Amended in Senate May 25, 2016

Amended in Assembly May 4, 2015

Amended in Assembly April 15, 2015

California Legislature—2015–16 Regular Session

Assembly Bill No. 741

Introduced by Assembly Member Williams

February 25, 2015

An act to amend Section 1502 begin delete of end delete begin insert of, and to add Sections 1502.1 and 1502.2 to, end insert the Health and Safety Code, relating to mental health.

LEGISLATIVE COUNSEL’S DIGEST

AB 741, as amended, Williams. Mental health: community care facilities.

Existing law, the California Community Care Facilities Act, provides for the licensing and regulation of community care facilities, as defined, by the State Department of Social Services. Existing law includes within the definition of community care begin delete facility, end delete begin insert facility end insert a social rehabilitation facility, which is a residential facility that provides social rehabilitation services in a group setting to adults recovering from mental illness. begin insert Existing law also defines for this purpose a short-term residential treatment center. end insert A violation of the act is a misdemeanor.

This bill would expand the definition of a social rehabilitation facility to include a residential facility that provides social rehabilitation services in a group setting to children, adolescents, or adults recovering from mental illness or in a mental health crisis. begin insert The bill would also expand the definition of a short-term residential treatment center to include a children’s crisis residential center, as defined, and would require the department to regulate those program, as specified. The bill would require the State Department of Health Care Services, in consultation with the County Behavioral Health Directors Association of California, representatives of provider associations, children’s advocates, and other stakeholders, to establish Medi-Cal rates for children’s crisis residential services, as prescribed. end insert By expanding the types of facilities that are regulated as a community care facility, this bill would expand the scope of an existing crime, thus creating a state-mandated local program.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that no reimbursement is required by this act for a specified reason.

Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: yes.

The people of the State of California do enact as follows:

SECTION 1.  

The Legislature finds and declares all of the
following:

(a) There is an urgent need to provide more crisis care
alternatives to hospitals for children and youth experiencing mental
health crises.

(b) The problems are especially acute for children and youth
who may have to wait for days for a hospital bed and who may be
transported, without a parent, to the nearest facility hundreds of
miles away.

(c) In 2012, the California Hospital Association reported that
two-thirds of the people taken to a hospital for a psychiatric
emergency did not meet the criteria for that level of begin delete care end delete begin insert care, end insert but
the care they needed was not available.

(d) The type of care that is needed includes crisis residential
treatment for children.

(e) This level of care is part of the full continuum of care
considered medically necessary for many children with serious
emotional disturbances.

(f) In 2013, the Legislature enacted the Investment in Mental
Health Wellness Act (Senate Bill 82, Chapter 34 of the Statutes
of 2013) to provide one-time funding to counties to expand the
availability of mental health crisis care services, including
short-term crisis residential treatment services. However, there is
currently no state licensing category for short-term crisis residential
programs for children. As a result, counties wanting to expand
local capacity to meet the needs of children and youth for crisis
residential treatment services were ineligible for this competitive
grant program.

(g) Federal Medicaid provisions allow for federal matching
funds for mental health services delivered to Medi-Cal beneficiaries
under 21 years of age in psychiatric residential treatment facilities,
including short-term crisis residential treatment programs.
However, because there is currently no state licensing category
for crisis residential treatment programs for children, California
is unable to benefit from these otherwise available federal financial
resources.

(h) In most communities, inpatient crisis treatment is completely
unavailable for children and begin delete youth end delete begin insert youth, end insert even though it may be
medically necessary.

(i) Crisis residential care is an essential level of care for the
treatment of children and youth with serious emotional disturbances
in a mental health crisis, and it often serves as an alternative to
hospitalization.

(j) It is imperative that public health care coverage include these
services as a covered benefit.

begin delete

SEC. 2.  

Section 1502 of the Health and Safety Code is amended
to read:

1502.  

As used in this chapter:

(a) “Community care facility” means any facility, place, or
building that is maintained and operated to provide nonmedical
residential care, day treatment, adult day care, or foster family
agency services for children, adults, or children and adults,
including, but not limited to, the physically handicapped, mentally
impaired, incompetent persons, and abused or neglected children,
and includes the following:

(1) “Residential facility” means any family home, group care
facility, or similar facility determined by the director, for 24-hour
nonmedical care of persons in need of personal services,
supervision, or assistance essential for sustaining the activities of
daily living or for the protection of the individual.

