BILL ANALYSIS                                                                                                                                                                                                    Ó



          SENATE COMMITTEE ON HUMAN SERVICES
                               Senator McGuire, Chair
                                2015 - 2016  Regular 

          Bill No:              AB 741
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          |Author:   |Williams                                              |
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          |----------+-----------------------+-----------+-----------------|
          |Version:  |May 25, 2016           |Hearing    |June 14, 2016    |
          |          |                       |Date:      |                 |
          |----------+-----------------------+-----------+-----------------|
          |Urgency:  |No                     |Fiscal:    |Yes              |
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          |Consultant|Mareva Brown                                          |
          |:         |                                                      |
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                 Subject:  Mental health:  community care facilities


            SUMMARY
          
          This bill expands the definition of a social rehabilitation  
          facility to include a residential facility that provides  
          services in a group setting to children and adolescents  
          recovering from mental illness or in a mental health crisis. The  
          bill also expands the definition of a short-term residential  
          treatment center to include a children's crisis residential  
          center, as defined. The bill would require the California  
          Department of Health Care Services (DHCS), in consultation with  
          specified stakeholders, to establish Medi-Cal rates for  
          children's crisis residential services.


            ABSTRACT
          
          Existing law:

            1)  Establishes a system of juvenile dependency for children  
              who are or are at risk of being physically, sexually or  
              emotionally abused, being neglected or being exploited to  
              ensure their safety, protection and physical and emotional  
              well-being. (WIC 300, et seq.)


            2)  Requires the state, through the California Department of  
              Social Services (CDSS) and county welfare departments, to  








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              establish and support a public system of child welfare  
              services to protect and promote the welfare of children.  
              (WIC 10600 and 16500)




            3)  Establishes California's Medicaid program, Medi-Cal,  
              though which eligible low-income individuals receive health  
              care and mental health services, including foster youth,  
              eligible recipients of the Adoption Assistance Program, and  
              Kin-Gap. Under Medi-Cal, establishes the federal Early and  
              Periodic Screening, Diagnosis and Treatment (EPSDT) program  
              to provide comprehensive and preventive health services  
              including specialty mental health services to Medi-Cal  
              beneficiaries under the age of 21. (WIC 14000 et seq., 42  
              USC Section 1396 et seq and 42 CFR 435.145.)




            4)  Requires county mental health departments to provide  
              children served by county social services and probation  
              departments, who meet the definition of medical necessity,  
              with mental health screening, assessment, participation in  
              multidisciplinary placement teams and specialty mental  
              health treatment. (WIC 5867.5)


            5)  Establishes a system of licensure and oversight for  
              community care facilities, including short term residential  
              treatment programs, designed to provide rehabilitation and  
              therapy for youth in foster care or other systems, as  
              specified. (HSC 1502)

            6)  Defines a "Social rehabilitation facility" to mean any  
              residential facility that provides social rehabilitation  
              services for no longer than 18 months in a group setting to  
              adults recovering from mental illness who temporarily need  
              assistance, guidance, or counseling. Requires program  
              components shall be subject to specified standards. (HSC  
              1502(a)(7)

            7)  Defines a "short-term residential treatment center" to  









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              mean a CDSS-licensed residential facility to provide  
              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. (HSC 1502 (a)(18)) 

            8)  Requires a short term residential treatment center to have  
              all of the following, as of January 1, 2017:

                  a.        National accreditation from an entity  
                    identified by CDSS, as specified.
                  b.        A mental health certification, as defined,  
                    which shall be in good standing.
                  c.        A current written plan of operation, as  
                    specified, which must include a statement of purposes  
                    and goals, plan for supervision, evaluation and  
                    training of staff, a program statement that includes a  
                    description of the program's ability to meet differing  
                    needs of children, a core services description, and  
                    other requirements. 
                  d.        A qualified administrator, as specified, and  
                    staff training to include specific topics of  
                    information relevant to the population of children  
                    served. (HSC 1562.01)

          This bill:

             1)   Makes a series of Legislative findings and declarations,  
               including:

                  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  









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                    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, 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  









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                    coverage include these services as a covered benefit.
          
             2)   Expands the existing definition of a social  
               rehabilitation facility from serving only adults to serving  
               children and adolescents.

             3)   Further expands the existing definition of a social  
               rehabilitation facility to permit treatment of individuals  
               experiencing a mental health crisis, rather than solely  
               those recovering from mental illness.
          
