Amended in Senate June 16, 2016

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 of, and to add Sections begin delete 1502.1 and 1502.2 end delete begin insert 1562.02 and 1562.03 end insert to, the Health and Safety Code, begin insert and to amend Section 11462.01 of the Welfare and Institutions Code, end insert 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 begin delete 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 end delete a short-term residential treatment begin delete center. end delete begin insert center, which is a residential facility licensed by the department 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. end insert A violation of the act is a misdemeanor.

This bill would begin delete 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 end delete begin insert authorize a end insert short-term residential treatment center to begin delete include end delete begin insert be operated as end insert a children’s crisis residential center, as defined, and would require the department to regulate those begin delete program, end delete begin insert programs, end insert 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.

begin insert

Existing law establishes the Aid to Families with Dependent Children-Foster Care (AFDC-FC) program, under which counties provide payments to foster care providers on behalf of qualified children in foster care. In order to be eligible for AFDC-FC, existing law requires a child or nonminor dependent to be placed in a specified placement, including, commencing January 1, 2017, a short-term residential treatment center.

end insert begin insert

Existing law, effective January 1, 2017, authorizes a short-term residential treatment center to have a program that is certified by the State Department of Health Care Services or by a county mental health plan to which the department has delegated certification authority, or a program that is not certified, or both, and requires a short-term residential treatment center to accept for placement children who meet certain criteria, subject to specified requirements.

end insert begin insert

This bill would authorize a short-term residential treatment center that is operating as a children’s crisis residential center to, subject to specified requirements, accept for admission or placement any child, referred by a parent or guardian, or by the representative of a public or private entity that has the right to make these decisions on behalf of a child who is in mental health crisis and, absent admission to a children’s crisis residential center, would otherwise require acceptance by the emergency department of a general hospital, or admission into a psychiatric hospital or the psychiatric inpatient unit of a general hospital.

end insert

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, 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.

begin delete

(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.

end delete begin delete

(h)

end delete

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

begin delete

(i)

end delete

begin insert (h) end insert  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.

begin delete

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

end delete begin insert

(i) It is imperative that California identify a licensing category
specifically for mental health crisis residential care that can be
utilized for children and youth who are beneficiaries of both public
and private health care plans.

end insert

SEC. 2.  

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

1502.  

begin insert (a) end insert begin insert   end insert As used in this chapter:

begin delete

(a)

end delete

begin insert (1) end insert  “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:

begin delete

(1)

end delete

begin insert (A) end insert  “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.

begin delete

(2)

end delete

begin insert (B) end insert  “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.

begin delete

(3)

end delete

begin insert (C) end insert  “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.

begin delete

(4)

end delete

begin insert (D) end insert  “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.

begin delete

(5)

end delete

begin insert (E) end insert  “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.

begin delete

(6)

end delete

begin insert (F) end insert  “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.

begin delete

(7)

end delete

begin insert (G) end insert  “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 individuals, including children,
adolescents, and adults, end delete begin insert adults end insert recovering from mental illness begin delete or
in a mental health crisis end delete 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.

begin delete

(8)

end delete

begin insert (H) end insert  “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

(9) (A)

end delete

begin insert (I) end insert begin insert   end insert begin insert (i) 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

(i)

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

(ii)

end delete

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

begin delete

(iii) 

end delete

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

begin delete

(iv)

end delete

begin insert (IV) end insert  Supervises adoptive placements.

begin delete

(B)

end delete

begin insert (ii) end insert  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.

begin delete

(10) (A)

end delete

begin insert (J) end insert begin insert   end insert begin insert (i) 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

(i)

end delete

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

begin delete

(ii)

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

(iii) 

end delete

begin insert (III) end insert begin insert   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

(B)

end delete

begin insert (ii) end insert  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.

begin delete

(11)

end delete

begin insert (K) end insert  “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.

begin delete

(12)

end delete

begin insert (L) end insert  “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.

begin delete

(13)

end delete

begin insert (M) end insert  “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.

begin delete

(14)

end delete

begin insert (N) end insert  “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, begin delete short-term, end delete begin insert short-term end insert shelter and
personal services to runaway youth or homeless youth, as defined
in paragraph (2) of subdivision (a) of Section 1502.35.

begin delete

(15)

end delete

begin insert (O) end insert  “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.

begin delete

(16)

end delete

begin insert (P) end insert  “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.

begin delete

(17)

end delete

begin insert (Q) end insert  “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.

