AB 501: Mental health: community care facilities.
- Session Year: 2017-2018
- House: Assembly
- Latest Version Date: 2017-10-12
(1)Existing law, the California Community Care Facilities Act, provides for the licensing and regulation of community care facilities, as defined, by the State Department of Social Services. Existing law includes within the definition of community care facility a short-term residential therapeutic program, which is a residential facility licensed by the department and operated by any public agency or private organization that provides an integrated program of specialized and intensive care and supervision, services and supports, treatment, and short-term, 24-hour care and supervision to children. A violation of the act is a misdemeanor.
This bill would authorize the State Department of Social Services to, no later than January 1, 2019, and contingent upon an appropriation in the annual Budget Act for these purposes, license a short-term residential therapeutic program operating as a childrens crisis residential program, as defined, and would require the department to regulate those programs, as specified. The bill would require the State Department of Health Care Services, in consultation with the State Department of Social Services and the County Behavioral Health Directors Association of California, among others, to provide guidance to counties for the provision of childrens crisis residential services, including funding for children who are Medi-Cal beneficiaries and who are admitted to a childrens crisis residential program. By expanding the types of facilities that are regulated as a community care facility, this bill would expand the scope of an existing crime, thus creating a state-mandated local program.
(2)Existing law establishes the Aid to Families with Dependent Children-Foster Care (AFDC-FC) program, under which counties provide payments to foster care providers on behalf of qualified children in foster care. In order to be eligible for AFDC-FC, existing law requires a child or nonminor dependent to be placed in a specified placement, including, a short-term residential therapeutic program.
Existing law requires a short-term residential therapeutic program to obtain a contract with a county mental health plan to provide specialty mental health services and demonstrate the ability to meet the therapeutic needs of each child identified in specified plan documents. Existing law authorizes a short-term residential therapeutic program to accept for placement children who meet certain criteria, except as otherwise specified.
This bill would authorize a short-term residential therapeutic program that is operating as a childrens crisis residential program to accept for admission any child who meets specified requirements, including, among other things, that the child has a serious behavioral health disorder and is referred by a parent or guardian, physician, or licensed mental health professional, or by the representative of a public or private entity that has the right to make these decisions on behalf of a child who is experiencing a mental health crisis.
The bill would require the State Department of Health Care Services, in consultation with certain stakeholders including the State Department of Social Services, to establish program standards and procedures, as specified, for a childrens crisis residential mental health program approval, and would require the childrens crisis residential mental health program approval to be a condition of continued licensure for a short-term residential therapeutic program operating as a childrens crisis residential program.
(3)Existing law establishes the Investment in Mental Health Wellness Act of 2013. Existing law provides that funds appropriated by the Legislature to the California Health Facilities Financing Authority for the purposes of the act be made available to selected counties or counties acting jointly, except as otherwise provided, and used to provide, among other things, a complete continuum of crisis services for children and youth 21 years of age and under regardless of where they live in the state. The act requires grant awards made by the authority to be used to expand local resources for the development, capital, equipment acquisition, and applicable program startup or expansion costs to increase capacity for client assistance and services generally and for client assistance and crisis services for children and youth 21 years of age and under in specified areas, including crisis residential treatment as authorized by specified provisions.
This bill would include within these specified areas crisis residential treatment provided at a childrens crisis residential program.
(4)The bill would require the State Department of Social Services and the State Department of Health Care Services to adopt regulations to implement the act no later than July 1, 2022, as specified, and would authorize the departments to implement and administer the changes made by this act through information notices, all-county letters, or similar written instructions until regulations are adopted.
(5)This bill would incorporate additional changes to Section 1502 of the Health and Safety Code proposed by SB 612 to be operative only if this bill and SB 612 are enacted and this bill is enacted last.
This bill would incorporate additional changes to Section 11462.01 of the Welfare and Institutions Code proposed by AB 404 to be operative only if this bill and AB 404 are enacted and this bill is enacted last.
(6)The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.
(1)Existing law, the California Community Care Facilities Act, provides for the licensing and regulation of community care facilities, as defined, by the State Department of Social Services. Existing law includes within the definition of community care facility a short-term residential therapeutic program, which is a residential facility licensed by the department and operated by any public agency or private organization that provides an integrated program of specialized and intensive care and supervision, services and supports, treatment, and short-term, 24-hour care and supervision to children. A violation of the act is a misdemeanor.
This bill would authorize the State Department of Social Services to, no later than January 1, 2019, and contingent upon an appropriation in the annual Budget Act for these purposes, license a short-term residential therapeutic program operating as a childrens crisis residential program, as defined, and would require the department to regulate those programs, as specified. The bill would require the State Department of Health Care Services, in consultation with the State Department of Social Services and the County Behavioral Health Directors Association of California, among others, to provide guidance to counties for the provision of childrens crisis residential services, including funding for children who are Medi-Cal beneficiaries and who are admitted to a childrens crisis residential program. By expanding the types of facilities that are regulated as a community care facility, this bill would expand the scope of an existing crime, thus creating a state-mandated local program.
(2)Existing law establishes the Aid to Families with Dependent Children-Foster Care (AFDC-FC) program, under which counties provide payments to foster care providers on behalf of qualified children in foster care. In order to be eligible for AFDC-FC, existing law requires a child or nonminor dependent to be placed in a specified placement, including, a short-term residential therapeutic program.
Existing law requires a short-term residential therapeutic program to obtain a contract with a county mental health plan to provide specialty mental health services and demonstrate the ability to meet the therapeutic needs of each child identified in specified plan documents. Existing law authorizes a short-term residential therapeutic program to accept for placement children who meet certain criteria, except as otherwise specified.
This bill would authorize a short-term residential therapeutic program that is operating as a childrens crisis residential program to accept for admission any child who meets specified requirements, including, among other things, that the child has a serious behavioral health disorder and is referred by a parent or guardian, physician, or licensed mental health professional, or by the representative of a public or private entity that has the right to make these decisions on behalf of a child who is experiencing a mental health crisis.
The bill would require the State Department of Health Care Services, in consultation with certain stakeholders including the State Department of Social Services, to establish program standards and procedures, as specified, for a childrens crisis residential mental health program approval, and would require the childrens crisis residential mental health program approval to be a condition of continued licensure for a short-term residential therapeutic program operating as a childrens crisis residential program.
(3)Existing law establishes the Investment in Mental Health Wellness Act of 2013. Existing law provides that funds appropriated by the Legislature to the California Health Facilities Financing Authority for the purposes of the act be made available to selected counties or counties acting jointly, except as otherwise provided, and used to provide, among other things, a complete continuum of crisis services for children and youth 21 years of age and under regardless of where they live in the state. The act requires grant awards made by the authority to be used to expand local resources for the development, capital, equipment acquisition, and applicable program startup or expansion costs to increase capacity for client assistance and services generally and for client assistance and crisis services for children and youth 21 years of age and under in specified areas, including crisis residential treatment as authorized by specified provisions.
This bill would include within these specified areas crisis residential treatment provided at a childrens crisis residential program.
(4)The bill would require the State Department of Social Services and the State Department of Health Care Services to adopt regulations to implement the act no later than July 1, 2022, as specified, and would authorize the departments to implement and administer the changes made by this act through information notices, all-county letters, or similar written instructions until regulations are adopted.
(5)This bill would incorporate additional changes to Section 1502 of the Health and Safety Code proposed by SB 612 to be operative only if this bill and SB 612 are enacted and this bill is enacted last.
This bill would incorporate additional changes to Section 11462.01 of the Welfare and Institutions Code proposed by AB 404 to be operative only if this bill and AB 404 are enacted and this bill is enacted last.
(6)The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.
(1)Existing law, the California Community Care Facilities Act, provides for the licensing and regulation of community care facilities, as defined, by the State Department of Social Services. Existing law includes within the definition of community care facility a short-term residential therapeutic program, which is a residential facility licensed by the department and operated by any public agency or private organization that provides an integrated program of specialized and intensive care and supervision, services and supports, treatment, and short-term, 24-hour care and supervision to children. A violation of the act is a misdemeanor.
This bill would authorize the State Department of Social Services to, no later than January 1, 2019, and contingent upon an appropriation in the annual Budget Act for these purposes, license a short-term residential therapeutic program operating as a childrens crisis residential program, as defined, and would require the department to regulate those programs, as specified. The bill would require the State Department of Health Care Services, in consultation with the State Department of Social Services and the County Behavioral Health Directors Association of California, among others, to provide guidance to counties for the provision of childrens crisis residential services, including funding for children who are Medi-Cal beneficiaries and who are admitted to a childrens crisis residential program. By expanding the types of facilities that are regulated as a community care facility, this bill would expand the scope of an existing crime, thus creating a state-mandated local program.
(2)Existing law establishes the Aid to Families with Dependent Children-Foster Care (AFDC-FC) program, under which counties provide payments to foster care providers on behalf of qualified children in foster care. In order to be eligible for AFDC-FC, existing law requires a child or nonminor dependent to be placed in a specified placement, including, a short-term residential therapeutic program.
Existing law requires a short-term residential therapeutic program to obtain a contract with a county mental health plan to provide specialty mental health services and demonstrate the ability to meet the therapeutic needs of each child identified in specified plan documents. Existing law authorizes a short-term residential therapeutic program to accept for placement children who meet certain criteria, except as otherwise specified.
This bill would authorize a short-term residential therapeutic program that is operating as a childrens crisis residential program to accept for admission any child who meets specified requirements, including, among other things, that the child has a serious behavioral health disorder and is referred by a parent or guardian, physician, or licensed mental health professional, or by the representative of a public or private entity that has the right to make these decisions on behalf of a child who is experiencing a mental health crisis.
The bill would require the State Department of Health Care Services, in consultation with certain stakeholders including the State Department of Social Services, to establish program standards and procedures, as specified, for a childrens crisis residential mental health program approval, and would require the childrens crisis residential mental health program approval to be a condition of continued licensure for a short-term residential therapeutic program operating as a childrens crisis residential program.
(3)Existing law establishes the Investment in Mental Health Wellness Act of 2013. Existing law provides that funds appropriated by the Legislature to the California Health Facilities Financing Authority for the purposes of the act be made available to selected counties or counties acting jointly, except as otherwise provided, and used to provide, among other things, a complete continuum of crisis services for children and youth 21 years of age and under regardless of where they live in the state. The act requires grant awards made by the authority to be used to expand local resources for the development, capital, equipment acquisition, and applicable program startup or expansion costs to increase capacity for client assistance and services generally and for client assistance and crisis services for children and youth 21 years of age and under in specified areas, including crisis residential treatment as authorized by specified provisions.
This bill would include within these specified areas crisis residential treatment provided at a childrens crisis residential program.
(4)The bill would require the State Department of Social Services and the State Department of Health Care Services to adopt regulations to implement the act no later than July 1, 2021, 2022, as specified, and would authorize the departments to implement and administer the changes made by this act through information notices, all-county letters, or similar written instructions until regulations are adopted.
(5)This bill would incorporate additional changes to Section 1502 of the Health and Safety Code proposed by SB 612 to be operative only if this bill and SB 612 are enacted and this bill is enacted last.
This bill would incorporate additional changes to Section 11462.01 of the Welfare and Institutions Code proposed by AB 404 to be operative only if this bill and AB 404 are enacted and this bill is enacted last.
(5)(6)The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.
(1)Existing law, the California Community Care Facilities Act, provides for the licensing and regulation of community care facilities, as defined, by the State Department of Social Services. Existing law includes within the definition of community care facility a short-term residential therapeutic program, which is a residential facility licensed by the department and operated by any public agency or private organization that provides an integrated program of specialized and intensive care and supervision, services and supports, treatment, and short-term, 24-hour care and supervision to children. A violation of the act is a misdemeanor.
This bill would authorize the State Department of Social Services to, no later than January 1, 2019, and contingent upon an appropriation in the annual Budget Act for these purposes, license a short-term residential therapeutic program operating as a childrens crisis residential program, as defined, and would require the department to regulate those programs, as specified. The bill would require the State Department of Health Care Services, in consultation with the State Department of Social Services and the County Behavioral Health Directors Association of California, among others, to provide guidance to counties for the provision of childrens crisis residential services, including funding for children who are Medi-Cal beneficiaries and who are admitted to a childrens crisis residential program. By expanding the types of facilities that are regulated as a community care facility, this bill would expand the scope of an existing crime, thus creating a state-mandated local program.
(2)Existing law establishes the Aid to Families with Dependent Children-Foster Care (AFDC-FC) program, under which counties provide payments to foster care providers on behalf of qualified children in foster care. In order to be eligible for AFDC-FC, existing law requires a child or nonminor dependent to be placed in a specified placement, including, a short-term residential therapeutic program.
Existing law requires a short-term residential therapeutic program to obtain a contract with a county mental health plan to provide specialty mental health services and demonstrate the ability to meet the therapeutic needs of each child identified in specified plan documents. Existing law authorizes a short-term residential therapeutic program to accept for placement children who meet certain criteria, except as otherwise specified.
This bill would authorize a short-term residential therapeutic program that is operating as a childrens crisis residential program to accept for admission any child who meets specified requirements, including, among other things, that the child has a serious behavioral health disorder and is referred by a parent or guardian, physician, or licensed mental health professional, or by the representative of a public or private entity that has the right to make these decisions on behalf of a child who is experiencing a mental health crisis.
The bill would require the State Department of Health Care Services, in consultation with certain stakeholders including the State Department of Social Services, to establish program standards and procedures, as specified, for a childrens crisis residential mental health program approval, and would require the childrens crisis residential mental health program approval to be a condition of continued licensure for a short-term residential therapeutic program operating as a childrens crisis residential program.
(3)Existing law establishes the Investment in Mental Health Wellness Act of 2013. Existing law provides that funds appropriated by the Legislature to the California Health Facilities Financing Authority for the purposes of the act be made available to selected counties or counties acting jointly, except as otherwise provided, and used to provide, among other things, a complete continuum of crisis services for children and youth 21 years of age and under regardless of where they live in the state. The act requires grant awards made by the authority to be used to expand local resources for the development, capital, equipment acquisition, and applicable program startup or expansion costs to increase capacity for client assistance and services generally and for client assistance and crisis services for children and youth 21 years of age and under in specified areas, including crisis residential treatment as authorized by specified provisions.
This bill would include within these specified areas crisis residential treatment provided at a childrens crisis residential program.
(4)The bill would require the State Department of Social Services and the State Department of Health Care Services to adopt regulations to implement the act no later than July 1, 2021, as specified, and would authorize the departments to implement and administer the changes made by this act through information notices, all-county letters, or similar written instructions until regulations are adopted.
(5)The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.
(1)Existing law, the California Community Care Facilities Act, provides for the licensing and regulation of community care facilities, as defined, by the State Department of Social Services. Existing law includes within the definition of community care facility a short-term residential therapeutic program, which is a residential facility licensed by the department and operated by any public agency or private organization that provides an integrated program of specialized and intensive care and supervision, services and supports, treatment, and short-term, 24-hour care and supervision to children. A violation of the act is a misdemeanor.
This bill would authorize the State Department of Social Services to, no later than January 1, 2019, and contingent upon an appropriation in the annual Budget Act for these purposes, license a short-term residential therapeutic program operating as a childrens crisis residential program, as defined, and would require the department to regulate those programs, as specified. The bill would require the State Department of Health Care Services, in consultation with the State Department of Social Services and the County Behavioral Health Directors Association of California, among others, to provide guidance to counties for the provision of childrens crisis residential services, including funding for children who are Medi-Cal beneficiaries and who are admitted to a childrens crisis residential program. By expanding the types of facilities that are regulated as a community care facility, this bill would expand the scope of an existing crime, thus creating a state-mandated local program.
(2)Existing law establishes the Aid to Families with Dependent Children-Foster Care (AFDC-FC) program, under which counties provide payments to foster care providers on behalf of qualified children in foster care. In order to be eligible for AFDC-FC, existing law requires a child or nonminor dependent to be placed in a specified placement, including, a short-term residential therapeutic program.
Existing law requires a short-term residential therapeutic program to obtain a contract with a county mental health plan to provide specialty mental health services and demonstrate the ability to meet the therapeutic needs of each child identified in specified plan documents. Existing law authorizes a short-term residential therapeutic program to accept for placement children who meet certain criteria, except as otherwise specified.
This bill would authorize a short-term residential therapeutic program that is operating as a childrens crisis residential program to accept for admission any child who meets specified requirements, including, among other things, that the child has a serious behavioral health disorder and is referred by a parent or guardian, physician, or licensed mental health professional, or by the representative of a public or private entity that has the right to make these decisions on behalf of a child who is experiencing a mental health crisis.
The bill would require the State Department of Health Care Services, in consultation with certain stakeholders including the State Department of Social Services, to establish program standards and procedures, as specified, for a childrens crisis residential mental health program approval, and would require the childrens crisis residential mental health program approval to be a condition of continued licensure for a short-term residential therapeutic program operating as a childrens crisis residential program.
(3)Existing law establishes the Investment in Mental Health Wellness Act of 2013. Existing law provides that funds appropriated by the Legislature to the California Health Facilities Financing Authority for the purposes of the act be made available to selected counties or counties acting jointly, except as otherwise provided, and used to provide, among other things, a complete continuum of crisis services for children and youth 21 years of age and under regardless of where they live in the state. The act requires grant awards made by the authority to be used to expand local resources for the development, capital, equipment acquisition, and applicable program startup or expansion costs to increase capacity for client assistance and services generally and for client assistance and crisis services for children and youth 21 years of age and under in specified areas, including crisis residential treatment as authorized by specified provisions.
This bill would include within these specified areas crisis residential treatment provided at a childrens crisis residential program.
(4)The bill would require the State Department of Social Services and the State Department of Health Care Services to adopt regulations to implement the act, act no later than July 1, 2021, as specified, and would authorize the departments to implement and administer the changes made by this act through information notices, all-county letters, or similar written instructions until regulations are adopted.
(5)The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.
(1)Existing law, the California Community Care Facilities Act, provides for the licensing and regulation of community care facilities, as defined, by the State Department of Social Services. Existing law includes within the definition of community care facility a short-term residential therapeutic program, which is a residential facility licensed by the department and operated by any public agency or private organization that provides an integrated program of specialized and intensive care and supervision, services and supports, treatment, and short-term, 24-hour care and supervision to children. A violation of the act is a misdemeanor.
This bill would authorize the State Department of Social Services to, no later than January 1, 2019, and contingent upon an appropriation in the annual Budget Act for these purposes, license a short-term residential therapeutic program operating as a childrens crisis residential program, as defined, and would require the department to regulate those programs, as specified. The bill would require the State Department of Health Care Services, in consultation with the State Department of Social Services and the County Behavioral Health Directors Association of California, among others, to provide guidance to counties for the provision of childrens crisis residential services, including funding for children who are Medi-Cal beneficiaries and who are admitted to a childrens crisis residential program. By expanding the types of facilities that are regulated as a community care facility, this bill would expand the scope of an existing crime, thus creating a state-mandated local program.
(2)Existing law establishes the Aid to Families with Dependent Children-Foster Care (AFDC-FC) program, under which counties provide payments to foster care providers on behalf of qualified children in foster care. In order to be eligible for AFDC-FC, existing law requires a child or nonminor dependent to be placed in a specified placement, including, a short-term residential therapeutic program.
Existing law requires a short-term residential therapeutic program to obtain a contract with a county mental health plan to provide specialty mental health services and demonstrate the ability to meet the therapeutic needs of each child identified in specified plan documents. Existing law authorizes a short-term residential therapeutic program to accept for placement children who meet certain criteria, except as otherwise specified.
This bill would authorize a short-term residential therapeutic program that is operating as a childrens crisis residential program to accept for admission any child who meets specified requirements, including, among other things, that the child has a serious behavioral health disorder and is referred by a parent or guardian, physician, or licensed mental health professional, or by the representative of a public or private entity that has the right to make these decisions on behalf of a child who is experiencing a mental health crisis.
The bill would require the State Department of Health Care Services, in consultation with certain stakeholders including the State Department of Social Services, to establish program standards and procedures, as specified, for a childrens crisis residential mental health program approval, and would require the childrens crisis residential mental health program approval to be a condition of continued licensure for a short-term residential therapeutic program operating as a childrens crisis residential program.
(3)Existing law establishes the Investment in Mental Health Wellness Act of 2013. Existing law provides that funds appropriated by the Legislature to the California Health Facilities Financing Authority for the purposes of the act be made available to selected counties or counties acting jointly, except as otherwise provided, and used to provide, among other things, a complete continuum of crisis services for children and youth 21 years of age and under regardless of where they live in the state. The act requires grant awards made by the authority to be used to expand local resources for the development, capital, equipment acquisition, and applicable program startup or expansion costs to increase capacity for client assistance and services generally and for client assistance and crisis services for children and youth 21 years of age and under in specified areas, including crisis residential treatment as authorized by specified provisions.
This bill would include within these specified areas crisis residential treatment provided at a childrens crisis residential program.
(4)The bill would require the State Department of Social Services and the State Department of Health Care Services to adopt regulations to implement the act, as specified, and would authorize the departments to implement and administer the changes made by this act through information notices, all-county letters, or similar written instructions until regulations are adopted.
(5)The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.
(1)Existing law, the California Community Care Facilities Act, provides for the licensing and regulation of community care facilities, as defined, by the State Department of Social Services. Existing law includes within the definition of community care facility a short-term residential therapeutic program, which is a residential facility licensed by the department and operated by any public agency or private organization that provides an integrated program of specialized and intensive care and supervision, services and supports, treatment, and short-term, 24-hour care and supervision to children. A violation of the act is a misdemeanor.
This bill would authorize the State Department of Social Services to, no later than January 1, 2019, and contingent upon an appropriation in the annual Budget Act for these purposes, license a short-term residential therapeutic program operating as a childrens crisis residential program, as defined, and would require the department to regulate those programs, as specified. The bill would require the State Department of Health Care Services, in consultation with the State Department of Social Services and the County Behavioral Health Directors Association of California, among others, to develop a rate provide guidance to counties for the provision of childrens crisis residential services, including funding for children who are Medi-Cal beneficiaries and who are admitted to a childrens crisis residential program. By expanding the types of facilities that are regulated as a community care facility, this bill would expand the scope of an existing crime, thus creating a state-mandated local program.
(2)Existing law establishes the Aid to Families with Dependent Children-Foster Care (AFDC-FC) program, under which counties provide payments to foster care providers on behalf of qualified children in foster care. In order to be eligible for AFDC-FC, existing law requires a child or nonminor dependent to be placed in a specified placement, including, a short-term residential therapeutic program.
Existing law requires a short-term residential therapeutic program to obtain a contract with a county mental health plan to provide specialty mental health services and demonstrate the ability to meet the therapeutic needs of each child identified in specified plan documents. Existing law authorizes a short-term residential therapeutic program to accept for placement children who meet certain criteria, except as otherwise specified.
This bill would authorize a short-term residential therapeutic program that is operating as a childrens crisis residential program to accept for admission any child who meets specified requirements, including, among other things, that the child has a serious behavioral health disorder and is referred by a parent or guardian, physician, or licensed mental health professional, or by the representative of a public or private entity that has the right to make these decisions on behalf of a child who is experiencing a mental health crisis.
The bill would require the State Department of Health Care Services, in consultation with certain stakeholders including the State Department of Social Services, to establish program standards and procedures, as specified, for a childrens crisis residential mental health program approval, and would require the childrens crisis residential mental health program approval to be a condition of continued licensure for a short-term residential therapeutic program operating as a childrens crisis residential program.
(3)Existing law establishes the Investment in Mental Health Wellness Act of 2013. Existing law provides that funds appropriated by the Legislature to the California Health Facilities Financing Authority for the purposes of the act be made available to selected counties or counties acting jointly, except as otherwise provided, and used to provide, among other things, a complete continuum of crisis services for children and youth 21 years of age and under regardless of where they live in the state. The act requires grant awards made by the authority to be used to expand local resources for the development, capital, equipment acquisition, and applicable program startup or expansion costs to increase capacity for client assistance and services generally and for client assistance and crisis services for children and youth 21 years of age and under in specified areas, including crisis residential treatment as authorized by specified provisions.
This bill would include within these specified areas crisis residential treatment provided at a childrens crisis residential program.
(4)The bill would require the State Department of Social Services and the State Department of Health Care Services to adopt regulations to implement the act on or before July 1, 2018, act, as specified, and would authorize the departments to implement and administer the changes made by this act through information notices, all-county letters, or similar written instructions until regulations are adopted.
(5)The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.
(1)Existing law, the California Community Care Facilities Act, provides for the licensing and regulation of community care facilities, as defined, by the State Department of Social Services. Existing law includes within the definition of community care facility a short-term residential therapeutic program, which is a residential facility licensed by the department and operated by any public agency or private organization that provides an integrated program of specialized and intensive care and supervision, services and supports, treatment, and short-term, 24-hour care and supervision to children. A violation of the act is a misdemeanor.
This bill would authorize the State Department of Social Services to, no later than July 1, 2018, January 1, 2019, and contingent upon an appropriation in the annual Budget Act for these purposes, license a short-term residential therapeutic program operating as a childrens crisis residential center, program, as defined, and would require the department to regulate those programs, as specified. The bill would require the State Department of Health Care Services, in consultation with the State Department of Social Services and the County Behavioral Health Directors Association of California, among others, to develop a rate for children who are Medi-Cal beneficiaries and who are admitted to a childrens crisis residential program. By expanding the types of facilities that are regulated as a community care facility, this bill would expand the scope of an existing crime, thus creating a state-mandated local program.
(2)Existing law establishes the Aid to Families with Dependent Children-Foster Care (AFDC-FC) program, under which counties provide payments to foster care providers on behalf of qualified children in foster care. In order to be eligible for AFDC-FC, existing law requires a child or nonminor dependent to be placed in a specified placement, including, a short-term residential therapeutic program.
Existing law requires a short-term residential therapeutic program to obtain a contract with a county mental health plan to provide specialty mental health services and demonstrate the ability to meet the therapeutic needs of each child identified in specified plan documents. Existing law authorizes a short-term residential therapeutic program to accept for placement children who meet certain criteria, except as otherwise specified.
This bill would authorize a short-term residential therapeutic program that is operating as a childrens crisis residential center program to accept for admission any child, child who meets specified requirements, including, among other things, that the child has a serious behavioral health disorder and is referred by a parent or guardian, or by the representative of a public or private entity that has the right to make these decisions on behalf of a child who is experiencing a mental health crisis and, absent admission to a childrens crisis residential center, would otherwise require acceptance by the emergency department of a general hospital, or admission into a psychiatric hospital or the psychiatric inpatient unit of a general hospital. crisis.
The bill would require the State Department of Health Care Services, in consultation with certain stakeholders including the State Department of Social Services, to establish program standards and procedures, as specified, for a childrens crisis residential mental health program approval, and would require the childrens crisis residential mental health program approval to be a condition of continued licensure for a short-term residential therapeutic program operating as a childrens crisis residential program.
(3)Existing law establishes the Investment in Mental Health Wellness Act of 2013. Existing law provides that funds appropriated by the Legislature to the California Health Facilities Financing Authority for the purposes of the act be made available to selected counties or counties acting jointly, except as otherwise provided, and used to provide, among other things, a complete continuum of crisis services for children and youth 21 years of age and under regardless of where they live in the state. The act requires grant awards made by the authority to be used to expand local resources for the development, capital, equipment acquisition, and applicable program startup or expansion costs to increase capacity for client assistance and crisis services for children and youth 21 years of age and under in specified areas, including crisis residential treatment as authorized by specified provisions.
This bill would include within these specified areas crisis residential treatment provided at a childrens crisis residential center. program.
(4)The bill would require the State Department of Social Services and the State Department of Health Care Services to adopt regulations to implement the act on or before July 1, 2018, as specified, and would authorize the departments to implement and administer the changes made by this act through information notices, all-county letters, or similar written instructions until regulations are adopted.
(5)The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.
(1)Existing law, the California Community Care Facilities Act, provides for the licensing and regulation of community care facilities, as defined, by the State Department of Social Services. Existing law includes within the definition of community care facility a short-term residential therapeutic program, which is a residential facility licensed by the department and operated by any public agency or private organization that provides an integrated program of specialized and intensive care and supervision, services and supports, treatment, and short-term, 24-hour care and supervision to children. A violation of the act is a misdemeanor.
This bill would authorize the State Department of Social Services to, no later than July 1, 2018, and contingent upon an appropriation in the annual Budget Act for these purposes, license a short-term residential therapeutic program to be operated operating as a childrens crisis residential center, as defined, and would require the department to regulate those programs, as specified. The bill would require the State Department of Health Care Services, in consultation with the State Department of Social Services and the County Behavioral Health Directors Association of California and representatives of provider associations, to establish interim Medi-Cal rates for childrens crisis residential services, as prescribed. California, among others, to develop a rate for children who are Medi-Cal beneficiaries and who are admitted to a childrens crisis residential program. By expanding the types of facilities that are regulated as a community care facility, this bill would expand the scope of an existing crime, thus creating a state-mandated local program.
(2)Existing law establishes the Aid to Families with Dependent Children-Foster Care (AFDC-FC) program, under which counties provide payments to foster care providers on behalf of qualified children in foster care. In order to be eligible for AFDC-FC, existing law requires a child or nonminor dependent to be placed in a specified placement, including, a short-term residential therapeutic program.
Existing law requires a short-term residential therapeutic program to obtain a contract with a county mental health plan to provide specialty mental health services and demonstrate the ability to meet the therapeutic needs of each child identified in specified plan documents. Existing law authorizes a short-term residential therapeutic program to accept for placement children who meet certain criteria, except as otherwise specified.
This bill would authorize a short-term residential therapeutic program that is operating as a childrens crisis residential center to accept for admission or placement any child, referred by a parent or guardian, or by the representative of a public or private entity that has the right to make these decisions on behalf of a child who is experiencing a mental health crisis and, absent admission to a childrens crisis residential center, would otherwise require acceptance by the emergency department of a general hospital, or admission into a psychiatric hospital or the psychiatric inpatient unit of a general hospital.
The bill would require the State Department of Health Care Services, in consultation with certain stakeholders including the State Department of Social Services, to establish program standards and procedures, as specified, for a childrens crisis residential mental health program approval, and would require the childrens crisis residential mental health program approval to be a condition of continued licensure for a short-term residential therapeutic program operating as a childrens crisis residential program.
(3)Existing law establishes the Investment in Mental Health Wellness Act of 2013. Existing law provides that funds appropriated by the Legislature to the California Health Facilities Financing Authority for the purposes of the act be made available to selected counties or counties acting jointly, except as otherwise provided, and used to provide, among other things, a complete continuum of crisis services for children and youth 21 years of age and under regardless of where they live in the state. The act requires grant awards made by the authority to be used to expand local resources for the development, capital, equipment acquisition, and applicable program startup or expansion costs to increase capacity for client assistance and crisis services for children and youth 21 years of age and under in specified areas, including crisis residential treatment as authorized by specified provisions.
This bill would include within these specified areas crisis residential treatment provided at a childrens crisis residential center.
(4)The bill would require the State Department of Social Services and the State Department of Health Care Services to adopt regulations to implement the act on or before July 1, 2018, as specified, and would authorize the departments to implement and administer the changes made by this act through information notices, all-county letters, or similar written instructions until regulations are adopted.
(4)(5)The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.
(1)Existing law, the California Community Care Facilities Act, provides for the licensing and regulation of community care facilities, as defined, by the State Department of Social Services. Existing law includes within the definition of community care facility a short-term residential therapeutic program, which is a residential facility licensed by the department and operated by any public agency or private organization that provides an integrated program of specialized and intensive care and supervision, services and supports, treatment, and short-term, 24-hour care and supervision to children. A violation of the act is a misdemeanor.
This bill would authorize a short-term residential therapeutic program to be operated as a childrens crisis residential center, as defined, and would require the department to regulate those programs, as specified. The bill would require the State Department of Health Care Services, in consultation with the County Behavioral Health Directors Association of California and representatives of provider associations, to establish interim Medi-Cal rates for childrens crisis residential services, as prescribed. By expanding the types of facilities that are regulated as a community care facility, this bill would expand the scope of an existing crime, thus creating a state-mandated local program.
(2)Existing law establishes the Aid to Families with Dependent Children-Foster Care (AFDC-FC) program, under which counties provide payments to foster care providers on behalf of qualified children in foster care. In order to be eligible for AFDC-FC, existing law requires a child or nonminor dependent to be placed in a specified placement, including, a short-term residential therapeutic program.
Existing law requires a short-term residential therapeutic program to obtain a contract with a county mental health plan to provide specialty mental health services and demonstrate the ability to meet the therapeutic needs of each child identified in specified plan documents. Existing law authorizes a short-term residential therapeutic program to accept for placement children who meet certain criteria, except as otherwise specified.
This bill would authorize a short-term residential therapeutic program that is operating as a childrens crisis residential center to accept for admission or placement any child, referred by a parent or guardian, or by the representative of a public or private entity that has the right to make these decisions on behalf of a child who is experiencing a mental health crisis and, absent admission to a childrens crisis residential center, would otherwise require acceptance by the emergency department of a general hospital, or admission into a psychiatric hospital or the psychiatric inpatient unit of a general hospital.
(3)Existing law establishes the Investment in Mental Health Wellness Act of 2013. Existing law provides that funds appropriated by the Legislature to the California Health Facilities Financing Authority for the purposes of the act be made available to selected counties or counties acting jointly, except as otherwise provided, and used to provide, among other things, a complete continuum of crisis services for children and youth 21 years of age and under regardless of where they live in the state. The act requires grant awards made by the authority to be used to expand local resources for the development, capital, equipment acquisition, and applicable program startup or expansion costs to increase capacity for client assistance and crisis services for children and youth 21 years of age and under in specified areas, including crisis residential treatment as authorized by specified provisions.
This bill would include within these specified areas crisis residential treatment provided at a childrens crisis residential center.
(4)The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.
The Legislature finds and declares all of the following:
(a)There is an urgent need to provide more crisis care alternatives to hospitals for children and youth experiencing mental health crises.
(b)The problems are especially acute for children and youth who may have to wait for days for a hospital bed and who may be transported, without a parent, to the nearest facility hundreds of miles away.
(c)In 2012, the California Hospital Association reported that two-thirds of the people taken to a hospital for a psychiatric emergency did not meet the criteria for that level of care, but the care they needed was not available.
(d)The type of care that is needed includes crisis residential treatment for children.
(e)This level of care is part of the full continuum of care considered medically necessary for many children with serious emotional disturbances.
(f)In 2013, the Legislature enacted the Investment in Mental Health Wellness Act (Senate Bill 82, Chapter 34 of the Statutes of 2013) to provide one-time funding to counties to expand the availability of mental health crisis care services, including short-term crisis residential treatment services. However, there is currently no state licensing category for short-term crisis residential programs for children. As a result, counties wanting to expand local capacity to meet the needs of children and youth for crisis residential treatment services were ineligible for this competitive grant program.
(g)In most communities, inpatient crisis treatment is completely unavailable for children and youth, even though it may be medically necessary.
(h)Crisis residential care is an essential level of care for the treatment of children and youth with serious emotional disturbances in a mental health crisis, and it often serves as an alternative to hospitalization.
(i)It is imperative that California identify a licensing category specifically for mental health crisis residential care that can be utilized for children and youth who are beneficiaries of both public and private health care plans.
SEC. 2.Section 1502 of the Health and Safety Code is amended to read:1502.As used in this chapter:
(a)Community care facility means any facility, place, or building that is maintained and operated to provide nonmedical residential care, day treatment, adult day care, or foster family agency services for children, adults, or children and adults, including, but not limited to, the physically handicapped, mentally impaired, incompetent persons, and abused or neglected children, and includes the following:
(1)Residential facility means any family home, group care facility, or similar facility determined by the department, for 24-hour nonmedical care of persons in need of personal services, supervision, or assistance essential for sustaining the activities of daily living or for the protection of the individual.
(2)Adult day program means any community-based facility or program that provides care to persons 18 years of age or older in need of personal services, supervision, or assistance essential for sustaining the activities of daily living or for the protection of these individuals on less than a 24-hour basis.
(3)Therapeutic day services facility means any facility that provides nonmedical care, counseling, educational or vocational support, or social rehabilitation services on less than a 24-hour basis to persons under 18 years of age who would otherwise be placed in foster care or who are returning to families from foster care. Program standards for these facilities shall be developed by the department, pursuant to Section 1530, in consultation with therapeutic day services and foster care providers.
(4)Foster family agency means any public agency or private organization, organized and operated on a nonprofit basis, engaged in any of the following:
(A)Recruiting, certifying, approving, and training of, and providing professional support to, foster parents and resource families.
(B)Coordinating with county placing agencies to find homes for foster children in need of care.
(C)Providing services and supports to licensed or certified foster parents, county-approved resource families, and children to the extent authorized by state and federal law.
(5)Foster family home means any residential facility providing 24-hour care for six or fewer foster children that is owned, leased, or rented and is the residence of the foster parent or parents, including their family, in whose care the foster children have been placed. The placement may be by a public or private child placement agency or by a court order, or by voluntary placement by a parent, parents, or guardian. It also means a foster family home described in Section 1505.2.
(6)Small family home means any residential facility, in the licensees family residence, that provides 24-hour care for six or fewer foster children who have mental disorders or developmental or physical disabilities and who require special care and supervision as a result of their disabilities. A small family home may accept children with special health care needs, pursuant to subdivision (a) of Section 17710 of the Welfare and Institutions Code. In addition to placing children with special health care needs, the department may approve placement of children without special health care needs, up to the licensed capacity.
(7)Social rehabilitation facility means any residential facility that provides social rehabilitation services for no longer than 18 months in a group setting to adults recovering from mental illness who temporarily need assistance, guidance, or counseling. Program components shall be subject to program standards pursuant to Article 1 (commencing with Section 5670) of Chapter 2.5 of Part 2 of Division 5 of the Welfare and Institutions Code.
(8)Community treatment facility means any residential facility that provides mental health treatment services to children in a group setting and that has the capacity to provide secure containment. Program components shall be subject to program standards developed and enforced by the State Department of Health Care Services pursuant to Section 4094 of the Welfare and Institutions Code.
Nothing in this section shall be construed to prohibit or discourage placement of persons who have mental or physical disabilities into any category of community care facility that meets the needs of the individual placed, if the placement is consistent with the licensing regulations of the department.
(9)Full-service adoption agency means any licensed entity engaged in the business of providing adoption services, that does all of the following:
(A)Assumes care, custody, and control of a child through relinquishment of the child to the agency or involuntary termination of parental rights to the child.
(B)Assesses the birth parents, prospective adoptive parents, or child.
(C)Places children for adoption.
(D)Supervises adoptive placements.
Private full-service adoption agencies shall be organized and operated on a nonprofit basis. As a condition of licensure to provide intercountry adoption services, a full-service adoption agency shall be accredited and in good standing according to Part 96 (commencing with Section 96.1) of Title 22 of the Code of Federal Regulations, or supervised by an accredited primary provider, or acting as an exempted provider, in compliance with Subpart F (commencing with Section 96.29) of Part 96 of Title 22 of the Code of Federal Regulations.
(10)Noncustodial adoption agency means any licensed entity engaged in the business of providing adoption services, that does all of the following:
(A)Assesses the prospective adoptive parents.
(B)Cooperatively matches children freed for adoption, who are under the care, custody, and control of a licensed adoption agency, for adoption, with assessed and approved adoptive applicants.
(C)Cooperatively supervises adoption placements with a full-service adoptive agency, but does not disrupt a placement or remove a child from a placement.
Private noncustodial adoption agencies shall be organized and operated on a nonprofit basis. As a condition of licensure to provide intercountry adoption services, a noncustodial adoption agency shall be accredited and in good standing according to Part 96 (commencing with Section 96.1) of Title 22 of the Code of Federal Regulations, or supervised by an accredited primary provider, or acting as an exempted provider, in compliance with Subpart F (commencing with Section 96.29) of Part 96 of Title 22 of the Code of Federal Regulations.
(11)Transitional shelter care facility means any group care facility that provides for 24-hour nonmedical care of persons in need of personal services, supervision, or assistance essential for sustaining the activities of daily living or for the protection of the individual. Program components shall be subject to program standards developed by the State Department of Social Services pursuant to Section 1502.3.
(12)Transitional housing placement provider means an organization licensed by the department pursuant to Section 1559.110 and Section 16522.1 of the Welfare and Institutions Code to provide transitional housing to foster children at least 16 years of age and not more than 18 years of age, and nonminor dependents, as defined in subdivision (v) of Section 11400 of the Welfare and Institutions Code, to promote their transition to adulthood. A transitional housing placement provider shall be privately operated and organized on a nonprofit basis.
(13)Group home means a residential facility that provides 24-hour care and supervision to children, delivered at least in part by staff employed by the licensee in a structured environment. The care and supervision provided by a group home shall be nonmedical, except as otherwise permitted by law.
(14)Runaway and homeless youth shelter means a group home licensed by the department to operate a program pursuant to Section 1502.35 to provide voluntary, short-term, shelter and personal services to runaway youth or homeless youth, as defined in paragraph (2) of subdivision (a) of Section 1502.35.
(15)Enhanced behavioral supports home means a facility certified by the State Department of Developmental Services pursuant to Article 3.6 (commencing with Section 4684.80) of Chapter 6 of Division 4.5 of the Welfare and Institutions Code, and licensed by the State Department of Social Services as an adult residential facility or a group home that provides 24-hour nonmedical care to individuals with developmental disabilities who require enhanced behavioral supports, staffing, and supervision in a homelike setting. An enhanced behavioral supports home shall have a maximum capacity of four consumers, shall conform to Section 441.530(a)(1) of Title 42 of the Code of Federal Regulations, and shall be eligible for federal Medicaid home- and community-based services funding.
(16)Community crisis home means a facility certified by the State Department of Developmental Services pursuant to Article 8 (commencing with Section 4698) of Chapter 6 of Division 4.5 of the Welfare and Institutions Code, and licensed by the State Department of Social Services pursuant to Article 9.7 (commencing with Section 1567.80), as an adult residential facility, providing 24-hour nonmedical care to individuals with developmental disabilities receiving regional center service, in need of crisis intervention services, and who would otherwise be at risk of admission to the acute crisis center at Fairview Developmental Center, Sonoma Developmental Center, an acute general hospital, acute psychiatric hospital, an institution for mental disease, as described in Part 5 (commencing with Section 5900) of Division 5 of the Welfare and Institutions Code, or an out-of-state placement. A community crisis home shall have a maximum capacity of eight consumers, as defined in subdivision (a) of Section 1567.80, shall conform to Section 441.530(a)(1) of Title 42 of the Code of Federal Regulations, and shall be eligible for federal Medicaid home- and community-based services funding.
(17)Crisis nursery means a facility licensed by the department to operate a program pursuant to Section 1516 to provide short-term care and supervision for children under six years of age who are voluntarily placed for temporary care by a parent or legal guardian due to a family crisis or stressful situation.
(18)Short-term residential therapeutic program means a residential facility operated by a public agency or private organization and licensed by the department pursuant to Section 1562.01 that provides an integrated program of specialized and intensive care and supervision, services and supports, treatment, and short-term, 24-hour care and supervision to children. The care and supervision provided by a short-term residential therapeutic program shall be nonmedical, except as otherwise permitted by law. Private short-term residential therapeutic programs shall be organized and operated on a nonprofit basis. A short-term residential therapeutic program may be operated as a childrens crisis residential program.
(19)Private alternative boarding school means a group home licensed by the department to operate a program pursuant to Section 1502.2 to provide youth with 24-hour residential care and supervision, which, in addition to providing educational services to youth, provides, or holds itself out as providing, behavioral-based services to youth with social, emotional, or behavioral issues. The care and supervision provided by a private alternative boarding school shall be nonmedical, except as otherwise permitted by law.
(20)Private alternative outdoor program means a group home licensed by the department to operate a program pursuant to Section 1502.21 to provide youth with 24-hour residential care and supervision, which provides, or holds itself out as providing, behavioral-based services in an outdoor living setting to youth with social, emotional, or behavioral issues. The care and supervision provided by a private alternative outdoor program shall be nonmedical, except as otherwise permitted by law.
(21)Childrens crisis residential program means a facility licensed by the department as a short-term residential therapeutic program pursuant to Section 1562.02 and approved by the State Department of Health Care Services, or a county mental health plan to which the State Department of Health Care Services has delegated approval authority, to operate a childrens crisis residential mental health program approval pursuant to Section 11462.011 of the Welfare and Institutions Code, to serve children experiencing mental health crises as an alternative to psychiatric hospitalization.
(b)Department or state department means the State Department of Social Services.
(c)Director means the Director of Social Services.
SEC. 2.5.Section 1502 of the Health and Safety Code is amended to read:1502.As used in this chapter:
(a)Community care facility means any facility, place, or building that is maintained and operated to provide nonmedical residential care, day treatment, adult day care, or foster family agency services for children, adults, or children and adults, including, but not limited to, the physically handicapped, mentally impaired, incompetent persons, and abused or neglected children, and includes the following:
(1)Residential facility means any family home, group care facility, or similar facility determined by the department, for 24-hour nonmedical care of persons in need of personal services, supervision, or assistance essential for sustaining the activities of daily living or for the protection of the individual.
(2)Adult day program means any community-based facility or program that provides care to persons 18 years of age or older in need of personal services, supervision, or assistance essential for sustaining the activities of daily living or for the protection of these individuals on less than a 24-hour basis.
(3)Therapeutic day services facility means any facility that provides nonmedical care, counseling, educational or vocational support, or social rehabilitation services on less than a 24-hour basis to persons under 18 years of age who would otherwise be placed in foster care or who are returning to families from foster care. Program standards for these facilities shall be developed by the department, pursuant to Section 1530, in consultation with therapeutic day services and foster care providers.
(4)Foster family agency means any public agency or private organization, organized and operated on a nonprofit basis, engaged in any of the following:
(A)Recruiting, certifying, approving, and training of, and providing professional support to, foster parents and resource families.
(B)Coordinating with county placing agencies to find homes for foster children in need of care.
(C)Providing services and supports to licensed or certified foster parents, county-approved resource families, and children to the extent authorized by state and federal law.
(5)Foster family home means any residential facility providing 24-hour care for six or fewer foster children that is owned, leased, or rented and is the residence of the foster parent or parents, including their family, in whose care the foster children have been placed. The placement may be by a public or private child placement agency or by a court order, or by voluntary placement by a parent, parents, or guardian. It also means a foster family home described in Section 1505.2.
(6)Small family home means any residential facility, in the licensees family residence, that provides 24-hour care for six or fewer foster children who have mental disorders or developmental or physical disabilities and who require special care and supervision as a result of their disabilities. A small family home may accept children with special health care needs, pursuant to subdivision (a) of Section 17710 of the Welfare and Institutions Code. In addition to placing children with special health care needs, the department may approve placement of children without special health care needs, up to the licensed capacity.
(7)Social rehabilitation facility means any residential facility that provides social rehabilitation services for no longer than 18 months in a group setting to adults recovering from mental illness who temporarily need assistance, guidance, or counseling. Program components shall be subject to program standards pursuant to Article 1 (commencing with Section 5670) of Chapter 2.5 of Part 2 of Division 5 of the Welfare and Institutions Code.
(8)Community treatment facility means any residential facility that provides mental health treatment services to children in a group setting and that has the capacity to provide secure containment. Program components shall be subject to program standards developed and enforced by the State Department of Health Care Services pursuant to Section 4094 of the Welfare and Institutions Code.
Nothing in this section shall be construed to prohibit or discourage placement of persons who have mental or physical disabilities into any category of community care facility that meets the needs of the individual placed, if the placement is consistent with the licensing regulations of the department.
(9)Full-service adoption agency means any licensed entity engaged in the business of providing adoption services, that does all of the following:
(A)Assumes care, custody, and control of a child through relinquishment of the child to the agency or involuntary termination of parental rights to the child.
(B)Assesses the birth parents, prospective adoptive parents, or child.
(C)Places children for adoption.
(D)Supervises adoptive placements.
Private full-service adoption agencies shall be organized and operated on a nonprofit basis. As a condition of licensure to provide intercountry adoption services, a full-service adoption agency shall be accredited and in good standing according to Part 96 (commencing with Section 96.1) of Title 22 of the Code of Federal Regulations, or supervised by an accredited primary provider, or acting as an exempted provider, in compliance with Subpart F (commencing with Section 96.29) of Part 96 of Title 22 of the Code of Federal Regulations.
(10)Noncustodial adoption agency means any licensed entity engaged in the business of providing adoption services, that does all of the following:
(A)Assesses the prospective adoptive parents.
(B)Cooperatively matches children freed for adoption, who are under the care, custody, and control of a licensed adoption agency, for adoption, with assessed and approved adoptive applicants.
(C)Cooperatively supervises adoption placements with a full-service adoptive agency, but does not disrupt a placement or remove a child from a placement.
Private noncustodial adoption agencies shall be organized and operated on a nonprofit basis. As a condition of licensure to provide intercountry adoption services, a noncustodial adoption agency shall be accredited and in good standing according to Part 96 (commencing with Section 96.1) of Title 22 of the Code of Federal Regulations, or supervised by an accredited primary provider, or acting as an exempted provider, in compliance with Subpart F (commencing with Section 96.29) of Part 96 of Title 22 of the Code of Federal Regulations.
(11)Transitional shelter care facility means any group care facility that provides for 24-hour nonmedical care of persons in need of personal services, supervision, or assistance essential for sustaining the activities of daily living or for the protection of the individual. Program components shall be subject to program standards developed by the State Department of Social Services pursuant to Section 1502.3.
(12)Transitional housing placement provider means an organization licensed by the department pursuant to Section 1559.110 to provide transitional housing to foster children who are at least 16 years of age to promote their transition to adulthood. A transitional housing placement provider shall be privately operated and organized on a nonprofit basis.
(13)Group home means a residential facility that provides 24-hour care and supervision to children, delivered at least in part by staff employed by the licensee in a structured environment. The care and supervision provided by a group home shall be nonmedical, except as otherwise permitted by law.
(14)Runaway and homeless youth shelter means a group home licensed by the department to operate a program pursuant to Section 1502.35 to provide voluntary, short-term, shelter and personal services to runaway youth or homeless youth, as defined in paragraph (2) of subdivision (a) of Section 1502.35.
(15)Enhanced behavioral supports home means a facility certified by the State Department of Developmental Services pursuant to Article 3.6 (commencing with Section 4684.80) of Chapter 6 of Division 4.5 of the Welfare and Institutions Code, and licensed by the State Department of Social Services as an adult residential facility or a group home that provides 24-hour nonmedical care to individuals with developmental disabilities who require enhanced behavioral supports, staffing, and supervision in a homelike setting. An enhanced behavioral supports home shall have a maximum capacity of four consumers, shall conform to Section 441.530(a)(1) of Title 42 of the Code of Federal Regulations, and shall be eligible for federal Medicaid home- and community-based services funding.
(16)Community crisis home means a facility certified by the State Department of Developmental Services pursuant to Article 8 (commencing with Section 4698) of Chapter 6 of Division 4.5 of the Welfare and Institutions Code, and licensed by the State Department of Social Services pursuant to Article 9.7 (commencing with Section 1567.80), as an adult residential facility, providing 24-hour nonmedical care to individuals with developmental disabilities receiving regional center service, in need of crisis intervention services, and who would otherwise be at risk of admission to the acute crisis center at Fairview Developmental Center, Sonoma Developmental Center, an acute general hospital, acute psychiatric hospital, an institution for mental disease, as described in Part 5 (commencing with Section 5900) of Division 5 of the Welfare and Institutions Code, or an out-of-state placement. A community crisis home shall have a maximum capacity of eight consumers, as defined in subdivision (a) of Section 1567.80, shall conform to Section 441.530(a)(1) of Title 42 of the Code of Federal Regulations, and shall be eligible for federal Medicaid home- and community-based services funding.
(17)Crisis nursery means a facility licensed by the department to operate a program pursuant to Section 1516 to provide short-term care and supervision for children under six years of age who are voluntarily placed for temporary care by a parent or legal guardian due to a family crisis or stressful situation.
(18)Short-term residential therapeutic program means a residential facility operated by a public agency or private organization and licensed by the department pursuant to Section 1562.01 that provides an integrated program of specialized and intensive care and supervision, services and supports, treatment, and short-term, 24-hour care and supervision to children. The care and supervision provided by a short-term residential therapeutic program shall be nonmedical, except as otherwise permitted by law. Private short-term residential therapeutic programs shall be organized and operated on a nonprofit basis. A short-term residential therapeutic program may be operated as a childrens crisis residential program.
(19)Private alternative boarding school means a group home licensed by the department to operate a program pursuant to Section 1502.2 to provide youth with 24-hour residential care and supervision, which, in addition to providing educational services to youth, provides, or holds itself out as providing, behavioral-based services to youth with social, emotional, or behavioral issues. The care and supervision provided by a private alternative boarding school shall be nonmedical, except as otherwise permitted by law.
(20)Private alternative outdoor program means a group home licensed by the department to operate a program pursuant to Section 1502.21 to provide youth with 24-hour residential care and supervision, which provides, or holds itself out as providing, behavioral-based services in an outdoor living setting to youth with social, emotional, or behavioral issues. The care and supervision provided by a private alternative outdoor program shall be nonmedical, except as otherwise permitted by law.
(21)Childrens crisis residential program means a facility licensed by the department as a short-term residential therapeutic program pursuant to Section 1562.02 and approved by the State Department of Health Care Services, or a county mental health plan to which the State Department of Health Care Services has delegated approval authority, to operate a childrens crisis residential mental health program approval pursuant to Section 11462.011 of the Welfare and Institutions Code, to serve children experiencing mental health crises as an alternative to psychiatric hospitalization.
(b)Department or state department means the State Department of Social Services.
(c)Director means the Director of Social Services.
SEC. 3.Section 1562.02 is added to the Health and Safety Code, to read:1562.02.(a)The department may license a short-term residential therapeutic program operating as a childrens crisis residential program pursuant to this chapter. A childrens crisis residential program shall meet all of the following requirements:
(1)If the program serves children who are not experiencing mental health crises, have an identifiable and physically separate unit for those children who are experiencing mental health crises. The separate unit shall be indicated on the short-term residential therapeutic programs license.
(2)Obtain and have in good standing a mental health program approval that includes a Medi-Cal mental health certification, as described in Section 11462.01 of the Welfare and Institutions Code, and a childrens crisis residential mental health program approval, as described in Section 11462.011 of the Welfare and Institutions Code, both of which are issued by the State Department of Health Care Services, or a county mental health plan to which the department has delegated approval authority. The short-term residential therapeutic program shall obtain a mental health program approval before operating as a childrens crisis residential program. The department may revoke a programs license pursuant to Section 1550 for a programs failure to maintain the mental health program approval.
(3)Comply with all applicable licensing standards for a short-term residential therapeutic program, unless the department specifies otherwise in regulations that comply with applicable statutory requirements related to licensure.
(b)Contingent upon an appropriation in the annual Budget Act for these purposes, the department shall begin implementation of this section no later than July 1, 2018, and shall commence the licensing process for childrens crisis residential programs no later than January 1, 2019.
SEC. 4.Section 1562.03 is added to the Health and Safety Code, to read:1562.03.(a)The department shall establish regulations for short-term residential therapeutic programs that are operated as childrens crisis residential programs. At a minimum, the regulations shall include all of the following:
(1)Therapeutic programming shall be provided seven days a week, including weekends and holidays, with sufficient mental health professional and paraprofessional staff, as required by the facilitys childrens crisis residential mental health program approval in accordance with the standards and procedures established pursuant to Section 11462.011 of the Welfare and Institutions Code, to maintain an appropriate treatment setting and services, based on individual childrens needs.
(2)The program shall be staffed with sufficient personnel to accept children 24 hours per day, seven days a week and to admit children, at a minimum, from 7 a.m. to 11 p.m., seven days a week, 365 days per year. The program shall be sufficiently staffed to discharge children, as appropriate, seven days a week, 365 days per year.
(3)Facilities shall be limited to fewer than 16 beds, with at least 50 percent of those beds in single-occupancy rooms.
(4)Facilities shall include ample physical space for accommodating individuals who provide daily emotional and physical supports to each child and for integrating family members into the day-to-day care of the youth.
(5)The program shall collaborate with each childs existing mental health team, if applicable, child and family team, if applicable, and other formal and natural supports within 24 hours of intake and throughout the course of care and treatment as appropriate.
(6)The program shall create and assist with the implementation of a plan for transitioning each admitted child from the program to his or her home and community, including the establishment of a mental health or child and family team if there is not one already.
(b)The program shall annually provide the department with all of the following data as it pertains to children in foster care and children not in foster care in conjunction with its application for licensure renewal:
(1)Age and gender of clients served.
(2)Duration of stay.
(3)Professional classification of staff and contracted staff.
(4)Type of placement the client was discharged to.
SEC. 5.Section 5848.5 of the Welfare and Institutions Code is amended to read:5848.5.(a)The Legislature finds and declares all of the following:
(1)California has realigned public community mental health services to counties and it is imperative that sufficient community-based resources be available to meet the mental health needs of eligible individuals.
(2)Increasing access to effective outpatient and crisis stabilization services provides an opportunity to reduce costs associated with expensive inpatient and emergency room care and to better meet the needs of individuals with mental health disorders in the least restrictive manner possible.
(3)Almost one-fifth of people with mental health disorders visit a hospital emergency room at least once per year. If an adequate array of crisis services is not available, it leaves an individual with little choice but to access an emergency room for assistance and, potentially, an unnecessary inpatient hospitalization.
(4)Recent reports have called attention to a continuing problem of inappropriate and unnecessary utilization of hospital emergency rooms in California due to limited community-based services for individuals in psychological distress and acute psychiatric crisis. Hospitals report that 70 percent of people taken to emergency rooms for psychiatric evaluation can be stabilized and transferred to a less intensive level of crisis care. Law enforcement personnel report that their personnel need to stay with people in the emergency room waiting area until a placement is found, and that less intensive levels of care tend not to be available.
(5)Comprehensive public and private partnerships at both local and regional levels, including across physical health services, mental health, substance use disorder, law enforcement, social services, and related supports, are necessary to develop and maintain high quality, patient-centered, and cost-effective care for individuals with mental health disorders that facilitates their recovery and leads towards wellness.
(6)The recovery of individuals with mental health disorders is important for all levels of government, business, and the local community.
(b)This section shall be known, and may be cited, as the Investment in Mental Health Wellness Act of 2013. The objectives of this section are to do all of the following:
(1)Expand access to early intervention and treatment services to improve the client experience, achieve recovery and wellness, and reduce costs.
(2)Expand the continuum of services to address crisis intervention, crisis stabilization, and crisis residential treatment needs that are wellness, resiliency, and recovery oriented.
(3)Add at least 25 mobile crisis support teams and at least 2,000 crisis stabilization and crisis residential treatment beds to bolster capacity at the local level to improve access to mental health crisis services and address unmet mental health care needs.
(4)Add at least 600 triage personnel to provide intensive case management and linkage to services for individuals with mental health care disorders at various points of access, such as at designated community-based service points, homeless shelters, and clinics.
(5)Reduce unnecessary hospitalizations and inpatient days by appropriately utilizing community-based services and improving access to timely assistance.
(6)Reduce recidivism and mitigate unnecessary expenditures of local law enforcement.
(7)Provide local communities with increased financial resources to leverage additional public and private funding sources to achieve improved networks of care for individuals with mental health disorders.
(8)Provide a complete continuum of crisis services for children and youth 21 years of age and under regardless of where they live in the state. The funds included in the 2016 Budget Act for the purpose of developing the continuum of mental health crisis services for children and youth 21 years of age and under shall be for the following objectives:
(A)Provide a continuum of crisis services for children and youth 21 years of age and under regardless of where they live in the state.
(B)Provide for early intervention and treatment services to improve the client experience, achieve recovery and wellness, and reduce costs.
(C)Expand the continuum of community-based services to address crisis intervention, crisis stabilization, and crisis residential treatment needs that are wellness-, resiliency-, and recovery-oriented.
(D)Add at least 200 mobile crisis support teams.
(E)Add at least 120 crisis stabilization services and beds and crisis residential treatment beds to increase capacity at the local level to improve access to mental health crisis services and address unmet mental health care needs.
(F)Add triage personnel to provide intensive case management and linkage to services for individuals with mental health care disorders at various points of access, such as at designated community-based service points, homeless shelters, schools, and clinics.
(G)Expand family respite care to help families and sustain caregiver health and well-being.
(H)Expand family supportive training and related services designed to help families participate in the planning process, access services, and navigate programs.
(I)Reduce unnecessary hospitalizations and inpatient days by appropriately utilizing community-based services.
(J)Reduce recidivism and mitigate unnecessary expenditures of local law enforcement.
(K)Provide local communities with increased financial resources to leverage additional public and private funding sources to achieve improved networks of care for children and youth 21 years of age and under with mental health disorders.
(c)Through appropriations provided in the annual Budget Act for this purpose, it is the intent of the Legislature to authorize the California Health Facilities Financing Authority, hereafter referred to as the authority, and the Mental Health Services Oversight and Accountability Commission, hereafter referred to as the commission, to administer competitive selection processes as provided in this section for capital capacity and program expansion to increase capacity for mobile crisis support, crisis intervention, crisis stabilization services, crisis residential treatment, and specified personnel resources.
(d)Funds appropriated by the Legislature to the authority for purposes of this section shall be made available to selected counties, or counties acting jointly. The authority may, at its discretion, also give consideration to private nonprofit corporations and public agencies in an area or region of the state if a county, or counties acting jointly, affirmatively supports this designation and collaboration in lieu of a county government directly receiving grant funds.
(1)Grant awards made by the authority shall be used to expand local resources for the development, capital, equipment acquisition, and applicable program startup or expansion costs to increase capacity for client assistance and services in the following areas:
(A)Crisis intervention, as authorized by Sections 14021.4, 14680, and 14684.
(B)Crisis stabilization, as authorized by Sections 14021.4, 14680, and 14684.
(C)Crisis residential treatment, as authorized by Sections 14021.4, 14680, and 14684 and as provided at a childrens crisis residential program, as defined in Section 1502 of the Health and Safety Code.
(D)Rehabilitative mental health services, as authorized by Sections 14021.4, 14680, and 14684.
(E)Mobile crisis support teams, including personnel and equipment, such as the purchase of vehicles.
(2)The authority shall develop selection criteria to expand local resources, including those described in paragraph (1), and processes for awarding grants after consulting with representatives and interested stakeholders from the mental health community, including, but not limited to, the County Behavioral Health Directors Association of California, service providers, consumer organizations, and other appropriate interests, such as health care providers and law enforcement, as determined by the authority. The authority shall ensure that grants result in cost-effective expansion of the number of community-based crisis resources in regions and communities selected for funding. The authority shall also take into account at least the following criteria and factors when selecting recipients of grants and determining the amount of grant awards:
(A)Description of need, including, at a minimum, a comprehensive description of the project, community need, population to be served, linkage with other public systems of health and mental health care, linkage with local law enforcement, social services, and related assistance, as applicable, and a description of the request for funding.
(B)Ability to serve the target population, which includes individuals eligible for Medi-Cal and individuals eligible for county health and mental health services.
(C)Geographic areas or regions of the state to be eligible for grant awards, which may include rural, suburban, and urban areas, and may include use of the five regional designations utilized by the County Behavioral Health Directors Association of California.
(D)Level of community engagement and commitment to project completion.
(E)Financial support that, in addition to a grant that may be awarded by the authority, will be sufficient to complete and operate the project for which the grant from the authority is awarded.
(F)Ability to provide additional funding support to the project, including public or private funding, federal tax credits and grants, foundation support, and other collaborative efforts.
(G)Memorandum of understanding among project partners, if applicable.
(H)Information regarding the legal status of the collaborating partners, if applicable.
(I)Ability to measure key outcomes, including improved access to services, health and mental health outcomes, and cost benefit of the project.
(3)The authority shall determine maximum grants awards, which shall take into consideration the number of projects awarded to the grantee, as described in paragraph (1), and shall reflect reasonable costs for the project and geographic region. The authority may allocate a grant in increments contingent upon the phases of a project.
(4)Funds awarded by the authority pursuant to this section may be used to supplement, but not to supplant, existing financial and resource commitments of the grantee or any other member of a collaborative effort that has been awarded a grant.
(5)All projects that are awarded grants by the authority shall be completed within a reasonable period of time, to be determined by the authority. Funds shall not be released by the authority until the applicant demonstrates project readiness to the authoritys satisfaction. If the authority determines that a grant recipient has failed to complete the project under the terms specified in awarding the grant, the authority may require remedies, including the return of all or a portion of the grant.
(6)A grantee that receives a grant from the authority under this section shall commit to using that capital capacity and program expansion project, such as the mobile crisis team, crisis stabilization unit, or crisis residential treatment program, for the duration of the expected life of the project.
(7)The authority may consult with a technical assistance entity, as described in paragraph (5) of subdivision (a) of Section 4061, for purposes of implementing this section.
(8)The authority may adopt emergency regulations relating to the grants for the capital capacity and program expansion projects described in this section, including emergency regulations that define eligible costs and determine minimum and maximum grant amounts.
(9)The authority shall provide reports to the fiscal and policy committees of the Legislature on or before May 1, 2014, and on or before May 1, 2015, on the progress of implementation, that include, but are not limited to, the following:
(A)A description of each project awarded funding.
(B)The amount of each grant issued.
(C)A description of other sources of funding for each project.
(D)The total amount of grants issued.
(E)A description of project operation and implementation, including who is being served.
(10)A recipient of a grant provided pursuant to paragraph (1) shall adhere to all applicable laws relating to scope of practice, licensure, certification, staffing, and building codes.
(e)Of the funds specified in paragraph (8) of subdivision (b), it is the intent of the Legislature to authorize the authority and the commission to administer competitive selection processes as provided in this section for capital capacity and program expansion to increase capacity for mobile crisis support, crisis intervention, crisis stabilization services, crisis residential treatment, family respite care, family supportive training and related services, and triage personnel resources for children and youth 21 years of age and under.
(f)Funds appropriated by the Legislature to the authority to address crisis services for children and youth 21 years of age and under for the purposes of this section shall be made available to selected counties or counties acting jointly. The authority may, at its discretion, also give consideration to private nonprofit corporations and public agencies in an area or region of the state if a county, or counties acting jointly, affirmatively support this designation and collaboration in lieu of a county government directly receiving grant funds.
(1)Grant awards made by the authority shall be used to expand local resources for the development, capital, equipment acquisition, and applicable program startup or expansion costs to increase capacity for client assistance and crisis services for children and youth 21 years of age and under in the following areas:
(A)Crisis intervention, as authorized by Sections 14021.4, 14680, and 14684.
(B)Crisis stabilization, as authorized by Sections 14021.4, 14680, and 14684.
(C)Crisis residential treatment, as authorized by Sections 14021.4, 14680, and 14684 and as provided at a childrens crisis residential program, as defined in Section 1502 of the Health and Safety Code.
(D)Mobile crisis support teams, including the purchase of equipment and vehicles.
(E)Family respite care.
(2)The authority shall develop selection criteria to expand local resources, including those described in paragraph (1), and processes for awarding grants after consulting with representatives and interested stakeholders from the mental health community, including, but not limited to, county mental health directors, service providers, consumer organizations, and other appropriate interests, such as health care providers and law enforcement, as determined by the authority. The authority shall ensure that grants result in cost-effective expansion of the number of community-based crisis resources in regions and communities selected for funding. The authority shall also take into account at least the following criteria and factors when selecting recipients of grants and determining the amount of grant awards:
(A)Description of need, including, at a minimum, a comprehensive description of the project, community need, population to be served, linkage with other public systems of health and mental health care, linkage with local law enforcement, social services, and related assistance, as applicable, and a description of the request for funding.
(B)Ability to serve the target population, which includes individuals eligible for Medi-Cal and individuals eligible for county health and mental health services.
(C)Geographic areas or regions of the state to be eligible for grant awards, which may include rural, suburban, and urban areas, and may include use of the five regional designations utilized by the California Behavioral Health Directors Association.
(D)Level of community engagement and commitment to project completion.
(E)Financial support that, in addition to a grant that may be awarded by the authority, will be sufficient to complete and operate the project for which the grant from the authority is awarded.
(F)Ability to provide additional funding support to the project, including public or private funding, federal tax credits and grants, foundation support, and other collaborative efforts.
(G)Memorandum of understanding among project partners, if applicable.
(H)Information regarding the legal status of the collaborating partners, if applicable.
(I)Ability to measure key outcomes, including utilization of services, health and mental health outcomes, and cost benefit of the project.
(3)The authority shall determine maximum grant awards, which shall take into consideration the number of projects awarded to the grantee, as described in paragraph (1), and shall reflect reasonable costs for the project, geographic region, and target ages. The authority may allocate a grant in increments contingent upon the phases of a project.
(4)Funds awarded by the authority pursuant to this section may be used to supplement, but not to supplant, existing financial and resource commitments of the grantee or any other member of a collaborative effort that has been awarded a grant.
(5)All projects that are awarded grants by the authority shall be completed within a reasonable period of time, to be determined by the authority. Funds shall not be released by the authority until the applicant demonstrates project readiness to the authoritys satisfaction. If the authority determines that a grant recipient has failed to complete the project under the terms specified in awarding the grant, the authority may require remedies, including the return of all, or a portion, of the grant.
(6)A grantee that receives a grant from the authority under this section shall commit to using that capital capacity and program expansion project, such as the mobile crisis team, crisis stabilization unit, family respite care, or crisis residential treatment program, for the duration of the expected life of the project.
(7)The authority may consult with a technical assistance entity, as described in paragraph (5) of subdivision (a) of Section 4061, for the purposes of implementing this section.
(8)The authority may adopt emergency regulations relating to the grants for the capital capacity and program expansion projects described in this section, including emergency regulations that define eligible costs and determine minimum and maximum grant amounts.
(9)The authority shall provide reports to the fiscal and policy committees of the Legislature on or before January 10, 2018, and annually thereafter, on the progress of implementation, that include, but are not limited to, the following:
(A)A description of each project awarded funding.
(B)The amount of each grant issued.
(C)A description of other sources of funding for each project.
(D)The total amount of grants issued.
(E)A description of project operation and implementation, including who is being served.
(10)A recipient of a grant provided pursuant to paragraph (1) shall adhere to all applicable laws relating to scope of practice, licensure, certification, staffing, and building codes.
(g)Funds appropriated by the Legislature to the commission for purposes of this section shall be allocated for triage personnel to provide intensive case management and linkage to services for individuals with mental health disorders at various points of access. These funds shall be made available to selected counties, counties acting jointly, or city mental health departments, as determined by the commission through a selection process. It is the intent of the Legislature for these funds to be allocated in an efficient manner to encourage early intervention and receipt of needed services for individuals with mental health disorders, and to assist in navigating the local service sector to improve efficiencies and the delivery of services.
(1)Triage personnel may provide targeted case management services face to face, by telephone, or by telehealth with the individual in need of assistance or his or her significant support person, and may be provided anywhere in the community. These service activities may include, but are not limited to, the following:
(A)Communication, coordination, and referral.
(B)Monitoring service delivery to ensure the individual accesses and receives services.
(C)Monitoring the individuals progress.
(D)Providing placement service assistance and service plan development.
(2)The commission shall take into account at least the following criteria and factors when selecting recipients and determining the amount of grant awards for triage personnel as follows:
(A)Description of need, including potential gaps in local service connections.
(B)Description of funding request, including personnel and use of peer support.
(C)Description of how triage personnel will be used to facilitate linkage and access to services, including objectives and anticipated outcomes.
(D)Ability to obtain federal Medicaid reimbursement, when applicable.
(E)Ability to administer an effective service program and the degree to which local agencies and service providers will support and collaborate with the triage personnel effort.
(F)Geographic areas or regions of the state to be eligible for grant awards, which shall include rural, suburban, and urban areas, and may include use of the five regional designations utilized by the County Behavioral Health Directors Association of California.
(3)The commission shall determine maximum grant awards, and shall take into consideration the level of need, population to be served, and related criteria, as described in paragraph (2), and shall reflect reasonable costs.
(4)Funds awarded by the commission for purposes of this section may be used to supplement, but not supplant, existing financial and resource commitments of the county, counties acting jointly, or city mental health department that received the grant.
(5)Notwithstanding any other law, a county, counties acting jointly, or city mental health department that receives an award of funds for the purpose of supporting triage personnel pursuant to this subdivision is not required to provide a matching contribution of local funds.
(6)Notwithstanding any other law, the commission, without taking any further regulatory action, may implement, interpret, or make specific this section by means of informational letters, bulletins, or similar instructions.
(7)The commission shall provide a status report to the fiscal and policy committees of the Legislature on the progress of implementation no later than March 1, 2014.
(h)Funds appropriated by the Legislature to the commission pursuant to paragraph (8) of subdivision (b) for the purposes of addressing childrens crisis services shall be allocated to support triage personnel and family supportive training and related services. These funds shall be made available to selected counties, counties acting jointly, or city mental health departments, as determined by the commission through a selection process. The commission may, at its discretion, also give consideration to private nonprofit corporations and public agencies in an area or region of the state if a county, or counties acting jointly, affirmatively supports this designation and collaboration in lieu of a county government directly receiving grant funds.
(1)These funds may provide for a range of crisis-related services for a child in need of assistance, or his or her parent, guardian, or caregiver. These service activities may include, but are not limited to, the following:
(A)Intensive coordination of care and services.
(B)Communication, coordination, and referral.
(C)Monitoring service delivery to the child or youth.
(D)Monitoring the childs progress.
(E)Providing placement service assistance and service plan development.
(F)Crisis or safety planning.
(2)The commission shall take into account at least the following criteria and factors when selecting recipients and determining the amount of grant awards for these funds, as follows:
(A)Description of need, including potential gaps in local service connections.
(B)Description of funding request, including personnel.
(C)Description of how personnel and other services will be used to facilitate linkage and access to services, including objectives and anticipated outcomes.
(D)Ability to obtain federal Medicaid reimbursement, when applicable.
(E)Ability to provide a matching contribution of local funds.
(F)Ability to administer an effective service program and the degree to which local agencies and service providers will support and collaborate with the triage personnel effort.
(G)Geographic areas or regions of the state to be eligible for grant awards, which shall include rural, suburban, and urban areas, and may include use of the five regional designations utilized by the County Behavioral Health Directors Association of California.
(3)The commission shall determine maximum grant awards, and shall take into consideration the level of need, population to be served, and related criteria, as described in paragraph (2), and shall reflect reasonable costs.
(4)Funds awarded by the commission for purposes of this section may be used to supplement, but not supplant, existing financial and resource commitments of the county, counties acting jointly, or a city mental health department that received the grant.
(5)Notwithstanding any other law, a county, counties acting jointly, or a city mental health department that receives an award of funds for the purpose of this section is not required to provide a matching contribution of local funds.
(6)Notwithstanding any other law, the commission, without taking any further regulatory action, may implement, interpret, or make specific this section by means of informational letters, bulletins, or similar instructions.
(7)The commission may waive requirements in this section for counties with a population of 100,000 or less, if the commission determines it is in the best interest of the state and meets the intent of the law.
(8)The commission shall provide a status report to the fiscal and policy committees of the Legislature on the progress of implementation no later than January 10, 2018, and annually thereafter.
SEC. 6.Section 11462.01 of the Welfare and Institutions Code, as added by Section 75 of Chapter 773 of the Statutes of 2015, is amended to read:11462.01.(a)(1)If a program will admit Medi-Cal beneficiaries, no later than 12 months following the date of initial licensure, a short-term residential therapeutic program, as defined in subdivision (ad) of Section 11400 of this code and paragraph (18) of subdivision (a) of Section 1502 of the Health and Safety Code, shall obtain a contract, subject to an agreement on rates and terms and conditions, with a county mental health plan to provide specialty mental health services and demonstrate the ability to meet the therapeutic needs of each child, as identified in any of the following:
(A)A mental health assessment.
(B)The childs case plan.
(C)The childs needs and services plan.
(D)Other documentation demonstrating the child has a mental health need.
(2)A short-term residential therapeutic program shall comply with any other mental health program approvals required by the State Department of Health Care Services or by a county mental health plan to which mental health program approval authority has been delegated.
(b)A short-term residential therapeutic program, except as specified in subdivision (c), may accept for placement a child who meets both of the criteria in paragraphs (1) and (2) and at least one of the conditions in paragraph (3).
(1)The child does not require inpatient care in a licensed health facility.
(2)The child has been assessed as requiring the level of services provided in a short-term residential therapeutic program in order to maintain the safety and well-being of the child or others due to behaviors, including those resulting from traumas, that render the child or those around the child unsafe or at risk of harm, or that prevent the effective delivery of needed services and supports provided in the childs own home or in other family settings, such as with a relative, guardian, foster family, resource family, or adoptive family. The assessment shall ensure the child has needs in common with other children or youth in the care of the facility, consistent with subdivision (c) of Section 16514.
(3)The child meets at least one of the following conditions:
(A)The child has been assessed, pursuant to Section 4096, as meeting the medical necessity criteria for Medi-Cal specialty mental health services, as provided for in Section 1830.205 or 1830.210 of Title 9 of the California Code of Regulations.
(B)The child has been assessed, pursuant to Section 4096, as seriously emotionally disturbed, as defined in subdivision (a) of Section 5600.3.
(C)The child requires emergency placement pursuant to paragraph (3) of subdivision (i).
(D)The child has been assessed, pursuant to Section 4096, as requiring the level of services provided by the short-term residential therapeutic program in order to meet his or her behavioral or therapeutic needs.
(4)Subject to the requirements of this subdivision, a short-term residential therapeutic program may have a specialized program to serve a child, including, but not limited to, the following:
(A)A commercially sexually exploited child.
(B)A private voluntary placement, if the youth exhibits status offender behavior, the parents or other relatives feel they cannot control the childs behavior, and short-term intervention is needed to transition the child back into the home.
(C)A juvenile sex offender.
(D)A child who is affiliated with, or impacted by, a gang.
(c)(1)A short-term residential therapeutic program that is operating as a childrens crisis residential program, as defined in Section 1502 of the Health and Safety Code, may accept for admission any child who meets all of the following requirements:
(A)The child is referred by a parent or guardian, physician, or licensed mental health professional, or by the representative of a public or private entity, including, but not limited to, the county probation agency or child welfare services agency with responsibility for the placement of a child in foster care, that has the right to make these decisions on behalf of a child who is in mental health crisis.
(B)The child is under 19, 20, or 21 years of age, depending on a programs licensing requirements.
(C)The child has a serious behavioral health disorder.
(D)The child requires a 24-hour-a-day, seven-day-a-week, staff-secured, unlocked treatment setting.
(2)The primary function of a childrens crisis residential program is to provide short-term crisis stabilization, therapeutic intervention, and specialized programming in an unlocked, staff-secured setting with a high degree of supervision and structure and the goal of supporting the rapid and successful transition of the child back to the community.
(d)A foster family agency that is certified as a Medi-Cal specialty mental health provider pursuant to Section 1810.435 of Title 9 of the California Code of Regulations by the State Department of Health Care Services, or by a county mental health plan to which the department has delegated certification authority, and which has entered into a contract with a county mental health plan pursuant to Section 1810.436 of Title 9 of the California Code of Regulations, shall provide, or provide access to, specialty mental health services to children under its care who do not require inpatient care in a licensed health facility and who meet the medical necessity criteria for Medi-Cal specialty mental health services provided for in Section 1830.205 or 1830.210 of Title 9 of the California Code of Regulations.
(e)A foster family agency that is not certified as a Medi-Cal specialty mental health provider shall provide access to specialty and non-specialty mental health services in that program for children who do not require inpatient care in a licensed health facility and who meet any of the conditions in paragraph (3) of subdivision (b). In this situation the foster family agency shall do the following:
(1)In the case of a child who is a Medi-Cal beneficiary, arrange for specialty mental health services from the county mental health plan.
(2)In all other cases, arrange for the child to receive mental health services.
(f)All short-term residential therapeutic programs shall maintain the level of care and services necessary to meet the needs of the children and youth in their care and shall maintain and have in good standing the appropriate mental health program approval. If a program will admit Medi-Cal beneficiaries, the mental health program approval shall include a certification to provide Medi-Cal specialty mental health services issued by the State Department of Health Care Services or a county mental health plan to which the department has delegated mental health program approval authority, pursuant to Section 4096.5 of this code or Section 1810.435 or 1810.436 of Title 9 of the California Code of Regulations. All foster family agencies that are certified as a Medi-Cal specialty mental health provider pursuant to Section 1810.435 of Title 9 of the California Code of Regulations shall maintain the level of care and services necessary to meet the needs of children and youth in their care and shall maintain and have in good standing the Medi-Cal specialty mental health provider certification issued by the State Department of Health Care Services or a county mental health plan to which the department has delegated certification authority.
(g)The assessments described in subparagraphs (A), (B), (C), and (D) of paragraph (3) of subdivision (b) shall ensure the childs individual behavioral or treatment needs are consistent with, and can be met by, the facility and shall be made by one of the following, as applicable:
(1)An interagency placement committee, as described in Section 4096, considering the recommendations from the child and family team, if any are available. If the short-term residential therapeutic program serves children who are placed by county child welfare agencies and children who are placed by probation departments, the interagency placement committee shall also ensure the requirements of subdivision (c) of Section 16514 have been met with respect to commonality of need.
(2)A licensed mental health professional as defined in subdivision (g) of Section 4096.
(3)For the purposes of this section, an AFDC-FC funded child with an individualized education program developed pursuant to Article 2 (commencing with Section 56320) of Chapter 4 of Part 30 of Division 4 of Title 2 of the Education Code that assesses the child as seriously emotionally disturbed, as defined in, and subject to, this section and recommends out-of-home placement at the level of care provided by the provider, shall be deemed to have met the assessment requirement.
(h)The evaluation described in subparagraph (A) of paragraph (3) of subdivision (i) shall be made pursuant to subdivision (b) of Section 706.6 or paragraph (2) of subdivision (c) of Section 16501.1.
(i)(1)The provider shall ensure that AFDC-FC funded children, assessed pursuant to subparagraphs (A) and (B) of paragraph (3) of subdivision (b), who are accepted for placement have been approved for placement by an interagency placement committee, as described in Section 4096, except as provided for in paragraph (3) of subdivision (g).
(2)The approval shall be in writing and shall indicate that the interagency placement committee has determined one of the following:
(A)The child meets the medical necessity criteria for Medi-Cal specialty mental health services, as provided for in Section 1830.205 or 1830.210 of Title 9 of the California Code of Regulations.
(B)The child is seriously emotionally disturbed, as described in subdivision (a) of Section 5600.3.
(3)(A)Nothing in subdivisions (a) to (h), inclusive, or this subdivision shall prevent an emergency placement of a child or youth into a certified short-term residential therapeutic program or childrens crisis residential program prior to the determination by the interagency placement committee, but only if a licensed mental health professional, as defined in subdivision (g) of Section 4096, has made a written determination within 72 hours of the childs or youths placement, that the child or youth requires the level of services and supervision provided by the short-term residential therapeutic program in order to meet his or her behavioral or therapeutic needs, or has made a written determination within 24 hours of the childs or youths placement in a childrens crisis residential program that the child or youth is experiencing a mental health crisis as defined in subdivision (c) and is in need of the care and services provided by the childrens crisis residential program. If the short-term residential therapeutic program serves children placed by county child welfare agencies and children placed by probation departments, the interagency placement committee shall also ensure the requirements of subdivision (c) of Section 16514 have been met with respect to commonality of need.
(i)The interagency placement committee, as appropriate, shall, within 30 days of placement, make the determinations, with recommendations from the child and family team, required by this subdivision.
(ii)If it determines the placement is appropriate, the interagency placement committee, with recommendations from the child and family team, shall transmit the approval, in writing, to the county placing agency and the short-term residential therapeutic program.
(iii)If it determines the placement is not appropriate, the interagency placement committee shall respond pursuant to subparagraph (B).
(B)(i)If the interagency placement committee determines at any time that the placement is not appropriate, it shall, with recommendations from the child and family team, transmit the disapproval, in writing, to the county placing agency and the short-term residential therapeutic program and shall include a recommendation as to the childs appropriate level of care and placement to meet his or her service needs. The necessary interagency placement committee representative or representatives shall participate in any child and family team meetings to refer the child or youth to an appropriate placement, as specified in this section.
(ii)The child may remain in the placement for the amount of time necessary to identify and transition the child to an alternative, suitable placement.
(iii)Notwithstanding clause (ii), if the interagency placement committee determined the placement was not appropriate due to a health and safety concern, immediate arrangements for the child to transition to an appropriate placement shall occur.
(j)Commencing January 1, 2017, for AFDC-FC funded children or youth, only those children or youth who are approved for placement, as set forth in this section, may be accepted by a short-term residential therapeutic program.
(k)The department shall, through regulation, establish consequences for the failure of a short-term residential therapeutic program to obtain written approval for placement of an AFDC-FC funded child or youth pursuant to this section.
(l)The department shall not establish a rate for a short-term residential therapeutic program unless the provider submits a recommendation from the host county or the primary placing county that the program is needed and that the provider is willing and capable of operating the program at the level sought. For purposes of this subdivision, host county, and primary placing county, mean the same as defined in the departments AFDC-FC ratesetting regulations.
(m)Any certified short-term residential therapeutic program shall be reclassified and paid at the appropriate program rate for which it is qualified if either of the following occurs:
(1)(A)It fails to maintain the level of care and services necessary to meet the needs of the children and youth in care, as required by subdivision (a). The determination shall be made consistent with the departments AFDC-FC ratesetting regulations developed pursuant to Section 11462 and shall take into consideration the highest level of care and associated rates for which the program may be eligible if granted an extension pursuant to Section 11462.04 or any reduction in rate associated with a provisional or probationary rate granted or imposed under Section 11466.01.
(B)In the event of a determination under this paragraph, the short-term residential therapeutic program may appeal the finding or submit a corrective action plan. The appeal process specified in Section 11466.6 shall be available to a short-term residential therapeutic program that provides intensive and therapeutic treatment. During any appeal, the short-term residential therapeutic program that provides intensive and therapeutic treatment shall maintain the appropriate level of care.
(2)It fails to maintain a certified mental health treatment program as required by subdivision (f).
(n)In addition to any other review required by law, the child and family team as defined in paragraph (4) of subdivision (a) of Section 16501 may periodically review the placement of the child or youth. If the child and family team make a recommendation that the child or youth no longer needs, or is not benefiting from, placement in a short-term residential therapeutic program, the team shall transmit the disapproval, in writing, to the county placing agency to consider a more appropriate placement.
(o)The department shall develop a process to address placements when, subsequent to the childs or youths placement, a determination is made by the interagency placement team and shall consider the recommendations of the child and family team, either that the child or youth is not in need of the care and services provided by the certified program. The process shall include, but not be limited to:
(1)Notice of the determination in writing to both the county placing agency and the short-term residential therapeutic program or foster family agency that provides intensive and therapeutic treatment.
(2)Notice of the countys plan, and a timeframe, for removal of the child or youth in writing to the short-term residential therapeutic program that provides intensive and therapeutic treatment.
(3)Referral to an appropriate placement.
(4)Actions to be taken if a child or youth is not timely removed from the short-term residential therapeutic program that provides intensive and therapeutic treatment or placed in an appropriate placement.
(p)(1)Nothing in this section shall prohibit a short-term residential therapeutic program from accepting private admissions of children or youth.
(2)When a referral is not from a public agency and public funding is not involved, there is no requirement for public agency review or determination of need.
(3)Children and youth subject to paragraphs (1) and (2) shall have been determined to be seriously emotionally disturbed, as described in subdivision (a) of Section 5600.3, and subject to Section 1502.4 of the Health and Safety Code, by a licensed mental health professional, as defined in subdivision (g) of Section 4096.
SEC. 6.5.Section 11462.01 of the Welfare and Institutions Code is amended to read:11462.01.(a)(1)If a program will admit Medi-Cal beneficiaries, no later than 12 months following the date of initial licensure, a short-term residential therapeutic program, as defined in subdivision (ad) of Section 11400 of this code and paragraph (18) of subdivision (a) of Section 1502 of the Health and Safety Code, shall obtain a contract, subject to an agreement on rates and terms and conditions, with a county mental health plan to provide specialty mental health services and demonstrate the ability to meet the therapeutic needs of each child, as identified in any of the following:
(A)A mental health assessment.
(B)The childs case plan.
(C)The childs needs and services plan.
(D)Other documentation demonstrating the child has a mental health need.
(2)A short-term residential therapeutic program shall comply with any other mental health program approvals required by the State Department of Health Care Services or by a county mental health plan to which mental health program approval authority has been delegated.
(b)A short-term residential therapeutic program, except as specified in subdivision (c), may accept for placement a child who meets both of the criteria in paragraphs (1) and (2) and at least one of the conditions in paragraph (3).
(1)The child does not require inpatient care in a licensed health facility.
(2)The child has been assessed as requiring the level of services provided in a short-term residential therapeutic program in order to maintain the safety and well-being of the child or others due to behaviors, including those resulting from traumas, that render the child or those around the child unsafe or at risk of harm, or that prevent the effective delivery of needed services and supports provided in the childs own home or in other family settings, such as with a relative, guardian, foster family, resource family, or adoptive family. The assessment shall ensure the child has needs in common with other children or youth in the care of the facility, consistent with subdivision (c) of Section 16514.
(3)The child meets at least one of the following conditions:
(A)The child has been assessed, pursuant to Section 4096, as meeting the medical necessity criteria for Medi-Cal specialty mental health services, as provided for in Section 1830.205 or 1830.210 of Title 9 of the California Code of Regulations.
(B)The child has been assessed, pursuant to Section 4096, as seriously emotionally disturbed, as defined in subdivision (a) of Section 5600.3.
(C)The child requires emergency placement pursuant to paragraph (3) of subdivision (h).
(D)The child has been assessed, pursuant to Section 4096, as requiring the level of services provided by the short-term residential therapeutic program in order to meet his or her behavioral or therapeutic needs.
(4)Subject to the requirements of this subdivision, a short-term residential therapeutic program may have a specialized program to serve a child, including, but not limited to, the following:
(A)A commercially sexually exploited child.
(B)A private voluntary placement, if the youth exhibits status offender behavior, the parents or other relatives feel they cannot control the childs behavior, and short-term intervention is needed to transition the child back into the home.
(C)A juvenile sex offender.
(D)A child who is affiliated with, or impacted by, a gang.
(c)(1)A short-term residential therapeutic program that is operating as a childrens crisis residential program, as defined in Section 1502 of the Health and Safety Code, may accept for admission any child who meets all of the following requirements:
(A)The child is referred by a parent or guardian, physician, or licensed mental health professional, or by the representative of a public or private entity, including, but not limited to, the county probation agency or child welfare services agency with responsibility for the placement of a child in foster care, that has the right to make these decisions on behalf of a child who is in mental health crisis.
(B)The child is under 19, 20, or 21 years of age, depending on a programs licensing requirements.
(C)The child has a serious behavioral health disorder.
(D)The child requires a 24-hour-a-day, seven-day-a-week, staff-secured, unlocked treatment setting.
(2)The primary function of a childrens crisis residential program is to provide short-term crisis stabilization, therapeutic intervention, and specialized programming in an unlocked, staff-secured setting with a high degree of supervision and structure and the goal of supporting the rapid and successful transition of the child back to the community.
(d)A foster family agency that is certified as a Medi-Cal specialty mental health provider pursuant to Section 1810.435 of Title 9 of the California Code of Regulations by the State Department of Health Care Services, or by a county mental health plan to which the department has delegated certification authority, and which has entered into a contract with a county mental health plan pursuant to Section 1810.436 of Title 9 of the California Code of Regulations, shall provide, or provide access to, specialty mental health services to children under its care who do not require inpatient care in a licensed health facility and who meet the medical necessity criteria for Medi-Cal specialty mental health services provided for in Section 1830.205 or 1830.210 of Title 9 of the California Code of Regulations.