(2) “Adult day program” means any community-based facility
or program that provides care to persons 18 years of age or older
in need of personal services, supervision, or assistance essential
for sustaining the activities of daily living or for the protection of
these individuals on less than a 24-hour basis.

(3) “Therapeutic day services facility” means any facility that
provides nonmedical care, counseling, educational or vocational
support, or social rehabilitation services on less than a 24-hour
basis to persons under 18 years of age who would otherwise be
placed in foster care or who are returning to families from foster
care. Program standards for these facilities shall be developed by
the department, pursuant to Section 1530, in consultation with
therapeutic day services and foster care providers.

(4) “Foster family agency” means any organization engaged in
the recruiting, certifying, and training of, and providing
professional support to, foster parents, or in finding homes or other
places for placement of children for temporary or permanent care
who require that level of care as an alternative to a group home.
Private foster family agencies shall be organized and operated on
a nonprofit basis.

(5) “Foster family home” means any residential facility
providing 24-hour care for six or fewer foster children that is
owned, leased, or rented and is the residence of the foster parent
or parents, including their family, in whose care the foster children
have been placed. The placement may be by a public or private
child placement agency or by a court order, or by voluntary
placement by a parent, parents, or guardian. It also means a foster
family home described in Section 1505.2.

(6) “Small family home” means any residential facility, in the
licensee’s family residence, that provides 24-hour care for six or
fewer foster children who have mental disorders or developmental
or physical disabilities and who require special care and supervision
as a result of their disabilities. A small family home may accept
children with special health care needs, pursuant to subdivision
(a) of Section 17710 of the Welfare and Institutions Code. In
addition to placing children with special health care needs, the
department may approve placement of children without special
health care needs, up to the licensed capacity.

(7) “Social rehabilitation facility” means any residential facility
that provides social rehabilitation services for no longer than 18
months in a group setting to individuals, including children,
adolescents, and adults, recovering from mental illness or in a
mental health crisis who temporarily need assistance, guidance,
or counseling. Program components shall be subject to program
standards pursuant to Article 1 (commencing with Section 5670)
of Chapter 2.5 of Part 2 of Division 5 of the Welfare and
Institutions Code.

(8) “Community treatment facility” means any residential
facility that provides mental health treatment services to children
in a group setting and that has the capacity to provide secure
containment. Program components shall be subject to program
standards developed and enforced by the State Department of
Health Care Services pursuant to Section 4094 of the Welfare and
Institutions Code.

(9) (A) “Full-service adoption agency” means any licensed
entity engaged in the business of providing adoption services, that
does all of the following:

(i) Assumes care, custody, and control of a child through
relinquishment of the child to the agency or involuntary termination
of parental rights to the child.

(ii) Assesses the birth parents, prospective adoptive parents, or
child.

(iii) Places children for adoption.

(iv) Supervises adoptive placements.

(B) Private full-service adoption agencies shall be organized
and operated on a nonprofit basis. As a condition of licensure to
provide intercountry adoption services, a full-service adoption
agency shall be accredited and in good standing according to Part
96 of Title 22 of the Code of Federal Regulations, or supervised
by an accredited primary provider, or acting as an exempted
provider, in compliance with Subpart F (commencing with Section
96.29) of Part 96 of Title 22 of the Code of Federal Regulations.

(10) (A) “Noncustodial adoption agency” means any licensed
entity engaged in the business of providing adoption services, that
does all of the following:

(i) Assesses the prospective adoptive parents.

(ii) Cooperatively matches children freed for adoption, who are
under the care, custody, and control of a licensed adoption agency,
for adoption, with assessed and approved adoptive applicants.

(iii) Cooperatively supervises adoptive placements with a
full-service adoptive agency, but does not disrupt a placement or
remove a child from a placement.

(B) Private noncustodial adoption agencies shall be organized
and operated on a nonprofit basis. As a condition of licensure to
provide intercountry adoption services, a noncustodial adoption
agency shall be accredited and in good standing according to Part
96 of Title 22 of the Code of Federal Regulations, or supervised
by an accredited primary provider, or acting as an exempted
provider, in compliance with Subpart F (commencing with Section
96.29) of Part 96 of Title 22 of the Code of Federal Regulations.