begin delete

(18)

end delete

begin insert (R) end insert  “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 delete “Short-term end delete begin insert A
short-term end insert residential treatment begin delete center” includes end delete begin insert center may be
operated as end insert a children’s crisis residential center.

begin insert

(S) “Children’s crisis residential center” means a short-term
residential treatment center operated specifically to divert children
experiencing a mental health crisis from psychiatric
hospitalization.

end insert begin delete

(b)

end delete

begin insert (2) end insert  “Department” or “state department” means the State
Department of Social Services.

begin delete

(c)

end delete

begin insert (3) end insert  “Director” means the Director of Social Services.

begin delete

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

end delete begin delete

(e)

end delete

begin insert (b) end insert  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.

begin delete

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.

end delete

begin insert

begin insert SEC. 3. end insert   

end insert

begin insert Section 1562.02 is added to the end insert begin insert Health and Safety
Code end insert begin insert , to read: end insert

begin insert

begin insert 1562.02. end insert   

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

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

(2) Length of stay for a single admission to a children’s crisis
center shall be limited to 10 consecutive days. An organization
providing children’s crisis residential services shall not admit a
child for more than two consecutive 10-day lengths of stay during
any 12-month period. Before extending the length of stay for a
Medi-Cal beneficiary beyond 10 consecutive days, an organization
providing children’s crisis residential services shall obtain prior
approval from the county mental health plan authorizing those
services.

(3) 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.

(4) The program shall be staffed with sufficient personnel to
accept children 24 hours per day, seven days a week and to 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.

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

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

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

(b) The department may adopt regulations, as needed, to waive
the requirements in Section 1562.01 that are in conflict with the
purposes or best practices of operating a children’s crisis
residential center.

end insert

begin insert

begin insert SEC. 4. end insert   

end insert

begin insert Section 1562.03 is added to the end insert begin insert Health and Safety
Code end insert begin insert , to read: end insert

begin insert

begin insert 1562.03. 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 insert

begin insert SEC. 5. end insert   

end insert

begin insert Section 11462.01 of the end insert begin insert Welfare and Institutions Code end insert begin insert ,
as added by Section 75 of Chapter 773 of the Statutes of 2015, is
amended to read: end insert

11462.01.  

(a) A short-term residential treatment center, as
defined in subdivision (ad) of Section 11400 and begin insert subparagraph
(R) end insert of paragraph begin delete (18) end delete begin insert (1) end insert of subdivision (a) of Section 1502 of the
Health and Safety Code, may have a program that is certified by
the State Department of Health Care Services or by a county mental
health plan to which the department has delegated certification
authority, pursuant to Section 4096.5, or a program that is not
certified, or both. A short-term residential treatment center begin insert , except
as specified in subdivision (d), end insert shall accept for placement children
who meet all of the following criteria, subject to the other
requirements of subdivisions (b) and (c):

(1) The child does not require inpatient care in a licensed health
facility.

(2) The child has been assessed as requiring the level of services
provided in a short-term residential treatment center in order to
maintain the safety and well-being of the child or others due to
behaviors, including those resulting from traumas, that render the
child or those around the child unsafe or at risk of harm, or that
prevent the effective delivery of needed services and supports
provided in the child’s own home or in other family settings, such
as with a relative, guardian, foster family, resource family, or
adoptive family.

(3) The child meets at least one of the following conditions:

(A) The child has been assessed as meeting the medical necessity
criteria for Medi-Cal specialty mental health Early and Periodic
Screening, Diagnosis, and Treatment Services, as the criteria are
described in Section 1830.210 of Title 9 of the California Code of
Regulations.

(B) The child has been assessed as seriously emotionally
disturbed, as described in subdivision (a) of Section 5600.3.

(C) The child has been assessed as requiring the level of services
provided in order to meet his or her behavioral or therapeutic needs.
In appropriate circumstances, this may include any of the
following:

(i) A commercially sexually exploited child.

(ii) A private voluntary placement, if the youth exhibits status
offender behavior, the parents or other relatives feel they cannot
control the child’s behavior, and short-term intervention is needed
to transition the child back into the home.

(iii) A juvenile sex offender.

(iv) A child who is affiliated with, or impacted by, a gang.

