recipients, organizations that represent county behavioral health agencies and county boards of supervisors, nonprofit community-based organizations, researchers, people with lived experience, county behavioral health agency partners, and any other entities or individuals that the agency deems necessary. The workgroup shall establish a workplan by which the MHSA-OAR shall be conducted, including a process for qualitative peer reviews of counties MHSA services.(B) The agency shall report annually to the Subcommittee on Health and Human Services of the Senate Committee on Budget and Fiscal Review and the Subcommittee on Health and Human Services of the Assembly Committee on Budget during the budget process with an update on the schedule for development of, and future changes to, the MHSA-OAR.(2) At a minimum, in establishing the work plan, the workgroup shall consider existing MHSA performance indicators being measured, additional, alternative, or additional and alternative process and outcome indicators to be measured, development of uniform elements of the county MHSA self-assessment and the county MHSA system improvement plans, timelines for implementation, recommendations for reducing the existing MHSA services data reporting burden, recommendations for financial incentives to counties for achievement on performance measures, and an analysis of the county and state workload associated with implementation of the requirements of this section.(3) The workgroup shall develop the uniform elements for the county MHSA system improvement plans required in paragraph (3) of subdivision (d). The agency, in consultation with the workgroup, shall develop the uniform elements of the updates to those plans, as required pursuant to subparagraph (D) of paragraph (3) of subdivision (d).(d) The MHSA-OAR shall consist of the following three components: performance indicators, a county MHSA self-assessment, and a county MHSA system improvement plan.(1) (A) The MHSA-OAR performance indicators shall be consistent with programmatic goals for the MHSA, and shall include both process and outcome measures. These measures shall be established in order to provide baseline and ongoing information about how the state and counties are performing over time and to inform and guide each county behavioral health agencys MHSA self-assessment and MHSA system improvement plan.(i) Process measures shall include measures of participant engagement, MHSA service delivery, and participation. Specific process measures shall be established by the agency, in consultation with the workgroup, and may include measures of engagement as shown by improvement in program participation, timeliness of service provision, rates of utilization of program components, and referrals and utilization of services.(ii) Outcome measures shall be determined based on the recommendations included in the analysis prepared by the University of California pursuant to subdivision (g), if the University of California enters into the contract described in subdivision (g).(B) Performance indicator data available in existing county data systems shall be collected by counties and provided to the agency, and performance indicator data available in existing state agency data systems shall be collected by the agency and provided to the counties. These data shall be reported in a manner, and on a schedule, determined by the agency, in consultation with the workgroup, but no less frequently than semiannually.(C) (i) During the first five-year MHSA-OAR cycle, performance indicator data reported by each county, shall be used to establish both county and statewide baselines for each of the process measures. After the first review cycle, the agency, in consultation with the workgroup, shall establish standard target thresholds for each of the process measures established by the workgroup.(ii) The agency, in consultation with the workgroup, shall develop a process for resolving any disputes regarding the establishment of standard process thresholds pursuant to clause (i).(D) For subsequent reviews, and based upon availability of additional data through interagency data-sharing agreements, the workgroup shall convene, as necessary, to consider whether to establish additional performance indicators that support the programmatic goals for the MHSA. Additional performance indicators established shall also be subject to the process described in subparagraph (C) and shall include consideration of when data on the additional performance indicators would be available for reporting, if not already available.(E) If, during subsequent reviews, there is sufficient reason to establish statewide performance standards for one or more outcome measures, the agency, in consultation with the workgroup, may establish those standards for each of the agreed-upon outcome measures.(2) (A) The county MHSA self-assessment component of the MHSA-OAR, as established by the workgroup, shall require the county behavioral health agencies to assess their performance on the established process and outcome measures that comprise the performance indicators, identify the strengths and weaknesses in their current practice and resource deployment, identify and describe how local operational decisions and systemic factors affect program outcomes, and consider areas of focus that may be included in the county MHSA system improvement plan, as described in paragraph (3). The county MHSA self-assessment process shall be designed to identify areas of best practices for replication and for system improvement at the county level, and shall guide the development of the county MHSA system improvement plan.