(11) “Transitional shelter care facility” means any group care
facility that provides for 24-hour nonmedical care of persons in
need of personal services, supervision, or assistance essential for
sustaining the activities of daily living or for the protection of the
individual. Program components shall be subject to program
standards developed by the State Department of Social Services
pursuant to Section 1502.3.

(12) “Transitional housing placement provider” means an
organization licensed by the department pursuant to Section
1559.110 and Section 16522.1 of the Welfare and Institutions Code
to provide transitional housing to foster children at least 16 years
of age and not more than 18 years of age, and nonminor
dependents, as defined in subdivision (v) of Section 11400 of the
Welfare and Institutions Code, to promote their transition to
adulthood. A transitional housing placement provider shall be
privately operated and organized on a nonprofit basis.

(13) “Group home” means a residential facility that provides
24-hour care and supervision to children, delivered at least in part
by staff employed by the licensee in a structured environment. The
care and supervision provided by a group home shall be
nonmedical, except as otherwise permitted by law.

(14) “Runaway and homeless youth shelter” means a group
home licensed by the department to operate a program pursuant
to Section 1502.35 to provide voluntary, short-term, shelter and
personal services to runaway youth or homeless youth, as defined
in paragraph (2) of subdivision (a) of Section 1502.35.

(15) “Enhanced behavioral supports home” means a facility
certified by the State Department of Developmental Services
pursuant to Article 3.6 (commencing with Section 4684.80) of
Chapter 6 of Division 4.5 of the Welfare and Institutions Code,
and licensed by the State Department of Social Services as an adult
residential facility or a group home that provides 24-hour
nonmedical care to individuals with developmental disabilities
who require enhanced behavioral supports, staffing, and
supervision in a homelike setting. An enhanced behavioral supports
home shall have a maximum capacity of four consumers, shall
conform to Section 441.530(a)(1) of Title 42 of the Code of Federal
Regulations, and shall be eligible for federal Medicaid home- and
community-based services funding.

(16) “Community crisis home” means a facility certified by the
State Department of Developmental Services pursuant to Article
8 (commencing with Section 4698) of Chapter 6 of Division 4.5
of the Welfare and Institutions Code, and licensed by the State
Department of Social Services pursuant to Article 9.7 (commencing
with Section 1567.80), as an adult residential facility, providing
24-hour nonmedical care to individuals with developmental
disabilities receiving regional center service, in need of crisis
intervention services, and who would otherwise be at risk of
admission to the acute crisis center at Fairview Developmental
Center, Sonoma Developmental Center, an acute general hospital,
acute psychiatric hospital, an institution for mental disease, as
described in Part 5 (commencing with Section 5900) of Division
5 of the Welfare and Institutions Code, or an out-of-state
placement. A community crisis home shall have a maximum
capacity of eight consumers, as defined in subdivision (a) of
Section 1567.80, shall conform to Section 441.530(a)(1) of Title
42 of the Code of Federal Regulations, and shall be eligible for
federal Medicaid home- and community-based services funding.

(17) “Crisis nursery” means a facility licensed by the department
to operate a program pursuant to Section 1516 to provide short-term
care and supervision for children under six years of age who are
voluntarily placed for temporary care by a parent or legal guardian
due to a family crisis or stressful situation.

(b) “Department” or “state department” means the State
Department of Social Services.

(c) “Director” means the Director of Social Services.

Nothing in this section shall be construed to prohibit or
discourage placement of persons who have mental or physical
disabilities into any category of community care facility that meets
the needs of the individual placed, if the placement is consistent
with the licensing regulations of the department.

end delete

begin insert

begin insert SEC. 2. end insert   

end insert

begin insert Section 1502 of the end insert begin insert Health and Safety Code end insert begin insert is amended
to read: end insert

1502.  