(b) A short-term residential treatment center program that is
certified by the State Department of Health Care Services, or by
a county mental health plan to which the department has delegated
certification authority, pursuant to Section 4096.5, shall solely
accept for placement, and provide access to mental health services
to, children who meet the criteria in paragraphs (1) and (2) of
subdivision (a), and meet the conditions of subparagraph (A) or
(B) of paragraph (3) of subdivision (a), or both of those
subparagraphs. Mental health services are provided directly by the
certified program.

(c) A short-term residential treatment center program that is not
certified pursuant to Section 4096.5 shall solely accept for
placement in that program a child who meets the criteria in
paragraphs (1) and (2) of subdivision (a), and meets the conditions
of subparagraph (A), (B), or (C) of paragraph (3) of subdivision
(a), or any combination of those subparagraphs. A child who meets
the conditions of subparagraphs (A) and (B) of paragraph (3) of
subdivision (a) may be accepted for placement, if the interagency
placement committee determines that a short-term residential
treatment facility that is not certified has a program that meets the
specific needs of the child and there is a commonality of needs
with the other children in the short-term residential treatment
center. In this situation, the short-term residential treatment center
shall do either of the following:

(1) In the case of a child who is a Medi-Cal beneficiary, arrange
for the child to receive specialty mental health services from the
county mental health plan.

(2) In all other cases, arrange for the child to receive mental
health services.

begin insert

(d) A short-term residential treatment center that is operating
as a children’s crisis residential center, as defined in Section 1502
of the Health and Safety Code, and subject to the other
requirements of subdivisions (b) and (c), may accept for admission
or placement any child, referred by a parent or guardian, or by
the representative of a public or private entity, including, but not
limited to, the county probation agency or child welfare services
agency with responsibility for the placement of a child in foster
care, that has the right to make these decisions on behalf of a child
who is in mental health crisis and, absent admission to a children’s
crisis residential center, would otherwise require acceptance by
the emergency department of a general hospital, or admission into
a psychiatric hospital or the psychiatric inpatient unit of a general
hospital.

end insert begin delete

(d)

end delete

begin insert (e) end insert  A foster family agency, as defined in subdivision (g) of
Section 11400 and begin insert subparagraph (D) of end insert paragraph begin delete (4) end delete begin insert (1) end insert of
subdivision (a) of Section 1502 of the Health and Safety Code,
may have a program that is certified by the State Department of
Health Care Services, or by a county mental health plan to which
the department has delegated certification authority, pursuant to
Section 1810.435 or 1810.436 of Title 9 of the California Code of
Regulations, or a program that is not certified, or both. A program,
subject to subdivisions begin delete (e) and (f), end delete begin insert (f) and (g), end insert shall provide access
to mental health services to the children. A foster family agency,
depending on whether or not it has a certified program, shall
provide access to mental health services to children who do not
require inpatient care in a licensed health facility and who meet
any one or more of the following conditions:

(1) A child who has been assessed as meeting the medical
necessity criteria for specialty mental health services under the
Medi-Cal Early and Periodic Screening, Diagnosis, and Treatment
benefit, as the criteria are described in Section 1830.210 of Title
9 of the California Code of Regulations.

(2) A child who has been assessed as seriously emotionally
disturbed, as described in subdivision (a) of Section 5600.3.

(3) A child who has been assessed as requiring the level of
services to meet his or her behavioral or therapeutic needs.

begin delete

(e)

end delete

begin insert (f) end insert  A foster family agency that is certified as a provider pursuant
to Section 1810.435 or 1810.436 of Title 9 of the California Code
of Regulations by the State Department of Health Care Services,
or by a county mental health plan to which the department has
delegated certification authority, shall provide access to mental
health services directly to children in its program who do not
require inpatient care in a licensed health facility and who meet
the conditions of paragraph (1) or (2) of subdivision begin delete (d). end delete begin insert (e). end insert

begin delete

(f)

end delete

begin insert (g) end insert  A foster family agency that is not certified as described in
subdivision begin delete (e) end delete begin insert (f) end insert may provide access to mental health services
in that program for children who do not require inpatient care in
a licensed health facility and who meet the conditions of paragraphs
(1) and (2) of subdivision begin delete (d). end delete begin insert (e). end insert In this situation the foster family
agency shall do the following:

(1) In the case of a child who is a Medi-Cal beneficiary, have
written interagency protocols in place to arrange for specialty
mental health services from the county mental health plan or an
organizational provider, as defined in Section 1810.231 of Title 9
of California Code of Regulations.

