Existing law grants the State Department of Health Care Services the sole authority in state government to license adult alcoholism or drug abuse recovery or treatment facilities. The department is authorized to issue a license to specified types of facilities if certain criteria are met. Existing law requires licensees to report specified events and incidents to the department, including, among others, the death of a resident at a licensed facility. Existing law authorizes the department to investigate allegations of violations of governing law and take action upon a finding of a violation, as specified.

This bill would require an operator of a licensed alcoholism or drug abuse recovery or treatment facility or certified alcohol or other drug program to include on its internet website and intake form paperwork a disclosure that an individual may check the internet website of the State Department of Health Care Services to confirm whether the facilitys license or programs certification has been placed in probationary status, been subject to a temporary suspension order, been revoked, or the operator has been given a notice of operation in violation of law. The bill would require the disclosure to include a link to the departments internet website that contains the Probationary Status, Temporary Suspension Order, Revoked and Notice of Operation in Violation of Law Program List. The bill would authorize a violation of this requirement to be subject to penalty imposed by the department.

Existing law grants the State Department of Health Care Services the sole authority in state government to license adult alcoholism or drug abuse recovery or treatment facilities. The department is authorized to issue a license to specified types of facilities if certain criteria are met. Existing law requires licensees to report specified events and incidents to the department, including, among others, the death of a resident at a licensed facility. Existing law authorizes the department to investigate allegations of violations of governing law and take action upon a finding of a violation, as specified.

This bill would require an operator of a licensed alcoholism or drug abuse recovery or treatment facility or certified alcohol or other drug program to include on its internet website and intake form paperwork a disclosure that an individual may check the internet website of the State Department of Health Care Services to confirm whether the facilitys license or programs certification has been placed in probationary status, been subject to a temporary suspension order, been revoked, or the operator has been given a notice of operation in violation of law. The bill would require the disclosure to include a link to the departments internet website that contains the Probationary Status, Temporary Suspension Order, Revoked and Notice of Operation in Violation of Law Program List. The bill would authorize a violation of this requirement to be subject to penalty imposed by the department.

Existing law grants the State Department of Health Care Services the sole authority in state government to license adult alcoholism or drug abuse recovery or treatment facilities. The department is authorized to issue a license to specified types of facilities if certain criteria are met. Existing law requires licensees to report specified events and incidents to the department, including, among others, the death of a resident at a licensed facility. Existing law authorizes the department to investigate allegations of violations of governing law and take action upon a finding of a violation, as specified.

This bill would require an operator of a licensed alcoholism or drug abuse recovery or treatment facility or certified alcohol or other drug program to include a disclosure on its internet website if a legal, disciplinary, or other enforcement action has been brought by the department and the facility or program was determined to be in violation. The bill would require the internet website disclosure to include the date and nature of the violation, and require the disclosure to be posted no later than 14 business days after the determination of violation. The bill would impose a $2,500 civil penalty for failure to comply with the internet website posting requirement. on its internet website and intake form paperwork a disclosure that an individual may check the internet website of the State Department of Health Care Services to confirm whether the facilitys license or programs certification has been placed in probationary status, been subject to a temporary suspension order, been revoked, or the operator has been given a notice of operation in violation of law. The bill would require the disclosure to include a link to the departments internet website that contains the Probationary Status, Temporary Suspension Order, Revoked and Notice of Operation in Violation of Law Program List. The bill would authorize a violation of this requirement to be subject to penalty imposed by the department.

Existing law grants the State Department of Health Care Services the sole authority in state government to license adult alcoholism or drug abuse recovery or treatment facilities. The department is authorized to issue a license to specified types of facilities if certain criteria are met. Existing law requires licensees to report specified events and incidents to the department, including, among others, the death of a resident at a licensed facility. Existing law authorizes the department to investigate allegations of violations of governing law and take action upon a finding of a violation, as specified.

This bill would require an operator of a licensed alcoholism or drug abuse recovery or treatment facility or certified alcohol or other drug program to include a disclosure on its internet website if a legal, disciplinary, or other enforcement action has been brought by the department and the facility or program was determined to be in violation. The bill would require the internet website disclosure to include the date and nature of the violation. violation, and require the disclosure to be posted no later than 14 business days after the determination of violation. The bill would impose a $2,500 civil penalty for failure to comply with the internet website posting requirement.

Existing law grants the State Department of Health Care Services the sole authority in state government to license adult alcoholism or drug abuse recovery or treatment facilities. The department is authorized to issue a license to specified types of facilities if certain criteria are met. Existing law requires licensees to report specified events and incidents to the department, including, among others, the death of a resident at a licensed facility. Existing law authorizes the department to investigate allegations of violations of governing law and take action upon a finding of a violation, as specified.