As used in this chapter:

(a) “Community care facility” means any facility, place, or
building that is maintained and operated to provide nonmedical
residential care, day treatment, adult day care, or foster family
agency services for children, adults, or children and adults,
including, but not limited to, the physically handicapped, mentally
impaired, incompetent persons, and abused or neglected children,
and includes the following:

(1) “Residential facility” means any family home, group care
facility, or similar facility determined by the director, for 24-hour
nonmedical care of persons in need of personal services,
supervision, or assistance essential for sustaining the activities of
daily living or for the protection of the individual.

(2) “Adult day program” means any community-based facility
or program that provides care to persons 18 years of age or older
in need of personal services, supervision, or assistance essential
for sustaining the activities of daily living or for the protection of
these individuals on less than a 24-hour basis.

(3) “Therapeutic day services facility” means any facility that
provides nonmedical care, counseling, educational or vocational
support, or social rehabilitation services on less than a 24-hour
basis to persons under 18 years of age who would otherwise be
placed in foster care or who are returning to families from foster
care. Program standards for these facilities shall be developed by
the department, pursuant to Section 1530, in consultation with
therapeutic day services and foster care providers.

(4) “Foster family agency” means any public agency or private
organization engaged in the recruiting, certifying, and training of,
and providing professional support to, foster parents, or in finding
homes or other places for placement of children for temporary or
permanent care who require that level of care. Private foster family
agencies shall be organized and operated on a nonprofit basis.

(5) “Foster family home” means any residential facility
providing 24-hour care for six or fewer foster children that is
owned, leased, or rented and is the residence of the foster parent
or parents, including their family, in whose care the foster children
have been placed. The placement may be by a public or private
child placement agency or by a court order, or by voluntary
placement by a parent, parents, or guardian. It also means a foster
family home described in Section 1505.2.

(6) “Small family home” means any residential facility, in the
licensee’s family residence, that provides 24-hour care for six or
fewer foster children who have mental disorders or developmental
or physical disabilities and who require special care and supervision
as a result of their disabilities. A small family home may accept
children with special health care needs, pursuant to subdivision
(a) of Section 17710 of the Welfare and Institutions Code. In
addition to placing children with special health care needs, the
department may approve placement of children without special
health care needs, up to the licensed capacity.

(7) “Social rehabilitation facility” means any residential facility
that provides social rehabilitation services for no longer than 18
months in a group setting to begin delete adults end delete begin insert individuals, including children,
adolescents, and adults, end insert recovering from mental illness begin insert or in a
mental health crisis end insert who temporarily need assistance, guidance,
or counseling. Program components shall be subject to program
standards pursuant to Article 1 (commencing with Section 5670)
of Chapter 2.5 of Part 2 of Division 5 of the Welfare and
Institutions Code.

(8) “Community treatment facility” means any residential
facility that provides mental health treatment services to children
in a group setting and that has the capacity to provide secure
containment. Program components shall be subject to program
standards developed and enforced by the State Department of
Health Care Services pursuant to Section 4094 of the Welfare and
Institutions Code.

begin delete

Nothing in this section shall be construed to prohibit or
discourage placement of persons who have mental or physical
disabilities into any category of community care facility that meets
the needs of the individual placed, if the placement is consistent
with the licensing regulations of the department.

end delete

(9)  begin insert (A) end insert begin insert   end insert “Full-service adoption agency” means any licensed
entity engaged in the business of providing adoption services, that
does all of the following:

begin delete

(A)

end delete

begin insert (i) end insert  Assumes care, custody, and control of a child through
relinquishment of the child to the agency or involuntary termination
of parental rights to the child.

begin delete

(B)

end delete

begin insert (ii) end insert  Assesses the birth parents, prospective adoptive parents, or
child.

begin delete

(C)

end delete

begin insert (iii) end insert  Places children for adoption.

begin delete

(D)

end delete

begin insert (iv) end insert  Supervises adoptive placements.

begin delete

Private

end delete

begin insert (B) end insert begin insert   end insert begin insert Private end insert full-service adoption agencies shall be organized
and operated on a nonprofit basis. As a condition of licensure to
provide intercountry adoption services, a full-service adoption
agency shall be accredited and in good standing according to Part
96 of Title 22 of the Code of Federal Regulations, or supervised
by an accredited primary provider, or acting as an exempted
provider, in compliance with Subpart F (commencing with Section
96.29) of Part 96 of Title 22 of the Code of Federal Regulations.

