Existing law, the Bronzan-McCorquodale Act, contains provisions governing the operation and financing of community mental health services in every county through locally administered and locally controlled community mental health programs.

This bill would require the State Department of Health Care Services (DHCS), jointly with the County Behavioral Health Directors Association of California, to implement a certification program to provide augmented services to adults with serious mental illness in homelike community settings, and would require those settings to be licensed by the State Department of Social Services (DSS) as a type of enhanced behavioral supports home known as an augmented residential care facility (ARCF). (ARCF), as defined. The bill would require an ARCF to have a maximum capacity of 6 residents, and to conform with the requirements of a specified federal regulation relating to community-based settings and specified provisions of the California Community Care Facilities Act. The bill would require the DHCS to issue a certification of program approval to an ARCF before DSS issues a license. The bill would require the DHCS to establish by regulation a rate methodology for ARCFs that includes a fixed-facility component for residential services and an individualized services and support component based on each consumers needs, as specified. The bill would prohibit a local mental or behavioral health agency from paying a rate to an ARCF for a consumer that exceeds the rate in the DHCS-approved ARCF placement plan for the facility unless certain conditions are met. The bill would authorize a local mental or behavioral health agency to recommend an applicant for certification to the DHCS as part of an approved community placement plan if the applicant meets specified requirements. The bill would authorize DHCS to decertify an ARCF that does not comply with program requirements, and to make recommendations to DSS regarding the facilitys license. The bill also would authorize DHCS DSS to initiate proceedings for temporary suspension of the license, as specified. The bill would be implemented only to the extent that funds for its purposes are made available through an appropriation in the annual Budget Act.

By creating requirements for augmented residential care facilities, a violation of which would be a crime, and by imposing new duties on local behavioral health agencies, the bill would impose a state-mandated local program.

Existing law, the Bronzan-McCorquodale Act, contains provisions governing the operation and financing of community mental health services in every county through locally administered and locally controlled community mental health programs.

Existing law, the California Community Care Facilities Act, provides for the licensing and regulation of various community care facilities, including, but not limited to, adult residential facilities and enhanced behavioral supports homes, as defined, by the State Department of Social Services. Under existing law, the department similarly regulates residential care facilities for the elderly. A violation of provisions relating to these facilities is a misdemeanor.

This bill would require the State Department of Health Care Services (DHCS), jointly with the County Behavioral Health Directors Association of California, to implement a certification program to provide augmented services to adults with serious mental illness in homelike community settings, and would require those settings to be licensed by the State Department of Social Services (DSS) as a type of enhanced behavioral supports home known as an augmented residential care facility (ARCF). The bill would require an ACRF ARCF to have a maximum capacity of 6 residents, and to conform with the requirements of a specified federal regulation relating to community-based settings and specified provisions of the California Community Care Facilities Act. The bill would require the DHCS to issue a certification of program approval to an ARCF before DSS issues a license. The bill would require the DHCS to establish by regulation a rate methodology for ARCFs that includes a fixed-facility component for residential services and an individualized services and support component based on each consumers needs, as specified. The bill would prohibit a local mental or behavioral health agency from paying a rate to an ARCF for a consumer that exceeds the rate in the DHCS-approved ARCF placement plan for the facility unless certain conditions are met. The bill would authorize a local mental or behavioral health agency to recommend an applicant for certification to the DHCS as part of an approved community placement plan if the applicant meets specified requirements. The bill would authorize DHCS to decertify an ARCF that does not comply with program requirements, and to make recommendations to DSS regarding the facilitys license. The bill also would authorize DHCS to initiate proceedings for temporary suspension of the license, as specified. The bill would be implemented only to the extent that funds for its purposes are made available through an appropriation in the annual Budget Act.

By creating requirements for augmented residential care facilities, a violation of which would be a crime, and by imposing new duties on local behavioral health agencies, the bill would impose a state-mandated local program.

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 with regard to certain mandates no reimbursement is required by this act for a specified reason.

With regard to any other mandates, this bill would provide that, if the Commission on State Mandates determines that the bill contains costs so mandated by the state, reimbursement for those costs shall be made pursuant to the statutory provisions noted above.

Existing law licenses as a community care facility an enhanced behavioral supports home, which is a facility certified by the State Department of Developmental Services and licensed by the State Department of Social Services as an adult residential facility or a group home. Existing law requires an enhanced behavioral supports home to be certified by the State Department of Developmental Services, and its plan of operation approved by both the State Department of Developmental Services and the State Department of Social Services prior to being licensed as a community care facility.

This bill would make technical, nonsubstantive changes to one of those provisions.

SENATE COMMITTEE ON

Senator Anna Caballero, Chair

2023 - 2024 Regular Session

SB 1082 (Eggman) - Augmented residential care facilities

Bill Summary:

SB 1082 would establish a new facility category, the Augmented Residential Care Facility (ARCF), subject to state licensure and certification.

Fiscal Impact:

• Unknown, ongoing General Fund costs for the Department of Health Care Services (DHCS) and the California Department of Social Services (CDSS) for state administration.
• Unknown, ongoing costs to local behavioral health agencies for monitoring and enforcement activities. Cost to counties for administration would be potentially reimbursable by the state, subject to a determination by the Commission on State Mandates.

Background:

Current law grants the DHCS the sole authority in state government to administer, license, certify, and regulate all substance use disorder functions and programs. DHCS has authority to implement a program certification procedure for 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.

CDSS licenses several types of adult residential facilities. Current law defines “adult residential facility” (ARF) as any facility of any capacity that provides 24-hour-a-day nonmedical care and supervision to persons 18 years of age through 59 years of age, and persons 60 years of age and older. Residential Care Facilities for the Elderly (RCFEs), licensed by CDSS, are defined as a housing arrangement chosen voluntarily by persons 60 years of age or over, or their authorized representative, where varying levels and intensities of care and supervision, protective supervision, personal care, or health-related services are provided, based upon their varying needs, as determined in order to be admitted and to remain in the facility. Within RCFEs, “health-related services” are services that are directly provided by an appropriate skilled professional, including a registered nurse, licensed vocational nurse, physical therapist, or occupational therapist.

