Existing law provides for the licensure and regulation of community care facilities by the State Department of Social Services. Existing law also provides for the licensure and regulation by the State Department of Health Care Services of adult alcoholism and drug abuse recovery and treatment facilities for adults.

This bill would, among other things, define a drug and alcohol free residence as a residential property that meets specified requirements and has been is operated as a cooperative living arrangement to provide an alcohol and drug free environment for persons recovering from alcoholism or drug abuse, or both, who seek a living environment in which to remain clean and sober. The bill would provide that a drug and alcohol free residence may be certified by an organization approved by the State Department of Health Care Services, defined as an approved certifying agency. The bill would provide that a residence housing persons who purport to be recovering from drug or alcohol abuse would be presumed to be a drug and alcohol free residence if the residence has been certified by an approved certifying organization. The bill would require an approved certifying organization, to organization to, among other things, maintain an affiliation with a recognized national organization, approved by the department, establish procedures to administer the application, certification, renewal, and disciplinary processes for a drug and alcohol free residence, and investigate and enforce violations by a residence of the organizations code of conduct, as provided. The bill would specify the information and documentation that an operator who seeks to have a residence certified is required to submit to an approved certifying organization.

This bill would require the department to maintain and post on its Internet Web site a registry that contains specified information regarding each drug and alcohol free residence that has been certified or has had its certification revoked. The bill would deem the activities of a certified drug and alcohol free residence a residential use of property under specified circumstances, and would limit referral of persons who are required to reside in a sober living environment, as specified, to certified drug and alcohol free residences. circumstances.

Existing law provides for the licensure and regulation of community care facilities by the State Department of Social Services. Existing law also provides for the licensure and regulation by the State Department of Health Care Services of adult alcoholism and drug abuse recovery and treatment facilities for adults.

This bill would would, among other things, define a sober living home drug and alcohol free residence as a residential property that meets specified requirements. requirements and has been certified by an organization approved by the State Department of Health Care Services, defined as an approved certifying agency. The bill would provide that a residence housing those purporting persons who purport to be recovering from drug or alcohol abuse would be presumed to be a sober living home drug and alcohol free residence if it the residence has been certified, registered, or approved by a state-recognized nonprofit organization. certified by an approved certifying organization. The bill would require the nonprofit organization to establish minimum standards for sober living homes, including protocols to address suspected drug and alcohol abuse or to report the death of a resident. an approved certifying organization, to among other things, maintain an affiliation with a recognized national organization, approved by the department, establish procedures to administer the application, certification, renewal, and disciplinary processes for a drug and alcohol free residence, and investigate and enforce violations by a residence of the organizations code of conduct, as provided. The bill would specify the information and documentation that an operator who seeks to have a residence certified is required to submit to an approved certifying organization.

Existing law provides for the licensure and regulation of community care facilities by the State Department of Social Services. Existing law also provides for the licensure and regulation by the State Department of Health Care Services of alcoholism and drug abuse recovery and treatment facilities for adults.

This bill would define a sober living home as a residential property that meets specified requirements. The bill would provide that a residence housing those purporting to be recovering from drug or alcohol abuse would be presumed to be a sober living home if it has been certified, registered, or approved by a state-recognized nonprofit organization. The bill would require the nonprofit organization to establish minimum standards for sober living homes, including protocols to address suspected drug and alcohol abuse or to report the death of a resident.

Date of Hearing: May 11, 2016

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Lorena Gonzalez, Chair

ABPCA Bill Id:AB 2255

Author:(Melendez) – As Amended Ver:April 26, 2016

Urgency: No State Mandated Local Program: No Reimbursable: No

SUMMARY:

This bill establishes state oversight of “drug and alcohol free residences" or sober living homes. Specifically, this bill:

1. Defines “drug and alcohol free residence” to mean a residential property that is operated as a cooperative living arrangement to provide an alcohol and drug free environment for persons recovering from alcoholism or drug abuse, or both, who seek a living environment in which to remain clean and sober.
2. Specifies a drug and alcohol free residence may be certified by an approved certifying organization, and specifies requirements for a certified drug and alcohol free residence.
3. Provides a residence that houses persons who purport to be recovering from drug and alcohol abuse must be presumed to be a drug and alcohol free residence if the residence has been certified by an approved certifying organization.
4. Requires an approved certifying organization to meet a number of requirements, including, among others, affiliation with an approved national organization, inspections of drug and alcohol free residences to ensure compliance with certification requirements, and ensuring operators meet specified standards and submit specified documents.
5. Requires the Department of Health Care Services (DHCS) to adopt application procedures and standards of approval for an organization that seeks to be approved by the department as an approved certifying organization.
6. Allows the department to revoke approval of an approved certifying organization, and to revoke the certification of a residence as a drug and alcohol free residence.
7. Allows the department to investigate complaints, impose sanctions, and commence disciplinary actions (unspecified).
8. Requires the department to maintain and post on its website a registry containing specified contact information for each certified facility.

