SB 35: Community Assistance, Recovery, and Empowerment (CARE) Court Program.
- Session Year: 2023-2024
- House: Senate
- Latest Version Date: 2023-09-30
Current Status:
Passed
(2023-09-30: Chaptered by Secretary of State. Chapter 283, Statutes of 2023.)
Introduced
In Committee
First Chamber
In Committee
Second Chamber
Enacted
(1)Existing law, the Community Assistance, Recovery, and Empowerment (CARE) Act, authorizes specified adult persons to petition a civil court to create a voluntary CARE agreement or a court-ordered CARE plan and implement services, to be provided by county behavioral health agencies, to provide behavioral health care, including stabilization medication, housing, and other enumerated services, to adults who are currently experiencing a severe mental illness and have a diagnosis identified in the disorder class schizophrenia and other psychotic disorders, and who meet other specified criteria. Existing law requires all evaluations and reports, documents, and filings submitted to the court under CARE proceedings be kept confidential.
This bill would authorize CARE Act proceedings to be conducted by a superior court judge or by a court-appointed commissioner or other subordinate judicial officer. The bill would require that there is no fee for filing a petition nor any fees charged by any public officer for services in filing or serving papers or for the performance of any duty enjoined by the CARE Act. The bill would authorize that the respondent is entitled to have an interpreter in all proceedings if necessary for the respondents full participation. This bill would require county behavioral health agencies to provide health information necessary to support findings in the filings to the court, as specified, and would exempt counties and their employees from civil or criminal liability for disclosure under these provisions. By increasing the reporting duties on county behavioral health agencies, this bill would create a state-mandated local program.
This bill would authorize health care providers and covered entities, as defined, to disclose specified health information to behavioral health agencies for some purposes and would require those entities to disclose that information for other specified purposes. The bill would authorize a county behavioral health agency to apply, ex parte, for an order requiring health care providers or covered entities to provide information, as specified, to the court, the behavioral health agency, or both. The bill would require behavioral health agencies to notify respondent of disclosure, as specified. The bill would exempt health care providers and covered entities from civil or criminal liability for disclosure under these provisions and would exempt information disclosed to a county behavioral health agency by a provider of health care or a covered entity from disclosure or inspection under the Public Records Act.
Existing law authorizes a specified individual to commence the CARE process, known as the original petitioner. Under existing law, if the original petitioner is a person other than the director of a county behavioral health agency, the court is required to issue an order relieving the original petitioner and appointing the director of the county behavioral health agency, or their successor, as the substitute petitioner. Under existing law, the original petitioner retains specified rights, including the right to participate in the initial hearing to determine the merits of the petition.
This bill would revise the rights of the original petitioner, including giving them the right to be present and make a statement on the merits of the petition at the initial hearing and authorizing the court to assign ongoing rights to an original petitioner who resides with the respondent or is a spouse, parent, sibling, child, or grandparent or other person who stands in loco parentis to the respondent. This bill would additionally authorize the respondent to petition the court for an order sealing their records, as specified, and the filing of such petition would create a presumption in favor of sealing.
Existing law authorizes the court to find a person, other than respondent, who has previously filed a pleading in CARE Act proceedings that was without merit and who files an additional petition for CARE Act proceedings that is also without merit, a vexatious litigant.
This bill would provide that a member of the State Bar who files a petition in order to gain an advantage over the respondent in another legal proceeding is subject to discipline, as specified, if it is determined the member filed the petition knowing that the filing was made to gain an advantage.
Existing law requires the court to appoint a public defender to represent the respondent in specified circumstances.
This bill would additionally authorize the appointment of counsel working in the capacity of a public defender.
Existing law requires the act to be implemented with technical assistance and continuous quality improvement, as specified, including expected start dates for specified counties. Existing law also requires the State Department of Health Care Services to implement guidelines under which counties can apply for and be provided additional time to implement the above-described provisions. Existing law authorizes the department to grant an extension once, and no later than December 1, 2025.
Existing law requires the county behavioral health agency to provide the court with specified reports to determine eligibility for the CARE process.
The bill would exempt reports made to determine eligibility for the CARE process from the Public Records Act.
Existing constitutional provisions require that a statute that limits the right of access to the meetings of public bodies or the writings of public officials and agencies be adopted with findings demonstrating the interest protected by the limitation and the need for protecting that interest.
This bill would make legislative findings to that effect.
(2)Existing law prohibits a person from being tried or adjudged to punishment while that person is mentally incompetent. Existing law establishes a process by which a defendants mental competency is evaluated and by which the defendant receives treatment, with the goal of returning the defendant to competency. Existing law authorizes misdemeanor defendants who have been determined to be incompetent to stand trial to be referred to the CARE program and requires the court to conduct a hearing to determine eligibility for the CARE program within 14 days of the date of the referral. If the hearing is delayed beyond 14 days, existing law requires the defendant, if confined in county jail, to be released on their own recognizance pending that hearing.
This bill would require the court to conduct the hearing within 14 court days of the date the petition is filed and, if the hearing is delayed beyond 14 court days, to release a defendant who is confined in county jail, pending the hearing.
(3)The bill would also make technical and conforming changes.
(4)The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that, if the Commission on State Mandates determines that the bill contains costs mandated by the state, reimbursement for those costs shall be made pursuant to the statutory provisions noted above.
This bill would declare that it is to take effect immediately as an urgency statute.
(1)Existing law, the Community Assistance, Recovery, and Empowerment (CARE) Act, authorizes specified adult persons to petition a civil court to create a voluntary CARE agreement or a court-ordered CARE plan and implement services, to be provided by county behavioral health agencies, to provide behavioral health care, including stabilization medication, housing, and other enumerated services, to adults who are currently experiencing a severe mental illness and have a diagnosis identified in the disorder class schizophrenia and other psychotic disorders, and who meet other specified criteria. Existing law requires all evaluations and reports, documents, and filings submitted to the court under CARE proceedings be kept confidential.
This bill would authorize CARE Act proceedings to be conducted by a superior court judge or by a court-appointed commissioner or other subordinate judicial officer. The bill would require that there is no fee for filing a petition nor any fees charged by any public officer for services in filing or serving papers or for the performance of any duty enjoined by the CARE Act. The bill would authorize that the respondent is entitled to have an interpreter in all proceedings if necessary for the respondents full participation. This bill would require county behavioral health agencies to provide health information necessary to support findings in the filings to the court, as specified, and would exempt counties and their employees from civil or criminal liability for disclosure under these provisions. By increasing the reporting duties on county behavioral health agencies, this bill would create a state-mandated local program.
This bill would authorize health care providers and covered entities, as defined, to disclose specified health information to behavioral health agencies for some purposes and would require those entities to disclose that information for other specified purposes. The bill would authorize a county behavioral health agency to apply, ex parte, for an order requiring health care providers or covered entities to provide information, as specified, to the court, the behavioral health agency, or both. The bill would require behavioral health agencies to notify respondent of disclosure, as specified. The bill would exempt health care providers and covered entities from civil or criminal liability for disclosure under these provisions and would exempt information disclosed to a county behavioral health agency by a provider of health care or a covered entity from disclosure or inspection under the Public Records Act.
Existing law authorizes a specified individual to commence the CARE process, known as the original petitioner. Under existing law, if the original petitioner is a person other than the director of a county behavioral health agency, the court is required to issue an order relieving the original petitioner and appointing the director of the county behavioral health agency, or their successor, as the substitute petitioner. Under existing law, the original petitioner retains specified rights, including the right to participate in the initial hearing to determine the merits of the petition.
This bill would revise the rights of the original petitioner, including giving them the right to be present and make a statement on the merits of the petition at the initial hearing and authorizing the court to assign ongoing rights to an original petitioner who resides with the respondent or is a spouse, parent, sibling, child, or grandparent or other person who stands in loco parentis to the respondent. This bill would additionally authorize the respondent to petition the court for an order sealing their records, as specified, and the filing of such petition would create a presumption in favor of sealing.
Existing law authorizes the court to find a person, other than respondent, who has previously filed a pleading in CARE Act proceedings that was without merit and who files an additional petition for CARE Act proceedings that is also without merit, a vexatious litigant.
This bill would provide that a member of the State Bar who files a petition in order to gain an advantage over the respondent in another legal proceeding is subject to discipline, as specified, if it is determined the member filed the petition knowing that the filing was made to gain an advantage.
Existing law requires the court to appoint a public defender to represent the respondent in specified circumstances.
This bill would additionally authorize the appointment of counsel working in the capacity of a public defender.
Existing law requires the act to be implemented with technical assistance and continuous quality improvement, as specified, including expected start dates for specified counties. Existing law also requires the State Department of Health Care Services to implement guidelines under which counties can apply for and be provided additional time to implement the above-described provisions. Existing law authorizes the department to grant an extension once, and no later than December 1, 2025.
Existing law requires the county behavioral health agency to provide the court with specified reports to determine eligibility for the CARE process.
The bill would exempt reports made to determine eligibility for the CARE process from the Public Records Act.
Existing constitutional provisions require that a statute that limits the right of access to the meetings of public bodies or the writings of public officials and agencies be adopted with findings demonstrating the interest protected by the limitation and the need for protecting that interest.
This bill would make legislative findings to that effect.
(2)Existing law prohibits a person from being tried or adjudged to punishment while that person is mentally incompetent. Existing law establishes a process by which a defendants mental competency is evaluated and by which the defendant receives treatment, with the goal of returning the defendant to competency. Existing law authorizes misdemeanor defendants who have been determined to be incompetent to stand trial to be referred to the CARE program and requires the court to conduct a hearing to determine eligibility for the CARE program within 14 days of the date of the referral. If the hearing is delayed beyond 14 days, existing law requires the defendant, if confined in county jail, to be released on their own recognizance pending that hearing.
This bill would require the court to conduct the hearing within 14 court days of the date the petition is filed and, if the hearing is delayed beyond 14 court days, to release a defendant who is confined in county jail, pending the hearing.
(3)The bill would also make technical and conforming changes.
(4)The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that, if the Commission on State Mandates determines that the bill contains costs mandated by the state, reimbursement for those costs shall be made pursuant to the statutory provisions noted above.
This bill would declare that it is to take effect immediately as an urgency statute.
(1)Existing law, the Community Assistance, Recovery, and Empowerment (CARE) Act, authorizes specified adult persons to petition a civil court to create a voluntary CARE agreement or a court-ordered CARE plan and implement services, to be provided by county behavioral health agencies, to provide behavioral health care, including stabilization medication, housing, and other enumerated services, to adults who are currently experiencing a severe mental illness and have a diagnosis identified in the disorder class schizophrenia and other psychotic disorders, and who meet other specified criteria. Existing law requires all evaluations and reports, documents, and filings submitted to the court under CARE proceedings be kept confidential.
This bill would authorize CARE Act proceedings to be conducted by a superior court judge or by a court-appointed commissioner or other subordinate judicial officer. The bill would require that there is no fee for filing a petition nor any fees charged by any public officer for services in filing or serving papers or for the performance of any duty enjoined by the CARE Act. The bill would authorize that the respondent is entitled to have an interpreter in all proceedings if necessary for the respondents full participation. This bill would require county behavioral health agencies to provide health information necessary to support findings in the filings to the court, as specified, and would exempt counties and their employees from civil or criminal liability for disclosure under these provisions. By increasing the reporting duties on county behavioral health agencies, this bill would create a state-mandated local program.
This bill would authorize health care providers and covered entities, as defined, to disclose specified health information to behavioral health agencies for some purposes and would require those entities to disclose that information for other specified purposes. The bill would authorize a county behavioral health agency to apply, ex parte, for an order requiring health care providers or covered entities to provide information, as specified, to the court, the behavioral health agency, or both. The bill would require behavioral health agencies to notify respondent of disclosure, as specified. The bill would exempt health care providers and covered entities from civil or criminal liability for disclosure under these provisions. provisions and would exempt information disclosed to a county behavioral health agency by a provider of health care or a covered entity from disclosure or inspection under the Public Records Act.
Existing law authorizes a specified individual to commence the CARE process, known as the original petitioner. Under existing law, if the original petitioner is a person other than the director of a county behavioral health agency, the court is required to issue an order relieving the original petitioner and appointing the director of the county behavioral health agency, or their successor, as the substitute petitioner. Under existing law, the original petitioner retains specified rights, including the right to participate in the initial hearing to determine the merits of the petition.
This bill would revise the rights of the original petitioner, including giving them the right to be present and make a statement on the merits of the petition at the initial hearing and authorizing the court to assign ongoing rights to an original petitioner who resides with the respondent or is a spouse, parent, sibling, child, or grandparent or other person who stands in loco parentis to the respondent. This bill would additionally authorize the respondent to petition the court for an order sealing their records, as specified, and the filing of such petition would create a presumption in favor of sealing.
Existing law authorizes the court to find a person, other than respondent, who has previously filed a pleading in CARE Act proceedings that was without merit and who files an additional petition for CARE Act proceedings that is also without merit, a vexatious litigant.
This bill would provide that a member of the State Bar who files a petition in order to gain an advantage over the respondent in another legal proceeding is subject to discipline, as specified, if it is determined the member filed the petition knowing that the filing was made to gain an advantage.
Existing law requires the court to appoint a public defender to represent the respondent in specified circumstances.
This bill would additionally authorize the appointment of counsel working in the capacity of a public defender.
Existing law requires the act to be implemented with technical assistance and continuous quality improvement, as specified, including expected start dates for specified counties. Existing law also requires the State Department of Health Care Services to implement guidelines under which counties can apply for and be provided additional time to implement the above-described provisions. Existing law authorizes the department to grant an extension once, and no later than December 1, 2025.
Existing law requires the county behavioral health agency to provide the court with specified reports to determine eligibility for the CARE process.
The bill would exempt reports made to determine eligibility for the CARE process from the Public Records Act.
Existing constitutional provisions require that a statute that limits the right of access to the meetings of public bodies or the writings of public officials and agencies be adopted with findings demonstrating the interest protected by the limitation and the need for protecting that interest.
This bill would make legislative findings to that effect.
(2)Existing law prohibits a person from being tried or adjudged to punishment while that person is mentally incompetent. Existing law establishes a process by which a defendants mental competency is evaluated and by which the defendant receives treatment, with the goal of returning the defendant to competency. Existing law authorizes misdemeanor defendants who have been determined to be incompetent to stand trial to be referred to the CARE program and requires the court to conduct a hearing to determine eligibility for the CARE program within 14 days of the date of the referral. If the hearing is delayed beyond 14 days, existing law requires the defendant, if confined in county jail, to be released on their own recognizance pending that hearing.
This bill would require the court to conduct the hearing within 30 14 court days of the date the petition is filed and, if the hearing is delayed beyond 30 14 court days, to release a defendant who is confined in county jail, pending the hearing.
(3)The bill would also make technical and conforming changes.
(4)The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that, if the Commission on State Mandates determines that the bill contains costs mandated by the state, reimbursement for those costs shall be made pursuant to the statutory provisions noted above.
This bill would declare that it is to take effect immediately as an urgency statute.
(1)Existing law, the Community Assistance, Recovery, and Empowerment (CARE) Act, authorizes specified adult persons to petition a civil court to create a voluntary CARE agreement or a court-ordered CARE plan and implement services, to be provided by county behavioral health agencies, to provide behavioral health care, including stabilization medication, housing, and other enumerated services, to adults who are currently experiencing a severe mental illness and have a diagnosis identified in the disorder class schizophrenia and other psychotic disorders, and who meet other specified criteria. Existing law requires all evaluations and reports, documents, and filings submitted to the court under CARE proceedings be kept confidential.
This bill would authorize CARE Act proceedings to be conducted by a superior court judge or by a court-appointed commissioner or other subordinate judicial officer. The bill would require that there is no fee for filing a petition nor any fees charged by any public officer for services in filing or serving papers or for the performance of any duty enjoined by the CARE Act. The bill would authorize that the respondent is entitled to have an interpreter in all proceedings if necessary for the respondents full participation. This bill would require county behavioral health agencies to provide health information necessary to support findings in the filings to the court, as specified, and would exempt counties and their employees from civil or criminal liability for disclosure under these provisions. By increasing the reporting duties on county behavioral health agencies, this bill would create a state-mandated local program.
This bill would authorize health care providers and covered entities, as defined, to disclose specified health information to behavioral health agencies for some purposes and would require those entities to disclose that information for other specified purposes. The bill would authorize a county behavioral health agency to apply, ex parte, for an order requiring health care providers or covered entities to provide information, as specified, to the court, the behavioral health agency, or both. The bill would exempt health care providers and covered entities from civil or criminal liability for disclosure under these provisions.
Existing law authorizes a specified individual to commence the CARE process, known as the original petitioner. Under existing law, if the original petitioner is a person other than the director of a county behavioral health agency, the court is required to issue an order relieving the original petitioner and appointing the director of the county behavioral health agency, or their successor, as the substitute petitioner. Under existing law, the original petitioner retains specified rights, including the right to participate in the initial hearing to determine the merits of the petition.
This bill would revise the rights of the original petitioner, including giving them the right to be present and make a statement on the merits of the petition at the initial hearing and authorizing the court to assign ongoing rights to an original petitioner who resides with the respondent or is a spouse, parent, sibling, child, or grandparent or other person who stands in loco parentis to the respondent.
Existing law requires the court to appoint a public defender to represent the respondent in specified circumstances.
This bill would additionally authorize the appointment of counsel working in the capacity of a public defender.
Existing law requires the act to be implemented with technical assistance and continuous quality improvement, as specified, including expected start dates for specified counties. Existing law also requires the State Department of Health Care Services to implement guidelines under which counties can apply for and be provided additional time to implement the above-described provisions. Existing law authorizes the department to grant an extension once, and no later than December 1, 2025.
(2)Existing law prohibits a person from being tried or adjudged to punishment while that person is mentally incompetent. Existing law establishes a process by which a defendants mental competency is evaluated and by which the defendant receives treatment, with the goal of returning the defendant to competency. Existing law authorizes misdemeanor defendants who have been determined to be incompetent to stand trial to be referred to the CARE program and requires the court to conduct a hearing to determine eligibility for the CARE program within 14 days of the date of the referral. If the hearing is delayed beyond 14 days, existing law requires the defendant, if confined in county jail, to be released on their own recognizance pending that hearing.
This bill would require the court to conduct the hearing within 30 days and, if the hearing is delayed beyond 30 days, to release a defendant who is confined in county jail, pending the hearing.
The(3)The bill would also make technical and conforming changes.
(4)The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that, if the Commission on State Mandates determines that the bill contains costs mandated by the state, reimbursement for those costs shall be made pursuant to the statutory provisions noted above.
This bill would declare that it is to take effect immediately as an urgency statute.
Existing law, the Community Assistance, Recovery, and Empowerment (CARE) Act, authorizes specified adult persons to petition a civil court to create a voluntary CARE agreement or a court-ordered CARE plan and implement services, to be provided by county behavioral health agencies, to provide behavioral health care, including stabilization medication, housing, and other enumerated services, to adults who are currently experiencing a severe mental illness and have a diagnosis identified in the disorder class schizophrenia and other psychotic disorders, and who meet other specified criteria.
This bill would authorize CARE Act proceedings to be conducted by a superior court judge or by a court-appointed commissioner or other subordinate judicial officer. The bill would require that there is no fee for filing a petition nor any fees charged by any public officer for services in filing or serving papers or for the performance of any duty enjoined by the CARE Act. The bill would authorize that the respondent is entitled to have an interpreter in all proceedings if necessary for the respondents full participation.
Existing law authorizes a specified individual to commence the CARE process, known as the original petitioner. Under existing law, if the original petitioner is a person other than the director of a county behavioral health agency, the court is required to issue an order relieving the original petitioner and appointing the director of the county behavioral health agency, or their successor, as the substitute petitioner. Under existing law, the original petitioner retains specified rights, including the right to participate in the initial hearing to determine the merits of the petition.
This bill would revise the rights of the original petitioner, including giving them the right to be present and make a statement on the merits of the petition at the initial hearing and authorizing the court to assign ongoing rights to an original petitioner who resides with the respondent or is a spouse, parent, sibling, child, or grandparent or other person who stands in loco parentis to the respondent.
Existing law requires the court to appoint a public defender to represent the respondent in specified circumstances.
This bill would additionally authorize the appointment of counsel working in the capacity of a public defender.
Existing law requires the act to be implemented with technical assistance and continuous quality improvement, as specified, including expected start dates for specified counties. Existing law also requires the State Department of Health Care Services to implement guidelines under which counties can apply for and be provided additional time to implement the above-described provisions. Existing law authorizes the department to grant an extension once, and no later than December 1, 2025.
The bill would also make technical and conforming changes.
This bill would declare that it is to take effect immediately as an urgency statute.
Existing law, the Community Assistance, Recovery, and Empowerment (CARE) Act, authorizes specified adult persons to petition a civil court to create a voluntary CARE agreement or a court-ordered CARE plan and implement services, to be provided by county behavioral health agencies, to provide behavioral health care, including stabilization medication, housing, and other enumerated services, to adults who are currently experiencing a severe mental illness and have a diagnosis identified in the disorder class schizophrenia and other psychotic disorders, and who meet other specified criteria.
This bill would authorize CARE Act proceedings to be conducted by a superior court judge or by a court-appointed commissioner or other subordinate judicial officer. The bill would require that there is no fee for filing a petition nor any fees charged by any public officer for services in filing or serving papers or for the performance of any duty enjoined by the CARE Act. The bill would authorize that the respondent is entitled to have an interpreter in all proceedings if necessary for the respondents full participation.
