BILL ANALYSIS Ó
-----------------------------------------------------------------
|SENATE RULES COMMITTEE | AB 741|
|Office of Senate Floor Analyses | |
|(916) 651-1520 Fax: (916) | |
|327-4478 | |
-----------------------------------------------------------------
THIRD READING
Bill No: AB 741
Author: Williams (D)
Amended: 8/19/16 in Senate
Vote: 21
SENATE HUMAN SERVICES COMMITTEE: 4-0, 6/14/16
AYES: McGuire, Hancock, Liu, Nguyen
NO VOTE RECORDED: Berryhill
SENATE HEALTH COMMITTEE: 8-0, 6/29/16
AYES: Hernandez, Nguyen, Hall, Mitchell, Monning, Nielsen,
Pan, Roth
NO VOTE RECORDED: Wolk
SENATE APPROPRIATIONS COMMITTEE: 7-0, 8/11/16
AYES: Lara, Bates, Beall, Hill, McGuire, Mendoza, Nielsen
ASSEMBLY FLOOR: 77-0, 6/2/15 - See last page for vote
SUBJECT: Mental health: community care facilities
SOURCE: California Alliance of Child and Family Services
California Council of Community Mental Health Agencies
DIGEST: This bill expands the definition of a short-term
residential treatment center to include a children's crisis
residential center to be used as a diversion from psychiatric
hospitalization, and limits the stay to 10 consecutive days and
no more than 20 total days within a six-month period.
AB 741
Page 2
Senate Floor Amendments of 8/19/16 resolve chaptering conflicts
with SB 524 (Lara) and AB 1997 (Stone).
ANALYSIS:
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
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, through
which eligible low-income individuals receive health care and
mental health services, including foster youth. 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.)
AB 741
Page 3
4) Requires county mental health departments to provide
children served by county social services and probation
departments, with mental health screening, assessment,
participation in multidisciplinary placement teams and
specialty mental health treatment, as specified. (WIC 5867.5)
5) Establishes a system of licensure and oversight for
community care facilities, including short term residential
treatment centers, to provide rehabilitation and therapy for
youth in foster care or other systems, as specified, and
defines a "short-term residential treatment center" to mean a
CDSS-licensed residential facility to provide short-term,
specialized, and intensive treatment, and 24-hour care and
supervision to children. (HSC 1502 (a)(18))
6) 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; and (d) a qualified administrator, as
specified, and staff training on 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 that there is an urgent need to provide more crisis
care alternatives to hospitals for children and youth
experiencing mental health crises and that it is imperative
that California identify a licensing category specifically
AB 741
Page 4
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.
2) Adds to the definition of "short-term residential treatment
center" that it includes a children's crisis residential
center, defined as a short-term residential treatment center
operated specifically to divert children experiencing a
mental health crisis from psychiatric hospitalization.
3) 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 for a single admission will be
limited to 10 consecutive days.
c) The length of stay may be extended once for no more
than two consecutive 10-day lengths of stay, however
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.
d) Prohibits a child from being admitted to a children's
crisis residential center for more than 20 total days in
any six-month period.
e) 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.
AB 741
Page 5
f) 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.
g) Requires facilities to be limited to fewer than 16
beds, with at least 50 percent of those beds in
single-occupancy rooms, and 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.
h) 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.
4) Requires each center to annually provide CDSS with all of
the following data as it pertains to children in foster care
and children not in foster care in conjunction with its
application for licensure renewal: (a) age and gender of
clients served; (b) duration of stay; (c) professional
classification of staff and contracted staff; and (d) type of
placement the client was discharged to.
5) Requires the Department of Health Care Services (DHCS) to
set interim Med-Cal rates for care within a crisis
residential home, requires and to consult with subject matter
experts from the County Behavioral Health Directors
Association of California and provider associations to obtain
data and background information necessary to ensure
sufficiency of the rate.
6) Requires that the board and care rate for foster children
admitted to a crisis residential center be the same as for a
AB 741
Page 6
short term residential treatment center (STRTC) and
establishes that nothing prevents a county from paying a
higher rate for crisis residential care.
7) Adds crisis residential centers to the list of services
eligible for grant awards under the Investment in Mental
Health Wellness Act of 2013 for startup costs to increase
capacity for crisis services to children and youth, as
specified.
8) Permits a children's crisis residential center to admit or
accept 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 that has the right to make these decisions on
behalf of a child who is in mental health crisis and who
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.
9) Permits emergency placement be made into a crisis
residential center but requires a mental health professional
determine within 24 hours of placement that the child is in
need of that level of care.
10) Makes various technical and conforming changes.
Background
AB 741
Page 7
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
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 STRTCs which provide brief, intensive,
mental health interventions to youth and adolescents who qualify
for that level of care. This bill expands that category of
treatment facilities to include short term crisis residential
care for adolescents who can be treated effectively in a 10-day
stay, in order to divert teens and youth from inpatient
psychiatric facilities.
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). About 7 in 10
youth in juvenile justice systems have at least one mental
AB 741
Page 8
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 noted that nearly
half of youth in foster care had clinically significant
emotional or behavioral problems, and more than half of children
entering foster care exhibited behavioral or social competency
problems that warranted mental health services. The report also
found that children under age seven who enter foster care show
high rates of developmental problems.
