BILL ANALYSIS
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|SENATE RULES COMMITTEE | AB 1969|
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THIRD READING
Bill No: AB 1969
Author: Steinberg (D), et al
Amended: 8/25/00 in Senate
Vote: 27
SENATE HEALTH & HUMAN SERV. COMMITTEE : 6-0, 6/28/00
AYES: Escutia, Figueroa, Hughes, Mountjoy, Solis,
Vasconcellos
SENATE APPROPRIATIONS COMMITTEE : 8-3, 8/23/00
AYES: Johnston, Alpert, Bowen, Burton, Escutia, Karnette,
Perata, Vasconcellos
NOES: Kelley, Leslie, Mountjoy
ASSEMBLY FLOOR : 76-0, 5/31/00 - See last page for vote
SUBJECT : Mental health: housing
SOURCE : County Mental Health Directors
DIGEST : 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.
ANALYSIS :
Existing law:
1.Authorizes the State Department of Health Services (DHS)
CONTINUED
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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.
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
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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).
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.
Comments
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 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
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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.
AB 1969 . This bill makes legislative findings and
declarations relative to:
1.The connection between homelessness among the mentally
ill and the lack of affordable housing.
2.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.
3.The need for monitoring of the living situations of the
mentally ill and that the monitoring should include more
than monitoring "bricks and mortar."
This bill 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.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: No
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According to the Senate Appropriations Committee, General
Fund cost of $3 million each in 2001-03 and 2002-03.
SUPPORT : (Verified 6/28/00) (Unable to verify at time of
this writing)
County Mental Health Directors (source)
California Council of Community Mental Health Agencies
California Mental Health Planning Council
California State Employees' Association
Crestwood Behavioral Health
Mental Health Association in California
Protection and Advocacy, Inc.
Union of American Physicians & Dentists
OPPOSITION : (Verified 8/10/00)
Department of Finance
ARGUMENTS IN SUPPORT : According to the author's office,
this bill is intended to improve coordination of oversight
of SNFs that serve persons with mental illness. The
author's office 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's office 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's office further argues there is a lack of proper
oversight for these facilities and difficulty accessing any
derogatory information about a facility. According the
author's office, 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.
According to his office, the author's stated purpose in
providing a new public access information system is to give
consumers and families access to information about the
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facilities where they or family might receive care and
treatment.
ARGUMENTS IN OPPOSITION : The Department of Finance
opposes this bill for fiscal reasons and states additional
opposition to the following:
1.The bill establishes a long-term care mental health
working group previously vetoed by the Governor.
2.The requirement for a state-level plan for the review of
MHRC's and SNF's duplicates provisions in Chapter 93,
Statutes of 2000.
3.The bill codifies existing administrative practice and
policy of DHS and DSS to forward copies of citations to
DMH, and the requirement in Chapter 430, Statutes of
1999, directing DHS to post nursing facility information
on the Internet, including information regarding
citations issued, the status of the citation and the
facility's plan of correction, and information as to
whether an appeal has been filed.
ASSEMBLY FLOOR :
AYES: Aanestad, Ackerman, Alquist, Aroner, Ashburn, Bates,
Battin, Bock, Brewer, Briggs, Calderon, Campbell,
Cardenas, Cardoza, Cedillo, Corbett, Correa, Cox,
Cunneen, Davis, Dickerson, Ducheny, Dutra, Firebaugh,
Florez, Frusetta, Gallegos, Granlund, Havice, Honda,
House, Jackson, Kaloogian, Keeley, Knox, Kuehl, Leach,
Lempert, Leonard, Longville, Lowenthal, Machado, Maddox,
Maldonado, Margett, Mazzoni, McClintock, Migden, Nakano,
Olberg, Oller, Robert Pacheco, Rod Pacheco, Papan,
Pescetti, Reyes, Romero, Runner, Scott, Shelley,
Steinberg, Strickland, Strom-Martin, Thompson, Thomson,
Torlakson, Villaraigosa, Vincent, Washington, Wayne,
Wesson, Wiggins, Wildman, Wright, Zettel, Hertzberg
CP:cm 8/27/00 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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