BILL ANALYSIS Ó
AB 395
Page 1
ASSEMBLY THIRD READING
AB 395 (Fox)
As Amended May 24, 2013
Majority vote
HEALTH 18-0 APPROPRIATIONS 17-0
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|Ayes:|Pan, Logue, Ammiano, |Ayes:|Gatto, Harkey, Bigelow, |
| |Atkins, Bonilla, Bonta, | |Bocanegra, Bradford, Ian |
| |Chesbro, Gomez, Roger | |Calderon, Campos, |
| |Hernández, Rendon, | |Donnelly, Eggman, Gomez, |
| |Maienschein, Mitchell, | |Hall, Ammiano, Linder, |
| |Nazarian, Nestande, V. | |Pan, Quirk, Wagner, Weber |
| |Manuel Pérez, Wagner, | | |
| |Wieckowski, Wilk | | |
| | | | |
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SUMMARY : Allows alcoholism or drug abuse recovery or treatment
facilities (treatment facilities) licensed by the Department of
Alcohol and Drug Programs (DADP) to provided limited medical
care. Specifically, this bill :
1)Expands the definition of treatment facility to include
facilities that provide 24-hour residential medical services
to adults recovering from drug and alcohol problems, as
specified, provided that: a) the facility is accredited by a
nationally recognized accrediting organization; b) the
facility uses a multidisciplinary team that includes at least
one physician and surgeon, licensed by the Medical Board of
California or the Osteopathic Medical Board, who is
knowledgeable about addiction medicine; and, c) the facility
is not a chemical recovery dependency hospitals, as defined.
2)Removes authorization for DADP to suspend, revoke, or take
other specified actions against a facility's license for
conduct that is inimical to the health, morals, welfare, or
safety of either an individual receiving services from the
facility or to the people of the State of California, and
instead allows DADP to suspend, revoke, or take other
specified actions against a facility's license due to conduct
that endangers the health or safety of an individual receiving
services.
AB 395
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3)Allows DADP to suspend, revoke, or take other specified
actions against a facility's license due to failure to report
to DADP, within 24 hours, the death of any resident for any
cause, even if the death did not occur at the facility.
FISCAL EFFECT : According to the Assembly Appropriations
Committee, costs to DADP (and/or the Department of Health Care
Services, which is assuming DADP's functions in this area), are
likely greater than $150,000, for enhanced oversight.
COMMENTS : The state's residential treatment facilities are
authorized to provide nonmedical services to individuals
recovering from alcohol and drug addiction. Treatment
facilities must be licensed by DADP, with licensing criteria
that are focused on health and safety rather than treatment
program content. Licensing of treatment facilities was shifted
from the Department of Social Services (DSS) to DADP in the
1980s because drug and alcohol treatment programs required less
intensive services than other facilities 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 12th step in the Alcoholics Anonymous process: reaching out
to help other alcoholics as a way of sustaining sobriety. The
social model is essentially nonmedical; accordingly, the
treatment programs were defined in statute as programs that
provide nonmedical services.
According to the author, this ban on the provision of medical
services in treatment facilities ignores evidence-based
principles of patient-centered addiction treatment, which call
for addressing all needs of a patient, including care for
medical and psychiatric problems and medication-assisted
detoxification services.
In September 2012, the California Senate Office of Oversight and
Outcomes (SOOO) published a report titled "Rogue Rehabs: State
failed to police drug and alcohol homes, with deadly results." A
major problem identified by the SOOO report is that DADP
interprets its mission as overseeing non-medical care in
residential homes, yet the industry routinely offers services
that include medications and care by doctors 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
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with detoxification. The report's survey of Web sites, press
releases, and non-profit tax returns identified 34 programs that
made claims that appeared to violate state law and regulations
barring medical care. 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.
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.
According to DADP, accreditation by two national organizations,
the Joint Commission and the Commission on Accreditation of
Rehabilitation Facilities is currently available for such
behavioral health care services as addiction treatment, opioid
treatment and maintenance programs, crisis stabilization, case
management and care coordination, and other services. This bill
would enable DADP to license treatment facilities with
nationally accredited programs that include physicians on-site
to provide 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.
Analysis Prepared by : Ben Russell / HEALTH / (916) 319-2097
FN: 0000935