(e)A foster family agency that is not certified as a Medi-Cal specialty mental health provider shall provide access to specialty and non-specialty mental health services in that program for children who do not require inpatient care in a licensed health facility and who meet any of the conditions in paragraph (3) of subdivision (b). In this situation the foster family agency shall do the following:
(1)In the case of a child who is a Medi-Cal beneficiary, arrange for specialty mental health services from the county mental health plan.
(2)In all other cases, arrange for the child to receive mental health services.
(f)All short-term residential therapeutic programs shall maintain the level of care and services necessary to meet the needs of the children and youth in their care and shall maintain and have in good standing the appropriate mental health program approval. If a program will admit Medi-Cal beneficiaries, the mental health program approval shall include a certification to provide Medi-Cal specialty mental health services issued by the State Department of Health Care Services or a county mental health plan to which the department has delegated mental health program approval authority, pursuant to Section 4096.5 of this code or Section 1810.435 or 1810.436 of Title 9 of the California Code of Regulations. All foster family agencies that are certified as a Medi-Cal specialty mental health provider pursuant to Section 1810.435 of Title 9 of the California Code of Regulations shall maintain the level of care and services necessary to meet the needs of children and youth in their care and shall maintain and have in good standing the Medi-Cal specialty mental health provider certification issued by the State Department of Health Care Services or a county mental health plan to which the department has delegated certification authority.
(g)The assessments described in subparagraphs (A), (B), (C), and (D) of paragraph (3) of subdivision (b) shall ensure the childs individual behavioral or treatment needs are consistent with, and can be met by, the facility and shall be made by one of the following, as applicable:
(1)An interagency placement committee, as described in Section 4096, considering the recommendations from the child and family team, if any are available. If the short-term residential therapeutic program serves children who are placed by county child welfare agencies and children who are placed by probation departments, the interagency placement committee shall also ensure the requirements of subdivision (c) of Section 16514 have been met with respect to commonality of need.
(2)A licensed mental health professional as defined in subdivision (g) of Section 4096.
(3)An individualized education program team. For the purposes of this section, an AFDC-FC funded child with an individualized education program developed pursuant to Article 2 (commencing with Section 56320) of Chapter 4 of Part 30 of Division 4 of Title 2 of the Education Code that assesses the child as seriously emotionally disturbed, as defined in, and subject to, this section and recommends out-of-home placement at the level of care provided by the provider, shall be deemed to have met the assessment requirement.
(4)The placing agency, with input from the child and family team. The assessment described in subparagraph (D) of paragraph (3) of subdivision (b) shall be made pursuant to subdivision (b) of Section 706.6 or paragraph (2) of subdivision (d) of Section 16501.1.
(h)(1)The provider shall ensure that AFDC-FC funded children, assessed pursuant to subparagraphs (A) and (B) of paragraph (3) of subdivision (b), who are accepted for placement have been approved for placement by an interagency placement committee, as described in Section 4096, except as provided for in paragraphs (3) and (4) of subdivision (g).
(2)The approval shall be in writing and shall indicate that the interagency placement committee has determined one of the following:
(A)The child meets the medical necessity criteria for Medi-Cal specialty mental health services, as provided for in Section 1830.205 or 1830.210 of Title 9 of the California Code of Regulations.
(B)The child is seriously emotionally disturbed, as described in subdivision (a) of Section 5600.3.
(3)(A)Nothing in subdivisions (a) to (g), inclusive, or this subdivision shall prevent an emergency placement of a child or youth into a certified short-term residential therapeutic program or childrens crisis residential program prior to the determination by the interagency placement committee, but only if a licensed mental health professional, as defined in subdivision (g) of Section 4096, has made a written determination within 72 hours of the childs or youths placement, that the child or youth requires the level of services and supervision provided by the short-term residential therapeutic program in order to meet his or her behavioral or therapeutic needs, or has made a written determination within 24 hours of the childs or youths placement in a childrens crisis residential program that the child or youth is experiencing a mental health crisis as defined in subdivision (c) and is in need of the care and services provided by the childrens crisis residential program. If the short-term residential therapeutic program serves children placed by county child welfare agencies and children placed by probation departments, the interagency placement committee shall also ensure the requirements of subdivision (c) of Section 16514 have been met with respect to commonality of need.
(i)The interagency placement committee, as appropriate, shall, within 30 days of placement, make the determinations, with recommendations from the child and family team, required by this subdivision.
(ii)If it determines the placement is appropriate, the interagency placement committee, with recommendations from the child and family team, shall transmit the approval, in writing, to the county placing agency and the short-term residential therapeutic program.
(iii)If it determines the placement is not appropriate, the interagency placement committee shall respond pursuant to subparagraph (B).
(B)(i)If the interagency placement committee determines at any time that the placement is not appropriate, it shall, with recommendations from the child and family team, transmit the disapproval, in writing, to the county placing agency and the short-term residential therapeutic program and shall include a recommendation as to the childs appropriate level of care and placement to meet his or her service needs. The necessary interagency placement committee representative or representatives shall participate in any child and family team meetings to refer the child or youth to an appropriate placement, as specified in this section.
(ii)The child may remain in the placement for the amount of time necessary to identify and transition the child to an alternative, suitable placement.
(iii)Notwithstanding clause (ii), if the interagency placement committee determined the placement was not appropriate due to a health and safety concern, immediate arrangements for the child to transition to an appropriate placement shall occur.
(i)Commencing January 1, 2017, for AFDC-FC funded children or youth, only those children or youth who are approved for placement, as set forth in this section, may be accepted by a short-term residential therapeutic program.
(j)The department shall, through regulation, establish consequences for the failure of a short-term residential therapeutic program to obtain written approval for placement of an AFDC-FC funded child or youth pursuant to this section.
(k)The department shall not establish a rate for a short-term residential therapeutic program unless the provider submits a recommendation from the host county or the primary placing county that the program is needed and that the provider is willing and capable of operating the program at the level sought. For purposes of this subdivision, host county, and primary placing county, mean the same as defined in the departments AFDC-FC ratesetting regulations.
(l) Any certified short-term residential therapeutic program shall be reclassified and paid at the appropriate program rate for which it is qualified if either of the following occurs:
(1)(A)It fails to maintain the level of care and services necessary to meet the needs of the children and youth in care, as required by subdivision (a). The determination shall be made consistent with the departments AFDC-FC ratesetting regulations developed pursuant to Section 11462 and shall take into consideration the highest level of care and associated rates for which the program may be eligible if granted an extension pursuant to Section 11462.04 or any reduction in rate associated with a provisional or probationary rate granted or imposed under Section 11466.01.
(B)In the event of a determination under this paragraph, the short-term residential therapeutic program may appeal the finding or submit a corrective action plan. The appeal process specified in Section 11466.6 shall be available to a short-term residential therapeutic program that provides intensive and therapeutic treatment. During any appeal, the short-term residential therapeutic program that provides intensive and therapeutic treatment shall maintain the appropriate level of care.
(2)It fails to maintain a certified mental health treatment program as required by subdivision (f).
(m)In addition to any other review required by law, the child and family team as defined in paragraph (4) of subdivision (a) of Section 16501 may periodically review the placement of the child or youth. If the child and family team make a recommendation that the child or youth no longer needs, or is not benefiting from, placement in a short-term residential therapeutic program, the team shall transmit the disapproval, in writing, to the county placing agency to consider a more appropriate placement.
(n)The department shall develop a process to address placements when, subsequent to the childs or youths placement, a determination is made by the interagency placement team and shall consider the recommendations of the child and family team, either that the child or youth is not in need of the care and services provided by the certified program. The process shall include, but not be limited to:
(1)Notice of the determination in writing to both the county placing agency and the short-term residential therapeutic program or foster family agency that provides intensive and therapeutic treatment.
(2)Notice of the countys plan, and a timeframe, for removal of the child or youth in writing to the short-term residential therapeutic program that provides intensive and therapeutic treatment.
(3)Referral to an appropriate placement.
(4)Actions to be taken if a child or youth is not timely removed from the short-term residential therapeutic program that provides intensive and therapeutic treatment or placed in an appropriate placement.
(o)(1)Nothing in this section shall prohibit a short-term residential therapeutic program from accepting private admissions of children or youth.
(2)When a referral is not from a public agency and public funding is not involved, there is no requirement for public agency review or determination of need.
(3)Children and youth subject to paragraphs (1) and (2) shall have been determined to be seriously emotionally disturbed, as described in subdivision (a) of Section 5600.3, and subject to Section 1502.4 of the Health and Safety Code, by a licensed mental health professional, as defined in subdivision (g) of Section 4096.
SEC. 7.Section 11462.011 is added to the Welfare and Institutions Code, to read:11462.011.(a)The State Department of Health Care Services shall, in consultation with the Department of Managed Health Care, the State Department of Social Services, the County Behavioral Health Directors Association of California, the County Welfare Directors Association of California, the Chief Probation Officers of California, provider representatives, and other relevant stakeholders, establish program standards and procedures for oversight, enforcement, and issuance of childrens crisis residential mental health program approvals, including provisional approvals that are effective for a period of less than one year. The State Department of Health Care Services shall also establish due process protections related to the childrens crisis residential mental health program approval process.
(b)The State Department of Health Care Services shall, in collaboration with the department, the County Behavioral Health Directors Association of California, provider representatives, and other relevant stakeholders, provide guidance to counties for the provision of childrens crisis residential services, including funding for children who are Medi-Cal beneficiaries and who are admitted to a childrens crisis residential program. This subdivision shall only be implemented to the extent that any necessary federal approvals are obtained and federal financial participation is available and is not otherwise jeopardized.
(c)(1)The childrens crisis residential program shall be used only as a diversion to admittance to a psychiatric hospital.
(2)(A)The length of the initial authorization for admission to a childrens crisis residential program shall be limited to 10 consecutive days.
(B)If a determination is made by a health care professional that a childrens crisis residential program is medically necessary and is the appropriate continued level of care, either of the following shall occur:
(i)In the case of a Medi-Cal beneficiary, the childrens crisis residential program shall notify the county mental health plan authorizing those services before extending the length of stay beyond 10 consecutive days.
(ii)In the case of non-Medi-Cal beneficiaries, reauthorizations for admission shall be obtained using the process established by the entity providing coverage.
(C)With the exception of clause (ii) of subparagraph (B), this paragraph shall be implemented only to the extent that any necessary federal approvals are obtained and the State Department of Health Care Services determines, in its sole discretion, that federal financial participation is not jeopardized.
(d)A childrens crisis residential mental health program approval issued by the State Department of Health Care Services, or a county mental health plan to which the department has delegated approval authority, shall be a condition of continued licensure for a short-term residential therapeutic program operating as a childrens crisis residential program.
(e)The State Department of Health Care Services, or a county mental health plan to which the department has delegated approval authority, may enforce the childrens crisis residential mental health program approval standards by taking any of the following actions against a noncompliant childrens crisis residential program:
(1)Suspend or revoke a childrens crisis residential mental health program approval.
(2)Impose monetary penalties.
(3)Place a childrens crisis residential mental health program on probation.
(4)Require a childrens crisis residential mental health program to prepare and comply with a corrective action plan.
(f)The State Department of Health Care Services, or a county mental health plan to which the department has delegated approval authority, shall provide a childrens crisis residential mental health program with due process protections when taking any of the actions described in subdivision (e).
(g)Contingent upon an appropriation in the annual Budget Act for these purposes, the department shall begin implementation of this section no later than July 1, 2018, and shall commence the operation of the approval process for childrens crisis residential mental health program approvals no later than January 1, 2019.
SEC. 8.(a)Contingent upon an appropriation from the annual Budget Act for these purposes, the State Department of Social Services and the State Department of Health Care Services shall adopt regulations to implement this act no later than July 1, 2022.
(b)Notwithstanding the rulemaking provisions of the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code), the State Department of Social Services and the State Department of Health Care Services may implement and administer the changes made by this act through information notices, all-county letters, or similar written instructions until regulations are adopted.
(c)This section shall become effective upon appropriation of funds by the Legislature for the purposes described in this section.
SEC. 9.The provisions amended or added by this act shall be implemented only if, and to the extent that, federal financial participation, as provided under Title XIX of the federal Social Security Act (42 U.S.C. Sec. 1396 et seq.) is not jeopardized and all necessary federal approvals have been obtained.
SEC. 10.(a)Section 2.5 of this bill incorporates amendments to Section 1502 of the Health and Safety Code proposed by both this bill and Senate Bill 612. That section shall only become operative if (1) both bills are enacted and become effective on or before January 1, 2018, (2) each bill amends Section 1502 of the Health and Safety Code, and (3) this bill is enacted after Senate Bill 612, in which case Section 2 of this bill shall not become operative.
(b)Section 6.5 of this bill incorporates amendments to Section 11462.01 of the Welfare and Institutions Code proposed by both this bill and Assembly Bill 404. That section shall only become operative if (1) both bills are enacted and become effective on or before January 1, 2018, (2) each bill amends Section 11462.01 of the Welfare and Institutions Code, and (3) this bill is enacted after Assembly Bill 404, in which case Section 6 of this bill shall not become operative.
SEC. 11.No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution.
The Legislature finds and declares all of the following:
(a)There is an urgent need to provide more crisis care alternatives to hospitals for children and youth experiencing mental health crises.
(b)The problems are especially acute for children and youth who may have to wait for days for a hospital bed and who may be transported, without a parent, to the nearest facility hundreds of miles away.
(c)In 2012, the California Hospital Association reported that two-thirds of the people taken to a hospital for a psychiatric emergency did not meet the criteria for that level of care, but the care they needed was not available.
(d)The type of care that is needed includes crisis residential treatment for children.
(e)This level of care is part of the full continuum of care considered medically necessary for many children with serious emotional disturbances.
(f)In 2013, the Legislature enacted the Investment in Mental Health Wellness Act (Senate Bill 82, Chapter 34 of the Statutes of 2013) to provide one-time funding to counties to expand the availability of mental health crisis care services, including short-term crisis residential treatment services. However, there is currently no state licensing category for short-term crisis residential programs for children. As a result, counties wanting to expand local capacity to meet the needs of children and youth for crisis residential treatment services were ineligible for this competitive grant program.
(g)In most communities, inpatient crisis treatment is completely unavailable for children and youth, even though it may be medically necessary.
(h)Crisis residential care is an essential level of care for the treatment of children and youth with serious emotional disturbances in a mental health crisis, and it often serves as an alternative to hospitalization.
(i)It is imperative that California identify a licensing category specifically for mental health crisis residential care that can be utilized for children and youth who are beneficiaries of both public and private health care plans.
SEC. 2.Section 1502 of the Health and Safety Code is amended to read:1502.As used in this chapter:
(a)Community care facility means any facility, place, or building that is maintained and operated to provide nonmedical residential care, day treatment, adult day care, or foster family agency services for children, adults, or children and adults, including, but not limited to, the physically handicapped, mentally impaired, incompetent persons, and abused or neglected children, and includes the following:
(1)Residential facility means any family home, group care facility, or similar facility determined by the department, for 24-hour nonmedical care of persons in need of personal services, supervision, or assistance essential for sustaining the activities of daily living or for the protection of the individual.
(2)Adult day program means any community-based facility or program that provides care to persons 18 years of age or older in need of personal services, supervision, or assistance essential for sustaining the activities of daily living or for the protection of these individuals on less than a 24-hour basis.
(3)Therapeutic day services facility means any facility that provides nonmedical care, counseling, educational or vocational support, or social rehabilitation services on less than a 24-hour basis to persons under 18 years of age who would otherwise be placed in foster care or who are returning to families from foster care. Program standards for these facilities shall be developed by the department, pursuant to Section 1530, in consultation with therapeutic day services and foster care providers.
(4)Foster family agency means any public agency or private organization, organized and operated on a nonprofit basis, engaged in any of the following:
(A)Recruiting, certifying, approving, and training of, and providing professional support to, foster parents and resource families.
(B)Coordinating with county placing agencies to find homes for foster children in need of care.
(C)Providing services and supports to licensed or certified foster parents, county-approved resource families, and children to the extent authorized by state and federal law.
(5)Foster family home means any residential facility providing 24-hour care for six or fewer foster children that is owned, leased, or rented and is the residence of the foster parent or parents, including their family, in whose care the foster children have been placed. The placement may be by a public or private child placement agency or by a court order, or by voluntary placement by a parent, parents, or guardian. It also means a foster family home described in Section 1505.2.
(6)Small family home means any residential facility, in the licensees family residence, that provides 24-hour care for six or fewer foster children who have mental disorders or developmental or physical disabilities and who require special care and supervision as a result of their disabilities. A small family home may accept children with special health care needs, pursuant to subdivision (a) of Section 17710 of the Welfare and Institutions Code. In addition to placing children with special health care needs, the department may approve placement of children without special health care needs, up to the licensed capacity.
(7)Social rehabilitation facility means any residential facility that provides social rehabilitation services for no longer than 18 months in a group setting to adults recovering from mental illness who temporarily need assistance, guidance, or counseling. Program components shall be subject to program standards pursuant to Article 1 (commencing with Section 5670) of Chapter 2.5 of Part 2 of Division 5 of the Welfare and Institutions Code.
(8)Community treatment facility means any residential facility that provides mental health treatment services to children in a group setting and that has the capacity to provide secure containment. Program components shall be subject to program standards developed and enforced by the State Department of Health Care Services pursuant to Section 4094 of the Welfare and Institutions Code.
Nothing in this section shall be construed to prohibit or discourage placement of persons who have mental or physical disabilities into any category of community care facility that meets the needs of the individual placed, if the placement is consistent with the licensing regulations of the department.
(9)Full-service adoption agency means any licensed entity engaged in the business of providing adoption services, that does all of the following:
(A)Assumes care, custody, and control of a child through relinquishment of the child to the agency or involuntary termination of parental rights to the child.
(B)Assesses the birth parents, prospective adoptive parents, or child.
(C)Places children for adoption.
(D)Supervises adoptive placements.
Private full-service adoption agencies shall be organized and operated on a nonprofit basis. As a condition of licensure to provide intercountry adoption services, a full-service adoption agency shall be accredited and in good standing according to Part 96 (commencing with Section 96.1) of Title 22 of the Code of Federal Regulations, or supervised by an accredited primary provider, or acting as an exempted provider, in compliance with Subpart F (commencing with Section 96.29) of Part 96 of Title 22 of the Code of Federal Regulations.
(10)Noncustodial adoption agency means any licensed entity engaged in the business of providing adoption services, that does all of the following:
(A)Assesses the prospective adoptive parents.
(B)Cooperatively matches children freed for adoption, who are under the care, custody, and control of a licensed adoption agency, for adoption, with assessed and approved adoptive applicants.
(C)Cooperatively supervises adoption placements with a full-service adoptive agency, but does not disrupt a placement or remove a child from a placement.
Private noncustodial adoption agencies shall be organized and operated on a nonprofit basis. As a condition of licensure to provide intercountry adoption services, a noncustodial adoption agency shall be accredited and in good standing according to Part 96 (commencing with Section 96.1) of Title 22 of the Code of Federal Regulations, or supervised by an accredited primary provider, or acting as an exempted provider, in compliance with Subpart F (commencing with Section 96.29) of Part 96 of Title 22 of the Code of Federal Regulations.
(11)Transitional shelter care facility means any group care facility that provides for 24-hour nonmedical care of persons in need of personal services, supervision, or assistance essential for sustaining the activities of daily living or for the protection of the individual. Program components shall be subject to program standards developed by the State Department of Social Services pursuant to Section 1502.3.
(12)Transitional housing placement provider means an organization licensed by the department pursuant to Section 1559.110 and Section 16522.1 of the Welfare and Institutions Code to provide transitional housing to foster children at least 16 years of age and not more than 18 years of age, and nonminor dependents, as defined in subdivision (v) of Section 11400 of the Welfare and Institutions Code, to promote their transition to adulthood. A transitional housing placement provider shall be privately operated and organized on a nonprofit basis.
(13)Group home means a residential facility that provides 24-hour care and supervision to children, delivered at least in part by staff employed by the licensee in a structured environment. The care and supervision provided by a group home shall be nonmedical, except as otherwise permitted by law.
(14)Runaway and homeless youth shelter means a group home licensed by the department to operate a program pursuant to Section 1502.35 to provide voluntary, short-term, shelter and personal services to runaway youth or homeless youth, as defined in paragraph (2) of subdivision (a) of Section 1502.35.
(15)Enhanced behavioral supports home means a facility certified by the State Department of Developmental Services pursuant to Article 3.6 (commencing with Section 4684.80) of Chapter 6 of Division 4.5 of the Welfare and Institutions Code, and licensed by the State Department of Social Services as an adult residential facility or a group home that provides 24-hour nonmedical care to individuals with developmental disabilities who require enhanced behavioral supports, staffing, and supervision in a homelike setting. An enhanced behavioral supports home shall have a maximum capacity of four consumers, shall conform to Section 441.530(a)(1) of Title 42 of the Code of Federal Regulations, and shall be eligible for federal Medicaid home- and community-based services funding.
(16)Community crisis home means a facility certified by the State Department of Developmental Services pursuant to Article 8 (commencing with Section 4698) of Chapter 6 of Division 4.5 of the Welfare and Institutions Code, and licensed by the State Department of Social Services pursuant to Article 9.7 (commencing with Section 1567.80), as an adult residential facility, providing 24-hour nonmedical care to individuals with developmental disabilities receiving regional center service, in need of crisis intervention services, and who would otherwise be at risk of admission to the acute crisis center at Fairview Developmental Center, Sonoma Developmental Center, an acute general hospital, acute psychiatric hospital, an institution for mental disease, as described in Part 5 (commencing with Section 5900) of Division 5 of the Welfare and Institutions Code, or an out-of-state placement. A community crisis home shall have a maximum capacity of eight consumers, as defined in subdivision (a) of Section 1567.80, shall conform to Section 441.530(a)(1) of Title 42 of the Code of Federal Regulations, and shall be eligible for federal Medicaid home- and community-based services funding.
(17)Crisis nursery means a facility licensed by the department to operate a program pursuant to Section 1516 to provide short-term care and supervision for children under six years of age who are voluntarily placed for temporary care by a parent or legal guardian due to a family crisis or stressful situation.
(18)Short-term residential therapeutic program means a residential facility operated by a public agency or private organization and licensed by the department pursuant to Section 1562.01 that provides an integrated program of specialized and intensive care and supervision, services and supports, treatment, and short-term, 24-hour care and supervision to children. The care and supervision provided by a short-term residential therapeutic program shall be nonmedical, except as otherwise permitted by law. Private short-term residential therapeutic programs shall be organized and operated on a nonprofit basis. A short-term residential therapeutic program may be operated as a childrens crisis residential program.
(19)Private alternative boarding school means a group home licensed by the department to operate a program pursuant to Section 1502.2 to provide youth with 24-hour residential care and supervision, which, in addition to providing educational services to youth, provides, or holds itself out as providing, behavioral-based services to youth with social, emotional, or behavioral issues. The care and supervision provided by a private alternative boarding school shall be nonmedical, except as otherwise permitted by law.
(20)Private alternative outdoor program means a group home licensed by the department to operate a program pursuant to Section 1502.21 to provide youth with 24-hour residential care and supervision, which provides, or holds itself out as providing, behavioral-based services in an outdoor living setting to youth with social, emotional, or behavioral issues. The care and supervision provided by a private alternative outdoor program shall be nonmedical, except as otherwise permitted by law.
(21)Childrens crisis residential program means a facility licensed by the department as a short-term residential therapeutic program pursuant to Section 1562.02 and approved by the State Department of Health Care Services, or a county mental health plan to which the State Department of Health Care Services has delegated approval authority, to operate a childrens crisis residential mental health program approval pursuant to Section 11462.011 of the Welfare and Institutions Code, to serve children experiencing mental health crises as an alternative to psychiatric hospitalization.
(b)Department or state department means the State Department of Social Services.
(c)Director means the Director of Social Services.
SEC. 2.5.Section 1502 of the Health and Safety Code is amended to read:1502.As used in this chapter:
(a)Community care facility means any facility, place, or building that is maintained and operated to provide nonmedical residential care, day treatment, adult day care, or foster family agency services for children, adults, or children and adults, including, but not limited to, the physically handicapped, mentally impaired, incompetent persons, and abused or neglected children, and includes the following:
(1)Residential facility means any family home, group care facility, or similar facility determined by the department, for 24-hour nonmedical care of persons in need of personal services, supervision, or assistance essential for sustaining the activities of daily living or for the protection of the individual.
(2)Adult day program means any community-based facility or program that provides care to persons 18 years of age or older in need of personal services, supervision, or assistance essential for sustaining the activities of daily living or for the protection of these individuals on less than a 24-hour basis.
(3)Therapeutic day services facility means any facility that provides nonmedical care, counseling, educational or vocational support, or social rehabilitation services on less than a 24-hour basis to persons under 18 years of age who would otherwise be placed in foster care or who are returning to families from foster care. Program standards for these facilities shall be developed by the department, pursuant to Section 1530, in consultation with therapeutic day services and foster care providers.
(4)Foster family agency means any public agency or private organization, organized and operated on a nonprofit basis, engaged in any of the following:
(A)Recruiting, certifying, approving, and training of, and providing professional support to, foster parents and resource families.
(B)Coordinating with county placing agencies to find homes for foster children in need of care.
(C)Providing services and supports to licensed or certified foster parents, county-approved resource families, and children to the extent authorized by state and federal law.
(5)Foster family home means any residential facility providing 24-hour care for six or fewer foster children that is owned, leased, or rented and is the residence of the foster parent or parents, including their family, in whose care the foster children have been placed. The placement may be by a public or private child placement agency or by a court order, or by voluntary placement by a parent, parents, or guardian. It also means a foster family home described in Section 1505.2.
(6)Small family home means any residential facility, in the licensees family residence, that provides 24-hour care for six or fewer foster children who have mental disorders or developmental or physical disabilities and who require special care and supervision as a result of their disabilities. A small family home may accept children with special health care needs, pursuant to subdivision (a) of Section 17710 of the Welfare and Institutions Code. In addition to placing children with special health care needs, the department may approve placement of children without special health care needs, up to the licensed capacity.
(7)Social rehabilitation facility means any residential facility that provides social rehabilitation services for no longer than 18 months in a group setting to adults recovering from mental illness who temporarily need assistance, guidance, or counseling. Program components shall be subject to program standards pursuant to Article 1 (commencing with Section 5670) of Chapter 2.5 of Part 2 of Division 5 of the Welfare and Institutions Code.
(8)Community treatment facility means any residential facility that provides mental health treatment services to children in a group setting and that has the capacity to provide secure containment. Program components shall be subject to program standards developed and enforced by the State Department of Health Care Services pursuant to Section 4094 of the Welfare and Institutions Code.
Nothing in this section shall be construed to prohibit or discourage placement of persons who have mental or physical disabilities into any category of community care facility that meets the needs of the individual placed, if the placement is consistent with the licensing regulations of the department.
(9)Full-service adoption agency means any licensed entity engaged in the business of providing adoption services, that does all of the following:
(A)Assumes care, custody, and control of a child through relinquishment of the child to the agency or involuntary termination of parental rights to the child.
(B)Assesses the birth parents, prospective adoptive parents, or child.
(C)Places children for adoption.
(D)Supervises adoptive placements.
Private full-service adoption agencies shall be organized and operated on a nonprofit basis. As a condition of licensure to provide intercountry adoption services, a full-service adoption agency shall be accredited and in good standing according to Part 96 (commencing with Section 96.1) of Title 22 of the Code of Federal Regulations, or supervised by an accredited primary provider, or acting as an exempted provider, in compliance with Subpart F (commencing with Section 96.29) of Part 96 of Title 22 of the Code of Federal Regulations.
(10)Noncustodial adoption agency means any licensed entity engaged in the business of providing adoption services, that does all of the following:
(A)Assesses the prospective adoptive parents.
(B)Cooperatively matches children freed for adoption, who are under the care, custody, and control of a licensed adoption agency, for adoption, with assessed and approved adoptive applicants.
(C)Cooperatively supervises adoption placements with a full-service adoptive agency, but does not disrupt a placement or remove a child from a placement.
Private noncustodial adoption agencies shall be organized and operated on a nonprofit basis. As a condition of licensure to provide intercountry adoption services, a noncustodial adoption agency shall be accredited and in good standing according to Part 96 (commencing with Section 96.1) of Title 22 of the Code of Federal Regulations, or supervised by an accredited primary provider, or acting as an exempted provider, in compliance with Subpart F (commencing with Section 96.29) of Part 96 of Title 22 of the Code of Federal Regulations.
(11)Transitional shelter care facility means any group care facility that provides for 24-hour nonmedical care of persons in need of personal services, supervision, or assistance essential for sustaining the activities of daily living or for the protection of the individual. Program components shall be subject to program standards developed by the State Department of Social Services pursuant to Section 1502.3.
(12)Transitional housing placement provider means an organization licensed by the department pursuant to Section 1559.110 to provide transitional housing to foster children who are at least 16 years of age to promote their transition to adulthood. A transitional housing placement provider shall be privately operated and organized on a nonprofit basis.
(13)Group home means a residential facility that provides 24-hour care and supervision to children, delivered at least in part by staff employed by the licensee in a structured environment. The care and supervision provided by a group home shall be nonmedical, except as otherwise permitted by law.
(14)Runaway and homeless youth shelter means a group home licensed by the department to operate a program pursuant to Section 1502.35 to provide voluntary, short-term, shelter and personal services to runaway youth or homeless youth, as defined in paragraph (2) of subdivision (a) of Section 1502.35.
(15)Enhanced behavioral supports home means a facility certified by the State Department of Developmental Services pursuant to Article 3.6 (commencing with Section 4684.80) of Chapter 6 of Division 4.5 of the Welfare and Institutions Code, and licensed by the State Department of Social Services as an adult residential facility or a group home that provides 24-hour nonmedical care to individuals with developmental disabilities who require enhanced behavioral supports, staffing, and supervision in a homelike setting. An enhanced behavioral supports home shall have a maximum capacity of four consumers, shall conform to Section 441.530(a)(1) of Title 42 of the Code of Federal Regulations, and shall be eligible for federal Medicaid home- and community-based services funding.
(16)Community crisis home means a facility certified by the State Department of Developmental Services pursuant to Article 8 (commencing with Section 4698) of Chapter 6 of Division 4.5 of the Welfare and Institutions Code, and licensed by the State Department of Social Services pursuant to Article 9.7 (commencing with Section 1567.80), as an adult residential facility, providing 24-hour nonmedical care to individuals with developmental disabilities receiving regional center service, in need of crisis intervention services, and who would otherwise be at risk of admission to the acute crisis center at Fairview Developmental Center, Sonoma Developmental Center, an acute general hospital, acute psychiatric hospital, an institution for mental disease, as described in Part 5 (commencing with Section 5900) of Division 5 of the Welfare and Institutions Code, or an out-of-state placement. A community crisis home shall have a maximum capacity of eight consumers, as defined in subdivision (a) of Section 1567.80, shall conform to Section 441.530(a)(1) of Title 42 of the Code of Federal Regulations, and shall be eligible for federal Medicaid home- and community-based services funding.
(17)Crisis nursery means a facility licensed by the department to operate a program pursuant to Section 1516 to provide short-term care and supervision for children under six years of age who are voluntarily placed for temporary care by a parent or legal guardian due to a family crisis or stressful situation.
(18)Short-term residential therapeutic program means a residential facility operated by a public agency or private organization and licensed by the department pursuant to Section 1562.01 that provides an integrated program of specialized and intensive care and supervision, services and supports, treatment, and short-term, 24-hour care and supervision to children. The care and supervision provided by a short-term residential therapeutic program shall be nonmedical, except as otherwise permitted by law. Private short-term residential therapeutic programs shall be organized and operated on a nonprofit basis. A short-term residential therapeutic program may be operated as a childrens crisis residential program.
(19)Private alternative boarding school means a group home licensed by the department to operate a program pursuant to Section 1502.2 to provide youth with 24-hour residential care and supervision, which, in addition to providing educational services to youth, provides, or holds itself out as providing, behavioral-based services to youth with social, emotional, or behavioral issues. The care and supervision provided by a private alternative boarding school shall be nonmedical, except as otherwise permitted by law.
(20)Private alternative outdoor program means a group home licensed by the department to operate a program pursuant to Section 1502.21 to provide youth with 24-hour residential care and supervision, which provides, or holds itself out as providing, behavioral-based services in an outdoor living setting to youth with social, emotional, or behavioral issues. The care and supervision provided by a private alternative outdoor program shall be nonmedical, except as otherwise permitted by law.
(21)Childrens crisis residential program means a facility licensed by the department as a short-term residential therapeutic program pursuant to Section 1562.02 and approved by the State Department of Health Care Services, or a county mental health plan to which the State Department of Health Care Services has delegated approval authority, to operate a childrens crisis residential mental health program approval pursuant to Section 11462.011 of the Welfare and Institutions Code, to serve children experiencing mental health crises as an alternative to psychiatric hospitalization.
(b)Department or state department means the State Department of Social Services.
(c)Director means the Director of Social Services.
SEC. 3.Section 1562.02 is added to the Health and Safety Code, to read:1562.02.(a)The department may license a short-term residential therapeutic program operating as a childrens crisis residential program pursuant to this chapter. A childrens crisis residential program shall meet all of the following requirements:
(1)If the program serves children who are not experiencing mental health crises, have an identifiable and physically separate unit for those children who are experiencing mental health crises. The separate unit shall be indicated on the short-term residential therapeutic programs license.
(2)Obtain and have in good standing a mental health program approval that includes a Medi-Cal mental health certification, as described in Section 11462.01 of the Welfare and Institutions Code, and a childrens crisis residential mental health program approval, as described in Section 11462.011 of the Welfare and Institutions Code, both of which are issued by the State Department of Health Care Services, or a county mental health plan to which the department has delegated approval authority. The short-term residential therapeutic program shall obtain a mental health program approval before operating as a childrens crisis residential program. The department may revoke a programs license pursuant to Section 1550 for a programs failure to maintain the mental health program approval.
(3)Comply with all applicable licensing standards for a short-term residential therapeutic program, unless the department specifies otherwise in regulations that comply with applicable statutory requirements related to licensure.
(b)Contingent upon an appropriation in the annual Budget Act for these purposes, the department shall begin implementation of this section no later than July 1, 2018, and shall commence the licensing process for childrens crisis residential programs no later than January 1, 2019.
SEC. 4.Section 1562.03 is added to the Health and Safety Code, to read:1562.03.(a)The department shall establish regulations for short-term residential therapeutic programs that are operated as childrens crisis residential programs. At a minimum, the regulations shall include all of the following:
(1)Therapeutic programming shall be provided seven days a week, including weekends and holidays, with sufficient mental health professional and paraprofessional staff, as required by the facilitys childrens crisis residential mental health program approval in accordance with the standards and procedures established pursuant to Section 11462.011 of the Welfare and Institutions Code, to maintain an appropriate treatment setting and services, based on individual childrens needs.
(2)The program shall be staffed with sufficient personnel to accept children 24 hours per day, seven days a week and to admit children, at a minimum, from 7 a.m. to 11 p.m., seven days a week, 365 days per year. The program shall be sufficiently staffed to discharge children, as appropriate, seven days a week, 365 days per year.
(3)Facilities shall be limited to fewer than 16 beds, with at least 50 percent of those beds in single-occupancy rooms.
(4)Facilities shall include ample physical space for accommodating individuals who provide daily emotional and physical supports to each child and for integrating family members into the day-to-day care of the youth.
(5)The program shall collaborate with each childs existing mental health team, if applicable, child and family team, if applicable, and other formal and natural supports within 24 hours of intake and throughout the course of care and treatment as appropriate.
(6)The program shall create and assist with the implementation of a plan for transitioning each admitted child from the program to his or her home and community, including the establishment of a mental health or child and family team if there is not one already.
(b)The program shall annually provide the department with all of the following data as it pertains to children in foster care and children not in foster care in conjunction with its application for licensure renewal:
(1)Age and gender of clients served.
(2)Duration of stay.
(3)Professional classification of staff and contracted staff.
(4)Type of placement the client was discharged to.
SEC. 5.Section 5848.5 of the Welfare and Institutions Code is amended to read:5848.5.(a)The Legislature finds and declares all of the following:
(1)California has realigned public community mental health services to counties and it is imperative that sufficient community-based resources be available to meet the mental health needs of eligible individuals.
(2)Increasing access to effective outpatient and crisis stabilization services provides an opportunity to reduce costs associated with expensive inpatient and emergency room care and to better meet the needs of individuals with mental health disorders in the least restrictive manner possible.
(3)Almost one-fifth of people with mental health disorders visit a hospital emergency room at least once per year. If an adequate array of crisis services is not available, it leaves an individual with little choice but to access an emergency room for assistance and, potentially, an unnecessary inpatient hospitalization.
(4)Recent reports have called attention to a continuing problem of inappropriate and unnecessary utilization of hospital emergency rooms in California due to limited community-based services for individuals in psychological distress and acute psychiatric crisis. Hospitals report that 70 percent of people taken to emergency rooms for psychiatric evaluation can be stabilized and transferred to a less intensive level of crisis care. Law enforcement personnel report that their personnel need to stay with people in the emergency room waiting area until a placement is found, and that less intensive levels of care tend not to be available.
(5)Comprehensive public and private partnerships at both local and regional levels, including across physical health services, mental health, substance use disorder, law enforcement, social services, and related supports, are necessary to develop and maintain high quality, patient-centered, and cost-effective care for individuals with mental health disorders that facilitates their recovery and leads towards wellness.
(6)The recovery of individuals with mental health disorders is important for all levels of government, business, and the local community.
(b)This section shall be known, and may be cited, as the Investment in Mental Health Wellness Act of 2013. The objectives of this section are to do all of the following:
(1)Expand access to early intervention and treatment services to improve the client experience, achieve recovery and wellness, and reduce costs.
(2)Expand the continuum of services to address crisis intervention, crisis stabilization, and crisis residential treatment needs that are wellness, resiliency, and recovery oriented.
(3)Add at least 25 mobile crisis support teams and at least 2,000 crisis stabilization and crisis residential treatment beds to bolster capacity at the local level to improve access to mental health crisis services and address unmet mental health care needs.
(4)Add at least 600 triage personnel to provide intensive case management and linkage to services for individuals with mental health care disorders at various points of access, such as at designated community-based service points, homeless shelters, and clinics.
(5)Reduce unnecessary hospitalizations and inpatient days by appropriately utilizing community-based services and improving access to timely assistance.
(6)Reduce recidivism and mitigate unnecessary expenditures of local law enforcement.
(7)Provide local communities with increased financial resources to leverage additional public and private funding sources to achieve improved networks of care for individuals with mental health disorders.
(8)Provide a complete continuum of crisis services for children and youth 21 years of age and under regardless of where they live in the state. The funds included in the 2016 Budget Act for the purpose of developing the continuum of mental health crisis services for children and youth 21 years of age and under shall be for the following objectives:
(A)Provide a continuum of crisis services for children and youth 21 years of age and under regardless of where they live in the state.
(B)Provide for early intervention and treatment services to improve the client experience, achieve recovery and wellness, and reduce costs.
(C)Expand the continuum of community-based services to address crisis intervention, crisis stabilization, and crisis residential treatment needs that are wellness-, resiliency-, and recovery-oriented.
(D)Add at least 200 mobile crisis support teams.
(E)Add at least 120 crisis stabilization services and beds and crisis residential treatment beds to increase capacity at the local level to improve access to mental health crisis services and address unmet mental health care needs.
(F)Add triage personnel to provide intensive case management and linkage to services for individuals with mental health care disorders at various points of access, such as at designated community-based service points, homeless shelters, schools, and clinics.
(G)Expand family respite care to help families and sustain caregiver health and well-being.
(H)Expand family supportive training and related services designed to help families participate in the planning process, access services, and navigate programs.
(I)Reduce unnecessary hospitalizations and inpatient days by appropriately utilizing community-based services.
(J)Reduce recidivism and mitigate unnecessary expenditures of local law enforcement.
(K)Provide local communities with increased financial resources to leverage additional public and private funding sources to achieve improved networks of care for children and youth 21 years of age and under with mental health disorders.
(c)Through appropriations provided in the annual Budget Act for this purpose, it is the intent of the Legislature to authorize the California Health Facilities Financing Authority, hereafter referred to as the authority, and the Mental Health Services Oversight and Accountability Commission, hereafter referred to as the commission, to administer competitive selection processes as provided in this section for capital capacity and program expansion to increase capacity for mobile crisis support, crisis intervention, crisis stabilization services, crisis residential treatment, and specified personnel resources.
(d)Funds appropriated by the Legislature to the authority for purposes of this section shall be made available to selected counties, or counties acting jointly. The authority may, at its discretion, also give consideration to private nonprofit corporations and public agencies in an area or region of the state if a county, or counties acting jointly, affirmatively supports this designation and collaboration in lieu of a county government directly receiving grant funds.
(1)Grant awards made by the authority shall be used to expand local resources for the development, capital, equipment acquisition, and applicable program startup or expansion costs to increase capacity for client assistance and services in the following areas:
(A)Crisis intervention, as authorized by Sections 14021.4, 14680, and 14684.
(B)Crisis stabilization, as authorized by Sections 14021.4, 14680, and 14684.
(C)Crisis residential treatment, as authorized by Sections 14021.4, 14680, and 14684 and as provided at a childrens crisis residential program, as defined in Section 1502 of the Health and Safety Code.
(D)Rehabilitative mental health services, as authorized by Sections 14021.4, 14680, and 14684.
(E)Mobile crisis support teams, including personnel and equipment, such as the purchase of vehicles.
(2)The authority shall develop selection criteria to expand local resources, including those described in paragraph (1), and processes for awarding grants after consulting with representatives and interested stakeholders from the mental health community, including, but not limited to, the County Behavioral Health Directors Association of California, service providers, consumer organizations, and other appropriate interests, such as health care providers and law enforcement, as determined by the authority. The authority shall ensure that grants result in cost-effective expansion of the number of community-based crisis resources in regions and communities selected for funding. The authority shall also take into account at least the following criteria and factors when selecting recipients of grants and determining the amount of grant awards:
(A)Description of need, including, at a minimum, a comprehensive description of the project, community need, population to be served, linkage with other public systems of health and mental health care, linkage with local law enforcement, social services, and related assistance, as applicable, and a description of the request for funding.
(B)Ability to serve the target population, which includes individuals eligible for Medi-Cal and individuals eligible for county health and mental health services.
(C)Geographic areas or regions of the state to be eligible for grant awards, which may include rural, suburban, and urban areas, and may include use of the five regional designations utilized by the County Behavioral Health Directors Association of California.
(D)Level of community engagement and commitment to project completion.
(E)Financial support that, in addition to a grant that may be awarded by the authority, will be sufficient to complete and operate the project for which the grant from the authority is awarded.
(F)Ability to provide additional funding support to the project, including public or private funding, federal tax credits and grants, foundation support, and other collaborative efforts.
(G)Memorandum of understanding among project partners, if applicable.
(H)Information regarding the legal status of the collaborating partners, if applicable.
(I)Ability to measure key outcomes, including improved access to services, health and mental health outcomes, and cost benefit of the project.
(3)The authority shall determine maximum grants awards, which shall take into consideration the number of projects awarded to the grantee, as described in paragraph (1), and shall reflect reasonable costs for the project and geographic region. The authority may allocate a grant in increments contingent upon the phases of a project.
(4)Funds awarded by the authority pursuant to this section may be used to supplement, but not to supplant, existing financial and resource commitments of the grantee or any other member of a collaborative effort that has been awarded a grant.
(5)All projects that are awarded grants by the authority shall be completed within a reasonable period of time, to be determined by the authority. Funds shall not be released by the authority until the applicant demonstrates project readiness to the authoritys satisfaction. If the authority determines that a grant recipient has failed to complete the project under the terms specified in awarding the grant, the authority may require remedies, including the return of all or a portion of the grant.
(6)A grantee that receives a grant from the authority under this section shall commit to using that capital capacity and program expansion project, such as the mobile crisis team, crisis stabilization unit, or crisis residential treatment program, for the duration of the expected life of the project.
(7)The authority may consult with a technical assistance entity, as described in paragraph (5) of subdivision (a) of Section 4061, for purposes of implementing this section.
(8)The authority may adopt emergency regulations relating to the grants for the capital capacity and program expansion projects described in this section, including emergency regulations that define eligible costs and determine minimum and maximum grant amounts.
(9)The authority shall provide reports to the fiscal and policy committees of the Legislature on or before May 1, 2014, and on or before May 1, 2015, on the progress of implementation, that include, but are not limited to, the following:
(A)A description of each project awarded funding.
(B)The amount of each grant issued.
(C)A description of other sources of funding for each project.
(D)The total amount of grants issued.
(E)A description of project operation and implementation, including who is being served.
(10)A recipient of a grant provided pursuant to paragraph (1) shall adhere to all applicable laws relating to scope of practice, licensure, certification, staffing, and building codes.
(e)Of the funds specified in paragraph (8) of subdivision (b), it is the intent of the Legislature to authorize the authority and the commission to administer competitive selection processes as provided in this section for capital capacity and program expansion to increase capacity for mobile crisis support, crisis intervention, crisis stabilization services, crisis residential treatment, family respite care, family supportive training and related services, and triage personnel resources for children and youth 21 years of age and under.
(f)Funds appropriated by the Legislature to the authority to address crisis services for children and youth 21 years of age and under for the purposes of this section shall be made available to selected counties or counties acting jointly. The authority may, at its discretion, also give consideration to private nonprofit corporations and public agencies in an area or region of the state if a county, or counties acting jointly, affirmatively support this designation and collaboration in lieu of a county government directly receiving grant funds.
(1)Grant awards made by the authority shall be used to expand local resources for the development, capital, equipment acquisition, and applicable program startup or expansion costs to increase capacity for client assistance and crisis services for children and youth 21 years of age and under in the following areas:
(A)Crisis intervention, as authorized by Sections 14021.4, 14680, and 14684.
(B)Crisis stabilization, as authorized by Sections 14021.4, 14680, and 14684.
(C)Crisis residential treatment, as authorized by Sections 14021.4, 14680, and 14684 and as provided at a childrens crisis residential program, as defined in Section 1502 of the Health and Safety Code.
(D)Mobile crisis support teams, including the purchase of equipment and vehicles.
(E)Family respite care.
(2)The authority shall develop selection criteria to expand local resources, including those described in paragraph (1), and processes for awarding grants after consulting with representatives and interested stakeholders from the mental health community, including, but not limited to, county mental health directors, service providers, consumer organizations, and other appropriate interests, such as health care providers and law enforcement, as determined by the authority. The authority shall ensure that grants result in cost-effective expansion of the number of community-based crisis resources in regions and communities selected for funding. The authority shall also take into account at least the following criteria and factors when selecting recipients of grants and determining the amount of grant awards:
(A)Description of need, including, at a minimum, a comprehensive description of the project, community need, population to be served, linkage with other public systems of health and mental health care, linkage with local law enforcement, social services, and related assistance, as applicable, and a description of the request for funding.
(B)Ability to serve the target population, which includes individuals eligible for Medi-Cal and individuals eligible for county health and mental health services.
(C)Geographic areas or regions of the state to be eligible for grant awards, which may include rural, suburban, and urban areas, and may include use of the five regional designations utilized by the California Behavioral Health Directors Association.
(D)Level of community engagement and commitment to project completion.
(E)Financial support that, in addition to a grant that may be awarded by the authority, will be sufficient to complete and operate the project for which the grant from the authority is awarded.
(F)Ability to provide additional funding support to the project, including public or private funding, federal tax credits and grants, foundation support, and other collaborative efforts.
(G)Memorandum of understanding among project partners, if applicable.
(H)Information regarding the legal status of the collaborating partners, if applicable.
(I)Ability to measure key outcomes, including utilization of services, health and mental health outcomes, and cost benefit of the project.
(3)The authority shall determine maximum grant awards, which shall take into consideration the number of projects awarded to the grantee, as described in paragraph (1), and shall reflect reasonable costs for the project, geographic region, and target ages. The authority may allocate a grant in increments contingent upon the phases of a project.
(4)Funds awarded by the authority pursuant to this section may be used to supplement, but not to supplant, existing financial and resource commitments of the grantee or any other member of a collaborative effort that has been awarded a grant.
(5)All projects that are awarded grants by the authority shall be completed within a reasonable period of time, to be determined by the authority. Funds shall not be released by the authority until the applicant demonstrates project readiness to the authoritys satisfaction. If the authority determines that a grant recipient has failed to complete the project under the terms specified in awarding the grant, the authority may require remedies, including the return of all, or a portion, of the grant.
(6)A grantee that receives a grant from the authority under this section shall commit to using that capital capacity and program expansion project, such as the mobile crisis team, crisis stabilization unit, family respite care, or crisis residential treatment program, for the duration of the expected life of the project.
(7)The authority may consult with a technical assistance entity, as described in paragraph (5) of subdivision (a) of Section 4061, for the purposes of implementing this section.
(8)The authority may adopt emergency regulations relating to the grants for the capital capacity and program expansion projects described in this section, including emergency regulations that define eligible costs and determine minimum and maximum grant amounts.
(9)The authority shall provide reports to the fiscal and policy committees of the Legislature on or before January 10, 2018, and annually thereafter, on the progress of implementation, that include, but are not limited to, the following:
(A)A description of each project awarded funding.
(B)The amount of each grant issued.
(C)A description of other sources of funding for each project.
(D)The total amount of grants issued.
(E)A description of project operation and implementation, including who is being served.
(10)A recipient of a grant provided pursuant to paragraph (1) shall adhere to all applicable laws relating to scope of practice, licensure, certification, staffing, and building codes.
(g)Funds appropriated by the Legislature to the commission for purposes of this section shall be allocated for triage personnel to provide intensive case management and linkage to services for individuals with mental health disorders at various points of access. These funds shall be made available to selected counties, counties acting jointly, or city mental health departments, as determined by the commission through a selection process. It is the intent of the Legislature for these funds to be allocated in an efficient manner to encourage early intervention and receipt of needed services for individuals with mental health disorders, and to assist in navigating the local service sector to improve efficiencies and the delivery of services.
(1)Triage personnel may provide targeted case management services face to face, by telephone, or by telehealth with the individual in need of assistance or his or her significant support person, and may be provided anywhere in the community. These service activities may include, but are not limited to, the following:
(A)Communication, coordination, and referral.
(B)Monitoring service delivery to ensure the individual accesses and receives services.
(C)Monitoring the individuals progress.
(D)Providing placement service assistance and service plan development.
(2)The commission shall take into account at least the following criteria and factors when selecting recipients and determining the amount of grant awards for triage personnel as follows:
(A)Description of need, including potential gaps in local service connections.
(B)Description of funding request, including personnel and use of peer support.
(C)Description of how triage personnel will be used to facilitate linkage and access to services, including objectives and anticipated outcomes.
(D)Ability to obtain federal Medicaid reimbursement, when applicable.
(E)Ability to administer an effective service program and the degree to which local agencies and service providers will support and collaborate with the triage personnel effort.
(F)Geographic areas or regions of the state to be eligible for grant awards, which shall include rural, suburban, and urban areas, and may include use of the five regional designations utilized by the County Behavioral Health Directors Association of California.
(3)The commission shall determine maximum grant awards, and shall take into consideration the level of need, population to be served, and related criteria, as described in paragraph (2), and shall reflect reasonable costs.
(4)Funds awarded by the commission for purposes of this section may be used to supplement, but not supplant, existing financial and resource commitments of the county, counties acting jointly, or city mental health department that received the grant.
(5)Notwithstanding any other law, a county, counties acting jointly, or city mental health department that receives an award of funds for the purpose of supporting triage personnel pursuant to this subdivision is not required to provide a matching contribution of local funds.
(6)Notwithstanding any other law, the commission, without taking any further regulatory action, may implement, interpret, or make specific this section by means of informational letters, bulletins, or similar instructions.
(7)The commission shall provide a status report to the fiscal and policy committees of the Legislature on the progress of implementation no later than March 1, 2014.
(h)Funds appropriated by the Legislature to the commission pursuant to paragraph (8) of subdivision (b) for the purposes of addressing childrens crisis services shall be allocated to support triage personnel and family supportive training and related services. These funds shall be made available to selected counties, counties acting jointly, or city mental health departments, as determined by the commission through a selection process. The commission may, at its discretion, also give consideration to private nonprofit corporations and public agencies in an area or region of the state if a county, or counties acting jointly, affirmatively supports this designation and collaboration in lieu of a county government directly receiving grant funds.
(1)These funds may provide for a range of crisis-related services for a child in need of assistance, or his or her parent, guardian, or caregiver. These service activities may include, but are not limited to, the following:
(A)Intensive coordination of care and services.
(B)Communication, coordination, and referral.
(C)Monitoring service delivery to the child or youth.
(D)Monitoring the childs progress.
(E)Providing placement service assistance and service plan development.
(F)Crisis or safety planning.
(2)The commission shall take into account at least the following criteria and factors when selecting recipients and determining the amount of grant awards for these funds, as follows:
(A)Description of need, including potential gaps in local service connections.
(B)Description of funding request, including personnel.
(C)Description of how personnel and other services will be used to facilitate linkage and access to services, including objectives and anticipated outcomes.
(D)Ability to obtain federal Medicaid reimbursement, when applicable.
(E)Ability to provide a matching contribution of local funds.
(F)Ability to administer an effective service program and the degree to which local agencies and service providers will support and collaborate with the triage personnel effort.
(G)Geographic areas or regions of the state to be eligible for grant awards, which shall include rural, suburban, and urban areas, and may include use of the five regional designations utilized by the County Behavioral Health Directors Association of California.
(3)The commission shall determine maximum grant awards, and shall take into consideration the level of need, population to be served, and related criteria, as described in paragraph (2), and shall reflect reasonable costs.
(4)Funds awarded by the commission for purposes of this section may be used to supplement, but not supplant, existing financial and resource commitments of the county, counties acting jointly, or a city mental health department that received the grant.
(5)Notwithstanding any other law, a county, counties acting jointly, or a city mental health department that receives an award of funds for the purpose of this section is not required to provide a matching contribution of local funds.
(6)Notwithstanding any other law, the commission, without taking any further regulatory action, may implement, interpret, or make specific this section by means of informational letters, bulletins, or similar instructions.
(7)The commission may waive requirements in this section for counties with a population of 100,000 or less, if the commission determines it is in the best interest of the state and meets the intent of the law.
(8)The commission shall provide a status report to the fiscal and policy committees of the Legislature on the progress of implementation no later than January 10, 2018, and annually thereafter.
SEC. 6.Section 11462.01 of the Welfare and Institutions Code, as added by Section 75 of Chapter 773 of the Statutes of 2015, is amended to read:11462.01.(a)(1)If a program will admit Medi-Cal beneficiaries, no later than 12 months following the date of initial licensure, a short-term residential therapeutic program, as defined in subdivision (ad) of Section 11400 of this code and paragraph (18) of subdivision (a) of Section 1502 of the Health and Safety Code, shall obtain a contract, subject to an agreement on rates and terms and conditions, with a county mental health plan to provide specialty mental health services and demonstrate the ability to meet the therapeutic needs of each child, as identified in any of the following:
(A)A mental health assessment.
(B)The childs case plan.
(C)The childs needs and services plan.
(D)Other documentation demonstrating the child has a mental health need.
(2)A short-term residential therapeutic program shall comply with any other mental health program approvals required by the State Department of Health Care Services or by a county mental health plan to which mental health program approval authority has been delegated.
(b)A short-term residential therapeutic program, except as specified in subdivision (c), may accept for placement a child who meets both of the criteria in paragraphs (1) and (2) and at least one of the conditions in paragraph (3).
(1)The child does not require inpatient care in a licensed health facility.
(2)The child has been assessed as requiring the level of services provided in a short-term residential therapeutic program in order to maintain the safety and well-being of the child or others due to behaviors, including those resulting from traumas, that render the child or those around the child unsafe or at risk of harm, or that prevent the effective delivery of needed services and supports provided in the childs own home or in other family settings, such as with a relative, guardian, foster family, resource family, or adoptive family. The assessment shall ensure the child has needs in common with other children or youth in the care of the facility, consistent with subdivision (c) of Section 16514.
(3)The child meets at least one of the following conditions:
(A)The child has been assessed, pursuant to Section 4096, as meeting the medical necessity criteria for Medi-Cal specialty mental health services, as provided for in Section 1830.205 or 1830.210 of Title 9 of the California Code of Regulations.
(B)The child has been assessed, pursuant to Section 4096, as seriously emotionally disturbed, as defined in subdivision (a) of Section 5600.3.
(C)The child requires emergency placement pursuant to paragraph (3) of subdivision (i).
(D)The child has been assessed, pursuant to Section 4096, as requiring the level of services provided by the short-term residential therapeutic program in order to meet his or her behavioral or therapeutic needs.
(4)Subject to the requirements of this subdivision, a short-term residential therapeutic program may have a specialized program to serve a child, including, but not limited to, the following:
(A)A commercially sexually exploited child.
(B)A private voluntary placement, if the youth exhibits status offender behavior, the parents or other relatives feel they cannot control the childs behavior, and short-term intervention is needed to transition the child back into the home.
(C)A juvenile sex offender.
(D)A child who is affiliated with, or impacted by, a gang.
(c)(1)A short-term residential therapeutic program that is operating as a childrens crisis residential program, as defined in Section 1502 of the Health and Safety Code, may accept for admission any child who meets all of the following requirements:
(A)The child is referred by a parent or guardian, physician, or licensed mental health professional, or by the representative of a public or private entity, including, but not limited to, the county probation agency or child welfare services agency with responsibility for the placement of a child in foster care, that has the right to make these decisions on behalf of a child who is in mental health crisis.
(B)The child is under 19, 20, or 21 years of age, depending on a programs licensing requirements.
(C)The child has a serious behavioral health disorder.
(D)The child requires a 24-hour-a-day, seven-day-a-week, staff-secured, unlocked treatment setting.
(2)The primary function of a childrens crisis residential program is to provide short-term crisis stabilization, therapeutic intervention, and specialized programming in an unlocked, staff-secured setting with a high degree of supervision and structure and the goal of supporting the rapid and successful transition of the child back to the community.
(d)A foster family agency that is certified as a Medi-Cal specialty mental health provider pursuant to Section 1810.435 of Title 9 of the California Code of Regulations by the State Department of Health Care Services, or by a county mental health plan to which the department has delegated certification authority, and which has entered into a contract with a county mental health plan pursuant to Section 1810.436 of Title 9 of the California Code of Regulations, shall provide, or provide access to, specialty mental health services to children under its care who do not require inpatient care in a licensed health facility and who meet the medical necessity criteria for Medi-Cal specialty mental health services provided for in Section 1830.205 or 1830.210 of Title 9 of the California Code of Regulations.
(e)A foster family agency that is not certified as a Medi-Cal specialty mental health provider shall provide access to specialty and non-specialty mental health services in that program for children who do not require inpatient care in a licensed health facility and who meet any of the conditions in paragraph (3) of subdivision (b). In this situation the foster family agency shall do the following:
(1)In the case of a child who is a Medi-Cal beneficiary, arrange for specialty mental health services from the county mental health plan.
(2)In all other cases, arrange for the child to receive mental health services.
(f)All short-term residential therapeutic programs shall maintain the level of care and services necessary to meet the needs of the children and youth in their care and shall maintain and have in good standing the appropriate mental health program approval. If a program will admit Medi-Cal beneficiaries, the mental health program approval shall include a certification to provide Medi-Cal specialty mental health services issued by the State Department of Health Care Services or a county mental health plan to which the department has delegated mental health program approval authority, pursuant to Section 4096.5 of this code or Section 1810.435 or 1810.436 of Title 9 of the California Code of Regulations. All foster family agencies that are certified as a Medi-Cal specialty mental health provider pursuant to Section 1810.435 of Title 9 of the California Code of Regulations shall maintain the level of care and services necessary to meet the needs of children and youth in their care and shall maintain and have in good standing the Medi-Cal specialty mental health provider certification issued by the State Department of Health Care Services or a county mental health plan to which the department has delegated certification authority.
(g)The assessments described in subparagraphs (A), (B), (C), and (D) of paragraph (3) of subdivision (b) shall ensure the childs individual behavioral or treatment needs are consistent with, and can be met by, the facility and shall be made by one of the following, as applicable:
(1)An interagency placement committee, as described in Section 4096, considering the recommendations from the child and family team, if any are available. If the short-term residential therapeutic program serves children who are placed by county child welfare agencies and children who are placed by probation departments, the interagency placement committee shall also ensure the requirements of subdivision (c) of Section 16514 have been met with respect to commonality of need.
(2)A licensed mental health professional as defined in subdivision (g) of Section 4096.
(3)For the purposes of this section, an AFDC-FC funded child with an individualized education program developed pursuant to Article 2 (commencing with Section 56320) of Chapter 4 of Part 30 of Division 4 of Title 2 of the Education Code that assesses the child as seriously emotionally disturbed, as defined in, and subject to, this section and recommends out-of-home placement at the level of care provided by the provider, shall be deemed to have met the assessment requirement.
(h)The evaluation described in subparagraph (A) of paragraph (3) of subdivision (i) shall be made pursuant to subdivision (b) of Section 706.6 or paragraph (2) of subdivision (c) of Section 16501.1.
(i)(1)The provider shall ensure that AFDC-FC funded children, assessed pursuant to subparagraphs (A) and (B) of paragraph (3) of subdivision (b), who are accepted for placement have been approved for placement by an interagency placement committee, as described in Section 4096, except as provided for in paragraph (3) of subdivision (g).
(2)The approval shall be in writing and shall indicate that the interagency placement committee has determined one of the following:
(A)The child meets the medical necessity criteria for Medi-Cal specialty mental health services, as provided for in Section 1830.205 or 1830.210 of Title 9 of the California Code of Regulations.
(B)The child is seriously emotionally disturbed, as described in subdivision (a) of Section 5600.3.
(3)(A)Nothing in subdivisions (a) to (h), inclusive, or this subdivision shall prevent an emergency placement of a child or youth into a certified short-term residential therapeutic program or childrens crisis residential program prior to the determination by the interagency placement committee, but only if a licensed mental health professional, as defined in subdivision (g) of Section 4096, has made a written determination within 72 hours of the childs or youths placement, that the child or youth requires the level of services and supervision provided by the short-term residential therapeutic program in order to meet his or her behavioral or therapeutic needs, or has made a written determination within 24 hours of the childs or youths placement in a childrens crisis residential program that the child or youth is experiencing a mental health crisis as defined in subdivision (c) and is in need of the care and services provided by the childrens crisis residential program. If the short-term residential therapeutic program serves children placed by county child welfare agencies and children placed by probation departments, the interagency placement committee shall also ensure the requirements of subdivision (c) of Section 16514 have been met with respect to commonality of need.
(i)The interagency placement committee, as appropriate, shall, within 30 days of placement, make the determinations, with recommendations from the child and family team, required by this subdivision.
(ii)If it determines the placement is appropriate, the interagency placement committee, with recommendations from the child and family team, shall transmit the approval, in writing, to the county placing agency and the short-term residential therapeutic program.
(iii)If it determines the placement is not appropriate, the interagency placement committee shall respond pursuant to subparagraph (B).
(B)(i)If the interagency placement committee determines at any time that the placement is not appropriate, it shall, with recommendations from the child and family team, transmit the disapproval, in writing, to the county placing agency and the short-term residential therapeutic program and shall include a recommendation as to the childs appropriate level of care and placement to meet his or her service needs. The necessary interagency placement committee representative or representatives shall participate in any child and family team meetings to refer the child or youth to an appropriate placement, as specified in this section.
(ii)The child may remain in the placement for the amount of time necessary to identify and transition the child to an alternative, suitable placement.
(iii)Notwithstanding clause (ii), if the interagency placement committee determined the placement was not appropriate due to a health and safety concern, immediate arrangements for the child to transition to an appropriate placement shall occur.
(j)Commencing January 1, 2017, for AFDC-FC funded children or youth, only those children or youth who are approved for placement, as set forth in this section, may be accepted by a short-term residential therapeutic program.
(k)The department shall, through regulation, establish consequences for the failure of a short-term residential therapeutic program to obtain written approval for placement of an AFDC-FC funded child or youth pursuant to this section.
(l)The department shall not establish a rate for a short-term residential therapeutic program unless the provider submits a recommendation from the host county or the primary placing county that the program is needed and that the provider is willing and capable of operating the program at the level sought. For purposes of this subdivision, host county, and primary placing county, mean the same as defined in the departments AFDC-FC ratesetting regulations.
(m)Any certified short-term residential therapeutic program shall be reclassified and paid at the appropriate program rate for which it is qualified if either of the following occurs:
(1)(A)It fails to maintain the level of care and services necessary to meet the needs of the children and youth in care, as required by subdivision (a). The determination shall be made consistent with the departments AFDC-FC ratesetting regulations developed pursuant to Section 11462 and shall take into consideration the highest level of care and associated rates for which the program may be eligible if granted an extension pursuant to Section 11462.04 or any reduction in rate associated with a provisional or probationary rate granted or imposed under Section 11466.01.
(B)In the event of a determination under this paragraph, the short-term residential therapeutic program may appeal the finding or submit a corrective action plan. The appeal process specified in Section 11466.6 shall be available to a short-term residential therapeutic program that provides intensive and therapeutic treatment. During any appeal, the short-term residential therapeutic program that provides intensive and therapeutic treatment shall maintain the appropriate level of care.
(2)It fails to maintain a certified mental health treatment program as required by subdivision (f).
(n)In addition to any other review required by law, the child and family team as defined in paragraph (4) of subdivision (a) of Section 16501 may periodically review the placement of the child or youth. If the child and family team make a recommendation that the child or youth no longer needs, or is not benefiting from, placement in a short-term residential therapeutic program, the team shall transmit the disapproval, in writing, to the county placing agency to consider a more appropriate placement.
(o)The department shall develop a process to address placements when, subsequent to the childs or youths placement, a determination is made by the interagency placement team and shall consider the recommendations of the child and family team, either that the child or youth is not in need of the care and services provided by the certified program. The process shall include, but not be limited to:
(1)Notice of the determination in writing to both the county placing agency and the short-term residential therapeutic program or foster family agency that provides intensive and therapeutic treatment.
(2)Notice of the countys plan, and a timeframe, for removal of the child or youth in writing to the short-term residential therapeutic program that provides intensive and therapeutic treatment.
(3)Referral to an appropriate placement.
(4)Actions to be taken if a child or youth is not timely removed from the short-term residential therapeutic program that provides intensive and therapeutic treatment or placed in an appropriate placement.
(p)(1)Nothing in this section shall prohibit a short-term residential therapeutic program from accepting private admissions of children or youth.
(2)When a referral is not from a public agency and public funding is not involved, there is no requirement for public agency review or determination of need.
(3)Children and youth subject to paragraphs (1) and (2) shall have been determined to be seriously emotionally disturbed, as described in subdivision (a) of Section 5600.3, and subject to Section 1502.4 of the Health and Safety Code, by a licensed mental health professional, as defined in subdivision (g) of Section 4096.
SEC. 6.5.Section 11462.01 of the Welfare and Institutions Code is amended to read:11462.01.(a)(1)If a program will admit Medi-Cal beneficiaries, no later than 12 months following the date of initial licensure, a short-term residential therapeutic program, as defined in subdivision (ad) of Section 11400 of this code and paragraph (18) of subdivision (a) of Section 1502 of the Health and Safety Code, shall obtain a contract, subject to an agreement on rates and terms and conditions, with a county mental health plan to provide specialty mental health services and demonstrate the ability to meet the therapeutic needs of each child, as identified in any of the following:
(A)A mental health assessment.
(B)The childs case plan.
(C)The childs needs and services plan.
(D)Other documentation demonstrating the child has a mental health need.
(2)A short-term residential therapeutic program shall comply with any other mental health program approvals required by the State Department of Health Care Services or by a county mental health plan to which mental health program approval authority has been delegated.
(b)A short-term residential therapeutic program, except as specified in subdivision (c), may accept for placement a child who meets both of the criteria in paragraphs (1) and (2) and at least one of the conditions in paragraph (3).
(1)The child does not require inpatient care in a licensed health facility.
(2)The child has been assessed as requiring the level of services provided in a short-term residential therapeutic program in order to maintain the safety and well-being of the child or others due to behaviors, including those resulting from traumas, that render the child or those around the child unsafe or at risk of harm, or that prevent the effective delivery of needed services and supports provided in the childs own home or in other family settings, such as with a relative, guardian, foster family, resource family, or adoptive family. The assessment shall ensure the child has needs in common with other children or youth in the care of the facility, consistent with subdivision (c) of Section 16514.
(3)The child meets at least one of the following conditions:
(A)The child has been assessed, pursuant to Section 4096, as meeting the medical necessity criteria for Medi-Cal specialty mental health services, as provided for in Section 1830.205 or 1830.210 of Title 9 of the California Code of Regulations.
(B)The child has been assessed, pursuant to Section 4096, as seriously emotionally disturbed, as defined in subdivision (a) of Section 5600.3.
(C)The child requires emergency placement pursuant to paragraph (3) of subdivision (h).
(D)The child has been assessed, pursuant to Section 4096, as requiring the level of services provided by the short-term residential therapeutic program in order to meet his or her behavioral or therapeutic needs.
(4)Subject to the requirements of this subdivision, a short-term residential therapeutic program may have a specialized program to serve a child, including, but not limited to, the following:
(A)A commercially sexually exploited child.
(B)A private voluntary placement, if the youth exhibits status offender behavior, the parents or other relatives feel they cannot control the childs behavior, and short-term intervention is needed to transition the child back into the home.
(C)A juvenile sex offender.
(D)A child who is affiliated with, or impacted by, a gang.
(c)(1)A short-term residential therapeutic program that is operating as a childrens crisis residential program, as defined in Section 1502 of the Health and Safety Code, may accept for admission any child who meets all of the following requirements:
(A)The child is referred by a parent or guardian, physician, or licensed mental health professional, or by the representative of a public or private entity, including, but not limited to, the county probation agency or child welfare services agency with responsibility for the placement of a child in foster care, that has the right to make these decisions on behalf of a child who is in mental health crisis.
(B)The child is under 19, 20, or 21 years of age, depending on a programs licensing requirements.
(C)The child has a serious behavioral health disorder.
(D)The child requires a 24-hour-a-day, seven-day-a-week, staff-secured, unlocked treatment setting.
(2)The primary function of a childrens crisis residential program is to provide short-term crisis stabilization, therapeutic intervention, and specialized programming in an unlocked, staff-secured setting with a high degree of supervision and structure and the goal of supporting the rapid and successful transition of the child back to the community.
(d)A foster family agency that is certified as a Medi-Cal specialty mental health provider pursuant to Section 1810.435 of Title 9 of the California Code of Regulations by the State Department of Health Care Services, or by a county mental health plan to which the department has delegated certification authority, and which has entered into a contract with a county mental health plan pursuant to Section 1810.436 of Title 9 of the California Code of Regulations, shall provide, or provide access to, specialty mental health services to children under its care who do not require inpatient care in a licensed health facility and who meet the medical necessity criteria for Medi-Cal specialty mental health services provided for in Section 1830.205 or 1830.210 of Title 9 of the California Code of Regulations.
(e)A foster family agency that is not certified as a Medi-Cal specialty mental health provider shall provide access to specialty and non-specialty mental health services in that program for children who do not require inpatient care in a licensed health facility and who meet any of the conditions in paragraph (3) of subdivision (b). In this situation the foster family agency shall do the following:
(1)In the case of a child who is a Medi-Cal beneficiary, arrange for specialty mental health services from the county mental health plan.
(2)In all other cases, arrange for the child to receive mental health services.
(f)All short-term residential therapeutic programs shall maintain the level of care and services necessary to meet the needs of the children and youth in their care and shall maintain and have in good standing the appropriate mental health program approval. If a program will admit Medi-Cal beneficiaries, the mental health program approval shall include a certification to provide Medi-Cal specialty mental health services issued by the State Department of Health Care Services or a county mental health plan to which the department has delegated mental health program approval authority, pursuant to Section 4096.5 of this code or Section 1810.435 or 1810.436 of Title 9 of the California Code of Regulations. All foster family agencies that are certified as a Medi-Cal specialty mental health provider pursuant to Section 1810.435 of Title 9 of the California Code of Regulations shall maintain the level of care and services necessary to meet the needs of children and youth in their care and shall maintain and have in good standing the Medi-Cal specialty mental health provider certification issued by the State Department of Health Care Services or a county mental health plan to which the department has delegated certification authority.
(g)The assessments described in subparagraphs (A), (B), (C), and (D) of paragraph (3) of subdivision (b) shall ensure the childs individual behavioral or treatment needs are consistent with, and can be met by, the facility and shall be made by one of the following, as applicable:
(1)An interagency placement committee, as described in Section 4096, considering the recommendations from the child and family team, if any are available. If the short-term residential therapeutic program serves children who are placed by county child welfare agencies and children who are placed by probation departments, the interagency placement committee shall also ensure the requirements of subdivision (c) of Section 16514 have been met with respect to commonality of need.
(2)A licensed mental health professional as defined in subdivision (g) of Section 4096.
(3)An individualized education program team. For the purposes of this section, an AFDC-FC funded child with an individualized education program developed pursuant to Article 2 (commencing with Section 56320) of Chapter 4 of Part 30 of Division 4 of Title 2 of the Education Code that assesses the child as seriously emotionally disturbed, as defined in, and subject to, this section and recommends out-of-home placement at the level of care provided by the provider, shall be deemed to have met the assessment requirement.
(4)The placing agency, with input from the child and family team. The assessment described in subparagraph (D) of paragraph (3) of subdivision (b) shall be made pursuant to subdivision (b) of Section 706.6 or paragraph (2) of subdivision (d) of Section 16501.1.
(h)(1)The provider shall ensure that AFDC-FC funded children, assessed pursuant to subparagraphs (A) and (B) of paragraph (3) of subdivision (b), who are accepted for placement have been approved for placement by an interagency placement committee, as described in Section 4096, except as provided for in paragraphs (3) and (4) of subdivision (g).
(2)The approval shall be in writing and shall indicate that the interagency placement committee has determined one of the following:
(A)The child meets the medical necessity criteria for Medi-Cal specialty mental health services, as provided for in Section 1830.205 or 1830.210 of Title 9 of the California Code of Regulations.
(B)The child is seriously emotionally disturbed, as described in subdivision (a) of Section 5600.3.
(3)(A)Nothing in subdivisions (a) to (g), inclusive, or this subdivision shall prevent an emergency placement of a child or youth into a certified short-term residential therapeutic program or childrens crisis residential program prior to the determination by the interagency placement committee, but only if a licensed mental health professional, as defined in subdivision (g) of Section 4096, has made a written determination within 72 hours of the childs or youths placement, that the child or youth requires the level of services and supervision provided by the short-term residential therapeutic program in order to meet his or her behavioral or therapeutic needs, or has made a written determination within 24 hours of the childs or youths placement in a childrens crisis residential program that the child or youth is experiencing a mental health crisis as defined in subdivision (c) and is in need of the care and services provided by the childrens crisis residential program. If the short-term residential therapeutic program serves children placed by county child welfare agencies and children placed by probation departments, the interagency placement committee shall also ensure the requirements of subdivision (c) of Section 16514 have been met with respect to commonality of need.
(i)The interagency placement committee, as appropriate, shall, within 30 days of placement, make the determinations, with recommendations from the child and family team, required by this subdivision.
(ii)If it determines the placement is appropriate, the interagency placement committee, with recommendations from the child and family team, shall transmit the approval, in writing, to the county placing agency and the short-term residential therapeutic program.
(iii)If it determines the placement is not appropriate, the interagency placement committee shall respond pursuant to subparagraph (B).
(B)(i)If the interagency placement committee determines at any time that the placement is not appropriate, it shall, with recommendations from the child and family team, transmit the disapproval, in writing, to the county placing agency and the short-term residential therapeutic program and shall include a recommendation as to the childs appropriate level of care and placement to meet his or her service needs. The necessary interagency placement committee representative or representatives shall participate in any child and family team meetings to refer the child or youth to an appropriate placement, as specified in this section.
(ii)The child may remain in the placement for the amount of time necessary to identify and transition the child to an alternative, suitable placement.
(iii)Notwithstanding clause (ii), if the interagency placement committee determined the placement was not appropriate due to a health and safety concern, immediate arrangements for the child to transition to an appropriate placement shall occur.
(i)Commencing January 1, 2017, for AFDC-FC funded children or youth, only those children or youth who are approved for placement, as set forth in this section, may be accepted by a short-term residential therapeutic program.
(j)The department shall, through regulation, establish consequences for the failure of a short-term residential therapeutic program to obtain written approval for placement of an AFDC-FC funded child or youth pursuant to this section.
(k)The department shall not establish a rate for a short-term residential therapeutic program unless the provider submits a recommendation from the host county or the primary placing county that the program is needed and that the provider is willing and capable of operating the program at the level sought. For purposes of this subdivision, host county, and primary placing county, mean the same as defined in the departments AFDC-FC ratesetting regulations.
(l) Any certified short-term residential therapeutic program shall be reclassified and paid at the appropriate program rate for which it is qualified if either of the following occurs:
(1)(A)It fails to maintain the level of care and services necessary to meet the needs of the children and youth in care, as required by subdivision (a). The determination shall be made consistent with the departments AFDC-FC ratesetting regulations developed pursuant to Section 11462 and shall take into consideration the highest level of care and associated rates for which the program may be eligible if granted an extension pursuant to Section 11462.04 or any reduction in rate associated with a provisional or probationary rate granted or imposed under Section 11466.01.
(B)In the event of a determination under this paragraph, the short-term residential therapeutic program may appeal the finding or submit a corrective action plan. The appeal process specified in Section 11466.6 shall be available to a short-term residential therapeutic program that provides intensive and therapeutic treatment. During any appeal, the short-term residential therapeutic program that provides intensive and therapeutic treatment shall maintain the appropriate level of care.
(2)It fails to maintain a certified mental health treatment program as required by subdivision (f).
(m)In addition to any other review required by law, the child and family team as defined in paragraph (4) of subdivision (a) of Section 16501 may periodically review the placement of the child or youth. If the child and family team make a recommendation that the child or youth no longer needs, or is not benefiting from, placement in a short-term residential therapeutic program, the team shall transmit the disapproval, in writing, to the county placing agency to consider a more appropriate placement.
(n)The department shall develop a process to address placements when, subsequent to the childs or youths placement, a determination is made by the interagency placement team and shall consider the recommendations of the child and family team, either that the child or youth is not in need of the care and services provided by the certified program. The process shall include, but not be limited to:
(1)Notice of the determination in writing to both the county placing agency and the short-term residential therapeutic program or foster family agency that provides intensive and therapeutic treatment.
(2)Notice of the countys plan, and a timeframe, for removal of the child or youth in writing to the short-term residential therapeutic program that provides intensive and therapeutic treatment.
(3)Referral to an appropriate placement.
(4)Actions to be taken if a child or youth is not timely removed from the short-term residential therapeutic program that provides intensive and therapeutic treatment or placed in an appropriate placement.
(o)(1)Nothing in this section shall prohibit a short-term residential therapeutic program from accepting private admissions of children or youth.
(2)When a referral is not from a public agency and public funding is not involved, there is no requirement for public agency review or determination of need.
(3)Children and youth subject to paragraphs (1) and (2) shall have been determined to be seriously emotionally disturbed, as described in subdivision (a) of Section 5600.3, and subject to Section 1502.4 of the Health and Safety Code, by a licensed mental health professional, as defined in subdivision (g) of Section 4096.
SEC. 7.Section 11462.011 is added to the Welfare and Institutions Code, to read:11462.011.(a)The State Department of Health Care Services shall, in consultation with the Department of Managed Health Care, the State Department of Social Services, the County Behavioral Health Directors Association of California, the County Welfare Directors Association of California, the Chief Probation Officers of California, provider representatives, and other relevant stakeholders, establish program standards and procedures for oversight, enforcement, and issuance of childrens crisis residential mental health program approvals, including provisional approvals that are effective for a period of less than one year. The State Department of Health Care Services shall also establish due process protections related to the childrens crisis residential mental health program approval process.
(b)The State Department of Health Care Services shall, in collaboration with the department, the County Behavioral Health Directors Association of California, provider representatives, and other relevant stakeholders, provide guidance to counties for the provision of childrens crisis residential services, including funding for children who are Medi-Cal beneficiaries and who are admitted to a childrens crisis residential program. This subdivision shall only be implemented to the extent that any necessary federal approvals are obtained and federal financial participation is available and is not otherwise jeopardized.
(c)(1)The childrens crisis residential program shall be used only as a diversion to admittance to a psychiatric hospital.
(2)(A)The length of the initial authorization for admission to a childrens crisis residential program shall be limited to 10 consecutive days.
(B)If a determination is made by a health care professional that a childrens crisis residential program is medically necessary and is the appropriate continued level of care, either of the following shall occur:
(i)In the case of a Medi-Cal beneficiary, the childrens crisis residential program shall notify the county mental health plan authorizing those services before extending the length of stay beyond 10 consecutive days.
(ii)In the case of non-Medi-Cal beneficiaries, reauthorizations for admission shall be obtained using the process established by the entity providing coverage.
(C)With the exception of clause (ii) of subparagraph (B), this paragraph shall be implemented only to the extent that any necessary federal approvals are obtained and the State Department of Health Care Services determines, in its sole discretion, that federal financial participation is not jeopardized.
(d)A childrens crisis residential mental health program approval issued by the State Department of Health Care Services, or a county mental health plan to which the department has delegated approval authority, shall be a condition of continued licensure for a short-term residential therapeutic program operating as a childrens crisis residential program.
(e)The State Department of Health Care Services, or a county mental health plan to which the department has delegated approval authority, may enforce the childrens crisis residential mental health program approval standards by taking any of the following actions against a noncompliant childrens crisis residential program:
(1)Suspend or revoke a childrens crisis residential mental health program approval.
(2)Impose monetary penalties.
(3)Place a childrens crisis residential mental health program on probation.
(4)Require a childrens crisis residential mental health program to prepare and comply with a corrective action plan.
(f)The State Department of Health Care Services, or a county mental health plan to which the department has delegated approval authority, shall provide a childrens crisis residential mental health program with due process protections when taking any of the actions described in subdivision (e).
(g)Contingent upon an appropriation in the annual Budget Act for these purposes, the department shall begin implementation of this section no later than July 1, 2018, and shall commence the operation of the approval process for childrens crisis residential mental health program approvals no later than January 1, 2019.
SEC. 8.(a)Contingent upon an appropriation from the annual Budget Act for these purposes, the State Department of Social Services and the State Department of Health Care Services shall adopt regulations to implement this act no later than July 1, 2022.
(b)Notwithstanding the rulemaking provisions of the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code), the State Department of Social Services and the State Department of Health Care Services may implement and administer the changes made by this act through information notices, all-county letters, or similar written instructions until regulations are adopted.
(c)This section shall become effective upon appropriation of funds by the Legislature for the purposes described in this section.
SEC. 9.The provisions amended or added by this act shall be implemented only if, and to the extent that, federal financial participation, as provided under Title XIX of the federal Social Security Act (42 U.S.C. Sec. 1396 et seq.) is not jeopardized and all necessary federal approvals have been obtained.
SEC. 10.(a)Section 2.5 of this bill incorporates amendments to Section 1502 of the Health and Safety Code proposed by both this bill and Senate Bill 612. That section shall only become operative if (1) both bills are enacted and become effective on or before January 1, 2018, (2) each bill amends Section 1502 of the Health and Safety Code, and (3) this bill is enacted after Senate Bill 612, in which case Section 2 of this bill shall not become operative.
(b)Section 6.5 of this bill incorporates amendments to Section 11462.01 of the Welfare and Institutions Code proposed by both this bill and Assembly Bill 404. That section shall only become operative if (1) both bills are enacted and become effective on or before January 1, 2018, (2) each bill amends Section 11462.01 of the Welfare and Institutions Code, and (3) this bill is enacted after Assembly Bill 404, in which case Section 6 of this bill shall not become operative.
SEC. 11.No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution.
The Legislature finds and declares all of the following:
(a)There is an urgent need to provide more crisis care alternatives to hospitals for children and youth experiencing mental health crises.
(b)The problems are especially acute for children and youth who may have to wait for days for a hospital bed and who may be transported, without a parent, to the nearest facility hundreds of miles away.
(c)In 2012, the California Hospital Association reported that two-thirds of the people taken to a hospital for a psychiatric emergency did not meet the criteria for that level of care, but the care they needed was not available.
(d)The type of care that is needed includes crisis residential treatment for children.
(e)This level of care is part of the full continuum of care considered medically necessary for many children with serious emotional disturbances.
(f)In 2013, the Legislature enacted the Investment in Mental Health Wellness Act (Senate Bill 82, Chapter 34 of the Statutes of 2013) to provide one-time funding to counties to expand the availability of mental health crisis care services, including short-term crisis residential treatment services. However, there is currently no state licensing category for short-term crisis residential programs for children. As a result, counties wanting to expand local capacity to meet the needs of children and youth for crisis residential treatment services were ineligible for this competitive grant program.
(g)In most communities, inpatient crisis treatment is completely unavailable for children and youth, even though it may be medically necessary.
(h)Crisis residential care is an essential level of care for the treatment of children and youth with serious emotional disturbances in a mental health crisis, and it often serves as an alternative to hospitalization.
(i)It is imperative that California identify a licensing category specifically for mental health crisis residential care that can be utilized for children and youth who are beneficiaries of both public and private health care plans.
SEC. 2.Section 1502 of the Health and Safety Code is amended to read:1502.As used in this chapter:
(a)Community care facility means any facility, place, or building that is maintained and operated to provide nonmedical residential care, day treatment, adult day care, or foster family agency services for children, adults, or children and adults, including, but not limited to, the physically handicapped, mentally impaired, incompetent persons, and abused or neglected children, and includes the following:
(1)Residential facility means any family home, group care facility, or similar facility determined by the department, for 24-hour nonmedical care of persons in need of personal services, supervision, or assistance essential for sustaining the activities of daily living or for the protection of the individual.
(2)Adult day program means any community-based facility or program that provides care to persons 18 years of age or older in need of personal services, supervision, or assistance essential for sustaining the activities of daily living or for the protection of these individuals on less than a 24-hour basis.
(3)Therapeutic day services facility means any facility that provides nonmedical care, counseling, educational or vocational support, or social rehabilitation services on less than a 24-hour basis to persons under 18 years of age who would otherwise be placed in foster care or who are returning to families from foster care. Program standards for these facilities shall be developed by the department, pursuant to Section 1530, in consultation with therapeutic day services and foster care providers.
(4)Foster family agency means any public agency or private organization, organized and operated on a nonprofit basis, engaged in any of the following:
(A)Recruiting, certifying, approving, and training of, and providing professional support to, foster parents and resource families.
(B)Coordinating with county placing agencies to find homes for foster children in need of care.
(C)Providing services and supports to licensed or certified foster parents, county-approved resource families, and children to the extent authorized by state and federal law.
(5)Foster family home means any residential facility providing 24-hour care for six or fewer foster children that is owned, leased, or rented and is the residence of the foster parent or parents, including their family, in whose care the foster children have been placed. The placement may be by a public or private child placement agency or by a court order, or by voluntary placement by a parent, parents, or guardian. It also means a foster family home described in Section 1505.2.
(6)Small family home means any residential facility, in the licensees family residence, that provides 24-hour care for six or fewer foster children who have mental disorders or developmental or physical disabilities and who require special care and supervision as a result of their disabilities. A small family home may accept children with special health care needs, pursuant to subdivision (a) of Section 17710 of the Welfare and Institutions Code. In addition to placing children with special health care needs, the department may approve placement of children without special health care needs, up to the licensed capacity.
(7)Social rehabilitation facility means any residential facility that provides social rehabilitation services for no longer than 18 months in a group setting to adults recovering from mental illness who temporarily need assistance, guidance, or counseling. Program components shall be subject to program standards pursuant to Article 1 (commencing with Section 5670) of Chapter 2.5 of Part 2 of Division 5 of the Welfare and Institutions Code.
(8)Community treatment facility means any residential facility that provides mental health treatment services to children in a group setting and that has the capacity to provide secure containment. Program components shall be subject to program standards developed and enforced by the State Department of Health Care Services pursuant to Section 4094 of the Welfare and Institutions Code.
Nothing in this section shall be construed to prohibit or discourage placement of persons who have mental or physical disabilities into any category of community care facility that meets the needs of the individual placed, if the placement is consistent with the licensing regulations of the department.
(9)Full-service adoption agency means any licensed entity engaged in the business of providing adoption services, that does all of the following:
(A)Assumes care, custody, and control of a child through relinquishment of the child to the agency or involuntary termination of parental rights to the child.
(B)Assesses the birth parents, prospective adoptive parents, or child.
(C)Places children for adoption.
(D)Supervises adoptive placements.
Private full-service adoption agencies shall be organized and operated on a nonprofit basis. As a condition of licensure to provide intercountry adoption services, a full-service adoption agency shall be accredited and in good standing according to Part 96 (commencing with Section 96.1) of Title 22 of the Code of Federal Regulations, or supervised by an accredited primary provider, or acting as an exempted provider, in compliance with Subpart F (commencing with Section 96.29) of Part 96 of Title 22 of the Code of Federal Regulations.
(10)Noncustodial adoption agency means any licensed entity engaged in the business of providing adoption services, that does all of the following:
(A)Assesses the prospective adoptive parents.
(B)Cooperatively matches children freed for adoption, who are under the care, custody, and control of a licensed adoption agency, for adoption, with assessed and approved adoptive applicants.
(C)Cooperatively supervises adoption placements with a full-service adoptive agency, but does not disrupt a placement or remove a child from a placement.
Private noncustodial adoption agencies shall be organized and operated on a nonprofit basis. As a condition of licensure to provide intercountry adoption services, a noncustodial adoption agency shall be accredited and in good standing according to Part 96 (commencing with Section 96.1) of Title 22 of the Code of Federal Regulations, or supervised by an accredited primary provider, or acting as an exempted provider, in compliance with Subpart F (commencing with Section 96.29) of Part 96 of Title 22 of the Code of Federal Regulations.
(11)Transitional shelter care facility means any group care facility that provides for 24-hour nonmedical care of persons in need of personal services, supervision, or assistance essential for sustaining the activities of daily living or for the protection of the individual. Program components shall be subject to program standards developed by the State Department of Social Services pursuant to Section 1502.3.
(12)Transitional housing placement provider means an organization licensed by the department pursuant to Section 1559.110 and Section 16522.1 of the Welfare and Institutions Code to provide transitional housing to foster children at least 16 years of age and not more than 18 years of age, and nonminor dependents, as defined in subdivision (v) of Section 11400 of the Welfare and Institutions Code, to promote their transition to adulthood. A transitional housing placement provider shall be privately operated and organized on a nonprofit basis.
(13)Group home means a residential facility that provides 24-hour care and supervision to children, delivered at least in part by staff employed by the licensee in a structured environment. The care and supervision provided by a group home shall be nonmedical, except as otherwise permitted by law.
(14)Runaway and homeless youth shelter means a group home licensed by the department to operate a program pursuant to Section 1502.35 to provide voluntary, short-term, shelter and personal services to runaway youth or homeless youth, as defined in paragraph (2) of subdivision (a) of Section 1502.35.