Proposed Law:

Specific provisions of the bill would:

• Define “ARCF” as a facility certified by DHCS and licensed by CDSS that provides 24-hour nonmedical care to individuals with serious mental illness who require augmented supports, staffing, and supervision in a homelike setting, with other facility characteristics to address a consumer’s complex behavioral health needs that are beyond what is typically available in other community facilities licensed as an adult residential facility or a residential care facility for the elderly.
• Require the DHCS, jointly with the County Behavioral Health Directors Association, to implement a certification program to provide augmented services to adults with serious mental illness in homelike community settings.
• Authorize the CDSS to license an adult residential facility or a residential care facility for the elderly as an ARCF, to provide 24-hour nonmedical services to up to six adults who have serious mental illness.
• Require DHCS to be responsible for granting the certificate of program approval for an ARCF; and require that the CDSS cannot issue a license unless the applicant has obtained a certification of program approval from DHCS.
• Require the local mental or behavioral health agency to monitor and enforce compliance of the program and health and safety requirements, including monitoring and evaluating the quality of care and support services.
• Require DHCS to establish by regulation a rate methodology for ARCFs, as specified.
• Condition implementation only to the extent that funds are made available through an appropriation in the annual Budget Act.

-- END --

SENATE COMMITTEE ON HUMAN SERVICES

Senator Alvarado-Gil, Chair

2023 - 2024 Regular

Subject: Augmented residential care facilities

SUMMARY

This bill would create Augmented Residential Care Facility as a new type of facility to provide 24-hour nonmedical care for up to six adults with serious mental illness. This bill would require ARCFs to be licensed by the Department of Social Services (CDSS) and certified by the Department of Health Care Services (DHCS). This bill would require an ARCF administrator to meet specified requirements and renew their administrator certificate every two years. This bill would require the local mental or behavioral health agency to monitor and enforce compliance of the program and health and safety requirements. This bill would require an ARCF administrator, CDSS, and DHCS to perform specified actions in the event that an ARCF closes. This bill makes requirements of the rates charged by an ARCF and to be paid by a consumer living at an ARCF.

ABSTRACT

Existing Law:

Bronzan-McCorquodale Act

1. Establishes the Bronzan-McCorquodale Act to organize and finance community mental health services for persons with mental health disorders in every county through locally administered and locally controlled community mental health programs. (WIC 5600 et seq.)
2. Defines “serious mental disorder” as a mental disorder that is severe in degree and persistent in duration, which may cause behavioral functioning which interferes substantially with the primary activities of daily living, and which may result in an inability to maintain stable adjustment and independent functioning without treatment, support, and rehabilitation for a long or indefinite period of time. Serious mental disorders include, but are not limited to:
   1. Schizophrenia
      
   2. Bipolar disorder
   3. Post-traumatic stress disorder
   4. Major affective disorders
   5. Severely disabling mental disorders. (WIC 5600.3(b))

California Community Care Facilities Act (CCCFA)

1. Establishes the CCCFA to establish a coordinated and comprehensive statewide service system of quality community care for mentally ill, developmentally and physically disabled, and children and adults who require care or services by a facility or organization issued a license or special permit. (HSC 1500 et seq.)
2. Defines “residential facility” as 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. (HSC 1501(a)(1))
3. Defines “adult residential facility” (ARF) as any facility of any capacity that provides 24-hour-a-day nonmedical care and supervision to persons 18 years of age through 59 years of age, and persons 60 years of age and older. Specifies that “adult community care facility” means an ARF. (22 CCR 800001(a)(5))
4. Requires any person seeking issuance of a license for a community care facility to submit an application to CDSS, on forms furnished by the department, which shall include specified information. (HSC 1520)
5. Requires CDSS to secure from an appropriate law enforcement agency a criminal record to determine whether an applicant for licensure has been convicted of a crime, as specified, or a crime for which CDSS is prohibited from granting a criminal record exemption. (HSC 1522)
6. Authorizes CDSS to deny an application for, or suspend or revoke, any license or administrator certificate upon any of the following grounds, or may deny a transfer of a license, as specified, for any of the following grounds:
   1. Violation of the CCCFA by the licensee or holder of a certificate.
   2. Aiding, abetting, or permitting the violation of the CCCFA.
   3. Conduct which is inimical to the health, morals, welfare, or safety of either the people of this state or an individual in, or receiving services from, the facility.
   4. The conviction of a licensee, holder of a special permit or certificate, or other person, as specified, at any time before or during licensure, of a crime, as specified.
   5. The licensee of any facility, holder of a certificate, or the person providing direct care or supervision knowingly allows any child to have illegal drugs or alcohol.
   6. Engaging in acts of financial malfeasance concerning the operation of a facility, as specified. (HSC 1550)
7. Authorizes the Director of CDSS to temporarily suspend any license prior to any hearing when, in the Director’s opinion, the action is urgent to protect residents or clients of the facility from physical or mental abuse, abandonment, or any other substantial threat to health or safety. (HSC 1550.5)
8. Requires proceedings for the suspension, revocation, or denial of a license or administrator certificate, or denial of transfer of a license, to be conducted in accordance with the formal hearing procedures described in Chapter 5 (commencing with Section 11500) of Part 1 of Division 3 of Title 2 of the Government Code. (HSC 1551)
9. Authorizes CDSS to require the immediate removal of or institute a disciplinary proceeding against a person who is not a client, as specified, who has: violated any provisions of the CCCFA, engaged in harmful conduct, as specified, been denied an exemption to work or be present in a facility when that person has been convicted of a crime, engaged in any other conduct that would constitute disciplinary action against a licensee, or engaged in acts of financial malfeasance concerning the operation of a facility, as specified. (HSC 1558)
10. Requires CDSS, in consultation with the Director of DHCS and the Director of DDS, to establish a training program to ensure that licensees, operators, and staffs of ARFs have appropriate training to provide the care and services for which a license or certificate is issued. Further requires an administrator of an ARF to successfully complete a department-approved administrator certification training program prior to employment. (HSC 1562.3(a-b))
11. Requires an administrator certification training program for ARFs to include a minimum of 35 hours of instruction conducive to simultaneous interaction with each other and the instructor, and that provides training on a uniform core of knowledge, as specified. Requires an applicant for an administrator’s certificate to, within 60 days of their completion of instruction, pass the administrator certification examination. (HSC 1562.3(c))
12. Requires CDSS to charge nonrefundable fees for processing an administrator certification application or renewal, reissuance of a lost administrator certificate, and a delinquency fee for processing a late administrator certification renewal application. (HSC 1562.3(j))