This bill would require an operator of a licensed alcoholism or drug abuse recovery or treatment facility or certified alcohol or other drug program to include a disclosure on its internet website if a legal, disciplinary, or other enforcement action has been brought by the department and the facility or program was determined to be in violation. The bill would require the internet website disclosure to include the date and nature of the violation. The bill would impose a $2,500 civil penalty for failure to comply with the internet website posting requirement.

 THIRD READING  

Bill No: AB 2081

Author: Davies (R)

Amended: 4/4/24 in Assembly

Vote: 21

SENATE HEALTH COMMITTEE: 10-0, 6/12/24

AYES: Roth, Nguyen, Glazer, Gonzalez, Grove, Hurtado, Limón, Menjivar, Rubio, Wiener

NO VOTE RECORDED: Smallwood-Cuevas

SENATE APPROPRIATIONS COMMITTEE: Senate Rule 28.8

ASSEMBLY FLOOR: 71-0, 5/16/24 (Consent) - See last page for vote

SUBJECT: Substance abuse: recovery and treatment programs

SOURCE: League of California Cities

DIGEST:

This bill requires entities licensed or certified by the Department of Health Care Services (DHCS) to include on their websites and intake paperwork a disclosure stating an individual may check DHCS’s website to confirm any actions taken against the entity.

ANALYSIS:

Existing law:

1. Requires DHCS to license and regulate residential alcoholism or drug abuse and substance use disorder (SUD) recovery or treatment facilities (RTFs). [Health and Safety Code (HSC) §11834.02, et seq.]
2. Grants DHCS the authority to implement a program certification procedure for outpatient alcohol and other drug treatment recovery services and to develop standards and regulations for the alcohol and other drug treatment recovery services describing the minimal level of service quality required of the service providers to qualify for and obtain state certification. [HSC §11830.1]
3. Requires DHCS to conduct onsite visits for compliance at least once during each certification or licensure period. Permits DHCS to conduct announced or unannounced site visits at any time to a certified or licensed program to determine compliance with applicable statutes and regulations. [HSC §11832.12 and 11834.01]

This bill:

1. Requires an operator of a RTF or a certified outpatient program to include on its website and intake paperwork a disclosure stating an individual may check DHCS’s website to confirm whether the entity’s license or certification has been placed on probationary status, been subject to a temporary suspension order, been revoked, or if the operator has been given a notice of operation in violation of law.
2. Requires DHCS to assess a penalty for a violation of the provisions in this bill.

Comments

1. Author’s statement. According to the author, “Far too many people in California are being caught in the deadly cycle of addiction. Thankfully, we have services where we can send our loved ones to if they need help breaking out of this cycle, but do we know where we are really sending them? It’s all too common today that we see stories of SUD facilities taking advantage of their patients, using them for personal gain. This bill requires SUD treatment facilities to provide a disclosure on their websites and intake paperwork that an individual may check DHCS’s website to see if facilities are on probation or have had their licensure or certification suspended. Fake SUD treatment facilities take advantage of patients with little oversight. This bill will bridge that gap by holding the establishments accountable to the patients they intend to serve. When a person seeks treatment, they should be able to know who is treating them.”
2. Licensed and certified programs. RTFs licensed by DHCS, based on what is commonly referred to as the “social model,” provide recovery, treatment, or detoxification services. (The Department of Public Health licenses medical model RTFs, known as chemical dependency recovery hospitals.) The services provided by social model RTFs include group and individual counseling, educational sessions, and alcoholism or drug abuse recovery and treatment planning. Social model RTFs are allowed to provide clients first aid and emergency care, and since the passage of AB 848 (Mark Stone, Chapter 744, Statutes of 2015), RTFs can apply to DHCS for an additional license to provide incidental medical services by a licensed physician or other health care practitioner. SB 823 (Hill, Chapter 781, Statutes of 2018) requires DHCS to adopt American Society of Addiction Medicine (ASAM) treatment criteria as the minimum standard of care for licensed RTFs. DHCS also is responsible for certification of a business entity with a physical location in the state that provides one or more of the following services to clients: treatment, recovery, or detoxification services, or medications for addiction treatment. DHCS also provides program certification for facilities that are licensed by the Department of Social Services that serve adolescents. As part of their licensing and certification functions, DHCS conducts reviews of licensed and certified programs every two years, or as necessary; checks for compliance with statute, regulations, and certification standards to ensure the health and safety of clients; investigates all complaints; and, has the authority to suspend or revoke a program’s license or certification for a violation of statute, regulations, and certification standards.
3. Informational hearing on patient brokering and subsequent legislation. On January 31, 2018, this Committee held an informational hearing to examine the SUD treatment system with a focus on treatment and services provided in licensed RTFs; insurance coverage; patient referrals; and the state’s regulation and oversight of the system, including the inability to impose restrictions on unregulated sober living homes. The hearing provided an overview of issues that had been affecting the state regarding unscrupulous facility operators, and gave an opportunity for state regulators to highlight efforts they have undertaken to combat the exploitation of the SUD system, including California Department of Insurance’s enforcement of unscrupulous sober living home operators that had been unlawfully providing services. The goal of the hearing was to examine the issues and to seek strategies and policies that would prevent unscrupulous individuals from exploiting the various industries that are supposed to help treat those with SUDs; to recognize federal and state protections for those with disabilities, including their housing rights and options for supportive housing at sober living homes; and to ensure that policies are not enacted, either at the local or state level, that will limit the number of recovery or treatment options for those who need them.

