COUNTY BEHAVIORAL HEALTH DIRECTORS ASSOCIATION OF CALIFORNIA
2125 19th Street, Sacramento, CA 95818 www.cbhda.org

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Organizations Filed Purposes: Advocacy and public policy development for public behavioral health systems.

Legislative Advocacy (2019-20)Budget Advocacy: - Realignment Backfill: In the face of looming budget cuts, CBHDA mobilized a coalition of 23 behavioral health organizations including statewide representatives of county agencies, providers, and consumers to support a $1 billion comprehensive realignment backfill which maximized the potential for behavioral health funding. - MHSA Flexibilities: CBHDA spearheaded efforts to bring MHSA county, community, client, and provider stakeholders to consensus on temporary MHSA flexibilities, which were proposed and included in the final June Budget deal, including protecting MHSA funds from being reverted. - FURS Funding: In partnership with CWDA and Children Now, CBHDA secured $15 million for start-up costs and $30 million in ongoing funding for the Family Urgent Response System (FURS). CBHDA successfully worked with stakeholders to protect FURS funding from elimination as had been proposed in the 2020 May Revision.Additional budget advocacy wins include:-With the support of the Legislative Committee, CBHDA worked to successfully enact clean-up budget language to AB 114 to safeguard Innovation funds from reversion. CBHDA secured passage of SB 79 to allow extensions to MHSA Innovation project timeliness and secured favorable guidance from DHCS on implementation. -Helped secure $40 Million in Workforce, Education and Training Funding for county behavioral health workforce investments and worked extensively with OSHPD to implement this grant program.Newly introduced or co-sponsored bills:- SB 803 (Beall) Peer Certification: Brought CBHDA back on as a co-sponsor for Peer Certification legislation alongside the Steinberg Institute and LA County. This is one of a small number of bills still moving through the legislative process post-COVID-19.- AB 2668 (Quirk-Silva)School-based mental health: Introduced legislation to establish new commercial insurance payment mechanism for school-based services.Successfully navigated numerous attempts to reform or redirect the MHSA:- Developed Strategic Partnerships with Key Reform Stakeholders: Engaged Administration and Key Stakeholders (Steinberg Institute) to ensure alignment with CBHDA and CSAC Joint MHSA Reform Principles. Successfully worked to avert attempts by numerous stakeholder groups to divert MHSA resources away from county behavioral health to fund broader homelessness or criminal justice initiatives. - Significantly Strengthened CBHDAs Process to Review and Adopt Positions on Legislation: Under new leadership, the legislative advocacy team has improved the process to review and take positions on legislation in a more timely fashion while ensuring input from the membership to guide positions. As a result: - Timely and comprehensive review: In 2020, with CBHDA staff, the Legislative Committee reviewed over 115 bills in detail that address mental health and SUD issues and developed positions, suggested amendments, and other legislative strategies. Based on the guidance from the Legislative Committee, at the end of Year 1 and beginning of Year 2 of the Legislative Session, CBHDA submitted over 190 position letters to committees and offices on vital pieces of legislation. - Changed course on over 50 Bills in the Legislative Process in the Last Year: Guided by the Legislative Committee, over 40 bills were successfully amended, including 30 bills to involve CBHDA as a stakeholder in policy implementation efforts. CBHDA was also successful in significantly amending or stopping over 15 pieces of legislation that would have adversely impacted county behavioral health, including legislation that would have diverted MHSA funds and created new unfunded mandates. Administrative Advocacy, 2019-20Network adequacy: - Secured language in legislation to restrict the state's ability to sanction counties unless ratios have been codified in state law or contract.- Secured adjustments to provider-to-beneficiary ratios for outpatient specialty mental health services, and a commitment from DHCS to continue to work with CBHDA to develop alternate approaches to measuring network capacity. - Worked with the state to ensure no Network Adequacy sanctions were levied on counties while negotiations are underway for a more reasonable and meaningful standard. CalAIM: Successfully advocated for the inclusion of CBHDA policy priorities into DHCSs initial CalAIM proposals for Medi-Cal waiver renewals and delivery system reforms which would, taken together, improve mental health and SUD integration, improve counties ability to draw down federal match for Medi-Cal services, and reduce administrative and documentation burdens, along with audit risk. CalAIM proposals influenced by CBHDA include:- Behavioral Health Payment Reform: Provided recommendations on moving away from CPE-based billing to one with fewer onerous documentation standards and a shorter cost-settlement horizon, which will reduce the financial exposure and risk, while reducing provider administrative burden. - Medical Necessity: Shaped proposals for adoption of universal, multi-dimensional assessment and bi-directional referral tools and elimination of requirement for diagnosis prior to reimbursement for services.- DMC-ODS Renewal: Recommended key changes to DMC-ODS STCs, including eliminating the two-episode limit on reimbursement of adult residential treatment and ending same-day billing prohibition on MAT for clients receiving recovery services. - MH/SUD Integration: Worked with DHCS to develop a proposal for eliminating the redundancy and inefficiencies by proposing the integration of mental health and SUD plans into single behavioral health managed care plan, which will also support clinical integration and improve client outcomes. - Population health management: Secured DHCS direction that Medi-Cal Managed Care Plans consult county behavioral health plans in the development of annual population health management plans which will be driver for development of Enhanced Care Management/In Lieu of Services. - Regional Contracting/Full Integration Pilots: Held off attempts at forcing counties to enter into regional contracts or to establish so-called Full-Integration Pilots to pilot standing up new plans alongside county behavioral health plans, which would take on full responsibility for physical and behavioral health. Children and Youth Behavioral Health: Ensured CBHDA had a voice in the many critical conversations and implementation efforts impacting children and youth in need of behavioral health services, including: - Joint Plan for Foster Care: Collaborated with CWDA in the development of a joint foster care proposal to further support the effort to expand access to behavioral health treatment for this population through automatic eligibility for child welfare involved families and children with a minimum set of services and benefits for consideration as part of the waiver renewal process. - CCR, Families First Prevention Services Act (FFPSA) and AB 2083 Implementation: Collaborated with county and state agency partners toward successful implementation of the Continuum of Care Reform (CCR), federal FFPSA, and the provisions outlined under AB 2083. This collaboration also included providing recommendations related to the structure of the Memorandum of Understanding (MOU) as required under statute. - Child Welfare Council: Joined the newly formed Mental Health Committee of the CWC and advocated for inclusion of SUD services as an important focus which led to renaming the committee the Behavioral Health Committee.

