BILL ANALYSIS �
AB 1983
Page 1
Date of Hearing: April 10, 2012
ASSEMBLY COMMITTEE ON HEALTH
William W. Monning, Chair
AB 1983 (Mansoor) - As Amended: April 9, 2012
SUBJECT : Substance abuse: recovery and treatment facilities.
SUMMARY : Defines integral alcohol and drug abuse treatment
facilities (integral facilities) for purposes of licensure by
the Department of Alcohol and Drug Programs (DADP) and excludes
integral facilities from being considered a residential use of
property. Specifically, this bill :
1)Defines integral facilities as any combination of two or more
facilities, located on the same or different parcels, that
collectively serve seven or more persons, not including the
licensee or members of the licensee's family or persons
employed as facility staff, that are under the control or
management of the same owner, operator, management company or
licensee or any affiliate of any of them, and which together
comprise one operation.
2)Requires integral facilities to include, but not be limited
to, the provision of housing in one facility and recovery
programming, treatment, meals, or any other service or
services at another facility, or facilities; or by assigning
staff, or a consultant or consultants, to provide services to
or in more than one facility.
3)Deletes existing law permitting DADP to issue a single license
to an alcoholism or drug abuse recovery or treatment facility
(treatment facility) wherein separate buildings or portions of
a residential treatment facility are integral components of a
single treatment facility and all of the components of the
treatment facility are managed by the same licensee, if the
applicant meets specified requirements; and instead, requires
DADP to issue a single license to integral facilities as
defined in this bill.
4)Excludes integral facilities as defined in this bill from
existing law requiring treatment facilities serving six or
fewer persons to be deemed a residential use of property.
EXISTING LAW :
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1)Vests DADP with the sole authority in state government to
license treatment facilities that provide a broad range of
services in a supportive environment for 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)Requires a treatment facility with six or fewer persons to be
considered a residential use of property and not subject to
conditional use permits, zoning ordinances, or other
clearances.
4)Prohibits for the purpose of all local ordinances, a treatment
facility serving six or fewer residents from being included
within the definition of a boarding home, rooming house,
institution or home for the care of minors, the aged, or
mentally infirm, foster care home, guest home, rest home,
sanitarium, mental hygiene home, or other similar term which
implies that the treatment facility is a business run for
profit or differs in any other way from a single family
residence.
5)Permits a city, county, or other local public entity to place
restrictions on building heights, setback, lot dimensions, or
placement of signs of a treatment facility serving six or
fewer persons as long as the restrictions are identical to
those applied to other single family residences.
6)Makes a legislative declaration that it is the policy of this
state that each county and city shall permit and encourage the
development of sufficient numbers and types of treatment
facilities as are commensurate with local need.
7)Prohibits, under the California Fair Employment and Housing
Act (FEHA), discrimination against any person in any housing
accommodation on the basis of race, color, religion, sex,
marital status, national origin, ancestry, familial status, or
disability. Specifies that discriminatory land use
regulations, zoning laws, and restrictive covenants are
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unlawful acts.
FISCAL EFFECT : This bill has not yet been analyzed by a fiscal
committee.
COMMENTS :
1)PURPOSE OF THIS BILL . According to the author, this bill
seeks to curb the use of single family residential properties
that the author states are falsely operating as integral
facilities to avoid state oversight. The author maintains
that these integral facilities consist of several sober living
homes that each house six or fewer clients and are operated by
one large treatment provider. The author asserts that
unregulated facilities serving six or fewer individuals that
operate as one larger "integral" facility are advertising a
broader scope of services without the state oversight that
ensures the safety of residents. The author argues that
subjecting these facilities to state licensure will enable the
state to monitor the complex nature of the services provided
at these facilities and ensure that residents are receiving
the proper level of care.
2)BACKGROUND . This bill is the result of concerns raised by the
recent order issued by DADP to suspend the license of
Morningside Recovery, LLC (Morningside), a large treatment
operator with three licensed facilities in the city of Costa
Mesa, located in the author's district. According to the
order, in addition to the three licensed facilities,
Morningside purported to operate eight sober living
environments, which are not subject to state licensure. The
order states that Morningside was operating its licensed
facilities beyond the scope of its licenses by using its eight
unlicensed facilities in conjunction with its licensed
facilities. The order also indicates that Morningside
operated all of its licensed and unlicensed facilities under
the same policies and procedures and client documentation did
not differentiate between the types of services or where they
were provided. DADP staff note in the order that Morningside
maintained a single roster for the care and supervision of
clients residing in all of its facilities but the roster did
not identify whether clients were served in the licensed or
unlicensed facilities.
