BILL ANALYSIS Ó
AB 395
Page 1
Date of Hearing: April 9, 2013
ASSEMBLY COMMITTEE ON HEALTH
Richard Pan, Chair
AB 395 (Fox) - As Introduced: February 15, 2013
SUBJECT : Alcoholism and drug abuse treatment facilities.
SUMMARY : Expands the types of facilities licensed by the
Department of Alcohol and Drug Programs (DADP) to include any
facility that does not require a health facility license and has
a nationally accredited program that uses a multidisciplinary
team to provide 24-hour residential medical services to adults
recovering from alcohol and drug abuse problems.
EXISTING LAW :
1)Establishes DADP to license residential treatment facilities
that provide a broad range of services in a supportive
environment to adults who are addicted to alcohol or drugs.
2)Defines a treatment facility as any premise, place, or
building that provides 24-hour residential non-medical
services to adults who are recovering from problems related to
alcohol, drug, or alcohol and drug misuse or abuse, and who
need alcohol, drug, or alcohol and drug recovery treatment or
detoxification services.
3)Defines residential nonmedical services provided by a licensed
treatment facility to mean recovery services, treatment
services, and detoxification services.
FISCAL EFFECT : This bill has not yet been analyzed by a fiscal
committee.
COMMENTS :
1)PURPOSE OF THIS BILL . The author states that, currently, DADP
lacks statutory authority to license and regulate treatment
facilities that have a physician available on site to provide
medical services relating to addiction treatment. According
to the author, the current ban on the provision of medical
services in treatment facilities is outdated because it
ignores evidence-based principles of patient-centered
addiction treatment, which call for addressing all needs of a
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patient, such as care for his or her medical and psychiatric
problems, in addition to providing medication-assisted
detoxification services. The author also maintains that
alcoholics and drug addicts often have greater immediate
medical needs than their sober counterparts because of the
toxic effect of alcohol and drugs, the failure of addicts to
recognize their own health problems, and the risky behaviors
in which many engage. The author points out that because of
the ban on providing medical services in these facilities,
patients with health problems must be sent to a doctor's
office or to the emergency department for treatment that is
inefficient and costly. The author asserts that this bill is
intended to extend DADP's licensing authority to facilities
with nationally accredited programs that include physicians on
site to provide care to patients when and where they need it.
2)DADP LICENSING AUTHORITY . DADP licenses residential treatment
facilities to provide nonmedical services to individuals who
are working to overcome their addiction to alcohol or other
drugs. According to DADP, these services include education,
group, or individual sessions; recovery or treatment planning;
and, detoxification services. In addition, a licensed
treatment facility may offer individualized services, such as
vocational and employment search training, community volunteer
opportunities, new skills training, peer support, social and
recreational activities, and information about and referral to
appropriate community services. This bill would require DADP
to license facilities that use a multidisciplinary team, led
by a physician, to provide residential medical services that
do not require it to obtain a separate health facility
license.
According to DADP, since current law only authorizes it to
license nonmedical services, many larger licensed facilities
enter into contracting arrangements with physicians to provide
medical services on-site, such as treatment of medical
symptoms associated with addiction, including post withdrawal
hypertension, seizure prevention, and impaired liver function.
Residents of smaller facilities (six beds or less) that
provide detoxification services are currently required to
obtain medical clearance from a physician off-site before
participating in a detoxification program. This bill would
enable DADP to license treatment facilities with nationally
accredited programs that include physicians on site to provide
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medical clearance and other routine medical services, such as
physicals, communicable disease screening, vital sign
assessment, and the prescribing, administering, and dispensing
of medications for withdrawal symptoms.
3)RECENT SENATE REPORT . A September 2012 investigative report
by the Senate Office of Oversight and Outcomes (SOOO)
identified gaps in DADP's regulation of residential programs,
including failure to pursue evidence of problems, slow
investigative responses to deaths and other serious incidents,
and reluctance to use the full spectrum of its statutory
powers to shut down programs that pose a danger to the public.
The report also documents widespread flouting of the state's
prohibition against residential programs providing medical
care.