Enhanced Behavioral Supports Homes

1. Defines “enhanced behavioral supports home” (EBSH) as a facility certified by the State Department of Developmental Services (DDS) and licensed by the State Department of Social Services (CDSS) 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, conform to federal regulations, and shall be eligible for federal Medicaid home- and community-based services (HCBS) funding. (HSC 1502(a)(15))
2. In federal law, requires home- and community-based settings to have all of the following qualities, and such other qualities as the Secretary of Health and Human Services determines to be appropriate, based on the needs of the individual as indicated in their person-centered service plan:
   1. The setting is integrated in and supports full access of individuals receiving Medicaid HCBS to the greater community.
   2. The setting is selected by the individual from among setting options.
   3. Ensures an individual’s right of privacy, dignity and respect, and freedom from coercion and restraint.
   4. Facilitates individual choice regarding services and supports, and who provides them.
   5. In a provider-owned or controlled residential setting, additional conditions must be met, as specified. (42 CFR 441.530)
3. Requires each EBSH to be licensed by CDSS as an ARF or a group home and certified by the State Department of Developmental Services (DDS). (WIC 1567.62(a))
4. Requires a certificate of program approval issued by DDS as a condition of licensure for the EBSH by CDSS. Prevents CDSS from issuing a license to an EBSH until receipt of the DDS-granted certificate of program approval. (WIC 1567.62(b-c))
5. States CDSS is not responsible for any of the following:
6. Developing and approving a consumer’s individual behavior supports plan in conjunction with the consumer’s individual behavior supports team.
7. Oversight of any services that may be provided by a licensed health professional or licensed mental health professional to a consumer, as defined. (WIC 1567.62(f))

Residential Care Facilities for the Elderly

1. Establishes the California Residential Care Facilities for the Elderly Act. (HSC 1569 et seq.)
2. Defines “administrator” as the individual designated by the licensee to act on behalf of the licensee in the overall management of the facility. The licensee, if an individual, and the administrator may be one and the same person. (HSC 1569.2(a))
3. Defines “residential care facility for the elderly” (RCFE) as a housing arrangement chosen voluntarily by persons 60 years of age or over, or their authorized representative, where varying levels and intensities of care and supervision, protective supervision, or personal care are provided, based upon their varying needs, as determined in order to be admitted and to remain in the facility. Persons under 60 years of age with compatible needs may be allowed to be admitted or retained in an RCFE under specified circumstances. (HSC 1569.2(o))
4. Defines “care and supervision” as the facility assuming responsibility for, or providing or promising to provide in the future, ongoing assistance with activities of dialing living without which the resident’s physical health, mental health, safety, or welfare would be endangered. Assistance includes assistance with taking medications, money management, or personal care. (HSC 1569.2(c))
5. Defines “protective supervision” as observing and assisting confused residents, including persons with dementia to safeguard them against injury. (HSC 1569.2(n))
6. Establishes Legislative intent to develop and implement a plan to establish three levels of care under the RCFE license, subject to future Budget Act appropriations and statutory authorization to implement levels of care. The guidelines for the development of these levels of care are:
   1. Level I—Base care and supervision. Residents at this level are able to maintain a higher degree of independence and need only minimum care and supervision, as defined, and minimal personal care assistance.
   2. Level II—Nonmedical personal care. Residents at this level have functional limitations and psychosocial needs requiring not only care and supervision but frequent assistance with personal activities of daily living and active intervention to help them maintain their potential for independent living.
   3. Level III—Health related assistance. Residents at this level require the services of lower levels and rely on the facility for extensive assistance with personal activities of daily living. This level may include residents who also require the occasional services of an appropriate skilled professional due to chronic health problems and returning residents recovering from illness, injury, or treatment that required placement in facilities providing higher levels of care. (HSC 1569.70(a))
7. Establishes Legislative intent that the levels of care plan shall include recommendations for a supplemental rate structure based on the services required at Levels II and III to be provided for residents who need those levels of care and are recipients of SSI/SSP. These rates shall be in addition to the basic SSI/SSP rate for providing care supervision and shall reflect actual costs of operation for RCFEs. (HSC 1569.70(b)(4))

Supplementary Security Income (SSI)/State Supplementary Payment (SSP)

1. In federal law, establishes a national SSI program for individuals who are income eligible and 65 years of age or older, blind, or disabled. (42 USC 1381 et seq.)
2. Establishes the Burton-Moscone-Bagley Citizens’ Income Security Act for Aged, Blind and Disabled Californians to create the SSP program to administer the federal SSI program. (WIC 12000 et seq.)

Health Facilities

1. Defines various types of health facilities, including:
2. “General acute care hospital” means a health facility with an organized medical staff that provides 24-hour inpatient care, including the following basic services: medical, nursing, surgical, anesthesia, laboratory, radiology, pharmacy, and dietary services.
3. “Acute psychiatric hospital” means a health facility with an organized medical staff that providers 24-hour inpatient care for persons with mental health disorders or other patients, as specified, including the following basic services: medical, nursing, rehabilitative, pharmacy, and dietary services.
4. “Skilled nursing facility” means a health facility that provides skilled nursing care and supportive care to patients whose primary need is for availability of skilled nursing care on an extended basis. (HSC 1250(a-c))

This Bill:

