BILL NUMBER: AB 741 AMENDED
BILL TEXT
AMENDED IN SENATE MAY 25, 2016
AMENDED IN ASSEMBLY MAY 4, 2015
AMENDED IN ASSEMBLY APRIL 15, 2015
INTRODUCED BY Assembly Member Williams
FEBRUARY 25, 2015
An act to amend Section 1502 of of, and to
add Sections 1502.1 and 1502.2 to, 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
facility, facility a social
rehabilitation facility, which is a residential facility that
provides social rehabilitation services in a group setting to adults
recovering from mental illness. Existing law also defines for
this purpose a short-term residential treatment center. 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. 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. 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 care
care, 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 youth youth,
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.
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.
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 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 adults
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.
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.
(9) (A) "Full-service adoption agency" means
any licensed entity engaged in the business of providing adoption
services, that does all of the following:
(A)
(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.
(B)
(ii) Assesses the birth parents, prospective adoptive
parents, or child.
(C)
(iii) Places children for adoption.
(D)
(iv) Supervises adoptive placements.
Private
(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:
(A)
(i) Assesses the prospective adoptive parents.
(B)
(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.
(C)
(iii) Cooperatively supervises adoptive placements with
a full-service adoptive agency, but does not disrupt a placement or
remove a child from a placement.
Private
(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.
(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. "Short-term residential treatment
center" includes a children's crisis residential center.
(b) "Department" or "state department" means the State Department
of Social Services.
(c) "Director" means the Director of Social Services.
(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.
(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.
SEC. 3. Section 1502.1 is added to the
Health and Safety Code , to read:
1502.1. 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.
SEC. 4. Section 1502.2 is added to the
Health and Safety Code , to read:
1502.2. (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.
SEC. 3. SEC. 5. 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.