This bill does not mandate certification, but does deem any certified facility as a “drug and alcohol free residence” to be overseen by the state.

FISCAL EFFECT:

Estimated GF costs to DHCS of $885,000 in 2017-18, $820,000 in 2018-19, and ongoing for seven staff to establish and oversee the program. Staff would review compliance, including periodically inspecting facilities, conducting complaint investigations, perform data entry, and performing any additional oversight requirements. Actual costs would depend on the number of homes that maintained certification.

DHCS indicates existing information technology systems could likely be used to meet the bill's requirements but that data entry would be a significant cost. This cost is included in the estimate above.

COMMENTS:

1. Purpose. According to the author, thousands of facilities treat former alcoholics and drug abusers, who are very susceptible to relapse, without possessing any formal credentials. The author states this will help people stay sober and improve community safety.
2. Background. DHCS, formerly the Department of Drug and Alcohol Programs, is the state oversight body for drug and alcohol treatment facilities and personnel. DHCS licenses substance use treatment facilities, which provide 24-hour residential nonmedical services to eligible adults who are recovering from problems related to alcohol or other drug (AOD) misuse or abuse. DHCS also offers a voluntary facility certification to both residential and nonresidential programs. Sober living homes are alcohol and drug free living environments for individuals attempting to maintain abstinence from alcohol and drugs. In contrast to alcoholism and drug abuse recovery or treatment programs, because sober living homes are private residences and do not offer treatment services, they are not regulated by the state.
3. Related Legislation.
   1. AB 2403 (Bloom), also pending in this committee, requires DHCS to issue a single license to a residential or integral alcoholism or drug abuse recovery or treatment facility when specified criteria are met, and establishes a definition for integral facilities.
   2. SB 1101 (Wieckowski) establishes new licensing requirements for alcohol and drug counselors, and transfers responsibilities pertaining to alcohol and drug counselor certification and the approval and regulation of certifying organizations from DHCS to the Department of Public Health. SB 1101 is pending in the Senate.
4. Prior Legislation. A litany of bills has addressed the issue of sober living homes and related issues over the last decade. Most recently, AB 2491 (Nestande) of 2014 would have exempted sober living homes from licensure as an adult alcoholism or drug abuse recovery or treatment facility and required sober living homes to meet specified requirements. AB 2491 was held on the Suspense file of the Senate Appropriations Committee.
5. Staff Comments. As this bill does not require facilities to be certified, it is unclear what benefit is gained from state oversight and registration of facilities by the state in a database. On the other hand, a requirement for certification raises significant legal and policy concerns. Finally, the role of state staff vis-à-vis the certifying entity is unclear. For example, the bill specifies the state should respond to complaints of an unspecified nature about a privately certified entity, and it also gives the state authority to revoke a certification it did not issue.

Analysis Prepared by: Lisa Murawski / APPR. / (916) 319-2081

Date of Hearing: April 19, 2016

ASSEMBLY COMMITTEE ON HEALTH

Jim Wood, Chair

ABPCA Bill Id:AB 2255

Author:(Melendez) – As Amended Ver:April 12, 2016

SUBJECT: Drug and alcohol free residences.

SUMMARY: Defines "drug and alcohol free residences" and requires these residences to be certified by a certifying organization approved by the Department of Health Care Services (DHCS) to register drug and alcohol free residences. Specifically, this bill:

