California Psychiatric Association
Legislative Priorities for 2001
The status of legislative bills
changes often.
To get up-to-date information on the status of bills discussed on this web
site go to:
California
State Senate Bill Information
Implementation as of April 23, 2001
Public Mental Health System: Assure the integrity of, and adequate
funding for, the public mental health system, including assuring proper
funding for medical treatment and full utilization of the skills of psychiatrists.
Priorities to include assuring that all programs have good outcome evaluations,
full funding for AB 1800 successor and AB 34 programs, early diagnosis and
treatment for foster kids, funding for dual diagnosis programs and police
training.
Action: There are numerous bills on this, but three are of
major importance. CPA supports AB 1422 (Thomson), AB 334 (Steinberg),
and AB 1119, by Speaker Hertzberg. AB 1422 implements the recommendation
of the State's Little Hoover Commission that treatment for mental illness
should be an entitlement for the mentally ill similar to the entitlement
to treatment that the developmentally disabled receive. AB 334 is
the vehicle to continue the funding of the programs begun by AB 34 in 1999,
and AB 1119 is a bill to create an internet-based medical and educational
record keeping system for foster children, which is secure and accessible
only to those who need the information, so that doctors can better care
for these children, and schools know their educational histories. CPA is
opposing AB 681 (Mountjoy) and AB 225 (Washington), which
could make it more difficult for foster children to get the psychiatric
treatment they need. April 18 amendments to AB 681 may address the CPA's
concerns, and are under review.
Patient Access to Needed Medications/Formularies: Advocate with respect
to Medi-Cal and managed care formulary issues consistent with the policy
adopted by the CPA Council at its March, 1997 meeting. (See reverse side).
Work to improve access to modern psychiatric medications in the public mental
health system and jails.
Action: We continue to work on holes in the system. This includes
co-sponsoring, with the state's sheriffs, SB 643 (Ortiz),
which assists counties in obtaining the newer psychiatric medications for
their jails, in return for the jails transitioning the inmates into appropriate
community mental health care upon release. We are also pursuing efforts
to make these medications more affordable for indigent programs.
Human Resources: Improve access to psychiatric care for all Californians.
This is to include increasing the numbers of psychiatrists being trained
and to assure adequate numbers of psychiatrists in both managed care programs
and in public programs.
Action: A CPA task force chaired by CPA president Barry Chaitin,
MD, will develop detailed recommendations. SB 1748 (Perata), enacted
in 2000, created a task force to develop recommendations to expand the human
resources available for public mental health programs. Its report is due
May 1. The University of California medical schools and residency programs
are to be represented. U.C. has nominated 2 CPA members to sit on that task
force. CPA also supports SB 632 (Perata), which creates numerous
programs to expand the numbers of psychiatrists, social workers and nurse
practitioners specializing in mental health. Similar amendments have recently
been made to AB 1422.
Medi-Cal: Seek adjustments to Medi-Cal and managed care fee schedules
that assure adequate payment to psychiatrists for their services. This includes
assuring adequate psychiatric and other medical care for foster children.
Action: CPA is participating in a medicine-wide coalition
seeking increases in the fees.
Reform of Mandatory Treatment Laws (LPS): Pursue task force efforts
to update and revise the Lanterman Petris Short Act (LPS) in light of today's
circumstances. Support legislation that would revise LPS and allow for mandatory
outpatient treatment in certain well-defined circumstances, especially for
treatment noncompliant persons who are seriously and persistently mentally
ill and likely to become a danger to themselves or others if untreated.
(Successor to AB 1800).
Action: Numerous bills have been introduced, and discussions
continue. These include AB 1421 (Thomson), which provides for demonstration
programs in several counties of court-ordered outpatient treatment, AB
1424 (Thomson), which includes numerous reforms to LPS agreed
upon by many parties last year, including provisions for police and hearing
officers to consider the full medical history of a person in connection
with hold decisions and hearings and precluding insurers from considering
voluntary vs. involuntary status in making coverage decisions, and SB
931 (Burton), which creates programs designed to lessen the need for
involuntary treatment.
Penal System: Advocate with respect to issues relating to the severely
mentally ill and the penal system in such a way as to assure that the severely
mentally ill and sexual predators are not confused with one another, and
to assure adequate psychiatric treatment for mentally ill prisoners. See
SB 643, above, under formularies.
Psychologists practicing medicine. Protect public safety by opposing
attempts by psychologists to expand their scope of practice to practice
medicine without full medical school training, including their efforts to
acquire authority to prescribe brain medications.
Action: At this time, we have identified no bill that can
be used as a vehicle, but are keeping our eyes open, since they have proven
that they "sneak attack."
Non-discriminatory insurance coverage: Assuring proper Implementation
of AB 88, enacted in 1999, which provides non-discriminatory health insurance
coverage for serious mental disorders. This may include tracking programs
and/or field seminars.
Action: CPA has an implementation task force which continues
to monitor implementation and to work on implementation problems as they
arise. CPA also supports SB 599 (Chesbro), which would provide parity
for substance abuse treatment.
MICRA: Protect the integrity of the California medical malpractice
law, the Medical Injury Compensation Reform Act (MICRA).
Action: There appears to be no bill on this subject this year.
Violence Prevention: Support legislation that embodies reasoned
regulatory action relating to violence. Support legislation that discourages
the purchase of handguns and places strong controls on availability of all
types of firearms to private citizens. CPA's legislative focus on domestic
violence is on the negative impacts of domestic violence and prevention,
not legal and criminal aspects. Focus on prevention of school violence through
removing disincentives to the identification and treatment of severely emotionally
disturbed children who may potentially be violent.
Action: CPA supports AB 1717 (Zettel), which protects children
who "whistle blow" to school authorities about threats from fellow
students, so they are not sued for their whistle blowing, and SB 52
(Scott), a major gun control measure.
Antitrust protection for doctors, so that doctor groups can negotiate
with HMOs.
Action: CMA is sponsoring, and CPA supports, AB 1600
(Keeley). AB 1600 provides mediation and arbitration procedures to give
doctors improved bargaining power in dealing with HMOs.
CALIFORNIA PSYCHIATRIC ASSOCIATION
Policy Regarding Medication Formularies
Adopted by CPA Council, March, 1997
Efficacy studies have demonstrated time and again that the effective
prescription and use of appropriate neuropsychiatric drugs reduces morbidity
and costs in the long run, and that the earlier in the course of a brain
disorder an effective medication is used, the greater its effectiveness.
For the good and welfare of the largest number of people, the California
Psychiatric Association recommends that managed care companies and health
insurance carriers be precluded from restricting a patient's access to any
effective central nervous system medication where the patient's physician
has determined that the patient would benefit from that medication.
The California Psychiatric Association supports legislation allowing
any drug that is approved by the federal Food and Drug Administration to
be approved for addition to the list of drugs covered by either Medi-Cal,
Medicare, or health care plans for the purpose of treating psychiatric disorders.
The California Psychiatric Association believes that such legislation
will be cost-effective and good social policy. Due to the severe side effects
associated with medications presently included on the Medi-Cal list of contract
drugs, and the drugs allowed by some managed care plans, for the treatment
of psychosis and psychiatric disorders, many patients are unwilling to take
the medications. In addition, some newer and more expensive drugs are much
more effective. Allowing the use of the most effective drugs with the least
side-effects may cost more out of pocket originally than providing a limited
formulary. However, studies show that total expenditures for the treatment
of psychosis and psychotic disorders, including nonpharmaceutical services
such as hospitalization (or incarceration) are not less expensive for states
with restricted formularies.
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