Existing law provides for the licensing and regulation of alcoholism or drug abuse recovery or treatment facilities, as defined, by the State Department of Health Care Services. Existing law authorizes those facilities to provide incidental medical services to a resident of the facility if those medical services are provided by, or under supervision of, a licensed physician and surgeon who is knowledgeable about addiction medicine.

This bill would require a person who has responsibility for residents or frequent or routine contact with residents of an alcoholism or drug abuse recovery or treatment facility to be subject to a criminal record review prior to that persons involvement in the provision of services, except this requirement would not apply to residents. The bill would require the department to conduct this review, and allow it to approve or deny a persons involvement in the provision of services based on the results of that review. The bill would prohibit the department from denying that involvement due to a drug-related conviction.

Existing law provides for the licensing and regulation of alcoholism or drug abuse recovery or treatment facilities, as defined, by the State Department of Health Care Services. Existing law authorizes those facilities to provide incidental medical services to a resident of the facility if those medical services are provided by, or under supervision of, a licensed physician and surgeon who is knowledgeable about addiction medicine.

Existing law provides for the licensing and regulation of alcoholism or drug abuse recovery or treatment facilities, as defined, by the State Department of Health Care Services. Existing law authorizes those facilities to provide incidental medical services to a resident of the facility if those medical services are provided by, or under supervision of, a licensed physician and surgeon who is knowledgeable about addiction medicine.

This bill would make a technical, nonsubstantive change to a related provision.

Date of Hearing: May 9, 2018

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Lorena Gonzalez Fletcher, Chair

ABPCA Bill Id:AB 2200

Author:(Patterson) – As Amended Ver:April 10, 2018

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

SUMMARY:

This bill requires the Department of Health Care Services (DHCS) to conduct criminal record reviews of persons providing drug and alcohol services and authorizes DHCS to approve or deny a person’s involvement in the provision of services based on the results of that review, with the caveat that a drug-related conviction shall not be cause for the department to deny a person's ability to provide services.

FISCAL EFFECT:

1. Ongoing staff costs to DHCS to in the range of $3 million GF annually to review background checks.
2. One-time information technology costs to DHCS of at least $1 million GF.
3. Significant costs to the Department of Justice, likely in the hundreds of thousands of dollars one-time and a lower amount ongoing, to process additional background checks (Fingerprint Fees Account).

COMMENTS:

1. Purpose. According to the author, more oversight of drug and alcohol counselors is needed because individuals suspected or found guilty of various crimes can become counselors.
2. Background. In California, there is no license, nor is there a central registry for substance use counselors. Only counselors who work in facilities that receive payment through Medi-Cal are required to be certified or registered through a state-approved certifying organization. DHCS, which administers the Medi-Cal program, oversees certified counselors indirectly via oversight of the certifying organizations. A 2013 report by the former California Senate Office of Oversight and Outcomes noted the state does not review counselors’ criminal backgrounds. Drug-related convictions would disqualify many people working as substance use counselors.

The state is experiencing an opioid addiction epidemic and has undertaken various initiatives in recent years to expand access to drug treatment. Access to drug treatment services is constrained in some areas by a dearth of providers.

1. Related Legislation. AB 700 (Jones-Sawyer) overhauls state standards for substance use disorder (SUD) counselors statewide, including standards for education, addiction-specific coursework, and supervised experience. It also requires DHCS to maintain and update a "career ladder" for SUD counselors, or a classification scheme whereby a range of experience and education types are recognized, including higher degrees, based on national standards.
2. Support. Several organizations write in support of this bill, including Advocates for Responsible Treatment, California Health Sciences University, and Parents and Addicts in Need. They believe it is important to ensure drug counselors are not guilty of crimes.
3. Opposition. The California Consortium of Addiction Programs and Professionals (CCAPP), one of the organizations that certifies counselors on behalf of DHCS, states in opposition they would support background checks only for independent practitioners who see clients in private settings, but argues that this should occur as a part of a licensing process for the profession.

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

Date of Hearing: April 17, 2018

ASSEMBLY COMMITTEE ON HEALTH

Jim Wood, Chair

ABPCA Bill Id:AB 2200

Author:(Patterson) – As Amended Ver:April 10, 2018

SUBJECT: Alcoholism or drug abuse recovery or treatment facilities.

SUMMARY: Requires a person who has responsibility for residents of an alcoholism or drug abuse recovery or treatment facility to be subject to a criminal record review prior to that person's involvement in the provision of services. Requires the Department of Health Care Services (DHCS) to conduct the criminal record reviews and gives DHCS the authority to approve or deny that person's involvement in the provision of services based on the results of the criminal record review of this person, and specifies that a drug-related conviction cannot be cause for DHCS to deny involvement in the provision of services.

