BILL ANALYSIS Ó
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: AB 741
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|AUTHOR: |Williams |
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|VERSION: |June 16, 2016 |
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|HEARING DATE: |June 29, 2016 | | |
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|CONSULTANT: |Scott Bain |
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SUBJECT : Mental health: community care facilities
SUMMARY : Allows a short-term residential treatment center to be
operated as a children's crisis residential center as defined,
which would be operated specifically to divert children
experiencing a mental health crisis from psychiatric
hospitalization. Requires the Department of Social Services to
establish regulations for short-term residential treatment
centers that are operated as children's crisis residential
centers, and requires the regulations to include specified
minimum components. Requires the Department of Health Care
Services to 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.
Existing law:
1)Requires, under the California Community Care Facilities Act,
the licensing and regulation of community care facilities, as
defined, by the Department of Social Services (DSS).
2)Defines a community care facility to include a short-term
residential treatment residential treatment center (STRTC).
Defines a STRTC as a residential facility licensed by DSS 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. Requires the care
and supervision provided by a STRTC to be non-medical, except
as otherwise permitted by law.
AB 741 (Williams) Page 2 of ?
3)Establishes the Medi-Cal program, administered by the
Department of Health Care Services (DHCS), under which
qualified low-income individuals receive health care services.
4)Establishes a schedule of benefits under the Medi-Cal program,
which includes Early, Periodic Screening, Diagnostic and
Treatment Services (EPSDT) for any individual under 21 years
of age, consistent with federal Medicaid requirements. EPSDT
includes screening, vision, hearing and dental services and
other necessary health care, diagnostic services, treatment,
and other measures described in federal Medicaid law to
correct or ameliorate defects and physical and mental
illnesses and conditions discovered by the screening services,
whether or not such services are covered under the State's
Medicaid Plan.
5)Requires county mental health plans to provide specialty
mental health services to eligible Medi-Cal beneficiaries,
including both adults and children. Includes EPSDT within the
scope of specialty mental health services for eligible
Medi-Cal beneficiaries under the age of 21.
This bill:
1)Allows a STRTC to be operated as a children's crisis
residential center (CCRC). Defines a CCRC as a STRTC operated
specifically to divert children experiencing a mental health
crisis from psychiatric hospitalization.
2)Requires DSS to establish regulations for STRTCs that are
operated as CCRC. Requires, at a minimum, the regulations to
include all of the following:
a) Requires the CCRC to be used only for diversion from
admittance to a psychiatric hospitalization;
b) Requires the length of stay for a single admission
to a CCRC to be limited to 10 consecutive days;
c) Prohibits an organization providing children's
AB 741 (Williams) Page 3 of ?
crisis residential services from admitting a child for
more than two consecutive 10-day lengths of stay during
any 12-month period. Requires an organization providing
children's crisis residential services to obtain prior
approval from the county mental health plan authorizing
those services before extending the length of stay for a
Medi-Cal beneficiary beyond 10 consecutive days;
d) Requires therapeutic programming to 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;
e) Requires the program to 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;
f) Requires the program to be sufficiently staffed to
discharge children, as appropriate, seven days a week,
365 days per year.
g) Requires facilities to be limited to fewer than 16
beds, with at least 50 percent of those beds in
single-occupancy rooms;
h) Requires facilities to 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; and,
i) Requires the CCRC to 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.
1)Permits DSS to adopt regulations, as needed, to waive the
STRTC licensure and accreditation requirements that are in
conflict with the purposes or best practices of operating a
CCRC.
2)Requires DHCS, 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 as needed that are
sufficient to reimburse the costs for CCRC 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
AB 741 (Williams) Page 4 of ?
services.
3)Requires, for foster children admitted for CCRC, programs to
receive payment for board and care equivalent to the rate paid
for STRTCs.
4)Prohibits the Medi-Cal rate provisions from preventing a
county from providing payment in excess of the STRTC rate in
order to meet the needs of individual children.