             4)   Adds to the definition of "short-term residential  
               treatment center" that it includes a children's crisis  
               residential center.
          
             5)   Requires that organizations providing children's  
               residential treatment services shall be certified to  
               provide specialty mental health services under Medi-Cal and  
               the EPSDT Program.
          

             6)   Adds a new section, WIC 1502.1, which requires CDSS to  
               establish regulations for short-term residential treatment  
               centers that are designated as children's crisis  
               residential centers, and requires, at a minimum, the  
               regulations include:



                  a.        Crisis residential centers be used only for  
                    diversion from admittance to a psychiatric  
                    hospitalization.



                  b.        The 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  









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                    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.        Further requires that facilities 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.        Requires the center 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.


             7)   Adds a new section, WIC 1502.2, which requires that  
               DHCS, in conjunction with various named and unnamed  
               stakeholders, 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. 










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             8)   Requires that crisis residential services programs  
               treating foster children shall receive payment for board  
               and care equivalent to the rate paid for short-term  
               residential treatment centers.

             9)   Establishes that nothing 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.

            FISCAL IMPACT
          
          An analysis by the Assembly Appropriations Committee identified  
          costs of $200,000 GF to CDSS to modify regulations governing  
          licensure to define program standards specific to children, as  
          well as potential ongoing costs to license additional  
          facilities. Licensure fees would cover some licensure costs;  
          however, any workload cost in excess of license would be GF  
          costs. 

          It is important to note that the bill has been substantially  
          amended since the Appropriations Committee analysis.

          
            BACKGROUND AND DISCUSSION
          
          Purpose of the bill:

          According to the author, this bill creates a needed licensing  
          category to ensure that counties and their community-based  
          providers can develop crisis residential programs for youth. The  
          intent is to ensure children and youth have access to crisis  
          residential treatment programs as an alternative to inpatient  
          placement. The author notes coverage for such services is  
          already required through Medi-Cal EPSDT and Specialty Mental  
          Health Services (SMHS) program standards and requirements, but  
          there is an access barrier because statute limits crisis  
          residential facilities to serving adults. 

          Child welfare

          California's child welfare system was designed to protect  
          children at risk of child abuse and neglect or exploitation by  
          providing intensive services to families to allow children to  









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          remain in their homes, or by arranging temporary or permanent  
          placement of the child in the safest and least restrictive  
          environment possible. Approximately 62,000 children were in the  
          custody of the child welfare system as of October 2015,  
          according to the state's child welfare case management system.  
          About 45,000 children were placed in out-of-home situations in  
          2016, according to data released by CDSS with the governor's  
          budget.

          Continuum of Care Reform Efforts

          After a three-year stakeholder effort, CDSS last year unveiled a  
          reform effort intended to reduce the reliance on group care, so  
          that children in foster care are raised primarily in family-like  
          environments. A cornerstone of this effort is the elimination of  
          the category of foster care group homes, effective January 1,  
          2017, and the creation of a category of short term residential  
          treatment centers (STRTCs) which provide brief, intensive,  
          mental health interventions to youth and adolescents who qualify  
          for that level of care. 
          
          Mental Illness

          Approximately 20 percent of youth between the ages of 13 and 18,  
          and 13 percent of younger youth experience severe mental  
          disorders in a given year, according to statistics compiled by  
          the National Alliance on Mental Illness (NAMI).<1> About 7 in 10  
          youth in juvenile justice systems have at least one mental  
          health condition and 20 percent are living with serious mental  
          illness. NAMI reports that almost half of children aged 8 to 15  
          who were diagnosed with a mental illness received no mental  
          health services in the previous year. 

          Foster youth experience a heightened rate of mental illness,  
          compared to peers, according to various studies. Specifically,  
          an American Psychological Association report<2> noted that  
          nearly half (47.9%) of youth in foster care were determined to  
          have clinically significant emotional or behavioral problems,  
          and more than half of children entering foster care exhibited  
          behavioral or social competency problems that warranted mental  
          ---------------------------
          <1> Mental Illness Facts and Numbers, 2013
          <2>  
          https://www.apa.org/pi/families/resources/newsletter/2012/01/wint 
          er.pdf








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          health services. In addition to the high rate of mental health  
          problems, children under age seven who enter foster care show  
          high rates of developmental problems, the report found.