(15)Enhanced behavioral supports home means a facility certified by the State Department of Developmental Services pursuant to Article 3.6 (commencing with Section 4684.80) of Chapter 6 of Division 4.5 of the Welfare and Institutions Code, and licensed by the State Department of Social Services as an adult residential facility or a group home that provides 24-hour nonmedical care to individuals with developmental disabilities who require enhanced behavioral supports, staffing, and supervision in a homelike setting. An enhanced behavioral supports home shall have a maximum capacity of four consumers, shall conform to Section 441.530(a)(1) of Title 42 of the Code of Federal Regulations, and shall be eligible for federal Medicaid home- and community-based services funding.
(16)Community crisis home means a facility certified by the State Department of Developmental Services pursuant to Article 8 (commencing with Section 4698) of Chapter 6 of Division 4.5 of the Welfare and Institutions Code, and licensed by the State Department of Social Services pursuant to Article 9.7 (commencing with Section 1567.80), as an adult residential facility, providing 24-hour nonmedical care to individuals with developmental disabilities receiving regional center service, in need of crisis intervention services, and who would otherwise be at risk of admission to the acute crisis center at Fairview Developmental Center, Sonoma Developmental Center, an acute general hospital, acute psychiatric hospital, an institution for mental disease, as described in Part 5 (commencing with Section 5900) of Division 5 of the Welfare and Institutions Code, or an out-of-state placement. A community crisis home shall have a maximum capacity of eight consumers, as defined in subdivision (a) of Section 1567.80, shall conform to Section 441.530(a)(1) of Title 42 of the Code of Federal Regulations, and shall be eligible for federal Medicaid home- and community-based services funding.
(17)Crisis nursery means a facility licensed by the department to operate a program pursuant to Section 1516 to provide short-term care and supervision for children under six years of age who are voluntarily placed for temporary care by a parent or legal guardian due to a family crisis or stressful situation.
(18)Short-term residential therapeutic program means a residential facility operated by a public agency or private organization and licensed by the department pursuant to Section 1562.01 that provides an integrated program of specialized and intensive care and supervision, services and supports, treatment, and short-term, 24-hour care and supervision to children. The care and supervision provided by a short-term residential therapeutic program shall be nonmedical, except as otherwise permitted by law. Private short-term residential therapeutic programs shall be organized and operated on a nonprofit basis. A short-term residential therapeutic program may be operated as a childrens crisis residential program.
(19)Private alternative boarding school means a group home licensed by the department to operate a program pursuant to Section 1502.2 to provide youth with 24-hour residential care and supervision, which, in addition to providing educational services to youth, provides, or holds itself out as providing, behavioral-based services to youth with social, emotional, or behavioral issues. The care and supervision provided by a private alternative boarding school shall be nonmedical, except as otherwise permitted by law.
(20)Private alternative outdoor program means a group home licensed by the department to operate a program pursuant to Section 1502.21 to provide youth with 24-hour residential care and supervision, which provides, or holds itself out as providing, behavioral-based services in an outdoor living setting to youth with social, emotional, or behavioral issues. The care and supervision provided by a private alternative outdoor program shall be nonmedical, except as otherwise permitted by law.
(21)Childrens crisis residential program means a facility licensed by the department as a short-term residential therapeutic program pursuant to Section 1562.02 and approved by the State Department of Health Care Services, or a county mental health plan to which the State Department of Health Care Services has delegated approval authority, to operate a childrens crisis residential mental health program approval pursuant to Section 11462.011 of the Welfare and Institutions Code, to serve children experiencing mental health crises as an alternative to psychiatric hospitalization.
(b)Department or state department means the State Department of Social Services.
(c)Director means the Director of Social Services.
SEC. 2.5.Section 1502 of the Health and Safety Code is amended to read:1502.As used in this chapter:
(a)Community care facility means any facility, place, or building that is maintained and operated to provide nonmedical residential care, day treatment, adult day care, or foster family agency services for children, adults, or children and adults, including, but not limited to, the physically handicapped, mentally impaired, incompetent persons, and abused or neglected children, and includes the following:
(1)Residential facility means any family home, group care facility, or similar facility determined by the department, for 24-hour nonmedical care of persons in need of personal services, supervision, or assistance essential for sustaining the activities of daily living or for the protection of the individual.
(2)Adult day program means any community-based facility or program that provides care to persons 18 years of age or older in need of personal services, supervision, or assistance essential for sustaining the activities of daily living or for the protection of these individuals on less than a 24-hour basis.
(3)Therapeutic day services facility means any facility that provides nonmedical care, counseling, educational or vocational support, or social rehabilitation services on less than a 24-hour basis to persons under 18 years of age who would otherwise be placed in foster care or who are returning to families from foster care. Program standards for these facilities shall be developed by the department, pursuant to Section 1530, in consultation with therapeutic day services and foster care providers.
(4)Foster family agency means any public agency or private organization, organized and operated on a nonprofit basis, engaged in any of the following:
(A)Recruiting, certifying, approving, and training of, and providing professional support to, foster parents and resource families.
(B)Coordinating with county placing agencies to find homes for foster children in need of care.
(C)Providing services and supports to licensed or certified foster parents, county-approved resource families, and children to the extent authorized by state and federal law.
(5)Foster family home means any residential facility providing 24-hour care for six or fewer foster children that is owned, leased, or rented and is the residence of the foster parent or parents, including their family, in whose care the foster children have been placed. The placement may be by a public or private child placement agency or by a court order, or by voluntary placement by a parent, parents, or guardian. It also means a foster family home described in Section 1505.2.
(6)Small family home means any residential facility, in the licensees family residence, that provides 24-hour care for six or fewer foster children who have mental disorders or developmental or physical disabilities and who require special care and supervision as a result of their disabilities. A small family home may accept children with special health care needs, pursuant to subdivision (a) of Section 17710 of the Welfare and Institutions Code. In addition to placing children with special health care needs, the department may approve placement of children without special health care needs, up to the licensed capacity.
(7)Social rehabilitation facility means any residential facility that provides social rehabilitation services for no longer than 18 months in a group setting to adults recovering from mental illness who temporarily need assistance, guidance, or counseling. Program components shall be subject to program standards pursuant to Article 1 (commencing with Section 5670) of Chapter 2.5 of Part 2 of Division 5 of the Welfare and Institutions Code.
(8)Community treatment facility means any residential facility that provides mental health treatment services to children in a group setting and that has the capacity to provide secure containment. Program components shall be subject to program standards developed and enforced by the State Department of Health Care Services pursuant to Section 4094 of the Welfare and Institutions Code.
Nothing in this section shall be construed to prohibit or discourage placement of persons who have mental or physical disabilities into any category of community care facility that meets the needs of the individual placed, if the placement is consistent with the licensing regulations of the department.
(9)Full-service adoption agency means any licensed entity engaged in the business of providing adoption services, that does all of the following:
(A)Assumes care, custody, and control of a child through relinquishment of the child to the agency or involuntary termination of parental rights to the child.
(B)Assesses the birth parents, prospective adoptive parents, or child.
(C)Places children for adoption.
(D)Supervises adoptive placements.
Private full-service adoption agencies shall be organized and operated on a nonprofit basis. As a condition of licensure to provide intercountry adoption services, a full-service adoption agency shall be accredited and in good standing according to Part 96 (commencing with Section 96.1) of Title 22 of the Code of Federal Regulations, or supervised by an accredited primary provider, or acting as an exempted provider, in compliance with Subpart F (commencing with Section 96.29) of Part 96 of Title 22 of the Code of Federal Regulations.
(10)Noncustodial adoption agency means any licensed entity engaged in the business of providing adoption services, that does all of the following:
(A)Assesses the prospective adoptive parents.
(B)Cooperatively matches children freed for adoption, who are under the care, custody, and control of a licensed adoption agency, for adoption, with assessed and approved adoptive applicants.
(C)Cooperatively supervises adoption placements with a full-service adoptive agency, but does not disrupt a placement or remove a child from a placement.
Private noncustodial adoption agencies shall be organized and operated on a nonprofit basis. As a condition of licensure to provide intercountry adoption services, a noncustodial adoption agency shall be accredited and in good standing according to Part 96 (commencing with Section 96.1) of Title 22 of the Code of Federal Regulations, or supervised by an accredited primary provider, or acting as an exempted provider, in compliance with Subpart F (commencing with Section 96.29) of Part 96 of Title 22 of the Code of Federal Regulations.
(11)Transitional shelter care facility means any group care facility that provides for 24-hour nonmedical care of persons in need of personal services, supervision, or assistance essential for sustaining the activities of daily living or for the protection of the individual. Program components shall be subject to program standards developed by the State Department of Social Services pursuant to Section 1502.3.
(12)Transitional housing placement provider means an organization licensed by the department pursuant to Section 1559.110 and Section 16522.1 of the Welfare and Institutions Code to provide transitional housing to foster children who are at least 16 years of age and not more than 18 years of age, and nonminor dependents, as defined in subdivision (v) of Section 11400 of the Welfare and Institutions Code, to promote their transition to adulthood. A transitional housing placement provider shall be privately operated and organized on a nonprofit basis.
(13)Group home means a residential facility that provides 24-hour care and supervision to children, delivered at least in part by staff employed by the licensee in a structured environment. The care and supervision provided by a group home shall be nonmedical, except as otherwise permitted by law.
(14)Runaway and homeless youth shelter means a group home licensed by the department to operate a program pursuant to Section 1502.35 to provide voluntary, short-term, shelter and personal services to runaway youth or homeless youth, as defined in paragraph (2) of subdivision (a) of Section 1502.35.
(15)Enhanced behavioral supports home means a facility certified by the State Department of Developmental Services pursuant to Article 3.6 (commencing with Section 4684.80) of Chapter 6 of Division 4.5 of the Welfare and Institutions Code, and licensed by the State Department of Social Services as an adult residential facility or a group home that provides 24-hour nonmedical care to individuals with developmental disabilities who require enhanced behavioral supports, staffing, and supervision in a homelike setting. An enhanced behavioral supports home shall have a maximum capacity of four consumers, shall conform to Section 441.530(a)(1) of Title 42 of the Code of Federal Regulations, and shall be eligible for federal Medicaid home- and community-based services funding.
(16)Community crisis home means a facility certified by the State Department of Developmental Services pursuant to Article 8 (commencing with Section 4698) of Chapter 6 of Division 4.5 of the Welfare and Institutions Code, and licensed by the State Department of Social Services pursuant to Article 9.7 (commencing with Section 1567.80), as an adult residential facility, providing 24-hour nonmedical care to individuals with developmental disabilities receiving regional center service, in need of crisis intervention services, and who would otherwise be at risk of admission to the acute crisis center at Fairview Developmental Center, Sonoma Developmental Center, an acute general hospital, acute psychiatric hospital, an institution for mental disease, as described in Part 5 (commencing with Section 5900) of Division 5 of the Welfare and Institutions Code, or an out-of-state placement. A community crisis home shall have a maximum capacity of eight consumers, as defined in subdivision (a) of Section 1567.80, shall conform to Section 441.530(a)(1) of Title 42 of the Code of Federal Regulations, and shall be eligible for federal Medicaid home- and community-based services funding.
(17)Crisis nursery means a facility licensed by the department to operate a program pursuant to Section 1516 to provide short-term care and supervision for children under six years of age who are voluntarily placed for temporary care by a parent or legal guardian due to a family crisis or stressful situation.
(18)Short-term residential therapeutic program means a residential facility operated by a public agency or private organization and licensed by the department pursuant to Section 1562.01 that provides an integrated program of specialized and intensive care and supervision, services and supports, treatment, and short-term, 24-hour care and supervision to children. The care and supervision provided by a short-term residential therapeutic program shall be nonmedical, except as otherwise permitted by law. Private short-term residential therapeutic programs shall be organized and operated on a nonprofit basis. A short-term residential therapeutic program may be operated as a childrens crisis residential program.
(19)Private alternative boarding school means a group home licensed by the department to operate a program pursuant to Section 1502.2 to provide youth with 24-hour residential care and supervision, which, in addition to providing educational services to youth, provides, or holds itself out as providing, behavioral-based services to youth with social, emotional, or behavioral issues. The care and supervision provided by a private alternative boarding school shall be nonmedical, except as otherwise permitted by law.
(20)Private alternative outdoor program means a group home licensed by the department to operate a program pursuant to Section 1502.21 to provide youth with 24-hour residential care and supervision, which provides, or holds itself out as providing, behavioral-based services in an outdoor living setting to youth with social, emotional, or behavioral issues. The care and supervision provided by a private alternative outdoor program shall be nonmedical, except as otherwise permitted by law.
(21)Childrens crisis residential program means a facility licensed by the department as a short-term residential therapeutic program pursuant to Section 1562.02 and approved by the State Department of Health Care Services, or a county mental health plan to which the State Department of Health Care Services has delegated approval authority, to operate a childrens crisis residential mental health program approval pursuant to Section 11462.011 of the Welfare and Institutions Code, to serve children experiencing mental health crises as an alternative to psychiatric hospitalization.
(b)Department or state department means the State Department of Social Services.
(c)Director means the Director of Social Services.
SEC. 3.Section 1562.02 is added to the Health and Safety Code, to read:1562.02.(a)The department may license a short-term residential therapeutic program operating as a childrens crisis residential program pursuant to this chapter. A childrens crisis residential program shall meet all of the following requirements:
(1)If the program serves children who are not experiencing mental health crises, have an identifiable and physically separate unit for those children who are experiencing mental health crises. The separate unit shall be indicated on the short-term residential therapeutic programs license.
(2)Obtain and have in good standing a mental health program approval that includes a Medi-Cal mental health certification, as described in Section 11462.01 of the Welfare and Institutions Code, and a childrens crisis residential mental health program approval, as described in Section 11462.011 of the Welfare and Institutions Code, both of which are issued by the State Department of Health Care Services, or a county mental health plan to which the department has delegated approval authority. The short-term residential therapeutic program shall obtain a mental health program approval before operating as a childrens crisis residential program. The department may revoke a programs license pursuant to Section 1550 for a programs failure to maintain the mental health program approval.
(3)Comply with all applicable licensing standards for a short-term residential therapeutic program, unless the department specifies otherwise in regulations that comply with applicable statutory requirements related to licensure.
(b)Contingent upon an appropriation in the annual Budget Act for these purposes, the department shall begin implementation of this section no later than July 1, 2018, and shall commence the licensing process for childrens crisis residential programs no later than January 1, 2019.
SEC. 4.Section 1562.03 is added to the Health and Safety Code, to read:1562.03.(a)The department shall establish regulations for short-term residential therapeutic programs that are operated as childrens crisis residential programs. At a minimum, the regulations shall include all of the following:
(1)Therapeutic programming shall be provided seven days a week, including weekends and holidays, with sufficient mental health professional and paraprofessional staff staff, as required by the facilitys childrens crisis residential mental health program approval in accordance with the standards and procedures established pursuant to Section 11462.011 of the Welfare and Institutions Code, to maintain an appropriate treatment setting and services, based on individual childrens needs.
(2)The program shall be staffed with sufficient personnel to accept children 24 hours per day, seven days a week and to admit children, at a minimum, from 7 a.m. to 11 p.m., seven days a week, 365 days per year. The program shall be sufficiently staffed to discharge children, as appropriate, seven days a week, 365 days per year.
(3)Facilities shall be limited to fewer than 16 beds, with at least 50 percent of those beds in single-occupancy rooms.
(4)Facilities shall include ample physical space for accommodating individuals who provide daily emotional and physical supports to each child and for integrating family members into the day-to-day care of the youth.
(5)The program shall collaborate with each childs existing mental health team, if applicable, child and family team, if applicable, and other formal and natural supports within 24 hours of intake and throughout the course of care and treatment as appropriate.
(6)The program shall create and assist with the implementation of a plan for transitioning each admitted child from the program to his or her home and community, including the establishment of a mental health or child and family team if there is not one already.
(b)The program shall annually provide the department with all of the following data as it pertains to children in foster care and children not in foster care in conjunction with its application for licensure renewal:
(1)Age and gender of clients served.
(2)Duration of stay.
(3)Professional classification of staff and contracted staff.
(4)Type of placement the client was discharged to.
SEC. 5.Section 5848.5 of the Welfare and Institutions Code is amended to read:5848.5.(a)The Legislature finds and declares all of the following:
(1)California has realigned public community mental health services to counties and it is imperative that sufficient community-based resources be available to meet the mental health needs of eligible individuals.
(2)Increasing access to effective outpatient and crisis stabilization services provides an opportunity to reduce costs associated with expensive inpatient and emergency room care and to better meet the needs of individuals with mental health disorders in the least restrictive manner possible.
(3)Almost one-fifth of people with mental health disorders visit a hospital emergency room at least once per year. If an adequate array of crisis services is not available, it leaves an individual with little choice but to access an emergency room for assistance and, potentially, an unnecessary inpatient hospitalization.
(4)Recent reports have called attention to a continuing problem of inappropriate and unnecessary utilization of hospital emergency rooms in California due to limited community-based services for individuals in psychological distress and acute psychiatric crisis. Hospitals report that 70 percent of people taken to emergency rooms for psychiatric evaluation can be stabilized and transferred to a less intensive level of crisis care. Law enforcement personnel report that their personnel need to stay with people in the emergency room waiting area until a placement is found, and that less intensive levels of care tend not to be available.
(5)Comprehensive public and private partnerships at both local and regional levels, including across physical health services, mental health, substance use disorder, law enforcement, social services, and related supports, are necessary to develop and maintain high quality, patient-centered, and cost-effective care for individuals with mental health disorders that facilitates their recovery and leads towards wellness.
(6)The recovery of individuals with mental health disorders is important for all levels of government, business, and the local community.
(b)This section shall be known, and may be cited, as the Investment in Mental Health Wellness Act of 2013. The objectives of this section are to do all of the following:
(1)Expand access to early intervention and treatment services to improve the client experience, achieve recovery and wellness, and reduce costs.
(2)Expand the continuum of services to address crisis intervention, crisis stabilization, and crisis residential treatment needs that are wellness, resiliency, and recovery oriented.
(3)Add at least 25 mobile crisis support teams and at least 2,000 crisis stabilization and crisis residential treatment beds to bolster capacity at the local level to improve access to mental health crisis services and address unmet mental health care needs.
(4)Add at least 600 triage personnel to provide intensive case management and linkage to services for individuals with mental health care disorders at various points of access, such as at designated community-based service points, homeless shelters, and clinics.
(5)Reduce unnecessary hospitalizations and inpatient days by appropriately utilizing community-based services and improving access to timely assistance.
(6)Reduce recidivism and mitigate unnecessary expenditures of local law enforcement.
(7)Provide local communities with increased financial resources to leverage additional public and private funding sources to achieve improved networks of care for individuals with mental health disorders.
(8)Provide a complete continuum of crisis services for children and youth 21 years of age and under regardless of where they live in the state. The funds included in the 2016 Budget Act for the purpose of developing the continuum of mental health crisis services for children and youth 21 years of age and under shall be for the following objectives:
(A)Provide a continuum of crisis services for children and youth 21 years of age and under regardless of where they live in the state.
(B)Provide for early intervention and treatment services to improve the client experience, achieve recovery and wellness, and reduce costs.
(C)Expand the continuum of community-based services to address crisis intervention, crisis stabilization, and crisis residential treatment needs that are wellness-, resiliency-, and recovery-oriented.
(D)Add at least 200 mobile crisis support teams.
(E)Add at least 120 crisis stabilization services and beds and crisis residential treatment beds to increase capacity at the local level to improve access to mental health crisis services and address unmet mental health care needs.
(F)Add triage personnel to provide intensive case management and linkage to services for individuals with mental health care disorders at various points of access, such as at designated community-based service points, homeless shelters, schools, and clinics.
(G)Expand family respite care to help families and sustain caregiver health and well-being.
(H)Expand family supportive training and related services designed to help families participate in the planning process, access services, and navigate programs.
(I)Reduce unnecessary hospitalizations and inpatient days by appropriately utilizing community-based services.
(J)Reduce recidivism and mitigate unnecessary expenditures of local law enforcement.
(K)Provide local communities with increased financial resources to leverage additional public and private funding sources to achieve improved networks of care for children and youth 21 years of age and under with mental health disorders.
(c)Through appropriations provided in the annual Budget Act for this purpose, it is the intent of the Legislature to authorize the California Health Facilities Financing Authority, hereafter referred to as the authority, and the Mental Health Services Oversight and Accountability Commission, hereafter referred to as the commission, to administer competitive selection processes as provided in this section for capital capacity and program expansion to increase capacity for mobile crisis support, crisis intervention, crisis stabilization services, crisis residential treatment, and specified personnel resources.
(d)Funds appropriated by the Legislature to the authority for purposes of this section shall be made available to selected counties, or counties acting jointly. The authority may, at its discretion, also give consideration to private nonprofit corporations and public agencies in an area or region of the state if a county, or counties acting jointly, affirmatively supports this designation and collaboration in lieu of a county government directly receiving grant funds.
(1)Grant awards made by the authority shall be used to expand local resources for the development, capital, equipment acquisition, and applicable program startup or expansion costs to increase capacity for client assistance and services in the following areas:
(A)Crisis intervention, as authorized by Sections 14021.4, 14680, and 14684.
(B)Crisis stabilization, as authorized by Sections 14021.4, 14680, and 14684.
(C)Crisis residential treatment, as authorized by Sections 14021.4, 14680, and 14684 and as provided at a childrens crisis residential program, as defined in Section 1502 of the Health and Safety Code.
(D)Rehabilitative mental health services, as authorized by Sections 14021.4, 14680, and 14684.
(E)Mobile crisis support teams, including personnel and equipment, such as the purchase of vehicles.
(2)The authority shall develop selection criteria to expand local resources, including those described in paragraph (1), and processes for awarding grants after consulting with representatives and interested stakeholders from the mental health community, including, but not limited to, the County Behavioral Health Directors Association of California, service providers, consumer organizations, and other appropriate interests, such as health care providers and law enforcement, as determined by the authority. The authority shall ensure that grants result in cost-effective expansion of the number of community-based crisis resources in regions and communities selected for funding. The authority shall also take into account at least the following criteria and factors when selecting recipients of grants and determining the amount of grant awards:
(A)Description of need, including, at a minimum, a comprehensive description of the project, community need, population to be served, linkage with other public systems of health and mental health care, linkage with local law enforcement, social services, and related assistance, as applicable, and a description of the request for funding.
(B)Ability to serve the target population, which includes individuals eligible for Medi-Cal and individuals eligible for county health and mental health services.
(C)Geographic areas or regions of the state to be eligible for grant awards, which may include rural, suburban, and urban areas, and may include use of the five regional designations utilized by the County Behavioral Health Directors Association of California.
(D)Level of community engagement and commitment to project completion.
(E)Financial support that, in addition to a grant that may be awarded by the authority, will be sufficient to complete and operate the project for which the grant from the authority is awarded.
(F)Ability to provide additional funding support to the project, including public or private funding, federal tax credits and grants, foundation support, and other collaborative efforts.
(G)Memorandum of understanding among project partners, if applicable.
(H)Information regarding the legal status of the collaborating partners, if applicable.
(I)Ability to measure key outcomes, including improved access to services, health and mental health outcomes, and cost benefit of the project.
(3)The authority shall determine maximum grants awards, which shall take into consideration the number of projects awarded to the grantee, as described in paragraph (1), and shall reflect reasonable costs for the project and geographic region. The authority may allocate a grant in increments contingent upon the phases of a project.
(4)Funds awarded by the authority pursuant to this section may be used to supplement, but not to supplant, existing financial and resource commitments of the grantee or any other member of a collaborative effort that has been awarded a grant.
(5)All projects that are awarded grants by the authority shall be completed within a reasonable period of time, to be determined by the authority. Funds shall not be released by the authority until the applicant demonstrates project readiness to the authoritys satisfaction. If the authority determines that a grant recipient has failed to complete the project under the terms specified in awarding the grant, the authority may require remedies, including the return of all or a portion of the grant.
(6)A grantee that receives a grant from the authority under this section shall commit to using that capital capacity and program expansion project, such as the mobile crisis team, crisis stabilization unit, or crisis residential treatment program, for the duration of the expected life of the project.
(7)The authority may consult with a technical assistance entity, as described in paragraph (5) of subdivision (a) of Section 4061, for purposes of implementing this section.
(8)The authority may adopt emergency regulations relating to the grants for the capital capacity and program expansion projects described in this section, including emergency regulations that define eligible costs and determine minimum and maximum grant amounts.
(9)The authority shall provide reports to the fiscal and policy committees of the Legislature on or before May 1, 2014, and on or before May 1, 2015, on the progress of implementation, that include, but are not limited to, the following:
(A)A description of each project awarded funding.
(B)The amount of each grant issued.
(C)A description of other sources of funding for each project.
(D)The total amount of grants issued.
(E)A description of project operation and implementation, including who is being served.
(10)A recipient of a grant provided pursuant to paragraph (1) shall adhere to all applicable laws relating to scope of practice, licensure, certification, staffing, and building codes.
(e)Of the funds specified in paragraph (8) of subdivision (b), it is the intent of the Legislature to authorize the authority and the commission to administer competitive selection processes as provided in this section for capital capacity and program expansion to increase capacity for mobile crisis support, crisis intervention, crisis stabilization services, crisis residential treatment, family respite care, family supportive training and related services, and triage personnel resources for children and youth 21 years of age and under.
(f)Funds appropriated by the Legislature to the authority to address crisis services for children and youth 21 years of age and under for the purposes of this section shall be made available to selected counties or counties acting jointly. The authority may, at its discretion, also give consideration to private nonprofit corporations and public agencies in an area or region of the state if a county, or counties acting jointly, affirmatively support this designation and collaboration in lieu of a county government directly receiving grant funds.
(1)Grant awards made by the authority shall be used to expand local resources for the development, capital, equipment acquisition, and applicable program startup or expansion costs to increase capacity for client assistance and crisis services for children and youth 21 years of age and under in the following areas:
(A)Crisis intervention, as authorized by Sections 14021.4, 14680, and 14684.
(B)Crisis stabilization, as authorized by Sections 14021.4, 14680, and 14684.
(C)Crisis residential treatment, as authorized by Sections 14021.4, 14680, and 14684 and as provided at a childrens crisis residential program, as defined in Section 1502 of the Health and Safety Code.
(D)Mobile crisis support teams, including the purchase of equipment and vehicles.
(E)Family respite care.
(2)The authority shall develop selection criteria to expand local resources, including those described in paragraph (1), and processes for awarding grants after consulting with representatives and interested stakeholders from the mental health community, including, but not limited to, county mental health directors, service providers, consumer organizations, and other appropriate interests, such as health care providers and law enforcement, as determined by the authority. The authority shall ensure that grants result in cost-effective expansion of the number of community-based crisis resources in regions and communities selected for funding. The authority shall also take into account at least the following criteria and factors when selecting recipients of grants and determining the amount of grant awards:
(A)Description of need, including, at a minimum, a comprehensive description of the project, community need, population to be served, linkage with other public systems of health and mental health care, linkage with local law enforcement, social services, and related assistance, as applicable, and a description of the request for funding.
(B)Ability to serve the target population, which includes individuals eligible for Medi-Cal and individuals eligible for county health and mental health services.
(C)Geographic areas or regions of the state to be eligible for grant awards, which may include rural, suburban, and urban areas, and may include use of the five regional designations utilized by the California Behavioral Health Directors Association.
(D)Level of community engagement and commitment to project completion.
(E)Financial support that, in addition to a grant that may be awarded by the authority, will be sufficient to complete and operate the project for which the grant from the authority is awarded.
(F)Ability to provide additional funding support to the project, including public or private funding, federal tax credits and grants, foundation support, and other collaborative efforts.
(G)Memorandum of understanding among project partners, if applicable.
(H)Information regarding the legal status of the collaborating partners, if applicable.
(I)Ability to measure key outcomes, including utilization of services, health and mental health outcomes, and cost benefit of the project.
(3)The authority shall determine maximum grant awards, which shall take into consideration the number of projects awarded to the grantee, as described in paragraph (1), and shall reflect reasonable costs for the project, geographic region, and target ages. The authority may allocate a grant in increments contingent upon the phases of a project.
(4)Funds awarded by the authority pursuant to this section may be used to supplement, but not to supplant, existing financial and resource commitments of the grantee or any other member of a collaborative effort that has been awarded a grant.
(5)All projects that are awarded grants by the authority shall be completed within a reasonable period of time, to be determined by the authority. Funds shall not be released by the authority until the applicant demonstrates project readiness to the authoritys satisfaction. If the authority determines that a grant recipient has failed to complete the project under the terms specified in awarding the grant, the authority may require remedies, including the return of all, or a portion, of the grant.
(6)A grantee that receives a grant from the authority under this section shall commit to using that capital capacity and program expansion project, such as the mobile crisis team, crisis stabilization unit, family respite care, or crisis residential treatment program, for the duration of the expected life of the project.
(7)The authority may consult with a technical assistance entity, as described in paragraph (5) of subdivision (a) of Section 4061, for the purposes of implementing this section.
(8)The authority may adopt emergency regulations relating to the grants for the capital capacity and program expansion projects described in this section, including emergency regulations that define eligible costs and determine minimum and maximum grant amounts.
(9)The authority shall provide reports to the fiscal and policy committees of the Legislature on or before January 10, 2018, and annually thereafter, on the progress of implementation, that include, but are not limited to, the following:
(A)A description of each project awarded funding.
(B)The amount of each grant issued.
(C)A description of other sources of funding for each project.
(D)The total amount of grants issued.
(E)A description of project operation and implementation, including who is being served.
(10)A recipient of a grant provided pursuant to paragraph (1) shall adhere to all applicable laws relating to scope of practice, licensure, certification, staffing, and building codes.
(g)Funds appropriated by the Legislature to the commission for purposes of this section shall be allocated for triage personnel to provide intensive case management and linkage to services for individuals with mental health disorders at various points of access. These funds shall be made available to selected counties, counties acting jointly, or city mental health departments, as determined by the commission through a selection process. It is the intent of the Legislature for these funds to be allocated in an efficient manner to encourage early intervention and receipt of needed services for individuals with mental health disorders, and to assist in navigating the local service sector to improve efficiencies and the delivery of services.
(1)Triage personnel may provide targeted case management services face to face, by telephone, or by telehealth with the individual in need of assistance or his or her significant support person, and may be provided anywhere in the community. These service activities may include, but are not limited to, the following:
(A)Communication, coordination, and referral.
(B)Monitoring service delivery to ensure the individual accesses and receives services.
(C)Monitoring the individuals progress.
(D)Providing placement service assistance and service plan development.
(2)The commission shall take into account at least the following criteria and factors when selecting recipients and determining the amount of grant awards for triage personnel as follows:
(A)Description of need, including potential gaps in local service connections.
(B)Description of funding request, including personnel and use of peer support.
(C)Description of how triage personnel will be used to facilitate linkage and access to services, including objectives and anticipated outcomes.
(D)Ability to obtain federal Medicaid reimbursement, when applicable.
(E)Ability to administer an effective service program and the degree to which local agencies and service providers will support and collaborate with the triage personnel effort.
(F)Geographic areas or regions of the state to be eligible for grant awards, which shall include rural, suburban, and urban areas, and may include use of the five regional designations utilized by the County Behavioral Health Directors Association of California.
(3)The commission shall determine maximum grant awards, and shall take into consideration the level of need, population to be served, and related criteria, as described in paragraph (2), and shall reflect reasonable costs.
(4)Funds awarded by the commission for purposes of this section may be used to supplement, but not supplant, existing financial and resource commitments of the county, counties acting jointly, or city mental health department that received the grant.
(5)Notwithstanding any other law, a county, counties acting jointly, or city mental health department that receives an award of funds for the purpose of supporting triage personnel pursuant to this subdivision is not required to provide a matching contribution of local funds.
(6)Notwithstanding any other law, the commission, without taking any further regulatory action, may implement, interpret, or make specific this section by means of informational letters, bulletins, or similar instructions.
(7)The commission shall provide a status report to the fiscal and policy committees of the Legislature on the progress of implementation no later than March 1, 2014.
(h)Funds appropriated by the Legislature to the commission pursuant to paragraph (8) of subdivision (b) for the purposes of addressing childrens crisis services shall be allocated to support triage personnel and family supportive training and related services. These funds shall be made available to selected counties, counties acting jointly, or city mental health departments, as determined by the commission through a selection process. The commission may, at its discretion, also give consideration to private nonprofit corporations and public agencies in an area or region of the state if a county, or counties acting jointly, affirmatively supports this designation and collaboration in lieu of a county government directly receiving grant funds.
(1)These funds may provide for a range of crisis-related services for a child in need of assistance, or his or her parent, guardian, or caregiver. These service activities may include, but are not limited to, the following:
(A)Intensive coordination of care and services.
(B)Communication, coordination, and referral.
(C)Monitoring service delivery to the child or youth.
(D)Monitoring the childs progress.
(E)Providing placement service assistance and service plan development.
(F)Crisis or safety planning.
(2)The commission shall take into account at least the following criteria and factors when selecting recipients and determining the amount of grant awards for these funds, as follows:
(A)Description of need, including potential gaps in local service connections.
(B)Description of funding request, including personnel.
(C)Description of how personnel and other services will be used to facilitate linkage and access to services, including objectives and anticipated outcomes.
(D)Ability to obtain federal Medicaid reimbursement, when applicable.
(E)Ability to provide a matching contribution of local funds.
(F)Ability to administer an effective service program and the degree to which local agencies and service providers will support and collaborate with the triage personnel effort.
(G)Geographic areas or regions of the state to be eligible for grant awards, which shall include rural, suburban, and urban areas, and may include use of the five regional designations utilized by the County Behavioral Health Directors Association of California.
(3)The commission shall determine maximum grant awards, and shall take into consideration the level of need, population to be served, and related criteria, as described in paragraph (2), and shall reflect reasonable costs.
(4)Funds awarded by the commission for purposes of this section may be used to supplement, but not supplant, existing financial and resource commitments of the county, counties acting jointly, or a city mental health department that received the grant.
(5)Notwithstanding any other law, a county, counties acting jointly, or a city mental health department that receives an award of funds for the purpose of this section is not required to provide a matching contribution of local funds.
(6)Notwithstanding any other law, the commission, without taking any further regulatory action, may implement, interpret, or make specific this section by means of informational letters, bulletins, or similar instructions.
(7)The commission may waive requirements in this section for counties with a population of 100,000 or less, if the commission determines it is in the best interest of the state and meets the intent of the law.
(8)The commission shall provide a status report to the fiscal and policy committees of the Legislature on the progress of implementation no later than January 10, 2018, and annually thereafter.
SEC. 6.Section 11462.01 of the Welfare and Institutions Code, as added by Section 75 of Chapter 773 of the Statutes of 2015, is amended to read:11462.01.(a)(1)If a program will admit Medi-Cal beneficiaries, no later than 12 months following the date of initial licensure, a short-term residential therapeutic program, as defined in subdivision (ad) of Section 11400 of this code and paragraph (18) of subdivision (a) of Section 1502 of the Health and Safety Code, shall obtain a contract, subject to an agreement on rates and terms and conditions, with a county mental health plan to provide specialty mental health services and demonstrate the ability to meet the therapeutic needs of each child, as identified in any of the following:
(A)A mental health assessment.
(B)The childs case plan.
(C)The childs needs and services plan.
(D)Other documentation demonstrating the child has a mental health need.
(2)A short-term residential therapeutic program shall comply with any other mental health program approvals required by the State Department of Health Care Services or by a county mental health plan to which mental health program approval authority has been delegated.
(b)A short-term residential therapeutic program, except as specified in subdivision (c), may accept for placement a child who meets both of the criteria in paragraphs (1) and (2) and at least one of the conditions in paragraph (3).
(1)The child does not require inpatient care in a licensed health facility.
(2)The child has been assessed as requiring the level of services provided in a short-term residential therapeutic program in order to maintain the safety and well-being of the child or others due to behaviors, including those resulting from traumas, that render the child or those around the child unsafe or at risk of harm, or that prevent the effective delivery of needed services and supports provided in the childs own home or in other family settings, such as with a relative, guardian, foster family, resource family, or adoptive family. The assessment shall ensure the child has needs in common with other children or youth in the care of the facility, consistent with subdivision (c) of Section 16514.
(3)The child meets at least one of the following conditions:
(A)The child has been assessed, pursuant to Section 4096, as meeting the medical necessity criteria for Medi-Cal specialty mental health services, as provided for in Section 1830.205 or 1830.210 of Title 9 of the California Code of Regulations.
(B)The child has been assessed, pursuant to Section 4096, as seriously emotionally disturbed, as defined in subdivision (a) of Section 5600.3.
(C)The child requires emergency placement pursuant to paragraph (3) of subdivision (i).
(D)The child has been assessed, pursuant to Section 4096, as requiring the level of services provided by the short-term residential therapeutic program in order to meet his or her behavioral or therapeutic needs.
(4)Subject to the requirements of this subdivision, a short-term residential therapeutic program may have a specialized program to serve a child, including, but not limited to, the following:
(A)A commercially sexually exploited child.
(B)A private voluntary placement, if the youth exhibits status offender behavior, the parents or other relatives feel they cannot control the childs behavior, and short-term intervention is needed to transition the child back into the home.
(C)A juvenile sex offender.
(D)A child who is affiliated with, or impacted by, a gang.
(c)(1)A short-term residential therapeutic program that is operating as a childrens crisis residential program, as defined in Section 1502 of the Health and Safety Code, may accept for admission any child who meets all of the following requirements:
(A)The child is referred by a parent or guardian, physician, or licensed mental health professional, or by the representative of a public or private entity, including, but not limited to, the county probation agency or child welfare services agency with responsibility for the placement of a child in foster care, that has the right to make these decisions on behalf of a child who is in mental health crisis.
(B)The child is under 19, 20, or 21 years of age, depending on a programs licensing requirements.
(C)The child has a serious behavioral health disorder.
(D)The child requires a 24-hour-a-day, seven-day-a-week, staff-secured, unlocked treatment setting.
(2)The primary function of a childrens crisis residential program is to provide short-term crisis stabilization, therapeutic intervention, and specialized programming in an unlocked, staff-secured setting with a high degree of supervision and structure and the goal of supporting the rapid and successful transition of the child back to the community.
(d)A foster family agency that is certified as a Medi-Cal specialty mental health provider pursuant to Section 1810.435 of Title 9 of the California Code of Regulations by the State Department of Health Care Services, or by a county mental health plan to which the department has delegated certification authority, and which has entered into a contract with a county mental health plan pursuant to Section 1810.436 of Title 9 of the California Code of Regulations, shall provide, or provide access to, specialty mental health services to children under its care who do not require inpatient care in a licensed health facility and who meet the medical necessity criteria for Medi-Cal specialty mental health services provided for in Section 1830.205 or 1830.210 of Title 9 of the California Code of Regulations.
(e)A foster family agency that is not certified as a Medi-Cal specialty mental health provider shall provide access to specialty and non-specialty mental health services in that program for children who do not require inpatient care in a licensed health facility and who meet any of the conditions in paragraph (3) of subdivision (b). In this situation the foster family agency shall do the following:
(1)In the case of a child who is a Medi-Cal beneficiary, arrange for specialty mental health services from the county mental health plan.
(2)In all other cases, arrange for the child to receive mental health services.
(f)All short-term residential therapeutic programs shall maintain the level of care and services necessary to meet the needs of the children and youth in their care and shall maintain and have in good standing the appropriate mental health program approval. If a program will admit Medi-Cal beneficiaries, the mental health program approval shall include a certification to provide Medi-Cal specialty mental health services issued by the State Department of Health Care Services or a county mental health plan to which the department has delegated mental health program approval authority, pursuant to Section 4096.5 of this code or Section 1810.435 or 1810.436 of Title 9 of the California Code of Regulations. All foster family agencies that are certified as a Medi-Cal specialty mental health provider pursuant to Section 1810.435 of Title 9 of the California Code of Regulations shall maintain the level of care and services necessary to meet the needs of children and youth in their care and shall maintain and have in good standing the Medi-Cal specialty mental health provider certification issued by the State Department of Health Care Services or a county mental health plan to which the department has delegated certification authority.
(g)The assessments described in subparagraphs (A), (B), (C), and (D) of paragraph (3) of subdivision (b) shall ensure the childs individual behavioral or treatment needs are consistent with, and can be met by, the facility and shall be made by one of the following, as applicable:
(1)An interagency placement committee, as described in Section 4096, considering the recommendations from the child and family team, if any are available. If the short-term residential therapeutic program serves children who are placed by county child welfare agencies and children who are placed by probation departments, the interagency placement committee shall also ensure the requirements of subdivision (c) of Section 16514 have been met with respect to commonality of need.
(2)A licensed mental health professional as defined in subdivision (g) of Section 4096.
(3)For the purposes of this section, an AFDC-FC funded child with an individualized education program developed pursuant to Article 2 (commencing with Section 56320) of Chapter 4 of Part 30 of Division 4 of Title 2 of the Education Code that assesses the child as seriously emotionally disturbed, as defined in, and subject to, this section and recommends out-of-home placement at the level of care provided by the provider, shall be deemed to have met the assessment requirement.
(h)The evaluation described in subparagraph (A) of paragraph (3) of subdivision (i) shall be made pursuant to subdivision (b) of Section 706.6 or paragraph (2) of subdivision (c) of Section 16501.1.
(i)(1)The provider shall ensure that AFDC-FC funded children, assessed pursuant to subparagraphs (A) and (B) of paragraph (3) of subdivision (b), who are accepted for placement have been approved for placement by an interagency placement committee, as described in Section 4096, except as provided for in paragraph (3) of subdivision (g).
(2)The approval shall be in writing and shall indicate that the interagency placement committee has determined one of the following:
(A)The child meets the medical necessity criteria for Medi-Cal specialty mental health services, as provided for in Section 1830.205 or 1830.210 of Title 9 of the California Code of Regulations.
(B)The child is seriously emotionally disturbed, as described in subdivision (a) of Section 5600.3.
(3)(A)Nothing in subdivisions (a) to (h), inclusive, or this subdivision shall prevent an emergency placement of a child or youth into a certified short-term residential therapeutic program or childrens crisis residential program prior to the determination by the interagency placement committee, but only if a licensed mental health professional, as defined in subdivision (g) of Section 4096, has made a written determination within 72 hours of the childs or youths placement, that the child or youth requires the level of services and supervision provided by the short-term residential therapeutic program in order to meet his or her behavioral or therapeutic needs, or has made a written determination within 24 hours of the childs or youths placement in a childrens crisis residential program that the child or youth is experiencing a mental health crisis as defined in subdivision (c) and is in need of the care and services provided by the childrens crisis residential program. If the short-term residential therapeutic program serves children placed by county child welfare agencies and children placed by probation departments, the interagency placement committee shall also ensure the requirements of subdivision (c) of Section 16514 have been met with respect to commonality of need.
(i)The interagency placement committee, as appropriate, shall, within 30 days of placement, make the determinations, with recommendations from the child and family team, required by this subdivision.
(ii)If it determines the placement is appropriate, the interagency placement committee, with recommendations from the child and family team, shall transmit the approval, in writing, to the county placing agency and the short-term residential therapeutic program.
(iii)If it determines the placement is not appropriate, the interagency placement committee shall respond pursuant to subparagraph (B).
(B)(i)If the interagency placement committee determines at any time that the placement is not appropriate, it shall, with recommendations from the child and family team, transmit the disapproval, in writing, to the county placing agency and the short-term residential therapeutic program and shall include a recommendation as to the childs appropriate level of care and placement to meet his or her service needs. The necessary interagency placement committee representative or representatives shall participate in any child and family team meetings to refer the child or youth to an appropriate placement, as specified in this section.
(ii)The child may remain in the placement for the amount of time necessary to identify and transition the child to an alternative, suitable placement.
(iii)Notwithstanding clause (ii), if the interagency placement committee determined the placement was not appropriate due to a health and safety concern, immediate arrangements for the child to transition to an appropriate placement shall occur.
(j)Commencing January 1, 2017, for AFDC-FC funded children or youth, only those children or youth who are approved for placement, as set forth in this section, may be accepted by a short-term residential therapeutic program.
(k)The department shall, through regulation, establish consequences for the failure of a short-term residential therapeutic program to obtain written approval for placement of an AFDC-FC funded child or youth pursuant to this section.
(l)The department shall not establish a rate for a short-term residential therapeutic program unless the provider submits a recommendation from the host county or the primary placing county that the program is needed and that the provider is willing and capable of operating the program at the level sought. For purposes of this subdivision, host county, and primary placing county, mean the same as defined in the departments AFDC-FC ratesetting regulations.
(m)Any certified short-term residential therapeutic program shall be reclassified and paid at the appropriate program rate for which it is qualified if either of the following occurs:
(1)(A)It fails to maintain the level of care and services necessary to meet the needs of the children and youth in care, as required by subdivision (a). The determination shall be made consistent with the departments AFDC-FC ratesetting regulations developed pursuant to Section 11462 and shall take into consideration the highest level of care and associated rates for which the program may be eligible if granted an extension pursuant to Section 11462.04 or any reduction in rate associated with a provisional or probationary rate granted or imposed under Section 11466.01.
(B)In the event of a determination under this paragraph, the short-term residential therapeutic program may appeal the finding or submit a corrective action plan. The appeal process specified in Section 11466.6 shall be available to a short-term residential therapeutic program that provides intensive and therapeutic treatment. During any appeal, the short-term residential therapeutic program that provides intensive and therapeutic treatment shall maintain the appropriate level of care.
(2)It fails to maintain a certified mental health treatment program as required by subdivision (f).
(n)In addition to any other review required by law, the child and family team as defined in paragraph (4) of subdivision (a) of Section 16501 may periodically review the placement of the child or youth. If the child and family team make a recommendation that the child or youth no longer needs, or is not benefiting from, placement in a short-term residential therapeutic program, the team shall transmit the disapproval, in writing, to the county placing agency to consider a more appropriate placement.
(o)The department shall develop a process to address placements when, subsequent to the childs or youths placement, a determination is made by the interagency placement team and shall consider the recommendations of the child and family team, either that the child or youth is not in need of the care and services provided by the certified program. The process shall include, but not be limited to:
(1)Notice of the determination in writing to both the county placing agency and the short-term residential therapeutic program or foster family agency that provides intensive and therapeutic treatment.
(2)Notice of the countys plan, and a timeframe, for removal of the child or youth in writing to the short-term residential therapeutic program that provides intensive and therapeutic treatment.
(3)Referral to an appropriate placement.
(4)Actions to be taken if a child or youth is not timely removed from the short-term residential therapeutic program that provides intensive and therapeutic treatment or placed in an appropriate placement.
(p)(1)Nothing in this section shall prohibit a short-term residential therapeutic program from accepting private admissions of children or youth.
(2)When a referral is not from a public agency and public funding is not involved, there is no requirement for public agency review or determination of need.
(3)Children and youth subject to paragraphs (1) and (2) shall have been determined to be seriously emotionally disturbed, as described in subdivision (a) of Section 5600.3, and subject to Section 1502.4 of the Health and Safety Code, by a licensed mental health professional, as defined in subdivision (g) of Section 4096.
SEC. 6.5.Section 11462.01 of the Welfare and Institutions Code is amended to read:11462.01.(a)(1)No If a program will admit Medi-Cal beneficiaries, no later than 12 months following the date of initial licensure, a short-term residential therapeutic program, as defined in subdivision (ad) of Section 11400 of this code and paragraph (18) of subdivision (a) of Section 1502 of the Health and Safety Code, shall obtain a contract, subject to an agreement on rates and terms and conditions, with a county mental health plan to provide specialty mental health services and demonstrate the ability to meet the therapeutic needs of each child, as identified in any of the following:
(A)A mental health assessment.
(B)The childs case plan.
(C)The childs needs and services plan.
(D)Other documentation demonstrating the child has a mental health need.
(2)A short-term residential therapeutic program shall comply with any other mental health program approvals required by the State Department of Health Care Services or by a county mental health plan to which mental health program approval authority has been delegated.
(b)A short-term residential therapeutic program program, except as specified in subdivision (c), may accept for placement a child who meets both of the criteria in paragraphs (1) and (2) and at least one of the conditions in paragraph (3).
(1)The child does not require inpatient care in a licensed health facility.
(2)The child has been assessed as requiring the level of services provided in a short-term residential therapeutic program in order to maintain the safety and well-being of the child or others due to behaviors, including those resulting from traumas, that render the child or those around the child unsafe or at risk of harm, or that prevent the effective delivery of needed services and supports provided in the childs own home or in other family settings, such as with a relative, guardian, foster family, resource family, or adoptive family. The assessment shall ensure the child has needs in common with other children or youth in the care of the facility, consistent with subdivision (c) of Section 16514.
(3)The child meets at least one of the following conditions:
(A)The child has been assessed, pursuant to Section 4096, as meeting the medical necessity criteria for Medi-Cal specialty mental health services, as provided for in Section 1830.205 or 1830.210 of Title 9 of the California Code of Regulations.
(B)The child has been assessed, pursuant to Section 4096, as seriously emotionally disturbed, as defined in subdivision (a) of Section 5600.3.
(C)The child requires emergency placement pursuant to paragraph (3) of subdivision (h).
(D)The child has been assessed, pursuant to Section 4096, as requiring the level of services provided by the short-term residential therapeutic program in order to meet his or her behavioral or therapeutic needs.
(4)Subject to the requirements of this subdivision, a short-term residential therapeutic program may have a specialized program to serve a child, including, but not limited to, the following:
(A)A commercially sexually exploited child.
(B)A private voluntary placement, if the youth exhibits status offender behavior, the parents or other relatives feel they cannot control the childs behavior, and short-term intervention is needed to transition the child back into the home.
(C)A juvenile sex offender.
(D)A child who is affiliated with, or impacted by, a gang.
(c)(1)A short-term residential therapeutic program that is operating as a childrens crisis residential program, as defined in Section 1502 of the Health and Safety Code, may accept for admission any child who meets all of the following requirements:
(A)The child is referred by a parent or guardian, physician, or licensed mental health professional, or by the representative of a public or private entity, including, but not limited to, the county probation agency or child welfare services agency with responsibility for the placement of a child in foster care, that has the right to make these decisions on behalf of a child who is in mental health crisis.
(B)The child is under 19, 20, or 21 years of age, depending on a programs licensing requirements.
(C)The child has a serious behavioral health disorder.
(D)The child requires a 24-hour-a-day, seven-day-a-week, staff-secured, unlocked treatment setting.
(2)The primary function of a childrens crisis residential program is to provide short-term crisis stabilization, therapeutic intervention, and specialized programming in an unlocked, staff-secured setting with a high degree of supervision and structure and the goal of supporting the rapid and successful transition of the child back to the community.
(c)(d)A foster family agency that is certified as a Medi-Cal specialty mental health provider pursuant to Section 1810.435 of Title 9 of the California Code of Regulations by the State Department of Health Care Services, or by a county mental health plan to which the department has delegated certification authority, and which has entered into a contract with a county mental health plan pursuant to Section 1810.436 of Title 9 of the California Code of Regulations, shall provide, or provide access to, specialty mental health services to children under its care who do not require inpatient care in a licensed health facility and who meet the medical necessity criteria for Medi-Cal specialty mental health services provided for in Section 1830.205 or 1830.210 of Title 9 of the California Code of Regulations.
(d)(e)A foster family agency that is not certified as a Medi-Cal specialty mental health provider shall provide access to specialty and non-specialty mental health services in that program for children who do not require inpatient care in a licensed health facility and who meet any of the conditions in paragraph (3) of subdivision (b). In this situation the foster family agency shall do the following:
(1)In the case of a child who is a Medi-Cal beneficiary, arrange for specialty mental health services from the county mental health plan.
(2)In all other cases, arrange for the child to receive mental health services.
(e)(f)All short-term residential therapeutic programs shall maintain the level of care and services necessary to meet the needs of the children and youth in their care and shall maintain and have in good standing the appropriate mental health program approval that includes approval. If a program will admit Medi-Cal beneficiaries, the mental health program approval shall include a certification to provide Medi-Cal specialty mental health services issued by the State Department of Health Care Services or a county mental health plan to which the department has delegated mental health program approval authority, pursuant to Section 4096.5 of this code or Section 1810.435 or 1810.436 of Title 9 of the California Code of Regulations. All foster family agencies that are certified as a Medi-Cal specialty mental health provider pursuant to Section 1810.435 of Title 9 of the California Code of Regulations shall maintain the level of care and services necessary to meet the needs of children and youth in their care and shall maintain and have in good standing the Medi-Cal specialty mental health provider certification issued by the State Department of Health Care Services or a county mental health plan to which the department has delegated certification authority.
(f)(g)The assessments described in subparagraphs (A), (B), (C), and (D) of paragraph (3) of subdivision (b) shall ensure the childs individual behavioral or treatment needs are consistent with, and can be met by, the facility and shall be made by one of the following, as applicable:
(1)An interagency placement committee, as described in Section 4096, considering the recommendations from the child and family team, if any are available. If the short-term residential therapeutic program serves children who are placed by county child welfare agencies and children who are placed by probation departments, the interagency placement committee shall also ensure the requirements of subdivision (c) of Section 16514 have been met with respect to commonality of need.
(2)A licensed mental health professional as defined in subdivision (g) of Section 4096.
(3)An individualized education program team. For the purposes of this section, an AFDC-FC funded child with an individualized education program developed pursuant to Article 2 (commencing with Section 56320) of Chapter 4 of Part 30 of Division 4 of Title 2 of the Education Code that assesses the child as seriously emotionally disturbed, as defined in, and subject to, this section and recommends out-of-home placement at the level of care provided by the provider, shall be deemed to have met the assessment requirement.
(g)(4)The evaluation placing agency, with input from the child and family team. The assessment described in subparagraph (A) (D) of paragraph (3) of subdivision (h) (b) shall be made pursuant to subdivision (b) of Section 706.6 or paragraph (2) of subdivision (c) (d) of Section 16501.1.
(h)(1)The provider shall ensure that AFDC-FC funded children, assessed pursuant to subparagraphs (A) and (B) of paragraph (3) of subdivision (b), who are accepted for placement have been approved for placement by an interagency placement committee, as described in Section 4096, except as provided for in paragraphs (3) and (4) of subdivision (f). (g).
(2)The approval shall be in writing and shall indicate that the interagency placement committee has determined one of the following:
(A)The child meets the medical necessity criteria for Medi-Cal specialty mental health services, as provided for in Section 1830.205 or 1830.210 of Title 9 of the California Code of Regulations.
(B)The child is seriously emotionally disturbed, as described in subdivision (a) of Section 5600.3.
(3)(A)Nothing in subdivisions (a) to (h), (g), inclusive, or this subdivision shall prevent an emergency placement of a child or youth into a certified short-term residential therapeutic program or childrens crisis residential program prior to the determination by the interagency placement committee, but only if a licensed mental health professional, as defined in subdivision (g) of Section 4096, has made a written determination within 72 hours of the childs or youths placement, that the child or youth requires the level of services and supervision provided by the short-term residential therapeutic program in order to meet his or her behavioral or therapeutic needs. needs, or has made a written determination within 24 hours of the childs or youths placement in a childrens crisis residential program that the child or youth is experiencing a mental health crisis as defined in subdivision (c) and is in need of the care and services provided by the childrens crisis residential program. If the short-term residential therapeutic program serves children placed by county child welfare agencies and children placed by probation departments, the interagency placement committee shall also ensure the requirements of subdivision (c) of Section 16514 have been met with respect to commonality of need.
(i)The interagency placement committee, as appropriate, shall, within 30 days of placement, make the determinations, with recommendations from the child and family team, required by this subdivision.
(ii)If it determines the placement is appropriate, the interagency placement committee, with recommendations from the child and family team, shall transmit the approval, in writing, to the county placing agency and the short-term residential therapeutic program.
(iii)If it determines the placement is not appropriate, the interagency placement committee shall respond pursuant to subparagraph (B).
(B)(i)If the interagency placement committee determines at any time that the placement is not appropriate, it shall, with recommendations from the child and family team, transmit the disapproval, in writing, to the county placing agency and the short-term residential therapeutic program and shall include a recommendation as to the childs appropriate level of care and placement to meet his or her service needs. The necessary interagency placement committee representative or representatives shall participate in any child and family team meetings to refer the child or youth to an appropriate placement, as specified in this section.
(ii)The child may remain in the placement for the amount of time necessary to identify and transition the child to an alternative, suitable placement.
(iii)Notwithstanding clause (ii), if the interagency placement committee determined the placement was not appropriate due to a health and safety concern, immediate arrangements for the child to transition to an appropriate placement shall occur.
(i)Commencing January 1, 2017, for AFDC-FC funded children or youth, only those children or youth who are approved for placement, as set forth in this section, may be accepted by a short-term residential therapeutic program.
(j)The department shall, through regulation, establish consequences for the failure of a short-term residential therapeutic program to obtain written approval for placement of an AFDC-FC funded child or youth pursuant to this section.
(k)The department shall not establish a rate for a short-term residential therapeutic program unless the provider submits a recommendation from the host county or the primary placing county that the program is needed and that the provider is willing and capable of operating the program at the level sought. For purposes of this subdivision, host county, and primary placing county, mean the same as defined in the departments AFDC-FC ratesetting regulations.
(l) Any certified short-term residential therapeutic program shall be reclassified and paid at the appropriate program rate for which it is qualified if either of the following occurs:
(1)(A)It fails to maintain the level of care and services necessary to meet the needs of the children and youth in care, as required by subdivision (a). The determination shall be made consistent with the departments AFDC-FC ratesetting regulations developed pursuant to Section 11462 and shall take into consideration the highest level of care and associated rates for which the program may be eligible if granted an extension pursuant to Section 11462.04 or any reduction in rate associated with a provisional or probationary rate granted or imposed under Section 11466.01.
(B)In the event of a determination under this paragraph, the short-term residential therapeutic program may appeal the finding or submit a corrective action plan. The appeal process specified in Section 11466.6 shall be available to a short-term residential therapeutic program that provides intensive and therapeutic treatment. During any appeal, the short-term residential therapeutic program that provides intensive and therapeutic treatment shall maintain the appropriate level of care.
(2)It fails to maintain a certified mental health treatment program as required by subdivision (e). (f).
(m)In addition to any other review required by law, the child and family team as defined in paragraph (4) of subdivision (a) of Section 16501 may periodically review the placement of the child or youth. If the child and family team make a recommendation that the child or youth no longer needs, or is not benefiting from, placement in a short-term residential therapeutic program, the team shall transmit the disapproval, in writing, to the county placing agency to consider a more appropriate placement.
(n)The department shall develop a process to address placements when, subsequent to the childs or youths placement, a determination is made by the interagency placement team and shall consider the recommendations of the child and family team, either that the child or youth is not in need of the care and services provided by the certified program. The process shall include, but not be limited to:
(1)Notice of the determination in writing to both the county placing agency and the short-term residential therapeutic program or foster family agency that provides intensive and therapeutic treatment.
(2)Notice of the countys plan, and a time frame, timeframe, for removal of the child or youth in writing to the short-term residential therapeutic program that provides intensive and therapeutic treatment.
(3)Referral to an appropriate placement.
(4)Actions to be taken if a child or youth is not timely removed from the short-term residential therapeutic program that provides intensive and therapeutic treatment or placed in an appropriate placement.
(o)(1)Nothing in this section shall prohibit a short-term residential therapeutic program from accepting private placements admissions of children or youth.
(2)When a referral is not from a public agency and no public funding is not involved, there is no requirement for public agency review or determination of need.
(3)Children and youth subject to paragraphs (1) and (2) shall have been determined to be seriously emotionally disturbed, as described in subdivision (a) of Section 5600.3, and subject to Section 1502.4 of the Health and Safety Code, by a licensed mental health professional, as defined in subdivision (g) of Section 4096.
SEC. 7.Section 11462.011 is added to the Welfare and Institutions Code, to read:11462.011.(a)The State Department of Health Care Services shall, in consultation with the Department of Managed Health Care, the State Department of Social Services, the County Behavioral Health Directors Association of California, the County Welfare Directors Association of California, the Chief Probation Officers of California, provider representatives, and other relevant stakeholders, establish program standards and procedures for oversight, enforcement, and issuance of childrens crisis residential mental health program approvals, including provisional approvals that are effective for a period of less than one year. The State Department of Health Care Services shall also establish due process protections related to the childrens crisis residential mental health program approval process.
(b)The State Department of Health Care Services shall, in collaboration with the department, the County Behavioral Health Directors Association of California, provider representatives, and other relevant stakeholders, provide guidance to counties for the provision of childrens crisis residential services, including funding for children who are Medi-Cal beneficiaries and who are admitted to a childrens crisis residential program. This subdivision shall only be implemented to the extent that any necessary federal approvals are obtained and federal financial participation is available and is not otherwise jeopardized.
(c)(1)The childrens crisis residential program shall be used only as a diversion to admittance to a psychiatric hospital.
(2)(A)The length of the initial authorization for admission to a childrens crisis residential program shall be limited to 10 consecutive days.
(B)If a determination is made by a health care professional that a childrens crisis residential program is medically necessary and is the appropriate continued level of care, either of the following shall occur:
(i)In the case of a Medi-Cal beneficiary, the childrens crisis residential program shall notify the county mental health plan authorizing those services before extending the length of stay beyond 10 consecutive days.
(ii)In the case of non-Medi-Cal beneficiaries, reauthorizations for admission shall be obtained using the process established by the entity providing coverage.
(C)With the exception of clause (ii) of this subparagraph, subparagraph (B), this paragraph shall be implemented only to the extent that any necessary federal approvals are obtained and the State Department of Health Care Services determines, in its sole discretion, that federal financial participation is not jeopardized.
(d)A childrens crisis residential mental health program approval issued by the State Department of Health Care Services, or a county mental health plan to which the department has delegated approval authority, shall be a condition of continued licensure for a short-term residential therapeutic program operating as a childrens crisis residential program.
(e)The State Department of Health Care Services, or a county mental health plan to which the department has delegated approval authority, may enforce the childrens crisis residential mental health program approval standards by taking any of the following actions against a noncompliant childrens crisis residential program:
(1)Suspend or revoke a childrens crisis residential mental health program approval.
(2)Impose monetary penalties.
(3)Place a childrens crisis residential mental health program on probation.
(4)Require a childrens crisis residential mental health program to prepare and comply with a corrective action plan.
(f)The State Department of Health Care Services, or a county mental health plan to which the department has delegated approval authority, shall provide a childrens crisis residential mental health program with due process protections when taking any of the actions described in subdivision (e).
(g)Contingent upon an appropriation in the annual Budget Act for these purposes, the department shall begin implementation of this section no later than July 1, 2018, and shall commence the operation of the approval process for childrens crisis residential mental health program approvals no later than January 1, 2019.
SEC. 8.(a)Contingent upon an appropriation from the annual Budget Act for these purposes, the State Department of Social Services and the State Department of Health Care Services shall adopt regulations to implement this act no later than July 1, 2021. 2022.
(b)Notwithstanding the rulemaking provisions of the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code), the State Department of Social Services and the State Department of Health Care Services may implement and administer the changes made by this act through information notices, all-county letters, or similar written instructions until regulations are adopted.
(c)This section shall become effective upon appropriation of funds by the Legislature for the purposes described in this section.
SEC. 9.The provisions amended or added by this act shall be implemented only if, and to the extent that, federal financial participation, as provided under Title XIX of the federal Social Security Act (42 U.S.C. Sec. 1396 et seq.) is not jeopardized and all necessary federal approvals have been obtained.
SEC. 10.(a)Section 2.5 of this bill incorporates amendments to Section 1502 of the Health and Safety Code proposed by both this bill and Senate Bill 612. That section shall only become operative if (1) both bills are enacted and become effective on or before January 1, 2018, (2) each bill amends Section 1502 of the Health and Safety Code, and (3) this bill is enacted after Senate Bill 612, in which case Section 2 of this bill shall not become operative.
(b)Section 6.5 of this bill incorporates amendments to Section 11462.01 of the Welfare and Institutions Code proposed by both this bill and Assembly Bill 404. That section shall only become operative if (1) both bills are enacted and become effective on or before January 1, 2018, (2) each bill amends Section 11462.01 of the Welfare and Institutions Code, and (3) this bill is enacted after Assembly Bill 404, in which case Section 6 of this bill shall not become operative.
SEC. 10.SEC. 11.No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution.
The Legislature finds and declares all of the following:
(a)There is an urgent need to provide more crisis care alternatives to hospitals for children and youth experiencing mental health crises.
(b)The problems are especially acute for children and youth who may have to wait for days for a hospital bed and who may be transported, without a parent, to the nearest facility hundreds of miles away.
(c)In 2012, the California Hospital Association reported that two-thirds of the people taken to a hospital for a psychiatric emergency did not meet the criteria for that level of care, but the care they needed was not available.
(d)The type of care that is needed includes crisis residential treatment for children.
(e)This level of care is part of the full continuum of care considered medically necessary for many children with serious emotional disturbances.
(f)In 2013, the Legislature enacted the Investment in Mental Health Wellness Act (Senate Bill 82, Chapter 34 of the Statutes of 2013) to provide one-time funding to counties to expand the availability of mental health crisis care services, including short-term crisis residential treatment services. However, there is currently no state licensing category for short-term crisis residential programs for children. As a result, counties wanting to expand local capacity to meet the needs of children and youth for crisis residential treatment services were ineligible for this competitive grant program.
(g)In most communities, inpatient crisis treatment is completely unavailable for children and youth, even though it may be medically necessary.
(h)Crisis residential care is an essential level of care for the treatment of children and youth with serious emotional disturbances in a mental health crisis, and it often serves as an alternative to hospitalization.
(i)It is imperative that California identify a licensing category specifically for mental health crisis residential care that can be utilized for children and youth who are beneficiaries of both public and private health care plans.
SEC. 2.Section 1502 of the Health and Safety Code is amended to read:1502.As used in this chapter:
(a)Community care facility means any facility, place, or building that is maintained and operated to provide nonmedical residential care, day treatment, adult day care, or foster family agency services for children, adults, or children and adults, including, but not limited to, the physically handicapped, mentally impaired, incompetent persons, and abused or neglected children, and includes the following:
(1)Residential facility means any family home, group care facility, or similar facility determined by the department, for 24-hour nonmedical care of persons in need of personal services, supervision, or assistance essential for sustaining the activities of daily living or for the protection of the individual.
(2)Adult day program means any community-based facility or program that provides care to persons 18 years of age or older in need of personal services, supervision, or assistance essential for sustaining the activities of daily living or for the protection of these individuals on less than a 24-hour basis.
(3)Therapeutic day services facility means any facility that provides nonmedical care, counseling, educational or vocational support, or social rehabilitation services on less than a 24-hour basis to persons under 18 years of age who would otherwise be placed in foster care or who are returning to families from foster care. Program standards for these facilities shall be developed by the department, pursuant to Section 1530, in consultation with therapeutic day services and foster care providers.
(4)Foster family agency means any public agency or private organization, organized and operated on a nonprofit basis, engaged in any of the following:
(A)Recruiting, certifying, approving, and training of, and providing professional support to, foster parents and resource families.
(B)Coordinating with county placing agencies to find homes for foster children in need of care.
(C)Providing services and supports to licensed or certified foster parents, county-approved resource families, and children to the extent authorized by state and federal law.
(5)Foster family home means any residential facility providing 24-hour care for six or fewer foster children that is owned, leased, or rented and is the residence of the foster parent or parents, including their family, in whose care the foster children have been placed. The placement may be by a public or private child placement agency or by a court order, or by voluntary placement by a parent, parents, or guardian. It also means a foster family home described in Section 1505.2.
(6)Small family home means any residential facility, in the licensees family residence, that provides 24-hour care for six or fewer foster children who have mental disorders or developmental or physical disabilities and who require special care and supervision as a result of their disabilities. A small family home may accept children with special health care needs, pursuant to subdivision (a) of Section 17710 of the Welfare and Institutions Code. In addition to placing children with special health care needs, the department may approve placement of children without special health care needs, up to the licensed capacity.
(7)Social rehabilitation facility means any residential facility that provides social rehabilitation services for no longer than 18 months in a group setting to adults recovering from mental illness who temporarily need assistance, guidance, or counseling. Program components shall be subject to program standards pursuant to Article 1 (commencing with Section 5670) of Chapter 2.5 of Part 2 of Division 5 of the Welfare and Institutions Code.
(8)Community treatment facility means any residential facility that provides mental health treatment services to children in a group setting and that has the capacity to provide secure containment. Program components shall be subject to program standards developed and enforced by the State Department of Health Care Services pursuant to Section 4094 of the Welfare and Institutions Code.
Nothing in this section shall be construed to prohibit or discourage placement of persons who have mental or physical disabilities into any category of community care facility that meets the needs of the individual placed, if the placement is consistent with the licensing regulations of the department.
(9)Full-service adoption agency means any licensed entity engaged in the business of providing adoption services, that does all of the following:
(A)Assumes care, custody, and control of a child through relinquishment of the child to the agency or involuntary termination of parental rights to the child.
(B)Assesses the birth parents, prospective adoptive parents, or child.
(C)Places children for adoption.
(D)Supervises adoptive placements.
Private full-service adoption agencies shall be organized and operated on a nonprofit basis. As a condition of licensure to provide intercountry adoption services, a full-service adoption agency shall be accredited and in good standing according to Part 96 (commencing with Section 96.1) of Title 22 of the Code of Federal Regulations, or supervised by an accredited primary provider, or acting as an exempted provider, in compliance with Subpart F (commencing with Section 96.29) of Part 96 of Title 22 of the Code of Federal Regulations.
(10)Noncustodial adoption agency means any licensed entity engaged in the business of providing adoption services, that does all of the following:
(A)Assesses the prospective adoptive parents.
(B)Cooperatively matches children freed for adoption, who are under the care, custody, and control of a licensed adoption agency, for adoption, with assessed and approved adoptive applicants.
(C)Cooperatively supervises adoption placements with a full-service adoptive agency, but does not disrupt a placement or remove a child from a placement.
Private noncustodial adoption agencies shall be organized and operated on a nonprofit basis. As a condition of licensure to provide intercountry adoption services, a noncustodial adoption agency shall be accredited and in good standing according to Part 96 (commencing with Section 96.1) of Title 22 of the Code of Federal Regulations, or supervised by an accredited primary provider, or acting as an exempted provider, in compliance with Subpart F (commencing with Section 96.29) of Part 96 of Title 22 of the Code of Federal Regulations.
(11)Transitional shelter care facility means any group care facility that provides for 24-hour nonmedical care of persons in need of personal services, supervision, or assistance essential for sustaining the activities of daily living or for the protection of the individual. Program components shall be subject to program standards developed by the State Department of Social Services pursuant to Section 1502.3.
(12)Transitional housing placement provider means an organization licensed by the department pursuant to Section 1559.110 and Section 16522.1 of the Welfare and Institutions Code to provide transitional housing to foster children at least 16 years of age and not more than 18 years of age, and nonminor dependents, as defined in subdivision (v) of Section 11400 of the Welfare and Institutions Code, to promote their transition to adulthood. A transitional housing placement provider shall be privately operated and organized on a nonprofit basis.
(13)Group home means a residential facility that provides 24-hour care and supervision to children, delivered at least in part by staff employed by the licensee in a structured environment. The care and supervision provided by a group home shall be nonmedical, except as otherwise permitted by law.
(14)Runaway and homeless youth shelter means a group home licensed by the department to operate a program pursuant to Section 1502.35 to provide voluntary, short-term, shelter and personal services to runaway youth or homeless youth, as defined in paragraph (2) of subdivision (a) of Section 1502.35.
(15)Enhanced behavioral supports home means a facility certified by the State Department of Developmental Services pursuant to Article 3.6 (commencing with Section 4684.80) of Chapter 6 of Division 4.5 of the Welfare and Institutions Code, and licensed by the State Department of Social Services as an adult residential facility or a group home that provides 24-hour nonmedical care to individuals with developmental disabilities who require enhanced behavioral supports, staffing, and supervision in a homelike setting. An enhanced behavioral supports home shall have a maximum capacity of four consumers, shall conform to Section 441.530(a)(1) of Title 42 of the Code of Federal Regulations, and shall be eligible for federal Medicaid home- and community-based services funding.
(16)Community crisis home means a facility certified by the State Department of Developmental Services pursuant to Article 8 (commencing with Section 4698) of Chapter 6 of Division 4.5 of the Welfare and Institutions Code, and licensed by the State Department of Social Services pursuant to Article 9.7 (commencing with Section 1567.80), as an adult residential facility, providing 24-hour nonmedical care to individuals with developmental disabilities receiving regional center service, in need of crisis intervention services, and who would otherwise be at risk of admission to the acute crisis center at Fairview Developmental Center, Sonoma Developmental Center, an acute general hospital, acute psychiatric hospital, an institution for mental disease, as described in Part 5 (commencing with Section 5900) of Division 5 of the Welfare and Institutions Code, or an out-of-state placement. A community crisis home shall have a maximum capacity of eight consumers, as defined in subdivision (a) of Section 1567.80, shall conform to Section 441.530(a)(1) of Title 42 of the Code of Federal Regulations, and shall be eligible for federal Medicaid home- and community-based services funding.
(17)Crisis nursery means a facility licensed by the department to operate a program pursuant to Section 1516 to provide short-term care and supervision for children under six years of age who are voluntarily placed for temporary care by a parent or legal guardian due to a family crisis or stressful situation.
(18)Short-term residential therapeutic program means a residential facility operated by a public agency or private organization and licensed by the department pursuant to Section 1562.01 that provides an integrated program of specialized and intensive care and supervision, services and supports, treatment, and short-term, 24-hour care and supervision to children. The care and supervision provided by a short-term residential therapeutic program shall be nonmedical, except as otherwise permitted by law. Private short-term residential therapeutic programs shall be organized and operated on a nonprofit basis. A short-term residential therapeutic program may be operated as a childrens crisis residential program.
(19)Private alternative boarding school means a group home licensed by the department to operate a program pursuant to Section 1502.2 to provide youth with 24-hour residential care and supervision, which, in addition to providing educational services to youth, provides, or holds itself out as providing, behavioral-based services to youth with social, emotional, or behavioral issues. The care and supervision provided by a private alternative boarding school shall be nonmedical, except as otherwise permitted by law.
(20)Private alternative outdoor program means a group home licensed by the department to operate a program pursuant to Section 1502.21 to provide youth with 24-hour residential care and supervision, which provides, or holds itself out as providing, behavioral-based services in an outdoor living setting to youth with social, emotional, or behavioral issues. The care and supervision provided by a private alternative outdoor program shall be nonmedical, except as otherwise permitted by law.
(21)Childrens crisis residential program means a facility licensed by the department as a short-term residential therapeutic program pursuant to Section 1562.02 and approved by the State Department of Health Care Services, or a county mental health plan to which the State Department of Health Care Services has delegated approval authority, to operate a childrens crisis residential mental health program approval pursuant to Section 11462.011 of the Welfare and Institutions Code, to serve children experiencing mental health crises as an alternative to psychiatric hospitalization.
(b)Department or state department means the State Department of Social Services.
(c)Director means the Director of Social Services.
SEC. 3.Section 1562.02 is added to the Health and Safety Code, to read:1562.02.(a)The department may license a short-term residential therapeutic program operating as a childrens crisis residential program pursuant to this chapter. A childrens crisis residential program shall meet all of the following requirements:
(1)If the program serves children who are not experiencing mental health crises, have an identifiable and physically separate unit for those children who are experiencing mental health crises. The separate unit shall be indicated on the short-term residential therapeutic programs license.
(2)Obtain and have in good standing a mental health program approval that includes a Medi-Cal mental health certification, as described in Section 11462.01 of the Welfare and Institutions Code, and a childrens crisis residential mental health program approval, as described in Section 11462.011 of the Welfare and Institutions Code, both of which are issued by the State Department of Health Care Services, or a county mental health plan to which the department has delegated approval authority. The short-term residential therapeutic program shall obtain a mental health program approval before operating as a childrens crisis residential program. The department may revoke a programs license pursuant to Section 1550 for a programs failure to maintain the mental health program approval.
(3)Comply with all applicable licensing standards for a short-term residential therapeutic program, unless otherwise specified by the department in regulations. specifies otherwise in regulations that comply with applicable statutory requirements related to licensure.
(b)Contingent upon an appropriation in the annual Budget Act for these purposes, the department shall begin implementation of this section no later than July 1, 2018, and shall commence the licensing process for childrens crisis residential programs no later than January 1, 2019.
SEC. 4.Section 1562.03 is added to the Health and Safety Code, to read:1562.03.(a)The department shall establish regulations for short-term residential therapeutic programs that are operated as childrens crisis residential programs. At a minimum, the regulations shall include all of the following:
(1)Therapeutic programming shall be provided seven days a week, including weekends and holidays, with sufficient mental health professional and paraprofessional staff to maintain an appropriate treatment setting and services, based on individual childrens needs.
(2)The program shall be staffed with sufficient personnel to accept children 24 hours per day, seven days a week and to admit children, at a minimum, from 7 a.m. to 11 p.m., seven days a week, 365 days per year. The program shall be sufficiently staffed to discharge children, as appropriate, seven days a week, 365 days per year.
(3)Facilities shall be limited to fewer than 16 beds, with at least 50 percent of those beds in single-occupancy rooms.
(4)Facilities shall include ample physical space for accommodating individuals who provide daily emotional and physical supports to each child and for integrating family members into the day-to-day care of the youth.
(5)The program shall collaborate with each childs existing mental health team, if applicable, child and family team, if applicable, and other formal and natural supports within 24 hours of intake and throughout the course of care and treatment as appropriate.
(6)The program shall create and assist with the implementation of a plan for transitioning each admitted child from the program to his or her home and community, including the establishment of a mental health or child and family team if there is not one already.
(b)The program shall annually provide the department with all of the following data as it pertains to children in foster care and children not in foster care in conjunction with its application for licensure renewal:
(1)Age and gender of clients served.
(2)Duration of stay.
(3)Professional classification of staff and contracted staff.
(4)Type of placement the client was discharged to.
SEC. 5.Section 5848.5 of the Welfare and Institutions Code is amended to read:5848.5.(a)The Legislature finds and declares all of the following:
(1)California has realigned public community mental health services to counties and it is imperative that sufficient community-based resources be available to meet the mental health needs of eligible individuals.
(2)Increasing access to effective outpatient and crisis stabilization services provides an opportunity to reduce costs associated with expensive inpatient and emergency room care and to better meet the needs of individuals with mental health disorders in the least restrictive manner possible.
(3)Almost one-fifth of people with mental health disorders visit a hospital emergency room at least once per year. If an adequate array of crisis services is not available, it leaves an individual with little choice but to access an emergency room for assistance and, potentially, an unnecessary inpatient hospitalization.
(4)Recent reports have called attention to a continuing problem of inappropriate and unnecessary utilization of hospital emergency rooms in California due to limited community-based services for individuals in psychological distress and acute psychiatric crisis. Hospitals report that 70 percent of people taken to emergency rooms for psychiatric evaluation can be stabilized and transferred to a less intensive level of crisis care. Law enforcement personnel report that their personnel need to stay with people in the emergency room waiting area until a placement is found, and that less intensive levels of care tend not to be available.
(5)Comprehensive public and private partnerships at both local and regional levels, including across physical health services, mental health, substance use disorder, law enforcement, social services, and related supports, are necessary to develop and maintain high quality, patient-centered, and cost-effective care for individuals with mental health disorders that facilitates their recovery and leads towards wellness.
(6)The recovery of individuals with mental health disorders is important for all levels of government, business, and the local community.
(b)This section shall be known, and may be cited, as the Investment in Mental Health Wellness Act of 2013. The objectives of this section are to do all of the following:
(1)Expand access to early intervention and treatment services to improve the client experience, achieve recovery and wellness, and reduce costs.
(2)Expand the continuum of services to address crisis intervention, crisis stabilization, and crisis residential treatment needs that are wellness, resiliency, and recovery oriented.
(3)Add at least 25 mobile crisis support teams and at least 2,000 crisis stabilization and crisis residential treatment beds to bolster capacity at the local level to improve access to mental health crisis services and address unmet mental health care needs.
(4)Add at least 600 triage personnel to provide intensive case management and linkage to services for individuals with mental health care disorders at various points of access, such as at designated community-based service points, homeless shelters, and clinics.
(5)Reduce unnecessary hospitalizations and inpatient days by appropriately utilizing community-based services and improving access to timely assistance.
(6)Reduce recidivism and mitigate unnecessary expenditures of local law enforcement.
(7)Provide local communities with increased financial resources to leverage additional public and private funding sources to achieve improved networks of care for individuals with mental health disorders.
(8)Provide a complete continuum of crisis services for children and youth 21 years of age and under regardless of where they live in the state. The funds included in the 2016 Budget Act for the purpose of developing the continuum of mental health crisis services for children and youth 21 years of age and under shall be for the following objectives:
(A)Provide a continuum of crisis services for children and youth 21 years of age and under regardless of where they live in the state.
(B)Provide for early intervention and treatment services to improve the client experience, achieve recovery and wellness, and reduce costs.
(C)Expand the continuum of community-based services to address crisis intervention, crisis stabilization, and crisis residential treatment needs that are wellness-, resiliency-, and recovery-oriented.
(D)Add at least 200 mobile crisis support teams.
(E)Add at least 120 crisis stabilization services and beds and crisis residential treatment beds to increase capacity at the local level to improve access to mental health crisis services and address unmet mental health care needs.
(F)Add triage personnel to provide intensive case management and linkage to services for individuals with mental health care disorders at various points of access, such as at designated community-based service points, homeless shelters, schools, and clinics.
(G)Expand family respite care to help families and sustain caregiver health and well-being.
(H)Expand family supportive training and related services designed to help families participate in the planning process, access services, and navigate programs.
(I)Reduce unnecessary hospitalizations and inpatient days by appropriately utilizing community-based services.
(J)Reduce recidivism and mitigate unnecessary expenditures of local law enforcement.
(K)Provide local communities with increased financial resources to leverage additional public and private funding sources to achieve improved networks of care for children and youth 21 years of age and under with mental health disorders.
(c)Through appropriations provided in the annual Budget Act for this purpose, it is the intent of the Legislature to authorize the California Health Facilities Financing Authority, hereafter referred to as the authority, and the Mental Health Services Oversight and Accountability Commission, hereafter referred to as the commission, to administer competitive selection processes as provided in this section for capital capacity and program expansion to increase capacity for mobile crisis support, crisis intervention, crisis stabilization services, crisis residential treatment, and specified personnel resources.
(d)Funds appropriated by the Legislature to the authority for purposes of this section shall be made available to selected counties, or counties acting jointly. The authority may, at its discretion, also give consideration to private nonprofit corporations and public agencies in an area or region of the state if a county, or counties acting jointly, affirmatively supports this designation and collaboration in lieu of a county government directly receiving grant funds.
(1)Grant awards made by the authority shall be used to expand local resources for the development, capital, equipment acquisition, and applicable program startup or expansion costs to increase capacity for client assistance and services in the following areas:
(A)Crisis intervention, as authorized by Sections 14021.4, 14680, and 14684.
(B)Crisis stabilization, as authorized by Sections 14021.4, 14680, and 14684.
(C)Crisis residential treatment, as authorized by Sections 14021.4, 14680, and 14684 and as provided at a childrens crisis residential program, as defined in Section 1502 of the Health and Safety Code.
(D)Rehabilitative mental health services, as authorized by Sections 14021.4, 14680, and 14684.
(E)Mobile crisis support teams, including personnel and equipment, such as the purchase of vehicles.
(2)The authority shall develop selection criteria to expand local resources, including those described in paragraph (1), and processes for awarding grants after consulting with representatives and interested stakeholders from the mental health community, including, but not limited to, the County Behavioral Health Directors Association of California, service providers, consumer organizations, and other appropriate interests, such as health care providers and law enforcement, as determined by the authority. The authority shall ensure that grants result in cost-effective expansion of the number of community-based crisis resources in regions and communities selected for funding. The authority shall also take into account at least the following criteria and factors when selecting recipients of grants and determining the amount of grant awards:
(A)Description of need, including, at a minimum, a comprehensive description of the project, community need, population to be served, linkage with other public systems of health and mental health care, linkage with local law enforcement, social services, and related assistance, as applicable, and a description of the request for funding.
(B)Ability to serve the target population, which includes individuals eligible for Medi-Cal and individuals eligible for county health and mental health services.
(C)Geographic areas or regions of the state to be eligible for grant awards, which may include rural, suburban, and urban areas, and may include use of the five regional designations utilized by the County Behavioral Health Directors Association of California.
(D)Level of community engagement and commitment to project completion.
(E)Financial support that, in addition to a grant that may be awarded by the authority, will be sufficient to complete and operate the project for which the grant from the authority is awarded.
(F)Ability to provide additional funding support to the project, including public or private funding, federal tax credits and grants, foundation support, and other collaborative efforts.
(G)Memorandum of understanding among project partners, if applicable.
(H)Information regarding the legal status of the collaborating partners, if applicable.
(I)Ability to measure key outcomes, including improved access to services, health and mental health outcomes, and cost benefit of the project.
(3)The authority shall determine maximum grants awards, which shall take into consideration the number of projects awarded to the grantee, as described in paragraph (1), and shall reflect reasonable costs for the project and geographic region. The authority may allocate a grant in increments contingent upon the phases of a project.
(4)Funds awarded by the authority pursuant to this section may be used to supplement, but not to supplant, existing financial and resource commitments of the grantee or any other member of a collaborative effort that has been awarded a grant.
(5)All projects that are awarded grants by the authority shall be completed within a reasonable period of time, to be determined by the authority. Funds shall not be released by the authority until the applicant demonstrates project readiness to the authoritys satisfaction. If the authority determines that a grant recipient has failed to complete the project under the terms specified in awarding the grant, the authority may require remedies, including the return of all or a portion of the grant.
(6)A grantee that receives a grant from the authority under this section shall commit to using that capital capacity and program expansion project, such as the mobile crisis team, crisis stabilization unit, or crisis residential treatment program, for the duration of the expected life of the project.
(7)The authority may consult with a technical assistance entity, as described in paragraph (5) of subdivision (a) of Section 4061, for purposes of implementing this section.
(8)The authority may adopt emergency regulations relating to the grants for the capital capacity and program expansion projects described in this section, including emergency regulations that define eligible costs and determine minimum and maximum grant amounts.
(9)The authority shall provide reports to the fiscal and policy committees of the Legislature on or before May 1, 2014, and on or before May 1, 2015, on the progress of implementation, that include, but are not limited to, the following:
(A)A description of each project awarded funding.
(B)The amount of each grant issued.
(C)A description of other sources of funding for each project.
(D)The total amount of grants issued.
(E)A description of project operation and implementation, including who is being served.
(10)A recipient of a grant provided pursuant to paragraph (1) shall adhere to all applicable laws relating to scope of practice, licensure, certification, staffing, and building codes.
(e)Of the funds specified in paragraph (8) of subdivision (b), it is the intent of the Legislature to authorize the authority and the commission to administer competitive selection processes as provided in this section for capital capacity and program expansion to increase capacity for mobile crisis support, crisis intervention, crisis stabilization services, crisis residential treatment, family respite care, family supportive training and related services, and triage personnel resources for children and youth 21 years of age and under.
(f)Funds appropriated by the Legislature to the authority to address crisis services for children and youth 21 years of age and under for the purposes of this section shall be made available to selected counties or counties acting jointly. The authority may, at its discretion, also give consideration to private nonprofit corporations and public agencies in an area or region of the state if a county, or counties acting jointly, affirmatively support this designation and collaboration in lieu of a county government directly receiving grant funds.
(1)Grant awards made by the authority shall be used to expand local resources for the development, capital, equipment acquisition, and applicable program startup or expansion costs to increase capacity for client assistance and crisis services for children and youth 21 years of age and under in the following areas:
(A)Crisis intervention, as authorized by Sections 14021.4, 14680, and 14684.
(B)Crisis stabilization, as authorized by Sections 14021.4, 14680, and 14684.
(C)Crisis residential treatment, as authorized by Sections 14021.4, 14680, and 14684 and as provided at a childrens crisis residential program, as defined in Section 1502 of the Health and Safety Code.
(D)Mobile crisis support teams, including the purchase of equipment and vehicles.
(E)Family respite care.
(2)The authority shall develop selection criteria to expand local resources, including those described in paragraph (1), and processes for awarding grants after consulting with representatives and interested stakeholders from the mental health community, including, but not limited to, county mental health directors, service providers, consumer organizations, and other appropriate interests, such as health care providers and law enforcement, as determined by the authority. The authority shall ensure that grants result in cost-effective expansion of the number of community-based crisis resources in regions and communities selected for funding. The authority shall also take into account at least the following criteria and factors when selecting recipients of grants and determining the amount of grant awards:
(A)Description of need, including, at a minimum, a comprehensive description of the project, community need, population to be served, linkage with other public systems of health and mental health care, linkage with local law enforcement, social services, and related assistance, as applicable, and a description of the request for funding.
(B)Ability to serve the target population, which includes individuals eligible for Medi-Cal and individuals eligible for county health and mental health services.
(C)Geographic areas or regions of the state to be eligible for grant awards, which may include rural, suburban, and urban areas, and may include use of the five regional designations utilized by the California Behavioral Health Directors Association.
(D)Level of community engagement and commitment to project completion.
(E)Financial support that, in addition to a grant that may be awarded by the authority, will be sufficient to complete and operate the project for which the grant from the authority is awarded.
(F)Ability to provide additional funding support to the project, including public or private funding, federal tax credits and grants, foundation support, and other collaborative efforts.
(G)Memorandum of understanding among project partners, if applicable.
(H)Information regarding the legal status of the collaborating partners, if applicable.
(I)Ability to measure key outcomes, including utilization of services, health and mental health outcomes, and cost benefit of the project.
(3)The authority shall determine maximum grant awards, which shall take into consideration the number of projects awarded to the grantee, as described in paragraph (1), and shall reflect reasonable costs for the project, geographic region, and target ages. The authority may allocate a grant in increments contingent upon the phases of a project.
(4)Funds awarded by the authority pursuant to this section may be used to supplement, but not to supplant, existing financial and resource commitments of the grantee or any other member of a collaborative effort that has been awarded a grant.
(5)All projects that are awarded grants by the authority shall be completed within a reasonable period of time, to be determined by the authority. Funds shall not be released by the authority until the applicant demonstrates project readiness to the authoritys satisfaction. If the authority determines that a grant recipient has failed to complete the project under the terms specified in awarding the grant, the authority may require remedies, including the return of all, or a portion, of the grant.
(6)A grantee that receives a grant from the authority under this section shall commit to using that capital capacity and program expansion project, such as the mobile crisis team, crisis stabilization unit, family respite care, or crisis residential treatment program, for the duration of the expected life of the project.
(7)The authority may consult with a technical assistance entity, as described in paragraph (5) of subdivision (a) of Section 4061, for the purposes of implementing this section.
(8)The authority may adopt emergency regulations relating to the grants for the capital capacity and program expansion projects described in this section, including emergency regulations that define eligible costs and determine minimum and maximum grant amounts.
(9)The authority shall provide reports to the fiscal and policy committees of the Legislature on or before January 10, 2018, and annually thereafter, on the progress of implementation, that include, but are not limited to, the following:
(A)A description of each project awarded funding.
(B)The amount of each grant issued.
(C)A description of other sources of funding for each project.
(D)The total amount of grants issued.
(E)A description of project operation and implementation, including who is being served.
(10)A recipient of a grant provided pursuant to paragraph (1) shall adhere to all applicable laws relating to scope of practice, licensure, certification, staffing, and building codes.
(g)Funds appropriated by the Legislature to the commission for purposes of this section shall be allocated for triage personnel to provide intensive case management and linkage to services for individuals with mental health disorders at various points of access. These funds shall be made available to selected counties, counties acting jointly, or city mental health departments, as determined by the commission through a selection process. It is the intent of the Legislature for these funds to be allocated in an efficient manner to encourage early intervention and receipt of needed services for individuals with mental health disorders, and to assist in navigating the local service sector to improve efficiencies and the delivery of services.