1. Adds Augmented Residential Care Facility certified by DHCS to the list of possible license types for an Enhanced Behavioral Supports Home.
2. Adds a certificate of program approval issued by DHCS as a condition of licensure, as applicable, for an Enhanced Behavioral Supports Home. When applicable, prohibits CDSS from licensing an Enhanced Behavioral Supports Home until the certificate of program approval granted by DHCS has been received.
3. Defines “Augmented Residential Care Facility” as a facility certified by DHCS and licensed by CDSS that provides 24-hour nonmedical care to individuals with serious mental illness who require augmented supports, staffing, and supervision in a homelike setting.
4. Defines “augmented services and supports” as additional staffing supervision, facility characteristics, or other services and supports to address a consumer’s complex behavioral health needs, which are beyond what is typically available in other community facilities licensed as an Adult Residential Facility or a Residential Care Facility for the Elderly.
5. Defines “individual supports plan” as the plan that identifies and documents the support and service needs of a consumer and details the strategies to be employed and services to be provided to address those needs, and include the entity responsible for providing those services and timelines for when each identified support will commence.
6. Defines “individual supports team” as those individuals who develop, monitor, and revise the individual supports plan for consumers residing in an Augmented Residential Care Facility. The team shall, at a minimum, be composed of all of the following individuals:
   1. The local mental or behavioral health agency coordinator and other local mental or behavioral health agency representatives, as necessary.
   2. The consumer and, where appropriate, the consumer’s conservator or authorized representative.
   3. The augmented residential care facilities administrator.
   4. The patients’ rights advocate, unless the consumer objects on their own behalf to participation by the patients’ rights advocate.
   5. Family members or natural support systems, unless the consumer objects on their own behalf to participation by those social supports.
   6. Others deemed necessary by the consumer, or the consumer’s conservator or authorized representative, for developing a comprehensive and effective individual supports plan.
7. Defines “intensive support needs” as meaning the consumer requires physical assistance in performing four or more of the following activities of daily living:
   1. Eating
   2. Dressing
   3. Bathing
   4. Transferring
   5. Toileting
   6. Continence.
8. Defines “special health care needs” as meaning the consumer has health conditions that are predictable and stable, as determined by the individual supports team, and for which the individual requires nursing supports for any of the following types of care:
   1. Nutrition support, including total parenteral feeding and gastrostomy feeding, and hydration.
   2. Cardiorespiratory monitoring.
   3. Oxygen support, including continuous positive airway pressure and bilevel positive airway pressure, and use of other inhalation-assistive devices.
   4. Nursing interventions for tracheostomy care and suctioning.
   5. Nursing interventions for colostomy, ileostomy, or other medical or surgical procedures.
   6. Special medication regimes, including injection and intravenous medications.
   7. Management of insulin-dependent diabetes.
   8. Bowel care management, including enemas or suppositories.
   9. Indwelling urinary catheter/catheter procedure.
   10. Treatment for antimicrobial-resistant infections.
   11. Treatment for wounds or pressure injuries.
   12. Postoperative care and rehabilitation.
   13. Pain management and palliative care.
   14. Renal dialysis.
   15. Treatment for substance use and addiction disorders.
   16. Administration and monitoring of medication-assisted treatment medications, including, but not limited to, methadone, antabuse, and suboxone.
9. Requires DHCS to, jointly with the County Behavioral Health Directors Association of California, implement a certification program to provide augmented services to adults with serious mentall illness in homelike community settings, which shall be licensed by CDSS.
10. Authorizes CDSS to license an ARCF, as an ARF or as an RCFE, to provide 24-hour services to up to six adults who have mental health care and intensive support needs. Requires an ARCF to conform to Section 441.530(a)(1) of Title 42 of CFR, described above, which requires home- and community-based settings to have specified qualifies.
11. Makes DHCS responsible for granting the certificate of program approval for an ARCF. Prohibits CDSS from issuing a license unless the applicant has obtained a certification of program approval from DHCS.
12. Requires CDSS to ensure that an ARCF meets the administration requirements under Article 2 of Chapter 3 of Division 2 of HSC, including, but not limited to, requirements relating to fingerprinting and criminal records and administrator certification requirements of an ARF, including, but not limited to, all of the following:
    1. Successfully complete a CDSS-approved administrator certification training program requiring a minimum of 35 hours of instruction conducive to learning in which participants are able to simultaneously interact with each other as well as with the instructor, and that provides training on a uniform core of knowledge, as specified.
    2. Unless an extension is granted to the applicant by CDSS, pass the examination provided in HSC 1562.3 within 60 days of the applicant’s completion of instruction.
    3. Submit an application for administrator certification to the department to include:
       1. An administrator certification application.
       2. A certificate of completion of the administrator certification training program.
       3. The fee for processing an administrator certification application, including the issuance of the administrator certificate, as specified.
    4. Provide documentation that the applicant has passed the administrator certification examination.
13. Requires an administrator certificate to expire every two years on the anniversary date of the initial issuance of the certificate. Requires an administrator certificate to be renewed every two years, and requires renewal to be conditional upon the certificate holder submitting documentation of completion of 40 hours of continuing education related to the uniform core of knowledge. Specifies no more than one-half of the required 40 hours of continuing education may be satisfied through self-paced coursed. Requires all other continuing education hours to be completed in an instructional setting conducive to learning in which participants must be able to simultaneously interact with each other and the instructor.
14. Requires the licensee to provide documentation that the administrator of an ARCF, prior to employment, has completed a minimum of 35 hours of initial training in the general laws, regulations and policies, and procedural standards applicable to facilities licensed by CDSS.
15. Requires this training to be provided by a vendor approved by CDSS and the cost of the training to be borne by the administrator or licensee.
16. Requires CDSS to administer employee actions, as specified.
17. Requires the local mental or behavioral health agency to monitor and enforce compliance of the program and health and safety requirements, including monitoring and evaluating the quality of care and support services. Requires DHCS to ensure that the local mental or behavioral health agency performs these functions.
18. Authorizes DHCS to decertify an ARCF that does not comply with program requirements. When DHCS determines that urgent action is necessary to protect clients of the ARCF from physical or mental abuse, abandonment, or any other substantial threat to their health and safety, DHCS may request the local mental or behavioral health agency or agencies to remove the clients from the ARCF or direct the local mental or behavioral health agency or agencies to obtain alternative services for the clients within 24 hours.
19. Authorizes CDSS to initiate proceedings for temporary suspension of an ARCF license.
20. Requires DHCS to inform CDSS of a licensee’s decertification with its recommendation concerning revocation of the license, and authorizes CDSS to initiate proceedings.
21. Requires DHCS and the local mental or behavioral health agencies to provide CDSS all available documentation and evidentiary support necessary for any enforcement proceedings to suspend the license, revoke or deny a license, or exclude an individual.
22. Requires the CDSS Community Care Licensing Division to enter into a memorandum of understanding (MOU) with DHCS to outline a formal protocol to address shared responsibilities, including monitoring responsibilities, complaint investigations, administrative actions, and closures.
23. Requires DHCS to establish by regulation a rate methodology for ARCFs that includes a fixed facility component for residential services and an individualized services and supports component based on each consumer’s needs as determined through the individual supports plan process, which may include assistance with transitioning to a less restrictive community residential setting.
24. Requires the established facility rate for a full month of service, as defined in regulations adopted pursuant to this article, to be paid based on the licensed capacity of the facility once the facility reaches maximum capacity, despite the temporary absence of one or more consumers from the facility or subsequent temporary vacancies created by consumers moving from the facility. Prior to the facility reaching licensed capacity, the facility rate shall be prorated based on the number of consumers residing in the facility.
25. When a consumer is temporarily absent from the facility, including when a consumer is in need of inpatient care in a general acute care hospital, acute psychiatric hospital, or skilled nursing facility, the local mental or behavioral health agency may, based on consumer need, continue to fund individual services, in addition to paying the facility rate. Individual consumer services funded by the local mental or behavioral health agency during a consumer’s absence from the facility shall be approved by the local mental or behavioral health agency director and shall only be approved in 14-day increments. Further requires the local mental or behavioral health agency to maintain documentation of the need for these services and the local mental or behavioral health agency director’s approval.
26. Prohibits a local mental or behavioral health agency from paying a rate to an ARCF for a consumer that exceeds the rate in the approved ARCF placement plan for that facility unless the local mental or behavioral health agency demonstrates that a higher rate is necessary to protect a consumer’s health and safety, and DHCS has granted prior written authorization.
27. Requires the payment rate for ARCF services to be negotiated between the local mental or behavioral health agency and the ARCF.
28. Requires the established rate for a full month of service to be made by the local mental or behavioral health agency if a consumer is temporarily absent from the ARCF for 14 days or less per month. If the consumer’s temporary absence is due to the need for inpatient care in a general acute care hospital, acute psychiatric hospital, or skilled nursing facility, the local mental or behavioral health agency shall continue to pay the established rate as long as no other consumer occupies the vacancy created by the consumer’s temporary absence, or until the individual supports team has determined that the consumer will not return to the facility. In all other cases, requires the established rate to be prorated for a partial month of service by dividing the established rate by 30.44, then multiplying the quotient by the number of days the consumer resided in the facility.
29. Authorizes the local mental or behavioral health agency to recommend for participation to DHCS an applicant to provide services as part of an approved community placement plan if the applicant meets all of the following requirements:
    1. The applicant employs or contracts with a program administrator who has a successful record of administering residential services for at least two years, as evidenced by substantial compliance with the applicable state licensing requirements.
    2. The applicant prepares and submits to the mental or behavioral health agency a complete facility program plan that includes, but is not limited to, all of the following:
       1. The total number of the consumers to be served.
       2. A profile of the consumer population to be served, including their health care and intensive support needs.
       3. A description of the program components, including a description of the health care and intensive support services to be provided.
       4. A week’s program schedule, including proposed consumer day and community integration activities.
       5. A week’s proposed program staffing pattern, including licensed, unlicensed, and support personnel and the number and distribution of hours for those personnel.
       6. An organizational chart, including identification of lead and supervisory personnel.
       7. The consultants to be utilized, including their professional disciplines and hours to be worked per week or month, as appropriate.
       8. The plan for accessing and retaining consultant and health care services, including assessments, in the areas of physical therapy, occupational therapy, respiratory therapy, speech pathology, audiology, pharmacy, dietary and nutrition, dental, and other areas required for meeting the needs identified in consumers’ individual supports plans.
       9. A description, including the size, layout, location, and condition, of the proposed home.
       10. A description of the equipment and supplies available, or to be obtained, for programming and care.
       11. The type, location, and response time of emergency medical service personnel.
       12. The inservice training program plan for at least the next 12 months, which shall include the plan for ensuring that the direct care personnel understand their roles and responsibilities related to implementing individual supports plans, prior to, or within, the first seven days of providing direct care in the home and for ensuring the administrator understands the unique roles, responsibilities, and expectations for administrators of community-based facilities.
       13. The plan for ensuring that outside services are coordinated, integrated, and consistent with those provided by the ARCF.
    3. The applicant submits a proposed budget itemizing direct and indirect costs, total costs, and the rate for services.
    4. The applicant submits written certification that they have the ability to comply with all of the requirements CCCFA administration.
30. Requires the local mental or behavioral health agency to provide the above documentation and a letter recommending program certification to the DHCS.
31. Requires DHCS to either approve or deny the recommendation and transmit its written decision to the local mental or behavioral health agency and to CDSS within 30 days of its decision. The decision of DHCS not to approve an application for program certification shall be the final administrative decision.
32. Requires any change in the ARCF operation that alters the contents of the approved program plan to be reported to DHCS and he local mental or behavioral health agency, and approved by both agencies, prior to implementation.
33. Specifies this article shall be implemented only to the extent that funds for its purposes are made available through an appropriation in the annual Budget Act.
34. Specifies no reimbursement is required by this act pursuant to Section 6 of Article XIII B of the California Constitution for certain costs that may be incurred by a local agency 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 XIII B of the California Constitution. Specifies that if the Commission on State Mandates determines that this act contains other costs mandated by the state, reimbursement to local agencies for those costs shall be made pursuant to Part 7 of Division 4 of Title 2 of the Government Code.

