BILL ANALYSIS Ó
AB 741
Page 1
GOVERNOR'S VETO
AB
741 (Williams)
As Enrolled September 8, 2016
2/3 vote
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|ASSEMBLY: |77-0 |(June 2, 2015) |SENATE: |38-0 |(August 24, |
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|ASSEMBLY: |79-1 |(August 30, | | | |
| | |2015) | | | |
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Original Committee Reference: HEALTH
SUMMARY: Expands the definition of a short-term residential
treatment center (STRTC) to include a children's crisis
residential center (CCRC) 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. Specifically, this bill:
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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
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discharge children, as appropriate, seven days a week, 365
days per year;
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 the Department of Social
Services (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 the Department of Health Care Services (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.
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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.
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), Chapter 612, and SB 524 (Lara), Chapter 864, Statutes
of 2016.
EXISTING LAW:
1)Establishes in federal law the Medicaid program to provide
comprehensive health benefits to low income persons.
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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
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
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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
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
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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
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
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offer a more appropriate alternative for children that do not
require a hospital level of care.
This bill has no known opposition.
GOVERNOR'S VETO MESSAGE:
I am returning Assembly Bill 741 without my signature.
This bill establishes a licensing category for children's crisis
residential centers which would be regulated by the Department
of Social Services.
The licensing category proposed by this bill limits the length
of treatment stays and the size of the centers. These
restrictions are not consistent with federal rules and put
funding in jeopardy.
I recognize there is an acute shortage of residential programs
that provide crisis mental health treatment for children and
teens. Therefore, I am directing the Departments of Social
Services and Health Care Services to work with county behavioral
health directors and children's advocates to develop a more
viable licensing category.
Analysis Prepared by:
Paula Villescaz / HEALTH / (916) 319-2097 FN:
0005149
AB 741
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