EXISTING LAW:

1. Gives DHCS the sole authority to determine the qualifications, including the appropriate skills, education, training, and experience, of personnel working within alcoholism or drug abuse recovery and treatment programs licensed, certified, or funded by DHCS.
2. Requires DHCS to require individuals that are providing counseling services be registered with or certified by an organization approved by DHCS to register and certify counselors.
3. Prohibits DHCS from approving a certifying organization that does not, prior to registering or certifying an individual, contact other DHCS-approved certifying organizations to determine whether the individual has ever had his or her registration or certification revoked.
4. Requires, if a counselor’s registration or certification has been previously revoked, the certifying organization to deny the request for registration and to send the counselor a written notice of denial.
5. Defines a substance use disorder (SUD) counselor as a person who is certified as an alcohol or other drug counselor by an approved certifying organization and who provides services or treatment at a licensed adult alcoholism or drug abuse recovery or treatment facility (licensed treatment facility).
6. Gives DHCS the sole authority to license facilities providing 24-hour residential nonmedical services to eligible adults who are recovering from problems related to alcohol or other drug (AOD) misuse or abuse. Requires licensure when at least one of the following services is provided: detoxification; group sessions; individual sessions; educational sessions; or, alcoholism or drug abuse recovery or treatment planning. 
7. Establishes requirements for application for licensure of a licensed treatment facility, requires DHCS to terminate licensure if these requirements are not met, and authorizes DHCS to deny a license of applicants that do not demonstrate an ability to comply with specified requirements.
8. Requires, if an applicant intends to provide incidental medical services, such as obtaining medical histories, monitoring health status, testing associated with detoxification from alcohol or drugs, and overseeing patient self-administered medications, evidence of a valid license of a physician and surgeon who will provide or oversee those services, and any other information deemed appropriate by DHCS, as specified.
9. Requires a treatment facility that serves six or fewer persons to be considered a residential use of property whether or not unrelated persons are living together. Requires the residents and operators of the facility to be considered a family for the purposes of any law or zoning ordinance that relates to the residential use of property.

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

COMMENTS:

1. PURPOSE OF THIS BILL. According to the author, currently, no background check is required for drug and alcohol counselors in California’s treatment facilities, unless that individual is working with minors. This has allowed for sex offenders and other criminals to work as a counselor in these settings, when it is not in the best interest of the individuals seeking treatment nor the owners of the facilities. More oversight is needed in an area where individuals suspected or found guilty of insurance fraud, drug abuse, sex crimes, and more serve as alcohol and drug abuse counselors.
2. BACKGROUND. Alcohol and drug dependency are treatable conditions, requiring extensive treatment and customized care. As individual problems, needs, and resources vary from individual to individual, a variety of treatment strategies must also be available if the needs of citizens are to be met. The increased demand for SUD treatment as a result of the expansion of individuals having insurance as a result of health care reform has placed a growing burden on the existing SUD treatment community. Currently, California has approximately 36,000 registered or certified counselors working in more than 2,500 private and publicly funded drug and alcohol programs, ranging from residential rehabs to driving under the influence and outpatient programs.
   1. Current Certifying Organizations. Currently DHCS authorizes two (down from a high of more than a dozen) different certifying organizations to certify counselors. Each program develops its own classroom curriculum, training, supervisor, and work experience requirements meeting the department’s requirements of a minimum of 155 documented hours of formal classroom AOD education, a minimum of 160 documented hours of supervised AOD training and supervised on-site by an AOD counselor who has been licensed or certified, 2,080 or more documented hours of paid or unpaid work experience providing counseling services in an AOD program, and a score of at least 70% on a written or oral examination approved by the certifying organization. DHCS recognizes the following two National Commission for Certifying Agencies accredited organizations for the purpose of registering and certifying AOD counselors in California:
      1. California Association of DUI Treatment Programs Accredited Program: Certified Alcohol & Other Drug Counselor (Expires 6/30/18); and,
      2. California Consortium of Addiction Programs and Professionals (Expires 4/30/22).
   2. Senate Report. A 2013 report by the California Senate Office of Oversight and Outcomes extensively examined the current process to become an SUD counselor, and noted some of the systemic flaws. California is one of only two states among the nation’s 15 largest states that makes no attempt to review counselors’ criminal backgrounds. Even within California, SUD counselors are the only health-related profession not required to undergo these checks. The ability to evade regulators represents a loophole. While the state’s two certifying organizations are required to check with each other to see if a counselor has ever had their certification revoked, the regulation state this must be done only upon certification. Individuals registered to become counselors (registrants) may work for up to five years before they must become certified, thus a counselor whose certification was previously revoked by another certifying agency could go as long as five years without being detected.
   3. Treatment facilities. 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 these are services that support and assist an individual in the alcohol and/or drug withdrawal process and to explore plans for continued treatment. These services can be provided by a variety of health care providers such as alcohol and drug counselors, mental health therapists, social workers, psychologists, nurses, and physicians.
   4. Recent substance use treatment reforms. On August 13, 2015, DHCS announced that the Centers for Medicare and Medicaid Services (CMS) approved California's Drug Medi-Cal Organized Delivery System (DMC-ODS) Waiver. Counties participating in the DMC-ODS waiver program will administer, or arrange for, SUD treatment for Medi-Cal beneficiaries. The DMC-ODS demonstration will be elective for five years.

