AB 848: Alcoholism and drug abuse treatment facilities.
- Session Year: 2015-2016
- House: Assembly
- Latest Version Date: 2015-10-10
Existing law requires the State Department of Health Care Services to license adult alcoholism or drug abuse recovery or treatment facilities, as defined. Existing law provides for the licensure and regulation of health care practitioners by various boards and other entities within the Department of Consumer Affairs, and prescribes the scope of practice of those health care practitioners.
This bill would authorize an adult alcoholism or drug abuse recovery or treatment facility that is licensed under those provisions to allow a licensed physician and surgeon or other health care practitioner, as defined, to provide incidental medical services, as defined, to a resident of the facility at the facility premises under specified limited circumstances, including, among others, that the resident signs an admission agreement and a physician and surgeon or other health care practitioner determines that it is medically appropriate for the resident to receive these services. The bill would require the department to establish and collect an additional fee from those facilities, in an amount sufficient to cover the departments reasonable costs of regulating the provision of those services. The bill would require the department, on or before July 1, 2018, to adopt regulations to implement its provisions. The bill would also make related findings and declarations.
Existing law requires the State Department of Health Care Services to license adult alcoholism or drug abuse recovery or treatment facilities, as defined. Existing law provides for the licensure and regulation of health care practitioners by various boards and other entities within the Department of Consumer Affairs, and prescribes the scope of practice of those health care practitioners.
This bill would authorize an adult alcoholism or drug abuse recovery or treatment facility that is licensed under those provisions to allow a licensed physician and surgeon or other health care practitioner, as defined, to provide incidental medical services, as defined, to a resident of the facility at the facility premises under specified limited circumstances, including, among others, that the resident signs an admission agreement and a physician and surgeon or other health care practitioner determines that it is medically appropriate for the resident to receive these services. The bill would require the department to establish and collect an additional fee from those facilities, in an amount sufficient to cover the departments reasonable costs of regulating the provision of those services. The bill would require the department, on or before July 1, 2018, to adopt regulations to implement its provisions. The bill would also make related findings and declarations.
Existing law requires the State Department of Health Care Services to license adult alcoholism or drug abuse recovery or treatment facilities, as defined. Existing law provides for the licensure and regulation of health care practitioners by various boards and other entities within the Department of Consumer Affairs, and prescribes the scope of practice of those health care practitioners.
This bill would authorize an adult alcoholism or drug abuse recovery or treatment facility that is licensed under those provisions to allow a licensed physician and surgeon or other health care practitioner, as defined, to provide incidental medical services services, as defined, to a resident of the facility at the facility premises under specified limited circumstances. circumstances, including, among others, that the resident signs an admission agreement and a physician and surgeon or other health care practitioner determines that it is medically appropriate for the resident to receive these services. The bill would require the department to establish and collect an additional fee from those facilities, in an amount sufficient to cover the departments reasonable costs of regulating the provision of those services. The bill would require the department, on or before July 1, 2018, to adopt regulations to implement its provisions. The bill would also make related findings and declarations.
Existing law requires the State Department of Health Care Services to license adult alcoholism or drug abuse recovery or treatment facilities, as defined. Existing law provides for the licensure and regulation of health care practitioners by various boards and other entities within the Department of Consumer Affairs, and prescribes the scope of practice of those health care practitioners.
This bill would authorize an adult alcoholism or drug abuse recovery or treatment facility that is licensed under those provisions to allow a licensed physician and surgeon or other health care practitioner, as defined, to provide incidental medical services to a resident of the facility at the facility premises under specified limited circumstances. The bill would require the department to establish and collect an additional fee from those facilities, in an amount sufficient to cover the departments reasonable costs of regulating the provision of those services. The bill would also make related findings and declarations.
Existing law requires the State Department of Health Care Services to license adult alcoholism or drug abuse recovery or treatment facilities, as defined. Existing law provides for the licensure and regulation of health care practitioners by various boards and other entities within the Department of Consumer Affairs, and prescribes the scope of practice of those health care practitioners.
This bill would authorize an adult alcoholism or drug abuse recovery or treatment facility that is licensed under those provisions to allow a licensed physician and surgeon or other health care practitioner, as defined, to provide incidental medical services to a resident of the facility at the facility premises under specified limited circumstances. The bill would require the department to establish and collect an additional fee from those facilities, in an amount sufficient to cover the departments reasonable costs of regulating the provision of those services. The bill would also make related findings and declarations.
Existing law requires the State Department of Health Care Services to license adult alcoholism or drug abuse recovery or treatment facilities, as defined. Existing law provides for the licensure and regulation of health care practitioners by various boards and other entities within the Department of Consumer Affairs, and prescribes the scope of practice of those health care practitioners.
This bill would authorize a an adult alcoholism or drug abuse recovery or treatment facility that is licensed under those provisions to allow a licensed physician and surgeon or other health care practitioner, as defined, to provide incidental medical services to a resident of the facility at the facility premises under specified limited circumstances. The bill would require the department to establish and collect an additional fee from those facilities, in an amount sufficient to cover the departments reasonable costs of regulating the provision of those services. The bill would also make related findings and declarations.
Existing law requires the State Department of Health Care Services to license adult alcoholism or drug abuse recovery or treatment facilities, as defined. Existing law provides for the licensure and regulation of health care practitioners by various boards and other entities within the Department of Consumer Affairs, and prescribes the scope of practice of those health care practitioners.
This bill would authorize a facility that is licensed under those provisions to allow a licensed physician and surgeon or other health care practitioner, as defined, to provide incidental medical services to a resident of the facility at the facility premises under specified limited circumstances. The bill would require the department to conduct an evaluation of that program, and, on or before January 1, 2019, to report that evaluation to the appropriate fiscal and policy committees of the Legislature. The bill would also make related findings and declarations.
Existing law requires the State Department of Health Care Services to license adult alcoholism and or drug abuse recovery or treatment facilities, as defined. Existing law provides for the licensure and regulation of health care practitioners by various boards and other entities within the Department of Consumer Affairs, and prescribes the scope of practice of those health care practitioners.
This bill would authorize a facility that is licensed under those provisions to allow a licensed physician and surgeon or other health care practitioner, as defined, to provide incidental medical services to a resident of the facility at the facility premises under specified limited circumstances. The bill would require the department to conduct an evaluation of that program, and, on or before January 1, 2019, to report that evaluation to the appropriate fiscal and policy committees of the Legislature. The bill would also make related findings and declarations.
Existing law requires the State Department of Health Care Services to license adult alcoholism and drug abuse recovery or treatment facilities, as defined. Existing law provides for the licensure and regulation of health care practitioners by various boards and other entities within the Department of Consumer Affairs, and prescribes the scope of practice of those health care practitioners.
This bill would authorize a facility to allow a licensed physician and surgeon or other health care practitioner, as defined, to provide incidental medical services to a resident of the facility at the facility premises under specified limited circumstances. The bill would require the department to conduct an evaluation of that program, and, on or before January 1, 2019, to report that evaluation to the appropriate fiscal and policy committees of the Legislature. The bill would also make related findings and declarations.
The Legislature hereby finds and declares all of the following:
(a)Substance abuse is a medical condition requiring interdisciplinary treatment including, when medically necessary, treatment by a licensed physician and surgeon.
(b)Subsequent to the enactment of state law licensing and regulating residential facilities providing alcohol and other drug detoxification treatment, public knowledge of addiction and treatment has advanced significantly.
(c)Lack of scientific understanding at the time of enactment of those state laws prevents the State Department of Health Care Services from licensing a residential treatment facility that uses a California-licensed physician and surgeon to provide necessary evaluation and treatment at the facility premises.
(d)This prohibition has been found to endanger persons in treatment, can result in treatment below the recognized standard of care, jeopardizes patient health, and delays patient recovery.
(e)To resolve this problem, it is the intent of the Legislature to enact this act in order to modernize and update state law and allow those in treatment to be protected and to receive modern medical treatment for a medical condition.
SEC. 2.Section 11834.025 is added to the Health and Safety Code, to read:11834.025.(a)(1)As a condition of providing incidental medical services, as defined in subdivision (a) of Section 11834.026, at a facility licensed by the department, the facility, within a reasonable period of time, as defined by the department in regulations, shall obtain from each program participant, a signed certification described in subdivision (b) from a health care practitioner.
(2)For purposes of this chapter, health care practitioner means a person duly licensed and regulated under Division 2 (commencing with Section 500) of the Business and Professions Code, who is acting within the scope of practice of his or her license or certificate.
(b)The department shall develop a standard certification form for use by a health care practitioner. The form shall include, but not be limited to, a description of the alcoholism and drug abuse recovery or treatment services that an applicant needs.
(c)(1)The department shall adopt regulations, on or before July 1, 2018, to implement this section. The regulations shall be adopted in accordance with the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code).
(2)Notwithstanding the rulemaking provisions of the Administrative Procedure Act, the department may, if it deems appropriate, implement, interpret, or make specific this section by means of provider bulletins, written guidelines, or similar instructions from the department only until the department adopts regulations.
SEC. 3.Section 11834.026 is added to the Health and Safety Code, to read:11834.026.(a)As used in this section, incidental medical services means services that are in compliance with the community standard of practice and are not required to be performed in a licensed clinic or licensed health facility, as defined by Section 1200 or 1250, respectively, to address medical issues associated with either detoxification from alcohol or drugs or the provision of alcoholism or drug abuse recovery or treatment services, including all of the following categories of services that the department shall further define by regulation:
(1)Obtaining medical histories.
(2)Monitoring health status to determine whether the health status warrants transfer of the patient in order to receive urgent or emergent care.
(3)Testing associated with detoxification from alcohol or drugs.
(4)Providing alcoholism or drug abuse recovery or treatment services.
(5)Overseeing patient self-administered medications.
(6)Treating substance abuse disorders, including detoxification.
(b)Incidental medical services do not include the provision of general primary medical care.
(c)Notwithstanding any other law, a licensed alcoholism or drug abuse recovery or treatment facility may permit incidental medical services to be provided to a resident at the facility premises by, or under the supervision of, one or more physicians and surgeons licensed by the Medical Board of California or the Osteopathic Medical Board who are knowledgeable about addiction medicine, or one or more other health care practitioners acting within the scope of practice of his or her license and under the direction of a physician and surgeon, and who are also knowledgeable about addiction medicine, if all of the following conditions are met:
(1)The facility, in the judgment of the department, has the ability to comply with the requirements of this chapter and all other applicable laws and regulations to meet the needs of a resident receiving incidental medical services pursuant to this chapter. The department shall specify in regulations the minimum requirements that a facility shall meet in order to be approved to permit the provision of incidental medical services on its premises. The license of a facility approved to permit the provision of incidental medical services shall reflect that those services are permitted at the facility premises.
(2)The physician and surgeon and any other health care practitioner has signed an acknowledgment on a form provided by the department that he or she has been advised of and understands the statutory and regulatory limitations on the services that may legally be provided at a licensed alcoholism or drug abuse recovery or treatment facility and the statutory and regulatory requirements and limitations for the physician and surgeon or other health care practitioner and for the facility, related to providing incidental medical services. The licensee shall maintain a copy of the signed form at the facility for a physician and surgeon or other health care practitioner providing incidental medical services at the facility premises.
(3)A physician and surgeon or other health care practitioner shall assess a resident, prior to that resident receiving incidental medical services, to determine whether it is medically appropriate for that resident to receive these services at the premises of the licensed facility. A copy of the form provided by the department shall be signed by the physician and surgeon and maintained in the residents file at the facility.
(4)The resident has signed an admission agreement. The admission agreement, at a minimum, shall describe the incidental medical services that the facility may permit to be provided and shall state that the permitted incidental medical services will be provided by, or under the supervision of, a physician and surgeon. The department shall specify in regulations, at a minimum, the content and manner of providing the admission agreement, and any other information that the department deems appropriate. The facility shall maintain a copy of the signed admission agreement in the residents file.
(5)Once incidental medical services are initiated for a resident, the physician and surgeon and facility shall monitor the resident to ensure that the resident remains appropriate to receive those services. If the physician and surgeon determines that a change in the residents medical condition requires other medical services or that a higher level of care is required, the facility shall immediately arrange for the other medical services or higher level of care, as appropriate.
(6)The facility maintains in its files a copy of the relevant professional license or other written evidence of licensure to practice medicine or perform medical services in the state for the physician and surgeon and any other health care practitioner providing incidental medical services at the facility.
(d)The department is not required to evaluate or have any responsibility or liability with respect to evaluating the incidental medical services provided by a physician and surgeon or other health care practitioner at a licensed facility. This section does not limit the departments ability to report suspected misconduct by a physician and surgeon or other health care practitioner to the appropriate licensing entity or to law enforcement.
(e)A facility licensed and approved by the department to allow provision of incidental medical services shall not by offering approved incidental medical services be deemed a clinic or health facility within the meaning of Section 1200 or 1250, respectively.
(f)Other than incidental medical services permitted to be provided or any urgent or emergent care required in the case of a life threatening emergency, this section does not authorize the provision at the premises of the facility of any medical or health care services or any other services that require a higher level of care than the care that may be provided within a licensed alcoholism or drug abuse recovery or treatment facility.
(g)This section does not require a residential treatment facility licensed by the department to provide incidental medical services or any services not otherwise permitted by law.
(h)(1)On or before July 1, 2018, the department shall adopt regulations to implement this section in accordance with the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code).
(2)Notwithstanding the rulemaking provisions of the Administrative Procedure Act, the department may, if it deems appropriate, implement, interpret, or make specific this section by means of provider bulletins, written guidelines, or similar instructions from the department until regulations are adopted.
SEC. 4.Section 11834.03 of the Health and Safety Code is amended to read:11834.03.(a)A person or entity applying for licensure shall file with the department, on forms provided by the department, all of the following:
(1)A completed written application for licensure.
(2)A fire clearance approved by the State Fire Marshal or local fire enforcement officer.
(3)A licensure fee, established in accordance with Chapter 7.3 (commencing with Section 11833.01).
(b)(1)If an applicant intends to permit services pursuant to Section 11834.026, the applicant shall submit evidence of a valid license of the physician and surgeon who will provide or oversee those services, and any other information the department deems appropriate.
(2)The department shall establish and collect an additional licensure fee for an application that includes a request to provide services pursuant to Section 11834.026. The fee shall be set at an amount sufficient to cover the reasonable costs to the department of the additional assessment and investigation necessary to license facilities to provide these services, including, but not limited to, processing applications, issuing licenses, and investigating reports of noncompliance with licensing regulations.
SEC. 5.Section 11834.36 of the Health and Safety Code is amended to read:11834.36.(a)The director may suspend or revoke any license issued under this chapter, or deny an application for licensure, extension of the licensing period, or modification to a license, upon any of the following grounds and in the manner provided in this chapter:
(1)Violation by the licensee of any provision of this chapter or regulations adopted pursuant to this chapter.
(2)Repeated violation by the licensee of any of the provisions of this chapter or regulations adopted pursuant to this chapter.
(3)Aiding, abetting, or permitting the violation of, or any repeated violation of, any of the provisions described in paragraph (1) or (2).
(4)Conduct in the operation of an alcoholism or drug abuse recovery or treatment facility that is inimical to the health, morals, welfare, or safety of either an individual in, or receiving services from, the facility or to the people of the State of California.
(5)Misrepresentation of any material fact in obtaining the alcoholism or drug abuse recovery or treatment facility license, including, but not limited to, providing false information or documentation to the department.
(6)The licensees refusal to allow the department entry into the facility to determine compliance with the requirements of this chapter or regulations adopted pursuant to this chapter.
(7)Violation by the licensee of Section 11834.026 or the regulations adopted pursuant to that section.
(8)Failure to pay any civil penalties assessed by the department.
(b)The director may temporarily suspend any license prior to any hearing when, in the opinion of the director, the action is necessary to protect residents of the alcoholism or drug abuse recovery or treatment facility from physical or mental abuse, abandonment, or any other substantial threat to health or safety. The director shall notify the licensee of the temporary suspension and the effective date of the temporary suspension and at the same time shall serve the provider with an accusation. Upon receipt of a notice of defense to the accusation by the licensee, the director shall, within 15 days, set the matter for hearing, and the hearing shall be held as soon as possible. The temporary suspension shall remain in effect until the time the hearing is completed and the director has made a final determination on the merits. However, the temporary suspension shall be deemed vacated if the director fails to make a final determination on the merits within 30 days after the department receives the proposed decision from the Office of Administrative Hearings.
The Legislature hereby finds and declares all of the following:
(a)Substance abuse is a medical condition requiring interdisciplinary treatment including, when medically necessary, treatment by a licensed physician and surgeon.
(b)Subsequent to the enactment of state law licensing and regulating residential facilities providing alcohol and other drug detoxification treatment, public knowledge of addiction and treatment has advanced significantly.
(c)Lack of scientific understanding at the time of enactment of those state laws prevents the State Department of Health Care Services from licensing a residential treatment facility that uses a California-licensed physician and surgeon to provide necessary evaluation and treatment at the facility premises.
(d)This prohibition has been found to endanger persons in treatment, can result in treatment below the recognized standard of care, jeopardizes patient health, and delays patient recovery.
(e)To resolve this problem, it is the intent of the Legislature to enact this act in order to modernize and update state law and allow those in treatment to be protected and to receive modern medical treatment for a medical condition.
SEC. 2.Section 11834.025 is added to the Health and Safety Code, to read:11834.025.(a)(1)As a condition of providing incidental medical services, as defined in subdivision (a) of Section 11834.026, at a facility licensed by the department, the facility, within a reasonable period of time, as defined by the department in regulations, shall obtain from each program participant, a signed certification described in subdivision (b) from a health care practitioner.
(2)For purposes of this chapter, health care practitioner means a person duly licensed and regulated under Division 2 (commencing with Section 500) of the Business and Professions Code, who is acting within the scope of practice of his or her license or certificate.
(b)The department shall develop a standard certification form for use by a health care practitioner. The form shall include, but not be limited to, a description of the alcoholism and drug abuse recovery or treatment services that an applicant needs.
(c)(1)The department shall adopt regulations, on or before July 1, 2018, to implement this section. The regulations shall be adopted in accordance with the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code).
(2)Notwithstanding the rulemaking provisions of the Administrative Procedure Act, the department may, if it deems appropriate, implement, interpret, or make specific this section by means of provider bulletins, written guidelines, or similar instructions from the department only until the department adopts regulations.
SEC. 3.Section 11834.026 is added to the Health and Safety Code, to read:11834.026.(a)As used in this section, incidental medical services means services that are in compliance with the community standard of practice and are not required to be performed in a licensed clinic or licensed health facility, as defined by Section 1200 or 1250, respectively, to address medical issues associated with either detoxification from alcohol or drugs or the provision of alcoholism or drug abuse recovery or treatment services, including all of the following categories of services that the department shall further define by regulation:
(1)Obtaining medical histories.
(2)Monitoring health status to determine whether the health status warrants transfer of the patient in order to receive urgent or emergent care.
(3)Testing associated with detoxification from alcohol or drugs.
(4)Providing alcoholism or drug abuse recovery or treatment services.
(5)Overseeing patient self-administered medications.
(6)Treating substance abuse disorders, including detoxification.
(b)Incidental medical services do not include the provision of general primary medical care.
(c)Notwithstanding any other law, a licensed alcoholism or drug abuse recovery or treatment facility may permit incidental medical services to be provided to a resident at the facility premises by, or under the supervision of, one or more physicians and surgeons licensed by the Medical Board of California or the Osteopathic Medical Board who are knowledgeable about addiction medicine, or one or more other health care practitioners acting within the scope of practice of his or her license and under the direction of a physician and surgeon, and who are also knowledgeable about addiction medicine, if all of the following conditions are met:
(1)The facility, in the judgment of the department, has the ability to comply with the requirements of this chapter and all other applicable laws and regulations to meet the needs of a resident receiving incidental medical services pursuant to this chapter. The department shall specify in regulations the minimum requirements that a facility shall meet in order to be approved to permit the provision of incidental medical services on its premises. The license of a facility approved to permit the provision of incidental medical services shall reflect that those services are permitted at the facility premises.
(2)The physician and surgeon and any other health care practitioner has signed an acknowledgment on a form provided by the department that he or she has been advised of and understands the statutory and regulatory limitations on the services that may legally be provided at a licensed alcoholism or drug abuse recovery or treatment facility and the statutory and regulatory requirements and limitations for the physician and surgeon or other health care practitioner and for the facility, related to providing incidental medical services. The licensee shall maintain a copy of the signed form at the facility for a physician and surgeon or other health care practitioner providing incidental medical services at the facility premises.
(3)A physician and surgeon or other health care practitioner shall assess a resident, prior to that resident receiving incidental medical services, to determine whether it is medically appropriate for that resident to receive these services at the premises of the licensed facility. A copy of the form provided by the department shall be signed by the physician and surgeon and maintained in the residents file at the facility.
(4)The resident has signed an admission agreement. The admission agreement, at a minimum, shall describe the incidental medical services that the facility may permit to be provided and shall state that the permitted incidental medical services will be provided by, or under the supervision of, a physician and surgeon. The department shall specify in regulations, at a minimum, the content and manner of providing the admission agreement, and any other information that the department deems appropriate. The facility shall maintain a copy of the signed admission agreement in the residents file.
(5)Once incidental medical services are initiated for a resident, the physician and surgeon and facility shall monitor the resident to ensure that the resident remains appropriate to receive those services. If the physician and surgeon determines that a change in the residents medical condition requires other medical services or that a higher level of care is required, the facility shall immediately arrange for the other medical services or higher level of care, as appropriate.
(6)The facility maintains in its files a copy of the relevant professional license or other written evidence of licensure to practice medicine or perform medical services in the state for the physician and surgeon and any other health care practitioner providing incidental medical services at the facility.
(d)The department is not required to evaluate or have any responsibility or liability with respect to evaluating the incidental medical services provided by a physician and surgeon or other health care practitioner at a licensed facility. This section does not limit the departments ability to report suspected misconduct by a physician and surgeon or other health care practitioner to the appropriate licensing entity or to law enforcement.
(e)A facility licensed and approved by the department to allow provision of incidental medical services shall not by offering approved incidental medical services be deemed a clinic or health facility within the meaning of Section 1200 or 1250, respectively.
(f)Other than incidental medical services permitted to be provided or any urgent or emergent care required in the case of a life threatening emergency, this section does not authorize the provision at the premises of the facility of any medical or health care services or any other services that require a higher level of care than the care that may be provided within a licensed alcoholism or drug abuse recovery or treatment facility.
(g)This section does not require a residential treatment facility licensed by the department to provide incidental medical services or any services not otherwise permitted by law.
(h)(1)On or before July 1, 2018, the department shall adopt regulations to implement this section in accordance with the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code).
(2)Notwithstanding the rulemaking provisions of the Administrative Procedure Act, the department may, if it deems appropriate, implement, interpret, or make specific this section by means of provider bulletins, written guidelines, or similar instructions from the department until regulations are adopted.
SEC. 4.Section 11834.03 of the Health and Safety Code is amended to read:11834.03.(a)A person or entity applying for licensure shall file with the department, on forms provided by the department, all of the following:
(1)A completed written application for licensure.
(2)A fire clearance approved by the State Fire Marshal or local fire enforcement officer.
(3)A licensure fee, established in accordance with Chapter 7.3 (commencing with Section 11833.01).
(b)(1)If an applicant intends to permit services pursuant to Section 11834.026, the applicant shall submit evidence of a valid license of the physician and surgeon who will provide or oversee those services, and any other information the department deems appropriate.
(2)The department shall establish and collect an additional licensure fee for an application that includes a request to provide services pursuant to Section 11834.026. The fee shall be set at an amount sufficient to cover the reasonable costs to the department of the additional assessment and investigation necessary to license facilities to provide these services, including, but not limited to, processing applications, issuing licenses, and investigating reports of noncompliance with licensing regulations.
SEC. 5.Section 11834.36 of the Health and Safety Code is amended to read:11834.36.(a)The director may suspend or revoke any license issued under this chapter, or deny an application for licensure, extension of the licensing period, or modification to a license, upon any of the following grounds and in the manner provided in this chapter:
(1)Violation by the licensee of any provision of this chapter or regulations adopted pursuant to this chapter.
(2)Repeated violation by the licensee of any of the provisions of this chapter or regulations adopted pursuant to this chapter.
(3)Aiding, abetting, or permitting the violation of, or any repeated violation of, any of the provisions described in paragraph (1) or (2).
(4)Conduct in the operation of an alcoholism or drug abuse recovery or treatment facility that is inimical to the health, morals, welfare, or safety of either an individual in, or receiving services from, the facility or to the people of the State of California.
(5)Misrepresentation of any material fact in obtaining the alcoholism or drug abuse recovery or treatment facility license, including, but not limited to, providing false information or documentation to the department.
(6)The licensees refusal to allow the department entry into the facility to determine compliance with the requirements of this chapter or regulations adopted pursuant to this chapter.
(7)Violation by the licensee of Section 11834.026 or the regulations adopted pursuant to that section.
(8)Failure to pay any civil penalties assessed by the department.
(b)The director may temporarily suspend any license prior to any hearing when, in the opinion of the director, the action is necessary to protect residents of the alcoholism or drug abuse recovery or treatment facility from physical or mental abuse, abandonment, or any other substantial threat to health or safety. The director shall notify the licensee of the temporary suspension and the effective date of the temporary suspension and at the same time shall serve the provider with an accusation. Upon receipt of a notice of defense to the accusation by the licensee, the director shall, within 15 days, set the matter for hearing, and the hearing shall be held as soon as possible. The temporary suspension shall remain in effect until the time the hearing is completed and the director has made a final determination on the merits. However, the temporary suspension shall be deemed vacated if the director fails to make a final determination on the merits within 30 days after the department receives the proposed decision from the Office of Administrative Hearings.
The Legislature hereby finds and declares all of the following:
(a)Substance abuse is a medical condition requiring interdisciplinary treatment including, when medically necessary, treatment by a licensed physician and surgeon.
(b)Subsequent to the enactment of state law licensing and regulating residential facilities providing alcohol and other drug detoxification treatment, public knowledge of addiction and treatment has advanced significantly.
(c)Lack of scientific understanding at the time of enactment of those state laws prevents the State Department of Health Care Services from licensing a residential treatment facility that uses a California-licensed physician and surgeon to provide necessary evaluation and treatment at the facility premises.
(d)This prohibition has been found to endanger persons in treatment, can result in treatment below the recognized standard of care, jeopardizes patient health, and delays patient recovery.
