BILL ANALYSIS
AB 2221
Page 1
Date of Hearing: April 20, 2010
ASSEMBLY COMMITTEE ON HEALTH
William W. Monning, Chair
AB 2221 (Beall) - As Amended: April 13, 2010
SUBJECT : Substance abuse: treatment facilities.
SUMMARY : Expands the category of residential treatment
facilities licensed by the Department of Alcohol and Drug
Programs (DADP) to include facilities that provide limited
residential medical services to adults recovering from alcohol
and drug abuse that are not required to have a separate health
facility license.
EXISTING LAW :
1)Establishes DADP to license treatment facilities that provide
a broad range of services in a supportive environment to
adults who are addicted to alcohol or drugs.
2)Defines a treatment facility as any premise, place, or
building that provides 24-hour residential non medical services
to adults who are recovering from problems related to alcohol,
drug, or alcohol and drug misuse or abuse, and who need
alcohol, drug, or alcohol and drug recovery treatment or
detoxification services.
3)Defines residential nonmedical services provided by a licensed
treatment facility to mean recovery services, treatment
services, and detoxification services.
4)Defines a chemical dependency recovery hospital as a health
facility that provides 24-hour inpatient care for persons who
have dependency on alcohol or other drugs, or both. Specifies
that the care includes, but is not limited to, patient
counseling, group therapy, physical conditioning, family
therapy, outpatient services, and dietetic services. Requires
the hospital to have a medical director who is a licensed
physician and surgeon.
FISCAL EFFECT : This bill has not yet been analyzed by a fiscal
committee.
COMMENTS :
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1)PURPOSE OF THIS BILL . According to the sponsor, the
California Society of Addiction Medicine (CSAM), this bill is
intended to ensure that California's physicians maintain their
vital role in providing medical services to individuals
withdrawing from alcohol and other drugs. CSAM notes that
this bill updates the existing definition of a residential
treatment facility to allow DADP to license and regulate
treatment facilities that have a physician available on site
to provide medical services relating to addiction treatment.
2)DADP LICENSURE AUTHORITY . DADP licenses residential treatment
facilities to provide nonmedical services to individuals who
are working to overcome their addiction to alcohol or other
drugs. According to DADP, these services include education,
group, or individual sessions; recovery or treatment planning;
and, detoxification services. In addition, a licensed
treatment facility may offer individualized services, such as
vocational and employment search training, community volunteer
opportunities, new skills training, peer support, social and
recreational activities, and information about and referral to
appropriate community services. This bill would require DADP
to extend its licensing authority to facilities that use a
multidisciplinary team, including an available physician, to
provide residential medical services that do not require it to
obtain a separate health facility license. DADP indicates
that since current law only authorizes it to license
nonmedical services, many larger licensed facilities enter
into contracting arrangements with physicians to provide
medical services on-site, such as treatment of medical
symptoms associated with addiction, including post withdrawal
hypertension, seizure prevention, and impaired liver function.
Residents of smaller facilities (six beds or less) that
provide detoxification services are currently required to
obtain medical clearance from a physician off-site before
participating in a detoxification program. This bill would
enable DADP to license treatment facilities with programs that
include physicians on site to provide medical clearance and
assist with other limited medical services, such as routine
physicals, communicable disease screening, vital sign
assessment, and the prescribing, administering, and dispensing
of medications for withdrawal symptoms.
3)NATIONAL ACCREDITING ORGANIZATIONS . According to DADP,
accreditation by two national organizations, the Joint
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Commission and the Commission on Accreditation of
Rehabilitation Facilities (CARF) is currently available for
such behavioral health care services as addiction treatment,
opioid treatment and maintenance programs, crisis
stabilization, case management and care coordination,
employment services, and vocational rehabilitation. The Joint
Commission and CARF each require a facility to demonstrate
that its program meets their respective quality standards in
order to obtain accreditation. These quality standards
evaluate important functions relating to client care and
program management, including administrative requirements,
financial management, personnel qualifications, client
services, performance outcomes, client safety, and information
privacy and security. The Joint Commission requires
accredited organizations to reapply for accreditation every
three years while CARF accreditation ranges from one to five
years, depending on the type of facility.
4)CHEMICAL DEPENDENCY RECOVERY HOSPITALS . Chemical dependency
recovery hospitals (CDRHs) are licensed by the Department of
Public Health. These facilities specialize in providing
services to chemically dependent adults who do not require
treatment in an acute-care medical facility on an inpatient,
intensive outpatient, outpatient, and partial hospitalization
basis. Basic services include patient counseling, group
therapy, physical conditioning, family therapy, outpatient
services, and dietetic services. According to 2008 data from
the Office of Statewide Health Planning and Development, there
are currently seven sites throughout California that are
licensed to provide chemical dependency services. The author
indicates that this bill is intended to apply the licensing
structure of DADP to residential treatment facilities that
provide limited medical services that do not require the
facility to hold a separate CDRH license.
5)PRIOR LEGISLATION . AB 1055 (Chesbro) of 2009, which contained
provisions substantially similar to this bill, died on the
Assembly Appropriations Committee Suspense File.
6)SUPPORT . Supporters, representing treatment facility
operators, providers, and consumers, state that this bill
updates existing law to ensure that physicians retain their
ability to participate in the full range of treatment for
Californians with addictions. CRC Health Group, Inc., a
treatment facility operator, writes that this bill will
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improve the continuum of care to people in recovery by
expressly authorizing facilities to provide important, but
routine, medical services on-site and enable modern recovery
techniques and protocols to include normal medical services as
part of the process. Drug Policy Alliance asserts in support
that allowing physicians to work in treatment and
detoxification facilities is vital because it provides a
mid-level of care for residents who need a doctor but do not
require the intense and costly intervention provided by CDRHs.
Lastly, the California Medical Association and California
Psychiatric Association add in support that this bill will
afford patients a full range of treatment options with
important patient protections in place.
7)POLICY QUESTION . This bill does not specify the scope of
medical services permitted to be provided by the facilities
that would be licensed under this bill. This bill should be
amended to clarify that the medical services in these
facilities should be limited to routine services directly
related to addiction treatment.
REGISTERED SUPPORT / OPPOSITION :
Support
California Society of Addiction Medicine (sponsor)
California Medical Association
California Psychiatric Association
County Alcohol and Drug Program Administrators Association of
California
CRC Health Group, Inc.
Drug Policy Alliance
Opposition
None on file.
Analysis Prepared by : Cassie Rafanan / HEALTH / (916)
319-2097