Amended in Senate April 2, 2014

Senate Bill No. 1161

Introduced by Senator Beall

February 20, 2014

An act to begin delete amend Section 224.71 of the Welfare and Institutions Code, relating to juveniles. end delete begin insert add Section 14124.27 to the Welfare and Institutions Code, relating to Medi-Cal. end insert

LEGISLATIVE COUNSEL’S DIGEST

SB 1161, as amended, Beall. begin delete Juveniles: Youth Bill of Rights. end delete begin insert Drug Medi-Cal. end insert

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Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid Program provisions. Existing federal law prohibits federal financial participation for care or services provided to patients in an institution for mental diseases (IMD). Existing law establishes the Drug Medi-Cal Treatment Program (Drug Medi-Cal) under which the department is authorized to enter into contracts with counties for various drug treatment services for Medi-Cal recipients, or is required to directly arrange for these services if a county elects not to do so.

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This bill would require the department to seek a specified waiver of the IMD exclusion under Drug Medi-Cal to provide short-term residential treatment in facilities with a bed capacity in excess of 16 beds and short-term inpatient medical detoxification in a hospital setting.

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Existing law, the Youth Bill of Rights, enumerates various specific rights for youth confined in a facility of the Division of Juvenile Facilities, including, among others, the right to live in a safe, healthy, and clean environment conducive to treatment and rehabilitation and where he or she is treated with dignity and respect.

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This bill would make technical, nonsubstantive changes to those provisions.

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Vote: majority. Appropriation: no. Fiscal committee:  begin delete no end delete begin insert yes end insert . State-mandated local program: no.

The people of the State of California do enact as follows:

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begin insert SECTION 1. end insert   

end insert begin insert

(a) The Legislature finds and declares all of the
following:

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(1) The federal Patient Protection and Affordable Care Act
(PPACA) (Public Law 111-148), as amended by the federal Health
Care and Education Reconciliation Act of 2010 (Public Law
111-152), offers previously uninsured Californians unprecedented
access to health services, including mental health and substance
use disorder services.

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(2) In 2013, the Legislature passed Assembly Bill 1 and Senate
Bill 1 in the 2013-14 First Extraordinary Session, which expanded
Medi-Cal coverage to low-income adults with incomes at or below
138 percent of the federal poverty level who were not previously
eligible, established the Medi-Cal benefit package for this
expansion population, and required the Medi-Cal program to
cover essential health benefits contained in PPACA, which are
now included in the state plan.

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(3) It is estimated that 250,000 Californians newly eligible for
Medi-Cal are in need of, or are seeking, substance use disorder
treatment.

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(4) Substance use disorder treatment often requires medical
detoxification and residential treatment services, services that
have been approved under California’s Medi-Cal expansion under
PPACA.

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(5) The federal exclusion for institutions for mental diseases
(IMD) only permits residential care for substance use disorder in
facilities with 16 beds or fewer and medical detoxification only in
a general acute hospital, making both services inaccessible to
Medi-Cal and Drug Medi-Cal beneficiaries.

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(6) Capacity for both medical detoxification and residential
treatment is severely limited in California in settings in compliance
with the federal exclusion for IMD.

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(7) Medical detoxification in a general acute care hospital is,
by far, the most expensive method to provide detoxification
treatment.

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(8) According to a letter from the Director of Health Care
Services to the federal Centers for Medicare and Medicaid
Services, only 21 percent of California’s beds are in facilities with
a capacity of 16 and under. Furthermore, other than 11 perinatal
programs, there are no Drug Medi-Cal licensed residential
substance use disorder facilities in California. Therefore,
California is severely limited in providing the expanded substance
use disorder residential treatment benefits as provided for by the
Medi-Cal expansion.

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(9) The Commonwealth of Massachusetts successfully included
IMD expenditure authority in its Section 1115 waiver. California
has a similar need for IMD expenditure authority.

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(10) The State Department of Health Care Services has the
authority, subject to federal approval, to seek a Section 1115
waiver.

