Report 2012-122 Recommendations and Responses in 2015-041

Report 2012-122: Mental Health Services Act: The State's Oversight Has Provided Little Assurance of the Act's Effectiveness, and Some Counties Can Improve Measurement of Their Program Performance

Department Number of Years Reported As Not Fully Implemented Total Recommendations to Department Not Implemented After One Year Not Implemented as of 2014-041 Response Not Implemented as of Most Recent Response
California Mental Health Planning Council 2 2 1 1 0
Department of Health Care Services 2 12 9 9 7
Mental Health Services Oversight and Accountability Commission 2 5 2 2 2
Santa Clara County Mental Health Department 2 2 2 1 0

Recommendation To: Health Care Services, Department of

To ensure that it monitors counties to the fullest extent as the MHSA specifies and that it implements best practices, Health Care Services should draft and enter into a performance contract with each county that contains assurances for effective oversight and furthers the intent of the MHSA, including demonstration that each of the county's MHSA programs are meeting the MHSA's intent.

Response

DHCS has incorporated provisions in the County Performance Contract that specify best practices for monitoring and oversight and provide guidance to counties to effectively demonstrate the implementation of their MHSA funded programs. DHCS outlines Department Compliance Investigations and County Breach, Plan of Correction and Withholding of State Mental Health Funds processes in each Performance Contract. Of the contracts submitted, 47 have been fully executed and six are in final processing.

Recommendation To: Health Care Services, Department of

Health Care Services should, as soon as is feasible, revise or create a reasonable and justifiable allocation methodology to ensure that counties are appropriately funded based on their identified needs for mental health services. Health Care Services should ensure that it reviews the methodology regularly and updates it as necessary so that the factors and their weighting are appropriate.

Response

DHCS has revised the allocation methodology. The uninsured population is no longer included in the estimate of need because the Affordable Care Act is expected to insure most Californians. The data in the remaining factors have been updated to calendar year 2015. DHCS continues to assess the methodology annually.

Recommendation To: Health Care Services, Department of

To ensure that it monitors counties to the fullest extent as the MHSA specifies and that it implements best practices, Health Care Services should conduct comprehensive on-site reviews of county MHSA programs, including verifying county compliance with MHSA requirements.

Response

DHCS has incorporated MHSA questions in the department's Triennial Medi-Cal review. Each county is reviewed at least once every three years. The Department has begun to implement fiscal audits of county mental health department's MHSA expenditures. The department has not implemented comprehensive program reviews as it is continuing to work on obtaining additional resources to implement those reviews. Once comprehensive program reviews are implemented, this recommendation will be fully implemented. In the meantime, DHCS is continuing to respond to concerns and questions that are raised through our Issue Resolution Process. (See Rec. 2 Attachment)

Recommendation To: Health Care Services, Department of

To ensure that counties have the needed guidance to implement and evaluate their MHSA programs, Health Care Services should coordinate with the Accountability Commission and issue guidance or regulations, as appropriate, for Facilities programs and for other MHSA requirements, such as a prudent reserve.

Response

DHCS is currently working with the Office of Statewide Health Planning and Development to promulgate regulations on the Workforce Education and Training component. DHCS is also working on drafting regulations to provide more guidance to counties regarding other MHSA requirements, such as the prudent reserve. Once these regulations have been promulgated, this recommendation will be fully implemented.

Recommendation To: Health Care Services, Department of

To ensure that counties have the needed guidance to implement and evaluate their MHSA programs, Health Care Services should collaborate with the Accountability Commission to develop and issue guidance or regulations, as appropriate, to counties on how to effectively evaluate and report on the performance of their MHSA programs.

Response

DHCS is planning to start discussions with the MHSOAC to determine the kind of guidance that needs to be produced to assist counties with effectively evaluating and reporting on the performance of their MHSA-funded programs.

Recommendation To: Health Care Services, Department of

To ensure that Health Care Services and other state entities can evaluate MHSA programs and assist the Accountability Commission in its efforts, Health Care Services should collect complete and relevant MHSA data from the counties.

Response

All of the data that DHCS collects is relevant data. DHCS is working to improve the timeliness of the data that is reported and the completeness of the data that is reported. DHCS has implemented processes that have improved the timeliness of data reporting in both the Client and Services Information (CSI) data system and the Data Collection and Reporting (DCR) data system. Counties are now reporting data timely.

- Client and Services Information (CSI) Data: According to the DHCS September 2015 county submission status report, 50 counties are current in submitting. County submissions average 86% current with data submission.

- Data Collection Reporting (DCR): According to the DHCS September 2015 county submission status report, 57 counties are current in submitting DCR full service partnership data. County submissions average 97%.

DHCS is starting to focus on improving the completeness of the data submitted. Once DHCS is completed the work necessary to improve the completeness of data, this recommendation will be fully implemented.

DHCS is currently working on relevancy in its data modernization project. Once the data modernization project is done, this recommendation will be fully implemented.