1. Defines a “drug and alcohol free residence” (recovery residence) as a residential property that has been certified and is operated as a cooperative living arrangement to provide an alcohol and drug free environment for persons recovering from alcoholism or drug abuse, or both, who seek a living environment in which to remain clean and sober.
2. Requires residents, including live-in managers, operators, or owners, to live a sober lifestyle. Requires residents to be actively participating in legitimate programs of recovery from substance use disorder, including, but not limited to, Alcoholics Anonymous or Narcotics Anonymous programs.
3. Requires residents within the recovery residence, and residents who have been referred and have access to ongoing outpatient treatment, aftercare, or other recovery maintenance services to continue to use these services in accordance with a clinically managed system of care if one exists for the resident.
4. Requires owners, managers, operators, and residents to observe and promote a zero tolerance policy regarding the consumption or possession of alcohol or controlled substances being used in any manner not consistent with a documented prescription.
5. Requires a residence that houses persons recovering from drug and alcohol abuse to be presumed to be a recovery residence if the residence has been certified by an approved certifying organization.
6. Requires, if a residence is certified as specified within 90 days of beginning its operations, the activities at that residence to be deemed a residential use of property and a use of property by a single family.
7. Defines an approved certifying organization as an organization approved by DHCS to register a residence as a drug and alcohol free residence.
8. Defines an approved national organization as a recognized national organization, approved by DHCS, the primary function of which is to improve access to, and the quality of, drug and alcohol recovery residences through standards, education, research, and advocacy. Requires an approved certifying organization do all of the following:
   1. Maintain an office in the state;
   2. Maintain nonprofit status in the state;
   3. Be an affiliate of, and continuously maintain affiliation with, an approved national organization;
   4. Maintain the most current standards published by the approved national organization;
   5. Document that the organization actively develops and confers professional, residential, or organizational quality designations according to applicable nationally recognized standards;
   6. Establish drug and alcohol free residence certification requirements;
   7. Establish procedures to administer the application, certification, renewal, and disciplinary processes for a drug and alcohol free residence;
   8. Inspect, at least annually, a drug and alcohol free residence to ensure compliance with certification requirements;
   9. Submit to DHCS and the operator of the certifying organization, a written code of conduct for a recovery residence that incorporates national standards for legal and ethical conduct for recovery residences;
   10. Submit to DHCS and the operator of a recovery residence disciplinary guidelines that include sanctions for first and subsequent violations of the organization’s code of conduct that allows the recovery residence notice and opportunity to correct a violation and requires the approved certifying organization to revoke the certification of the residence if the required corrective action is not completed within the specified time period;
   11. Respond to and investigate suspected violations of the organization’s code of conduct;
   12. Require an operator who seeks to have a residence certified to submit all of the following documents with the operator’s completed application and fee:
       1. Procedures and requirements for verifying that a resident remains drug and alcohol free;
       2. A prohibition on the premises against alcohol, illegal drugs, or the use of prescribed medications by an individual except as prescribed by a physician and used in accordance with the prescription;
       3. Policies to support a resident’s recovery efforts;
       4. A good neighbor policy to address neighborhood concerns and complaints;
       5. A policy for informing local government officials and neighbors about the approved certification organization’s complaint procedures, the contact number of the operator of the residence, and a contact number of a minimum of one resident assigned with the responsibility of mitigating a complaint;
       6. Rules for residents, copies of forms provided to a resident, relapse policy, fee and refund policies, and eviction procedures and policies;
       7. Proof that the operator of the residence has completed a minimum of 10 hours of alcohol and drug free program management education approved by the approved certifying organization; and,
       8. Proof that a minimum of one resident has received certification approved by the approved certifying organization. Certification must include, at a minimum, the following subjects: ethics, health and safety topics related to addiction recovery and maintenance, and emergency planning procedures.
   13. Review the registry posted on DHCS’s Internet Website to determine whether the residence that the operator has applied to have certified has had a previous certification revoked or the operator submitting the application for certification has operated a residence for which a previous certification has been revoked; and,
   14. Deny an application for certification if the residence address or operator name in the application is listed on the registry and send the applicant a written notice of denial of certification.
9. Requires DHCS to adopt application procedures and standards of approval for an organization that seeks to be approved by DHCS as an approved certifying organization or as an approved national organization.
10. Permits DHCS to conduct periodic reviews of an approved certifying organization to determine whether the organization is in compliance with all applicable laws. Permits DHCS to revoke approval of an approved certifying organization.
11. Permits DHCS to investigate complaints it receives regarding a recovery residence independently or in conjunction with the approved certifying organization and permits DHCS to impose sanctions and commence disciplinary actions, including revoking the certification of a residence as a drug and alcohol free residence.
12. Permits a city, county, city and county, or local law enforcement agency that suspects that a drug and alcohol residence is not operating in compliance with the residence’s code of conduct to request DHCS to revoke the certification of that residence.
13. Requires DHCS to maintain and post on its Internet Website a registry containing all of the following information:
    1. The street address and the name and contact telephone number of the operator of each residence that has been certified as a drug and alcohol free residence pursuant to this section;
    2. The street address of each residence that has had its certification revoked; and,
    3. The name of each operator of a residence that has had its certification revoked.
14. Requires, on and after January 1, 2018, a state agency, state-contracted vendor, county agency, or county-contracted vendor that directs substance abuse treatment, or a judge or parole board that sets terms and conditions for the release, parole, or discharge of a person from custody, if it requires a person to reside in a sober living environment, to refer that person only to a residence listed as a certified drug and alcohol free residence on the registry posted on the DHCS’s Internet Website.