(B) (i) The county MHSA self-assessment process shall be completed every five years by the county, in consultation and collaboration with local stakeholders, and submitted to the agency.(ii) Local stakeholders shall include county behavioral health directors, supervisors, and caseworkers; current and former MHSA service recipients; and county behavioral health agency partners. To the extent possible and relevant, local stakeholders shall also include representatives of tribal organizations and the local behavioral health board. Additional specific county behavioral health agency partners shall be determined by the county and may include, but are not limited to, adult education providers, providers of services for survivors of domestic violence, the local housing continuum of care, county human service departments, county drug and alcohol programs, community-based service providers, and organizations that represent MHSA recipients, as appropriate.(3) (A) (i) The county MHSA system improvement plan shall, at a minimum, describe how the county will improve its MHSA program performance in strategic focus areas based upon information learned through the county MHSA self-assessment process. The county MHSA system improvement plan shall include the uniform elements established by the workgroup pursuant to paragraph (3) of subdivision (c).(ii) The county MHSA system improvement plan shall be completed every five years by the county, approved in public session by the countys board of supervisors or, as applicable, chief elected official, and be submitted to the agency.(B) The county MHSA system improvement plan shall include an MHSA services peer review element, the purpose of which shall be to provide additional insight and technical assistance by peer counties.(C) Strategic focus areas for the county MHSA system improvement plan shall be determined by the county, informed by the county MHSA self-assessment process, as described in paragraph (2), with targets for improvement based upon what is learned in the county MHSA self-assessment process.(D) The county behavioral health agency shall complete an annual progress report on the status of its system improvement plan and shall submit these reports to the agency.(e) (1) The agency shall receive, review, and, based on its determination of whether the county MHSA system improvement plan meets the required elements, certify as complete all county-submitted performance indicator data, county MHSA self-assessments, county MHSA system improvement plans, and annual progress reports, and shall identify and promote the replication of best practices in MHSA service delivery to achieve the established process and outcome measures.(2) The agency shall monitor, on an ongoing basis, county performance on the measures developed pursuant to subdivision (d).(3) The agency shall, on an annual basis, submit a report to the Legislature that summarizes county performance on the established process and outcome measures during the reporting period, analyzes county performance trends over time, and makes findings and recommendations for common MHSA services improvements identified in the county MHSA self-assessments and county MHSA system improvement plans, including information on common statutory, regulatory, or fiscal barriers identified as inhibiting system improvements and any recommendations to overcome those barriers.(4) (A) The agency shall, in partnership with the University of California, if the contract is executed pursuant to subdivision (g), facilitate the provision of technical assistance to county behavioral health agencies as part of the peer review that supports the countys selected areas for improvement, as described in its system improvement plan.(B) If, in the course of its review of county MHSA system improvement plans and annual updates, or, in the course of its review of regularly submitted performance indicator data, the agency determines that a county is consistently failing to make progress toward its strategic focus areas for improvement or is consistently failing to meet the process measure standard target thresholds established pursuant to subparagraph (C) of paragraph (1) of subdivision (d), the agency shall engage the county in a process of targeted technical assistance and support to address and resolve the identified shortcomings.(f) A county shall execute and fulfill components of its MHSA system improvement plan that can be accomplished with existing resources.