Recommendation To: Health Care Services, Department of

To ensure that Health Care Services and other state entities can evaluate MHSA programs and assist the Accountability Commission in its efforts, Health Care Services should resolve all known technical issues with the partnership and client services systems and provide adequate and expert resources to manage the systems going forward.

Response

DHCS has resolved the technical problems counties are experiencing in uploading data as evidenced by the improvements in timely reporting. DHCS is also updating the CSI system that should improve data submission. The upgrades to the CSI system should be completed by the end of 2015. Finally, DHCS is continuing to work on the data modernization project, but full implementation of this recommendation does not depend upon fully implementing the data modernization project.

Recommendation To: Health Care Services, Department of

Health Care Services should develop standardized data collection guidelines or regulations, as appropriate, that will address inconsistencies in the data that counties report to the State. In developing these guidelines or regulations, Health Care Services should consult with the Accountability Commission to ensure that data collected reasonably fulfill statewide evaluation purposes.

Response

DHCS is planning to meet with the Mental Health Services Oversight and Accountability Commission (MHSOAC) to review the current guidance provided to counties regarding data collection and reporting to the DCR to determine the need to develop more standardized guidance. DHCS will develop more standardized guidance if it determines in consultation with MHSOAC that such guidance is needed.

Recommendation To: Health Care Services, Department of

To help ensure county compliance with stakeholder regulations, Health Care Services should provide technical assistance to counties on the MHSA local planning review process and ensure that its guidance to counties is clear and consistent with state regulations.

Response

DHCS is planning to include training and technical assistance on the local planning in the California Institute for Behavioral Health Solutions (CIBHS) contract in FY 2015-16. Once that is complete, this recommendation will be fully implemented.

Recommendation To: Mental Health Planning Council, California

The Planning Council should document and make public the reviews that it performs of MHSA programs to demonstrate that it is performing all required reviews.

Response

The California Mental Health Planning Council released 4 reports in early 2015 which document the Council's reviews of the public mental health system including MHSA programs. The Council has proactively sought data and information from a variety of sources and endeavored to solicit input and viewpoints from specific populations. These reports fulfill the requirement that the Council make public the reviews it performs.

Additional reports will be released each January of reviews and work done in the prior year. The reports are posted on the Council's website, distributed electronically and shared with key policy makers.

Copies of these reports will be sent to the State Auditor via email.

Recommendation To: Santa Clara County Mental Health Department

Santa Clara County should ensure that all MHSA invoices are adequately supported with information that demonstrates that MHSA services were provided.

Response

Santa Clara County has fully implemented the recommendation. Since our last reporting status update provided in October 2014 the County has created another set of invoicing guidelines and templates specifically for the current fiscal year (FY) 2016. The new FY16 invoicing templates includes invoicing guidelines, information about invoice types, and details about eligible services. Attached is supporting documentation that demonstrates the work the County has done around the implementation of this particular recommendation. Annually, the County will continue to review invoicing guidelines: update guidelines and templates as needed each fiscal year. In addition, the County will continue to provide one-on-one trainings to our contracted providers around the County's invoicing guidelines and use of templates.

Recommendation To: Mental Health Services Oversight and Accountability Commission

To ensure that counties have needed guidance to implement and evaluate MHSA programs, the Accountability Commission should issue regulations, as appropriate, for Prevention and Innovation programs.

Response

On June 5, 2015, the Mental Health Services Oversight and Accountably Commission submitted the final rulemaking for both the Innovation and Prevention and Early Intervention (PEI) regulations to the Office of Administrative Law. On July 16, 2015 the Office of Administrative Law approved the Innovation regulations which will become effective on October 1, 2015. On July 17, 2015 the Office of Administrative Law disapproved the PEI regulations due to a minor inconsistency in one of the definitions. The Commission made the necessary changes to the PEI regulation section to address the Office of Administrative Law's decision and on August 31, 2015, resubmitted the revised PEI rulemaking file to the Office of Administrative Law. The Office of Administrative Law has until October 13, 2015 to render its decision.

Recommendation To: Mental Health Services Oversight and Accountability Commission

To fulfill its charge to evaluate MHSA programs, the Accountability Commission should undertake the evaluations specified in its implementation plan.

Response

The Evaluation Master Plan, adopted by the Commission on March 2013, is a five year plan and will not be fully implemented until fiscal year 2017-2018. Since August 2013 when the BSA issued this recommendation, the Commission has undertaken the evaluations specified in the Commission's implementation plan for this period of time (i.e. fiscal years 2013-2014 and 2014-2015). At this point in time, two months into the 2015-16 fiscal year, the evaluations for the current fiscal year have not yet begun. However, the Commission followed its normal process and at the October 23, 2014 meeting voted on specific evaluation activities to take place in fiscal year 2015-2016.

Current Status of Recommendations

All Recommendations in 2015-041