Existing law authorizes CARE Act proceedings to commence in the county where the respondent resides, is found, or is facing criminal or civil proceedings. a specified individual to commence the CARE process, known as the original petitioner. Under existing law, if the original petitioner is a person other than the director of a county behavioral health agency, the court is required to issue an order relieving the original petitioner and appointing the director of the county behavioral health agency, or their successor, as the substitute petitioner. Under existing law, the original petitioner retains specified rights, including the right to participate in the initial hearing to determine the merits of the petition.
This bill would revise the rights of the original petitioner, including giving them the right to be present and make a statement on the merits of the petition at the initial hearing and authorizing the court to assign ongoing rights to an original petitioner who resides with the respondent or is a spouse, parent, sibling, child, or grandparent or other person who stands in loco parentis to the respondent.
Existing law requires the court to appoint a public defender to represent the respondent in specified circumstances.
This bill would additionally authorize the appointment of counsel working in the capacity of a public defender.
Existing law requires the act to be implemented with technical assistance and continuous quality improvement, as specified, including expected start dates for specified counties. Existing law also requires the State Department of Health Care Services to implement guidelines under which counties can apply for and be provided additional time to implement the above-described provisions. Existing law authorizes the department to grant an extension once, and no later than December 1, 2025.
This bill would instead authorize the department to grant an extension no later than December 15, 2025.The bill would also make technical and conforming changes.
Existing law, the Community Assistance, Recovery, and Empowerment (CARE) Act, effective January 1, 2023, authorizes specified adult persons to petition a civil court to create a voluntary CARE agreement or a court-ordered CARE plan and implement services, to be provided by county behavioral health agencies, to provide behavioral health care, including stabilization medication, housing, and other enumerated services, to adults who are currently experiencing a severe mental illness and have a diagnosis identified in the disorder class schizophrenia and other psychotic disorders, and who meet other specified criteria.
Existing law authorizes CARE Act proceedings to commence in the county where the respondent resides, is found, or is facing criminal or civil proceedings.
This bill would make technical, nonsubstantive changes to that provision.Existing law requires the act to be implemented with technical assistance and continuous quality improvement, as specified, including expected start dates for specified counties. Existing law also requires the State Department of Health Care Services to implement guidelines under which counties can apply for and be provided additional time to implement the above-described provisions. Existing law authorizes the department to grant an extension once, and no later than December 1, 2025.
This bill would instead authorize the department to grant an extension no later than December 15, 2025.
Existing law, the Community Assistance, Recovery, and Empowerment (CARE) Act, effective January 1, 2023, authorizes specified adult persons to petition a civil court to create a voluntary CARE agreement or a court-ordered CARE plan and implement services, to be provided by county behavioral health agencies, to provide behavioral health care, including stabilization medication, housing, and other enumerated services, to adults who are currently experiencing a severe mental illness and have a diagnosis identified in the disorder class schizophrenia and other psychotic disorders, and who meet other specified criteria.
Existing law authorizes CARE Act proceedings to commence in the county where the respondent resides, is found, or is facing criminal or civil proceedings.
This bill would make technical, nonsubstantive changes to that provision.
(a)If the defendant is found mentally competent, the criminal process shall resume, and the trial on the offense charged or hearing on the alleged violation shall proceed.
(b)If the defendant is found mentally incompetent, the trial, judgment, or hearing on the alleged violation shall be suspended and the court may do either of the following:
(1)(A)Conduct a hearing, pursuant to Chapter 2.8A (commencing with Section 1001.35) of Title 6, and, if the court deems the defendant eligible, grant diversion pursuant to Section 1001.36 for a period not to exceed one year from the date the individual is accepted into diversion or the maximum term of imprisonment provided by law for the most serious offense charged in the misdemeanor complaint, whichever is shorter.
(B)If the court opts to conduct a hearing pursuant to this paragraph, the hearing shall be held no later than 30 days after the finding of incompetence. If the hearing is delayed beyond 30 days, the court shall order the defendant to be released on their own recognizance pending the hearing.
(C)If the defendant performs satisfactorily on diversion pursuant to this section, at the end of the period of diversion, the court shall dismiss the criminal charges that were the subject of the criminal proceedings at the time of the initial diversion.
(D)If the court finds the defendant ineligible for diversion based on the circumstances set forth in subdivision (b), (c), (d), or (g) of Section 1001.36, the court may, after notice to the defendant, defense counsel, and the prosecution, hold a hearing to determine whether to do any of the following:
(i)Order modification of the treatment plan in accordance with a recommendation from the treatment provider.
(ii)Refer the defendant to assisted outpatient treatment pursuant to Section 5346 of the Welfare and Institutions Code. A referral to assisted outpatient treatment may only occur in a county where services are available pursuant to Section 5348 of the Welfare and Institutions Code, and the agency agrees to accept responsibility for treatment of the defendant. A hearing to determine eligibility for assisted outpatient treatment shall be held within 45 days after the date of the referral. If the hearing is delayed beyond 45 days, the court shall order the defendant, if confined in county jail, to be released on their own recognizance pending that hearing. If the defendant is accepted into assisted outpatient treatment, the charges shall be dismissed pursuant to Section 1385.
(iii)Refer the defendant to the county conservatorship investigator in the county of commitment for possible conservatorship proceedings for the defendant pursuant to Chapter 3 (commencing with Section 5350) of Part 1 of Division 5 of the Welfare and Institutions Code. A defendant shall only be referred to the conservatorship investigator if, based on the opinion of a qualified mental health expert, the defendant appears to be gravely disabled, as defined in subparagraph (A) of paragraph (1) of subdivision (h) of Section 5008 of the Welfare and Institution Code. Any hearings required in the conservatorship proceedings shall be held in the superior court in the county of commitment. The court shall transmit a copy of the order directing initiation of conservatorship proceedings to the county mental health director or the directors designee and shall notify the county mental health director or their designee of the outcome of the proceedings. Before establishing a conservatorship, the public guardian shall investigate all available alternatives to conservatorship pursuant to Section 5354 of the Welfare and Institutions Code. If a petition is not filed within 60 days of the referral, the court shall order the defendant, if confined in county jail, to be released on their own recognizance pending conservatorship proceedings. If the outcome of the conservatorship proceedings results in the establishment of conservatorship, the charges shall be dismissed pursuant to Section 1385.
(iv)Refer the defendant to the CARE program pursuant to Section 5978 of the Welfare and Institutions Code. A hearing to determine eligibility for CARE shall be held within 14 court days after the date on which the petition for the referral is filed. If the hearing is delayed beyond 14 court days, the court shall order the defendant, if confined in county jail, to be released on their own recognizance pending that hearing. If the defendant is accepted into CARE, the charges shall be dismissed pursuant to Section 1385.
(2)Dismiss the charges pursuant to Section 1385. If the criminal action is dismissed, the court shall transmit a copy of the order of dismissal to the county behavioral health director or the directors designee.
(c)If the defendant is found mentally incompetent and is on a grant of probation for a misdemeanor offense, the court shall dismiss the pending revocation matter and may return the defendant to supervision. If the revocation matter is dismissed pursuant to this subdivision, the court may modify the terms and conditions of supervision to include appropriate mental health treatment.
(d)It is the intent of the Legislature that a defendant subject to the terms of this section receive mental health treatment in a treatment facility and not a jail. A term of four days will be deemed to have been served for every two days spent in actual custody against the maximum term of diversion. A defendant not in actual custody shall otherwise receive day for day credit against the term of diversion from the date the defendant is accepted into diversion. Actual custody has the same meaning as in Section 4019.
(e)This section shall apply only as provided in subdivision (b) of Section 1367.
SEC. 2.Section 5970 of the Welfare and Institutions Code is amended to read:5970.This part shall be known, and may be cited, as the Community Assistance, Recovery, and Empowerment (CARE) Act.
SEC. 3.Section 5970.5 of the Welfare and Institutions Code is amended to read:5970.5.This part shall be implemented as follows, with technical assistance and continuous quality improvement, pursuant to Section 5983:
(a)A first cohort of counties, which shall include the Counties of Glenn, Orange, Riverside, San Diego, Stanislaus, and Tuolumne, and the City and County of San Francisco, shall begin no later than October 1, 2023, unless the county is provided additional time pursuant to paragraph (2) of subdivision (c).
(b)A second cohort of counties, representing the remaining population of the state, shall begin no later than December 1, 2024, unless the county is provided additional time pursuant to paragraph (2) of subdivision (c).
(c)(1)The department shall issue guidelines under which counties can apply for, and be provided, additional time to implement this part. The guidelines shall not be subject to the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code).
(2)The department shall approve implementation delay for the first or second cohort if the county experiences a state or local emergency and the delay of the provision of the CARE process is necessary as a result of the emergency.
(3)The department shall only grant one extension per county and the final date for counties to implement under any circumstances shall be December 1, 2025.
(d)This part shall become operative only upon the department, in consultation with county stakeholders, developing a CARE Act allocation to provide state financial assistance to counties to implement the care process in this act.
SEC. 4.Section 5971 of the Welfare and Institutions Code is amended to read:5971.Unless the context otherwise requires, the following definitions shall govern the construction of this part.
(a)CARE agreement means a voluntary settlement agreement entered into by the parties. A CARE agreement includes the same elements as a CARE plan to support the respondent in accessing community-based services and supports.
(b)CARE plan means an individualized, appropriate range of community-based services and supports, as set forth in this part, which include clinically appropriate behavioral health care and stabilization medications, housing, and other supportive services, as appropriate, pursuant to Section 5982.
(c)CARE process means the court and related proceedings to implement the CARE Act.
(d)Counsel means the attorney representing the respondent, appointed pursuant to Section 5977, or chosen by the respondent, in CARE Act proceedings and matters related to CARE agreements and CARE plans. Representation of a respondent in these matters does not alter counsels obligations under the State Bar Act and the Rules of Professional Conduct, including subdivision (e) of Section 6068 of the Business and Professions Code and rule 1.6 of the Rules of Professional Conduct.
(e)County behavioral health agency means the local director of mental health services described in Section 5607, the local behavioral health director, or both as applicable, or their designee.
(f)Court-ordered evaluation means an evaluation ordered by a superior court pursuant to Section 5977.1.
(g)Department means the State Department of Health Care Services.
(h)Graduation plan means a voluntary agreement entered into by the parties at the end of the CARE program that includes a strategy to support a successful transition out of court jurisdiction and that may include a psychiatric advance directive. A graduation plan includes the same elements as a CARE plan to support the respondent in accessing community-based services and supports. The graduation plan shall not place additional requirements on the local government entities and is not enforceable by the court.
(i)Homeless outreach worker means a person who engages people experiencing homelessness to assess for unmet needs, offer information, services, or other assistance, or provide care coordination.
(j)Indian health care provider means a health care program operated by the Indian Health Service, an Indian tribe, a tribal organization, or urban Indian organization (I/T/U) as those terms are defined in Section 4 of the Indian Health Care Improvement Act (25 U.S.C. Sec. 1603).
(k)Legal proceeding means any administrative, civil, or criminal proceeding, including, but not limited to, juvenile court proceedings and family court proceedings and services, and any form of alternative dispute resolution, including arbitration and mediation, except for the following:
(1)A proceeding under this part.
(2)A proceeding under the Lanterman-Petris-Short Act described in paragraph (2) or (3) of subdivision (a) of Section 5979.
(3)A proceeding from which the respondent was referred to CARE Act proceedings as described in Section 5978.
(4)A disciplinary proceeding under Chapter 4 (commencing with Section 6000) of Division 3 of the Business and Professions Code.
(5)An appeal from any of the proceedings identified in paragraphs (1) through (4), inclusive.
(l)Licensed behavioral health professional means either of the following:
(1)A licensed mental health professional, as defined in subdivision (j) of Section 4096.
(2)A person who has been granted a waiver of licensure requirements by the department pursuant to Section 5751.2.
(m)Parties means the petitioner, the respondent, the county behavioral health agency in the county where proceedings under this part are pending, and any local governmental entity added by the court pursuant to paragraph (4) of subdivision (d) of Section 5977.1.
(n)Petitioner means the person who files the CARE Act petition with the court. Additionally, if the petitioner is a person listed in Section 5974 other than the director of a county behavioral health agency, or their designee, the petitioner shall have the right to file a petition with the court, but at the initial hearing the court shall substitute the director of a county behavioral health agency, or their designee, of the county in which the proceedings are filed as petitioner. The original petitioner may, at the courts discretion and in furtherance of the interests of the respondent, retain rights as described in subparagraph (A) of paragraph (6) of subdivision (b) of Section 5977.
(o)Psychiatric advance directive means a legal document, executed on a voluntary basis in accordance with the requirements for advance health care directives in Division 4.7 (commencing with Section 4600) of the Probate Code, by a person who has the capacity to make medical decisions, that allows a person with mental illness to protect their autonomy and ability to direct their own care by documenting their preferences for treatment in advance of a mental health crisis.
(p)Respondent means the person who is the subject of the petition for the CARE process.
(q)Stabilization medications means medications included in the CARE plan that primarily consist of antipsychotic medications to reduce symptoms of hallucinations, delusions, and disorganized thinking. Stabilization medications may be administered as long-acting injections if clinically indicated. Stabilization medications shall not be forcibly administered.
(r)Supporter means an adult designated by the respondent who assists the person who is the subject of the petition, which assistance may include supporting the person to understand, make, communicate, implement, or act on their own life decisions during the CARE process, including a CARE agreement, a CARE plan, and developing a graduation plan. A supporter shall not act independently.
SEC. 5.Section 5972 of the Welfare and Institutions Code is amended to read:5972.An individual shall qualify for the CARE process only if all of the following criteria are met:
(a)The person is 18 years of age or older.
(b)The person is currently experiencing a serious mental disorder, as defined in paragraph (2) of subdivision (b) of Section 5600.3 and has a diagnosis identified in the disorder class: schizophrenia spectrum and other psychotic disorders, as defined in the most current version of the Diagnostic and Statistical Manual of Mental Disorders. This section does not establish respondent eligibility based upon a psychotic disorder that is due to a medical condition or is not primarily psychiatric in nature, including, but not limited to, physical health conditions such as traumatic brain injury, autism, dementia, or neurologic conditions. A person who has a current diagnosis of substance use disorder as defined in paragraph (2) of subdivision (a) of Section 1374.72 of the Health and Safety Code but who does not also meet the required criteria in this section shall not qualify for the CARE process.
(c)The person is not clinically stabilized in on-going voluntary treatment.
(d)At least one of the following is true:
(1)The person is unlikely to survive safely in the community without supervision and the persons condition is substantially deteriorating.
(2)The person is in need of services and supports in order to prevent a relapse or deterioration that would be likely to result in grave disability or serious harm to the person or others, as used in Section 5150.
(e)Participation in a CARE plan or CARE agreement would be the least restrictive alternative necessary to ensure the persons recovery and stability.
(f)It is likely that the person will benefit from participation in a CARE plan or CARE agreement.
SEC. 6.Section 5973 of the Welfare and Institutions Code is amended to read:5973.(a)Proceedings under this part may be commenced in any of the following:
(1)The county in which the respondent resides.
(2)The county where the respondent is found.
(3)The county where the respondent is facing criminal or civil proceedings.
(b)If the respondent does not reside in the county in which proceedings are initiated under this subdivision, as determined in accordance with Section 244 of the Government Code, except as provided in subdivision (f) of Section 5982, and this part is operative in the respondents county of residence, the proceeding shall, with the respondents consent, be transferred to the county of residence as soon as reasonably feasible. Should the respondent not consent to the transfer, the proceedings shall continue in the county where the respondent was found.
SEC. 7.Section 5974 of the Welfare and Institutions Code is amended to read:5974.The following adult persons may file a petition to commence the CARE process:
(a)A person with whom the respondent resides.
(b)A spouse, parent, sibling, child, or grandparent or an individual who stands in loco parentis to the respondent.
(c)The director of a hospital in which the respondent is hospitalized, including hospitalized pursuant to Section 5150 or 5250, or the directors designee.
(d)The director of a public or charitable organization, agency, or home, or their designee, who has, within the previous 30 days, provided or who is currently providing behavioral health services to the respondent or in whose institution the respondent resides.
(e)A licensed behavioral health professional, or their designee, who is, or has been within the previous 30 days, either supervising the treatment of, or treating the respondent for a mental illness.
(f)A first responder, including a peace officer, firefighter, paramedic, emergency medical technician, mobile crisis response worker, or homeless outreach worker, who has had repeated interactions with the respondent in the form of multiple arrests, multiple detentions and transportation pursuant to Section 5150, multiple attempts to engage the respondent in voluntary treatment, or other repeated efforts to aid the respondent in obtaining professional assistance.
(g)The public guardian or public conservator, or their designee, of the county in which the respondent resides or is found.
(h)The director of a county behavioral health agency, or their designee, of the county in which the respondent resides or is found.
(i)The director of county adult protective services, or their designee, of the county in which the respondent resides or is found.
(j)The director of a California Indian health services program, California tribal behavioral health department, who has, within the previous 30 days, provided or who is currently providing behavioral health services to the respondent, or the directors designee.
(k)The judge of a tribal court located in California before which the respondent has appeared within the previous 30 days, or the judges designee.
(l)The respondent.
SEC. 8.Section 5975.1 of the Welfare and Institutions Code is amended to read:5975.1.(a)Notwithstanding Section 391 of the Code of Civil Procedure, if a person other than the respondent files a petition for CARE Act proceedings that is without merit or is intended to harass or annoy the respondent, and the person has previously filed a pleading in CARE Act proceedings that was without merit or was intended to harass or annoy the respondent, the petition shall be grounds for the court to determine that the person is a vexatious litigant for the purposes of Title 3A (commencing with Section 391) of Part 2 of the Code of Civil Procedure.
(b)(1)If a person other than the respondent files a petition for CARE Act proceedings in order to gain an advantage over the respondent in another legal proceeding, then, notwithstanding any other provision of this part, it is cause for suspension, disbarment, or other discipline if a member of the State Bar is found to have filed the petition or assisted in the filing of the petition with knowledge that the filing was being made in order to gain that advantage.
(2)For purposes of this subdivision, legal proceeding shall not include:
(A)A proceeding under Part 1 (commencing with Section 5000) of Division 5.
(B)A proceeding under Section 300.
SEC. 9.Section 5975.2 is added to the Welfare and Institutions Code, to read:5975.2.CARE Act proceedings may be conducted by a superior court judge or by a court-appointed commissioner or other subordinate judicial officer.
SEC. 10.Section 5975.3 is added to the Welfare and Institutions Code, to read:5975.3.There shall be no fee for filing under this chapter nor shall any fees be charged by any public officer for services in filing or serving papers or for the performance of any duty enjoined by the CARE Act.
SEC. 11.Section 5976 of the Welfare and Institutions Code is amended to read:5976.The respondent shall:
(a)Receive notice of the hearings.
(b)Receive a copy of the court-ordered evaluation.
(c)Be entitled to be represented by counsel at all stages of a proceeding commenced under this chapter, regardless of the ability to pay.
(d)Be allowed to have a supporter be present with them to perform the functions described in Sections 5980 and 5981, subject to the limits provided in those sections.
(e)Have the right to be present at the hearing unless the respondent waives that right.
(f)Have the right to present evidence.
(g)Have the right to call witnesses.
(h)Have the right to cross-examine witnesses.
(i)Have the right to appeal decisions, and to be informed of the right to appeal.
(j)Have the right to an interpreter in all proceedings if necessary for the respondent to fully participate.
SEC. 12.Section 5976.5 of the Welfare and Institutions Code is amended to read:5976.5.(a)Notwithstanding any other law, and except as otherwise provided in this section, a hearing held under this part is presumptively closed to the public.
(b)The respondent may demand that the hearing be public and be held in a place suitable for attendance by the public.
(c)The respondent may request the presence of any family member or friend without waiving the right to keep the hearing closed to the rest of the public.
(d)A request by any other party to the proceeding to make the hearing public may be granted if the judicial officer conducting the hearing finds that the public interest in an open hearing clearly outweighs the respondents interest in privacy.
(e)All reports, evaluations, diagnoses, or other information filed with the court related to the respondents health shall be confidential. The respondent may at any time petition the court for an order sealing these records or any other court records in a proceeding held under this part. Notwithstanding any rule of court prohibiting records kept confidential by law from consideration for sealing, if such a petition is filed, there shall exist a presumption in favor of sealing.
(f)The fact that evidence is admitted at a proceeding held under this part shall not be the basis for admission of that evidence in any subsequent legal proceeding.
(g)Photographs, recordings, transcripts, other records of proceedings held under this part, and testimony regarding proceedings held under this part shall not be admissible in any subsequent legal proceeding except upon motion by one of the following in that subsequent legal proceeding:
(1)The respondent.
(2)The county behavioral health agency, the public guardian, or the public conservator.
(h)In a proceeding held under this part, this section shall not affect the applicability of paragraph (2) of subdivision (c) of Section 5977.1, make admissible any evidence that is not otherwise admissible, or permit a witness to base an opinion on any matter that is not a proper basis for that opinion. The admission or exclusion of evidence shall be pursuant to the rules of evidence established by the Evidence Code, including, but not limited to, Section 352 of the Evidence Code, and by judicial decision.
(i)Before commencing a hearing, the judicial officer shall inform the respondent of their rights under this section.
SEC. 13.Section 5977 of the Welfare and Institutions Code is amended to read:5977.(a)(1)The court shall promptly review the petition to determine if the petitioner has made a prima facie showing that the respondent is, or may be, a person described in Section 5972.