The Legislature passed, and Governor Brown signed, a package of bills that aimed to address the emerging issues in the SUD treatment and recovery realm. SB 1228 (Lara, Chapter 792, Statutes of 2018) prohibits facilities that are licensed or certified by DHCS, and anyone associated with them, from gaining financially for referring a person to treatment, also known as “patient brokering.” SB 992 (Hernandez, Chapter 784, Statutes of 2018) and AB 3162 (Friedman, Chapter 775, Statutes of 2018) made several changes to licensing statute for RTFs, particularly requiring RTFs and other facilities under DHCS’s purview to disclose certain business relationships, including with sober living homes, and requiring all RTF licensed services to be provided within the structures notated on an RTF’s license.

1. Troubling trends in the SUD field. Various media reports over the years have documented how unscrupulous individuals have found ways to exploit the SUD treatment system. Senate Health Committee staff, at the time around the 2018 informational hearing on patient brokering, had received reports of emerging trends and requested DHCS to confirm that some of the issues expressed were in fact occurring in licensed RTFs, including:
   1. Denying individuals admission to RTFs who had valid prescriptions from health care professionals for medications to aid in their recovery;
   2. RTF operators holding various licenses that were found to endanger the health and safety of residents at one RTF continued to operate the other RTFs while DHCS worked to suspend or revoke all of the licenses; and,
   3. RTF licensees who had a license suspended or revoked often reapplied for and subsequently were issued licensure after only two years.

While the package of SUD bills from 2018 were intended to address these troubling trends, some of the bad actors who claim to be part of the SUD industry, to this day, often operate multiple residences and claim they do not require licensure by DHCS because they do not provide any treatment services, even though often times this is found not to be the case. Media reports, as well as anecdotes from advocates, claim that these are the operators who shuffle clients among their various businesses as a means to skirt licensing laws.

Related/Prior Legislation

AB 2574 (Valencia, 2024) revises the requirement in existing law for certain entities to disclose that they own or control, or have a financial interest in, a recovery residence, and any contractual relationship with an entity that regularly provides services to addiction treatment or recovery clients to also include a general partner, director, or officer of the licensee. The bill is set for hearing on June 24, 2024 in the Senate Appropriations Committee.

FISCAL EFFECT: Appropriation: No Fiscal Com.: Yes Local: No

SUPPORT: (Verified 6/21/24)

League of California Cities (source)

Association of California Cities – Orange County

City of Buena Park

City of Cypress

City of Fountain Valley

City of Huntington Beach

City of Laguna Beach

City of Laguna Niguel

City of Newport Beach

City of Oceanside

City of Placentia

City of San Juan Capistrano

City of Thousand Oaks

City of Villa Park

County of Orange, Board of Supervisors

OPPOSITION: (Verified 6/21/24)

California Association of Alcohol and Drug Program Executives

ARGUMENTS IN SUPPORT: Supporters of this bill argue that compliance with state licensing laws administered through DHCS is essential to safeguarding residents’ well-being and maintaining quality care. This bill would ensure that those seeking treatment easily know what violations, if any, have occurred within a treatment facility and would hold providers accountable by making these violations easily accessible. This bill is commonsense, transparent legislation that protects residents and holds providers accountable for maintaining high quality treatment.

ARGUMENTS IN OPPOSITION: The California Association of Alcohol and Drug Program Executives opposes because they believe this bill is unnecessary given the existence of a similar statute already in law. Current law mandates that providers disclose their DHCS license number and the expiration date of their license on their website and in any marketing materials. Additionally, it requires SUD providers to give this information to anyone who inquires about the RTFs license through any method of communication. This existing law ensures that essential information about licensing and certification of SUD treatment facilities is readily available to the public.

ASSEMBLY FLOOR: 71-0, 5/16/24

AYES: Aguiar-Curry, Alanis, Arambula, Bains, Bauer-Kahan, Bennett, Berman, Boerner, Bonta, Bryan, Calderon, Juan Carrillo, Wendy Carrillo, Chen, Connolly, Davies, Dixon, Essayli, Mike Fong, Friedman, Gabriel, Gallagher, Garcia, Grayson, Haney, Hart, Holden, Hoover, Jackson, Jones-Sawyer, Kalra, Lackey, Lee, Low, Lowenthal, Maienschein, McCarty, McKinnor, Muratsuchi, Stephanie Nguyen, Ortega, Pacheco, Papan, Jim Patterson, Joe Patterson, Pellerin, Petrie-Norris, Quirk-Silva, Ramos, Rendon, Reyes, Luz Rivas, Rodriguez, Blanca Rubio, Sanchez, Santiago, Schiavo, Soria, Ta, Ting, Valencia, Villapudua, Waldron, Wallis, Ward, Weber, Wicks, Wilson, Wood, Zbur, Robert Rivas