(2) In all other cases, arrange for the child to receive mental
health services.

begin delete

(g)

end delete

begin insert (h) end insert  All short-term residential treatment centers and foster family
agencies that operate a certified program shall maintain the level
of care and services necessary to meet the needs of the children
and youth in their care and shall maintain and have in good
standing the appropriate mental health certification issued by the
State Department of Health Care Services or a county mental health
plan to which the department has delegated certification authority,
pursuant to Section 4096.5 of this code or Section 1810.435 or
1810.436 of Title 9 of the California Code of Regulations.

begin delete

(h)

end delete

begin insert (i) end insert  The assessments described in subparagraphs (A) and (B) of
paragraph (3) of subdivision (a) and paragraphs (1) and (2) of
subdivision begin delete (d), end delete begin insert (e), end insert shall be made by all of the following, as
applicable:

(1) An interagency placement committee, as described in Section
4096, considering the recommendations from the child and family
team, if any are available.

(2) A licensed mental health professional as defined in
subdivision (g) of Section 4096.

(3) For the purposes of this section, an AFDC-FC funded child
with an individualized education program developed pursuant to
Article 2 (commencing with Section 56320) of Chapter 4 of Part
30 of Division 4 of Title 2 of the Education Code that assesses the
child as seriously emotionally disturbed, as defined in, and subject
to, this section and recommends out-of-home placement at the
level of care provided by the provider, shall be deemed to have
met the assessment requirement.

(4) For the purposes of this section, and only for placement into
a foster family agency, an AFDC-FC funded child assessed
pursuant to subdivision (b) of Section 706.6 or paragraph (2) of
subdivision (c) of Section 16501.1, in consultation with a mental
health professional, as defined in subdivision (g) of Section 4096.5,
shall be deemed to have met the assessment requirement.

begin delete

(i)

end delete

begin insert (j) end insert  The assessments described in subparagraph (C) of paragraph
(3) of subdivision (a) and paragraph (3) of subdivision begin delete (d) end delete begin insert (e) end insert shall
be made pursuant to subdivision (b) of Section 706.6 or paragraph
(2) of subdivision (c) of Section 16501.1.

begin delete

(j)

end delete

begin insert (k) end insert  (1) The provider shall ensure that AFDC-FC funded
children, assessed pursuant to subparagraphs (A) and (B) of
paragraph (3) of subdivision (a) or paragraphs (1) and (2) of
subdivision begin delete (d), end delete begin insert (e), end insert who are accepted for placement have been
approved for placement by an interagency placement committee,
as described in Section 4096, except as provided for in paragraphs
(3) and (4) of subdivision begin delete (h). end delete begin insert (i). end insert

(2) The approval shall be in writing and shall indicate that the
interagency placement committee has determined all of the
following:

(A) The child meets the medical necessity criteria for Medi-Cal
specialty mental health Early and Periodic Screening, Diagnosis,
and Treatment services, as the criteria are described in Section
1830.210 of Title 9 of the California Code of Regulations.

(B) The child is seriously emotionally disturbed, as described
in subdivision (a) of Section 5600.3.

(C) Subject to Section 1502.4 of the Health and Safety Code,
the child needs the level of care provided by the program.

(3) (A) Nothing in subdivisions (a) to begin delete (i), end delete begin insert (j), end insert inclusive, or this
subdivision shall prevent an emergency placement of a child or
youth into a certified short-term residential treatment center begin insert ,
children’s crisis residential center, end insert or foster family agency program
prior to the determination by the interagency placement committee,
but only if a licensed mental health professional, as defined in
subdivision (g) of Section 4096, has made a written determination
within 72 hours of the child’s or youth’s placement, that the child
or youth is seriously emotionally disturbed begin insert or has made a written
determination within 24 hours of the child’s or youth’s placement
in a children’s crisis residential center that the child or youth is
experiencing a mental health crisis as defined in subdivision (d), end insert
and is in need of the care and services provided by the certified
short-term residential treatment center begin insert , children’s crisis residential
center, end insert or foster family agency.

(i) The interagency placement committee, as appropriate, shall,
within 30 days of placement, make the determinations, with
recommendations from the child and family team, required by this
subdivision.

(ii) If it determines the placement is appropriate, the interagency
placement committee, with recommendations from the child and
family team, shall transmit the approval, in writing, to the county
placing agency and the short-term residential treatment center or
foster family agency.

(iii) If it determines the placement is not appropriate, the
interagency placement committee shall respond pursuant to
subparagraph (B).