EXISTING LAW:

1. Establishes DHCS as the sole licensing authority for adult alcoholism or drug abuse recovery or treatment facilities. Permits new licenses to be issued for a period of two years, and requires DHCS to conduct onsite program visits for compliance at least once during the two year licensing period.
2. Defines “alcoholism or drug abuse recovery or treatment facility” (treatment facility) as any premise, place, or building that provides 24-hour residential nonmedical services to adults who are recovering from problems related to alcohol, drug, or alcohol and drug misuse or abuse, and who need alcohol, drug, or alcohol and drug recovery treatment or detoxification services.
3. Establishes requirements for application to DHCS for licensure of a facility, requires DHCS to terminate licensure if these requirements are not met, and authorizes DHCS to deny applicants that do not demonstrate an ability to comply with specified requirements.
4. Requires, if an applicant intends to provide incidental medical services, such as obtaining medical histories, monitoring health status, testing associated with detoxification from alcohol or drugs, and overseeing patient self-administered medications, evidence of a valid license of a physician and surgeon who will provide or oversee those services, and any other information deemed appropriate by DHCS, as specified.
5. Permits DHCS to issue single licenses to residential facilities and a facility where separate buildings or portions of a residential facility are integral components of a single treatment facility and all of the components of the facility are managed by the same licensee.
6. Authorizes DHCS to assess civil penalties on facilities that provide alcoholism or drug abuse recovery, treatment, or detoxification services without a license.
7. Requires a treatment facility that serves six or fewer persons to be considered a residential use of property whether or not unrelated persons are living together. Requires the residents and operators of the facility to be considered a family for the purposes of any law or zoning ordinance that relates to the residential use of property.
8. Excludes, for the purposes of local ordinances, a treatment facility that serves six or fewer persons from the definition of a boarding house, rooming house, institution or home for the care of minors, the aged, or persons with mental health disorders, foster care home, guest home, rest home, community residence, or other similar term that implies that the alcoholism or drug abuse recovery or treatment home is a business run for profit or differs in any other way from a single-family residence.
9. Authorizes a city, county, or other local public entity from placing restrictions on building heights, setback, lot dimensions, or placement of signs of a treatment facility that serves six or fewer persons as long as the restrictions are identical to those applied to other single-family residences.
10. Specifies that any local ordinance that deals with health and safety, building standards, environmental impact standards, or any other matter within the jurisdiction of a local public entity also applies to a treatment facility, however, local ordinances cannot distinguish treatment facilities that serve six or fewer persons from other single-family dwellings or distinguish residents of treatment facilities from persons who reside in other single-family dwellings.
11. Prohibits a conditional use permit, zoning variance, or other zoning clearance from being required of an alcoholism or drug abuse recovery or treatment facility that serves six or fewer persons that is not required of a single-family residence in the same zone.
12. Prohibits, under the California Fair Employment and Housing Act (FEHA), discrimination against any person in any housing accommodation on the basis of race, color, religion, sex, marital status, national origin, ancestry, familial status, or disability. Specifies that discriminatory land use regulations, zoning laws, and restrictive covenants are unlawful acts.
13. Prohibits under the federal Americans with Disabilities Act of 1990 (ADA), prohibits discrimination by any public entity by reason of an individual’s disability. Makes it unlawful, under the federal Fair Housing Act, to make unavailable or deny, a dwelling to any buyer or renter because of a disability.

FISCAL EFFECT: This bill has not yet been analyzed by a fiscal committee.

COMMENTS:

1. PURPOSE OF THIS BILL. According to the author, thousands of facilities treat former alcoholics and drug abusers, who are very susceptible to relapse, without possessing any formal credentials. Defining drug and alcohol free residences as a type of treatment facility will not only protect former abusers from relapsing, but will also increase the safety of our communities statewide.
2. BACKGROUND. Alcoholism or drug abuse recovery or treatment facilities provide 24- hour non-medical care and specialize in providing services to chemically dependent adults who do not require treatment in an acute-care medical facility on an inpatient, intensive outpatient, outpatient, and partial hospitalization basis. These facilities range in size from six-bed facilities in residential neighborhoods to centers that accommodate more than 100 beds. The basic services provided by facilities include group, individual and educational sessions, alcoholism or drug abuse recovery and treatment planning. Detoxification services are also provided and are defined by the DHCS as services to support and assist an individual in the alcohol and/or drug withdrawal process and to explore plans for continued treatment. These services can be provided by a variety of health care providers such as alcohol and drug counselors, mental health therapists, social workers, psychologists, nurses and physicians.