5)Permits a STRTC that is operating as a CCRC to 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 hospital, or admission into a
psychiatric hospital or the psychiatric inpatient unit of a
hospital.
FISCAL
EFFECT : According to the Assembly Appropriations Committee of a
narrower previous version of this bill:
1)$200,000 General Fund (GF) to Department of Social Services to
modify regulations governing licensure to define program
standards specific to children.
2)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.
PRIOR
VOTES :
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|Assembly Floor: |77 - 0 |
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|Assembly Appropriations Committee: |17 - 0 |
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|Assembly Health Committee: |19 - 0 |
AB 741 (Williams) Page 5 of ?
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COMMENTS :
1)Author's statement. According to the author, the objective
for mental health services, guided by the federal Olmstead
Act, is to provide treatment in the least restrictive setting
possible. The overarching goal of existing programs is to keep
youth in crisis in calm, familiar environments where their
mental health needs can be met. However, without a licensing
category specific to children's crisis residential programs,
this critically needed service is missing from the continuum
of care. This bill expands the definition of Short-Term
Residential Treatment Center, thereby creating a category of
licensing in state statute for children's crisis residential
services. With the appropriate licensing category established,
the state and counties would have all the elements of the
continuum available to implement the services under the EPSDT
requirements already in place.
2)Short-Term Residential Treatment Center. Last year, AB 403
(Stone, Chapter 773, Statutes of 2015), codified the continuum
of care reform effort by eliminating group homes and creating
a new licensure category known as STRTCs, effective January 1,
2017. STRTCs that operate a mental health program that serves
children who have either been assessed as meeting the medical
necessity criteria for Medi-Cal specialty mental health
services under EPSDT or who have been assessed as seriously
emotionally disturbed must obtain and have in good standing a
mental health certification. STRTCs must accept for placement
children who do not required inpatient care in a licensed
health facility but who have been assessed as requiring the
level of services provided in a STRTC 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.
In addition, a child must meet 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
EPSDT;
b) The child has been assessed as seriously emotionally
AB 741 (Williams) Page 6 of ?
disturbed; and,
c) The child has been assessed as requiring the level
of services provided in order to meet his or her
behavioral or therapeutic needs, which can include, in
appropriate circumstances, a commercially sexually
exploited child, 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), a juvenile sex
offender or a child who is affiliated with, or impacted
by, a gang.
1)Double referral. This bill is double referred. This bill was
previously heard by the Senate Human Services Committee and
passed on a 4-0 vote.
2)Related legislation. AB 1997 (Stone of 2016) is the clean-up
bill to AB 403, and will include modifications to the
licensure and certification of STRTCs. AB 1997 is pending in
the Assembly Committee on Human Services.
3)Prior 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.
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.
4)Support. This bill is sponsored by the California Alliance of
Child and Family Services (the Alliance), which is a statewide
association of accredited private non-profit organizations
providing care, services, treatment and support to vulnerable
children, youth and families. The Alliance writes this bill is
AB 741 (Williams) Page 7 of ?
aimed at addressing a critical component missing in the
continuum of specialty mental health services for children and
youth in California. This bill would create the needed
licensing category to ensure that counties and their
community-based providers have the ability to develop crisis
residential programs to ensure children and youth have access
to mental health services that are responsive to the
individual needs and strengths in a timely manner and
consistent with ESPDT and specialty mental health services
program standards and requirements. The Alliance argues the
lack of a licensing component for crisis residential services
is preventing the development of this much needed program,
which would provide a residentially-based acute care option in
a less restrictive environment than inpatient hospitalization,
and would offer a more appropriate alternative for children
who do not require a hospital level of care.
SUPPORT AND OPPOSITION :
Support: California Alliance of Child and Family Services
(co-sponsor)
American Federation of State, County and Municipal
Employees (AFSCME)
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
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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.
Youth In Mind
Oppose: None received
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