NO VOTE RECORDED: Addis, Alvarez, Cervantes, Megan Dahle, Flora, Vince Fong, Gipson, Irwin, Mathis

Prepared by: Reyes Diaz / HEALTH / (916) 651-4111

6/25/24 13:06:33

**** END ****

SENATE COMMITTEE ON HEALTH

Senator Richard Roth, Chair

BILL NO: AB 2081

SUBJECT: Substance abuse: recovery and treatment programs

SUMMARY:

Requires entities licensed or certified by the Department of Health Care Services (DHCS) to include on their websites and intake paperwork, a disclosure stating an individual may check DHCS’s website to confirm any actions taken against the entity.

Existing law:

1. Requires DHCS to license and regulate residential alcoholism or drug abuse (or substance use disorder [SUD]) recovery or treatment facilities (RTFs). [HSC §11834.02, et seq.]
2. Grants DHCS the authority to implement a program certification procedure for outpatient alcohol and other drug treatment recovery services and to develop standards and regulations for the alcohol and other drug treatment recovery services describing the minimal level of service quality required of the service providers to qualify for and obtain state certification. [HSC §11830.1]
3. Requires DHCS to conduct onsite visits for compliance at least once during each certification or licensure period. Permits DHCS to conduct announced or unannounced site visits at any time to a certified or licensed program to determine compliance with applicable statutes and regulations. [HSC §11832.12 and 11834.01]

This bill:

1. Requires an operator of a RTF or a certified outpatient program to include on its website and intake paperwork, a disclosure stating an individual may check DHCS’s website to confirm whether the entity’s license or certification has been placed on probationary status, been subject to a temporary suspension order, been revoked, or if the operator has been given a notice of operation in violation of law.
2. Requires DHCS to assess a penalty for a violation of the provisions in this bill.

FISCAL EFFECT:

According to the Assembly Appropriations Committee, this bill results in negligible state costs.

PRIOR VOTES:

COMMENTS:

1. Author’s statement. According to the author, far too many people in California are being caught in the deadly cycle of addiction. Thankfully, we have services where we can send our loved ones to if they need help breaking out of this cycle, but do we know where we are really sending them? It’s all too common today that we see stories of SUD facilities taking advantage of their patients, using them for personal gain. This bill requires SUD treatment facilities to provide a disclosure on their websites and intake paperwork that an individual may check DHCS’s website to see if facilities are on probation or have had their licensure or certification suspended. Fake SUD treatment facilities take advantage of patients with little oversight. This bill will bridge that gap by holding the establishments accountable to the patients they intend to serve. When a person seeks treatment, they should be able to know who is treating them.
2. Licensed and certified programs. RTFs licensed by DHCS, based on what is commonly referred to as the “social model,” provide recovery, treatment, or detoxification services. (The Department of Public Health licenses medical model RTFs, known as chemical dependency recovery hospitals.) The services provided by social model RTFs include group and individual counseling, educational sessions, and alcoholism or drug abuse recovery and treatment planning. Social model RTFs are allowed to provide clients first aid and emergency care, and since the passage of AB 848 (Mark Stone, Chapter 744, Statutes of 2015), RTFs can apply to DHCS for an additional license to provide incidental medical services by a licensed physician or other health care practitioner. SB 823 (Hill, Chapter 781, Statutes of 2018) requires DHCS to adopt American Society of Addiction Medicine (ASAM) treatment criteria as the minimum standard of care for licensed RTFs. DHCS also is responsible for certification of a business entity with a physical location in the state that provides one or more of the following services to clients: treatment, recovery, or detoxification services, or medications for addiction treatment. DHCS also provides program certification for facilities that are licensed by the Department of Social Services that serve adolescents. As part of their licensing and certification functions, DHCS conducts reviews of licensed and certified programs every two years, or as necessary; checks for compliance with statute, regulations, and certification standards to ensure the health and safety of clients; investigates all complaints; and, has the authority to suspend or revoke a program’s license or certification for a violation of statute, regulations, and certification standards.
3. Informational hearing on patient brokering and subsequent legislation. On January 31, 2018, this Committee held an informational hearing to examine the SUD treatment system with a focus on treatment and services provided in licensed RTFs; insurance coverage; patient referrals; and the state’s regulation and oversight of the system, including the inability to impose restrictions on unregulated sober living homes. The hearing provided an overview of issues that had been affecting the state regarding unscrupulous facility operators, and gave an opportunity for state regulators to highlight efforts they have undertaken to combat the exploitation of the SUD system, including CDI’s enforcement of unscrupulous sober living home operators that had been unlawfully providing services. The goal of the hearing was to examine the issues and to seek strategies and policies that would prevent unscrupulous individuals from exploiting the various industries that are supposed to help treat those with SUDs; to recognize federal and state protections for those with disabilities, including their housing rights and options for supportive housing at sober living homes; and to ensure that policies are not enacted, either at the local or state level, that will limit the number of recovery or treatment options for those who need them.

