BILL ANALYSIS                                                                                                                                                                                                    �



                                                                  AB 2335
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          Date of Hearing:  April 22, 2014

                            ASSEMBLY COMMITTEE ON HEALTH
                                 Richard Pan, Chair
                   AB 2335 (Mansoor) - As Amended:  March 28, 2014
           
          SUBJECT  :  Sober living homes.

           SUMMARY  :  Exempts a sober living home or supportive housing from  
          licensure as an alcohol and drug treatment program.   
          Specifically,  this bill  :  

          1)Defines sober living home or supportive housing as any  
            independent, residential property that provides a transitional  
            living environment for adults who are recovering from problems  
            related to alcohol, drug, or alcohol and drug misuse or abuse  
            that does not require participation in alcohol or drug  
            recovery treatment or detoxification services as a condition  
            of tenancy.

          2)Requires sober living homes or supportive housing, to meet  
            this definition, to satisfy certain requirements, including:

             a)   There are no more than six residents living on the  
               property, each of which has his or her own room or  
               apartment and a lease or rental agreement in his or her own  
               name, and pays his or her own rent; and,

             b)   Owners, managers, operators, and residents do not  
               provide any of the following contractual medical services  
               onsite: recovery services, treatment services,  
               detoxification services, routine home visits for medical  
               checkups, diagnostic evaluation of medical and  
               psychological problems, and prescription and delivery of  
               oral medication.

             c)   Owners, managers, operators, and residents ensure that  
               the property and its use comply with applicable federal,  
               state, and local laws.

           EXISTING LAW  :  

          1)Gives the Department of Health Care Services (DHCS) licensing  
            authority over adult alcoholism or drug abuse recovery or  
            treatment facilities, which include any facility that provides  








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            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.

          2)Requires a treatment facility that serves six or fewer  
            residents to be considered a residential use of property and  
            not subject to special taxes or fees, conditional use permits,  
            zoning ordinances, or other clearances.

          3)Prohibits, under the California Fair Employment and Housing  
            Act, 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  
            unlawful acts.

          4)Under the federal Americans with Disabilities Act, prohibits  
            discrimination by any public entity by reason of an  
            individual's disability.  Under the federal Fair Housing Act,  
            makes it unlawful to make unavailable or deny, a dwelling to  
            any buyer or renter because of a disability.

           FISCAL EFFECT  :  This bill has not yet been analyzed by a fiscal  
          committee.

           COMMENTS  :

          1)PURPOSE OF THIS BILL  .  The author asserts that this bill is  
            needed to clarify a blurred line between medical care  
            providers and the sober living home model by separating the  
            two if a sober living home is to be unlicensed by DHCS.  The  
            author asserts this problem was highlighted in a report  
            published in September 2012 by the Senate Office of Oversight  
            and Outcomes (SOOO) entitled "Rogue Rehabs: State Failed to  
            Police Drug and Alcohol Homes, With Deadly Results."  The  
            author contends that this bill will ensure that there is a  
            separation between treatment providers and an unlicensed  
            residential rehabilitation facility, thereby allowing the  
            state to provide better oversight and guarantee an appropriate  
            quality of care.

           2)BACKGROUND  .  Sober living homes are alcohol and drug free  








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            living environments for individuals attempting to maintain  
            abstinence from alcohol and drugs.  They offer no formal  
            treatment but either mandate or strongly encourage attendance  
            at 12-step groups.  Sober living homes provide a resource for  
            individuals completing residential treatment, attending  
            outpatient programs, leaving incarceration, or seeking  
            alternatives to formal treatment.  Sober living homes are  
            financially sustained through resident fees and individuals  
            can typically stay as long as they wish.  Because they do not  
            offer formal treatment services, they are not monitored by  
            state licensing agencies.  However, many sober living homes  
            are members of sober living home coalitions or associations  
            that monitor health, safety, quality, and adherence to a  
            social model philosophy of recovery that emphasizes 12-step  
            group involvement and peer support.  

           3)LICENSED RESIDENTIAL TREATMENT PROGRAMS  .  The state's  
            residential treatment facilities are authorized to provide  
            nonmedical services to individuals recovering from alcohol and  
            drug addiction.  Residential treatment programs must be  
            licensed by DHCS, with licensing criteria that are focused on  
            health and safety rather than treatment program content.   
            Under state regulations, licensure is required when at least  
            one of the following services is provided: detoxification,  
            group sessions, individual sessions, educational sessions, or  
            alcoholism or drug abuse recovery or treatment planning.  