(g) The agency shall request the University of California to enter into a contract with the state to provide all of the following services:(1) (A) Prepare an analysis of how data pertaining to the provision of mental health services and client outcomes collected by the counties and provided to the state may be used to demonstrate the impact of services funded by the Mental Health Services Fund on life outcomes. The analysis shall be delivered to the agency, the Legislature, and the workgroup established pursuant to subparagraph (A) of paragraph (1) of subdivision (c) on or before July 1, 2024, and shall include both of the following:(i) Recommendations of what outcomes should be used to measure the impact of the Mental Health Services Act. Recommended life outcome measures shall include measures of the reduction of the negative outcomes described in subdivision (d) of Section 5840, which address prevention and early intervention strategies for mental illness, and measures of employment, educational attainment, program exits and program reentries, adherence to treatment plans, attainment of housing, reduction in contacts with law enforcement, reduction in hospitalizations, and reductions in homelessness.(ii) An estimate of how much an impact funding from the Mental Health Service Services Fund can have on each recommended outcome.(B) The analysis required to be delivered to the Legislature pursuant to subparagraph (A) shall be submitted in compliance with Section 9795 of the Government Code.(2) Create and maintain a dashboard modeled after the California Child Welfare Indicators Project to publicly report the data collected by counties and to report the status of county process and outcome indicators as described in this section.(3) Consult with the agency to provide technical assistance to county behavioral health agencies as described in subparagraph (A) of paragraph (4) of subdivision (e). | |
| 65 | 64 | ||
| 66 | 65 | ||
| 67 | 66 | ||
| 68 | 67 | 5846.5. (a) This section shall be known, and may be cited as, the Mental Health Services Act (MHSA) Outcomes and Accountability Review Act of 2022. | |
| 69 | 68 | ||
| 70 | - | (b) The California Health and Human Services Agency shall establish, by July 1, 2025, the California MHSA Outcomes and Accountability Review (MHSA-OAR) to facilitate a local accountability system that fosters continuous quality improvement in county programs funded by the MHSA and in the collection and dissemination by the agency of best practices in service delivery. The MHSA-OAR shall cover MHSA-funded services provided to current and former recipients and shall include the programmatic elements that each county offers as part of its MHSA service array, as well as any local program components, and shall consist of performance indicators, | |
| 69 | + | (b) The California Health and Human Services Agency shall establish, by July 1, 2025, the California MHSA Outcomes and Accountability Review (MHSA-OAR) to facilitate a local accountability system that fosters continuous quality improvement in county programs funded by the MHSA and in the collection and dissemination by the agency of best practices in service delivery. The MHSA-OAR shall cover MHSA-funded services provided to current and former recipients and shall include the programmatic elements that each county offers as part of its MHSA service array, as well as any local program components, and shall consist of performance indicators, a county MHSA self-assessment process, and a county MHSA system improvement plan. | |
| 71 | 70 | ||
| 72 | - | (c) (1) (A) On or before October 1, 2023, the agency shall convene a workgroup comprised of representatives from the State Department of Health Care Services, the Mental Health Services Oversight and Accountability Commission, county behavioral health agencies, legislative staff, interested behavioral health advocacy and research organizations, current and former MHSA service recipients, organizations that represent county behavioral health agencies and county boards of supervisors, nonprofit community-based organizations, researchers, people with lived experience, county behavioral health agency partners, and any other entities or individuals that the agency deems necessary. The workgroup shall establish a workplan by which the MHSA-OAR shall be conducted, including a process for qualitative peer reviews | |
| 71 | + | (c) (1) (A) On or before October 1, 2023, the agency shall convene a workgroup comprised of representatives from the State Department of Health Care Services, the Mental Health Services Oversight and Accountability Commission, county behavioral health agencies, legislative staff, interested behavioral health advocacy and research organizations, current and former MHSA service recipients, organizations that represent county behavioral health agencies and county boards of supervisors, nonprofit community-based organizations, researchers, people with lived experience, county behavioral health agency partners, and any other entities or individuals that the agency deems necessary. The workgroup shall establish a workplan by which the MHSA-OAR shall be conducted, including a process for qualitative peer reviews of counties MHSA services. | |
| 73 | 72 | ||
| 74 | 73 | (B) The agency shall report annually to the Subcommittee on Health and Human Services of the Senate Committee on Budget and Fiscal Review and the Subcommittee on Health and Human Services of the Assembly Committee on Budget during the budget process with an update on the schedule for development of, and future changes to, the MHSA-OAR. | |
| 75 | 74 | ||
| 76 | - | (2) At a minimum, in establishing the work plan, the workgroup shall consider existing MHSA performance indicators being measured, additional, alternative, or additional and alternative process and outcome | |