(e)To resolve this problem, it is the intent of the Legislature to enact this act in order to modernize and update state law and allow those in treatment to be protected and to receive modern medical treatment for a medical condition.
SEC. 2.Section 11834.025 is added to the Health and Safety Code, to read:11834.025.(a)(1)As a condition of providing incidental medical services, as defined in subdivision (a) of Section 11834.026, at a facility licensed by the department, the facility facility, within a reasonable period of time, as defined by the department in regulations, shall obtain from an applicant for services each program participant, a signed certification described in subdivision (b) from a health care practitioner.
(2)For purposes of this chapter, health care practitioner means a person duly licensed and regulated under Division 2 (commencing with Section 500) of the Business and Professions Code, who is acting within the scope of practice of his or her license or certificate.
(b)The department shall develop a standard certification form for use by a health care practitioner. The form shall include, but not be limited to, a description of the alcoholism and drug abuse recovery or treatment services that an applicant needs.
(c)(1)The department shall adopt regulations, on or before July 1, 2017, 2018, to implement this section. The regulations shall be adopted in accordance with the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code).
(2)Notwithstanding the rulemaking provisions of the Administrative Procedure Act, the department may, if it deems appropriate, implement, interpret, or make specific this section by means of provider bulletins, written guidelines, or similar instructions from the department only until the department adopts regulations.
SEC. 3.Section 11834.026 is added to the Health and Safety Code, to read:11834.026.(a)As used in this section, incidental medical services means services, as specified by the department in regulations, services that are in compliance with the community standard of practice and are not required to be performed in a licensed clinic or licensed health facility, as defined by Section 1200 or 1250, respectively, to address physical and mental health medical issues associated with either detoxification from alcohol or drugs or the provision of alcoholism or drug abuse recovery or treatment services, that in the opinion of a physician are not required to be performed in a licensed clinic or a general acute care hospital, as defined in Section 1200 or 1250, respectively, or a medically managed inpatient treatment program. including all of the following categories of services that the department shall further define by regulation:
(1)Obtaining medical histories.
(2)Monitoring health status to determine whether the health status warrants transfer of the patient in order to receive urgent or emergent care.
(3)Testing associated with detoxification from alcohol or drugs.
(4)Providing alcoholism or drug abuse recovery or treatment services.
(5)Overseeing patient self-administered medications.
(6)Treating substance abuse disorders, including detoxification.
(b)Incidental medical services do not include the provision of general primary medical care.
(b)
(c)Notwithstanding any other law, a licensed alcoholism or drug abuse recovery or treatment facility may permit incidental medical services to be provided to a resident at the facility premises by by, or under the supervision of, one or more independent physicians and surgeons licensed by the Medical Board of California or the Osteopathic Medical Board who are knowledgeable about addiction medicine, or one or more other health care practitioners acting within the scope of practice of his or her license and under the direction of a physician and surgeon, and who are also knowledgeable about addiction medicine, when if all of the following conditions are met:
(1)The facility, in the judgment of the department, has the ability to comply with the requirements of this chapter, to provide any level of care between Level 3.1 and Level 3.7 of the American Society of Addiction Medicine criteria, and to comply with chapter and all other applicable laws and regulations to meet the needs of a resident receiving incidental medical services from a physician pursuant to this chapter. The department shall specify in regulations the minimum requirements that a facility shall meet in order to be approved to permit the provision of incidental medical services on its premises. The license of a facility approved to provide permit the provision of incidental medical services shall reflect that those services are permitted to be provided at the facility premises.
(2)The physician and surgeon and any other health care practitioner has signed an acknowledgment on a form provided by the department that he or she has been advised of and understands the statutory and regulatory limitations on the services that may legally be provided by at a licensed alcoholism or drug abuse recovery or treatment facility that is providing any level of care between Level 3.1 and Level 3.7 of the American Society of Addiction Medicine criteria, and the statutory and regulatory requirements and limitations for the physician and surgeon or other health care protection practitioner and for the facility, related to providing incidental medical services. The licensee shall maintain a copy of the signed form at the facility for a physician and surgeon or other health care practitioner providing incidental medical services at the facility premises.
(3)There is an agreed-upon written protocol between the physician and surgeon and the alcoholism or drug abuse recovery or treatment facility signed by the physician and surgeon and the licensee. The protocol shall address, at a minimum, the respective areas of responsibility of the physician and surgeon and the facility and the need for communicating and sharing resident information related to the physician and surgeon providing incidental medical services. The department shall specify by regulations the issues that shall be addressed and the information that shall be included in the protocol. The facility shall maintain a copy of the signed protocol at the facility.
(4)The facility in its admissions agreement with a client shall clearly identify the individual financially responsible for incidental medical services provided and the manner in which those services shall be billed.
(5)There is ongoing communication between the physician and the alcoholism or drug abuse recovery or treatment facility about the services provided to the resident by the physician and surgeon and the frequency and duration of incidental medical services to be provided. Resident information shall be shared between the physician and surgeon and the alcoholism or drug abuse recovery or treatment facility regarding the resident's need for incidental medical services and the services to be provided to the resident by the physician and surgeon, including, but not limited to, medical information, as defined by the Confidentiality of Medical Information Act (Part 2.6 (commencing with Section 56) of Division 1 of the Civil Code). The department shall specify by regulations any other requirements or limitations on these communications.
(6)There is initial and ongoing communication between the physician and surgeon or other health care practitioner and the residents health plan or health insurer prior to the provision of incidental medical services, to the extent allowable by state and federal privacy and confidentiality laws, to ensure coordination of care.
(7)The facility does not interfere with the physician and surgeon or other health care practitioner providing incidental medical services.
(8)In addition to any other medical authorization that may be required before a facility resident receives incidental medical services, the resident is authorized by the physician and surgeon as medically appropriate to receive the incidental medical services at the premises of the licensed facility. A
(3)A physician and surgeon or other health care practitioner shall assess a resident, prior to that resident receiving incidental medical services, to determine whether it is medically appropriate for that resident to receive these services at the premises of the licensed facility. A copy of the authorization, on a form provided by the department, department shall be signed by the physician and surgeon and maintained in the residents file at the facility.
(9)Before a facility resident receives incidental medical services, the resident
(4)The resident has signed an acknowledgment and consent to receive those services on a form provided by the department. admission agreement. The form, admission agreement, at a minimum, shall describe the incidental medical services that the facility may permit to be provided and shall state that the permitted incidental medical services will be provided by by, or under the supervision of, a physician and surgeon or other health care practitioner working under the direction of the physician and surgeon. The department shall specify in regulations, at a minimum, the content and manner of providing the form, admission agreement, and any other information that the department deems appropriate. The facility shall maintain a copy of the signed acknowledgment and consent admission agreement in the residents file.
(10)
(5)Once incidental medical services are initiated for a resident, the physician and surgeon and facility shall continuously monitor the resident to ensure that the resident remains appropriate to receive those services. If the physician and surgeon determines that a change in the residents medical or psychiatric condition requires other medical or psychiatric services or that a higher level of care is required than the facility may legally provide, the physician and surgeon required, the facility shall immediately notify the licensee and shall assist the licensee to initiate emergency care, urgent care, or other arrange for the other medical services or higher level of care, as appropriate. If the licensee believes that a resident requires a higher level of care than the facility can legally provide, the licensee shall immediately notify the physician and surgeon and the department. The department shall specify by regulations any other requirements or limitations pertaining to changes in condition of a resident who is receiving incidental medical services, and any other requirements the department deems appropriate.
(11)
(6)The facility maintains in its files a copy of the physician and surgeons license relevant professional license or other written evidence of licensure to practice medicine in the state. or perform medical services in the state for the physician and surgeon and any other health care practitioner providing incidental medical services at the facility.
(12)The physician and surgeon and the facility both maintain compliance with the departments regulations relating to providing incidental medical services.
(c)The facility shall report to the department in a timely manner any violation of the regulations relating to providing incidental medical services or the signed protocol described in paragraph (3) of subdivision (b). The department shall specify in regulations, at a minimum, the steps required to be taken when the department substantiates that information provided by the licensee.
(d)Nothing in this section requires a facility to provide incidental medical services or any services beyond those otherwise permitted by this chapter.
(e)
(d)The department shall is not required to evaluate or have any responsibility or liability with respect to evaluating the incidental medical services provided. provided by a physician and surgeon or other health care practitioner at a licensed facility. This section does not limit the departments ability to report suspected misconduct by a physician and surgeon or other health care practitioner to the appropriate licensing entity or to law enforcement.
(f)
(e)A facility licensed and approved by the department to allow provision of incidental medical services shall not by offering approved incidental medical services be considered deemed a clinic or health facility within the meaning of Section 1200 or 1250, respectively.
(g)
(f)Other than incidental medical services, including those provided at any level between Level 3.1 and Level 3.7 of the American Society of Addiction Medicine criteria, minor first aid, services permitted to be provided or any urgent or emergent care required in the case of a life threatening emergency, this section does not authorize the provision at the premises of the facility of any medical or health care services or any other services that require a higher level of care than the care that may be provided within a licensed alcoholism or drug abuse recovery or treatment facility.
(g)This section does not require a residential treatment facility licensed by the department to provide incidental medical services or any services not otherwise permitted by law.
(h)(1)On or before July 1, 2017, 2018, the department shall adopt regulations to implement this section in accordance with the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code).
(2)Notwithstanding the rulemaking provisions of the Administrative Procedure Act, the department may, if it deems appropriate, implement, interpret, or make specific this section by means of provider bulletins, written guidelines, or similar instructions from the department until regulations are adopted.
SEC. 4.Section 11834.03 of the Health and Safety Code is amended to read:11834.03.(a)A person or entity applying for licensure shall file with the department, on forms provided by the department, all of the following:
(1)A completed written application for licensure.
(2)A fire clearance approved by the State Fire Marshal or local fire enforcement officer.
(3)A licensure fee, established in accordance with Chapter 7.3 (commencing with Section 11833.01).
(b)(1)If an applicant intends to permit services pursuant to Section 11834.026, the applicant shall submit a copy of the written protocol, evidence of a valid license of the physician and surgeon who will provide or oversee those services, and any other information the department deems appropriate, including, but not limited to, a copy of the alcoholism or drug abuse recovery or treatment facilitys accreditation by a nationally recognized accrediting organization that evaluates the level of services provided, if the facility is accredited. appropriate.
(2)The department shall establish and collect an additional licensure fee for an application that includes a request to provide services pursuant to Section 11834.026. The fee shall be set at an amount sufficient to cover the departments reasonable costs of regulating the provision of those services. to the department of the additional assessment and investigation necessary to license facilities to provide these services, including, but not limited to, processing applications, issuing licenses, and investigating reports of noncompliance with licensing regulations.
SEC. 5.Section 11834.36 of the Health and Safety Code is amended to read:11834.36.(a)The director may suspend or revoke any license issued under this chapter, or deny an application for licensure, for extension of the licensing period, or to modify the terms and conditions of modification to a license, upon any of the following grounds and in the manner provided in this chapter:
(1)Violation by the licensee of any provision of this chapter or regulations adopted pursuant to this chapter.
(2)Repeated violation by the licensee of any of the provisions of this chapter or regulations adopted pursuant to this chapter.
(3)Aiding, abetting, or permitting the violation of, or any repeated violation of, any of the provisions described in paragraph (1) or (2).
(4)Conduct in the operation of an alcoholism or drug abuse recovery or treatment facility that is inimical to the health, morals, welfare, or safety of either an individual in, or receiving services from, the facility or to the people of the State of California.
(5)Misrepresentation of any material fact in obtaining the alcoholism or drug abuse recovery or treatment facility license, including, but not limited to, providing false information or documentation to the department.
(6)The licensees refusal to allow the department entry into the facility to determine compliance with the requirements of this chapter or regulations adopted pursuant to this chapter.
(7)Violation by the licensee of Section 11834.026 or the regulations adopted pursuant to that section.
(8)Failure to pay any civil penalties assessed by the department.
(b)The director may temporarily suspend any license prior to any hearing when, in the opinion of the director, the action is necessary to protect residents of the alcoholism or drug abuse recovery or treatment facility from physical or mental abuse, abandonment, or any other substantial threat to health or safety. The director shall notify the licensee of the temporary suspension and the effective date of the temporary suspension and at the same time shall serve the provider with an accusation. Upon receipt of a notice of defense to the accusation by the licensee, the director shall, within 15 days, set the matter for hearing, and the hearing shall be held as soon as possible. The temporary suspension shall remain in effect until the time the hearing is completed and the director has made a final determination on the merits. However, the temporary suspension shall be deemed vacated if the director fails to make a final determination on the merits within 30 days after the department receives the proposed decision from the Office of Administrative Hearings.
The Legislature hereby finds and declares all of the following:
(a)Substance abuse is a medical condition requiring interdisciplinary treatment including, when medically necessary, treatment by a licensed physician and surgeon.
(b)Subsequent to the enactment of state law licensing and regulating residential facilities providing alcohol and other drug detoxification treatment, public knowledge of addiction and treatment has advanced significantly.
(c)Lack of scientific understanding at the time of enactment of those state laws prevents the State Department of Health Care Services from licensing a residential treatment facility that uses a California-licensed physician and surgeon to provide necessary evaluation and treatment at the facility premises.
(d)This prohibition has been found to endanger persons in treatment, can result in treatment below the recognized standard of care, jeopardizes patient health, and delays patient recovery.
(e)To resolve this problem, it is the intent of the Legislature to enact this act in order to modernize and update state law and allow those in treatment to be protected and to receive modern medical treatment for a medical condition.
SEC. 2.Section 11834.025 is added to the Health and Safety Code, to read:11834.025.(a)(1)As a condition of providing incidental medical services, as defined in subdivision (a) of Section 11834.026, at a facility licensed by the department, the facility shall obtain from an applicant for services a signed certification described in subdivision (b) from a health care practitioner.
(2)For purposes of this chapter, health care practitioner means a person duly licensed and regulated under Division 2 (commencing with Section 500) of the Business and Professions Code, who is acting within the scope of practice of his or her license or certificate.
(b)The department shall develop a standard certification form for use by a health care practitioner. The form shall include, but not be limited to, a description of the alcoholism and drug abuse recovery or treatment services that an applicant needs.
(c)(1)The department shall adopt regulations, on or before July 1, 2017, to implement this section. The regulations shall be adopted in accordance with the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code).
(2)Notwithstanding the rulemaking provisions of the Administrative Procedure Act, the department may, if it deems appropriate, implement, interpret, or make specific this section by means of provider bulletins, written guidelines, or similar instructions from the department only until the department adopts regulations.
SEC. 3.Section 11834.026 is added to the Health and Safety Code, to read:11834.026.(a)As used in this section, incidental medical services means services, as specified by the department in regulations, to address physical and mental health issues associated with either detoxification from alcohol or drugs or the provision of alcoholism or drug abuse recovery or treatment services, that in the opinion of a physician are not required to be performed in a licensed clinic or a general acute care hospital, as defined in Section 1200 or 1250, respectively, or a medically managed inpatient treatment program.
(b)Notwithstanding any other law, a licensed alcoholism or drug abuse recovery or treatment facility may permit incidental medical services to be provided to a resident at the facility premises by one or more independent physicians and surgeons licensed by the Medical Board of California or the Osteopathic Medical Board who are knowledgeable about addiction medicine, or one or more other health care practitioners acting within the scope of practice of his or her license and under the direction of a physician and surgeon, and who are also knowledgeable about addiction medicine, when all of the following conditions are met:
(1)The facility, in the judgment of the department, has the ability to comply with the requirements of this chapter, to provide any level of care between Level 3.1 and Level 3.7 of the ASAM American Society of Addiction Medicine criteria, and to comply with all other applicable laws and regulations to meet the needs of a resident receiving incidental medical services from a physician pursuant to this chapter. The department shall specify in regulations the minimum requirements that a facility shall meet in order to be approved to permit the provision of incidental medical services on its premises. The license of a facility approved to provide incidental medical services shall reflect that those services are permitted to be provided at the facility premises.
(2)The physician and surgeon and any other health care practitioner has signed an acknowledgment on a form provided by the department that he or she has been advised of and understands the statutory and regulatory limitations on the services that may legally be provided by a licensed alcoholism or drug abuse recovery or treatment facility that is providing any level of care between Level 3.1 and Level 3.7 of the ASAM American Society of Addiction Medicine criteria, and the statutory and regulatory requirements and limitations for the physician and surgeon or other health care protection and for the facility, related to providing incidental medical services. The licensee shall maintain a copy of the signed form at the facility for a physician and surgeon or other health care practitioner providing incidental medical services at the facility premises.
(3)There is an agreed-upon written protocol between the physician and surgeon and the alcoholism or drug abuse recovery or treatment facility signed by the physician and surgeon and the licensee. The protocol shall address, at a minimum, the respective areas of responsibility of the physician and surgeon and the facility and the need for communicating and sharing resident information related to the physician and surgeon providing incidental medical services. The department shall specify by regulations the issues that shall be addressed and the information that shall be included in the protocol. The facility shall maintain a copy of the signed protocol at the facility.
(4)The facility in its admissions agreement with a client shall clearly identify the individual financially responsible for incidental medical services provided and the manner in which those services shall be billed.
(5)There is ongoing communication between the physician and the alcoholism or drug abuse recovery or treatment facility about the services provided to the resident by the physician and surgeon and the frequency and duration of incidental medical services to be provided. Resident information shall be shared between the physician and surgeon and the alcoholism or drug abuse recovery or treatment facility regarding the resident's need for incidental medical services and the services to be provided to the resident by the physician and surgeon, including, but not limited to, medical information, as defined by the Confidentiality of Medical Information Act (Part 2.6 (commencing with Section 56) of Division 1 of the Civil Code). The department shall specify by regulations any other requirements or limitations on these communications.
(6)There is initial and ongoing communication between the physician and surgeon or other health care practitioner and the residents health plan or health insurer prior to the provision of incidental medical services, to the extent allowable by state and federal privacy and confidentiality laws, to ensure coordination of care.
(7)The facility does not interfere with the physician and surgeon or other health care practitioner providing incidental medical services.
(8)In addition to any other medical authorization that may be required before a facility resident receives incidental medical services, the resident is authorized by the physician and surgeon as medically appropriate to receive the incidental medical services at the premises of the licensed facility. A copy of the authorization, on a form provided by the department, shall be signed by the physician and surgeon and maintained in the residents file at the facility.
(9)Before a facility resident receives incidental medical services, the resident has signed an acknowledgment and consent to receive those services on a form provided by the department. The form, at a minimum, shall describe the incidental medical services that the facility may permit to be provided and shall state that the permitted incidental medical services will be provided by a physician and surgeon or other health care practitioner working under the direction of the physician and surgeon. The department shall specify in regulations, at a minimum, the content and manner of providing the form, and any other information that the department deems appropriate. The facility shall maintain a copy of the signed acknowledgment and consent in the residents file.
(10)Once incidental medical services are initiated for a resident, the physician and surgeon and facility shall continuously monitor the resident to ensure that the resident remains appropriate to receive those services. If the physician and surgeon determines that a change in the residents medical or psychiatric condition requires other medical or psychiatric services or that a higher level of care is required than the facility may legally provide, the physician and surgeon shall immediately notify the licensee and shall assist the licensee to initiate emergency care, urgent care, or other higher level of care, as appropriate. If the licensee believes that a resident requires a higher level of care than the facility can legally provide, the licensee shall immediately notify the physician and surgeon and the department. The department shall specify by regulations any other requirements or limitations pertaining to changes in condition of a resident who is receiving incidental medical services, and any other requirements the department deems appropriate.
(11)The facility maintains in its files a copy of the physician and surgeons license or other written evidence of licensure to practice medicine in the state.
(12)The physician and surgeon and the facility both maintain compliance with the departments regulations relating to providing incidental medical services.
(c)The facility shall report to the department in a timely manner any violation of the regulations relating to providing incidental medical services or the signed protocol described in paragraph (3) of subdivision (b). The department shall specify in regulations, at a minimum, the steps required to be taken when the department substantiates that information provided by the licensee.
(d)Nothing in this section requires a facility to provide incidental medical services or any services beyond those otherwise permitted by this chapter.
(e)The department shall not evaluate or have any responsibility or liability with respect to evaluating incidental medical services provided. This section does not limit the departments ability to report suspected misconduct by a physician and surgeon or other health care practitioner to the appropriate licensing entity or to law enforcement.
(f)A facility licensed and approved by the department to allow provision of incidental medical services shall not by offering approved incidental medical services be considered a clinic or health facility within the meaning of Section 1200 or 1250, respectively.
(g)Other than incidental medical services, including those provided at any level between Level 3.1 and Level 3.7 of the ASAM American Society of Addiction Medicine criteria, minor first aid, or in the case of a life threatening emergency, this section does not authorize the provision at the premises of the facility of any medical or health care services or any other services that require a higher level of care than the care that may be provided within a licensed alcoholism or drug abuse recovery or treatment facility.
(h)(1)On or before July 1, 2017, the department shall adopt regulations to implement this section in accordance with the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code).
(2)Notwithstanding the rulemaking provisions of the Administrative Procedure Act, the department may, if it deems appropriate, implement, interpret, or make specific this section by means of provider bulletins, written guidelines, or similar instructions from the department until regulations are adopted.
SEC. 4.Section 11834.03 of the Health and Safety Code is amended to read:11834.03.(a)A person or entity applying for licensure shall file with the department, on forms provided by the department, all of the following:
(1)A completed written application for licensure.
(2)A fire clearance approved by the State Fire Marshal or local fire enforcement officer.
(3)A licensure fee, established in accordance with Chapter 7.3 (commencing with Section 11833.01).
(b)(1)If an applicant intends to permit services pursuant to Section 11834.026, the applicant shall submit a copy of the written protocol, evidence of a valid license of the physician and surgeon who will provide those services, and any other information the department deems appropriate, including, but not limited to, a copy of the alcoholism or drug abuse recovery or treatment facilitys accreditation by a nationally recognized accrediting organization. organization that evaluates the level of services provided, if the facility is accredited.
(2)The department shall establish and collect an additional licensure fee for an application that includes a request to provide detoxification services or services pursuant to Section 11834.026. The fee shall be set at an amount sufficient to cover the departments reasonable costs of regulating the provision of those services.
SEC. 5.Section 11834.36 of the Health and Safety Code is amended to read:11834.36.(a)The director may suspend or revoke any license issued under this chapter, or deny an application for licensure, for extension of the licensing period, or to modify the terms and conditions of a license, upon any of the following grounds and in the manner provided in this chapter:
(1)Violation by the licensee of any provision of this chapter or regulations adopted pursuant to this chapter.
(2)Repeated violation by the licensee of any of the provisions of this chapter or regulations adopted pursuant to this chapter.
(3)Aiding, abetting, or permitting the violation of, or any repeated violation of, any of the provisions described in paragraph (1) or (2).
(4)Conduct in the operation of an alcoholism or drug abuse recovery or treatment facility that is inimical to the health, morals, welfare, or safety of either an individual in, or receiving services from, the facility or to the people of the State of California.
(5)Misrepresentation of any material fact in obtaining the alcoholism or drug abuse recovery or treatment facility license, including, but not limited to, providing false information or documentation to the department.
(6)The licensees refusal to allow the department entry into the facility to determine compliance with the requirements of this chapter or regulations adopted pursuant to this chapter.
(7)Violation by the licensee of Section 11834.026 or the regulations adopted pursuant to that section.
(8)Failure to pay any civil penalties assessed by the department.
(b)The director may temporarily suspend any license prior to any hearing when, in the opinion of the director, the action is necessary to protect residents of the alcoholism or drug abuse recovery or treatment facility from physical or mental abuse, abandonment, or any other substantial threat to health or safety. The director shall notify the licensee of the temporary suspension and the effective date of the temporary suspension and at the same time shall serve the provider with an accusation. Upon receipt of a notice of defense to the accusation by the licensee, the director shall, within 15 days, set the matter for hearing, and the hearing shall be held as soon as possible. The temporary suspension shall remain in effect until the time the hearing is completed and the director has made a final determination on the merits. However, the temporary suspension shall be deemed vacated if the director fails to make a final determination on the merits within 30 days after the department receives the proposed decision from the Office of Administrative Hearings.
The Legislature hereby finds and declares all of the following:
(a)Substance abuse is a medical condition requiring interdisciplinary treatment including, when medically necessary, treatment by a licensed physician and surgeon.
(b)Subsequent to the enactment of state law licensing and regulating residential facilities providing alcohol and other drug detoxification treatment, public knowledge of addiction and treatment has advanced significantly.
(c)Lack of scientific understanding at the time of enactment of those state laws prevents the State Department of Health Care Services from licensing a residential treatment facility that uses a California-licensed physician and surgeon to provide necessary evaluation and treatment at the facility premises.
(d)This prohibition has been found to endanger persons in treatment, can result in treatment below the recognized standard of care, jeopardizes patient health, and delays patient recovery.
(e)To resolve this problem, it is the intent of the Legislature to enact this act in order to modernize and update state law and allow those in treatment to be protected and to receive modern medical treatment for a medical condition.
SEC. 2.Section 11834.025 is added to the Health and Safety Code, to read:11834.025.(a)(1)As a condition of providing alcoholism or drug abuse recovery or treatment services under this chapter incidental medical services, as defined in subdivision (a) of Section 11834.026, at a facility licensed by the department, the facility shall obtain from an applicant for services a signed certification described in subdivision (b) from a health care practitioner.
(2)For purposes of this chapter, health care practitioner means a person duly licensed and regulated under Division 2 (commencing with Section 500) of the Business and Professions Code, who is acting within the scope of practice of his or her license or certificate.
(b)The department shall develop a standard certification form for use by a health care practitioner. The form shall include, but not be limited to, a description of the alcoholism and drug abuse recovery or treatment services that a licensed alcoholism or drug abuse recovery or treatment facility may provide under state law, and a certification by the health care practitioner that the health condition or medical or psychiatric history of the applicant does not require a level of care that is higher than the level of care that may legally be provided by a licensed alcoholism or drug abuse recovery or treatment facility. an applicant needs.
(c)(1)The department shall adopt regulations, on or before July 1, 2017, to implement this section. The regulations shall be adopted in accordance with the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code).
(2)Notwithstanding the rulemaking provisions of the Administrative Procedure Act, the department may, if it deems appropriate, implement, interpret, or make specific this section by means of provider bulletins, written guidelines, or similar instructions from the department only until the department adopts regulations.
