BILL ANALYSIS Ó
SENATE COMMITTEE ON APPROPRIATIONS
Senator Ricardo Lara, Chair
2015 - 2016 Regular Session
AB 741 (Williams) - Mental health: community care facilities
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|Version: June 16, 2016 |Policy Vote: HUMAN S. 4 - 0, |
| | HEALTH 8 - 0 |
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|Urgency: No |Mandate: Yes |
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|Hearing Date: August 1, 2016 |Consultant: Brendan McCarthy |
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This bill meets the criteria for referral to the Suspense File.
Bill
Summary: AB 741 would allow a short-term residential treatment
center to be operated as a children's crisis residential center,
with specified regulatory requirements.
Fiscal
Impact:
One-time costs of about $550,000 for the development of
regulations by the Department of Social Services (General
Fund). The bill requires the Department to adopt regulations
to specify the requirements for operating a short-term
residential treatment center as a children's crisis
residential center.
Unknown information technology costs, likely in the low
hundreds of thousands, for the Department of Social Services
to modify its internal systems for licensing and regulating
children's crisis residential treatment centers (General
Fund).
AB 741 (Williams) Page 1 of
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Ongoing costs of about $125,000 per year for the Department of
Social Services to license and regulate children's crisis
residential center (General Fund). Although the Department
does collect licensing fees from regulated entities, those
fees are not set at a level that is sufficient to fund the
Department's licensing and enforcement program.
No significant administrative costs are anticipated by the
Department of Health Care Services. The bill requires the
Department to establish Medi-Cal rates to pay for the costs of
providing children's crisis residential services. However, the
Department indicates that the Medi-Cal State Plan already
includes children's crisis residential services and includes a
methodology to pay for those services. The Department
indicates that the reimbursement rate will be the same as that
provided for adult crisis residential services.
Unknown increase in Medi-Cal costs due to increased
utilization of children's crisis residential services (General
Fund, local funds, and federal funds). The intention of the
bill is to provide services to children in children's crisis
residential centers, rather than in psychiatric hospitals or
general acute care hospitals. In those cases, there would
likely be cost savings to Medi-Cal, since the reimbursement
rates for crisis residential services will be lower than
inpatient hospital rates. However, there is a consensus that
there is a significant shortage in available psychiatric beds
for children in the state. There is likely to be a significant
unmet need for psychiatric inpatient services. Therefore, some
of the utilization of children's crisis residential care will
be in addition to those services currently being provided in
hospitals, rather than a substitution for services already
being provided. The size of this impact is unknown.
Background: Under current law (AB 403, Stone, Statutes of 2015), the state
is implementing what is referred to as the continuum of care
reform effort. The purpose of this effort is to reform the
system for providing residential services to foster youth,
particularly those with mental health issues. Under the reform,
the state is phasing out group homes for foster youth, and
replacing them with short-term residential treatment facilities.
While mental health services are intended to be part of the
services offered by short-term residential treatment facilities,
AB 741 (Williams) Page 2 of
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those facilities are not intended to be used as an alternative
to inpatient psychiatric care (as are adult crisis residential
centers).
Proposed Law:
AB 741 would allow a short-term residential treatment center
to be operated as a children's crisis residential center, with
specified regulatory requirements.
Specific provisions of the bill would:
Define "children's crisis residential center" as a short-term
residential treatment facility operated specifically to divert
children experiencing a mental health crisis from psychiatric
hospitalization;
Require the Department of Social Services to establish
regulations for short-term residential treatment centers that
are operated as children's crisis residential centers;
Specify requirements for children's crisis residential centers
- such as the maximum duration of stay, requirements for
therapeutic services, operating hours, and other requirements;
Require the Department of Health Care Services, in
consultation with specified stakeholders, to establish
Medi-Cal rates that are sufficient to reimburse for the costs
of providing children's crisis residential services;
Require reimbursements paid to children's crisis residential
centers for board and care to be equivalent to those paid for
short-term residential treatment services;
Specify the criteria for a children's crisis residential
center to admit residents.
Related
Legislation:
AB 403 (Stone, Statutes of 2015) codified the continuum of
care reform efforts, including establishing short-term
residential treatment centers as a replacement for group
homes.
AB 1997 (Stone, 2016) is a technical cleanup measure to AB
403. That bill will be heard in this committee.
Staff
Comments: Under current law, Medi-Cal specialty mental health
services and the operation of the foster care system have been
AB 741 (Williams) Page 3 of
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realigned to the counties. Counties fund these programs with
realignment funds and federal funds. However, pursuant to
Government Code Section 30026.5, legislation enacted after
September 30, 2012, that has an overall effect of increasing the
costs already borne by a local agency for programs or levels of
service under the 2011 Realignment shall apply to local agencies
only to the extent that the state provides annual funding for
the cost increase. Local agencies are not be obligated to
provide programs or levels of service required by legislation
above the level for which funding has been provided. To the
extent that counties experience increased costs under the bill
(for example, due to greater provision of crisis residential
services for children who are not currently receiving
residential services), counties could seek additional funding
from the state to offset those increased costs.
The 2016-17 Budget Act includes $30 million (General Fund and
Mental Health Services Act Fund) for grants to develop capacity
for children's mental health services. The implementing law does
not specifically authorize those funds to be used to support new
children's crisis residential centers. However, the use of that
funding to support the development of children's crisis
residential centers does appear to conform to the intent of the
budget action.
The only costs that may be incurred by a local agency relate to
crimes and infractions. Under the California Constitution, such
costs are not reimbursable by the state.
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