(2)If the court finds that the petitioner has not made a prima facie showing that the respondent is, or may be, a person described in Section 5972, the court may dismiss the case without prejudice subject to consideration of Section 5975.1.
(3)If the court finds that the petitioner has made a prima facie showing that the respondent is, or may be, a person described in Section 5972, the court shall do one of the following:
(A)If the petitioner is the director of a county behavioral health agency, or their designee, the court shall do the following:
(i)Set the matter for an initial appearance on the petition within 14 court days.
(ii)Appoint a qualified legal services project, as defined in Sections 6213 to 6214.5, inclusive, of the Business and Professions Code, to represent the respondent. If no legal services project has agreed to accept these appointments, a public defender or other counsel working in that capacity shall be appointed to represent the respondent.
(iii)Determine whether the petition includes all of the following information and, if it does not, order the county behavioral health agency to submit a written report with the court within 14 court days that includes all of the following:
(I)A determination as to whether the respondent meets, or is likely to meet, the criteria for the CARE process.
(II)The outcome of efforts made to voluntarily engage the respondent prior to the filing of the petition.
(III)Conclusions and recommendations about the respondents ability to voluntarily engage in services.
(iv)Order the county behavioral health agency to provide notice to the respondent, the appointed counsel, and the county behavioral health agency in the county where the respondent resides, if different from the county where the CARE process has commenced.
(B)If the petitioner is a person other than the director of a county behavioral health agency, or their designee, the court shall order a county agency, or their designee, as determined by the court, to investigate, as necessary, and file a written report with the court within 14 court days and provide notice to the respondent and petitioner that a report has been ordered. The written report shall include all of the following:
(i)A determination as to whether the respondent meets, or is likely to meet, the criteria for the CARE process.
(ii)The outcome of efforts made to voluntarily engage the respondent during the 14-day report period.
(iii)Conclusions and recommendations about the respondents ability to voluntarily engage in services.
(iv)The information, including protected health information, necessary to support the determinations, conclusions, and recommendations in the report.
(4)If, upon a request by the county agency ordered to investigate and file a report under subparagraph (B) of paragraph (3), the court finds that the county agency is making progress to engage the respondent, the court may, in its discretion, grant the county agency no more than 30 additional days to continue to work with, engage, and enroll the individual in voluntary treatment and services. The county agency shall provide notice to the respondent and petitioner that an extension for filing a report has been granted.
(5)Upon receipt of the report described in subparagraph (B) of paragraph (3), the court shall, within five days, take one of the following actions:
(A)If the court determines that voluntary engagement with the respondent is effective, and that the individual has enrolled or is likely to enroll in voluntary behavioral health treatment, the court shall dismiss the matter.
(B)If the court determines that the county agencys report does not support the petitions prima facie showing that the respondent is, or may be, a person described in Section 5972, the court shall dismiss the matter. This section shall not prevent a county behavioral health agency from continuing to voluntarily engage with a person not described in Section 5972 but who is in need of services and supports.
(C)If the court determines that the county agencys report does support the petitions prima facie showing that the respondent is, or may be, a person described in Section 5972, and engagement with the county agency was not effective, the court shall do all of the following:
(i)Set an initial appearance on the petition within 14 court days.
(ii)Appoint a qualified legal services project, as defined in Sections 6213 to 6214.5, inclusive, of the Business and Professions Code or, if no legal services project has agreed to accept these appointments, a public defender or other counsel working in that capacity to represent the respondent.
(iii)Order the county agency to provide notice of the initial appearance to the petitioner, the respondent, the appointed counsel, the county behavioral health agency in the county where the respondent resides, and, if different, the county where the CARE court proceedings have commenced.
(b)At the initial appearance on the petition, all of the following shall apply:
(1)The court shall permit the respondent to substitute their own counsel.
(2)Petitioner shall be present. If the petitioner is not present, the matter may be dismissed.
(3)Respondent may waive personal appearance and appear through counsel. If the respondent does not waive personal appearance and does not appear at the hearing, and the court makes a finding in open court that reasonable attempts to elicit the attendance of the respondent have failed, the court may conduct the hearing in the respondents absence if the court makes a finding in open court that conducting the hearing without the participation or presence of the respondent would be in the respondents best interest.
(4)A representative from the county behavioral health agency shall be present.
(5)If the respondent asserts that they are enrolled in a federally recognized Indian tribe or are receiving services from an Indian health care provider, a tribal court, or a tribal organization, a representative from the program, the tribe, or the tribal court shall be allowed to be present, subject to the consent of the respondent. The tribal representative shall be entitled to notice by the county of the initial appearance.
(6)(A)If the petitioner is a person other than the director of a county behavioral health agency, or their designee, the court shall issue an order relieving the original petitioner and appointing the director of the county behavioral health agency or their designee as the successor petitioner.
(B)If the original petitioner is described in subdivision (a) or (b) of Section 5974, all of the following apply:
(i)The original petitioner shall have the right to be present and make a statement at the initial hearing on the merits of the petition held pursuant to paragraph (7).
(ii)The court may, in its discretion, assign ongoing rights of notice to the original petitioner.
(iii)To the extent that the respondent consents, the court may allow the original petitioner to participate in the respondents CARE proceedings.
(iv)The original petitioner may file a new petition with the court, pursuant to Section 5974, if the matter is dismissed and there is a change in circumstances.
(C)If the original petitioner is not described in subdivision (a) or (b) of Section 5974, the court shall not assign ongoing rights to the original petitioner, other than the right to be present and make a statement at the hearing on the merits of the petition held pursuant to paragraph (7).
(7)(A)The court shall set a hearing on the merits of the petition within 10 days, at which time the court shall determine whether, by clear and convincing evidence, the respondent meets the CARE criteria in Section 5972. In making this determination, the court shall consider all evidence properly before it, including any report from the county behavioral health agency ordered pursuant to paragraph (3) of subdivision (a) and any additional admissible evidence presented by the parties, including the petition submitted and any statement given by the original petitioner.
(B)The hearing on the merits of the petition may be conducted concurrently with the initial appearance upon stipulation of the successor petitioner and the respondent, subject to the approval by the court.
(c)(1)If, at the hearing on the merits of the petition, the court finds there is not clear and convincing evidence that the respondent meets the CARE criteria in Section 5972, the court shall dismiss the case without prejudice, unless the court makes a finding, in open court, that the original petitioners filing was not in good faith, in which case the dismissal shall be with prejudice.
(2)If, at the hearing on the merits of the petition, the court finds by clear and convincing evidence that the respondent meets the CARE criteria in Section 5972, the court shall order the county behavioral health agency to work with the respondent, the respondents counsel, and the supporter to engage the respondent in behavioral health treatment and attempt to enter into a CARE agreement. The court shall set a case management hearing within 14 days.
(3)If the respondent is enrolled in a federally recognized Indian tribe, the respondent shall provide notice of the case management hearing to the tribe, subject to the consent of the respondent.
(d)The following shall apply to any written report submitted by a county behavioral health agency to the court pursuant to this section:
(1)The report is confidential and not subject to disclosure or inspection under the California Public Records Act (Division 10 (commencing with Section 7920.000) of Title 1 of the Government Code).
(2)The report is inadmissible in any subsequent legal proceeding, except upon motion of the respondent in that subsequent legal proceeding.
(3)The report shall be confidential pursuant to subdivision (e) of Section 5976.5.
(4)This subdivision shall not affect the applicability of paragraph (2) of subdivision (c) of Section 5977.1, make admissible any evidence that is not otherwise admissible, or permit a witness to base an opinion on any matter that is not a proper basis for such an opinion. The admission or exclusion of evidence shall be pursuant to the rules of evidence established by the Evidence Code, including, but not limited to, Section 352 of the Evidence Code, and by judicial decision.
SEC. 14.Section 5977.1 of the Welfare and Institutions Code is amended to read:5977.1.(a)(1)At the case management hearing, the court shall hear evidence as to whether the parties have entered, or are likely to enter, into a CARE agreement.
(2)If the court finds that the parties have entered, or are likely to enter, into a CARE agreement, the court shall do one of the following:
(A)Approve the terms of the CARE agreement or modify the terms of the CARE agreement and approve the agreement as modified by the court, and continue the matter and set a progress hearing for 60 days.
(B)Continue the matter for 14 days to allow the parties additional time to enter into a CARE agreement, upon stipulation of the parties.
(b)If the court finds that the parties have not entered into a CARE agreement, and are not likely to enter into a CARE agreement, the court shall order the county behavioral health agency, through a licensed behavioral health professional, to conduct a clinical evaluation of the respondent, unless there is an existing clinical evaluation of the respondent completed within the last 30 days and the parties stipulate to the use of that evaluation. The evaluation shall address, at a minimum, the following:
(1)A clinical diagnosis of the respondent.
(2)Whether the respondent has the legal capacity to give informed consent regarding psychotropic medication.
(3)Any other information as ordered by the court or that the licensed behavioral health professional conducting the evaluation determines would help the court make future informed decisions about the appropriate care and services the respondent should receive.
(4)An analysis of recommended services, programs, housing, medications, and interventions that support the recovery and stability of the respondent.
(c)(1)The court shall set a clinical evaluation hearing to review the evaluation within 21 days. The court shall order the county to file the evaluation with the court and provide the evaluation to the respondents counsel no later than five days prior to the scheduled clinical evaluation hearing. The clinical evaluation hearing may be continued for a maximum of 14 days upon stipulation of the respondent and the county behavioral health agency, unless there is good cause for a longer extension.
(2)At the clinical evaluation review hearing, the court shall review the evaluation and other evidence from the county behavioral health agency and the respondent. The county behavioral health agency and the respondent may present evidence and call witnesses, including the person who conducted the evaluation. Only relevant and admissible evidence that fully complies with the rules of evidence may be considered by the court.
(3)At the conclusion of the hearing, the court shall determine whether the respondent, by clear and convincing evidence, meets the CARE criteria in Section 5972 and make orders as follows:
(A)If the court finds that the respondent meets the CARE criteria, the court shall order the county behavioral health agency, the respondent, and the respondents counsel and supporter to jointly develop a CARE plan within 14 days.
(B)If the court does not find that clear and convincing evidence establishes that the respondent meets the CARE criteria, the court shall dismiss the petition.
(4)If the respondent is a self-identified American Indian or Alaska Native individual, as defined in Sections 1603(13), 1603(28), and 1679(a) of Title 25 of the United States Code, has been determined eligible as an Indian under Section 136.12 of Title 42 of the Code of Federal Regulations, or is currently receiving services from an Indian health care provider or tribal court, the county behavioral health agency shall use its best efforts to meaningfully consult with and incorporate the Indian health care provider or tribal court available to the respondent to develop the CARE plan.
(5)The evaluation and all reports, documents, and filings submitted to the court shall be confidential.
(6)The date for the hearing to review and consider approval of the proposed CARE plan shall be set not more than 14 days from the date of the order to develop a CARE plan, unless the court finds good cause for an extension. The party requesting an extension of time for the CARE plan review hearing shall provide notice to the opposing party and their counsel of the request for extension of time, and the courts order if the request is granted.
(d)(1)At the CARE plan review hearing, the parties shall present their plan or plans to the court. The county behavioral health agency or the respondent, or both, may present a proposed CARE plan.
(2)After consideration of the plans proposed by the parties, the court shall adopt the elements of a CARE plan that support the recovery and stability of the respondent. The court may issue any orders necessary to support the respondent in accessing appropriate services and supports, including prioritization for those services and supports, subject to applicable laws and available funding pursuant to Section 5982. These orders shall constitute the CARE plan.
(3)A court may order medication if it finds, upon review of the court-ordered evaluation and hearing from the parties, that, by clear and convincing evidence, the respondent lacks the capacity to give informed consent to the administration of medically necessary stabilization medication. To the extent the court orders medically necessary stabilization medication, the medication shall not be forcibly administered and the respondents failure to comply with a medication order shall not result in a penalty, including, but not limited to, contempt or termination of the CARE plan pursuant to Section 5979.
(4)If the proposed CARE plan includes services and supports, such as housing, provided directly or indirectly through another local governmental entity, that local entity may agree to provide the service or support, or the court may consider a motion by either of the parties to add the local entity as a party to the CARE proceeding. If the local entity agrees to provide the service or support, it may request to be added as a party by the court.
(5)If, after presentation of the CARE plan or plans, the court determines that additional information is needed, including from a licensed behavioral health professional, the court shall order a supplemental report to be filed by the county behavioral health agency for which the court may grant a continuance of no more than 14 days, unless there is good cause for a longer extension.
(6)If there is no CARE plan because the parties have not had sufficient time to complete it, the court may grant a continuance of no more than 14 days, unless there is good cause for a longer extension.
(e)The issuance of an order approving a CARE plan pursuant to paragraph (2) of subdivision (d) begins the CARE process timeline, which shall not exceed one year.
SEC. 15.Section 5977.2 of the Welfare and Institutions Code is amended to read:5977.2.(a)(1)At intervals set by the court and not less frequently than every 60 days after the court orders the CARE plan, the court shall hold a status review hearing. The county behavioral health agency shall file with the court and serve on the respondent, and the respondents counsel and supporter, a report no fewer than five court days prior to the review hearing with the following information:
(A)The progress that the respondent has made on the CARE plan.
(B)What services and supports in the CARE plan were provided, and what services and supports were not provided.
(C)Any issues the respondent expressed or exhibited in adhering to the CARE plan.
(D)Recommendations for changes to the services and supports to make the CARE plan more successful.
(2)The respondent shall be permitted to respond to the report submitted by the county behavioral health agency and to the county behavioral health agencys testimony. The respondent shall be permitted to introduce their own information and recommendations.
(3)Subject to applicable law, intermittent lapses or setbacks described in this section of the report shall not impact access to services, treatment, or housing.
(b)The county behavioral health agency or the respondent may request, or the court upon its own motion may set, a hearing to occur at any time during the CARE process to address a change of circumstances.
SEC. 16.Section 5977.3 of the Welfare and Institutions Code is amended to read:5977.3.(a)(1)In the 11th month of the process timeline, the court shall hold a one-year status hearing. Not fewer than five court days prior to the one-year status hearing, the county behavioral health agency shall file a report with the court and shall serve the report on the respondent and the respondents counsel and supporter. The report shall include the following information:
(A)The progress that the respondent has made on the CARE plan, including a final assessment of the respondents stability.
(B)What services and supports in the CARE plan were provided, and what services and supports were not provided, over the life of the program.
(C)Any issues the respondent expressed or exhibited in adhering to the CARE plan.
(D)Recommendations for next steps, including what ongoing and additional services would benefit the respondent that the county behavioral health agency can facilitate or provide.
(2)At an evidentiary hearing, the respondent shall be permitted to respond to the report submitted by the county behavioral health agency and to the county behavioral health agencys testimony. Respondent shall be permitted to introduce their own information and recommendations. The respondent shall have the right at the hearing to call witnesses and to present evidence as to whether the respondent agrees with the report. The respondent may request either to be graduated from the program or to remain in the program.
(3)The court shall issue an order as follows:
(A)If the respondent elects to be graduated from the program, the court shall order the county behavioral health agency and the respondent to work jointly on a voluntary graduation plan. The court shall schedule a hearing in the 12th month after adoption of the CARE plan for presentation of the graduation plan. The court shall review the graduation plan and recite the terms in open court. The graduation plan shall not place additional requirements on local governmental entities and is not enforceable by the court, except that the graduation plan may, at the respondents election, include a psychiatric advance directive, which shall have the force of law. Upon completion of the hearing, the respondent shall be officially graduated from the program.
(B)If the respondent elects to remain in the CARE process, respondent may request any amount of time, up to and including one additional year. The court may permit the ongoing voluntary participation of the respondent if the court finds both of the following:
(i)The respondent did not successfully complete the CARE plan.
(ii)The respondent would benefit from continuation of the CARE plan.
(C)The court shall issue an order permitting the respondent to continue in the CARE plan or denying respondents request to remain in the CARE plan, and state its reasons in open court.
(b)The respondent may be involuntarily reappointed to the program only if the court finds, by clear and convincing evidence, that all of the following conditions apply:
(1)The respondent did not successfully complete the CARE process.
(2)All services and supports required through the CARE process were provided to the respondent.
(3)The respondent would benefit from continuation in the CARE process.
(4)The respondent currently meets the requirements in Section 5972.
(c)A respondent may only be reappointed to the CARE process once, for up to one additional year.
SEC. 17.Section 5977.4 of the Welfare and Institutions Code is amended to read:5977.4.(a)In all CARE Act proceedings, the judicial officer shall control the proceedings during the hearings with a view to the expeditious and effective ascertainment of the jurisdictional facts and the ascertainment of all information relative to the present condition and future welfare of the respondent. Except when there is a contested issue of fact or law, the proceedings shall be conducted in an informal nonadversarial atmosphere with a view to obtaining the maximum cooperation of the respondent, all persons interested in the respondents welfare, and all other parties, with any provisions that the court may make for the disposition and care of the respondent. All evaluations and reports, documents, and filings submitted to the court pursuant to CARE Act proceedings shall be confidential.
(b)The hearings described in this chapter shall occur in person unless the court, in its discretion, allows a party or witness to appear remotely through the use of remote technology. The respondent shall have the right to be in person for all hearings.
(c)Consistent with its constitutional rulemaking authority, the Judicial Council shall adopt rules to implement the policies and provisions in this section and in Sections 5977, 5977.1, 5977.2, and 5977.3 to promote statewide consistency, including, but not limited to, what is included in the petition form packet, communications between the CARE Act court and the juvenile court, if applicable, and the process by which counsel will be appointed.
(d)(1)Consistent with paragraph (9) of subdivision (b) of Section 56.10 of the Civil Code, the county behavioral health agency shall include in any report evaluation, or other document filed with the court, the information, including protected health information, necessary to support the determinations, conclusions, and recommendations in the filing. The county behavioral health agency shall not, unless ordered to do so by the court, submit to the court original or photocopied records underlying the information in a report evaluation or other document required or ordered under this subdivision. The county behavioral health agency shall serve an unredacted copy of any report evaluation, or other document filed with the court on the respondent and the respondents counsel and, with the consent of the respondent, on the supporter in a manner authorized by law. Neither a county nor an employee or agent thereof shall be held civilly or criminally liable for any disclosure authorized or required by this paragraph.
(2)(A)Consistent with paragraph (1) of subdivision (c) of Section 56.10 of the Civil Code, a provider of health care, as defined in Section 56.05 of the Civil Code, or a covered entity, as defined in Section 160.103 of Title 45 of the Code of Federal Regulations, may disclose to the county behavioral health agency any information, including protected health information, and mental health records excluding psychotherapy notes, in its possession about the respondent that is relevant to the county behavioral health agencys provision, coordination, or management of services and supports under this part, including, but not limited to, the preparation of any required investigations, evaluations, or reports. Such a disclosure is a disclosure for treatment purposes, which may be made only to the extent permitted under Section 164.506 of Title 45 of the Code of Federal Regulations. The information disclosed may include substance use disorder patient records only to the extent permitted by Part 2 (commencing with Section 2.1) of Title 42 of the Code of Federal Regulations.
(B)Consistent with paragraph (9) of subdivision (b) of Section 56.10 of the Civil Code, a provider of health care, as defined in Section 56.05 of the Civil Code, or a covered entity, as defined in Section 160.103 of Title 45 of the Code of Federal Regulations, that filed a CARE Act petition or executed an affidavit included with a CARE Act petition pursuant to paragraph (1) of subdivision (d) of Section 5975 shall provide to the county behavioral health agency any information, including protected health information, and mental health records excluding psychotherapy notes, in its possession about the respondent that may be relevant in connection with an investigation, evaluation, or other report or hearing under this part, or with the provision of services and supports under this part. The provision of information under this paragraph is a disclosure required by law, which may be made only to the extent permitted under subdivision (a) of Section 164.512 of Title 45 of the Code of Federal Regulations. The information disclosed shall include substance use disorder patient records only to the extent permitted by Part 2 (commencing with Section 2.1) of Title 42 of the Code of Federal Regulations.
(C)The county behavioral health agency may apply to the court ex parte for an order requiring any provider of health care, as defined in Section 56.05 of the Civil Code, or any covered entity, as defined in Section 160.103 of Title 45 of the Code of Federal Regulations, to provide to the county behavioral health agency, to the court, or both, any information, including, but not limited to, protected health information, and mental health records excluding psychotherapy notes, in its possession about the respondent that may be relevant in connection with an investigation, evaluation, or other report or hearing under this part, or with the provision of services and supports under this part. The provision of information under this paragraph is a disclosure required by law, which may be made only to the extent permitted under Section 164.512 of Title 45 of the Code of Federal Regulations. The information ordered to be disclosed may include substance use disorder patient records only to the extent permitted by Part 2 (commencing with Section 2.1) of Title 42 of the Code of Federal Regulations.
(D)A provider of health care or covered entity shall not be held civilly or criminally liable for any disclosure authorized or required by this section.
(E)The county behavioral health agency shall notify the respondent of a disclosure under this paragraph as follows:
(i)By mail at the respondents last known address, if any.
(ii)To the respondents counsel.
(iii)By including a copy of the notification under clause (i) or (ii) with the next notice of hearing served upon the respondent, if any.
(F)All information, including the facts and records, or summary thereof, shared under this subdivision shall further be disclosed to the respondent and the respondents counsel, and with the consent of the respondent, to the supporter.
(3)(A)Except as expressly provided, further disclosure or redisclosure of information is not authorized by this subdivision.