From 1976 to 2014, the National Institute on Drug Abuse supported the Community Epidemiology Work Group (CEWG), a network of local drug abuse experts who reported semiannually on drug trends and emerging issues in sentinel sites including major metropolitan areas and some states around the United States.  CEWG monitoring included the cities of Los Angeles, San Diego, and San Francisco. As of 2014, all of the California cities monitored by the CEWG were experiencing an increase in incidences of drug abuse including heroin, prescription drugs and synthetic drug abuse.

• 1. Recent substance use treatment reforms. Medicaid is playing an increasingly important role as a payor for services provided to individuals with SUD in the United States. An estimated 12% of adult Medicaid beneficiaries ages 18-64 have an SUD. The Patient Protection and Affordable Care Act (ACA) included one of the largest expansions of mental health and substance use disorder coverage in a generation by adding mental health and substance use disorder services as an Essential Health Benefit category. In July of 2015, in response to this growing need, the Centers for Medicare & Medicaid Services (CMS) notified states of opportunities to design service delivery systems for individuals with SUD, including a new opportunity for demonstration projects approved under section 1115 of the Social Security Act to ensure that a continuum of care is available to individuals with SUD. Participating states are eligible to receive federal financial participation (FFP) for costs not otherwise matchable, such as services delivered to targeted populations, in limited geographic areas, or in settings that are not otherwise covered under the Medicaid program. On August 13, 2015, DHCS announced that CMS approved California's Drug Medi-Cal Organized Delivery System (DMC-ODS) Waiver. Counties participating in the DMC-ODS waiver program will administer, or arrange for, substance use disorder treatment for Medi-Cal beneficiaries. The DMC-ODS demonstration will be elective for five years.

The DMC-ODS provides a continuum of care modeled after the American Society of Addiction Medicine (ASAM) Criteria for SUD treatment services.  As part of their participation in the DMC-ODS, CMS requires all residential providers to meet the ASAM requirements and obtain a DHCS-issued ASAM designation.  The ASAM criteria is a nationally accepted set of treatment criteria for SUD care and is being adopted beyond Medi-Cal beneficiaries as the SUD industry standard. As of March 14, DHCS has designated 168 residential alcohol and/or other drug treatment facilities with the appropriate ASAM level of care. DHCS has initiated a phased-in implementation of the DMC-ODS and established five regions throughout the state. DHCS determined the order of implementation based on location, population, and county and provider readiness.

1. Phase One, Bay Area: Alameda, Contra Costa, Marin, Monterey, Napa, San Benito, San Francisco, San Mateo, Santa Clara, Santa Cruz, Solano, Sonoma;
2. Phase Two, Kern and Southern California: Kern, Imperial, Los Angeles, Orange, Riverside, San Bernardino, San Diego, San Luis Obispo, Santa Barbara, Ventura;
3. Phase Three, Central and Northern California: Calaveras, Eldorado, Fresno Inyo, Kings, Madera, Merced, Mono, Placer, Sacramento, Stanislaus, Yolo, San Joaquin, Sutter, Tuolumne, Yuba;
4. Phase Four, Northern California: Butte, Colusa, Del Norte, Glenn, Humboldt, Lake, Lassen, Mendocino, Modoc, Nevada, Plumas, Shasta, Siskiyou, Tehama, Trinity; and,
5. Phase Five: Tribal Partners

DHCS has developed a designation program to certify that all providers are certified based on the level of care they are capable of delivering consistent with ASAM Criteria. As part of this designation program, facilities must complete the DHCS ASAM designation questionnaire and will be given a provisional designation. The provisional status of the DHCS ASAM designation will remain on the residential treatment facility license until verification of the designation(s) is completed during an on-site visit. Over the next several months, DHCS will also be adding the ASAM designation process to the initial licensing process; eventually all residential providers will have an ASAM designation.

• 1. ADA, Fair Housing and Equal Protection. The FEHA makes it illegal to engage in various discriminatory practices relating to the sale and rental of housing based on race, color, religion, sex, marital status, national origin, ancestry, familial status, or disability. It also prohibits land use regulations, zoning ordinances, and restrictive covenants from discriminating in housing on the basis of the aforementioned categories. FEHA also states that groups of people with disabilities living together in a single dwelling unit are considered a family.
     
