BILL ANALYSIS �
SENATE HEALTH
COMMITTEE ANALYSIS
Senator Elaine K. Alquist, Chair
BILL NO: AB 972
A
AUTHOR: Butler and Beall
B
AMENDED: June 15, 2011
HEARING DATE: June 22, 2011
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CONSULTANT:
7
Tadeo
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SUBJECT
Substance abuse: treatment facilities
SUMMARY
Expands, until January 1, 2017, the category of residential
treatment facilities licensed by the Department of Alcohol
and Drug Programs (DADP) to include facilities that provide
limited 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.
Establishes a fee for facilities that provide limited
medical services and makes other changes to the licensing
fees for residential treatment facilities.
CHANGES TO EXISTING LAW
Existing law:
Requires DADP to license all adult alcoholism or drug abuse
recovery or treatment facilities.
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
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recovery, treatment or detoxification service.
Defines residential nonmedical services provided by a
licensed treatment facility to mean recovery services,
treatment services and detoxification services.
Requires that a chemical dependency recovery hospital
obtain a license issued by the Department of Public Health
(DPH). 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
DAPD to charge a fee to all programs for licensure and
certification, regardless of form or ownership of the
program.
Permits DAPD to establish fee scales using different
capacity levels, other measures, or categories or
classifications that DADP deems necessary or convenient to
maintain an effective and equitable fee structure.
Requires fees to be evaluated annually taking overall cost
of licensure and certification activities into
consideration. Requires DAPD to submit any new fees or fee
changes to the Legislature for approval no later than April
1.
Requires the Licensing and Certification Division, no later
than the beginning of the 2010-11 fiscal year, to be
supported entirely by federal and special funds, unless
funds are specifically appropriated from the General Fund
by legislation.
This bill:
Expands the definition of adult alcoholism or drug abuse
recovery or treatment facilities to include any program
that uses a physician to provide medical services
exclusively to residents, for the purpose of assisting in
detoxification and recovery, within a facility that is
accredited by a nationally recognized accrediting
organization, (referred to a program of limited medical
STAFF ANALYSIS OF ASSEMBLY BILL 972 (Butler and Beall)Page
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services). Limits the medical services to:
Medical evaluation, psychiatric counseling, and
prescription of medications for assistance with
detoxification;
Additional psychiatric evaluation and counseling,
if necessary;
Prescribing and monitoring of medications,
including public health inoculations;
Obtaining medical histories and routine
examinations for general oversight of the medical
condition of residents within the facility; and
Routine, noninvasive testing, including drawing
blood samples for laboratory examination and testing
offsite.
Prohibits the provisions of this bill from being construed
to allow the state or a local governmental entity to
require medical services to be provided within a facility
as a condition of licensure, funding, or other regulatory
supervision.
Requires DADP to calculate and establish the fee for
initial licensure of alcohol and drug treatment facilities,
and for extension of the period of licensure, every two
years in an amount sufficient to cover DADP costs in
administering the licensure for entities that are not local
governments or nonprofits.
Prohibits a fee from being levied for licensure of a
nonprofit or local government entity. Also prohibits a fee
from exceeding the reasonable cost to the state for
administrative duties, as specified.
Allows DADP to charge a fee, not in excess of the patient
slot fee ($31) for a narcotic treatment program, for
licensure or certification of a facility that provides a
program of limited medical services, as specified.
Sunsets the provisions of this bill on January 1, 2017.
FISCAL IMPACT
According to the Assembly Appropriations Committee analysis
of AB 972, DADP has estimated General Fund costs of
$125,000 in the first year and $250,000 ongoing.
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Specifically, DADP would require 2.5 permanent positions to
conduct facility site reviews, establish regulations and
fees, review applications, monitor compliance, investigate
complaints, and conduct accounting and collections
activities.
The analysis points out that DADP estimates up to 248
licensed alcohol and other drug treatment facilities
throughout California may elect to offer medical services
if this bill were to be enacted. Although DADP currently
monitors these facilities, the department contends there
would be a higher level of monitoring necessary if these
facilities were to provide medical services.
BACKGROUND AND DISCUSSION
According to the author, persons in rehabilitation who
receive medical assistance as part of treatment for alcohol
and drug abuse have a greatly improved rate of success for
recovery. These persons often have a wide variety of
health problems related to their past alcohol and drug use,
such as cirrhosis, hepatitis C, and hypertension, and
having a doctor immediately available to monitor these
conditions on the premises of a DADP licensed facility is
far more efficient than taking people back and forth to a
clinic or hospital. The author states that AB 972 would
provide immediate, limited medical care to persons that are
in rehabilitation treatment in a manner that is more
economical than operating a substance abuse hospital or
psychiatric clinic, and in the rare instances when a higher
level of service is required, the resident can be
transported.