(B)Information disclosed to a county behavioral health agency by a provider of health care, as defined in Section 56.05 of the Civil Code, or a covered entity, as defined in Section 160.103 of Title 45 of the Code of Federal Regulations is confidential and not subject to disclosure or inspection under the California Public Records Act (Division 10 (commencing with Section 7920.000) of Title 1 of the Government Code).
(C)Disclosure of information under this part shall not be deemed to in any way alter the duties or responsibilities of a county behavioral health agency, of a provider of health care, as defined in Section 56.05 of the Civil Code, or of a covered entity, as defined in Section 160.103 of Title 45 of the Code of Federal Regulations, with respect to the disclosed information under the Confidentiality of Medical Information Act (Part 2.6 (commencing with Section 56) of Division 1 of the Civil Code), or the federal Health Insurance Portability and Accountability Act of 1996 (Public Law 104-191).
SEC. 18.Section 5978 of the Welfare and Institutions Code is amended to read:5978.(a)A court may refer an individual from assisted outpatient treatment, as well as from conservatorship proceedings pursuant Chapter 3 (commencing with Section 5350) of Part 1 of Division 5 (LPS conservatorship) to CARE Act proceedings. If the individual is referred from assisted outpatient treatment, the county behavioral health director or their designee shall be the petitioner. If the individual is referred from LPS conservatorship proceedings, the conservator or proposed conservator shall be the petitioner pursuant to Section 5974.
(b)A court may refer an individual from misdemeanor proceedings pursuant to Section 1370.01 of the Penal Code to CARE Act proceedings. The county behavioral health director or their designee shall be the petitioner.
SEC. 19.Section 5981.5 of the Welfare and Institutions Code is amended to read:5981.5.(a)The Legal Services Trust Fund Commission at the State Bar shall provide funding to qualified legal services projects, as defined in Sections 6213 to 6214.5, inclusive, of the Business and Professions Code, to be used to provide legal counsel appointed pursuant to subdivision (c) of Section 5976, for representation in CARE Act proceedings, matters related to CARE agreements and CARE plans, and to qualified support centers, as defined in subdivision (b) of Section 6213 of, and Section 6215 of, the Business and Professions Code, for training, support, and coordination.
(b)For purposes of implementing this part, the Legal Services Trust Fund Commission may enter into exclusive or nonexclusive contracts, or amend existing contracts, on a bid or negotiated basis, or award grants, provided that they make a finding that both of the following are satisfied:
(1)The Legal Services Trust Fund Commission shall retain control over the distribution of funds to the contractor or grantee.
(2)The contract or grant includes provisions to ensure transparency, accountability, and oversight in delivering the services, including measurement of outcomes established pursuant to Sections 5984, 5985, and 5986.
SEC. 20.Section 5982 of the Welfare and Institutions Code is amended to read:5982.(a)The CARE plan may include only the following:
(1)Behavioral health services funded through the 1991 and 2011 Realignment, Medi-Cal behavioral health, health care plans and insurers, and services supported by the Mental Health Services Act pursuant to Part 3 (commencing with Section 5800).
(2)Medically necessary stabilization medications, to the extent not described in paragraph (1).
(3)Housing resources funded through the No Place Like Home Program (Part 3.9 (commencing with Section 5849.1) of Division 5 of the Welfare and Institutions Code); California Housing Accelerator (Chapter 6.6 (commencing with Section 50672) of Part 2 of Division 31 of the Health and Safety Code); the Multifamily Housing Program (Chapter 6.7 (commencing with Section 50675) of Part 2 of Division 31 of the Health and Safety Code); the Homeless Housing, Assistance, and Prevention Program (Chapter 6 (commencing with Section 50216) of Part 1 of Division 31 of the Health and Safety Code); the Encampment Resolution Funding Program (Chapter 7 (commencing with Section 50250) of Part 1 of Division 31 of the Health and Safety Code); the Project Roomkey and Rehousing Program pursuant to Provision 22 of Item 5180-151-0001 of the Budget Act of 2021 (Ch. 21, Stats. 2021); the Community Care Expansion Program (Chapter 20 (commencing with Section 18999.97) of Part 6 of Division 9 of the Welfare and Institutions Code); the CalWORKs Housing Support Program (Article 3.3 (commencing with Section 11330) of Chapter 2 of Part 3 of Division 9 of the Welfare and Institutions Code); the CalWORKs Homeless Assistance pursuant to clause (i) of subparagraph (A) of paragraph (2) of subdivision (f) of Section 11450 of Article 6 of Chapter 2 of Part 3 of Division 9 of the Welfare and Institutions Code; the Housing and Disability Advocacy Program (Chapter 17 (commencing with Section 18999) of Part 6 of Division 9 of the Welfare and Institutions Code); the Home Safe Program (Chapter 14 (commencing with Section 15770) of Part 3 of Division 9 of the Welfare and Institutions Code); the Bringing Families Home Program (Article 6 (commencing with Section 16523) of Chapter 5 of Part 4 of Division 9 of the Welfare and Institutions Code); the Transitional Housing Placement program for nonminor dependents (Article 4 (commencing with Section 16522) of Chapter 5 of Part 4 of Division 9 of the Welfare and Institutions Code); the Transitional Housing Program-Plus pursuant to subdivision (s) of Section 11400 and paragraph (2) of subdivision (a) of Section 11403.2 of Article 5 of Chapter 2 of Part 3 of Division 9 of the Welfare and Institutions Code and Article 4 (commencing with Section 16522) of Chapter 5 of Part 4 of Division 9 of the Welfare and Institutions Code; the Behavioral Health Continuum Infrastructure Program (Chapter 1 (commencing with Section 5960) of Part 7 of Division 5 of the Welfare and Institutions Code); the Behavioral Health Bridge Housing Program; HUD-Veterans Affairs Supportive Housing Program (Section 8(o)(19) of the United States Housing Act of 1937 [42 U.S.C. Section 1437f(o)(19)]); Supportive Services for Veteran Families (Section 604 of the Veterans Mental Health and Other Care Improvements Act of 2008 [38 U.S.C. Sec. 2044]); HUD Continuum of Care program (Section 103 of the McKinney-Vento Homeless Assistance Act [42 U.S.C. Sec. 11302]); the Emergency Solutions Grant (Subtitle B of Title IV of the McKinney-Vento Homeless Assistance Act [42 U.S.C. Secs. 11371-11378]); HUD Housing Choice Voucher program (Section 8 of the United States Housing Act of 1937 [42 U.S.C. Sec. 1437f]); the Emergency Housing Vouchers (Section 3202 of the American Rescue Plan Act of 2021 [Public Law 117-2]; Section 8(o) of the United States Housing Act of 1937 [42 U.S.C. Sec. 1437f(o)]); HOME Investment Partnerships Program (Title II of the Cranston-Gonzalez National Affordable Housing Act [42 U.S.C. Sec. 12721 et seq.]); the Community Development Block Grant Program (Title 1 of the Housing and Community Development Act of 1974 [42 U.S.C. Sec. 5301 et seq.]); housing supported by the Mental Health Services Act pursuant to Part 3 (commencing with Section 5800); community development block grants; and other state and federal housing resources.
(4)Social services funded through Supplemental Security Income/State Supplementary Payment (SSI/SSP), Cash Assistance Program for Immigrants (CAPI), CalWORKs, California Food Assistance Program, In-Home Supportive Services program, and CalFresh.
(5)Services provided pursuant to Part 5 (commencing with Section 17000) of Division 9.
(b)Individuals who are CARE process participants shall be prioritized for any appropriate bridge housing funded by the Behavioral Health Bridge Housing program.
(c)If the county behavioral health agency elects not to enroll the respondent into a full service partnership, as defined in Section 3620 of Title 9 of the California Code of Regulations, the court may request information on the reasons for this and any barriers to enrollment.
(d)All CARE plan services and supports ordered by the court are subject to available funding and all applicable federal and state statutes and regulations, contractual provisions, and policy guidance governing initial and ongoing program eligibility. In addition to the resources funded through programs listed in subdivision (a), the State Department of Health Care Services may identify other adjacent covered Medi-Cal services, including, but not limited to, enhanced care management and available community supports, which may be suggested, although not ordered, by the court, subject to all applicable federal and state statutes, regulations, contractual provisions, and policy guidance.
(e)This section does not prevent a county or other local governmental entity from recommending their own services that are their own responsibility not listed in subdivision (a) or (c). Any such recommendation is not required by this section and shall be made at the request of the county for the purposes of Section 6 of Article XIIIB, and Sections 6 and 36 of Article XIII of the California Constitution.
(f)(1)For respondents who are Medi-Cal beneficiaries, the county in which the respondent resides is the county of responsibility as defined in Section 1810.228 of Title 9 of the California Code of Regulations.
(2)If a proceeding commences in a county where the respondent is found or is facing criminal or civil proceedings that is different than the county in which the respondent resides, the county in which the respondent is found or is facing criminal or civil proceedings shall not delay proceedings under this part and is the responsible county behavioral health agency for providing or coordinating all components of the CARE agreement or CARE plan.
(3)The county in which the respondent resides, as defined in paragraph (1), shall be responsible for the costs of providing all CARE agreement or CARE plan behavioral health services, as defined in paragraph (1) of subdivision (a).
(4)In the event of a dispute over responsibility for any costs of providing components of the CARE agreement or CARE plan, the impacted counties shall resolve the dispute in accordance with the arbitration process established in Section 1850.405 of Title 9 of the California Code of Regulations for county mental health plans, including for respondents who are not Medi-Cal beneficiaries, and pursuant to any related guidance issued pursuant to subdivision (b) of Section 5984.
SEC. 21.Section 5983 of the Welfare and Institutions Code is amended to read:5983.(a)The California Health and Human Services Agency, or a designated department within the agency, shall do both of the following:
(1)Engage an independent, research-based entity, as described in Section 5986, to advise on the development of data-driven process and outcome measures to guide the planning, collaboration, reporting, and evaluation of the CARE Act pursuant to this part.
(2)Convene a working group to provide coordination and on-going engagement with, and support collaboration among, relevant state and local partners and other stakeholders throughout the phases of county implementation to support the successful implementation of the CARE Act. The working group shall meet no more than quarterly. The working group shall meet during the implementation and shall end no later than December 31, 2026.
(b)The department shall provide training and technical assistance to county behavioral health agencies to support the implementation of this part, including training regarding the CARE process, CARE agreement and plan services and supports, supported decisionmaking, the supporter role, trauma-informed care, elimination of bias, psychiatric advance directives, family psychoeducation, and data collection.
(c)The Judicial Council, in consultation with the department, other relevant state entities, and the County Behavioral Health Directors Association, shall provide training and technical assistance to judicial officers to support the implementation of this part, including training regarding the CARE process, CARE agreement and plan services and supports, working with the supporter, supported decisionmaking, the supporter role, the family role, trauma-informed care, elimination of bias, best practices, and evidence-based models of care for people with severe behavioral health conditions.
(d)The department, in consultation with other relevant state departments and the California Interagency Council on Homelessness, shall provide training to counsel regarding the CARE process and CARE agreement and plan services and supports.
SEC. 22.Section 5986 of the Welfare and Institutions Code is amended to read:5986.(a)An independent, research-based entity shall be retained by the department to develop, in consultation with county behavioral health agencies, county CARE courts, racial justice experts, and other appropriate stakeholders, including providers and CARE court participants, an independent evaluation of the effectiveness of the CARE Act. The independent evaluation shall employ statistical research methodology and include a logic model, hypotheses, comparative or quasi-experimental analyses, and conclusions regarding the extent to which the CARE Act model is associated, correlated, and causally related with the performance of the outcome measures included in the annual reports. The independent evaluation shall include results from a survey conducted of program participants. The independent evaluation shall highlight racial, ethnic, and other demographic disparities, and include causal inference or descriptive analyses regarding the impact of the CARE Act on disparity reduction efforts.
(b)The department shall provide a preliminary report to the Legislature by December 31, 2026, and a final report to the Legislature by December 31, 2028. The department shall post the preliminary and final reports on its internet website.
(c)Each county behavioral health department, each county CARE court, and any other state or local governmental entity, as determined by the department, shall provide the required data to the department, in a format and frequency as directed by the department.
(d)A report to be submitted pursuant to this section shall be submitted in compliance with Section 9795 of the Government Code.
SEC. 23.The Legislature finds and declares that Sections 13 and 17 of this act, which amend Sections 5977 and 5977.4 of the Welfare and Institutions Code, impose a limitation on the publics right of access to the meetings of public bodies or the writings of public officials and agencies within the meaning of Section 3 of Article I of the California Constitution. Pursuant to that constitutional provision, the Legislature makes the following findings to demonstrate the interest protected by the limitation and the need for protecting that interest:
In order to protect the highly sensitive personal information, including protected health information, of a respondent that is in the possession of public entities under the CARE Act, it is in the states interest to limit public access to information.
SEC. 24.If the Commission on State Mandates determines that this act contains costs mandated by the state, reimbursement to local agencies and school districts for those costs shall be made pursuant to Part 7 (commencing with Section 17500) of Division 4 of Title 2 of the Government Code.
SEC. 25.This act is an urgency statute necessary for the immediate preservation of the public peace, health, or safety within the meaning of Article IV of the California Constitution and shall go into immediate effect. The facts constituting the necessity are:
The CARE Act takes effect in October 2023, and therefore important changes to the act must take effect immediately to ensure the CARE Acts success.
(a)If the defendant is found mentally competent, the criminal process shall resume, and the trial on the offense charged or hearing on the alleged violation shall proceed.
(b)If the defendant is found mentally incompetent, the trial, judgment, or hearing on the alleged violation shall be suspended and the court may do either of the following:
(1)(A)Conduct a hearing, pursuant to Chapter 2.8A (commencing with Section 1001.35) of Title 6, and, if the court deems the defendant eligible, grant diversion pursuant to Section 1001.36 for a period not to exceed one year from the date the individual is accepted into diversion or the maximum term of imprisonment provided by law for the most serious offense charged in the misdemeanor complaint, whichever is shorter.
(B)If the court opts to conduct a hearing pursuant to this paragraph, the hearing shall be held no later than 30 days after the finding of incompetence. If the hearing is delayed beyond 30 days, the court shall order the defendant to be released on their own recognizance pending the hearing.
(C)If the defendant performs satisfactorily on diversion pursuant to this section, at the end of the period of diversion, the court shall dismiss the criminal charges that were the subject of the criminal proceedings at the time of the initial diversion.
(D)If the court finds the defendant ineligible for diversion based on the circumstances set forth in subdivision (b), (c), (d), or (g) of Section 1001.36, the court may, after notice to the defendant, defense counsel, and the prosecution, hold a hearing to determine whether to do any of the following:
(i)Order modification of the treatment plan in accordance with a recommendation from the treatment provider.
(ii)Refer the defendant to assisted outpatient treatment pursuant to Section 5346 of the Welfare and Institutions Code. A referral to assisted outpatient treatment may only occur in a county where services are available pursuant to Section 5348 of the Welfare and Institutions Code, and the agency agrees to accept responsibility for treatment of the defendant. A hearing to determine eligibility for assisted outpatient treatment shall be held within 45 days after the date of the referral. If the hearing is delayed beyond 45 days, the court shall order the defendant, if confined in county jail, to be released on their own recognizance pending that hearing. If the defendant is accepted into assisted outpatient treatment, the charges shall be dismissed pursuant to Section 1385.
(iii)Refer the defendant to the county conservatorship investigator in the county of commitment for possible conservatorship proceedings for the defendant pursuant to Chapter 3 (commencing with Section 5350) of Part 1 of Division 5 of the Welfare and Institutions Code. A defendant shall only be referred to the conservatorship investigator if, based on the opinion of a qualified mental health expert, the defendant appears to be gravely disabled, as defined in subparagraph (A) of paragraph (1) of subdivision (h) of Section 5008 of the Welfare and Institution Code. Any hearings required in the conservatorship proceedings shall be held in the superior court in the county of commitment. The court shall transmit a copy of the order directing initiation of conservatorship proceedings to the county mental health director or the directors designee and shall notify the county mental health director or their designee of the outcome of the proceedings. Before establishing a conservatorship, the public guardian shall investigate all available alternatives to conservatorship pursuant to Section 5354 of the Welfare and Institutions Code. If a petition is not filed within 60 days of the referral, the court shall order the defendant, if confined in county jail, to be released on their own recognizance pending conservatorship proceedings. If the outcome of the conservatorship proceedings results in the establishment of conservatorship, the charges shall be dismissed pursuant to Section 1385.
(iv)Refer the defendant to the CARE program pursuant to Section 5978 of the Welfare and Institutions Code. A hearing to determine eligibility for CARE shall be held within 14 court days after the date on which the petition for the referral is filed. If the hearing is delayed beyond 14 court days, the court shall order the defendant, if confined in county jail, to be released on their own recognizance pending that hearing. If the defendant is accepted into CARE, the charges shall be dismissed pursuant to Section 1385.
(2)Dismiss the charges pursuant to Section 1385. If the criminal action is dismissed, the court shall transmit a copy of the order of dismissal to the county behavioral health director or the directors designee.
(c)If the defendant is found mentally incompetent and is on a grant of probation for a misdemeanor offense, the court shall dismiss the pending revocation matter and may return the defendant to supervision. If the revocation matter is dismissed pursuant to this subdivision, the court may modify the terms and conditions of supervision to include appropriate mental health treatment.
(d)It is the intent of the Legislature that a defendant subject to the terms of this section receive mental health treatment in a treatment facility and not a jail. A term of four days will be deemed to have been served for every two days spent in actual custody against the maximum term of diversion. A defendant not in actual custody shall otherwise receive day for day credit against the term of diversion from the date the defendant is accepted into diversion. Actual custody has the same meaning as in Section 4019.
(e)This section shall apply only as provided in subdivision (b) of Section 1367.
SEC. 2.Section 5970 of the Welfare and Institutions Code is amended to read:5970.This part shall be known, and may be cited, as the Community Assistance, Recovery, and Empowerment (CARE) Act.
SEC. 3.Section 5970.5 of the Welfare and Institutions Code is amended to read:5970.5.This part shall be implemented as follows, with technical assistance and continuous quality improvement, pursuant to Section 5983:
(a)A first cohort of counties, which shall include the Counties of Glenn, Orange, Riverside, San Diego, Stanislaus, and Tuolumne, and the City and County of San Francisco, shall begin no later than October 1, 2023, unless the county is provided additional time pursuant to paragraph (2) of subdivision (c).
(b)A second cohort of counties, representing the remaining population of the state, shall begin no later than December 1, 2024, unless the county is provided additional time pursuant to paragraph (2) of subdivision (c).
(c)(1)The department shall issue guidelines under which counties can apply for, and be provided, additional time to implement this part. The guidelines shall not be subject to the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code).
(2)The department shall approve implementation delay for the first or second cohort if the county experiences a state or local emergency and the delay of the provision of the CARE process is necessary as a result of the emergency.
(3)The department shall only grant one extension per county and the final date for counties to implement under any circumstances shall be December 1, 2025.
(d)This part shall become operative only upon the department, in consultation with county stakeholders, developing a CARE Act allocation to provide state financial assistance to counties to implement the care process in this act.
SEC. 4.Section 5971 of the Welfare and Institutions Code is amended to read:5971.Unless the context otherwise requires, the following definitions shall govern the construction of this part.
(a)CARE agreement means a voluntary settlement agreement entered into by the parties. A CARE agreement includes the same elements as a CARE plan to support the respondent in accessing community-based services and supports.
(b)CARE plan means an individualized, appropriate range of community-based services and supports, as set forth in this part, which include clinically appropriate behavioral health care and stabilization medications, housing, and other supportive services, as appropriate, pursuant to Section 5982.
(c)CARE process means the court and related proceedings to implement the CARE Act.
(d)Counsel means the attorney representing the respondent, appointed pursuant to Section 5977, or chosen by the respondent, in CARE Act proceedings and matters related to CARE agreements and CARE plans. Representation of a respondent in these matters does not alter counsels obligations under the State Bar Act and the Rules of Professional Conduct, including subdivision (e) of Section 6068 of the Business and Professions Code and rule 1.6 of the Rules of Professional Conduct.
(e)County behavioral health agency means the local director of mental health services described in Section 5607, the local behavioral health director, or both as applicable, or their designee.
(f)Court-ordered evaluation means an evaluation ordered by a superior court pursuant to Section 5977.1.
(g)Department means the State Department of Health Care Services.
(h)Graduation plan means a voluntary agreement entered into by the parties at the end of the CARE program that includes a strategy to support a successful transition out of court jurisdiction and that may include a psychiatric advance directive. A graduation plan includes the same elements as a CARE plan to support the respondent in accessing community-based services and supports. The graduation plan shall not place additional requirements on the local government entities and is not enforceable by the court.
(i)Homeless outreach worker means a person who engages people experiencing homelessness to assess for unmet needs, offer information, services, or other assistance, or provide care coordination.
(j)Indian health care provider means a health care program operated by the Indian Health Service, an Indian tribe, a tribal organization, or urban Indian organization (I/T/U) as those terms are defined in Section 4 of the Indian Health Care Improvement Act (25 U.S.C. Sec. 1603).
(k)Legal proceeding means any administrative, civil, or criminal proceeding, including, but not limited to, juvenile court proceedings and family court proceedings and services, and any form of alternative dispute resolution, including arbitration and mediation, except for the following:
(1)A proceeding under this part.
(2)A proceeding under the Lanterman-Petris-Short Act described in paragraph (2) or (3) of subdivision (a) of Section 5979.