SEC. 3.Section 11834.026 is added to the Health and Safety Code, to read:11834.026.(a)As used in this section, incidental medical services means services, as specified by the department in regulations, to address physical and mental health issues associated with either detoxification from alcohol or drugs or the provision of alcoholism or drug abuse recovery or treatment services, that in the opinion of a physician are not required to be performed in a licensed clinic or licensed health facility, or a general acute care hospital, as defined in Section 1200 or 1250, respectively. respectively, or a medically managed inpatient treatment program.
(b)Notwithstanding any other law, a licensed alcoholism or drug abuse recovery or treatment facility may permit incidental medical services to be provided to a resident at the facility premises by one or more independent physicians and surgeons licensed by the Medical Board of California or the Osteopathic Medical Board who are knowledgeable about addiction medicine, or one or more other health care practitioners acting within the scope of practice of his or her license and under the direction of a physician and surgeon, and who are also knowledgeable about addiction medicine, when all of the following conditions are met:
(1)The facility, in the judgment of the department, has the ability to comply with the requirements of this chapter, to provide any level of care between Level 3.1 and Level 3.7 of the ASAM criteria, and to comply with all other applicable laws and regulations to meet the needs of a resident receiving incidental medical services from a physician pursuant to this chapter. The department shall specify in regulations the minimum requirements that a facility shall meet in order to be approved to permit the provision of incidental medical services on its premises. The license of a facility approved to provide incidental medical services shall reflect that those services are permitted to be provided at the facility premises.
(2)The physician and surgeon and any other health care practitioner has signed an acknowledgment on a form provided by the department that he or she has been advised of and understands the statutory and regulatory limitations on the services that may legally be provided by a licensed alcoholism or drug abuse recovery or treatment facility, facility that is providing any level of care between Level 3.1 and Level 3.7 of the ASAM criteria, and the statutory and regulatory requirements and limitations for the physician and surgeon or other health care protection and for the facility, related to providing incidental medical services. The licensee shall maintain a copy of the signed form at the facility for a physician and surgeon or other health care practitioner providing incidental medical services at the facility premises.
(3)There is an agreed-upon written protocol between the physician and surgeon and the alcoholism or drug abuse recovery or treatment facility signed by the physician and surgeon and the licensee. The protocol shall address, at a minimum, the respective areas of responsibility of the physician and surgeon and the facility and the need for communicating and sharing resident information related to the physician and surgeon providing incidental medical services. The department shall specify by regulations the issues that shall be addressed and the information that shall be included in the protocol. The facility shall maintain a copy of the signed protocol at the facility.
(4)The facility in its admissions agreement with a client shall clearly identify the individual financially responsible for incidental medical services provided and the manner in which those services shall be billed.
(5)There is ongoing communication between the physician and the alcoholism or drug abuse recovery or treatment facility about the services provided to the resident by the physician and surgeon and the frequency and duration of incidental medical services to be provided. Resident information shall be shared between the physician and surgeon and the alcoholism or drug abuse recovery or treatment facility regarding the resident's need for incidental medical services and the services to be provided to the resident by the physician and surgeon, including, but not limited to, medical information, as defined by the Confidentiality of Medical Information Act (Part 2.6 (commencing with Section 56) of Division 1 of the Civil Code). The department shall specify by regulations any other requirements or limitations on these communications.
(6)There is initial and ongoing communication between the physician and surgeon or other health care practitioner and the residents health plan or health insurer prior to the provision of incidental medical services, to the extent allowable by state and federal privacy and confidentiality laws, to ensure coordination of care.
(7)The facility does not provide incidental medical services and does not assist with or interfere with the physician and surgeon or other health care practitioner providing incidental medical services.
(8)In addition to any other medical authorization that may be required before a facility resident receives incidental medical services, the resident is authorized by the physician and surgeon as medically appropriate to receive the incidental medical services at the premises of the licensed facility. A copy of the authorization, on a form provided by the department, shall be signed by the physician and surgeon and maintained in the residents file at the facility.
(9)Before a facility resident receives incidental medical services, the resident has signed an acknowledgment and consent to receive those services on a form provided by the department. The form, at a minimum, shall describe the incidental medical services that the facility may permit to be provided and shall state that the permitted incidental medical services will be provided by a physician and surgeon or other health care practitioner working under the direction of the physician and surgeon and not by the facility staff. surgeon. The department shall specify in regulations, at a minimum, the content and manner of providing the form, and any other information that the department deems appropriate. The facility shall maintain a copy of the signed acknowledgment and consent in the residents file.
(10)Once incidental medical services are initiated for a resident, the physician and surgeon and facility shall continuously monitor the resident to ensure that the resident remains appropriate to receive those services. If the physician and surgeon determines that a change in the residents medical or psychiatric condition requires other medical or psychiatric services or that a higher level of care is required than the facility may legally provide, the physician and surgeon shall immediately notify the licensee and shall assist the licensee to initiate emergency care, urgent care, or other higher level of care, as appropriate. If the licensee believes that a resident requires a higher level of care than the facility can legally provide, the licensee shall immediately notify the physician and surgeon and the department. The department shall specify by regulations any other requirements or limitations pertaining to changes in condition of a resident who is receiving incidental medical services, and any other requirements the department deems appropriate.
(11)The facility maintains in its files a copy of the physician and surgeons license or other written evidence of licensure to practice medicine in the state.
(12)The physician and surgeon and the facility both maintain compliance with the departments regulations relating to providing incidental medical services.
(c)The facility shall report to the department in a timely manner any violation or suspected violation by the physician and surgeon of the regulations relating to providing incidental medical services or the signed protocol described in paragraph (3) of subdivision (b). The department shall specify in regulations, at a minimum, the steps required to be taken when the department substantiates that information provided by the licensee.
(d)This Nothing in this section does not require requires a facility to provide incidental medical services or any services beyond those otherwise permitted by this chapter.
(e)The department shall not evaluate or have any responsibility or liability with respect to evaluating incidental medical services provided. This section does not limit the departments ability to report suspected misconduct by a physician and surgeon or other health care practitioner to the appropriate licensing entity or to law enforcement.
(f)A facility licensed and approved by the department to allow provision of incidental medical services shall not by offering approved incidental medical services be considered a clinic or health facility within the meaning of Section 1200 or 1250, respectively.
(g)Other than incidental medical services provided, services, including those provided at any level between Level 3.1 and Level 3.7 of the ASAM criteria, minor first aid, or in the case of a life threatening emergency, this section does not authorize the provision at the premises of the facility of any medical or health care services or any other services that require a higher level of care than the care that may be provided within a licensed alcoholism or drug abuse recovery or treatment facility.
(h)(1)On or before July 1, 2017, the department shall adopt regulations to implement this section in accordance with the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code).
(2)Notwithstanding the rulemaking provisions of the Administrative Procedure Act, the department may, if it deems appropriate, implement, interpret, or make specific this section by means of provider bulletins, written guidelines, or similar instructions from the department until regulations are adopted.
SEC. 4.Section 11834.03 of the Health and Safety Code is amended to read:11834.03.(a)A person or entity applying for licensure shall file with the department, on forms provided by the department, all of the following:
(1)A completed written application for licensure.
(2)A fire clearance approved by the State Fire Marshal or local fire enforcement officer.
(3)A licensure fee, established in accordance with Chapter 7.3 (commencing with Section 11833.01).
(b)(1)If an applicant intends to permit services pursuant to Section 11834.026, the applicant shall submit a copy of the written protocol, evidence of a valid license of the physician and surgeon who will provide those services, and any other information the department deems appropriate, including, but not limited to, a copy of the alcoholism or drug abuse recovery or treatment facilitys accreditation by a nationally recognized accrediting organization.
(2)The department shall establish and collect an additional licensure fee for an application that includes a request to provide detoxification services or services pursuant to Section 11834.026. The fee shall be set at an amount sufficient to cover the departments reasonable costs of regulating the provision of those services.
SEC. 5.Section 11834.36 of the Health and Safety Code is amended to read:11834.36.(a)The director may suspend or revoke any license issued under this chapter, or deny an application for licensure, for extension of the licensing period, or to modify the terms and conditions of a license, upon any of the following grounds and in the manner provided in this chapter:
(1)Violation by the licensee of any provision of this chapter or regulations adopted pursuant to this chapter.
(2)Repeated violation by the licensee of any of the provisions of this chapter or regulations adopted pursuant to this chapter.
(3)Aiding, abetting, or permitting the violation of, or any repeated violation of, any of the provisions described in paragraph (1) or (2).
(4)Conduct in the operation of an alcoholism or drug abuse recovery or treatment facility that is inimical to the health, morals, welfare, or safety of either an individual in, or receiving services from, the facility or to the people of the State of California.
(5)Misrepresentation of any material fact in obtaining the alcoholism or drug abuse recovery or treatment facility license, including, but not limited to, providing false information or documentation to the department.
(6)The licensees refusal to allow the department entry into the facility to determine compliance with the requirements of this chapter or regulations adopted pursuant to this chapter.
(7)Violation by the licensee of Section 11834.026 or the regulations adopted pursuant to that section.
(8)Failure to pay any civil penalties assessed by the department.
(b)The director may temporarily suspend any license prior to any hearing when, in the opinion of the director, the action is necessary to protect residents of the alcoholism or drug abuse recovery or treatment facility from physical or mental abuse, abandonment, or any other substantial threat to health or safety. The director shall notify the licensee of the temporary suspension and the effective date of the temporary suspension and at the same time shall serve the provider with an accusation. Upon receipt of a notice of defense to the accusation by the licensee, the director shall, within 15 days, set the matter for hearing, and the hearing shall be held as soon as possible. The temporary suspension shall remain in effect until the time the hearing is completed and the director has made a final determination on the merits. However, the temporary suspension shall be deemed vacated if the director fails to make a final determination on the merits within 30 days after the department receives the proposed decision from the Office of Administrative Hearings.
The Legislature hereby finds and declares all of the following:
(a)Substance abuse is a medical condition requiring interdisciplinary treatment including, when medically necessary, treatment by a licensed physician and surgeon.
(b)Subsequent to the enactment of state law licensing and regulating residential facilities providing alcohol and other drug detoxification treatment, public knowledge of addiction and treatment has advanced significantly.
(c)Lack of scientific understanding at the time of enactment of those state laws prevents the State Department of Health Care Services from licensing a residential treatment facility that uses a California-licensed physician and surgeon to provide necessary evaluation and treatment at the facility premises.
(d)This prohibition has been found to endanger persons in treatment, can result in treatment below the recognized standard of care, jeopardizes patient health, and delays patient recovery.
(e)To resolve this problem, it is the intent of the Legislature to enact this act in order to modernize and update state law and allow those in treatment to be protected and to receive modern medical treatment for a medical condition.
SEC. 2.Section 11834.025 is added to the Health and Safety Code, to read:11834.025.(a)(1)As a condition of providing alcoholism or drug abuse recovery or treatment services under this chapter at a facility licensed by the department, the facility shall obtain from an applicant for services a signed certification described in subdivision (b) from a health care practitioner.
(2)For purposes of this chapter, health care practitioner means a person duly licensed and regulated under Division 2 (commencing with Section 500) of the Business and Professions Code, who is acting within the scope of practice of his or her license or certificate.
(b)The department shall develop a standard certification form for use by a health care practitioner. The form shall include, but not be limited to, a description of the alcoholism and drug abuse recovery or treatment services that a licensed alcoholism or drug abuse recovery or treatment facility may provide under state law, and a certification by the health care practitioner that the health condition or medical or psychiatric history of the applicant does not require a level of care that is higher than the level of care that may legally be provided by a licensed alcoholism or drug abuse recovery or treatment facility.
(c)On or before January 1, 2017, the department shall adopt emergency regulations to implement this section. The regulations shall prescribe, among other things, the timeframe within which the certification described in subdivision (b) shall be provided to a facility.
(1)(A)The initial adoption of emergency regulations pursuant to this section and each readoption of emergency regulations shall be deemed an emergency and necessary for the immediate preservation of the public peace, health, safety, or general welfare. Initial emergency regulations and any readoption of emergency regulations authorized by this section shall be exempt from review by the Office of Administrative Law. The initial emergency regulations and each readoption of emergency regulations authorized by this section shall be submitted to the Office of Administrative Law for filing with the Secretary of State and publication in the California Code of Regulations and each shall remain in effect only until the earlier of 180 days following the effective date of the emergency regulations or the effective date of final regulations adopted by the department.
(B)
(c)(1)The department shall adopt final regulations regulations, on or before July 1, 2017. 2017, to implement this section. The final regulations shall be adopted in accordance with the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code).
(2)Notwithstanding the rulemaking provisions of the Administrative Procedure Act, the department may, if it deems appropriate, implement, interpret, or make specific this section by means of provider bulletins, written guidelines, or similar instructions from the department only until the department adopts emergency regulations.
SEC. 3.Section 11834.026 is added to the Health and Safety Code, to read:11834.026.(a)As used in this section, incidental medical services means services, as specified by the department in regulations, to address physical and mental health issues associated with either detoxification from alcohol or drugs or the provision of alcoholism or drug abuse recovery or treatment services, that in the opinion of a physician are not required to be performed in a licensed clinic or licensed health facility, as defined in Section 1200 or 1250, respectively.
(b)Notwithstanding any other law, a licensed alcoholism or drug abuse recovery or treatment facility may permit incidental medical services to be provided to a resident at the facility premises by one or more independent physicians and surgeons licensed by the Medical Board of California or the Osteopathic Medical Board who are knowledgeable about addiction medicine, or one or more other health care practitioners acting within the scope of practice of his or her license and under the direction of a physician and surgeon, and who are also knowledgeable about addiction medicine, when all of the following conditions are met:
(1)The facility, in the judgment of the department, has the ability to comply with the requirements of this chapter and all other applicable laws and regulations to meet the needs of a resident receiving incidental medical services from a physician pursuant to this chapter. The department shall specify in regulations the minimum requirements that a facility shall meet in order to be approved to permit the provision of incidental medical services on its premises. The license of a facility approved to provide incidental medical services shall reflect that those services are permitted to be provided at the facility premises.
(2)The physician and surgeon and any other health care practitioner has signed an acknowledgment on a form provided by the department that he or she has been advised of and understands the statutory and regulatory limitations on the services that may legally be provided by a licensed alcoholism or drug abuse recovery or treatment facility, and the statutory and regulatory requirements and limitations for the physician and surgeon or other health care protection and for the facility, related to providing incidental medical services. The licensee shall maintain a copy of the signed form at the facility for a physician and surgeon or other health care practitioner providing incidental medical services at the facility premises.
(3)There is an agreed-upon written protocol between the physician and surgeon and the alcoholism or drug abuse recovery or treatment facility signed by the physician and surgeon and the licensee. The protocol shall address, at a minimum, the respective areas of responsibility of the physician and surgeon and the facility and the need for communicating and sharing resident information related to the physician and surgeon providing incidental medical services. The department shall specify by regulations the issues that shall be addressed and the information that shall be included in the protocol. The facility shall maintain a copy of the signed protocol at the facility.
(4)The facility in its admissions agreement with a client shall clearly identify the individual financially responsible for incidental medical services provided and the manner in which those services shall be billed.
(5)There is ongoing communication between the physician and the alcoholism or drug abuse recovery or treatment facility about the services provided to the resident by the physician and surgeon and the frequency and duration of incidental medical services to be provided. Resident information shall be shared between the physician and surgeon and the alcoholism or drug abuse recovery or treatment facility regarding the resident's need for incidental medical services and the services to be provided to the resident by the physician and surgeon, including, but not limited to, medical information, as defined by the Confidentiality of Medical Information Act (Part 2.6 (commencing with Section 56) of Division 1 of the Civil Code). The department shall specify by regulations any other requirements or limitations on these communications.
(6)There is initial and ongoing communication between the physician and surgeon or other health care practitioner and the residents health plan or health insurer prior to the provision of incidental medical services, to the extent allowable by state and federal privacy and confidentiality laws, to ensure coordination of care.
(7)The facility does not provide incidental medical services and does not assist with or interfere with the physician and surgeon or other health care practitioner providing incidental medical services.
(8)In addition to any other medical authorization that may be required before a facility resident receives incidental medical services, the resident is authorized by the physician and surgeon as medically appropriate to receive the incidental medical services at the premises of the licensed facility. A copy of the authorization, on a form provided by the department, shall be signed by the physician and surgeon and maintained in the residents file at the facility.
(9)Before a facility resident receives incidental medical services, the resident has signed an acknowledgment and consent to receive those services on a form provided by the department. The form, at a minimum, shall describe the incidental medical services that the facility may permit to be provided and shall state that the permitted incidental medical services will be provided by a physician and surgeon or other health care practitioner working under the direction of the physician and surgeon and not by the facility staff. The department shall specify in regulations, at a minimum, the content and manner of providing the form, and any other information that the department deems appropriate. The facility shall maintain a copy of the signed acknowledgment and consent in the residents file.
(10)Once incidental medical services are initiated for a resident, the physician and surgeon and facility shall continuously monitor the resident to ensure that the resident remains appropriate to receive those services. If the physician and surgeon determines that a change in the residents medical or psychiatric condition requires other medical or psychiatric services or that a higher level of care is required than the facility may legally provide, the physician and surgeon shall immediately notify the licensee and shall assist the licensee to initiate emergency care, urgent care, or other higher level of care, as appropriate. If the licensee believes that a resident requires a higher level of care than the facility can legally provide, the licensee shall immediately notify the physician and surgeon and the department. The department shall specify by regulations any other requirements or limitations pertaining to changes in condition of a resident who is receiving incidental medical services, and any other requirements the department deems appropriate.
(11)The facility maintains in its files a copy of the physician and surgeons license or other written evidence of licensure to practice medicine in the state.
(12)The physician and surgeon and the facility both maintain compliance with the departments regulations relating to providing incidental medical services.
(c)The facility shall report to the department in a timely manner any violation or suspected violation by the physician and surgeon of the regulations relating to providing incidental medical services or the signed protocol described in paragraph (3) of subdivision (b). The department shall specify in regulations, at a minimum, the steps required to be taken when the department substantiates that information provided by the licensee.
(d)This section does not require a facility to provide incidental medical services or any services beyond those permitted by this chapter.
(e)The department shall not evaluate or have any responsibility or liability with respect to evaluating incidental medical services provided. This section does not limit the departments ability to report suspected misconduct by a physician and surgeon or other health care practitioner to the appropriate licensing entity or to law enforcement.
(f)A facility licensed and approved by the department to allow provision of incidental medical services shall not by offering approved incidental medical services be considered a clinic or health facility within the meaning of Section 1200 or 1250, respectively.
(g)Other than incidental medical services provided, minor first aid, or in the case of a life threatening emergency, this section does not authorize the provision at the premises of the facility of any medical or health care services or any other services that require a higher level of care than the care that may be provided within a licensed alcoholism or drug abuse recovery or treatment facility.
(h)The department shall promulgate regulations to implement this section.
(1)The department shall adopt emergency regulations on or before January 1, 2017. Prior to adoption of emergency regulations, the department shall seek appropriate technical assistance from stakeholders and shall allow interested stakeholders to provide comments through any means the department deems appropriate.
(2)(A)The initial adoption of emergency regulations pursuant to this section and each readoption of emergency regulations shall be deemed an emergency and necessary for the immediate preservation of the public peace, health, safety, or general welfare. Initial emergency regulations and each readoption of emergency regulations authorized by this section shall be exempt from review by the Office of Administrative Law. The initial emergency regulations and each readoption of emergency regulations authorized by this section shall be submitted to the Office of Administrative Law for filing with the Secretary of State and publication in the California Code of Regulations and each shall remain in effect only until the earlier of 180 days following the effective date of the emergency regulations or the effective date of final regulations adopted by the department.
(B)
(h)(1)On or before July 1, 2017, the department shall adopt final regulations to implement this section in accordance with the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code).
(3)
(2)Notwithstanding the rulemaking provisions of the Administrative Procedure Act, the department may, if it deems appropriate, implement, interpret, or make specific this section by means of provider bulletins, written guidelines, or similar instructions from the department until emergency regulations are adopted.
SEC. 4.Section 11834.03 of the Health and Safety Code is amended to read:11834.03.(a)A person or entity applying for licensure shall file with the department, on forms provided by the department, all of the following:
(1)A completed written application for licensure.
(2)A fire clearance approved by the State Fire Marshal or local fire enforcement officer.
(3)A licensure fee, established in accordance with Chapter 7.3 (commencing with Section 11833.01).
(b)(1)If an applicant intends to permit services pursuant to Section 11834.026, the applicant shall submit a copy of the written protocol, evidence of a valid license of the physician and surgeon who will provide those services, and any other information the department deems appropriate, including, but not limited to, a copy of the alcoholism or drug abuse recovery or treatment facilitys accreditation by a nationally recognized accrediting organization.
(c)
(2)The department may shall establish and collect an additional licensure fee for an application that includes a request to provide detoxification services or services pursuant to Section 11834.026. The fee shall be set at an amount sufficient to cover the departments reasonable costs of regulating the provision of those services.
SEC. 5.Section 11834.36 of the Health and Safety Code is amended to read:11834.36.(a)The director may suspend or revoke any license issued under this chapter, or deny an application for licensure, for extension of the licensing period, or to modify the terms and conditions of a license, upon any of the following grounds and in the manner provided in this chapter:
(1)Violation by the licensee of any provision of this chapter or regulations adopted pursuant to this chapter.
(2)Repeated violation by the licensee of any of the provisions of this chapter or regulations adopted pursuant to this chapter.
(3)Aiding, abetting, or permitting the violation of, or any repeated violation of, any of the provisions described in paragraph (1) or (2).
(4)Conduct in the operation of an alcoholism or drug abuse recovery or treatment facility that is inimical to the health, morals, welfare, or safety of either an individual in, or receiving services from, the facility or to the people of the State of California.
(5)Misrepresentation of any material fact in obtaining the alcoholism or drug abuse recovery or treatment facility license, including, but not limited to, providing false information or documentation to the department.
(6)The licensees refusal to allow the department entry into the facility to determine compliance with the requirements of this chapter or regulations adopted pursuant to this chapter.
(7)Violation by the licensee of Section 11834.026 or the regulations adopted pursuant to that section.
(8)Failure to pay any civil penalties assessed by the department.
(b)The director may temporarily suspend any license prior to any hearing when, in the opinion of the director, the action is necessary to protect residents of the alcoholism or drug abuse recovery or treatment facility from physical or mental abuse, abandonment, or any other substantial threat to health or safety. The director shall notify the licensee of the temporary suspension and the effective date of the temporary suspension and at the same time shall serve the provider with an accusation. Upon receipt of a notice of defense to the accusation by the licensee, the director shall, within 15 days, set the matter for hearing, and the hearing shall be held as soon as possible. The temporary suspension shall remain in effect until the time the hearing is completed and the director has made a final determination on the merits. However, the temporary suspension shall be deemed vacated if the director fails to make a final determination on the merits within 30 days after the department receives the proposed decision from the Office of Administrative Hearings.
The Legislature hereby finds and declares all of the following:
(a)Substance abuse is a medical condition requiring interdisciplinary treatment including, when medically necessary, treatment by a licensed physician and surgeon.
(b)Subsequent to the enactment of state law licensing and regulating residential facilities providing alcohol and other drug detoxification treatment, public knowledge of addiction and treatment has advanced significantly.
(c)Lack of scientific understanding at the time of enactment of those state laws prevents the State Department of Health Care Services from licensing a residential treatment facility that uses a California-licensed physician and surgeon to provide necessary evaluation and treatment at the facility premises.
(d)This prohibition has been found to endanger persons in treatment, can result in treatment below the recognized standard of care, jeopardizes patient health, and delays patient recovery.
(e)To resolve this problem, it is the intent of the Legislature to enact this act in order to modernize and update state law and allow those in treatment to be protected and to receive modern medical treatment for a medical condition.
SEC. 2.Section 11834.025 is added to the Health and Safety Code, to read:11834.025.(a)(1)As a condition of providing alcoholism or drug abuse recovery or treatment services under this chapter at a facility licensed by the department, the facility shall obtain from an applicant for services a signed certification described in subdivision (b) from a health care practitioner.
(2)For purposes of this chapter, health care practitioner means a person duly licensed and regulated under Division 2 (commencing with Section 500) of the Business and Professions Code, who is acting within the scope of practice of his or her license or certificate.
(b)The department shall develop a standard certification form for use by a health care practitioner. The form shall include, but not be limited to, a description of the alcoholism and drug abuse recovery or treatment services that a licensed alcoholism or drug abuse recovery or treatment facility may provide under state law, and a certification by the health care practitioner that the health condition or medical or psychiatric history of the applicant does not require a level of care that is higher than the level of care that may legally be provided by a licensed alcoholism or drug abuse recovery or treatment facility.
(c)On or before January 1, 2017, the department shall adopt emergency regulations to implement this section. The regulations shall prescribe, among other things, the timeframe within which the certification described in subdivision (b) shall be provided to a facility.
(1)(A)The initial adoption of emergency regulations pursuant to this section and each readoption of emergency regulations shall be deemed an emergency and necessary for the immediate preservation of the public peace, health, safety, or general welfare. Initial emergency regulations and any readoption of emergency regulations authorized by this section shall be exempt from review by the Office of Administrative Law. The initial emergency regulations and each readoption of emergency regulations authorized by this section shall be submitted to the Office of Administrative Law for filing with the Secretary of State and publication in the California Code of Regulations and each shall remain in effect only until the earlier of 180 days following the effective date of the emergency regulations or the effective date of final regulations adopted by the department.
(B)The department shall adopt final regulations on or before July 1, 2017. The final regulations shall be adopted in accordance with the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code).
(2)Notwithstanding the rulemaking provisions of the Administrative Procedure Act, the department may, if it deems appropriate, implement, interpret, or make specific this section by means of provider bulletins, written guidelines, or similar instructions from the department only until the department adopts emergency regulations.
SEC. 3.Section 11834.026 is added to the Health and Safety Code, to read:11834.026.(a)As used in this section, incidental medical services means services, as specified by the department in regulations, to address physical and mental health issues associated with either detoxification from alcohol or drugs or the provision of alcoholism or drug abuse recovery or treatment services, that in the opinion of a physician are not required to be performed in a licensed clinic or licensed health facility, as defined in Section 1200 or 1250, respectively.