FISCAL IMPACT

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

BACKGROUND AND DISCUSSION

Purpose of the Bill:

According to the author, “We know that there is a desperate need for affordable housing in California and that lack of affordability is a driving factor in the increase size of our unhoused population. In January of 2023, point-in-time estimates of homelessness conducted in the state found 181,399 people identified as experiencing homelessness. Some unhoused individuals struggle with a serious mental illness or substance use disorder that requires intensive support services including supportive housing. To combat this crisis the state has created numerous initiatives in the last few years with a focus on shoring up our behavioral health system. Those proposals include a $2.2 billion investment in the Behavioral Health Continuum Infrastructure Program and the recent passage of Proposition 1, a $6.3 billion bond to develop an array of behavioral health treatment, residential care settings and supportive housing, providing the appropriate level of care to those with a serious mental illness or substance abuse disorder.”

The author continues, “These massive investments target various gaps in the state’s behavioral health facility infrastructure that are invaluable but they do not address the chronically low reimbursement rates that Adult Residential Facilities and Residential Care Facilities for the Elderly encounter. With our aging population rapidly increasing and affordable housing scarce, community care facilities play a critical role in both the housing continuum and the continuum of care for low-income individuals with more acute behavioral and medical conditions. This bill seeks to address the inadequate reimbursement rates by developing an Augmented Residential Care Facility Plan. This plan will create a rate that includes a fixed-facility component for residential services in the least restrictive setting and an individualized services and support component based on the needs of individuals with serious mental illness who have complex care needs and require 24-hour non-medical care. Addressing the long-standing ARF and RCFE issue is critical and aligns with other state initiatives creating a robust behavioral health system.”

Enhanced Behavioral Supports Homes

SB 856 (Committee on Budget and Fiscal Review, Chapter 30, Statutes of 2014), a budget trailer bill, implemented a series of recommendations made in a California Health and Human Services Agency report titled Plan for the Future of Developmental Centers in California^[1]. SB 856 established Enhanced Behavioral Supports Homes Enhanced Behavioral Supports Homes through a pilot program to develop up to six Enhanced Behavioral Supports Homes per year to provide intensive behavioral services and supports to adults with developmental disabilities who are at risk of institutionalization or out-of-state placement, or are transitioning to the community from a developmental center, other state-operated residential facility, institution for mental disease, or out-of-state placement. The pilot was made permanent through AB 79 (Committee on Budget, Chapter 11, Statutes of 2020), a budget trailer bill.