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Additionally, the order notes that, on at least one occasion,
Morningside admitted a client for treatment at a licensed
facility and then immediately housed the client at an
unlicensed facility where the client received treatment, and,
on at least two separate occasions, clients underwent
detoxification treatment and received their medication at one
of Morningside's eight unlicensed facilities. As a result,
DADP ordered Morningside to immediately cease admitting
clients to its three Costa Mesa treatment centers and to
relocate clients currently residing at the three centers to
other treatment facilities to complete their currently
scheduled program within 14 days of the order, dated November
2011. DADP has since initiated legal action to revoke
Morningside's licenses and a hearing on the matter is
scheduled for May 21, 2012.
3)SOBER LIVING HOMES . Sober living environments are cooperative
living arrangements for recovering alcohol and drug abusers.
Sober living homes operate on the concept that by surrounding
oneself with individuals who are experiencing the same
self-help learning process, recovering from one's addiction is
much easier. Residents may participate in Twelve-Step
meetings or other educational meetings to help maintain their
sobriety and pursue other activities, including employment.
DADP notes that sober living environments serve as an interim
environment between licensed treatment facilities and a
client's home. Sober living homes are exempt from licensure
and have no authority to offer treatment or services.
However, DADP indicates there have been numerous complaints
relating to unlicensed facilities, including sober living
homes. DADP specifies that, on average, it receives 70
complaints per year relative to unlicensed facilities,
including sober living homes. Many of the complaints allege
that unlicensed facilities, including sober living homes, are
offering addiction treatment services.
4)DRUG AND ALCOHOL TREATMENT FACILITIES . According to DADP,
treatment facilities provide non-medical services to
individuals who are working to overcome their addiction to
alcohol or other drugs. 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
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recreational activities, and information about and referral to
appropriate community services.
DADP indicates that, to obtain licensure as a treatment
facility, prospective applicants must first identify a
location where they plan to provide non-medical alcoholism or
drug abuse recovery, treatment, or detoxification services.
Applicants must also complete an initial application, submit
an approved fire clearance from the local fire authority, and
pay an applicable license fee. According to DADP, the
licensing process primarily focuses on health and safety
concerns, such as appropriate fire clearances, food service
standards, personnel requirements, physical environment
requirements, and residents' personal rights. Finally,
applicants are required to pass a treatment facility on-site
inspection conducted by DADP to determine compliance with all
applicable laws and regulations. An applicant that passes the
inspection is issued a license valid for two years. DADP then
conducts an onsite program visit for compliance with the
requirements of the license at least once during the two year
period. Licensed facilities are mandated to display their
license, which indicates the treatment capacity and the
population they are allowed to serve, in a public location.
5)DADP'S GOOD NEIGHBOR GUIDELINES . Currently, DADP includes in
the initial application package that is provided to
prospective applicants a copy of its Good Neighbor Guidelines,
a document developed to provide any entity interested in
operating a treatment facility with ideas, suggestions, and
tips, identified by experienced providers and licensing
reviewers, for establishing and maintaining positive
relationships in the community. The guidelines recommend that
treatment facility operators know the proposed neighborhood
and the appropriate zoning requirements; ensure that all
required fire permits, licenses, business licenses, and any
other permits have been secured; prepare a neighbor
introduction letter and written materials about the program
that can be shared with neighbors; and, develop a neighborhood
complaint protocol to inform staff of the procedure to follow
should a neighbor complain to the treatment facility. DADP
investigates all complaints involving licensed treatment
facilities and averages a total of 400 complaints per year
regarding the 2,500 facilities that are currently licensed.