(3)A proceeding from which the respondent was referred to CARE Act proceedings as described in Section 5978.
(4)A disciplinary proceeding under Chapter 4 (commencing with Section 6000) of Division 3 of the Business and Professions Code.
(5)An appeal from any of the proceedings identified in paragraphs (1) through (4), inclusive.
(l)Licensed behavioral health professional means either of the following:
(1)A licensed mental health professional, as defined in subdivision (j) of Section 4096.
(2)A person who has been granted a waiver of licensure requirements by the department pursuant to Section 5751.2.
(m)Parties means the petitioner, the respondent, the county behavioral health agency in the county where proceedings under this part are pending, and any local governmental entity added by the court pursuant to paragraph (4) of subdivision (d) of Section 5977.1.
(n)Petitioner means the person who files the CARE Act petition with the court. Additionally, if the petitioner is a person listed in Section 5974 other than the director of a county behavioral health agency, or their designee, the petitioner shall have the right to file a petition with the court, but at the initial hearing the court shall substitute the director of a county behavioral health agency, or their designee, of the county in which the proceedings are filed as petitioner. The original petitioner may, at the courts discretion and in furtherance of the interests of the respondent, retain rights as described in subparagraph (A) of paragraph (6) of subdivision (b) of Section 5977.
(o)Psychiatric advance directive means a legal document, executed on a voluntary basis in accordance with the requirements for advance health care directives in Division 4.7 (commencing with Section 4600) of the Probate Code, by a person who has the capacity to make medical decisions, that allows a person with mental illness to protect their autonomy and ability to direct their own care by documenting their preferences for treatment in advance of a mental health crisis.
(p)Respondent means the person who is the subject of the petition for the CARE process.
(q)Stabilization medications means medications included in the CARE plan that primarily consist of antipsychotic medications to reduce symptoms of hallucinations, delusions, and disorganized thinking. Stabilization medications may be administered as long-acting injections if clinically indicated. Stabilization medications shall not be forcibly administered.
(r)Supporter means an adult designated by the respondent who assists the person who is the subject of the petition, which assistance may include supporting the person to understand, make, communicate, implement, or act on their own life decisions during the CARE process, including a CARE agreement, a CARE plan, and developing a graduation plan. A supporter shall not act independently.
SEC. 5.Section 5972 of the Welfare and Institutions Code is amended to read:5972.An individual shall qualify for the CARE process only if all of the following criteria are met:
(a)The person is 18 years of age or older.
(b)The person is currently experiencing a serious mental disorder, as defined in paragraph (2) of subdivision (b) of Section 5600.3 and has a diagnosis identified in the disorder class: schizophrenia spectrum and other psychotic disorders, as defined in the most current version of the Diagnostic and Statistical Manual of Mental Disorders. This section does not establish respondent eligibility based upon a psychotic disorder that is due to a medical condition or is not primarily psychiatric in nature, including, but not limited to, physical health conditions such as traumatic brain injury, autism, dementia, or neurologic conditions. A person who has a current diagnosis of substance use disorder as defined in paragraph (2) of subdivision (a) of Section 1374.72 of the Health and Safety Code but who does not also meet the required criteria in this section shall not qualify for the CARE process.
(c)The person is not clinically stabilized in on-going voluntary treatment.
(d)At least one of the following is true:
(1)The person is unlikely to survive safely in the community without supervision and the persons condition is substantially deteriorating.
(2)The person is in need of services and supports in order to prevent a relapse or deterioration that would be likely to result in grave disability or serious harm to the person or others, as used in Section 5150.
(e)Participation in a CARE plan or CARE agreement would be the least restrictive alternative necessary to ensure the persons recovery and stability.
(f)It is likely that the person will benefit from participation in a CARE plan or CARE agreement.
SEC. 6.Section 5973 of the Welfare and Institutions Code is amended to read:5973.(a)Proceedings under this part may be commenced in any of the following:
(1)The county in which the respondent resides.
(2)The county where the respondent is found.
(3)The county where the respondent is facing criminal or civil proceedings.
(b)If the respondent does not reside in the county in which proceedings are initiated under this subdivision, as determined in accordance with Section 244 of the Government Code, except as provided in subdivision (f) of Section 5982, and this part is operative in the respondents county of residence, the proceeding shall, with the respondents consent, be transferred to the county of residence as soon as reasonably feasible. Should the respondent not consent to the transfer, the proceedings shall continue in the county where the respondent was found.
SEC. 7.Section 5974 of the Welfare and Institutions Code is amended to read:5974.The following adult persons may file a petition to commence the CARE process:
(a)A person with whom the respondent resides.
(b)A spouse, parent, sibling, child, or grandparent or an individual who stands in loco parentis to the respondent.
(c)The director of a hospital in which the respondent is hospitalized, including hospitalized pursuant to Section 5150 or 5250, or the directors designee.
(d)The director of a public or charitable organization, agency, or home, or their designee, who has, within the previous 30 days, provided or who is currently providing behavioral health services to the respondent or in whose institution the respondent resides.
(e)A licensed behavioral health professional, or their designee, who is, or has been within the previous 30 days, either supervising the treatment of, or treating the respondent for a mental illness.
(f)A first responder, including a peace officer, firefighter, paramedic, emergency medical technician, mobile crisis response worker, or homeless outreach worker, who has had repeated interactions with the respondent in the form of multiple arrests, multiple detentions and transportation pursuant to Section 5150, multiple attempts to engage the respondent in voluntary treatment, or other repeated efforts to aid the respondent in obtaining professional assistance.
(g)The public guardian or public conservator, or their designee, of the county in which the respondent resides or is found.
(h)The director of a county behavioral health agency, or their designee, of the county in which the respondent resides or is found.
(i)The director of county adult protective services, or their designee, of the county in which the respondent resides or is found.
(j)The director of a California Indian health services program, California tribal behavioral health department, who has, within the previous 30 days, provided or who is currently providing behavioral health services to the respondent, or the directors designee.
(k)The judge of a tribal court located in California before which the respondent has appeared within the previous 30 days, or the judges designee.
(l)The respondent.
SEC. 8.Section 5975.1 of the Welfare and Institutions Code is amended to read:5975.1.(a)Notwithstanding Section 391 of the Code of Civil Procedure, if a person other than the respondent files a petition for CARE Act proceedings that is without merit or is intended to harass or annoy the respondent, and the person has previously filed a pleading in CARE Act proceedings that was without merit or was intended to harass or annoy the respondent, the petition shall be grounds for the court to determine that the person is a vexatious litigant for the purposes of Title 3A (commencing with Section 391) of Part 2 of the Code of Civil Procedure.
(b)(1)If a person other than the respondent files a petition for CARE Act proceedings in order to gain an advantage over the respondent in another legal proceeding, then, notwithstanding any other provision of this part, it is cause for suspension, disbarment, or other discipline if a member of the State Bar is found to have filed the petition or assisted in the filing of the petition with knowledge that the filing was being made in order to gain that advantage.
(2)For purposes of this subdivision, legal proceeding shall not include:
(A)A proceeding under Part 1 (commencing with Section 5000) of Division 5.
(B)A proceeding under Section 300.
SEC. 9.Section 5975.2 is added to the Welfare and Institutions Code, to read:5975.2.CARE Act proceedings may be conducted by a superior court judge or by a court-appointed commissioner or other subordinate judicial officer.
SEC. 10.Section 5975.3 is added to the Welfare and Institutions Code, to read:5975.3.There shall be no fee for filing under this chapter nor shall any fees be charged by any public officer for services in filing or serving papers or for the performance of any duty enjoined by the CARE Act.
SEC. 11.Section 5976 of the Welfare and Institutions Code is amended to read:5976.The respondent shall:
(a)Receive notice of the hearings.
(b)Receive a copy of the court-ordered evaluation.
(c)Be entitled to be represented by counsel at all stages of a proceeding commenced under this chapter, regardless of the ability to pay.
(d)Be allowed to have a supporter be present with them to perform the functions described in Sections 5980 and 5981, subject to the limits provided in those sections.
(e)Have the right to be present at the hearing unless the respondent waives that right.
(f)Have the right to present evidence.
(g)Have the right to call witnesses.
(h)Have the right to cross-examine witnesses.
(i)Have the right to appeal decisions, and to be informed of the right to appeal.
(j)Have the right to an interpreter in all proceedings if necessary for the respondent to fully participate.
SEC. 12.Section 5976.5 of the Welfare and Institutions Code is amended to read:5976.5.(a)Notwithstanding any other law, and except as otherwise provided in this section, a hearing held under this part is presumptively closed to the public.
(b)The respondent may demand that the hearing be public and be held in a place suitable for attendance by the public.
(c)The respondent may request the presence of any family member or friend without waiving the right to keep the hearing closed to the rest of the public.
(d)A request by any other party to the proceeding to make the hearing public may be granted if the judicial officer conducting the hearing finds that the public interest in an open hearing clearly outweighs the respondents interest in privacy.
(e)All reports, evaluations, diagnoses, or other information filed with the court related to the respondents health shall be confidential. The respondent may at any time petition the court for an order sealing these records or any other court records in a proceeding held under this part. Notwithstanding any rule of court prohibiting records kept confidential by law from consideration for sealing, if such a petition is filed, there shall exist a presumption in favor of sealing.
(f)The fact that evidence is admitted at a proceeding held under this part shall not be the basis for admission of that evidence in any subsequent legal proceeding.
(g)Photographs, recordings, transcripts, other records of proceedings held under this part, and testimony regarding proceedings held under this part shall not be admissible in any subsequent legal proceeding except upon motion by one of the following in that subsequent legal proceeding:
(1)The respondent.
(2)The county behavioral health agency, the public guardian, or the public conservator.
(h)In a proceeding held under this part, this section shall not affect the applicability of paragraph (2) of subdivision (c) of Section 5977.1, make admissible any evidence that is not otherwise admissible, or permit a witness to base an opinion on any matter that is not a proper basis for that opinion. The admission or exclusion of evidence shall be pursuant to the rules of evidence established by the Evidence Code, including, but not limited to, Section 352 of the Evidence Code, and by judicial decision.
(i)Before commencing a hearing, the judicial officer shall inform the respondent of their rights under this section.
SEC. 13.Section 5977 of the Welfare and Institutions Code is amended to read:5977.(a)(1)The court shall promptly review the petition to determine if the petitioner has made a prima facie showing that the respondent is, or may be, a person described in Section 5972.
(2)If the court finds that the petitioner has not made a prima facie showing that the respondent is, or may be, a person described in Section 5972, the court may dismiss the case without prejudice subject to consideration of Section 5975.1.
(3)If the court finds that the petitioner has made a prima facie showing that the respondent is, or may be, a person described in Section 5972, the court shall do one of the following:
(A)If the petitioner is the director of a county behavioral health agency, or their designee, the court shall do the following:
(i)Set the matter for an initial appearance on the petition within 14 court days.
(ii)Appoint a qualified legal services project, as defined in Sections 6213 to 6214.5, inclusive, of the Business and Professions Code, to represent the respondent. If no legal services project has agreed to accept these appointments, a public defender or other counsel working in that capacity shall be appointed to represent the respondent.
(iii)Determine whether the petition includes all of the following information and, if it does not, order the county behavioral health agency to submit a written report with the court within 14 court days that includes all of the following:
(I)A determination as to whether the respondent meets, or is likely to meet, the criteria for the CARE process.
(II)The outcome of efforts made to voluntarily engage the respondent prior to the filing of the petition.
(III)Conclusions and recommendations about the respondents ability to voluntarily engage in services.
(iv)Order the county behavioral health agency to provide notice to the respondent, the appointed counsel, and the county behavioral health agency in the county where the respondent resides, if different from the county where the CARE process has commenced.
(B)If the petitioner is a person other than the director of a county behavioral health agency, or their designee, the court shall order a county agency, or their designee, as determined by the court, to investigate, as necessary, and file a written report with the court within 14 court days and provide notice to the respondent and petitioner that a report has been ordered. The written report shall include all of the following:
(i)A determination as to whether the respondent meets, or is likely to meet, the criteria for the CARE process.
(ii)The outcome of efforts made to voluntarily engage the respondent during the 14-day report period.
(iii)Conclusions and recommendations about the respondents ability to voluntarily engage in services.
(iv)The information, including protected health information, necessary to support the determinations, conclusions, and recommendations in the report.
(4)If, upon a request by the county agency ordered to investigate and file a report under subparagraph (B) of paragraph (3), the court finds that the county agency is making progress to engage the respondent, the court may, in its discretion, grant the county agency no more than 30 additional days to continue to work with, engage, and enroll the individual in voluntary treatment and services. The county agency shall provide notice to the respondent and petitioner that an extension for filing a report has been granted.
(5)Upon receipt of the report described in subparagraph (B) of paragraph (3), the court shall, within five days, take one of the following actions:
(A)If the court determines that voluntary engagement with the respondent is effective, and that the individual has enrolled or is likely to enroll in voluntary behavioral health treatment, the court shall dismiss the matter.
(B)If the court determines that the county agencys report does not support the petitions prima facie showing that the respondent is, or may be, a person described in Section 5972, the court shall dismiss the matter. This section shall not prevent a county behavioral health agency from continuing to voluntarily engage with a person not described in Section 5972 but who is in need of services and supports.
(C)If the court determines that the county agencys report does support the petitions prima facie showing that the respondent is, or may be, a person described in Section 5972, and engagement with the county agency was not effective, the court shall do all of the following:
(i)Set an initial appearance on the petition within 14 court days.
(ii)Appoint a qualified legal services project, as defined in Sections 6213 to 6214.5, inclusive, of the Business and Professions Code or, if no legal services project has agreed to accept these appointments, a public defender or other counsel working in that capacity to represent the respondent.
(iii)Order the county agency to provide notice of the initial appearance to the petitioner, the respondent, the appointed counsel, the county behavioral health agency in the county where the respondent resides, and, if different, the county where the CARE court proceedings have commenced.
(b)At the initial appearance on the petition, all of the following shall apply:
(1)The court shall permit the respondent to substitute their own counsel.
(2)Petitioner shall be present. If the petitioner is not present, the matter may be dismissed.
(3)Respondent may waive personal appearance and appear through counsel. If the respondent does not waive personal appearance and does not appear at the hearing, and the court makes a finding in open court that reasonable attempts to elicit the attendance of the respondent have failed, the court may conduct the hearing in the respondents absence if the court makes a finding in open court that conducting the hearing without the participation or presence of the respondent would be in the respondents best interest.
(4)A representative from the county behavioral health agency shall be present.
(5)If the respondent asserts that they are enrolled in a federally recognized Indian tribe or are receiving services from an Indian health care provider, a tribal court, or a tribal organization, a representative from the program, the tribe, or the tribal court shall be allowed to be present, subject to the consent of the respondent. The tribal representative shall be entitled to notice by the county of the initial appearance.
(6)(A)If the petitioner is a person other than the director of a county behavioral health agency, or their designee, the court shall issue an order relieving the original petitioner and appointing the director of the county behavioral health agency or their designee as the successor petitioner.
(B)If the original petitioner is described in subdivision (a) or (b) of Section 5974, all of the following apply:
(i)The original petitioner shall have the right to be present and make a statement at the initial hearing on the merits of the petition held pursuant to paragraph (7).
(ii)The court may, in its discretion, assign ongoing rights of notice to the original petitioner.
(iii)To the extent that the respondent consents, the court may allow the original petitioner to participate in the respondents CARE proceedings.
(iv)The original petitioner may file a new petition with the court, pursuant to Section 5974, if the matter is dismissed and there is a change in circumstances.
(C)If the original petitioner is not described in subdivision (a) or (b) of Section 5974, the court shall not assign ongoing rights to the original petitioner, other than the right to be present and make a statement at the hearing on the merits of the petition held pursuant to paragraph (7).
(7)(A)The court shall set a hearing on the merits of the petition within 10 days, at which time the court shall determine whether, by clear and convincing evidence, the respondent meets the CARE criteria in Section 5972. In making this determination, the court shall consider all evidence properly before it, including any report from the county behavioral health agency ordered pursuant to paragraph (3) of subdivision (a) and any additional admissible evidence presented by the parties, including the petition submitted and any statement given by the original petitioner.
(B)The hearing on the merits of the petition may be conducted concurrently with the initial appearance upon stipulation of the successor petitioner and the respondent, subject to the approval by the court.
(c)(1)If, at the hearing on the merits of the petition, the court finds there is not clear and convincing evidence that the respondent meets the CARE criteria in Section 5972, the court shall dismiss the case without prejudice, unless the court makes a finding, in open court, that the original petitioners filing was not in good faith, in which case the dismissal shall be with prejudice.
(2)If, at the hearing on the merits of the petition, the court finds by clear and convincing evidence that the respondent meets the CARE criteria in Section 5972, the court shall order the county behavioral health agency to work with the respondent, the respondents counsel, and the supporter to engage the respondent in behavioral health treatment and attempt to enter into a CARE agreement. The court shall set a case management hearing within 14 days.
(3)If the respondent is enrolled in a federally recognized Indian tribe, the respondent shall provide notice of the case management hearing to the tribe, subject to the consent of the respondent.
(d)The following shall apply to any written report submitted by a county behavioral health agency to the court pursuant to this section:
(1)The report is confidential and not subject to disclosure or inspection under the California Public Records Act (Division 10 (commencing with Section 7920.000) of Title 1 of the Government Code).
(2)The report is inadmissible in any subsequent legal proceeding, except upon motion of the respondent in that subsequent legal proceeding.
(3)The report shall be confidential pursuant to subdivision (e) of Section 5976.5.
(4)This subdivision shall not affect the applicability of paragraph (2) of subdivision (c) of Section 5977.1, make admissible any evidence that is not otherwise admissible, or permit a witness to base an opinion on any matter that is not a proper basis for such an opinion. The admission or exclusion of evidence shall be pursuant to the rules of evidence established by the Evidence Code, including, but not limited to, Section 352 of the Evidence Code, and by judicial decision.
SEC. 14.Section 5977.1 of the Welfare and Institutions Code is amended to read:5977.1.(a)(1)At the case management hearing, the court shall hear evidence as to whether the parties have entered, or are likely to enter, into a CARE agreement.
(2)If the court finds that the parties have entered, or are likely to enter, into a CARE agreement, the court shall do one of the following:
(A)Approve the terms of the CARE agreement or modify the terms of the CARE agreement and approve the agreement as modified by the court, and continue the matter and set a progress hearing for 60 days.
(B)Continue the matter for 14 days to allow the parties additional time to enter into a CARE agreement, upon stipulation of the parties.
(b)If the court finds that the parties have not entered into a CARE agreement, and are not likely to enter into a CARE agreement, the court shall order the county behavioral health agency, through a licensed behavioral health professional, to conduct a clinical evaluation of the respondent, unless there is an existing clinical evaluation of the respondent completed within the last 30 days and the parties stipulate to the use of that evaluation. The evaluation shall address, at a minimum, the following:
(1)A clinical diagnosis of the respondent.
(2)Whether the respondent has the legal capacity to give informed consent regarding psychotropic medication.
(3)Any other information as ordered by the court or that the licensed behavioral health professional conducting the evaluation determines would help the court make future informed decisions about the appropriate care and services the respondent should receive.
(4)An analysis of recommended services, programs, housing, medications, and interventions that support the recovery and stability of the respondent.
(c)(1)The court shall set a clinical evaluation hearing to review the evaluation within 21 days. The court shall order the county to file the evaluation with the court and provide the evaluation to the respondents counsel no later than five days prior to the scheduled clinical evaluation hearing. The clinical evaluation hearing may be continued for a maximum of 14 days upon stipulation of the respondent and the county behavioral health agency, unless there is good cause for a longer extension.
(2)At the clinical evaluation review hearing, the court shall review the evaluation and other evidence from the county behavioral health agency and the respondent. The county behavioral health agency and the respondent may present evidence and call witnesses, including the person who conducted the evaluation. Only relevant and admissible evidence that fully complies with the rules of evidence may be considered by the court.
(3)At the conclusion of the hearing, the court shall determine whether the respondent, by clear and convincing evidence, meets the CARE criteria in Section 5972 and make orders as follows:
(A)If the court finds that the respondent meets the CARE criteria, the court shall order the county behavioral health agency, the respondent, and the respondents counsel and supporter to jointly develop a CARE plan within 14 days.
(B)If the court does not find that clear and convincing evidence establishes that the respondent meets the CARE criteria, the court shall dismiss the petition.
(4)If the respondent is a self-identified American Indian or Alaska Native individual, as defined in Sections 1603(13), 1603(28), and 1679(a) of Title 25 of the United States Code, has been determined eligible as an Indian under Section 136.12 of Title 42 of the Code of Federal Regulations, or is currently receiving services from an Indian health care provider or tribal court, the county behavioral health agency shall use its best efforts to meaningfully consult with and incorporate the Indian health care provider or tribal court available to the respondent to develop the CARE plan.
(5)The evaluation and all reports, documents, and filings submitted to the court shall be confidential.
(6)The date for the hearing to review and consider approval of the proposed CARE plan shall be set not more than 14 days from the date of the order to develop a CARE plan, unless the court finds good cause for an extension. The party requesting an extension of time for the CARE plan review hearing shall provide notice to the opposing party and their counsel of the request for extension of time, and the courts order if the request is granted.
(d)(1)At the CARE plan review hearing, the parties shall present their plan or plans to the court. The county behavioral health agency or the respondent, or both, may present a proposed CARE plan.