          Capacity issues
          
          California has few crisis diversion programs for adolescents and  
          few options in a mental health crisis aside from emergency  
          hospitalization. According to a 2015 paper published by six  
          mental health advocacy organizations, the lack of crisis options  
          for children and teens results in untreated mental health issues  
          which worsen over time. The paper, "Kids in Crisis: California's  
          Failure to Provide Appropriate services for Youth Experiencing a  
          Mental Health Crisis," described California's system as  
          inconsistent statewide with many families turning to local  
          hospital emergency rooms for help. The document, which was  
          published by a workgroup led by the California Council of  
          Community Mental Health Agencies, advocated for the creation of  
          community-based crisis facilities for children and youth. "The  
          emergency room should be the last resort for a child in crisis,  
          yet in our current system, this is where children are first  
          being identified," the report noted.

          "For children's crisis services, the state has observed a  
          decrease in the availability of inpatient psychiatric hospital  
          beds, all while still lacking a comprehensive community-based  
          solution to meet the mental health needs of children within our  
          communities," the report noted. "While there are existing crisis  
          service programs in California, the availability of these  
          programs are limited in the type of services that are available  
          and vary significantly from one county to another county. For  
          example, a handful of counties may operate children's mobile  
          crisis teams, but there are no crisis stabilization units or  
          beds within their region. Therefore, inpatient hospitalization  
          is the only option for a youth experiencing a crisis in many  
          areas of the state, and in many instances it is "the least  
          effective measure," according to the report.

          A study of California hospital emergency rooms, published by the  














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          California Hospital Association in 2012,<3> indicated children  
          and adolescents with a primary psychiatric diagnosis waited an  
          average 12.97 hours for psychiatric evaluation and placement -  
          nearly three hours longer than adults in the same situation.  
          Total length of stay for children and teens in crisis was  
          estimated to be in excess of 19 hours.  "The extraordinary wait  
          times for patients with mental illness in the emergency  
          department, as well as the lack of resources available to  
          emergency departments for effectively treating and appropriately  
          placing these patients, indicate the existence of a mental  
          health system in California that prevents patients in acute need  
          of psychiatric treatment from getting it at the right time, in  
          the right place," the study concluded. 

          Related legislation:
           
          AB 403 (Stone, Chapter 773, Statutes of 2015) codified the  
          continuum of care reform effort by eliminating group homes and  
          creating short term residential treatment centers, home-based  
          therapeutic efforts and other reforms.

          AB 1997 (Stone, 2016) is the clean-up bill to AB 403, and will  
          include modifications to the licensure and certification of  
          STRTCs.

          SB 1013 (Committee on Budget and Fiscal Review, Chapter 35,  
          Statutes of 2012) called for the department to establish a  
          working group to develop recommended revisions to the current  
          rate-setting system, resulting in the Continuum of Care Reform  
          effort.

          SB 82 (Committee on Budget and Fiscal Review, Chapter 34,  
          Statutes of 2013) established the Investment in Mental Health  
          Wellness Act of 2013, which authorized the California Health  
          Facilities Financing Authority to administer a local grant  
          program to increase capacity for crisis support programs. 

            COMMENTS
          
          In creating a new category of licensure within the Short Term  
          ---------------------------
          <3> California Hospital Association, et al. "Impact of the  
          Mental Healthcare Delivery System on California
          Emergency Departments," Western Journal of Emergency Medicine,  
          February 2012.








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          Residential Treatment Centers, the author is establishing this  
          new category within a licensure category that has yet to be  
          implemented. While there is agreement that this type of facility  
          is needed, there is disagreement about the best path to  
          accomplish licensure. To address various concerns raised, the  
          author proposes the amendments on the mockup attached. These  
          amendments do the following: 

             1.   Clarify in Legislative intent language the need for a  
               licensing category to serve adolescents with crisis mental  
               health needs.
             2.   Restore the definition of social rehabilitation  
               facilities to existing statute, as the amendments were  
               inadvertently maintained when the definition was moved to  
               the Short Term Residential Treatment Center (SRTRC)
             3.   Define crisis residential center in the context of an  
               STRTC licensing category.
             4.   Move the description of crisis residential facility to a  
               new subdivision of statute.
             5.   Add authority for CDSS to develop regulations and to  
               waive specific STRTC requirements that would be in conflict  
               with a crisis residential facility.
             6.   Clarifies admission requirements to a crisis residential  
               facility. 
             7.   Permits emergency placement into a crisis residential  
               facility, pending placement approval.