Member servicesChildren and Youth Behavioral Health: Ensured CBHDA had a voice in the many critical conversations and implementation efforts impacting children and youth in need of behavioral health services, including: - Joint Plan for Foster Care: Collaborated with CWDA in the development of a joint foster care proposal to further support the effort to expand access to behavioral health treatment for this population through automatic eligibility for child welfare involved families and children with a minimum set of services and benefits for consideration as part of the waiver renewal process. - CCR, Families First Prevention Services Act (FFPSA) and AB 2083 Implementation: Collaborated with county and state agency partners toward successful implementation of the Continuum of Care Reform (CCR), federal FFPSA, and the provisions outlined under AB 2083. This collaboration also included providing recommendations related to the structure of the Memorandum of Understanding (MOU) as required under statute. - Child Welfare Council: Joined the newly formed Mental Health Committee of the CWC and advocated for inclusion of SUD services as an important focus which led to renaming the committee the Behavioral Health Committee.

Communications:COVID-19 ResponseCOVID-19 Regulatory Flexibility: Coordinated county feedback on local needs for emergency regulatory relief and worked with DHCS to propose key changes via state-level executive orders and federal emergency SPA and waiver requests to facilitate the ability to stabilize contracted providers, and deliver services via phone and telehealth. In addition, successfully secured an increase in the county administrative cap to acknowledge increased costs and lower billing. - FEMA Grant: Worked alongside DHCS to develop an $84 million FEMA RSP Grant to create a statewide virtual EAP crisis counseling network. Approval from FEMA is still pending. - HMIOT Extensions: Successfully acquired case by case extensions to the $50 million Homeless Mentally Ill Outreach and Treatment program administered by DHCS.- Clinical Training: Engaged CIBHS and secured private foundation funding to develop trainings for counties, with input from our Medical Directors, on telehealth across discreet populations to help support the rapid evolution and deployment of telehealth services. Increased CBHDAs Statewide Profile- Secured broad County Behavioral Health Director representation on both the CalAIM workgroups, as well as the states newly formed Behavioral Health Stakeholder Advisory Committee;- Secured CBHDA appointment to the Behavioral Health Task Force;- Secured CBHDA appointment to the Governors Regional Council of Homeless Advisors where we prevented a proposal to sweep MHSA funds to help fund the states response to homelessness and instead helped to influence the states decision for new investments in addressing homelessness;- Secured appointments on the newly formed Child Welfare Councils Behavioral Health Committee, and Foster Care Reform work group under CalAIM; and,- Secured two county behavioral health seats on the Newsom Administrations ACEs Aware campaign being led by the newly appointed Surgeon General.

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