BILL ANALYSIS Ó
AB 40
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Date of Hearing: May 15, 2013
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Mike Gatto, Chair
AB 40 (Mansoor) - As Amended: May 7, 2013
Policy Committee: HealthVote:19-0
Urgency: No State Mandated Local Program:
No Reimbursable: No
SUMMARY
This bill requires the Department of Alcohol and Drug Programs
(DADP) death investigation policy design to ensure a resident's
death is reported by the licensee and addressed by the
department in a timely manner, as specified.
FISCAL EFFECT
Unknown costs to DADP (and/or Department of Health Care
Services, which is assuming DADP's functions in this area),
likely in excess of $150,000, based on the current lack of
consistent policy and oversight by DADP to ensure compliance by
licensees.
COMMENTS
1)Rationale . This bill addresses problems raised in a September
2012 report by the California Senate Office of Oversight and
Outcomes (SOOO). According to SOOO, DADP fails to pursue
evidence of problems, is slow responding to deaths and other
serious incidents, and is reluctant to use its authority to
shut down dangerous programs.
2)Background . The state's residential alcohol and drug treatment
programs are authorized to provide nonmedical services to
individuals recovering from alcohol and drug addiction. DADP
licensing focuses on health and safety rather than treatment
program content. DADP conducts site visits every two years to
check for compliance with regulations.
Licensing shifted from the Department of Social Services (DSS)
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to DADP in the 1980s because programs required less intensive
services than other residential programs licensed by DSS. At
the time, the dominant model of treatment for substance abuse
recovery was the social model, a peer-oriented program based
on the 12 steps in the Alcoholics Anonymous process: reaching
out to help other alcoholics as a way of sustaining sobriety.
The social model is essentially nonmedical; programs were
defined in statute as providing nonmedical services.
Over the last decade or more, the pendulum has shifted in
favor of medical interventions. Despite the lack of specific
licensing, SOOO found the industry routinely offers services
that include medications and care by physicians and other
medical professionals. Though many programs continue to adhere
to the social model, much of the industry has abandoned that
model in favor of a "comfortable" model that provides medicine
to help with detoxification. The report's survey of websites,
press releases, and non-profit tax returns identified 34
programs that made claims in apparent violation of state law
and regulations barring medical care.
According to the SOOO report, DADP says it is now more
aggressive in halting practices that could lead to injury or
death, and the record shows DADP is revoking and suspending
licenses more frequently. DADP has implemented new policies
intended to focus limited resources on cases posing the
greatest public risk. This new approach may be a function of
the current leadership and subject to change, especially when
the department's duties are shifted to DHCS in July 2013.
3)Related legislation . AB 395 (Fox), pending in this committee,
revises the definition of alcoholism or drug abuse recovery or
treatment facility to include programs providing medical
services.
4)Previous legislation . AB 972 (Butler), 2011, AB 2221 (Beall),
2010, and AB 1055 (Chesbro), 2009, took similar approaches to
include as DADP licensees, residential programs that provided
some medical services. AB 972 and AB 2221 were held on the
Senate Appropriations Suspense File. AB 1055 was held on this
committee's Suspense File.
Analysis Prepared by : Debra Roth / APPR. / (916) 319-2081
AB 40
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