The Legislature passed, and Governor Brown signed, a package of bills that aimed to address the emerging issues in the SUD treatment and recovery realm. SB 1228 (Lara, Chapter 792, Statutes of 2018) prohibits facilities that are licensed or certified by DHCS, and anyone associated with them, from gaining financially for referring a person to treatment, also known as “patient brokering.” SB 992 (Hernandez, Chapter 784, Statutes of 2018) and AB 3162 (Friedman, Chapter 775, Statutes of 2018) made several changes to licensing statute for RTFs, particularly requiring RTFs and other facilities under DHCS’s purview to disclose certain business relationships, including with sober living homes, and requiring all RTF licensed services to be provided within the structures notated on an RTF’s license.

1. Troubling trends in the SUD field. Various media reports over the years have documented how unscrupulous individuals have found ways to exploit the SUD treatment system. Senate Health Committee staff, at the time around the 2018 informational hearing on patient brokering, had received reports of emerging trends and requested DHCS to confirm that some of the issues expressed were in fact occurring in licensed RTFs, including:
   1. Denying individuals admission to RTFs who had valid prescriptions from health care professionals for medications to aid in their recovery;
   2. RTF operators holding various licenses that were found to endanger the health and safety of residents at one RTF continued to operate the other RTFs while DHCS worked to suspend or revoke all of the licenses; and,
   3. RTF licensees who had a license suspended or revoked often reapplied for and subsequently were issued licensure after only two years.

While the package of SUD bills from 2018 were intended to address these troubling trends, some of the bad actors who claim to be part of the SUD industry, to this day, often operate multiple residences and claim they do not require licensure by DHCS because they do not provide any treatment services, even though often times this is found not to be the case. Media reports, as well as anecdotes from advocates, claim that these are the operators who shuffle clients among their various businesses as a means to skirt licensing laws.

1. Related legislation. AB 2574 (Valencia) revises the requirement in existing law for certain entities to disclose that they own or control, or have a financial interest in, a recovery residence, and any contractual relationship with an entity that regularly provides services to addiction treatment or recovery clients to also include a general partner, director, or officer of the licensee. AB 2574 is set for hearing on June 12, 2024, in this Committee.
2. Prior legislation. SB 823 (Hill, Chapter 781, Statutes of 2018) requires DHCS to adopt ASAM treatment criteria as the minimum standard of care for licensed RTFs.

SB 992 (Hernandez, Chapter 784, Statute of 2018), among other things, implemented the requirement that DHCS-licensed or certified programs disclose relationships with RRs.

SB 1228 (Lara, Chapter 792, Statutes of 2018) prohibits certain persons, programs, or entities, and persons employed by, or working for, that program, from giving or receiving remuneration or anything of value for the referral of a person who is seeking SUD recovery and treatment services, as specified.

AB 3162 (Friedman, Chapter 775, Statutes of 2018) made various changes to current law regarding licensed RTFs including: making initial licenses provisional for one year; requiring services offered by the RTF to be specified on the license and provided within the licensed RTF, as specified; and, increasing civil penalties for the violation of licensing law.

AB 848 (Mark Stone, Chapter 744, Statutes of 2015), implemented law that permits RTFs to apply for an additional license to provide incidental medical services by a licensed physician or other health care practitioner to the residents of an RTF.

1. Support. Supporters of this bill argue that compliance with state licensing laws administered through DHCS is essential to safeguarding residents’ well-being and maintaining quality care. This bill would ensure that those seeking treatment easily know what violations, if any, have occurred within a treatment facility and would hold providers accountable by making these violations easily accessible. This bill is commonsense, transparent legislation that protects residents and holds providers accountable for maintaining high quality treatment.
2. Opposition. The California Association of Alcohol and Drug Program Executives opposes because they believe this bill is unnecessary given the existence of a similar statute already in law. Current law mandates that providers disclose their DHCS license number and the expiration date of their license on their website and in any marketing materials. Additionally, it requires SUD providers to give this information to anyone who inquires about the RTFs license through any method of communication. This existing law ensures that essential information about licensing and certification of SUD treatment facilities is readily available to the public.