DADP licensure authority
DADP licenses residential treatment facilities to provide
nonmedical services to individuals who are working to
overcome their addiction to alcohol or 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
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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.
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
acute-care medical facility on an inpatient, intensive
outpatient, outpatient, or 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.
National accreditation organizations
Accreditation by two national organizations, the Joint
Commission and the Joint 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 functions
relating to client care and program management, including
administrative requirements, financial management,
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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.
Prior legislation
AB 1055 (Chesbro) of 2010, contained provisions
substantially similar to AB 972. This bill was held on the
Assembly Appropriations Committee Suspense File.
AB 2221 (Beall) of 2009, was substantially similar to AB
972. This bill was held on the Senate Appropriations
Committee Suspense File.
Arguments in support
According to CRC Health Group, Inc. (CRC), a co-sponsor of
AB 972, this bill would allow alcohol and drug treatment
programs to include modern medical care as part of the
continuum of care they offer their clients. CRC states
that AB 972 will also allow providers to conform their
practices to modern insurance requirements, as most
insurance companies require that medical services be
available. CRC adds that this bill imposes no additional
regulatory work or cost for DADP because it transfers all
of the regulatory work to nationally recognized agencies
that establish medical standards for hospital and clinics.
The California Medical Association (CMA) states that if
alcohol and drug addiction is dealt with appropriately,
many addicts can shed their dependence and move on to
healthy and productive lives; therefore, it is essential
the treatment facilities have all the tools necessary to
ensure patients receive proper care and are given the best
chances for success. CMA contends that medical assistance
and physician involvement are important elements in this
process.
The California Psychiatric Association (CPA) states that
DADP has recently interpreted state laws and regulations to
be ambiguous related to authorizing physician provision of
services in residential non-medical facilities. CPA
further states that, although DADP previously allowed the
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practice, it now forbids physicians from providing medical
services in these settings without becoming licensed health
facilities. CPA contends that AB 972 remedies this
situation and affords a full range of treatment options
critical to recovery for those participating in residential
recovery services.
PRIOR ACTIONS
Assembly Health: 17-1
Assembly Appropriations: 17-0
Assembly Floor: 77-1
COMMENTS
1. As drafted, AB 972 removes fee changes and funding
safeguards. It is the author's intent to make licensing
fee changes for alcohol and drug abuse recovery or
treatment facilities, which include establishing a new fee
every two years instead of annually, requiring that the fee
not exceed the reasonable cost to the state, and exempting
nonprofit or government entities from the fee. However,
the bill as drafted also removes measures which require the
Licensing and Certification Division to be supported
entirely by federal and special funds, and require
legislative action to raise fees. A suggested amendment
would be to keep these safeguards in place.
Suggested amendment: on page 2, insert after line 16:
(b) The department shall submit any proposed new fees
or fee changes to the Legislature for approval no later
than April 1 of each year as part of the spring finance
letter process. No new fees or fee changes shall be
implemented without legislative approval.
(c) Unless funds are specifically appropriated from
the General Fund in the annual Budget Act or other
legislation to support the division, the Licensing and
Certification Division, no later than the beginning of
the 2010-11 fiscal year, shall be supported entirely by
federal funds and special funds.
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2. Clarifying amendments. It is the author's intent to
allow DADP to charge an additional fee for licensure for
alcohol and drug abuse recovery or treatment facilities
that provide limited medical services, but as written AB
972 appears to exempt these facilities from the initial
fee. In addition, the cost of this additional fee is
ambiguous.
Suggested clarifying amendments: on page 2, lines 17-21
amend as follows:
(b) (d) Additionally, for For licensure or
certification of a facility that provides a program of
limited medical services as authorized in subdivision (e)
of Section 11834.02, the department may charge a per bed
fee based on and not to exceed fee not in excess of the
patient slot fee for a narcotic treatment program
licensed by the department.
POSITIONS
Support: California Society of Addiction Medicine
(co-sponsor)
CRC Health Group, Inc. (co-sponsor)
California Association of Addiction
Recovery Resources
California Medical Association
California Psychiatric Association
County Alcohol and Drug Program Administrators
Association of
California
Drug Policy Alliance
Elements Behavioral Health -
Promises Treatment Centers
Oppose:None received.
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