BILL ANALYSIS Ó AB 741 Page 1 CONCURRENCE IN SENATE AMENDMENTS AB 741 (Williams) As Amended August 19, 2016 Majority vote -------------------------------------------------------------------- |ASSEMBLY: |77-0 |(June 2, 2015) |SENATE: |38-0 |(August 24, | | | | | | |2016) | | | | | | | | | | | | | | | -------------------------------------------------------------------- Original Committee Reference: HEALTH SUMMARY: Allows a short-term residential treatment center (STRTC) to be operated as a children's crisis residential center (CCRC) as defined, which would be operated specifically to divert children experiencing a mental health crisis from psychiatric hospitalization. Requires the Department of Social Services (DSS) to establish regulations for STRTCs that are operated as CCRCs, and requires the regulations to include specified minimum components. Requires the Department of Health Care Services (DHCS) 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. The Senate amendments AB 741 Page 2 1)Establish legislative findings and declarations. 2)Define a CCRC as a STRTC operated specifically to divert children experiencing a mental health crisis from psychiatric hospitalization. 3)Require DSS to establish regulations for STRTCs that are operated as CCRC. Requires, at a minimum, the regulations to include all of the following: a) Require the CCRC to be used only for diversion from admittance to a psychiatric hospitalization; b) Require the length of stay for a single admission to a CCRC to be limited to 10 consecutive days, permit a length of stay to be extended once for no more than two consecutive 10-day lengths of stay, and prohibit a child from being admitted to a CCRC for more than a 20-day period in 6 months; c) Require 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; d) Require 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; e) Require the program to be sufficiently staffed to discharge children, as appropriate, seven days a week, 365 days per year; AB 741 Page 3 f) Require facilities to be limited to fewer than 16 beds, with at least 50% of those beds in single-occupancy rooms; g) Require 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, h) Require 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. 4)Require CCRCs to annually provide DSS with the age and gender of the clients served, the duration of stay, the professional classification of staff and contracted staff, and the type of placement the client was discharged to. 5)Require DHCS 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 services. Requires DHCS to consult with subject matter experts from the California Behavioral Health Directors Association and provider associations to obtain information necessary to ensure sufficiency of the rate. 6)Require, for foster children admitted for CCRC, programs to receive payment for board and care equivalent to the rate paid for STRTCs. 7)Prohibit 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. AB 741 Page 4 8)Permit 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. 9)Make CCRCs eligible for grant funding authorized in the 2016 Budget Act. 10)Add language to avoid chaptering conflicts with AB 1997 (Stone) and SB 524 (Lara) of the current legislative session. EXISTING LAW: 1)Establishes in federal law the Medicaid program to provide comprehensive health benefits to low income persons. 2)Establishes the Medi-Cal program as California's Medicaid program. 3)Establishes specified Medi-Cal benefits, some required by federal law, and other benefits which are optional under federal law. 4)Defines "social rehabilitation facility" as any residential facility that provides social rehabilitation services in a group setting up to 18 months to adults recovering from mental AB 741 Page 5 illness who temporarily need assistance, guidance, or counseling. FISCAL EFFECT: According to the Senate Appropriations Committee: 1)One-time costs of about $550,000 for the development of regulations by DSS (General Fund). This bill requires DSS to adopt regulations to specify the requirements for operating a short-term residential treatment center as a children's crisis residential center. 2)Unknown information technology costs, likely in the low hundreds of thousands, for the DSS to modify its internal systems for licensing and regulating children's crisis residential treatment centers (General Fund). 3)Ongoing costs of about $125,000 per year for DSS to license and regulate children's crisis residential center (General Fund). Although DSS does collect licensing fees from regulated entities, those fees are not set at a level that is sufficient to fund DSS's licensing and enforcement program. 4)No significant administrative costs are anticipated by DHCS. This bill requires DHCS to establish Medi-Cal rates to pay for the costs of providing children's crisis residential services. However, DHCS indicates that the Medi-Cal State Plan already includes children's crisis residential services and includes a methodology to pay for those services. DHCS indicates that the reimbursement rate will be the same as that provided for adult crisis residential services. 5)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 AB 741 Page 6 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. COMMENTS: 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 experiencing a mental health crisis in calm, familiar environments where their mental health needs can be met. Currently, an estimated three out of every four children in the United States that need mental health services, do not receive them. Nearly 20% of high school students in California consider suicide at some point in their lives and more than 10% actually attempt it. With 47 out of 58 counties lacking any child/adolescent psychiatric hospital inpatient beds for children under 12 (and fewer than 70 beds statewide), the need for children's crisis residential services could not be more acute. Among the benefits already included in the State Mental Health Plan are: crisis intervention; crisis stabilization; crisis residential treatment services; and the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) supplemental Specialty Mental Health Services (SMHS). Without a licensing category specific to children's crisis residential programs, however, this critically needed service - both in lieu of inpatient care and as a step down from inpatient care - is missing from the continuum of care. According to the California Alliance of Child and Family Services, cosponsors of this bill, and other supporters, this AB 741 Page 7 bill is aimed at addressing a critical component missing in the continuum of specialty mental health services for children and youth in California - children's crisis residential services. This bill creates the needed licensing category to ensure that counties and their community-based providers have the ability to develop crisis residential programs with an appropriate licensing category, to ensure children and youth have access to mental health services that are responsive to their individual needs and strengths in a timely manner, and consistent with the requirements of the Medi-Cal EPSDT and SMHS program standards and requirements. There is no question that a full continuum of care for children and youth with critical mental health needs is both essential and required by law. The lack of a licensing component for crisis residential services, however, 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 that do not require a hospital level of care. This bill has no known opposition. Analysis Prepared by: Paula Villescaz / HEALTH / (916) 319-2097 FN: 0004752