| 75 | + | (2) At a minimum, in establishing the work plan, the workgroup shall consider existing MHSA performance indicators being measured, additional, alternative, or additional and alternative process and outcome indicators to be measured, development of uniform elements of the county MHSA self-assessment and the county MHSA system improvement plans, timelines for implementation, recommendations for reducing the existing MHSA services data reporting burden, recommendations for financial incentives to counties for achievement on performance measures, and an analysis of the county and state workload associated with implementation of the requirements of this section. | |
| 77 | 76 | ||
| 78 | - | (3) The workgroup shall develop the uniform elements for the county MHSA system improvement plans required in paragraph (3) of subdivision (d). The agency, in consultation with the workgroup, shall develop the uniform elements of the updates to those plans, as required pursuant to subparagraph (D) | |
| 77 | + | (3) The workgroup shall develop the uniform elements for the county MHSA system improvement plans required in paragraph (3) of subdivision (d). The agency, in consultation with the workgroup, shall develop the uniform elements of the updates to those plans, as required pursuant to subparagraph (D) of paragraph (3) of subdivision (d). | |
| 79 | 78 | ||
| 80 | - | (4) On or after July 1, 2025, the workgroup may be disbanded or incorporated into existing advisory bodies, at the discretion of the agency. | |
| 81 | - | ||
| 82 | - | (d) The MHSA-OAR shall consist of the following three components: performance indicators, including specific processes and outcome measures, a county MHSA self-assessment, and a county MHSA system improvement plan. | |
| 79 | + | (d) The MHSA-OAR shall consist of the following three components: performance indicators, a county MHSA self-assessment, and a county MHSA system improvement plan. | |
| 83 | 80 | ||
| 84 | 81 | (1) (A) The MHSA-OAR performance indicators shall be consistent with programmatic goals for the MHSA, and shall include both process and outcome measures. These measures shall be established in order to provide baseline and ongoing information about how the state and counties are performing over time and to inform and guide each county behavioral health agencys MHSA self-assessment and MHSA system improvement plan. | |
| 85 | 82 | ||
| 86 | 83 | (i) Process measures shall include measures of participant engagement, MHSA service delivery, and participation. Specific process measures shall be established by the agency, in consultation with the workgroup, and may include measures of engagement as shown by improvement in program participation, timeliness of service provision, rates of utilization of program components, and referrals and utilization of services. | |
| 87 | 84 | ||
| 88 | 85 | (ii) Outcome measures shall be determined based on the recommendations included in the analysis prepared by the University of California pursuant to subdivision (g), if the University of California enters into the contract described in subdivision (g). | |
| 89 | 86 | ||
| 90 | - | (B) | |
| 87 | + | (B) Performance indicator data available in existing county data systems shall be collected by counties and provided to the agency, and performance indicator data available in existing state agency data systems shall be collected by the agency and provided to the counties. These data shall be reported in a manner, and on a schedule, determined by the agency, in consultation with the workgroup, but no less frequently than semiannually. | |
| 91 | 88 | ||
| 92 | - | (C) (i) During the first five | |
| 89 | + | (C) (i) During the first five-year MHSA-OAR cycle, performance indicator data reported by each county, shall be used to establish both county and statewide baselines for each of the process measures. After the first review cycle, the agency, in consultation with the workgroup, shall establish standard target thresholds for each of the process measures established by the workgroup. | |
| 93 | 90 | ||
| 94 | 91 | (ii) The agency, in consultation with the workgroup, shall develop a process for resolving any disputes regarding the establishment of standard process thresholds pursuant to clause (i). | |
| 95 | 92 | ||
| 96 | - | (D) For subsequent reviews, and based upon availability of additional data through interagency data-sharing agreements, the workgroup shall convene, as necessary, to | |
| 93 | + | (D) For subsequent reviews, and based upon availability of additional data through interagency data-sharing agreements, the workgroup shall convene, as necessary, to consider whether to establish additional performance indicators that support the programmatic goals for the MHSA. Additional performance indicators established shall also be subject to the process described in subparagraph (C) and shall include consideration of when data on the additional performance indicators would be available for reporting, if not already available. | |
| 97 | 94 | ||
| 98 | - | (E) If, during subsequent reviews, there is sufficient reason to establish statewide performance standards for one or more outcome measures, the agency, in consultation with the workgroup, | |
| 95 | + | (E) If, during subsequent reviews, there is sufficient reason to establish statewide performance standards for one or more outcome measures, the agency, in consultation with the workgroup, may establish those standards for each of the agreed-upon outcome measures. | |