(1)Triage personnel may provide targeted case management services face to face, by telephone, or by telehealth with the individual in need of assistance or his or her significant support person, and may be provided anywhere in the community. These service activities may include, but are not limited to, the following:
(A)Communication, coordination, and referral.
(B)Monitoring service delivery to ensure the individual accesses and receives services.
(C)Monitoring the individuals progress.
(D)Providing placement service assistance and service plan development.
(2)The commission shall take into account at least the following criteria and factors when selecting recipients and determining the amount of grant awards for triage personnel as follows:
(A)Description of need, including potential gaps in local service connections.
(B)Description of funding request, including personnel and use of peer support.
(C)Description of how triage personnel will be used to facilitate linkage and access to services, including objectives and anticipated outcomes.
(D)Ability to obtain federal Medicaid reimbursement, when applicable.
(E)Ability to administer an effective service program and the degree to which local agencies and service providers will support and collaborate with the triage personnel effort.
(F)Geographic areas or regions of the state to be eligible for grant awards, which shall include rural, suburban, and urban areas, and may include use of the five regional designations utilized by the County Behavioral Health Directors Association of California.
(3)The commission shall determine maximum grant awards, and shall take into consideration the level of need, population to be served, and related criteria, as described in paragraph (2), and shall reflect reasonable costs.
(4)Funds awarded by the commission for purposes of this section may be used to supplement, but not supplant, existing financial and resource commitments of the county, counties acting jointly, or city mental health department that received the grant.
(5)Notwithstanding any other law, a county, counties acting jointly, or city mental health department that receives an award of funds for the purpose of supporting triage personnel pursuant to this subdivision is not required to provide a matching contribution of local funds.
(6)Notwithstanding any other law, the commission, without taking any further regulatory action, may implement, interpret, or make specific this section by means of informational letters, bulletins, or similar instructions.
(7)The commission shall provide a status report to the fiscal and policy committees of the Legislature on the progress of implementation no later than March 1, 2014.
(h)Funds appropriated by the Legislature to the commission pursuant to paragraph (8) of subdivision (b) for the purposes of addressing childrens crisis services shall be allocated to support triage personnel and family supportive training and related services. These funds shall be made available to selected counties, counties acting jointly, or city mental health departments, as determined by the commission through a selection process. The commission may, at its discretion, also give consideration to private nonprofit corporations and public agencies in an area or region of the state if a county, or counties acting jointly, affirmatively supports this designation and collaboration in lieu of a county government directly receiving grant funds.
(1)These funds may provide for a range of crisis-related services for a child in need of assistance, or his or her parent, guardian, or caregiver. These service activities may include, but are not limited to, the following:
(A)Intensive coordination of care and services.
(B)Communication, coordination, and referral.
(C)Monitoring service delivery to the child or youth.
(D)Monitoring the childs progress.
(E)Providing placement service assistance and service plan development.
(F)Crisis or safety planning.
(2)The commission shall take into account at least the following criteria and factors when selecting recipients and determining the amount of grant awards for these funds, as follows:
(A)Description of need, including potential gaps in local service connections.
(B)Description of funding request, including personnel.
(C)Description of how personnel and other services will be used to facilitate linkage and access to services, including objectives and anticipated outcomes.
(D)Ability to obtain federal Medicaid reimbursement, when applicable.
(E)Ability to provide a matching contribution of local funds.
(F)Ability to administer an effective service program and the degree to which local agencies and service providers will support and collaborate with the triage personnel effort.
(G)Geographic areas or regions of the state to be eligible for grant awards, which shall include rural, suburban, and urban areas, and may include use of the five regional designations utilized by the County Behavioral Health Directors Association of California.
(3)The commission shall determine maximum grant awards, and shall take into consideration the level of need, population to be served, and related criteria, as described in paragraph (2), and shall reflect reasonable costs.
(4)Funds awarded by the commission for purposes of this section may be used to supplement, but not supplant, existing financial and resource commitments of the county, counties acting jointly, or a city mental health department that received the grant.
(5)Notwithstanding any other law, a county, counties acting jointly, or a city mental health department that receives an award of funds for the purpose of this section is not required to provide a matching contribution of local funds.
(6)Notwithstanding any other law, the commission, without taking any further regulatory action, may implement, interpret, or make specific this section by means of informational letters, bulletins, or similar instructions.
(7)The commission may waive requirements in this section for counties with a population of 100,000 or less, if the commission determines it is in the best interest of the state and meets the intent of the law.
(8)The commission shall provide a status report to the fiscal and policy committees of the Legislature on the progress of implementation no later than January 10, 2018, and annually thereafter.
SEC. 6.Section 11462.01 of the Welfare and Institutions Code, as added by Section 75 of Chapter 773 of the Statutes of 2015, is amended to read:11462.01.(a)(1)If a program will admit Medi-Cal beneficiaries, no later than 12 months following the date of initial licensure, a short-term residential therapeutic program, as defined in subdivision (ad) of Section 11400 of this code and paragraph (18) of subdivision (a) of Section 1502 of the Health and Safety Code, shall obtain a contract, subject to an agreement on rates and terms and conditions, with a county mental health plan to provide specialty mental health services and demonstrate the ability to meet the therapeutic needs of each child, as identified in any of the following:
(A)A mental health assessment.
(B)The childs case plan.
(C)The childs needs and services plan.
(D)Other documentation demonstrating the child has a mental health need.
(2)A short-term residential therapeutic program shall comply with any other mental health program approvals required by the State Department of Health Care Services or by a county mental health plan to which mental health program approval authority has been delegated.
(b)A short-term residential therapeutic program, except as specified in subdivision (c), may accept for placement a child who meets both of the criteria in paragraphs (1) and (2) and at least one of the conditions in paragraph (3).
(1)The child does not require inpatient care in a licensed health facility.
(2)The child has been assessed as requiring the level of services provided in a short-term residential therapeutic program in order to maintain the safety and well-being of the child or others due to behaviors, including those resulting from traumas, that render the child or those around the child unsafe or at risk of harm, or that prevent the effective delivery of needed services and supports provided in the childs own home or in other family settings, such as with a relative, guardian, foster family, resource family, or adoptive family. The assessment shall ensure the child has needs in common with other children or youth in the care of the facility, consistent with subdivision (c) of Section 16514.
(3)The child meets at least one of the following conditions:
(A)The child has been assessed, pursuant to Section 4096, as meeting the medical necessity criteria for Medi-Cal specialty mental health services, as provided for in Section 1830.205 or 1830.210 of Title 9 of the California Code of Regulations.
(B)The child has been assessed, pursuant to Section 4096, as seriously emotionally disturbed, as defined in subdivision (a) of Section 5600.3.
(C)The child requires emergency placement pursuant to paragraph (3) of subdivision (i).
(D)The child has been assessed, pursuant to Section 4096, as requiring the level of services provided by the short-term residential therapeutic program in order to meet his or her behavioral or therapeutic needs.
(4)Subject to the requirements of this subdivision, a short-term residential therapeutic program may have a specialized program to serve a child, including, but not limited to, the following:
(A)A commercially sexually exploited child.
(B)A private voluntary placement, if the youth exhibits status offender behavior, the parents or other relatives feel they cannot control the childs behavior, and short-term intervention is needed to transition the child back into the home.
(C)A juvenile sex offender.
(D)A child who is affiliated with, or impacted by, a gang.
(c)(1)A short-term residential therapeutic program that is operating as a childrens crisis residential program, as defined in Section 1502 of the Health and Safety Code, may accept for admission any child who meets all of the following requirements:
(A)The child is referred by a parent or guardian, physician, or licensed mental health professional, or by the representative of a public or private entity, including, but not limited to, the county probation agency or child welfare services agency with responsibility for the placement of a child in foster care, that has the right to make these decisions on behalf of a child who is in mental health crisis.
(B)The child is under 19, 20, or 21 years of age, depending on a programs licensing requirements.
(C)The child has a serious behavioral health disorder.
(D)The child requires a 24-hour-a-day, seven-day-a-week, staff-secured, unlocked treatment setting.
(2)The primary function of a childrens crisis residential program is to provide short-term crisis stabilization, therapeutic intervention, and specialized programming in an unlocked, staff-secured setting with a high degree of supervision and structure and the goal of supporting the rapid and successful transition of the child back to the community.
(d)A foster family agency that is certified as a Medi-Cal specialty mental health provider pursuant to Section 1810.435 of Title 9 of the California Code of Regulations by the State Department of Health Care Services, or by a county mental health plan to which the department has delegated certification authority, and which has entered into a contract with a county mental health plan pursuant to Section 1810.436 of Title 9 of the California Code of Regulations, shall provide, or provide access to, specialty mental health services to children under its care who do not require inpatient care in a licensed health facility and who meet the medical necessity criteria for Medi-Cal specialty mental health services provided for in Section 1830.205 or 1830.210 of Title 9 of the California Code of Regulations.
(e)A foster family agency that is not certified as a Medi-Cal specialty mental health provider shall provide access to specialty and non-specialty mental health services in that program for children who do not require inpatient care in a licensed health facility and who meet any of the conditions in paragraph (3) of subdivision (b). In this situation the foster family agency shall do the following:
(1)In the case of a child who is a Medi-Cal beneficiary, arrange for specialty mental health services from the county mental health plan.
(2)In all other cases, arrange for the child to receive mental health services.
(f)All short-term residential therapeutic programs shall maintain the level of care and services necessary to meet the needs of the children and youth in their care and shall maintain and have in good standing the appropriate mental health program approval. If a program will admit Medi-Cal beneficiaries, the mental health program approval shall include a certification to provide Medi-Cal specialty mental health services issued by the State Department of Health Care Services or a county mental health plan to which the department has delegated mental health program approval authority, pursuant to Section 4096.5 of this code or Section 1810.435 or 1810.436 of Title 9 of the California Code of Regulations. All foster family agencies that are certified as a Medi-Cal specialty mental health provider pursuant to Section 1810.435 of Title 9 of the California Code of Regulations shall maintain the level of care and services necessary to meet the needs of children and youth in their care and shall maintain and have in good standing the Medi-Cal specialty mental health provider certification issued by the State Department of Health Care Services or a county mental health plan to which the department has delegated certification authority.
(g)The assessments described in subparagraphs (A), (B), (C), and (D) of paragraph (3) of subdivision (b) shall ensure the childs individual behavioral or treatment needs are consistent with, and can be met by, the facility and shall be made by one of the following, as applicable:
(1)An interagency placement committee, as described in Section 4096, considering the recommendations from the child and family team, if any are available. If the short-term residential therapeutic program serves children who are placed by county child welfare agencies and children who are placed by probation departments, the interagency placement committee shall also ensure the requirements of subdivision (c) of Section 16514 have been met with respect to commonality of need.
(2)A licensed mental health professional as defined in subdivision (g) of Section 4096.
(3)For the purposes of this section, an AFDC-FC funded child with an individualized education program developed pursuant to Article 2 (commencing with Section 56320) of Chapter 4 of Part 30 of Division 4 of Title 2 of the Education Code that assesses the child as seriously emotionally disturbed, as defined in, and subject to, this section and recommends out-of-home placement at the level of care provided by the provider, shall be deemed to have met the assessment requirement.
(h)The evaluation described in subparagraph (A) of paragraph (3) of subdivision (i) shall be made pursuant to subdivision (b) of Section 706.6 or paragraph (2) of subdivision (c) of Section 16501.1.
(i)(1)The provider shall ensure that AFDC-FC funded children, assessed pursuant to subparagraphs (A) and (B) of paragraph (3) of subdivision (b), who are accepted for placement have been approved for placement by an interagency placement committee, as described in Section 4096, except as provided for in paragraph (3) of subdivision (g).
(2)The approval shall be in writing and shall indicate that the interagency placement committee has determined one of the following:
(A)The child meets the medical necessity criteria for Medi-Cal specialty mental health services, as provided for in Section 1830.205 or 1830.210 of Title 9 of the California Code of Regulations.
(B)The child is seriously emotionally disturbed, as described in subdivision (a) of Section 5600.3.
(3)(A)Nothing in subdivisions (a) to (h), inclusive, or this subdivision shall prevent an emergency placement of a child or youth into a certified short-term residential therapeutic program or childrens crisis residential program prior to the determination by the interagency placement committee, but only if a licensed mental health professional, as defined in subdivision (g) of Section 4096, has made a written determination within 72 hours of the childs or youths placement, that the child or youth requires the level of services and supervision provided by the short-term residential therapeutic program in order to meet his or her behavioral or therapeutic needs, or has made a written determination within 24 hours of the childs or youths placement in a childrens crisis residential program that the child or youth is experiencing a mental health crisis as defined in subdivision (c) and is in need of the care and services provided by the childrens crisis residential program. If the short-term residential therapeutic program serves children placed by county child welfare agencies and children placed by probation departments, the interagency placement committee shall also ensure the requirements of subdivision (c) of Section 16514 have been met with respect to commonality of need.
(i)The interagency placement committee, as appropriate, shall, within 30 days of placement, make the determinations, with recommendations from the child and family team, required by this subdivision.
(ii)If it determines the placement is appropriate, the interagency placement committee, with recommendations from the child and family team, shall transmit the approval, in writing, to the county placing agency and the short-term residential therapeutic program.
(iii)If it determines the placement is not appropriate, the interagency placement committee shall respond pursuant to subparagraph (B).
(B)(i)If the interagency placement committee determines at any time that the placement is not appropriate, it shall, with recommendations from the child and family team, transmit the disapproval, in writing, to the county placing agency and the short-term residential therapeutic program and shall include a recommendation as to the childs appropriate level of care and placement to meet his or her service needs. The necessary interagency placement committee representative or representatives shall participate in any child and family team meetings to refer the child or youth to an appropriate placement, as specified in this section.
(ii)The child may remain in the placement for the amount of time necessary to identify and transition the child to an alternative, suitable placement.
(iii)Notwithstanding clause (ii), if the interagency placement committee determined the placement was not appropriate due to a health and safety concern, immediate arrangements for the child to transition to an appropriate placement shall occur.
(j)Commencing January 1, 2017, for AFDC-FC funded children or youth, only those children or youth who are approved for placement, as set forth in this section, may be accepted by a short-term residential therapeutic program.
(k)The department shall, through regulation, establish consequences for the failure of a short-term residential therapeutic program to obtain written approval for placement of an AFDC-FC funded child or youth pursuant to this section.
(l)The department shall not establish a rate for a short-term residential therapeutic program unless the provider submits a recommendation from the host county or the primary placing county that the program is needed and that the provider is willing and capable of operating the program at the level sought. For purposes of this subdivision, host county, and primary placing county, mean the same as defined in the departments AFDC-FC ratesetting regulations.
(m)Any certified short-term residential therapeutic program shall be reclassified and paid at the appropriate program rate for which it is qualified if either of the following occurs:
(1)(A)It fails to maintain the level of care and services necessary to meet the needs of the children and youth in care, as required by subdivision (a). The determination shall be made consistent with the departments AFDC-FC ratesetting regulations developed pursuant to Section 11462 and shall take into consideration the highest level of care and associated rates for which the program may be eligible if granted an extension pursuant to Section 11462.04 or any reduction in rate associated with a provisional or probationary rate granted or imposed under Section 11466.01.
(B)In the event of a determination under this paragraph, the short-term residential therapeutic program may appeal the finding or submit a corrective action plan. The appeal process specified in Section 11466.6 shall be available to a short-term residential therapeutic program that provides intensive and therapeutic treatment. During any appeal, the short-term residential therapeutic program that provides intensive and therapeutic treatment shall maintain the appropriate level of care.
(2)It fails to maintain a certified mental health treatment program as required by subdivision (f).
(n)In addition to any other review required by law, the child and family team as defined in paragraph (4) of subdivision (a) of Section 16501 may periodically review the placement of the child or youth. If the child and family team make a recommendation that the child or youth no longer needs, or is not benefiting from, placement in a short-term residential therapeutic program, the team shall transmit the disapproval, in writing, to the county placing agency to consider a more appropriate placement.
(o)The department shall develop a process to address placements when, subsequent to the childs or youths placement, a determination is made by the interagency placement team and shall consider the recommendations of the child and family team, either that the child or youth is not in need of the care and services provided by the certified program. The process shall include, but not be limited to:
(1)Notice of the determination in writing to both the county placing agency and the short-term residential therapeutic program or foster family agency that provides intensive and therapeutic treatment.
(2)Notice of the countys plan, and a timeframe, for removal of the child or youth in writing to the short-term residential therapeutic program that provides intensive and therapeutic treatment.
(3)Referral to an appropriate placement.
(4)Actions to be taken if a child or youth is not timely removed from the short-term residential therapeutic program that provides intensive and therapeutic treatment or placed in an appropriate placement.
(p)(1)Nothing in this section shall prohibit a short-term residential therapeutic program from accepting private admissions of children or youth.
(2)When a referral is not from a public agency and public funding is not involved, there is no requirement for public agency review or determination of need.
(3)Children and youth subject to paragraphs (1) and (2) shall have been determined to be seriously emotionally disturbed, as described in subdivision (a) of Section 5600.3, and subject to Section 1502.4 of the Health and Safety Code, by a licensed mental health professional, as defined in subdivision (g) of Section 4096.
SEC. 7.Section 11462.011 is added to the Welfare and Institutions Code, to read:11462.011.(a)The State Department of Health Care Services shall, in consultation with the Department of Managed Health Care, the State Department of Social Services, the County Behavioral Health Directors Association of California, the County Welfare Directors Association of California, the Chief Probation Officers of California, provider representatives, and other relevant stakeholders, establish program standards and procedures for oversight, enforcement, and issuance of childrens crisis residential mental health program approvals, including provisional approvals that are effective for a period of less than one year. The State Department of Health Care Services shall also establish due process protections related to the childrens crisis residential mental health program approval process.
(b)The State Department of Health Care Services shall, in collaboration with the department, the County Behavioral Health Directors Association of California, provider representatives, and other relevant stakeholders, provide guidance to counties for the provision of childrens crisis residential services, including funding for children who are Medi-Cal beneficiaries and who are admitted to a childrens crisis residential program. This subdivision shall only be implemented to the extent that any necessary federal approvals are obtained and federal financial participation is available and is not otherwise jeopardized.
(c)(1)The childrens crisis residential program shall be used only as a diversion to admittance to a psychiatric hospital.
(2)(A)The length of the initial authorization for admission to a childrens crisis residential program shall be limited to 10 consecutive days.
(B)If a determination is made by a health care professional that a childrens crisis residential program is medically necessary and is the appropriate continued level of care, either of the following shall occur:
(i)In the case of a Medi-Cal beneficiary, the childrens crisis residential program shall notify the county mental health plan authorizing those services before extending the length of stay beyond 10 consecutive days.
(ii)In the case of non-Medi-Cal beneficiaries, reauthorizations for admission shall be obtained using the process established by the entity providing coverage.
(C)With the exception of clause (ii) of this subparagraph, this paragraph shall be implemented only to the extent that any necessary federal approvals are obtained and the State Department of Health Care Services determines, in its sole discretion, that federal financial participation is not jeopardized.
(d)A childrens crisis residential mental health program approval issued by the State Department of Health Care Services, or a county mental health plan to which the department has delegated approval authority, shall be a condition of continued licensure for a short-term residential therapeutic program operating as a childrens crisis residential program.
(e)The State Department of Health Care Services, or a county mental health plan to which the department has delegated approval authority, may enforce the childrens crisis residential mental health program approval standards by taking any of the following actions against a noncompliant childrens crisis residential program:
(1)Suspend or revoke a childrens crisis residential mental health program approval.
(2)Impose monetary penalties.
(3)Place a childrens crisis residential mental health program on probation.
(4)Require a childrens crisis residential mental health program to prepare and comply with a corrective action plan.
(f)The State Department of Health Care Services, or a county mental health plan to which the department has delegated approval authority, shall provide a childrens crisis residential mental health program with due process protections when taking any of the actions described in subdivision (e).
(g)Contingent upon an appropriation in the annual Budget Act for these purposes, the department shall begin implementation of this section no later than July 1, 2018, and shall commence the operation of the approval process for childrens crisis residential mental health program approvals no later than January 1, 2019.
SEC. 8.(a)Contingent upon an appropriation from the annual Budget Act for these purposes, the State Department of Social Services and the State Department of Health Care Services shall adopt regulations to implement this act no later than July 1, 2021.
(b)Notwithstanding the rulemaking provisions of the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code), the State Department of Social Services and the State Department of Health Care Services may implement and administer the changes made by this act through information notices, all-county letters, or similar written instructions until regulations are adopted.
(c)This section shall become effective upon appropriation of funds by the Legislature for the purposes described in this section.
SEC. 9.The provisions amended or added by this act shall be implemented only if, and to the extent that, federal financial participation, as provided under Title XIX of the federal Social Security Act (42 U.S.C. Sec. 1396 et seq.) is not jeopardized and all necessary federal approvals have been obtained.
SEC. 10.No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution.
The Legislature finds and declares all of the following:
(a)There is an urgent need to provide more crisis care alternatives to hospitals for children and youth experiencing mental health crises.
(b)The problems are especially acute for children and youth who may have to wait for days for a hospital bed and who may be transported, without a parent, to the nearest facility hundreds of miles away.
(c)In 2012, the California Hospital Association reported that two-thirds of the people taken to a hospital for a psychiatric emergency did not meet the criteria for that level of care, but the care they needed was not available.
(d)The type of care that is needed includes crisis residential treatment for children.
(e)This level of care is part of the full continuum of care considered medically necessary for many children with serious emotional disturbances.
(f)In 2013, the Legislature enacted the Investment in Mental Health Wellness Act (Senate Bill 82, Chapter 34 of the Statutes of 2013) to provide one-time funding to counties to expand the availability of mental health crisis care services, including short-term crisis residential treatment services. However, there is currently no state licensing category for short-term crisis residential programs for children. As a result, counties wanting to expand local capacity to meet the needs of children and youth for crisis residential treatment services were ineligible for this competitive grant program.
(g)In most communities, inpatient crisis treatment is completely unavailable for children and youth, even though it may be medically necessary.
(h)Crisis residential care is an essential level of care for the treatment of children and youth with serious emotional disturbances in a mental health crisis, and it often serves as an alternative to hospitalization.
(i)It is imperative that California identify a licensing category specifically for mental health crisis residential care that can be utilized for children and youth who are beneficiaries of both public and private health care plans.
SEC. 2.Section 1502 of the Health and Safety Code is amended to read:1502.As used in this chapter:
(a)Community care facility means any facility, place, or building that is maintained and operated to provide nonmedical residential care, day treatment, adult day care, or foster family agency services for children, adults, or children and adults, including, but not limited to, the physically handicapped, mentally impaired, incompetent persons, and abused or neglected children, and includes the following:
(1)Residential facility means any family home, group care facility, or similar facility determined by the department, for 24-hour nonmedical care of persons in need of personal services, supervision, or assistance essential for sustaining the activities of daily living or for the protection of the individual.
(2)Adult day program means any community-based facility or program that provides care to persons 18 years of age or older in need of personal services, supervision, or assistance essential for sustaining the activities of daily living or for the protection of these individuals on less than a 24-hour basis.
(3)Therapeutic day services facility means any facility that provides nonmedical care, counseling, educational or vocational support, or social rehabilitation services on less than a 24-hour basis to persons under 18 years of age who would otherwise be placed in foster care or who are returning to families from foster care. Program standards for these facilities shall be developed by the department, pursuant to Section 1530, in consultation with therapeutic day services and foster care providers.
(4)Foster family agency means any public agency or private organization, organized and operated on a nonprofit basis, engaged in any of the following:
(A)Recruiting, certifying, approving, and training of, and providing professional support to, foster parents and resource families.
(B)Coordinating with county placing agencies to find homes for foster children in need of care.
(C)Providing services and supports to licensed or certified foster parents, county-approved resource families, and children to the extent authorized by state and federal law.
(5)Foster family home means any residential facility providing 24-hour care for six or fewer foster children that is owned, leased, or rented and is the residence of the foster parent or parents, including their family, in whose care the foster children have been placed. The placement may be by a public or private child placement agency or by a court order, or by voluntary placement by a parent, parents, or guardian. It also means a foster family home described in Section 1505.2.
(6)Small family home means any residential facility, in the licensees family residence, that provides 24-hour care for six or fewer foster children who have mental disorders or developmental or physical disabilities and who require special care and supervision as a result of their disabilities. A small family home may accept children with special health care needs, pursuant to subdivision (a) of Section 17710 of the Welfare and Institutions Code. In addition to placing children with special health care needs, the department may approve placement of children without special health care needs, up to the licensed capacity.
(7)Social rehabilitation facility means any residential facility that provides social rehabilitation services for no longer than 18 months in a group setting to adults recovering from mental illness who temporarily need assistance, guidance, or counseling. Program components shall be subject to program standards pursuant to Article 1 (commencing with Section 5670) of Chapter 2.5 of Part 2 of Division 5 of the Welfare and Institutions Code.
(8)Community treatment facility means any residential facility that provides mental health treatment services to children in a group setting and that has the capacity to provide secure containment. Program components shall be subject to program standards developed and enforced by the State Department of Health Care Services pursuant to Section 4094 of the Welfare and Institutions Code.
Nothing in this section shall be construed to prohibit or discourage placement of persons who have mental or physical disabilities into any category of community care facility that meets the needs of the individual placed, if the placement is consistent with the licensing regulations of the department.
(9)Full-service adoption agency means any licensed entity engaged in the business of providing adoption services, that does all of the following:
(A)Assumes care, custody, and control of a child through relinquishment of the child to the agency or involuntary termination of parental rights to the child.
(B)Assesses the birth parents, prospective adoptive parents, or child.
(C)Places children for adoption.
(D)Supervises adoptive placements.
Private full-service adoption agencies shall be organized and operated on a nonprofit basis. As a condition of licensure to provide intercountry adoption services, a full-service adoption agency shall be accredited and in good standing according to Part 96 (commencing with Section 96.1) of Title 22 of the Code of Federal Regulations, or supervised by an accredited primary provider, or acting as an exempted provider, in compliance with Subpart F (commencing with Section 96.29) of Part 96 of Title 22 of the Code of Federal Regulations.
(10)Noncustodial adoption agency means any licensed entity engaged in the business of providing adoption services, that does all of the following:
(A)Assesses the prospective adoptive parents.
(B)Cooperatively matches children freed for adoption, who are under the care, custody, and control of a licensed adoption agency, for adoption, with assessed and approved adoptive applicants.
(C)Cooperatively supervises adoption placements with a full-service adoptive agency, but does not disrupt a placement or remove a child from a placement.
Private noncustodial adoption agencies shall be organized and operated on a nonprofit basis. As a condition of licensure to provide intercountry adoption services, a noncustodial adoption agency shall be accredited and in good standing according to Part 96 (commencing with Section 96.1) of Title 22 of the Code of Federal Regulations, or supervised by an accredited primary provider, or acting as an exempted provider, in compliance with Subpart F (commencing with Section 96.29) of Part 96 of Title 22 of the Code of Federal Regulations.
(11)Transitional shelter care facility means any group care facility that provides for 24-hour nonmedical care of persons in need of personal services, supervision, or assistance essential for sustaining the activities of daily living or for the protection of the individual. Program components shall be subject to program standards developed by the State Department of Social Services pursuant to Section 1502.3.
(12)Transitional housing placement provider means an organization licensed by the department pursuant to Section 1559.110 and Section 16522.1 of the Welfare and Institutions Code to provide transitional housing to foster children at least 16 years of age and not more than 18 years of age, and nonminor dependents, as defined in subdivision (v) of Section 11400 of the Welfare and Institutions Code, to promote their transition to adulthood. A transitional housing placement provider shall be privately operated and organized on a nonprofit basis.
(13)Group home means a residential facility that provides 24-hour care and supervision to children, delivered at least in part by staff employed by the licensee in a structured environment. The care and supervision provided by a group home shall be nonmedical, except as otherwise permitted by law.
(14)Runaway and homeless youth shelter means a group home licensed by the department to operate a program pursuant to Section 1502.35 to provide voluntary, short-term, shelter and personal services to runaway youth or homeless youth, as defined in paragraph (2) of subdivision (a) of Section 1502.35.
(15)Enhanced behavioral supports home means a facility certified by the State Department of Developmental Services pursuant to Article 3.6 (commencing with Section 4684.80) of Chapter 6 of Division 4.5 of the Welfare and Institutions Code, and licensed by the State Department of Social Services as an adult residential facility or a group home that provides 24-hour nonmedical care to individuals with developmental disabilities who require enhanced behavioral supports, staffing, and supervision in a homelike setting. An enhanced behavioral supports home shall have a maximum capacity of four consumers, shall conform to Section 441.530(a)(1) of Title 42 of the Code of Federal Regulations, and shall be eligible for federal Medicaid home- and community-based services funding.
(16)Community crisis home means a facility certified by the State Department of Developmental Services pursuant to Article 8 (commencing with Section 4698) of Chapter 6 of Division 4.5 of the Welfare and Institutions Code, and licensed by the State Department of Social Services pursuant to Article 9.7 (commencing with Section 1567.80), as an adult residential facility, providing 24-hour nonmedical care to individuals with developmental disabilities receiving regional center service, in need of crisis intervention services, and who would otherwise be at risk of admission to the acute crisis center at Fairview Developmental Center, Sonoma Developmental Center, an acute general hospital, acute psychiatric hospital, an institution for mental disease, as described in Part 5 (commencing with Section 5900) of Division 5 of the Welfare and Institutions Code, or an out-of-state placement. A community crisis home shall have a maximum capacity of eight consumers, as defined in subdivision (a) of Section 1567.80, shall conform to Section 441.530(a)(1) of Title 42 of the Code of Federal Regulations, and shall be eligible for federal Medicaid home- and community-based services funding.
(17)Crisis nursery means a facility licensed by the department to operate a program pursuant to Section 1516 to provide short-term care and supervision for children under six years of age who are voluntarily placed for temporary care by a parent or legal guardian due to a family crisis or stressful situation.
(18)Short-term residential therapeutic program means a residential facility operated by a public agency or private organization and licensed by the department pursuant to Section 1562.01 that provides an integrated program of specialized and intensive care and supervision, services and supports, treatment, and short-term, 24-hour care and supervision to children. The care and supervision provided by a short-term residential therapeutic program shall be nonmedical, except as otherwise permitted by law. Private short-term residential therapeutic programs shall be organized and operated on a nonprofit basis. A short-term residential therapeutic program may be operated as a childrens crisis residential program.
(19)Private alternative boarding school means a group home licensed by the department to operate a program pursuant to Section 1502.2 to provide youth with 24-hour residential care and supervision, which, in addition to providing educational services to youth, provides, or holds itself out as providing, behavioral-based services to youth with social, emotional, or behavioral issues. The care and supervision provided by a private alternative boarding school shall be nonmedical, except as otherwise permitted by law.
(20)Private alternative outdoor program means a group home licensed by the department to operate a program pursuant to Section 1502.21 to provide youth with 24-hour residential care and supervision, which provides, or holds itself out as providing, behavioral-based services in an outdoor living setting to youth with social, emotional, or behavioral issues. The care and supervision provided by a private alternative outdoor program shall be nonmedical, except as otherwise permitted by law.
(21)Childrens crisis residential program means a facility licensed by the department as a short-term residential therapeutic program pursuant to Section 1562.02 and approved by the State Department of Health Care Services, or a county mental health plan to which the State Department of Health Care Services has delegated approval authority, to operate a childrens crisis residential mental health program approval pursuant to Section 11462.011 of the Welfare and Institutions Code, to serve children experiencing mental health crises as an alternative to psychiatric hospitalization.
(b)Department or state department means the State Department of Social Services.
(c)Director means the Director of Social Services.
SEC. 3.Section 1562.02 is added to the Health and Safety Code, to read:1562.02.(a)The department may license a short-term residential therapeutic program operating as a childrens crisis residential program pursuant to this chapter. A childrens crisis residential program shall meet all of the following requirements:
(1)If the program serves children who are not experiencing mental health crises, have an identifiable and physically separate unit for those children who are experiencing mental health crises. The separate unit shall be indicated on the short-term residential therapeutic programs license.
(2)Obtain and have in good standing a mental health program approval that includes a Medi-Cal mental health certification, as described in Section 11462.01 of the Welfare and Institutions Code, and a childrens crisis residential mental health program approval, as described in Section 11462.011 of the Welfare and Institutions Code, both of which are issued by the State Department of Health Care Services, or a county mental health plan to which the department has delegated approval authority. The short-term residential therapeutic program shall obtain a mental health program approval before operating as a childrens crisis residential program. The department may revoke a programs license pursuant to Section 1550 for a programs failure to maintain the mental health program approval.
(3)Comply with all applicable licensing standards for a short-term residential therapeutic program, unless otherwise specified by the department in regulations.
(b)Contingent upon an appropriation in the annual Budget Act for these purposes, the department shall begin implementation of this section no later than July 1, 2018, and shall commence the licensing process for childrens crisis residential programs no later than January 1, 2019.
SEC. 4.Section 1562.03 is added to the Health and Safety Code, to read:1562.03.(a)The department shall establish regulations for short-term residential therapeutic programs that are operated as childrens crisis residential programs. At a minimum, the regulations shall include all of the following:
(1)Therapeutic programming shall be provided seven days a week, including weekends and holidays, with sufficient mental health professional and paraprofessional staff to maintain an appropriate treatment setting and services, based on individual childrens needs.
(2)The program shall be staffed with sufficient personnel to accept children 24 hours per day, seven days a week and to admit children, at a minimum, from 7 a.m. to 11 p.m., seven days a week, 365 days per year. The program shall be sufficiently staffed to discharge children, as appropriate, seven days a week, 365 days per year.
(3)Facilities shall be limited to fewer than 16 beds, with at least 50 percent of those beds in single-occupancy rooms.
(4)Facilities shall include ample physical space for accommodating individuals who provide daily emotional and physical supports to each child and for integrating family members into the day-to-day care of the youth.
(5)The program shall collaborate with each childs existing mental health team, if applicable, child and family team, if applicable, and other formal and natural supports within 24 hours of intake and throughout the course of care and treatment as appropriate.
(6)The program shall create and assist with the implementation of a plan for transitioning each admitted child from the program to his or her home and community, including the establishment of a mental health or child and family team if there is not one already.
(b)The program shall annually provide the department with all of the following data as it pertains to children in foster care and children not in foster care in conjunction with its application for licensure renewal:
(1)Age and gender of clients served.
(2)Duration of stay.
(3)Professional classification of staff and contracted staff.
(4)Type of placement the client was discharged to.
SEC. 5.Section 5848.5 of the Welfare and Institutions Code is amended to read:5848.5.(a)The Legislature finds and declares all of the following:
(1)California has realigned public community mental health services to counties and it is imperative that sufficient community-based resources be available to meet the mental health needs of eligible individuals.
(2)Increasing access to effective outpatient and crisis stabilization services provides an opportunity to reduce costs associated with expensive inpatient and emergency room care and to better meet the needs of individuals with mental health disorders in the least restrictive manner possible.
(3)Almost one-fifth of people with mental health disorders visit a hospital emergency room at least once per year. If an adequate array of crisis services is not available, it leaves an individual with little choice but to access an emergency room for assistance and, potentially, an unnecessary inpatient hospitalization.
(4)Recent reports have called attention to a continuing problem of inappropriate and unnecessary utilization of hospital emergency rooms in California due to limited community-based services for individuals in psychological distress and acute psychiatric crisis. Hospitals report that 70 percent of people taken to emergency rooms for psychiatric evaluation can be stabilized and transferred to a less intensive level of crisis care. Law enforcement personnel report that their personnel need to stay with people in the emergency room waiting area until a placement is found, and that less intensive levels of care tend not to be available.
(5)Comprehensive public and private partnerships at both local and regional levels, including across physical health services, mental health, substance use disorder, law enforcement, social services, and related supports, are necessary to develop and maintain high quality, patient-centered, and cost-effective care for individuals with mental health disorders that facilitates their recovery and leads towards wellness.
(6)The recovery of individuals with mental health disorders is important for all levels of government, business, and the local community.
(b)This section shall be known, and may be cited, as the Investment in Mental Health Wellness Act of 2013. The objectives of this section are to do all of the following:
(1)Expand access to early intervention and treatment services to improve the client experience, achieve recovery and wellness, and reduce costs.
(2)Expand the continuum of services to address crisis intervention, crisis stabilization, and crisis residential treatment needs that are wellness, resiliency, and recovery oriented.
(3)Add at least 25 mobile crisis support teams and at least 2,000 crisis stabilization and crisis residential treatment beds to bolster capacity at the local level to improve access to mental health crisis services and address unmet mental health care needs.
(4)Add at least 600 triage personnel to provide intensive case management and linkage to services for individuals with mental health care disorders at various points of access, such as at designated community-based service points, homeless shelters, and clinics.
(5)Reduce unnecessary hospitalizations and inpatient days by appropriately utilizing community-based services and improving access to timely assistance.
(6)Reduce recidivism and mitigate unnecessary expenditures of local law enforcement.
(7)Provide local communities with increased financial resources to leverage additional public and private funding sources to achieve improved networks of care for individuals with mental health disorders.
(8)Provide a complete continuum of crisis services for children and youth 21 years of age and under regardless of where they live in the state. The funds included in the 2016 Budget Act for the purpose of developing the continuum of mental health crisis services for children and youth 21 years of age and under shall be for the following objectives:
(A)Provide a continuum of crisis services for children and youth 21 years of age and under regardless of where they live in the state.
(B)Provide for early intervention and treatment services to improve the client experience, achieve recovery and wellness, and reduce costs.
(C)Expand the continuum of community-based services to address crisis intervention, crisis stabilization, and crisis residential treatment needs that are wellness-, resiliency-, and recovery-oriented.
(D)Add at least 200 mobile crisis support teams.
(E)Add at least 120 crisis stabilization services and beds and crisis residential treatment beds to increase capacity at the local level to improve access to mental health crisis services and address unmet mental health care needs.
(F)Add triage personnel to provide intensive case management and linkage to services for individuals with mental health care disorders at various points of access, such as at designated community-based service points, homeless shelters, schools, and clinics.
(G)Expand family respite care to help families and sustain caregiver health and well-being.
(H)Expand family supportive training and related services designed to help families participate in the planning process, access services, and navigate programs.
(I)Reduce unnecessary hospitalizations and inpatient days by appropriately utilizing community-based services.
(J)Reduce recidivism and mitigate unnecessary expenditures of local law enforcement.
(K)Provide local communities with increased financial resources to leverage additional public and private funding sources to achieve improved networks of care for children and youth 21 years of age and under with mental health disorders.
(c)Through appropriations provided in the annual Budget Act for this purpose, it is the intent of the Legislature to authorize the California Health Facilities Financing Authority, hereafter referred to as the authority, and the Mental Health Services Oversight and Accountability Commission, hereafter referred to as the commission, to administer competitive selection processes as provided in this section for capital capacity and program expansion to increase capacity for mobile crisis support, crisis intervention, crisis stabilization services, crisis residential treatment, and specified personnel resources.
(d)Funds appropriated by the Legislature to the authority for purposes of this section shall be made available to selected counties, or counties acting jointly. The authority may, at its discretion, also give consideration to private nonprofit corporations and public agencies in an area or region of the state if a county, or counties acting jointly, affirmatively supports this designation and collaboration in lieu of a county government directly receiving grant funds.
(1)Grant awards made by the authority shall be used to expand local resources for the development, capital, equipment acquisition, and applicable program startup or expansion costs to increase capacity for client assistance and services in the following areas:
(A)Crisis intervention, as authorized by Sections 14021.4, 14680, and 14684.
(B)Crisis stabilization, as authorized by Sections 14021.4, 14680, and 14684.
(C)Crisis residential treatment, as authorized by Sections 14021.4, 14680, and 14684 and as provided at a childrens crisis residential program, as defined in Section 1502 of the Health and Safety Code.
(D)Rehabilitative mental health services, as authorized by Sections 14021.4, 14680, and 14684.
(E)Mobile crisis support teams, including personnel and equipment, such as the purchase of vehicles.
(2)The authority shall develop selection criteria to expand local resources, including those described in paragraph (1), and processes for awarding grants after consulting with representatives and interested stakeholders from the mental health community, including, but not limited to, the County Behavioral Health Directors Association of California, service providers, consumer organizations, and other appropriate interests, such as health care providers and law enforcement, as determined by the authority. The authority shall ensure that grants result in cost-effective expansion of the number of community-based crisis resources in regions and communities selected for funding. The authority shall also take into account at least the following criteria and factors when selecting recipients of grants and determining the amount of grant awards:
(A)Description of need, including, at a minimum, a comprehensive description of the project, community need, population to be served, linkage with other public systems of health and mental health care, linkage with local law enforcement, social services, and related assistance, as applicable, and a description of the request for funding.
(B)Ability to serve the target population, which includes individuals eligible for Medi-Cal and individuals eligible for county health and mental health services.
(C)Geographic areas or regions of the state to be eligible for grant awards, which may include rural, suburban, and urban areas, and may include use of the five regional designations utilized by the County Behavioral Health Directors Association of California.
(D)Level of community engagement and commitment to project completion.
(E)Financial support that, in addition to a grant that may be awarded by the authority, will be sufficient to complete and operate the project for which the grant from the authority is awarded.
(F)Ability to provide additional funding support to the project, including public or private funding, federal tax credits and grants, foundation support, and other collaborative efforts.
(G)Memorandum of understanding among project partners, if applicable.
(H)Information regarding the legal status of the collaborating partners, if applicable.
(I)Ability to measure key outcomes, including improved access to services, health and mental health outcomes, and cost benefit of the project.
(3)The authority shall determine maximum grants awards, which shall take into consideration the number of projects awarded to the grantee, as described in paragraph (1), and shall reflect reasonable costs for the project and geographic region. The authority may allocate a grant in increments contingent upon the phases of a project.
(4)Funds awarded by the authority pursuant to this section may be used to supplement, but not to supplant, existing financial and resource commitments of the grantee or any other member of a collaborative effort that has been awarded a grant.
(5)All projects that are awarded grants by the authority shall be completed within a reasonable period of time, to be determined by the authority. Funds shall not be released by the authority until the applicant demonstrates project readiness to the authoritys satisfaction. If the authority determines that a grant recipient has failed to complete the project under the terms specified in awarding the grant, the authority may require remedies, including the return of all or a portion of the grant.
(6)A grantee that receives a grant from the authority under this section shall commit to using that capital capacity and program expansion project, such as the mobile crisis team, crisis stabilization unit, or crisis residential treatment program, for the duration of the expected life of the project.
(7)The authority may consult with a technical assistance entity, as described in paragraph (5) of subdivision (a) of Section 4061, for purposes of implementing this section.
(8)The authority may adopt emergency regulations relating to the grants for the capital capacity and program expansion projects described in this section, including emergency regulations that define eligible costs and determine minimum and maximum grant amounts.
(9)The authority shall provide reports to the fiscal and policy committees of the Legislature on or before May 1, 2014, and on or before May 1, 2015, on the progress of implementation, that include, but are not limited to, the following:
(A)A description of each project awarded funding.
(B)The amount of each grant issued.
(C)A description of other sources of funding for each project.
(D)The total amount of grants issued.
(E)A description of project operation and implementation, including who is being served.
(10)A recipient of a grant provided pursuant to paragraph (1) shall adhere to all applicable laws relating to scope of practice, licensure, certification, staffing, and building codes.
(e)Of the funds specified in paragraph (8) of subdivision (b), it is the intent of the Legislature to authorize the authority and the commission to administer competitive selection processes as provided in this section for capital capacity and program expansion to increase capacity for mobile crisis support, crisis intervention, crisis stabilization services, crisis residential treatment, family respite care, family supportive training and related services, and triage personnel resources for children and youth 21 years of age and under.
(f)Funds appropriated by the Legislature to the authority to address crisis services for children and youth 21 years of age and under for the purposes of this section shall be made available to selected counties or counties acting jointly. The authority may, at its discretion, also give consideration to private nonprofit corporations and public agencies in an area or region of the state if a county, or counties acting jointly, affirmatively support this designation and collaboration in lieu of a county government directly receiving grant funds.
(1)Grant awards made by the authority shall be used to expand local resources for the development, capital, equipment acquisition, and applicable program startup or expansion costs to increase capacity for client assistance and crisis services for children and youth 21 years of age and under in the following areas:
(A)Crisis intervention, as authorized by Sections 14021.4, 14680, and 14684.
(B)Crisis stabilization, as authorized by Sections 14021.4, 14680, and 14684.
(C)Crisis residential treatment, as authorized by Sections 14021.4, 14680, and 14684 and as provided at a childrens crisis residential program, as defined in Section 1502 of the Health and Safety Code.
(D)Mobile crisis support teams, including the purchase of equipment and vehicles.
(E)Family respite care.
(2)The authority shall develop selection criteria to expand local resources, including those described in paragraph (1), and processes for awarding grants after consulting with representatives and interested stakeholders from the mental health community, including, but not limited to, county mental health directors, service providers, consumer organizations, and other appropriate interests, such as health care providers and law enforcement, as determined by the authority. The authority shall ensure that grants result in cost-effective expansion of the number of community-based crisis resources in regions and communities selected for funding. The authority shall also take into account at least the following criteria and factors when selecting recipients of grants and determining the amount of grant awards:
(A)Description of need, including, at a minimum, a comprehensive description of the project, community need, population to be served, linkage with other public systems of health and mental health care, linkage with local law enforcement, social services, and related assistance, as applicable, and a description of the request for funding.
(B)Ability to serve the target population, which includes individuals eligible for Medi-Cal and individuals eligible for county health and mental health services.
(C)Geographic areas or regions of the state to be eligible for grant awards, which may include rural, suburban, and urban areas, and may include use of the five regional designations utilized by the California Behavioral Health Directors Association.
(D)Level of community engagement and commitment to project completion.
(E)Financial support that, in addition to a grant that may be awarded by the authority, will be sufficient to complete and operate the project for which the grant from the authority is awarded.
(F)Ability to provide additional funding support to the project, including public or private funding, federal tax credits and grants, foundation support, and other collaborative efforts.
(G)Memorandum of understanding among project partners, if applicable.
(H)Information regarding the legal status of the collaborating partners, if applicable.
(I)Ability to measure key outcomes, including utilization of services, health and mental health outcomes, and cost benefit of the project.
(3)The authority shall determine maximum grant awards, which shall take into consideration the number of projects awarded to the grantee, as described in paragraph (1), and shall reflect reasonable costs for the project, geographic region, and target ages. The authority may allocate a grant in increments contingent upon the phases of a project.
(4)Funds awarded by the authority pursuant to this section may be used to supplement, but not to supplant, existing financial and resource commitments of the grantee or any other member of a collaborative effort that has been awarded a grant.
(5)All projects that are awarded grants by the authority shall be completed within a reasonable period of time, to be determined by the authority. Funds shall not be released by the authority until the applicant demonstrates project readiness to the authoritys satisfaction. If the authority determines that a grant recipient has failed to complete the project under the terms specified in awarding the grant, the authority may require remedies, including the return of all, or a portion, of the grant.
(6)A grantee that receives a grant from the authority under this section shall commit to using that capital capacity and program expansion project, such as the mobile crisis team, crisis stabilization unit, family respite care, or crisis residential treatment program, for the duration of the expected life of the project.
(7)The authority may consult with a technical assistance entity, as described in paragraph (5) of subdivision (a) of Section 4061, for the purposes of implementing this section.
(8)The authority may adopt emergency regulations relating to the grants for the capital capacity and program expansion projects described in this section, including emergency regulations that define eligible costs and determine minimum and maximum grant amounts.
(9)The authority shall provide reports to the fiscal and policy committees of the Legislature on or before January 10, 2018, and annually thereafter, on the progress of implementation, that include, but are not limited to, the following:
(A)A description of each project awarded funding.
(B)The amount of each grant issued.
(C)A description of other sources of funding for each project.
(D)The total amount of grants issued.
(E)A description of project operation and implementation, including who is being served.
(10)A recipient of a grant provided pursuant to paragraph (1) shall adhere to all applicable laws relating to scope of practice, licensure, certification, staffing, and building codes.
(g)Funds appropriated by the Legislature to the commission for purposes of this section shall be allocated for triage personnel to provide intensive case management and linkage to services for individuals with mental health disorders at various points of access. These funds shall be made available to selected counties, counties acting jointly, or city mental health departments, as determined by the commission through a selection process. It is the intent of the Legislature for these funds to be allocated in an efficient manner to encourage early intervention and receipt of needed services for individuals with mental health disorders, and to assist in navigating the local service sector to improve efficiencies and the delivery of services.
(1)Triage personnel may provide targeted case management services face to face, by telephone, or by telehealth with the individual in need of assistance or his or her significant support person, and may be provided anywhere in the community. These service activities may include, but are not limited to, the following:
(A)Communication, coordination, and referral.
(B)Monitoring service delivery to ensure the individual accesses and receives services.
(C)Monitoring the individuals progress.
(D)Providing placement service assistance and service plan development.
(2)The commission shall take into account at least the following criteria and factors when selecting recipients and determining the amount of grant awards for triage personnel as follows:
(A)Description of need, including potential gaps in local service connections.
(B)Description of funding request, including personnel and use of peer support.
(C)Description of how triage personnel will be used to facilitate linkage and access to services, including objectives and anticipated outcomes.
(D)Ability to obtain federal Medicaid reimbursement, when applicable.
(E)Ability to administer an effective service program and the degree to which local agencies and service providers will support and collaborate with the triage personnel effort.
(F)Geographic areas or regions of the state to be eligible for grant awards, which shall include rural, suburban, and urban areas, and may include use of the five regional designations utilized by the County Behavioral Health Directors Association of California.
(3)The commission shall determine maximum grant awards, and shall take into consideration the level of need, population to be served, and related criteria, as described in paragraph (2), and shall reflect reasonable costs.
(4)Funds awarded by the commission for purposes of this section may be used to supplement, but not supplant, existing financial and resource commitments of the county, counties acting jointly, or city mental health department that received the grant.
(5)Notwithstanding any other law, a county, counties acting jointly, or city mental health department that receives an award of funds for the purpose of supporting triage personnel pursuant to this subdivision is not required to provide a matching contribution of local funds.
(6)Notwithstanding any other law, the commission, without taking any further regulatory action, may implement, interpret, or make specific this section by means of informational letters, bulletins, or similar instructions.
(7)The commission shall provide a status report to the fiscal and policy committees of the Legislature on the progress of implementation no later than March 1, 2014.
(h)Funds appropriated by the Legislature to the commission pursuant to paragraph (8) of subdivision (b) for the purposes of addressing childrens crisis services shall be allocated to support triage personnel and family supportive training and related services. These funds shall be made available to selected counties, counties acting jointly, or city mental health departments, as determined by the commission through a selection process. The commission may, at its discretion, also give consideration to private nonprofit corporations and public agencies in an area or region of the state if a county, or counties acting jointly, affirmatively supports this designation and collaboration in lieu of a county government directly receiving grant funds.
(1)These funds may provide for a range of crisis-related services for a child in need of assistance, or his or her parent, guardian, or caregiver. These service activities may include, but are not limited to, the following:
(A)Intensive coordination of care and services.
(B)Communication, coordination, and referral.
(C)Monitoring service delivery to the child or youth.
(D)Monitoring the childs progress.
(E)Providing placement service assistance and service plan development.
(F)Crisis or safety planning.
(2)The commission shall take into account at least the following criteria and factors when selecting recipients and determining the amount of grant awards for these funds, as follows:
(A)Description of need, including potential gaps in local service connections.
(B)Description of funding request, including personnel.
(C)Description of how personnel and other services will be used to facilitate linkage and access to services, including objectives and anticipated outcomes.
(D)Ability to obtain federal Medicaid reimbursement, when applicable.
(E)Ability to provide a matching contribution of local funds.
(F)Ability to administer an effective service program and the degree to which local agencies and service providers will support and collaborate with the triage personnel effort.
(G)Geographic areas or regions of the state to be eligible for grant awards, which shall include rural, suburban, and urban areas, and may include use of the five regional designations utilized by the County Behavioral Health Directors Association of California.
(3)The commission shall determine maximum grant awards, and shall take into consideration the level of need, population to be served, and related criteria, as described in paragraph (2), and shall reflect reasonable costs.
(4)Funds awarded by the commission for purposes of this section may be used to supplement, but not supplant, existing financial and resource commitments of the county, counties acting jointly, or a city mental health department that received the grant.
(5)Notwithstanding any other law, a county, counties acting jointly, or a city mental health department that receives an award of funds for the purpose of this section is not required to provide a matching contribution of local funds.
(6)Notwithstanding any other law, the commission, without taking any further regulatory action, may implement, interpret, or make specific this section by means of informational letters, bulletins, or similar instructions.
(7)The commission may waive requirements in this section for counties with a population of 100,000 or less, if the commission determines it is in the best interest of the state and meets the intent of the law.
(8)The commission shall provide a status report to the fiscal and policy committees of the Legislature on the progress of implementation no later than January 10, 2018, and annually thereafter.
SEC. 6.Section 11462.01 of the Welfare and Institutions Code, as added by Section 75 of Chapter 773 of the Statutes of 2015, is amended to read:11462.01.(a)(1)If a program will admit Medi-Cal beneficiaries, no later than 12 months following the date of initial licensure, a short-term residential therapeutic program, as defined in subdivision (ad) of Section 11400 of this code and paragraph (18) of subdivision (a) of Section 1502 of the Health and Safety Code, shall obtain a contract, subject to an agreement on rates and terms and conditions, with a county mental health plan to provide specialty mental health services and demonstrate the ability to meet the therapeutic needs of each child, as identified in any of the following:
(A)A mental health assessment.
(B)The childs case plan.
(C)The childs needs and services plan.
(D)Other documentation demonstrating the child has a mental health need.
(2)A short-term residential therapeutic program shall comply with any other mental health program approvals required by the State Department of Health Care Services or by a county mental health plan to which mental health program approval authority has been delegated.
(b)A short-term residential therapeutic program, except as specified in subdivision (c), may accept for placement a child who meets both of the criteria in paragraphs (1) and (2) and at least one of the conditions in paragraph (3).
(1)The child does not require inpatient care in a licensed health facility.
(2)The child has been assessed as requiring the level of services provided in a short-term residential therapeutic program in order to maintain the safety and well-being of the child or others due to behaviors, including those resulting from traumas, that render the child or those around the child unsafe or at risk of harm, or that prevent the effective delivery of needed services and supports provided in the childs own home or in other family settings, such as with a relative, guardian, foster family, resource family, or adoptive family. The assessment shall ensure the child has needs in common with other children or youth in the care of the facility, consistent with subdivision (c) of Section 16514.
(3)The child meets at least one of the following conditions:
(A)The child has been assessed, pursuant to Section 4096, as meeting the medical necessity criteria for Medi-Cal specialty mental health services, as provided for in Section 1830.205 or 1830.210 of Title 9 of the California Code of Regulations.
(B)The child has been assessed, pursuant to Section 4096, as seriously emotionally disturbed, as defined in subdivision (a) of Section 5600.3.
(C)The child requires emergency placement pursuant to paragraph (3) of subdivision (i).
(D)The child has been assessed, pursuant to Section 4096, as requiring the level of services provided by the short-term residential therapeutic program in order to meet his or her behavioral or therapeutic needs.
(4)Subject to the requirements of this subdivision, a short-term residential therapeutic program may have a specialized program to serve a child, including, but not limited to, the following:
(A)A commercially sexually exploited child.
(B)A private voluntary placement, if the youth exhibits status offender behavior, the parents or other relatives feel they cannot control the childs behavior, and short-term intervention is needed to transition the child back into the home.
(C)A juvenile sex offender.
(D)A child who is affiliated with, or impacted by, a gang.
(c)(1)A short-term residential therapeutic program that is operating as a childrens crisis residential program, as defined in Section 1502 of the Health and Safety Code, may accept for admission any child who meets all of the following requirements:
(A)The child is referred by a parent or guardian, physician, or licensed mental health professional, or by the representative of a public or private entity, including, but not limited to, the county probation agency or child welfare services agency with responsibility for the placement of a child in foster care, that has the right to make these decisions on behalf of a child who is in mental health crisis.
(B)The child is under 19, 20, or 21 years of age, depending on a programs licensing requirements.
(C)The child has a serious behavioral health disorder.
(D)The child requires a 24-hour-a-day, seven-day-a-week, staff-secured, unlocked treatment setting.
(2)The primary function of a childrens crisis residential program is to provide short-term crisis stabilization, therapeutic intervention, and specialized programming in an unlocked, staff-secured setting with a high degree of supervision and structure and the goal of supporting the rapid and successful transition of the child back to the community.
(d)A foster family agency that is certified as a Medi-Cal specialty mental health provider pursuant to Section 1810.435 of Title 9 of the California Code of Regulations by the State Department of Health Care Services, or by a county mental health plan to which the department has delegated certification authority, and which has entered into a contract with a county mental health plan pursuant to Section 1810.436 of Title 9 of the California Code of Regulations, shall provide, or provide access to, specialty mental health services to children under its care who do not require inpatient care in a licensed health facility and who meet the medical necessity criteria for Medi-Cal specialty mental health services provided for in Section 1830.205 or 1830.210 of Title 9 of the California Code of Regulations.
(e)A foster family agency that is not certified as a Medi-Cal specialty mental health provider shall provide access to specialty and non-specialty mental health services in that program for children who do not require inpatient care in a licensed health facility and who meet any of the conditions in paragraph (3) of subdivision (b). In this situation the foster family agency shall do the following:
(1)In the case of a child who is a Medi-Cal beneficiary, arrange for specialty mental health services from the county mental health plan.
(2)In all other cases, arrange for the child to receive mental health services.
(f)All short-term residential therapeutic programs shall maintain the level of care and services necessary to meet the needs of the children and youth in their care and shall maintain and have in good standing the appropriate mental health program approval. If a program will admit Medi-Cal beneficiaries, the mental health program approval shall include a certification to provide Medi-Cal specialty mental health services issued by the State Department of Health Care Services or a county mental health plan to which the department has delegated mental health program approval authority, pursuant to Section 4096.5 of this code or Section 1810.435 or 1810.436 of Title 9 of the California Code of Regulations. All foster family agencies that are certified as a Medi-Cal specialty mental health provider pursuant to Section 1810.435 of Title 9 of the California Code of Regulations shall maintain the level of care and services necessary to meet the needs of children and youth in their care and shall maintain and have in good standing the Medi-Cal specialty mental health provider certification issued by the State Department of Health Care Services or a county mental health plan to which the department has delegated certification authority.
(g)The assessments described in subparagraphs (A), (B), (C), and (D) of paragraph (3) of subdivision (b) shall ensure the childs individual behavioral or treatment needs are consistent with, and can be met by, the facility and shall be made by one of the following, as applicable:
(1)An interagency placement committee, as described in Section 4096, considering the recommendations from the child and family team, if any are available. If the short-term residential therapeutic program serves children who are placed by county child welfare agencies and children who are placed by probation departments, the interagency placement committee shall also ensure the requirements of subdivision (c) of Section 16514 have been met with respect to commonality of need.
(2)A licensed mental health professional as defined in subdivision (g) of Section 4096.
(3)For the purposes of this section, an AFDC-FC funded child with an individualized education program developed pursuant to Article 2 (commencing with Section 56320) of Chapter 4 of Part 30 of Division 4 of Title 2 of the Education Code that assesses the child as seriously emotionally disturbed, as defined in, and subject to, this section and recommends out-of-home placement at the level of care provided by the provider, shall be deemed to have met the assessment requirement.
(h)The evaluation described in subparagraph (A) of paragraph (3) of subdivision (i) shall be made pursuant to subdivision (b) of Section 706.6 or paragraph (2) of subdivision (c) of Section 16501.1.
(i)(1)The provider shall ensure that AFDC-FC funded children, assessed pursuant to subparagraphs (A) and (B) of paragraph (3) of subdivision (b), who are accepted for placement have been approved for placement by an interagency placement committee, as described in Section 4096, except as provided for in paragraph (3) of subdivision (g).
(2)The approval shall be in writing and shall indicate that the interagency placement committee has determined one of the following:
(A)The child meets the medical necessity criteria for Medi-Cal specialty mental health services, as provided for in Section 1830.205 or 1830.210 of Title 9 of the California Code of Regulations.
(B)The child is seriously emotionally disturbed, as described in subdivision (a) of Section 5600.3.
(3)(A)Nothing in subdivisions (a) to (h), inclusive, or this subdivision shall prevent an emergency placement of a child or youth into a certified short-term residential therapeutic program or childrens crisis residential program prior to the determination by the interagency placement committee, but only if a licensed mental health professional, as defined in subdivision (g) of Section 4096, has made a written determination within 72 hours of the childs or youths placement, that the child or youth requires the level of services and supervision provided by the short-term residential therapeutic program in order to meet his or her behavioral or therapeutic needs, or has made a written determination within 24 hours of the childs or youths placement in a childrens crisis residential program that the child or youth is experiencing a mental health crisis as defined in subdivision (c) and is in need of the care and services provided by the childrens crisis residential program. If the short-term residential therapeutic program serves children placed by county child welfare agencies and children placed by probation departments, the interagency placement committee shall also ensure the requirements of subdivision (c) of Section 16514 have been met with respect to commonality of need.
(i)The interagency placement committee, as appropriate, shall, within 30 days of placement, make the determinations, with recommendations from the child and family team, required by this subdivision.
(ii)If it determines the placement is appropriate, the interagency placement committee, with recommendations from the child and family team, shall transmit the approval, in writing, to the county placing agency and the short-term residential therapeutic program.
(iii)If it determines the placement is not appropriate, the interagency placement committee shall respond pursuant to subparagraph (B).
(B)(i)If the interagency placement committee determines at any time that the placement is not appropriate, it shall, with recommendations from the child and family team, transmit the disapproval, in writing, to the county placing agency and the short-term residential therapeutic program and shall include a recommendation as to the childs appropriate level of care and placement to meet his or her service needs. The necessary interagency placement committee representative or representatives shall participate in any child and family team meetings to refer the child or youth to an appropriate placement, as specified in this section.
(ii)The child may remain in the placement for the amount of time necessary to identify and transition the child to an alternative, suitable placement.
(iii)Notwithstanding clause (ii), if the interagency placement committee determined the placement was not appropriate due to a health and safety concern, immediate arrangements for the child to transition to an appropriate placement shall occur.
(j)Commencing January 1, 2017, for AFDC-FC funded children or youth, only those children or youth who are approved for placement, as set forth in this section, may be accepted by a short-term residential therapeutic program.
(k)The department shall, through regulation, establish consequences for the failure of a short-term residential therapeutic program to obtain written approval for placement of an AFDC-FC funded child or youth pursuant to this section.
(l)The department shall not establish a rate for a short-term residential therapeutic program unless the provider submits a recommendation from the host county or the primary placing county that the program is needed and that the provider is willing and capable of operating the program at the level sought. For purposes of this subdivision, host county, and primary placing county, mean the same as defined in the departments AFDC-FC ratesetting regulations.
(m)Any certified short-term residential therapeutic program shall be reclassified and paid at the appropriate program rate for which it is qualified if either of the following occurs:
(1)(A)It fails to maintain the level of care and services necessary to meet the needs of the children and youth in care, as required by subdivision (a). The determination shall be made consistent with the departments AFDC-FC ratesetting regulations developed pursuant to Section 11462 and shall take into consideration the highest level of care and associated rates for which the program may be eligible if granted an extension pursuant to Section 11462.04 or any reduction in rate associated with a provisional or probationary rate granted or imposed under Section 11466.01.
(B)In the event of a determination under this paragraph, the short-term residential therapeutic program may appeal the finding or submit a corrective action plan. The appeal process specified in Section 11466.6 shall be available to a short-term residential therapeutic program that provides intensive and therapeutic treatment. During any appeal, the short-term residential therapeutic program that provides intensive and therapeutic treatment shall maintain the appropriate level of care.
(2)It fails to maintain a certified mental health treatment program as required by subdivision (f).
(n)In addition to any other review required by law, the child and family team as defined in paragraph (4) of subdivision (a) of Section 16501 may periodically review the placement of the child or youth. If the child and family team make a recommendation that the child or youth no longer needs, or is not benefiting from, placement in a short-term residential therapeutic program, the team shall transmit the disapproval, in writing, to the county placing agency to consider a more appropriate placement.
(o)The department shall develop a process to address placements when, subsequent to the childs or youths placement, a determination is made by the interagency placement team and shall consider the recommendations of the child and family team, either that the child or youth is not in need of the care and services provided by the certified program. The process shall include, but not be limited to:
(1)Notice of the determination in writing to both the county placing agency and the short-term residential therapeutic program or foster family agency that provides intensive and therapeutic treatment.
(2)Notice of the countys plan, and a timeframe, for removal of the child or youth in writing to the short-term residential therapeutic program that provides intensive and therapeutic treatment.
(3)Referral to an appropriate placement.
(4)Actions to be taken if a child or youth is not timely removed from the short-term residential therapeutic program that provides intensive and therapeutic treatment or placed in an appropriate placement.
(p)(1)Nothing in this section shall prohibit a short-term residential therapeutic program from accepting private admissions of children or youth.
(2)When a referral is not from a public agency and public funding is not involved, there is no requirement for public agency review or determination of need.
(3)Children and youth subject to paragraphs (1) and (2) shall have been determined to be seriously emotionally disturbed, as described in subdivision (a) of Section 5600.3, and subject to Section 1502.4 of the Health and Safety Code, by a licensed mental health professional, as defined in subdivision (g) of Section 4096.
SEC. 7.Section 11462.011 is added to the Welfare and Institutions Code, to read:11462.011.(a)The State Department of Health Care Services shall, in consultation with the Department of Managed Health Care, the State Department of Social Services, the County Behavioral Health Directors Association of California, the County Welfare Directors Association of California, the Chief Probation Officers of California, provider representatives, and other relevant stakeholders, establish program standards and procedures for oversight, enforcement, and issuance of childrens crisis residential mental health program approvals, including provisional approvals that are effective for a period of less than one year. The State Department of Health Care Services shall also establish due process protections related to the childrens crisis residential mental health program approval process.
(b)The State Department of Health Care Services shall, in collaboration with the department, the County Behavioral Health Directors Association of California, provider representatives, and other relevant stakeholders, provide guidance to counties for the provision of childrens crisis residential services, including funding for children who are Medi-Cal beneficiaries and who are admitted to a childrens crisis residential program. This subdivision shall only be implemented to the extent that any necessary federal approvals are obtained and federal financial participation is available and is not otherwise jeopardized.
(c)(1)The childrens crisis residential program shall be used only as a diversion to admittance to a psychiatric hospital.
(2)(A)The length of the initial authorization for admission to a childrens crisis residential program shall be limited to 10 consecutive days.
(B)If a determination is made by a health care professional that a childrens crisis residential program is medically necessary and is the appropriate continued level of care, either of the following shall occur:
(i)In the case of a Medi-Cal beneficiary, the childrens crisis residential program shall notify the county mental health plan authorizing those services before extending the length of stay beyond 10 consecutive days.
(ii)In the case of non-Medi-Cal beneficiaries, reauthorizations for admission shall be obtained using the process established by the entity providing coverage.
(C)With the exception of clause (ii) of this subparagraph, this paragraph shall be implemented only to the extent that any necessary federal approvals are obtained and the State Department of Health Care Services determines, in its sole discretion, that federal financial participation is not jeopardized.
(d)A childrens crisis residential mental health program approval issued by the State Department of Health Care Services, or a county mental health plan to which the department has delegated approval authority, shall be a condition of continued licensure for a short-term residential therapeutic program operating as a childrens crisis residential program.
(e)The State Department of Health Care Services, or a county mental health plan to which the department has delegated approval authority, may enforce the childrens crisis residential mental health program approval standards by taking any of the following actions against a noncompliant childrens crisis residential program:
(1)Suspend or revoke a childrens crisis residential mental health program approval.
(2)Impose monetary penalties.
(3)Place a childrens crisis residential mental health program on probation.
(4)Require a childrens crisis residential mental health program to prepare and comply with a corrective action plan.
(f)The State Department of Health Care Services, or a county mental health plan to which the department has delegated approval authority, shall provide a childrens crisis residential mental health program with due process protections when taking any of the actions described in subdivision (e).
(g)Contingent upon an appropriation in the annual Budget Act for these purposes, the department shall begin implementation of this section no later than July 1, 2018, and shall commence the operation of the approval process for childrens crisis residential mental health program approvals no later than January 1, 2019.
SEC. 8.(a)Contingent upon an appropriation from the annual Budget Act for these purposes, the State Department of Social Services and the State Department of Health Care Services shall adopt regulations to implement this act. act no later than July 1, 2021.
(b)Notwithstanding the rulemaking provisions of the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code), the State Department of Social Services and the State Department of Health Care Services may implement and administer the changes made by this act through information notices, all-county letters, or similar written instructions until regulations are adopted.
(c)This section shall become effective upon appropriation of funds by the Legislature for the purposes described in this section.
SEC. 9.The provisions amended or added by this act shall be implemented only if, and to the extent that, federal financial participation, as provided under Title XIX of the federal Social Security Act (42 U.S.C. Sec. 1396 et seq.) is not jeopardized and all necessary federal approvals have been obtained.
SEC. 10.No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution.
The Legislature finds and declares all of the following:
(a)There is an urgent need to provide more crisis care alternatives to hospitals for children and youth experiencing mental health crises.
(b)The problems are especially acute for children and youth who may have to wait for days for a hospital bed and who may be transported, without a parent, to the nearest facility hundreds of miles away.
(c)In 2012, the California Hospital Association reported that two-thirds of the people taken to a hospital for a psychiatric emergency did not meet the criteria for that level of care, but the care they needed was not available.
(d)The type of care that is needed includes crisis residential treatment for children.
(e)This level of care is part of the full continuum of care considered medically necessary for many children with serious emotional disturbances.
(f)In 2013, the Legislature enacted the Investment in Mental Health Wellness Act (Senate Bill 82, Chapter 34 of the Statutes of 2013) to provide one-time funding to counties to expand the availability of mental health crisis care services, including short-term crisis residential treatment services. However, there is currently no state licensing category for short-term crisis residential programs for children. As a result, counties wanting to expand local capacity to meet the needs of children and youth for crisis residential treatment services were ineligible for this competitive grant program.
(g)In most communities, inpatient crisis treatment is completely unavailable for children and youth, even though it may be medically necessary.
(h)Crisis residential care is an essential level of care for the treatment of children and youth with serious emotional disturbances in a mental health crisis, and it often serves as an alternative to hospitalization.
(i)It is imperative that California identify a licensing category specifically for mental health crisis residential care that can be utilized for children and youth who are beneficiaries of both public and private health care plans.
SEC. 2.Section 1502 of the Health and Safety Code is amended to read:1502.As used in this chapter:
(a)Community care facility means any facility, place, or building that is maintained and operated to provide nonmedical residential care, day treatment, adult day care, or foster family agency services for children, adults, or children and adults, including, but not limited to, the physically handicapped, mentally impaired, incompetent persons, and abused or neglected children, and includes the following:
(1)Residential facility means any family home, group care facility, or similar facility determined by the department, for 24-hour nonmedical care of persons in need of personal services, supervision, or assistance essential for sustaining the activities of daily living or for the protection of the individual.
(2)Adult day program means any community-based facility or program that provides care to persons 18 years of age or older in need of personal services, supervision, or assistance essential for sustaining the activities of daily living or for the protection of these individuals on less than a 24-hour basis.
(3)Therapeutic day services facility means any facility that provides nonmedical care, counseling, educational or vocational support, or social rehabilitation services on less than a 24-hour basis to persons under 18 years of age who would otherwise be placed in foster care or who are returning to families from foster care. Program standards for these facilities shall be developed by the department, pursuant to Section 1530, in consultation with therapeutic day services and foster care providers.
(4)Foster family agency means any public agency or private organization, organized and operated on a nonprofit basis, engaged in any of the following:
(A)Recruiting, certifying, approving, and training of, and providing professional support to, foster parents and resource families.
(B)Coordinating with county placing agencies to find homes for foster children in need of care.
(C)Providing services and supports to licensed or certified foster parents, county-approved resource families, and children to the extent authorized by state and federal law.
(5)Foster family home means any residential facility providing 24-hour care for six or fewer foster children that is owned, leased, or rented and is the residence of the foster parent or parents, including their family, in whose care the foster children have been placed. The placement may be by a public or private child placement agency or by a court order, or by voluntary placement by a parent, parents, or guardian. It also means a foster family home described in Section 1505.2.
(6)Small family home means any residential facility, in the licensees family residence, that provides 24-hour care for six or fewer foster children who have mental disorders or developmental or physical disabilities and who require special care and supervision as a result of their disabilities. A small family home may accept children with special health care needs, pursuant to subdivision (a) of Section 17710 of the Welfare and Institutions Code. In addition to placing children with special health care needs, the department may approve placement of children without special health care needs, up to the licensed capacity.
(7)Social rehabilitation facility means any residential facility that provides social rehabilitation services for no longer than 18 months in a group setting to adults recovering from mental illness who temporarily need assistance, guidance, or counseling. Program components shall be subject to program standards pursuant to Article 1 (commencing with Section 5670) of Chapter 2.5 of Part 2 of Division 5 of the Welfare and Institutions Code.
(8)Community treatment facility means any residential facility that provides mental health treatment services to children in a group setting and that has the capacity to provide secure containment. Program components shall be subject to program standards developed and enforced by the State Department of Health Care Services pursuant to Section 4094 of the Welfare and Institutions Code.
Nothing in this section shall be construed to prohibit or discourage placement of persons who have mental or physical disabilities into any category of community care facility that meets the needs of the individual placed, if the placement is consistent with the licensing regulations of the department.
(9)Full-service adoption agency means any licensed entity engaged in the business of providing adoption services, that does all of the following:
(A)Assumes care, custody, and control of a child through relinquishment of the child to the agency or involuntary termination of parental rights to the child.
(B)Assesses the birth parents, prospective adoptive parents, or child.
(C)Places children for adoption.
(D)Supervises adoptive placements.
Private full-service adoption agencies shall be organized and operated on a nonprofit basis. As a condition of licensure to provide intercountry adoption services, a full-service adoption agency shall be accredited and in good standing according to Part 96 (commencing with Section 96.1) of Title 22 of the Code of Federal Regulations, or supervised by an accredited primary provider, or acting as an exempted provider, in compliance with Subpart F (commencing with Section 96.29) of Part 96 of Title 22 of the Code of Federal Regulations.
(10)Noncustodial adoption agency means any licensed entity engaged in the business of providing adoption services, that does all of the following:
(A)Assesses the prospective adoptive parents.
(B)Cooperatively matches children freed for adoption, who are under the care, custody, and control of a licensed adoption agency, for adoption, with assessed and approved adoptive applicants.
(C)Cooperatively supervises adoption placements with a full-service adoptive agency, but does not disrupt a placement or remove a child from a placement.
Private noncustodial adoption agencies shall be organized and operated on a nonprofit basis. As a condition of licensure to provide intercountry adoption services, a noncustodial adoption agency shall be accredited and in good standing according to Part 96 (commencing with Section 96.1) of Title 22 of the Code of Federal Regulations, or supervised by an accredited primary provider, or acting as an exempted provider, in compliance with Subpart F (commencing with Section 96.29) of Part 96 of Title 22 of the Code of Federal Regulations.
(11)Transitional shelter care facility means any group care facility that provides for 24-hour nonmedical care of persons in need of personal services, supervision, or assistance essential for sustaining the activities of daily living or for the protection of the individual. Program components shall be subject to program standards developed by the State Department of Social Services pursuant to Section 1502.3.
(12)Transitional housing placement provider means an organization licensed by the department pursuant to Section 1559.110 and Section 16522.1 of the Welfare and Institutions Code to provide transitional housing to foster children at least 16 years of age and not more than 18 years of age, and nonminor dependents, as defined in subdivision (v) of Section 11400 of the Welfare and Institutions Code, to promote their transition to adulthood. A transitional housing placement provider shall be privately operated and organized on a nonprofit basis.
(13)Group home means a residential facility that provides 24-hour care and supervision to children, delivered at least in part by staff employed by the licensee in a structured environment. The care and supervision provided by a group home shall be nonmedical, except as otherwise permitted by law.
(14)Runaway and homeless youth shelter means a group home licensed by the department to operate a program pursuant to Section 1502.35 to provide voluntary, short-term, shelter and personal services to runaway youth or homeless youth, as defined in paragraph (2) of subdivision (a) of Section 1502.35.
(15)Enhanced behavioral supports home means a facility certified by the State Department of Developmental Services pursuant to Article 3.6 (commencing with Section 4684.80) of Chapter 6 of Division 4.5 of the Welfare and Institutions Code, and licensed by the State Department of Social Services as an adult residential facility or a group home that provides 24-hour nonmedical care to individuals with developmental disabilities who require enhanced behavioral supports, staffing, and supervision in a homelike setting. An enhanced behavioral supports home shall have a maximum capacity of four consumers, shall conform to Section 441.530(a)(1) of Title 42 of the Code of Federal Regulations, and shall be eligible for federal Medicaid home- and community-based services funding.
(16)Community crisis home means a facility certified by the State Department of Developmental Services pursuant to Article 8 (commencing with Section 4698) of Chapter 6 of Division 4.5 of the Welfare and Institutions Code, and licensed by the State Department of Social Services pursuant to Article 9.7 (commencing with Section 1567.80), as an adult residential facility, providing 24-hour nonmedical care to individuals with developmental disabilities receiving regional center service, in need of crisis intervention services, and who would otherwise be at risk of admission to the acute crisis center at Fairview Developmental Center, Sonoma Developmental Center, an acute general hospital, acute psychiatric hospital, an institution for mental disease, as described in Part 5 (commencing with Section 5900) of Division 5 of the Welfare and Institutions Code, or an out-of-state placement. A community crisis home shall have a maximum capacity of eight consumers, as defined in subdivision (a) of Section 1567.80, shall conform to Section 441.530(a)(1) of Title 42 of the Code of Federal Regulations, and shall be eligible for federal Medicaid home- and community-based services funding.
(17)Crisis nursery means a facility licensed by the department to operate a program pursuant to Section 1516 to provide short-term care and supervision for children under six years of age who are voluntarily placed for temporary care by a parent or legal guardian due to a family crisis or stressful situation.
(18)Short-term residential therapeutic program means a residential facility operated by a public agency or private organization and licensed by the department pursuant to Section 1562.01 that provides an integrated program of specialized and intensive care and supervision, services and supports, treatment, and short-term, 24-hour care and supervision to children. The care and supervision provided by a short-term residential therapeutic program shall be nonmedical, except as otherwise permitted by law. Private short-term residential therapeutic programs shall be organized and operated on a nonprofit basis. A short-term residential therapeutic program may be operated as a childrens crisis residential program.
(19)Private alternative boarding school means a group home licensed by the department to operate a program pursuant to Section 1502.2 to provide youth with 24-hour residential care and supervision, which, in addition to providing educational services to youth, provides, or holds itself out as providing, behavioral-based services to youth with social, emotional, or behavioral issues. The care and supervision provided by a private alternative boarding school shall be nonmedical, except as otherwise permitted by law.
(20)Private alternative outdoor program means a group home licensed by the department to operate a program pursuant to Section 1502.21 to provide youth with 24-hour residential care and supervision, which provides, or holds itself out as providing, behavioral-based services in an outdoor living setting to youth with social, emotional, or behavioral issues. The care and supervision provided by a private alternative outdoor program shall be nonmedical, except as otherwise permitted by law.
(21)Childrens crisis residential program means a facility licensed by the department as a short-term residential therapeutic program pursuant to Section 1562.02 and approved by the State Department of Health Care Services, or a county mental health plan to which the State Department of Health Care Services has delegated approval authority, to operate a childrens crisis residential mental health program approval pursuant to Section 11462.011 of the Welfare and Institutions Code, to serve children experiencing mental health crises as an alternative to psychiatric hospitalization.
(b)Department or state department means the State Department of Social Services.
(c)Director means the Director of Social Services.
SEC. 3.Section 1562.02 is added to the Health and Safety Code, to read:1562.02.(a)The department may license a short-term residential therapeutic program operating as a childrens crisis residential program pursuant to this chapter. A childrens crisis residential program shall meet all of the following requirements:
(1)If the program serves children who are not experiencing mental health crises, have an identifiable and physically separate unit for those children who are experiencing mental health crises. The separate unit shall be indicated on the short-term residential therapeutic programs license.
(2)Obtain and have in good standing a mental health program approval that includes a Medi-Cal mental health certification, as described in Section 11462.01 of the Welfare and Institutions Code, and a childrens crisis residential mental health program approval, as described in Section 11462.011 of the Welfare and Institutions Code, both of which are issued by the State Department of Health Care Services, or a county mental health plan to which the department has delegated approval authority. The short-term residential therapeutic program shall obtain a mental health program approval before operating as a childrens crisis residential program. The department may revoke a programs license pursuant to Section 1550 for a programs failure to maintain the mental health program approval.
(3)Comply with all applicable licensing standards for a short-term residential therapeutic program, unless otherwise specified by the department in regulations.
(b)Contingent upon an appropriation in the annual Budget Act for these purposes, the department shall begin implementation of this section no later than July 1, 2018, and shall commence the licensing process for childrens crisis residential programs no later than January 1, 2019.
SEC. 4.Section 1562.03 is added to the Health and Safety Code, to read:1562.03.(a)The department shall establish regulations for short-term residential therapeutic programs that are operated as childrens crisis residential programs. At a minimum, the regulations shall include all of the following:
(1)Therapeutic programming shall be provided seven days a week, including weekends and holidays, with sufficient professional and paraprofessional staff to maintain an appropriate treatment setting and services, based on individual childrens needs.
(2)The program shall be staffed with sufficient personnel to accept children 24 hours per day, seven days a week and to admit children, at a minimum, from 7 a.m. to 11 p.m., seven days a week, 365 days per year. The program shall be sufficiently staffed to discharge children, as appropriate, seven days a week, 365 days per year.
(3)Facilities shall be limited to fewer than 16 beds, with at least 50 percent of those beds in single-occupancy rooms.
(4)Facilities shall include ample physical space for accommodating individuals who provide daily emotional and physical supports to each child and for integrating family members into the day-to-day care of the youth.
(5)The program shall collaborate with each childs existing mental health team, if applicable, child and family team, if applicable, and other formal and natural supports within 24 hours of intake and throughout the course of care and treatment as appropriate.
(6)The program shall create and assist with the implementation of a plan for transitioning each admitted child from the program to his or her home and community, including the establishment of a mental health or child and family team if there is not one already.
(b)The program shall annually provide the department with all of the following data as it pertains to children in foster care and children not in foster care in conjunction with its application for licensure renewal:
(1)Age and gender of clients served.
(2)Duration of stay.
(3)Professional classification of staff and contracted staff.
(4)Type of placement the client was discharged to.
SEC. 5.Section 5848.5 of the Welfare and Institutions Code is amended to read:5848.5.(a)The Legislature finds and declares all of the following:
(1)California has realigned public community mental health services to counties and it is imperative that sufficient community-based resources be available to meet the mental health needs of eligible individuals.
(2)Increasing access to effective outpatient and crisis stabilization services provides an opportunity to reduce costs associated with expensive inpatient and emergency room care and to better meet the needs of individuals with mental health disorders in the least restrictive manner possible.
(3)Almost one-fifth of people with mental health disorders visit a hospital emergency room at least once per year. If an adequate array of crisis services is not available, it leaves an individual with little choice but to access an emergency room for assistance and, potentially, an unnecessary inpatient hospitalization.
(4)Recent reports have called attention to a continuing problem of inappropriate and unnecessary utilization of hospital emergency rooms in California due to limited community-based services for individuals in psychological distress and acute psychiatric crisis. Hospitals report that 70 percent of people taken to emergency rooms for psychiatric evaluation can be stabilized and transferred to a less intensive level of crisis care. Law enforcement personnel report that their personnel need to stay with people in the emergency room waiting area until a placement is found, and that less intensive levels of care tend not to be available.
(5)Comprehensive public and private partnerships at both local and regional levels, including across physical health services, mental health, substance use disorder, law enforcement, social services, and related supports, are necessary to develop and maintain high quality, patient-centered, and cost-effective care for individuals with mental health disorders that facilitates their recovery and leads towards wellness.
(6)The recovery of individuals with mental health disorders is important for all levels of government, business, and the local community.
(b)This section shall be known, and may be cited, as the Investment in Mental Health Wellness Act of 2013. The objectives of this section are to do all of the following:
(1)Expand access to early intervention and treatment services to improve the client experience, achieve recovery and wellness, and reduce costs.
(2)Expand the continuum of services to address crisis intervention, crisis stabilization, and crisis residential treatment needs that are wellness, resiliency, and recovery oriented.
(3)Add at least 25 mobile crisis support teams and at least 2,000 crisis stabilization and crisis residential treatment beds to bolster capacity at the local level to improve access to mental health crisis services and address unmet mental health care needs.
(4)Add at least 600 triage personnel to provide intensive case management and linkage to services for individuals with mental health care disorders at various points of access, such as at designated community-based service points, homeless shelters, and clinics.
(5)Reduce unnecessary hospitalizations and inpatient days by appropriately utilizing community-based services and improving access to timely assistance.
(6)Reduce recidivism and mitigate unnecessary expenditures of local law enforcement.
(7)Provide local communities with increased financial resources to leverage additional public and private funding sources to achieve improved networks of care for individuals with mental health disorders.
(8)Provide a complete continuum of crisis services for children and youth 21 years of age and under regardless of where they live in the state. The funds included in the 2016 Budget Act for the purpose of developing the continuum of mental health crisis services for children and youth 21 years of age and under shall be for the following objectives:
(A)Provide a continuum of crisis services for children and youth 21 years of age and under regardless of where they live in the state.
(B)Provide for early intervention and treatment services to improve the client experience, achieve recovery and wellness, and reduce costs.
(C)Expand the continuum of community-based services to address crisis intervention, crisis stabilization, and crisis residential treatment needs that are wellness-, resiliency-, and recovery-oriented.
(D)Add at least 200 mobile crisis support teams.
(E)Add at least 120 crisis stabilization services and beds and crisis residential treatment beds to increase capacity at the local level to improve access to mental health crisis services and address unmet mental health care needs.
(F)Add triage personnel to provide intensive case management and linkage to services for individuals with mental health care disorders at various points of access, such as at designated community-based service points, homeless shelters, schools, and clinics.
(G)Expand family respite care to help families and sustain caregiver health and well-being.
(H)Expand family supportive training and related services designed to help families participate in the planning process, access services, and navigate programs.
(I)Reduce unnecessary hospitalizations and inpatient days by appropriately utilizing community-based services.
(J)Reduce recidivism and mitigate unnecessary expenditures of local law enforcement.
(K)Provide local communities with increased financial resources to leverage additional public and private funding sources to achieve improved networks of care for children and youth 21 years of age and under with mental health disorders.
(c)Through appropriations provided in the annual Budget Act for this purpose, it is the intent of the Legislature to authorize the California Health Facilities Financing Authority, hereafter referred to as the authority, and the Mental Health Services Oversight and Accountability Commission, hereafter referred to as the commission, to administer competitive selection processes as provided in this section for capital capacity and program expansion to increase capacity for mobile crisis support, crisis intervention, crisis stabilization services, crisis residential treatment, and specified personnel resources.
(d)Funds appropriated by the Legislature to the authority for purposes of this section shall be made available to selected counties, or counties acting jointly. The authority may, at its discretion, also give consideration to private nonprofit corporations and public agencies in an area or region of the state if a county, or counties acting jointly, affirmatively supports this designation and collaboration in lieu of a county government directly receiving grant funds.
(1)Grant awards made by the authority shall be used to expand local resources for the development, capital, equipment acquisition, and applicable program startup or expansion costs to increase capacity for client assistance and services in the following areas:
(A)Crisis intervention, as authorized by Sections 14021.4, 14680, and 14684.
(B)Crisis stabilization, as authorized by Sections 14021.4, 14680, and 14684.
(C)Crisis residential treatment, as authorized by Sections 14021.4, 14680, and 14684 and as provided at a childrens crisis residential program, as defined in Section 1502 of the Health and Safety Code.
(D)Rehabilitative mental health services, as authorized by Sections 14021.4, 14680, and 14684.
(E)Mobile crisis support teams, including personnel and equipment, such as the purchase of vehicles.
(2)The authority shall develop selection criteria to expand local resources, including those described in paragraph (1), and processes for awarding grants after consulting with representatives and interested stakeholders from the mental health community, including, but not limited to, the County Behavioral Health Directors Association of California, service providers, consumer organizations, and other appropriate interests, such as health care providers and law enforcement, as determined by the authority. The authority shall ensure that grants result in cost-effective expansion of the number of community-based crisis resources in regions and communities selected for funding. The authority shall also take into account at least the following criteria and factors when selecting recipients of grants and determining the amount of grant awards:
(A)Description of need, including, at a minimum, a comprehensive description of the project, community need, population to be served, linkage with other public systems of health and mental health care, linkage with local law enforcement, social services, and related assistance, as applicable, and a description of the request for funding.
(B)Ability to serve the target population, which includes individuals eligible for Medi-Cal and individuals eligible for county health and mental health services.
(C)Geographic areas or regions of the state to be eligible for grant awards, which may include rural, suburban, and urban areas, and may include use of the five regional designations utilized by the County Behavioral Health Directors Association of California.
(D)Level of community engagement and commitment to project completion.
(E)Financial support that, in addition to a grant that may be awarded by the authority, will be sufficient to complete and operate the project for which the grant from the authority is awarded.
(F)Ability to provide additional funding support to the project, including public or private funding, federal tax credits and grants, foundation support, and other collaborative efforts.
(G)Memorandum of understanding among project partners, if applicable.
(H)Information regarding the legal status of the collaborating partners, if applicable.
(I)Ability to measure key outcomes, including improved access to services, health and mental health outcomes, and cost benefit of the project.
(3)The authority shall determine maximum grants awards, which shall take into consideration the number of projects awarded to the grantee, as described in paragraph (1), and shall reflect reasonable costs for the project and geographic region. The authority may allocate a grant in increments contingent upon the phases of a project.
(4)Funds awarded by the authority pursuant to this section may be used to supplement, but not to supplant, existing financial and resource commitments of the grantee or any other member of a collaborative effort that has been awarded a grant.
(5)All projects that are awarded grants by the authority shall be completed within a reasonable period of time, to be determined by the authority. Funds shall not be released by the authority until the applicant demonstrates project readiness to the authoritys satisfaction. If the authority determines that a grant recipient has failed to complete the project under the terms specified in awarding the grant, the authority may require remedies, including the return of all or a portion of the grant.
(6)A grantee that receives a grant from the authority under this section shall commit to using that capital capacity and program expansion project, such as the mobile crisis team, crisis stabilization unit, or crisis residential treatment program, for the duration of the expected life of the project.
(7)The authority may consult with a technical assistance entity, as described in paragraph (5) of subdivision (a) of Section 4061, for purposes of implementing this section.
(8)The authority may adopt emergency regulations relating to the grants for the capital capacity and program expansion projects described in this section, including emergency regulations that define eligible costs and determine minimum and maximum grant amounts.
(9)The authority shall provide reports to the fiscal and policy committees of the Legislature on or before May 1, 2014, and on or before May 1, 2015, on the progress of implementation, that include, but are not limited to, the following:
(A)A description of each project awarded funding.
(B)The amount of each grant issued.
(C)A description of other sources of funding for each project.
(D)The total amount of grants issued.
(E)A description of project operation and implementation, including who is being served.
(10)A recipient of a grant provided pursuant to paragraph (1) shall adhere to all applicable laws relating to scope of practice, licensure, certification, staffing, and building codes.
