BILL ANALYSIS Ó
AB 395
Page 1
Date of Hearing: May 15, 2013
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Mike Gatto, Chair
AB 395 (Fox) - As Amended: April 18, 2013
Policy Committee: HealthVote:18-0
Urgency: No State Mandated Local Program:
No Reimbursable: No
SUMMARY
This bill redefines "alcoholism or drug abuse recovery or
treatment facility," to include, in addition to a facility
providing residential nonmedical services, a facility providing
a program with residential medical services, as specified.
FISCAL EFFECT
Costs to DADP (and/or Department of Health Care Services, which
is assuming DADP's functions in this area), likely greater than
$150,000, to oversee programs offering a medical component.
Potentially minor and absorbable one-time costs for regulations.
COMMENTS
1)Rationale . DADP lacks explicit statutory authority to license
facilities with a physician available on site to provide
medical services as part of a residential addiction treatment
program. Proponents of this measure, including the sponsor,
California Society of Addiction Medicine (CSAM), argue the
existing law is outdated because it ignores evidence-based
principles of patient-centered addiction treatment, which call
for addressing all needs of a patient, such as care for
medical and psychiatric problems, in addition to providing
medication-assisted detoxification services. 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.
2)Senate report . This bill addresses serious problems raised in
AB 395
Page 2
a September 2012 report by the California Senate Office of
Oversight and Outcomes (SOOO). According to SOOO, there is
"widespread flouting of the state's ban on medical care at
residential?programs," and it may be appropriate to change
state law to better reflect today's practices. SOOO was also
critical of DADP's failure to pursue evidence of problems,
slow response to deaths and other serious incidents, and
reluctance to use its authority to shut down dangerous
programs.
3)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)
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
AB 395
Page 3
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.
4)Related legislation . AB 40 (Mansoor), requires 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, a specified.
5)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