(2)After consideration of the plans proposed by the parties, the court shall adopt the elements of a CARE plan that support the recovery and stability of the respondent. The court may issue any orders necessary to support the respondent in accessing appropriate services and supports, including prioritization for those services and supports, subject to applicable laws and available funding pursuant to Section 5982. These orders shall constitute the CARE plan.
(3)A court may order medication if it finds, upon review of the court-ordered evaluation and hearing from the parties, that, by clear and convincing evidence, the respondent lacks the capacity to give informed consent to the administration of medically necessary stabilization medication. To the extent the court orders medically necessary stabilization medication, the medication shall not be forcibly administered and the respondents failure to comply with a medication order shall not result in a penalty, including, but not limited to, contempt or termination of the CARE plan pursuant to Section 5979.
(4)If the proposed CARE plan includes services and supports, such as housing, provided directly or indirectly through another local governmental entity, that local entity may agree to provide the service or support, or the court may consider a motion by either of the parties to add the local entity as a party to the CARE proceeding. If the local entity agrees to provide the service or support, it may request to be added as a party by the court.
(5)If, after presentation of the CARE plan or plans, the court determines that additional information is needed, including from a licensed behavioral health professional, the court shall order a supplemental report to be filed by the county behavioral health agency for which the court may grant a continuance of no more than 14 days, unless there is good cause for a longer extension.
(6)If there is no CARE plan because the parties have not had sufficient time to complete it, the court may grant a continuance of no more than 14 days, unless there is good cause for a longer extension.
(e)The issuance of an order approving a CARE plan pursuant to paragraph (2) of subdivision (d) begins the CARE process timeline, which shall not exceed one year.
SEC. 15.Section 5977.2 of the Welfare and Institutions Code is amended to read:5977.2.(a)(1)At intervals set by the court and not less frequently than every 60 days after the court orders the CARE plan, the court shall hold a status review hearing. The county behavioral health agency shall file with the court and serve on the respondent, and the respondents counsel and supporter, a report no fewer than five court days prior to the review hearing with the following information:
(A)The progress that the respondent has made on the CARE plan.
(B)What services and supports in the CARE plan were provided, and what services and supports were not provided.
(C)Any issues the respondent expressed or exhibited in adhering to the CARE plan.
(D)Recommendations for changes to the services and supports to make the CARE plan more successful.
(2)The respondent shall be permitted to respond to the report submitted by the county behavioral health agency and to the county behavioral health agencys testimony. The respondent shall be permitted to introduce their own information and recommendations.
(3)Subject to applicable law, intermittent lapses or setbacks described in this section of the report shall not impact access to services, treatment, or housing.
(b)The county behavioral health agency or the respondent may request, or the court upon its own motion may set, a hearing to occur at any time during the CARE process to address a change of circumstances.
SEC. 16.Section 5977.3 of the Welfare and Institutions Code is amended to read:5977.3.(a)(1)In the 11th month of the process timeline, the court shall hold a one-year status hearing. Not fewer than five court days prior to the one-year status hearing, the county behavioral health agency shall file a report with the court and shall serve the report on the respondent and the respondents counsel and supporter. The report shall include the following information:
(A)The progress that the respondent has made on the CARE plan, including a final assessment of the respondents stability.
(B)What services and supports in the CARE plan were provided, and what services and supports were not provided, over the life of the program.
(C)Any issues the respondent expressed or exhibited in adhering to the CARE plan.
(D)Recommendations for next steps, including what ongoing and additional services would benefit the respondent that the county behavioral health agency can facilitate or provide.
(2)At an evidentiary hearing, the respondent shall be permitted to respond to the report submitted by the county behavioral health agency and to the county behavioral health agencys testimony. Respondent shall be permitted to introduce their own information and recommendations. The respondent shall have the right at the hearing to call witnesses and to present evidence as to whether the respondent agrees with the report. The respondent may request either to be graduated from the program or to remain in the program.
(3)The court shall issue an order as follows:
(A)If the respondent elects to be graduated from the program, the court shall order the county behavioral health agency and the respondent to work jointly on a voluntary graduation plan. The court shall schedule a hearing in the 12th month after adoption of the CARE plan for presentation of the graduation plan. The court shall review the graduation plan and recite the terms in open court. The graduation plan shall not place additional requirements on local governmental entities and is not enforceable by the court, except that the graduation plan may, at the respondents election, include a psychiatric advance directive, which shall have the force of law. Upon completion of the hearing, the respondent shall be officially graduated from the program.
(B)If the respondent elects to remain in the CARE process, respondent may request any amount of time, up to and including one additional year. The court may permit the ongoing voluntary participation of the respondent if the court finds both of the following:
(i)The respondent did not successfully complete the CARE plan.
(ii)The respondent would benefit from continuation of the CARE plan.
(C)The court shall issue an order permitting the respondent to continue in the CARE plan or denying respondents request to remain in the CARE plan, and state its reasons in open court.
(b)The respondent may be involuntarily reappointed to the program only if the court finds, by clear and convincing evidence, that all of the following conditions apply:
(1)The respondent did not successfully complete the CARE process.
(2)All services and supports required through the CARE process were provided to the respondent.
(3)The respondent would benefit from continuation in the CARE process.
(4)The respondent currently meets the requirements in Section 5972.
(c)A respondent may only be reappointed to the CARE process once, for up to one additional year.
SEC. 17.Section 5977.4 of the Welfare and Institutions Code is amended to read:5977.4.(a)In all CARE Act proceedings, the judicial officer shall control the proceedings during the hearings with a view to the expeditious and effective ascertainment of the jurisdictional facts and the ascertainment of all information relative to the present condition and future welfare of the respondent. Except when there is a contested issue of fact or law, the proceedings shall be conducted in an informal nonadversarial atmosphere with a view to obtaining the maximum cooperation of the respondent, all persons interested in the respondents welfare, and all other parties, with any provisions that the court may make for the disposition and care of the respondent. All evaluations and reports, documents, and filings submitted to the court pursuant to CARE Act proceedings shall be confidential.
(b)The hearings described in this chapter shall occur in person unless the court, in its discretion, allows a party or witness to appear remotely through the use of remote technology. The respondent shall have the right to be in person for all hearings.
(c)Consistent with its constitutional rulemaking authority, the Judicial Council shall adopt rules to implement the policies and provisions in this section and in Sections 5977, 5977.1, 5977.2, and 5977.3 to promote statewide consistency, including, but not limited to, what is included in the petition form packet, communications between the CARE Act court and the juvenile court, if applicable, and the process by which counsel will be appointed.
(d)(1)Consistent with paragraph (9) of subdivision (b) of Section 56.10 of the Civil Code, the county behavioral health agency shall include in any report evaluation, or other document filed with the court, the information, including protected health information, necessary to support the determinations, conclusions, and recommendations in the filing. The county behavioral health agency shall not, unless ordered to do so by the court, submit to the court original or photocopied records underlying the information in a report evaluation or other document required or ordered under this subdivision. The county behavioral health agency shall serve an unredacted copy of any report evaluation, or other document filed with the court on the respondent and the respondents counsel and, with the consent of the respondent, on the supporter in a manner authorized by law. Neither a county nor an employee or agent thereof shall be held civilly or criminally liable for any disclosure authorized or required by this paragraph.
(2)(A)Consistent with paragraph (1) of subdivision (c) of Section 56.10 of the Civil Code, a provider of health care, as defined in Section 56.05 of the Civil Code, or a covered entity, as defined in Section 160.103 of Title 45 of the Code of Federal Regulations, may disclose to the county behavioral health agency any information, including protected health information, and mental health records excluding psychotherapy notes, in its possession about the respondent that is relevant to the county behavioral health agencys provision, coordination, or management of services and supports under this part, including, but not limited to, the preparation of any required investigations, evaluations, or reports. Such a disclosure is a disclosure for treatment purposes, which may be made only to the extent permitted under Section 164.506 of Title 45 of the Code of Federal Regulations. The information disclosed may include substance use disorder patient records only to the extent permitted by Part 2 (commencing with Section 2.1) of Title 42 of the Code of Federal Regulations.
(B)Consistent with paragraph (9) of subdivision (b) of Section 56.10 of the Civil Code, a provider of health care, as defined in Section 56.05 of the Civil Code, or a covered entity, as defined in Section 160.103 of Title 45 of the Code of Federal Regulations, that filed a CARE Act petition or executed an affidavit included with a CARE Act petition pursuant to paragraph (1) of subdivision (d) of Section 5975 shall provide to the county behavioral health agency any information, including protected health information, and mental health records excluding psychotherapy notes, in its possession about the respondent that may be relevant in connection with an investigation, evaluation, or other report or hearing under this part, or with the provision of services and supports under this part. The provision of information under this paragraph is a disclosure required by law, which may be made only to the extent permitted under subdivision (a) of Section 164.512 of Title 45 of the Code of Federal Regulations. The information disclosed shall include substance use disorder patient records only to the extent permitted by Part 2 (commencing with Section 2.1) of Title 42 of the Code of Federal Regulations.
(C)The county behavioral health agency may apply to the court ex parte for an order requiring any provider of health care, as defined in Section 56.05 of the Civil Code, or any covered entity, as defined in Section 160.103 of Title 45 of the Code of Federal Regulations, to provide to the county behavioral health agency, to the court, or both, any information, including, but not limited to, protected health information, and mental health records excluding psychotherapy notes, in its possession about the respondent that may be relevant in connection with an investigation, evaluation, or other report or hearing under this part, or with the provision of services and supports under this part. The provision of information under this paragraph is a disclosure required by law, which may be made only to the extent permitted under Section 164.512 of Title 45 of the Code of Federal Regulations. The information ordered to be disclosed may include substance use disorder patient records only to the extent permitted by Part 2 (commencing with Section 2.1) of Title 42 of the Code of Federal Regulations.
(D)A provider of health care or covered entity shall not be held civilly or criminally liable for any disclosure authorized or required by this section.
(E)The county behavioral health agency shall notify the respondent of a disclosure under this paragraph as follows:
(i)By mail at the respondents last known address, if any.
(ii)To the respondents counsel.
(iii)By including a copy of the notification under clause (i) or (ii) with the next notice of hearing served upon the respondent, if any.
(F)All information, including the facts and records, or summary thereof, shared under this subdivision shall further be disclosed to the respondent and the respondents counsel, and with the consent of the respondent, to the supporter.
(3)(A)Except as expressly provided, further disclosure or redisclosure of information is not authorized by this subdivision.
(B)Information disclosed to a county behavioral health agency by a provider of health care, as defined in Section 56.05 of the Civil Code, or a covered entity, as defined in Section 160.103 of Title 45 of the Code of Federal Regulations is confidential and not subject to disclosure or inspection under the California Public Records Act (Division 10 (commencing with Section 7920.000) of Title 1 of the Government Code).
(C)Disclosure of information under this part shall not be deemed to in any way alter the duties or responsibilities of a county behavioral health agency, of a provider of health care, as defined in Section 56.05 of the Civil Code, or of a covered entity, as defined in Section 160.103 of Title 45 of the Code of Federal Regulations, with respect to the disclosed information under the Confidentiality of Medical Information Act (Part 2.6 (commencing with Section 56) of Division 1 of the Civil Code), or the federal Health Insurance Portability and Accountability Act of 1996 (Public Law 104-191).
SEC. 18.Section 5978 of the Welfare and Institutions Code is amended to read:5978.(a)A court may refer an individual from assisted outpatient treatment, as well as from conservatorship proceedings pursuant Chapter 3 (commencing with Section 5350) of Part 1 of Division 5 (LPS conservatorship) to CARE Act proceedings. If the individual is referred from assisted outpatient treatment, the county behavioral health director or their designee shall be the petitioner. If the individual is referred from LPS conservatorship proceedings, the conservator or proposed conservator shall be the petitioner pursuant to Section 5974.
(b)A court may refer an individual from misdemeanor proceedings pursuant to Section 1370.01 of the Penal Code to CARE Act proceedings. The county behavioral health director or their designee shall be the petitioner.
SEC. 19.Section 5981.5 of the Welfare and Institutions Code is amended to read:5981.5.(a)The Legal Services Trust Fund Commission at the State Bar shall provide funding to qualified legal services projects, as defined in Sections 6213 to 6214.5, inclusive, of the Business and Professions Code, to be used to provide legal counsel appointed pursuant to subdivision (c) of Section 5976, for representation in CARE Act proceedings, matters related to CARE agreements and CARE plans, and to qualified support centers, as defined in subdivision (b) of Section 6213 of, and Section 6215 of, the Business and Professions Code, for training, support, and coordination.
(b)For purposes of implementing this part, the Legal Services Trust Fund Commission may enter into exclusive or nonexclusive contracts, or amend existing contracts, on a bid or negotiated basis, or award grants, provided that they make a finding that both of the following are satisfied:
(1)The Legal Services Trust Fund Commission shall retain control over the distribution of funds to the contractor or grantee.
(2)The contract or grant includes provisions to ensure transparency, accountability, and oversight in delivering the services, including measurement of outcomes established pursuant to Sections 5984, 5985, and 5986.
SEC. 20.Section 5982 of the Welfare and Institutions Code is amended to read:5982.(a)The CARE plan may include only the following:
(1)Behavioral health services funded through the 1991 and 2011 Realignment, Medi-Cal behavioral health, health care plans and insurers, and services supported by the Mental Health Services Act pursuant to Part 3 (commencing with Section 5800).
(2)Medically necessary stabilization medications, to the extent not described in paragraph (1).
(3)Housing resources funded through the No Place Like Home Program (Part 3.9 (commencing with Section 5849.1) of Division 5 of the Welfare and Institutions Code); California Housing Accelerator (Chapter 6.6 (commencing with Section 50672) of Part 2 of Division 31 of the Health and Safety Code); the Multifamily Housing Program (Chapter 6.7 (commencing with Section 50675) of Part 2 of Division 31 of the Health and Safety Code); the Homeless Housing, Assistance, and Prevention Program (Chapter 6 (commencing with Section 50216) of Part 1 of Division 31 of the Health and Safety Code); the Encampment Resolution Funding Program (Chapter 7 (commencing with Section 50250) of Part 1 of Division 31 of the Health and Safety Code); the Project Roomkey and Rehousing Program pursuant to Provision 22 of Item 5180-151-0001 of the Budget Act of 2021 (Ch. 21, Stats. 2021); the Community Care Expansion Program (Chapter 20 (commencing with Section 18999.97) of Part 6 of Division 9 of the Welfare and Institutions Code); the CalWORKs Housing Support Program (Article 3.3 (commencing with Section 11330) of Chapter 2 of Part 3 of Division 9 of the Welfare and Institutions Code); the CalWORKs Homeless Assistance pursuant to clause (i) of subparagraph (A) of paragraph (2) of subdivision (f) of Section 11450 of Article 6 of Chapter 2 of Part 3 of Division 9 of the Welfare and Institutions Code; the Housing and Disability Advocacy Program (Chapter 17 (commencing with Section 18999) of Part 6 of Division 9 of the Welfare and Institutions Code); the Home Safe Program (Chapter 14 (commencing with Section 15770) of Part 3 of Division 9 of the Welfare and Institutions Code); the Bringing Families Home Program (Article 6 (commencing with Section 16523) of Chapter 5 of Part 4 of Division 9 of the Welfare and Institutions Code); the Transitional Housing Placement program for nonminor dependents (Article 4 (commencing with Section 16522) of Chapter 5 of Part 4 of Division 9 of the Welfare and Institutions Code); the Transitional Housing Program-Plus pursuant to subdivision (s) of Section 11400 and paragraph (2) of subdivision (a) of Section 11403.2 of Article 5 of Chapter 2 of Part 3 of Division 9 of the Welfare and Institutions Code and Article 4 (commencing with Section 16522) of Chapter 5 of Part 4 of Division 9 of the Welfare and Institutions Code; the Behavioral Health Continuum Infrastructure Program (Chapter 1 (commencing with Section 5960) of Part 7 of Division 5 of the Welfare and Institutions Code); the Behavioral Health Bridge Housing Program; HUD-Veterans Affairs Supportive Housing Program (Section 8(o)(19) of the United States Housing Act of 1937 [42 U.S.C. Section 1437f(o)(19)]); Supportive Services for Veteran Families (Section 604 of the Veterans Mental Health and Other Care Improvements Act of 2008 [38 U.S.C. Sec. 2044]); HUD Continuum of Care program (Section 103 of the McKinney-Vento Homeless Assistance Act [42 U.S.C. Sec. 11302]); the Emergency Solutions Grant (Subtitle B of Title IV of the McKinney-Vento Homeless Assistance Act [42 U.S.C. Secs. 11371-11378]); HUD Housing Choice Voucher program (Section 8 of the United States Housing Act of 1937 [42 U.S.C. Sec. 1437f]); the Emergency Housing Vouchers (Section 3202 of the American Rescue Plan Act of 2021 [Public Law 117-2]; Section 8(o) of the United States Housing Act of 1937 [42 U.S.C. Sec. 1437f(o)]); HOME Investment Partnerships Program (Title II of the Cranston-Gonzalez National Affordable Housing Act [42 U.S.C. Sec. 12721 et seq.]); the Community Development Block Grant Program (Title 1 of the Housing and Community Development Act of 1974 [42 U.S.C. Sec. 5301 et seq.]); housing supported by the Mental Health Services Act pursuant to Part 3 (commencing with Section 5800); community development block grants; and other state and federal housing resources.
(4)Social services funded through Supplemental Security Income/State Supplementary Payment (SSI/SSP), Cash Assistance Program for Immigrants (CAPI), CalWORKs, California Food Assistance Program, In-Home Supportive Services program, and CalFresh.
(5)Services provided pursuant to Part 5 (commencing with Section 17000) of Division 9.
(b)Individuals who are CARE process participants shall be prioritized for any appropriate bridge housing funded by the Behavioral Health Bridge Housing program.
(c)If the county behavioral health agency elects not to enroll the respondent into a full service partnership, as defined in Section 3620 of Title 9 of the California Code of Regulations, the court may request information on the reasons for this and any barriers to enrollment.
(d)All CARE plan services and supports ordered by the court are subject to available funding and all applicable federal and state statutes and regulations, contractual provisions, and policy guidance governing initial and ongoing program eligibility. In addition to the resources funded through programs listed in subdivision (a), the State Department of Health Care Services may identify other adjacent covered Medi-Cal services, including, but not limited to, enhanced care management and available community supports, which may be suggested, although not ordered, by the court, subject to all applicable federal and state statutes, regulations, contractual provisions, and policy guidance.
(e)This section does not prevent a county or other local governmental entity from recommending their own services that are their own responsibility not listed in subdivision (a) or (c). Any such recommendation is not required by this section and shall be made at the request of the county for the purposes of Section 6 of Article XIIIB, and Sections 6 and 36 of Article XIII of the California Constitution.
(f)(1)For respondents who are Medi-Cal beneficiaries, the county in which the respondent resides is the county of responsibility as defined in Section 1810.228 of Title 9 of the California Code of Regulations.
(2)If a proceeding commences in a county where the respondent is found or is facing criminal or civil proceedings that is different than the county in which the respondent resides, the county in which the respondent is found or is facing criminal or civil proceedings shall not delay proceedings under this part and is the responsible county behavioral health agency for providing or coordinating all components of the CARE agreement or CARE plan.
(3)The county in which the respondent resides, as defined in paragraph (1), shall be responsible for the costs of providing all CARE agreement or CARE plan behavioral health services, as defined in paragraph (1) of subdivision (a).
(4)In the event of a dispute over responsibility for any costs of providing components of the CARE agreement or CARE plan, the impacted counties shall resolve the dispute in accordance with the arbitration process established in Section 1850.405 of Title 9 of the California Code of Regulations for county mental health plans, including for respondents who are not Medi-Cal beneficiaries, and pursuant to any related guidance issued pursuant to subdivision (b) of Section 5984.
SEC. 21.Section 5983 of the Welfare and Institutions Code is amended to read:5983.(a)The California Health and Human Services Agency, or a designated department within the agency, shall do both of the following:
(1)Engage an independent, research-based entity, as described in Section 5986, to advise on the development of data-driven process and outcome measures to guide the planning, collaboration, reporting, and evaluation of the CARE Act pursuant to this part.
(2)Convene a working group to provide coordination and on-going engagement with, and support collaboration among, relevant state and local partners and other stakeholders throughout the phases of county implementation to support the successful implementation of the CARE Act. The working group shall meet no more than quarterly. The working group shall meet during the implementation and shall end no later than December 31, 2026.
(b)The department shall provide training and technical assistance to county behavioral health agencies to support the implementation of this part, including training regarding the CARE process, CARE agreement and plan services and supports, supported decisionmaking, the supporter role, trauma-informed care, elimination of bias, psychiatric advance directives, family psychoeducation, and data collection.
(c)The Judicial Council, in consultation with the department, other relevant state entities, and the County Behavioral Health Directors Association, shall provide training and technical assistance to judicial officers to support the implementation of this part, including training regarding the CARE process, CARE agreement and plan services and supports, working with the supporter, supported decisionmaking, the supporter role, the family role, trauma-informed care, elimination of bias, best practices, and evidence-based models of care for people with severe behavioral health conditions.
(d)The department, in consultation with other relevant state departments and the California Interagency Council on Homelessness, shall provide training to counsel regarding the CARE process and CARE agreement and plan services and supports.