(e)Of the funds specified in paragraph (8) of subdivision (b), it is the intent of the Legislature to authorize the authority and the commission to administer competitive selection processes as provided in this section for capital capacity and program expansion to increase capacity for mobile crisis support, crisis intervention, crisis stabilization services, crisis residential treatment, family respite care, family supportive training and related services, and triage personnel resources for children and youth 21 years of age and under.
(f)Funds appropriated by the Legislature to the authority to address crisis services for children and youth 21 years of age and under for the purposes of this section shall be made available to selected counties or counties acting jointly. The authority may, at its discretion, also give consideration to private nonprofit corporations and public agencies in an area or region of the state if a county, or counties acting jointly, affirmatively support this designation and collaboration in lieu of a county government directly receiving grant funds.
(1)Grant awards made by the authority shall be used to expand local resources for the development, capital, equipment acquisition, and applicable program startup or expansion costs to increase capacity for client assistance and crisis services for children and youth 21 years of age and under in the following areas:
(A)Crisis intervention, as authorized by Sections 14021.4, 14680, and 14684.
(B)Crisis stabilization, as authorized by Sections 14021.4, 14680, and 14684.
(C)Crisis residential treatment, as authorized by Sections 14021.4, 14680, and 14684 and as provided at a childrens crisis residential program, as defined in Section 1502 of the Health and Safety Code.
(D)Mobile crisis support teams, including the purchase of equipment and vehicles.
(E)Family respite care.
(2)The authority shall develop selection criteria to expand local resources, including those described in paragraph (1), and processes for awarding grants after consulting with representatives and interested stakeholders from the mental health community, including, but not limited to, county mental health directors, service providers, consumer organizations, and other appropriate interests, such as health care providers and law enforcement, as determined by the authority. The authority shall ensure that grants result in cost-effective expansion of the number of community-based crisis resources in regions and communities selected for funding. The authority shall also take into account at least the following criteria and factors when selecting recipients of grants and determining the amount of grant awards:
(A)Description of need, including, at a minimum, a comprehensive description of the project, community need, population to be served, linkage with other public systems of health and mental health care, linkage with local law enforcement, social services, and related assistance, as applicable, and a description of the request for funding.
(B)Ability to serve the target population, which includes individuals eligible for Medi-Cal and individuals eligible for county health and mental health services.
(C)Geographic areas or regions of the state to be eligible for grant awards, which may include rural, suburban, and urban areas, and may include use of the five regional designations utilized by the California Behavioral Health Directors Association.
(D)Level of community engagement and commitment to project completion.
(E)Financial support that, in addition to a grant that may be awarded by the authority, will be sufficient to complete and operate the project for which the grant from the authority is awarded.
(F)Ability to provide additional funding support to the project, including public or private funding, federal tax credits and grants, foundation support, and other collaborative efforts.
(G)Memorandum of understanding among project partners, if applicable.
(H)Information regarding the legal status of the collaborating partners, if applicable.
(I)Ability to measure key outcomes, including utilization of services, health and mental health outcomes, and cost benefit of the project.
(3)The authority shall determine maximum grant awards, which shall take into consideration the number of projects awarded to the grantee, as described in paragraph (1), and shall reflect reasonable costs for the project, geographic region, and target ages. The authority may allocate a grant in increments contingent upon the phases of a project.
(4)Funds awarded by the authority pursuant to this section may be used to supplement, but not to supplant, existing financial and resource commitments of the grantee or any other member of a collaborative effort that has been awarded a grant.
(5)All projects that are awarded grants by the authority shall be completed within a reasonable period of time, to be determined by the authority. Funds shall not be released by the authority until the applicant demonstrates project readiness to the authoritys satisfaction. If the authority determines that a grant recipient has failed to complete the project under the terms specified in awarding the grant, the authority may require remedies, including the return of all, or a portion, of the grant.
(6)A grantee that receives a grant from the authority under this section shall commit to using that capital capacity and program expansion project, such as the mobile crisis team, crisis stabilization unit, family respite care, or crisis residential treatment program, for the duration of the expected life of the project.
(7)The authority may consult with a technical assistance entity, as described in paragraph (5) of subdivision (a) of Section 4061, for the purposes of implementing this section.
(8)The authority may adopt emergency regulations relating to the grants for the capital capacity and program expansion projects described in this section, including emergency regulations that define eligible costs and determine minimum and maximum grant amounts.
(9)The authority shall provide reports to the fiscal and policy committees of the Legislature on or before January 10, 2018, and annually thereafter, on the progress of implementation, that include, but are not limited to, the following:
(A)A description of each project awarded funding.
(B)The amount of each grant issued.
(C)A description of other sources of funding for each project.
(D)The total amount of grants issued.
(E)A description of project operation and implementation, including who is being served.
(10)A recipient of a grant provided pursuant to paragraph (1) shall adhere to all applicable laws relating to scope of practice, licensure, certification, staffing, and building codes.
(g)Funds appropriated by the Legislature to the commission for purposes of this section shall be allocated for triage personnel to provide intensive case management and linkage to services for individuals with mental health disorders at various points of access. These funds shall be made available to selected counties, counties acting jointly, or city mental health departments, as determined by the commission through a selection process. It is the intent of the Legislature for these funds to be allocated in an efficient manner to encourage early intervention and receipt of needed services for individuals with mental health disorders, and to assist in navigating the local service sector to improve efficiencies and the delivery of services.
(1)Triage personnel may provide targeted case management services face to face, by telephone, or by telehealth with the individual in need of assistance or his or her significant support person, and may be provided anywhere in the community. These service activities may include, but are not limited to, the following:
(A)Communication, coordination, and referral.
(B)Monitoring service delivery to ensure the individual accesses and receives services.
(C)Monitoring the individuals progress.
(D)Providing placement service assistance and service plan development.
(2)The commission shall take into account at least the following criteria and factors when selecting recipients and determining the amount of grant awards for triage personnel as follows:
(A)Description of need, including potential gaps in local service connections.
(B)Description of funding request, including personnel and use of peer support.
(C)Description of how triage personnel will be used to facilitate linkage and access to services, including objectives and anticipated outcomes.
(D)Ability to obtain federal Medicaid reimbursement, when applicable.
(E)Ability to administer an effective service program and the degree to which local agencies and service providers will support and collaborate with the triage personnel effort.
(F)Geographic areas or regions of the state to be eligible for grant awards, which shall include rural, suburban, and urban areas, and may include use of the five regional designations utilized by the County Behavioral Health Directors Association of California.
(3)The commission shall determine maximum grant awards, and shall take into consideration the level of need, population to be served, and related criteria, as described in paragraph (2), and shall reflect reasonable costs.
(4)Funds awarded by the commission for purposes of this section may be used to supplement, but not supplant, existing financial and resource commitments of the county, counties acting jointly, or city mental health department that received the grant.
(5)Notwithstanding any other law, a county, counties acting jointly, or city mental health department that receives an award of funds for the purpose of supporting triage personnel pursuant to this subdivision is not required to provide a matching contribution of local funds.
(6)Notwithstanding any other law, the commission, without taking any further regulatory action, may implement, interpret, or make specific this section by means of informational letters, bulletins, or similar instructions.
(7)The commission shall provide a status report to the fiscal and policy committees of the Legislature on the progress of implementation no later than March 1, 2014.
(h)Funds appropriated by the Legislature to the commission pursuant to paragraph (8) of subdivision (b) for the purposes of addressing childrens crisis services shall be allocated to support triage personnel and family supportive training and related services. These funds shall be made available to selected counties, counties acting jointly, or city mental health departments, as determined by the commission through a selection process. The commission may, at its discretion, also give consideration to private nonprofit corporations and public agencies in an area or region of the state if a county, or counties acting jointly, affirmatively supports this designation and collaboration in lieu of a county government directly receiving grant funds.
(1)These funds may provide for a range of crisis-related services for a child in need of assistance, or his or her parent, guardian, or caregiver. These service activities may include, but are not limited to, the following:
(A)Intensive coordination of care and services.
(B)Communication, coordination, and referral.
(C)Monitoring service delivery to the child or youth.
(D)Monitoring the childs progress.
(E)Providing placement service assistance and service plan development.
(F)Crisis or safety planning.
(2)The commission shall take into account at least the following criteria and factors when selecting recipients and determining the amount of grant awards for these funds, as follows:
(A)Description of need, including potential gaps in local service connections.
(B)Description of funding request, including personnel.
(C)Description of how personnel and other services will be used to facilitate linkage and access to services, including objectives and anticipated outcomes.
(D)Ability to obtain federal Medicaid reimbursement, when applicable.
(E)Ability to provide a matching contribution of local funds.
(F)Ability to administer an effective service program and the degree to which local agencies and service providers will support and collaborate with the triage personnel effort.
(G)Geographic areas or regions of the state to be eligible for grant awards, which shall include rural, suburban, and urban areas, and may include use of the five regional designations utilized by the County Behavioral Health Directors Association of California.
(3)The commission shall determine maximum grant awards, and shall take into consideration the level of need, population to be served, and related criteria, as described in paragraph (2), and shall reflect reasonable costs.
(4)Funds awarded by the commission for purposes of this section may be used to supplement, but not supplant, existing financial and resource commitments of the county, counties acting jointly, or a city mental health department that received the grant.
(5)Notwithstanding any other law, a county, counties acting jointly, or a city mental health department that receives an award of funds for the purpose of this section is not required to provide a matching contribution of local funds.
(6)Notwithstanding any other law, the commission, without taking any further regulatory action, may implement, interpret, or make specific this section by means of informational letters, bulletins, or similar instructions.
(7)The commission may waive requirements in this section for counties with a population of 100,000 or less, if the commission determines it is in the best interest of the state and meets the intent of the law.
(8)The commission shall provide a status report to the fiscal and policy committees of the Legislature on the progress of implementation no later than January 10, 2018, and annually thereafter.
SEC. 6.Section 11462.01 of the Welfare and Institutions Code, as added by Section 75 of Chapter 773 of the Statutes of 2015, is amended to read:11462.01.(a)(1)If a program is not intended for the exclusive use of private insurance plans, will admit Medi-Cal beneficiaries, no later than 12 months following the date of initial licensure, a short-term residential therapeutic program, as defined in subdivision (ad) of Section 11400 of this code and paragraph (18) of subdivision (a) of Section 1502 of the Health and Safety Code, shall obtain a contract, subject to an agreement on rates and terms and conditions, with a county mental health plan to provide specialty mental health services and demonstrate the ability to meet the therapeutic needs of each child, as identified in any of the following:
(A)A mental health assessment.
(B)The childs case plan.
(C)The childs needs and services plan.
(D)Other documentation demonstrating the child has a mental health need.
(2)A short-term residential therapeutic program shall comply with any other mental health program approvals required by the State Department of Health Care Services or by a county mental health plan to which mental health program approval authority has been delegated.
(b)A short-term residential therapeutic program, except as specified in subdivision (c), may accept for placement a child who meets both of the criteria in paragraphs (1) and (2) and at least one of the conditions in paragraph (3).
(1)The child does not require inpatient care in a licensed health facility.
(2)The child has been assessed as requiring the level of services provided in a short-term residential therapeutic program in order to maintain the safety and well-being of the child or others due to behaviors, including those resulting from traumas, that render the child or those around the child unsafe or at risk of harm, or that prevent the effective delivery of needed services and supports provided in the childs own home or in other family settings, such as with a relative, guardian, foster family, resource family, or adoptive family. The assessment shall ensure the child has needs in common with other children or youth in the care of the facility, consistent with subdivision (c) of Section 16514.
(3)The child meets at least one of the following conditions:
(A)The child has been assessed, pursuant to Section 4096, as meeting the medical necessity criteria for Medi-Cal specialty mental health services, as provided for in Section 1830.205 or 1830.210 of Title 9 of the California Code of Regulations.
(B)The child has been assessed, pursuant to Section 4096, as seriously emotionally disturbed, as defined in subdivision (a) of Section 5600.3.
(C)The child requires emergency placement pursuant to paragraph (3) of subdivision (i).
(D)The child has been assessed, pursuant to Section 4096, as requiring the level of services provided by the short-term residential therapeutic program in order to meet his or her behavioral or therapeutic needs.
(4)Subject to the requirements of this subdivision, a short-term residential therapeutic program may have a specialized program to serve a child, including, but not limited to, the following:
(A)A commercially sexually exploited child.
(B)A private voluntary placement, if the youth exhibits status offender behavior, the parents or other relatives feel they cannot control the childs behavior, and short-term intervention is needed to transition the child back into the home.
(C)A juvenile sex offender.
(D)A child who is affiliated with, or impacted by, a gang.
(c)(1)A short-term residential therapeutic program that is operating as a childrens crisis residential program, as defined in Section 1502 of the Health and Safety Code, may accept for admission any child who meets all of the following requirements:
(A)The child is referred by a parent or guardian, physician, or licensed mental health professional, or by the representative of a public or private entity, including, but not limited to, the county probation agency or child welfare services agency with responsibility for the placement of a child in foster care, that has the right to make these decisions on behalf of a child who is in mental health crisis.
(B)The child is under 19, 20, or 21 years of age, depending on a programs licensing requirements.
(C)The child has a serious behavioral health disorder.
(D)The child requires a 24-hour-a-day, seven-day-a-week, staff-secured, unlocked treatment setting.
(2)The primary function of a childrens crisis residential program is to provide short-term crisis stabilization, therapeutic intervention, and specialized programming in an unlocked, staff-secured setting with a high degree of supervision and structure and the goal of supporting the rapid and successful transition of the child back to the community.
(d)A foster family agency that is certified as a Medi-Cal specialty mental health provider pursuant to Section 1810.435 of Title 9 of the California Code of Regulations by the State Department of Health Care Services, or by a county mental health plan to which the department has delegated certification authority, and which has entered into a contract with a county mental health plan pursuant to Section 1810.436 of Title 9 of the California Code of Regulations, shall provide, or provide access to, specialty mental health services to children under its care who do not require inpatient care in a licensed health facility and who meet the medical necessity criteria for Medi-Cal specialty mental health services provided for in Section 1830.205 or 1830.210 of Title 9 of the California Code of Regulations.
(e)A foster family agency that is not certified as a Medi-Cal specialty mental health provider shall provide access to specialty and non-specialty mental health services in that program for children who do not require inpatient care in a licensed health facility and who meet any of the conditions in paragraph (3) of subdivision (b). In this situation the foster family agency shall do the following:
(1)In the case of a child who is a Medi-Cal beneficiary, arrange for specialty mental health services from the county mental health plan.
(2)In all other cases, arrange for the child to receive mental health services.
(f)All short-term residential therapeutic programs shall maintain the level of care and services necessary to meet the needs of the children and youth in their care and shall maintain and have in good standing the appropriate mental health program approval. If a program will admit Medi-Cal beneficiaries, the mental health program approval shall include a certification to provide Medi-Cal specialty mental health services issued by the State Department of Health Care Services or a county mental health plan to which the department has delegated mental health program approval authority, pursuant to Section 4096.5 of this code or Section 1810.435 or 1810.436 of Title 9 of the California Code of Regulations. All foster family agencies that are certified as a Medi-Cal specialty mental health provider pursuant to Section 1810.435 of Title 9 of the California Code of Regulations shall maintain the level of care and services necessary to meet the needs of children and youth in their care and shall maintain and have in good standing the Medi-Cal specialty mental health provider certification issued by the State Department of Health Care Services or a county mental health plan to which the department has delegated certification authority.
(g)The assessments described in subparagraphs (A), (B), (C), and (D) of paragraph (3) of subdivision (b) shall ensure the childs individual behavioral or treatment needs are consistent with, and can be met by, the facility and shall be made by one of the following, as applicable:
(1)An interagency placement committee, as described in Section 4096, considering the recommendations from the child and family team, if any are available. If the short-term residential therapeutic program serves children who are placed by county child welfare agencies and children who are placed by probation departments, the interagency placement committee shall also ensure the requirements of subdivision (c) of Section 16514 have been met with respect to commonality of need.
(2)A licensed mental health professional as defined in subdivision (g) of Section 4096.
(3)For the purposes of this section, an AFDC-FC funded child with an individualized education program developed pursuant to Article 2 (commencing with Section 56320) of Chapter 4 of Part 30 of Division 4 of Title 2 of the Education Code that assesses the child as seriously emotionally disturbed, as defined in, and subject to, this section and recommends out-of-home placement at the level of care provided by the provider, shall be deemed to have met the assessment requirement.
(h)The evaluation described in subparagraph (A) of paragraph (3) of subdivision (i) shall be made pursuant to subdivision (b) of Section 706.6 or paragraph (2) of subdivision (c) of Section 16501.1.
(i)(1)The provider shall ensure that AFDC-FC funded children, assessed pursuant to subparagraphs (A) and (B) of paragraph (3) of subdivision (b), who are accepted for placement have been approved for placement by an interagency placement committee, as described in Section 4096, except as provided for in paragraph (3) of subdivision (g).
(2)The approval shall be in writing and shall indicate that the interagency placement committee has determined one of the following:
(A)The child meets the medical necessity criteria for Medi-Cal specialty mental health services, as provided for in Section 1830.205 or 1830.210 of Title 9 of the California Code of Regulations.
(B)The child is seriously emotionally disturbed, as described in subdivision (a) of Section 5600.3.
(3)(A)Nothing in subdivisions (a) to (h), inclusive, or this subdivision shall prevent an emergency placement of a child or youth into a certified short-term residential therapeutic program or childrens crisis residential program prior to the determination by the interagency placement committee, but only if a licensed mental health professional, as defined in subdivision (g) of Section 4096, has made a written determination within 72 hours of the childs or youths placement, that the child or youth requires the level of services and supervision provided by the short-term residential therapeutic program in order to meet his or her behavioral or therapeutic needs, or has made a written determination within 24 hours of the childs or youths placement in a childrens crisis residential program that the child or youth is experiencing a mental health crisis as defined in subdivision (c) and is in need of the care and services provided by the childrens crisis residential program. If the short-term residential therapeutic program serves children placed by county child welfare agencies and children placed by probation departments, the interagency placement committee shall also ensure the requirements of subdivision (c) of Section 16514 have been met with respect to commonality of need.
(i)The interagency placement committee, as appropriate, shall, within 30 days of placement, make the determinations, with recommendations from the child and family team, required by this subdivision.
(ii)If it determines the placement is appropriate, the interagency placement committee, with recommendations from the child and family team, shall transmit the approval, in writing, to the county placing agency and the short-term residential therapeutic program.
(iii)If it determines the placement is not appropriate, the interagency placement committee shall respond pursuant to subparagraph (B).
(B)(i)If the interagency placement committee determines at any time that the placement is not appropriate, it shall, with recommendations from the child and family team, transmit the disapproval, in writing, to the county placing agency and the short-term residential therapeutic program and shall include a recommendation as to the childs appropriate level of care and placement to meet his or her service needs. The necessary interagency placement committee representative or representatives shall participate in any child and family team meetings to refer the child or youth to an appropriate placement, as specified in this section.
(ii)The child may remain in the placement for the amount of time necessary to identify and transition the child to an alternative, suitable placement.
(iii)Notwithstanding clause (ii), if the interagency placement committee determined the placement was not appropriate due to a health and safety concern, immediate arrangements for the child to transition to an appropriate placement shall occur.
(j)Commencing January 1, 2017, for AFDC-FC funded children or youth, only those children or youth who are approved for placement, as set forth in this section, may be accepted by a short-term residential therapeutic program.
(k)The department shall, through regulation, establish consequences for the failure of a short-term residential therapeutic program to obtain written approval for placement of an AFDC-FC funded child or youth pursuant to this section.
(l)The department shall not establish a rate for a short-term residential therapeutic program unless the provider submits a recommendation from the host county or the primary placing county that the program is needed and that the provider is willing and capable of operating the program at the level sought. For purposes of this subdivision, host county, and primary placing county, mean the same as defined in the departments AFDC-FC ratesetting regulations.
(m)Any certified short-term residential therapeutic program shall be reclassified and paid at the appropriate program rate for which it is qualified if either of the following occurs:
(1)(A)It fails to maintain the level of care and services necessary to meet the needs of the children and youth in care, as required by subdivision (a). The determination shall be made consistent with the departments AFDC-FC ratesetting regulations developed pursuant to Section 11462 and shall take into consideration the highest level of care and associated rates for which the program may be eligible if granted an extension pursuant to Section 11462.04 or any reduction in rate associated with a provisional or probationary rate granted or imposed under Section 11466.01.
(B)In the event of a determination under this paragraph, the short-term residential therapeutic program may appeal the finding or submit a corrective action plan. The appeal process specified in Section 11466.6 shall be available to a short-term residential therapeutic program that provides intensive and therapeutic treatment. During any appeal, the short-term residential therapeutic program that provides intensive and therapeutic treatment shall maintain the appropriate level of care.
(2)It fails to maintain a certified mental health treatment program as required by subdivision (f).
(n)In addition to any other review required by law, the child and family team as defined in paragraph (4) of subdivision (a) of Section 16501 may periodically review the placement of the child or youth. If the child and family team make a recommendation that the child or youth no longer needs, or is not benefiting from, placement in a short-term residential therapeutic program, the team shall transmit the disapproval, in writing, to the county placing agency to consider a more appropriate placement.
(o)The department shall develop a process to address placements when, subsequent to the childs or youths placement, a determination is made by the interagency placement team and shall consider the recommendations of the child and family team, either that the child or youth is not in need of the care and services provided by the certified program. The process shall include, but not be limited to:
(1)Notice of the determination in writing to both the county placing agency and the short-term residential therapeutic program or foster family agency that provides intensive and therapeutic treatment.
(2)Notice of the countys plan, and a timeframe, for removal of the child or youth in writing to the short-term residential therapeutic program that provides intensive and therapeutic treatment.
(3)Referral to an appropriate placement.
(4)Actions to be taken if a child or youth is not timely removed from the short-term residential therapeutic program that provides intensive and therapeutic treatment or placed in an appropriate placement.
(p)(1)Nothing in this section shall prohibit a short-term residential therapeutic program from accepting private admissions of children or youth.
(2)When a referral is not from a public agency and no public funding is not involved, there is no requirement for public agency review or determination of need.
(3)Children and youth subject to paragraphs (1) and (2) shall have been determined to be seriously emotionally disturbed, as described in subdivision (a) of Section 5600.3, and subject to Section 1502.4 of the Health and Safety Code, by a licensed mental health professional, as defined in subdivision (g) of Section 4096.
SEC. 7.Section 11462.011 is added to the Welfare and Institutions Code, to read:11462.011.(a)The State Department of Health Care Services shall, in consultation with the Department of Managed Health Care, the State Department of Social Services, the County Behavioral Health Directors Association of California, the County Welfare Directors Association of California, the Chief Probation Officers of California, provider representatives, and other relevant stakeholders, establish program standards and procedures for oversight, enforcement, and issuance of childrens crisis residential mental health program approvals, including provisional approvals that are effective for a period of less than one year. The State Department of Health Care Services shall also establish due process protections related to the childrens crisis residential mental health program approval process.
(b)The State Department of Health Care Services shall, in collaboration with the department, the County Behavioral Health Directors Association of California, provider representatives, and other relevant stakeholders, provide guidance to counties for the provision of childrens crisis residential services, including funding for children who are Medi-Cal beneficiaries and who are admitted to a childrens crisis residential program. This subdivision shall only be implemented to the extent that any necessary federal approvals are obtained and federal financial participation is available and is not otherwise jeopardized.
(c)(1)The childrens crisis residential program shall be used only as a diversion to admittance to a psychiatric hospital.
(2)(A)The length of the initial authorization for admission to a childrens crisis residential program shall be limited to 10 consecutive days.
(B)If a determination is made by a health care professional that a childrens crisis residential program is medically necessary and is the appropriate continued level of care, either of the following shall occur:
(i)In the case of a Medi-Cal beneficiary, the childrens crisis residential program shall notify the county mental health plan authorizing those services before extending the length of stay beyond 10 consecutive days.
(ii)In the case of beneficiaries of private insurance, non-Medi-Cal beneficiaries, reauthorizations for admission shall be obtained using the process established by the individual plans. entity providing coverage.
(C)With the exception of clause (ii) of this subparagraph, this paragraph shall be implemented only to the extent that any necessary federal approvals are obtained and the State Department of Health Care Services determines, in its sole discretion, that federal financial participation is not jeopardized.
(d)A childrens crisis residential mental health program approval issued by the State Department of Health Care Services, or a county mental health plan to which the department has delegated approval authority, shall be a condition of continued licensure for a short-term residential therapeutic program operating as a childrens crisis residential program.
(e)The State Department of Health Care Services, or a county mental health plan to which the department has delegated approval authority, may enforce the childrens crisis residential mental health program approval standards by taking any of the following actions against a noncompliant childrens crisis residential program:
(1)Suspend or revoke a childrens crisis residential mental health program approval.
(2)Impose monetary penalties.
(3)Place a childrens crisis residential mental health program on probation.
(4)Require a childrens crisis residential mental health program to prepare and comply with a corrective action plan.
(f)The State Department of Health Care Services, or a county mental health plan to which the department has delegated approval authority, shall provide a childrens crisis residential mental health program with due process protections when taking any of the actions described in subdivision (e).
(g)Contingent upon an appropriation in the annual Budget Act for these purposes, the department shall begin implementation of this section no later than July 1, 2018, and shall commence the operation of the approval process for childrens crisis residential mental health program approvals no later than January 1, 2019.
SEC. 8.(a)Contingent upon an appropriation from the annual Budget Act for these purposes, the State Department of Social Services and the State Department of Health Care Services shall adopt regulations to implement this act.
(b)Notwithstanding the rulemaking provisions of the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code), the State Department of Social Services and the State Department of Health Care Services may implement and administer the changes made by this act through information notices, all-county letters, or similar written instructions until regulations are adopted.
(c)This section shall become effective upon appropriation of funds by the Legislature for the purposes described in this section.
SEC. 9.The provisions amended or added by this act shall be implemented only if, and to the extent that, federal financial participation, as provided under Title XIX of the federal Social Security Act (42 U.S.C. Sec. 1396 et seq.) is not jeopardized and all necessary federal approvals have been obtained.
SEC. 10.No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution.
The Legislature finds and declares all of the following:
(a)There is an urgent need to provide more crisis care alternatives to hospitals for children and youth experiencing mental health crises.
(b)The problems are especially acute for children and youth who may have to wait for days for a hospital bed and who may be transported, without a parent, to the nearest facility hundreds of miles away.
(c)In 2012, the California Hospital Association reported that two-thirds of the people taken to a hospital for a psychiatric emergency did not meet the criteria for that level of care, but the care they needed was not available.
(d)The type of care that is needed includes crisis residential treatment for children.
(e)This level of care is part of the full continuum of care considered medically necessary for many children with serious emotional disturbances.
(f)In 2013, the Legislature enacted the Investment in Mental Health Wellness Act (Senate Bill 82, Chapter 34 of the Statutes of 2013) to provide one-time funding to counties to expand the availability of mental health crisis care services, including short-term crisis residential treatment services. However, there is currently no state licensing category for short-term crisis residential programs for children. As a result, counties wanting to expand local capacity to meet the needs of children and youth for crisis residential treatment services were ineligible for this competitive grant program.
(g)In most communities, inpatient crisis treatment is completely unavailable for children and youth, even though it may be medically necessary.
(h)Crisis residential care is an essential level of care for the treatment of children and youth with serious emotional disturbances in a mental health crisis, and it often serves as an alternative to hospitalization.
(i)It is imperative that California identify a licensing category specifically for mental health crisis residential care that can be utilized for children and youth who are beneficiaries of both public and private health care plans.
SEC. 2.Section 1502 of the Health and Safety Code is amended to read:1502.As used in this chapter:
(a)Community care facility means any facility, place, or building that is maintained and operated to provide nonmedical residential care, day treatment, adult day care, or foster family agency services for children, adults, or children and adults, including, but not limited to, the physically handicapped, mentally impaired, incompetent persons, and abused or neglected children, and includes the following:
(1)Residential facility means any family home, group care facility, or similar facility determined by the department, for 24-hour nonmedical care of persons in need of personal services, supervision, or assistance essential for sustaining the activities of daily living or for the protection of the individual.
(2)Adult day program means any community-based facility or program that provides care to persons 18 years of age or older in need of personal services, supervision, or assistance essential for sustaining the activities of daily living or for the protection of these individuals on less than a 24-hour basis.
(3)Therapeutic day services facility means any facility that provides nonmedical care, counseling, educational or vocational support, or social rehabilitation services on less than a 24-hour basis to persons under 18 years of age who would otherwise be placed in foster care or who are returning to families from foster care. Program standards for these facilities shall be developed by the department, pursuant to Section 1530, in consultation with therapeutic day services and foster care providers.
(4)Foster family agency means any public agency or private organization, organized and operated on a nonprofit basis, engaged in any of the following:
(A)Recruiting, certifying, approving, and training of, and providing professional support to, foster parents and resource families.
(B)Coordinating with county placing agencies to find homes for foster children in need of care.
(C)Providing services and supports to licensed or certified foster parents, county-approved resource families, and children to the extent authorized by state and federal law.
(5)Foster family home means any residential facility providing 24-hour care for six or fewer foster children that is owned, leased, or rented and is the residence of the foster parent or parents, including their family, in whose care the foster children have been placed. The placement may be by a public or private child placement agency or by a court order, or by voluntary placement by a parent, parents, or guardian. It also means a foster family home described in Section 1505.2.
(6)Small family home means any residential facility, in the licensees family residence, that provides 24-hour care for six or fewer foster children who have mental disorders or developmental or physical disabilities and who require special care and supervision as a result of their disabilities. A small family home may accept children with special health care needs, pursuant to subdivision (a) of Section 17710 of the Welfare and Institutions Code. In addition to placing children with special health care needs, the department may approve placement of children without special health care needs, up to the licensed capacity.
(7)Social rehabilitation facility means any residential facility that provides social rehabilitation services for no longer than 18 months in a group setting to adults recovering from mental illness who temporarily need assistance, guidance, or counseling. Program components shall be subject to program standards pursuant to Article 1 (commencing with Section 5670) of Chapter 2.5 of Part 2 of Division 5 of the Welfare and Institutions Code.
(8)Community treatment facility means any residential facility that provides mental health treatment services to children in a group setting and that has the capacity to provide secure containment. Program components shall be subject to program standards developed and enforced by the State Department of Health Care Services pursuant to Section 4094 of the Welfare and Institutions Code.
Nothing in this section shall be construed to prohibit or discourage placement of persons who have mental or physical disabilities into any category of community care facility that meets the needs of the individual placed, if the placement is consistent with the licensing regulations of the department.
(9)Full-service adoption agency means any licensed entity engaged in the business of providing adoption services, that does all of the following:
(A)Assumes care, custody, and control of a child through relinquishment of the child to the agency or involuntary termination of parental rights to the child.
(B)Assesses the birth parents, prospective adoptive parents, or child.
(C)Places children for adoption.
(D)Supervises adoptive placements.
Private full-service adoption agencies shall be organized and operated on a nonprofit basis. As a condition of licensure to provide intercountry adoption services, a full-service adoption agency shall be accredited and in good standing according to Part 96 (commencing with Section 96.1) of Title 22 of the Code of Federal Regulations, or supervised by an accredited primary provider, or acting as an exempted provider, in compliance with Subpart F (commencing with Section 96.29) of Part 96 of Title 22 of the Code of Federal Regulations.
(10)Noncustodial adoption agency means any licensed entity engaged in the business of providing adoption services, that does all of the following:
(A)Assesses the prospective adoptive parents.
(B)Cooperatively matches children freed for adoption, who are under the care, custody, and control of a licensed adoption agency, for adoption, with assessed and approved adoptive applicants.
(C)Cooperatively supervises adoption placements with a full-service adoptive agency, but does not disrupt a placement or remove a child from a placement.
Private noncustodial adoption agencies shall be organized and operated on a nonprofit basis. As a condition of licensure to provide intercountry adoption services, a noncustodial adoption agency shall be accredited and in good standing according to Part 96 (commencing with Section 96.1) of Title 22 of the Code of Federal Regulations, or supervised by an accredited primary provider, or acting as an exempted provider, in compliance with Subpart F (commencing with Section 96.29) of Part 96 of Title 22 of the Code of Federal Regulations.
(11)Transitional shelter care facility means any group care facility that provides for 24-hour nonmedical care of persons in need of personal services, supervision, or assistance essential for sustaining the activities of daily living or for the protection of the individual. Program components shall be subject to program standards developed by the State Department of Social Services pursuant to Section 1502.3.
(12)Transitional housing placement provider means an organization licensed by the department pursuant to Section 1559.110 and Section 16522.1 of the Welfare and Institutions Code to provide transitional housing to foster children at least 16 years of age and not more than 18 years of age, and nonminor dependents, as defined in subdivision (v) of Section 11400 of the Welfare and Institutions Code, to promote their transition to adulthood. A transitional housing placement provider shall be privately operated and organized on a nonprofit basis.
(13)Group home means a residential facility that provides 24-hour care and supervision to children, delivered at least in part by staff employed by the licensee in a structured environment. The care and supervision provided by a group home shall be nonmedical, except as otherwise permitted by law.
(14)Runaway and homeless youth shelter means a group home licensed by the department to operate a program pursuant to Section 1502.35 to provide voluntary, short-term, shelter and personal services to runaway youth or homeless youth, as defined in paragraph (2) of subdivision (a) of Section 1502.35.
(15)Enhanced behavioral supports home means a facility certified by the State Department of Developmental Services pursuant to Article 3.6 (commencing with Section 4684.80) of Chapter 6 of Division 4.5 of the Welfare and Institutions Code, and licensed by the State Department of Social Services as an adult residential facility or a group home that provides 24-hour nonmedical care to individuals with developmental disabilities who require enhanced behavioral supports, staffing, and supervision in a homelike setting. An enhanced behavioral supports home shall have a maximum capacity of four consumers, shall conform to Section 441.530(a)(1) of Title 42 of the Code of Federal Regulations, and shall be eligible for federal Medicaid home- and community-based services funding.
(16)Community crisis home means a facility certified by the State Department of Developmental Services pursuant to Article 8 (commencing with Section 4698) of Chapter 6 of Division 4.5 of the Welfare and Institutions Code, and licensed by the State Department of Social Services pursuant to Article 9.7 (commencing with Section 1567.80), as an adult residential facility, providing 24-hour nonmedical care to individuals with developmental disabilities receiving regional center service, in need of crisis intervention services, and who would otherwise be at risk of admission to the acute crisis center at Fairview Developmental Center, Sonoma Developmental Center, an acute general hospital, acute psychiatric hospital, an institution for mental disease, as described in Part 5 (commencing with Section 5900) of Division 5 of the Welfare and Institutions Code, or an out-of-state placement. A community crisis home shall have a maximum capacity of eight consumers, as defined in subdivision (a) of Section 1567.80, shall conform to Section 441.530(a)(1) of Title 42 of the Code of Federal Regulations, and shall be eligible for federal Medicaid home- and community-based services funding.
(17)Crisis nursery means a facility licensed by the department to operate a program pursuant to Section 1516 to provide short-term care and supervision for children under six years of age who are voluntarily placed for temporary care by a parent or legal guardian due to a family crisis or stressful situation.
(18)Short-term residential therapeutic program means a residential facility operated by a public agency or private organization and licensed by the department pursuant to Section 1562.01 that provides an integrated program of specialized and intensive care and supervision, services and supports, treatment, and short-term, 24-hour care and supervision to children. The care and supervision provided by a short-term residential therapeutic program shall be nonmedical, except as otherwise permitted by law. Private short-term residential therapeutic programs shall be organized and operated on a nonprofit basis. A short-term residential therapeutic program may be operated as a childrens crisis residential program.
(19)Private alternative boarding school means a group home licensed by the department to operate a program pursuant to Section 1502.2 to provide youth with 24-hour residential care and supervision, which, in addition to providing educational services to youth, provides, or holds itself out as providing, behavioral-based services to youth with social, emotional, or behavioral issues. The care and supervision provided by a private alternative boarding school shall be nonmedical, except as otherwise permitted by law.
(20)Private alternative outdoor program means a group home licensed by the department to operate a program pursuant to Section 1502.21 to provide youth with 24-hour residential care and supervision, which provides, or holds itself out as providing, behavioral-based services in an outdoor living setting to youth with social, emotional, or behavioral issues. The care and supervision provided by a private alternative outdoor program shall be nonmedical, except as otherwise permitted by law.
(21)Childrens crisis residential program means a facility licensed by the department as a short-term residential therapeutic program pursuant to Section 1562.02 and approved by the State Department of Health Care Services, or a county mental health plan to which the State Department of Health Care Services has delegated approval authority, to operate a childrens crisis residential mental health program approval pursuant to Section 11462.011 of the Welfare and Institutions Code, to serve children experiencing mental health crises as an alternative to psychiatric hospitalization.
(b)Department or state department means the State Department of Social Services.
(c)Director means the Director of Social Services.
SEC. 3.Section 1562.02 is added to the Health and Safety Code, to read:1562.02.(a)The department may license a short-term residential therapeutic program operating as a childrens crisis residential program pursuant to this chapter. A childrens crisis residential program shall meet all of the following requirements:
(1)If the program serves children who are not experiencing mental health crises, have an identifiable and physically separate unit for those children who are experiencing mental health crises. The separate unit shall be indicated on the short-term residential therapeutic programs license.
(2)Obtain and have in good standing a mental health program approval that includes a Medi-Cal mental health certification, as described in Section 11462.01 of the Welfare and Institutions Code, and a childrens crisis residential mental health program approval, as described in Section 11462.011 of the Welfare and Institutions Code, both of which are issued by the State Department of Health Care Services, or a county mental health plan to which the department has delegated approval authority. The short-term residential therapeutic program shall obtain a mental health program approval before operating as a childrens crisis residential program. The department may revoke a programs license pursuant to Section 1550 for a programs failure to maintain the mental health program approval.
(3)Comply with all applicable licensing standards for a short-term residential therapeutic program, unless otherwise specified by the department in regulations.
(b)The State Department of Health Care Services shall, in collaboration with the department, the County Behavioral Health Directors Association of California, provider representatives, and other relevant stakeholders, develop a rate for children who are Medi-Cal beneficiaries and who are admitted to a childrens crisis residential program. This subdivision shall be implemented only to the extent that federal financial participation is available and any necessary federal approvals have been obtained.(c)(b)Contingent upon an appropriation in the annual Budget Act for these purposes, the department shall begin implementation of this section no later than July 1, 2018, and shall commence the licensing process for childrens crisis residential programs no later than January 1, 2019.
SEC. 4.Section 1562.03 is added to the Health and Safety Code, to read:1562.03.(a)The department shall establish regulations for short-term residential therapeutic programs that are operated as childrens crisis residential programs. At a minimum, the regulations shall include all of the following:
(1)The childrens crisis residential program shall be used only for diversion from admittance to a psychiatric hospital.(2)(A)Length of the initial authorization for admission to a childrens crisis residential program shall be limited to 10 consecutive days.(B)If a determination is made by a health care professional that a childrens crisis residential program is the appropriate continued level of care, the childrens crisis residential program shall obtain prior approval from the county mental health plan authorizing those services before extending the length of stay for a Medi-Cal beneficiary beyond 10 consecutive days. In the case of beneficiaries of private insurance, reauthorizations for admission shall be obtained using the process established by the individual plans. (3)(1)Therapeutic programming shall be provided seven days a week, including weekends and holidays, with sufficient professional and paraprofessional staff to maintain an appropriate treatment setting and services, based on individual childrens needs.
(4)(2)The program shall be staffed with sufficient personnel to accept children 24 hours per day, seven days a week and to admit children, at a minimum, from 7 a.m. to 11 p.m., seven days a week, 365 days per year. The program shall be sufficiently staffed to discharge children, as appropriate, seven days a week, 365 days per year.
(5)(3)Facilities shall be limited to fewer than 16 beds, with at least 50 percent of those beds in single-occupancy rooms.
(6)(4)Facilities shall include ample physical space for accommodating individuals who provide daily emotional and physical supports to each child and for integrating family members into the day-to-day care of the youth.
(7)(5)The program shall collaborate with each childs existing mental health team, if applicable, child and family team, if applicable, and other formal and natural supports within 24 hours of intake and throughout the course of care and treatment as appropriate.
(8)(6)The program shall create and assist with the implementation of a plan for transitioning each admitted child from the program to his or her home and community, including the establishment of a mental health or child and family team if there is not one already.
(b)The program shall annually provide the department with all of the following data as it pertains to children in foster care and children not in foster care in conjunction with its application for licensure renewal:
(1)Age and gender of clients served.
(2)Duration of stay.
(3)Professional classification of staff and contracted staff.
(4)Type of placement the client was discharged to.
SEC. 5.Section 5848.5 of the Welfare and Institutions Code is amended to read:5848.5.(a)The Legislature finds and declares all of the following:
(1)California has realigned public community mental health services to counties and it is imperative that sufficient community-based resources be available to meet the mental health needs of eligible individuals.
(2)Increasing access to effective outpatient and crisis stabilization services provides an opportunity to reduce costs associated with expensive inpatient and emergency room care and to better meet the needs of individuals with mental health disorders in the least restrictive manner possible.
(3)Almost one-fifth of people with mental health disorders visit a hospital emergency room at least once per year. If an adequate array of crisis services is not available, it leaves an individual with little choice but to access an emergency room for assistance and, potentially, an unnecessary inpatient hospitalization.
(4)Recent reports have called attention to a continuing problem of inappropriate and unnecessary utilization of hospital emergency rooms in California due to limited community-based services for individuals in psychological distress and acute psychiatric crisis. Hospitals report that 70 percent of people taken to emergency rooms for psychiatric evaluation can be stabilized and transferred to a less intensive level of crisis care. Law enforcement personnel report that their personnel need to stay with people in the emergency room waiting area until a placement is found, and that less intensive levels of care tend not to be available.
(5)Comprehensive public and private partnerships at both local and regional levels, including across physical health services, mental health, substance use disorder, law enforcement, social services, and related supports, are necessary to develop and maintain high quality, patient-centered, and cost-effective care for individuals with mental health disorders that facilitates their recovery and leads towards wellness.
(6)The recovery of individuals with mental health disorders is important for all levels of government, business, and the local community.
(b)This section shall be known, and may be cited, as the Investment in Mental Health Wellness Act of 2013. The objectives of this section are to do all of the following:
(1)Expand access to early intervention and treatment services to improve the client experience, achieve recovery and wellness, and reduce costs.
(2)Expand the continuum of services to address crisis intervention, crisis stabilization, and crisis residential treatment needs that are wellness, resiliency, and recovery oriented.
(3)Add at least 25 mobile crisis support teams and at least 2,000 crisis stabilization and crisis residential treatment beds to bolster capacity at the local level to improve access to mental health crisis services and address unmet mental health care needs.
(4)Add at least 600 triage personnel to provide intensive case management and linkage to services for individuals with mental health care disorders at various points of access, such as at designated community-based service points, homeless shelters, and clinics.
(5)Reduce unnecessary hospitalizations and inpatient days by appropriately utilizing community-based services and improving access to timely assistance.
(6)Reduce recidivism and mitigate unnecessary expenditures of local law enforcement.
(7)Provide local communities with increased financial resources to leverage additional public and private funding sources to achieve improved networks of care for individuals with mental health disorders.
(8)Provide a complete continuum of crisis services for children and youth 21 years of age and under regardless of where they live in the state. The funds included in the 2016 Budget Act for the purpose of developing the continuum of mental health crisis services for children and youth 21 years of age and under shall be for the following objectives:
(A)Provide a continuum of crisis services for children and youth 21 years of age and under regardless of where they live in the state.
(B)Provide for early intervention and treatment services to improve the client experience, achieve recovery and wellness, and reduce costs.
(C)Expand the continuum of community-based services to address crisis intervention, crisis stabilization, and crisis residential treatment needs that are wellness-, resiliency-, and recovery-oriented.
(D)Add at least 200 mobile crisis support teams.
(E)Add at least 120 crisis stabilization services and beds and crisis residential treatment beds to increase capacity at the local level to improve access to mental health crisis services and address unmet mental health care needs.
(F)Add triage personnel to provide intensive case management and linkage to services for individuals with mental health care disorders at various points of access, such as at designated community-based service points, homeless shelters, schools, and clinics.
(G)Expand family respite care to help families and sustain caregiver health and well-being.
(H)Expand family supportive training and related services designed to help families participate in the planning process, access services, and navigate programs.
(I)Reduce unnecessary hospitalizations and inpatient days by appropriately utilizing community-based services.
(J)Reduce recidivism and mitigate unnecessary expenditures of local law enforcement.
(K)Provide local communities with increased financial resources to leverage additional public and private funding sources to achieve improved networks of care for children and youth 21 years of age and under with mental health disorders.
(c)Through appropriations provided in the annual Budget Act for this purpose, it is the intent of the Legislature to authorize the California Health Facilities Financing Authority, hereafter referred to as the authority, and the Mental Health Services Oversight and Accountability Commission, hereafter referred to as the commission, to administer competitive selection processes as provided in this section for capital capacity and program expansion to increase capacity for mobile crisis support, crisis intervention, crisis stabilization services, crisis residential treatment, and specified personnel resources.
(d)Funds appropriated by the Legislature to the authority for purposes of this section shall be made available to selected counties, or counties acting jointly. The authority may, at its discretion, also give consideration to private nonprofit corporations and public agencies in an area or region of the state if a county, or counties acting jointly, affirmatively supports this designation and collaboration in lieu of a county government directly receiving grant funds.
(1)Grant awards made by the authority shall be used to expand local resources for the development, capital, equipment acquisition, and applicable program startup or expansion costs to increase capacity for client assistance and services in the following areas:
(A)Crisis intervention, as authorized by Sections 14021.4, 14680, and 14684.
(B)Crisis stabilization, as authorized by Sections 14021.4, 14680, and 14684.
(C)Crisis residential treatment, as authorized by Sections 14021.4, 14680, and 14684. 14684 and as provided at a childrens crisis residential program, as defined in Section 1502 of the Health and Safety Code.
(D)Rehabilitative mental health services, as authorized by Sections 14021.4, 14680, and 14684.
(E)Mobile crisis support teams, including personnel and equipment, such as the purchase of vehicles.
(2)The authority shall develop selection criteria to expand local resources, including those described in paragraph (1), and processes for awarding grants after consulting with representatives and interested stakeholders from the mental health community, including, but not limited to, the County Behavioral Health Directors Association of California, service providers, consumer organizations, and other appropriate interests, such as health care providers and law enforcement, as determined by the authority. The authority shall ensure that grants result in cost-effective expansion of the number of community-based crisis resources in regions and communities selected for funding. The authority shall also take into account at least the following criteria and factors when selecting recipients of grants and determining the amount of grant awards:
(A)Description of need, including, at a minimum, a comprehensive description of the project, community need, population to be served, linkage with other public systems of health and mental health care, linkage with local law enforcement, social services, and related assistance, as applicable, and a description of the request for funding.
(B)Ability to serve the target population, which includes individuals eligible for Medi-Cal and individuals eligible for county health and mental health services.
(C)Geographic areas or regions of the state to be eligible for grant awards, which may include rural, suburban, and urban areas, and may include use of the five regional designations utilized by the County Behavioral Health Directors Association of California.
(D)Level of community engagement and commitment to project completion.
(E)Financial support that, in addition to a grant that may be awarded by the authority, will be sufficient to complete and operate the project for which the grant from the authority is awarded.
(F)Ability to provide additional funding support to the project, including public or private funding, federal tax credits and grants, foundation support, and other collaborative efforts.
(G)Memorandum of understanding among project partners, if applicable.
(H)Information regarding the legal status of the collaborating partners, if applicable.
(I)Ability to measure key outcomes, including improved access to services, health and mental health outcomes, and cost benefit of the project.
(3)The authority shall determine maximum grants awards, which shall take into consideration the number of projects awarded to the grantee, as described in paragraph (1), and shall reflect reasonable costs for the project and geographic region. The authority may allocate a grant in increments contingent upon the phases of a project.
(4)Funds awarded by the authority pursuant to this section may be used to supplement, but not to supplant, existing financial and resource commitments of the grantee or any other member of a collaborative effort that has been awarded a grant.
(5)All projects that are awarded grants by the authority shall be completed within a reasonable period of time, to be determined by the authority. Funds shall not be released by the authority until the applicant demonstrates project readiness to the authoritys satisfaction. If the authority determines that a grant recipient has failed to complete the project under the terms specified in awarding the grant, the authority may require remedies, including the return of all or a portion of the grant.
(6)A grantee that receives a grant from the authority under this section shall commit to using that capital capacity and program expansion project, such as the mobile crisis team, crisis stabilization unit, or crisis residential treatment program, for the duration of the expected life of the project.
(7)The authority may consult with a technical assistance entity, as described in paragraph (5) of subdivision (a) of Section 4061, for purposes of implementing this section.
(8)The authority may adopt emergency regulations relating to the grants for the capital capacity and program expansion projects described in this section, including emergency regulations that define eligible costs and determine minimum and maximum grant amounts.
(9)The authority shall provide reports to the fiscal and policy committees of the Legislature on or before May 1, 2014, and on or before May 1, 2015, on the progress of implementation, that include, but are not limited to, the following:
(A)A description of each project awarded funding.
(B)The amount of each grant issued.
(C)A description of other sources of funding for each project.
(D)The total amount of grants issued.
(E)A description of project operation and implementation, including who is being served.
(10)A recipient of a grant provided pursuant to paragraph (1) shall adhere to all applicable laws relating to scope of practice, licensure, certification, staffing, and building codes.
(e)Of the funds specified in paragraph (8) of subdivision (b), it is the intent of the Legislature to authorize the authority and the commission to administer competitive selection processes as provided in this section for capital capacity and program expansion to increase capacity for mobile crisis support, crisis intervention, crisis stabilization services, crisis residential treatment, family respite care, family supportive training and related services, and triage personnel resources for children and youth 21 years of age and under.
(f)Funds appropriated by the Legislature to the authority to address crisis services for children and youth 21 years of age and under for the purposes of this section shall be made available to selected counties or counties acting jointly. The authority may, at its discretion, also give consideration to private nonprofit corporations and public agencies in an area or region of the state if a county, or counties acting jointly, affirmatively support this designation and collaboration in lieu of a county government directly receiving grant funds.
(1)Grant awards made by the authority shall be used to expand local resources for the development, capital, equipment acquisition, and applicable program startup or expansion costs to increase capacity for client assistance and crisis services for children and youth 21 years of age and under in the following areas:
(A)Crisis intervention, as authorized by Sections 14021.4, 14680, and 14684.
(B)Crisis stabilization, as authorized by Sections 14021.4, 14680, and 14684.
(C)Crisis residential treatment, as authorized by Sections 14021.4, 14680, and 14684 and as provided at a childrens crisis residential program, as defined in Section 1502 of the Health and Safety Code.
(D)Mobile crisis support teams, including the purchase of equipment and vehicles.
(E)Family respite care.
(2)The authority shall develop selection criteria to expand local resources, including those described in paragraph (1), and processes for awarding grants after consulting with representatives and interested stakeholders from the mental health community, including, but not limited to, county mental health directors, service providers, consumer organizations, and other appropriate interests, such as health care providers and law enforcement, as determined by the authority. The authority shall ensure that grants result in cost-effective expansion of the number of community-based crisis resources in regions and communities selected for funding. The authority shall also take into account at least the following criteria and factors when selecting recipients of grants and determining the amount of grant awards:
(A)Description of need, including, at a minimum, a comprehensive description of the project, community need, population to be served, linkage with other public systems of health and mental health care, linkage with local law enforcement, social services, and related assistance, as applicable, and a description of the request for funding.
(B)Ability to serve the target population, which includes individuals eligible for Medi-Cal and individuals eligible for county health and mental health services.
(C)Geographic areas or regions of the state to be eligible for grant awards, which may include rural, suburban, and urban areas, and may include use of the five regional designations utilized by the California Behavioral Health Directors Association.
(D)Level of community engagement and commitment to project completion.
(E)Financial support that, in addition to a grant that may be awarded by the authority, will be sufficient to complete and operate the project for which the grant from the authority is awarded.
(F)Ability to provide additional funding support to the project, including public or private funding, federal tax credits and grants, foundation support, and other collaborative efforts.
(G)Memorandum of understanding among project partners, if applicable.
(H)Information regarding the legal status of the collaborating partners, if applicable.
(I)Ability to measure key outcomes, including utilization of services, health and mental health outcomes, and cost benefit of the project.
(3)The authority shall determine maximum grant awards, which shall take into consideration the number of projects awarded to the grantee, as described in paragraph (1), and shall reflect reasonable costs for the project, geographic region, and target ages. The authority may allocate a grant in increments contingent upon the phases of a project.
(4)Funds awarded by the authority pursuant to this section may be used to supplement, but not to supplant, existing financial and resource commitments of the grantee or any other member of a collaborative effort that has been awarded a grant.
(5)All projects that are awarded grants by the authority shall be completed within a reasonable period of time, to be determined by the authority. Funds shall not be released by the authority until the applicant demonstrates project readiness to the authoritys satisfaction. If the authority determines that a grant recipient has failed to complete the project under the terms specified in awarding the grant, the authority may require remedies, including the return of all, or a portion, of the grant.
(6)A grantee that receives a grant from the authority under this section shall commit to using that capital capacity and program expansion project, such as the mobile crisis team, crisis stabilization unit, family respite care, or crisis residential treatment program, for the duration of the expected life of the project.
(7)The authority may consult with a technical assistance entity, as described in paragraph (5) of subdivision (a) of Section 4061, for the purposes of implementing this section.
(8)The authority may adopt emergency regulations relating to the grants for the capital capacity and program expansion projects described in this section, including emergency regulations that define eligible costs and determine minimum and maximum grant amounts.
(9)The authority shall provide reports to the fiscal and policy committees of the Legislature on or before January 10, 2018, and annually thereafter, on the progress of implementation, that include, but are not limited to, the following:
(A)A description of each project awarded funding.
(B)The amount of each grant issued.
(C)A description of other sources of funding for each project.
(D)The total amount of grants issued.
(E)A description of project operation and implementation, including who is being served.
(10)A recipient of a grant provided pursuant to paragraph (1) shall adhere to all applicable laws relating to scope of practice, licensure, certification, staffing, and building codes.
(g)Funds appropriated by the Legislature to the commission for purposes of this section shall be allocated for triage personnel to provide intensive case management and linkage to services for individuals with mental health disorders at various points of access. These funds shall be made available to selected counties, counties acting jointly, or city mental health departments, as determined by the commission through a selection process. It is the intent of the Legislature for these funds to be allocated in an efficient manner to encourage early intervention and receipt of needed services for individuals with mental health disorders, and to assist in navigating the local service sector to improve efficiencies and the delivery of services.
(1)Triage personnel may provide targeted case management services face to face, by telephone, or by telehealth with the individual in need of assistance or his or her significant support person, and may be provided anywhere in the community. These service activities may include, but are not limited to, the following:
(A)Communication, coordination, and referral.
(B)Monitoring service delivery to ensure the individual accesses and receives services.
(C)Monitoring the individuals progress.
(D)Providing placement service assistance and service plan development.
(2)The commission shall take into account at least the following criteria and factors when selecting recipients and determining the amount of grant awards for triage personnel as follows:
(A)Description of need, including potential gaps in local service connections.
(B)Description of funding request, including personnel and use of peer support.
(C)Description of how triage personnel will be used to facilitate linkage and access to services, including objectives and anticipated outcomes.
(D)Ability to obtain federal Medicaid reimbursement, when applicable.
(E)Ability to administer an effective service program and the degree to which local agencies and service providers will support and collaborate with the triage personnel effort.
(F)Geographic areas or regions of the state to be eligible for grant awards, which shall include rural, suburban, and urban areas, and may include use of the five regional designations utilized by the County Behavioral Health Directors Association of California.
(3)The commission shall determine maximum grant awards, and shall take into consideration the level of need, population to be served, and related criteria, as described in paragraph (2), and shall reflect reasonable costs.
(4)Funds awarded by the commission for purposes of this section may be used to supplement, but not supplant, existing financial and resource commitments of the county, counties acting jointly, or city mental health department that received the grant.
(5)Notwithstanding any other law, a county, counties acting jointly, or city mental health department that receives an award of funds for the purpose of supporting triage personnel pursuant to this subdivision is not required to provide a matching contribution of local funds.
(6)Notwithstanding any other law, the commission, without taking any further regulatory action, may implement, interpret, or make specific this section by means of informational letters, bulletins, or similar instructions.
(7)The commission shall provide a status report to the fiscal and policy committees of the Legislature on the progress of implementation no later than March 1, 2014.
(h)Funds appropriated by the Legislature to the commission pursuant to paragraph (8) of subdivision (b) for the purposes of addressing childrens crisis services shall be allocated to support triage personnel and family supportive training and related services. These funds shall be made available to selected counties, counties acting jointly, or city mental health departments, as determined by the commission through a selection process. The commission may, at its discretion, also give consideration to private nonprofit corporations and public agencies in an area or region of the state if a county, or counties acting jointly, affirmatively supports this designation and collaboration in lieu of a county government directly receiving grant funds.
(1)These funds may provide for a range of crisis-related services for a child in need of assistance, or his or her parent, guardian, or caregiver. These service activities may include, but are not limited to, the following:
(A)Intensive coordination of care and services.
(B)Communication, coordination, and referral.
(C)Monitoring service delivery to the child or youth.
(D)Monitoring the childs progress.
(E)Providing placement service assistance and service plan development.
(F)Crisis or safety planning.
(2)The commission shall take into account at least the following criteria and factors when selecting recipients and determining the amount of grant awards for these funds, as follows:
(A)Description of need, including potential gaps in local service connections.
(B)Description of funding request, including personnel.
(C)Description of how personnel and other services will be used to facilitate linkage and access to services, including objectives and anticipated outcomes.
(D)Ability to obtain federal Medicaid reimbursement, when applicable.
(E)Ability to provide a matching contribution of local funds.
(F)Ability to administer an effective service program and the degree to which local agencies and service providers will support and collaborate with the triage personnel effort.
(G)Geographic areas or regions of the state to be eligible for grant awards, which shall include rural, suburban, and urban areas, and may include use of the five regional designations utilized by the County Behavioral Health Directors Association of California.
(3)The commission shall determine maximum grant awards, and shall take into consideration the level of need, population to be served, and related criteria, as described in paragraph (2), and shall reflect reasonable costs.
(4)Funds awarded by the commission for purposes of this section may be used to supplement, but not supplant, existing financial and resource commitments of the county, counties acting jointly, or a city mental health department that received the grant.
(5)Notwithstanding any other law, a county, counties acting jointly, or a city mental health department that receives an award of funds for the purpose of this section is not required to provide a matching contribution of local funds.
(6)Notwithstanding any other law, the commission, without taking any further regulatory action, may implement, interpret, or make specific this section by means of informational letters, bulletins, or similar instructions.
(7)The commission may waive requirements in this section for counties with a population of 100,000 or less, if the commission determines it is in the best interest of the state and meets the intent of the law.
(8)The commission shall provide a status report to the fiscal and policy committees of the Legislature on the progress of implementation no later than January 10, 2018, and annually thereafter.
SEC. 6.Section 11462.01 of the Welfare and Institutions Code, as added by Section 75 of Chapter 773 of the Statutes of 2015, is amended to read:11462.01.(a)(1)If a program is not intended for the exclusive use of private insurance plans, no later than 12 months following the date of initial licensure, a short-term residential therapeutic program, as defined in subdivision (ad) of Section 11400 of this code and paragraph (18) of subdivision (a) of Section 1502 of the Health and Safety Code, shall obtain a contract, subject to an agreement on rates and terms and conditions, with a county mental health plan to provide specialty mental health services and demonstrate the ability to meet the therapeutic needs of each child, as identified in any of the following:
(A)A mental health assessment.
(B)The childs case plan.
(C)The childs needs and services plan.
(D)Other documentation demonstrating the child has a mental health need.
(2)A short-term residential therapeutic program shall comply with any other mental health program approvals required by the State Department of Health Care Services or by a county mental health plan to which mental health program approval authority has been delegated.
(b)A short-term residential therapeutic program, except as specified in subdivision (c), may accept for placement a child who meets both of the criteria in paragraphs (1) and (2) and at least one of the conditions in paragraph (3).
(1)The child does not require inpatient care in a licensed health facility.
(2)The child has been assessed as requiring the level of services provided in a short-term residential therapeutic program in order to maintain the safety and well-being of the child or others due to behaviors, including those resulting from traumas, that render the child or those around the child unsafe or at risk of harm, or that prevent the effective delivery of needed services and supports provided in the childs own home or in other family settings, such as with a relative, guardian, foster family, resource family, or adoptive family. The assessment shall ensure the child has needs in common with other children or youth in the care of the facility, consistent with subdivision (c) of Section 16514.
(3)The child meets at least one of the following conditions:
(A)The child has been assessed, pursuant to Section 4096, as meeting the medical necessity criteria for Medi-Cal specialty mental health services, as provided for in Section 1830.205 or 1830.210 of Title 9 of the California Code of Regulations.
(B)The child has been assessed, pursuant to Section 4096, as seriously emotionally disturbed, as defined in subdivision (a) of Section 5600.3.
(C)The child requires emergency placement pursuant to paragraph (3) of subdivision (i).
(D)The child has been assessed, pursuant to Section 4096, as requiring the level of services provided by the short-term residential therapeutic program in order to meet his or her behavioral or therapeutic needs.
(4)Subject to the requirements of this subdivision, a short-term residential therapeutic program may have a specialized program to serve a child, including, but not limited to, the following:
(A)A commercially sexually exploited child.
(B)A private voluntary placement, if the youth exhibits status offender behavior, the parents or other relatives feel they cannot control the childs behavior, and short-term intervention is needed to transition the child back into the home.
(C)A juvenile sex offender.
(D)A child who is affiliated with, or impacted by, a gang.
(c)(1)A short-term residential therapeutic program that is operating as a childrens crisis residential program, as defined in Section 1502 of the Health and Safety Code, may accept for admission any child who meets all of the following requirements:
(A)The child is referred by a parent or guardian, physician, or licensed mental health professional, or by the representative of a public or private entity, including, but not limited to, the county probation agency or child welfare services agency with responsibility for the placement of a child in foster care, that has the right to make these decisions on behalf of a child who is in mental health crisis.
(B)The child is under 19, 20, or 21 years of age, depending on a programs licensing requirements.
(C)The child has a serious behavioral health disorder.
(D)The child requires a 24-hour-a-day, seven-day-a-week, staff-secured, unlocked treatment setting.
(2)The primary function of a childrens crisis residential program is to provide short-term crisis stabilization, therapeutic intervention, and specialized programming in an unlocked, staff-secured setting with a high degree of supervision and structure and the goal of supporting the rapid and successful transition of the child back to the community.
(d)A foster family agency that is certified as a Medi-Cal specialty mental health provider pursuant to Section 1810.435 of Title 9 of the California Code of Regulations by the State Department of Health Care Services, or by a county mental health plan to which the department has delegated certification authority, and which has entered into a contract with a county mental health plan pursuant to Section 1810.436 of Title 9 of the California Code of Regulations, shall provide, or provide access to, specialty mental health services to children under its care who do not require inpatient care in a licensed health facility and who meet the medical necessity criteria for Medi-Cal specialty mental health services provided for in Section 1830.205 or 1830.210 of Title 9 of the California Code of Regulations.
(e)A foster family agency that is not certified as a Medi-Cal specialty mental health provider shall provide access to specialty and non-specialty mental health services in that program for children who do not require inpatient care in a licensed health facility and who meet any of the conditions in paragraph (3) of subdivision (b). In this situation the foster family agency shall do the following:
(1)In the case of a child who is a Medi-Cal beneficiary, arrange for specialty mental health services from the county mental health plan.
(2)In all other cases, arrange for the child to receive mental health services.
(f)All short-term residential therapeutic programs shall maintain the level of care and services necessary to meet the needs of the children and youth in their care and shall maintain and have in good standing the appropriate mental health program approval. If a program will admit Medi-Cal beneficiaries, the mental health program approval shall include a certification to provide Medi-Cal specialty mental health services issued by the State Department of Health Care Services or a county mental health plan to which the department has delegated mental health program approval authority, pursuant to Section 4096.5 of this code or Section 1810.435 or 1810.436 of Title 9 of the California Code of Regulations. All foster family agencies that are certified as a Medi-Cal specialty mental health provider pursuant to Section 1810.435 of Title 9 of the California Code of Regulations shall maintain the level of care and services necessary to meet the needs of children and youth in their care and shall maintain and have in good standing the Medi-Cal specialty mental health provider certification issued by the State Department of Health Care Services or a county mental health plan to which the department has delegated certification authority.
(g)The assessments described in subparagraphs (A), (B), (C), and (D) of paragraph (3) of subdivision (b) shall ensure the childs individual behavioral or treatment needs are consistent with, and can be met by, the facility and shall be made by one of the following, as applicable:
(1)An interagency placement committee, as described in Section 4096, considering the recommendations from the child and family team, if any are available. If the short-term residential therapeutic program serves children who are placed by county child welfare agencies and children who are placed by probation departments, the interagency placement committee shall also ensure the requirements of subdivision (c) of Section 16514 have been met with respect to commonality of need.
(2)A licensed mental health professional as defined in subdivision (g) of Section 4096.
(3)For the purposes of this section, an AFDC-FC funded child with an individualized education program developed pursuant to Article 2 (commencing with Section 56320) of Chapter 4 of Part 30 of Division 4 of Title 2 of the Education Code that assesses the child as seriously emotionally disturbed, as defined in, and subject to, this section and recommends out-of-home placement at the level of care provided by the provider, shall be deemed to have met the assessment requirement.
(h)The evaluation described in subparagraph (A) of paragraph (3) of subdivision (i) shall be made pursuant to subdivision (b) of Section 706.6 or paragraph (2) of subdivision (c) of Section 16501.1.
(i)(1)The provider shall ensure that AFDC-FC funded children, assessed pursuant to subparagraphs (A) and (B) of paragraph (3) of subdivision (b), who are accepted for placement have been approved for placement by an interagency placement committee, as described in Section 4096, except as provided for in paragraphs (3) and (4) paragraph (3) of subdivision (g).
(2)The approval shall be in writing and shall indicate that the interagency placement committee has determined one of the following:
(A)The child meets the medical necessity criteria for Medi-Cal specialty mental health services, as provided for in Section 1830.205 or 1830.210 of Title 9 of the California Code of Regulations.
(B)The child is seriously emotionally disturbed, as described in subdivision (a) of Section 5600.3.
(3)(A)Nothing in subdivisions (a) to (h), inclusive, or this subdivision shall prevent an emergency placement of a child or youth into a certified short-term residential therapeutic program or childrens crisis residential program prior to the determination by the interagency placement committee, but only if a licensed mental health professional, as defined in subdivision (g) of Section 4096, has made a written determination within 72 hours of the childs or youths placement, that the child or youth requires the level of services and supervision provided by the short-term residential therapeutic program in order to meet his or her behavioral or therapeutic needs, or has made a written determination within 24 hours of the childs or youths placement in a childrens crisis residential program that the child or youth is experiencing a mental health crisis as defined in subdivision (c) and is in need of the care and services provided by the childrens crisis residential program. If the short-term residential therapeutic program serves children placed by county child welfare agencies and children placed by probation departments, the interagency placement committee shall also ensure the requirements of subdivision (c) of Section 16514 have been met with respect to commonality of need.
(i)The interagency placement committee, as appropriate, shall, within 30 days of placement, make the determinations, with recommendations from the child and family team, required by this subdivision.
(ii)If it determines the placement is appropriate, the interagency placement committee, with recommendations from the child and family team, shall transmit the approval, in writing, to the county placing agency and the short-term residential therapeutic program.
(iii)If it determines the placement is not appropriate, the interagency placement committee shall respond pursuant to subparagraph (B).
(B)(i)If the interagency placement committee determines at any time that the placement is not appropriate, it shall, with recommendations from the child and family team, transmit the disapproval, in writing, to the county placing agency and the short-term residential therapeutic program and shall include a recommendation as to the childs appropriate level of care and placement to meet his or her service needs. The necessary interagency placement committee representative or representatives shall participate in any child and family team meetings to refer the child or youth to an appropriate placement, as specified in this section.
(ii)The child may remain in the placement for the amount of time necessary to identify and transition the child to an alternative, suitable placement.
(iii)Notwithstanding clause (ii), if the interagency placement committee determined the placement was not appropriate due to a health and safety concern, immediate arrangements for the child to transition to an appropriate placement shall occur.
(j)Commencing January 1, 2017, for AFDC-FC funded children or youth, only those children or youth who are approved for placement, as set forth in this section, may be accepted by a short-term residential therapeutic program.
(k)The department shall, through regulation, establish consequences for the failure of a short-term residential therapeutic program to obtain written approval for placement of an AFDC-FC funded child or youth pursuant to this section.
(l)The department shall not establish a rate for a short-term residential therapeutic program unless the provider submits a recommendation from the host county or the primary placing county that the program is needed and that the provider is willing and capable of operating the program at the level sought. For purposes of this subdivision, host county, and primary placing county, mean the same as defined in the departments AFDC-FC ratesetting regulations.
(m)Any certified short-term residential therapeutic program shall be reclassified and paid at the appropriate program rate for which it is qualified if either of the following occurs:
(1)(A)It fails to maintain the level of care and services necessary to meet the needs of the children and youth in care, as required by subdivision (a). The determination shall be made consistent with the departments AFDC-FC ratesetting regulations developed pursuant to Section 11462 and shall take into consideration the highest level of care and associated rates for which the program may be eligible if granted an extension pursuant to Section 11462.04 or any reduction in rate associated with a provisional or probationary rate granted or imposed under Section 11466.01.
(B)In the event of a determination under this paragraph, the short-term residential therapeutic program may appeal the finding or submit a corrective action plan. The appeal process specified in Section 11466.6 shall be available to a short-term residential therapeutic program that provides intensive and therapeutic treatment. During any appeal, the short-term residential therapeutic program that provides intensive and therapeutic treatment shall maintain the appropriate level of care.
(2)It fails to maintain a certified mental health treatment program as required by subdivision (f).
(n)In addition to any other review required by law, the child and family team as defined in paragraph (4) of subdivision (a) of Section 16501 may periodically review the placement of the child or youth. If the child and family team make a recommendation that the child or youth no longer needs, or is not benefiting from, placement in a short-term residential therapeutic program, the team shall transmit the disapproval, in writing, to the county placing agency to consider a more appropriate placement.
(o)The department shall develop a process to address placements when, subsequent to the childs or youths placement, a determination is made by the interagency placement team and shall consider the recommendations of the child and family team, either that the child or youth is not in need of the care and services provided by the certified program. The process shall include, but not be limited to:
(1)Notice of the determination in writing to both the county placing agency and the short-term residential therapeutic program or foster family agency that provides intensive and therapeutic treatment.
(2)Notice of the countys plan, and a timeframe, for removal of the child or youth in writing to the short-term residential therapeutic program that provides intensive and therapeutic treatment.
(3)Referral to an appropriate placement.
(4)Actions to be taken if a child or youth is not timely removed from the short-term residential therapeutic program that provides intensive and therapeutic treatment or placed in an appropriate placement.
(p)(1)Nothing in this section shall prohibit a short-term residential therapeutic program from accepting private admissions of children or youth.
(2)When a referral is not from a public agency and no public funding is involved, there is no requirement for public agency review or determination of need.
(3)Children and youth subject to paragraphs (1) and (2) shall have been determined to be seriously emotionally disturbed, as described in subdivision (a) of Section 5600.3, and subject to Section 1502.4 of the Health and Safety Code, by a licensed mental health professional, as defined in subdivision (g) of Section 4096.
SEC. 7.Section 11462.011 is added to the Welfare and Institutions Code, to read:11462.011.(a)The State Department of Health Care Services shall, in consultation with the Department of Managed Health Care, the State Department of Social Services, the County Behavioral Health Directors Association of California, the County Welfare Directors Association of California, the Chief Probation Officers of California, provider representatives, and other relevant stakeholders, establish program standards and procedures for oversight, enforcement, and issuance of childrens crisis residential mental health program approvals, including provisional approvals that are effective for a period of less than one year. The State Department of Health Care Services shall also establish due process protections related to the childrens crisis residential mental health program approval process.
(b)The State Department of Health Care Services shall, in collaboration with the department, the County Behavioral Health Directors Association of California, provider representatives, and other relevant stakeholders, provide guidance to counties for the provision of childrens crisis residential services, including funding for children who are Medi-Cal beneficiaries and who are admitted to a childrens crisis residential program. This subdivision shall only be implemented to the extent that any necessary federal approvals are obtained and federal financial participation is available and is not otherwise jeopardized.
(c)(1)The childrens crisis residential program shall be used only as a diversion to admittance to a psychiatric hospital.
(2)(A)The length of the initial authorization for admission to a childrens crisis residential program shall be limited to 10 consecutive days.
(B)If a determination is made by a health care professional that a childrens crisis residential program is medically necessary and is the appropriate continued level of care, either of the following shall occur:
(i)In the case of a Medi-Cal beneficiary, the childrens crisis residential program shall notify the county mental health plan authorizing those services before extending the length of stay beyond 10 consecutive days.
(ii)In the case of beneficiaries of private insurance, reauthorizations for admission shall be obtained using the process established by the individual plans.
(C)With the exception of clause (ii) of this subparagraph, this paragraph shall be implemented only to the extent that any necessary federal approvals are obtained and the State Department of Health Care Services determines, in its sole discretion, that federal financial participation is not jeopardized.
(b)(d)A childrens crisis residential mental health program approval issued by the State Department of Health Care Services, or a county mental health plan to which the department has delegated approval authority, shall be a condition of continued licensure for a short-term residential therapeutic program operating as a childrens crisis residential program.
(c)(e)The State Department of Health Care Services, or a county mental health plan to which the department has delegated approval authority, may enforce the childrens crisis residential mental health program approval standards by taking any of the following actions against a noncompliant childrens crisis residential program:
(1)Suspend or revoke a childrens crisis residential mental health program approval.
(2)Impose monetary penalties.
(3)Place a childrens crisis residential mental health program on probation.
(4)Require a childrens crisis residential mental health program to prepare and comply with a corrective action plan.
(d)(f)The State Department of Health Care Services, or a county mental health plan to which the department has delegated approval authority, shall provide a childrens crisis residential mental health program with due process protections when taking any of the actions described in subdivision (c). (e).
(e)(g)Contingent upon an appropriation in the annual Budget Act for these purposes, the department shall begin implementation of this section no later than July 1, 2018, and shall commence the operation of the approval process for childrens crisis residential mental health program approvals no later than January 1, 2019.
SEC. 8.(a)Contingent upon an appropriation from the annual Budget Act for these purposes, the State Department of Social Services and the State Department of Health Care Services shall adopt regulations to implement this act on or before July 1, 2018. act.
(b)Notwithstanding the rulemaking provisions of the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code), the State Department of Social Services and the State Department of Health Care Services may implement and administer the changes made by this act through information notices, all-county letters, or similar written instructions until regulations are adopted.
(c)This section shall become effective upon appropriation of funds by the Legislature for the purposes described in this section.
SEC. 9.The provisions amended or added by this act shall be implemented only if, and to the extent that, federal financial participation, as provided under Title XIX of the federal Social Security Act (42 U.S.C. Sec. 1396 et seq.) is not jeopardized and all necessary federal approvals have been obtained.
SEC. 9.SEC. 10.No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution.
The Legislature finds and declares all of the following:
(a)There is an urgent need to provide more crisis care alternatives to hospitals for children and youth experiencing mental health crises.
(b)The problems are especially acute for children and youth who may have to wait for days for a hospital bed and who may be transported, without a parent, to the nearest facility hundreds of miles away.
(c)In 2012, the California Hospital Association reported that two-thirds of the people taken to a hospital for a psychiatric emergency did not meet the criteria for that level of care, but the care they needed was not available.
(d)The type of care that is needed includes crisis residential treatment for children.
(e)This level of care is part of the full continuum of care considered medically necessary for many children with serious emotional disturbances.
(f)In 2013, the Legislature enacted the Investment in Mental Health Wellness Act (Senate Bill 82, Chapter 34 of the Statutes of 2013) to provide one-time funding to counties to expand the availability of mental health crisis care services, including short-term crisis residential treatment services. However, there is currently no state licensing category for short-term crisis residential programs for children. As a result, counties wanting to expand local capacity to meet the needs of children and youth for crisis residential treatment services were ineligible for this competitive grant program.
(g)In most communities, inpatient crisis treatment is completely unavailable for children and youth, even though it may be medically necessary.
(h)Crisis residential care is an essential level of care for the treatment of children and youth with serious emotional disturbances in a mental health crisis, and it often serves as an alternative to hospitalization.
(i)It is imperative that California identify a licensing category specifically for mental health crisis residential care that can be utilized for children and youth who are beneficiaries of both public and private health care plans.
SEC. 2.Section 1502 of the Health and Safety Code is amended to read:1502.As used in this chapter:
(a)Community care facility means any facility, place, or building that is maintained and operated to provide nonmedical residential care, day treatment, adult day care, or foster family agency services for children, adults, or children and adults, including, but not limited to, the physically handicapped, mentally impaired, incompetent persons, and abused or neglected children, and includes the following:
(1)Residential facility means any family home, group care facility, or similar facility determined by the department, for 24-hour nonmedical care of persons in need of personal services, supervision, or assistance essential for sustaining the activities of daily living or for the protection of the individual.
(2)Adult day program means any community-based facility or program that provides care to persons 18 years of age or older in need of personal services, supervision, or assistance essential for sustaining the activities of daily living or for the protection of these individuals on less than a 24-hour basis.
(3)Therapeutic day services facility means any facility that provides nonmedical care, counseling, educational or vocational support, or social rehabilitation services on less than a 24-hour basis to persons under 18 years of age who would otherwise be placed in foster care or who are returning to families from foster care. Program standards for these facilities shall be developed by the department, pursuant to Section 1530, in consultation with therapeutic day services and foster care providers.
(4)Foster family agency means any public agency or private organization, organized and operated on a nonprofit basis, engaged in any of the following:
(A)Recruiting, certifying, approving, and training of, and providing professional support to, foster parents and resource families.
(B)Coordinating with county placing agencies to find homes for foster children in need of care.
(C)Providing services and supports to licensed or certified foster parents, county-approved resource families, and children to the extent authorized by state and federal law.
(5)Foster family home means any residential facility providing 24-hour care for six or fewer foster children that is owned, leased, or rented and is the residence of the foster parent or parents, including their family, in whose care the foster children have been placed. The placement may be by a public or private child placement agency or by a court order, or by voluntary placement by a parent, parents, or guardian. It also means a foster family home described in Section 1505.2.
(6)Small family home means any residential facility, in the licensees family residence, that provides 24-hour care for six or fewer foster children who have mental disorders or developmental or physical disabilities and who require special care and supervision as a result of their disabilities. A small family home may accept children with special health care needs, pursuant to subdivision (a) of Section 17710 of the Welfare and Institutions Code. In addition to placing children with special health care needs, the department may approve placement of children without special health care needs, up to the licensed capacity.
(7)Social rehabilitation facility means any residential facility that provides social rehabilitation services for no longer than 18 months in a group setting to adults recovering from mental illness who temporarily need assistance, guidance, or counseling. Program components shall be subject to program standards pursuant to Article 1 (commencing with Section 5670) of Chapter 2.5 of Part 2 of Division 5 of the Welfare and Institutions Code.
(8)Community treatment facility means any residential facility that provides mental health treatment services to children in a group setting and that has the capacity to provide secure containment. Program components shall be subject to program standards developed and enforced by the State Department of Health Care Services pursuant to Section 4094 of the Welfare and Institutions Code.
Nothing in this section shall be construed to prohibit or discourage placement of persons who have mental or physical disabilities into any category of community care facility that meets the needs of the individual placed, if the placement is consistent with the licensing regulations of the department.
(9)Full-service adoption agency means any licensed entity engaged in the business of providing adoption services, that does all of the following:
(A)Assumes care, custody, and control of a child through relinquishment of the child to the agency or involuntary termination of parental rights to the child.
(B)Assesses the birth parents, prospective adoptive parents, or child.
(C)Places children for adoption.
(D)Supervises adoptive placements.
Private full-service adoption agencies shall be organized and operated on a nonprofit basis. As a condition of licensure to provide intercountry adoption services, a full-service adoption agency shall be accredited and in good standing according to Part 96 (commencing with Section 96.1) of Title 22 of the Code of Federal Regulations, or supervised by an accredited primary provider, or acting as an exempted provider, in compliance with Subpart F (commencing with Section 96.29) of Part 96 of Title 22 of the Code of Federal Regulations.
(10)Noncustodial adoption agency means any licensed entity engaged in the business of providing adoption services, that does all of the following:
(A)Assesses the prospective adoptive parents.
(B)Cooperatively matches children freed for adoption, who are under the care, custody, and control of a licensed adoption agency, for adoption, with assessed and approved adoptive applicants.
(C)Cooperatively supervises adoption placements with a full-service adoptive agency, but does not disrupt a placement or remove a child from a placement.
Private noncustodial adoption agencies shall be organized and operated on a nonprofit basis. As a condition of licensure to provide intercountry adoption services, a noncustodial adoption agency shall be accredited and in good standing according to Part 96 (commencing with Section 96.1) of Title 22 of the Code of Federal Regulations, or supervised by an accredited primary provider, or acting as an exempted provider, in compliance with Subpart F (commencing with Section 96.29) of Part 96 of Title 22 of the Code of Federal Regulations.
(11)Transitional shelter care facility means any group care facility that provides for 24-hour nonmedical care of persons in need of personal services, supervision, or assistance essential for sustaining the activities of daily living or for the protection of the individual. Program components shall be subject to program standards developed by the State Department of Social Services pursuant to Section 1502.3.
(12)Transitional housing placement provider means an organization licensed by the department pursuant to Section 1559.110 and Section 16522.1 of the Welfare and Institutions Code to provide transitional housing to foster children at least 16 years of age and not more than 18 years of age, and nonminor dependents, as defined in subdivision (v) of Section 11400 of the Welfare and Institutions Code, to promote their transition to adulthood. A transitional housing placement provider shall be privately operated and organized on a nonprofit basis.
(13)Group home means a residential facility that provides 24-hour care and supervision to children, delivered at least in part by staff employed by the licensee in a structured environment. The care and supervision provided by a group home shall be nonmedical, except as otherwise permitted by law.
(14)Runaway and homeless youth shelter means a group home licensed by the department to operate a program pursuant to Section 1502.35 to provide voluntary, short-term, shelter and personal services to runaway youth or homeless youth, as defined in paragraph (2) of subdivision (a) of Section 1502.35.
(15)Enhanced behavioral supports home means a facility certified by the State Department of Developmental Services pursuant to Article 3.6 (commencing with Section 4684.80) of Chapter 6 of Division 4.5 of the Welfare and Institutions Code, and licensed by the State Department of Social Services as an adult residential facility or a group home that provides 24-hour nonmedical care to individuals with developmental disabilities who require enhanced behavioral supports, staffing, and supervision in a homelike setting. An enhanced behavioral supports home shall have a maximum capacity of four consumers, shall conform to Section 441.530(a)(1) of Title 42 of the Code of Federal Regulations, and shall be eligible for federal Medicaid home- and community-based services funding.
(16)Community crisis home means a facility certified by the State Department of Developmental Services pursuant to Article 8 (commencing with Section 4698) of Chapter 6 of Division 4.5 of the Welfare and Institutions Code, and licensed by the State Department of Social Services pursuant to Article 9.7 (commencing with Section 1567.80), as an adult residential facility, providing 24-hour nonmedical care to individuals with developmental disabilities receiving regional center service, in need of crisis intervention services, and who would otherwise be at risk of admission to the acute crisis center at Fairview Developmental Center, Sonoma Developmental Center, an acute general hospital, acute psychiatric hospital, an institution for mental disease, as described in Part 5 (commencing with Section 5900) of Division 5 of the Welfare and Institutions Code, or an out-of-state placement. A community crisis home shall have a maximum capacity of eight consumers, as defined in subdivision (a) of Section 1567.80, shall conform to Section 441.530(a)(1) of Title 42 of the Code of Federal Regulations, and shall be eligible for federal Medicaid home- and community-based services funding.
(17)Crisis nursery means a facility licensed by the department to operate a program pursuant to Section 1516 to provide short-term care and supervision for children under six years of age who are voluntarily placed for temporary care by a parent or legal guardian due to a family crisis or stressful situation.
(18)Short-term residential therapeutic program means a residential facility operated by a public agency or private organization and licensed by the department pursuant to Section 1562.01 that provides an integrated program of specialized and intensive care and supervision, services and supports, treatment, and short-term, 24-hour care and supervision to children. The care and supervision provided by a short-term residential therapeutic program shall be nonmedical, except as otherwise permitted by law. Private short-term residential therapeutic programs shall be organized and operated on a nonprofit basis. A short-term residential therapeutic program may be operated as a childrens crisis residential center. program.
(19)Private alternative boarding school means a group home licensed by the department to operate a program pursuant to Section 1502.2 to provide youth with 24-hour residential care and supervision, which, in addition to providing educational services to youth, provides, or holds itself out as providing, behavioral-based services to youth with social, emotional, or behavioral issues. The care and supervision provided by a private alternative boarding school shall be nonmedical, except as otherwise permitted by law.
(20)Private alternative outdoor program means a group home licensed by the department to operate a program pursuant to Section 1502.21 to provide youth with 24-hour residential care and supervision, which provides, or holds itself out as providing, behavioral-based services in an outdoor living setting to youth with social, emotional, or behavioral issues. The care and supervision provided by a private alternative outdoor program shall be nonmedical, except as otherwise permitted by law.
(21)Childrens crisis residential program means a facility licensed by the department as a short-term residential therapeutic program pursuant to Section 1562.02 and approved by the State Department of Health Care Services, or a county mental health plan to which the State Department of Health Care Services has delegated approval authority, to operate a childrens crisis residential mental health program approval pursuant to Section 11462.011 of the Welfare and Institutions Code, to serve children experiencing mental health crises as an alternative to psychiatric hospitalization.
(b)Department or state department means the State Department of Social Services.
(c)Director means the Director of Social Services.
SEC. 3.Section 1562.02 is added to the Health and Safety Code, to read:1562.02.(a)The department may license a short-term residential therapeutic program operating as a childrens crisis residential program pursuant to this chapter. A childrens crisis residential program shall meet all of the following requirements:
(1)If the program serves children who are not experiencing mental health crises, have an identifiable and physically separate unit for those children who are experiencing mental health crises. The separate unit shall be indicated on the short-term residential therapeutic programs license.
(2)Obtain and have in good standing a mental health program approval that includes a Medi-Cal mental health certification, as described in Section 11462.01 of the Welfare and Institutions Code, and a childrens crisis residential mental health program approval, as described in Section 11462.01 11462.011 of the Welfare and Institutions Code, both of which are issued by the State Department of Health Care Services, or a county mental health plan to which the department has delegated approval authority. The short-term residential therapeutic program shall obtain a mental health program approval before operating as a childrens crisis residential program. The department may revoke a programs license pursuant to Section 1550 for a programs failure to maintain the mental health program approval.
(3)Comply with all applicable licensing standards for a short-term residential therapeutic program, unless otherwise specified by the department in regulations.
(b)The State Department of Health Care Services shall, in collaboration with the department, the County Behavioral Health Directors Association of California, provider representatives, and other relevant stakeholders, develop a rate for children who are Medi-Cal beneficiaries and who are admitted to a childrens crisis residential program. This subdivision shall be implemented only to the extent that federal financial participation is available and any necessary federal approvals have been obtained.
(c)Contingent upon an appropriation in the annual Budget Act for these purposes, the department shall begin implementation of this section no later than January 1, 2018, July 1, 2018, and shall commence the licensing process for childrens crisis residential programs no later than July 1, 2018. January 1, 2019.
SEC. 4.Section 1562.03 is added to the Health and Safety Code, to read:1562.03.(a)The department shall establish regulations for short-term residential therapeutic programs that are operated as childrens crisis residential centers. programs. At a minimum, the regulations shall include all of the following:
(1)The childrens crisis residential center program shall be used only for diversion from admittance to a psychiatric hospitalization. hospital.
(2)(A)Length of the initial authorization for admission to a childrens crisis residential program shall be limited to 10 consecutive days.
(B)Before extending the length of stay for a Medi-Cal beneficiary beyond 10 consecutive days, If a determination is made by a health care professional that a childrens crisis residential program is the appropriate continued level of care, the childrens crisis residential program shall obtain prior approval from the county mental health plan authorizing those services. services before extending the length of stay for a Medi-Cal beneficiary beyond 10 consecutive days. In the case of beneficiaries of private insurance, reauthorizations for admission shall be obtained using the process established by the individual plans.
(3)Therapeutic programming shall be provided seven days a week, including weekends and holidays, with sufficient professional and paraprofessional staff to maintain an appropriate treatment setting and services, based on individual childrens needs.
(4)The program shall be staffed with sufficient personnel to accept children 24 hours per day, seven days a week and to admit children, at a minimum, from 7 a.m. to 11 p.m., seven days a week, 365 days per year. The program shall be sufficiently staffed to discharge children, as appropriate, seven days a week, 365 days per year.
(5)Facilities shall be limited to fewer than 16 beds, with at least 50 percent of those beds in single-occupancy rooms.
(6)Facilities shall include ample physical space for accommodating individuals who provide natural daily emotional and physical supports to each child and for integrating family members into the day-to-day care of the youth.
(7)The program shall collaborate with each childs existing mental health team, if applicable, child and family team, if applicable, and other formal and natural supports within 24 hours of intake and throughout the course of care and treatment as appropriate.
(8)The program shall assist in the development create and assist with the implementation of a plan for transitioning each admitted child from the program to his or her home and community, including the establishment of a mental health or child and family team if there is not one already.
(b)The program shall annually provide the department with all of the following data as it pertains to children in foster care and children not in foster care in conjunction with its application for licensure renewal:
(1)Age and gender of clients served.
(2)Duration of stay.
(3)Professional classification of staff and contracted staff.
(4)Type of placement the client was discharged to.
SEC. 5.Section 5848.5 of the Welfare and Institutions Code is amended to read:5848.5.(a)The Legislature finds and declares all of the following:
(1)California has realigned public community mental health services to counties and it is imperative that sufficient community-based resources be available to meet the mental health needs of eligible individuals.
(2)Increasing access to effective outpatient and crisis stabilization services provides an opportunity to reduce costs associated with expensive inpatient and emergency room care and to better meet the needs of individuals with mental health disorders in the least restrictive manner possible.
(3)Almost one-fifth of people with mental health disorders visit a hospital emergency room at least once per year. If an adequate array of crisis services is not available, it leaves an individual with little choice but to access an emergency room for assistance and, potentially, an unnecessary inpatient hospitalization.
(4)Recent reports have called attention to a continuing problem of inappropriate and unnecessary utilization of hospital emergency rooms in California due to limited community-based services for individuals in psychological distress and acute psychiatric crisis. Hospitals report that 70 percent of people taken to emergency rooms for psychiatric evaluation can be stabilized and transferred to a less intensive level of crisis care. Law enforcement personnel report that their personnel need to stay with people in the emergency room waiting area until a placement is found, and that less intensive levels of care tend not to be available.
(5)Comprehensive public and private partnerships at both local and regional levels, including across physical health services, mental health, substance use disorder, law enforcement, social services, and related supports, are necessary to develop and maintain high quality, patient-centered, and cost-effective care for individuals with mental health disorders that facilitates their recovery and leads towards wellness.
(6)The recovery of individuals with mental health disorders is important for all levels of government, business, and the local community.