(B) If the interagency placement committee determines at any
time that the placement is not appropriate, it shall, with
recommendations from the child and family team, transmit the
disapproval, in writing, to the county placing agency and the
short-term residential treatment center or foster family agency,
and the child or youth shall be referred to an appropriate placement,
as specified in this section.

begin delete

(k)

end delete

begin insert (l) end insert  Commencing January 1, 2017, for AFDC-FC funded children
or youth, only those children or youth who are approved for
placement, as set forth in this section, may be accepted by a
short-term residential treatment center or foster family agency.

begin delete

(l)

end delete

begin insert (m) end insert  The department shall, through regulation, establish
consequences for the failure of a short-term residential treatment
center, or a foster family agency, to obtain written approval for
placement of an AFDC-FC funded child or youth pursuant to this
section.

begin delete

(m)

end delete

begin insert (n) end insert  The department shall not establish a rate for a short-term
residential treatment center or foster family agency unless the
provider submits a recommendation from the host county or the
primary placing county that the program is needed and that the
provider is willing and capable of operating the program at the
level sought. For purposes of this subdivision, “host county,” and
“primary placing county,” mean the same as defined in the
department’s AFDC-FC ratesetting regulations.

begin delete

(n)

end delete

begin insert (o) end insert  Any certified short-term residential treatment center or foster
family agency shall be reclassified and paid at the appropriate
program rate for which it is qualified if either of the following
occurs:

(1) (A) It fails to maintain the level of care and services
necessary to meet the needs of the children and youth in care, as
required by subdivision (a). The determination shall be made
consistent with the department’s AFDC-FC ratesetting regulations
developed pursuant to Sections 11462 and 11463 and shall take
into consideration the highest level of care and associated rates
for which the program is eligible.

(B) In the event of a determination under this paragraph, the
short-term residential treatment center or foster family agency may
appeal the finding or submit a corrective action plan. The appeal
process specified in Section 11466.6 shall be available to a
short-term residential treatment center or foster family agency that
provides intensive and therapeutic treatment. During any appeal,
the short-term residential treatment center or foster family agency
that provides intensive and therapeutic treatment shall maintain
the appropriate level of care.

(2) It fails to maintain a certified mental health treatment
program as required by subdivision begin delete (g). end delete begin insert (h). end insert

begin delete

(o)

end delete

begin insert (p) end insert  In addition to any other review required by law, the child
and family team as defined in paragraph (4) of subdivision (a) of
Section 16501 may periodically review the placement of the child
or youth. If the child and family team make a recommendation
that the child or youth no longer needs, or is not benefiting from,
placement in a short-term residential treatment center or foster
family agency, or one of its programs, the team shall transmit the
disapproval, in writing, to the county placing agency to consider
a more appropriate placement.

begin delete

(p)

end delete

begin insert (q) end insert  The department shall develop a process to address
placements when, subsequent to the child’s or youth’s placement,
a determination is made by the interagency placement team and
shall consider the recommendations of the child and family team,
either that the child or youth is not in need of the care and services
provided by the certified program. The process shall include, but
not be limited to:

(1) Notice of the determination in writing to both the county
placing agency and the short-term residential treatment center or
foster family agency that provides intensive and therapeutic
treatment.

(2) Notice of the county’s plan, and a time frame, for removal
of the child or youth in writing to the short-term residential
treatment center or foster family agency that provides intensive
and therapeutic treatment.

(3) Referral to an appropriate placement.

(4) Actions to be taken if a child or youth is not timely removed
from the short-term residential treatment center or foster family
agency that provides intensive and therapeutic treatment or placed
in an appropriate placement.

begin delete

(q)

end delete

begin insert (r) end insert  (1) Nothing in this section shall prohibit a short-term
residential treatment center or foster family agency from accepting
private placements of children or youth.

(2) When a referral is not from a public agency and no public
funding is involved, there is no requirement for public agency
review nor determination of need.

(3) Children and youth subject to paragraphs (1) and (2) shall
have been determined to be seriously emotionally disturbed, as
described in subdivision (a) of Section 5600.3, and subject to
Section 1502.4 of the Health and Safety Code, by a licensed mental
health professional, as defined in subdivision (g) of Section 4096.

begin delete

(r)

end delete

begin insert (s) end insert  This section shall become operative on January 1, 2017.

begin delete SEC. 5. end delete

begin insert SEC. 6. 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.