2019 Policy Platform 

VIEW OUR 2019 PRIORITY BILL LIST HERE


CBHA is a statewide association of mental health and substance use disorder non-profit community agencies dedicated to the proposition that the people of California deserve a rational, comprehensive, community-based behavioral health system that is adequately funded with an outcome based, data driven, and culturally responsive approach to serve all those in need of services. We work strategically and collaboratively to pursue public policy initiatives that create system change for communities across our state that support integrated health care services for children, youth, adults, and the elderly. This includes a comprehensive behavioral health care system with a full array of mental health and substance use disorder programs and services integrated with the physical health care system, along with housing, social services, education, and vocational rehabilitation.

In the next year, the primary goal of CBHA is to address challenges facing the behavioral health system at the federal and state level. We must continue to fight any challenges to the current health care system at the federal level including protecting the expansion of Medicaid known as Medi-Cal in California and the requirement that all health insurance plans include coverage for mental health and substance use disorder services as part of an integrated system of care through the American Care Act. Proposed cuts to Medicaid would devastate health care in our state. At the state level, we must continue to fight any efforts that would cut funding or services for all non-profit providers of care for health and human services.

PRIORITY POLICY AREAS

1) 2020 Waivers
The year 2020 marks the expiration of two important waivers: 1) The Medicaid Section 1115 Waiver and 2) the 1915(b) Specialty Mental Health Services Consolidation Waiver.  The renewal of these waivers creates opportunities for CBHA, in collaboration with other partners in the behavioral health community, to work with the incoming Administration to shape the policy included in the waivers. 

2) Workforce
Expanding the behavioral health workforce, which includes recruiting, training, and retaining staff, is a top priority for CBHA. There has been an increasing demand for services in both the mental health and substance use disorder fields. This has been exacerbated by an increased demand for services created by the inclusion of behavioral health services as an Essential Health Benefit in the Affordable Care Act (ACA). CBHA members statewide constantly struggle to fill open positions at all levels, but it is especially difficult recruiting licensed clinicians.

In recognition of the challenges of cultivating an adequate workforce, CBHA supports efforts to bolster the behavioral health workforce. CBHA played a central role in crafting language for Proposition 63 which set aside 10 years of funding for Workforce, Education, and Training (WET) programs throughout the state. We also support strengthening the behavioral health pipeline by providing education and training opportunities at the primary school, high school, and college levels. CBHA supports the expansion of roles for peers and other allied health professionals. Lastly, we promote an integrated team approach to healthcare including psychiatric nurse practitioners, mental health clinicians, psychologists, psychiatrists, and primary care providers. This team approach is a critical component of providing patients with whole person care.

3) Payment Reform
CBHA is working at the county level to advocate for appropriate reimbursement rates for services. We assist member agencies by advocating, at the state level, for opportunities to reform the payment system to reflect clinical performance and other outcome-based metrics.

4) Reversion of MHSA Funds
The Welfare and Institutions Code requires by October 1, 2018 and by October 1 of each subsequent year, DHCS, in consultation with counties, to publish on its Internet Website a report detailing funds subject to reversion by county and by originally allocated purpose. CBHA promotes the use of reversion funds for their allocated purposes.

5) Proposition 64
The Adult Use of Marijuana Act (AUMA), approved by voters on November 2016, mandates and earmarks specific funds for youth Substance Use Disorder (SUD) treatment and prevention. There is no comprehensive system of care for children, youth, and young adults who need help dealing with alcohol and drug problems. CBHA and our partners in this effort believe this mandate is an unprecedented opportunity to invest in our state’s youth and fill longstanding and persistent gaps in youth SUD care by creating that system of treatment. CBHA, in collaboration with the California Consortium of Addiction Programs and Professionals (CCAPP) and California Association of Alcohol and Drug Program Executives (CAADPE) has developed a series of recommendations on how the funds should be allocated: 80% for treatment and early intervention and 20% for prevention (which may also include early intervention). This allocation formula is consistent with the Substance Abuse and Mental Health Services Administration (SAMHSA) Substance Abuse Prevention and Treatment block grant.

6) Paperwork Reduction
Varying county-mandated documentation requirements result in California having an average of 20 minutes needed to document each therapy/treatment visit, which is four times the national average. Not only does this reduce the amount of time for professionals to provide services, the frustration associated with excessive documentation encourages trained and licensed staff to seek jobs outside of this field.  Statewide standards must be established to increase treatment capacity and retain a qualified work force.

7) School Based Mental Health
Prevention and early intervention is a key tenet of best practice in the delivery of behavioral health services. CBHA advocates for flexibility in how various funding streams a student is eligible for can work in concert to provide whole person care. CBHA is committed to work with the California Department of Education (CDE) to pursue partnerships that will enable community-based organizations to contract with the CDE to provide needed behavioral health services, and support training of school personnel to recognize behavioral health needs for school aged youth. These services should also include a focus on providing treatment for substance use disorders. All services should be offered within and outside of the school setting throughout the calendar year.

8) System of Care Disparities
The disparity of mental health and substance use disorder services in the suburban and rural areas of our state needs to be addressed. Service providers in these areas face myriad issues providing adequate treatment. As a solution, CBHA advocates for the creation of a comprehensive and integrated system of care where SUDs and mental health are combined e.g. integration of funding siloes to streamline services.

9) Crisis Care for Youth
The absence of sufficient and cost-effective community-based crisis services represents a substantial gap in the continuum of behavioral health care available in California. This is especially true for children and youth whose first introduction to the state’s mental health system may be through accessing crisis services. Adequate funding to ensure timely access to such services is critical to improving the full continuum of crisis care services in community-based settings. Services include: mobile crisis intervention and assessment, crisis stabilization, comprehensive home-based assessments, and in-home behavioral services. Positive outcomes from such approaches could include reduced reliance on psychiatric hospitalization and result in substantial cost savings.

10) Reduce Racial, Ethnic, and Other Cultural Barriers
Encourage the State of California and the behavioral health community to further address the disparity of mental health and substance use disorder services among different communities based on culture, race, ethnicity, age, sexual orientation, and gender identity.

ADDITIONAL GOALS

1) DHCS Restructure Focused on Behavioral Health
Encourage the State of California to invest the resources and personnel necessary to address the behavioral care crisis in our state. Specifically, we request consideration of a new Assistant Secretary for Behavioral Health within the Health and Human Services Agency or a restructuring of the current organization to more directly address behavioral health.

2) Use of Technology
Address geographic disparities and barriers to accessing care by utilizing technology. This may include telehealth to expedite service provision and address workforce issues, and applications to track data and treatment outcomes. Also, advocate for better interoperability between electronic health record systems.

3) Criminal Justice
Partner with allied stakeholders to promote incarcerated individuals’ transition into the community by promoting access to behavioral healthcare, including medically assisted treatment, prior to and after release.