The report points out that DADP interprets state law to mean
that medical professionals who operate in residential
treatment settings must maintain a separate relationship with
clients and not receive payments from the program. However,
SOOO surveyed websites, press releases, and non-profit tax
returns, and identified 34 programs that made claims that
appeared to violate state law and regulations barring medical
care. Additionally, program directors interviewed for the
report asserted that they must twist themselves into knots to
comply with the state ban while also satisfying insurers and
accrediting agencies that often require the involvement of
medical professionals.
The report notes that California is unusual among populous
states in prohibiting medical care in residential treatment
programs. SOOO contacted nine other states and found that all
but one of them allowed physicians and other medical
professionals to work in such settings. Several, according to
the report, required the involvement of physicians in programs
providing detoxification.
Among the recommendations in the report is for the Legislature
to consider approving a bill allowing medical care in
residential treatment facilities, given that many experts
believe that medical care is an integral part of successful
treatment. However, the report adds that it would not be
enough to simply lift the ban and the state may have to
strengthen other laws and regulations to make sure that
medical care is safe and effective, for instance, and address
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the question of whether the involvement of doctors would
violate a law prohibiting the corporate practice of medicine.
4)NATIONAL ACCREDITING ORGANIZATIONS . According to DADP,
accreditation by two national organizations, the Joint
Commission and the Commission on Accreditation of
Rehabilitation Facilities (CARF) is currently available for
such behavioral health care services as addiction treatment,
opioid treatment and maintenance programs, crisis
stabilization, case management and care coordination,
employment services, and vocational rehabilitation. The Joint
Commission and CARF each require a facility to demonstrate
that its program meets their respective quality standards in
order to obtain accreditation. These quality standards
evaluate important functions relating to client care and
program management, including administrative requirements,
financial management, personnel qualifications, client
services, performance outcomes, client safety, and information
privacy and security. Accreditation from either the Joint
Commission or CARF is valid for three years.
The SOOO report notes that accreditation surveys represent a
snapshot in time and, while they may consider the track record
of a program, they are more focused on present activities. If
a program has had problems in the past, accreditation agencies
like CARF want to see that it is taking steps to remedy them.
The report points out that accreditation is not a substitute
for government oversight and should be viewed as a tool that
government entities can use in performing oversight.
5)PRIOR LEGISLATION .
a) AB 972 (Butler) of 2011 would have included provisions
substantially similar to this bill but these provisions
were subsequently deleted and the bill was amended to
address a different subject.
b) AB 2221 (Beall) of 2010, which was substantively similar
to this bill, died on the Senate Appropriations Committee
Suspense File.
c) AB 1055 (Chesbro) of 2009, which contained provisions
substantially similar to this bill, died on the Assembly
Appropriations Committee Suspense File.
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6)SUPPORT . The sponsor of this bill, the California Society of
Addiction Medicine, states in support that the underlying
California statute that guides DADP in the regulation of
residential treatment facilities was written at a time when
substance abuse treatment programs stressed self-help and peer
support but our understanding of the medical side of addiction
and treatment has since advanced while the underlying law has
remained the same. The sponsor maintains that this bill takes
a modest first step toward solving this problem by updating
the law to match the actual practice in the field by allowing
residential treatment facilities to provide limited medical
services under state supervision. Elements Behavioral Health
writes in support that this bill will greatly improve the
quality of care offered to people in residential treatment
facilities by clarifying that providing competently
administered medical care is consistent with the state's
interest in supporting these facilities without jeopardizing
the residential nature of their services.
7)AUTHOR'S AMENDMENT . The author will be offering the following
amendment in committee to clarify that the multidisciplinary
teams used in medical treatment programs allowed under this
bill must include a physician certified in addiction medicine:
On page 2, line 12, after "team" insert " ,which includes a
physician certified in addiction medicine, "
8)POLICY COMMENT . SB 1014, Chapter 36, Statutes of 2012,
transfers DADP's functions to other state departments
effective July 1, 2013, including the transfer of its
licensing functions to the Department of Health Care Services
and requires DADP to consult with stakeholders to ensure a
smooth transition. The author may wish to address, from a
policy perspective, how the requirements of this bill interact
with the transfer of DADP's licensing functions to its
successor agency, should this bill become law.
REGISTERED SUPPORT / OPPOSITION :
Support
California Society of Addiction Medicine (sponsor)
Elements Behavioral Health
Opposition
AB 395
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None on file.
Analysis Prepared by : Cassie Royce / HEALTH / (916) 319-2097