(b)Notwithstanding any other law, a licensed alcoholism or drug abuse recovery or treatment facility may permit incidental medical services to be provided to a resident at the facility premises by one or more independent physicians and surgeons licensed by the Medical Board of California or the Osteopathic Medical Board who are knowledgeable about addiction medicine, or one or more other health care practitioners acting within the scope of practice of his or her license and under the direction of a physician and surgeon, and who are also knowledgeable about addiction medicine, when all of the following conditions are met:
(1)The facility, in the judgment of the department, has the ability to comply with the requirements of this chapter and all other applicable laws and regulations to meet the needs of a resident receiving incidental medical services from a physician pursuant to this chapter. The department shall specify in regulations the minimum requirements that a facility shall meet in order to be approved to permit the provision of incidental medical services on its premises. The license of a facility approved to provide incidental medical services shall reflect that those services are permitted to be provided at the facility premises.
(2)The physician and surgeon and any other health care practitioner has signed an acknowledgment on a form provided by the department that he or she has been advised of and understands the statutory and regulatory limitations on the services that may legally be provided by a licensed alcoholism or drug abuse recovery or treatment facility, and the statutory and regulatory requirements and limitations for the physician and surgeon or other health care protection and for the facility, related to providing incidental medical services. The licensee shall maintain a copy of the signed form at the facility for a physician and surgeon or other health care practitioner providing incidental medical services at the facility premises.
(3)There is an agreed-upon written protocol between the physician and surgeon and the alcoholism or drug abuse recovery or treatment facility signed by the physician and surgeon and the licensee. The protocol shall address, at a minimum, the respective areas of responsibility of the physician and surgeon and the facility and the need for communicating and sharing resident information related to the physician and surgeon providing incidental medical services. The department shall specify by regulations the issues that shall be addressed and the information that shall be included in the protocol. The facility shall maintain a copy of the signed protocol at the facility.
(4)The facility in its admissions agreement with a client shall clearly identify the individual financially responsible for incidental medical services provided and the manner in which those services shall be billed.
(5)There is ongoing communication between the physician and the alcoholism or drug abuse recovery or treatment facility about the services provided to the resident by the physician and surgeon and the frequency and duration of incidental medical services to be provided. Resident information shall be shared between the physician and surgeon and the alcoholism or drug abuse recovery or treatment facility regarding the resident's need for incidental medical services and the services to be provided to the resident by the physician and surgeon, including, but not limited to, medical information, as defined by the Confidentiality of Medical Information Act (Part 2.6 (commencing with Section 56) of Division 1 of the Civil Code). The department shall specify by regulations any other requirements or limitations on these communications.
(6)There is initial and ongoing communication between the physician and surgeon or other health care practitioner and the residents health plan or health insurer prior to the provision of incidental medical services, to the extent allowable by state and federal privacy and confidentiality laws, to ensure coordination of care.
(7)The facility does not provide incidental medical services and does not assist with or interfere with the physician and surgeon or other health care practitioner providing incidental medical services.
(8)In addition to any other medical authorization that may be required before a facility resident receives incidental medical services, the resident is authorized by the physician and surgeon as medically appropriate to receive the incidental medical services at the premises of the licensed facility. A copy of the authorization, on a form provided by the department, shall be signed by the physician and surgeon and maintained in the residents file at the facility.
(9)Before a facility resident receives incidental medical services, the resident has signed an acknowledgment and consent to receive those services on a form provided by the department. The form, at a minimum, shall describe the incidental medical services that the facility may permit to be provided and shall state that the permitted incidental medical services will be provided by a physician and surgeon or other health care practitioner working under the direction of the physician and surgeon and not by the facility staff. The department shall specify in regulations, at a minimum, the content and manner of providing the form, and any other information that the department deems appropriate. The facility shall maintain a copy of the signed acknowledgment and consent in the residents file.
(10)Once incidental medical services are initiated for a resident, the physician and surgeon and facility shall continuously monitor the resident to ensure that the resident remains appropriate to receive those services. If the physician and surgeon determines that a change in the residents medical or psychiatric condition requires other medical or psychiatric services or that a higher level of care is required than the facility may legally provide, the physician and surgeon shall immediately notify the licensee and shall assist the licensee to initiate emergency care, urgent care, or other higher level of care, as appropriate. If the licensee believes that a resident requires a higher level of care than the facility can legally provide, the licensee shall immediately notify the physician and surgeon and the department. The department shall specify by regulations any other requirements or limitations pertaining to changes in condition of a resident who is receiving incidental medical services, and any other requirements the department deems appropriate.
(11)The facility maintains in its files a copy of the physician and surgeons license or other written evidence of licensure to practice medicine in the state.
(12)The physician and surgeon and the facility both maintain compliance with the departments regulations relating to providing incidental medical services.
(c)The facility shall report to the department in a timely manner any violation or suspected violation by the physician and surgeon of the regulations relating to providing incidental medical services or the signed protocol described in paragraph (3) of subdivision (b). The department shall specify in regulations, at a minimum, the steps required to be taken when the department substantiates that information provided by the licensee.
(d)This section does not require a facility to provide incidental medical services or any services beyond those permitted by this chapter.
(e)The department shall not evaluate or have any responsibility or liability with respect to evaluating incidental medical services provided. This section does not limit the departments ability to report suspected misconduct by a physician and surgeon or other health care practitioner to the appropriate licensing entity or to law enforcement.
(f)A facility licensed and approved by the department to allow provision of incidental medical services shall not by offering approved incidental medical services be considered a clinic or health facility within the meaning of Section 1200 or 1250, respectively.
(g)Other than incidental medical services provided, minor first aid, or in the case of a life threatening emergency, this section does not authorize the provision at the premises of the facility of any medical or health care services or any other services that require a higher level of care than the care that may be provided within a licensed alcoholism or drug abuse recovery or treatment facility.
(h)The department shall promulgate regulations to implement this section.
(1)The department shall adopt emergency regulations on or before January 1, 2017. Prior to adoption of emergency regulations, the department shall seek appropriate technical assistance from stakeholders and shall allow interested stakeholders to provide comments through any means the department deems appropriate.
(2)(A)The initial adoption of emergency regulations pursuant to this section and each readoption of emergency regulations shall be deemed an emergency and necessary for the immediate preservation of the public peace, health, safety, or general welfare. Initial emergency regulations and each readoption of emergency regulations authorized by this section shall be exempt from review by the Office of Administrative Law. The initial emergency regulations and each readoption of emergency regulations authorized by this section shall be submitted to the Office of Administrative Law for filing with the Secretary of State and publication in the California Code of Regulations and each shall remain in effect only until the earlier of 180 days following the effective date of the emergency regulations or the effective date of final regulations adopted by the department.
(B)On or before July 1, 2017, the department shall adopt final regulations in accordance with the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code).
(3)Notwithstanding the rulemaking provisions of the Administrative Procedure Act, the department may, if it deems appropriate, implement, interpret, or make specific this section by means of provider bulletins, written guidelines, or similar instructions from the department until emergency regulations are adopted.
SEC. 4.Section 11834.03 of the Health and Safety Code is amended to read:11834.03.(a)A person or entity applying for licensure shall file with the department, on forms provided by the department, all of the following:
(1)A completed written application for licensure.
(2)A fire clearance approved by the State Fire Marshal or local fire enforcement officer.
(3)A licensure fee, established in accordance with Chapter 7.3 (commencing with Section 11833.01).
(b)If an applicant intends to permit services pursuant to Section 11834.026, the applicant shall submit a copy of the written protocol, evidence of a valid license of the physician and surgeon who will provide those services, and any other information the department deems appropriate, including, but not limited to, a copy of the alcoholism or drug abuse recovery or treatment facilitys accreditation by a nationally recognized accrediting organization.
(c)The department may establish an additional licensure fee for an application that includes a request to provide detoxification services or services pursuant to Section 11834.026.
SEC. 5.Section 11834.05 is added to the Health and Safety Code, to read:11834.05.(a)The department shall conduct an evaluation of the program licensing those alcoholism or drug abuse recovery or treatment facilities identified in Section 11834.026. On or before January 1, 2019, the department shall submit a report on that evaluation to the appropriate policy and fiscal committees of the Legislature.
(b)This section shall remain in effect only until January 1, 2020, and as of that date is repealed, unless a later enacted statute, that is enacted before January 1, 2020, deletes or extends that date.
SEC. 6.SEC. 5.Section 11834.36 of the Health and Safety Code is amended to read:11834.36.(a)The director may suspend or revoke any license issued under this chapter, or deny an application for licensure, for extension of the licensing period, or to modify the terms and conditions of a license, upon any of the following grounds and in the manner provided in this chapter:
(1)Violation by the licensee of any provision of this chapter or regulations adopted pursuant to this chapter.
(2)Repeated violation by the licensee of any of the provisions of this chapter or regulations adopted pursuant to this chapter.
(3)Aiding, abetting, or permitting the violation of, or any repeated violation of, any of the provisions described in paragraph (1) or (2).
(4)Conduct in the operation of an alcoholism or drug abuse recovery or treatment facility that is inimical to the health, morals, welfare, or safety of either an individual in, or receiving services from, the facility or to the people of the State of California.
(5)Misrepresentation of any material fact in obtaining the alcoholism or drug abuse recovery or treatment facility license, including, but not limited to, providing false information or documentation to the department.
(6)The licensees refusal to allow the department entry into the facility to determine compliance with the requirements of this chapter or regulations adopted pursuant to this chapter.
(7)Violation by the licensee of Section 11834.026 or the regulations adopted pursuant to that section.
(8)Failure to pay any civil penalties assessed by the department.
(b)The director may temporarily suspend any license prior to any hearing when, in the opinion of the director, the action is necessary to protect residents of the alcoholism or drug abuse recovery or treatment facility from physical or mental abuse, abandonment, or any other substantial threat to health or safety. The director shall notify the licensee of the temporary suspension and the effective date of the temporary suspension and at the same time shall serve the provider with an accusation. Upon receipt of a notice of defense to the accusation by the licensee, the director shall, within 15 days, set the matter for hearing, and the hearing shall be held as soon as possible. The temporary suspension shall remain in effect until the time the hearing is completed and the director has made a final determination on the merits. However, the temporary suspension shall be deemed vacated if the director fails to make a final determination on the merits within 30 days after the department receives the proposed decision from the Office of Administrative Hearings.
The Legislature hereby finds and declares all of the following:
(a)Substance abuse is a medical condition requiring interdisciplinary treatment including, when medically necessary, treatment by a licensed physician and surgeon.
(b)Subsequent to the enactment of state law licensing and regulating residential facilities providing alcohol and other drug detoxification treatment, public knowledge of addiction and treatment has advanced significantly.
(c)Lack of scientific understanding at the time of enactment of those state laws prevents the State Department of Health Care Services from licensing a residential treatment facility that uses a California-licensed physician and surgeon to provide necessary evaluation and treatment at the facility premises.
(d)This prohibition has been found to endanger persons in treatment, can result in treatment below the recognized standard of care, jeopardizes patient health, and delays patient recovery.
(e)To resolve this problem, it is the intent of the Legislature to enact this act in order to modernize and update state law and allow those in treatment to be protected and to receive modern medical treatment for a medical condition.
SEC. 2.Section 11834.025 is added to the Health and Safety Code, to read:11834.025.(a)(1)As a condition of providing alcoholism or drug abuse recovery or treatment services under this chapter at a facility licensed by the department, the facility shall obtain from an applicant for services a signed certification described in subdivision (b) from a health care practitioner.
(2)For purposes of this chapter, health care practitioner means a person duly licensed and regulated under Division 2 (commencing with Section 500) of the Business and Professions Code, who is acting within the scope of practice of his or her license or certificate.
(b)The department shall develop a standard certification form for use by a health care practitioner. The form shall include, but not be limited to, a description of the alcoholism and drug abuse recovery or treatment services that a licensed alcoholism or drug abuse recovery or treatment facility may provide under state law, and a certification by the health care practitioner that the health condition or medical or psychiatric history of the applicant does not require a level of care that is higher than the level of care that may legally be provided by a licensed alcoholism or drug abuse recovery or treatment facility.
(c)On or before January 1, 2017, the department shall adopt emergency regulations to implement this section. The regulations shall prescribe, among other things, the timeframe within which the certification described in subdivision (b) shall be provided to a facility.
(1)(A)The initial adoption of emergency regulations pursuant to this section and each readoption of emergency regulations shall be deemed an emergency and necessary for the immediate preservation of the public peace, health, safety, or general welfare. Initial emergency regulations and any readoption of emergency regulations authorized by this section shall be exempt from review by the Office of Administrative Law. The initial emergency regulations and each readoption of emergency regulations authorized by this section shall be submitted to the Office of Administrative Law for filing with the Secretary of State and publication in the California Code of Regulations and each shall remain in effect only until the earlier of 180 days following the effective date of the emergency regulations or the effective date of final regulations adopted by the department.
(B)The department shall adopt final regulations on or before July 1, 2016 2017. The final regulations shall be adopted in accordance with the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code).
(2)Notwithstanding the rulemaking provisions of the Administrative Procedure Act, the department may, if it deems appropriate, implement, interpret, or make specific this section by means of provider bulletins, written guidelines, or similar instructions from the department only until the department adopts emergency regulations.
SEC. 3.Section 11834.026 is added to the Health and Safety Code, to read:11834.026.(a)As used in this section, incidental medical services means services, as specified by the department in regulations, to address physical and mental health issues associated with either detoxification from alcohol or drugs or the provision of alcoholism or drug abuse recovery or treatment services, that in the opinion of a physician are not required to be performed in a licensed clinic or licensed health facility, as defined in Section 1200 or 1250, respectively.
(b)Notwithstanding any other law, a licensed alcoholism or drug abuse recovery or treatment facility may permit incidental medical services to be provided to a resident at the facility premises by one or more independent physicians and surgeons licensed by the Medical Board of California or the Osteopathic Medical Board who are knowledgeable about addiction medicine, or one or more other health care practitioner practitioners acting within the scope of practice of his or her license and under the direction of a physician and surgeon, and who are also knowledgeable about addiction medicine, when all of the following conditions are met:
(1)The facility, in the judgment of the department, has the ability to comply with the requirements of this chapter and all other applicable laws and regulations to meet the needs of a resident receiving incidental medical services from a physician pursuant to this chapter. The department shall specify in regulations the minimum requirements that a facility shall meet in order to be approved to permit the provision of incidental medical services on its premises. The license of a facility approved to provide incidental medical services shall reflect that those services are permitted to be provided at the facility premises.
(2)The physician and surgeon and any other health care practitioner has signed an acknowledgment on a form provided by the department that he or she has been advised of and understands the statutory and regulatory limitations on the services that may legally be provided by a licensed alcoholism or drug abuse recovery or treatment facility, and the statutory and regulatory requirements and limitations for the physician and surgeon or other health care protection and for the facility, related to providing incidental medical services. The licensee shall maintain a copy of the signed form at the facility for a physician and surgeon or other health care practitioner providing incidental medical services at the facility premises.
(3)There is an agreed-upon written protocol between the physician and surgeon and the alcoholism or drug abuse recovery or treatment facility signed by the physician and surgeon and the licensee. The protocol shall address, at a minimum, the respective areas of responsibility of the physician and surgeon and the facility and the need for communication communicating and sharing resident information related to the physician and surgeon providing incidental medical services. The department shall specify by regulations the issues that shall be addressed and the information that shall be included in the protocol. The facility shall maintain a copy of the signed protocol at the facility.
(4)The facility in its admissions agreement with a client shall clearly identify the individual financially responsible for incidental medical services provided and the manner in which those services shall be billed.
(5)There is ongoing communication between the physician and the alcoholism or drug abuse recovery or treatment facility about the services provided to the resident by the physician and surgeon and the frequency and duration of incidental medical services to be provided. Resident information shall be shared between the physician and surgeon and the alcoholism or drug abuse recovery or treatment facility regarding the resident's need for incidental medical services and the services to be provided to the resident by the physician and surgeon, including, but not limited to, medical information, as defined by the Confidentiality of Medical Information Act (Part 2.6 (commencing with Section 56) of Division 1 of the Civil Code). The department shall specify by regulations any other requirements or limitations on these communications.
(6)There is initial and ongoing communication between the physician and surgeon or other health care practitioner and the residents health plan or health insurer prior to the provision of incidental medical services, to the extent allowable by state and federal privacy and confidentiality laws, to ensure coordination of care.
(7)The facility does not provide incidental medical services and does not assist with or interfere with the physician and surgeon or other health care practitioner providing incidental medical services.
(8)In addition to any other medical authorization that may be required before a facility resident receives incidental medical services, the resident is authorized by the physician and surgeon as medically appropriate to receive the incidental medical services at the premises of the licensed facility. A copy of the authorization, on a form provided by the department, shall be signed by the physician and surgeon and maintained in the residents file at the facility.
(9)Before a facility resident receives incidental medical services, the resident has signed an acknowledgment and consent to receive those services on a form provided by the department. The form, at a minimum, shall describe the incidental medical services that the facility may permit to be provided and shall state that the permitted incidental medical services will be provided by a physician and surgeon or other health care practitioner working under the direction of the physician and surgeon and not by the facility staff. The department shall specify in regulations, at a minimum, the content and manner of providing the form, and any other information that the department deems appropriate. The facility shall maintain a copy of the signed acknowledgment and consent in the residents file.
(10)Once incidental medical services are initiated for a resident, the physician and surgeon and facility shall continuously monitor the resident to ensure that the resident remains appropriate to receive those services. If the physician and surgeon determines that a change in the residents medical or psychiatric condition requires other medical or psychiatric services or that a higher level of care is required than the facility may legally provide, the physician and surgeon shall immediately notify the licensee and shall assist the licensee to initiate emergency care, urgent care, or other higher level of care, as appropriate. If the licensee believes that a resident requires a higher level of care than the facility can legally provide, the licensee shall immediately notify the physician and surgeon and the department. The department shall specify by regulations any other requirements or limitations pertaining to changes in condition of a resident who is receiving incidental medical services, and any other requirements the department deems appropriate.
(11)The facility maintains in its files a copy of the physician and surgeons license or other written evidence of licensure to practice medicine in the state.
(12)The physician and surgeon and the facility both maintain compliance with the departments regulations relating to providing incidental medical services.
(c)The facility shall timely report to the department in a timely manner any violation or suspected violation by the physician and surgeon of the regulations relating to providing incidental medical services or the signed protocol described in paragraph (3) of subdivision (b). The department shall specify in regulations, at a minimum, the steps required to be taken when the department substantiates that information provided by the licensee.
(d)This section does not require a facility to provide incidental medical services or any services beyond those permitted by this chapter.
(e)The department shall not evaluate or have any responsibility or liability with respect to evaluating incidental medical services provided. This section does not limit the departments ability to report suspected misconduct by a physician and surgeon or other health care practitioner to the appropriate licensing entity or to law enforcement.
(f)A facility licensed and approved by the department to allow provision of incidental medical services shall not by offering approved incidental medical services be considered a clinic or health facility within the meaning of Section 1200 or 1250, respectively.
(g)Other than incidental medical services provided, minor first aid, or in the case of a life threatening emergency, this section does not authorize the provision at the premises of the facility of any medical or health care services or any other services that require a higher level of care than the care that may be provided within a licensed alcoholism or drug abuse recovery or treatment facility.
(h)The department shall promulgate regulations to implement this section.
(1)The department shall adopt emergency regulations on or before January 1, 2017. Prior to adoption of emergency regulations, the department shall seek appropriate technical assistance from stakeholders and shall allow interested stakeholders to provide comments through any means the department deems appropriate.
(2)(A)The initial adoption of emergency regulations pursuant to this section and each readoption of emergency regulations shall be deemed an emergency and necessary for the immediate preservation of the public peace, health, safety, or general welfare. Initial emergency regulations and each readoption of emergency regulations authorized by this section shall be exempt from review by the Office of Administrative Law. The initial emergency regulations and each readoption of emergency regulations authorized by this section shall be submitted to the Office of Administrative Law for filing with the Secretary of State and publication in the California Code of Regulations and each shall remain in effect only until the earlier of 180 days following the effective date of the emergency regulations or the effective date of final regulations adopted by the department.
(B)On or before July 1, 2017, the department shall adopt final regulations in accordance with the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code).
(3)Notwithstanding the rulemaking provisions of the Administrative Procedure Act, the department may, if it deems appropriate, implement, interpret, or make specific this section by means of provider bulletins, written guidelines, or similar instructions from the department until emergency regulations are adopted.
SEC. 4.Section 11834.03 of the Health and Safety Code is amended to read:11834.03.(a)A person or entity applying for licensure shall file with the department, on forms provided by the department, all of the following:
(1)A completed written application for licensure.
(2)A fire clearance approved by the State Fire Marshal or local fire enforcement officer.
(3)A licensure fee, established in accordance with Chapter 7.3 (commencing with Section 11833.01).
(b)If an applicant intends to permit services pursuant to Section 11834.026, the applicant shall submit a copy of the written protocol, evidence of a valid license of the physician and surgeon who will provide those services, and any other information the department deems appropriate, including, but not limited to, a copy of the alcoholism or drug abuse recovery or treatment facilitys accreditation by a nationally recognized accrediting organization.
(c)The department may establish an additional licensure fee for an application that includes a request to provide detoxification services or services pursuant to Section 11834.026.
SEC. 5.Section 11834.05 is added to the Health and Safety Code, to read:11834.05.(a)The department shall conduct an evaluation of the program licensing those alcoholism or drug abuse recovery or treatment facilities identified in Section 11834.026. On or before January 1, 2019, the department shall submit a report on that evaluation to the appropriate policy and fiscal committees of the Legislature.
(b)This section shall remain in effect only until January 1, 2020, and as of that date is repealed, unless a later enacted statute, that is enacted before January 1, 2020, deletes or extends that date.
SEC. 6.Section 11834.36 of the Health and Safety Code is amended to read:11834.36.(a)The director may suspend or revoke any license issued under this chapter, or deny an application for licensure, for extension of the licensing period, or to modify the terms and conditions of a license, upon any of the following grounds and in the manner provided in this chapter:
(1)Violation by the licensee of any provision of this chapter or regulations adopted pursuant to this chapter.
(2)Repeated violation by the licensee of any of the provisions of this chapter or regulations adopted pursuant to this chapter.
(3)Aiding, abetting, or permitting the violation of, or any repeated violation of, any of the provisions described in paragraph (1) or (2).
(4)Conduct in the operation of an alcoholism or drug abuse recovery or treatment facility that is inimical to the health, morals, welfare, or safety of either an individual in, or receiving services from, the facility or to the people of the State of California.
(5)Misrepresentation of any material fact in obtaining the alcoholism or drug abuse recovery or treatment facility license, including, but not limited to, providing false information or documentation to the department.
(6)The licensees refusal to allow the department entry into the facility to determine compliance with the requirements of this chapter or regulations adopted pursuant to this chapter.
(7)Violation by the licensee of Section 11834.026 or the regulations adopted pursuant to that section.
(8)Failure to pay any civil penalties assessed by the department.
(b)The director may temporarily suspend any license prior to any hearing when, in the opinion of the director, the action is necessary to protect residents of the alcoholism or drug abuse recovery or treatment facility from physical or mental abuse, abandonment, or any other substantial threat to health or safety. The director shall notify the licensee of the temporary suspension and the effective date of the temporary suspension and at the same time shall serve the provider with an accusation. Upon receipt of a notice of defense to the accusation by the licensee, the director shall, within 15 days, set the matter for hearing, and the hearing shall be held as soon as possible. The temporary suspension shall remain in effect until the time the hearing is completed and the director has made a final determination on the merits. However, the temporary suspension shall be deemed vacated if the director fails to make a final determination on the merits within 30 days after the department receives the proposed decision from the Office of Administrative Hearings.
The Legislature hereby finds and declares all of the following:
(a)Substance abuse is a medical condition requiring interdisciplinary treatment including, when medically necessary, treatment by a licensed physician and surgeon.
(b)Subsequent to the enactment of state law licensing and regulating residential facilities providing alcohol and other drug detoxification treatment, public knowledge of addiction and treatment has advanced significantly.
(c)Lack of scientific understanding at the time of enactment of those state laws prevents the State Department of Health Care Services from licensing a residential treatment facility that uses a California-licensed physician and surgeon to provide necessary evaluation and treatment at the facility premises.
(d)This prohibition has been found to endanger persons in treatment, can result in treatment below the recognized standard of care, jeopardizes patient health, and delays patient recovery.
(e)To resolve this problem, it is the intent of the Legislature to enact this act in order to modernize and update state law and allow those in treatment be protected and to receive modern medical treatment for a medical condition.
SEC. 2.Section 11834.025 is added to the Health and Safety Code, to read:11834.025.(a)(1)As a condition of providing alcoholism or drug abuse recovery or treatment services under this chapter at a facility licensed by the department, the facility shall obtain from an applicant for services a signed certification described in subdivision (b) from a health care practitioner.
(2)For purposes of this chapter, health care practitioner means a person duly licensed and regulated under Division 2 (commencing with Section 500) of the Business and Professions Code, who is acting within the scope of practice his or her license or certificate.
(b)The department shall develop a standard certification form for use by a health care practitioner. The form shall include, but not be limited to, a description of the alcoholism and drug abuse recovery or treatment services that a licensed alcoholism or drug abuse recovery or treatment facility may provide under state law, and a certification by the health care practitioner that the health condition or medical or psychiatric history of the applicant does not require a level of care that is higher than the level of care that may legally be provided by a licensed alcoholism or drug abuse recovery or treatment facility.
(c)On or before January 1, 2017, the department shall adopt emergency regulations to implement this section. The regulations shall prescribe, among other things, the timeframe within which the certification described in subdivision (b) shall be provided to a facility.
(1)(A)The initial adoption of emergency regulations pursuant to this section and each readoption of emergency regulations shall be deemed an emergency and necessary for the immediate preservation of the public peace, health, safety, or general welfare. Initial emergency regulations and any readoption of emergency regulations authorized by this section shall be exempt from review by the Office of Administrative Law. The initial emergency regulations and each readoption of emergency regulations authorized by this section shall be submitted to the Office of Administrative Law for filing with the Secretary of State and publication in the California Code of Regulations and each shall remain in effect only until the earlier of 180 days following the effective date of the emergency regulations or the effective date of final regulations adopted by the department.
(B)The department shall adopt final regulations on or before July 1, 2016. The final regulations shall be adopted in accordance with the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code).
(2)Notwithstanding the rulemaking provisions of the Administrative Procedure Act, the department may, if it deems appropriate, implement, interpret, or make specific this section by means of provider bulletins, written guidelines, or similar instructions from the department only until the department adopts emergency regulations.
