BILL ANALYSIS Ó
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: AB 395
AUTHOR: Fox
AMENDED: June 24, 2013
HEARING DATE: July 3, 2013
CONSULTANT: Robinson-Taylor
SUBJECT : Alcoholism and drug abuse treatment facilities.
SUMMARY : Expands the types of facilities licensed by the
Department of Alcohol and Drug Programs (ADP) to include any
facility that 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 Department of Alcohol and Drug Programs (ADP) 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 residential 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 non-medical services provided by a
licensed treatment facility to mean recovery services,
treatment services, and detoxification services.
4.Defines a chemical dependency recovery hospital as a health
facility that provides 24-hour inpatient care for persons who
have dependency on alcohol or other drugs, or both. Specifies
that the care includes, but is not limited to, patient
counseling, group therapy, physical conditioning, family
therapy, outpatient services, and dietetic services. Requires
the hospital to have a medical director who is a licensed
physician and surgeon.
5.Eliminates ADP on July 1, 2013, and shifts department
functions to the Department of Health Care Services (DHCS) and
Continued---
AB 395 | Page 2
the Department of Public Health (DPH).
This bill:
1.Defines "alcoholism or drug abuse recovery or treatment
facility" or "facility" to mean either of the following:
a. A premises, 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; or,
b. A premises, place, or building that provides 24-hour
residential 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 and
medical care if the premises, place, or building:
i. Is not a chemical recovery
dependency hospital;
ii. Is accredited by a nationally
recognized accrediting organization; and
iii. 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.
2.Adds the following to the list of instances when the director
of ADP is permitted to suspend or revoke an alcoholism or drug
abuse recovery or treatment facility's license:
a. Conduct in the operation of the facility
endangers the health or safety of an individual
receiving services; and,
b. Failure to report to the department, within
24-hours, the death of a resident for any cause, even
if the death did not occur at the facility.
FISCAL EFFECT : According to the Assembly Appropriations
Committee analysis, this bill will result in costs to ADP
(and/or DHCS, which is assuming ADP's functions in this area),
likely greater than $150,000, to oversee programs offering a
medical component. This bill will also result in potentially
minor and absorbable one-time costs for regulations.
AB 395 | Page
3
PRIOR VOTES :
Assembly Health: 18- 0
Assembly Appropriations:17- 0
Assembly Floor: 73- 1
COMMENTS :
1.Author's statement. Medical services are especially critical
during the early stages of detoxification, and have been shown
to significantly enhance substance abuse treatment outcomes.
The author maintains that this bill would permit medical
services in ADP licensed residential treatment facilities to
include:
a. Medical assistance with detoxification including
monitoring blood pressure and vital signs, observing for
signs of seizure risk, and management of oral
medications;
b. Psychiatric evaluation and counseling;
c. Prescribing and monitoring medications, including
public health inoculations; and,
d. General oversight of the medical condition of
residents in the facility.
According to the author, those who enter treatment for
addiction often have other health problems and non-invasive
counseling and medical management are crucial to their overall
health. The author maintains that this bill mirrors policies
ADP already uses in its oversight of other programs. Under
this bill, inspection and quality assurance would be provided
by a nationally recognized accrediting organization, such as
the Commission on Accreditation of Rehabilitation Facilities
(CARF) or the Joint Commission. The author argues that
currently, ADP lacks statutory authority to license
residential treatment facilities that provide medical services
associated with detoxification. The author states that this
bill is intended to allow physicians to provide limited
medical services in residential treatment facilities licensed
by ADP to assist with alcohol, drug, or alcohol and drug
recovery treatment or detoxification services.
2.ADP oversight of residential treatment facilities. ADP was
established in 1979 and is charged with directing,
coordinating and providing leadership in the state's efforts
to reduce or prevent alcoholism, narcotic addiction, drug
abuse and problem gambling. ADP's licensing of residential
AB 395 | Page 4
treatment facilities focuses on health and safety rather than
the content of the treatment programs. Once every two years,
a department analyst visits the program to assure that it's
complying with regulations. In addition to biannual
compliance reviews, ADP investigates complaints and deaths and
may suspend and revoke licenses. ADP may also impose fines,
but does not keep track of the total collected.