     In addition, the ADA gives civil rights protection to individuals with disabilities, similar to the protection provided to individuals on the basis of race, sex, national origin, and religion. Under these Federal laws, an individual with a “disability” is someone who has a current “physical or mental impairment” that “substantially limits” one or more of that person’s “major life activities,” such as caring for one’s self, working, etc., or as a record of such a substantially limiting impairment, or is regarded as having such an impairment. Specifically, ADA applies to those who have successfully completed a drug rehabilitation program, or who are currently enrolled in such programs..
  2. Pacific Shores Properties v. City of Newport Beach (Pacific shores). In the late 1990s, the number of residential facilities for recovering drug and alcohol abusers began to increase in the City of Newport Beach. By April of 2007, 73 homes existed in the city, only 48 of which were licensed. Among these homes were Pacific Shores Properties LLC, Newport Coast Recovery LLC (NCR), and Yellowstone Women’s First Step House, Inc. (collectively, the “Group Homes”). Pacific Shores and Yellowstone were unlicensed, while NCR provided services to more than seven individuals at a time and was therefore a state-licensed facility. As a result of the increasing number of group homes, the City’s residents began voicing hostile complaints and concerns. In 2008, responding to resident discontent, the City of Newport Beach drafted an ordinance that subjected “residential care facilities” to strict zoning requirements and significantly limiting both the continued existence of group homes and the creation of new ones. These new restrictions had an almost immediate impact on residential treatment facilities, and by 2009, the number of group housing opportunities was reduced by 40% and altogether shutting down about one-third of group homes.  In 2010, the Group Homes filed suit against the City alleging discrimination under the FHA, the ADA, the California FEHA, and the Equal Protection Clause. While the district court ruled in favor of the City of Newport Beach, the Group Homes appealed this decision to the United States Court of Appeals for the Ninth Circuit. In 2013, the Ninth Circuit Court of Appeals reversed the district court’s decision and held that the ordinance enacted by the City of Newport discriminated against residential treatment facilities on the basis of disability, and that its enactment and enforcement harmed a protected class and was therefore in violation of federal law.
  3. Siting Difficulties. A technical assistance publication published by the U.S. Department of Health and Human Services (DHHS) entitled “Siting Drug and Alcohol Treatment Programs: Legal Challenges to the NIMBY Syndrome”, states that community opposition, ‘not in my backyard (NIMBY), prevents or delays the siting of treatment programs, even when an already existing program tries to relocate. NIMBY is often targeted toward other types of health and social service facilities, like shelters for the homeless, group homes for the mentally ill, halfway houses for ex-offenders, and health-related facilities for those with AIDS. According to DHHS, many discriminatory zoning ordinances and practices may be unlawful under the FHA and the ADA. It is also noted that communities often fear the decline of property values and increased crime because of residential treatment facilities in the neighborhood. However, the DHHS document states that in almost every instance a community’s fears are unfounded, as residential treatment facilities pose no danger to the health and welfare of neighbors nor draw substance abusers or pushers to the area.
  4. Facility Accreditation. Two national organizations, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and the Joint Commission on Accreditation of Rehabilitation Facilities (CARF), accredit facilities that provide behavioral health care services such as addiction treatment, opioid treatment and maintenance programs, crisis stabilization, case management and care coordination, employment services and vocational rehabilitation. JCAHO and CARF each require facilities to demonstrate that their programs meet the accrediting organizations’ quality standards in order to obtain accreditation. These quality standards evaluate functions relating to client care and program management, including administrative requirements, financial management, personnel qualifications, client services, performance outcomes, client safety and information privacy and security. JCAHO requires accredited organizations to reapply for accreditation every three years while CARF accreditation ranges from one to five years, depending on the type of facility.

The total number of adult recovery maintenance facilities, sober living homes, or similar entities in the state is not known. According to 2012 data that indicated the two private entities that register sober living homes had registered about 850 sober living homes in the state. However, these organizations indicated that they may be registering as few as one-third of the total number of sober living homes in the state.

1. SUPPORT. Multiple cities write in support of the bill that by requiring that a residence housing individuals purporting to be recovering from drug or alcohol abuse be presumed to be a sober living home if it has been certified, registered or approved by a state-recognized non-profit organization, the state can ensure a sober living home is able to operate within a defined set of guidelines to achieve its purpose and mission, and in a manner that is suitable to its location within a residential neighborhood. The cities argue that the bill assists those individuals with drug or alcohol abuse issues to more readily identify sober living homes that can provide the level and quality of services needed for rehabilitation.