SEC. 3.Section 11834.026 is added to the Health and Safety Code, to read:11834.026.(a)As used in this section, incidental medical services means services, as specified by the department in regulations, to address physical and mental health issues associated with either detoxification from alcohol or drugs or the provision of alcoholism or drug abuse recovery or treatment services, that in the opinion of a physician are not required to be performed in a licensed clinic or licensed health facility, as defined in Section 1200 or 1250, respectively.
(b)Notwithstanding any other law, a licensed alcoholism or drug abuse recovery or treatment facility may permit incidental medical services to be provided to a resident at the facility premises by one or more independent physicians and surgeons licensed by the Medical Board of California or the Osteopathic Medical Board who are knowledgeable about addiction medicine, or one or more other health care practitioner acting within the scope of practice of his or her license and under the direction of a physician and surgeon, and also knowledgeable about addiction medicine, when all of the following conditions are met:
(1)The facility, in the judgment of the department, has the ability to comply with the requirements of this chapter and all other applicable laws and regulations to meet the needs of a resident receiving incidental medical services from a physician pursuant to this chapter. The department shall specify in regulations the minimum requirements that a facility shall meet in order to be approved to permit the provision of incidental medical services on its premises. The license of a facility approved to provide incidental medical services shall reflect that those services are permitted to be provided at the facility premises.
(2)The physician and surgeon and any other health care practitioner has signed an acknowledgment on a form provided by the department that he or she has been advised of and understands the statutory and regulatory limitations on the services that may legally be provided by licensed alcoholism or drug abuse recovery or treatment facility, and the statutory and regulatory requirements and limitations for the physician and surgeon or other health care protection and for the facility, related to providing incidental medical services. The licensee shall maintain a copy of the signed form at the facility for a physician and surgeon or other health care practitioner providing incidental medical services at the facility premises.
(3)There is an agreed-upon written protocol between the physician and surgeon and the alcoholism or drug abuse recovery or treatment facility signed by the physician and surgeon and the licensee. The protocol shall address, at a minimum, the respective areas of responsibility of the physician and surgeon and the facility and the need for communication and sharing resident information related to the physician and surgeon providing incidental medical services. The department shall specify by regulations the issues that shall be addressed and the information that shall be included in the protocol. The facility shall maintain a copy of the signed protocol at the facility.
(4)The facility in its admissions agreement with a client shall clearly identify the individual financially responsible for incidental medical services provided and the manner in which those services shall be billed.
(5)There is ongoing communication between the physician and the alcoholism or drug abuse recovery or treatment facility about the services provided to the resident by the physician and surgeon and the frequency and duration of incidental medical services to be provided. Resident information shall be shared between the physician and surgeon and the alcoholism or drug abuse recovery or treatment facility regarding the resident's need for incidental medical services and the services to be provided to the resident by the physician and surgeon, including, but not limited to, medical information, as defined by the Confidentiality of Medical Information Act (Part 2.6 (commencing with Section 56) of Division 1 of the Civil Code). The department shall specify by regulations any other requirements or limitations on these communications.
(6)There is initial and ongoing communication between the physician and surgeon or other health care practitioner and the residents health plan or health insurer prior to the provision of incidental medical services, to the extent allowable by state and federal privacy and confidentiality laws, to ensure coordination of care.
(7)The facility does not provide incidental medical services and does not assist with or interfere with the physician and surgeon or other health care practitioner providing incidental medical services.
(8)In addition to any other medical authorization that may be required before a facility resident receives incidental medical services, the resident is authorized by the physician and surgeon as medically appropriate to receive the incidental medical services at the premises of the licensed facility. A copy of the authorization, on a form provided by the department, shall be signed by the physician and maintained in the residents file at the facility.
(9)Before a facility resident receives incidental medical services, the resident has signed an acknowledgment and consent to receive those services on a form provided by the department. The form, at a minimum, shall describe the incidental medical services that the facility may permit to be provided and shall state that the permitted incidental medical services will be provided by a physician and surgeon or other health care practitioner working under the direction of the physician and surgeon and not by the facility staff. The department shall specify in regulations, at a minimum, the content and manner of providing the form, and any other information that the department deems appropriate. The facility shall maintain a copy of the signed acknowledgment and consent in the residents file.
(10)Once incidental medical services are initiated for a resident, the physician and surgeon and facility shall continuously monitor the resident to ensure that the resident remains appropriate to receive those services. If the physician and surgeon determines that a change in the residents medical or psychiatric condition requires other medical or psychiatric services or that a higher level of care is required than the facility may legally provide, the physician and surgeon shall immediately notify the licensee and shall assist the licensee to initiate emergency care, urgent care, or other higher level of care, as appropriate. If the licensee believes that a resident requires a higher level of care than the facility can legally provide, the licensee shall immediately notify the physician and surgeon and the department. The department shall specify by regulations any other requirements or limitations pertaining to changes in condition of a resident who is receiving incidental medical services, and any other requirements the department deems appropriate.
(11)The facility maintains in its files a copy of the physician and surgeons license or other written evidence of licensure to practice medicine in the state.
(12)The physician and surgeon and the facility both maintain compliance with the departments regulations relating to providing incidental medical services.
(c)The facility shall timely report to the department any violation or suspected violation by the physician and surgeon of the regulations relating to providing incidental medical services or the signed protocol described in paragraph (3) of subdivision (b). The department shall specify in regulations, at a minimum, the steps required to be taken when the department substantiates that information provided by the licensee.
(d)This section does not require a facility to provide incidental medical services or any services beyond those permitted by this chapter.
(e)The department shall not evaluate or have any responsibility or liability with respect to evaluating incidental medical services provided. This section does not limit the departments ability to report suspected misconduct by a physician and surgeon or other health care practitioner to the appropriate licensing entity or to law enforcement.
(f)A facility licensed and approved by the department to allow provision of incidental medical services shall not by offering approved incidental medical services be considered a clinic or health facility within the meaning of Section 1200 or 1250, respectively.
(g)Other than incidental medical services provided, minor first aid, or in the case of a life threatening emergency, this section does not authorize the provision at the premises of the facility of any medical or health care services or any other services that require a higher level of care than the care that may be provided within a licensed alcoholism or drug abuse recovery or treatment facility.
(h)The department shall promulgate regulations to implement this section.
(1)The department shall adopt emergency regulations on or before January 1, 2017. Prior to adoption of emergency regulations, the department shall seek appropriate technical assistance from stakeholders and shall allow interested stakeholders to provide comments through any means the department deems appropriate.
(2)(A)The initial adoption of emergency regulations pursuant to this section and each readoption of emergency regulations shall be deemed an emergency and necessary for the immediate preservation of the public peace, health, safety, or general welfare. Initial emergency regulations and each readoption of emergency regulations authorized by this section shall be exempt from review by the Office of Administrative Law. The initial emergency regulations and each readoption of emergency regulations authorized by this section shall be submitted to the Office of Administrative Law for filing with the Secretary of State and publication in the California Code of Regulations and each shall remain in effect only until the earlier of 180 days following the effective date of the emergency regulations or the effective date of final regulations adopted by the department.
(B)On or before July 1, 2017, the department shall adopt final regulations in accordance with the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code).
(3)Notwithstanding the rulemaking provisions of the Administrative Procedure Act, the department may, if it deems appropriate, implement, interpret, or make specific this section by means of provider bulletins, written guidelines, or similar instructions from the department until emergency regulations are adopted.
SEC. 4.Section 11834.03 of the Health and Safety Code is amended to read:11834.03.Any (a)A person or entity applying for licensure shall file with the department, on forms provided by the department, all of the following:
(a)
(1)A completed written application for licensure.
(b)
(2)A fire clearance approved by the State Fire Marshal or local fire enforcement officer.
(c)
(3)A licensure fee, established in accordance with Chapter 7.3 (commencing with Section 11833.01).
(b)If an applicant intends to permit services pursuant to Section 11834.026, the applicant shall submit a copy of the written protocol, evidence of a valid license of the physician and surgeon who will provide those services, and any other information the department deems appropriate, including, but not limited to, a copy of the alcoholism or drug abuse recovery or treatment facilitys accreditation by a nationally recognized accrediting organization.
(c)The department may establish an additional licensure fee for an application that includes a request to provide detoxification services or services pursuant to Section 11834.026.
SEC. 5.Section 11834.05 is added to the Health and Safety Code, to read:11834.05.(a)The department shall conduct an evaluation of the program licensing those alcoholism or drug abuse recovery or treatment facilities identified Section 11834.026. On or before January 1, 2019, the department shall submit a report on that evaluation to the appropriate policy and fiscal committees of the Legislature.
(b)This section shall remain in effect only until January 1, 2020, and as of that date is repealed, unless a later enacted statute, that is enacted before January 1, 2020, deletes or extends that date.
SEC. 6.Section 11834.36 of the Health and Safety Code is amended to read:11834.36.(a)The director may suspend or revoke any license issued under this chapter, or deny an application for licensure, for extension of the licensing period, or to modify the terms and conditions of a license, upon any of the following grounds and in the manner provided in this chapter:
(1)Violation by the licensee of any provision of this chapter or regulations adopted pursuant to this chapter.
(2)Repeated violation by the licensee of any of the provisions of this chapter or regulations adopted pursuant to this chapter.
(3)Aiding, abetting, or permitting the violation of, or any repeated violation of, any of the provisions described in paragraph (1) or (2).
(4)Conduct in the operation of an alcoholism or drug abuse recovery or treatment facility that is inimical to the health, morals, welfare, or safety of either an individual in, or receiving services from, the facility or to the people of the State of California.
(5)Misrepresentation of any material fact in obtaining the alcoholism or drug abuse recovery or treatment facility license. license, including, but not limited to, providing false information or documentation to the department.
(6)The licensees refusal to allow the department entry into the facility to determine compliance with the requirements of this chapter or regulations adopted pursuant to this chapter.
(7)Violation by the licensee of Section 11834.026 or the regulations adopted pursuant to that section.
(6)
(8)Failure to pay any civil penalties assessed by the department.
(b)The director may temporarily suspend any license prior to any hearing when, in the opinion of the director, the action is necessary to protect residents of the alcoholism or drug abuse recovery or treatment facility from physical or mental abuse, abandonment, or any other substantial threat to health or safety. The director shall notify the licensee of the temporary suspension and the effective date of the temporary suspension and at the same time shall serve the provider with an accusation. Upon receipt of a notice of defense to the accusation by the licensee, the director shall, within 15 days, set the matter for hearing, and the hearing shall be held as soon as possible. The temporary suspension shall remain in effect until the time the hearing is completed and the director has made a final determination on the merits. However, the temporary suspension shall be deemed vacated if the director fails to make a final determination on the merits within 30 days after the department receives the proposed decision from the Office of Administrative Hearings.
|
Date
|
Status
|
|---|---|
| Sep 1, 2015 | In Assembly. Concurrence in Senate amendments pending. May be considered on or after September 3 pursuant to Assembly Rule 77. |
| Jun 18, 2015 | Referred to Com. on HEALTH. |
| Jun 30, 2015 | In committee: Set, first hearing. Hearing canceled at the request of author. |
| Jul 2, 2015 | From committee chair, with author's amendments: Amend, and re-refer to committee. Read second time, amended, and re-referred to Com. on HEALTH. |
| Jul 16, 2015 | From committee: Amend, and do pass as amended and re-refer to Com. on APPR. (Ayes 8. Noes 1.) (July 15). |
| Jul 16, 2015 | Read second time and amended. Re-referred to Com. on APPR. |
| Aug 17, 2015 | In committee: Referred to APPR. suspense file. |
| Aug 27, 2015 | From committee: Amend, and do pass as amended. (Ayes 6. Noes 1.) (August 27). |
| Aug 31, 2015 | Read second time and amended. Ordered to third reading. |
| Jun 3, 2015 | Read third time. Passed. Ordered to the Senate. (Ayes 74. Noes 3. Page 1871.) |
| Sep 1, 2015 | Read third time. Passed. Ordered to the Assembly. |
| Sep 1, 2015 | Read third time. Passed. Ordered to the Assembly. (Ayes 29. Noes 9. Page 2353.). |
| Sep 3, 2015 | Senate amendments concurred in. To Engrossing and Enrolling. (Ayes 72. Noes 4. Page 2837.). |
| Sep 3, 2015 | Senate amendments concurred in. To Engrossing and Enrolling. (Ayes 72. Noes 4.). |
| Sep 16, 2015 | Enrolled and presented to the Governor at 4 p.m. |
| Oct 10, 2015 | Approved by the Governor. |
| Oct 10, 2015 | Chaptered by Secretary of State - Chapter 744, Statutes of 2015. |
| Feb 26, 2015 | Read first time. To print. |
| Jun 3, 2015 | Read third time. Passed. Ordered to the Senate. |
| Jun 3, 2015 | In Senate. Read first time. To Com. on RLS. for assignment. |
| Jun 2, 2015 | Read second time. Ordered to third reading. |
| Jun 1, 2015 | Read second time and amended. Ordered returned to second reading. |
| May 28, 2015 | From committee: Amend, and do pass as amended. (Ayes 12. Noes 0.) (May 28). |
| May 20, 2015 | In committee: Set, first hearing. Referred to APPR. suspense file. |
| May 20, 2015 | In committee: Set, first hearing. Referred to suspense file. |
| May 7, 2015 | Re-referred to Com. on APPR. |
| May 6, 2015 | From committee chair, with author's amendments: Amend, and re-refer to Com. on APPR. Read second time and amended. |
| Apr 29, 2015 | From committee: Do pass and re-refer to Com. on APPR. (Ayes 19. Noes 0.) (April 28). Re-referred to Com. on APPR. |
| Apr 14, 2015 | From committee: Do pass and re-refer to Com. on HEALTH. (Ayes 12. Noes 2.) (April 14). Re-referred to Com. on HEALTH. |
| Apr 7, 2015 | Re-referred to Com. on B. & P. |
| Apr 6, 2015 | From committee chair, with author's amendments: Amend, and re-refer to Com. on B. & P. Read second time and amended. |
| Mar 16, 2015 | Referred to Com. on B. & P. |
| Feb 27, 2015 | From printer. May be heard in committee March 29. |
|
Date
|
Description
|
Location
|
Votes
|
|
|---|---|---|---|---|
| Sep 3, 2015 | AB 848 STONE Concurrence in Senate Amendments | Assembly Floor |
Passed |
|
| Sep 1, 2015 | Assembly 3rd Reading AB848 Mark Stone By Hernandez | Senate Floor |
Passed |
|
| Aug 27, 2015 | Do pass as amended | Senate Standing Committee on Appropriations |
Passed |
|
| Aug 17, 2015 | Placed on suspense file | Senate Standing Committee on Appropriations |
Passed |
|
| Jul 15, 2015 | Do pass as amended, but first amend, and re-refer to the Committee on [Appropriations] | Senate Standing Committee on Health |
Passed |
|
| Jun 3, 2015 | AB 848 STONE Assembly Third Reading | Assembly Floor |
Passed |
|
| May 28, 2015 | Do pass as amended. | Assembly Standing Committee on Appropriations |
Passed |
|
| Apr 28, 2015 | Do pass and be re-referred to the Committee on [Appropriations] | Assembly Standing Committee on Health |
Passed |
|
| Apr 14, 2015 | Do pass and be re-referred to the Committee on [Health] | Assembly Standing Committee on Business and Professions |
Passed |
This list shows positions taken on this bill by organizations on the date displayed, which is linked to the original source.
Positions by individuals are not included.
|
Organization
|
Position
|
Date
|
|---|---|---|
| Alkermes, Inc. | ** Support | Sep 1, 2015 |
| Burbank, City of | ** Against | Apr 28, 2015 |
| California Narcotic Officers' Association | ** Support | Sep 1, 2015 |
| California Naturopathic Doctors Association | ** Support | Sep 1, 2015 |
| California Society Of Addiction Medicine | ** Support | Sep 1, 2015 |
| Centers | ** Support | Jul 15, 2015 |
| County Behavioral Health Directors Association | * Indeterminate | Jul 15, 2015 |
| County Behavioral Health Directors Association of California | ** Support | Sep 1, 2015 |
| Elements Behavioral Health | * Support | Apr 28, 2015 |
| Elements of Behavioral Health | ** Support | Sep 1, 2015 |
| HEALTH | ** Against | Apr 28, 2015 |
| In support of the Bill | * Support | Apr 28, 2015 |
| Janus of Santa Cruz | ** Support | Sep 1, 2015 |
| Mayor Ed Lee | * Support | Apr 28, 2015 |
| Medication for the Treatment of Opiate and Alcohol Addiction | * Support | Apr 28, 2015 |
| Promises Treatment | ** Support | Jul 15, 2015 |
| Promises Treatment Centers | ** Support | Sep 1, 2015 |
| San Francisco Department Of Public Health | ** Support | Sep 1, 2015 |
| San Francisco, City And County Of | * Support | Apr 28, 2015 |
AB 848
Page 6
CONCURRENCE IN SENATE AMENDMENTS
AB 848
(Mark Stone)
As Amended August 31, 2015
Majority vote
ASSEMBLY: |
74-3 |
(June 3, 2015) |
SENATE: |
29-9 |
(September 1, 2015) |
Original Committee Reference: B. & P.
SUMMARY: 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 the Department of Health Care Services (DHCS) to conduct an evaluation of the program on or before July 1, 2018. Specifically, this bill:
Specifies that a health care practitioner should submit a signed certification form, within a reasonable period of time, as defined by the DHCS in regulations, to a facility licensed by the DHCS where they plan to provide alcoholism or drug abuse recovery or treatment services.
Defines "health care practitioner" as a healing arts professional, licensed under Business and Professions Code Section 500, and who is acting within the scope of practice of his or her license or certificate.
Specifies that the DHCS shall develop a standard certification form, for use by a health care practitioner, that includes, but is not limited to, a description of the alcoholism and drug abuse recovery or treatment services that an applicant needs.
Defines "incidental medical services" as services that are in compliance with the community standard of practice and are not required to be performed in a licensed clinic or licensed health facility, as defined by Section 1200 or 1250, respectively, to address medical issues associated with either detoxification from alcohol or drugs or the provisions of alcoholism or drug abuse recovery or treatment services, including all of the following categories of services that the DHCS shall further define by regulation:
Obtaining medical histories.
Monitoring health status to determine whether the health status warrants transfer of the patient in order to receive urgent or emergent care.
Testing associated with detoxification from alcohol or drugs.
Providing alcoholism or drug abuse recovery or treatment services.
Overseeing patient self-administered medications.
Treating substance abuse disorders, including detoxification.
Specifies that incidental medical services do not include the provision of general primary medical care.
Specifies that a facility may permit incidental medical services to be provided to a resident at the facility by, or under the supervision of, one or more physicians and surgeons licensed by the Medical Board of California or the Osteopathic Medical Board who are knowledgeable about addiction medicine, or one or more other health care practitioners acting within the scope of practice of his or her license and under the direction of a physician and surgeon, and are also knowledgeable about addiction medicine if all of the following conditions are met:
The facility must comply with all other applicable laws and regulations to meet the needs of a resident receiving incidental medical services.
Specifies that the physician and surgeon and any other health care practitioner has signed an acknowledgment on a form provided by the DHCS that he or she has been advised of and understands the statutory and regulatory limitations on the services that may legally be provided at the facility, and the statutory and regulatory requirements and limitations for the physician and surgeon or other health care professional and for the facility.
Indicates that a physician and surgeon or other health care practitioner shall assess a resident, prior to that resident receiving incidental medical services, to determine whether it is medically appropriate for the resident to receive these services at the premises of the licensed facility. A copy of the form provide by the DHCS shall be signed by the physician and surgeon and maintained in the resident's file at the facility.
Requires that before a facility resident receives incidental medical services, the resident has signed an admission agreement. The admission agreement, at a minimum, shall describe the incidental medical services that the facility may permit to be provided and shall state that the permitted incidental medical services will be provided by, or under the supervision of, a physician and surgeon. The department shall specify in regulations, at a minimum, the content and manner of providing the admission agreement, and any other information that the department deems appropriate. The facility shall maintain a copy of the signed admission agreement in the resident's file.
Specifies that once incidental medical services are initiated for a resident, the physician and surgeon, and the facility shall monitor the resident to ensure that the services remain appropriate for the resident. If the physician and surgeon determines that a change in the resident's medical condition requires other medical services or that a higher level of care is required, the facility shall immediately arrange for the other medical services or higher level of care, as appropriate.
Requires the facility to maintain in its files a copy of the relevant professional license or other written evidence of licensure to practice medicine or perform medical services in the state for the physician and surgeon and any other health care practitioner providing incidental medical services at the facility.
Indicates that the DHCS shall not evaluate or have any responsibility or liability with respect to evaluating incidental medical services provided by a physician and surgeon or other health care practitioner at a licensed facility.
States that a facility licensed and approved by the DHCS to allow for the provision of incidental medical services shall not be deemed a clinic or health facility.
Specifies that, other than incidental medical services permitted to be provided or any urgent of emergent care required in the case of a life threatening emergency, provision of medical or health care services or services that require a higher level of care than the care that is permitted to be provided at a facility, is not permitted at a facility.
Specifies that this section does not require a residential treatment facility licensed by the DHCS to provide incidental medical services or any services not otherwise permitted by law.
Specifies that on or before July 1, 2018, the DHCS shall adopt regulations to implement this section I accordance with the Administrative Procedure Act, and notwithstanding the rulemaking provisions of the Administrative Procedure Act, the DHCS, if it deems appropriate, implement, interpret, or make specific this section by means of provider bulletins, written guidelines, or similar instructions from the DHCS until regulations are adopted.
Indicates that if an applicant for facility licensure intends to permit incidental medical services, the applicant shall submit evidence of a valid license of the physician and surgeon who will provide or oversee those services, and any other information the DHCS deems appropriate.
Allows the DHCS to establish and collect an additional licensure fee for an application that includes a request for a facility to provide services.
Further specifies that the fee shall be set at an amount sufficient to cover the reasonable costs to the DHCS of the additional assessment and investigation necessary to license facilities to provide these services, including, but not limited to, processing applications, issuing licenses, and investigating reports of noncompliance with licensing regulations.
Permits the director of DHCS to temporarily suspend any license prior to any hearing when, in the opinion of the director, the action is necessary to protect residents of the facility from physical or mental abuse, abandonment, or any other substantial threat to health or safety.
Makes other findings and declarations.
The Senate amendments delay the deadline for adopting regulations until July 1, 2018, further define incidental medical services and the categories of services that the DHCS shall define by regulation, and make a number of clarifying and technical changes.
FISCAL EFFECT: According to the Senate Appropriations Committee, this bill will result in:
One-time costs of about $550,000 to develop program requirements and adopt regulations by the DHCS.
Ongoing costs of about $550,000 per year to perform ongoing licensing, inspection, and enforcement activities relating to facilities licensed to provide incidental medical services by the DHCS, offset by fee revenues.
Unknown additional legal costs relating to future enforcement actions that may result in appeals or litigation. The DHCS has indicated that there could be significant additional legal costs due to enforcement activity and the complexities of determining appropriate medical care for residents. Whether or not such costs will occur is not known at this time.
COMMENTS:
Purpose. This bill is co-sponsored by the California Society of Addiction Medicine, Elements Behavioral Health and JANUS of Santa Cruz. According to the author, "AB 848 protects the physical and mental health of people seeking alcohol and drug rehabilitation services in residential treatment facilities. Under AB 848, physicians and other appropriate medical personnel can be available on-site to provide 24-hour medical services related to clients' addictions. Clients of these facilities often have a variety of medical needs related to their addictions. Because clients’ medical needs can affect and even interfere with their recovery, they may have better recovery outcomes when they have on-site access to medical care including vital sign monitoring, seizure risk assessment, medication management, and psychiatric therapy…The measure requires that facilities seeking licensure adhere to protocol that protect client privacy, notify clients of financial responsibility for medical care, and clearly define the level of medical care to be provided. The measure requires DHCS to promulgate final regulations by July 1, 2017, to implement the policy. Additionally, the measure requires that DHCS perform an evaluation of the law’s effectiveness by 2019."
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 (California Senate Office of Oversight and Outcomes report, Rogue Rehabs: State failed to police drug and alcohol homes, with deadly results, September 2012).
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, "… a service to support and to assist and individual in the alcohol and/or drug withdrawal process and to explore plans for continued service." 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.
Currently, the only medical care that facilities are allowed to provide to clients is first aid and emergency care. If a patient requires medical care, they must leave the facility to receive care from a medical professional and the patient must pay the medical professional directly for services.
Facility Licensing and Oversight. Prior to July 1, 2013, the Department of Alcohol and Drug Programs (ADP) was responsible for oversight of alcoholism or drug abuse recovery or treatment facilities. Effective with the passage of the 2013-2014 Budget Act and associated legislation, all ADP programs and staff, except the Office of Problem Gambling, transferred to the DHCS. Now, the DHCS is responsible for oversight. The DHCS licenses the facilities and conducts reviews of their operations every two years. As part of the review process, the DHCS checks for compliance with a variety of requirements including, whether staff has passed tuberculosis tests, that residents have completed health questionnaires and if at least one staff member is certified in first aid and cardiopulmonary resuscitation (CPR).
The DHCS's Substance Use Disorder (SUD) Compliance Division investigates complaints against facilities. The SUD Compliance Division also investigates violations of the code of conduct of registered or certified alcohol and drug counselors. Additionally, facilities licensed or certified by DHCS are required to report counselor misconduct to DHCS within 24 hours of the violation. Facilities that do not comply with existing requirements are subject to civil penalties and license suspension or revocation.
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.
Senate Office of Oversight and Outcomes Report. In 2012, the Senate Office of Oversight and Outcomes (SOOO) published a report, Rogue Rehabs: State failed to police drug and alcohol homes, with deadly results. The report focused on "gaps" in the ADP’s regulation of residential programs as well as a review of the state's ban on medical care at residential drug and alcohol programs. The SOOO advised that state law be changed to "better reflect current treatment practices…[there is a] mismatch between the department’s regulation and the industry’s prevalent practices. " The SOOO recommended, "…lifting the ban on medical care as long as it is accompanied with more extensive oversight."
Other States. As part of the SOOO's aforementioned investigation in 2012, it contacted nine other highly populous states. The SOOO found, "California is unusual among populous states in prohibiting medical care." All but one of the nine states allowed physicians and other medical professionals to work in residential rehabilitation facilities.
