BILL ANALYSIS
AB 1969
Page 1
Date of Hearing: April 25, 2000
ASSEMBLY COMMITTEE ON HEALTH
Martin Gallegos, Chair
AB 1969 (Steinberg) - As Amended: April 13, 2000
SUBJECT : Mental health: housing.
SUMMARY : Establishes a long-term mental health care working
group to further coordination and monitoring of treatment of
persons with mental illness in long-term care facilities,
appropriates an unspecified sum for counties for caring for
patients in institutions with mental disease. Specifically,
this bill :
1)Makes findings and declarations relative to the nexus between
homelessness among the mentally ill and affordable housing,
the continuum of services that comprise housing for the
mentally ill, and the need for monitoring of the living
situations of the mentally ill to include more than monitoring
"bricks and mortar."
2)Expresses the intent of the Legislature to require skilled
nursing facilities (SNFs) licensed by the Department of Health
Services (DHS) that are designated as institutions for mental
disease to receive stringent monitoring and enhanced penalties
for licensing violations.
3)Requires the Department of Mental Health (DMH), in conjunction
with DHS, to establish a long-term mental health care working
group that includes representatives of county mental health
programs, consumers, family members of residents with mental
disease who are in long-term care facilities, and long-term
care providers.
4)Requires the long-term mental health care working group to
develop a plan for the development of long-term mental health
care facilities that are community-based and serve no more
than sixteen people. Requires the plan to consider whether a
new licensure category is needed and the elements of
monitoring and evaluation that would be included in the
development of a new licensure category.
5)Requires the long-term mental health care working group to
make recommendations to the Legislature on or before January
AB 1969
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1, 2002.
6)Requires DMH, in conjunction with DHS, to develop and submit
to the Legislature, on or before March 1, 2001, a state plan
for a single evaluation and monitoring program under one
regulating authority for the review of mental health
rehabilitation centers and SNFs with special treatment
programs, as specified. Requires the plan to include the cost
and timeline for implementation.
7)Requires DHS to forward to DMH and the county in which the
facility is located, citations issued to a SNF that has a
special treatment program. Requires DMH to forward to the
county in which a facility is located, copies of SNF and
mental health rehabilitation center citations, as specified.
8)Requires, to the extent state funds are available, counties
that contract for services from institutions for mental
disease to establish a clinical quality support program that
includes:
a)Regular visits by county clinical staff to assess needs of
residents of institutions for mental disease placed by the
county;
b)Chart review by county clinical staff to ensure that
residents' clinical needs, including ancillary needs, are
met;
c)Regular meetings with client case managers to access
service needs and outcomes; and
d)Clinical case consultation, as specified.
9)Appropriates an unspecified amount from the General Fund to
DMH to be allocated to county departments of mental health
based on the total number of clients placed in institutions
for mental disease by each county.
EXISTING LAW :
1)Authorizes DHS to license and regulate health facilities,
including SNFs that provide services to persons with severe
mental illness.
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2)Establishes DMH, with the jurisdiction over the execution of
laws relating to the care, custody, and treatment of mentally
ill persons, as set forth in the Welfare and Institutions
Code.
3)Permits counties to determine whether to place severely
mentally ill persons in state-run hospitals, or to contract
for these services with local private providers.
FISCAL EFFECT : Unknown
COMMENTS :
1)PURPOSE OF THIS BILL . According to the author, this bill is
intended to improve coordination of oversight of SNFs that
also serve persons with mental illness. The author cites a
lack of coordination between DHS and DMH, noting that DMH may
find a deficiency with one of these facilities, but have no
authority to issue a citation or impose fines. Also, the
author argues that there is no central repository of
information about facility citations for consumer groups to
access. The author proposes to remedy this situation with
this bill by creating a long-term care mental health working
group to develop a plan to coordinate care between DHS and
DMH, and to provide greater access to citation and deficiency
information regarding SNFs with special treatment programs by
posting information on the Internet.
2)SUPPORT . The Union of American Physicians and Dentists (UAPD)
argues that this bill will help bridge the gap between the
mentally ill and the SNFs that provide them services. UAPD
notes that establishing a mechanism that allows public access
to health care facility information will enable an assessment
of the housing options available to persons with mental
illness. Protection and Advocacy, Inc. (PAI) believes that
this bill will greatly improve mental health services in
California by enhancing monitoring of certain facilities.
Further, PAI notes that the approach in this bill is
respectful of the rights and preferences of mental health
clients, and is consistent with the principle that persons
with mental illness should be able to participate in every
aspect of their treatment, as are others with other types of
medical illnesses.
3)FINANCIAL INCENTIVES DRIVING COUNTY PLACEMENT DECISIONS .
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Following the realignment of responsibility and payment for
mental health services in 1991, counties gained the option of
paying to place noncriminal persons with severe mental illness
in state-run hospitals, or contracting out with private
providers at the local level to provide care. A recent Los
Angeles Times article provided by the author indicates that
many counties have chosen to redirect patients to private
facilities that tend to be less expensive than state hospital
care. This redirection has also resulted in a large increase
in the number of citations issued to a select group of private
facilities. DHS has issued 200 citations against 35 of the 45
facilities certified to provide care for the mentally ill
since 1992. Eight facilities received almost half of these
citations. DMH was apparently unaware of, or ill-equipped to
intervene in these situations where DHS had issued citations.
4)RELATED LEGISLATION . At least 27 bills relating to mental
health are pending before the Legislature. These proposals
address subjects including involuntary treatment, school
intervention and prevention, police officer training, patient
advocacy, suicide treatment and prevention, advance
directives, discharge planning, mental health courts, dual
diagnoses of mental illness and substance abuse, and funding
for outreach and treatment services. As these proposals
progress through the legislative process, amendments to avoid
policy conflicts and chaptering problems will need to be
developed.
REGISTERED SUPPORT / OPPOSITION :
Support
Protection and Advocacy, Inc.
Union of American Physicians and Dentists
Opposition
None on file
Analysis Prepared by : Ann Blackwood / HEALTH / (916) 319-2097