SUPPORT AND OPPOSITION:

Support: League of California Cities (sponsor)

Association of California Cities – Orange County

City of Buena Park

City of Cypress

City of Fountain Valley

City of Huntington Beach

City of Laguna Beach

City of Laguna Niguel

City of Newport Beach

City of Placentia

City of San Juan Capistrano

City of Villa Park

County of Orange, Board of Supervisors

Oppose: California Association of Alcohol and Drug Program Executives

-- END --

Date of Hearing: May 8, 2024

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Buffy Wicks, Chair

ABPCA Bill Id:AB 2081

Author:(Davies) – As Amended Ver:April 4, 2024

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

SUMMARY:

This bill requires a licensed alcoholism or drug abuse recovery or treatment facility, or a certified alcohol or other drug program to disclose on its website and intake paperwork that an individual may check the Department of Health Care Services website to confirm whether the facility’s license or program’s certification has been placed in probationary status, subject to a temporary suspension order, or revoked, or the operator has been given a notice of operation in violation of law.

FISCAL EFFECT:

Negligible state costs.

COMMENTS:

Purpose. This bill is sponsored by the League of California Cities. According to the author:

Too many people in California are being caught in the deadly cycle of addiction. Thankfully we have services where we can send our loved ones to if they need help breaking out of this cycle, but where are we really sending them? It’s all too common today that we see stories of substance abuse facilities taking advantage of their patients, using them for personal gain. AB 2081 requires substance abuse facilities to post to their website any violations brought against them. Fake substance abuse treatment facilities take advantage of patients with little oversight. My bill will bridge that gap by holding the establishments accountable to the patients they intend to serve. When a person seeks treatment, they should be able to know who is treating them, at all levels.

Opposition. The California Association of Alcohol and Drug Program Executives (CAADPE) opposes this bill, arguing it singles out alcoholism or drug abuse recovery or treatment facilities and certified alcohol or other drug programs, creating a disparate standard for substance use disorder (SUD) providers compared to other types of facilities, such as nursing homes or clinics, which are not subject to similar disclosure mandates. CAADPE further contends this bill does not differentiate between the rarer intentional, serious abuses committed by bad actors and harmless, non-intentional documentation violations that are much more commonplace and risks unjustly tarnishing the reputation of facilities that may have inadvertently fallen afoul of documentation guidelines.

Analysis Prepared by: Allegra Kim / APPR. / (916) 319-2081

Date of Hearing: April 2, 2024

ASSEMBLY COMMITTEE ON HEALTH

Mia Bonta, Chair

ABPCA Bill Id:AB 2081

Author:((Davies) – As Amended Ver:March 13, 2024

SUBJECT: Substance abuse: recovery and treatment programs.

SUMMARY: Requires an operator of a licensed alcoholism or drug abuse recovery or treatment facility (RTF) or certified alcohol or other drug (AOD) program to disclose on its internet website if a legal, disciplinary, or other enforcement action has been brought by the Department of Health Care Services (DHCS), whether the RTF or program was determined to be in violation, and must include the date and nature of the violation. Specifically, this bill:

1. Requires an operator of a licensed alcoholism or drug abuse RTF or certified AOD program to disclose on its internet website if a legal, disciplinary, or other enforcement action has been brought by DHCS, whether the RTF or program was determined to be in violation, and must include the date and nature of the violation.
2. Requires the disclosure to be posted within 14 business days following determination of a violation by DHCS.
3. Imposes a $2,500 civil penalty for failure to comply.

EXISTING LAW:

1. Grants DHCS the sole authority in state government to license alcoholism or drug abuse RTFs. [Health and Safety Code (HSC) §11834.01]
2. Defines “alcoholism or drug abuse RTF” as any place or building that provides 24-hour residential nonmedical services to adults who are recovering from problems related to alcohol, drug, or alcohol and drug misuse or abuse, and who need alcohol, drug, or alcohol and drug recovery treatment or detoxification services. [HSC §11834.02]
3. Requires RTF licensees to provide at least one of the following nonmedical services: recovery; treatment; or, detoxification services. Requires DHCS to adopt regulations requiring records and procedures appropriate for the type of service provided. Provides that the records and procedures can include all of the following: admission criteria; intake process; assessments; recovery, treatment, or detoxification planning; referral; documentation of provision of recovery, treatment, or detoxification services; discharge and continuing care planning; or indicators of recovery, treatment, or, detoxification outcomes. [HSC §11834.26]
4. Permits the DHCS Director to suspend or revoke any license issued to a RTF, or deny an application for licensure, extend the licensing period, or modify a license for any reason that includes, but is not limited to, a violation of licensing laws, repeated violations, conduct that puts the health and safety of a resident of the RTF in jeopardy, and an RTF’s refusal to allow DHCS representatives to enter an RTF. [HSC §11834.36]
5. Permits the DHCS Director, to temporarily suspend any license, prior to any disciplinary hearing, when DHCS’s Director determines the action is necessary to protect residents of the RTF from physical and mental abuse, abandonment, or any other substantial threat to health and safety, as specified. [HSC §11834.36]
6. Permits DHCS to levy civil penalties against a RTF in addition to penalties of suspension or revocation of a license or certification. [HSC §11834.34]
7. Prohibits a DHCS licensed or certified program, and specified individuals associated with or employed by those programs, from giving or receiving remuneration or anything of value for the referral of a person who is seeking alcoholism or drug abuse recovery and treatment services, as specified. Permits DHCS to investigate allegations of violations and take action, such as revocation of licensure or certification or assessment of penalties. [HSC §11831.6 and 11831.7]
8. Requires a facility licensed by DHCS to disclose its license number and the date that the license is scheduled to expire on its internet website, in any print, audio, or electronic advertising, and to any person who inquires about the licensure or certification of the program. [HSC §11831.12]