          AMEND 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  









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          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.

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

           (i)  (h) 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.

            (j) It is imperative that   California identify a licensing  
          category specifically for mental health crisis residential care  









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          that can be utilized for children and youth who are  
          beneficiaries of both public and private health care plans.   
           
          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.

          ?

          (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,   to adults  
           recovering from mental illness  or in a mental health crisis  that  
          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.










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          ?

          (18)  (A)  "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.   may be  
          operated as a children's crisis residential center.
          (B) "Crisis residential center" means a "short-term residential  
          treatment center" operated specifically to divert children  
          experiencing a mental health crisis from psychiatric  
          hospitalization.
           
          (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)   (d)  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    1562.02  is added to the Health and  
          Safety Code, to read:
            

           1502.1.   1562.02  The department shall establish regulations for  
          short-term residential treatment centers that are  designated   
           operated  as children's crisis residential centers. 

              (a)  At a minimum, the regulations shall include all of the  
               following:
            









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

           (b)   (2)  Length of stay  for a single admission to a children's  
          crisis center shall   will  be limited to 10 consecutive days.  No  
          organization providing children's crisis residential services  
          shall 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 such services. 
           

           (c)  (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.

           (d)  (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.

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

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

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

           (b) The department shall have the authority to develop  
          regulations as needed and to waive such requirements as set  
          forth in Section 1562.01 that are in conflict with the purposes  









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          or best practices of operating a children's crisis residential  
          center.
           

           ADD: SEC. 5. Section 11462.01 of the Welfare and Institutions  
          Code is amended to read:

           11462.01. (a) A short-term residential treatment center, as  
          defined in subdivision (ad) of Section 11400 and paragraph (18)  
          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,  
           except as specified in paragraph (d),  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  









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          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.
           (d) A short-term residential treatment center that is operating  
          as a "crisis residential center" as defined in Section 1562.02  
          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, which has the right to make  
          such decisions on behalf of a child  who is in mental health  









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          crisis and, absent admission to a "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.

           ?
          11462.01. (j)(3)(A)  Nothing in subdivisions (a) to (i),  
          inclusive, or this subdivision shall prevent an emergency  
          placement of a child or youth into a certified short-term  
          residential treatment center 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,  or has made a written determination within 24 hours  
          of the child's or youth's placement in a crisis residential  
          center that the child or   youth is experiencing a mental health  
          crisis as defined in subdivision (d),  and is in need of the care  
          and services provided by the certified short-term residential  
          treatment center,  crisis residential center  , or foster family  
          agency. 


           SEC. 5.   SEC 6  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.
                                          
           

          PRIOR VOTES
           
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          |Assembly Floor:                                            |77 - |
          |                                                           |0    |
          |-----------------------------------------------------------+-----|
          |Assembly Appropriations Committee:                         |17 - |
          |                                                           |0    |









          AB 741 (Williams)                                         PageS  
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          |-----------------------------------------------------------+-----|
          |Assembly Health Committee:                                 |19 - |
          |                                                           |0    |
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            POSITIONS
                                          
          Support:       
               California Alliance of Child and Family Services  
          (Co-Sponsor)
               Aviva Family and Children's Services
               California Chapter of the American College of Emergency  
          Physicians
               California Coalition for Youth
               California Health + Advocates
               California Mental Health Advocates for Children and Youth
               California Primary Care Association
               California State PTA
               California State University Channel Islands 
               Casa Pacifica Centers for Children and Families
               Common Sense Kids Action
               David & Margaret Youth and Family Services
               Disability Rights California
               Family Care Network, Inc.
               Hathaway-Sycamores Child and Family Services
               Hillsides
               Junior Blind of America
               Lincoln Child Center
               NAMI California
               National Association of Social Workers, California Chapter
               National Council for Behavioral Health
               Pacific Clinics
               Redwood Community Services
               Redwood Quality Management Company 
               Remi Vista, Inc.
               Santa Barbara County Board of Supervisors
               Seneca Family of Agencies
               Sierra Sacramento Valley Medical Society
               Stars Behavioral Health Group
               Steinberg Institute 
               Trinity Youth Services
               United Advocates for Children and Families
               Young Minds Advocacy Project
               Youth Homes, Inc.









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               Youth In Mind

          Oppose:
               None.

                                      -- END -