BILL ANALYSIS
SENATE HEALTH
COMMITTEE ANALYSIS
Senator Elaine K. Alquist, Chair
BILL NO: AB 2221
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AUTHOR: Beall
B
AMENDED: April 27, 2010
HEARING DATE: June 23, 2010
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CONSULTANT:
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Dunstan/jl
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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 provided that the facility is not
otherwise required to have a separate health facility
license.
CHANGES TO EXISTING LAW
Existing law:
Existing law requires DADP to license all adult alcoholism
or drug abuse recovery or treatment facilities. Existing
law defines a recovery or treatment facility as a facility
that provides 24-hour residential, nonmedical services to
adults who are recovering from problems related to
substance abuse and provides that a licensee must provide
at least one recovery, treatment or detoxification service.
Continued---
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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. Requires that a chemical
dependency recovery hospital obtain a license issued by the
Department of Public Health.
This bill:
Expands the definition of adult alcoholism or drug abuse
recovery or treatment facilities to include any program
that uses a multidisciplinary team to provide medical
services within a residential facility that is accredited
by a nationally recognized accrediting organization.
Allows that the team may include a physician. Limits the
medical services to routine services within the scope of
practice of an addiction medicine specialist. Restricts
the medical services to those provided 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. Restricts those facilities that
otherwise require a health facility license from being
licensed under this definition.
FISCAL IMPACT
According to the Assembly Appropriations Committee
analysis, the costs associated with this legislation should
be minor and absorbable within existing resources.
BACKGROUND AND DISCUSSION
According to the author, current law allows DADP to license
only those facilities that provide nonmedical services in
residential treatment facilities. The author states that
when DADP discovered that it lacked statutory authority to
license these facilities if physicians were available to
provide care, it began telling facilities that they would
lose their license if they continue to provide medical
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services. The author argues that this bill allows
physicians to provide medical services in substance abuse
treatment facilities licensed by DADP that provide 24-hour
residential services to adults who also need alcohol, drug,
or alcohol and drug recovery treatment or detoxification
services. The author states that this bill is intended to
apply the licensing structure of DADP to residential
treatment facilities that provide medical services by a
physician on staff for the sole purpose of assisting with
detoxification services.
Background
DADP licenses residential treatment facilities to provide
nonmedical services to individuals who are working to
overcome their addiction to alcohol or other drugs. 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.
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 fewer) that provide detoxification
services are currently required to obtain medical clearance
from a physician off site before participating in a
detoxification program. Treatment facilities desire to
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.
In contrast to the facilities licensed by DADP, chemical
dependency recovery hospitals are licensed by DPH. These
facilities specialize in providing services to chemically
dependent adults who do not require treatment in an
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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. These facilities must have
agreements with acute care hospitals for any necessary
services such as a pharmacy that may not be offered at the
chemical dependency recovery hospital. According to 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.
Accreditation by two national organizations, the Joint
Commission on Accreditation of Healthcare Organizations
(JCAHO) and the Joint Commission on Accreditation of
Rehabilitation Facilities (CARF) are 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. JCAHO 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 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. JCAHO 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.
Prior legislation
AB 1055 (Chesbro) of 2009 contained provisions
substantially similar to this bill. AB 1055 was held on
the Assembly Appropriations Committee Suspense File.
Arguments in 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. The Drug Policy Alliance
states that it is vital to allow physicians to work in
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treatment and detoxification facilities because it provides
a mid-level of care for patients who need a doctor but do
not require the intense and costly intervention provided by
chemical dependency recovery hospitals. The California
Psychiatric Association acknowledges that DADP had
mistakenly licensed facilities that provided medical
services in the recent past, but allowing them to do so
again under the authority granted in AB 2221, would afford
the full continuum of care to those participating in
residential recovery services. CRC Health Group, Inc., a
treatment facility operator, writes that this bill will
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. The County Alcohol and
Drug Program Administrators Association of California
states that this bill will allow California physicians to
continue to play a key role in the treatment of addiction,
without mandating that residential programs include
physicians on staff.
Arguments in opposition
The Department of Public Health (DPH) opposed the bill
because of their concerns that allowing medical services to
be provided in residential adult alcohol and drug treatment
facilities undermines the strong public protection afforded
by DPH licensure and oversight of medical services. They
argue that AB 2221 seeks to provide medical services,
currently undefined, in DADP licensed facilities. DPH
states that the provision of medical services in settings
such as those licensed by DADP requires licensure as a
clinic, and therefore subject to DPH oversight. They
conclude by stating that this bill fails to assign facility
liability and lacks definition of what medical services may
be provided in these facilities.
PRIOR ACTIONS
Assembly Health: 18-0
Assembly Appropriations: 16-0
Assembly Floor: 69-0
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COMMENTS
1. Scope of routine services is not well defined. The
term, "within the scope of practice of an addiction
medicine specialist" is used to define what type of medical
services could be provided at a licensed recovery or
treatment facility. However, since an addiction medicine
specialist is a physician and surgeon, the term does not
actually limit the medical services that can be provided.
Proposed amendment
Page 2, beginning line 9
As used in this chapter, "alcoholism or drug abuse recovery
or treatment facility" or "facility" also means any
premises, place, or building that provides a program,
accredited by a nationally recognized accrediting
organization, that uses a multidisciplinary team, including
a physician and surgeon when available, to provide medical
services within a residential facility, limited to routine
services within the scope of practice of an addiction
medicine specialist that do not require a health facility
license, 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.
2. DPH raises legitimate issue about oversight of medical
services. There is a need to examine the appropriate ways
to license facilities that provide medical services as part
of their multidisciplinary approach. It should be noted,
however, that many of these facilities have been providing
medical services, and it was only the discovery by DADP
that it lacked sufficient legal authority to continue to
license them that has raised this issue. This bill is not
trying to address a situation where there are demonstrated
problems that reflect a lack of oversight and regulation.
Indeed, medical services are an important component of the
services at many of these facilities, given that many with
substance abuse have another mental illness diagnosis, and
treatment of both conditions is the most efficient method.
To provide time to develop a more appropriate licensing
system, the committee may want to consider imposing a
sunset on the bill, which would allow medical services to
be provided while they meet national accreditation
standards. The sunset would allow time to develop a
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permanent licensing scheme for these facilities.
Proposed amendment
Page 2, after line 32.
(e) The authority granted by this section to operate a
facility that provides medical services on site, as
described in paragraph (a) shall remain in effect until
January 1, 2013.
3. Concerns have been raised that facilities could be
required to provide medical services. This would increase
the cost of treatment and is not necessary in many
instances.
Proposed amendment
Page 2, after line 32.
(f) Nothing contained in this section shall be construed
to permit the state or any local governmental entity to
require the provision of medical services on site as a
condition of licensure, funding or other regulatory
supervision.
POSITIONS
Support: California Association of Alcoholism and Drug
Abuse Counselors
California Medical Association
California Psychiatric Association
County Alcohol and Drug Program Administrators
Association of California
CRC Health Group
Drug Policy Alliance
Oppose: Department of Public Health
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