Enhanced Behavioral Supports Homes provide non-medical care for individuals with developmental disabilities in a home-like setting and provide enhanced monitoring by regional center case managers, regional behavior professionals, and DDS. Enhanced Behavioral Supports Homes are considered a “step up” from independent living, meaning they provide more supports and services to individuals. The Enhanced Behavioral Supports Homes are certified by DDS and licensed by the CDSS Community Care Licensing Division. Under state law, Enhanced Behavioral Supports Homes are licensed as Adult Residential Facilities. As of March 31, 2024, there were 73 licensed Adult Residential Facilities operating as Enhanced Behavioral Supports Homes with a capacity to serve 273 residents.^[2] Each Enhanced Behavioral Supports Home serves three to four residents.

This bill would create a new facility type, ARCFs, as a new type of EBSH. The bill text closely mirrors the licensing language for Enhanced Behavioral Supports Homes, including definitions, certification and licensure requirements, and requirements of administrator.

Adult Residential Facilities for Persons with Special Health Care Needs

SB 962 (Chesbro, Chapter 558, Statutes of 2005) established Adult Residential Facilities for Persons with Special Health Care Needs through a pilot project to provide 24-hour health care and intensive support services to up to five adults with developmental disabilities who have special health care and intensive support needs. Like Enhanced Behavioral Supports Homes, Adult Residential Facilities for Persons with Special Health Care Needs are certified by DDS and licensed by the CDSS Community Care Licensing Division. Additionally, the regional center must monitor and enforce program compliance and health and safety requirements for Adult Residential Facilities for Persons with Special Health Care Needs. State law defines “intensive support needs” to mean the resident requires physical assistance in performing four or more of the following activities of daily living: eating, dressing, bathing, transferring, toileting, and continence. Additionally, state law defines “special health care needs” for an Adult Residential Facility for Persons with Special Health Care Needs to mean the resident has health conditions that are predictable and stable, and for which they require nursing supports for any of the following types of care: nutrition support; cardiorespiratory monitoring; oxygen support; nursing interventions for tracheostomy care and suctioning; nursing interventions for colostomy, ileostomy, or other medical or surgical procedures; special medication regimes; management of insulin-dependent diabetes; bowel care management; indwelling urinary catheter/catheter procedure; treatment for antimicrobial resistant infections; treatment for wounds or pressure injuries; postoperative care and rehabilitation; pain management and palliative care; or renal dialysis. The Adult Residential Facility for Persons with Special Health Care Needs pilot was made permanent through SB 853 (Committee on Budget and Fiscal Review, Chapter 717, Statutes of 2010), a budget trailer bill.

Under state law, Adult Residential Facilities for Persons with Special Health Care Needs are required to have a licensed registered nurse, licensed vocational nurse, or licensed psychiatric technician who is awake and on duty 24-hours per day, seven days per week, and that at least two staff on the premises are awake and on duty when providing care to four or more residents. Additionally, Adult Residential Facilities for Persons with Special Health Care Needs must ensure residents remain under the care of a physician at all times, and are examined by the primary care physician at least once every 60 days.^[3] As of March 31, 2024, there were 92 licensed ARFs operating as Adult Residential Facilities for Persons with Special Health Care Needs with a capacity to serve 438 residents.^[4]

This bill would create ARCFs as a new facility type to provide 24-hour nonmedical care to individuals with serious mental illness who require augmented supports, staffing and supervision in a homelike setting. The bill text closely mirrors the definitions for “intensive support needs” and “special health care needs” for Adult Residential Facilities for Persons with Special Health Care Needs, which provide 24-hour medical care.

Related/Prior Legislation:

AB 1766 (Bloom, Chapter 139, Statutes of 2020) requires CDSS to collect and report specified information to a county’s department of mental or behavioral health regarding ARFs and RCFEs.

AB 79 (Committee on Budget, Chapter 11, Statutes of 2020), a budget trailer bill, removed the sunset on the EBSH pilot program, among other things.

SB 856 (Committee on Budget and Fiscal Review, Chapter 30, Statutes of 2014), a budget trailer bill, created a pilot project at DDS to develop up to six Enhanced Behavioral Supports Homes per year to provide intensive behavioral services and supports to eligible adults and children with developmental disabilities who need intensive services and supports, among other changes to the developmental services system.

SB 853 (Committee on Budget and Fiscal Review, Chapter 717, Statutes of 2010), a budget trailer bill, removed the sunset on the ARFPSHN pilot project, among other things.

SB 962 (Chesbro, Chapter 558, Statutes of 2005) established Adult Residential Facilities for Persons with Special Health Care Needs as a new type of licensed community care facility as part of a pilot project to serve people with developmental disabilities with special health care and intensive support needs who were living at Agnews Developmental Center.

SB 944 (Mello, Chapter 888, Statutes of 1991), among other things, provided legislative intent to develop and implement a plan to establish three levels of care under the RCFE license, subject to future Budget Act appropriations and statutory authorization to implement levels of care.

COMMENTS

This bill seeks to create Augmented Residential Care Facilities to provide 24-hour nonmedical care for adults with serious mental illness. The licensing language in this bill is substantially similar to current code sections related to Enhanced Behavioral Supports Homes, which provide 24-hour nonmedical care for individuals with developmental disabilities. Enhanced Behavioral Supports Homes have a tiered rate structure through the 1915(c) Home and Community-Based Services Waiver.^[5] Tiered rates range from $1,398 to $12,715 per month per consumer with a developmental disability. The author has expressed interest in replicating the Enhanced Behavioral Supports Homes model and rate structure for adults with serious mental illness who are on State Supplemental Income who need care through a community care facility.

The author should consider removing language related to health care services, as the bill defines Augmented Residential Care Facilities as providing nonmedical care. Additionally, the author may wish to clarify whether the new facility will be licensed as an Enhanced Behavioral Supports Home, Adult Residential Facility, or Residential Care Facility for the Elderly. The author may wish to further define the individual supports plan process and the term “consumer,” and decide their appropriateness for the population with serious mental illness, as these concepts mirror language in the Enhanced Behavioral Supports Homes code. The committee recommends for the author to work with CDSS on amendments related to licensure.

Previous efforts to create a new facility and license type were proposed first as temporary pilot projects and later made permanent. The author may wish to consider establishing Augmented Residential Care Facilities as a pilot program limited to a specified amount of new facilities per year as this type of facility and level of care for adults with serious mental illness would be new in the state.

Proposed Amendments: The author and Senate Committee on Health have agreed to amendments to be passed in this committee. The amendments combine the definition for “Augmented Residential Care Facility” and “augmented services and supports.”