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. "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 report 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. It cited a statewide decrease in the availability
of inpatient psychiatric hospital beds for children and
adolescents and a lack of comprehensive community-based
AB 741
Page 9
solutions to meet the mental health needs of children. It also
noted that 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 that same
region. Therefore, inpatient hospitalization is the only option
for a youth experiencing a crisis in many areas of the state,
which often is "the least effective measure," according to the
report.
A 2012 study of California hospital emergency rooms, published
by the California Hospital Association, 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 more than 19 hours.
Related/Prior Legislation
AB 1997 (Stone, 2016) is the clean-up bill to AB 403 (Stone,
2015), and will include modifications to the licensure and
certification of STRTCs.
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 741
Page 10
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.
FISCAL EFFECT: Appropriation: No Fiscal
Com.:YesLocal: Yes
An analysis by the Senate Appropriations Committee identified
one-time costs of about $550,000 for the development of
regulations by CDSS (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. It also identified unknown
information technology costs, likely in the low hundreds of
thousands, for CDSS to modify its internal systems for licensing
and regulating children's crisis residential treatment centers
(GF) and ongoing costs of about $125,000 per year for CDSS to
license and regulate children's crisis residential center (GF).
Licensing fees are not set at a level that is sufficient to fund
the Department's licensing and enforcement program.
The analysis identified no significant administrative costs
anticipated by DHCS, which is required by this bill to establish
Medi-Cal rates to pay for the costs of providing children's
crisis residential services. DHCS 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.
AB 741
Page 11
Additionally, the analysis identified an 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.
SUPPORT: (Verified 8/15/16)
California Alliance of Child and Family Services (co-source)
California Council of Community Mental Health Agencies
(co-source)
Anka Behavioral Health, Inc.
Aviva Family and Children's Services
Bill Wilson Center
California Chapter of the American College of Emergency
Physicians
California Coalition for Youth
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
Child Abuse Listening Mediation
Common Sense Kids Action
County of Santa Barbara
Crittenton Services for Children and Families
David & Margaret Youth and Family Services
Disability Rights California
Family Care Network, Inc.
AB 741
Page 12
Foster Care Task Force
Hathaway-Sycamores Child and Family Services
Hillsides
Junior Blind of America
La Clinica de la Raza
Lincoln Child Center
Mental Health America of Los Angeles
NAMI California
National Association of Social Workers, California Chapter
National Council for Behavioral Health
Oxnard Police Department
Pacific Clinics
Redwood Community Services
Redwood Quality Management Company
Remi Vista, Inc.
San Diego Center for Children
Santa Barbara County Board of Supervisors
Santa Barbara County Sheriff Bill Brown
Seneca Family of Agencies
Sierra Sacramento Valley Medical Society
Stanford Youth Solutions
Stars Behavioral Health Group
Steinberg Institute
The Guidance Center
The Village Family Services
Transitions-Mental Health Association
Trinity Youth Services
United Advocates for Children and Families
United Parents
Uplift Family Services
Ventura County Board of Supervisors
Ventura County Sheriff Geoff Dean
West Coast Children's Clinic
Young Minds Advocacy Project
Youth Homes, Inc.
Youth In Mind
OPPOSITION: (Verified8/15/16)
California Department of Finance
AB 741
Page 13
ARGUMENTS IN SUPPORT: The California Alliance of Children
and Family Services, sponsor, writes that this bill creates 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.
ARGUMENTS IN OPPOSITION: The California Department of
Finance writes that it is opposed to this bill, in addition to
cost factors, because the implementation of the Continuum of
Care Reform is still underway and discussions continue regarding
certification of the STRTCs. "Therefore, it is premature to
include this additional STRTC category before implementation of
that effort," according to DOF.
ASSEMBLY FLOOR: 77-0, 6/2/15
AYES: Achadjian, Alejo, Travis Allen, Baker, Bigelow, Bloom,
Bonilla, Bonta, Brown, Burke, Calderon, Campos, Chang, Chau,
Chiu, Chu, Cooley, Cooper, Dababneh, Dahle, Daly, Dodd,
Eggman, Frazier, Beth Gaines, Gallagher, Cristina Garcia,
Eduardo Garcia, Gatto, Gipson, Gomez, Gonzalez, Gordon, Gray,
Hadley, Harper, Roger Hernández, Holden, Irwin, Jones,
Jones-Sawyer, Kim, Lackey, Levine, Linder, Lopez, Low,
Maienschein, Mathis, Mayes, McCarty, Medina, Melendez, Mullin,
Nazarian, Obernolte, O'Donnell, Olsen, Patterson, Perea,
Quirk, Rendon, Ridley-Thomas, Rodriguez, Salas, Santiago,
Steinorth, Mark Stone, Thurmond, Ting, Wagner, Waldron, Weber,
Wilk, Williams, Wood, Atkins
NO VOTE RECORDED: Brough, Chávez, Grove
Prepared by:Mareva Brown / HUMAN S. / (916) 651-1524
8/22/16 22:39:46
**** END ****
AB 741
Page 14