| 99 | 96 | ||
| 100 | - | (2) (A) The county MHSA self-assessment component of the MHSA-OAR, as established by the workgroup, shall require the county behavioral health agencies to assess their performance on the established process and outcome measures that comprise the performance indicators, | |
| 97 | + | (2) (A) The county MHSA self-assessment component of the MHSA-OAR, as established by the workgroup, shall require the county behavioral health agencies to assess their performance on the established process and outcome measures that comprise the performance indicators, identify the strengths and weaknesses in their current practice and resource deployment, identify and describe how local operational decisions and systemic factors affect program outcomes, and consider areas of focus that may be included in the county MHSA system improvement plan, as described in paragraph (3). The county MHSA self-assessment process shall be designed to identify areas of best practices for replication and for system improvement at the county level, and shall guide the development of the county MHSA system improvement plan. | |
| 101 | 98 | ||
| 102 | - | (B) (i) The county MHSA self-assessment process shall be completed every five | |
| 99 | + | (B) (i) The county MHSA self-assessment process shall be completed every five years by the county, in consultation and collaboration with local stakeholders, and submitted to the agency. | |
| 103 | 100 | ||
| 104 | 101 | (ii) Local stakeholders shall include county behavioral health directors, supervisors, and caseworkers; current and former MHSA service recipients; and county behavioral health agency partners. To the extent possible and relevant, local stakeholders shall also include representatives of tribal organizations and the local behavioral health board. Additional specific county behavioral health agency partners shall be determined by the county and may include, but are not limited to, adult education providers, providers of services for survivors of domestic violence, the local housing continuum of care, county human service departments, county drug and alcohol programs, community-based service providers, and organizations that represent MHSA recipients, as appropriate. | |
| 105 | 102 | ||
| 106 | 103 | (3) (A) (i) The county MHSA system improvement plan shall, at a minimum, describe how the county will improve its MHSA program performance in strategic focus areas based upon information learned through the county MHSA self-assessment process. The county MHSA system improvement plan shall include the uniform elements established by the workgroup pursuant to paragraph (3) of subdivision (c). | |
| 107 | 104 | ||
| 108 | - | (ii) The county MHSA system improvement plan shall be completed every five | |
| 105 | + | (ii) The county MHSA system improvement plan shall be completed every five years by the county, approved in public session by the countys board of supervisors or, as applicable, chief elected official, and be submitted to the agency. | |
| 109 | 106 | ||
| 110 | - | (B) The county MHSA system improvement plan shall include an MHSA services peer review element, | |
| 107 | + | (B) The county MHSA system improvement plan shall include an MHSA services peer review element, the purpose of which shall be to provide additional insight and technical assistance by peer counties. | |
| 111 | 108 | ||
| 112 | 109 | (C) Strategic focus areas for the county MHSA system improvement plan shall be determined by the county, informed by the county MHSA self-assessment process, as described in paragraph (2), with targets for improvement based upon what is learned in the county MHSA self-assessment process. | |
| 113 | 110 | ||
| 114 | - | ||
| 115 | - | ||
| 116 | - | (D) | |
| 117 | - | ||
| 118 | - | ||
| 119 | - | ||
| 120 | - | (C) The county behavioral health agency shall complete an annual progress report on the status of its system improvement plan and shall submit these reports to the agency. | |
| 111 | + | (D) The county behavioral health agency shall complete an annual progress report on the status of its system improvement plan and shall submit these reports to the agency. | |
| 121 | 112 | ||
| 122 | 113 | (e) (1) The agency shall receive, review, and, based on its determination of whether the county MHSA system improvement plan meets the required elements, certify as complete all county-submitted performance indicator data, county MHSA self-assessments, county MHSA system improvement plans, and annual progress reports, and shall identify and promote the replication of best practices in MHSA service delivery to achieve the established process and outcome measures. | |
| 123 | 114 | ||
| 124 | - | (2) The agency shall monitor, on an ongoing basis, county performance on the measures | |
| 115 | + | (2) The agency shall monitor, on an ongoing basis, county performance on the measures developed pursuant to subdivision (d). | |
| 125 | 116 | ||
| 126 | - | (3) The agency shall, on an annual basis, submit a report to the Legislature that summarizes county performance on the established process and outcome measures | |