The California Consortium of Addiction Programs and Professionals (CCAPP) write in support of the bill that this measure is necessary in order to allow quality drug and alcohol free residences to continue their important mission, while ridding the system of “homes” that abuse residents and ruin neighborhoods. It will allow local governments to identify quality homes by certification status; register complaints with confidence they will be addressed; and, teach owners, operators, and residents how to build relationships with neighbors in positive ways. CCAPP states that modeled upon California’s counselor certification law/regulations, this bill would utilize private certifying organizations, with qualified staff and long histories of quality assessment of sober living, to approve drug and alcohol free residences for certification and to respond to complaints from the public or local government. To give the bill “teeth,” referrals and reimbursement made from public sources would be tied to certification status. In addition, DHCS would be given authority to revoke certification of any drug and alcohol free residence for which it has found to be not in conformance with national quality standards. CCAPP concludes that private certification, backed by department oversight, with national standards at the helm has the potential to foster quality and reduce the number of “bad actors” doing business in California.

1. OPPOSITION. Western Center on Law and Poverty (Western Center) states in opposition to the bill that it is not in the interest of the State of California to erect barriers to housing for those with special needs. The state has a serious shortage of specialized housing that serves those with barriers – many of whom are coming from state institutions of care. Successful re-integration into the community is crucial to helping those with special needs make a transition to a productive life and it is crucial for the state to have the person succeed to reduce the burden on taxpayers. Western Center concludes that this measure will encourage local governments to create additional barriers that may have the effect of reducing the number of facilities within their jurisdiction. Once one community reduces the number of facilities, there will be tremendous political pressure on neighboring jurisdictions to enact similar bands to avoid over-concentration of facilities in one community.

Cliffside Malibu writes in opposition to the bill that it would have the effect of reducing access to treatment for the state's residents and is contrary to the State's avowed interest in alleviating problems related to addiction and would grant local municipalities new power to force residential treatment facilities from their communities. Cliffside Malibu further states that California's approach to the treatment of alcohol and drug abuse treatment relies, to a significant degree, on thousands of state-licensed six-bed substance abuse treatment facilities in residential communities throughout California. Those programs are supplemented with transitional sober living homes throughout the state. Sober living environments offer safe and structured living situations to bridge the gap between treatment and returning fulltime to independent living. They are necessary because it is detrimental for people in early recovery to return to the people, places, and situations that fueled their addiction. It's also often difficult for people in early recovery to go straight from residential treatment to the potentially hectic atmosphere of their own homes.

1. COMMITTEE COMMENTS.
   1. Local regulation. This bill requires, if a recovery residence is certified within 90 days, the activities at that residence to be deemed a residential use of property and a use of property by a single family. This Committee may wish to consider an amendment clarifying that as a residential use of property, recovery residences should be excluded from local city and county ordinances.
   2. Voluntary certification. As discussed above, individuals recovering from alcohol or drug dependency have been deemed by the court system to be a protected class and have been extended civil rights protections afforded under the ADA and other state laws. If the provisions of this bill required recovery residences to be certified, the measure would single out these individuals, and likely be in violation of federal and state anti-discrimination laws. The Committee may wish to consider an amendment clarifying that certification of a recovery residence is optional under the provisions of this bill, and does not prohibit the operation of establishments which serve six or fewer persons and are deemed residential uses of property.
   3. Existing need for treatment options. Requires, after January 1, 2018, a state agency, county agency, or a judge or parole board that sets terms and conditions for the release, parole, and other entities as specified, when requiring a person to reside in a sober living environment, to refer that person only to a residence listed as a certified drug and alcohol free residence on the registry posted on the DHCS’s Internet Website. Federal data on drug abuse patterns and trends, expanded efforts in the ACA, and a state overhaul of how alcohol and drug treatment services are administered are all indicators of an additional need for treatment facilities. The conditions imposed by this bill are too restrictive and may prevent those persons legitimately seeking treatment for a drug or alcohol problem from receiving such treatment when the treatment is available from a facility that is not certified. The Committee may wish to consider an amendment deleting the provisions of this bill requiring referral to certified recovery residences in specified circumstances.
   4. Sober lifestyle. This bill requires residents, including live-in managers, operators, or owners, to live a "sober lifestyle." It is unclear what that means or why the language is necessary given that the measure already explicitly prohibits alcohol or drug use that is inconsistent with a prescription from a doctor. The Committee may wish to consider if it is appropriate to legislate any kind of lifestyle.
   5. Authority to Revoke.  This bill authorizes DHCS to approve the certifying agencies that would certify recovery residences but also gives authority for DHCS to revoke certification.  However, it is unclear how DHCS can revoke a certification it did not issue.
2. RELATED LEGISLATION.
   1. AB 1915 (Santiago) would establish the Residential Treatment Facility Expansion Fund for the purpose of making grants or loans to residential treatment centers that are expanding services or to substance use disorder treatment service facilities that are expanding to provide residential treatment services. AB 1915 is pending in the Assembly Health Committee.
   2. AB 2403 (Bloom) would require DHCS to issue a single license to a residential or integral alcoholism or drug abuse recovery or treatment facility when specified criteria are met and establishes a definition for integral facilities. AB 2403 is pending in the Assembly Health Committee.
   3. SB 1101 (Wieckowski) would establish new licensing requirements for alcohol and drug counselors and would transfer responsibilities pertaining to alcohol and drug counselor certification and the approval and regulation of certifying organizations from DHCS to the Department of Public Health. SB 1101 is pending in the Senate Health Committee.
   4. SB 1283 (Bates) would require DHCS to licensee and regulate adult recovery maintenance facilities and would establish licensure fees for that purpose. SB 1283 is pending in the Senate Health Committee.
3. PREVIOUS LEGISLATION.
   1. AB 848 (Stone), Chapter 744, Statutes of 2015, authorizes alcoholism and drug treatment facilities to allow a licensed physician, or other health care practitioner, to provide incidental medical services to a resident of the facility and requires DHCS to conduct an evaluation of the program on or before July 1, 2018.
   2. AB 2491 (Nestande) of 2014 would have exempted sober living homes from licensure as an adult alcoholism or drug abuse recovery or treatment facility and required sober living homes to meet specified requirements, including the active participation of residents in legitimate recovery programs and the maintenance of records of meeting attendance. AB 2491 was held under submission in the Senate Appropriations Committee.
   3. AB 1983 (Mansoor) of 2012 would have defined integral alcohol and drug abuse treatment facilities for purposes of licensure by the Department of Alcohol and Drug Programs (DADP) and excluded integral facilities from being considered a residential use of property. AB 1983 failed passage in the Assembly Health Committee.
   4. AB 1284 (Huffman) of 2009 would have required DADP to notify the appropriate city or county planning agency of a proposed facility's application for licensure as a residential treatment facility if it operates as an integral component of an existing licensed facility managed by the same licensee and is located within 300 feet of the existing facility. AB 1284 died on the Assembly Appropriations Committee Suspense File.
      