SEC. 22.Section 5986 of the Welfare and Institutions Code is amended to read:5986.(a)An independent, research-based entity shall be retained by the department to develop, in consultation with county behavioral health agencies, county CARE courts, racial justice experts, and other appropriate stakeholders, including providers and CARE court participants, an independent evaluation of the effectiveness of the CARE Act. The independent evaluation shall employ statistical research methodology and include a logic model, hypotheses, comparative or quasi-experimental analyses, and conclusions regarding the extent to which the CARE Act model is associated, correlated, and causally related with the performance of the outcome measures included in the annual reports. The independent evaluation shall include results from a survey conducted of program participants. The independent evaluation shall highlight racial, ethnic, and other demographic disparities, and include causal inference or descriptive analyses regarding the impact of the CARE Act on disparity reduction efforts.
(b)The department shall provide a preliminary report to the Legislature by December 31, 2026, and a final report to the Legislature by December 31, 2028. The department shall post the preliminary and final reports on its internet website.
(c)Each county behavioral health department, each county CARE court, and any other state or local governmental entity, as determined by the department, shall provide the required data to the department, in a format and frequency as directed by the department.
(d)A report to be submitted pursuant to this section shall be submitted in compliance with Section 9795 of the Government Code.
SEC. 23.The Legislature finds and declares that Sections 13 and 17 of this act, which amend Sections 5977 and 5977.4 of the Welfare and Institutions Code, impose a limitation on the publics right of access to the meetings of public bodies or the writings of public officials and agencies within the meaning of Section 3 of Article I of the California Constitution. Pursuant to that constitutional provision, the Legislature makes the following findings to demonstrate the interest protected by the limitation and the need for protecting that interest:
In order to protect the highly sensitive personal information, including protected health information, of a respondent that is in the possession of public entities under the CARE Act, it is in the states interest to limit public access to information.
SEC. 24.If the Commission on State Mandates determines that this act contains costs mandated by the state, reimbursement to local agencies and school districts for those costs shall be made pursuant to Part 7 (commencing with Section 17500) of Division 4 of Title 2 of the Government Code.
SEC. 25.This act is an urgency statute necessary for the immediate preservation of the public peace, health, or safety within the meaning of Article IV of the California Constitution and shall go into immediate effect. The facts constituting the necessity are:
The CARE Act takes effect in October 2023, and therefore important changes to the act must take effect immediately to ensure the CARE Acts success.
(a)If the defendant is found mentally competent, the criminal process shall resume, and the trial on the offense charged or hearing on the alleged violation shall proceed.
(b)If the defendant is found mentally incompetent, the trial, judgment, or hearing on the alleged violation shall be suspended and the court may do either of the following:
(1)(A)Conduct a hearing, pursuant to Chapter 2.8A (commencing with Section 1001.35) of Title 6, and, if the court deems the defendant eligible, grant diversion pursuant to Section 1001.36 for a period not to exceed one year from the date the individual is accepted into diversion or the maximum term of imprisonment provided by law for the most serious offense charged in the misdemeanor complaint, whichever is shorter.
(B)If the court opts to conduct a hearing pursuant to this paragraph, the hearing shall be held no later than 30 days after the finding of incompetence. If the hearing is delayed beyond 30 days, the court shall order the defendant to be released on their own recognizance pending the hearing.
(C)If the defendant performs satisfactorily on diversion pursuant to this section, at the end of the period of diversion, the court shall dismiss the criminal charges that were the subject of the criminal proceedings at the time of the initial diversion.
(D)If the court finds the defendant ineligible for diversion based on the circumstances set forth in subdivision (b), (c), (d), or (g) of Section 1001.36, the court may, after notice to the defendant, defense counsel, and the prosecution, hold a hearing to determine whether to do any of the following:
(i)Order modification of the treatment plan in accordance with a recommendation from the treatment provider.
(ii)Refer the defendant to assisted outpatient treatment pursuant to Section 5346 of the Welfare and Institutions Code. A referral to assisted outpatient treatment may only occur in a county where services are available pursuant to Section 5348 of the Welfare and Institutions Code, and the agency agrees to accept responsibility for treatment of the defendant. A hearing to determine eligibility for assisted outpatient treatment shall be held within 45 days after the date of the referral. If the hearing is delayed beyond 45 days, the court shall order the defendant, if confined in county jail, to be released on their own recognizance pending that hearing. If the defendant is accepted into assisted outpatient treatment, the charges shall be dismissed pursuant to Section 1385.
(iii)Refer the defendant to the county conservatorship investigator in the county of commitment for possible conservatorship proceedings for the defendant pursuant to Chapter 3 (commencing with Section 5350) of Part 1 of Division 5 of the Welfare and Institutions Code. A defendant shall only be referred to the conservatorship investigator if, based on the opinion of a qualified mental health expert, the defendant appears to be gravely disabled, as defined in subparagraph (A) of paragraph (1) of subdivision (h) of Section 5008 of the Welfare and Institution Code. Any hearings required in the conservatorship proceedings shall be held in the superior court in the county of commitment. The court shall transmit a copy of the order directing initiation of conservatorship proceedings to the county mental health director or the directors designee and shall notify the county mental health director or their designee of the outcome of the proceedings. Before establishing a conservatorship, the public guardian shall investigate all available alternatives to conservatorship pursuant to Section 5354 of the Welfare and Institutions Code. If a petition is not filed within 60 days of the referral, the court shall order the defendant, if confined in county jail, to be released on their own recognizance pending conservatorship proceedings. If the outcome of the conservatorship proceedings results in the establishment of conservatorship, the charges shall be dismissed pursuant to Section 1385.
(iv)Refer the defendant to the CARE program pursuant to Section 5978 of the Welfare and Institutions Code. A hearing to determine eligibility for CARE shall be held within 30 14 court days after the date of on which the petition for the referral. referral is filed. If the hearing is delayed beyond 30 14 court days, the court shall order the defendant, if confined in county jail, to be released on their own recognizance pending that hearing. If the defendant is accepted into CARE, the charges shall be dismissed pursuant to Section 1385.
(2)Dismiss the charges pursuant to Section 1385. If the criminal action is dismissed, the court shall transmit a copy of the order of dismissal to the county behavioral health director or the directors designee.
(c)If the defendant is found mentally incompetent and is on a grant of probation for a misdemeanor offense, the court shall dismiss the pending revocation matter and may return the defendant to supervision. If the revocation matter is dismissed pursuant to this subdivision, the court may modify the terms and conditions of supervision to include appropriate mental health treatment.
(d)It is the intent of the Legislature that a defendant subject to the terms of this section receive mental health treatment in a treatment facility and not a jail. A term of four days will be deemed to have been served for every two days spent in actual custody against the maximum term of diversion. A defendant not in actual custody shall otherwise receive day for day credit against the term of diversion from the date the defendant is accepted into diversion. Actual custody has the same meaning as in Section 4019.
(e)This section shall apply only as provided in subdivision (b) of Section 1367.
SEC. 2.Section 5970 of the Welfare and Institutions Code is amended to read:5970.This part shall be known, and may be cited, as the Community Assistance, Recovery, and Empowerment (CARE) Act.
SEC. 3.Section 5970.5 of the Welfare and Institutions Code is amended to read:5970.5.This part shall be implemented as follows, with technical assistance and continuous quality improvement, pursuant to Section 5983:
(a)A first cohort of counties, which shall include the Counties of Glenn, Orange, Riverside, San Diego, Stanislaus, and Tuolumne, and the City and County of San Francisco, shall begin no later than October 1, 2023, unless the county is provided additional time pursuant to paragraph (2) of subdivision (c).
(b)A second cohort of counties, representing the remaining population of the state, shall begin no later than December 1, 2024, unless the county is provided additional time pursuant to paragraph (2) of subdivision (c).
(c)(1)The department shall issue guidelines under which counties can apply for, and be provided, additional time to implement this part. The guidelines shall not be subject to the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code).
(2)The department shall approve implementation delay for the first or second cohort if the county experiences a state or local emergency and the delay of the provision of the CARE process is necessary as a result of the emergency.
(3)The department shall only grant one extension per county and the final date for counties to implement under any circumstances shall be December 1, 2025.
(d)This part shall become operative only upon the department, in consultation with county stakeholders, developing a CARE Act allocation to provide state financial assistance to counties to implement the care process in this act.
SEC. 4.Section 5971 of the Welfare and Institutions Code is amended to read:5971.Unless the context otherwise requires, the following definitions shall govern the construction of this part.
(a)CARE agreement means a voluntary settlement agreement entered into by the parties. A CARE agreement includes the same elements as a CARE plan to support the respondent in accessing community-based services and supports.
(b)CARE plan means an individualized, appropriate range of community-based services and supports, as set forth in this part, which include clinically appropriate behavioral health care and stabilization medications, housing, and other supportive services, as appropriate, pursuant to Section 5982.
(c)CARE process means the court and related proceedings to implement the CARE Act.
(d)Counsel means the attorney representing the respondent, appointed pursuant to Section 5977, or chosen by the respondent, in CARE Act proceedings and matters related to CARE agreements and CARE plans. Representation of a respondent in these matters does not alter counsels obligations under the State Bar Act and the Rules of Professional Conduct, including subdivision (e) of Section 6068 of the Business and Professions Code and rule 1.6 of the Rules of Professional Conduct.
(e)County behavioral health agency means the local director of mental health services described in Section 5607, the local behavioral health director, or both as applicable, or their designee.
(f)Court-ordered evaluation means an evaluation ordered by a superior court pursuant to Section 5977.1.
(g)Department means the State Department of Health Care Services.
(h)Graduation plan means a voluntary agreement entered into by the parties at the end of the CARE program that includes a strategy to support a successful transition out of court jurisdiction and that may include a psychiatric advance directive. A graduation plan includes the same elements as a CARE plan to support the respondent in accessing community-based services and supports. The graduation plan shall not place additional requirements on the local government entities and is not enforceable by the court.
(i)Homeless outreach worker means a person who engages people experiencing homelessness to assess for unmet needs, offer information, services, or other assistance, or provide care coordination.
(j)Indian health care provider means a health care program operated by the Indian Health Service, an Indian tribe, a tribal organization, or urban Indian organization (I/T/U) as those terms are defined in Section 4 of the Indian Health Care Improvement Act (25 U.S.C. Sec. 1603).
(k)Legal proceeding means any administrative, civil, or criminal proceeding, including, but not limited to, juvenile court proceedings and family court proceedings and services, and any form of alternative dispute resolution, including arbitration and mediation, except for the following:
(1)A proceeding under this part.
(2)A proceeding under the Lanterman-Petris-Short Act described in paragraph (2) or (3) of subdivision (a) of Section 5979.
(3)A proceeding from which the respondent was referred to CARE Act proceedings as described in Section 5978.
(4)A disciplinary proceeding under Chapter 4 (commencing with Section 6000) of Division 3 of the Business and Professions Code.
(5)An appeal from any of the proceedings identified in paragraphs (1) through (4), inclusive.
(k)(l)Licensed behavioral health professional means either of the following:
(1)A licensed mental health professional, as defined in subdivision (j) of Section 4096.
(2)A person who has been granted a waiver of licensure requirements by the department pursuant to Section 5751.2.
(l)(m)Parties means the petitioner, the respondent, the county behavioral health agency in the county where proceedings under this part are pending, and any local governmental entity added by the court pursuant to paragraph (4) of subdivision (d) of Section 5977.1.
(m)(n)Petitioner means the person who files the CARE Act petition with the court. Additionally, if the petitioner is a person listed in Section 5974 other than the director of a county behavioral health agency, or their designee, the petitioner shall have the right to file a petition with the court, but at the initial hearing the court shall substitute the director of a county behavioral health agency, or their designee, of the county in which the proceedings are filed as petitioner. The original petitioner may, at the courts discretion and in furtherance of the interests of the respondent, retain rights as described in subparagraph (A) of paragraph (6) of subdivision (b) of Section 5977.
(n)(o)Psychiatric advance directive means a legal document, executed on a voluntary basis in accordance with the requirements for advance health care directives in Division 4.7 (commencing with Section 4600) of the Probate Code, by a person who has the capacity to make medical decisions, that allows a person with mental illness to protect their autonomy and ability to direct their own care by documenting their preferences for treatment in advance of a mental health crisis.
(o)(p)Respondent means the person who is the subject of the petition for the CARE process.
(p)(q)Stabilization medications means medications included in the CARE plan that primarily consist of antipsychotic medications to reduce symptoms of hallucinations, delusions, and disorganized thinking. Stabilization medications may be administered as long-acting injections if clinically indicated. Stabilization medications shall not be forcibly administered.
(q)(r)Supporter means an adult designated by the respondent who assists the person who is the subject of the petition, which assistance may include supporting the person to understand, make, communicate, implement, or act on their own life decisions during the CARE process, including a CARE agreement, a CARE plan, and developing a graduation plan. A supporter shall not act independently.
SEC. 5.Section 5972 of the Welfare and Institutions Code is amended to read:5972.An individual shall qualify for the CARE process only if all of the following criteria are met:
(a)The person is 18 years of age or older.
(b)The person is currently experiencing a serious mental disorder, as defined in paragraph (2) of subdivision (b) of Section 5600.3 and has a diagnosis identified in the disorder class: schizophrenia spectrum and other psychotic disorders, as defined in the most current version of the Diagnostic and Statistical Manual of Mental Disorders. This section does not establish respondent eligibility based upon a psychotic disorder that is due to a medical condition or is not primarily psychiatric in nature, including, but not limited to, physical health conditions such as traumatic brain injury, autism, dementia, or neurologic conditions. A person who has a current diagnosis of substance use disorder as defined in paragraph (2) of subdivision (a) of Section 1374.72 of the Health and Safety Code but who does not also meet the required criteria in this section shall not qualify for the CARE process.
(c)The person is not clinically stabilized in on-going voluntary treatment.
(d)At least one of the following is true:
(1)The person is unlikely to survive safely in the community without supervision and the persons condition is substantially deteriorating.
(2)The person is in need of services and supports in order to prevent a relapse or deterioration that would be likely to result in grave disability or serious harm to the person or others, as used in Section 5150.
(e)Participation in a CARE plan or CARE agreement would be the least restrictive alternative necessary to ensure the persons recovery and stability.
(f)It is likely that the person will benefit from participation in a CARE plan or CARE agreement.
SEC. 6.Section 5973 of the Welfare and Institutions Code is amended to read:5973.(a)Proceedings under this part may be commenced in any of the following:
(1)The county in which the respondent resides.
(2)The county where the respondent is found.
(3)The county where the respondent is facing criminal or civil proceedings.
(b)If the respondent does not reside in the county in which proceedings are initiated under this subdivision, as determined in accordance with Section 244 of the Government Code, except as provided in subdivision (f) of Section 5982, and this part is operative in the respondents county of residence, the proceeding shall, with the respondents consent, be transferred to the county of residence as soon as reasonably feasible. Should the respondent not consent to the transfer, the proceedings shall continue in the county where the respondent was found.
SEC. 7.Section 5974 of the Welfare and Institutions Code is amended to read:5974.The following adult persons may file a petition to commence the CARE process:
(a)A person with whom the respondent resides.
(b)A spouse, parent, sibling, child, or grandparent or an individual who stands in loco parentis to the respondent.
(c)The director of a hospital in which the respondent is hospitalized, including hospitalized pursuant to Section 5150 or 5250, or the directors designee.
(d)The director of a public or charitable organization, agency, or home, or their designee, who has, within the previous 30 days, provided or who is currently providing behavioral health services to the respondent or in whose institution the respondent resides.
(e)A licensed behavioral health professional, or their designee, who is, or has been within the previous 30 days, either supervising the treatment of, or treating the respondent for a mental illness.
(f)A first responder, including a peace officer, firefighter, paramedic, emergency medical technician, mobile crisis response worker, or homeless outreach worker, who has had repeated interactions with the respondent in the form of multiple arrests, multiple detentions and transportation pursuant to Section 5150, multiple attempts to engage the respondent in voluntary treatment, or other repeated efforts to aid the respondent in obtaining professional assistance.
(g)The public guardian or public conservator, or their designee, of the county in which the respondent resides or is found.
(h)The director of a county behavioral health agency, or their designee, of the county in which the respondent resides or is found.
(i)The director of county adult protective services, or their designee, of the county in which the respondent resides or is found.
(j)The director of a California Indian health services program, California tribal behavioral health department, who has, within the previous 30 days, provided or who is currently providing behavioral health services to the respondent, or the directors designee.
(k)The judge of a tribal court located in California before which the respondent has appeared within the previous 30 days, or the judges designee.
(l)The respondent.
SEC. 8.Section 5975.1 of the Welfare and Institutions Code is amended to read:5975.1.(a)Notwithstanding Section 391 of the Code of Civil Procedure, if a person other than the respondent files a petition for CARE Act proceedings that is without merit or is intended to harass or annoy the respondent, and the person has previously filed a pleading in CARE Act proceedings that was without merit or was intended to harass or annoy the respondent, the petition shall be grounds for the court to determine that the person is a vexatious litigant for the purposes of Title 3A (commencing with Section 391) of Part 2 of the Code of Civil Procedure.
(b)(1)If a person other than the respondent files a petition for CARE Act proceedings in order to gain an advantage over the respondent in another legal proceeding, then, notwithstanding any other provision of this part, it is cause for suspension, disbarment, or other discipline if a member of the State Bar is found to have filed the petition or assisted in the filing of the petition with knowledge that the filing was being made in order to gain that advantage.
(2)For purposes of this subdivision, legal proceeding shall not include:
(A)A proceeding under Part 1 (commencing with Section 5000) of Division 5.
(B)A proceeding under Section 300.
SEC. 8.SEC. 9.Section 5975.2 is added to the Welfare and Institutions Code, to read:5975.2.CARE Act proceedings may be conducted by a superior court judge or by a court-appointed commissioner or other subordinate judicial officer.
SEC. 9.SEC. 10.Section 5975.3 is added to the Welfare and Institutions Code, to read:5975.3.There shall be no fee for filing under this chapter nor shall any fees be charged by any public officer for services in filing or serving papers or for the performance of any duty enjoined by the CARE Act.
SEC. 10.SEC. 11.Section 5976 of the Welfare and Institutions Code is amended to read:5976.The respondent shall:
(a)Receive notice of the hearings.
(b)Receive a copy of the court-ordered evaluation.
(c)Be entitled to be represented by counsel at all stages of a proceeding commenced under this chapter, regardless of the ability to pay.
(d)Be allowed to have a supporter be present with them to perform the functions described in Sections 5980 and 5981, subject to the limits provided in those sections.
(e)Have the right to be present at the hearing unless the respondent waives that right.
(f)Have the right to present evidence.
(g)Have the right to call witnesses.
(h)Have the right to cross-examine witnesses.
(i)Have the right to appeal decisions, and to be informed of the right to appeal.
(j)Have the right to an interpreter in all proceedings if necessary for the respondent to fully participate.
SEC. 11.SEC. 12.Section 5976.5 of the Welfare and Institutions Code is amended to read:5976.5.(a)Notwithstanding any other law, and except as otherwise provided in this section, a hearing held under this part is presumptively closed to the public.
(b)The respondent may demand that the hearing be public and be held in a place suitable for attendance by the public.
(c)The respondent may request the presence of any family member or friend without waiving the right to keep the hearing closed to the rest of the public.
(d)A request by any other party to the proceeding to make the hearing public may be granted if the judicial officer conducting the hearing finds that the public interest in an open hearing clearly outweighs the respondents interest in privacy.
(e)All reports, evaluations, diagnoses, or other information filed with the court related to the respondents health shall be confidential. The respondent may at any time petition the court for an order sealing these records or any other court records in a proceeding held under this part. Notwithstanding any rule of court prohibiting records kept confidential by law from consideration for sealing, if such a petition is filed, there shall exist a presumption in favor of sealing.
(f)The fact that evidence is admitted at a proceeding held under this part shall not be the basis for admission of that evidence in any subsequent legal proceeding.
(g)Photographs, recordings, transcripts, other records of proceedings held under this part, and testimony regarding proceedings held under this part shall not be admissible in any subsequent legal proceeding except upon motion by one of the following in that subsequent legal proceeding:
(1)The respondent.
(2)The county behavioral health agency, the public guardian, or the public conservator.
(h)In a proceeding held under this part, this section shall not affect the applicability of paragraph (2) of subdivision (c) of Section 5977.1, make admissible any evidence that is not otherwise admissible, or permit a witness to base an opinion on any matter that is not a proper basis for that opinion. The admission or exclusion of evidence shall be pursuant to the rules of evidence established by the Evidence Code, including, but not limited to, Section 352 of the Evidence Code, and by judicial decision.
(f)(i)Before commencing a hearing, the judicial officer shall inform the respondent of their rights under this section.
SEC. 12.SEC. 13.Section 5977 of the Welfare and Institutions Code is amended to read:5977.(a)(1)The court shall promptly review the petition to determine if the petitioner has made a prima facie showing that the respondent is, or may be, a person described in Section 5972.
(2)If the court finds that the petitioner has not made a prima facie showing that the respondent is, or may be, a person described in Section 5972, the court may dismiss the case without prejudice subject to consideration of Section 5975.1.
(3)If the court finds that the petitioner has made a prima facie showing that the respondent is, or may be, a person described in Section 5972, the court shall do one of the following:
(A)If the petitioner is the director of a county behavioral health agency, or their designee, the court shall do the following:
(i)Set the matter for an initial appearance on the petition within 14 court days.
(ii)Appoint a qualified legal services project, as defined in Sections 6213 to 6214.5, inclusive, of the Business and Professions Code, to represent the respondent. If no legal services project has agreed to accept these appointments, a public defender or other counsel working in that capacity shall be appointed to represent the respondent.