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

COMMENTS:

1. PURPOSE OF THIS BILL. According to the author, too many people in California are caught in the deadly cycle of addiction and thankfully we have services where we can send our loved ones to if they need help breaking out of this cycle. However, the author questions where are we really sending them? The author contends that it’s all too common today that we see stories of substance abuse facilities taking advantage of their patients and using them for personal gain. The author states that fake substance abuse treatment facilities take advantage of patients with little oversight and this bill will bridge that gap by holding those establishments accountable to the patients they intend to serve. The author concludes when a person seeks treatment they should be able to know who is treating them, at all levels.
2. BACKGROUND. RTFs provide 24-hour nonmedical care to eligible adults who are recovering from AOD usage. RTFs are based on what is commonly referred to as the social model, which centers on experiential knowledge, peer-to-peer interaction, and community engagement. These facilities range in size from six-beds in residential neighborhoods to centers that accommodate more than 100 beds. The basic services provided by these facilities include group, individual and educational sessions, detoxification, alcoholism or drug abuse, recovery and treatment planning. These services can be provided by a variety of health care providers such as alcohol and drug counselors, mental health therapists, social workers, psychologists, nurses, and physicians.
   1. Alcohol and Drug Treatment Facility Licensing and Certification. DHCS has sole authority to license RTFs in the state. Licensure is required when at least one of the following services is provided: detoxification; group sessions; individual sessions; educational sessions; or, alcoholism or other drug abuse recovery or treatment planning. Additionally, facilities may be subject to other types of permits, clearances, business taxes, or local fees that may be required by the cities or counties in which the facilities are located.

As part of their licensing function, DHCS conducts reviews of RTF operations every two years, or as necessary. DHCS's Substance Use Disorder Compliance Division checks for compliance with statute and regulations to ensure the health and safety of RTF residents and investigates all complaints related to RTFs, including deaths, complaints against staff, and allegations of operating without a license. DHCS has the authority to suspend or revoke a license for conduct in the operation of an RTF that is inimical to the health, morals, welfare, or safety of either an individual in, or receiving services from, the facility or to the people of the State of California.

AB 118 (Committee on Budget), Chapter 42, Statutes of 2023, requires other non-residential, outpatient AOD programs be certified by DHCS. Certification is required when at least one of the following is provided: outpatient treatment services; recovery services; detoxification; or medications for addiction treatment. DHCS does not license alcohol and drug recovery residences with six or less beds that don’t provide licensable services, known as "recovery residences."

• 1. Prevalence of Substance Use Disorder (SUD) in California. A 2022 publication from the California Health Care Foundation, entitled “Substance Use in California: Prevalence and Treatment” reported that substance use in California is widespread with over half of Californians over age 12 reporting using alcohol in the past month and 20% reporting using marijuana in the past year. According to the report, 9% of Californians have met the criteria for a SUD within the last year. While the health care system is moving toward acknowledging SUDs as a chronic illness, only about 10% of people with an SUD within the last year received treatment. Overdose deaths from both opioids and psychostimulants (such as amphetamines), are soaring. This issue, compounded by the increased availability of fentanyl, has resulted in a 10-fold increase in fentanyl related deaths between 2015 and 2019. The California Department of Public Health’s Opioid Overdose Dashboard reported 7,385 deaths related to “any” opioid overdose in 2022, with 6,473 (87.7%) of those deaths fentanyl related.