6)SITING OF FACILITIES . According to the federal Substance
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Abuse and Mental Health Services Administration's (SAMHSA)
publication entitled "Siting Drug and Alcohol Treatment
Programs: Legal Challenges to the NIMBY Syndrome," many people
recognize the pervasiveness of alcohol and drug problems but
such concern has not always resulted in communities welcoming
alcohol and other drug treatment programs into their
neighborhoods. Community opposition, often referred to as
"not in my backyard" (NIMBY) syndrome, often prevents or
delays the siting of a treatment program. The SAMHSA
publication states that the NIMBY syndrome is not new and does
not arise solely in opposition to alcohol and other drug
treatment programs. Community resistance is often mobilized
to prevent the opening or expansion of many types of health
and social service facilities, including shelters for the
homeless, group homes for the mentally ill, halfway houses for
ex-offenders, and health-related facilities for those with
AIDS. According to the SAMHSA publication, there are five
myths related to locating a treatment facility: a) Community
residents may fear that property values will decline; b)
Merchants may be concerned that crime will increase; c) The
community may believe that a treatment program will bring in
"outsiders," perhaps outsiders of a different class or ethnic
group; d) The community may believe that an over-concentration
of services already exists in the vicinity; and, e) The
community may simply confuse the problem's solutions with its
manifestations. The SAMHSA publication states that, in almost
every instance, a community's fear of having an alcohol or
other drug treatment program located within its borders is
unfounded and, in reality, treatment programs pose no
legitimate danger to the health or welfare of the residents,
nor do they draw substance abusers and drug pushers to the
area.
7)FAIR HOUSING & ANTI-DISCRIMINATION PROTECTIONS . FEHA makes it
illegal to engage in various discriminatory practices relating
to the sale and rental of housing based on race, color,
religion, sex, marital status, national origin, ancestry,
familial status, or disability. It also prohibits land use
regulations, zoning ordinances, and restrictive covenants from
discriminating in housing on the basis of the aforementioned
categories. FEHA also states that groups of people with
disabilities living together in a single dwelling unit are
considered a family.
In addition, the Americans with Disability Act of 1990 (ADA)
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gives civil rights protection to individuals with
disabilities, similar to the protection provided to
individuals on the basis of race, sex, national origin, and
religion. Alcohol and drug dependency are considered a
disability that receive protection under the ADA.
Specifically, ADA applies to those who have successfully
completed a drug rehabilitation program, or who are currently
enrolled in such programs.
Consequently, this bill could create disparate legal treatment
of entities with identical program models based on ownership
rather than type of operation, services offered, or conduct.
For example, under this bill, two identical treatment
facilities, both with six or fewer residents, in which one is
operated as the sole residential treatment facility of a
single operator, and the other is one of five residential
treatment facilities owned and operated by one operator, would
not have the same legal protections against local government
incursion. Although both facilities would provide identical
services, and both would demonstrate compliance with DADP
requirements, the facility owned by the operator with multiple
locations would be subject to additional regulation by local
government, such as land use approvals and zoning
requirements, while the solely-owned treatment facility would
not.
8)PRIOR LEGISLATION .
a) AB 1284 (Huffman) of 2009 would have required DADP to
notify the appropriate city or county planning agency of a
proposed facility's application for licensure as a
residential treatment facility if it operates as an
integral component of an existing licensed facility managed
by the same licensee and is located within 300 feet of the
existing facility. AB 1284 died on the Assembly
Appropriations Committee Suspense File.
b) SB 268 (Harman) of 2009, which was substantially similar
to SB 1000 (Harman) of 2008, failed passage in the Assembly
Health Committee and was subsequently amended to a
different topic.
c) AB 2903 (Huffman) of 2008 would have authorized DADP to
require any person or entity applying for licensure to
provide specified information to DADP before a license is
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issued. AB 2903 was held in the Senate Health Committee.
d) SB 1000 (Harman) of 2008 would have required applicants
seeking a treatment facility license from DADP to certify
that the facility is consistent with local zoning
ordinances and would have required DADP to verify the
certification. SB 1000 failed passage in the Senate Health
Committee.
e) AB 724 (Benoit) of 2007 would have defined a sober
living home as a residential property that is operated as a
cooperative living arrangement to provide an alcohol and
drug free environment for persons recovering from
alcoholism or drug abuse and meets other specified
requirements. AB 724 failed passage in the Senate Health
Committee.
f) SB 530 (Dutton) of 2007 would have prohibited DADP from
licensing a treatment facility if another treatment
facility was located within 300 feet. SB 530 was held in
the Senate Health Committee.
g) AB 370 (Adams) of 2007 would have permitted a local
government to include a residential care facility serving
six or fewer persons, including a sober living facility,
within the definition of single family residence. AB 370
died on the Assembly Appropriations Committee Suspense
File.
h) AB 3007 (Emmerson) of 2006 would have prohibited DADP
from licensing a treatment facility if another treatment
facility was located within 300 feet. AB 3007 died on the
Assembly Appropriations Committee Suspense File.