   5. SB 268 (Harman) of 2009, which was substantially similar to SB 1000 (Harman) of 2008, failed passage in the Assembly Health Committee and was subsequently amended to a different topic.
      
   6. AB 2903 (Huffman) of 2008 would have authorized DADP to require any person or entity applying for licensure to provide specified information to DADP before a license is issued. AB 2903 was held in the Senate Health Committee.
      
   7. SB 1000 (Harman) of 2008 would have required applicants seeking a treatment facility license from DADP to certify that the facility is consistent with local zoning ordinances and would have required DADP to verify the certification. SB 1000 failed passage in the Senate Health Committee.
   8. SB 992 (Wiggins) of 2007 would have required the Department of Alcohol and Drug

Programs to license adult recovery maintenance facilities and applied existing alcohol and drug abuse recovery or treatment facilities licensure requirements to adult recovery maintenance facilities. SB 992 was vetoed by Governor Schwarzenegger.

• 1. AB 724 (Benoit) of 2007 would have defined a sober living home as a residential property that is operated as a cooperative living arrangement to provide an alcohol and drug free environment for persons recovering from alcoholism or drug abuse and meets other specified requirements. AB 724 failed passage in the Senate Health Committee.
     
  2. SB 530 (Dutton) of 2007 would have prohibited DADP from licensing a treatment facility if another treatment facility was located within 300 feet. SB 530 was held in the Senate Health Committee.
     
  3. AB 370 (Adams) of 2007 would have permitted a local government to include a residential care facility serving six or fewer persons, including a sober living facility, within the definition of single family residence. AB 370 died on the Assembly Appropriations Committee Suspense File.
     
  4. AB 3007 (Emmerson) of 2006 would have prohibited DADP from licensing a treatment facility if another treatment facility was located within 300 feet. AB 3007 died on the Assembly Appropriations Committee Suspense File.

REGISTERED SUPPORT / OPPOSITION:

Support

Association of California Cities – Orange County

California Consortium of Addiction Programs and Professionals

California Police Chiefs Association

City of Dana Point

City of Costa Mesa

City of Hemet

City of Laguna Niguel

City of Menifee

City of Rancho Mirage

City of Riverside

City of Whittier

League of California Cities

National Coalition Against Prescription Drug Abuse

Dozens of individuals

Opposition

Cliffside Malibu

Western Center on Law and Poverty

Analysis Prepared by: Paula Villescaz / HEALTH / (916) 319-2097