1. SUPPORT. The League of California Cities is sponsoring this bill, stating it would require a higher standard of transparency and greater protections for individuals seeking alcoholism or substance use treatment. The League of California Cities argues that compliance with state licensing laws administered through DHCS is essential to safeguarding residents’ well-being and maintaining quality care. They continue that this bill would ensure that those seeking treatment easily know what violations, if any, have occurred within a RTF and would hold providers accountable by making these violations easily accessible to the public.
2. OPPOSITION. The California Association of Alcohol and Drug Program Executives (CAADPE) is opposed to this bill, stating that it singles out RTFs and AOD programs by mandating them to disclose legal, disciplinary, or enforcement actions on their internet websites. CAADPE states that this requirement creates a disparate standard for SUD providers compared to other types of facilities, such as nursing homes or clinics, which are not subject to similar disclosure mandates. CAADPE continues that this bill does not differentiate between the rarer intentional, serious abuses committed by bad actors and harmless, non-intentional documentation violations that are much more commonplace as providers strive to navigate the complex landscape of medical rules and requirements regarding documentation. CAADPE argues that imposing blanket disclosure requirements without considering the nature and severity of violations risks unjustly tarnishing the reputation of facilities that may have inadvertently fallen afoul of documentation guidelines.
3. RELATED LEGISLATION.
   1. AB 2121 (Dixon) requires RTFs licensed by DHCS to be located more than 300 feet from another RTF or community care facility. Requires DHCS to notify the city or county in which the facility is located of the issuance of a license. AB 2121 is currently pending in the Assembly Health Committee.
   2. AB 2574 (Valencia) requires sober living homes, as defined, that are an integral part of a licensed RTF to be exempt from being considered a residential use of property. AB 2574 is currently pending in the Assembly Health Committee.
   3. SB 1334 (Newman) requires local jurisdictions to require a use permit or conditional use permit for RTFs or recovery residences, as defined, that serve seven or more residents. As part of the permit, the local jurisdiction may require that RTFs and recovery residences be at least 1,000 feet from another RTF or recovery residence. SB 1334 is currently pending in the Senate Health Committee.
4. PREVIOUS LEGISLATION.
   1. SB 349 (Umberg), Chapter 15, Statutes of 2022, creates the California Ethical Treatment for Persons with Addiction Act to provide protection for SUD treatment clients and their families. Imposes requirements and proscribed unlawful acts relating to marketing and advertising with respect to treatment provide. Requires treatment providers to adopt a client bill of rights for persons seeking treatment for SUD, and to make the bill of rights available to all clients and prospective clients; a treatment provider to maintain records of referrals to or from a recovery residence (RR), as specified and, provides that acts made unlawful by the bill be subject to a civil fine of up to $20,000 per violation.
   2. AB 1158 (Petrie Norris), Chapter 443, Statutes of 2021, requires an RFT licensed by DHCS serving more than six residents to maintain specified insurance coverages, including commercial general liability insurance and employer’s liability insurance. Required a licensee serving six or fewer residents to maintain general liability insurance coverage. Requires any government entity that contract with privately owned RR or RTF serving more than six residents to require the contractors to, at all times, maintain specific insurance coverage.
   3. SB 589 (Bates) of 2020 would have prohibited an operator of a licensed RTF, an AOD program, a RR, or a third party from engaging in specified marketing activities including make a false or misleading statements or providing false or misleading information about the entity’s products, goods, services, or geographical locations in its marketing, advertising materials, or media, or on its internet website or on a third-party internet AB 589 was vetoed by the Governor with the following message:

“This bill would establish several prohibitions related to the advertisement of SUD services by the operator of a RTF, an AOD, a RR, or a third party that provides any advertising or marketing services or directory listings to any of those entities.
While it is important to protect vulnerable patients and their families from unethical marketing practices, I am concerned that as crafted, this measure creates a false promise. DHCS has no jurisdiction or licensing oversight over RRs or third parties. As such, it cannot take enforcement against those entities for violations of advertisement requirements.”

1. DOUBLE REFERRAL. This bill is double-referred, upon passage of this Committee, it will be referred to the Assembly Judiciary Committee.
2. SUGGESTED AMENDMENTS.
   1. DHCS has authority to levy penalties, including license suspension or revocation, against facilities that are in violation of the Chapter this bill is amending. Additionally, the penalty proposed in this bill is higher than defined penalties for more egregious violations, such as operating a facility without a license which is $2,000. The Committee may wish to remove the civil penalty provision from this bill given DHCS’s existing authority to levy appropriate fines for violations.
   2. As drafted, this bill would require a RTF to post a legal, disciplinary, or other enforcement action brought by DHCS within 14 days. This assumes that the facility will post the action and DHCS will be able to enforce noncompliance in a timely manner. DHCS has the responsibility to investigate all compliance complaints against licensed RTFs and outpatient programs that are certified by DHCS. Complaints are triaged based on priority, ranked from high, medium, to low status, and completion of each complaint varies from 30 days to up to two years. The 2023 state budget restructured licensing and certification fees to provide additional resources to support DHCS’ efforts to strengthen compliance oversight. Even so, it is unlikely that DHCS will be able to enforce the provisions of this bill in the timelines outlined in the bill and provide consumers with the transparency the author seeks.

As part of the DHCS’ effort to enhance transparency of licensing and certification compliance reviews, DHCS posts all complaint and compliance reports on the DHCS website. A DHCS webpage posts regularly updated reports of licensed and unlicensed facilities that are: on probationary status; temporary suspension orders; have revoked licenses; and, given notices of operation in violation of law. The Committee may wish to amend the bill to require facilities to provide the link to this webpage to ensure consumers are able to access the most up-to-date information on enforcement actions brought to all facilities by DHCS.

REGISTERED SUPPORT / OPPOSITION:

Support

League of California Cities (sponsor)

City of Laguna Niguel

Oppose

California Association of Alcohol and Drug Program Executives, Inc.

Analysis Prepared by: Riana King / HEALTH / (916) 319-2097