BILL ANALYSIS                                                                                                                                                                                                    



                                                                  AB 1969
                                                                  Page  1

          CONCURRENCE IN SENATE AMENDMENTS
          AB 1969 (Steinberg)
          As Amended  August 25, 2000
          Majority vote
           
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          |ASSEMBLY:  |76-0 |(May 31, 2000)  |SENATE: |29-2 |(August 28,    |
          |           |     |                |        |     |2000)          |
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           Original Committee Reference:    HEALTH  
           
          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)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.

          3)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.  Requires the  
            long-term mental health care working group to make  
            recommendations to the Legislature on or before January 1,  
            2002.

          4)Requires DMH, in conjunction with DHS, to develop and submit  








                                                                  AB 1969
                                                                  Page  2

            to the Legislature, on or before March 1, 2001, a state plan  
            for a consolidated and streamlined evaluation and monitoring  
            program under one regulating authority for the review of  
            mental health rehabilitation centers and skilled nursing  
            facilities (SNFs) with special treatment programs, as  
            specified.  Requires the plan to include the cost and timeline  
            for implementation.
           
          5)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.

          6)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 as  
            specified.

          7)Requires, on or before July 1, 2001, DHS to develop a  
            mechanism to allow public access, including internet access,  
            to information regarding long-term care facilities licensed or  
            certified by DHS, including mental health rehabilitation  
            centers and special treatment programs, as specified.

           The Senate amendments  delete the appropriation from this bill  
          and make minor, nonsubstantive changes.

           EXISTING LAW  : 

          1)Authorizes DHS to license and regulate health facilities,  
            including SNFs that provide services to persons with severe  
            mental illness.

          2)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.

           AS PASSED BY THE ASSEMBLY  , this bill established 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.









                                                                  AB 1969
                                                                  Page  3

           FISCAL EFFECT  :  According to the Assembly Appropriations  
          Committee analysis, GF costs to DMH, estimated at $3 million  
          annually, to allocate funds to counties for clinical quality  
          support programs in institutions for mental disease. 

           COMMENTS  :   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. 
           
           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) believes that this bill will  
          greatly improve mental health services in California by  
          enhancing monitoring of certain facilities.  

          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 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. DMH was apparently unaware  
          of, or ill-equipped to intervene in these situations where DHS  
          had issued citations.
           
          Analysis Prepared by  :  Ann Blackwood / HEALTH / (916) 319-2097  
          FN: 0006798