BILL ANALYSIS
AB 1969
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Date of Hearing: May 24, 2000
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Carole Migden, Chairwoman
AB 1969 (Steinberg) - As Amended: May 17, 2000
Policy Committee: HealthVote:14-0
(Consent)
Urgency: No State Mandated Local Program:
No Reimbursable:
SUMMARY
This bill requires development of plans to better coordinate the
oversight of long-term care facilities serving persons with
mental illness by requiring the Department of Mental Health
(DMH), in conjunction with the Department of Health Services
(DHS), to do the following:
1)Establish a long-term care mental health working group with
specified representatives to develop and submit a plan to the
Legislature by January 1, 2002, with recommendations for
developing long-term care facilities that are community-based,
serve no more than 16 persons, and are able to diagnose,
treat, and care for persons with mental diseases. The group
must consider whether to establish a new licensing category
for this type of facility.
2)Develop, by March 1, 2001, a plan for a streamlined and
consolidated evaluation and monitoring program to review
mental health rehabilitation centers and skilled nursing
facilities with special treatment programs. The plan must
include specified provisions regarding a timeline to implement
the plan, penalties, and resident safeguards.
3)By July 1, 2001, develop a mechanism that allows public
access, including Internet access, to accurate information on
long-term care facilities licensed or certified by DMH. The
information must include facility profiles, substantiated
complaints, deficiencies, and any appeal resolution pertaining
to a citation or complaint.
4)Require counties that contract for services from any
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institution for mental disease (IMD) to establish a clinical
quality support program with specified elements, to the extent
designated funds are available from the state.
FISCAL EFFECT
1)Unknown GF costs to DMH, estimated at $3 million annually, to
allocate funds to counties for clinical quality support
programs in IMDs. The bill contains a blank appropriation for
this purpose.
2)Minor GF costs to DMH, likely about $200,000, to develop the
two plans required by this bill and comply with other
requirements.
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COMMENTS
1) Purpose . This bill, sponsored by the California Mental Health
Directors Association, is intended to improve the coordination
between DMH and DHS for actions that affect about 4,500
persons with mental illness living in long-term care
facilities that operate special treatment programs tailored to
their needs. DMH certifies the special treatment program,
while DHS licenses the facility and issues citations as
appropriate. However, if DMH finds a deficiency in one of
these programs, it has no authority to issue a citation or
impose fines. It may require a plan of correction, or
de-certify the institution and/or ban further admissions if
the facility remains deficient. In serious cases, DMH
notifies DHS to review the deficiency and take appropriate
action. According to the author's office, the current system
is inefficient and disjointed.
To promote better coordination and oversight of these
facilities, this bill requires DMH and DHS to develop a plan
to improve the current system. It also calls for a working
group to develop recommendations for developing small
community-based facilities to serve mentally ill persons who
need long-term care. The bill also requires DMH to provide
families and the general public with access to information on
these facilities, particularly those with deficiencies, via
the Internet or other measures. Finally, the bill attempts to
improve the quality of clinical care provided in IMDs, which
serve 16 or more mentally ill residents who need long-term
care.
2) Background . Following the 1991 realignment of responsibility
and payment for mental health services, counties were given
the option of paying to place non-criminal persons with severe
mental illness in state-run hospitals, or contracting with
private institutions at the local level for their care. A
recent Los Angeles Times article indicates that many counties
have chosen to redirect patients to private facilities that
tend to be less expensive than state hospitals. One
consequence of this redirection is an increase in citations
issued against a select group of these specialized private
facilities. Since 1992, DHS has issued 200 citations against
35 of the 45 facilities certified to provide care for mentally
ill persons. Eight facilities received almost half of these
citations. DMH was not always aware of the DHS citations.
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Analysis Prepared by : Joyce Iseri / APPR. / (319) 319-2081