BILL ANALYSIS
SENATE HEALTH AND HUMAN SERVICES
COMMITTEE ANALYSIS
Senator Martha M. Escutia, Chair
BILL NO: AB 1969
A
AUTHOR: Steinberg
B
AMENDED: May 26, 2000
HEARING DATE: June 28, 2000
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FISCAL: Appropriations
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CONSULTANT:
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McCarthy / ak
SUBJECT
Mental health: housing
SUMMARY
This bill establishes a long-term care mental health
working group to develop long-term care facilities for
persons with mental illness and also establishes an
internet-accessible information source with specified data
on mental health facilities.
ABSTRACT
Existing law:
1.Authorizes the state Department of Health Services (DHS)
to license and regulate health facilities, including
skilled nursing facilities (SNFs) that provide services
to persons with severe mental illness, among others;
2.Establishes the state Department of Mental Health (DMH),
which administers various state and federally funded
programs relating to the care, custody, and treatment of
mentally ill persons, as set forth in the Welfare and
Institutions Code;
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3.Provides that under the 1991 realignment of state and
county health and welfare responsibilities and funding,
counties have primary responsibility for provision of
mental health care services to low-income county
residents;
4.Permits counties to determine whether to place severely
mentally ill persons in state-run hospitals, or to
contract with local private providers for 24-hour
residential care and treatment services.
This bill:
1.Requires DMH to establish a long-term care mental health
working group to prepare a plan for the development of
long-term care mental health facilities that are
community-based and serve no more than sixteen persons;
2.Requires the plan to consider whether a new licensure
category is needed, along with monitoring and evaluation
of that new licensing category, and requires the working
group to make recommendations to the Legislature on or
before January 1, 2002;
3.Requires DMH, in conjunction with DHS, to develop and
submit to the Legislature, on or before March 1, 2001, a
state plan for consolidated and streamlined evaluations
and monitoring of mental health rehabilitation centers
and SNFs with special treatment programs;
4.Requires DMH to develop a mechanism that allows "public
and consumer access", including internet access to
information on all long term care facilities licensed or
certified by DMH, including mental health rehabilitation
centers and programs certified for a special treatment
program;
5.Specifies the public access information shall include
facility "profiles", with data on facility services and
ownership including, but not limited to, name, address
and telephone of facility, number of beds, whether the
facility accepts Medi-Cal or Medicare, and deficiencies
found in reviews, citations received, facility appeals,
and links to website information maintained by DHS
(including long term care ombudsman services);
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6.Specifies an exception to the data to be accessible
through the public access mechanism, such that the
address of a facility serving six or fewer persons will
not be posted on the internet;
7.Requires DHS to forward to DMH copies of any citations
issued to a SNF that has a DMH-certified special
treatment program, and, in turn, requires DMH to forward
copies to the county in which the facility is located;
8.Requires DMH to forward to the county in which a facility
is located, copies of any deficiencies found in a SNF
that has a special treatment program or in a mental
health rehabilitation center, as specified;
9.Requires, to the extent state funds are available,
counties that contract for services with institutions for
mental disease to establish "clinical quality support
programs," as specified;
10.Appropriates $3 million from the General Fund to DMH in
FY 2000-2001 to be allocated to counties based on the
number of clients placed in institutions for mental
disease by each county.
FISCAL IMPACT
According to the Assembly Appropriations Committee
analysis, this bill would result in GF costs to DMH,
estimated at $3 million annually, to allocate funds to
counties for clinical quality support programs in
institutions for mental disease.
BACKGROUND AND DISCUSSION
1.Background
The Department of Health Services (DHS) has licensing and
citation authority over skilled nursing facilities (SNF).
However, DMH has authority to "certify" or "de-certify"
a "special treatment program" within a SNF; a special
treatment program serves persons with mental illness. If
a SNF that has a specially licensed special treatment
program, certified by DMH, has an identified deficiency,
"citation" authority rests with DHS. DMH has limited
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authority; it cannot issue a citation or impose fines.
However, if a SNF with a special treatment program is in
violation of a regulation, DMH can issue a "deficiency"
notice along with a request for a correction plan. DMH
has authority to "de-certify" an institution, or ban
further admissions to the facility, if the facility fails
to implement the correction plan. Under egregious
circumstances, DMH can notify DHS to review the
deficiency and, if necessary, DHS can take appropriate
action against the institution.
Following the "realignment" of responsibility and payment
for mental health services in 1991, counties gained the
option of paying to place noncriminal persons with acute,
severe mental illness, requiring immediate treatment, as
defined, in state-run hospitals, or contracting out with
private providers at the local level to provide care.