Implementation Issues. As indicated above, there have been a number of bills that have attempted to address the issue of removing the ban on provision of medical services at alcoholism or drug abuse recovery or treatment facilities. While there have been recent changes to these facilities, e.g. the licensing and oversight of these facilities was transferred to the DHCS in 2013, the Legislature may wish to consider requiring additional implementation safeguards should this bill pass.
As noted in the SOOO report, it is recommended that the DHCS, the facility and/or the accrediting organization implement regulations requiring that the credentials and malpractice insurance for medical professionals providing medical treatment be checked before they contract with the facility. It may also be beneficial to set up a system to require a yearly review of the medical professional’s credentials and insurance to assure ongoing compliance and patient protection.
As is consistent with practices in other states, it may also be beneficial for programs that offer any type of medical detoxification to hire a medical director to oversee the administration of this treatment.
To safeguard against the state's prohibition against the corporate practice of medicine, physicians should contract with the facilities instead of working directly for them. This would necessitate that the employment contract specify that the program cannot control or interfere with the physician's practice and that the physician retains the ability to make decisions. The contract should also clearly state that the physician is not paid for the types or amount of services provided.
Analysis Prepared by: Le Ondra Clark Harvey / B. & P. / (916) 319-3301 FN: 0001923
AB 848
Page 8
|
Office of Senate Floor Analyses (916) 651-1520 Fax: (916) 327-4478 |
THIRD READING
Bill No: AB 848
Amended: 8/31/15 in Senate
SENATE HEALTH COMMITTEE: 8-1, 7/15/15
AYES: Hernandez, Hall, Mitchell, Monning, Nielsen, Pan, Roth, Wolk
NOES: Nguyen
SENATE APPROPRIATIONS COMMITTEE: 6-1, 8/27/15
AYES: Lara, Beall, Hill, Leyva, Mendoza, Nielsen
NOES: Bates
ASSEMBLY FLOOR: 74-3, 6/3/15 - See last page for vote
SUBJECT: Alcoholism and drug abuse treatment facilities
SOURCE: California Society of Addiction Medicine
Elements of Behavioral Health/Promises Treatment Centers
Janus of Santa Cruz
DIGEST: This bill allows alcoholism or drug abuse recovery or treatment facilities licensed by the Department of Health Care Services to provide incidental medical services, as specified, upon receiving a license to provide those services. This bill requires incidental medical services to be provided by a physician and surgeon or other health care practitioner who are knowledgeable about addiction medicine, as specified.
Existing law:
Requires the Department of Health Care Services (DHCS) to license nonmedical adult alcoholism or drug abuse recovery or treatment facilities (RTFs), and specifies that a license is valid for two years.
Defines an RTF as a facility that provides 24-hour residential, nonmedical services, defined as recovery services, treatment services, and detoxification services, to adults who are recovering from problems related to alcohol, drug, or alcohol and drug misuse or abuse.
Prohibits a licensee from operating an RTF beyond the conditions of the license, and if it does, the RTF is subject to civil penalties, suspension, or revocation of the license.
Allows DHCS’s director to suspend or revoke any license, or deny an application for licensure, for extension of the licensing period, or to modify the terms and conditions of a license for specified reasons, including repeated violations of licensing laws or misrepresentation of any material fact in obtaining a license.
Provides for the licensure of physicians and surgeons, and the enforcement of the disciplinary and criminal provisions of the Medical Practice Act, by the Medical Board of California (MBC) within the Department of Consumer Affairs.
This bill:
Allows RTFs to apply to DHCS to obtain a license to provide “incidental medical services (IMS).” Defines IMS as services that are in compliance with the community standard of practice and are not required to be performed in a licensed clinic or licensed health facility, as specified. Specifies that IMS includes obtaining medical histories, monitoring health status, overseeing patient self-administration of medications, and other services to be further defined by DHCS by regulation.
Requires, as a condition of providing IMS, an RTF to obtain from an applicant (a prospective resident) a signed certification from a health care practitioner that includes, but is not limited to, a description of the recovery or treatment services that the applicant needs.
Allows RTFs to permit IMS to a resident of the RTF on the premises by one or more physicians licensed by MBC or the Osteopathic Medical Board of California (OMBC) who are knowledgeable about addiction medicine, or one or more other health care practitioners acting within the scope of their license and under the direction or supervision of a physician, who are also knowledgeable about addiction medicine, when all of the following conditions are met:
The RTF, in the judgment of DHCS, has the ability to comply with the licensing requirements;
The physician and any other health care practitioner has signed and acknowledged on a form provided by DHCS that he or she has been advised of and understands the statutory and regulatory limitations on the IMS services allowed at the RTF;
The RTF resident is authorized by a physician as medically appropriate to received IMS on the premises of the RTF;
Before a resident received IMS, the resident signs an admission agreement to receive IMS. Requires the admission agreement, at a minimum, to describe the IMS that the RTF may permit to be provided and states that the permitted IMS will be provided by, or under the supervision of, a physician or other health care practitioner working under the direction of a physician;
Once IMS are initiated for a resident, the physician monitors the resident to ensure that the resident remains appropriate to receive IMS. Requires, if the physician determines a change in the resident’s medical condition requires other medical services or a higher level of care than what an RTF may provide, the physician to immediately notify the RTF and to assist the RTF in initiating emergency care, urgent care, or other higher level of care, as appropriate; and
The RTF maintains in its files the physician’s license or other written evidence of licensure to practice medicine in the state.
Specifies that DHCS is not responsible for evaluating and does not have liability with respect to evaluating IMS.
Specifies that an RTF providing IMS is not deemed a clinic or health facility, as specified.
Specifies that a license to provide IMS does not authorize an RTF to provide on the premises any medical or health care services or any other services that require a higher level of care than what the RTF can provide.
Requires an RTF that intends to apply to provide IMS to submit evidence of a physician’s license who will provide the services, and any other information DHCS deems appropriate.
Requires DHCS to establish and collect an additional licensure fee for an RTF that includes a request to provide IMS. Requires the fee to be in an amount sufficient to cover DHCS’s reasonable costs related to IMS, including processing applications, issuing licenses, and investigating reports of noncompliance with licensing regulations.
Broadens DHCS’s director’s authority to suspend or revoke a license, or deny an application for licensure, extension of licensure period, or modify a license to include, but not limited to, the following:
An RTF providing false information or documentation to DHCS;
An RTF’s refusal to allow DHCS to enter an RTF to determine compliance with licensing laws; and
Violation by the RTF of any IMS regulations adopted by DHCS.
Requires DHCS to adopt regulations to implement the provisions of this bill on or before July 1, 2018, and allows DHCS to implement, interpret, or make specific these provisions by means of provider bulletins, written guidelines, or similar instructions until regulations are adopted.
Background
RTFs licensed by DHCS, based on what is commonly referred to as the social model, are currently allowed to provide recovery, treatment, and detoxification services. (The Department of Public Health licenses medical model RTFs known as chemical dependency recovery hospitals.) Social model RTFs range in size from six-bed facilities in residential neighborhoods to centers that accommodate hundreds of beds. According to DHCS, there are 298 licensed social model RTFs that serve six or fewer people, and the largest RTF that DHCS licenses has a capacity of 309 beds. The services provided by these RTFs include group and individual counseling, educational sessions, and alcoholism or drug abuse recovery and treatment planning. Social model RTFs are allowed to provide clients first aid and emergency care. However, if a resident needs medical care (defined by DHCS as a service provided by a professional required to hold a professional license from the MBC, the OMBC, the Board of Registered Nursing, etc.), the resident must be referred to the proper facility to receive care from a medical professional, and the resident must pay the medical professional directly for services.
According to the MBC and DHCS, nothing in current law prohibits a medical professional from conducting a house call at an RTF for a resident. MBC also states that social model RTFs can contract with a physician or a physician group to provide medical services, as long as the RTF contracts with, not employs, the medical professional. The contract also should contain language that makes it clear that the RTF cannot interfere with, control, or otherwise direct the medical professional and that the medical professional has decision-making authority. The contract should also specify that the medical professional is paid a flat or hourly fee, not fees based on the kinds or amounts of services provided.
Comments
Author’s statement. According to the author, many patients seeking treatment at RTFs have physical and mental health needs related to their addictions when they arrive at these facilities, yet the state has barred RTFs from having medical personnel onsite to provide medical treatment related to addiction. Facility staff may provide basic first aid or emergency care, but these are the only exceptions to medical care. Instead, patients who have medical needs related to their addictions must be transported to a doctor’s office or health care facility to receive care. This requirement to transport patients who could receive care in their RTFs is burdensome to patients, facilities, and physicians alike. RTFs should be able to provide the best possible care for vulnerable people struggling to overcome addictions. Sometimes, the best possible care can include medical treatment related to addiction and recovery if that care has been determined in the view of a physician to be able to be provided onsite rather than in a health care facility. By allowing such care to be provided onsite, AB 848 allows thousands of vulnerable people to recover from addiction safely.
Facility licensing and oversight. Prior to July 1, 2013, the Department of Alcohol and Drug Programs (ADP) was responsible for oversight of RTFs. Effective with the passage of the 2013-2014 Budget Act and associated legislation, all ADP programs and staff, except the Office of Problem Gambling, transferred to DHCS. As part of their licensing function, DHCS conducts reviews of social model RTF operations every two years, or as necessary. As part of the review process, DHCS checks for compliance with a variety of requirements, including whether staff has passed tuberculosis tests, that residents have completed health questionnaires prior to admission at an RTF, and if at least one staff member is certified in first aid and CPR.
DHCS’s Substance Use Disorder (SUD) Compliance Division investigates all complaints related to social model RTFs, including deaths, complaints against staff, and allegations of operating without a license. The SUD Compliance Division also investigates violations of the code of conduct of registered or certified alcohol and drug counselors. Additionally, RTFs licensed by DHCS are required to report counselor misconduct to DHCS within 24 hours of the violation. RTFs that do not comply with existing requirements are subject to civil penalties and license suspension or revocation.
Reports about RTFs. In 2012, the Senate Office of Oversight and Outcomes (SOOO) published a report, Rogue Rehabs: State failed to police drug and alcohol homes, with deadly results. The report focused on gaps in ADP’s regulation of residential programs, as well as a review of the state’s ban on medical care at RTFs. SOOO advised that state law be changed to better reflect current treatment practices and stated that there is a mismatch between ADP’s regulation and the industry’s prevalent practices. SOOO recommended lifting the ban on medical care as long as it is accompanied with more extensive oversight.
An article published in Mother Jones in the May/June 2015 issue, “The Rehab Racket: The Way We Treat Addiction is a Costly, Dangerous Mess,” written by the same author of the SOOO report, notes that deaths sometimes occur at RTFs not just because of the effects caused by a person’s addiction but also from the treatment they receive at the RTF. The article cites a case at one RTF in California where a physician, who had been repeatedly investigated by and had several actions taken against his license over several years by the MBC, excessively prescribed medications to residents of the RTF with no regard for their health or safety, and despite the physician’s history, he was allowed to continue to treat residents of the RTF. The article points out that the vast majority of people in need of treatment do not receive anything that approximates evidence-based care.
The article further notes that while 18.7 million Americans needed alcohol treatment in 2010 only 1.7 million (or 8.8%) received it in specialized facilities. Issues that compound the problem include: a) out of 14,148 addiction treatment facilities in the U.S., only 26% are RTFs; b) only 15% of costs of addiction treatment are covered by private insurance (treatment can range from $1,800 a month at a government-subsidized RTF to $60,000 a month at an RTF that treats celebrities and other high-profile clients); and c) for every federal and state government dollar spent, 95.6 cents went to pay for consequences of substance abuse while only 1.9 cents were spent on any type of prevention or treatment.
Other states. As part of its investigation, SOOO contacted nine other highly populous states and found that California is unusual in prohibiting medical care at social model RTFs. Eight of the nine states (IL, IN, NY, NC, OH, PA, TX, and WA) allowed physicians and other medical professionals to work in social model RTFs. One state, MA, refers RTF clients to local doctors, but nurses are available at the RTFs.
FISCAL EFFECT: Appropriation: No Fiscal Com.: Yes Local: No
According to the Senate Appropriations Committee:
One-time costs of about $550,000 to develop program requirements and adopt regulations by DHCS (General Fund).
Ongoing costs of about $550,000 per year to perform ongoing licensing, inspection, and enforcement activities relating to facilities licensed to provide IMS by DHCS, offset by fee revenues (Residential and Outpatient Program Licensing Fund).
Unknown additional legal costs relating to future enforcement actions that may result in appeals or litigation (Residential and Outpatient Program Licensing Fund). DHCS has indicated that there could be significant additional legal costs due to enforcement activity and the complexities of determining appropriate medical care for residents. Whether or not such costs will occur is not known at this time.
California Society of Addiction Medicine (co-source)
Elements of Behavioral Health/Promises Treatment Centers (co-source)
Janus of Santa Cruz (co-source)
Alkermes, Inc.
California Narcotic Officers’ Association
California Naturopathic Doctors Association
CalNet
County Behavioral Health Directors Association of California
San Francisco Department of Public Health
OPPOSITION: (Verified 8/28/15)
City of Long Beach
ARGUMENTS IN SUPPORT: The cosponsors and other supporters, comprised of RTFs and behavioral health advocates, argue that for too long the RTF licensing authority has prohibited RTFs from having onsite medical personnel to evaluate or provide medical care to residents, which precludes RTFs from meeting residents’ medical needs that could easily and efficiently be provided onsite. Supporters further argue that, currently, residents who need medical care have to be transported to a doctor’s office or emergency room, which is inefficient, costly, and sometimes dangerous, and also disrupts a resident’s recovery efforts.
ARGUMENTS IN OPPOSITION: The City of Long Beach writes to oppose allowing medical treatment in residential neighborhoods on a routine basis. The City argues that medical treatment should be performed in areas of the city that are zoned and permitted for medical facilities—not in local neighborhoods.
ASSEMBLY FLOOR: 74-3, 6/3/15
AYES: Achadjian, Alejo, Travis Allen, Baker, Bigelow, Bloom, Bonilla, Bonta, Brough, Brown, Burke, Calderon, Campos, Chang, Chau, Chávez, Chiu, Chu, Cooley, Cooper, Dababneh, Dahle, Daly, Dodd, Eggman, Frazier, Beth Gaines, Cristina Garcia, Eduardo Garcia, Gipson, Gomez, Gonzalez, Gordon, Gray, Grove, Hadley, Roger Hernández, Holden, Irwin, Jones, Jones-Sawyer, Kim, Lackey, Levine, Linder, Lopez, Low, Maienschein, Mathis, McCarty, Medina, Melendez, Mullin, Nazarian, Obernolte, O'Donnell, Olsen, Patterson, Perea, Quirk, Rendon, Ridley-Thomas, Rodriguez, Salas, Santiago, Steinorth, Mark Stone, Ting, Wagner, Waldron, Weber, Williams, Wood, Atkins
NOES: Gallagher, Gatto, Wilk
NO VOTE RECORDED: Harper, Mayes, Thurmond
Prepared by: Reyes Diaz / HEALTH /
8/31/15 11:43:35
**** END ****
AB 848 (Mark Stone) Page 0 of 1
SENATE COMMITTEE ON APPROPRIATIONS
Senator Ricardo Lara, Chair
2015 - 2016 Regular Session
AB 848 (Mark Stone) - Alcoholism and drug abuse treatment facilities
|
|
Version: July 16, 2015 |
Policy Vote: HEALTH 8 - 1 |
Urgency: No |
Mandate: No |
Hearing Date: August 27, 2015 |
Consultant: Brendan McCarthy |
*********** ANALYSIS ADDENDUM – SUSPENSE FILE ***********
The following information is revised to reflect amendments
adopted by the committee on August 27, 2015
Bill Summary:
AB 848 would allow alcoholism and drug abuse recovery or treatment facilities licensed by the Department of Health Care Services to provide incidental medical services.
Fiscal Impact:
One-time costs of about $550,000 to develop program requirements and adopt regulations by the Department of Health Care Services (General Fund).
Ongoing costs of about $550,000 per year to perform ongoing licensing, inspection, and enforcement activities relating to facilities licensed to provide incidental medical services by the Department of Health Care Services, offset by fee revenues (Residential and Outpatient Program Licensing Fund).
Unknown additional legal costs relating to future enforcement actions that may result in appeals or litigation (Residential and Outpatient Program Licensing Fund). The Department has indicated that there could be significant additional legal costs due to enforcement activity and the complexities of determining appropriate medical care for residents. Whether or not such costs will occur is not known at this time.
Author Amendments:
Delay the deadline for adopting regulations until July 1, 2018 and make a number of clarifying and technical changes.
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AB 848 (Mark Stone) Page 2 of 2
SENATE COMMITTEE ON APPROPRIATIONS
Senator Ricardo Lara, Chair
2015 - 2016 Regular Session
AB 848 (Mark Stone) - Alcoholism and drug abuse treatment facilities
|
|
Version: July 16, 2015 |
Policy Vote: HEALTH 8 - 1 |
Urgency: No |
Mandate: No |
Hearing Date: August 17, 2015 |
Consultant: Brendan McCarthy |
This bill meets the criteria for referral to the Suspense File.
Bill Summary:
AB 848 would allow alcoholism and drug abuse recovery or treatment facilities licensed by the Department of Health Care Services to provide incidental medical services.
Fiscal Impact:
One-time costs of about $550,000 to develop program requirements and adopt regulations by the Department of Health Care Services (General Fund).
Ongoing costs of about $550,000 per year to perform ongoing licensing, inspection, and enforcement activities relating to facilities licensed to provide incidental medical services by the Department of Health Care Services, offset by fee revenues (Residential and Outpatient Program Licensing Fund).
Unknown additional legal costs relating to future enforcement actions that may result in appeals or litigation (Residential and Outpatient Program Licensing Fund). The Department has indicated that there could be significant additional legal costs due to enforcement activity and the complexities of determining appropriate medical care for residents. Whether or not such costs will occur is not known at this time.
Background:
Under current law, the Department of Health Care Services licenses and regulates residential treatment facilities that provide recovery and detoxification services to adults who are addicted to alcohol and/or drugs. (These licensing functions were transferred to the Department of Health Care Services from the Department of Alcohol and Drug Programs, which was eliminated.)
Current law does not allow operators of those licensed facilities to provide medical care to patients. However, the Senate Office of Oversight and Outcomes found that many licensed facilities do provide medical care to patients, in violation of current licensing requirements.
Proposed Law:
AB 848 would allow alcoholism and drug abuse recovery or treatment facilities licensed by the Department of Health Care Services to provide incidental medical services.
Specific provisions of the bill would:
Require a licensed facility to obtain a form signed by a health care provider from an applicant for services (i.e. a resident) that lists the necessary medical services the applicant needs;
Require the Department of Health Care Services to define incidental medical services in regulation;
Authorize a licensed alcoholism or drug abuse recovery or treatment facility to permit incidental medical services to be provided to a resident of the facility, if specified conditions are met;
Require the Department to adopt implementing regulations by July 1, 2017, but also allow the Department to implement the requirements of the bill prior to adoption of those regulations through provider bulletins or other means;
Require a facility that intends to permit incidental medical services to provide specified information to the Department;
Require the Department to establish an additional license fee for those facilities that wish to permit incidental medical services, in an amount sufficient to cover the Department’s licensing and regulatory costs.
Related Legislation:
AB 395 (Fox, 2013) would have expanded the types of facilities licensed by the Department of Health Care Services as alcoholism or drug abuse recovery or treatment facilities to include facilities that provide medical care. That bill was held on this committee’s Suspense File.
AB 972 (Butler and Beall, 2011) would have expanded the category of residential treatment facilities to include facilities that provide limited medical services. That bill was held on this committee’s Suspense File.
AB 2221 (Beall, 2010) was similar to AB 972. that bill was held on this committee’s Suspense File.
Staff Comments:
According to the Senate Office of Oversight and Outcomes report, there has been a trend in the alcohol and drug treatment industry in recent years away from a purely “social model” of treatment (based on group counseling) towards a model that incorporates more medical interventions into detoxification and treatment. As noted above, the report indicates that there are many treatment facilities in the state that are currently providing medical services to residents.
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AB 848 (Mark Stone) Page 7 of 7
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: AB 848
AUTHOR: |
Mark Stone |
||
VERSION: |
July 2, 2015 |
||
HEARING DATE: |
July 15, 2015 |
|
|
CONSULTANT: |
Reyes Diaz |
||
SUBJECT: Alcoholism and drug abuse treatment facilities.
SUMMARY:
Allows alcoholism or drug abuse recovery or treatment facilities licensed by the Department of Health Care Services to provide incidental medical services, as specified, upon receiving a license to provide those services. Requires incidental medical services to be provided by a physician and surgeon or other health care practitioner who are knowledgeable about addiction medicine, as specified.
Existing law:
Requires the Department of Health Care Services (DHCS) to license nonmedical adult alcoholism or drug abuse recovery or treatment facilities (RTFs), and specifies that a license is valid for two years.
Defines an RTF as a facility that provides 24-hour residential, nonmedical services, defined as recovery services, treatment services, and detoxification services, to adults who are recovering from problems related to alcohol, drug, or alcohol and drug misuse or abuse.
Prohibits a licensee from operating an RTF beyond the conditions of the license, and if it does, the RTF is subject to civil penalties, suspension, or revocation of the license.
Allows DHCS’s director to suspend or revoke any license, or deny an application for licensure, for extension of the licensing period, or to modify the terms and conditions of a license for specified reasons, including repeated violations of licensing laws or misrepresentation of any material fact in obtaining a license.
Provides for the licensure of physicians and surgeons, and the enforcement of the disciplinary and criminal provisions of the Medical Practice Act, by the Medical Board of California (MBC) within the Department of Consumer Affairs.
This bill:
Allows RTFs to apply to DHCS to obtain a license to provide “incidental medical services (IMS).” Defines IMS as services, to be specified by DHCS in regulations, to address physical and mental health issues associated with either detoxification from alcohol or drugs or the provision of alcoholism or drug abuse recovery or treatment services that in the opinion of a physician are not required to be performed in a licensed clinic or acute care hospital, as specified, or in a medically managed inpatient treatment program.
Requires, as a condition of providing IMS, an RTF to obtain from an applicant (a prospective resident) a signed certification from a health care practitioner that includes, but is not limited to, a description of the recovery or treatment services that the applicant needs.
Allows RTFs to permit IMS to a resident of the RTF on the premises by one or more independent physicians licensed by MBC or the Osteopathic Medical Board of California (OMBC) who are knowledgeable about addiction medicine, or one or more other health care practitioners acting within the scope of their license and under the direction of a physician, who are also knowledgeable about addiction medicine, when all of the following conditions are met:
The RTF, in the judgment of DHCS, has the ability to comply with the licensing requirements and provide any level of care between Level 3.1 and Level 3.7 of the American Society of Addiction Medicine (ASAM) criteria;
The physician and any other health care practitioner has signed and acknowledged on a form provided by DHCS that he or she has been advised of and understands the statutory and regulatory limitations on the IMS services allowed at the RTF;
There is an agreed-upon written protocol between the physician and the RTF signed by the physician and the RTF that addresses, at a minimum, the respective areas of responsibility of the physician and RTF and the need for communicating and sharing resident information related to IMS services;
The RTF, in its admission agreement with a resident, clearly identifies the individual financially responsible for IMS and the manner in which those services are billed;
There is ongoing communication between the physician and RTF about services provided to the resident, and the frequency and duration of IMS to be provided, pursuant to the Confidentiality of Medical Information Act;
There is initial and ongoing communication between the physician or other health care practitioner and the resident’s health plan or health insurer prior to the provision of IMS, to the extent allowable by state and federal privacy and confidentiality laws, to ensure coordination of care;
The RTF does not interfere with the physician or other health care practitioner providing IMS;
The RTF resident is authorized by a physician as medically appropriate to received IMS on the premises of the RTF;
Before a resident received IMS, the resident acknowledges and consents to receiving IMS on a form provided by DHCS. Requires the form, at a minimum, to describe the IMS that the RTF may permit to be provided and states that the permitted IMS will be provided by a physician or other health care practitioner working under the direction of a physician;
Once IMS are initiated for a resident, the physician continuously monitors the resident to ensure that the resident remains appropriate to receive IMS. Requires, if the physician determines a change in the resident’s medical or psychiatric condition requires other medical or psychiatric services or a higher level of care than what an RTF may provide, the physician to immediately notify the RTF and to assist the RTF in initiating emergency care, urgent care, or other higher level of care, as appropriate. Requires an RTF to notify a physician or DHCS when the RTF believes a resident requires a higher level of care;
The RTF maintains in its files the physician’s license or other written evidence of licensure to practice medicine in the state; and,
The physician and RTF comply with DHCS’s regulations for providing IMS
Requires an RTF to report to DHCS in a timely manner any violation of regulations related to IMS or the signed protocol. Requires DHCS to specify in regulations, at a minimum, the steps required to be taken when DHCS substantiates this information provided by the RTF.
Specifies that DHCS is not responsible for evaluating and does not have liability with respect to evaluating IMS.
Specifies that an RTF providing IMS is not considered a clinic or health facility, as specified.
Specifies that a license to provide IMS does not authorize an RTF to provide on the premises any medical or health care services or any other services that require a higher level of care than what the RTF can provide.
Requires an RTF that intends to apply to provide IMS to submit a copy of the written protocol, evidence of a physician’s license who will provide the services, and any other information DHCS deems appropriate, including, but not limited to, a copy of the RTF’s accreditation by a nationally recognized accrediting organization.
Requires DHCS to establish and collect an additional licensure fee for an RTF that includes a request to provide detoxification services or IMS. Requires the fee to be in an amount sufficient to cover DHCS’s reasonable costs of regulating detoxification services and IMS.
Broadens DHCS’s director’s authority to suspend or revoke a license, or deny an application for licensure, extension of licensure period, or to modify the terms and conditions of a license to include the following:
An RTF providing false information or documentation to DHCS;
An RTF’s refusal to allow DHCS to enter an RTF to determine compliance with licensing laws; and
Violation by the RTF of any IMS regulations adopted by DHCS.
Requires DHCS to adopt regulations to implement the provisions of this bill on or before July 1, 2017, and allows DHCS to implement, interpret, or make specific these provisions by means of provider bulletins, written guidelines, or similar instructions until regulations are adopted.
FISCAL EFFECT:
According to the Assembly Appropriations Committee:
Costs to adopt regulations, likely in the range of $200,000 over two years (licensing fees and Substance Abuse Prevention and Treatment Block Grant).
Unknown ongoing costs to oversee this new requirement as a component of licensure, possibly in the range of $100,000 annually (licensing fees).