| 117 | + | (3) The agency shall, on an annual basis, submit a report to the Legislature that summarizes county performance on the established process and outcome measures during the reporting period, analyzes county performance trends over time, and makes findings and recommendations for common MHSA services improvements identified in the county MHSA self-assessments and county MHSA system improvement plans, including information on common statutory, regulatory, or fiscal barriers identified as inhibiting system improvements and any recommendations to overcome those barriers. | |
| 127 | 118 | ||
| 128 | - | (4) (A) The agency shall, in partnership with the University of California, if the contract is executed pursuant to subdivision (g), facilitate the provision of technical assistance to county behavioral health agencies as part of the peer review that supports the countys selected areas for improvement, as described in its system improvement plan. | |
| 119 | + | (4) (A) The agency shall, in partnership with the University of California, if the contract is executed pursuant to subdivision (g), facilitate the provision of technical assistance to county behavioral health agencies as part of the peer review that supports the countys selected areas for improvement, as described in its system improvement plan. | |
| 129 | 120 | ||
| 130 | - | (B) If, in the course of its review of county MHSA system improvement plans and annual updates, or, in the course of its review of regularly submitted performance indicator data, the agency determines that a county is consistently failing to make progress toward its strategic focus areas for improvement or is consistently failing to meet the process measure | |
| 121 | + | (B) If, in the course of its review of county MHSA system improvement plans and annual updates, or, in the course of its review of regularly submitted performance indicator data, the agency determines that a county is consistently failing to make progress toward its strategic focus areas for improvement or is consistently failing to meet the process measure standard target thresholds established pursuant to subparagraph (C) of paragraph (1) of subdivision (d), the agency shall engage the county in a process of targeted technical assistance and support to address and resolve the identified shortcomings. | |
| 131 | 122 | ||
| 132 | 123 | (f) A county shall execute and fulfill components of its MHSA system improvement plan that can be accomplished with existing resources. | |
| 133 | 124 | ||
| 134 | 125 | (g) The agency shall request the University of California to enter into a contract with the state to provide all of the following services: | |
| 135 | 126 | ||
| 136 | 127 | (1) (A) Prepare an analysis of how data pertaining to the provision of mental health services and client outcomes collected by the counties and provided to the state may be used to demonstrate the impact of services funded by the Mental Health Services Fund on life outcomes. The analysis shall be delivered to the agency, the Legislature, and the workgroup established pursuant to subparagraph (A) of paragraph (1) of subdivision (c) on or before July 1, 2024, and shall include both of the following: | |
| 137 | 128 | ||
| 138 | - | (i) Recommendations of what outcomes | |
| 129 | + | (i) Recommendations of what outcomes should be used to measure the impact of the Mental Health Services Act. Recommended life outcome measures shall include measures of the reduction of the negative outcomes described in subdivision (d) of Section 5840, which address prevention and early intervention strategies for mental illness, and measures of employment, educational attainment, program exits and program reentries, adherence to treatment plans, attainment of housing, reduction in contacts with law enforcement, reduction in hospitalizations, and reductions in homelessness. | |
| 139 | 130 | ||
| 140 | - | (ii) An estimate of how much an impact funding from the Mental Health Services Fund can have on each recommended outcome. | |
| 131 | + | (ii) An estimate of how much an impact funding from the Mental Health Service Services Fund can have on each recommended outcome. | |
| 141 | 132 | ||
| 142 | 133 | (B) The analysis required to be delivered to the Legislature pursuant to subparagraph (A) shall be submitted in compliance with Section 9795 of the Government Code. | |
| 143 | 134 | ||
| 144 | - | (2) Create and maintain a dashboard modeled after the California Child Welfare Indicators Project to publicly report the data collected by counties and to report the status of county process and outcome | |
| 135 | + | (2) Create and maintain a dashboard modeled after the California Child Welfare Indicators Project to publicly report the data collected by counties and to report the status of county process and outcome indicators as described in this section. | |
| 145 | 136 | ||
| 146 | 137 | (3) Consult with the agency to provide technical assistance to county behavioral health agencies as described in subparagraph (A) of paragraph (4) of subdivision (e). | |
| 147 | 138 | ||
| 148 | 139 | SEC. 2. 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. | |
| 149 | 140 | ||
| 150 | 141 | SEC. 2. 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. | |
| 151 | 142 | ||
| 152 | 143 | SEC. 2. 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. | |
| 153 | 144 | ||
| 154 | 145 | ### SEC. 2. |