           4)SOOO REPORT  .  The SOOO report focuses on two key problems in  
            state oversight of licensed residential treatment programs.   
            First, the SOOO report identifies a pattern, over the past  
            decade, of state regulators failing to identify potentially  
            dangerous problems and, when problems are identified,  
            neglecting to follow up to assure that they have been  
            corrected.  Second, the SOOO report found evidence of the  
            widespread provision of medical treatment by licensed  
            residential treatment programs, in direct violation of state  
            law.  The SOOO report focuses on licensed facilities and does  
            not identify a problem in sober living homes.

           5)OPPOSITION  .  The California Association of Addiction Recovery  
            Resources (CAARR), in opposition, writes that it would be  
            detrimental to the addiction recovery continuum of care to  
            limit a sober living home to six residents or to require that  
            each resident have his or her own bedroom, or to require each  
            resident to have a separate lease.  CAARR writes that these  








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            requirements would effectively doom most sober living homes  
            based on financial considerations.

           6)RELATED LEGISLATION  .  

             a)   AB 395 (Fox) would have allowed licensed residential  
               treatment facilities to provide medical services by a  
               physician to residents to assist in detoxification and  
               treatment, under certain conditions.  AB 395 was held on  
               the suspense file in the Senate Appropriations Committee.

             b)   AB 40 (Mansoor) would have required licensed residential  
               treatment facilities to report deaths and other unusual  
               events to the state within specified time frames.  AB 40  
               was held on the suspense file in the Assembly  
               Appropriations Committee.  

             c)   AB 2374 (Mansoor) requires licensed residential  
               treatment facilities to report deaths and other unusual  
               events to the state within specified time frames and  
               requires organizations that certify alcohol and other drug  
               counselors to check databases of other counselor certifying  
               organizations prior to registering or certifying a  
               counselor.  AB 2374 is pending in this Committee and is set  
               for hearing April 22, 2014.

             d)   AB 2491 (Nestande) exempts sober living homes, meaning 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, from licensure as an adult alcoholism or drug abuse  
               recovery or treatment facility.  AB 2491 is pending in this  
               Committee and is set for hearing April 29, 2014.

           7)PREVIOUS LEGISLATION  .  

             a)   AB 1983 (Mansoor) of 2012 would have required integral  
               facilities, meaning any combination of two or more  
               facilities that collectively serve seven or more persons  
               and provide housing in one facility and recovery  
               programming, treatment, meals, or any other services at  
               another facility, as specified, to be subject to state  
               licensure as an alcoholism or drug abuse recovery or  
               treatment facility.  AB 1983 died without a hearing in the  
               Assembly Health Committee.  








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             b)   AB 1284 (Huffman) of 2009 would have required the state  
               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 was held on the suspense file  
               in the Assembly Appropriations Committee.

             c)   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.

             d)   AB 2903 (Huffman) of 2008 would have authorized state  
               licensing authorities to require any person or entity  
               applying for licensure to provide specified information  
               before a license is issued.  AB 2903 was held in the Senate  
               Health Committee.

             e)   SB 1000 (Harman) of 2008 would have required applicants  
               seeking a treatment facility license to certify that the  
               facility is consistent with local zoning ordinances.  SB  
               1000 failed passage in the Senate Health Committee.

             f)   AB 724 (Benoit) of 2007 would have exempted sober living  
               homes, meaning 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, from licensure as an adult  
               alcoholism or drug abuse recovery or treatment facility.   
               AB 724 failed passage in the Senate Health Committee.

             g)   SB 530 (Dutton) of 2007 would have prohibited licensure  
               of a treatment facility if another treatment facility was  
               located within 300 feet.  SB 530 was held in the Senate  
               Health Committee.

             h)   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  
               was held on the suspense file in the Assembly  
               Appropriations Committee.








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             i)   AB 3007 (Emmerson) of 2006 would have prohibited  
               licensure of a treatment facility if another treatment  
               facility was located within 300 feet.  AB 3007 was held on  
               the suspense file in the Assembly Appropriations Committee.

           8)POLICY COMMENTS  .  Under current law, sober living homes do not  
            provide treatment services, so there is no requirement that  
            they be licensed as treatment facilities.  Therefore this  
            bill, since it provides a licensure exemption for certain  
            facilities that are already exempt from license, is  
            unnecessary.  In addition, this bill, to the extent that it  
            may be interpreted to require licensure for sober living homes  
            that do not meet the narrow definition supplied in this bill,  
            could create confusion.  Moreover, federal law and court  
            decisions prohibit discrimination against the disabled,  
            including those recovering from substance abuse.  This bill,  
            to the extent that it is interpreted to create special  
            restrictions on housing arrangements for individuals who are  
            recovering from substance abuse problems, could be in  
            violation of this prohibition.

           REGISTERED SUPPORT / OPPOSITION  :  

           Support 
           
          None on file.

           Opposition 
           
          California Association of Addiction Recovery Resources
           
          Analysis Prepared by  :    Ben Russell / HEALTH / (916) 319-2097