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(b) It is the intent of the Legislature to expeditiously expand
statewide capacity for mental health and substance use disorder
treatment services for all Californians newly eligible for health
care services under the expansion of Medi-Cal eligibility who are
in need of or currently seeking treatment.

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begin insert

begin insert SEC. 2. end insert   

end insert

begin insert Section 14124.27 is added to the end insert begin insert Welfare and
Institutions Code end insert begin insert , end insert immediately following Section 14124.26 begin insert , to
read: end insert

begin insert

begin insert 14124.27. end insert   

(a) The department shall seek a waiver of federal
law under Section 1115 of the federal Social Security Act (42
U.S.C. Sec. 1315) to receive enhanced federal financial
participation under the Drug Medi-Cal program in accordance
with this section.

(b) The department shall seek a waiver of the institution for
mental diseases (IMD) exclusion in Section 1396d(a)(29)(B) of
Title 42 of the United States Code to provide short-term residential
treatment in facilities with bed capacities in excess of 16 beds, 30
to 90 days maximum, with an average length of stay of 60 days,
and short-term inpatient medical detoxification in a hospital
setting, including, but not limited to, free-standing psychiatric and
chemical dependency recovery hospitals, for three to seven days
maximum, with an average length of stay of five days.

(c) This section shall be implemented only to the extent federal
approval is obtained and to the extent that federal financial
participation is available.

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begin delete

SECTION 1.  

Section 224.71 of the Welfare and Institutions
Code is amended to read:

224.71.  

It is the policy of the state that a youth confined in a
facility of the Division of Juvenile Facilities, Department of
Corrections and Rehabilitation, shall have all of the following
rights:

(a) To live in a safe, healthy, and clean environment conducive
to treatment and rehabilitation and where he or she is treated with
dignity and respect.

(b) To be free from physical, sexual, emotional, or other abuse,
or corporal punishment.

(c) To receive adequate and healthy food and water, sufficient
personal hygiene items, and clothing that is adequate and clean.

(d) To receive adequate and appropriate medical, dental, vision,
and mental health services.

(e) To refuse the administration of psychotropic and other
medications consistent with applicable law or unless immediately
necessary for the preservation of life or the prevention of serious
bodily harm.

(f) To not be searched for the purpose of harassment or
humiliation or as a form of discipline or punishment.

(g) To maintain frequent and continuing contact with parents,
guardians, siblings, children, and extended family members,
through visits, telephone calls, and mail.

(h) To make and receive confidential telephone calls, send and
receive confidential mail, and have confidential visits with
attorneys and their authorized representatives, ombudspersons and
other advocates, holders of public office, state and federal court
personnel, and legal service organizations.

(i) To have fair and equal access to all available services,
placement, care, treatment, and benefits, and to not be subjected
to discrimination or harassment on the basis of actual or perceived
race, ethnic group identification, ancestry, national origin, color,
religion, sex, sexual orientation, gender identity, mental or physical
disability, or HIV status.

(j) To have regular opportunity for age-appropriate physical
exercise and recreation, including time spent outdoors.

(k) To contact attorneys, ombudspersons and other advocates,
and representatives of state or local agencies, regarding conditions
of confinement or violations of rights, and to be free from
retaliation for making these contacts or complaints.

(l) To participate in religious services and activities of their
choice.

(m) To not be deprived of any of the following as a disciplinary
measure: food, contact with parents, guardians, or attorneys, sleep,
exercise, education, bedding, access to religious services, a daily
shower, a drinking fountain, a toilet, medical services, reading
material, or the right to send and receive mail.

(n) To receive a quality education that complies with state law,
to attend age-appropriate school classes and vocational training,
and to continue to receive educational services while on
disciplinary or medical status.

(o) To attend all court hearings pertaining to them.

(p) To have counsel and a prompt probable cause hearing when
detained on probation or parole violations.

(q) To make at least two free telephone calls within an hour
after initially being placed in a facility of the Division of Juvenile
Facilities following an arrest.

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