(10)  begin insert (A) end insert begin insert   end insert “Noncustodial adoption agency” means any licensed
entity engaged in the business of providing adoption services, that
does all of the following:

begin delete

(A)

end delete

begin insert (i) end insert  Assesses the prospective adoptive parents.

begin delete

(B)

end delete

begin insert (ii) end insert  Cooperatively matches children freed for adoption, who are
under the care, custody, and control of a licensed adoption agency,
for adoption, with assessed and approved adoptive applicants.

begin delete

(C)

end delete

begin insert (iii) end insert  Cooperatively supervises adoptive placements with a
full-service adoptive agency, but does not disrupt a placement or
remove a child from a placement.

begin delete

Private

end delete

begin insert (B) end insert begin insert   end insert begin insert Private end insert noncustodial adoption agencies shall be organized
and operated on a nonprofit basis. As a condition of licensure to
provide intercountry adoption services, a noncustodial adoption
agency shall be accredited and in good standing according to Part
96 of Title 22 of the Code of Federal Regulations, or supervised
by an accredited primary provider, or acting as an exempted
provider, in compliance with Subpart F (commencing with Section
96.29) of Part 96 of Title 22 of the Code of Federal Regulations.

(11) “Transitional shelter care facility” means any group care
facility that provides for 24-hour nonmedical care of persons in
need of personal services, supervision, or assistance essential for
sustaining the activities of daily living or for the protection of the
individual. Program components shall be subject to program
standards developed by the State Department of Social Services
pursuant to Section 1502.3.

(12) “Transitional housing placement provider” means an
organization licensed by the department pursuant to Section
1559.110 and Section 16522.1 of the Welfare and Institutions Code
to provide transitional housing to foster children at least 16 years
of age and not more than 18 years of age, and nonminor
dependents, as defined in subdivision (v) of Section 11400 of the
Welfare and Institutions Code, to promote their transition to
adulthood. A transitional housing placement provider shall be
privately operated and organized on a nonprofit basis.

(13) “Group home” means a residential facility that provides
24-hour care and supervision to children, delivered at least in part
by staff employed by the licensee in a structured environment. The
care and supervision provided by a group home shall be
nonmedical, except as otherwise permitted by law.

(14) “Runaway and homeless youth shelter” means a group
home licensed by the department to operate a program pursuant
to Section 1502.35 to provide voluntary, short-term, shelter and
personal services to runaway youth or homeless youth, as defined
in paragraph (2) of subdivision (a) of Section 1502.35.

(15) “Enhanced behavioral supports home” means a facility
certified by the State Department of Developmental Services
pursuant to Article 3.6 (commencing with Section 4684.80) of
Chapter 6 of Division 4.5 of the Welfare and Institutions Code,
and licensed by the State Department of Social Services as an adult
residential facility or a group home that provides 24-hour
nonmedical care to individuals with developmental disabilities
who require enhanced behavioral supports, staffing, and
supervision in a homelike setting. An enhanced behavioral supports
home shall have a maximum capacity of four consumers, shall
conform to Section 441.530(a)(1) of Title 42 of the Code of Federal
Regulations, and shall be eligible for federal Medicaid home- and
community-based services funding.

(16) “Community crisis home” means a facility certified by the
State Department of Developmental Services pursuant to Article
8 (commencing with Section 4698) of Chapter 6 of Division 4.5
of the Welfare and Institutions Code, and licensed by the State
Department of Social Services pursuant to Article 9.7 (commencing
with Section 1567.80), as an adult residential facility, providing
24-hour nonmedical care to individuals with developmental
disabilities receiving regional center service, in need of crisis
intervention services, and who would otherwise be at risk of
admission to the acute crisis center at Fairview Developmental
Center, Sonoma Developmental Center, an acute general hospital,
acute psychiatric hospital, an institution for mental disease, as
described in Part 5 (commencing with Section 5900) of Division
5 of the Welfare and Institutions Code, or an out-of-state
placement. A community crisis home shall have a maximum
capacity of eight consumers, as defined in subdivision (a) of
Section 1567.80, shall conform to Section 441.530(a)(1) of Title
42 of the Code of Federal Regulations, and shall be eligible for
federal Medicaid home- and community-based services funding.