(b)This section shall be known, and may be cited, as the Investment in Mental Health Wellness Act of 2013. The objectives of this section are to do all of the following:
(1)Expand access to early intervention and treatment services to improve the client experience, achieve recovery and wellness, and reduce costs.
(2)Expand the continuum of services to address crisis intervention, crisis stabilization, and crisis residential treatment needs that are wellness, resiliency, and recovery oriented.
(3)Add at least 25 mobile crisis support teams and at least 2,000 crisis stabilization and crisis residential treatment beds to bolster capacity at the local level to improve access to mental health crisis services and address unmet mental health care needs.
(4)Add at least 600 triage personnel to provide intensive case management and linkage to services for individuals with mental health care disorders at various points of access, such as at designated community-based service points, homeless shelters, and clinics.
(5)Reduce unnecessary hospitalizations and inpatient days by appropriately utilizing community-based services and improving access to timely assistance.
(6)Reduce recidivism and mitigate unnecessary expenditures of local law enforcement.
(7)Provide local communities with increased financial resources to leverage additional public and private funding sources to achieve improved networks of care for individuals with mental health disorders.
(8)Provide a complete continuum of crisis services for children and youth 21 years of age and under regardless of where they live in the state. The funds included in the 2016 Budget Act for the purpose of developing the continuum of mental health crisis services for children and youth 21 years of age and under shall be for the following objectives:
(A)Provide a continuum of crisis services for children and youth 21 years of age and under regardless of where they live in the state.
(B)Provide for early intervention and treatment services to improve the client experience, achieve recovery and wellness, and reduce costs.
(C)Expand the continuum of community-based services to address crisis intervention, crisis stabilization, and crisis residential treatment needs that are wellness-, resiliency-, and recovery-oriented.
(D)Add at least 200 mobile crisis support teams.
(E)Add at least 120 crisis stabilization services and beds and crisis residential treatment beds to increase capacity at the local level to improve access to mental health crisis services and address unmet mental health care needs.
(F)Add triage personnel to provide intensive case management and linkage to services for individuals with mental health care disorders at various points of access, such as at designated community-based service points, homeless shelters, schools, and clinics.
(G)Expand family respite care to help families and sustain caregiver health and well-being.
(H)Expand family supportive training and related services designed to help families participate in the planning process, access services, and navigate programs.
(I)Reduce unnecessary hospitalizations and inpatient days by appropriately utilizing community-based services.
(J)Reduce recidivism and mitigate unnecessary expenditures of local law enforcement.
(K)Provide local communities with increased financial resources to leverage additional public and private funding sources to achieve improved networks of care for children and youth 21 years of age and under with mental health disorders.
(c)Through appropriations provided in the annual Budget Act for this purpose, it is the intent of the Legislature to authorize the California Health Facilities Financing Authority, hereafter referred to as the authority, and the Mental Health Services Oversight and Accountability Commission, hereafter referred to as the commission, to administer competitive selection processes as provided in this section for capital capacity and program expansion to increase capacity for mobile crisis support, crisis intervention, crisis stabilization services, crisis residential treatment, and specified personnel resources.
(d)Funds appropriated by the Legislature to the authority for purposes of this section shall be made available to selected counties, or counties acting jointly. The authority may, at its discretion, also give consideration to private nonprofit corporations and public agencies in an area or region of the state if a county, or counties acting jointly, affirmatively supports this designation and collaboration in lieu of a county government directly receiving grant funds.
(1)Grant awards made by the authority shall be used to expand local resources for the development, capital, equipment acquisition, and applicable program startup or expansion costs to increase capacity for client assistance and services in the following areas:
(A)Crisis intervention, as authorized by Sections 14021.4, 14680, and 14684.
(B)Crisis stabilization, as authorized by Sections 14021.4, 14680, and 14684.
(C)Crisis residential treatment, as authorized by Sections 14021.4, 14680, and 14684.
(D)Rehabilitative mental health services, as authorized by Sections 14021.4, 14680, and 14684.
(E)Mobile crisis support teams, including personnel and equipment, such as the purchase of vehicles.
(2)The authority shall develop selection criteria to expand local resources, including those described in paragraph (1), and processes for awarding grants after consulting with representatives and interested stakeholders from the mental health community, including, but not limited to, the County Behavioral Health Directors Association of California, service providers, consumer organizations, and other appropriate interests, such as health care providers and law enforcement, as determined by the authority. The authority shall ensure that grants result in cost-effective expansion of the number of community-based crisis resources in regions and communities selected for funding. The authority shall also take into account at least the following criteria and factors when selecting recipients of grants and determining the amount of grant awards:
(A)Description of need, including, at a minimum, a comprehensive description of the project, community need, population to be served, linkage with other public systems of health and mental health care, linkage with local law enforcement, social services, and related assistance, as applicable, and a description of the request for funding.
(B)Ability to serve the target population, which includes individuals eligible for Medi-Cal and individuals eligible for county health and mental health services.
(C)Geographic areas or regions of the state to be eligible for grant awards, which may include rural, suburban, and urban areas, and may include use of the five regional designations utilized by the County Behavioral Health Directors Association of California.
(D)Level of community engagement and commitment to project completion.
(E)Financial support that, in addition to a grant that may be awarded by the authority, will be sufficient to complete and operate the project for which the grant from the authority is awarded.
(F)Ability to provide additional funding support to the project, including public or private funding, federal tax credits and grants, foundation support, and other collaborative efforts.
(G)Memorandum of understanding among project partners, if applicable.
(H)Information regarding the legal status of the collaborating partners, if applicable.
(I)Ability to measure key outcomes, including improved access to services, health and mental health outcomes, and cost benefit of the project.
(3)The authority shall determine maximum grants awards, which shall take into consideration the number of projects awarded to the grantee, as described in paragraph (1), and shall reflect reasonable costs for the project and geographic region. The authority may allocate a grant in increments contingent upon the phases of a project.
(4)Funds awarded by the authority pursuant to this section may be used to supplement, but not to supplant, existing financial and resource commitments of the grantee or any other member of a collaborative effort that has been awarded a grant.
(5)All projects that are awarded grants by the authority shall be completed within a reasonable period of time, to be determined by the authority. Funds shall not be released by the authority until the applicant demonstrates project readiness to the authoritys satisfaction. If the authority determines that a grant recipient has failed to complete the project under the terms specified in awarding the grant, the authority may require remedies, including the return of all or a portion of the grant.
(6)A grantee that receives a grant from the authority under this section shall commit to using that capital capacity and program expansion project, such as the mobile crisis team, crisis stabilization unit, or crisis residential treatment program, for the duration of the expected life of the project.
(7)The authority may consult with a technical assistance entity, as described in paragraph (5) of subdivision (a) of Section 4061, for purposes of implementing this section.
(8)The authority may adopt emergency regulations relating to the grants for the capital capacity and program expansion projects described in this section, including emergency regulations that define eligible costs and determine minimum and maximum grant amounts.
(9)The authority shall provide reports to the fiscal and policy committees of the Legislature on or before May 1, 2014, and on or before May 1, 2015, on the progress of implementation, that include, but are not limited to, the following:
(A)A description of each project awarded funding.
(B)The amount of each grant issued.
(C)A description of other sources of funding for each project.
(D)The total amount of grants issued.
(E)A description of project operation and implementation, including who is being served.
(10)A recipient of a grant provided pursuant to paragraph (1) shall adhere to all applicable laws relating to scope of practice, licensure, certification, staffing, and building codes.
(e)Of the funds specified in paragraph (8) of subdivision (b), it is the intent of the Legislature to authorize the authority and the commission to administer competitive selection processes as provided in this section for capital capacity and program expansion to increase capacity for mobile crisis support, crisis intervention, crisis stabilization services, crisis residential treatment, family respite care, family supportive training and related services, and triage personnel resources for children and youth 21 years of age and under.
(f)Funds appropriated by the Legislature to the authority to address crisis services for children and youth 21 years of age and under for the purposes of this section shall be made available to selected counties or counties acting jointly. The authority may, at its discretion, also give consideration to private nonprofit corporations and public agencies in an area or region of the state if a county, or counties acting jointly, affirmatively support this designation and collaboration in lieu of a county government directly receiving grant funds.
(1)Grant awards made by the authority shall be used to expand local resources for the development, capital, equipment acquisition, and applicable program startup or expansion costs to increase capacity for client assistance and crisis services for children and youth 21 years of age and under in the following areas:
(A)Crisis intervention, as authorized by Sections 14021.4, 14680, and 14684.
(B)Crisis stabilization, as authorized by Sections 14021.4, 14680, and 14684.
(C)Crisis residential treatment, as authorized by Sections 14021.4, 14680, and 14684 and as provided at a childrens crisis residential program, as defined in Section 1502 of the Health and Safety Code.
(D)Mobile crisis support teams, including the purchase of equipment and vehicles.
(E)Family respite care.
(2)The authority shall develop selection criteria to expand local resources, including those described in paragraph (1), and processes for awarding grants after consulting with representatives and interested stakeholders from the mental health community, including, but not limited to, county mental health directors, service providers, consumer organizations, and other appropriate interests, such as health care providers and law enforcement, as determined by the authority. The authority shall ensure that grants result in cost-effective expansion of the number of community-based crisis resources in regions and communities selected for funding. The authority shall also take into account at least the following criteria and factors when selecting recipients of grants and determining the amount of grant awards:
(A)Description of need, including, at a minimum, a comprehensive description of the project, community need, population to be served, linkage with other public systems of health and mental health care, linkage with local law enforcement, social services, and related assistance, as applicable, and a description of the request for funding.
(B)Ability to serve the target population, which includes individuals eligible for Medi-Cal and individuals eligible for county health and mental health services.
(C)Geographic areas or regions of the state to be eligible for grant awards, which may include rural, suburban, and urban areas, and may include use of the five regional designations utilized by the California Behavioral Health Directors Association.
(D)Level of community engagement and commitment to project completion.
(E)Financial support that, in addition to a grant that may be awarded by the authority, will be sufficient to complete and operate the project for which the grant from the authority is awarded.
(F)Ability to provide additional funding support to the project, including public or private funding, federal tax credits and grants, foundation support, and other collaborative efforts.
(G)Memorandum of understanding among project partners, if applicable.
(H)Information regarding the legal status of the collaborating partners, if applicable.
(I)Ability to measure key outcomes, including utilization of services, health and mental health outcomes, and cost benefit of the project.
(3)The authority shall determine maximum grant awards, which shall take into consideration the number of projects awarded to the grantee, as described in paragraph (1), and shall reflect reasonable costs for the project, geographic region, and target ages. The authority may allocate a grant in increments contingent upon the phases of a project.
(4)Funds awarded by the authority pursuant to this section may be used to supplement, but not to supplant, existing financial and resource commitments of the grantee or any other member of a collaborative effort that has been awarded a grant.
(5)All projects that are awarded grants by the authority shall be completed within a reasonable period of time, to be determined by the authority. Funds shall not be released by the authority until the applicant demonstrates project readiness to the authoritys satisfaction. If the authority determines that a grant recipient has failed to complete the project under the terms specified in awarding the grant, the authority may require remedies, including the return of all, or a portion, of the grant.
(6)A grantee that receives a grant from the authority under this section shall commit to using that capital capacity and program expansion project, such as the mobile crisis team, crisis stabilization unit, family respite care, or crisis residential treatment program, for the duration of the expected life of the project.
(7)The authority may consult with a technical assistance entity, as described in paragraph (5) of subdivision (a) of Section 4061, for the purposes of implementing this section.
(8)The authority may adopt emergency regulations relating to the grants for the capital capacity and program expansion projects described in this section, including emergency regulations that define eligible costs and determine minimum and maximum grant amounts.
(9)The authority shall provide reports to the fiscal and policy committees of the Legislature on or before January 10, 2018, and annually thereafter, on the progress of implementation, that include, but are not limited to, the following:
(A)A description of each project awarded funding.
(B)The amount of each grant issued.
(C)A description of other sources of funding for each project.
(D)The total amount of grants issued.
(E)A description of project operation and implementation, including who is being served.
(10)A recipient of a grant provided pursuant to paragraph (1) shall adhere to all applicable laws relating to scope of practice, licensure, certification, staffing, and building codes.
(g)Funds appropriated by the Legislature to the commission for purposes of this section shall be allocated for triage personnel to provide intensive case management and linkage to services for individuals with mental health disorders at various points of access. These funds shall be made available to selected counties, counties acting jointly, or city mental health departments, as determined by the commission through a selection process. It is the intent of the Legislature for these funds to be allocated in an efficient manner to encourage early intervention and receipt of needed services for individuals with mental health disorders, and to assist in navigating the local service sector to improve efficiencies and the delivery of services.
(1)Triage personnel may provide targeted case management services face to face, by telephone, or by telehealth with the individual in need of assistance or his or her significant support person, and may be provided anywhere in the community. These service activities may include, but are not limited to, the following:
(A)Communication, coordination, and referral.
(B)Monitoring service delivery to ensure the individual accesses and receives services.
(C)Monitoring the individuals progress.
(D)Providing placement service assistance and service plan development.
(2)The commission shall take into account at least the following criteria and factors when selecting recipients and determining the amount of grant awards for triage personnel as follows:
(A)Description of need, including potential gaps in local service connections.
(B)Description of funding request, including personnel and use of peer support.
(C)Description of how triage personnel will be used to facilitate linkage and access to services, including objectives and anticipated outcomes.
(D)Ability to obtain federal Medicaid reimbursement, when applicable.
(E)Ability to administer an effective service program and the degree to which local agencies and service providers will support and collaborate with the triage personnel effort.
(F)Geographic areas or regions of the state to be eligible for grant awards, which shall include rural, suburban, and urban areas, and may include use of the five regional designations utilized by the County Behavioral Health Directors Association of California.
(3)The commission shall determine maximum grant awards, and shall take into consideration the level of need, population to be served, and related criteria, as described in paragraph (2), and shall reflect reasonable costs.
(4)Funds awarded by the commission for purposes of this section may be used to supplement, but not supplant, existing financial and resource commitments of the county, counties acting jointly, or city mental health department that received the grant.
(5)Notwithstanding any other law, a county, counties acting jointly, or city mental health department that receives an award of funds for the purpose of supporting triage personnel pursuant to this subdivision is not required to provide a matching contribution of local funds.
(6)Notwithstanding any other law, the commission, without taking any further regulatory action, may implement, interpret, or make specific this section by means of informational letters, bulletins, or similar instructions.
(7)The commission shall provide a status report to the fiscal and policy committees of the Legislature on the progress of implementation no later than March 1, 2014.
(h)Funds appropriated by the Legislature to the commission pursuant to paragraph (8) of subdivision (b) for the purposes of addressing childrens crisis services shall be allocated to support triage personnel and family supportive training and related services. These funds shall be made available to selected counties, counties acting jointly, or city mental health departments, as determined by the commission through a selection process. The commission may, at its discretion, also give consideration to private nonprofit corporations and public agencies in an area or region of the state if a county, or counties acting jointly, affirmatively supports this designation and collaboration in lieu of a county government directly receiving grant funds.
(1)These funds may provide for a range of crisis-related services for a child in need of assistance, or his or her parent, guardian, or caregiver. These service activities may include, but are not limited to, the following:
(A)Intensive coordination of care and services.
(B)Communication, coordination, and referral.
(C)Monitoring service delivery to the child or youth.
(D)Monitoring the childs progress.
(E)Providing placement service assistance and service plan development.
(F)Crisis or safety planning.
(2)The commission shall take into account at least the following criteria and factors when selecting recipients and determining the amount of grant awards for these funds, as follows:
(A)Description of need, including potential gaps in local service connections.
(B)Description of funding request, including personnel.
(C)Description of how personnel and other services will be used to facilitate linkage and access to services, including objectives and anticipated outcomes.
(D)Ability to obtain federal Medicaid reimbursement, when applicable.
(E)Ability to provide a matching contribution of local funds.
(F)Ability to administer an effective service program and the degree to which local agencies and service providers will support and collaborate with the triage personnel effort.
(G)Geographic areas or regions of the state to be eligible for grant awards, which shall include rural, suburban, and urban areas, and may include use of the five regional designations utilized by the County Behavioral Health Directors Association of California.
(3)The commission shall determine maximum grant awards, and shall take into consideration the level of need, population to be served, and related criteria, as described in paragraph (2), and shall reflect reasonable costs.
(4)Funds awarded by the commission for purposes of this section may be used to supplement, but not supplant, existing financial and resource commitments of the county, counties acting jointly, or a city mental health department that received the grant.
(5)Notwithstanding any other law, a county, counties acting jointly, or a city mental health department that receives an award of funds for the purpose of this section is not required to provide a matching contribution of local funds.
(6)Notwithstanding any other law, the commission, without taking any further regulatory action, may implement, interpret, or make specific this section by means of informational letters, bulletins, or similar instructions.
(7)The commission may waive requirements in this section for counties with a population of 100,000 or less, if the commission determines it is in the best interest of the state and meets the intent of the law.
(8)The commission shall provide a status report to the fiscal and policy committees of the Legislature on the progress of implementation no later than January 10, 2018, and annually thereafter.
SEC. 6.Section 11462.01 of the Welfare and Institutions Code, as added by Section 75 of Chapter 773 of the Statutes of 2015, is amended to read:11462.01.(a)(1)If a program is not intended for the exclusive use of private insurance plans, no later than 12 months following the date of initial licensure, a short-term residential therapeutic program, as defined in subdivision (ad) of Section 11400 of this code and paragraph (18) of subdivision (a) of Section 1502 of the Health and Safety Code, shall obtain a contract, subject to an agreement on rates and terms and conditions, with a county mental health plan to provide specialty mental health services and demonstrate the ability to meet the therapeutic needs of each child, as identified in any of the following:
(A)A mental health assessment.
(B)The childs case plan.
(C)The childs needs and services plan.
(D)Other documentation demonstrating the child has a mental health need.
(2)A short-term residential therapeutic program shall comply with any other mental health program approvals required by the State Department of Health Care Services or by a county mental health plan to which mental health program approval authority has been delegated.
(b)A short-term residential therapeutic program, except as specified in subdivision (c), may accept for placement a child who meets both of the criteria in paragraphs (1) and (2) and at least one of the conditions in paragraph (3).
(1)The child does not require inpatient care in a licensed health facility.
(2)The child has been assessed as requiring the level of services provided in a short-term residential therapeutic program in order to maintain the safety and well-being of the child or others due to behaviors, including those resulting from traumas, that render the child or those around the child unsafe or at risk of harm, or that prevent the effective delivery of needed services and supports provided in the childs own home or in other family settings, such as with a relative, guardian, foster family, resource family, or adoptive family. The assessment shall ensure the child has needs in common with other children or youth in the care of the facility, consistent with subdivision (c) of Section 16514.
(3)The child meets at least one of the following conditions:
(A)The child has been assessed, pursuant to Section 4096, as meeting the medical necessity criteria for Medi-Cal specialty mental health services, as provided for in Section 1830.205 or 1830.210 of Title 9 of the California Code of Regulations.
(B)The child has been assessed, pursuant to Section 4096, as seriously emotionally disturbed, as defined in subdivision (a) of Section 5600.3.
(C)The child requires emergency placement pursuant to paragraph (3) of subdivision (i).
(D)The child has been assessed, pursuant to Section 4096, as requiring the level of services provided by the short-term residential therapeutic program in order to meet his or her behavioral or therapeutic needs.
(4)Subject to the requirements of this subdivision, a short-term residential therapeutic program may have a specialized program to serve a child, including, but not limited to, the following:
(A)A commercially sexually exploited child.
(B)A private voluntary placement, if the youth exhibits status offender behavior, the parents or other relatives feel they cannot control the childs behavior, and short-term intervention is needed to transition the child back into the home.
(C)A juvenile sex offender.
(D)A child who is affiliated with, or impacted by, a gang.
(c)(1)A short-term residential therapeutic program that is operating as a childrens crisis residential program, as defined in Section 1502 of the Health and Safety Code, may accept for admission any child, child who meets all of the following requirements:
(A)The child is referred by a parent or guardian, or by the representative of a public or private entity, including, but not limited to, the county probation agency or child welfare services agency with responsibility for the placement of a child in foster care, that has the right to make these decisions on behalf of a child who is in mental health crisis and, absent admission to a childrens crisis residential program, would otherwise require acceptance by the emergency department of a general hospital, or admission into a psychiatric hospital or the psychiatric inpatient unit of a general hospital. crisis.
(B)The child is under 19, 20, or 21 years of age, depending on a programs licensing requirements.
(C)The child has a serious behavioral health disorder.
(D)The child requires a 24-hour-a-day, seven-day-a-week, staff-secured, unlocked treatment setting.
(2)The primary function of a childrens crisis residential program is to provide short-term crisis stabilization, therapeutic intervention, and specialized programming in an unlocked, staff-secured setting with a high degree of supervision and structure and the goal of supporting the rapid and successful transition of the child back to the community.
(d)A foster family agency that is certified as a Medi-Cal specialty mental health provider pursuant to Section 1810.435 of Title 9 of the California Code of Regulations by the State Department of Health Care Services, or by a county mental health plan to which the department has delegated certification authority, and which has entered into a contract with a county mental health plan pursuant to Section 1810.436 of Title 9 of the California Code of Regulations, shall provide, or provide access to, specialty mental health services to children under its care who do not require inpatient care in a licensed health facility and who meet the medical necessity criteria for Medi-Cal specialty mental health services provided for in Section 1830.205 or 1830.210 of Title 9 of the California Code of Regulations.
(e)A foster family agency that is not certified as a Medi-Cal specialty mental health provider shall provide access to specialty and non-specialty mental health services in that program for children who do not require inpatient care in a licensed health facility and who meet any of the conditions in paragraph (3) of subdivision (b). In this situation the foster family agency shall do the following:
(1)In the case of a child who is a Medi-Cal beneficiary, arrange for specialty mental health services from the county mental health plan.
(2)In all other cases, arrange for the child to receive mental health services.
(f)All short-term residential therapeutic programs shall maintain the level of care and services necessary to meet the needs of the children and youth in their care and shall maintain and have in good standing the appropriate mental health program approval. If a program will admit Medi-Cal beneficiaries, the mental health program approval shall include a certification to provide Medi-Cal specialty mental health services issued by the State Department of Health Care Services or a county mental health plan to which the department has delegated mental health program approval authority, pursuant to Section 4096.5 of this code or Section 1810.435 or 1810.436 of Title 9 of the California Code of Regulations. All foster family agencies that are certified as a Medi-Cal specialty mental health provider pursuant to Section 1810.435 of Title 9 of the California Code of Regulations shall maintain the level of care and services necessary to meet the needs of children and youth in their care and shall maintain and have in good standing the Medi-Cal specialty mental health provider certification issued by the State Department of Health Care Services or a county mental health plan to which the department has delegated certification authority.
(g)The assessments described in subparagraphs (A), (B), (C), and (D) of paragraph (3) of subdivision (b) shall ensure the childs individual behavioral or treatment needs are consistent with, and can be met by, the facility and shall be made by one of the following, as applicable:
(1)An interagency placement committee, as described in Section 4096, considering the recommendations from the child and family team, if any are available. If the short-term residential therapeutic program serves children who are placed by county child welfare agencies and children who are placed by probation departments, the interagency placement committee shall also ensure the requirements of subdivision (c) of Section 16514 have been met with respect to commonality of need.
(2)A licensed mental health professional as defined in subdivision (g) of Section 4096.
(3)For the purposes of this section, an AFDC-FC funded child with an individualized education program developed pursuant to Article 2 (commencing with Section 56320) of Chapter 4 of Part 30 of Division 4 of Title 2 of the Education Code that assesses the child as seriously emotionally disturbed, as defined in, and subject to, this section and recommends out-of-home placement at the level of care provided by the provider, shall be deemed to have met the assessment requirement.
(h)The evaluation described in subparagraph (A) of paragraph (3) of subdivision (i) shall be made pursuant to subdivision (b) of Section 706.6 or paragraph (2) of subdivision (c) of Section 16501.1.
(i)(1)The provider shall ensure that AFDC-FC funded children, assessed pursuant to subparagraphs (A) and (B) of paragraph (3) of subdivision (b), who are accepted for placement have been approved for placement by an interagency placement committee, as described in Section 4096, except as provided for in paragraphs (3) and (4) of subdivision (g).
(2)The approval shall be in writing and shall indicate that the interagency placement committee has determined one of the following:
(A)The child meets the medical necessity criteria for Medi-Cal specialty mental health services, as provided for in Section 1830.205 or 1830.210 of Title 9 of the California Code of Regulations.
(B)The child is seriously emotionally disturbed, as described in subdivision (a) of Section 5600.3.
(3)(A)Nothing in subdivisions (a) to (h), inclusive, or this subdivision shall prevent an emergency placement of a child or youth into a certified short-term residential therapeutic program or childrens crisis residential program prior to the determination by the interagency placement committee, but only if a licensed mental health professional, as defined in subdivision (g) of Section 4096, has made a written determination within 72 hours of the childs or youths placement, that the child or youth requires the level of services and supervision provided by the short-term residential therapeutic program in order to meet his or her behavioral or therapeutic needs, or has made a written determination within 24 hours of the childs or youths placement in a childrens crisis residential program that the child or youth is experiencing a mental health crisis as defined in subdivision (c) and is in need of the care and services provided by the childrens crisis residential program. If the short-term residential therapeutic program serves children placed by county child welfare agencies and children placed by probation departments, the interagency placement committee shall also ensure the requirements of subdivision (c) of Section 16514 have been met with respect to commonality of need.
(i)The interagency placement committee, as appropriate, shall, within 30 days of placement, make the determinations, with recommendations from the child and family team, required by this subdivision.
(ii)If it determines the placement is appropriate, the interagency placement committee, with recommendations from the child and family team, shall transmit the approval, in writing, to the county placing agency and the short-term residential therapeutic program.
(iii)If it determines the placement is not appropriate, the interagency placement committee shall respond pursuant to subparagraph (B).
(B)(i)If the interagency placement committee determines at any time that the placement is not appropriate, it shall, with recommendations from the child and family team, transmit the disapproval, in writing, to the county placing agency and the short-term residential therapeutic program and shall include a recommendation as to the childs appropriate level of care and placement to meet his or her service needs. The necessary interagency placement committee representative or representatives shall participate in any child and family team meetings to refer the child or youth to an appropriate placement, as specified in this section.
(ii)The child may remain in the placement for the amount of time necessary to identify and transition the child to an alternative, suitable placement.
(iii)Notwithstanding clause (ii), if the interagency placement committee determined the placement was not appropriate due to a health and safety concern, immediate arrangements for the child to transition to an appropriate placement shall occur.
(j)Commencing January 1, 2017, for AFDC-FC funded children or youth, only those children or youth who are approved for placement, as set forth in this section, may be accepted by a short-term residential therapeutic program.
(k)The department shall, through regulation, establish consequences for the failure of a short-term residential therapeutic program to obtain written approval for placement of an AFDC-FC funded child or youth pursuant to this section.
(l)The department shall not establish a rate for a short-term residential therapeutic program unless the provider submits a recommendation from the host county or the primary placing county that the program is needed and that the provider is willing and capable of operating the program at the level sought. For purposes of this subdivision, host county, and primary placing county, mean the same as defined in the departments AFDC-FC ratesetting regulations.
(m)Any certified short-term residential therapeutic program shall be reclassified and paid at the appropriate program rate for which it is qualified if either of the following occurs:
(1)(A)It fails to maintain the level of care and services necessary to meet the needs of the children and youth in care, as required by subdivision (a). The determination shall be made consistent with the departments AFDC-FC ratesetting regulations developed pursuant to Section 11462 and shall take into consideration the highest level of care and associated rates for which the program may be eligible if granted an extension pursuant to Section 11462.04 or any reduction in rate associated with a provisional or probationary rate granted or imposed under Section 11466.01.
(B)In the event of a determination under this paragraph, the short-term residential therapeutic program may appeal the finding or submit a corrective action plan. The appeal process specified in Section 11466.6 shall be available to a short-term residential therapeutic program that provides intensive and therapeutic treatment. During any appeal, the short-term residential therapeutic program that provides intensive and therapeutic treatment shall maintain the appropriate level of care.
(2)It fails to maintain a certified mental health treatment program as required by subdivision (f).
(n)In addition to any other review required by law, the child and family team as defined in paragraph (4) of subdivision (a) of Section 16501 may periodically review the placement of the child or youth. If the child and family team make a recommendation that the child or youth no longer needs, or is not benefiting from, placement in a short-term residential therapeutic program, the team shall transmit the disapproval, in writing, to the county placing agency to consider a more appropriate placement.
(o)The department shall develop a process to address placements when, subsequent to the childs or youths placement, a determination is made by the interagency placement team and shall consider the recommendations of the child and family team, either that the child or youth is not in need of the care and services provided by the certified program. The process shall include, but not be limited to:
(1)Notice of the determination in writing to both the county placing agency and the short-term residential therapeutic program or foster family agency that provides intensive and therapeutic treatment.
(2)Notice of the countys plan, and a timeframe, for removal of the child or youth in writing to the short-term residential therapeutic program that provides intensive and therapeutic treatment.
(3)Referral to an appropriate placement.
(4)Actions to be taken if a child or youth is not timely removed from the short-term residential therapeutic program that provides intensive and therapeutic treatment or placed in an appropriate placement.
(p)(1)Nothing in this section shall prohibit a short-term residential therapeutic program from accepting private admissions of children or youth.
(2)When a referral is not from a public agency and no public funding is involved, there is no requirement for public agency review or determination of need.
(3)Children and youth subject to paragraphs (1) and (2) shall have been determined to be seriously emotionally disturbed, as described in subdivision (a) of Section 5600.3, and subject to Section 1502.4 of the Health and Safety Code, by a licensed mental health professional, as defined in subdivision (g) of Section 4096.
SEC. 7.Section 11462.011 is added to the Welfare and Institutions Code, to read:11462.011.(a)The State Department of Health Care Services shall, in consultation with the Department of Managed Health Care, the State Department of Social Services, the County Behavioral Health Directors Association of California, the County Welfare Directors Association of California, the Chief Probation Officers of California, provider representatives, and other relevant stakeholders, establish program standards and procedures for oversight, enforcement, and issuance of childrens crisis residential mental health program approvals, including provisional approvals that are effective for a period of less than one year. The State Department of Health Care Services shall also establish due process protections related to the childrens crisis residential mental health program approval process.
(b)A childrens crisis residential mental health program approval issued by the State Department of Health Care Services, or a county mental health plan to which the department has delegated approval authority, shall be a condition of continued licensure for a short-term residential therapeutic program operating as a childrens crisis residential program.
(c)The State Department of Health Care Services, or a county mental health plan to which the department has delegated approval authority, may enforce the childrens crisis residential mental health program approval standards by taking any of the following actions against a noncompliant childrens crisis residential program:
(1)Suspend or revoke a childrens crisis residential mental health program approval.
(2)Impose monetary penalties.
(3)Place a childrens crisis residential mental health program on probation.
(4)Require a childrens crisis residential mental health program to prepare and comply with a corrective action plan.
(d)The State Department of Health Care Services, or a county mental health plan to which the department has delegated approval authority, shall provide a childrens crisis residential mental health program with due process protections when taking any of the actions described in subdivision (c).
(e)Contingent upon an appropriation in the annual Budget Act for these purposes, the department shall begin implementation of this section no later than July 1, 2018, and shall commence the operation of the approval process for childrens crisis residential mental health program approvals no later than January 1, 2019.
SEC. 8.(a)Contingent upon an appropriation from the annual Budget Act for these purposes, the State Department of Social Services and the State Department of Health Care Services shall adopt regulations to implement this act on or before July 1, 2018.
(b)Notwithstanding the rulemaking provisions of the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code), the State Department of Social Services and the State Department of Health Care Services may implement and administer the changes made by this act through information notices, all-county letters, or similar written instructions until regulations are adopted.
(c)This section shall become effective upon appropriation of funds by the Legislature for the purposes described in this section.
SEC. 9.No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution.
The Legislature finds and declares all of the following:
(a)There is an urgent need to provide more crisis care alternatives to hospitals for children and youth experiencing mental health crises.
(b)The problems are especially acute for children and youth who may have to wait for days for a hospital bed and who may be transported, without a parent, to the nearest facility hundreds of miles away.
(c)In 2012, the California Hospital Association reported that two-thirds of the people taken to a hospital for a psychiatric emergency did not meet the criteria for that level of care, but the care they needed was not available.
(d)The type of care that is needed includes crisis residential treatment for children.
(e)This level of care is part of the full continuum of care considered medically necessary for many children with serious emotional disturbances.
(f)In 2013, the Legislature enacted the Investment in Mental Health Wellness Act (Senate Bill 82, Chapter 34 of the Statutes of 2013) to provide one-time funding to counties to expand the availability of mental health crisis care services, including short-term crisis residential treatment services. However, there is currently no state licensing category for short-term crisis residential programs for children. As a result, counties wanting to expand local capacity to meet the needs of children and youth for crisis residential treatment services were ineligible for this competitive grant program.
(g)In most communities, inpatient crisis treatment is completely unavailable for children and youth, even though it may be medically necessary.
(h)Crisis residential care is an essential level of care for the treatment of children and youth with serious emotional disturbances in a mental health crisis, and it often serves as an alternative to hospitalization.
(i)It is imperative that California identify a licensing category specifically for mental health crisis residential care that can be utilized for children and youth who are beneficiaries of both public and private health care plans.
SEC. 2.Section 1502 of the Health and Safety Code is amended to read:1502.As used in this chapter:
(a)Community care facility means any facility, place, or building that is maintained and operated to provide nonmedical residential care, day treatment, adult day care, or foster family agency services for children, adults, or children and adults, including, but not limited to, the physically handicapped, mentally impaired, incompetent persons, and abused or neglected children, and includes the following:
(1)Residential facility means any family home, group care facility, or similar facility determined by the department, for 24-hour nonmedical care of persons in need of personal services, supervision, or assistance essential for sustaining the activities of daily living or for the protection of the individual.
(2)Adult day program means any community-based facility or program that provides care to persons 18 years of age or older in need of personal services, supervision, or assistance essential for sustaining the activities of daily living or for the protection of these individuals on less than a 24-hour basis.
(3)Therapeutic day services facility means any facility that provides nonmedical care, counseling, educational or vocational support, or social rehabilitation services on less than a 24-hour basis to persons under 18 years of age who would otherwise be placed in foster care or who are returning to families from foster care. Program standards for these facilities shall be developed by the department, pursuant to Section 1530, in consultation with therapeutic day services and foster care providers.
(4)Foster family agency means any public agency or private organization, organized and operated on a nonprofit basis, engaged in any of the following:
(A)Recruiting, certifying, approving, and training of, and providing professional support to, foster parents and resource families.
(B)Coordinating with county placing agencies to find homes for foster children in need of care.
(C)Providing services and supports to licensed or certified foster parents, county-approved resource families, and children to the extent authorized by state and federal law.
(5)Foster family home means any residential facility providing 24-hour care for six or fewer foster children that is owned, leased, or rented and is the residence of the foster parent or parents, including their family, in whose care the foster children have been placed. The placement may be by a public or private child placement agency or by a court order, or by voluntary placement by a parent, parents, or guardian. It also means a foster family home described in Section 1505.2.
(6)Small family home means any residential facility, in the licensees family residence, that provides 24-hour care for six or fewer foster children who have mental disorders or developmental or physical disabilities and who require special care and supervision as a result of their disabilities. A small family home may accept children with special health care needs, pursuant to subdivision (a) of Section 17710 of the Welfare and Institutions Code. In addition to placing children with special health care needs, the department may approve placement of children without special health care needs, up to the licensed capacity.
(7)Social rehabilitation facility means any residential facility that provides social rehabilitation services for no longer than 18 months in a group setting to adults recovering from mental illness who temporarily need assistance, guidance, or counseling. Program components shall be subject to program standards pursuant to Article 1 (commencing with Section 5670) of Chapter 2.5 of Part 2 of Division 5 of the Welfare and Institutions Code.
(8)Community treatment facility means any residential facility that provides mental health treatment services to children in a group setting and that has the capacity to provide secure containment. Program components shall be subject to program standards developed and enforced by the State Department of Health Care Services pursuant to Section 4094 of the Welfare and Institutions Code.
Nothing in this section shall be construed to prohibit or discourage placement of persons who have mental or physical disabilities into any category of community care facility that meets the needs of the individual placed, if the placement is consistent with the licensing regulations of the department.
(9)Full-service adoption agency means any licensed entity engaged in the business of providing adoption services, that does all of the following:
(A)Assumes care, custody, and control of a child through relinquishment of the child to the agency or involuntary termination of parental rights to the child.
(B)Assesses the birth parents, prospective adoptive parents, or child.
(C)Places children for adoption.
(D)Supervises adoptive placements.
Private full-service adoption agencies shall be organized and operated on a nonprofit basis. As a condition of licensure to provide intercountry adoption services, a full-service adoption agency shall be accredited and in good standing according to Part 96 (commencing with Section 96.1) of Title 22 of the Code of Federal Regulations, or supervised by an accredited primary provider, or acting as an exempted provider, in compliance with Subpart F (commencing with Section 96.29) of Part 96 of Title 22 of the Code of Federal Regulations.
(10)Noncustodial adoption agency means any licensed entity engaged in the business of providing adoption services, that does all of the following:
(A)Assesses the prospective adoptive parents.
(B)Cooperatively matches children freed for adoption, who are under the care, custody, and control of a licensed adoption agency, for adoption, with assessed and approved adoptive applicants.
(C)Cooperatively supervises adoption placements with a full-service adoptive agency, but does not disrupt a placement or remove a child from a placement.
Private noncustodial adoption agencies shall be organized and operated on a nonprofit basis. As a condition of licensure to provide intercountry adoption services, a noncustodial adoption agency shall be accredited and in good standing according to Part 96 (commencing with Section 96.1) of Title 22 of the Code of Federal Regulations, or supervised by an accredited primary provider, or acting as an exempted provider, in compliance with Subpart F (commencing with Section 96.29) of Part 96 of Title 22 of the Code of Federal Regulations.
(11)Transitional shelter care facility means any group care facility that provides for 24-hour nonmedical care of persons in need of personal services, supervision, or assistance essential for sustaining the activities of daily living or for the protection of the individual. Program components shall be subject to program standards developed by the State Department of Social Services pursuant to Section 1502.3.
(12)Transitional housing placement provider means an organization licensed by the department pursuant to Section 1559.110 and Section 16522.1 of the Welfare and Institutions Code to provide transitional housing to foster children at least 16 years of age and not more than 18 years of age, and nonminor dependents, as defined in subdivision (v) of Section 11400 of the Welfare and Institutions Code, to promote their transition to adulthood. A transitional housing placement provider shall be privately operated and organized on a nonprofit basis.
(13)Group home means a residential facility that provides 24-hour care and supervision to children, delivered at least in part by staff employed by the licensee in a structured environment. The care and supervision provided by a group home shall be nonmedical, except as otherwise permitted by law.
(14)Runaway and homeless youth shelter means a group home licensed by the department to operate a program pursuant to Section 1502.35 to provide voluntary, short-term, shelter and personal services to runaway youth or homeless youth, as defined in paragraph (2) of subdivision (a) of Section 1502.35.
(15)Enhanced behavioral supports home means a facility certified by the State Department of Developmental Services pursuant to Article 3.6 (commencing with Section 4684.80) of Chapter 6 of Division 4.5 of the Welfare and Institutions Code, and licensed by the State Department of Social Services as an adult residential facility or a group home that provides 24-hour nonmedical care to individuals with developmental disabilities who require enhanced behavioral supports, staffing, and supervision in a homelike setting. An enhanced behavioral supports home shall have a maximum capacity of four consumers, shall conform to Section 441.530(a)(1) of Title 42 of the Code of Federal Regulations, and shall be eligible for federal Medicaid home- and community-based services funding.
(16)Community crisis home means a facility certified by the State Department of Developmental Services pursuant to Article 8 (commencing with Section 4698) of Chapter 6 of Division 4.5 of the Welfare and Institutions Code, and licensed by the State Department of Social Services pursuant to Article 9.7 (commencing with Section 1567.80), as an adult residential facility, providing 24-hour nonmedical care to individuals with developmental disabilities receiving regional center service, in need of crisis intervention services, and who would otherwise be at risk of admission to the acute crisis center at Fairview Developmental Center, Sonoma Developmental Center, an acute general hospital, acute psychiatric hospital, an institution for mental disease, as described in Part 5 (commencing with Section 5900) of Division 5 of the Welfare and Institutions Code, or an out-of-state placement. A community crisis home shall have a maximum capacity of eight consumers, as defined in subdivision (a) of Section 1567.80, shall conform to Section 441.530(a)(1) of Title 42 of the Code of Federal Regulations, and shall be eligible for federal Medicaid home- and community-based services funding.
(17)Crisis nursery means a facility licensed by the department to operate a program pursuant to Section 1516 to provide short-term care and supervision for children under six years of age who are voluntarily placed for temporary care by a parent or legal guardian due to a family crisis or stressful situation.
(18)Short-term residential therapeutic program means a residential facility operated by a public agency or private organization and licensed by the department pursuant to Section 1562.01 that provides an integrated program of specialized and intensive care and supervision, services and supports, treatment, and short-term, 24-hour care and supervision to children. The care and supervision provided by a short-term residential therapeutic program shall be nonmedical, except as otherwise permitted by law. Private short-term residential therapeutic programs shall be organized and operated on a nonprofit basis. A short-term residential therapeutic program may be operated as a childrens crisis residential center.
(19)Private alternative boarding school means a group home licensed by the department to operate a program pursuant to Section 1502.2 to provide youth with 24-hour residential care and supervision, which, in addition to providing educational services to youth, provides, or holds itself out as providing, behavioral-based services to youth with social, emotional, or behavioral issues. The care and supervision provided by a private alternative boarding school shall be nonmedical, except as otherwise permitted by law.
(20)Private alternative outdoor program means a group home licensed by the department to operate a program pursuant to Section 1502.21 to provide youth with 24-hour residential care and supervision, which provides, or holds itself out as providing, behavioral-based services in an outdoor living setting to youth with social, emotional, or behavioral issues. The care and supervision provided by a private alternative outdoor program shall be nonmedical, except as otherwise permitted by law.
(21)Childrens crisis residential center means a short-term residential therapeutic program operated specifically to divert children experiencing a mental health crisis from psychiatric hospitalization.(21)Childrens crisis residential program means a facility licensed by the department as a short-term residential therapeutic program pursuant to Section 1562.02 and approved by the State Department of Health Care Services, or a county mental health plan to which the State Department of Health Care Services has delegated approval authority, to operate a childrens crisis residential mental health program approval pursuant to Section 11462.011 of the Welfare and Institutions Code, to serve children experiencing mental health crises as an alternative to psychiatric hospitalization.
(b)Department or state department means the State Department of Social Services.
(c)Director means the Director of Social Services.
SEC. 3.Section 1562.02 is added to the Health and Safety Code, to read:1562.02.(a)The department may license a short-term residential therapeutic program operating as a childrens crisis residential program pursuant to this chapter. A childrens crisis residential program shall meet all of the following requirements:
(1)If the program serves children who are not experiencing mental health crises, have an identifiable and physically separate unit for those children who are experiencing mental health crises. The separate unit shall be indicated on the short-term residential therapeutic programs license.
(2)Obtain and have in good standing a mental health program approval that includes a Medi-Cal mental health certification, as described in Section 11462.01 of the Welfare and Institutions Code, and a childrens crisis residential mental health program approval, as described in Section 11462.01 of the Welfare and Institutions Code, both of which are issued by the State Department of Health Care Services, or a county mental health plan to which the department has delegated approval authority. The short-term residential therapeutic program shall obtain a mental health program approval before operating as a childrens crisis residential program. The department may revoke a programs license pursuant to Section 1550 for a programs failure to maintain the mental health program approval.
(3)Comply with all applicable licensing standards for a short-term residential therapeutic program, unless otherwise specified by the department in regulations.
(b)The State Department of Health Care Services shall, in collaboration with the department, the County Behavioral Health Directors Association of California, provider representatives, and other relevant stakeholders, develop a rate for children who are Medi-Cal beneficiaries and who are admitted to a childrens crisis residential program. This subdivision shall be implemented only to the extent that federal financial participation is available and any necessary federal approvals have been obtained.
(c)Contingent upon an appropriation in the annual Budget Act for these purposes, the department shall begin implementation of this section no later than January 1, 2018, and shall commence the licensing process for childrens crisis residential programs no later than July 1, 2018.
SEC. 3.SEC. 4.Section 1562.02 1562.03 is added to the Health and Safety Code, to read:1562.02.1562.03.(a)The department shall establish regulations for short-term residential therapeutic programs that are operated as childrens crisis residential centers. At a minimum, the regulations shall include all of the following:
(1)The childrens crisis residential center shall be used only for diversion from admittance to a psychiatric hospitalization.
(2)(A)Length of stay for a single admission the initial authorization for admission to a childrens crisis residential center program shall be limited to 10 consecutive days.
(B)Notwithstanding subparagraph (A), the length of stay may be extended once for no more than two consecutive 10-day lengths of stay. Before extending the length of stay for a Medi-Cal beneficiary beyond 10 consecutive days, an organization providing the childrens crisis residential services program shall obtain prior approval from the county mental health plan authorizing those services. In the case of beneficiaries of private insurance, reauthorizations for admission shall be obtained using the process established by the individual plans.
(C)A child shall not be admitted to a childrens crisis residential center regulated under this section for more than 20 total days in any six-month period.(3)Therapeutic programming shall be provided seven days a week, including weekends and holidays, with sufficient professional and paraprofessional staff to maintain an appropriate treatment setting and services, based on individual childrens needs.
(4)The program shall be staffed with sufficient personnel to accept children 24 hours per day, seven days a week and to admit children, at a minimum, from 7 a.m. to 11 p.m., seven days a week, 365 days per year. The program shall be sufficiently staffed to discharge children, as appropriate, seven days a week, 365 days per year.
(5)Facilities shall be limited to fewer than 16 beds, with at least 50 percent of those beds in single-occupancy rooms.
(6)Facilities shall include ample physical space for accommodating individuals who provide natural supports to each child and for integrating family members into the day-to-day care of the youth.
(7)The center program shall collaborate with each childs existing mental health team, if applicable, child and family team, if applicable, and other formal and natural supports within 24 hours of intake and throughout the course of care and treatment as appropriate.
(8)The program shall assist in the development of a plan for transitioning each admitted child from the program to his or her home and community, including the establishment of a mental health or child and family team if there is not one already.
(b)The center program shall annually provide the department with all of the following data as it pertains to children in foster care and children not in foster care in conjunction with its application for licensure renewal:
(1)Age and gender of clients served.
(2)Duration of stay.
(3)Professional classification of staff and contracted staff.
(4)Type of placement the client was discharged to.
SEC. 4.Section 1562.03 is added to the Health and Safety Code, to read:1562.03.(a)(1)The State Department of Health Care Services shall establish interim Medi-Cal rates as needed that are sufficient to reimburse the costs for childrens crisis residential services in excess of any specialty mental health services that would have been otherwise authorized, provided, and invoiced for each eligible Medi-Cal beneficiary receiving childrens crisis residential services.(2)The department shall consult with subject matter experts from the County Behavioral Health Directors Association of California and provider associations to obtain data and background information necessary to ensure sufficiency of the rate.(b)For foster children admitted for childrens crisis residential services, programs shall receive payment for board and care equivalent to the rate paid for short-term residential therapeutic programs.(c)Nothing in this chapter shall prevent a county from providing payment in excess of the short-term residential therapeutic program rate in order to meet the needs of individual children.SEC. 5.Section 5848.5 of the Welfare and Institutions Code is amended to read:5848.5.(a)The Legislature finds and declares all of the following:
(1)California has realigned public community mental health services to counties and it is imperative that sufficient community-based resources be available to meet the mental health needs of eligible individuals.
(2)Increasing access to effective outpatient and crisis stabilization services provides an opportunity to reduce costs associated with expensive inpatient and emergency room care and to better meet the needs of individuals with mental health disorders in the least restrictive manner possible.
(3)Almost one-fifth of people with mental health disorders visit a hospital emergency room at least once per year. If an adequate array of crisis services is not available, it leaves an individual with little choice but to access an emergency room for assistance and, potentially, an unnecessary inpatient hospitalization.
(4)Recent reports have called attention to a continuing problem of inappropriate and unnecessary utilization of hospital emergency rooms in California due to limited community-based services for individuals in psychological distress and acute psychiatric crisis. Hospitals report that 70 percent of people taken to emergency rooms for psychiatric evaluation can be stabilized and transferred to a less intensive level of crisis care. Law enforcement personnel report that their personnel need to stay with people in the emergency room waiting area until a placement is found, and that less intensive levels of care tend not to be available.
(5)Comprehensive public and private partnerships at both local and regional levels, including across physical health services, mental health, substance use disorder, law enforcement, social services, and related supports, are necessary to develop and maintain high quality, patient-centered, and cost-effective care for individuals with mental health disorders that facilitates their recovery and leads towards wellness.
(6)The recovery of individuals with mental health disorders is important for all levels of government, business, and the local community.
(b)This section shall be known, and may be cited, as the Investment in Mental Health Wellness Act of 2013. The objectives of this section are to do all of the following:
(1)Expand access to early intervention and treatment services to improve the client experience, achieve recovery and wellness, and reduce costs.
(2)Expand the continuum of services to address crisis intervention, crisis stabilization, and crisis residential treatment needs that are wellness, resiliency, and recovery oriented.
(3)Add at least 25 mobile crisis support teams and at least 2,000 crisis stabilization and crisis residential treatment beds to bolster capacity at the local level to improve access to mental health crisis services and address unmet mental health care needs.
(4)Add at least 600 triage personnel to provide intensive case management and linkage to services for individuals with mental health care disorders at various points of access, such as at designated community-based service points, homeless shelters, and clinics.
(5)Reduce unnecessary hospitalizations and inpatient days by appropriately utilizing community-based services and improving access to timely assistance.
(6)Reduce recidivism and mitigate unnecessary expenditures of local law enforcement.
(7)Provide local communities with increased financial resources to leverage additional public and private funding sources to achieve improved networks of care for individuals with mental health disorders.
(8)Provide a complete continuum of crisis services for children and youth 21 years of age and under regardless of where they live in the state. The funds included in the 2016 Budget Act for the purpose of developing the continuum of mental health crisis services for children and youth 21 years of age and under shall be for the following objectives:
(A)Provide a continuum of crisis services for children and youth 21 years of age and under regardless of where they live in the state.
(B)Provide for early intervention and treatment services to improve the client experience, achieve recovery and wellness, and reduce costs.
(C)Expand the continuum of community-based services to address crisis intervention, crisis stabilization, and crisis residential treatment needs that are wellness-, resiliency-, and recovery-oriented.
(D)Add at least 200 mobile crisis support teams.
(E)Add at least 120 crisis stabilization services and beds and crisis residential treatment beds to increase capacity at the local level to improve access to mental health crisis services and address unmet mental health care needs.
(F)Add triage personnel to provide intensive case management and linkage to services for individuals with mental health care disorders at various points of access, such as at designated community-based service points, homeless shelters, schools, and clinics.
(G)Expand family respite care to help families and sustain caregiver health and well-being.
(H)Expand family supportive training and related services designed to help families participate in the planning process, access services, and navigate programs.
(I)Reduce unnecessary hospitalizations and inpatient days by appropriately utilizing community-based services.
(J)Reduce recidivism and mitigate unnecessary expenditures of local law enforcement.
(K)Provide local communities with increased financial resources to leverage additional public and private funding sources to achieve improved networks of care for children and youth 21 years of age and under with mental health disorders.
(c)Through appropriations provided in the annual Budget Act for this purpose, it is the intent of the Legislature to authorize the California Health Facilities Financing Authority, hereafter referred to as the authority, and the Mental Health Services Oversight and Accountability Commission, hereafter referred to as the commission, to administer competitive selection processes as provided in this section for capital capacity and program expansion to increase capacity for mobile crisis support, crisis intervention, crisis stabilization services, crisis residential treatment, and specified personnel resources.
(d)Funds appropriated by the Legislature to the authority for purposes of this section shall be made available to selected counties, or counties acting jointly. The authority may, at its discretion, also give consideration to private nonprofit corporations and public agencies in an area or region of the state if a county, or counties acting jointly, affirmatively supports this designation and collaboration in lieu of a county government directly receiving grant funds.
(1)Grant awards made by the authority shall be used to expand local resources for the development, capital, equipment acquisition, and applicable program startup or expansion costs to increase capacity for client assistance and services in the following areas:
(A)Crisis intervention, as authorized by Sections 14021.4, 14680, and 14684.
(B)Crisis stabilization, as authorized by Sections 14021.4, 14680, and 14684.
(C)Crisis residential treatment, as authorized by Sections 14021.4, 14680, and 14684.
(D)Rehabilitative mental health services, as authorized by Sections 14021.4, 14680, and 14684.
(E)Mobile crisis support teams, including personnel and equipment, such as the purchase of vehicles.
(2)The authority shall develop selection criteria to expand local resources, including those described in paragraph (1), and processes for awarding grants after consulting with representatives and interested stakeholders from the mental health community, including, but not limited to, the County Behavioral Health Directors Association of California, service providers, consumer organizations, and other appropriate interests, such as health care providers and law enforcement, as determined by the authority. The authority shall ensure that grants result in cost-effective expansion of the number of community-based crisis resources in regions and communities selected for funding. The authority shall also take into account at least the following criteria and factors when selecting recipients of grants and determining the amount of grant awards:
(A)Description of need, including, at a minimum, a comprehensive description of the project, community need, population to be served, linkage with other public systems of health and mental health care, linkage with local law enforcement, social services, and related assistance, as applicable, and a description of the request for funding.
(B)Ability to serve the target population, which includes individuals eligible for Medi-Cal and individuals eligible for county health and mental health services.
(C)Geographic areas or regions of the state to be eligible for grant awards, which may include rural, suburban, and urban areas, and may include use of the five regional designations utilized by the County Behavioral Health Directors Association of California.
(D)Level of community engagement and commitment to project completion.
(E)Financial support that, in addition to a grant that may be awarded by the authority, will be sufficient to complete and operate the project for which the grant from the authority is awarded.
(F)Ability to provide additional funding support to the project, including public or private funding, federal tax credits and grants, foundation support, and other collaborative efforts.
(G)Memorandum of understanding among project partners, if applicable.
(H)Information regarding the legal status of the collaborating partners, if applicable.
(I)Ability to measure key outcomes, including improved access to services, health and mental health outcomes, and cost benefit of the project.
(3)The authority shall determine maximum grants awards, which shall take into consideration the number of projects awarded to the grantee, as described in paragraph (1), and shall reflect reasonable costs for the project and geographic region. The authority may allocate a grant in increments contingent upon the phases of a project.
(4)Funds awarded by the authority pursuant to this section may be used to supplement, but not to supplant, existing financial and resource commitments of the grantee or any other member of a collaborative effort that has been awarded a grant.
(5)All projects that are awarded grants by the authority shall be completed within a reasonable period of time, to be determined by the authority. Funds shall not be released by the authority until the applicant demonstrates project readiness to the authoritys satisfaction. If the authority determines that a grant recipient has failed to complete the project under the terms specified in awarding the grant, the authority may require remedies, including the return of all or a portion of the grant.
(6)A grantee that receives a grant from the authority under this section shall commit to using that capital capacity and program expansion project, such as the mobile crisis team, crisis stabilization unit, or crisis residential treatment program, for the duration of the expected life of the project.
(7)The authority may consult with a technical assistance entity, as described in paragraph (5) of subdivision (a) of Section 4061, for purposes of implementing this section.
(8)The authority may adopt emergency regulations relating to the grants for the capital capacity and program expansion projects described in this section, including emergency regulations that define eligible costs and determine minimum and maximum grant amounts.
(9)The authority shall provide reports to the fiscal and policy committees of the Legislature on or before May 1, 2014, and on or before May 1, 2015, on the progress of implementation, that include, but are not limited to, the following:
(A)A description of each project awarded funding.
(B)The amount of each grant issued.
(C)A description of other sources of funding for each project.
(D)The total amount of grants issued.
(E)A description of project operation and implementation, including who is being served.
(10)A recipient of a grant provided pursuant to paragraph (1) shall adhere to all applicable laws relating to scope of practice, licensure, certification, staffing, and building codes.
(e)Of the funds specified in paragraph (8) of subdivision (b), it is the intent of the Legislature to authorize the authority and the commission to administer competitive selection processes as provided in this section for capital capacity and program expansion to increase capacity for mobile crisis support, crisis intervention, crisis stabilization services, crisis residential treatment, family respite care, family supportive training and related services, and triage personnel resources for children and youth 21 years of age and under.
(f)Funds appropriated by the Legislature to the authority to address crisis services for children and youth 21 years of age and under for the purposes of this section shall be made available to selected counties or counties acting jointly. The authority may, at its discretion, also give consideration to private nonprofit corporations and public agencies in an area or region of the state if a county, or counties acting jointly, affirmatively support this designation and collaboration in lieu of a county government directly receiving grant funds.
(1)Grant awards made by the authority shall be used to expand local resources for the development, capital, equipment acquisition, and applicable program startup or expansion costs to increase capacity for client assistance and crisis services for children and youth 21 years of age and under in the following areas:
(A)Crisis intervention, as authorized by Sections 14021.4, 14680, and 14684.
(B)Crisis stabilization, as authorized by Sections 14021.4, 14680, and 14684.
(C)Crisis residential treatment, as authorized by Sections 14021.4, 14680, and 14684 and as provided at a childrens crisis residential center, program, as defined in Section 1502 of the Health and Safety Code.
(D)Mobile crisis support teams, including the purchase of equipment and vehicles.
(E)Family respite care.
(2)The authority shall develop selection criteria to expand local resources, including those described in paragraph (1), and processes for awarding grants after consulting with representatives and interested stakeholders from the mental health community, including, but not limited to, county mental health directors, service providers, consumer organizations, and other appropriate interests, such as health care providers and law enforcement, as determined by the authority. The authority shall ensure that grants result in cost-effective expansion of the number of community-based crisis resources in regions and communities selected for funding. The authority shall also take into account at least the following criteria and factors when selecting recipients of grants and determining the amount of grant awards:
(A)Description of need, including, at a minimum, a comprehensive description of the project, community need, population to be served, linkage with other public systems of health and mental health care, linkage with local law enforcement, social services, and related assistance, as applicable, and a description of the request for funding.
(B)Ability to serve the target population, which includes individuals eligible for Medi-Cal and individuals eligible for county health and mental health services.
(C)Geographic areas or regions of the state to be eligible for grant awards, which may include rural, suburban, and urban areas, and may include use of the five regional designations utilized by the California Behavioral Health Directors Association.
(D)Level of community engagement and commitment to project completion.
(E)Financial support that, in addition to a grant that may be awarded by the authority, will be sufficient to complete and operate the project for which the grant from the authority is awarded.
(F)Ability to provide additional funding support to the project, including public or private funding, federal tax credits and grants, foundation support, and other collaborative efforts.
(G)Memorandum of understanding among project partners, if applicable.
(H)Information regarding the legal status of the collaborating partners, if applicable.
(I)Ability to measure key outcomes, including utilization of services, health and mental health outcomes, and cost benefit of the project.
(3)The authority shall determine maximum grant awards, which shall take into consideration the number of projects awarded to the grantee, as described in paragraph (1), and shall reflect reasonable costs for the project, geographic region, and target ages. The authority may allocate a grant in increments contingent upon the phases of a project.
(4)Funds awarded by the authority pursuant to this section may be used to supplement, but not to supplant, existing financial and resource commitments of the grantee or any other member of a collaborative effort that has been awarded a grant.
(5)All projects that are awarded grants by the authority shall be completed within a reasonable period of time, to be determined by the authority. Funds shall not be released by the authority until the applicant demonstrates project readiness to the authoritys satisfaction. If the authority determines that a grant recipient has failed to complete the project under the terms specified in awarding the grant, the authority may require remedies, including the return of all, or a portion, of the grant.
(6)A grantee that receives a grant from the authority under this section shall commit to using that capital capacity and program expansion project, such as the mobile crisis team, crisis stabilization unit, family respite care, or crisis residential treatment program, for the duration of the expected life of the project.
(7)The authority may consult with a technical assistance entity, as described in paragraph (5) of subdivision (a) of Section 4061, for the purposes of implementing this section.
(8)The authority may adopt emergency regulations relating to the grants for the capital capacity and program expansion projects described in this section, including emergency regulations that define eligible costs and determine minimum and maximum grant amounts.
(9)The authority shall provide reports to the fiscal and policy committees of the Legislature on or before January 10, 2018, and annually thereafter, on the progress of implementation, that include, but are not limited to, the following:
(A)A description of each project awarded funding.
(B)The amount of each grant issued.
(C)A description of other sources of funding for each project.
(D)The total amount of grants issued.
(E)A description of project operation and implementation, including who is being served.
(10)A recipient of a grant provided pursuant to paragraph (1) shall adhere to all applicable laws relating to scope of practice, licensure, certification, staffing, and building codes.
(g)Funds appropriated by the Legislature to the commission for purposes of this section shall be allocated for triage personnel to provide intensive case management and linkage to services for individuals with mental health disorders at various points of access. These funds shall be made available to selected counties, counties acting jointly, or city mental health departments, as determined by the commission through a selection process. It is the intent of the Legislature for these funds to be allocated in an efficient manner to encourage early intervention and receipt of needed services for individuals with mental health disorders, and to assist in navigating the local service sector to improve efficiencies and the delivery of services.
(1)Triage personnel may provide targeted case management services face to face, by telephone, or by telehealth with the individual in need of assistance or his or her significant support person, and may be provided anywhere in the community. These service activities may include, but are not limited to, the following:
(A)Communication, coordination, and referral.
(B)Monitoring service delivery to ensure the individual accesses and receives services.
(C)Monitoring the individuals progress.
(D)Providing placement service assistance and service plan development.
(2)The commission shall take into account at least the following criteria and factors when selecting recipients and determining the amount of grant awards for triage personnel as follows:
(A)Description of need, including potential gaps in local service connections.
(B)Description of funding request, including personnel and use of peer support.
(C)Description of how triage personnel will be used to facilitate linkage and access to services, including objectives and anticipated outcomes.
(D)Ability to obtain federal Medicaid reimbursement, when applicable.
(E)Ability to administer an effective service program and the degree to which local agencies and service providers will support and collaborate with the triage personnel effort.
(F)Geographic areas or regions of the state to be eligible for grant awards, which shall include rural, suburban, and urban areas, and may include use of the five regional designations utilized by the County Behavioral Health Directors Association of California.
(3)The commission shall determine maximum grant awards, and shall take into consideration the level of need, population to be served, and related criteria, as described in paragraph (2), and shall reflect reasonable costs.
(4)Funds awarded by the commission for purposes of this section may be used to supplement, but not supplant, existing financial and resource commitments of the county, counties acting jointly, or city mental health department that received the grant.
(5)Notwithstanding any other law, a county, counties acting jointly, or city mental health department that receives an award of funds for the purpose of supporting triage personnel pursuant to this subdivision is not required to provide a matching contribution of local funds.
(6)Notwithstanding any other law, the commission, without taking any further regulatory action, may implement, interpret, or make specific this section by means of informational letters, bulletins, or similar instructions.
(7)The commission shall provide a status report to the fiscal and policy committees of the Legislature on the progress of implementation no later than March 1, 2014.
(h)Funds appropriated by the Legislature to the commission pursuant to paragraph (8) of subdivision (b) for the purposes of addressing childrens crisis services shall be allocated to support triage personnel and family supportive training and related services. These funds shall be made available to selected counties, counties acting jointly, or city mental health departments, as determined by the commission through a selection process. The commission may, at its discretion, also give consideration to private nonprofit corporations and public agencies in an area or region of the state if a county, or counties acting jointly, affirmatively supports this designation and collaboration in lieu of a county government directly receiving grant funds.
(1)These funds may provide for a range of crisis-related services for a child in need of assistance, or his or her parent, guardian, or caregiver. These service activities may include, but are not limited to, the following:
(A)Intensive coordination of care and services.
(B)Communication, coordination, and referral.
(C)Monitoring service delivery to the child or youth.
(D)Monitoring the childs progress.
(E)Providing placement service assistance and service plan development.
(F)Crisis or safety planning.
(2)The commission shall take into account at least the following criteria and factors when selecting recipients and determining the amount of grant awards for these funds, as follows:
(A)Description of need, including potential gaps in local service connections.
(B)Description of funding request, including personnel.
(C)Description of how personnel and other services will be used to facilitate linkage and access to services, including objectives and anticipated outcomes.
(D)Ability to obtain federal Medicaid reimbursement, when applicable.
(E)Ability to provide a matching contribution of local funds.
(F)Ability to administer an effective service program and the degree to which local agencies and service providers will support and collaborate with the triage personnel effort.
(G)Geographic areas or regions of the state to be eligible for grant awards, which shall include rural, suburban, and urban areas, and may include use of the five regional designations utilized by the County Behavioral Health Directors Association of California.
(3)The commission shall determine maximum grant awards, and shall take into consideration the level of need, population to be served, and related criteria, as described in paragraph (2), and shall reflect reasonable costs.
(4)Funds awarded by the commission for purposes of this section may be used to supplement, but not supplant, existing financial and resource commitments of the county, counties acting jointly, or a city mental health department that received the grant.
(5)Notwithstanding any other law, a county, counties acting jointly, or a city mental health department that receives an award of funds for the purpose of this section is not required to provide a matching contribution of local funds.
(6)Notwithstanding any other law, the commission, without taking any further regulatory action, may implement, interpret, or make specific this section by means of informational letters, bulletins, or similar instructions.
(7)The commission may waive requirements in this section for counties with a population of 100,000 or less, if the commission determines it is in the best interest of the state and meets the intent of the law.
(8)The commission shall provide a status report to the fiscal and policy committees of the Legislature on the progress of implementation no later than January 10, 2018, and annually thereafter.
SEC. 6.Section 11462.01 of the Welfare and Institutions Code, as added by Section 75 of Chapter 773 of the Statutes of 2015, is amended to read:11462.01.(a)(1)No If a program is not intended for the exclusive use of private insurance plans, no later than 12 months following the date of initial licensure, a short-term residential therapeutic program, as defined in subdivision (ad) of Section 11400 of this code and paragraph (18) of subdivision (a) of Section 1502 of the Health and Safety Code, shall obtain a contract, subject to an agreement on rates and terms and conditions, with a county mental health plan to provide specialty mental health services and demonstrate the ability to meet the therapeutic needs of each child, as identified in any of the following:
(A)A mental health assessment.
(B)The childs case plan.
(C)The childs needs and services plan.
(D)Other documentation demonstrating the child has a mental health need.
(2)A short-term residential therapeutic program shall comply with any other mental health program approvals required by the State Department of Health Care Services or by a county mental health plan to which mental health program approval authority has been delegated.
(b)A short-term residential therapeutic program, except as specified in subdivision (c), may accept for placement a child who meets both of the criteria in paragraphs (1) and (2) and at least one of the conditions in paragraph (3).
(1)The child does not require inpatient care in a licensed health facility.
(2)The child has been assessed as requiring the level of services provided in a short-term residential therapeutic program in order to maintain the safety and well-being of the child or others due to behaviors, including those resulting from traumas, that render the child or those around the child unsafe or at risk of harm, or that prevent the effective delivery of needed services and supports provided in the childs own home or in other family settings, such as with a relative, guardian, foster family, resource family, or adoptive family. The assessment shall ensure the child has needs in common with other children or youth in the care of the facility, consistent with subdivision (c) of Section 16514.
(3)The child meets at least one of the following conditions:
(A)The child has been assessed, pursuant to Section 4096, as meeting the medical necessity criteria for Medi-Cal specialty mental health services, as provided for in Section 1830.205 or 1830.210 of Title 9 of the California Code of Regulations.
(B)The child has been assessed, pursuant to Section 4096, as seriously emotionally disturbed, as defined in subdivision (a) of Section 5600.3.
(C)The child requires emergency placement pursuant to paragraph (3) of subdivision (i).
(D)The child has been assessed, pursuant to Section 4096, as requiring the level of services provided by the short-term residential therapeutic program in order to meet his or her behavioral or therapeutic needs.
(4)Subject to the requirements of this subdivision, a short-term residential therapeutic program may have a specialized program to serve a child, including, but not limited to, the following:
(A)A commercially sexually exploited child.
(B)A private voluntary placement, if the youth exhibits status offender behavior, the parents or other relatives feel they cannot control the childs behavior, and short-term intervention is needed to transition the child back into the home.
(C)A juvenile sex offender.
(D)A child who is affiliated with, or impacted by, a gang.
(c)A short-term residential therapeutic program that is operating as a childrens crisis residential center, program, as defined in Section 1502 of the Health and Safety Code, may accept for admission or placement any child, referred by a parent or guardian, or by the representative of a public or private entity, including, but not limited to, the county probation agency or child welfare services agency with responsibility for the placement of a child in foster care, that has the right to make these decisions on behalf of a child who is in mental health crisis and, absent admission to a childrens crisis residential center, program, would otherwise require acceptance by the emergency department of a general hospital, or admission into a psychiatric hospital or the psychiatric inpatient unit of a general hospital.
(d)A foster family agency that is certified as a Medi-Cal specialty mental health provider pursuant to Section 1810.435 of Title 9 of the California Code of Regulations by the State Department of Health Care Services, or by a county mental health plan to which the department has delegated certification authority, and which has entered into a contract with a county mental health plan pursuant to Section 1810.436 of Title 9 of the California Code of Regulations, shall provide, or provide access to, specialty mental health services to children under its care who do not require inpatient care in a licensed health facility and who meet the medical necessity criteria for Medi-Cal specialty mental health services provided for in Section 1830.205 or 1830.210 of Title 9 of the California Code of Regulations.
(e)A foster family agency that is not certified as a Medi-Cal specialty mental health provider shall provide access to specialty and non-specialty mental health services in that program for children who do not require inpatient care in a licensed health facility and who meet any of the conditions in paragraph (3) of subdivision (b). In this situation the foster family agency shall do the following:
(1)In the case of a child who is a Medi-Cal beneficiary, arrange for specialty mental health services from the county mental health plan.
(2)In all other cases, arrange for the child to receive mental health services.
(f)All short-term residential therapeutic programs shall maintain the level of care and services necessary to meet the needs of the children and youth in their care and shall maintain and have in good standing the appropriate mental health program approval that includes approval. If a program will admit Medi-Cal beneficiaries, the mental health program approval shall include a certification to provide Medi-Cal specialty mental health services issued by the State Department of Health Care Services or a county mental health plan to which the department has delegated mental health program approval authority, pursuant to Section 4096.5 of this code or Section 1810.435 or 1810.436 of Title 9 of the California Code of Regulations. All foster family agencies that are certified as a Medi-Cal specialty mental health provider pursuant to Section 1810.435 of Title 9 of the California Code of Regulations shall maintain the level of care and services necessary to meet the needs of children and youth in their care and shall maintain and have in good standing the Medi-Cal specialty mental health provider certification issued by the State Department of Health Care Services or a county mental health plan to which the department has delegated certification authority.
(g)The assessments described in subparagraphs (A), (B), (C), and (D) of paragraph (3) of subdivision (b) shall ensure the childs individual behavioral or treatment needs are consistent with, and can be met by, the facility and shall be made by one of the following, as applicable:
(1)An interagency placement committee, as described in Section 4096, considering the recommendations from the child and family team, if any are available. If the short-term residential therapeutic program serves children who are placed by county child welfare agencies and children who are placed by probation departments, the interagency placement committee shall also ensure the requirements of subdivision (c) of Section 16514 have been met with respect to commonality of need.
(2)A licensed mental health professional as defined in subdivision (g) of Section 4096.
(3)For the purposes of this section, an AFDC-FC funded child with an individualized education program developed pursuant to Article 2 (commencing with Section 56320) of Chapter 4 of Part 30 of Division 4 of Title 2 of the Education Code that assesses the child as seriously emotionally disturbed, as defined in, and subject to, this section and recommends out-of-home placement at the level of care provided by the provider, shall be deemed to have met the assessment requirement.
(h)The evaluation described in subparagraph (A) of paragraph (3) of subdivision (i) shall be made pursuant to subdivision (b) of Section 706.6 or paragraph (2) of subdivision (c) of Section 16501.1.
(i)(1)The provider shall ensure that AFDC-FC funded children, assessed pursuant to subparagraphs (A) and (B) of paragraph (3) of subdivision (b), who are accepted for placement have been approved for placement by an interagency placement committee, as described in Section 4096, except as provided for in paragraphs (3) and (4) of subdivision (g).
(2)The approval shall be in writing and shall indicate that the interagency placement committee has determined one of the following:
(A)The child meets the medical necessity criteria for Medi-Cal specialty mental health services, as provided for in Section 1830.205 or 1830.210 of Title 9 of the California Code of Regulations.
(B)The child is seriously emotionally disturbed, as described in subdivision (a) of Section 5600.3.
(3)(A)Nothing in subdivisions (a) to (h), inclusive, or this subdivision shall prevent an emergency placement of a child or youth into a certified short-term residential therapeutic program or childrens crisis residential center program prior to the determination by the interagency placement committee, but only if a licensed mental health professional, as defined in subdivision (g) of Section 4096, has made a written determination within 72 hours of the childs or youths placement, that the child or youth requires the level of services and supervision provided by the short-term residential therapeutic program in order to meet his or her behavioral or therapeutic needs, or has made a written determination within 24 hours of the childs or youths placement in a childrens crisis residential center program that the child or youth is experiencing a mental health crisis as defined in subdivision (c) and is in need of the care and services provided by the childrens crisis residential center. program. If the short-term residential therapeutic program serves children placed by county child welfare agencies and children placed by probation departments, the interagency placement committee shall also ensure the requirements of subdivision (c) of Section 16514 have been met with respect to commonality of need.
(i)The interagency placement committee, as appropriate, shall, within 30 days of placement, make the determinations, with recommendations from the child and family team, required by this subdivision.
(ii)If it determines the placement is appropriate, the interagency placement committee, with recommendations from the child and family team, shall transmit the approval, in writing, to the county placing agency and the short-term residential therapeutic program.
(iii)If it determines the placement is not appropriate, the interagency placement committee shall respond pursuant to subparagraph (B).
(B)(i)If the interagency placement committee determines at any time that the placement is not appropriate, it shall, with recommendations from the child and family team, transmit the disapproval, in writing, to the county placing agency and the short-term residential therapeutic program and shall include a recommendation as to the childs appropriate level of care and placement to meet his or her service needs. The necessary interagency placement committee representative or representatives shall participate in any child and family team meetings to refer the child or youth to an appropriate placement, as specified in this section.
(ii)The child may remain in the placement for the amount of time necessary to identify and transition the child to an alternative, suitable placement.
(iii)Notwithstanding clause (ii), if the interagency placement committee determined the placement was not appropriate due to a health and safety concern, immediate arrangements for the child to transition to an appropriate placement shall occur.
(j)Commencing January 1, 2017, for AFDC-FC funded children or youth, only those children or youth who are approved for placement, as set forth in this section, may be accepted by a short-term residential therapeutic program.
(k)The department shall, through regulation, establish consequences for the failure of a short-term residential therapeutic program to obtain written approval for placement of an AFDC-FC funded child or youth pursuant to this section.
(l)The department shall not establish a rate for a short-term residential therapeutic program unless the provider submits a recommendation from the host county or the primary placing county that the program is needed and that the provider is willing and capable of operating the program at the level sought. For purposes of this subdivision, host county, and primary placing county, mean the same as defined in the departments AFDC-FC ratesetting regulations.
(m)Any certified short-term residential therapeutic program shall be reclassified and paid at the appropriate program rate for which it is qualified if either of the following occurs:
(1)(A)It fails to maintain the level of care and services necessary to meet the needs of the children and youth in care, as required by subdivision (a). The determination shall be made consistent with the departments AFDC-FC ratesetting regulations developed pursuant to Section 11462 and shall take into consideration the highest level of care and associated rates for which the program may be eligible if granted an extension pursuant to Section 11462.04 or any reduction in rate associated with a provisional or probationary rate granted or imposed under Section 11466.01.
(B)In the event of a determination under this paragraph, the short-term residential therapeutic program may appeal the finding or submit a corrective action plan. The appeal process specified in Section 11466.6 shall be available to a short-term residential therapeutic program that provides intensive and therapeutic treatment. During any appeal, the short-term residential therapeutic program that provides intensive and therapeutic treatment shall maintain the appropriate level of care.
(2)It fails to maintain a certified mental health treatment program as required by subdivision (f).
(n)In addition to any other review required by law, the child and family team as defined in paragraph (4) of subdivision (a) of Section 16501 may periodically review the placement of the child or youth. If the child and family team make a recommendation that the child or youth no longer needs, or is not benefiting from, placement in a short-term residential therapeutic program, the team shall transmit the disapproval, in writing, to the county placing agency to consider a more appropriate placement.
(o)The department shall develop a process to address placements when, subsequent to the childs or youths placement, a determination is made by the interagency placement team and shall consider the recommendations of the child and family team, either that the child or youth is not in need of the care and services provided by the certified program. The process shall include, but not be limited to:
(1)Notice of the determination in writing to both the county placing agency and the short-term residential therapeutic program or foster family agency that provides intensive and therapeutic treatment.
(2)Notice of the countys plan, and a time frame, timeframe, for removal of the child or youth in writing to the short-term residential therapeutic program that provides intensive and therapeutic treatment.
(3)Referral to an appropriate placement.
(4)Actions to be taken if a child or youth is not timely removed from the short-term residential therapeutic program that provides intensive and therapeutic treatment or placed in an appropriate placement.
(p)(1)Nothing in this section shall prohibit a short-term residential therapeutic program from accepting private placements admissions of children or youth.
(2)When a referral is not from a public agency and no public funding is involved, there is no requirement for public agency review or determination of need.
(3)Children and youth subject to paragraphs (1) and (2) shall have been determined to be seriously emotionally disturbed, as described in subdivision (a) of Section 5600.3, and subject to Section 1502.4 of the Health and Safety Code, by a licensed mental health professional, as defined in subdivision (g) of Section 4096.
SEC. 7.Section 11462.011 is added to the Welfare and Institutions Code, to read:11462.011.(a)The State Department of Health Care Services shall, in consultation with the Department of Managed Health Care, the State Department of Social Services, the County Behavioral Health Directors Association of California, the County Welfare Directors Association of California, the Chief Probation Officers of California, provider representatives, and other relevant stakeholders, establish program standards and procedures for oversight, enforcement, and issuance of childrens crisis residential mental health program approvals, including provisional approvals that are effective for a period of less than one year. The State Department of Health Care Services shall also establish due process protections related to the childrens crisis residential mental health program approval process.
(b)A childrens crisis residential mental health program approval issued by the State Department of Health Care Services, or a county mental health plan to which the department has delegated approval authority, shall be a condition of continued licensure for a short-term residential therapeutic program operating as a childrens crisis residential program.
(c)The State Department of Health Care Services, or a county mental health plan to which the department has delegated approval authority, may enforce the childrens crisis residential mental health program approval standards by taking any of the following actions against a noncompliant childrens crisis residential program:
(1)Suspend or revoke a childrens crisis residential mental health program approval.
(2)Impose monetary penalties.
(3)Place a childrens crisis residential mental health program on probation.
(4)Require a childrens crisis residential mental health program to prepare and comply with a corrective action plan.
(d)The State Department of Health Care Services, or a county mental health plan to which the department has delegated approval authority, shall provide a childrens crisis residential mental health program with due process protections when taking any of the actions described in subdivision (c).
(e)Contingent upon an appropriation in the annual Budget Act for these purposes, the department shall begin implementation of this section no later than July 1, 2018, and shall commence the operation of the approval process for childrens crisis residential mental health program approvals no later than January 1, 2019.
SEC. 8.(a)Contingent upon an appropriation from the annual Budget Act for these purposes, the State Department of Social Services and the State Department of Health Care Services shall adopt regulations to implement this act on or before July 1, 2018.
(b)Notwithstanding the rulemaking provisions of the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code), the State Department of Social Services and the State Department of Health Care Services may implement and administer the changes made by this act through information notices, all-county letters, or similar written instructions until regulations are adopted.
(c)This section shall become effective upon appropriation of funds by the Legislature for the purposes described in this section.
SEC. 7.SEC. 9.No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution.
The Legislature finds and declares all of the following:
(a)There is an urgent need to provide more crisis care alternatives to hospitals for children and youth experiencing mental health crises.
(b)The problems are especially acute for children and youth who may have to wait for days for a hospital bed and who may be transported, without a parent, to the nearest facility hundreds of miles away.
(c)In 2012, the California Hospital Association reported that two-thirds of the people taken to a hospital for a psychiatric emergency did not meet the criteria for that level of care, but the care they needed was not available.
(d)The type of care that is needed includes crisis residential treatment for children.
(e)This level of care is part of the full continuum of care considered medically necessary for many children with serious emotional disturbances.
(f)In 2013, the Legislature enacted the Investment in Mental Health Wellness Act (Senate Bill 82, Chapter 34 of the Statutes of 2013) to provide one-time funding to counties to expand the availability of mental health crisis care services, including short-term crisis residential treatment services. However, there is currently no state licensing category for short-term crisis residential programs for children. As a result, counties wanting to expand local capacity to meet the needs of children and youth for crisis residential treatment services were ineligible for this competitive grant program.
(g)In most communities, inpatient crisis treatment is completely unavailable for children and youth, even though it may be medically necessary.
(h)Crisis residential care is an essential level of care for the treatment of children and youth with serious emotional disturbances in a mental health crisis, and it often serves as an alternative to hospitalization.
(i)It is imperative that California identify a licensing category specifically for mental health crisis residential care that can be utilized for children and youth who are beneficiaries of both public and private health care plans.
SEC. 2.Section 1502 of the Health and Safety Code is amended to read:1502.As used in this chapter:
(a)Community care facility means any facility, place, or building that is maintained and operated to provide nonmedical residential care, day treatment, adult day care, or foster family agency services for children, adults, or children and adults, including, but not limited to, the physically handicapped, mentally impaired, incompetent persons, and abused or neglected children, and includes the following:
(1)Residential facility means any family home, group care facility, or similar facility determined by the department, for 24-hour nonmedical care of persons in need of personal services, supervision, or assistance essential for sustaining the activities of daily living or for the protection of the individual.
(2)Adult day program means any community-based facility or program that provides care to persons 18 years of age or older in need of personal services, supervision, or assistance essential for sustaining the activities of daily living or for the protection of these individuals on less than a 24-hour basis.
(3)Therapeutic day services facility means any facility that provides nonmedical care, counseling, educational or vocational support, or social rehabilitation services on less than a 24-hour basis to persons under 18 years of age who would otherwise be placed in foster care or who are returning to families from foster care. Program standards for these facilities shall be developed by the department, pursuant to Section 1530, in consultation with therapeutic day services and foster care providers.
(4)Foster family agency means any public agency or private organization, organized and operated on a nonprofit basis, engaged in any of the following:
(A)Recruiting, certifying, approving, and training of, and providing professional support to, foster parents and resource families.
(B)Coordinating with county placing agencies to find homes for foster children in need of care.
(C)Providing services and supports to licensed or certified foster parents, county-approved resource families, and children to the extent authorized by state and federal law.
(5)Foster family home means any residential facility providing 24-hour care for six or fewer foster children that is owned, leased, or rented and is the residence of the foster parent or parents, including their family, in whose care the foster children have been placed. The placement may be by a public or private child placement agency or by a court order, or by voluntary placement by a parent, parents, or guardian. It also means a foster family home described in Section 1505.2.
(6)Small family home means any residential facility, in the licensees family residence, that provides 24-hour care for six or fewer foster children who have mental disorders or developmental or physical disabilities and who require special care and supervision as a result of their disabilities. A small family home may accept children with special health care needs, pursuant to subdivision (a) of Section 17710 of the Welfare and Institutions Code. In addition to placing children with special health care needs, the department may approve placement of children without special health care needs, up to the licensed capacity.
(7)Social rehabilitation facility means any residential facility that provides social rehabilitation services for no longer than 18 months in a group setting to adults recovering from mental illness who temporarily need assistance, guidance, or counseling. Program components shall be subject to program standards pursuant to Article 1 (commencing with Section 5670) of Chapter 2.5 of Part 2 of Division 5 of the Welfare and Institutions Code.
(8)Community treatment facility means any residential facility that provides mental health treatment services to children in a group setting and that has the capacity to provide secure containment. Program components shall be subject to program standards developed and enforced by the State Department of Health Care Services pursuant to Section 4094 of the Welfare and Institutions Code.
Nothing in this section shall be construed to prohibit or discourage placement of persons who have mental or physical disabilities into any category of community care facility that meets the needs of the individual placed, if the placement is consistent with the licensing regulations of the department.
(9)Full-service adoption agency means any licensed entity engaged in the business of providing adoption services, that does all of the following:
(A)Assumes care, custody, and control of a child through relinquishment of the child to the agency or involuntary termination of parental rights to the child.
(B)Assesses the birth parents, prospective adoptive parents, or child.
(C)Places children for adoption.
(D)Supervises adoptive placements.
Private full-service adoption agencies shall be organized and operated on a nonprofit basis. As a condition of licensure to provide intercountry adoption services, a full-service adoption agency shall be accredited and in good standing according to Part 96 (commencing with Section 96.1) of Title 22 of the Code of Federal Regulations, or supervised by an accredited primary provider, or acting as an exempted provider, in compliance with Subpart F (commencing with Section 96.29) of Part 96 of Title 22 of the Code of Federal Regulations.
(10)Noncustodial adoption agency means any licensed entity engaged in the business of providing adoption services, that does all of the following:
(A)Assesses the prospective adoptive parents.
(B)Cooperatively matches children freed for adoption, who are under the care, custody, and control of a licensed adoption agency, for adoption, with assessed and approved adoptive applicants.
(C)Cooperatively supervises adoption placements with a full-service adoptive agency, but does not disrupt a placement or remove a child from a placement.
Private noncustodial adoption agencies shall be organized and operated on a nonprofit basis. As a condition of licensure to provide intercountry adoption services, a noncustodial adoption agency shall be accredited and in good standing according to Part 96 (commencing with Section 96.1) of Title 22 of the Code of Federal Regulations, or supervised by an accredited primary provider, or acting as an exempted provider, in compliance with Subpart F (commencing with Section 96.29) of Part 96 of Title 22 of the Code of Federal Regulations.
(11)Transitional shelter care facility means any group care facility that provides for 24-hour nonmedical care of persons in need of personal services, supervision, or assistance essential for sustaining the activities of daily living or for the protection of the individual. Program components shall be subject to program standards developed by the State Department of Social Services pursuant to Section 1502.3.
(12)Transitional housing placement provider means an organization licensed by the department pursuant to Section 1559.110 and Section 16522.1 of the Welfare and Institutions Code to provide transitional housing to foster children at least 16 years of age and not more than 18 years of age, and nonminor dependents, as defined in subdivision (v) of Section 11400 of the Welfare and Institutions Code, to promote their transition to adulthood. A transitional housing placement provider shall be privately operated and organized on a nonprofit basis.
(13)Group home means a residential facility that provides 24-hour care and supervision to children, delivered at least in part by staff employed by the licensee in a structured environment. The care and supervision provided by a group home shall be nonmedical, except as otherwise permitted by law.
(14)Runaway and homeless youth shelter means a group home licensed by the department to operate a program pursuant to Section 1502.35 to provide voluntary, short-term, shelter and personal services to runaway youth or homeless youth, as defined in paragraph (2) of subdivision (a) of Section 1502.35.
(15)Enhanced behavioral supports home means a facility certified by the State Department of Developmental Services pursuant to Article 3.6 (commencing with Section 4684.80) of Chapter 6 of Division 4.5 of the Welfare and Institutions Code, and licensed by the State Department of Social Services as an adult residential facility or a group home that provides 24-hour nonmedical care to individuals with developmental disabilities who require enhanced behavioral supports, staffing, and supervision in a homelike setting. An enhanced behavioral supports home shall have a maximum capacity of four consumers, shall conform to Section 441.530(a)(1) of Title 42 of the Code of Federal Regulations, and shall be eligible for federal Medicaid home- and community-based services funding.
(16)Community crisis home means a facility certified by the State Department of Developmental Services pursuant to Article 8 (commencing with Section 4698) of Chapter 6 of Division 4.5 of the Welfare and Institutions Code, and licensed by the State Department of Social Services pursuant to Article 9.7 (commencing with Section 1567.80), as an adult residential facility, providing 24-hour nonmedical care to individuals with developmental disabilities receiving regional center service, in need of crisis intervention services, and who would otherwise be at risk of admission to the acute crisis center at Fairview Developmental Center, Sonoma Developmental Center, an acute general hospital, acute psychiatric hospital, an institution for mental disease, as described in Part 5 (commencing with Section 5900) of Division 5 of the Welfare and Institutions Code, or an out-of-state placement. A community crisis home shall have a maximum capacity of eight consumers, as defined in subdivision (a) of Section 1567.80, shall conform to Section 441.530(a)(1) of Title 42 of the Code of Federal Regulations, and shall be eligible for federal Medicaid home- and community-based services funding.
(17)Crisis nursery means a facility licensed by the department to operate a program pursuant to Section 1516 to provide short-term care and supervision for children under six years of age who are voluntarily placed for temporary care by a parent or legal guardian due to a family crisis or stressful situation.
(18)Short-term residential therapeutic program means a residential facility operated by a public agency or private organization and licensed by the department pursuant to Section 1562.01 that provides an integrated program of specialized and intensive care and supervision, services and supports, treatment, and short-term, 24-hour care and supervision to children. The care and supervision provided by a short-term residential therapeutic program shall be nonmedical, except as otherwise permitted by law. Private short-term residential therapeutic programs shall be organized and operated on a nonprofit basis. A short-term residential therapeutic program may be operated as a childrens crisis residential center.
(19)Private alternative boarding school means a group home licensed by the department to operate a program pursuant to Section 1502.2 to provide youth with 24-hour residential care and supervision, which, in addition to providing educational services to youth, provides, or holds itself out as providing, behavioral-based services to youth with social, emotional, or behavioral issues. The care and supervision provided by a private alternative boarding school shall be nonmedical, except as otherwise permitted by law.
(20)Private alternative outdoor program means a group home licensed by the department to operate a program pursuant to Section 1502.21 to provide youth with 24-hour residential care and supervision, which provides, or holds itself out as providing, behavioral-based services in an outdoor living setting to youth with social, emotional, or behavioral issues. The care and supervision provided by a private alternative outdoor program shall be nonmedical, except as otherwise permitted by law.
(21)Childrens crisis residential center means a short-term residential therapeutic program operated specifically to divert children experiencing a mental health crisis from psychiatric hospitalization.
(b)Department or state department means the State Department of Social Services.
(c)Director means the Director of Social Services.
SEC. 3.Section 1562.02 is added to the Health and Safety Code, to read:1562.02.(a)The department shall establish regulations for short-term residential therapeutic programs that are operated as childrens crisis residential centers. At a minimum, the regulations shall include all of the following:
(1)The childrens crisis residential center shall be used only for diversion from admittance to a psychiatric hospitalization.
(2)(A)Length of stay for a single admission to a childrens crisis residential center shall be limited to 10 consecutive days.
(B)Notwithstanding subparagraph (A), the length of stay may be extended once for no more than two consecutive 10-day lengths of stay. Before extending the length of stay for a Medi-Cal beneficiary beyond 10 consecutive days, an organization providing childrens crisis residential services shall obtain prior approval from the county mental health plan authorizing those services.
(C)A child shall not be admitted to a childrens crisis residential center regulated under this section for more than 20 total days in any six-month period.