Residential treatment facilities range in size from six-bed
facilities in residential neighborhoods to centers that
accommodate more than 100 beds. Some facilities rely on
public funding while others, including a cluster of facilities
in Malibu, charge tens of thousands of dollars a month.
Current law permits residential treatment facilities to only
provide "non-medical" treatment. ADP interprets this to mean
that programs must not pay medical professionals directly,
either through a salary or a contract. Instead, ADP
interprets current law to mean that each client must pay
medical professionals directly.
According to a trailer bill approved as part of the 2012-13
Budget, ADP is scheduled to be eliminated on July 1, 2013.
The majority of its functions, including the department's
licensing and certification functions, will be transferred to
DHCS.
3.Senate Report. A September 2012 investigative report by the
Senate Office of Oversight and Outcomes (SOOO) identified gaps
in ADP's regulation of residential treatment 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 treatment programs providing
medical care.
The report points out that despite ADP's interpretation of 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, 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
AB 395 | Page
5
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 SOOO reports that they found many programs that adhered to
the "social model" of treatment centered on counseling and
group meetings in the tradition of Alcoholics Anonymous. But
in many ways, according to SOOO, the industry has abandoned
that model in favor of "comfortable" detoxification with the
assistance of medicines and doctors. 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. The report suggests the state
may have to strengthen other laws and regulations to make sure
that medical care is safe and effective, for instance, and
address the question of whether the involvement of doctors
would violate a law prohibiting the corporate practice of
medicine.
4.National accreditation organizations. According to ADP,
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
AB 395 | Page 6
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. SB 1014 (Committee on Budget), Chapter 36, Statutes
of 2012, transfers ADP's functions to other state
departments effective July 1, 2013, including the
transfer of its licensing functions to DHCS.
b. AB 972 (Butler) of 2011 would have included
provisions substantially similar to this bill.
Provisions in AB 972 were subsequently deleted and the
bill was amended to address a different subject.
c. AB 2221 (Beall) of 2010, was substantively similar
to this bill. AB 2221 died on the Senate Appropriations
Committee Suspense File.
d. AB 1055 (Chesbro) of 2009, contained provisions
substantially similar to this bill. AB 1055 died on the
Assembly Appropriations Committee Suspense File.
6.Support. The sponsor of this bill, the California Society of
Addiction Medicine, states in support that the underlying
California statute that guides ADP 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. Promises Treatment Centers
writes in support that this bill will greatly improve the
quality of care offered to people in residential treatment
AB 395 | Page
7
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.Policy Comments.
a. SB 1014 (Committee on Budget) transferred ADP's
functions to other state departments effective July 1,
2013, including the transfer of its licensing functions
to DHCS. This bill should be amended to address how the
requirements of this bill interact with the transfer of
ADP's licensing functions to DHCS, should this bill
become law.
b. While the author's statement describes the types of
medical services intended by this bill to be provided at
residential treatment facilities, this bill's language
currently does not specify the scope of medical services
proposed to be provided in these facilities. This bill
should be amended to describe the proposed scope of
medical services.
c. Among the recommendations in the SOOO 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. Since this bill
will require a new licensing scheme under a new
department's authority, the Committee may wish to
consider requiring DHCS to ensure that an evaluation of
the program is completed and, within two years after
implementation, submit a report to the appropriate policy
and fiscal committees of the Legislature. The
requirement for submitting the report would become
inoperative four years after the date the report is due.
SUPPORT AND OPPOSITION :
Support: California Society of Addiction Medicine (sponsor)
California Council of Community Mental Health Agencies
County Alcohol and Drug Program Administrators
Association of California
Promises Treatment Centers
Oppose: None received.
AB 395 | Page 8
-- END --