(17) “Crisis nursery” means a facility licensed by the department
to operate a program pursuant to Section 1516 to provide short-term
care and supervision for children under six years of age who are
voluntarily placed for temporary care by a parent or legal guardian
due to a family crisis or stressful situation.

(18) “Short-term residential treatment center” means a
residential facility licensed by the department pursuant to Section
1562.01 and operated by any public agency or private organization
that provides short-term, specialized, and intensive treatment, and
24-hour care and supervision to children. The care and supervision
provided by a short-term residential treatment center shall be
nonmedical, except as otherwise permitted by law. begin insert “Short-term
residential treatment center” includes a children’s crisis residential
center. end insert

(b) “Department” or “state department” means the State
Department of Social Services.

(c) “Director” means the Director of Social Services.

begin insert

(d) Organizations providing children’s residential treatment
services shall be certified to provide specialty mental health
services under Medi-Cal and the Early and Periodic Screening,
Diagnostic, and Treatment (EPSDT) Program.

end insert begin insert

(e) Nothing in this section shall be construed to prohibit or
discourage placement of persons who have mental or physical
disabilities into any category of community care facility that meets
the needs of the individual placed, if the placement is consistent
with the licensing regulations of the department.

end insert

begin insert

begin insert SEC. 3. end insert   

end insert

begin insert Section 1502.1 is added to the end insert begin insert Health and Safety Code end insert begin insert ,
to read: end insert

begin insert

begin insert 1502.1. end insert   

The department shall establish regulations for
short-term residential treatment centers that are designated as
children’s crisis residential centers. At a minimum, the regulations
shall include all of the following:

(a) The children’s crisis residential center shall be used only
for diversion from admittance to a psychiatric hospitalization.

(b) Length of stay will be limited to 10 consecutive days.

(c) Therapeutic programming shall be provided seven days a
week, including weekends and holidays, with sufficient professional
and paraprofessional staff to maintain an appropriate treatment
setting and services, based on individual children’s needs.

(d) The program shall be staffed with sufficient personnel to
accept and admit children, at a minimum, from 7 a.m. to 11 p.m.,
seven days a week, 365 days per year. The program shall be
sufficiently staffed to discharge children, as appropriate, seven
days a week, 365 days per year.

(e) Facilities shall be limited to fewer than 16 beds, with at least
50 percent of those beds in single-occupancy rooms.

(f) Facilities shall include ample physical space for working
with individuals who provide natural supports to each child and
for integrating family members into the day-to-day care of the
youth.

(g) The center shall collaborate with each child’s mental health
team, child and family team, and other paid and natural supports
within 24 hours of intake and throughout the course of care and
treatment as appropriate.

end insert

begin insert

begin insert SEC. 4. end insert   

end insert

begin insert Section 1502.2 is added to the end insert begin insert Health and Safety Code end insert begin insert ,
to read: end insert

begin insert

begin insert 1502.2. end insert   

(a) The State Department of Health Care Services, in
consultation with the County Behavioral Health Directors
Association of California, representatives of provider associations,
children’s advocates, and other stakeholders shall establish
Medi-Cal rates as needed that are sufficient to reimburse the costs
for children’s crisis residential services in excess of any specialty
mental health services that would have been otherwise authorized,
provided, and invoiced for each eligible Medi-Cal beneficiary
receiving children’s crisis residential services.

(b) For foster children admitted for children’s crisis residential
services, programs shall receive payment for board and care
equivalent to the rate paid for short-term residential treatment
centers.

(c) Nothing in this chapter shall prevent a county from providing
payment in excess of the short-term residential treatment center
rate in order to meet the needs of individual children.

end insert

begin delete SEC. 3. end delete

begin insert SEC. 5. end insert   

No reimbursement is required by this act pursuant to
Section 6 of Article XIII B of the California Constitution because
the only costs that may be incurred by a local agency or school
district will be incurred because this act creates a new crime or
infraction, eliminates a crime or infraction, or changes the penalty
for a crime or infraction, within the meaning of Section 17556 of
the Government Code, or changes the definition of a crime within
the meaning of Section 6 of Article XIII B of the California
Constitution.