(3)Therapeutic programming shall be provided seven days a week, including weekends and holidays, with sufficient professional and paraprofessional staff to maintain an appropriate treatment setting and services, based on individual childrens needs.
(4)The program shall be staffed with sufficient personnel to accept children 24 hours per day, seven days a week and to admit children, at a minimum, from 7 a.m. to 11 p.m., seven days a week, 365 days per year. The program shall be sufficiently staffed to discharge children, as appropriate, seven days a week, 365 days per year.
(5)Facilities shall be limited to fewer than 16 beds, with at least 50 percent of those beds in single-occupancy rooms.
(6)Facilities shall include ample physical space for accommodating individuals who provide natural supports to each child and for integrating family members into the day-to-day care of the youth.
(7)The center shall collaborate with each childs mental health team, child and family team, and other formal and natural supports within 24 hours of intake and throughout the course of care and treatment as appropriate.
(b)The center shall annually provide the department with all of the following data as it pertains to children in foster care and children not in foster care in conjunction with its application for licensure renewal:
(1)Age and gender of clients served.
(2)Duration of stay.
(3)Professional classification of staff and contracted staff.
(4)Type of placement the client was discharged to.
SEC. 4.Section 1562.03 is added to the Health and Safety Code, to read:1562.03.(a)(1)The State Department of Health Care Services shall establish interim Medi-Cal rates as needed that are sufficient to reimburse the costs for childrens crisis residential services in excess of any specialty mental health services that would have been otherwise authorized, provided, and invoiced for each eligible Medi-Cal beneficiary receiving childrens crisis residential services.
(2)The department shall consult with subject matter experts from the County Behavioral Health Directors Association of California and provider associations to obtain data and background information necessary to ensure sufficiency of the rate.
(b)For foster children admitted for childrens crisis residential services, programs shall receive payment for board and care equivalent to the rate paid for short-term residential therapeutic programs.
(c)Nothing in this chapter shall prevent a county from providing payment in excess of the short-term residential therapeutic program rate in order to meet the needs of individual children.
SEC. 5.Section 5848.5 of the Welfare and Institutions Code is amended to read:5848.5.(a)The Legislature finds and declares all of the following:
(1)California has realigned public community mental health services to counties and it is imperative that sufficient community-based resources be available to meet the mental health needs of eligible individuals.
(2)Increasing access to effective outpatient and crisis stabilization services provides an opportunity to reduce costs associated with expensive inpatient and emergency room care and to better meet the needs of individuals with mental health disorders in the least restrictive manner possible.
(3)Almost one-fifth of people with mental health disorders visit a hospital emergency room at least once per year. If an adequate array of crisis services is not available, it leaves an individual with little choice but to access an emergency room for assistance and, potentially, an unnecessary inpatient hospitalization.
(4)Recent reports have called attention to a continuing problem of inappropriate and unnecessary utilization of hospital emergency rooms in California due to limited community-based services for individuals in psychological distress and acute psychiatric crisis. Hospitals report that 70 percent of people taken to emergency rooms for psychiatric evaluation can be stabilized and transferred to a less intensive level of crisis care. Law enforcement personnel report that their personnel need to stay with people in the emergency room waiting area until a placement is found, and that less intensive levels of care tend not to be available.
(5)Comprehensive public and private partnerships at both local and regional levels, including across physical health services, mental health, substance use disorder, law enforcement, social services, and related supports, are necessary to develop and maintain high quality, patient-centered, and cost-effective care for individuals with mental health disorders that facilitates their recovery and leads towards wellness.
(6)The recovery of individuals with mental health disorders is important for all levels of government, business, and the local community.
(b)This section shall be known, and may be cited, as the Investment in Mental Health Wellness Act of 2013. The objectives of this section are to do all of the following:
(1)Expand access to early intervention and treatment services to improve the client experience, achieve recovery and wellness, and reduce costs.
(2)Expand the continuum of services to address crisis intervention, crisis stabilization, and crisis residential treatment needs that are wellness, resiliency, and recovery oriented.
(3)Add at least 25 mobile crisis support teams and at least 2,000 crisis stabilization and crisis residential treatment beds to bolster capacity at the local level to improve access to mental health crisis services and address unmet mental health care needs.
(4)Add at least 600 triage personnel to provide intensive case management and linkage to services for individuals with mental health care disorders at various points of access, such as at designated community-based service points, homeless shelters, and clinics.
(5)Reduce unnecessary hospitalizations and inpatient days by appropriately utilizing community-based services and improving access to timely assistance.
(6)Reduce recidivism and mitigate unnecessary expenditures of local law enforcement.
(7)Provide local communities with increased financial resources to leverage additional public and private funding sources to achieve improved networks of care for individuals with mental health disorders.
(8)Provide a complete continuum of crisis services for children and youth 21 years of age and under regardless of where they live in the state. The funds included in the 2016 Budget Act for the purpose of developing the continuum of mental health crisis services for children and youth 21 years of age and under shall be for the following objectives:
(A)Provide a continuum of crisis services for children and youth 21 years of age and under regardless of where they live in the state.
(B)Provide for early intervention and treatment services to improve the client experience, achieve recovery and wellness, and reduce costs.
(C)Expand the continuum of community-based services to address crisis intervention, crisis stabilization, and crisis residential treatment needs that are wellness-, resiliency-, and recovery-oriented.
(D)Add at least 200 mobile crisis support teams.
(E)Add at least 120 crisis stabilization services and beds and crisis residential treatment beds to increase capacity at the local level to improve access to mental health crisis services and address unmet mental health care needs.
(F)Add triage personnel to provide intensive case management and linkage to services for individuals with mental health care disorders at various points of access, such as at designated community-based service points, homeless shelters, schools, and clinics.
(G)Expand family respite care to help families and sustain caregiver health and well-being.
(H)Expand family supportive training and related services designed to help families participate in the planning process, access services, and navigate programs.
(I)Reduce unnecessary hospitalizations and inpatient days by appropriately utilizing community-based services.
(J)Reduce recidivism and mitigate unnecessary expenditures of local law enforcement.
(K)Provide local communities with increased financial resources to leverage additional public and private funding sources to achieve improved networks of care for children and youth 21 years of age and under with mental health disorders.
(c)Through appropriations provided in the annual Budget Act for this purpose, it is the intent of the Legislature to authorize the California Health Facilities Financing Authority, hereafter referred to as the authority, and the Mental Health Services Oversight and Accountability Commission, hereafter referred to as the commission, to administer competitive selection processes as provided in this section for capital capacity and program expansion to increase capacity for mobile crisis support, crisis intervention, crisis stabilization services, crisis residential treatment, and specified personnel resources.
(d)Funds appropriated by the Legislature to the authority for purposes of this section shall be made available to selected counties, or counties acting jointly. The authority may, at its discretion, also give consideration to private nonprofit corporations and public agencies in an area or region of the state if a county, or counties acting jointly, affirmatively supports this designation and collaboration in lieu of a county government directly receiving grant funds.
(1)Grant awards made by the authority shall be used to expand local resources for the development, capital, equipment acquisition, and applicable program startup or expansion costs to increase capacity for client assistance and services in the following areas:
(A)Crisis intervention, as authorized by Sections 14021.4, 14680, and 14684.
(B)Crisis stabilization, as authorized by Sections 14021.4, 14680, and 14684.
(C)Crisis residential treatment, as authorized by Sections 14021.4, 14680, and 14684.
(D)Rehabilitative mental health services, as authorized by Sections 14021.4, 14680, and 14684.
(E)Mobile crisis support teams, including personnel and equipment, such as the purchase of vehicles.
(2)The authority shall develop selection criteria to expand local resources, including those described in paragraph (1), and processes for awarding grants after consulting with representatives and interested stakeholders from the mental health community, including, but not limited to, the County Behavioral Health Directors Association of California, service providers, consumer organizations, and other appropriate interests, such as health care providers and law enforcement, as determined by the authority. The authority shall ensure that grants result in cost-effective expansion of the number of community-based crisis resources in regions and communities selected for funding. The authority shall also take into account at least the following criteria and factors when selecting recipients of grants and determining the amount of grant awards:
(A)Description of need, including, at a minimum, a comprehensive description of the project, community need, population to be served, linkage with other public systems of health and mental health care, linkage with local law enforcement, social services, and related assistance, as applicable, and a description of the request for funding.
(B)Ability to serve the target population, which includes individuals eligible for Medi-Cal and individuals eligible for county health and mental health services.
(C)Geographic areas or regions of the state to be eligible for grant awards, which may include rural, suburban, and urban areas, and may include use of the five regional designations utilized by the County Behavioral Health Directors Association of California.
(D)Level of community engagement and commitment to project completion.
(E)Financial support that, in addition to a grant that may be awarded by the authority, will be sufficient to complete and operate the project for which the grant from the authority is awarded.
(F)Ability to provide additional funding support to the project, including public or private funding, federal tax credits and grants, foundation support, and other collaborative efforts.
(G)Memorandum of understanding among project partners, if applicable.
(H)Information regarding the legal status of the collaborating partners, if applicable.
(I)Ability to measure key outcomes, including improved access to services, health and mental health outcomes, and cost benefit of the project.
(3)The authority shall determine maximum grants awards, which shall take into consideration the number of projects awarded to the grantee, as described in paragraph (1), and shall reflect reasonable costs for the project and geographic region. The authority may allocate a grant in increments contingent upon the phases of a project.
(4)Funds awarded by the authority pursuant to this section may be used to supplement, but not to supplant, existing financial and resource commitments of the grantee or any other member of a collaborative effort that has been awarded a grant.
(5)All projects that are awarded grants by the authority shall be completed within a reasonable period of time, to be determined by the authority. Funds shall not be released by the authority until the applicant demonstrates project readiness to the authoritys satisfaction. If the authority determines that a grant recipient has failed to complete the project under the terms specified in awarding the grant, the authority may require remedies, including the return of all or a portion of the grant.
(6)A grantee that receives a grant from the authority under this section shall commit to using that capital capacity and program expansion project, such as the mobile crisis team, crisis stabilization unit, or crisis residential treatment program, for the duration of the expected life of the project.
(7)The authority may consult with a technical assistance entity, as described in paragraph (5) of subdivision (a) of Section 4061, for purposes of implementing this section.
(8)The authority may adopt emergency regulations relating to the grants for the capital capacity and program expansion projects described in this section, including emergency regulations that define eligible costs and determine minimum and maximum grant amounts.
(9)The authority shall provide reports to the fiscal and policy committees of the Legislature on or before May 1, 2014, and on or before May 1, 2015, on the progress of implementation, that include, but are not limited to, the following:
(A)A description of each project awarded funding.
(B)The amount of each grant issued.
(C)A description of other sources of funding for each project.
(D)The total amount of grants issued.
(E)A description of project operation and implementation, including who is being served.
(10)A recipient of a grant provided pursuant to paragraph (1) shall adhere to all applicable laws relating to scope of practice, licensure, certification, staffing, and building codes.
(e)Of the funds specified in paragraph (8) of subdivision (b), it is the intent of the Legislature to authorize the authority and the commission to administer competitive selection processes as provided in this section for capital capacity and program expansion to increase capacity for mobile crisis support, crisis intervention, crisis stabilization services, crisis residential treatment, family respite care, family supportive training and related services, and triage personnel resources for children and youth 21 years of age and under.
(f)Funds appropriated by the Legislature to the authority to address crisis services for children and youth 21 years of age and under for the purposes of this section shall be made available to selected counties or counties acting jointly. The authority may, at its discretion, also give consideration to private nonprofit corporations and public agencies in an area or region of the state if a county, or counties acting jointly, affirmatively support this designation and collaboration in lieu of a county government directly receiving grant funds.
(1)Grant awards made by the authority shall be used to expand local resources for the development, capital, equipment acquisition, and applicable program startup or expansion costs to increase capacity for client assistance and crisis services for children and youth 21 years of age and under in the following areas:
(A)Crisis intervention, as authorized by Sections 14021.4, 14680, and 14684.
(B)Crisis stabilization, as authorized by Sections 14021.4, 14680, and 14684.
(C)Crisis residential treatment, as authorized by Sections 14021.4, 14680, and 14684. 14684 and as provided at a childrens crisis residential center, as defined in Section 1502 of the Health and Safety Code.
(D)Mobile crisis support teams, including the purchase of equipment and vehicles.
(E)Family respite care.
(2)The authority shall develop selection criteria to expand local resources, including those described in paragraph (1), and processes for awarding grants after consulting with representatives and interested stakeholders from the mental health community, including, but not limited to, county mental health directors, service providers, consumer organizations, and other appropriate interests, such as health care providers and law enforcement, as determined by the authority. The authority shall ensure that grants result in cost-effective expansion of the number of community-based crisis resources in regions and communities selected for funding. The authority shall also take into account at least the following criteria and factors when selecting recipients of grants and determining the amount of grant awards:
(A)Description of need, including, at a minimum, a comprehensive description of the project, community need, population to be served, linkage with other public systems of health and mental health care, linkage with local law enforcement, social services, and related assistance, as applicable, and a description of the request for funding.
(B)Ability to serve the target population, which includes individuals eligible for Medi-Cal and individuals eligible for county health and mental health services.
(C)Geographic areas or regions of the state to be eligible for grant awards, which may include rural, suburban, and urban areas, and may include use of the five regional designations utilized by the California Behavioral Health Directors Association.
(D)Level of community engagement and commitment to project completion.
(E)Financial support that, in addition to a grant that may be awarded by the authority, will be sufficient to complete and operate the project for which the grant from the authority is awarded.
(F)Ability to provide additional funding support to the project, including public or private funding, federal tax credits and grants, foundation support, and other collaborative efforts.
(G)Memorandum of understanding among project partners, if applicable.
(H)Information regarding the legal status of the collaborating partners, if applicable.
(I)Ability to measure key outcomes, including utilization of services, health and mental health outcomes, and cost benefit of the project.
(3)The authority shall determine maximum grant awards, which shall take into consideration the number of projects awarded to the grantee, as described in paragraph (1), and shall reflect reasonable costs for the project, geographic region, and target ages. The authority may allocate a grant in increments contingent upon the phases of a project.
(4)Funds awarded by the authority pursuant to this section may be used to supplement, but not to supplant, existing financial and resource commitments of the grantee or any other member of a collaborative effort that has been awarded a grant.
(5)All projects that are awarded grants by the authority shall be completed within a reasonable period of time, to be determined by the authority. Funds shall not be released by the authority until the applicant demonstrates project readiness to the authoritys satisfaction. If the authority determines that a grant recipient has failed to complete the project under the terms specified in awarding the grant, the authority may require remedies, including the return of all, or a portion, of the grant.
(6)A grantee that receives a grant from the authority under this section shall commit to using that capital capacity and program expansion project, such as the mobile crisis team, crisis stabilization unit, family respite care, or crisis residential treatment program, for the duration of the expected life of the project.
(7)The authority may consult with a technical assistance entity, as described in paragraph (5) of subdivision (a) of Section 4061, for the purposes of implementing this section.
(8)The authority may adopt emergency regulations relating to the grants for the capital capacity and program expansion projects described in this section, including emergency regulations that define eligible costs and determine minimum and maximum grant amounts.
(9)The authority shall provide reports to the fiscal and policy committees of the Legislature on or before January 10, 2018, and annually thereafter, on the progress of implementation, that include, but are not limited to, the following:
(A)A description of each project awarded funding.
(B)The amount of each grant issued.
(C)A description of other sources of funding for each project.
(D)The total amount of grants issued.
(E)A description of project operation and implementation, including who is being served.
(10)A recipient of a grant provided pursuant to paragraph (1) shall adhere to all applicable laws relating to scope of practice, licensure, certification, staffing, and building codes.
(g)Funds appropriated by the Legislature to the commission for purposes of this section shall be allocated for triage personnel to provide intensive case management and linkage to services for individuals with mental health disorders at various points of access. These funds shall be made available to selected counties, counties acting jointly, or city mental health departments, as determined by the commission through a selection process. It is the intent of the Legislature for these funds to be allocated in an efficient manner to encourage early intervention and receipt of needed services for individuals with mental health disorders, and to assist in navigating the local service sector to improve efficiencies and the delivery of services.
(1)Triage personnel may provide targeted case management services face to face, by telephone, or by telehealth with the individual in need of assistance or his or her significant support person, and may be provided anywhere in the community. These service activities may include, but are not limited to, the following:
(A)Communication, coordination, and referral.
(B)Monitoring service delivery to ensure the individual accesses and receives services.
(C)Monitoring the individuals progress.
(D)Providing placement service assistance and service plan development.
(2)The commission shall take into account at least the following criteria and factors when selecting recipients and determining the amount of grant awards for triage personnel as follows:
(A)Description of need, including potential gaps in local service connections.
(B)Description of funding request, including personnel and use of peer support.
(C)Description of how triage personnel will be used to facilitate linkage and access to services, including objectives and anticipated outcomes.
(D)Ability to obtain federal Medicaid reimbursement, when applicable.
(E)Ability to administer an effective service program and the degree to which local agencies and service providers will support and collaborate with the triage personnel effort.
(F)Geographic areas or regions of the state to be eligible for grant awards, which shall include rural, suburban, and urban areas, and may include use of the five regional designations utilized by the County Behavioral Health Directors Association of California.
(3)The commission shall determine maximum grant awards, and shall take into consideration the level of need, population to be served, and related criteria, as described in paragraph (2), and shall reflect reasonable costs.
(4)Funds awarded by the commission for purposes of this section may be used to supplement, but not supplant, existing financial and resource commitments of the county, counties acting jointly, or city mental health department that received the grant.
(5)Notwithstanding any other law, a county, counties acting jointly, or city mental health department that receives an award of funds for the purpose of supporting triage personnel pursuant to this subdivision is not required to provide a matching contribution of local funds.
(6)Notwithstanding any other law, the commission, without taking any further regulatory action, may implement, interpret, or make specific this section by means of informational letters, bulletins, or similar instructions.
(7)The commission shall provide a status report to the fiscal and policy committees of the Legislature on the progress of implementation no later than March 1, 2014.
(h)Funds appropriated by the Legislature to the commission pursuant to paragraph (8) of subdivision (b) for the purposes of addressing childrens crisis services shall be allocated to support triage personnel and family supportive training and related services. These funds shall be made available to selected counties, counties acting jointly, or city mental health departments, as determined by the commission through a selection process. The commission may, at its discretion, also give consideration to private nonprofit corporations and public agencies in an area or region of the state if a county, or counties acting jointly, affirmatively supports this designation and collaboration in lieu of a county government directly receiving grant funds.
(1)These funds may provide for a range of crisis-related services for a child in need of assistance, or his or her parent, guardian, or caregiver. These service activities may include, but are not limited to, the following:
(A)Intensive coordination of care and services.
(B)Communication, coordination, and referral.
(C)Monitoring service delivery to the child or youth.
(D)Monitoring the childs progress.
(E)Providing placement service assistance and service plan development.
(F)Crisis or safety planning.
(2)The commission shall take into account at least the following criteria and factors when selecting recipients and determining the amount of grant awards for these funds, as follows:
(A)Description of need, including potential gaps in local service connections.
(B)Description of funding request, including personnel.
(C)Description of how personnel and other services will be used to facilitate linkage and access to services, including objectives and anticipated outcomes.
(D)Ability to obtain federal Medicaid reimbursement, when applicable.
(E)Ability to provide a matching contribution of local funds.
(F)Ability to administer an effective service program and the degree to which local agencies and service providers will support and collaborate with the triage personnel effort.
(G)Geographic areas or regions of the state to be eligible for grant awards, which shall include rural, suburban, and urban areas, and may include use of the five regional designations utilized by the County Behavioral Health Directors Association of California.
(3)The commission shall determine maximum grant awards, and shall take into consideration the level of need, population to be served, and related criteria, as described in paragraph (2), and shall reflect reasonable costs.
(4)Funds awarded by the commission for purposes of this section may be used to supplement, but not supplant, existing financial and resource commitments of the county, counties acting jointly, or a city mental health department that received the grant.
(5)Notwithstanding any other law, a county, counties acting jointly, or a city mental health department that receives an award of funds for the purpose of this section is not required to provide a matching contribution of local funds.
(6)Notwithstanding any other law, the commission, without taking any further regulatory action, may implement, interpret, or make specific this section by means of informational letters, bulletins, or similar instructions.
(7)The commission may waive requirements in this section for counties with a population of 100,000 or less, if the commission determines it is in the best interest of the state and meets the intent of the law.
(8)The commission shall provide a status report to the fiscal and policy committees of the Legislature on the progress of implementation no later than January 10, 2018, and annually thereafter.
SEC. 6.Section 11462.01 of the Welfare and Institutions Code, as added by Section 75 of Chapter 773 of the Statutes of 2015, is amended to read:11462.01.(a)(1)No later than 12 months following the date of initial licensure, a short-term residential therapeutic program, as defined in subdivision (ad) of Section 11400 of this code and paragraph (18) of subdivision (a) of Section 1502 of the Health and Safety Code, shall obtain a contract, subject to an agreement on rates and terms and conditions, with a county mental health plan to provide specialty mental health services and demonstrate the ability to meet the therapeutic needs of each child, as identified in any of the following:
(A)A mental health assessment.
(B)The childs case plan.
(C)The childs needs and services plan.
(D)Other documentation demonstrating the child has a mental health need.
(2)A short-term residential therapeutic program shall comply with any other mental health program approvals required by the State Department of Health Care Services or by a county mental health plan to which mental health program approval authority has been delegated.
(b)A short-term residential therapeutic program program, except as specified in subdivision (c), may accept for placement a child who meets both of the criteria in paragraphs (1) and (2) and at least one of the conditions in paragraph (3).
(1)The child does not require inpatient care in a licensed health facility.
(2)The child has been assessed as requiring the level of services provided in a short-term residential therapeutic program in order to maintain the safety and well-being of the child or others due to behaviors, including those resulting from traumas, that render the child or those around the child unsafe or at risk of harm, or that prevent the effective delivery of needed services and supports provided in the childs own home or in other family settings, such as with a relative, guardian, foster family, resource family, or adoptive family. The assessment shall ensure the child has needs in common with other children or youth in the care of the facility, consistent with subdivision (c) of Section 16514.
(3)The child meets at least one of the following conditions:
(A)The child has been assessed, pursuant to Section 4096, as meeting the medical necessity criteria for Medi-Cal specialty mental health services, as provided for in Section 1830.205 or 1830.210 of Title 9 of the California Code of Regulations.
(B)The child has been assessed, pursuant to Section 4096, as seriously emotionally disturbed, as defined in subdivision (a) of Section 5600.3.
(C)The child requires emergency placement pursuant to paragraph (3) of subdivision (h). (i).
(D)The child has been assessed, pursuant to Section 4096, as requiring the level of services provided by the short-term residential therapeutic program in order to meet his or her behavioral or therapeutic needs.
(4)Subject to the requirements of this subdivision, a short-term residential therapeutic program may have a specialized program to serve a child, including, but not limited to, the following:
(A)A commercially sexually exploited child.
(B)A private voluntary placement, if the youth exhibits status offender behavior, the parents or other relatives feel they cannot control the childs behavior, and short-term intervention is needed to transition the child back into the home.
(C)A juvenile sex offender.
(D)A child who is affiliated with, or impacted by, a gang.
(c)A short-term residential therapeutic program that is operating as a childrens crisis residential center, as defined in Section 1502 of the Health and Safety Code, may accept for admission or placement any child, referred by a parent or guardian, or by the representative of a public or private entity, including, but not limited to, the county probation agency or child welfare services agency with responsibility for the placement of a child in foster care, that has the right to make these decisions on behalf of a child who is in mental health crisis and, absent admission to a childrens crisis residential center, would otherwise require acceptance by the emergency department of a general hospital, or admission into a psychiatric hospital or the psychiatric inpatient unit of a general hospital.
(c)(d)A foster family agency that is certified as a Medi-Cal specialty mental health provider pursuant to Section 1810.435 of Title 9 of the California Code of Regulations by the State Department of Health Care Services, or by a county mental health plan to which the department has delegated certification authority, and which has entered into a contract with a county mental health plan pursuant to Section 1810.436 of Title 9 of the California Code of Regulations, shall provide, or provide access to, specialty mental health services to children under its care who do not require inpatient care in a licensed health facility and who meet the medical necessity criteria for Medi-Cal specialty mental health services provided for in Section 1830.205 or 1830.210 of Title 9 of the California Code of Regulations.
(d)(e)A foster family agency that is not certified as a Medi-Cal specialty mental health provider shall provide access to specialty and non-specialty mental health services in that program for children who do not require inpatient care in a licensed health facility and who meet any of the conditions in paragraph (3) of subdivision (b). In this situation the foster family agency shall do the following:
(1)In the case of a child who is a Medi-Cal beneficiary, arrange for specialty mental health services from the county mental health plan.
(2)In all other cases, arrange for the child to receive mental health services.
(e)(f)All short-term residential therapeutic programs shall maintain the level of care and services necessary to meet the needs of the children and youth in their care and shall maintain and have in good standing the appropriate mental health program approval that includes a certification to provide Medi-Cal specialty mental health services issued by the State Department of Health Care Services or a county mental health plan to which the department has delegated mental health program approval authority, pursuant to Section 4096.5 of this code or Section 1810.435 or 1810.436 of Title 9 of the California Code of Regulations. All foster family agencies that are certified as a Medi-Cal specialty mental health provider pursuant to Section 1810.435 of Title 9 of the California Code of Regulations shall maintain the level of care and services necessary to meet the needs of children and youth in their care and shall maintain and have in good standing the Medi-Cal specialty mental health provider certification issued by the State Department of Health Care Services or a county mental health plan to which the department has delegated certification authority.
(f)(g)The assessments described in subparagraphs (A), (B), (C), and (D) of paragraph (3) of subdivision (b) shall ensure the childs individual behavioral or treatment needs are consistent with, and can be met by, the facility and shall be made by one of the following, as applicable:
(1)An interagency placement committee, as described in Section 4096, considering the recommendations from the child and family team, if any are available. If the short-term residential therapeutic program serves children who are placed by county child welfare agencies and children who are placed by probation departments, the interagency placement committee shall also ensure the requirements of subdivision (c) of Section 16514 have been met with respect to commonality of need.
(2)A licensed mental health professional as defined in subdivision (g) of Section 4096.
(3)For the purposes of this section, an AFDC-FC funded child with an individualized education program developed pursuant to Article 2 (commencing with Section 56320) of Chapter 4 of Part 30 of Division 4 of Title 2 of the Education Code that assesses the child as seriously emotionally disturbed, as defined in, and subject to, this section and recommends out-of-home placement at the level of care provided by the provider, shall be deemed to have met the assessment requirement.
(g)(h)The evaluation described in subparagraph (A) of paragraph (3) of subdivision (h) (i) shall be made pursuant to subdivision (b) of Section 706.6 or paragraph (2) of subdivision (c) of Section 16501.1.
(h)(i)(1)The provider shall ensure that AFDC-FC funded children, assessed pursuant to subparagraphs (A) and (B) of paragraph (3) of subdivision (b), who are accepted for placement have been approved for placement by an interagency placement committee, as described in Section 4096, except as provided for in paragraphs (3) and (4) of subdivision (f). (g).
(2)The approval shall be in writing and shall indicate that the interagency placement committee has determined one of the following:
(A)The child meets the medical necessity criteria for Medi-Cal specialty mental health services, as provided for in Section 1830.205 or 1830.210 of Title 9 of the California Code of Regulations.
(B)The child is seriously emotionally disturbed, as described in subdivision (a) of Section 5600.3.
(3)(A)Nothing in subdivisions (a) to (h), inclusive, or this subdivision shall prevent an emergency placement of a child or youth into a certified short-term residential therapeutic program or childrens crisis residential center prior to the determination by the interagency placement committee, but only if a licensed mental health professional, as defined in subdivision (g) of Section 4096, has made a written determination within 72 hours of the childs or youths placement, that the child or youth requires the level of services and supervision provided by the short-term residential therapeutic program in order to meet his or her behavioral or therapeutic needs. needs, or has made a written determination within 24 hours of the childs or youths placement in a childrens crisis residential center that the child or youth is experiencing a mental health crisis as defined in subdivision (c) and is in need of the care and services provided by the childrens crisis residential center. If the short-term residential therapeutic program serves children placed by county child welfare agencies and children placed by probation departments, the interagency placement committee shall also ensure the requirements of subdivision (c) of Section 16514 have been met with respect to commonality of need.
(i)The interagency placement committee, as appropriate, shall, within 30 days of placement, make the determinations, with recommendations from the child and family team, required by this subdivision.
(ii)If it determines the placement is appropriate, the interagency placement committee, with recommendations from the child and family team, shall transmit the approval, in writing, to the county placing agency and the short-term residential therapeutic program.
(iii)If it determines the placement is not appropriate, the interagency placement committee shall respond pursuant to subparagraph (B).
(B)(i)If the interagency placement committee determines at any time that the placement is not appropriate, it shall, with recommendations from the child and family team, transmit the disapproval, in writing, to the county placing agency and the short-term residential therapeutic program and shall include a recommendation as to the childs appropriate level of care and placement to meet his or her service needs. The necessary interagency placement committee representative or representatives shall participate in any child and family team meetings to refer the child or youth to an appropriate placement, as specified in this section.
(ii)The child may remain in the placement for the amount of time necessary to identify and transition the child to an alternative, suitable placement.
(iii)Notwithstanding clause (ii), if the interagency placement committee determined the placement was not appropriate due to a health and safety concern, immediate arrangements for the child to transition to an appropriate placement shall occur.
(i)(j)Commencing January 1, 2017, for AFDC-FC funded children or youth, only those children or youth who are approved for placement, as set forth in this section, may be accepted by a short-term residential therapeutic program.
(j)(k)The department shall, through regulation, establish consequences for the failure of a short-term residential therapeutic program to obtain written approval for placement of an AFDC-FC funded child or youth pursuant to this section.
(k)(l)The department shall not establish a rate for a short-term residential therapeutic program unless the provider submits a recommendation from the host county or the primary placing county that the program is needed and that the provider is willing and capable of operating the program at the level sought. For purposes of this subdivision, host county, and primary placing county, mean the same as defined in the departments AFDC-FC ratesetting regulations.
(l)(m)Any certified short-term residential therapeutic program shall be reclassified and paid at the appropriate program rate for which it is qualified if either of the following occurs:
(1)(A)It fails to maintain the level of care and services necessary to meet the needs of the children and youth in care, as required by subdivision (a). The determination shall be made consistent with the departments AFDC-FC ratesetting regulations developed pursuant to Section 11462 and shall take into consideration the highest level of care and associated rates for which the program may be eligible if granted an extension pursuant to Section 11462.04 or any reduction in rate associated with a provisional or probationary rate granted or imposed under Section 11466.01.
(B)In the event of a determination under this paragraph, the short-term residential therapeutic program may appeal the finding or submit a corrective action plan. The appeal process specified in Section 11466.6 shall be available to a short-term residential therapeutic program that provides intensive and therapeutic treatment. During any appeal, the short-term residential therapeutic program that provides intensive and therapeutic treatment shall maintain the appropriate level of care.
(2)It fails to maintain a certified mental health treatment program as required by subdivision (e). (f).
(m)(n)In addition to any other review required by law, the child and family team as defined in paragraph (4) of subdivision (a) of Section 16501 may periodically review the placement of the child or youth. If the child and family team make a recommendation that the child or youth no longer needs, or is not benefiting from, placement in a short-term residential therapeutic program, the team shall transmit the disapproval, in writing, to the county placing agency to consider a more appropriate placement.
(n)(o)The department shall develop a process to address placements when, subsequent to the childs or youths placement, a determination is made by the interagency placement team and shall consider the recommendations of the child and family team, either that the child or youth is not in need of the care and services provided by the certified program. The process shall include, but not be limited to:
(1)Notice of the determination in writing to both the county placing agency and the short-term residential therapeutic program or foster family agency that provides intensive and therapeutic treatment.
(2)Notice of the countys plan, and a time frame, for removal of the child or youth in writing to the short-term residential therapeutic program that provides intensive and therapeutic treatment.
(3)Referral to an appropriate placement.
(4)Actions to be taken if a child or youth is not timely removed from the short-term residential therapeutic program that provides intensive and therapeutic treatment or placed in an appropriate placement.
(o)(p)(1)Nothing in this section shall prohibit a short-term residential therapeutic program from accepting private placements of children or youth.
(2)When a referral is not from a public agency and no public funding is involved, there is no requirement for public agency review or determination of need.
(3)Children and youth subject to paragraphs (1) and (2) shall have been determined to be seriously emotionally disturbed, as described in subdivision (a) of Section 5600.3, and subject to Section 1502.4 of the Health and Safety Code, by a licensed mental health professional, as defined in subdivision (g) of Section 4096.
SEC. 7.No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution.
|
Date
|
Status
|
|---|---|
| Oct 12, 2017 | Chaptered by Secretary of State - Chapter 704, Statutes of 2017. |
| Oct 12, 2017 | Approved by the Governor. |
| Sep 20, 2017 | Enrolled and presented to the Governor at 4:30 p.m. |
| Sep 13, 2017 | Assembly Rule 77(a) suspended. |
| Sep 13, 2017 | Assembly Rule 77(a) suspended. (Page 3254.) |
| Sep 12, 2017 | In Assembly. Concurrence in Senate amendments pending. May be considered on or after September 14 pursuant to Assembly Rule 77. |
| Sep 11, 2017 | Read third time. Passed. Ordered to the Assembly. |
| Sep 11, 2017 | Read third time. Passed. Ordered to the Assembly. (Ayes 39. Noes 0. Page 2706.). |
| Sep 6, 2017 | Read second time. Ordered to third reading. |
| Sep 5, 2017 | Read third time and amended. Ordered to second reading. |
| Sep 5, 2017 | Read second time. Ordered to third reading. |
| Sep 1, 2017 | From committee: Amend, and do pass as amended. (Ayes 7. Noes 0.) (September 1). |
| Aug 21, 2017 | In committee: Referred to APPR. suspense file. |
| Jul 18, 2017 | Read second time and amended. Re-referred to Com. on APPR. |
| Jul 17, 2017 | From committee: Amend, and do pass as amended and re-refer to Com. on APPR. with recommendation: To Consent Calendar. (Ayes 8. Noes 0.) (July 12). |
| Jul 5, 2017 | From committee chair, with author's amendments: Amend, and re-refer to committee. Read second time, amended, and re-referred to Com. on HEALTH. |
| Jun 29, 2017 | Read second time and amended. Re-referred to Com. on HEALTH. |
| Jun 28, 2017 | From committee: Amend, and do pass as amended and re-refer to Com. on HEALTH with recommendation: To Consent Calendar. (Ayes 5. Noes 0.) (June 27). |
| Jun 14, 2017 | Referred to Coms. on HUMAN S. and HEALTH. |
| Jun 1, 2017 | In Senate. Read first time. To Com. on RLS. for assignment. |
| May 31, 2017 | Read third time. Passed. Ordered to the Senate. (Ayes 75. Noes 0. Page 1977.) |
| May 26, 2017 | From committee: Do pass. (Ayes 17. Noes 0.) (May 26). |
| May 17, 2017 | In committee: Set, first hearing. Referred to APPR. suspense file. |
| Apr 26, 2017 | From committee: Do pass and re-refer to Com. on APPR. with recommendation: To Consent Calendar. (Ayes 7. Noes 0.) (April 25). Re-referred to Com. on APPR. |
| Apr 17, 2017 | Re-referred to Com. on HUM. S. |
| Apr 6, 2017 | Read second time and amended. |
| Apr 5, 2017 | From committee: Amend, and do pass as amended and re-refer to Com. on HUM. S. (Ayes 15. Noes 0.) (April 4). |
| Mar 28, 2017 | Re-referred to Com. on HEALTH. |
| Mar 27, 2017 | From committee chair, with author's amendments: Amend, and re-refer to Com. on HEALTH. Read second time and amended. |
| Feb 27, 2017 | Referred to Coms. on HEALTH and HUM. S. |
| Feb 14, 2017 | From printer. May be heard in committee March 16. |
| Feb 13, 2017 | Read first time. To print. |
|
Date
|
Description
|
Location
|
Votes
|
|
|---|---|---|---|---|
| Sep 13, 2017 | AB 501 RIDLEY-THOMAS Concurrence in Senate Amendments | Assembly Floor |
Passed |
|
| Sep 11, 2017 | Assembly 3rd Reading AB501 Ridley-Thomas By Roth | Senate Floor |
Passed |
|
| Sep 1, 2017 | Do pass as amended | Senate Standing Committee on Appropriations |
Passed |
|
| Aug 21, 2017 | Placed on suspense file | Senate Standing Committee on Appropriations |
Passed |
|
| Jul 12, 2017 | Do pass as amended, but first amend, and re-refer to the Committee on [Appropriations] with the recommendation: To Consent Calendar | Senate Standing Committee on Health |
Passed |
|
| Jun 27, 2017 | Do pass as amended, but first amend, and re-refer to the Committee on [Health] with the recommendation: To Consent Calendar | Senate Standing Committee on Human Services |
Passed |
|
| May 31, 2017 | AB 501 RIDLEY-THOMAS Assembly Third Reading | Assembly Floor |
Passed |
|
| May 26, 2017 | Do pass. | Assembly Standing Committee on Appropriations |
Passed |
|
| Apr 25, 2017 | Do pass and be re-referred to the Committee on [Appropriations] with recommendation: To Consent Calendar | Assembly Standing Committee on Human Services |
Passed |
|
| Apr 4, 2017 | Do pass as amended and be re-referred to the Committee on [Human Services] | Assembly Standing Committee on Health |
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
|
|---|---|---|
| 5 acres | ** Support | Sep 6, 2017 |
| Alameda County Board of Supervisors | ** Support | Sep 6, 2017 |
| ASPIRANET | ** Support | Sep 6, 2017 |
| aviva family & children's services | ** Support | Sep 6, 2017 |
| Bill Wilson Center | ** Support | Sep 6, 2017 |
| California Alliance Of Child And Family Services | ** Support | Sep 6, 2017 |
| California Council Of Community Behavioral Health Agencies | ** Support | Sep 6, 2017 |
| California Mental Health Advocates for Children and Youth | ** Support | Sep 6, 2017 |
| California Psychological Association | ** Support | Sep 6, 2017 |
| California State Association Of Counties | ** Support | Sep 6, 2017 |
| California Youth Empowerment Network | ** Support | Sep 6, 2017 |
| Casa Pacifica Centers for Children and Families | ** Support | Sep 6, 2017 |
| Chief Probation Officers Of California | ** Support | Sep 6, 2017 |
| Children Now | ** Support | Sep 6, 2017 |
| children's institute, inc. | ** Support | Sep 6, 2017 |
| Common Sense Kids Action | ** Support | Sep 6, 2017 |
| County Behavioral Health Directors Association | ** Support | Sep 6, 2017 |
| County Behavioral Health Directors Association of CA | ** Support | Apr 21, 2017 |
| County Welfare Directors Association of California | ** Support | Sep 6, 2017 |
| Crittenton | ** Support | Sep 6, 2017 |
| David & Margaret Youth and Family Services | ** Support | Sep 6, 2017 |
| didi hirsch | ** Support | Sep 6, 2017 |
| East Bay Children's Law Office | ** Support | Sep 6, 2017 |
| Families Now | ** Support | Sep 6, 2017 |
| Family Care Network, Inc. | ** Support | Sep 6, 2017 |
| Five Acres | ** Support | Apr 21, 2017 |
| Fred Finch Youth Centers | ** Support | Sep 6, 2017 |
| hathaway-sycamores child & family services | ** Support | Sep 6, 2017 |
| Hillsides | ** Support | Sep 6, 2017 |
| Humboldt County Transition Age Youth Collaboration | ** Support | Sep 6, 2017 |
| John Burton Advocates for Youth | ** Support | Sep 6, 2017 |
| Junior Blind | ** Support | Mar 31, 2017 |
| Junior Blind Of America | ** Support | Sep 6, 2017 |
| Lincoln | ** Support | Sep 6, 2017 |
| LIUNA Locals 777 & 792 | ** Support | Sep 6, 2017 |
| Maryvale | ** Support | Sep 6, 2017 |
| Mental Health America of California | ** Support | Sep 6, 2017 |
| milestone house | ** Support | Sep 6, 2017 |
| Nami California | ** Support | Sep 6, 2017 |
| National Association of Social Workers | ** Support | Sep 6, 2017 |
| National Association of Social Workers, CA Chapter | ** Support | Apr 21, 2017 |
| NorCal Mental Health America | ** Support | Sep 6, 2017 |
| Pacific Clinics | ** Support | Sep 6, 2017 |
| Pacifica Clinics | ** Support | Apr 21, 2017 |
| Peace Officers Research Association Of California | ** Support | Sep 6, 2017 |
| Redwood Community Services | ** Support | Sep 6, 2017 |
| Redwood Quality Management Company | ** Support | Sep 6, 2017 |
| San Diego Center for Children | ** Support | Sep 6, 2017 |
| Seneca Family of Agencies | ** Support | Sep 6, 2017 |
| Sierra Vista Child and Family Services | ** Support | Sep 6, 2017 |
| Stanford Youth Solutions | ** Support | Sep 6, 2017 |
| Stars Behavioral Health Group | ** Support | Sep 6, 2017 |
| Steinberg Institute | ** Support | Sep 6, 2017 |
| Sunny Hills Services | ** Support | Sep 6, 2017 |
| tessie cleveland community services corp. | ** Support | Sep 6, 2017 |
| the steinfirst group | ** Support | Sep 6, 2017 |
| Uplift Family Services | ** Support | Sep 6, 2017 |
| Ventura County Board of Supervisors | ** Support | Sep 6, 2017 |
| vista del mar | ** Support | Sep 6, 2017 |
| Vista Del Mar Child & Family Services | ** Support | Apr 21, 2017 |
| Westcoast Children's Clinic | ** Support | Sep 6, 2017 |
| Young Minds Advocacy | ** Support | Sep 6, 2017 |
CONCURRENCE IN SENATE AMENDMENTS
CSA1 Bill Id:AB 501
Author:(Ridley-Thomas)
As Amended Ver:September 5, 2017
Majority vote
ASSEMBLY: | 75-0 | (May 31, 2017) | SENATE: | 39-0 | (September 11, 2017) |
Original Committee Reference: HEALTH
SUMMARY: Expands the definition of a short-term residential treatment center (STRTC) to include a children's crisis residential center (CCRC) to be used as a diversion from psychiatric hospitalization and creates a new facility licensure category for CCRCs, and makes related changes. Specifically, this bill:
- Defines a CCRC as a facility licensed by the Department of Social Services (DSS) as a STRTC, and approved by the State Department of Health Care Services (DHCS), or a county mental health plan (MHP) to which DHCS services has delegated approval authority, to serve children experiencing mental health crises as an alternative to psychiatric hospitalization.
- Requires DHCS, in collaboration with DSS, County Behavioral Health Directors Association, provider representatives, and other relevant stakeholders, to develop a rate for pediatric Medi-Cal beneficiaries that are admitted to a CCRC, only to the extent that federal financial participation is available and necessary federal approvals have been obtained.
- Requires DSS to begin implementation of CCRC licensing no later than July 1, 2018, contingent upon a budget appropriation.
- Requires the CCRC to annually provide DSS with specified information as it pertains to children served, including foster children, when applying for a license renewal.
- Permits a CCRC to accept any child including those referred by:
- A parent or guardian;
- A representative of a public or private entity; or,
- A county probation agency or child welfare services agency with responsibility for the placement of a child in foster care that has the right to make these decisions on behalf of a child who is in mental health crisis.
- Permits a CCRC to accept any child to a CCRC that would otherwise require acceptance by the emergency department of a general hospital, or admission into a psychiatric hospital or the psychiatric inpatient unit of a general hospital.
- Requires DHCS to establish due process protections related to the children's crisis residential mental health program approval process.
- Requires, in order to maintain a license, a STRTC operating a CCRC to have a children's crisis residential mental health program approval issued by DHCS or county MHP.
- Permits DHCS or county MHP to suspend or revoke a children's crisis residential mental health program approval, impose monetary penalties, place a CCRC on probation, and require a CCRC to prepare and comply with a corrective action plan if a CCRC is noncompliant.
The Senate amendments clarify that DSS cannot waive existing statutory licensure requirements and make changes to avoid chaptering out conflicts with SB 612 (Mitchell) and AB 404 (Mark Stone) of the current legislative session since they all amend the same code sections.
FISCAL EFFECT: According to the Senate Appropriations Committee, minor costs for DSS to develop regulations and make system changes for its licensing program and unknown potential additional licensing costs (General Fund). Additionally, ongoing costs of $590,000 in 2018-19 and $550,000 per year thereafter for DHCS to develop regulations, file a state plan amendment, certify children's crisis residential programs, and take any necessary enforcement actions (General Fund and federal funds). Unknown increases in Medi-Cal costs due to increased utilization of CCRC program services (General Fund, local funds, and federal funds) and insignificant state costs to reimburse county MHPs for administrative costs.
COMMENTS: According to the author, alternatives to inpatient hospitalization are essential to both children experiencing a mental health crisis and the family. Instead of emergency rooms or unnecessary hospitalization, what a child needs is a calming and therapeutic place where he or she can receive treatment to work through the crisis. Community Based programs provide just that, in the form of crisis intervention services. The primary goal of these services is to stabilize and improve psychological symptoms of distress and to engage individuals in an appropriate treatment service to address the problem that led to the crisis. These services are performed at a residential home-like setting. This provides the optimum environment for a child to feel relaxed while receiving essential therapeutic help.
- STRTCs. The STRTCs, created by state statute in 2016, are intended to replace the existing group homes with the highest rate classification levels (RCL) – RCL 13 and 14 – which currently require certification by DHCS to provide specialty mental health services. All STRTCs are required to have national accreditation from an entity identified by DSS. STRTCs are permitted to address mental health treatment in two ways. An STRTC that is certified by DHCS or a county mental health plan may only accept children who have been assessed as meeting medical necessity required for specialty mental health care under the federal Early and Periodic Screening, Diagnosis and Treatment (EPSDT) program or who have been assessed as being Seriously Emotionally Disturbed.
- Crisis Residential Programs and Crisis Stabilization. According to a 2010 report by the California Mental Health Planning Council, crisis residential programs are a lower-cost, community-based treatment option in home-like settings that help reduce emergency department visits and divert hospitalization and incarcerations. These programs include peer-run programs such as crisis respites that offer safer, trauma-informed alternatives to psychiatric emergency units, or other locked facilities. The report indicates that crisis residential programs reduce unnecessary stays in psychiatric hospitals, reduce the number and expense of emergency room visits, and divert inappropriate incarcerations while producing the same or superior outcomes to those of institutionalized care. The report states that, as the costs for inpatient treatment continue to rise, the need to expand an appropriate array of acute treatment settings becomes more urgent, and state and county mental health systems should encourage and support alternatives to costly institutionalization and improve the continuum of care to better serve individuals experiencing an acute psychiatric episode. Crisis stabilization services are those lasting less than 24 hours for individuals who are in psychiatric crisis whose needs cannot be accommodated safely in a residential service setting. Crisis stabilization must be provided onsite at a 24-hour health facility, hospital-based outpatient program, or at other certified provider sites. The goal of crisis stabilization is to stabilize the consumer and re-integrate him or her back into the community quickly.
The California Alliance of Child and Family Services (CACFS), sponsor of the bill, states that this bill addresses a critical component missing from the continuum of specialty mental health services for children and youth in California. CACFS states that this bill would create the needed licensing category to ensure that county MHPs, commercial insurance companies, and their community-based providers can develop mental health crisis residential programs within an appropriate licensing category and ensure children and youth can access mental health services that are responsive to their individual needs and strengths in a timely manner. CACFS states that the creation of the licensing category is consistent with Medi-Cal EPSDT specialty mental health services program standards and requirements, and this bill will fill a gap in regulations which prevent California from fully complying with EPSDT specialty mental health services entitlement for children and youth.
Children Now states that currently, an estimated three out of every four children in the United States that need mental health services do not receive them and that nearly 20% of high school students in California consider suicide at some point in their lives and more than 10% actually attempt it. With 47 out of 58 counties lacking any child/adolescent psychiatric hospital inpatient beds for children under age 12 (and fewer than 70 beds statewide) the need for children's mental health crisis residential services could not be more acute.
The Steinberg Institute states that a full continuum of care for children and youth with urgent mental health is needed, and the lack of a licensing component for crisis residential services is preventing the development of this much needed program. While crisis residential services are still acute in nature, it is provided in a less restrictive environment, and would be a more appropriate alternative for children but do not require the level of care that an acute inpatient hospitalization provides.
There is no known opposition to this bill.
Analysis Prepared by: Paula Villescaz / HEALTH / (916) 319-2097 FN: 0001973
Office of Senate Floor Analyses (916) 651-1520 Fax: (916) 327-4478 | AB |
THIRD READING
Bill No: AB 501
Amended: 9/5/17 in Senate
SENATE HUMAN SERVICES COMMITTEE: 5-0, 6/27/17
AYES: Wiener, Berryhill, Glazer, Newman, Nguyen
SENATE HEALTH COMMITTEE: 8-0, 7/12/17
AYES: Hernandez, Nguyen, Atkins, Leyva, Mitchell, Monning, Newman, Roth
NO VOTE RECORDED: Nielsen
SENATE APPROPRIATIONS COMMITTEE: 7-0, 9/1/17
AYES: Lara, Bates, Beall, Bradford, Hill, Nielsen, Wiener
ASSEMBLY FLOOR: 75-0, 5/31/17 - See last page for vote
SUBJECT: Mental health: community care facilities
SOURCE: California Alliance of Child and Family Services
DIGEST:
This bill authorizes the California Department of Social Services (CDSS) to license a short-term residential therapeutic program as a children’s crisis residential program, as defined, to provide care for children who have serious behavioral health disorders, among other conditions. This bill permits referral into a crisis center by a parent, physician, licensed mental health professional, or by the representative of a public or private entity who is authorized to make decisions on behalf of the child. This bill makes related changes.
Senate Floor Amendments of 9/5/17 add cross-referencing language for licensing requirements of the crisis residential program, and extend the date by one year the deadline of adoption of regulations. Amendments additionally resolve potential chaptering conflicts between this bill and AB 404 (Stone), as well as between this bill and SB 612 (Mitchell).
Existing law:
- Requires CDSS and county welfare departments, to establish and support a public system of child welfare services to protect and promote the welfare of children.
- Requires county mental health departments to provide children served by county social services and probation departments, who meet the definition of medical necessity, with mental health screening, assessment, participation in multidisciplinary placement teams and specialty mental health treatment.
- Establishes a system of licensure and oversight for community care facilities, including short-term residential therapeutic programs (STRTPs), to provide rehabilitation and therapy for youth in foster care or probation.
- Defines an STRTP to mean a CDSS-licensed residential facility operated by a public agency or private, nonprofit organization that provides an integrated program of specialized services and supports, treatment, and short-term, 24-hour care and supervision to children.
- Establishes the Investment in Mental Health Wellness Act of 2013 to expand, among other things, the continuum of services to address crisis intervention and crisis residential treatment needs, and identifies a need for a continuum of crisis services for children and youth, among other goals.
- Requires an STRTP to obtain a contract with a county mental health plan to provide specialty mental health services, as specified, no later than 12 months from the date of initial licensure and to be able to meet the therapeutic needs of each child, as defined.
This bill:
- Permits an STRTP to be operated as a children’s crisis residential program, and defines a “children’s crisis residential program” to mean a facility licensed by CDSS as an STRTP and approved by the Department of Health Care Services (DHCS) or a county mental health plan to operate a children’s crisis residential mental health program approval, as specified, to serve children experiencing mental health crises as an alternative to psychiatric hospitalization.
- Requires a children’s crisis residential program to meet all of the following requirements:
- If the program serves children who are not experiencing mental health crises, have an identifiable and physically separate unit for those children who are experiencing mental health crises. The separate unit shall be indicated on the STRTP’s license.
- Obtain and have in good standing a mental health program approval that includes a Medi-Cal mental health certification and a children’s crisis residential mental health program approval, as defined, both of which are issued by DHCS, or a county mental health plan to which the department has delegated approval authority. The STRTP shall obtain a mental health program approval before operating as a children’s crisis residential program. The department may revoke a program’s license for a program’s failure to maintain the mental health program approval, as specified.
- Comply with all applicable licensing standards for an STRTP, unless the department specifies otherwise in regulations that comply with applicable statutory requirements related to licensure.
- Requires, contingent upon an appropriation in the annual Budget Act, CDSS to begin implementing this bill no later than July 1, 2018, and to begin licensing children’s crisis residential programs no later than January 1, 2019.
- Requires CDSS to establish regulations for STRTPs that are operated as children’s crisis residential programs that include minimum requirements:
- Therapeutic programming shall be provided seven days a week, including weekends and holidays, with sufficient mental health professional and paraprofessional staff, as required by the facility’s children’s crisis residential mental health program approval in accordance with the standards and procedures, as specified, to maintain an appropriate treatment setting and services, based on individual children’s needs.
- The program shall be staffed with sufficient personnel to accept children 24 hours per day, seven days a week and to admit children, at a minimum, from 7 a.m. to 11 p.m., seven days a week, 365 days per year. The program shall be sufficiently staffed to discharge children, as appropriate, seven days a week, 365 days per year.
- Facilities shall be limited to fewer than 16 beds, with at least 50 percent of those beds in single-occupancy rooms.
- Facilities shall include ample physical space for accommodating individuals who provide daily emotional and physical supports to each child and for integrating family members into the day-to-day care of the youth.
- The program shall collaborate with each child’s existing mental health or child and family teams, if applicable, and other formal and natural supports within 24 hours of intake and throughout the course of care and treatment as appropriate.
- The program shall create and assist with the implementation of a plan for transitioning each admitted child from the program to his or her home and community, including establishing a mental health or child and family team if there is not one already.
- Requires each children’s crisis residential home in conjunction with its application for licensure renewal to annually provide CDSS with all of the following data about children in foster care and children not in foster care: The age and gender of clients served, duration of stay, professional classification of staff and contracted staff and the type of discharge placement for each client.
- Permits children’s crisis residential programs to be eligible for grant funding under the Investment in Mental Health Wellness Act of 2013.
- Permits an STRTP operating as a children’s crisis residential program to accept any child for admission who meets the following requirements:
- The child is referred by a parent or guardian, physician, or licensed mental health professional, or by the representative of a public or private entity, including, but not limited to, the county probation agency or child welfare services agency with responsibility for the placement of a child in foster care, that has the right to make these decisions on behalf of a child who is in mental health crisis.
- The child’s age falls within the program’s licensing requirements.
- The child has a serious behavioral health disorder.
- The child requires a 24-hour-a-day, seven-day-a-week, staff-secured, unlocked treatment setting.
- Mandates that a children’s crisis residential program be used only as a diversion to admittance to a psychiatric hospital.
- Limits the initial authorization for placement into a crisis residential program to 10 consecutive days, as specified, and establishes requirements for additional authorizations if it is medically determined that a child needs longer treatment in the crisis residential facility.
- Permits an emergency placement into a children’s crisis residential program but requires a licensed mental health professional to make a written determination within 24 hours of placement that the child or youth is experiencing a mental health crisis, as defined, and is in need of the care and services provided by the children’s crisis residential program.
- Authorizes DHCS or a county mental health plan to suspend or revoke a mental health program approval, impose monetary penalties, place a program on probation or take other enforcement action, as specified.
- Makes implementation of this bill effective only upon appropriation of funds by the Legislature and federal financial participation, as specified.
- Includes language to resolve chaptering conflicts between this bill and SB 612 (Mitchell), and between this bill and AB 404 (Stone).
Background
According to the author, an estimated three of every four children in the United States who need mental health services do not receive them, and nearly 20 percent of high school students in California consider suicide at some point in their lives. California has an acute shortage of mental health crisis beds, the author states.
The child welfare system oversees care of some 64,000 children in California who were removed from their homes because of allegations of abuse, neglect or exploitation. If a court determines that staying at home is not in the best interest of the child, the child welfare agency arranges for and monitors temporary or permanent placement of the child in the safest and least-restrictive environment possible. Often children are placed with relatives, non-related extended family members, or foster parents.
Continuum of Care Reform (CCR). In January 2015, CDSS published the “California’s Child Welfare Continuum of Care Reform” report after a three-year workgroup process. The working group and report were required by budget trailer bill (SB 1013, Chapter 25, Statutes of 2012), which mandated the workgroup consider, at a minimum, reforms to programs provided by Foster Family Agencies and group homes, and how to ensure the provision of services in family-like settings, including after care services, when appropriate. The report emphasized home-based family care placements of children and changing the goals of congregate care placements. One key element of the CCR effort was the elimination of foster care group homes and the creation of a new STRTP licensure category, effective January 1, 2017. All STRTPs are required to have national accreditation from an entity identified by CDSS, a mental health approval and Medi-Cal certification from the county. This bill creates the new children’s crisis home model within the STRTP.
Children’s Mental Health
One in five children between the ages of 13 and 18 live with a mental health condition, according the National Alliance on Mental Illness (NAMI). About 70 percent of the youth in juvenile justice systems have at least one mental health condition and 20 percent are living with serious mental illness. NAMI reports that almost half of children aged 8 to 15 who were diagnosed with a mental illness received no mental health services in the prior year.
Various studies have shown that foster youth have heightened rates of mental illness. An American Psychological Association report noted that nearly half (47.9 percent) of youth in foster care had clinically significant emotional or behavioral problems, and more than half of children entering foster care exhibited behavioral or social competency problems that warranted mental health services.
Capacity crisis. California has few crisis diversion programs for adolescents and few options for children in a mental health crisis. A 2015 paper published by six mental health advocacy organizations said the lack of crisis options for children and teens results in untreated mental health issues, which worsen over time. The paper, which was published by a workgroup led by California Council of Community Mental Health Agencies, advocated for community-based crisis facilities for children and youth and identified a decrease in the statewide availability of inpatient psychiatric hospital beds for children, and ongoing challenges to find community-based mental health care for children:
“While there are existing crisis service programs in California, the availability of these programs is limited in the type of services that are available and vary significantly from one county to another county. For example, a handful of counties may operate children’s mobile crisis teams, but there are no crisis stabilization units or beds within their region. Therefore, inpatient hospitalization is the only option for a youth experiencing a crisis in many areas of the state, and in many instances it is the least effective measure.”
A 2012 study of California hospital emergency rooms indicated that children and adolescents with a primary psychiatric diagnosis waited an average 12.97 hours for psychiatric evaluation and placement – nearly three hours longer than adults in the same situation. Total length of stay for children and teens in crisis was estimated to be in excess of 19 hours.
FISCAL EFFECT: Appropriation: Fiscal Com.: Local:
According to the Senate Appropriations Committee:
- Minor costs for CDSS to develop regulations and make system changes for its licensing program. CDSS is currently in the process of developing regulations and processes for licensing STRTPs. CDSS indicates that the regulations that would be necessary under this bill can be developed as part of the larger regulation development process underway, at minimal additional cost.
- Unknown potential additional licensing costs to CDSS (General Fund). The Department indicates that it is likely the additional workload to license short-term therapeutic programs operated as children’s crisis residential programs would not substantially increase the licensing costs that are anticipated to license STRTPs. However, to the extent that this bill results in additional facilities seeking licensure specifically to operate as a children’s crisis residential program, there would be additional licensing workload. Whether that would actually occur is unknown.
- Ongoing costs of $590,000 in 2018-19 and $550,000 per year thereafter for DHCS to develop regulations, file a state plan amendment, certify children’s crisis residential programs, and take any necessary enforcement actions (General Fund and federal funds).
- Unknown increase in Medi-Cal costs due to increased utilization of children’s crisis residential program services (General Fund, local funds, and federal funds). The intention of this bill is to provide services to children in children’s crisis residential programs, rather than in psychiatric hospitals or general acute care hospitals. In those cases, there would likely be cost savings to Medi-Cal, since the reimbursement rates for crisis residential services will be lower than inpatient hospital rates. However, there is a consensus that there is a significant shortage in available psychiatric beds for children in the state. There is likely to be a significant unmet need for psychiatric inpatient services. Therefore, some of the utilization of children’s crisis residential care will be in addition to those services currently being provided in hospitals, rather than a substitution for services already being provided. The size of this impact is unknown.
- No significant state costs to reimburse county mental health plans for administrative costs are anticipated. Under this bill, county mental health plans could be delegated the authority to certify children’s crisis residential programs (rather than DHCS). However, this responsibility is not mandatory on the counties. Similarly, county mental health plans are not obligated under this bill to contract with children’s crisis residential programs.
California Alliance of Child and Family Services (source)
5 Acres
Alameda County Board of Supervisors
Aspiranet
Aviva Family & Children’s Services
Bill Wilson Center
California Council of Community Behavioral Health Agencies
California Mental Health Advocates for Children and Youth
California Psychological Association
California State Association of Counties
California Youth Empowerment Network
Casa Pacifica Centers for Children and Families
Chief Probation Officers of California
Children Now
Children’s Institute, Inc.
Common Sense Kids Action
County Behavioral Health Directors Association
County Welfare Directors Association of California
Crittenton
David & Margaret Youth and Family Services
Didi Hirsch
East Bay Children’s Law Office
Families Now
Family Care Network, Inc.
Fred Finch Youth Centers
Hathaway-Sycamores Child & Family Services
Hillsides
Humboldt County Transition Age Youth Collaboration
John Burton Advocates for Youth
Junior Blind of America
Lincoln
LIUNA Locals 777 & 792
Maryvale
Mental Health America of California
Milestone House
NAMI California
National Association of Social Workers
NorCal Mental Health America
Pacific Clinics
Peace Officers Research Association of California
Redwood Community Services
Redwood Quality Management Company
San Diego Center for Children
Seneca Family of Agencies
Sierra Vista Child and Family Services
Stanford Youth Solutions
Stars Behavioral Health Group
Statewide Taskforce on Accessing Health Services for California Children in Foster Care
Steinberg Institute
Sunny Hills Services
Tessie Cleveland Community Services Corp.
The California Chapter of the American College of Emergency Physicians
The Steinfirst Group
Uplift Family Services
Ventura County Board of Supervisors
Vista Del Mar
WestCoast Children’s Clinic
Young Minds Advocacy
OPPOSITION: (Verified 8/29/17)
None received
ASSEMBLY FLOOR: 75-0, 5/31/17
AYES: Acosta, Aguiar-Curry, Travis Allen, Arambula, Baker, Berman, Bigelow, Bloom, Bocanegra, Bonta, Burke, Caballero, Calderon, Cervantes, Chau, Chávez, Chiu, Chu, Cooley, Cooper, Cunningham, Dababneh, Dahle, Daly, Flora, Fong, Frazier, Friedman, Gallagher, Cristina Garcia, Eduardo Garcia, Gipson, Gloria, Gomez, Gonzalez Fletcher, Gray, Grayson, Harper, Holden, Irwin, Jones-Sawyer, Kalra, Kiley, Lackey, Levine, Limón, Low, Maienschein, Mathis, Mayes, McCarty, Medina, Mullin, Muratsuchi, Nazarian, Obernolte, O'Donnell, Patterson, Quirk, Quirk-Silva, Reyes, Ridley-Thomas, Rodriguez, Rubio, Salas, Santiago, Steinorth, Mark Stone, Thurmond, Ting, Voepel, Waldron, Weber, Wood, Rendon
NO VOTE RECORDED: Brough, Chen, Choi, Eggman, Melendez
9/6/17 16:02:25
**** END ****
Office of Senate Floor Analyses (916) 651-1520 Fax: (916) 327-4478 | AB |
THIRD READING
Bill No: AB 501
: 9/1/17
SENATE HUMAN SERVICES COMMITTEE: 5-0, 6/27/17
AYES: Wiener, Berryhill, Glazer, Newman, Nguyen
SENATE HEALTH COMMITTEE: 8-0, 7/12/17
AYES: Hernandez, Nguyen, Atkins, Leyva, Mitchell, Monning, Newman, Roth
NO VOTE RECORDED: Nielsen
SENATE APPROPRIATIONS COMMITTEE: 7-0, 9/1/17
AYES: Lara, Bates, Beall, Bradford, Hill, Nielsen, Wiener
ASSEMBLY FLOOR: 75-0, 5/31/17 - See last page for vote
SUBJECT: Mental health: community care facilities
SOURCE: California Alliance of Child and Family Services
DIGEST:
This bill authorizes the California Department of Social Services (CDSS) to license a short-term residential therapeutic program as a children’s crisis residential program, as defined, to provide care for children who have serious behavioral health disorders, among other conditions. This bill permits referral into a crisis center by a parent, physician, licensed mental health professional, or by the representative of a public or private entity who is authorized to make decisions on behalf of the child. This bill makes related changes.
Existing law:
- Requires CDSS and county welfare departments, to establish and support a public system of child welfare services to protect and promote the welfare of children.
- Requires county mental health departments to provide children served by county social services and probation departments, who meet the definition of medical necessity, with mental health screening, assessment, participation in multidisciplinary placement teams and specialty mental health treatment.
- Establishes a system of licensure and oversight for community care facilities, including short-term residential therapeutic programs (STRTPs), to provide rehabilitation and therapy for youth in foster care or probation.
- Defines an STRTP to mean a CDSS-licensed residential facility operated by a public agency or private, nonprofit organization that provides an integrated program of specialized services and supports, treatment, and short-term, 24-hour care and supervision to children.
- Establishes the Investment in Mental Health Wellness Act of 2013 to expand, among other things, the continuum of services to address crisis intervention and crisis residential treatment needs, and identifies a need for a continuum of crisis services for children and youth, among other goals.
- Requires an STRTP to obtain a contract with a county mental health plan to provide specialty mental health services, as specified, no later than 12 months from the date of initial licensure and to be able to meet the therapeutic needs of each child, as defined.
This bill:
- Permits an STRTP to be operated as a children’s crisis residential program, and defines a “children’s crisis residential program” to mean a facility licensed by CDSS as an STRTP and approved by the Department of Health Care Services (DHCS) or a county mental health plan to operate a children’s crisis residential mental health program approval, as specified, to serve children experiencing mental health crises as an alternative to psychiatric hospitalization.
- Requires a children’s crisis residential program to meet all of the following requirements:
- If the program serves children who are not experiencing mental health crises, have an identifiable and physically separate unit for those children who are experiencing mental health crises. The separate unit shall be indicated on the STRTP’s license.
- Obtain and have in good standing a mental health program approval that includes a Medi-Cal mental health certification and a children’s crisis residential mental health program approval, as defined, both of which are issued by DHCS, or a county mental health plan to which the department has delegated approval authority. The STRTP shall obtain a mental health program approval before operating as a children’s crisis residential program. The department may revoke a program’s license for a program’s failure to maintain the mental health program approval, as specified.
- Comply with all applicable licensing standards for an STRTP, unless the department specifies otherwise in regulations that comply with applicable statutory requirements related to licensure.
- Requires, contingent upon an appropriation in the annual Budget Act, CDSS to begin implementing this section no later than July 1, 2018, and to begin licensing children’s crisis residential programs no later than January 1, 2019.
- Requires CDSS to establish regulations for STRTPs that are operated as children’s crisis residential programs that include minimum requirements:
- Therapeutic programming shall be provided seven days a week, including weekends and holidays, with sufficient mental health professional and paraprofessional staff to maintain an appropriate treatment setting and services, based on individual children’s needs.
- The program shall be staffed with sufficient personnel to accept children 24 hours per day, seven days a week and to admit children, at a minimum, from 7 a.m. to 11 p.m., seven days a week, 365 days per year. The program shall be sufficiently staffed to discharge children, as appropriate, seven days a week, 365 days per year.
- Facilities shall be limited to fewer than 16 beds, with at least 50 percent of those beds in single-occupancy rooms.
- Facilities shall include ample physical space for accommodating individuals who provide daily emotional and physical supports to each child and for integrating family members into the day-to-day care of the youth.
- The program shall collaborate with each child’s existing mental health or child and family teams, if applicable, and other formal and natural supports within 24 hours of intake and throughout the course of care and treatment as appropriate.
- The program shall create and assist with the implementation of a plan for transitioning each admitted child from the program to his or her home and community, including establishing a mental health or child and family team if there is not one already.
- Requires each children’s crisis residential home in conjunction with its application for licensure renewal to annually provide CDSS with all of the following data about children in foster care and children not in foster care: The age and gender of clients served, duration of stay, professional classification of staff and contracted staff and the type of discharge placement for each client.
- Permits children’s crisis residential programs to be eligible for grant funding under the Investment in Mental Health Wellness Act of 2013.
- Permits an STRTP operating as a children’s crisis residential program to accept any child for admission who meets the following requirements:
- The child is referred by a parent or guardian, physician, or licensed mental health professional, or by the representative of a public or private entity, including, but not limited to, the county probation agency or child welfare services agency with responsibility for the placement of a child in foster care, that has the right to make these decisions on behalf of a child who is in mental health crisis.
- The child’s age falls within the program’s licensing requirements.
- The child has a serious behavioral health disorder.
- The child requires a 24-hour-a-day, seven-day-a-week, staff-secured, unlocked treatment setting.
- Mandates that a children’s crisis residential program be used only as a diversion to admittance to a psychiatric hospital.
- Limits the initial authorization for placement into a crisis residential program to 10 consecutive days, as specified, and establishes requirements for additional authorizations if it is medically determined that a child needs longer treatment in the crisis residential facility.
- Permits an emergency placement into a children’s crisis residential program but requires a licensed mental health professional to make a written determination within 24 hours of placement that the child or youth is experiencing a mental health crisis, as defined, and is in need of the care and services provided by the children’s crisis residential program.
- Authorizes DHCS or a county mental health plan to suspend or revoke a mental health program approval, impose monetary penalties, place a program on probation or take other enforcement action, as specified.
- Makes implementation of this bill effective only upon appropriation of funds by the Legislature and federal financial participation, as specified.
Background
According to the author, an estimated three of every four children in the United States who need mental health services do not receive them, and nearly 20 percent of high school students in California consider suicide at some point in their lives. California has an acute shortage of mental health crisis beds, the author states.
The child welfare system oversees care of some 64,000 children in California who were removed from their homes because of allegations of abuse, neglect or exploitation. If a court determines that staying at home is not in the best interest of the child, the child welfare agency arranges for and monitors temporary or permanent placement of the child in the safest and least-restrictive environment possible. Often children are placed with relatives, non-related extended family members, or foster parents.
Continuum of Care Reform (CCR). In January 2015, CDSS published the “California’s Child Welfare Continuum of Care Reform” report after a three-year workgroup process. The working group and report were required by budget trailer bill (SB 1013, Chapter 25, Statutes of 2012), which mandated the workgroup consider, at a minimum, reforms to programs provided by Foster Family Agencies and group homes, and how to ensure the provision of services in family-like settings, including after care services, when appropriate. The report emphasized home-based family care placements of children and changing the goals of congregate care placements. One key element of the CCR effort was the elimination of foster care group homes and the creation of a new STRTP licensure category, effective January 1, 2017. All STRTPs are required to have national accreditation from an entity identified by CDSS, a mental health approval and Medi-Cal certification from the county. This bill creates the new children’s crisis home model within the STRTP.
Children’s Mental Health
One in five children between the ages of 13 and 18 live with a mental health condition, according the National Alliance on Mental Illness (NAMI). About 70 percent of the youth in juvenile justice systems have at least one mental health condition and 20 percent are living with serious mental illness. NAMI reports that almost half of children aged 8 to 15 who were diagnosed with a mental illness received no mental health services in the prior year.
Various studies have shown that foster youth have heightened rates of mental illness. An American Psychological Association report noted that nearly half (47.9 percent) of youth in foster care had clinically significant emotional or behavioral problems, and more than half of children entering foster care exhibited behavioral or social competency problems that warranted mental health services.
Capacity crisis. California has few crisis diversion programs for adolescents and few options for children in a mental health crisis. A 2015 paper published by six mental health advocacy organizations said the lack of crisis options for children and teens results in untreated mental health issues, which worsen over time. The paper, which was published by a workgroup led by California Council of Community Mental Health Agencies, advocated for community-based crisis facilities for children and youth and identified a decrease in the statewide availability of inpatient psychiatric hospital beds for children, and ongoing challenges to find community-based mental health care for children:
“While there are existing crisis service programs in California, the availability of these programs is limited in the type of services that are available and vary significantly from one county to another county. For example, a handful of counties may operate children’s mobile crisis teams, but there are no crisis stabilization units or beds within their region. Therefore, inpatient hospitalization is the only option for a youth experiencing a crisis in many areas of the state, and in many instances it is the least effective measure.”
A 2012 study of California hospital emergency rooms indicated that children and adolescents with a primary psychiatric diagnosis waited an average 12.97 hours for psychiatric evaluation and placement – nearly three hours longer than adults in the same situation. Total length of stay for children and teens in crisis was estimated to be in excess of 19 hours.
FISCAL EFFECT: Appropriation: Fiscal Com.: Local:
According to the Senate Appropriations Committee:
- Minor costs for CDSS to develop regulations and make system changes for its licensing program. CDSS is currently in the process of developing regulations and processes for licensing STRTPs. CDSS indicates that the regulations that would be necessary under this bill can be developed as part of the larger regulation development process underway, at minimal additional cost.
- Unknown potential additional licensing costs to CDSS (General Fund). The Department indicates that it is likely the additional workload to license short-term therapeutic programs operated as children’s crisis residential programs would not substantially increase the licensing costs that are anticipated to license STRTPs. However, to the extent that this bill results in additional facilities seeking licensure specifically to operate as a children’s crisis residential program, there would be additional licensing workload. Whether that would actually occur is unknown.
- Ongoing costs of $590,000 in 2018-19 and $550,000 per year thereafter for DHCS to develop regulations, file a state plan amendment, certify children’s crisis residential programs, and take any necessary enforcement actions (General Fund and federal funds).
- Unknown increase in Medi-Cal costs due to increased utilization of children’s crisis residential program services (General Fund, local funds, and federal funds). The intention of this bill is to provide services to children in children’s crisis residential programs, rather than in psychiatric hospitals or general acute care hospitals. In those cases, there would likely be cost savings to Medi-Cal, since the reimbursement rates for crisis residential services will be lower than inpatient hospital rates. However, there is a consensus that there is a significant shortage in available psychiatric beds for children in the state. There is likely to be a significant unmet need for psychiatric inpatient services. Therefore, some of the utilization of children’s crisis residential care will be in addition to those services currently being provided in hospitals, rather than a substitution for services already being provided. The size of this impact is unknown.
- No significant state costs to reimburse county mental health plans for administrative costs are anticipated. Under this bill, county mental health plans could be delegated the authority to certify children’s crisis residential programs (rather than DHCS). However, this responsibility is not mandatory on the counties. Similarly, county mental health plans are not obligated under this bill to contract with children’s crisis residential programs.
California Alliance of Child and Family Services (source)
5 Acres
Alameda County Board of Supervisors
Aspiranet
Aviva Family & Children’s Services
Bill Wilson Center
California Council of Community Behavioral Health Agencies
California Mental Health Advocates for Children and Youth
California Psychological Association
California State Association of Counties
California Youth Empowerment Network
Casa Pacifica Centers for Children and Families
Chief Probation Officers of California
Children Now
Children’s Institute, Inc.
Common Sense Kids Action
County Behavioral Health Directors Association
County Welfare Directors Association of California
Crittenton
David & Margaret Youth and Family Services
Didi Hirsch
East Bay Children’s Law Office
Families Now
Family Care Network, Inc.
Fred Finch Youth Centers
Hathaway-Sycamores Child & Family Services
Hillsides
Humboldt County Transition Age Youth Collaboration
John Burton Advocates for Youth
Junior Blind of America
Lincoln
LIUNA Locals 777 & 792
Maryvale
Mental Health America of California
Milestone House
NAMI California
National Association of Social Workers
NorCal Mental Health America
Pacific Clinics
Peace Officers Research Association of California
Redwood Community Services
Redwood Quality Management Company
San Diego Center for Children
Seneca Family of Agencies
Sierra Vista Child and Family Services
Stanford Youth Solutions
Stars Behavioral Health Group
Statewide Taskforce on Accessing Health Services for California Children in Foster Care
Steinberg Institute
Sunny Hills Services
Tessie Cleveland Community Services Corp.
The California Chapter of the American College of Emergency Physicians
The Steinfirst Group
Uplift Family Services
Ventura County Board of Supervisors
Vista Del Mar
WestCoast Children’s Clinic
Young Minds Advocacy
OPPOSITION: (Verified 8/29/17)
None received
ASSEMBLY FLOOR: 75-0, 5/31/17
AYES: Acosta, Aguiar-Curry, Travis Allen, Arambula, Baker, Berman, Bigelow, Bloom, Bocanegra, Bonta, Burke, Caballero, Calderon, Cervantes, Chau, Chávez, Chiu, Chu, Cooley, Cooper, Cunningham, Dababneh, Dahle, Daly, Flora, Fong, Frazier, Friedman, Gallagher, Cristina Garcia, Eduardo Garcia, Gipson, Gloria, Gomez, Gonzalez Fletcher, Gray, Grayson, Harper, Holden, Irwin, Jones-Sawyer, Kalra, Kiley, Lackey, Levine, Limón, Low, Maienschein, Mathis, Mayes, McCarty, Medina, Mullin, Muratsuchi, Nazarian, Obernolte, O'Donnell, Patterson, Quirk, Quirk-Silva, Reyes, Ridley-Thomas, Rodriguez, Rubio, Salas, Santiago, Steinorth, Mark Stone, Thurmond, Ting, Voepel, Waldron, Weber, Wood, Rendon
NO VOTE RECORDED: Brough, Chen, Choi, Eggman, Melendez
9/5/17 9:41:26
**** END ****
SENATE COMMITTEE ON
Senator Ricardo Lara, Chair
2017 - 2018 Regular Session
AB 501 (Ridley-Thomas) - Mental health: community care facilities
Version: | Policy Vote: |
Urgency: | Mandate: |
Hearing Date: | Consultant: |
Bill Summary:
AB 501 would allow a short-term residential therapeutic program to be operated as a children’s crisis residential mental health program, with specified regulatory requirements.
*********** ANALYSIS ADDENDUM – SUSPENSE FILE ***********
The following information is revised to reflect amendments
adopted by the committee on September 1, 2017
Fiscal Impact:
- Minor costs for the Department of Social Services to develop regulations and make system changes for its licensing program. The Department of Social Services is currently in the process of developing regulations and processes for licensing short-term residential therapeutic programs. The Department indicates that the regulations that would be necessary under this bill can be developed as part of the larger regulation development process underway, at minimal additional cost.
- Unknown potential additional licensing costs to the Department of Social Services (General Fund). The Department indicates that it is likely the additional workload to license short-term therapeutic programs operated as children’s crisis residential programs would not substantially increase the licensing costs that are anticipated to license short-term residential therapeutic programs. However, to the extent that this bill results in additional facilities seeking licensure specifically to operate as a children’s crisis residential program, there would be additional licensing workload. Whether that would actually occur is unknown.
- Ongoing costs of $590,000 in 2018-19 and $550,000 per year thereafter for the Department of Health Care Services to develop regulations, file a state plan amendment, certify children’s crisis residential programs, and take any necessary enforcement actions (General Fund and federal funds).
- Unknown increase in Medi-Cal costs due to increased utilization of children’s crisis residential program services (General Fund, local funds, and federal funds). The intention of the bill is to provide services to children in children’s crisis residential programs, rather than in psychiatric hospitals or general acute care hospitals. In those cases, there would likely be cost savings to Medi-Cal, since the reimbursement rates for crisis residential services will be lower than inpatient hospital rates. However, there is a consensus that there is a significant shortage in available psychiatric beds for children in the state. There is likely to be a significant unmet need for psychiatric inpatient services. Therefore, some of the utilization of children’s crisis residential care will be in addition to those services currently being provided in hospitals, rather than a substitution for services already being provided. The size of this impact is unknown.
- No significant state costs to reimburse county mental health plans for administrative costs are anticipated. Under the bill, county mental health plans could be delegated the authority to certify children’s crisis residential programs (rather than the Department of Health Care Services). However, this responsibility is not mandatory on the counties. Similarly, county mental health plans are not obligated under the bill to contract with children’s crisis residential programs.
Committee Amendments:
clarify that the Department of Social Services may not waive statutory licensure requirements.
-- END --
SENATE COMMITTEE ON
Senator Ricardo Lara, Chair
2017 - 2018 Regular Session
AB 501 (Ridley-Thomas) - Mental health: community care facilities
Version: | Policy Vote: |
Urgency: | Mandate: |
Hearing Date: | Consultant: |
This bill meets the criteria for referral to the Suspense File.
Bill Summary:
AB 501 would allow a short-term residential therapeutic program to be operated as a children’s crisis residential mental health program, with specified regulatory requirements.
Fiscal Impact:
- Minor costs for the Department of Social Services to develop regulations and make system changes for its licensing program. The Department of Social Services is currently in the process of developing regulations and processes for licensing short-term residential therapeutic programs. The Department indicates that the regulations that would be necessary under this bill can be developed as part of the larger regulation development process underway, at minimal additional cost.
- Unknown potential additional licensing costs to the Department of Social Services (General Fund). The Department indicates that it is likely the additional workload to license short-term therapeutic programs operated as children’s crisis residential programs would not substantially increase the licensing costs that are anticipated to license short-term residential therapeutic programs. However, to the extent that this bill results in additional facilities seeking licensure specifically to operate as a children’s crisis residential program, there would be additional licensing workload. Whether that would actually occur is unknown.
- Ongoing costs of $590,000 in 2018-19 and $550,000 per year thereafter for the Department of Health Care Services to develop regulations, file a state plan amendment, certify children’s crisis residential programs, and take any necessary enforcement actions (General Fund and federal funds).
- Unknown increase in Medi-Cal costs due to increased utilization of children’s crisis residential program services (General Fund, local funds, and federal funds). The intention of the bill is to provide services to children in children’s crisis residential programs, rather than in psychiatric hospitals or general acute care hospitals. In those cases, there would likely be cost savings to Medi-Cal, since the reimbursement rates for crisis residential services will be lower than inpatient hospital rates. However, there is a consensus that there is a significant shortage in available psychiatric beds for children in the state. There is likely to be a significant unmet need for psychiatric inpatient services. Therefore, some of the utilization of children’s crisis residential care will be in addition to those services currently being provided in hospitals, rather than a substitution for services already being provided. The size of this impact is unknown.
- No significant state costs to reimburse county mental health plans for administrative costs are anticipated. Under the bill, county mental health plans could be delegated the authority to certify children’s crisis residential programs (rather than the Department of Health Care Services). However, this responsibility is not mandatory on the counties. Similarly, county mental health plans are not obligated under the bill to contract with children’s crisis residential programs.
Background:
Under current law (AB 403, Stone, Statutes of 2015), the state is implementing what is referred to as the continuum of care reform effort. The purpose of this effort is to reform the system for providing residential services to foster youth, particularly those with mental health issues. Under the reform, the state is phasing out group homes for foster youth, and replacing them with short-term residential therapeutic programs. While mental health services are intended to be part of the services offered by short-term residential therapeutic programs, those facilities are not intended to be used as an alternative to inpatient psychiatric care (as are adult crisis residential centers).
Proposed Law:
AB 501 would allow a short-term residential therapeutic program to be operated as a children’s crisis residential program, with specified regulatory requirements.
Specific provisions of the bill would:
- Authorize a short term residential therapeutic program to operate as a children’s crisis residential mental health program;
- Require a children’s crisis residential program to be licensed by the Department of Social Services and to be approved by the Department of Health Care Services or a county mental health plan to operate as a children’s crisis residential mental health program, as an alternative to psychiatric hospitalization;
- Specify the licensing and regulatory requirements on a short-term residential therapeutic program operating as a children’s crisis residential program;
- Require the Department of Social Services to establish regulations, with specified requirements;
- Make children’s crisis residential programs eligible for specified funding approved in the 2016 Budget Act;
- Specify the criteria for admission of a child to a children’s crisis residential program;
- Require the Department of Health Care Services, in consultation with specified entities, to establish program standards for approving children’s crisis residential mental health programs and to provide guidance to counties for the provision of children’s crisis residential services;
- Specify requirements and limitations on the use of children’s crisis residential programs;
- Generally make implementation of the bill contingent upon an appropriation in the annual Budget Act;
- Require the adoption of regulations under the bill no later than July 1, 2021, but allow the bill to be implemented without adopting regulations until regulations are adopted;
- Make implementation of the bill contingent on obtaining federal approval and the availability of federal financial participation.
Related Legislation:
AB 741 (Williams, 2016) was substantially similar to this bill. That bill was vetoed by Governor Brown.
Staff Comments:
The author and sponsors have been working with the Administration to address the issues raised by the Governor in vetoing AB 741.
This bill provides that implementation by the Department of Social Services and the Department of Health Care Services would be contingent upon an appropriation in the annual budget act. No funding for the purposes of this bill was included in the 2017 Budget Act. Therefore, implementation of the bill would not begin until at least July 1, 2018 (assuming that funding was provided in next year’s budget act.).
Proposition 30 of 2012 provides that any legislation enacted after September 30, 2012 that has an overall effect of increasing the costs already borne by a local agency for realigned services applies to local agencies only to the extent that the State provides annual funding for the cost increase. Local agencies are not be obligated to provide programs or levels of service required by legislation above the level for which funding has been provided.
The provisions of specialty mental health services in the Medi-Cal program has been realigned to the counties. Therefore, to the extent to which there is increased utilization of Medi-Cal specialty mental health services (for example due to increased utilization of services, as noted above), counties would only be responsible for providing those services to the extent funding was provided. However, it is not clear how this requirement would work in practice with this bill. Medi-Cal mental health services are a state and federal entitlement and licensure and approval of short-term residential therapeutic programs operating as a children’s crisis residential program is a state responsibility. Practically speaking, it is not clear how a county could avoid incurring additional costs under the bill, if the state did not provide additional funding.
The only costs that may be incurred by a local agency relate to crimes and infractions. Under the California Constitution, such costs are not reimbursable by the state.
-- END --
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: AB 501
AUTHOR: | Ridley-Thomas | ||
VERSION: | July 5, 2017 | ||
HEARING DATE: | July 12, 2017 | ||
CONSULTANT: | Scott Bain | ||
SUBJECT: Mental health: community care facilities
SUMMARY:
Permits the Department of Social Services (DSS) to license a short-term residential therapeutic program operating as a children’s crisis residential program, defined as a facility licensed as a short-term residential treatment program to serve children experiencing mental health crises as an alternative to psychiatric hospitalization. Establishes requirements for a children’s crisis residential program, and for DSS the Department of Health Care Services in implementing this bill.
Existing law:
- Requires, under the California Community Care Facilities Act, the licensing and regulation of community care facilities, as defined, by the DSS.
- Defines a community care facility to include a short-term residential treatment program (STRTP). Defines a STRTP as a residential facility operated by a public agency or private non-profit organization and licensed by DSS that provides an integrated program of specialized and intensive care and supervision, services and supports, treatment, and short-term, 24-hour care and supervision to children.
- Requires the care and supervision provided by a STRTP to be non-medical, except as otherwise permitted by law.
- Establishes the Medi-Cal program, administered by the Department of Health Care Services (DHCS), under which qualified low-income individuals receive health care services.
- Establishes a schedule of benefits under the Medi-Cal program, which includes Early, Periodic Screening, Diagnostic and Treatment Services (EPSDT) for any individual under 21 years of age, consistent with federal Medicaid requirements. EPSDT includes screening, vision, hearing and dental services and other necessary health care, diagnostic services, treatment, and other measures described in federal Medicaid law to correct or ameliorate defects and physical and mental illnesses and conditions discovered by the screening services, whether or not such services are covered under the State’s Medicaid Plan.
- Requires county mental health plans to provide specialty mental health services to eligible Medi-Cal beneficiaries, including both adults and children. Includes EPSDT within the scope of specialty mental health services for eligible Medi-Cal beneficiaries under the age of 21.
This bill:
- Permits DSS to license a STRTP operating as a children’s crisis residential program. Defines a “children’s crisis residential program” as a facility licensed by DSS as a STRTP and approved by DHCS, or a county mental health plan to which DSS has delegated approval authority, to operate a children’s crisis residential mental health program to serve children experiencing mental health crises as an alternative to psychiatric hospitalization.
- Requires a children’s crisis residential program to meet all of the following requirements:
- To have an identifiable and physically separate unit for those children who are experiencing mental health crises, if the program serves children who are not experiencing a mental health crisis. Requires the separate unit to be indicated on the short-term residential therapeutic program’s license;
- Obtain and have in good standing a mental health program approval that includes a Medi-Cal mental health certification, and a children’s crisis residential mental health program approval, issued by DHCS, or a county mental health plan to which DSS has delegated approval authority;
- To obtain a mental health program approval before operating as a children’s crisis residential program; and,
- Comply with all applicable licensing standards for a short-term residential therapeutic program, unless otherwise specified by DSS in regulations.
- Permits DSS to revoke a program’s license for a program’s failure to maintain the mental health program approval.
- Requires DSS, contingent upon an appropriation in the annual Budget Act for these purposes, to begin implementation of the above requirements no later than July 1, 2018, and to commence the licensing process for children’s crisis residential programs no later than January 1, 2019.
- Requires DSS to establish regulations for short-term residential therapeutic programs that are operated as children’s crisis residential programs. Requires, at a minimum, the regulations to include all of the following:
- Requires therapeutic programming to be provided seven days a week, including weekends and holidays, with sufficient professional and paraprofessional staff to maintain an appropriate treatment setting and services, based on individual children’s needs;
- Requires the program to be staffed with sufficient personnel to accept children 24 hours per day, seven days a week and to admit children, at a minimum, from 7 a.m. to 11 p.m., seven days a week, 365 days per year;
- Requires the program to be sufficiently staffed to discharge children, as appropriate, seven days a week, 365 days per year;
- Requires facilities to be limited to fewer than 16 beds, with at least 50% of those beds in single-occupancy rooms;
- Requires facilities to include ample physical space for accommodating individuals who provide daily emotional and physical supports to each child and for integrating family members into the day-to-day care of the youth;
- Requires the program to collaborate with each child’s existing mental health team, if applicable, child and family team, if applicable, and other formal and natural supports within 24 hours of intake and throughout the course of care and treatment as appropriate; and,
- Requires the program to create and assist with the implementation of a plan for transitioning each admitted child from the program to his or her home and community, including the establishment of a mental health or child and family team if there is not one already.
- Requires the program to annually provide DSS with all of the following data as it pertains to children in foster care and children not in foster care in conjunction with its application for licensure renewal:
- Age and gender of clients served;
- Duration of stay;
- Professional classification of staff and contracted staff; and,
- Type of placement the client was discharged to.
- Permits a STRTP to be operated as a children’s crisis residential program.
- Permits a STRTP that is operating as a children’s crisis residential program to accept for admission any child who meets all of the following requirements:
- The child is referred by a parent or guardian, physician, or licensed mental health professional, or by the representative of a public or private entity, including, but not limited to, the county probation agency or child welfare services agency with responsibility for the placement of a child in foster care, that has the right to make these decisions on behalf of a child who is in mental health crisis;
- The child is under 19, 20, or 21 years of age, depending on a program’s licensing requirements;
- The child has a serious behavioral health disorder;
- The child requires a 24-hour-a-day, seven-day-a-week, staff-secured, unlocked treatment setting; and,
- The primary function of a children’s crisis residential program is to provide short-term crisis stabilization, therapeutic intervention, and specialized programming in an unlocked, staff-secured setting with a high degree of supervision and structure and the goal of supporting the rapid and successful transition of the child back to the community.
- Clarifies that children’s crisis residential treatment homes are eligible for funding under the Investment in Mental Health Wellness Act of 2013.