PRIOR VOTES:
Assembly Floor: |
74 - 3 |
Assembly Appropriations Committee: |
12 - 0 |
Assembly Business and Professions Committee: |
12 - 2 |
COMMENTS:
Author’s statement. According to the author, many patients seeking treatment at RTFs have physical and mental health needs related to their addictions when they arrive at these facilities, yet the state has barred RTFs from having medical personnel onsite to provide medical treatment related to addiction. Facility staff may provide basic first aid or emergency care, but these are the only exceptions to medical care. Instead, patients who have medical needs related to their addictions must be transported to a doctor’s office or health care facility to receive care. This requirement to transport patients who could receive care in their RTFs is burdensome to patients, facilities, and physicians alike. RTFs should be able to provide the best possible care for vulnerable people struggling to overcome addictions. Sometimes, the best possible care can include medical treatment related to addiction and recovery if that care has been determined in the view of a physician to be able to be provided onsite rather than in a health care facility. By allowing such care to be provided onsite, AB 848 allows thousands of vulnerable people to recover from addiction safely.
Background. RTFs licensed by DHCS, based on what is commonly referred to as the social model, are currently allowed to provide recovery, treatment, and detoxification services. (The Department of Public Health licenses medical model RTFs known as chemical dependency recovery hospitals.) Social model RTFs range in size from six-bed facilities in residential neighborhoods to centers that accommodate hundreds of beds. According to DHCS, there are 298 licensed social model RTFs that serve six or fewer people, and the largest RTF that DHCS licenses has a capacity of 309 beds. The services provided by these RTFs include group and individual counseling, educational sessions, and alcoholism or drug abuse recovery and treatment planning. Social model RTFs are allowed to provide clients first aid and emergency care. However, if a resident needs medical care (defined by DHCS as a service provided by a professional required to hold a professional license from the MBC, the OMBC, the Board of Registered Nursing, etc.), the resident must be referred to the proper facility to receive care from a medical professional, and the resident must pay the medical professional directly for services.
According to the MBC and DHCS, nothing in current law prohibits a medical professional from conducting a house call at an RTF for a resident. MBC also states that social model RTFs can contract with a physician or a physician group to provide medical services, as long as the RTF contracts with, not employs, the medical professional. The contract also should contain language that makes it clear that the RTF cannot interfere with, control, or otherwise direct the medical professional and that the medical professional has decision-making authority. The contract should also specify that the medical professional is paid a flat or hourly fee, not fees based on the kinds or amounts of services provided.
Facility Licensing and Oversight. Prior to July 1, 2013, the Department of Alcohol and Drug Programs (ADP) was responsible for oversight of RTFs. Effective with the passage of the 2013-2014 Budget Act and associated legislation, all ADP programs and staff, except the Office of Problem Gambling, transferred to DHCS. As part of their licensing function, DHCS conducts reviews of social model RTF operations every two years, or as necessary. As part of the review process, DHCS checks for compliance with a variety of requirements, including whether staff has passed tuberculosis tests, that residents have completed health questionnaires prior to admission at an RTF, and if at least one staff member is certified in first aid and CPR.
DHCS’s Substance Use Disorder (SUD) Compliance Division investigates all complaints related to social model RTFs, including deaths, complaints against staff, and allegations of operating without a license. The SUD Compliance Division also investigates violations of the code of conduct of registered or certified alcohol and drug counselors. Additionally, RTFs licensed by DHCS are required to report counselor misconduct to DHCS within 24 hours of the violation. RTFs that do not comply with existing requirements are subject to civil penalties and license suspension or revocation.
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.
Reports about RTFs. In 2012, the Senate Office of Oversight and Outcomes (SOOO) published a report, Rogue Rehabs: State failed to police drug and alcohol homes, with deadly results. The report focused on gaps in ADP’s regulation of residential programs, as well as a review of the state’s ban on medical care at RTFs. SOOO advised that state law be changed to better reflect current treatment practices and stated that there is a mismatch between ADP’s regulation and the industry’s prevalent practices. SOOO recommended lifting the ban on medical care as long as it is accompanied with more extensive oversight.
An article published in Mother Jones in the May/June 2015 issue, “The Rehab Racket: The Way We Treat Addiction is a Costly, Dangerous Mess,” written by the same author of the SOOO report, notes that deaths sometimes occur at RTFs not just because of the effects caused by a person’s addiction but also from the treatment they receive at the RTF. The article cites a case at one RTF in California where a physician, who had been repeatedly investigated by and had several actions taken against his license over several years by the MBC, excessively prescribed medications to residents of the RTF with no regard for their health or safety, and despite the physician’s history, he was allowed to continue to treat residents of the RTF. The article points out that the vast majority of people in need of treatment do not receive anything that approximates evidence-based care.
The article further notes that while 18.7 million Americans needed alcohol treatment in 2010 only 1.7 million (or 8.8%) received it in specialized facilities. Issues that compound the problem include: a) out of 14,148 addiction treatment facilities in the U.S., only 26% are RTFs; b) only 15% of costs of addiction treatment are covered by private insurance (treatment can range from $1,800 a month at a government-subsidized RTF to $60,000 a month at an RTF that treats celebrities and other high-profile clients); and c) for every federal and state government dollar spent, 95.6 cents went to pay for consequences of substance abuse while only 1.9 cents were spent on any type of prevention or treatment.
Other States. As part of its investigation, SOOO contacted nine other highly populous states and found that California is unusual in prohibiting medical care at social model RTFs. Eight of the nine states (IL, IN, NY, NC, OH, PA, TX, and WA) allowed physicians and other medical professionals to work in social model RTFs. One state, MA, refers RTF clients to local doctors, but nurses are available at the RTFs.
Prior legislation. AB 395 (Fox, 2013), would have expanded the types of facilities licensed by the ADP to include any facility that has a nationally accredited program that uses a multidisciplinary team to provide 24-hour residential medical services to adults recovering from alcohol and drug abuse problems. AB 395 died on the Senate Appropriations Committee suspense file.
AB 972 (Butler and Beall, 2011), would have expanded, until January 1, 2017, the category of residential treatment facilities licensed by the ADP to include facilities that provide limited medical services to adults recovering from alcohol and drug abuse, provided that the facility is not otherwise required to have a separate health facility license. Would have established a fee for facilities that provide limited medical services and makes other changes to the licensing fees for residential treatment facilities. AB 972 was held in the Senate Appropriations Committee.
AB 2221 (Beall, 2010), would have permitted 24-hour residential treatment facilities that provide services to adults recovering from alcohol and drug abuse that are licensed by the ADP to provide unspecified medical services and would have provided that such a facility would not require a health facility license. AB 2221 died on the Senate Appropriations Committee suspense file.
AB 1055 (Chesbro, 2009), would have expanded the ADP licensure authority for alcohol and drug treatment facilities to include 24-hour facilities that do not require a health facility license. AB 1055 died on the Assembly Appropriations Committee suspense file.
Support. The cosponsors and other supporters, comprised of RTFs and behavioral health advocates, argue that for too long the RTF licensing authority has prohibited RTFs from having onsite medical personnel to evaluate or provide medical care to residents, which precludes RTFs from meeting residents’ medical needs that could easily and efficiently be provided onsite. Supporters further argue that, currently, residents who need medical care have to be transported to a doctor’s office or emergency room, which is inefficient, costly, and sometimes dangerous, and also disrupts a resident’s recovery efforts.
Technical amendments.
This bill provides that DHCS is not responsible for evaluating and does not have liability with respect to evaluating IMS. Although the bill does require a facility that opts to provide IMS to provide DHCS proof of accreditation by a nationally recognized accrediting organization, it is not clear who the entity responsible for evaluating the IMS provided at an RTF will be. The author may wish to clarify who the responsible entity for evaluating the IMS will be.
This bill requires DHCS to establish an additional fee for RTFs that provide detoxification services and IMS. However, RTFs are already allowed to provide detoxification services. The author may wish to clarify if the intent it so establish an additional fee for a service that is already allowed.
This bill references the American Society of Addiction Medicine by acronym only (ASAM). For clarity, the author may wish to amend to spell out ASAM where it is referenced.
SUPPORT AND OPPOSITION:
Support: California Society of Addiction Medicine (co-sponsor)
Elements of Behavioral Health/Promises Treatment Centers (co-sponsor)
Janus of Santa Cruz (co-sponsor)
Alkermes, Inc.
California Narcotic Officers’ Association
County Behavioral Health Directors Association of California
San Francisco Department of Public Health
Oppose: None received.
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AB 848
Page 5
ASSEMBLY THIRD READING
AB 848
(Mark Stone)
As Amended June 1, 2015
Majority vote
Committee |
Votes |
Ayes |
Noes |
Business & Professions |
12-2 |
Bonilla, Jones, Baker, Bloom, Campos, Chang, Dodd, Eggman, Holden, Mullin, Ting, Wood |
Gatto, Wilk |
Health |
19-0 |
Bonta, Maienschein, Bonilla, Burke, Chávez, Chiu, Gomez, Gonzalez, Roger Hernández, Lackey, Nazarian, Patterson, Ridley-Thomas, Rodriguez, Santiago, Steinorth, Thurmond, Waldron, Wood |
|
Appropriations |
12-0 |
Gomez, Bonta, Calderon, Daly, Eggman, Eduardo Garcia, Gordon, Holden, Quirk, Rendon, Weber, Wood |
|
SUMMARY: 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 the Department of Health Care Services (DHCS) to conduct an evaluation of the program on or before January 1, 2019, and to report the results of the evaluation to the appropriate fiscal and policy committees of the Legislature. Specifically, this bill:
Specifies that a health care practitioner should submit a signed certification form to a facility licensed by the DHCS where they plan to provide alcoholism or drug abuse recovery or treatment services.
Defines "health care practitioner" as a healing arts professional, licensed under Business and Professions Code Section 500, and who is acting within the scope of practice of his or her license or certificate.
Specifies that the DHCS shall develop a standard certification form, for use by a health care practitioner, that:
Describes the alcoholism and drug abuse recovery or treatment services provided, and
Certifies that the health condition or medical or psychiatric history of the applicant does not require a level of care that is higher than the level of care that may legally be provided by a licensed facility.
Defines "incidental medical services" as services to address the physical and mental health issues associated with either detoxification from alcohol or drugs or the provisions of alcoholism or drug abuse recovery or treatment services, that in the opinion of a physician are not required to be performed in a licensed clinic or health facility.
Specifies that a facility may permit incidental medical services to be provided to a resident at the facility by one or more independent physicians and surgeons licensed by the Medical Board of California or the Osteopathic Medical Board who are knowledgeable about addiction medicine, or one or more other health care practitioners acting within the scope of practice of his or her license and under the direction of a physician and surgeon, and are also knowledgeable about addiction medicine.
States that the facility must comply with all other applicable laws and regulations to meet the needs of a resident receiving incidental medical services from a physician.
Specifies that the physician and surgeon and any other health care practitioner has signed an acknowledgment on a form provided by the DHCS that he or she has been advised of and understands the statutory and regulatory limitations on the services that may legally be provided by the facility, and the statutory and regulatory requirements and limitations for the physician and surgeon or other health care professional and for the facility.
Requires that there is an agreed-upon written protocol between the physician and surgeon and the facility signed by the physician and surgeon and the licensee.
Specifies that the facility, in its admissions agreement with a client, shall clearly identify the individual financially responsible for incidental medical services that are provided.
States there should be ongoing communication between the physician and the facility about the services provided to the resident by the physician and surgeon and the frequency and duration of incidental medical services to be provided.
Requires initial and ongoing communication between the physician and surgeon or other health care practitioner and the resident's health plan or health insurer prior to the provision of incidental medical services to ensure coordination of care.
Specifies that the facility will not provide incidental medical services and will not assist with or interfere with the physician and surgeon or other health care practitioner providing incidental medical services.
States that the resident must be authorized by the physician and surgeon as medically appropriate to receive the incidental medical services at the facility.
Requires that before a facility resident receives incidental medical services, the resident has signed an acknowledgment and consent to receive those services on a form provided by the DHCS.
Specifies that once incidental medical services are initiated for a resident, the physician and surgeon, and the facility shall continuously monitor the resident to ensure that the services remain appropriate for the resident.
Requires the facility to maintain in its files a copy of the physician's and surgeon's license or other written evidence of licensure to practice medicine in the state.
Requires the facility to report, in a timely manner, to the DHCS, any violation or suspected violation by the physician and surgeon of the regulations relating to providing incidental medical services.
Indicates that the DHCS shall not evaluate or have any responsibility or liability with respect to evaluating incidental medical services provided.
States that a facility licensed and approved by the DHCS to allow for the provision of incidental medical services shall not be considered a clinic or health facility.
Specifies that, other than incidental medical services, minor first aid, or in the case of a life threatening emergency, provision of medical or health care services or services that require a higher level of care than the care that is permitted to be provided at a facility, is not permitted at a facility.
Indicates that if an applicant for facility licensure intends to permit incidental medical services, the applicant shall submit a copy of a valid license of the physician and surgeon who will provide those services, and any other information the DHCS deems appropriate, including, but not limited to, a copy of the facility’s accreditation by a nationally recognized accrediting organization.
Allows the DHCS to establish and collect an additional licensure fee for an application that includes a request for a facility to provide detoxification services.
Further specifies that the fee shall be set at an amount sufficient to cover the department's reasonable costs of regulating the provision of those services.
Permits the director of DHCS to temporarily suspend any license prior to any hearing when, in the opinion of the director, the action is necessary to protect residents of the facility from physical or mental abuse, abandonment, or any other substantial threat to health or safety.
Makes other findings and declarations.
FISCAL EFFECT: According to the Assembly Appropriations Committee:
Costs to adopt regulations, likely in the range of $200,000 over two years (licensing fees and Substance Abuse Prevention and Treatment Block Grant).
Unknown ongoing costs to oversee this new requirement as a component of licensure, possibly in the range of $100,000 annually (licensing fees).
COMMENTS:
Purpose. This bill is co-sponsored by the California Society of Addiction Medicine, Elements Behavioral Health and JANUS of Santa Cruz. According to the author, "AB 848 protects the physical and mental health of people seeking alcohol and drug rehabilitation services in residential treatment facilities. Under AB 848, physicians and other appropriate medical personnel can be available on-site to provide 24-hour medical services related to clients' addictions. Clients of these facilities often have a variety of medical needs related to their addictions. Because clients’ medical needs can affect and even interfere with their recovery, they may have better recovery outcomes when they have on-site access to medical care including vital sign monitoring, seizure risk assessment, medication management, and psychiatric therapy…The measure requires that facilities seeking licensure adhere to protocol that protect client privacy, notify clients of financial responsibility for medical care, and clearly define the level of medical care to be provided. The measure requires DHCS to promulgate final regulations by July 1, 2017, to implement the policy. Additionally, the measure requires that DHCS perform an evaluation of the law’s effectiveness by 2019."
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 (California Senate Office of Oversight and Outcomes report, Rogue Rehabs: State failed to police drug and alcohol homes, with deadly results, September 2012).
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, "… a service to support and to assist and individual in the alcohol and/or drug withdrawal process and to explore plans for continued service." 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.
Currently, the only medical care that facilities are allowed to provide to clients is first aid and emergency care. If a patient requires medical care, they must leave the facility to receive care from a medical professional and the patient must pay the medical professional directly for services.
Facility Licensing and Oversight. Prior to July 1, 2013, the Department of Alcohol and Drug Programs (ADP) was responsible for oversight of alcoholism or drug abuse recovery or treatment facilities. Effective with the passage of the 2013-2014 Budget Act and associated legislation, all ADP programs and staff, except the Office of Problem Gambling, transferred to the DHCS. Now, the DHCS is responsible for oversight. The DHCS licenses the facilities and conducts reviews of their operations every two years. As part of the review process, the DHCS checks for compliance with a variety of requirements including, whether staff has passed tuberculosis tests, that residents have completed health questionnaires and if at least one staff member is certified in first aid and cardiopulmonary resuscitation (CPR).
The DHCS's Substance Use Disorder (SUD) Compliance Division investigates complaints against facilities. The SUD Compliance Division also investigates violations of the code of conduct of registered or certified alcohol and drug counselors. Additionally, facilities licensed or certified by DHCS are required to report counselor misconduct to DHCS within 24 hours of the violation. Facilities that do not comply with existing requirements are subject to civil penalties and license suspension or revocation.
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.
Senate Office of Oversight and Outcomes Report. In 2012, the Senate Office of Oversight and Outcomes (SOOO) published a report, Rogue Rehabs: State failed to police drug and alcohol homes, with deadly results. The report focused on "gaps" in the ADP’s regulation of residential programs as well as a review of the state's ban on medical care at residential drug and alcohol programs. The SOOO advised that state law be changed to "better reflect current treatment practices…[there is a] mismatch between the department’s regulation and the industry’s prevalent practices. " The SOOO recommended, "…lifting the ban on medical care as long as it is accompanied with more extensive oversight."
Other States. As part of the SOOO's aforementioned investigation in 2012, it contacted nine other highly populous states. The SOOO found, "California is unusual among populous states in prohibiting medical care." All but one of the nine states allowed physicians and other medical professionals to work in residential rehabilitation facilities.
Implementation Issues:
As indicated above, there have been a number of bills that have attempted to address the issue of removing the ban on provision of medical services at alcoholism or drug abuse recovery or treatment facilities. While there have been recent changes to these facilities, e.g. the licensing and oversight of these facilities was transferred to the DHCS in 2013, the Legislature may wish to consider requiring additional implementation safeguards should this bill pass.
As noted in the SOOO report, it is recommended that the DHCS, the facility and/or the accrediting organization implement regulations requiring that the credentials and malpractice insurance for medical professionals providing medical treatment be checked before they contract with the facility. It may also be beneficial to set up a system to require a yearly review of the medical professional’s credentials and insurance to assure ongoing compliance and patient protection.
As is consistent with practices in other states, it may also be beneficial for programs that offer any type of medical detoxification to hire a medical director to oversee the administration of this treatment.
To safeguard against the state’s prohibition against the corporate practice of medicine, physicians should contract with the facilities instead of working directly for them. This would necessitate that the employment contract specify that the program cannot control or interfere with the physician's practice and that the physician retains the ability to make decisions. The contract should also clearly state that the physician is not paid for the types or amount of services provided.
Analysis Prepared by: Le Ondra Clark Harvey / B. & P. / (916) 319-3301 FN: 0000802
AB 848
Page 2
Date of Hearing: May 20, 2015
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Jimmy Gomez, Chair
AB 848
(Mark Stone) – As Amended May 6, 2015
Policy Committee: |
Business and Professions |
Vote: |
12 - 2 |
|
Health |
|
19 - 0 |
|
|
|
|
Urgency: No State Mandated Local Program: No Reimbursable: No
SUMMARY:
This bill authorizes alcoholism and drug treatment facilities to allow a licensed physician, or other qualified health care practitioner, to provide incidental medical services as defined to a resident of the facility. Requires DHCS to develop a standard certification form and, on or before January 1, 2017, to adopt emergency regulations that are only effective for 180 days or once final regulations are adopted, whichever comes first. Exempts emergency regulations adopted by DHCS from review by the Office of Administrative Law. Requires DHCS to adopt final regulations.
FISCAL EFFECT:
Significant costs to adopt emergency and final regulations, likely in the range of $400,000 over two years (licensing fees and Substance Abuse Prevention and Treatment (SAPT) Block Grant).
Unknown ongoing costs to oversee this new requirement as a component of licensure, possibly in the range of $100,000 annually (licensing fees and Substance Abuse Prevention and Treatment (SAPT) Block Grant).
COMMENTS:
Purpose. The author believes this bill will allow people to get appropriate whole-person care that is unfortunately unavailable at residential drug treatment facilities because of current-law restrictions. Alcohol and drug rehabilitation facilities cannot be licensed by DHCS if they use on-site doctors or other medical personnel to evaluate or provide medical care to facility clients. This prohibition precludes facilities from meeting the medical needs of clients that could easily and efficiently be provided on-site. Instead, if clients have medical needs during the course of their residential treatment, facility staff must transport them to doctors’ offices, clinics, or hospital emergency rooms, which can be inefficient and costly.
Background. An alcoholism or drug abuse recovery or treatment facility provides 24-hour residential non-medical services, defined as recovery services, treatment services, and detoxification services to adults who are recovering from problems related to alcohol, drug, or alcohol and drug misuse or abuse. These facilities are licensed by DHCS, formerly the Department of Drug and Alcohol Programs. They are community facilities, not medical facilities. These facilities grew out of a "social rehabilitation" model, which is somewhat in conflict with the evolution of drug treatment, which often can be medication-assisted.
A September 2012 investigative report by the Senate Office of Oversight and Outcomes (SOOO) identified gaps in the Department of Drug and Alcohol Program’s (DADP's) regulation of residential programs. The report recommended, among other things, the Legislature consider approving a bill allowing medical care in residential treatment facilities, given that many experts believe that medical care is an integral part of successful treatment.
Previous Legislation. AB 395 (Fox) of 2013, AB 972 (Butler) of 2011, AB 2221 (Beall) of 2010, and AB 1055 (Chesbro) of 2009, took similar approaches to include as DADP licensees residential programs that provided some medical services. AB 395, AB 972, and AB 2221 were held on the Senate Appropriations Suspense File. AB 1055 was held on this committee's Suspense File.
Analysis Prepared by: Lisa Murawski / APPR. / (916) 319-2081
AB 848
Page 8
Date of Hearing: April 28, 2015
ASSEMBLY COMMITTEE ON HEALTH
Rob Bonta, Chair
AB 848
(Mark Stone) – As Amended April 6, 2015
SUBJECT: Alcoholism and drug abuse treatment facilities.
SUMMARY: Authorizes alcoholism and drug treatment facilities to allow a licensed physician, or other qualified health care practitioner, to provide incidental medical services to a resident of the facility. Specifically, this bill:
Requires a health care practitioner to submit a signed certification form to a facility licensed by the Department of Health Care Services (DHCS) where they plan to provide alcoholism or drug abuse recovery or treatment (treatment facility) services.
Defines “health care practitioner” as a licensed healing arts professional, who is acting within the scope of practice of his or her license or certificate.
Requires DHCS to develop a standard certification form, for use by a health care practitioner, that:
Describes the alcoholism and drug abuse recovery or treatment services provided; and,
Certifies that the health condition or medical or psychiatric history of the applicant does not require a level of care that is higher than the level of care that may legally be provided by a licensed facility.
Requires DHCS, on or before January 1, 2017, to adopt emergency regulations that are only effective for 180 days or once final regulations are adopted, whichever comes first.
Exempts emergency regulations adopted by DHCS from review by the Office of Administrative Law and requires them to be submitted for filing with the Secretary of State.
Defines “incidental medical services” as services to address the physical and mental health issues associated with either detoxification from alcohol or drugs or the provisions of alcoholism or drug abuse recovery or treatment services, that in the opinion of a physician are not required to be performed in a licensed clinic or health facility.
Allows a treatment facility to provide incidental medical services to a resident at the treatment facility by one or more independent physicians and surgeons or other health care practitioners acting within the scope of practice of his or her licensure, as specified.
Requires the treatment facility to comply with all other applicable laws and regulations to meet the needs of a resident receiving incidental medical services from a physician.
Requires the physician and surgeon and any other health care practitioner to sign their acknowledgment on a form provided by DHCS that he or she has been advised of and understands the statutory and regulatory limitations on the services that may legally be provided by the treatment facility, and the statutory and regulatory requirements and limitations for the physician and surgeon or other health care professional.
Requires an agreed-upon written protocol between the physician and surgeon and the treatment facility signed by the physician and surgeon and the licensee.
Requires the treatment facility, in its admissions agreement with a client, to clearly identify the individual financially responsible for incidental medical services that are provided.
Requires ongoing communication between the physician and the treatment facility about the services provided to the resident by the physician and surgeon and the frequency and duration of incidental medical services to be provided.
Requires initial and ongoing communication between the physician and surgeon or other health care practitioner and the resident’s health plan or health insurer prior to the provision of incidental medical services to ensure coordination of care.
Prohibits the treatment facility from providing incidental medical services and from assisting or interfering with the physician and surgeon or other health care practitioner providing incidental medical services.
Requires that before a treatment facility resident receives incidental medical services, the resident has signed an acknowledgment and consent to receive those services on a form provided by DHCS.
Requires that, once incidental medical services are initiated for a resident, the physician and surgeon and the treatment facility continuously monitor the resident to ensure that the services remain appropriate for the resident.
Requires the treatment facility to maintain in its files a copy of the physician and surgeon’s license or other written evidence of licensure to practice medicine in the state.
Requires the treatment facility to report, in a timely manner, to DHCS any violation or suspected violation by the physician and surgeon of the regulations relating to providing incidental medical services.
Absolves DHCS from any responsibility or liability with respect to evaluating incidental medical services provided.
Specifies that a treatment facility licensed and approved by DHCS to allow for the provision of incidental medical services is not considered a clinic or health facility.
Prohibits medical or health care services or services that require a higher level of care than can be provided at a treatment facility from being provided at a treatment facility.
Requires that, if an applicant for treatment facility licensure intends to permit incidental medical services, the applicant submit a copy of a valid license of the physician and surgeon who will provide those services, and any other information DHCS deems appropriate.
Allows DHCS to establish an additional licensure fee for an application that includes a request for a treatment facility to provide detoxification services.
Requires DHCS to conduct an evaluation of the program licensing treatment facilities and to submit a report to the appropriate policy and fiscal committees of the Legislature on or before January 1, 2019.
Permits the Director of DHCS to temporarily suspend any license prior to any hearing when the action is necessary to protect residents of the treatment facility from physical or mental abuse, abandonment, or any other substantial threat to health or safety.
EXISTING LAW:
Requires DHCS to license adult alcoholism or drug abuse recovery treatment facilities and specifies that a license for a drug abuse recovery or treatment facility is valid for two years.
Defines an “alcoholism or drug abuse recovery or treatment facility” as a facility that provides 24-hour residential non-medical services, defined as recovery services, treatment services, and detoxification services to adults who are recovering from problems related to alcohol, drug, or alcohol and drug misuse or abuse.
Prohibits a licensee from operating such a facility beyond the conditions of the license and if it does, the facility is subject civil penalties, suspension or revocation of the license.
FISCAL EFFECT: This bill has not yet been analyzed by a fiscal committee.