PRIOR VOTES

POSITIONS

Support:

The California Association of Local Behavioral Health Boards and Commissions (Sponsor)

Steinberg Institute (Co-Sponsor)

Oppose:

None

Senate Health Committee Amendments

5677. The following definitions apply for purposes of this article:

(a) “Augmented residential care facility” or “ARCF” means a facility certified by the State Department of Health Care Services and licensed by the State Department of Social Services that provides 24-hour nonmedical care to individuals with serious mental illness who require augmented services and supports, staffing, and supervision in a homelike setting. setting, with other facility characteristics, to address a consumer’s complex behavioral health needs that are beyond what is typically available in other community facilities licensed as an adult residential facility or a residential care facility for the elderly.

(b) “Augmented services and supports” means additional staffing supervision, facility characteristics, or other services and supports to address a consumer’s complex behavioral health needs, which are beyond what is typically available in other community facilities licensed as an adult residential facility or a residential care facility for the elderly.

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1. https://www.chhs.ca.gov/wp-content/uploads/2017/06/DDS-Task-Force/Resource-Library/PlanfortheFutureofDevelopmentalCenters.pdf ↑

2. “Adult Residential Facilities,” https://www.ccld.dss.ca.gov/carefacilitysearch/DownloadData ↑

3. HSC 4684.63 ↑

4. “Adult Residential Facilities,” https://www.ccld.dss.ca.gov/carefacilitysearch/DownloadData ↑

5. https://www.dds.ca.gov/wp-content/uploads/2023/11/1915c_HCBS_DD-Waiver_12.01.23.pdf ↑

SENATE COMMITTEE ON HEALTH

Senator Richard Roth, Chair

BILL NO: SB 1082

SUBJECT: Augmented residential care facilities.

SUMMARY:

Establishes a licensure process for augmented residential care facilities by the California Department of Social Services that also requires program certification by the Department of Health Care Services as a condition for being issued a license. Requires this bill to be implemented only to the extent that funds for its purposes are made available through an appropriation in the annual Budget Act.

Existing law:

1. Grants the Department of Health Care Services (DHCS) the sole authority in state government to administer, license, certify, and regulate all substance use disorder (SUD) functions and programs. [HSC §11750, et seq.]
2. Grants DHCS the authority to implement a program certification procedure for 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 each enhanced behavioral supports home to be licensed as an adult residential facility (ARF) or a group home by the California Department of Social Services (CDSS) and certified by the California Department of Developmental Services (CDDS). Requires a certificate of program approval issued by CDDS to be a condition of licensure for the enhanced behavioral supports home by CDSS. [HSC §1567.62]
4. Requires any person, entity, or agent signing on behalf of an entity, seeking a license for a residential care facility for the elderly (RCFE) to file an application with CDSS, as specified. [HSC §1569.15]
5. States the intent of the Legislature, pursuant to the Broznan-McCorquodale Act (BMA), to encourage the development of a system of residential treatment programs (RTPs) in every county that provides a range of alternatives to institutional care based on principles of residential, community-based treatment. [WIC §5670]

This bill:

1. Establishes a licensure process for augmented residential care facilities (ARCFs), as defined, by CDSS as either an ARF or RCFE that provide 24-hour services to up to six adults who have mental health care and intensive support needs, as specified, and provide additional staffing, supervision, facility characteristics, or other services and supports to address a consumer’s complex behavioral health needs that are beyond what is typically available in other community facilities licensed as an ARF or a RCFE.
2. Requires DHCS, jointly with the County Behavioral Health Directors Association of California, to implement a certification program for ARCFs serving adults with serious mental illness (SMI) in homelike community settings. Prohibits CDSS from issuing an ARCF license unless the applicant has obtained certification from DHCS.
3. Requires DHCS to establish, by regulation, a rate methodology for ARCFs that includes a fixed facility component for residential services, and an individualized services and supports component based on each consumer’s needs as determined through an individual supports plan, as specified. Requires payment rates for ARCF services to be negotiated between the local mental or behavioral health agency and the ARCF.
4. Permits a local mental or behavioral health agency to recommend to DHCS an applicant to participate to provide ARCF services as part of an approved community placement plan if the applicant meets certain criteria, such as having successfully administered residential services for at least two years; submitting a complete facility program plan, as specified; submitting a proposed budget; and, certifying in writing that they have the ability to comply with all requirements.
5. Requires DHCS to either approve or deny the recommendation and transmit its written decision to the local mental or behavioral health agency and CDSS within 30 days of its decision. Requires DHCS’s decision to be the final administrative decision.
6. Requires any change in the ARCF operation that alters the contents of the approved program plan to be reported to DHCS and the local mental or behavioral agency, and approved by both agencies prior to implementation.
7. Permits DHCS to decertify ARCFs that do not comply with program requirements. Permits DHCS to request the local mental or behavioral health agency or agencies to remove clients from the ARCF or to direct those entities to obtain alternative services for clients within 24 hours when DHCS determines that urgent action is necessary to protect clients from physical or mental abuse, abandonment, or any other substantial threat to their health and safety.
8. Requires DHCS, upon decertifying ARCFs, to inform CDSS about the decertification with its recommendation to revoke the ARCF license. Requires CDSS to enter into a memorandum of understanding with DHCS to outline a formal protocol to address shared responsibilities, including monitoring, investigating complaints, administrative actions, and closures.
9. Requires DHCS and the local mental or behavioral health agency to provide CDSS all available documentation and evidentiary support necessary for any enforcement proceedings to suspend an ARCF license.
10. Requires CDSS to ensure that ARCFs meet specified administration requirements, such as fingerprinting and criminal records, as well as administrator certification and training requirements, as specified.
11. Requires this bill to be implemented only to the extent that funds for its purposes are made available through an appropriation in the annual Budget Act.

FISCAL EFFECT:

This bill has not been analyzed by a fiscal committee.