The DMC-ODS waiver provides a continuum of care modeled after the American Society of Addiction Medicine (ASAM) Criteria for SUD treatment services.  As part of participation in the DMC-ODS, CMS requires all residential providers to meet the ASAM requirements and obtain a DHCS-issued ASAM designation.  The ASAM criterion is a nationally accepted set of treatment criteria for SUD care and is being adopted beyond Medi-Cal beneficiaries as the SUD industry standard. As of March 14, 2017, DHCS has designated 168 residential alcohol and/or other drug treatment facilities with the appropriate ASAM level of care. DHCS has initiated a phased-in implementation of the DMC-ODS waiver and established five regions throughout the state. DHCS determined the order of implementation based on location, population, and county and provider readiness, in five phases.

1. SUPPORT. California Health Sciences University states in support that under current law, employees at licensed facilities may be guilty of insurance fraud, selling drugs, or a whole host of other crimes that their employer may not be aware of simply because a background check is not required. This bill will require for all employees at licensed treatment facilities to undergo criminal background check before beginning their employment. DHCS is then allowed to approve or deny an application for employment at such a facility based on the background check findings. This will help ensure that patients at these facilities will receive the counseling and care that they need from individuals committed to their recovery, and that they won’t be taken advantage of by criminals merely seeking a weak target.
   
2. OPPOSITION. The California Consortium of Addiction Programs and Professionals (CCAPP) state in opposition that they would support background checks for independent practitioners who see clients in private settings, with no oversight. CCAPP argues that this should occur as a part of a licensing process for the profession. CCAPP notes that 32 states, including all populous states, require licensure, which includes a background check, for this profession. CCAPP argues that although it supports the concept of ensuring the quality and safety of the workforce providing services in California, they believe that background checks should be performed for providers who work outside of licensed certified programs. Persons working at licensed certified programs are routinely background checked by the owners/managers of the programs they work at. Additionally DHCS regulates these programs and holds them accountable if a client is harmed by an employee.
3. RELATED LEGISLATION.
   1. AB 2804 (Waldron) specifies legislative intent to establish one-year and five-year plans aimed at expanding the SUD treatment workforce in California to aid in the treatment of alcohol and drug abuse. This bill is pending in the Assembly Appropriations Committee.
   2. AB 2214 (Rodriguez) establishes a voluntary certification process for recovery residences and would require specified entities or persons who direct individuals into substance use treatment, or a judge or parole board, to first refer a person to a residence listed as a certified recovery residence. AB 2214 passed out of Assembly Health Committee and is now before Assembly Appropriations.
   3. AB 700 (Jones-Sawyer) of 2017 establishes classifications for SUD counselor certification, registrants, and interns using federal recommendations. AB 700 is pending in Senate Health Committee.
4. PREVIOUS LEGISLATION.
   1. SB 570 (DeSaulnier) of 2014 would have established a licensing and certification system for alcohol and drug abuse counselors to be administered by DHCS. AB 570 was held in the Senate Appropriations Committee.
   2. AB 2007 (Williams) of 2012 would have established a licensing and certification system for SUD counselors to be administered by the Department of Public Health. AB 2007 was held in Assembly Health Committee.
   3. SB 1203 (DeSaulnier) of 2010 would have instituted a licensing and certification structure for AOD counselors by Department of Alcohol and Drug Programs (DADP). SB 1203 was held in the Assembly Rules Committee.
   4. AB 239 (DeSaulnier) of 2008, would have established two categories of licensed alcoholism and drug abuse counselors for persons licensed to practice alcoholism and drug abuse counseling under clinical supervision, and persons licensed to conduct an independent practice of alcoholism and drug abuse counseling, and to provide supervision to other counselors, both to be overseen by the Department of Consumer Affairs Board of Behavioral Sciences. AB 239 was vetoed by Governor Arnold Schwarzenegger who stated, in his veto message, that he was directing DADP to craft a uniform standard for all alcohol and drug counselors whether in private practice or in facilities.

REGISTERED SUPPORT / OPPOSITION:

Support

Advocates for Responsible Treatment

California Health Sciences University

Parents and Addicts in Need

Numerous Individuals

Opposition

California Consortium of Addiction Programs and Professionals

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