Research indicates that as planned, many counties have
chosen to redirect patients to private facilities that
tend to be less expensive than state hospital care. This
redirection apparently has resulted in an increase in the
number of citations issued to certain private facilities.
2.AB 1969
This bill makes legislative findings and declarations
relative to:
the connection between homelessness among the mentally
ill and the lack of affordable housing;
a finding that 24-hour housing for seriously mentally
ill persons should include a continuum of housing
options, such as state hospitals, board and care,
rehabilitation centers and independent living;
the need for monitoring of the living situations of
the mentally ill and that the monitoring should
include more than monitoring "bricks and mortar."
AB 1969 requires 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.
1.Stated purpose of AB 1969
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According to the author, this bill is intended to improve
coordination of oversight of SNFs that 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 has no
authority to issue a citation or impose fines.
The author states that approximately 4,500 people with
mental illness are placed in long-term care facilities
that operate special treatment programs designed
specifically to treat persons with mental illness. The
author further argues there is a lack of proper oversight
for these facilities and difficulty accessing any
derogatory information about a facility. According to
information submitted to the Committee by the author, DHS
has issued 200 citations against 35 of the 45 facilities
certified to provide care for the mentally ill since
1992. The author argues that DMH was unaware of, or
ill-equipped to intervene in these situations where DHS
had issued citations.
The author's stated purpose in providing a new public
access information system is to give consumers and
families access to information about the facilities where
they or family might receive care and treatment.
2.Arguments of proponents
The Union of American Physicians and Dentists 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)
argues that this bill will greatly improve mental health
services in California by enhancing monitoring of certain
facilities.
QUESTIONS AND CONCERNS
1.AB 1969 requires that DMH develop a mechanism for public
access to information on facility location, services,
number of beds, etc., including making that data
accessible through the Internet. Existing law enacted in
AB 893 (Chapter 430, Statutes of 1999), also requires DHS
to develop a similar "consumer information service
system" to provide updated and accurate information to
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the general public and consumers regarding long term
health care facilities in their communities (Health and
Safety Code Section 1422.5). That consumer information
system is required to include for each long term health
care facility a "profile" similar to the one required in
this bill, including the facility's name, address,
telephone number, number of units or beds in the
facility, whether it accepts Medi-Cal or Medicare
patients, whether it is a nursing home, or if it has a
special unit for persons with Alzheimer's disease or
other dementias, information on substantiated complaints
or state citations, as well as responsive actions taken,
appeals filed and the resolution of appeals. The 1999
bill, AB 893, also required DHS to make the information
available on the internet.
2. AB 1969 further requires that the public access mechanism
include data related to facility, citations, deficiencies
and appeals. Crestwood Behavioral Health, while in
support of this bill, notes that as the 1999 statute
requires DHS to develop the consumer information system
on long-term care facilities by July 1, 2000. Crestwood
expresses concern that AB 1969 would duplicate this
statute.
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3.Current federal and state law prohibit discrimination in
housing against persons with disabilities, including
persons with mental illness. Current state law also
requires that, for the purposes of local zoning
ordinances, group housing for 6 or fewer persons must be
considered the same as single family housing.
AB 1969 would require that a "profile" (as described above)
of a facility, including a facility housing 6 or fewer
persons, would be included in the information that DMH
would be required to make accessible to the public and
consumers, including accessible through the internet.
This bill makes one exception for facilities housing 6 or
fewer persons; it would not allow the address of such
facilities to be posted on the internet, but the address
would otherwise be made available through the public
access system DMH would be required to develop.
4.Pending legislation, AB 2547 (Hertzberg), which passed
this Committee on June 21, 2000, authorizes DHS to expand
public access to licensing and certification data
pertaining to health facilities, by posting the health
facility licensing data on the internet. That bill also
exempts from posting on the internet the address of a
health facility licensed to serve six or fewer persons.
The Committee may want to inquire whether there be any
overlap, in terms of the facilities for which information
would be required to be posted by DHS under AB 2547, and
the data to be posted by DMH under AB 1969.
PRIOR ACTIONS
Assembly Floor: 76-0Pass
Assembly Appropriations: 21-0Do Pass as Amended
Assembly Health: 14-0Do Pass as Amended to
Consent
POSITIONS
Support: County Mental Health Directors (sponsor)
California Council of Community Mental
Health Agencies
California Mental Health Planning Council
California State Employees' Association
Crestwood Behavioral Health
Mental Health Association in California
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Protection and Advocacy, Inc.
Union of American Physicians & Dentists
Oppose: None received
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