COMMENTS:

1. Author’s statement. According to the author, we know that there is a desperate need for affordable housing in California, which is a driving factor in the increased size of our unhoused population, some of whom struggle with SMI/SUD that requires intensive support services, including supportive housing. To combat this crisis the state has created numerous initiatives, including a $2.2 billion investment in the Behavioral Health Continuum Infrastructure Program and passage of Proposition 1, a $6.3 billion bond to develop an array of behavioral health treatment, residential care settings, and supportive housing, providing the appropriate level of care to those with SMI/SUD. These massive investments target gaps in the state’s behavioral health facility infrastructure that are invaluable, but they do not address the chronically low reimbursement rates that ARFs and RCFEs encounter. This bill seeks to address this discrepancy by developing an ARCF plan, which will create a rate that includes a fixed-facility component for residential services and an individualized services component based on the needs of individuals with SMI who have complex care needs and require 24-hour, non-medical care.
2. RTPs. The BMA sets forth criteria for the community system of RTPs as follows:
3. Facilities should be settings, whether residential or day, as close to a normal home environment as possible without sacrificing client safety or care. RTPs should be relatively small, preferably 15 beds or less, but in any case with the appearance of a non-institutional setting. The individual elements of the system should, where possible, be in separate facilities, and not part of one large facility attempting to serve an entire range of clients;
4. Staffing patterns should reflect, to the maximum extent feasible, at all levels, the cultural, linguistic, ethnic, sexual and other social characteristics of the community the facility serves. The programs should be designed to use appropriate multidisciplinary, professional consultation and staff to meet the specific diagnostic and treatment needs of the clients. The programs should use paraprofessionals and persons who have been consumers of mental health services where appropriate;
5. Programs should, to the maximum extent feasible, be designed to reduce the dependence on medications as a sole treatment tool. Programs in which prescriptions for medication are a component of the program should be subject to medication monitoring. The programs should have a rehabilitation focus that encourages the client to develop the skills to become self-sufficient and capable of increasing levels of independent functioning. Where appropriate, they should include prevocational and vocational programs. The program should encourage the participation of the clients in the daily operation of the setting in development of treatment and rehabilitation planning and evaluation. Participation in any element of the system should not preclude the involvement of clients in individual therapy. Individual therapists of clients should, where possible, be directly involved in the development and implementation of a treatment plan, including medication and day program decisions; and,
6. Coordination of the programs should demonstrate specific linkages with one another, and with the general treatment and social service system, as a whole. These connections should not be limited to the mental health system, but should include, whenever possible, community resources utilized by the general population.

The BMA further identifies the following programs as the community system of RTPs designed to provide, at every level, alternatives to institutional settings:

1. A program for a short-term crisis residential alternative to hospitalization for individuals experiencing an acute episode or crisis requiring temporary removal from their home environment;
2. A long-term residential treatment program, with a full day treatment component as a part of the program, for persons who may require intensive support for as long as two or three years;
3. A transitional residential program designed for persons who are able to take part in programs in the general community, but who, without the support of counseling, as well as the therapeutic community, would be at risk of returning to the hospital;
4. A program for semi-supervised, independent, but structured living arrangements for persons who do not need the intensive support of the other system programs, but who, without some support and structure, are at risk to return to a condition requiring hospitalization;
5. A program to provide emergency housing or respite care services, or both;
6. A day rehabilitation program that should be designed to provide structured education, training, and support services to promote the development of independent living skills and community support;
7. A program for socialization centers designed to serve a broad range of clients, including those in the system programs, when appropriate, as well as persons living in the community in general;
8. An in-home treatment program designed as an alternative to out-of-home placement for individuals who are otherwise not appropriate for, or do not choose to participate in, other elements of the community residential treatment system; and,
9. A volunteer-based companion program designed to encourage the development of personal relationships with residents of community care facilities with the goal of motivating and assisting residents to make a successful transition to independent living, or to programs of the community system of RTPs.
10. Issue brief on ARFs. An issue brief by the California Association of Local Behavioral Health Boards and Commissions states ARFs are a critical component of California’s housing continuum. Lack of ARFs (and RCFEs) impacts families, local communities, and, most of all, individuals with SMI who for health and/or physical reasons cannot live independently. The social and financial costs are high as individuals enter revolving doors between crisis facilities, psychiatric facilities, emergency rooms, homelessness and incarceration. Local budgets are impacted due to crisis management, expensive placements, and incarcerations. The brief further notes that counties that responded to the 2021 California Behavioral Health Planning Council’s survey estimates that their need for ARF beds for individuals with SMI totals 4,052 persons (for 27 counties out of 58). According to CDSS’s internal tracking system of facilities, 488 licensed ARFs and RCFEs serving individuals with SMI closed in 2021 (excluding those that closed due to a change of location or ownership, resulting in a new licensed being issued), totaling a loss of 3,852 beds.
11. Double referral. This bill is double referred. Should it pass out of this Committee, it will be referred to the Senate Committee on Human Services.
12. Related legislation. SB 1017 (Eggman) requires DHCS, in consultation with the California Department of Public Health and CDSS, to develop a solution to collect, aggregate, and display information about beds in specified facilities to identify the availability of inpatient and residential mental health or SUD treatment. SB 1017 is set for hearing on April 15, 2024 in the Senate Appropriations Committee.
13. Prior legislation. SB 363 (Eggman of 2023), SB 1154 (Eggman of 2022), AB 682 (Eggman of 2019), AB 1136 (Eggman of 2018), and AB 2743 (Eggman of 2016) were substantially similar to SB 1017. SB 363, SB 1154, AB 682, and AB 2743 were held on the Assembly Appropriations Committee suspense file. AB 1136 was held on the Senate Appropriations Committee suspense file.
14. Support. The California Association of Local Behavioral Health Boards and Commissions states that ARFs and RCFEs are essential components of California’s housing continuum. However, small, often family operated; ARFs and RCFEs that serve individuals with SMI have been closing throughout California due to low reimbursement rates, increased labor costs, and an increase in land values. In just two years, from 2021 through 2022, nearly 1,000 of these facilities closed. These closures are devastating for families, local communities, and most of all, those living with SMI. The social and financial costs are high as individuals enter revolving doors between hospitalization, homelessness, and incarceration. This bill draws on a successful model currently in place for individuals with intellectual and developmental disabilities. This model includes a rate structure that facilitates Medi-Cal matching for individuals with SMI who are on Supplemental Security Income who need 24/7 care and housing.
15. Technical amendments. The author may wish to amend this bill to combine definitions, as the term “augmented services and supports” does not appear in this bill beyond its definition, as follows:

5677. The following definitions apply for purposes of this article:

(a) “Augmented residential care facility” or “ARCF” means a facility certified by the State Department of Health Care Services and licensed by the State Department of Social Services that provides 24-hour nonmedical care to individuals with serious mental illness who require augmented services and supports, staffing, and supervision in a homelike setting. setting, with other facility characteristics, to address a consumer’s complex behavioral health needs that are beyond what is typically available in other community facilities licensed as an adult residential facility or a residential care facility for the elderly.

(b) “Augmented services and supports” means additional staffing supervision, facility characteristics, or other services and supports to address a consumer’s complex behavioral health needs, which are beyond what is typically available in other community facilities licensed as an adult residential facility or a residential care facility for the elderly.

SUPPORT AND OPPOSITION:

Support: California Association of Local Behavioral Health Boards and Commissions (cosponsor)

Steinberg Institute (cosponsor)

Oppose: None received

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