- Requires DHCS, in consultation with the Department of Managed Health Care, DSS, the County Behavioral Health Directors Association of California (CBHDA), the County Welfare Directors Association of California, the Chief Probation Officers of California, provider representatives, and other relevant stakeholders, to establish program standards and procedures for oversight, enforcement, and issuance of children’s crisis residential mental health program approvals, including provisional approvals that are effective for a period of less than one year.
- Requires DHSC to also establish due process protections related to the children’s crisis residential mental health program approval process.
- Requires DHCS, in collaboration with DSS, CBHDA, provider representatives, and other relevant stakeholders, to provide guidance to counties for the provision of children’s crisis residential services, including funding for children who are Medi-Cal beneficiaries and who are admitted to a children’s crisis residential program. Requires this provision to only be implemented to the extent that any necessary federal approvals are obtained and federal financial participation (FFP) is available and is not otherwise jeopardized.
- Requires the children’s crisis residential program to be used only as a diversion to admittance to a psychiatric hospital.
- Limits the length of the initial authorization for admission to a children’s crisis residential program to ten consecutive days.
- Limits the existing certification requirements, which require an STRTP to obtain a certification to provide Medi-Cal specialty mental health services issued by the DHCS or a county mental health plan, to only those STRTPs that admit Medi-Cal beneficiaries.
- Requires, if a determination is made by a health care professional that a children’s crisis residential program is medically necessary and is the appropriate continued level of care, either of the following to occur:
- Requires the children’s crisis residential program to notify the county mental health plan authorizing those services before extending the length of stay beyond 10 consecutive days, in the case of a Medi-Cal beneficiary; or,
- Requires reauthorizations for admission to be obtained using the process established by the entity providing coverage, in the case of non-Medi-Cal beneficiaries.
- Requires the Medi-Cal beneficiary provision in 16a) above to be implemented only to the extent that any necessary federal approvals are obtained and DHCS determines, in its sole discretion, that federal financial participation (FFP) is not jeopardized.
- Requires a children’s crisis residential mental health program approval issued by DHCS, or a county mental health plan to which DSS has delegated approval authority, to be a condition of continued licensure for a STRTP operating as a children’s crisis residential program.
- Permits an emergency placement in a children’s crisis residential program if a licensed mental health professional has made a written determination within 72 hours of the child’s or youth’s placement, that the child or youth requires the level of services and supervision provided by the short-term residential therapeutic program in order to meet his or her behavioral or therapeutic needs, or has made a written determination within 24 hours of the child’s or youth’s placement in a children’s crisis residential program that the child or youth is experiencing a mental health crisis and is in need of the care and services provided by the children’s crisis residential program.
- Permits DHCS, or a county mental health plan to which DSS has delegated approval authority, to enforce the children’s crisis residential mental health program approval standards by taking any of the following actions against a non-compliant children’s crisis residential program:
- Suspend or revoke a children’s crisis residential mental health program approval;
- Impose monetary penalties;
- Place a children’s crisis residential mental health program on probation; or,
- Require a children’s crisis residential mental health program to prepare and comply with a corrective action plan.
- Requires DHCS, or a county mental health plan to which the DSS has delegated approval authority, to provide a children’s crisis residential mental health program with due process protections when taking any of the above enforcement actions.
- Requires DSS, contingent upon an appropriation in the annual Budget Act for these purposes, to begin implementation of the above requirements no later than July 1, 2018, and to commence the operation of the approval process for children’s crisis residential mental health program approvals no later than January 1, 2019.
- Requires DHCS and DSS, contingent upon an appropriation from the annual Budget Act for these purposes, to adopt regulations to implement this bill. Permits DSS and DHCS to implement and administer the changes made by this bill through information notices, all-county letters, or similar written instructions until regulations are adopted.
- Requires the above described change to become effective upon appropriation of funds by the Legislature for the purposes described in this bill.
- Requires the provisions amended or added by this bill to be implemented only if, and to the extent that, Medicaid FFP is not jeopardized and all necessary federal approvals have been obtained.
FISCAL EFFECT:
According to the Assembly Appropriations Committee:
- Administrative costs to DSS are expected to be minor and absorbable.
- Administrative costs to DHCS, to develop a rate and to approve programs, estimated in the range of $200,000 General Fund (GF/federal) for the first year and potentially less in future years.
- The impact on Medi-Cal spending is uncertain. Utilization of the children's crisis residential services should increase (local/federal). However, the intention of the bill is to provide services to children in children's crisis residential centers, rather than in psychiatric hospitals or general acute care hospitals. In those cases, there could be Medi-Cal cost savings, since the reimbursement rates for crisis residential services will be lower than inpatient hospital rates.
PRIOR VOTES:
Assembly Floor: | 75 - 0 |
Assembly Appropriations Committee: | 17 - 0 |
Assembly Health Committee: | 15 - 0 |
COMMENTS:
- Author’s statement. According to the author, not every child in mental health crisis needs to be hospitalized, yet that is the only alternative available in California if a child temporarily cannot be safely treated at home. Alternatives to inpatient hospitalization are essential to both children experiencing a mental health crisis and their families. What a child needs is a calming and therapeutic place near home where she or he can receive treatment to work through the crisis. Community-based residential mental health crisis programs can provide just that. The primary goal of these services is to stabilize and improve psychological symptoms of distress and to engage individuals in an appropriate treatment service to address the problem that led to the crisis. These services are provided in a residential home-like setting that offers the optimum environment for a child to obtain essential therapeutic help.
- Background. In January 2015, DSS published the “California’s Child Welfare Continuum of Care Reform” report after a three-year workgroup process. The working group and report were required by budget trailer bill (SB 1013, Chapter 25, Statutes of 2012), which mandated the workgroup consider, at a minimum, reforms to programs provided by Foster Family Agencies (FFAs) and group homes, and how to ensure the provision of services in family-like settings, including after care services, when appropriate. The report emphasized home-based family care placements of children and changing the goals of congregate care placements. “Children should live in their communities in home-based family care settings,” the report noted. It also emphasized that underpinning the change in service delivery is the belief that “all children, including those in out-of-home care, deserve to grow up in families and develop a sense of community.”
AB 403 (Stone, Chapter 773, Statutes of 2015), codified the continuum of care reform effort by eliminating group homes and creating a new licensure category known as short-term residential treatment centers (now known as STRTPs). STRTPs that operate a mental health program that serves children who have either been assessed as meeting the medical necessity criteria for Medi-Cal specialty mental health services under EPSDT or who have been assessed as seriously emotionally disturbed must obtain and have in good standing a mental health certification. STRTPs must accept for placement children who do not required inpatient care in a licensed health facility but who have been assessed as requiring the level of services provided in a STRTP in order to maintain the safety and well-being of the child or others due to behaviors, including those resulting from traumas, that render the child or those around the child unsafe or at risk of harm, or that prevent the effective delivery of needed services and supports provided in the child’s own home or in other family settings. In addition, a child must meet at least one of the following conditions: - The child has been assessed as meeting the medical necessity criteria for Medi-Cal specialty mental health EPSDT;
- The child has been assessed as seriously emotionally disturbed; or,
- The child has been assessed as requiring the level of services provided in order to meet his or her behavioral or therapeutic needs, which can include, in appropriate circumstances, a commercially sexually exploited child, a private voluntary placement (if the youth exhibits status offender behavior, the parents or other relatives feel they cannot control the child’s behavior, and short-term intervention is needed to transition the child back into the home), a juvenile sex offender or a child who is affiliated with, or impacted by, a gang.
- Prevalence of mental illness in children and crisis diversion programs. Approximately 20% of youth between the ages of 13 and 18 live with a mental health condition, according to statistics compiled by the National Alliance on Mental Illness (NAMI). About 70% of the youth in juvenile justice systems have at least one mental health condition and 20% are living with serious mental illness. NAMI reports that almost half of children aged eight to 15 who were diagnosed with a mental illness received no mental health services in the prior year. Foster youth experience a heightened rate of mental illness, compared to their peers, according to various studies.
Aside from emergency hospitalization, California has few crisis diversion programs for adolescents and few options for children in a mental health crisis. A 2015 paper published by six mental health advocacy organizations said the lack of crisis options for children and teens results in untreated mental health issues, which worsen over time. The paper, “Kids in Crisis: California’s Failure to Provide Appropriate services for Youth Experiencing a Mental Health Crisis,” described California’s system as inconsistent statewide with many families turning to local hospital emergency rooms for help. The paper, which was published by a workgroup led by California Council of Community Mental Health Agencies, advocated for the creation of community-based crisis facilities for children and youth, stating: “The emergency room should be the last resort for a child in crisis, yet in our current system, this is where children are first being identified.”
- Double referral. This bill was heard in the Senate Human Services Committee on June 27, 2017 and passed with a 5-0 vote.
- Prior legislation. AB 741 (Williams) was similar to this bill in that it would have allowed a short-term residential treatment center to be operated as a children’s crisis residential center as defined, which would be operated specifically to divert children experiencing a mental health crisis from psychiatric hospitalization. AB 741 would have required DHCS to establish Medi-Cal rates as needed that are sufficient to reimburse the costs for children’s crisis residential services in excess of any specialty mental health services that would have been otherwise authorized, provided, and invoiced for each eligible Medi-Cal beneficiary receiving children’s crisis residential services.
AB 741 was vetoed by Governor Brown, who stated the licensing category proposed by AB 741 limits the length of treatment stays and the size of the centers, and these restrictions are not consistent with federal rules and put funding in jeopardy. Governor Brown directed DSS and DHCS to work with county behavioral health directors and children's advocates to develop a more viable licensing category in recognition that there is an acute shortage of residential programs that provide crisis mental health treatment for children and teens.
AB 1997 (Stone, Chapter 612, Statutes of 2016) was a clean-up bill to AB 403 that included modifications to the licensure and certification of STRTCs.
SB 1013 (Committee on Budget and Fiscal Review, Chapter 35, Statutes of 2012) called for DSS to establish a working group to develop recommended revisions to the current rate-setting system, resulting in the Continuum of Care Reform effort.
SB 82 (Committee on Budget and Fiscal Review, Chapter 34, Statutes of 2013) established the Investment in Mental Health Wellness Act of 2013, which authorized the California Health Facilities Financing Authority to administer a local grant program to increase capacity for crisis support programs.
- Support. This bill is sponsored by the California Alliance of Child and Family Services (the Alliance), which is a statewide association of accredited private non-profit organizations providing care, services, treatment and support to vulnerable children, youth and families. The Alliance writes this bill addresses a critical component missing from the continuum of specialty mental health services for children and youth in California - children’s crisis residential services. The Alliance states this legislation would create the needed licensing category to ensure that county mental health plans, commercial insurance companies, and their community-based providers can develop mental health crisis residential programs within an appropriate licensing category and ensure children and youth can access mental health services that are responsive to their individual needs and strengths in a timely manner. The Alliance argues the creation of the licensing category is consistent with Medi-Cal EPSDT Specialty Mental Health Services program standards and requirements, and this bill will fill a gap in regulations which prevent California from fully complying with the EPSDT SMHS entitlement for children and youth. The Alliance states there is no question that a full continuum of crisis care for children and youth with urgent mental health needs is vital, and the lack of a licensing component for crisis residential services is preventing the development of these much needed programs. The Alliance concludes crisis residential services offer an alternative for children who in the short term cannot be safely treated in the community but do not require an inpatient level of care.
- Policy issues.
- No due date for required regulations. This bill requires DHCS and DSS, contingent upon an appropriation, to adopt regulations to implement this bill, but does not specify a date which regulations must be adopted. The required regulations contain several important policy provisions related to the children’s crisis residential programs, including the level and type of staffing and monetary penalties for noncompliance. Without a date, this bill would permit DSS and DHCS to implement and administer the changes made by this bill through information notices, all-county letters, or similar written instructions indefinitely until regulations are adopted.
- Professional staff of children’s crisis residential programs. This bill requires therapeutic programming to be provided seven days a week, including weekends and holidays, with sufficient professional and paraprofessional staff to maintain an appropriate treatment setting and services, based on individual children’s needs. Staff recommends an amendment to clarify that the professional staff are “mental health” professional staff.
SUPPORT AND OPPOSITION:
Support: California Alliance of Child and Family Services (sponsor)
5 Acres
Alameda County Board of Supervisors
Aspiranet
Aviva Family & Children’s Services
Bill Wilson Center
California Council of Community Behavioral Health Agencies
California Mental Health Advocates for Children and Youth (CMHACY)
California Psychological Association
California State Association of Counties
California Youth Empowerment Network
Casa Pacifica Centers for Children and Families
Chief Probation Officers of California
Children Now
Children’s Institute, Inc.
Common Sense Kids Action
County Behavioral Health Directors Association
County Welfare Directors Association of California
Crittenton
David & Margaret Youth and Family Services
Didi Hirsch
East Bay Children’s Law Office
Families Now
Family Care Network, Inc.
Fred Finch Youth Centers
Hathaway-Sycamores Child & Family Services
Hillsides
Humboldt County Transition Age Youth Collaboration
John Burton Advocates for Youth
Junior Blind of America
Lincoln
LIUNA Locals 777 & 792
Maryvale
Mental Health America of California
Milestone House
NAMI California
National Association of Social Workers
NorCal Mental Health America
Pacific Clinics
Redwood Community Services
Redwood Quality Management Company
San Diego Center for Children
Seneca Family of Agencies
Sierra Vista Child and Family Services
Stanford Youth Solutions
Stars Behavioral Health Group (SBHG)
Statewide Taskforce on Accessing Health Services for California Children in Foster Care
Steinberg Institute
Sunny Hills Services
Tessie Cleveland Community Services Corp.
The California Chapter of the American College of Emergency Physicians
The Steinfirst Group
Uplift Family Services
Ventura County Board of Supervisors
Vista Del Mar
WestCoast Children’s Clinic
Young Minds Advocacy
Oppose: None received
SENATE COMMITTEE ON HUMAN SERVICES
Senator Wiener, Chair
2017 - 2018 Regular
Bill No: AB 501
Author: | Ridley-Thomas | ||
Version: | April 6, 2017 | Hearing Date: | June 27, 2017 |
Urgency: | No | Fiscal: | Yes |
Consultant: | Mareva Brown | ||
Subject: Mental health: community care facilities
SUMMARY
This bill authorizes the California Department of Social Services (CDSS) to license a short-term residential therapeutic program as a children’s crisis residential program, as defined, and to provide care for children who have serious behavioral health disorders, among other conditions. It requires the state Department of Health Care Services (DHCS) to establish Medi-Cal rates for children’s crisis residential services, and permits placement into a crisis center by either a parent, or by the representative of a public or private entity who is authorized to make decisions on behalf of the child. The bill makes related changes to statute.
ABSTRACT
Existing law:
- Establishes a system of juvenile dependency for children who are or are at risk of being physically, sexually or emotionally abused, being neglected or being exploited to ensure their safety, protection and physical and emotional well-being. (WIC 300, et seq.)
- Requires CDSS and county welfare departments, to establish and support a public system of child welfare services to protect and promote the welfare of children. (WIC 10600 and 16500)
- Establishes California’s Medicaid program, Medi-Cal, though which eligible low-income individuals receive health care and mental health services, including foster youth, eligible recipients of the Adoption Assistance Program, and Kin-Gap. Under Medi-Cal, establishes the federal Early and Periodic Screening, Diagnosis and Treatment (EPSDT) program to provide comprehensive and preventive health services including specialty mental health services to Medi-Cal beneficiaries under the age of 21. (WIC 14000 et seq., 42 USC Section 1396 et seq. and 42 CFR 435.145.)
- Requires county mental health departments to provide children served by county social services and probation departments, who meet the definition of medical necessity, with mental health screening, assessment, participation in multidisciplinary placement teams and specialty mental health treatment. (WIC 5867.5)
- Establishes a system of licensure and oversight for community care facilities, including short-term residential therapeutic programs (STRTPs), designed to provide rehabilitation and therapy for youth in foster care or other systems, as specified. (HSC 1502)
- Defines an STRTP to mean a CDSS-licensed residential facility operated by a public agency or private, nonprofit organization that provides an integrated program of specialized and intensive care and supervision, services and supports, treatment, and short-term, 24-hour care and supervision to children. The care and supervision provided by a short-term residential therapeutic program shall be nonmedical, except as otherwise permitted by law. (HSC 1502 (a)(18))
- Establishes the Investment in Mental Health Wellness Act of 2013 to expand access to early intervention and treatment services, expand the continuum of services to address crisis intervention and crisis residential treatment needs, and add targeted supports to the community mental health system. Includes in the list of identified needs a complete continuum of crisis services for children and youth 21 years of age and under and the reduction of unnecessary hospitalizations and inpatient days by appropriately utilizing community-based services, among other goals. (WIC 5848.5 (b))
- Requires an STRTP to obtain a contract with a county mental health plan to provide specialty mental health services, as specified, no later than 12 months from the date of initial licensure and to be able to meet the therapeutic needs of each child, as defined. (WIC 11462.01)
- Permits emergency placement into an STRTP providing that the interagency placement committee makes a determination within 72 hours of the placement that the child requires the level of services of an STRTP. (WIC 11462.01 (i)(3))
This bill:
- Makes a series of Legislative findings and declarations about the urgent need to provide mental health crisis care alternatives to hospitals, the acute need for crisis services for children and youth and the lack of a state licensing category for short-term crisis residential programs for children.
- Permits an STRTP to be operated as a children’s crisis residential program, and defines a “children’s crisis residential program” to mean a facility licensed by CDSS as an STRTP and approved by DHCS or a county mental health plan to operate a children’s crisis residential mental health program approval, as specified, to serve children experiencing mental health crises as an alternative to psychiatric hospitalization.
- Requires a children’s crisis residential program to meet all of the following requirements:
- If the program serves children who are not experiencing mental health crises, have an identifiable and physically separate unit for those children who are experiencing mental health crises. The separate unit shall be indicated on the STRTP’s license.
- Obtain and have in good standing a mental health program approval that includes a Medi-Cal mental health certification and a children’s crisis residential mental health program approval, as defined, both of which are issued by DHCS, or a county mental health plan to which the department has delegated approval authority. The STRTP shall obtain a mental health program approval before operating as a children’s crisis residential program. The department may revoke a program’s license for a program’s failure to maintain the mental health program approval, as specified.
- Comply with all applicable licensing standards for an STRTP, unless otherwise specified by the department in regulations
- Requires DHCS, in collaboration with CDSS, and specified stakeholders to develop a rate for children who are Medi-Cal beneficiaries and who are admitted to a children’s crisis residential program. Permits implementation of the rate only to the extent that federal financial participation is available and necessary federal approvals have been obtained.
- Contingent upon an appropriation in the annual Budget Act requires CDSS to begin implementing this section no later than July 1, 2018, and to begin licensing children’s crisis residential programs no later than January 1, 2019.
- Requires CDSS to establish regulations for STRTPs that are operated as children’s crisis residential programs that include at minimum a requirement that the program be used only for diversion from admittance to a psychiatric hospital, and the following:
- Limit the length of the initial authorization for admission to 10 consecutive days.
- If a determination is made by a health care professional that a children’s crisis residential program is the appropriate continued level of care, the program shall obtain prior approval from the county mental health plan authorizing those services before extending the length of stay for a Medi-Cal beneficiary beyond 10 consecutive days. In the case of beneficiaries of private insurance, reauthorizations for admission shall be obtained using the process established by the individual plans.
- Therapeutic programming shall be provided seven days a week, including weekends and holidays, with sufficient professional and paraprofessional staff to maintain an appropriate treatment setting and services, based on individual children’s needs.
- The program shall be staffed with sufficient personnel to accept children 24 hours per day, seven days a week and to admit children, at a minimum, from 7 a.m. to 11 p.m., seven days a week, 365 days per year. The program shall be sufficiently staffed to discharge children, as appropriate, seven days a week, 365 days per year.
- Facilities shall be limited to fewer than 16 beds, with at least 50 percent of those beds in single-occupancy rooms.
- Facilities shall include ample physical space for accommodating individuals who provide daily emotional and physical supports to each child and for integrating family members into the day-to-day care of the youth.
- The program shall collaborate with each child’s existing mental health or child and family teams, if applicable, and other formal and natural supports within 24 hours of intake and throughout the course of care and treatment as appropriate.
- The program shall create and assist with the implementation of a plan for transitioning each admitted child from the program to his or her home and community, including establishing a mental health or child and family team if there is not one already.
- Requires each children’s crisis residential home in conjunction with its application for licensure renewal to annually provide CDSS with all of the following data about children in foster care and children not in foster care: The age and gender of clients served, duration of stay, professional classification of staff and contracted staff and the type of discharge placement for each client.
- Includes children’s crisis residential programs among the programs eligible for grant funding under the Investment in Mental Health Wellness Act of 2013, as specified.
- Authorizes the creation of STRTPs for the exclusive use of private insurance plans and makes related changes.
- Permits an STRTP operating as a children’s crisis residential program to accept any child for admission who meets the following requirements:
- The child is referred by a parent or guardian, or by the representative of a public or private entity, including, but not limited to, the county probation agency or child welfare services agency with responsibility for the placement of a child in foster care, that has the right to make these decisions on behalf of a child who is in mental health crisis.
- The child’s age falls within the program’s licensing requirements.
- The child has a serious behavioral health disorder.
- The child requires a 24-hour-a-day, seven-day-a-week, staff-secured, unlocked treatment setting.
- Permits an emergency placement into a children’s crisis residential program but requires a licensed mental health professional to make a written determination within 24 hours of placement that the child or youth is experiencing a mental health crisis, as defined, and is in need of the care and services provided by the children’s crisis residential program.
- Requires DHCS in consultation with CDSS and other identified stakeholders to establish program standards and procedures for oversight, enforcement, and issuance of children’s crisis residential mental health program approvals, including provisional approvals that are effective for a period of less than one year. Requires DHCS to also establish due process protections related to the program approval process.
- Requires that a children’s crisis residential program maintain its mental health program approval, issued by DHCS or a county mental health plan, as a condition of ongoing licensure by CDSS.
- Authorizes DHCS or a county mental health plan to enforce the children’s crisis residential mental health program approval standards against a noncompliant children’s crisis residential program by suspending or revoking a mental health program approval, imposing monetary penalties, placing a program on probation or requiring a program to prepare and comply with a corrective action plan. Requires the enforcing agency to provide a children’s crisis residential mental health program with due process protections in the event of enforcement action.
- Permits implementation of the bill through information notices, all-county letters or similar written instructions until regulations are adopted.
- Makes implementation of the bill effective only upon appropriation of funds by the Legislature.
FISCAL IMPACT
An analysis by the Assembly Appropriations Committee identified minor and absorbable administrative costs to CDSS, and approximately $200,000 in administrative costs to DHCS to develop a rate and to approve programs for the first year and potentially less in future years. The analysis noted that the impact on Medi-Cal spending is uncertain. Utilization of the children’s crisis residential services should increase (local/federal). However, the intention of the bill is to provide services to children in children’s crisis residential centers, rather than in psychiatric hospitals or general acute care hospitals. In those cases, there could be Medi-Cal savings, since the reimbursement rates for crisis residential services will be lower than inpatient hospital rates.
BACKGROUND AND DISCUSSION
Purpose of the bill:
According to the author, an estimated three of every four children in the United States who need mental health services do not receive them, and nearly 20 percent of high school students in California consider suicide at some point in their lives. The author also states there is an acute shortage of mental health crisis beds in California, which this bill seeks to address. “Currently,” the author states, “there is no licensing category specific to children’s crisis residential services. The crisis care licensing category currently in existence is limited to individuals aged 18 and older and the services provided under that licensing category do not meet the unique needs of children and families.” As a result, the author states, crisis services which would be used in lieu of inpatient psychiatric care are missing from the continuum of care.
Background
The child welfare system oversees care of some 61,000 children in California who were removed from their homes because of allegations of abuse, neglect or exploitation, according to data produced by UC Berkeley’s Child Welfare Indicators website. If a court determines that staying at home is not in the best interest of the child, the child welfare agency arranges for and monitors temporary or permanent placement of the child in the safest and least-restrictive environment possible. Often children are placed with relatives, non-related extended family members (NREFM), or foster parents.
Continuum of Care Reform (CCR) effort
In January 2015, CDSS published the “California’s Child Welfare Continuum of Care Reform” report after a three-year workgroup process. The working group and report were required by budget trailer bill (SB 1013, Chapter 25, Statutes of 2012), which mandated the workgroup consider, at a minimum, reforms to programs provided by Foster Family Agencies (FFAs) and group homes, and how to ensure the provision of services in family-like settings, including after care services, when appropriate.
The report emphasized home-based family care placements of children and changing the goals of congregate care placements. “Children should live in their communities in home-based family care settings,” the report noted. It also emphasized that underpinning the change in service delivery is the belief that “all children, including those in out-of-home care, deserve to grow up in families and develop a sense of community.”[1]
One key element of the CCR effort was the elimination of foster care group homes and the creation of a new STRTP licensure category, effective January 1, 2017. All STRTPs are required to have national accreditation from an entity identified by CDSS, a mental health approval and Medi-Cal certification from the county to provide treatment. This bill creates the new children’s crisis home model within the STRTP.
Children’s mental health
Approximately 20 percent of youth between the ages of 13 and 18 live with a mental health condition, according to statistics compiled by the National Alliance on Mental Illness.[2] About 70 percent of the youth in juvenile justice systems have at least one mental health condition and 20 percent are living with serious mental illness. NAMI reports that almost half of children aged 8 to 15 who were diagnosed with a mental illness received no mental health services in the prior year.
Foster youth experience a heightened rate of mental illness, compared to their peers, according to various studies. An American Psychological Association report[3] noted that nearly half (47.9 percent) of youth in foster care were found to have clinically significant emotional or behavioral problems, and more than half of children entering foster care exhibited behavioral or social competency problems that warranted mental health services. In addition to the high rate of mental health problems, children under age seven who enter foster care show high rates of developmental problems, the report found.
Capacity crisis
Aside from emergency hospitalization, California has few crisis diversion programs for adolescents and few options for children in a mental health crisis. A 2015 paper published by six mental health advocacy organizations said the lack of crisis options for children and teens results in untreated mental health issues, which worsen over time. The paper, “Kids in Crisis: California’s Failure to Provide Appropriate services for Youth Experiencing a Mental Health Crisis,” described California’s system as inconsistent statewide with many families turning to local hospital emergency rooms for help. The paper, which was published by a workgroup led by California Council of Community Mental Health Agencies, advocated for the creation of community-based crisis facilities for children and youth. “The emergency room should be the last resort for a child in crisis, yet in our current system, this is where children are first being identified,” the report noted.
The report identified a decrease in the statewide availability of inpatient psychiatric hospital beds for children, and ongoing challenges to find community-based mental health care for children. “While there are existing crisis service programs in California, the availability of these programs is limited in the type of services that are available and vary significantly from one county to another county. For example, a handful of counties may operate children’s mobile crisis teams, but there are no crisis stabilization units or beds within their region. Therefore, inpatient hospitalization is the only option for a youth experiencing a crisis in many areas of the state, and in many instances it is the least effective measure.”
A 2012 study of California hospital emergency rooms[4] indicated that children and adolescents with a primary psychiatric diagnosis waited an average 12.97 hours for psychiatric evaluation and placement – nearly three hours longer than adults in the same situation. Total length of stay for children and teens in crisis was estimated to be in excess of 19 hours. “The extraordinary wait times for patients with mental illness in the emergency department, as well as the lack of resources available to emergency departments for effectively treating and appropriately placing these patients, indicate the existence of a mental health system in California that prevents patients in acute need of psychiatric treatment from getting it at the right time, in the right place,” the study concluded.
Related legislation:
AB 741 (Williams, 2016) was nearly identical to this bill. It was vetoed by the Governor, who acknowledged in his veto message that crisis services are needed for children but suggested the bill was structurally flawed.
AB 403 (Stone, Chapter 773, Statutes of 2015) codified the continuum of care reform effort by eliminating group homes and creating short term residential treatment centers, home-based therapeutic efforts and other reforms.
SB 82 (Committee on Budget and Fiscal Review, Chapter 34, Statutes of 2013) established the Investment in Mental Health Wellness Act of 2013, which authorized the California Health Facilities Financing Authority to administer a local grant program to increase capacity for crisis support programs.
SB 1013 (Committee on Budget and Fiscal Review, Chapter 35, Statutes of 2012), required CDSS to establish a working group to develop recommended revisions to the current rate-setting system, resulting in the Continuum of Care Reform effort.
COMMENTS
In 2016 a substantially similar bill was vetoed by Gov. Brown, with the message, “I recognize there is an acute shortage of residential programs that provide crisis mental health treatment for children and teens. Therefore, I am directing the Departments of Social Services and Health Care Services to work with county behavioral health directors and children's advocates to develop a more viable licensing category.”
In response, the author, sponsor and the Administration met to discuss changes to the language that would merit a signature. This bill includes changes suggested by the Administration, as well as some additional language to set program parameters. The committee amendments below reflect additional technical assistance provided recently by the Administration, including relocating some language to a more appropriate section of statute.
Staff recommends the following amendments:
SEC. 3. Section 1562.02 is added to the Health and Safety Code, to read:
1562.02. (a) The department may license a short-term residential therapeutic program operating as a children’s crisis residential program pursuant to this chapter. A children’s crisis residential program shall meet all of the following requirements:
(1) If the program serves children who are not experiencing mental health crises, have an identifiable and physically separate unit for those children who are experiencing mental health crises. The separate unit shall be indicated on the short-term residential therapeutic program’s license.
(2) Obtain and have in good standing a mental health program approval that includes a Medi-Cal mental health certification, as described in Section 11462.01 of the Welfare and Institutions Code, and a children’s crisis residential mental health program approval, as described in Section 11462.011 of the Welfare and Institutions Code, both of which are issued by the State Department of Health Care Services, or a county mental health plan to which the department has delegated approval authority. The short-term residential therapeutic program shall obtain a mental health program approval before operating as a children’s crisis residential program. The department may revoke a program’s license pursuant to Section 1550 for a program’s failure to maintain the mental health program approval.
(3) Comply with all applicable licensing standards for a short-term residential therapeutic program, unless otherwise specified by the department in regulations.
(b) The State Department of Health Care Services shall, in collaboration with the department, the County Behavioral Health Directors Association of California, provider representatives, and other relevant stakeholders, develop a rate for children who are Medi-Cal beneficiaries and who are admitted to a children’s crisis residential program. This subdivision shall be implemented only to the extent that federal financial participation is available and any necessary federal approvals have been obtained.
(c) (b) Contingent upon an appropriation in the annual Budget Act for these purposes, the department shall begin implementation of this section no later than July 1, 2018, and shall commence the licensing process for children’s crisis residential programs no later than January 1, 2019.
SEC. 4. Section 1562.03 is added to the Health and Safety Code, to read:
1562.03. (a) The department shall establish regulations for short-term residential therapeutic programs that are operated as children’s crisis residential programs. At a minimum, the regulations shall include all of the following:
(1) The children’s crisis residential program shall be used only for diversion from admittance to a psychiatric hospital.
(2) (A) Length of the initial authorization for admission to a children’s crisis residential program shall be limited to 10 consecutive days.
(B) If a determination is made by a health care professional that a children’s crisis residential program is the appropriate continued level of care, the children’s crisis residential program shall obtain prior approval from the county mental health plan authorizing those services before extending the length of stay for a Medi-Cal beneficiary beyond 10 consecutive days. In the case of beneficiaries of private insurance, reauthorizations for admission shall be obtained using the process established by the individual plans.
(3) Therapeutic programming shall be provided seven days a week, including weekends and holidays, with sufficient professional and paraprofessional staff to maintain an appropriate treatment setting and services, based on individual children’s needs.
(4) (2) The program shall be staffed with sufficient personnel to accept children 24 hours per day, seven days a week and to admit children, at a minimum, from 7 a.m. to 11 p.m., seven days a week, 365 days per year. The program shall be sufficiently staffed to discharge children, as appropriate, seven days a week, 365 days per year.
(5) (3)Facilities shall be limited to fewer than 16 beds, with at least 50 percent of those beds in single-occupancy rooms.
(6) (4) Facilities shall include ample physical space for accommodating individuals who provide daily emotional and physical supports to each child and for integrating family members into the day-to-day care of the youth.
(7) (5) The program shall collaborate with each child’s existing mental health team, if applicable, child and family team, if applicable, and other formal and natural supports within 24 hours of intake and throughout the course of care and treatment as appropriate.
(8) (6) The program shall create and assist with the implementation of a plan for transitioning each admitted child from the program to his or her home and community, including the establishment of a mental health or child and family team if there is not one already.
(b) The program shall annually provide the department with all of the following data as it pertains to children in foster care and children not in foster care in conjunction with its application for licensure renewal:
(1) Age and gender of clients served.
(2) Duration of stay.
(3) Professional classification of staff and contracted staff.
(4) Type of placement the client was discharged to.
SEC. 5. Section 5848.5 of the Welfare and Institutions Code is amended to read:
5848.5.
…
(d) Funds appropriated by the Legislature to the authority for purposes of this section shall be made available to selected counties, or counties acting jointly. The authority may, at its discretion, also give consideration to private nonprofit corporations and public agencies in an area or region of the state if a county, or counties acting jointly, affirmatively supports this designation and collaboration in lieu of a county government directly receiving grant funds.
(1) Grant awards made by the authority shall be used to expand local resources for the development, capital, equipment acquisition, and applicable program startup or expansion costs to increase capacity for client assistance and services in the following areas:
(A) Crisis intervention, as authorized by Sections 14021.4, 14680, and 14684.
(B) Crisis stabilization, as authorized by Sections 14021.4, 14680, and 14684.
(C) Crisis residential treatment, as authorized by Sections 14021.4, 14680, and 14684 and as provided at a children’s crisis residential program, as defined in Section 1502 of the Health and Safety Code.
(D) Rehabilitative mental health services, as authorized by Sections 14021.4, 14680, and 14684.
(E) Mobile crisis support teams, including personnel and equipment, such as the purchase of vehicles.
…
SEC. 6. Section 11462.01 of the Welfare and Institutions Code, as added by Section 75 of Chapter 773 of the Statutes of 2015, is amended to read:
11462.01. … (c) (1) A short-term residential therapeutic program that is operating as a children’s crisis residential program, as defined in Section 1502 of the Health and Safety Code, may accept for admission any child who meets all of the following requirements:
(A) The child is referred by a parent or guardian, physician, licensed mental health professional, or by the representative of a public or private entity, including, but not limited to, the county probation agency or child welfare services agency with responsibility for the placement of a child in foster care, that has the right to make these decisions on behalf of a child who is in mental health crisis.
(B) The child is under 19, 20, or 21 years of age, depending on a program’s licensing requirements.
(C) The child has a serious behavioral health disorder.
(D) The child requires a 24-hour-a-day, seven-day-a-week, staff-secured, unlocked treatment setting.
(2) The primary function of a children’s crisis residential program is to provide short-term crisis stabilization, therapeutic intervention, and specialized programming in an unlocked, staff-secured setting with a high degree of supervision and structure and the goal of supporting the rapid and successful transition of the child back to the community.
…
(g) The assessments described in subparagraphs (A), (B), (C), and (D) of paragraph (3) of subdivision (b) shall ensure the child’s individual behavioral or treatment needs are consistent with, and can be met by, the facility and shall be made by one of the following, as applicable:
(1) An interagency placement committee, as described in Section 4096, considering the recommendations from the child and family team, if any are available. If the short-term residential therapeutic program serves children who are placed by county child welfare agencies and children who are placed by probation departments, the interagency placement committee shall also ensure the requirements of subdivision (c) of Section 16514 have been met with respect to commonality of need.
(2) A licensed mental health professional as defined in subdivision (g) of Section 4096.
(3) For the purposes of this section, an AFDC-FC funded child with an individualized education program developed pursuant to Article 2 (commencing with Section 56320) of Chapter 4 of Part 30 of Division 4 of Title 2 of the Education Code that assesses the child as seriously emotionally disturbed, as defined in, and subject to, this section and recommends out-of-home placement at the level of care provided by the provider, shall be deemed to have met the assessment requirement.
(h) The evaluation described in subparagraph (A) of paragraph (3) of subdivision (i) shall be made pursuant to subdivision (b) of Section 706.6 or paragraph (2) of subdivision (c) of Section 16501.1.
(i) (1) The provider shall ensure that AFDC-FC funded children, assessed pursuant to subparagraphs (A) and (B) of paragraph (3) of subdivision (b), who are accepted for placement have been approved for placement by an interagency placement committee, as described in Section 4096, except as provided for in paragraphs (3) and (4) paragraph (3) of subdivision (g).
(2) The approval shall be in writing and shall indicate that the interagency placement committee has determined one of the following:
(A) The child meets the medical necessity criteria for Medi-Cal specialty mental health services, as provided for in Section 1830.205 or 1830.210 of Title 9 of the California Code of Regulations.
(B) The child is seriously emotionally disturbed, as described in subdivision (a) of Section 5600.3.
…
SEC. 7. Section 11462.011 is added to the Welfare and Institutions Code, to read:
11462.011. (a) The State Department of Health Care Services shall, in consultation with the Department of Managed Health Care, the State Department of Social Services, the County Behavioral Health Directors Association of California, the County Welfare Directors Association of California, the Chief Probation Officers of California, provider representatives, and other relevant stakeholders, establish program standards and procedures for oversight, enforcement, and issuance of children’s crisis residential mental health program approvals, including provisional approvals that are effective for a period of less than one year. The State Department of Health Care Services shall also establish due process protections related to the children’s crisis residential mental health program approval process.
(b) The State Department of Health Care Services shall, in collaboration with the department, the County Behavioral Health Directors Association of California, provider representatives, and other relevant stakeholders, provide guidance to the counties for the provision of children’s crisis residential services, including funding, for children who are Medi-Cal beneficiaries and who are admitted to a children’s crisis residential program. This clause shall only be implemented to the extent that any necessary federal approvals are obtained and federal financial participation is available and is not otherwise jeopardized.
(c)(1) The children’s crisis residential program shall be used only as a diversion to admittance to a psychiatric hospital.
(2) (A) Length of the initial authorization for admission to a children’s crisis residential program shall be limited to 10 consecutive days.
(B) If a determination is made by a health care professional that a children’s crisis residential program is medically necessary and is the appropriate continued level of care:
(i) In the case of a Medi-Cal beneficiary, the children’s crisis residential program shall notify the county mental health plan authorizing those services before extending the length of stay beyond 10 consecutive days.
(ii) In the case of beneficiaries of private insurance, reauthorizations for admission shall be obtained using the process established by the individual plans.
(C) With the exception of (B)(ii), this paragraph shall be implemented only to the extent that any necessary federal approvals are obtained and the State Department of Health Care Services determines, in its sole discretion, that federal financial participation is not jeopardized.
(d) A children’s crisis residential mental health program approval issued by the State Department of Health Care Services, or a county mental health plan to which the department has delegated approval authority, shall be a condition of continued licensure for a short-term residential therapeutic program operating as a children’s crisis residential program.
(c) (e) The State Department of Health Care Services, or a county mental health plan to which the department has delegated approval authority, may enforce the children’s crisis residential mental health program approval standards by taking any of the following actions against a noncompliant children’s crisis residential program:
(1) Suspend or revoke a children’s crisis residential mental health program approval.
(2) Impose monetary penalties.
(3) Place a children’s crisis residential mental health program on probation.
(4) Require a children’s crisis residential mental health program to prepare and comply with a corrective action plan.
(d) (f) The State Department of Health Care Services, or a county mental health plan to which the department has delegated approval authority, shall provide a children’s crisis residential mental health program with due process protections when taking any of the actions described in subdivision (c) (e).
(e) (g) Contingent upon an appropriation in the annual Budget Act for these purposes, the department shall begin implementation of this section no later than July 1, 2018, and shall commence the operation of the approval process for children’s crisis residential mental health program approvals no later than January 1, 2019.
SEC. 8. (a) Contingent upon an appropriation from the annual Budget Act for these purposes, the State Department of Social Services and the State Department of Health Care Services shall adopt regulations to implement this act on or before July 1, 2018.
(b) Notwithstanding the rulemaking provisions of the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code), the State Department of Social Services and the State Department of Health Care Services may implement and administer the changes made by this act through information notices, all-county letters, or similar written instructions until regulations are adopted.
(c) This section shall become effective upon appropriation of funds by the Legislature for the purposes described in this section.
SEC. 9.
The provisions amended or added by the act which added this section shall be implemented only if and to the extent that federal financial participation under Title XIX of the federal Social Security Act (42 U.S.C. Sec. 1396 et seq.) is not jeopardized and all necessary federal approvals have been obtained.
PRIOR VOTES
Assembly Floor: | 75 - 0 |
Assembly Appropriations Committee: | 17 - 0 |
Assembly Health Committee: | 15 - 0 |
POSITIONS
Support:
California Alliance of Child and Family Services (Sponsor)
5 Acres
Alameda County Board of Supervisors
Aspiranet
Aviva Family & Children’s Services
Bill Wilson Center
California Council of Community Behavioral Health Agencies
California Mental Health Advocates for Children and Youth (CMHACY)
California State Association of Counties
California Psychological Association
California Youth Empowerment Network
Casa Pacifica Centers for Children and Families
Chief Probation Officers of California
Children Now
Children’s Institute, Inc.
Common Sense Kids Action
County Behavioral Health Directors Association
County Welfare Directors Association of California
Crittenton
David & Margaret Youth and Family Services
Didi Hirsch
East Bay Children’s Law Office
Family Care Network, Inc.
Families Now
Fred Finch Youth Centers
Hathaway-Sycamores Child & Family Services
Hillsides
Humboldt County Transition Age Youth Collaboration
John Burton Advocates for Youth
Junior Blind of America
Lincoln
LIUNA Locals 777 & 792
Maryvale
Mental Health America of California
Milestone House
NAMI California
National Association of Social Workers
NorCal Mental Health America
Pacific Clinics
Redwood Community Services
Redwood Quality Management Company
San Diego Center for Children
Seneca Family of Agencies
Sierra Vista Child and Family Services
Stanford Youth Solutions
Stars Behavioral Health Group (SBHG)
Statewide Taskforce on Accessing Health Services for California Children in Foster Care
Steinberg Institute
Sunny Hills Services
Tessie Cleveland Community Services Corp.
The California Chapter of the American College of Emergency Physicians
The Steinfirst Group
Uplift Family Services
Ventura County Board of Supervisors
Vista Del Mar
WestCoast Children’s Clinic
Young Minds Advocacy
Oppose:
None received.
-- END --
http://www.cdss.ca.gov/cdssweb/entres/pdf/CCR_LegislativeReport.pdf ↑
Mental Illness Facts, Children and Teens, 2014 ↑
https://www.apa.org/pi/families/resources/newsletter/2012/01/winter.pdf ↑
California Hospital Association, et al. “Impact of the Mental Healthcare Delivery System on California
Emergency Departments,” Western Journal of Emergency Medicine, February 2012. ↑
ASSEMBLY THIRD READING
ATR Bill Id:AB 501
Author:(Ridley-Thomas)
As Amended Ver:April 6, 2017
Majority vote
Committee | Votes | Ayes | Noes |
Health | 15-0 | Wood, Maienschein, Bonta, Burke, Gallagher, Limón, McCarty, Nazarian, Patterson, Quirk-Silva, Ridley-Thomas, Rodriguez, Santiago, Thurmond, Waldron | |
Human Services | 7-0 | Rubio, Choi, Arambula, Maienschein, Reyes, Mark Stone, Gonzalez Fletcher | |
Appropriations | 17-0 | Gonzalez Fletcher, Bigelow, Bloom, Bocanegra, Bonta, Brough, Calderon, McCarty, Quirk, Fong, Friedman, Gallagher, Eduardo Garcia, Gray, Muratsuchi, Obernolte, Reyes |
|
SUMMARY: Expands the definition of a short-term residential treatment center (STRTC) to include a children's crisis residential center (CCRC) to be used as a diversion from psychiatric hospitalization and creates a new facility licensure category for CCRCs, and makes related changes. Specifically, this bill:
- Defines a CCRC as a facility licensed by the Department of Social Services (DSS) as a STRTC, and approved by the State Department of Health Care Services (DHCS), or a county mental health plan (MHP) to which DHCS services has delegated approval authority, to serve children experiencing mental health crises as an alternative to psychiatric hospitalization.
- Requires DHCS, in collaboration with DSS, County Behavioral Health Directors Association, provider representatives, and other relevant stakeholders, to develop a rate for pediatric Medi-Cal beneficiaries that are admitted to a CCRC, only to the extent that federal financial participation is available and necessary federal approvals have been obtained.
- Requires DSS to begin implementation of CCRC licensing no later than July 1, 2018, contingent upon a budget appropriation.
- Requires the CCRC to annually provide DSS with specified information as it pertains to children served, including foster children, when applying for a license renewal.
- Permits a CCRC to accept any child including those referred by:
- A parent or guardian;
- A representative of a public or private entity; or,
- A county probation agency or child welfare services agency with responsibility for the placement of a child in foster care that has the right to make these decisions on behalf of a child who is in mental health crisis.
- Permits a CCRC to accept any child to a CCRC that would otherwise require acceptance by the emergency department of a general hospital, or admission into a psychiatric hospital or the psychiatric inpatient unit of a general hospital.
- Requires DHCS to establish due process protections related to the children's crisis residential mental health program approval process.
- Requires, in order to maintain a license, a STRTC operating a CCRC to have a children's crisis residential mental health program approval issued by DHCS or county MHP.
- Permits DHCS or county MHP to suspend or revoke a children's crisis residential mental health program approval, impose monetary penalties, place a CCRC on probation, and require a CCRC to prepare and comply with a corrective action plan if a CCRC is noncompliant.
FISCAL EFFECT: According to the Assembly Appropriations Committee:
- Administrative costs to DSS are expected to be minor and absorbable.
- Administrative costs to DHCS, to develop a rate and to approve programs, estimated in the range of $200,000 (General Fund (GF)/federal) for the first year and potentially less in future years.
- The impact on Medi-Cal spending is uncertain. Utilization of the children's crisis residential services should increase (local/federal). However, the intention of the bill is to provide services to children in children's crisis residential centers, rather than in psychiatric hospitals or general acute care hospitals. In those cases, there could be Medi-Cal cost savings, since the reimbursement rates for crisis residential services will be lower than inpatient hospital rates.
COMMENTS: According to the author, alternatives to inpatient hospitalization are essential to both children experiencing a mental health crisis and the family. Instead of emergency rooms or unnecessary hospitalization, what a child needs is a calming and therapeutic place where he or she can receive treatment to work through the crisis. Community Based programs provide just that, in the form of crisis intervention services. The primary goal of these services is to stabilize and improve psychological symptoms of distress and to engage individuals in an appropriate treatment service to address the problem that led to the crisis. These services are performed at a residential home-like setting. This provides the optimum environment for a child to feel relaxed while receiving essential therapeutic help.
- STRTCs. The STRTCs, created by state statute in 2016, are intended to replace the existing group homes with the highest rate classification levels (RCL) – RCL 13 and 14 – which currently require certification by DHCS to provide specialty mental health services. All STRTCs are required to have national accreditation from an entity identified by DSS. STRTCs are permitted to address mental health treatment in two ways. An STRTC that is certified by DHCS or a county mental health plan may only accept children who have been assessed as meeting medical necessity required for specialty mental health care under the EPSDT program or who have been assessed as being Seriously Emotionally Disturbed.
- Crisis Residential Programs and Crisis Stabilization. According to a 2010 report by the California Mental Health Planning Council, crisis residential programs are a lower-cost, community-based treatment option in home-like settings that help reduce emergency department visits and divert hospitalization and incarcerations. These programs include peer-run programs such as crisis respites that offer safer, trauma-informed alternatives to psychiatric emergency units, or other locked facilities. The report indicates that crisis residential programs reduce unnecessary stays in psychiatric hospitals, reduce the number and expense of emergency room visits, and divert inappropriate incarcerations while producing the same or superior outcomes to those of institutionalized care. The report states that, as the costs for inpatient treatment continue to rise, the need to expand an appropriate array of acute treatment settings becomes more urgent, and state and county mental health systems should encourage and support alternatives to costly institutionalization and improve the continuum of care to better serve individuals experiencing an acute psychiatric episode. Crisis stabilization services are those lasting less than 24 hours for individuals who are in psychiatric crisis whose needs cannot be accommodated safely in a residential service setting. Crisis stabilization must be provided onsite at a 24-hour health facility, hospital-based outpatient program, or at other certified provider sites. The goal of crisis stabilization is to stabilize the consumer and re-integrate him or her back into the community quickly.
The California Alliance of Child and Family Services (CACFS), sponsor of the bill, states that this bill addresses a critical component missing from the continuum of specialty mental health services for children and youth in California. CACFS states that this bill would create the needed licensing category to ensure that county MHPs, commercial insurance companies, and their community-based providers can develop mental health crisis residential programs within an appropriate licensing category and ensure children and youth can access mental health services that are responsive to their individual needs and strengths in a timely manner. CACFS states that the creation of the licensing category is consistent with Medi-Cal EPSDT specialty mental health services program standards and requirements, and this bill will fill a gap in regulations which prevent California from fully complying with EPSDT specialty mental health services entitlement for children and youth.
Children Now states that currently, an estimated three out of every four children in the U.S. that need mental health services do not receive them and that nearly 20% of high school students in California consider suicide at some point in their lives and more than 10% actually attempt it. With 47 out of 58 counties lacking any child/adolescent psychiatric hospital inpatient beds for children under age 12 (and fewer than 70 beds statewide) the need for children's mental health crisis residential services could not be more acute.
The Steinberg Institute states that a full continuum of care for children and youth with urgent mental health is needed, and the lack of a licensing component for crisis residential services is preventing the development of this much needed program. While crisis residential services are still acute in nature, it is provided in a less restrictive environment, and would be a more appropriate alternative for children but do not require the level of care that an acute inpatient hospitalization provides.
There is no known opposition to this bill.
Analysis Prepared by: Paula Villescaz / HEALTH / (916) 319-2097 FN: 0000667
Date of Hearing: May 17, 2017
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Lorena Gonzalez Fletcher, Chair
ABPCA Bill Id:AB 501
Author:(Ridley-Thomas) – As Amended Ver:April 6, 2017
Policy Committee: | Health | Vote: | 15 - 0 |
Human Services | 7 - 0 |
Urgency: No State Mandated Local Program: Yes Reimbursable: No
SUMMARY:
This bill expands the definition of a short-term residential treatment center (STRTC) to include a children's crisis residential center, and makes related changes. Specifically, this bill:
- Defines “Children’s crisis residential program” as a facility licensed by the Department of Social Services (DSS) as a short-term residential therapeutic program and approved by the Department of Health Care Services (DHCS) or a county mental health plan, to serve children experiencing mental health crises as an alternative to psychiatric hospitalization.
- Requires DSS to develop regulations for short-term residential therapeutic programs that are operated as children’s crisis residential programs, which must require that length of an initial authorization for admission cannot exceed 10 consecutive days.
- Establishes a program approval process under DHCS, including program standards and procedures for oversight, enforcement, and issuance of children’s crisis residential mental health program approvals.
- Requires DHCS to develop a Medi-Cal rate for children who are Medi-Cal beneficiaries and who are admitted to a children’s crisis residential program.
- Contingent on a budget appropriation for the purpose, requires DSS to begin implementation of licensing no later than July 1, 2018, and to commence licensing for children’s crisis residential programs no later than January 1, 2019.
- Contingent on a budget appropriation for the purpose, requires DSS and DHCS to adopt implementing regulations by July 1, 2018, and allows the departments to implement through other means prior to the adoption of regulations.
- Makes crisis residential treatment, as provided at a children’s crisis residential program, eligible for capacity-expansion grants authorized in existing law.
FISCAL EFFECT:
- Administrative costs to DSS are expected to be minor and absorbable.
- Administrative costs to DHCS, to develop a rate and to approve programs, estimated in the range of $200,000 (GF/federal) for the first year and potentially less in future years.
- The impact on Medi-Cal spending is uncertain. Utilization of the children’s crisis residential services should increase (local/federal). However, the intention of the bill is to provide services to children in children’s crisis residential centers, rather than in psychiatric hospitals or general acute care hospitals. In those cases, there could be Medi-Cal cost savings, since the reimbursement rates for crisis residential services will be lower than inpatient hospital rates.
COMMENTS:
- Purpose. The purpose of this bill is to create a licensure subcategory for children’s crisis residential programs in order to provide a community-based alternative care setting for children in crisis. Children’s crisis residential program is to provide short-term crisis stabilization, therapeutic intervention, and specialized programming in an unlocked, staff-secured setting with a high degree of supervision and structure, and the goal of supporting the rapid and successful transition of the child back to the community.
- Background. DSS has been implementing reforms to the foster care system pursuant to AB 403 (Stone), Chapter 773, Statutes of 2015, which changed placement and treatment options for youth in foster care under what is called “Continuum of Care Reform” (CCR). In keeping with CCR’s goal of lessening reliance on group homes, the licensing category of foster care group homes was eliminated and, effective January 1, 2017, the licensing category of short-term residential therapeutic programs was created in order to provide brief, intensive, mental health interventions to youth and adolescents who qualify for that level of care. Current statute requires an STRTC to provide short-term, 24-hour nonmedical care and supervision. This bill would create a subcategory of the new licensure category. As DSS is currently in the process of developing regulations to govern this licensure category, the department could incorporate the subcategory as well.
Mental health services for youth enrolled in Medi-Cal are covered under a federal entitlement to a package of services known as Early and Periodic Screening, Diagnosis, and Treatment (EPSDT). Under realignment, counties use dedicated funding to provide covered services to eligible youth through county mental health plans.
- Prior Legislation. AB 741 (Williams), of the 2015-16 Legislative Session, was similar to this bill. It was vetoed by the Governor, who noted limitations on the length of treatment stays and the size of the centers were not consistent with federal rules and jeopardized federal funding. The veto message also directed DSS and DHCS to work with county behavioral health directors and children's advocates to develop a more viable licensing category. This bill may address issues identified in the veto message, as its provisions addressing facility size and treatment length are more flexible than that in the vetoed bill.
- Staff Comment. This bill makes implementation of the licensing and rate development code section contingent on an appropriation. If costs are minor, a specific budget appropriation may not be needed. Thus, the author may wish to reconsider making implementation contingent on an appropriation for the purpose.
Analysis Prepared by: Lisa Murawski / APPR. / (916) 319-2081
Date of Hearing: April 25, 2015
ASSEMBLY COMMITTEE ON HUMAN SERVICES
Blanca Rubio, Chair
ABPCA Bill Id:AB 501 (
Author:Ridley-Thomas) – As Amended Ver:April 6, 2017
SUBJECT: Mental health: community care facilities
SUMMARY: Allows a short-term residential therapeutic program (STRTP) to be operated as a children’s crisis residential program (CCRP) and specifies the operating criteria for an STRTP operating as a CCRP.
Specifically, this bill:
- Makes a number of Legislative findings and declarations relating to the need to provide crisis care alternatives to hospitals for children and youth experiencing mental health crises.
- Defines a CCRP as a facility licensed by the Department of Social Services (DSS) as an STRTP, and approved by the Department of Health Care Services (DHCS), or a county mental health plan with approval authority delegated by DHCS, to operate a children’s crisis residential mental health program as an alternative to psychiatric hospitalization for children experiencing mental health crises, as specified.
- Allows an STRTP to be operated as a CCRP.
- Allows DSS to license an STRTP operating as a CCRP so long as the following requirements are met:
- For STRTPs that serve children who are not experiencing mental health crises, an identifiable and physically separate unit must exist for those children who are experiencing mental health crises, and the separate unit must be indicated on the STRTP program license;
- Obtain and have in good standing, prior to operating as a CCRP, a mental health program approval that includes a Medi-Cal mental health certification and a children’s crisis residential mental health program approval, as issued by DHCS or a county mental health plan with approval authority, with license revocation by DSS as penalty for failure to maintain mental health program approval; and
- Comply with all applicable STRTP licensing standards, except where specified.
- Instructs DHCS to consult with relevant stakeholders, as specified, to develop a rate for children who are Medi-Cal beneficiaries and who are admitted to a CCRP, upon availability of federal financial participation and receipt of all necessary federal approvals.
- Requires DSS to begin implementation of CCRP licensing no later than July 1, 2018, and licensure of CCRPs by January 1, 2019, contingent upon a budget appropriation.
- Instructs DSS to establish regulations for STRTPs that operate as CCRPs, including all of the following:
- A CCRP may only be used for diversion from psychiatric hospitalization;
- The length of an initial authorization for admission to a CCRP may not exceed 10 consecutive days, except as specified.
- A CCRPs must provide therapeutic programming seven days a week, including weekends and holidays, as specified;
- CCRPs must be adequately staffed in order to accept and discharge children at all times, as specified;
- Facilities must be limited to fewer than 16 beds with at least 50% of those beds in single-occupancy rooms;
- Facilities must provide ample physical space in order to accommodate individuals providing daily emotional and physical supports to each child and integrate family members into day-to-day care of the youth;
- A CCRP must collaborate with each child’s existing mental health team, child and family team, or other formal and natural supports, as applicable, within 24 hours of intake and over the course of a youth’s care as appropriate; and
- A CCRP must create and assist with the implementation of a transition plan for each admitted child into his or her home and community, which includes the establishment of a mental health or child and family team, if one does not already exist.
- Requires a CCRP to annually provide DSS with certain data as it pertains to foster youth and non-foster youth, as specified, in conjunction with its application for licensure renewal.
- Includes CCRPs among the facility types for which Investment in Mental Health Wellness grant awards may be made in order to expand local resources for the development, capital, equipment acquisition, and applicable program startup or expansion costs.
- Permits a CCRP to accept admission of any child who meets all of the following requirements:
- The child is referred by a parent or guardian, or by the representatives of a public or private entity, as specified;
- The child is under 19, 20, or 21 years of age, depending on a program’s licensing requirements;
- The child has a serious behavioral health disorder; and
- The child requires a 24-hour-a-day, seven-day-a-week, staff-secured, unlocked treatment setting.
- Clarifies that the primary function of a CCRP is to provide necessary supports and services, as specified, in an unlocked, staff-secured setting with a high degree of supervision and structure in order to support the rapid and successful transition of the child back to the community.
- Specifies that nothing shall prevent an emergency placement of a child or youth into a CCRP if a licensed mental health professional has made a written determination within 24 hours of the youth’s placement in a CCRP that the youth is experiencing a mental health crisis and is in need for the care and services provided by the CCRP, as specified.
- Requires DHCS, in consultation with specified stakeholders, to establish program standards and procedures for oversight, enforcement, and issuance of children’s crisis residential mental health program approvals, including provisional approvals that are effective for a period of less than one year and further, requires DHCS to establish due process protections related to the children’s residential mental health program approval process.
- Requires, in order to maintain licensure, an STRTP operating a CCRP to have a children’s crisis residential mental health program approval issued by DHCS or county mental health plan with delegated approval authority, as specified.
- Allows DHCS or a county mental health plan with delegated approval authority to enforce children’s crisis residential mental health program approval standards by taking certain actions against a noncompliant CCRP and requires DHCS or an approved county mental health plan to provide due process protections related to taking the described actions, as specified.
- Requires, contingent upon a budget appropriation, DSS to begin implementation of due process protections no later than July 1, 2018, and requires DSS to begin the operation of the approval process for children’s crisis residential mental health program approvals no later than January 1, 2019.
- Requires DSS and DHCS to adopt regulations for implementation before July 1, 2018, contingent upon a budget appropriation, and permits implementation and administration of the requirements of this bill via information notices, all-county letters, or similar written instruction until such regulations are adopted.
- Makes technical changes.
EXISTING LAW:
- States that the purpose of foster care law is to provide maximum safety and protection for children who are currently being physically, sexually, or emotionally abused, neglected, or exploited, and to ensure the safety, protection, and physical and emotional well-being of children who are at risk of harm. (WIC 300.2)
- Defines a “short-term residential therapeutic program” (STRTP) to mean a DSS-licensed residential facility to provide short-term, specialized, and intensive treatment, and 24-hour care and supervision to children. The care and supervision provided by a short-term residential therapeutic program shall be nonmedical, except as otherwise permitted by law. (HSC 1502 (a)(18))
- Requires an STRTP to have all of the following, as of January 1, 2017:
- National accreditation from an entity identified by DSS, as specified;
- A mental health certification, as defined, which shall be in good standing;
- A current written plan of operation, as specified, which must include a statement of purposes and goals, plan for supervision, evaluation and training of staff, a program statement that includes a description of the program’s ability to meet differing needs of children, a core services description, and other requirements; and
- A qualified administrator, as specified, and staff training to include specific topics of information relevant to the population of children served. (HSC 1562.01)
- Permits DSS to deny an application for, suspend, or revoke any license issued to a community care facility for certain violations, as specified. (HSC 1550 et seq.)
- Establishes California’s Medicaid program, Medi-Cal, though which eligible low-income individuals receive health care and mental health services, including foster youth, eligible recipients of the Adoption Assistance Program, and Kin-Gap. Under Medi-Cal, establishes the federal Early and Periodic Screening, Diagnosis and Treatment (EPSDT) program to provide comprehensive and preventive health services including specialty mental health services to Medi-Cal beneficiaries under the age of 21. (WIC 14000 et seq., 42 USC Section 1396 et seq. and 42 CFR 435.145.)
- Establishes the federal Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program to provide comprehensive and preventive health services, including preventive, dental, mental health, and developmental, and specialty services, to Medicaid beneficiaries under the age of 21. Requires states to administer EPSDT as a condition of receiving federal Medicaid funds. (42 USC Section 1396d)
- Requires county mental health departments to provide children served by county social services and probation departments, who meet the definition of medical necessity, with mental health screening, assessment, participation in multidisciplinary placement teams and specialty mental health treatment. (WIC 5867.5)
- Requires each local mental health plan to establish a procedure to ensure access to outpatient specialty mental health services, as required by EPSDT program standards, for any child in foster care who has been placed outside his or her county of adjudication. (WIC 14716)
- Establishes, under the terms of the federal 1915(b) Medicaid waiver, a managed care program providing Medi-Cal specialty mental health services for eligible low-income persons administered through local county mental health plans under contract with DHCS. (WIC 14021.4 (b))
FISCAL EFFECT: Unknown.
COMMENTS:
Child Welfare Services: The purpose of California’s Child Welfare Services (CWS) system is to protect children from abuse and neglect and provide for their health and safety. When children are identified as being at risk of abuse, neglect or abandonment, county juvenile courts hold legal jurisdiction and children are served by the CWS system through the appointment of a social worker. Through this system, there are multiple opportunities for the custody of the child, or his or her placement outside of the home, to be evaluated, reviewed and determined by the judicial system, in consultation with the child's social worker, to help provide the best possible services to the child. The CWS system seeks to help children who have been removed from their homes reunify with their parents or guardians, whenever appropriate, or unite them with other individuals they consider to be family. There are currently over 64,000 children and youth in California’s child welfare system
Continuum of Care Reform (CCR): In 2015, Governor Brown signed AB 403 (Stone), Chapter 773, Statutes of 2015, which reformed placement and treatment options for youth in foster care under what is called “Continuum of Care Reform” (CCR). The bill was sponsored by DSS and built upon years of policy changes aimed at improving outcomes for youth in foster care. Primarily, and as a result of growing consensus among the child welfare field at both the national and state level, efforts have been made at reducing the reliance on group homes as a placement setting for foster youth. AB 403 aimed to ensure that youth in foster care would have their day-to-day physical, mental and emotional needs met and that they have the opportunity to grow up in permanent and supportive homes, and that they can grow into self-sufficient and successful adults. AB 403 included various changes to the Resource Family Approval program. In 2016, AB 1997 (Stone), Chapter 612, Statutes of 2016 was signed into law and adopted changes to further facilitate implementation of CCR recommendations.
In order to ensure youth receive necessary services, a case plan for each child is created and is often considered the foundation and unifying tool in which a child’s needs and services are consolidated in one location. Current law requires that a written case plan be completed no more than 60 days after the initial removal of a child from care, or by the date of the dispositional hearing, whichever is first. The case plan provides a centralized file that includes: a description of the type of home or institution in which the child is placed, the reasons for that placement decision, including specific goals and appropriateness of the planned services in meeting those goals, and the original allegations of abuse or neglect or the conditions cited as the basis for declaring the child a dependent of the court.
Short-term residential therapeutic programs (STRTPs): In keeping with CCR’s goal of moving away from reliance on congregate care, the licensing category of foster care group homes was eliminated and, effective January 1, 2017, the licensing category of short-term residential therapeutic programs was created in order to provide brief, intensive, mental health interventions to youth and adolescents who qualify for that level of care. Current statute requires an STRTP to provide short-term, 24-hour nonmedical care and supervision.
Mental health needs of youth: Approximately 20% of youth between the ages of 13 and 18, and 13% of younger youth experience severe mental disorders in a given year, according to statistics from the National Alliance on Mental Illness (NAMI). About seven in 10 youth in juvenile justice systems have at least one mental health condition, and 20% are living with serious mental illness. NAMI also reports that almost half of children aged 8 to 15 who were diagnosed with a mental illness received no mental health service in the previous year.
Compared to their peers, foster youth experience a heightened rate of mental illness according to various studies. Specifically, a study conducted by the American Psychological Association in 2012, found that nearly half of youth in foster care were determined to have clinically significant emotional or behavioral problems, and between one-half and three-fourths of children entering foster care exhibited behavioral or social competency problems that warranted mental health services. In addition to the high rate of mental health problems, children under age 7 who enter foster care show high rates of developmental problems, according to the report.
Mental health crises in youth: When a child experiences a mental health crisis, they are oftentimes brought by family members to hospital emergency rooms that are often ill-equipped to provide for the complex needs of the youth. A January 2015 study entitled “Kids in Crisis: California’s Failure to Provide Appropriate Services for Youth Experiencing a Mental Health Crisis” found that in the absence of crisis diversion programs, families have no choice but to bring their children to emergency rooms where they are often held for hours, even days, in emergency room hallways and exam rooms. These youth often go without mental health treatment while staff attempts to locate an appropriate placement in an inpatient psychiatric facility. The report goes on to explain that there is no comprehensive acute crisis service system for children throughout the state such that children are denied timely access to appropriate levels of care in the least restrictive environments as a result of a shortage of inpatient hospitalization alternatives.
According to the report, community-based programs provide a calming and therapeutic place for youth to receive treatment and work through their crisis with the necessary supportive services. These services seek to stabilize and improve psychological symptoms of distress and to engage individuals in an appropriate treatment in order to address the underlying problem that led to the crisis. However, in recent years the state has experienced a decrease in the availability of inpatient psychiatric hospital beds with a concurrent lack of comprehensive community-based therapeutic programs.
A study of California hospital emergency rooms, published by the California Hospital Association in 2012, indicated children and adolescents with a primary psychiatric diagnosis wait an average 12.97 hours for psychiatric evaluation and placement – nearly three hours longer than adults in a similar situation. The study concluded, “The extraordinary wait times for patients with mental illness in the emergency department, as well as the lack of resources available to emergency departments for effectively treating and appropriately placing these patients, indicate the existence of a mental health system in California that prevents patients in acute need of psychiatric treatment from getting it at the right time, in the right place.”
Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Program: The EPSDT program is a federal entitlement administered by the Health Resource and Services Administration (HRSA) that requires states and counties to provide comprehensive and preventative health care services to low-income children who are enrolled in Medicaid. Federal regulations require states to inform all Medicaid-eligible children under age 21 and their families about EPSDT within 60 days of enrollment; inform Medicaid-eligible pregnant women, adoptive and foster care parents of eligible children about EPSDT services; offer and provide assistance with transportation to medical care; and offer and provide assistance with scheduling appointments with EPSDT care and services.
EPSDT provides two key benefits for eligible youth, including comprehensive screening services and medically necessary services. Comprehensive health screenings entail, at a minimum, medical, dental, vision, and hearing; development history; and physical exams including assessments of nutritional status, immunizations, laboratory tests, health education, and lead screenings. Medically necessary services include dental services, prescription medications, physical therapy, and medical equipment in order to facilitate diagnostic and treatment services in order to address defects, and physical and mental illnesses discovered by screening processes.
California’s Medicaid program, Medi-Cal, provides EPSDT services to youth; specifically, periodic screenings are provided to determine health care needs and, based upon the identified health needs and diagnosis, treatment is offered to individuals. In order to qualify for EPSDT services, a youth must be under 21 years old and be enrolled in full-scope Medi-Cal, meaning the youth receives free or low-cost health coverage, including medical, dental, mental health, and vision care benefits. In 2012, through the realignment process, California transferred oversight of EPSDT to the counties. Prior to this, EPSDT services were billable through Medi-Cal reimbursement and a combination of county, state, and federal funds, with counties paying a 5 percent share of the cost, the state paying 45%, and the federal government matching at 50%. Under realignment, counties receive an annual allocation from the state and are responsible for using this allocation to provide EPSDT mandated services to eligible youth through county mental health plans.
Need for this bill: According to the author’s office, “Alternatives to inpatient hospitalization are essential to both children experiencing a mental health crisis and the family. Instead of ERs or unnecessary hospitalization, what a child needs is a calming and therapeutic place where he or she can receive treatment to work through the crisis. Community-based programs provide just that, in the form of crisis intervention services. The primary goal of these services is to stabilize and improve psychological symptoms of distress and to engage individuals in an appropriate treatment service to address the problem that led to the crisis. These services are performed at a residential home-like setting. This provides the optimum environment for a child to feel relaxed while receiving essential therapeutic help.”
PRIOR LEGISLATION:
AB 404 (Stone), 2017, this bill will further Continuum of Care Reform efforts made by AB 403 and AB 1997. This bill is currently awaiting hearing in the Assembly Human Services Committee.
AB 741 (Williams), 2016, would have expanded the definition of a short-term residential treatment center (STRTC) to include a children’s crisis residential center (CCRC) to be used as a diversion from psychiatric hospitalization, and would have limited the stay to 10 consecutive days and no more than 20 total days within a six-month period. It was vetoed by the Governor.
AB 1997 (Stone), Chapter 612, Statutes of 2016, furthered Continuum of Care Reform efforts.
AB 403 (Stone), Chapter 773, Statutes of 2015, implemented Continuum of Care Reform recommendations to better serve children and youth in California’s child welfare services system.
SB 1013, Committee on Budget and Fiscal Review), Chapter 35, Statutes of 2012, called for the department to establish a working group to develop recommended revisions to the current rate-setting system, resulting in the Continuum of Care Reform effort.
SB 82 (Committee on Budget and Fiscal Review), Chapter 34, Statutes of 2013, established the Investment in Mental Health Wellness Act of 2013, which authorized the California Health Facilities Financing Authority to administer a local grant program to increase capacity for crisis support programs.
SECOND COMMITTEE OF REFERENCE. This bill was previously heard in the Assembly Committee on Health on April 4, 2017 and was approved on a 15-0 vote.
REGISTERED SUPPORT / OPPOSITION:
Support
California Alliance of Child and Family Services (Sponsor)
Alameda County Board of Supervisors
Ariva Family and Children’s Services
Aspiranet
California Council of Community Behavioral Health Agencies
California Psychological Association
California Mental Health Advocates for Children and Youth (CMHACY)
Casa Pacifica Centers for Children and Families
Children Now
Children’s Institute, Inc.
Common Sense Kids Action
County Welfare Directors Association
County Behavioral Health Directors Association of CA
Crittenton
East Bay Children’s Law Office
Family Care Network, Inc.
Families NOW
Five Acres
Fred Finch Youth Centers
Hathaway-Sycamores Child and Family Services
Hillsides
Humboldt County Transition Age Youth Collaboration
John Burton Advocates for Youth
Junior Blind of America
Lincoln
LIUNA Locals 777 &792
Maryvale
Nami-California
National Association of Social Workers, CA Chapter
NorCal Mental Health America
Pacifica Clinics
Redwood Community Services
Redwood Quality Management Company
San Diego Center for Children
Seneca Family of Agencies
Sierra Vista Child and Family Services
Stars Behavioral Health Group
Statewide Taskforce on Accessing Health Services for California Children in Foster Care
Steinberg Institute
Sunny Hills Services
Uplift Family Services
Vista Del Mar Child & Family Services
Westcoast Children’s Clinic
Young Minds Advocacy
Opposition
None of file.
Analysis Prepared by: Kelsy Castillo / HUM. S. / (916) 806-6157
Date of Hearing: April 4, 2017
ASSEMBLY COMMITTEE ON HEALTH
Jim Wood, Chair
ABPCA Bill Id:AB 501
Author:Ridley-Thomas – As Amended Ver:March 27, 2017
SUBJECT: Mental health: community care facilities.
SUMMARY: Expands the definition of a short-term residential treatment center (STRTC) to include a children's crisis residential center (CCRC) to be used as a diversion from psychiatric hospitalization and creates a new facility licensure category for CCRCs. Specifically, this bill:
- Establishes legislative findings and declarations regarding the need for crisis care alternatives for children and youth experiencing mental health crisis.
- Permits a STRTC to also be operated as a CCRC.
- Defines a CCRC as a facility licensed by the Department of Social Services (DSS) as a STRTC, and approved by the State Department of Health Care Services (DHCS), or a county mental health plan (MHP) to which DHCS services has delegated approval authority, to serve children experiencing mental health crises as an alternative to psychiatric hospitalization.
- Permits DSS to license a STRTC as a CCRC if the CCRC meets the following requirements:
- Provide an identifiable and physically separate unit for children who are experiencing mental health crisis, if the program also serves children who are not experiencing mental health crisis, and requires the separate unit to be indicated on the STRTC license;
- Obtain and have in good standing a mental health program approval, including a Medi-Cal mental health certification and a children's crisis residential mental health program approval, both issued by DHCS or the county MHP with delegated approval authority. Permits DHCS to revoke a program license for failure to maintain MHP approval; and,
- Comply with all applicable licensing standards for STRTC, unless otherwise specified in regulation.
- Requires DHCS, in collaboration with DSS, County Behavioral Health Directors Association (CBHDA), provider representatives, and other relevant stakeholders, to develop a rate for pediatric Medi-Cal beneficiaries that are admitted to a CCRC, only to the extent that federal financial participation (FFP) is available and necessary federal approvals have been obtained.
- Requires DSS to begin implementation of CCRC licensing no later than July 1, 2018, contingent upon a budget appropriation.
- Requires DSS to establish regulations for STRTC that are operated as CCRC that include the following:
- Require a CCRC to only be used for diversion from admittance to a psychiatric hospital;
- Limit the initial admission stay for a child in a CCRC to 10 consecutive days;
- Require a CCRC to obtain approval from a county MHP before extending the length of stay for a Medi-Cal beneficiary beyond 10 consecutive days. For a child with private insurance, requires reauthorizations for admission to be obtained using the process established by the individual plans;
- Provide therapeutic programming seven days a week, including weekends and holidays, with sufficient professional and paraprofessional staff to maintain an appropriate treatment setting and services;
- Require the program to be staffed with sufficient personnel to accept children 24 hours per day, seven days a week and to admit children, at a minimum, from 7:00 a.m. to 11:00 p.m., seven days a week, 365 days per year and require the program to be sufficiently staffed to discharge children, as appropriate, seven days a week, 365 days per year;
- Limit facilities to fewer than 16 beds, with at least half of those beds being single-occupancy rooms;
- Require facilities to include ample physical space for accommodating individuals who provide natural supports to each child and for integrating family members into the day-to-day care of the youth;
- Require the CCRC to collaborate with each child's existing mental health team within 24 hours of intake and throughout the course of care and treatment; and,
- Require the CCRC to assist in the development of a transition plan for the child from the facility to his or her home community, including the establishment of a mental health team if one does not exist.
- Requires the CCRC to annually provide DSS with the following information as it pertains to children served, including foster children, when applying for a license renewal:
- Age and gender of clients served;
- Duration of stay;
- Professional classification of staff and contracted staff; and,
- Type of placement the client was discharged to.
- Authorize the California Health Facilities Financing Authority and the Mental Health Services Oversight and Accountability Commission, to include CCRCs in existing grant programs that expand capacity for mental health crisis support, intervention and stabilization services.
- Permits a CCRC to accept any child including those referred by:
- A parent or guardian;
- A representative of a public or private entity; or,
- A county probation agency or child welfare services agency with responsibility for the placement of a child in foster care that has the right to make these decisions on behalf of a child who is in mental health crisis.
- Permits a CCRC to accept any child to a CCRC that would otherwise require acceptance by the emergency department of a general hospital, or admission into a psychiatric hospital or the psychiatric inpatient unit of a general hospital.
- Prohibits the placement of a child in a CCRC from being delayed by the interagency placement committee process that facilitates placement of foster youth, if a licensed mental health professional has made a written determination within 72 hours of the child’s or youth’s placement that the child or youth requires the level of services and supervision provided by the STRTC in order to meet his or her behavioral or therapeutic needs, or has made a written determination within 24 hours of the child’s or youth’s placement in a CCRC that the child or youth is experiencing a mental health crisis and is in need of the care and services provided by the CCRC.
- Requires DHCS, in consultation with the Department of Managed Health Care (DMHC), DSS, CBHDA, the County Welfare Directors Association of California, the Chief Probation Officers of California, provider representatives, and other relevant stakeholders, to establish program standards and procedures for oversight, enforcement, and issuance of children's crisis residential mental health program approvals, including provisional approvals that are effective for a period of less than one year.
- Requires DHCS to establish due process protections related to the children's crisis residential mental health program approval process.
- Requires, in order to maintain a license, a STRTC operating a CCRC to have a children's crisis residential mental health program approval issued by DHCS or county MHP.
- Permits DHCS or county MHP to suspend or revoke a children's crisis residential mental health program approval, impose monetary penalties, place a CCRC on probation, and require a CCRC to prepare and comply with a corrective action plan if a CCRC is noncompliant.
- Requires DSS and DHSC to adopt regulations for implementation before July 1, 2018, contingent upon a budget appropriation.
- Permits DSS and DHCS to implement provisions of this bill through information notices, all-county letters, or similar written instructions until regulations are adopted.
EXISTING LAW:
- Requires the state, through DSS and county welfare departments, to establish and support a public system of child welfare services to protect and promote the welfare of children.
- Defines STRTC as a residential facility licensed by DSS and operated by any public agency or private organization that provides short-term, specialized, and intensive treatment, and 24-hour care and supervision to children. Requires the care and supervision provided by a STRTC to be nonmedical.
- Provides for licensure of a Foster Family Agency, which is a public or private agency engaged in the recruiting, certifying, and training of, and providing professional support to, foster parents, or in finding homes or other places for placement for children for temporary or permanent care, as an alternative to group care.
- Establishes Medi-Cal, through which eligible low-income individuals receive health care and mental health services, including foster youth, eligible recipients of the Adoption Assistance Program, and Kin-Gap. Establishes the federal Early and Periodic Screening, Diagnosis and Treatment (EPSDT) program to provide comprehensive and preventive health services including specialty mental health services to Medi-Cal beneficiaries under the age of 21.
- Restricts the placement of children younger than 6 into a group home or STRTC, except in specified circumstances and requires that the child remain no longer than 120 days, with extensions of 60 days only under specified circumstances and with written approval of the director or deputy director of the county child welfare or probation department. Restricts the placement duration of a child aged 6-12 years old to a treatment facility for no longer than six months with written authorization required to extend the stay.
FISCAL EFFECT: This bill has not yet been analyzed by a fiscal committee.
COMMENTS:
- PURPOSE OF THIS BILL. According to the author, alternatives to inpatient hospitalization are essential to both children experiencing a mental health crisis and the family. Instead of emergency rooms or unnecessary hospitalization, what a child needs is a calming and therapeutic place where he or she can receive treatment to work through the crisis. Community Based programs provide just that, in the form of crisis intervention services. The primary goal of these services is to stabilize and improve psychological symptoms of distress and to engage individuals in an appropriate treatment service to address the problem that led to the crisis. These services are performed at a residential home-like setting. This provides the optimum environment for a child to feel relaxed while receiving essential therapeutic help.
- BACKGROUND.
- STRTCs. The STRTCs, created by state statute in 2016, are intended to replace the existing group homes with the highest rate classification levels – RCL 13 and 14 – which currently require certification by DHCS to provide specialty mental health services. All STRTCs are required to have national accreditation from an entity identified by DSS. STRTCs are permitted to address mental health treatment in two ways. An STRTC that is certified by DHCS or a county mental health plan may only accept children who have been assessed as meeting medical necessity required for specialty mental health care under the EPSDT program or who have been assessed as being Seriously Emotionally Disturbed.
- Crisis Residential Programs and Crisis Stabilization. According to a 2010 report by the California Mental Health Planning Council, crisis residential programs are a lower-cost, community-based treatment option in home-like settings that help reduce emergency department visits and divert hospitalization and incarcerations. These programs include peer-run programs such as crisis respites that offer safer, trauma-informed alternatives to psychiatric emergency units, or other locked facilities. The report indicates that crisis residential programs reduce unnecessary stays in psychiatric hospitals, reduce the number and expense of emergency room visits, and divert inappropriate incarcerations while producing the same or superior outcomes to those of institutionalized care. The report states that, as the costs for inpatient treatment continue to rise, the need to expand an appropriate array of acute treatment settings becomes more urgent, and state and county mental health systems should encourage and support alternatives to costly institutionalization and improve the continuum of care to better serve individuals experiencing an acute psychiatric episode. Crisis stabilization services are those lasting less than 24 hours for individuals who are in psychiatric crisis whose needs cannot be accommodated safely in a residential service setting. Crisis stabilization must be provided onsite at a 24-hour health facility, hospital-based outpatient program, or at other certified provider sites. The goal of crisis stabilization is to stabilize the consumer and re-integrate him or her back into the community quickly. According to various reports, costs of providing care in a crisis stabilization unit are significantly lower than inpatient hospitalization.
- EPSDT. California has a decentralized public mental health system with most direct services provided through the county mental health system. Counties (i.e., county mental health plans) have the primary funding and programmatic responsibility for the majority of local mental health programs. The state is required to meet certain federal requirements, including those set forth by Medicaid’s child health component, known as the EPSDT program. EPSDT is a Medi-Cal benefit for individuals under the age of 21 who have full-scope Medi-Cal eligibility. Federal law, including statutes, regulations, and guidelines, requires that Medi-Cal cover a very comprehensive set of benefits and services for children, different from adult benefits. EPSDT provides eligible children access to a range of mental health services that include, but are not limited to:
- Mental health assessment;
- Therapy;
- Rehabilitation;
- Mental health services;
- Medication support services;
- Day rehabilitation;
- Day treatment intensive;
- Crisis intervention/stabilization;
- Targeted case management; and,
- Therapeutic behavioral services.
- Section 1915(b) Medi-Cal Specialty Mental Health Services Waiver. Specialty Medi-Cal mental health services are provided under the terms of the federal Medicaid/Medi-Cal Specialty Mental Health Services Consolidation 1915(b) Waiver (Waiver) program. The waiver established a managed care program for specialty mental health services separate from the overall Medi-Cal program. Medi-Cal beneficiaries must receive specialty mental health services through county-operated MHPs. County MHPs provide services directly or through contracts in the local community using a combination of county funds, realignment revenues, and Mental Health Services Act funds. Counties pay for services locally, incurring Certified Public Expenditures, which the state then uses as the state match to claim federal Medicaid reimbursement and the state, in turn, returns the federal funds to the county MHPs. The Waiver has been in place since the mid-1990s and was approved for a new five-year term, from July 1, 2015, through June 30, 2020. DHCS has reported data on the number of children and youth eligible to receive Medi-Cal services in 2013-14 as slightly over 6 million. Of these 6 million children, 262,318 or 4.4%, received specialty mental health services. The count of children and youth with five or more specialty mental health visits was 201,192 or 3.3%. The average per beneficiary expenditure for approved services in 2013-14 was $6,092.
- Class Action Lawsuit. In 2002, plaintiffs filed a federal class action lawsuit against the County of Los Angeles, Katie A. vs Bonta 2.02-cv-5662 (C.D. Cal.), alleging violations of federal Medicaid laws, and the American with Disabilities Act. The suit challenged California's failure to provide home and community based mental health services to children who are in the foster care system or are at risk of removal from their families. The facts of the case revealed that Katie A. entered foster care at age four, received a mental health assessment at age five, and, by age 14, had been assigned to 37 foster care placements, 19 psychiatric institution placements, and seven stays in children’s shelters.
The lawsuit alleged a failure to properly assess the plaintiff's mental health needs, a failure to provide adequate mental health treatment, and an overuse of congregate and shelter care. A settlement agreement was reached which required children in foster care, who are being considered for high-level group care, inpatient psychiatric care, or other intensive treatments, as specified, to be eligible for EPSDT services. The state subsequently developed a series of intensive mental health services for such children, a manual for care coordination between state and local mental health and child welfare providers, and a program of therapeutic foster care.
- SUPPORT. The California Alliance of Child and Family Services (CACFS), sponsor of the bill, states that this bill addresses a critical component missing from the continuum of specialty mental health services for children and youth in California. CACFS states that this bill would create the needed licensing category to ensure that county MHPs, commercial insurance companies, and their community-based providers can develop mental health crisis residential programs within an appropriate licensing category and ensure children and youth can access mental health services that are responsive to their individual needs and strengths in a timely manner. CACFS states that the creation of the licensing category is consistent with Medi-Cal EPSDT specialty mental health services program standards and requirements, and this bill will fill a gap in regulations which prevent California from fully complying with EPSDT specialty mental health services entitlement for children and youth.
Children Now states that currently, an estimated three out of every four children in the U.S. that need mental health services do not receive them and that nearly 20% of high school students in California consider suicide at some point in their lives and more than 10% actually attempt it. With 47 out of 58 counties lacking any child/adolescent psychiatric hospital inpatient beds for children under age 12 (and fewer than 70 beds statewide) the need for children's mental health crisis residential services could not be more acute.
The Steinberg Institute states that a full continuum of care for children and youth with urgent mental health is needed, and the lack of a licensing component for crisis residential services is preventing the development of this much needed program. While crisis residential services are still acute in nature, it is provided in a less restrictive environment, and would be a more appropriate alternative for children but do not require the level of care that an acute inpatient hospitalization provides.
- RELATED LEGISLATION.
- AB 1473 (Quirk-Silva) requires DHCS to create a pilot crisis stabilization program in the County of Orange to provide mental health and safety support for older adults. AB 1473 is pending in the Assembly Health Committee.
- AB 451 (Arambula) requires an acute psychiatric hospital that does not maintain an emergency department to provide emergency services and care necessary to relieve or eliminate a psychiatric emergency medical condition. Prohibits a general acute care hospital, or acute psychiatric hospital, as a condition of accepting a transfer, from requiring a person to be in custody due to a mental disorder that makes that person a danger to himself/herself, others and or gravely disabled (commonly referred to as a “5150” hold). AB 451 is pending in the Assembly Health Committee.
- PREVIOUS LEGISLATION.
- AB 1997 (Mark Stone), Chapter 612, Statutes of 2016 adopts changes to further facilitate implementation of Continuum of Care Reform recommendations adopted by AB 403 (Stone), Chapter 773, Statutes of 2015 to better serve children and youth in California's child welfare services system including, but not limited to: modifications of the Resource Family Approval process; required payment of basic rate to all families regardless of approval process; and altered requirements for mental health certification of STRTP.
- AB 741 (Williams) of 2016 expands the definition of a STRTC to include a CCRC to be used as a diversion from psychiatric hospitalization, and limits the stay to 10 consecutive days and no more than 20 total days within a six-month period. AB741 was vetoed by the Governor, who stated:
I am returning Assembly Bill 741 without my signature.
This bill establishes a licensing category for children's crisis residential centers which would be regulated by the Department of Social Services.
The licensing category proposed by this bill limits the length of treatment stays and the size of the centers. These restrictions are not consistent with federal rules and put funding in jeopardy.
I recognize there is an acute shortage of residential programs that provide crisis mental health treatment for children and teens. Therefore, I am directing the Departments of Social Services and Health Care Services to work with county behavioral health directors and children's advocates to develop a more viable licensing category. - AB 403 phases out the current use of congregate care settings, including group homes, as long-term placements for the care of children in California’s child welfare services system and implements new rate structures for services and treatment, along with other Continuum of Care Reform recommendations, to better serve children and families. Requires that any congregate care settings and foster family agencies be accredited by a national accrediting organization and created the STRTC licensure category charged with providing treatment in lieu of group homes beginning January 1, 2017, provide only short-term mental health treatment until home-based family care can be established for a child.
- POLICY COMMENT. This bill currently requires CCRC facilities to include ample physical space for accommodating individuals who provide natural supports to each child and for integrating family members into the day-to-day care of the youth. The author may wish to consider clarifying the meaning of "natural supports" to include any parent, guardian, family member, or member of the child's health care support team.
- PROPOSED AMENDMENTS.
- Implementation timeline. This bill currently requires DSS and DHSC to promulgate regulations by January 1, 2018 with an implementation date of July 1, 2018, subject to a budget appropriation. Until regulations are promulgated, the bill permits each department to implement provisions of this bill through information notices, all-county letters, or similar written instructions until regulations are adopted. To ensure appropriate implementation, the Committee may wish to extend the deadline to adopt regulations by two years to July 1, 2020.
- Emergency Room Services and Care. This bill currently authorizes a CCRC to accept any child that would otherwise require acceptance by the emergency department of a general acute hospital, or admission into a psychiatric hospital or psychiatric inpatient unit of a general hospital. This authorization seems broad and it is unclear if these provisions could require a CCRC to meet the same level of admittance requirements and care as emergency departments and hospitals. The Committee may wish to clarify these provisions and determine who should be making the referrals to CCRCs.
- Transition plan. This bill currently requires the CCRC to assist in the development of a plan for transitioning each admitted child from the program to his or her home and community. This bill does not specify who is responsible for creating and implementing a transition plan before a child is discharged from a CCRC. The Committee may wish to clarify that the CCRC create and assist with the implementation of a plan for transitioning each admitted child from the program to his or her home and community.
- Determination of stay. The bill currently limits the initial admission stay for a child in a CCRC to 10 consecutive days and requires approval from a county MHP before permitting an extension of this time frame. For a child with private insurance, the bill requires reauthorizations for admission to be obtained using the process established by the individual plans. These provisions only require payor approval, not the determination of need by a health care professional. To ensure that an extension is in the best interest of a child, the Committee may wish to consider adding the approval of a health care professional before a 10 day stay for a child is extended.
- DOUBLE REFERRAL. This bill is double referred; upon passage in this Committee, this bill will be referred to the Assembly Human Services Committee.
REGISTERED SUPPORT / OPPOSITION:
Support
California Alliance of Child and Family Services (sponsor)
Advancing Human Services for the Welfare of All Californians
Aspiranet
California Council of Community Behavioral Health Agencies
California Mental Health Advocates for Children and Youth
California Psychological Association
CASA Pacifica Centers for Children & Families
Children Now
Common Sense Kids Action
Crittenton
East Bay Children's Law Offices
Families Now
Fred Finch Youth Center
Hillsides
Humboldt County Transition Age Youth Collaboration
John Burton Advocates for Youth
Junior Blind
NAMI California
NorCal Mental Health America
Redwood Community Service, Inc.
Redwood Quality Management Company
Seneca Family of Agencies
Sierra Vista Child & Family Services
Statewide Task Force on Accessing Health Services for California Children in Foster Care
Steinberg Institute
Sunny Hills Services
Uplift Family Services
Young Minds Advocacy
Opposition
None on file.
Analysis Prepared by: Paula Villescaz / HEALTH / (916) 319-2097
Discussed in Hearing
1MIN
Assembly Floor
3MIN
Senate Floor
1H
Senate Standing Committee on Appropriations
1MIN
Assembly Floor
1H
Assembly Standing Committee on Appropriations
9MIN
Assembly Standing Committee on Health
Bill Author
Bill Co-Author(s):