COMMENTS:
PURPOSE OF THIS BILL. According to the author, this bill protects the physical and mental health of people seeking alcohol and drug rehabilitation services in residential treatment facilities. Under the provisions of this bill, physicians and other appropriate medical personnel can be available on-site to provide 24-hour medical services related to clients’ addictions. Clients of these facilities often have a variety of medical needs related to their addictions. Because clients’ medical needs can affect and even interfere with their recovery, they may have better recovery outcomes when they have on-site access to medical care including vital sign monitoring, seizure risk assessment, medication management, and psychiatric therapy.
The author states that unfortunately, alcohol and drug rehabilitation facilities cannot be licensed by DHCS if they use on-site doctors or other medical personnel to evaluate or provide medical care to facility clients. This prohibition precludes facilities from meeting the medical needs of clients that could easily and efficiently be provided on-site. Instead, under current law, if clients have medical needs during the course of their residential treatment, facility staff must transport them to doctors’ offices, clinics, or hospital emergency rooms, which can be inefficient and costly. Further, when clients are removed from facilities in the midst of their treatment, their recovery efforts may be disrupted. By failing to allow these residential rehabilitation facilities to have medical personnel on-site, the state reduces the effectiveness of the critical services being provided to people suffering from substance addiction.
The author further states that to help ensure that people recovering from addiction remain safe during their stay at treatment facilities and to improve their recovery outlook, facilities should be allowed to use medical personnel to provide appropriate on-site physical and mental health services. This bill allows DHCS to license a facility that uses a physician or other eligible medical practitioner to provide incidental medical services to treat conditions associated with drug and alcohol addiction and recovery and that are deemed to be treatable on-site rather than in a clinic or hospital. This bill requires that facilities seeking licensure adhere to protocol that protect client privacy, notify clients of financial responsibility for medical care, and clearly define the level of medical care to be provided. The measure requires DHCS to promulgate final regulations by July 1, 2017 to implement the policy. Additionally, this bill requires that DHCS perform an evaluation of the law’s effectiveness by 2019.
The author concludes that residential alcohol and drug treatment facilities should provide the best possible care for vulnerable people struggling to overcome addictions, which can include medical treatment related to addiction and recovery. This bill will allow thousands of vulnerable people to recover from addiction safely.
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 to assist and individual in the alcohol and/or drug withdrawal process and to explore plans for continued service. 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.
Currently, the only medical care that facilities are allowed to provide to clients is first aid and emergency care. If a patient requires medical care, they must leave the facility to receive care from a medical professional and the patient must pay the medical professional directly for services.
Drug Medi-Cal Waiver Amendment. On November 21, 2014, DHCS submitted a proposal to amend the Special Terms and Conditions the California Section 1115 Bridge to Reform Waiver. California's Drug Medi-Cal Organized Delivery System (DMC-ODS) 1115 demonstration waiver provides a continuum of care modeled after the American Society of Addiction Medicine Criteria for substance use disorder treatment services.
The waiver amendment is intended to make improvements to the DMC service delivery system, create more local control and accountability in selection of high quality providers, improve local coordination of case management services, ensure implementation of evidence based practices in substance abuse treatment, and increase coordination with other systems of care including physical health. The DMC-ODS waiver amendment is intended to demonstrate how organized substance use disorder care increases the success of DMC beneficiaries while decreasing other system health care costs. Participation for providing services under this waiver is voluntary; eight to 12 counties are expected to initially opt-in to waiver participation.
This waiver amendment would allow the state to extend the DMC Residential Treatment Service, as an integral aspect of the continuum of care, to additional beneficiaries. Historically, the Residential Treatment Service was only available to pregnant / postpartum beneficiaries in facilities with a capacity of 16 or less beds. This waiver will create a Residential Treatment Service operable in facilities with no bed capacity limit. Should the terms of this waiver be approved, this provisions provided for in this bill will be necessary in order to achieve the DMC-ODS goals of improving and increasing care coordination for individuals recovering from an alcohol or substance abuse disorder in a treatment facility.
Senate Office of Oversight and Outcomes Report. A September 2012 investigative report by the Senate Office of Oversight and Outcomes (SOOO) identified gaps in the Department of Drug and Alcohol Program’s (DADP's) regulation of residential programs, including failure to pursue evidence of problems, slow investigative responses to deaths and other serious incidents, and reluctance to use the full spectrum of its statutory powers to shut down programs that pose a danger to the public. The report also documents widespread flouting of the state’s prohibition against residential programs providing medical care. The regulation responsibility of these residential programs now lies with DHCS.
The report points out that DADP interprets state law to mean that medical professionals who operate in residential treatment settings must maintain a separate relationship with clients and not receive payments from the program. However, SOOO surveyed websites, press releases, and non-profit tax returns, and identified 34 programs that made claims that appeared to violate state law and regulations barring medical care. Additionally, program directors interviewed for the report asserted that they must twist themselves into knots to comply with the state ban while also satisfying insurers and accrediting agencies that often require the involvement of medical professionals.
The report notes that California is unusual among populous states in prohibiting medical care in residential treatment programs. SOOO contacted nine other states and found that all but one of them allowed physicians and other medical professionals to work in such settings. Several, according to the report, required the involvement of physicians in programs providing detoxification.
Among the recommendations in the report is for the Legislature to consider approving a bill allowing medical care in residential treatment facilities, given that many experts believe that medical care is an integral part of successful treatment. However, the report adds that it would not be enough to simply lift the ban and the state may have to strengthen other laws and regulations to make sure that medical care is safe and effective, for instance, and address the question of whether the involvement of doctors would violate a law prohibiting the corporate practice of medicine.
Facility Licensing and Oversight. Prior to July 1, 2013, DADP was responsible for oversight of alcoholism or drug abuse recovery or treatment facilities. Effective with the passage of the 2013-2014 Budget Act and associated legislation, all ADP programs and staff, except the Office of Problem Gambling, transferred to DHCS. DHCS licenses the facilities and conducts reviews of their operations every two years. As part of the review process, DHCS checks for compliance with a variety of requirements including whether staff has passed tuberculosis tests, that residents have completed health questionnaires and if at least one staff member is certified in first aid and CPR.
DHCS investigates complaints against facilities and investigates violations of the code of conduct of registered or certified alcohol and drug counselors. Additionally, facilities licensed or certified by DHCS are required to report counselor misconduct to DHCS within 24 hours of the violation. Facilities that do not comply with existing requirements are subject to civil penalties and license suspension or revocation.
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.
SUPPORT. The California Society of Addiction Medicine, (CSAM), cosponsors of this bill, state that passage of this bill will make it clear that physicians may provide appropriate medical services to persons undergoing withdrawal in residential treatment facilities. For many years now, CSAM has been working to resolve the problem in law in which the state licenses residential facilities that treat people addicted to drugs or alcohol, but the licensure requirements do not explicitly allow residential facilities to employ physicians who would provide medical services to a facility's clients. Such a ban precludes facilities from meeting a variety of on-site medical needs of their clients, including emergency care, psychiatric treatment, or medical conditions related to clients' addictions. Instead, when clients have medical needs during the course of their residential treatment, facility staff must send them to doctors' offices or hospital emergency departments, which is inefficient and costly.
Janus of Santa Cruz, also cosponsors of this bill, state under current law, DHCS cannot license facilities that provide on-site medical personnel to evaluate or provide medical care to facility clients. This prohibition precludes facilities from meeting clients’ medical needs that could easily and efficiently be provided on-site. Instead, if clients have medical needs during the course of their residential treatment, facility staff must transport them to doctors’ offices, clinics, or hospital emergency rooms, which can be inefficient, costly, and potentially even dangerous. By failing to allow facilities to have medical personnel on-site, the state reduces the effectiveness of the critical services being provided to people suffering from addiction.
Janus of Santa Cruz states that to help ensure that people recovering from addiction remain safe during their stay and to improve their recovery outlook, facilities should be allowed to use medical personnel to provide appropriate on-site physical and mental health services. Janus of Santa Cruz concludes that this bill accomplishes this goal by allowing DHCS to license facilities that use on-site doctors or other approved medical personnel to provide to facility clients incidental medical services related to recovery and addiction.
Promises Treatment Centers, also cosponsors of this bill, state that this bill follows the findings of a recent California Senate report that showed the failure to allow appropriate medical treatment of sick patients resulted in greater illness and even death. Promises Treatment Centers concludes that this bill simply seeks to allow licensed physicians to treat these individuals when the situation calls for it while remaining consistent with the state’s interest in supporting residential care facilities without jeopardizing the residential nature of such facilities.
OPPOSITION. The City of Burbank writes in opposition that this bill will allow regular and ongoing medical treatment and procedures to be administered on site at group homes within their community. Although the City of Burbank understands the goal of this bill to provide treatment and medical services to the residents of these homes, this would be a fundamental change in the character on scope of activities that would be allowed to take place in our neighborhoods. The City of Burbank has a large concentration of homes and in many areas they have substantially changed the nature and quality of life of our community. Under current law, group homes are supposed to behave and be exactly like any other family residence and that is the rationale for the absence of local control. This bill will fundamentally change the rules of the game by making group homes quasi-residences and medical treatment facilities. There are existing regulations and requirements including local zoning for medical facilities for good reasons. The City of Burbank argues that this bill changes the balance from behaving like every other residence, and thus not meriting local control, to behaving like a quasi-medical/quasi residential structure.
PREVIOUS LEGISLATION.
AB 395 (Fox) of 2013 would have expanded the types of facilities licensed by DADP to include any facility that has a nationally accredited program that uses a multidisciplinary team to provide 24-hour residential medical services to adults recovering from alcohol and drug abuse problems. AB 395 was held on the Senate Appropriations Committee Suspense File.
AB 972 (Butler and Beall) of 2011 would have expanded, until January 1, 2017, the category of residential treatment facilities licensed by the DADP to include facilities that provide limited medical services to adults recovering from alcohol and drug abuse, provided that the facility is not otherwise required to have a separate health facility license. Would have established a fee for facilities that provide limited medical services and makes other changes to the licensing fees for residential treatment facilities. AB 972 was held on the Senate Appropriations Committee Suspense File.
AB 2221 (Beall) of 2010 would have permitted 24-hour residential treatment facilities that provide services to adults recovering from alcohol and drug abuse that are licensed by the DADP to provide unspecified medical services and would have provided that such a facility would not require a health facility license. AB 2221 was held on the Senate Appropriations Committee Suspense File.
AB 1055 (Chesbro) of 2009 would have expanded the DADP licensure authority for alcohol and drug treatment facilities to include 24-hour facilities that do not require a health facility license. This bill was held on the Assembly Appropriations Committee suspense file.
POLICY COMMENT. Various versions of this bill have been attempted numerous times. This year, this bill is being presented while the state is also adopting a new alcohol and drug treatment system through the DMC-ODS Waiver Amendment. Should the terms of this waiver be approved, the provisions provided for in this bill will be necessary in order to achieve the DMC-ODS goals of improving and increasing care coordination for individuals recovering from an alcohol or substance abuse disorder in a treatment facility.
DOUBLE REFERRAL. This bill is double referred; it passed the Assembly Business and Professions Committee on a vote of 12-2 on April 14, 2015.
REGISTERED SUPPORT / OPPOSITION:
Support
California Society of Addiction Medicine (cosponsor)
Elements Behavioral Health (cosponsor)
JANUS of Santa Cruz (cosponsor)
Alkermes Inc.
California Naturopathic Doctors Association
California Narcotic Officers’ Association
County Behavioral Health Directors Association
Opposition
City of Burbank
Analysis Prepared by: Paula Villescaz / HEALTH / (916) 319-2097
AB 848
Page 8
Date of Hearing: April 14, 2015
ASSEMBLY COMMITTEE ON BUSINESS AND PROFESSIONS
Susan Bonilla, Chair
AB 848
(Mark Stone) – As Amended April 6, 2015
NOTE: Double Referral. This bill is double referred, and if passed by this Co0mmittee, it will be referred to the Assembly Health Committee.
SUBJECT: Alcoholism and drug abuse treatment facilities.
SUMMARY: 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 the Department of Health Care Services (DHCS) to conduct an evaluation of the program on or before January 1, 2019, and to report the results of the evaluation to the appropriate fiscal and policy committees of the Legislature.
EXISTING LAW
Provides for the licensure of physicians and surgeons, and the enforcement of the disciplinary and criminal provisions of the Medical Practice Act, by the Medical Board of California (MBC) located within the Department of Consumer Affairs (DCA). (BPC § 2000; 2004)
Defines a “licensee” as the holder of a physician and surgeons certificate who is engaged in the professional practice authorized by the certificate under the jurisdiction of the MBC. (BPC § 2041)
Defines an “alcoholism or drug abuse recovery or treatment facility” (facility) as a facility that provides 24-hour residential non-medical services, defined as recovery services, treatment services and detoxification services, to adults who are recovering from problems related to alcohol, drug, or alcohol and drug misuse or abuse. (HSC § 11834.02)
Specifies that a licensee shall not operate such a facility beyond the conditions of the license and if it does, the facility is subject civil penalties, suspension or revocation of the license. (HSC §§ 11834.15, 11834.16)
Specifies that a license for a drug abuse recovery or treatment facility is valid for two (2) years. (HSC § 11834.16)
THIS BILL
Specifies that a health care practitioner should submit a signed certification form to a facility licensed by the DHCS where they plan to provide alcoholism or drug abuse recovery or treatment services.
Defines “health care practitioner” as a healing arts professional, licensed under BPC § 500, and who is acting within the scope of practice of his or her license or certificate.
Specifies that the DHCS shall develop a standard certification form, for use by a health care practitioner, that:
describes the alcoholism and drug abuse recovery or treatment services provided, and
certifies that the health condition or medical or psychiatric history of the applicant does not require a level of care that is higher than the level of care that may legally be provided by a licensed facility.
Specifies that on or before January 1, 2017, the DHCS shall adopt emergency regulations that are exempt from review by the Office of Administrative Law and shall be submitted for filing with the Secretary of State.
Defines “incidental medical services” as services to address the physical and mental health issues associated with either detoxification from alcohol or drugs or the provisions of alcoholism or drug abuse recovery or treatment services, that in the opinion of a physician are not required to be performed in a licensed clinic or health facility.
Specifies that a facility may permit incidental medical services to be provided to a resident at the facility by one or more independent physicians and surgeons licensed by the MBC or the Osteopathic Medical Board who are knowledgeable about addiction medicine, or one or more other health care practitioners acting within the scope of practice of his or her license and under the direction of a physician and surgeon, and are also knowledgeable about addiction medicine.
States that the facility must comply with all other applicable laws and regulations to meet the needs of a resident receiving incidental medical services from a physician.
Specifies that the physician and surgeon and any other health care practitioner has signed an acknowledgment on a form provided by the DHCS that he or she has been advised of and understands the statutory and regulatory limitations on the services that may legally be provided by the facility, and the statutory and regulatory requirements and limitations for the physician and surgeon or other health care professional and for the facility.
Requires that there is an agreed-upon written protocol between the physician and surgeon and the facility signed by the physician and surgeon and the licensee.
Specifies that the facility, in its admissions agreement with a client, shall clearly identify the individual financially responsible for incidental medical services that are provided.
States there should be ongoing communication between the physician and the facility about the services provided to the resident by the physician and surgeon and the frequency and duration of incidental medical services to be provided.
Requires initial and ongoing communication between the physician and surgeon or other health care practitioner and the resident’s health plan or health insurer prior to the provision of incidental medical services to ensure coordination of care.
Specifies that the facility will not provide incidental medical services and will not assist with or interfere with the physician and surgeon or other health care practitioner providing incidental medical services.
States that the resident must be authorized by the physician and surgeon as medically appropriate to receive the incidental medical services at the facility.
Requires that before a facility resident receives incidental medical services, the resident has signed an acknowledgment and consent to receive those services on a form provided by the DHCS.
Specifies that once incidental medical services are initiated for a resident, the physician and surgeon and the facility shall continuously monitor the resident to ensure that the services remain appropriate for the resident.
Requires the facility to maintain in its files a copy of the physician and surgeon’s license or other written evidence of licensure to practice medicine in the state.
Requires the facility to report, in a timely manner, to the DHCS, any violation or suspected violation by the physician and surgeon of the regulations relating to providing incidental medical services.
Indicates that the DHCS shall not evaluate or have any responsibility or liability with respect to evaluating incidental medical services provided.
States that a facility licensed and approved by the DHCS to allow for the provision of incidental medical services shall not be considered a clinic or health facility.
Specifies that, other than incidental medical services, minor first aid, or in the case of a life threatening emergency, provision of medical or health care services or services that require a higher level of care than the care that is permitted to be provided at a facility, is not permitted at a facility.
Indicates that if an applicant for facility licensure intends to permit incidental medical services, the applicant shall submit a copy of a valid license of the physician and surgeon who will provide those services, and any other information the DHCS deems appropriate, including, but not limited to, a copy of the facility’s accreditation by a nationally recognized accrediting organization.
Allows the DHCS to establish an additional licensure fee for an application that includes a request for a facility to provide detoxification services.
Requires the DHCS to conduct an evaluation of the program licensing those facilities and to submit a report to the appropriate policy and fiscal committees of the Legislature on or before January 1, 2019.
Permits the director of DHCS to temporarily suspend any license prior to any hearing when, in the opinion of the director, the action is necessary to protect residents of the facility from physical or mental abuse, abandonment, or any other substantial threat to health or safety.
Makes other findings and declarations.
FISCAL EFFECT: Unknown. This bill is keyed fiscal by the Legislative Counsel.
COMMENTS
Purpose. This bill is co-sponsored by the California Society of Addiction Medicine, Elements Behavioral Health and JANUS of Santa Cruz. According to the author, “AB 848 protects the physical and mental health of people seeking alcohol and drug rehabilitation services in residential treatment facilities. Under AB 848, physicians and other appropriate medical personnel can be available on-site to provide 24-hour medical services related to clients’ addictions. Clients of these facilities often have a variety of medical needs related to their addictions. Because clients’ medical needs can affect and even interfere with their recovery, they may have better recovery outcomes when they have on-site access to medical care including vital sign monitoring, seizure risk assessment, medication management, and psychiatric therapy…The measure requires that facilities seeking licensure adhere to protocol that protect client privacy, notify clients of financial responsibility for medical care, and clearly define the level of medical care to be provided. The measure requires DHCS to promulgate final regulations by July 1, 2017 to implement the policy. Additionally, the measure requires that DHCS perform an evaluation of the law’s effectiveness by 2019.”
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 (California Senate Office of Oversight and Outcomes report, Rogue Rehabs: State failed to police drug and alcohol homes, with deadly results, September, 2012).
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, “… a service to support and to assist and individual in the alcohol and/or drug withdrawal process and to explore plans for continued service.” 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.
Currently, the only medical care that facilities are allowed to provide to clients is first aid and emergency care. If a patient requires medical care, they must leave the facility to receive care from a medical professional and the patient must pay the medical professional directly for services.
Facility Licensing and Oversight. Prior to July 1, 2013, the Department of Alcohol and Drug Programs (ADP) was responsible for oversight of alcoholism or drug abuse recovery or treatment facilities. Effective with the passage of the 2013-2014 Budget Act and associated legislation, all ADP programs and staff, except the Office of Problem Gambling, transferred to the DHCS. Now, the DHCS is responsible for oversight. The DHCS licenses the facilities and conducts reviews of their operations every two years. As part of the review process, the DHCS checks for compliance with a variety of requirements including, whether staff has passed tuberculosis tests, that residents have completed health questionnaires and if at least one staff member is certified in first aid and CPR.
The DHCS’s Substance Use Disorder (SUD) Compliance Division investigates complaints against facilities. The SUD Compliance Division also investigates violations of the code of conduct of registered or certified alcohol and drug counselors. Additionally, facilities licensed or certified by DHCS are required to report counselor misconduct to DHCS within 24 hours of the violation. Facilities that do not comply with existing requirements are subject to civil penalties and license suspension or revocation.
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.
Senate Office of Oversight and Outcomes Report. In 2012, the Senate Office of Oversight and Outcomes (SOOO) published a report, Rogue Rehabs: State failed to police drug and alcohol homes, with deadly results. The report focused on “gaps” in the ADP’s regulation of residential programs as well as a review of the state’s ban on medical care at residential drug and alcohol programs. The SOOO advised that state law be changed to “better reflect current treatment practices…[there is a] mismatch between the department’s regulation and the industry’s prevalent practices.” The SOOO recommended, “…lifting the ban on medical care as long as it is accompanied with more extensive oversight.”
Other States. As part of the SOOO’s aforementioned investigation in 2012, it contacted nine (9) other highly populous states. The SOOO found, “California is unusual among populous states in prohibiting medical care.” All but one of the nine states allowed physicians and other medical professionals to work in residential rehabilitation facilities.
|
Illinois |
Indiana |
Massachusetts |
New York |
North Carolina |
Ohio |
Pennsylvania |
Texas |
Washington |
Allows medical care in residential rehabilitation facilities |
Y |
Y |
N* |
Y |
Y |
Y |
Y |
Y |
Y |
*Rehabilitation homes refer clients to local doctors; nurses are available at homes
Prior Related Legislation. AB 395 (Fox) of 2013, would have expanded the types of facilities licensed by the ADP to include any facility that has a nationally accredited program that uses a multidisciplinary team to provide 24-hour residential medical services to adults recovering from alcohol and drug abuse problems. NOTE: This bill died on the Senate Appropriations Committee suspense file.
AB 972 (Butler and Beall) of 2011, would have expanded, until January 1, 2017, the category of residential treatment facilities licensed by the ADP to include facilities that provide limited medical services to adults recovering from alcohol and drug abuse, provided that the facility is not otherwise required to have a separate health facility license. Would have established a fee for facilities that provide limited medical services and makes other changes to the licensing fees for residential treatment facilities. NOTE: This bill was held in the Senate Appropriations Committee.
AB 2221 (Beall) of 2010, would have permitted 24-hour residential treatment facilities that provide services to adults recovering from alcohol and drug abuse that are licensed by the ADP to provide unspecified medical services and would have provided that such a facility would not require a health facility license. NOTE: This bill died on the Senate Appropriations Committee suspense file.
AB 1055 (Chesbro) of 2009, would have expanded the ADP licensure authority for alcohol and drug treatment facilities to include 24-hour facilities that do not require a health facility license. NOTE: This bill died on the Assembly Appropriations Committee suspense file.
ARGUMENTS IN SUPPORT
The California Society of Addiction Medicine also writes in support and notes in its letter, “Passage of this bill will make it clear that physicians may provide appropriate medical services to persons undergoing withdrawal in residential treatment facilities…[the current] ban precludes facilities from meeting a variety of on-site medical needs of their clients, including emergency care, psychiatric treatment, or medical conditions related to clients’ addictions. Instead, when clients have medical needs during the course of their residential treatment, facility staff must send them to doctors’ offices of hospital emergency departments, which inefficient and costly.”
Elements Behavioral Health, a division of Promises Treatment Centers states its concern with the implications of current statute in its letter of support, “Until very recently the state’s Alcohol and Drug Program (ADP) interpreted “non-medical” licensure language to distinguish licensed residential facilities from hospitals. Patients of these facilities routinely were provided with basic medical care which, much less a house call, included the prescription ad monitoring of medicine, taking blood samples and blood pressure, the provisions of psychiatric evaluations, administration of public health inoculations and the general oversight of a patient’s health conditions. A few years ago ADP began threatening loss of licensure if such basic medical care was provided.”
JANUS of Santa Cruz writes in support, “Alcoholism or drug abuse recovery and treatment facilities like Janus provide 24-hour residential non-medical care to clients...Under current law, DHCS cannot license facilities that provide on-site medical personnel to evaluate or provide medical care to clients…Instead, if clients have medical needs during the course of their residential treatment, facility staff must transport them to doctors’ offices, clinics, or hospital emergency rooms, which can be inefficient, costly, and potentially even dangerous.”
The California Naturopathic Doctors Association supports the bill and writes, “The CNDA urges your support of AB 848…as a means of improving patients’ access to their chosen primary care provider.”
The California Narcotic Officers’ Association also writes in support, “Alcoholism or drug abuse recovery and treatment facilities…are required to offer…services that are designed to help clients taper off or quit substances in a safe environment. The challenge is that clients…often have a variety of medical needs related to their addictions. As a result, facility clients may have better recovery outcomes when they have access to medical care including vital sign monitoring, seizure risk assessment, medication management, and psychiatric therapy.”
Alkermes Inc. supports the bill and writes, “As you know, the treatment of substance abuse is complicated from both a logistical and clinical perspective. Additionally, the landscape surrounding substance use disorder treatment in California is in a state of transformation…AB 848 provides the opportunity to expand access to treatment and care for those receiving services.”
ARGUMENTS IN OPPOSITION
None on file.
IMPLEMENTATION ISSUES
As indicated above, there have been a number of bills that have attempted to address the issue of removing the ban on provision of medical services at alcoholism or drug abuse recovery or treatment facilities. While there have been recent changes to these facilities, e.g. the licensing and oversight of these facilities was transferred to the DHCS in 2013, the Committee may wish to consider requiring additional implementation safeguards should this bill pass.
As noted in the SOOO report, it is recommended that the DHCS, the facility and/or the accrediting organization implement regulations requiring that the credentials and malpractice insurance for medical professionals providing medical treatment be checked before they contract with the facility. It may also be beneficial to set up a system to require a yearly review of the medical professional’s credentials and insurance to assure ongoing compliance and patient protection.
As is consistent with practices in other states, it may also be beneficial for programs that offer any type of medical detoxification to hire a medical director to oversee the administration of this treatment.
To safeguard against the state’s prohibition against the corporate practice of medicine, physicians should contract with the facilities instead of working directly for them. This would necessitate that the employment contract specify that the program cannot control or interfere with the physician’s practice and that the physician retains the ability to make decisions. The contract should also clearly state that the physician is not paid for the types or amount of services provided.
REGISTERED SUPPORT / OPPOSITION
Support:
California Society of Addiction Medicine (co-sponsor)
Elements Behavioral Health (co-sponsor)
JANUS of Santa Cruz (co-sponsor)
Alkermes Inc.
California Naturopathic Doctors Association
California Narcotic Officers’ Association
County Behavioral Health Directors Association
Opposition:
None on file.
Analysis Prepared by: Le Ondra Clark Harvey, Ph.D. / B. & P. / (916) 319-3301
Discussed in Hearing
1MIN
Assembly Floor
2MIN
Senate Floor
1MIN
Senate Standing Committee on Appropriations
7MIN
Senate Standing Committee on Health
1MIN
Assembly Floor
8MIN
Assembly Standing Committee on Health
Bill Author
Bill Co-Author(s):