9)SUPPORT . Maintain Our Residential Neighborhoods (MORN) writes
in support that this bill will ensure that the state agency
charged with oversight of treatment facilities for recovering
addicts is properly apprised of the deteriorating safety
measures in the rapidly proliferating and unregulated
rehabilitation businesses located throughout local
communities. MORN believes this bill will eliminate the
practice of what it calls quasi-psychiatric integral
facilities masquerading as rehabilitation businesses that
house clients in sober living homes and bypass the appropriate
requirements in state law for residential treatment
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facilities. The City of Laguna Beach writes in support of the
introduced version of this bill, stating that it gives DADP
the necessary authority to monitor all drug and alcohol
treatment facilities in California.
10)OPPOSITION . Opponents, representing treatment providers,
contend that this bill reflects a long and sad history of
stigma attached to individuals who are in recovery from
substance abuse disorders. The County Alcohol and Drug
Program Administrators Association of California asserts that
the obvious solution to untreated substance abuse, which lies
at the root of some community problems, is to provide more
resources for treatment, not to target or discriminate against
individuals in recovery who are trying to straighten out their
lives. The California Association of Addiction Recovery
Resources argues that this bill would entitle local
governments to discriminate against a protected class of
people by denying recovering addicts opportunities for housing
and result in an even greater shortage of community-based
treatment programs that currently exist. Cliffside Malibu
points out that existing law already provides a carefully
constructed regulatory scheme designed to foster the recovery
of individuals suffering from alcohol or drug abuse by
allowing for the operation of treatment programs in
residential neighborhoods and notes that a provider with
multiple 6-bed locations is required to adequately demonstrate
that each program is functioning independently prior to
receiving a valid license. Elements Behavioral Health, CRC
Health Group, Inc. and Narconon Fresh Start add that this bill
needlessly disrupts well established recovery programs.
11)POLICY COMMENTS .
a) Conflicts with other state laws . Under current law, a
licensed treatment facility, as with any development, is
required to comply with local land use restrictions. There
is, however, a significant difference in that state law
requires an alcoholism or drug abuse treatment facility
serving six or fewer persons to be considered a residential
use of property for the purposes of state and local
regulation. As a residential use, a treatment facility
with six or fewer persons must only comply with those local
requirements that apply to persons living in other single
family residences. For example, under existing law, a
facility of six would require no land use approval in most
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instances. However, for a facility of seven or more
persons, a local government could, and often does, require
a conditional use permit or other land use permit. By
defining individual integral facilities as those that
collectively serve seven or more persons, this bill
directly conflicts with these other state laws that require
these smaller treatment facilities to be treated as
residential properties.
b) Potential conflict regarding oversight authority . DADP
is proposed for elimination as part of the Governor's
fiscal year 2012-13 Budget and its respective programs are
being proposed for transfer to other state departments.
Specifically, DADP's licensing activities are being
proposed to shift to the Department of Social Services. In
light of this and other restructuring proposals that have
yet to be approved by the Legislature, is it appropriate at
this time to impose additional licensing responsibilities
on DADP for the newly-defined category of providers in this
bill?
REGISTERED SUPPORT / OPPOSITION :
Support
City of Laguna Beach (prior version)
Maintain Our Residential Neighborhoods
Opposition
California Association of Addiction Recovery Resources
California Society of Addiction Medicine
Cliffside Malibu
County Alcohol and Drug Program Administrators Association of
California
CRC Health Group, Inc.
Elements Behavioral Health
Narconon Fresh Start
Analysis Prepared by : Cassie Royce / HEALTH / (916) 319-2097