(iii)Determine whether the petition includes all of the following information and, if it does not, order the county behavioral health agency to submit a written report with the court within 14 court days that includes all of the following:
(I)A determination as to whether the respondent meets, or is likely to meet, the criteria for the CARE process.
(II)The outcome of efforts made to voluntarily engage the respondent prior to the filing of the petition.
(III)Conclusions and recommendations about the respondents ability to voluntarily engage in services.
(iv)Order the county behavioral health agency to provide notice to the respondent, the appointed counsel, and the county behavioral health agency in the county where the respondent resides, if different from the county where the CARE process has commenced.
(B)If the petitioner is a person other than the director of a county behavioral health agency, or their designee, the court shall order a county agency, or their designee, as determined by the court, to investigate, as necessary, and file a written report with the court within 14 court days and provide notice to the respondent and petitioner that a report has been ordered. The written report shall include all of the following:
(i)A determination as to whether the respondent meets, or is likely to meet, the criteria for the CARE process.
(ii)The outcome of efforts made to voluntarily engage the respondent during the 14-day report period.
(iii)Conclusions and recommendations about the respondents ability to voluntarily engage in services.
(iv)The information, including protected health information, necessary to support the determinations, conclusions, and recommendations in the report.
(4)If, upon a request by the county agency ordered to investigate and file a report under subparagraph (B) of paragraph (3), the court finds that the county agency is making progress to engage the respondent, the court may, in its discretion, grant the county agency no more than 30 additional days to continue to work with, engage, and enroll the individual in voluntary treatment and services. The county agency shall provide notice to the respondent and petitioner that an extension for filing a report has been granted.
(5)Upon receipt of the report described in subparagraph (B) of paragraph (3), the court shall, within five days, take one of the following actions:
(A)If the court determines that voluntary engagement with the respondent is effective, and that the individual has enrolled or is likely to enroll in voluntary behavioral health treatment, the court shall dismiss the matter.
(B)If the court determines that the county agencys report does not support the petitions prima facie showing that the respondent is, or may be, a person described in Section 5972, the court shall dismiss the matter. This section shall not prevent a county behavioral health agency from continuing to voluntarily engage with a person not described in Section 5972 but who is in need of services and supports.
(C)If the court determines that the county agencys report does support the petitions prima facie showing that the respondent is, or may be, a person described in Section 5972, and engagement with the county agency was not effective, the court shall do all of the following:
(i)Set an initial appearance on the petition within 14 court days.
(ii)Appoint a qualified legal services project, as defined in Sections 6213 to 6214.5, inclusive, of the Business and Professions Code or, if no legal services project has agreed to accept these appointments, a public defender or other counsel working in that capacity to represent the respondent.
(iii)Order the county agency to provide notice of the initial appearance to the petitioner, the respondent, the appointed counsel, the county behavioral health agency in the county where the respondent resides, and, if different, the county where the CARE court proceedings have commenced.
(b)At the initial appearance on the petition, all of the following shall apply:
(1)The court shall permit the respondent to substitute their own counsel.
(2)Petitioner shall be present. If the petitioner is not present, the matter may be dismissed.
(3)Respondent may waive personal appearance and appear through counsel. If the respondent does not waive personal appearance and does not appear at the hearing, and the court makes a finding in open court that reasonable attempts to elicit the attendance of the respondent have failed, the court may conduct the hearing in the respondents absence if the court makes a finding in open court that conducting the hearing without the participation or presence of the respondent would be in the respondents best interest.
(4)A representative from the county behavioral health agency shall be present.
(5)If the respondent asserts that they are enrolled in a federally recognized Indian tribe or are receiving services from an Indian health care provider, a tribal court, or a tribal organization, a representative from the program, the tribe, or the tribal court shall be allowed to be present, subject to the consent of the respondent. The tribal representative shall be entitled to notice by the county of the initial appearance.
(6)(A)If the petitioner is a person other than the director of a county behavioral health agency, or their designee, the court shall issue an order relieving the original petitioner and appointing the director of the county behavioral health agency or their designee as the successor petitioner.
(B)If the original petitioner is described in subdivision (a) or (b) of Section 5974, all of the following apply:
(i)The original petitioner shall have the right to be present and make a statement at the initial hearing on the merits of the petition held pursuant to paragraph (7).
(ii)The court may, in its discretion, assign ongoing rights of notice to the original petitioner.
(iii)To the extent that the respondent consents, the court may allow the original petitioner to participate in the respondents CARE proceedings.
(iv)The original petitioner may file a new petition with the court, pursuant to Section 5974, if the matter is dismissed and there is a change in circumstances.
(C)If the original petitioner is not described in subdivision (a) or (b) of Section 5974, the court shall not assign ongoing rights to the original petitioner, other than the right to be present and make a statement at the hearing on the merits of the petition held pursuant to paragraph (7).
(7)(A)The court shall set a hearing on the merits of the petition within 10 days, at which time the court shall determine whether, by clear and convincing evidence, the respondent meets the CARE criteria in Section 5972. In making this determination, the court shall consider all evidence properly before it, including any report from the county behavioral health agency ordered pursuant to paragraph (3) of subdivision (a) and any additional admissible evidence presented by the parties, including the petition submitted and any statement given by the original petitioner.
(B)The hearing on the merits of the petition may be conducted concurrently with the initial appearance upon stipulation of the successor petitioner and the respondent, subject to the approval by the court.
(c)(1)If, at the hearing on the merits of the petition, the court finds there is not clear and convincing evidence that the respondent meets the CARE criteria in Section 5972, the court shall dismiss the case without prejudice, unless the court makes a finding, in open court, that the original petitioners filing was not in good faith, in which case the dismissal shall be with prejudice.
(2)If, at the hearing on the merits of the petition, the court finds by clear and convincing evidence that the respondent meets the CARE criteria in Section 5972, the court shall order the county behavioral health agency to work with the respondent, the respondents counsel, and the supporter to engage the respondent in behavioral health treatment and attempt to enter into a CARE agreement. The court shall set a case management hearing within 14 days.
(3)If the respondent is enrolled in a federally recognized Indian tribe, the respondent shall provide notice of the case management hearing to the tribe, subject to the consent of the respondent.
(d)The following shall apply to any written report submitted by a county behavioral health agency to the court pursuant to this section:
(1)The report is confidential and not subject to disclosure or inspection under the California Public Records Act (Division 10 (commencing with Section 7920.000) of Title 1 of the Government Code).
(2)The report is inadmissible in any subsequent legal proceeding, except upon motion of the respondent in that subsequent legal proceeding.
(3)The report shall be confidential pursuant to subdivision (e) of Section 5976.5.
(4)This subdivision shall not affect the applicability of paragraph (2) of subdivision (c) of Section 5977.1, make admissible any evidence that is not otherwise admissible, or permit a witness to base an opinion on any matter that is not a proper basis for such an opinion. The admission or exclusion of evidence shall be pursuant to the rules of evidence established by the Evidence Code, including, but not limited to, Section 352 of the Evidence Code, and by judicial decision.
SEC. 13.SEC. 14.Section 5977.1 of the Welfare and Institutions Code is amended to read:5977.1.(a)(1)At the case management hearing, the court shall hear evidence as to whether the parties have entered, or are likely to enter, into a CARE agreement.
(2)If the court finds that the parties have entered, or are likely to enter, into a CARE agreement, the court shall do one of the following:
(A)Approve the terms of the CARE agreement or modify the terms of the CARE agreement and approve the agreement as modified by the court, and continue the matter and set a progress hearing for 60 days.
(B)Continue the matter for 14 days to allow the parties additional time to enter into a CARE agreement, upon stipulation of the parties.
(b)If the court finds that the parties have not entered into a CARE agreement, and are not likely to enter into a CARE agreement, the court shall order the county behavioral health agency, through a licensed behavioral health professional, to conduct a clinical evaluation of the respondent, unless there is an existing clinical evaluation of the respondent completed within the last 30 days and the parties stipulate to the use of that evaluation. The evaluation shall address, at a minimum, the following:
(1)A clinical diagnosis of the respondent.
(2)Whether the respondent has the legal capacity to give informed consent regarding psychotropic medication.
(3)Any other information as ordered by the court or that the licensed behavioral health professional conducting the evaluation determines would help the court make future informed decisions about the appropriate care and services the respondent should receive.
(4)An analysis of recommended services, programs, housing, medications, and interventions that support the recovery and stability of the respondent.
(c)(1)The court shall set a clinical evaluation hearing to review the evaluation within 21 days. The court shall order the county to file the evaluation with the court and provide the evaluation to the respondents counsel no later than five days prior to the scheduled clinical evaluation hearing. The clinical evaluation hearing may be continued for a maximum of 14 days upon stipulation of the respondent and the county behavioral health agency, unless there is good cause for a longer extension.
(2)At the clinical evaluation review hearing, the court shall review the evaluation and other evidence from the county behavioral health agency and the respondent. The county behavioral health agency and the respondent may present evidence and call witnesses, including the person who conducted the evaluation. Only relevant and admissible evidence that fully complies with the rules of evidence may be considered by the court.
(3)At the conclusion of the hearing, the court shall determine whether the respondent, by clear and convincing evidence, meets the CARE criteria in Section 5972 and make orders as follows:
(A)If the court finds that the respondent meets the CARE criteria, the court shall order the county behavioral health agency, the respondent, and the respondents counsel and supporter to jointly develop a CARE plan within 14 days.
(B)If the court does not find that clear and convincing evidence establishes that the respondent meets the CARE criteria, the court shall dismiss the petition.
(4)If the respondent is a self-identified American Indian or Alaska Native individual, as defined in Sections 1603(13), 1603(28), and 1679(a) of Title 25 of the United States Code, has been determined eligible as an Indian under Section 136.12 of Title 42 of the Code of Federal Regulations, or is currently receiving services from an Indian health care provider or tribal court, the county behavioral health agency shall use its best efforts to meaningfully consult with and incorporate the Indian health care provider or tribal court available to the respondent to develop the CARE plan.
(5)The evaluation and all reports, documents, and filings submitted to the court shall be confidential.
(6)The date for the hearing to review and consider approval of the proposed CARE plan shall be set not more than 14 days from the date of the order to develop a CARE plan, unless the court finds good cause for an extension. The party requesting an extension of time for the CARE plan review hearing shall provide notice to the opposing party and their counsel of the request for extension of time, and the courts order if the request is granted.
(d)(1)At the CARE plan review hearing, the parties shall present their plan or plans to the court. The county behavioral health agency or the respondent, or both, may present a proposed CARE plan.
(2)After consideration of the plans proposed by the parties, the court shall adopt the elements of a CARE plan that support the recovery and stability of the respondent. The court may issue any orders necessary to support the respondent in accessing appropriate services and supports, including prioritization for those services and supports, subject to applicable laws and available funding pursuant to Section 5982. These orders shall constitute the CARE plan.
(3)A court may order medication if it finds, upon review of the court-ordered evaluation and hearing from the parties, that, by clear and convincing evidence, the respondent lacks the capacity to give informed consent to the administration of medically necessary stabilization medication. To the extent the court orders medically necessary stabilization medication, the medication shall not be forcibly administered and the respondents failure to comply with a medication order shall not result in a penalty, including, but not limited to, contempt or termination of the CARE plan pursuant to Section 5979.
(4)If the proposed CARE plan includes services and supports, such as housing, provided directly or indirectly through another local governmental entity, that local entity may agree to provide the service or support, or the court may consider a motion by either of the parties to add the local entity as a party to the CARE proceeding. If the local entity agrees to provide the service or support, it may request to be added as a party by the court.
(5)If, after presentation of the CARE plan or plans, the court determines that additional information is needed, including from a licensed behavioral health professional, the court shall order a supplemental report to be filed by the county behavioral health agency for which the court may grant a continuance of no more than 14 days, unless there is good cause for a longer extension.
(6)If there is no CARE plan because the parties have not had sufficient time to complete it, the court may grant a continuance of no more than 14 days, unless there is good cause for a longer extension.
(e)The issuance of an order approving a CARE plan pursuant to paragraph (2) of subdivision (d) begins the CARE process timeline, which shall not exceed one year.
SEC. 14.SEC. 15.Section 5977.2 of the Welfare and Institutions Code is amended to read:5977.2.(a)(1)At intervals set by the court and not less frequently than every 60 days after the court orders the CARE plan, the court shall hold a status review hearing. The county behavioral health agency shall file with the court and serve on the respondent, and the respondents counsel and supporter, a report no fewer than five court days prior to the review hearing with the following information:
(A)The progress that the respondent has made on the CARE plan.
(B)What services and supports in the CARE plan were provided, and what services and supports were not provided.
(C)Any issues the respondent expressed or exhibited in adhering to the CARE plan.
(D)Recommendations for changes to the services and supports to make the CARE plan more successful.
(2)The respondent shall be permitted to respond to the report submitted by the county behavioral health agency and to the county behavioral health agencys testimony. The respondent shall be permitted to introduce their own information and recommendations.
(3)Subject to applicable law, intermittent lapses or setbacks described in this section of the report shall not impact access to services, treatment, or housing.
(b)The county behavioral health agency or the respondent may request, or the court upon its own motion may set, a hearing to occur at any time during the CARE process to address a change of circumstances.
SEC. 15.SEC. 16.Section 5977.3 of the Welfare and Institutions Code is amended to read:5977.3.(a)(1)In the 11th month of the process timeline, the court shall hold a one-year status hearing. Not fewer than five court days prior to the one-year status hearing, the county behavioral health agency shall file a report with the court and shall serve the report on the respondent and the respondents counsel and supporter. The report shall include the following information:
(A)The progress that the respondent has made on the CARE plan, including a final assessment of the respondents stability.
(B)What services and supports in the CARE plan were provided, and what services and supports were not provided, over the life of the program.
(C)Any issues the respondent expressed or exhibited in adhering to the CARE plan.
(D)Recommendations for next steps, including what ongoing and additional services would benefit the respondent that the county behavioral health agency can facilitate or provide.
(2)At an evidentiary hearing, the respondent shall be permitted to respond to the report submitted by the county behavioral health agency and to the county behavioral health agencys testimony. Respondent shall be permitted to introduce their own information and recommendations. The respondent shall have the right at the hearing to call witnesses and to present evidence as to whether the respondent agrees with the report. The respondent may request either to be graduated from the program or to remain in the program.
(3)The court shall issue an order as follows:
(A)If the respondent elects to be graduated from the program, the court shall order the county behavioral health agency and the respondent to work jointly on a voluntary graduation plan. The court shall schedule a hearing in the 12th month after adoption of the CARE plan for presentation of the graduation plan. The court shall review the graduation plan and recite the terms in open court. The graduation plan shall not place additional requirements on local governmental entities and is not enforceable by the court, except that the graduation plan may, at the respondents election, include a psychiatric advance directive, which shall have the force of law. Upon completion of the hearing, the respondent shall be officially graduated from the program.
(B)If the respondent elects to remain in the CARE process, respondent may request any amount of time, up to and including one additional year. The court may permit the ongoing voluntary participation of the respondent if the court finds both of the following:
(i)The respondent did not successfully complete the CARE plan.
(ii)The respondent would benefit from continuation of the CARE plan.
(C)The court shall issue an order permitting the respondent to continue in the CARE plan or denying respondents request to remain in the CARE plan, and state its reasons in open court.
(b)The respondent may be involuntarily reappointed to the program only if the court finds, by clear and convincing evidence, that all of the following conditions apply:
(1)The respondent did not successfully complete the CARE process.
(2)All services and supports required through the CARE process were provided to the respondent.
(3)The respondent would benefit from continuation in the CARE process.
(4)The respondent currently meets the requirements in Section 5972.
(c)A respondent may only be reappointed to the CARE process once, for up to one additional year.
SEC. 16.SEC. 17.Section 5977.4 of the Welfare and Institutions Code is amended to read:5977.4.(a)In all CARE Act proceedings, the judicial officer shall control the proceedings during the hearings with a view to the expeditious and effective ascertainment of the jurisdictional facts and the ascertainment of all information relative to the present condition and future welfare of the respondent. Except when there is a contested issue of fact or law, the proceedings shall be conducted in an informal nonadversarial atmosphere with a view to obtaining the maximum cooperation of the respondent, all persons interested in the respondents welfare, and all other parties, with any provisions that the court may make for the disposition and care of the respondent. All evaluations and reports, documents, and filings submitted to the court pursuant to CARE Act proceedings shall be confidential.
(b)The hearings described in this chapter shall occur in person unless the court, in its discretion, allows a party or witness to appear remotely through the use of remote technology. The respondent shall have the right to be in person for all hearings.
(c)Consistent with its constitutional rulemaking authority, the Judicial Council shall adopt rules to implement the policies and provisions in this section and in Sections 5977, 5977.1, 5977.2, and 5977.3 to promote statewide consistency, including, but not limited to, what is included in the petition form packet, communications between the CARE Act court and the juvenile court, if applicable, and the process by which counsel will be appointed.
(d)(1)Notwithstanding any other law, Consistent with paragraph (9) of subdivision (b) of Section 56.10 of the Civil Code, the county behavioral health agency shall include in any report evaluation, or other document filed with the court, the information, including protected health information, necessary to support the determinations, conclusions, and recommendations in the filing. The county behavioral health agency shall not, unless ordered to do so by the court, submit to the court original or photocopied records underlying the information in a report evaluation or other document required or ordered under this subdivision. The county behavioral health agency shall serve an unredacted copy of any report evaluation, or other document filed with the court on the respondent and the respondents counsel and, with the consent of the respondent, on the supporter in a manner authorized by law. Neither a county nor an employee or agent thereof shall be held civilly or criminally liable for any disclosure authorized or required by this paragraph.
(2)(A)Notwithstanding any other law, Consistent with paragraph (1) of subdivision (c) of Section 56.10 of the Civil Code, a provider of health care, as defined in Section 56.05 of the Civil Code, or a covered entity, as defined in Section 160.103 of Title 45 of the Code of Federal Regulations, may disclose to the county behavioral health agency any information, including protected health information, and mental health records excluding psychotherapy notes, and substance use disorder patient records, to the extent permitted by Part 2 (commencing with Section 2.1) of Title 42 of the Code of Federal Regulations, in its possession about the respondent that is relevant to the county behavioral health agencys provision, coordination, or management of services and supports under this section, part, including, but not limited to, the preparation of any required investigations, evaluations, or reports. Such a disclosure is a disclosure for treatment purposes purposes, which may be made only to the extent permitted under Section 164.506 of Title 45 of the Code of Federal Regulations. The information disclosed may include substance use disorder patient records only to the extent permitted by Part 2 (commencing with Section 2.1) of Title 42 of the Code of Federal Regulations.
(B)Notwithstanding any other law, Consistent with paragraph (9) of subdivision (b) of Section 56.10 of the Civil Code, a provider of health care, as defined in Section 56.05 of the Civil Code, or a covered entity, as defined in Section 160.103 of Title 45 of the Code of Federal Regulations, that filed a CARE Act petition or executed an affidavit included with a CARE Act petition pursuant to paragraph (1) of subdivision (d) of Section 5975 shall provide to the county behavioral health agency any information, including protected health information, and mental health records excluding psychotherapy notes, and substance use disorder patient records, to the extent permitted by Part 2 (commencing with Section 2.1) of Title 42 of the Code of Federal Regulations, in its possession about the respondent that may be relevant in connection with an investigation, evaluation, or other report or hearing under this section, part, or with the provision of services and supports under this section. part. The provision of information under this paragraph is a disclosure required by law, which may be made only to the extent permitted under subdivision (a) of Section 164.512 of Title 45 of the Code of Federal Regulations. The information disclosed shall include substance use disorder patient records only to the extent permitted by Part 2 (commencing with Section 2.1) of Title 42 of the Code of Federal Regulations.
(C)The county behavioral health agency may apply to the court ex parte for an order requiring any provider of health care, as defined in Section 56.05 of the Civil Code, or any covered entity, as defined in Section 160.103 of Title 45 of the Code of Federal Regulations, to provide to the county behavioral health agency, to the court, or both, any information, including, but not limited to, protected health information, and mental health records excluding psychotherapy notes, and substance use disorder patient records, to the extent permitted by Part 2 (commencing with Section 2.1) of Title 42 of the Code of Federal Regulations, in its possession about the respondent that may be relevant in connection with an investigation, evaluation, or other report or hearing under this section, part, or with the provision of services and supports under this section. part. The provision of information under this paragraph is a disclosure required by law, which may be made only to the extent permitted under Section 164.512 of Title 45 of the Code of Federal Regulations. The information ordered to be disclosed may include substance use disorder patient records only to the extent permitted by Part 2 (commencing with Section 2.1) of Title 42 of the Code of Federal Regulations.
(D)A provider of health care or covered entity shall not be held civilly or criminally liable for any disclosure authorized or required by this section.
(E)The county behavioral health agency shall notify the respondent of a disclosure under this paragraph as follows:
(i)By mail at the respondents last known address, if any.
(ii)To the respondents counsel.
(iii)By including a copy of the notification under clause (i) or (ii) with the next notice of hearing served upon the respondent, if any.
(E)(F)All information, including the facts and records, or summary thereof, shared under this subdivision shall further be disclosed to the respondent and the respondents counsel, and with the consent of the respondent, to the supporter.
(3)(A)Except as expressly provided, no further disclosure or redisclosure of information is not authorized by this subdivision.
(B)Information disclosed to a county behavioral health agency by a provider of health care, as defined in Section 56.05 of the Civil Code, or a covered entity, as defined in Section 160.103 of Title 45 of the Code of Federal Regulations is confidential and not subject to disclosure or inspection under the California Public Records Act (Division 10 (commencing with Section 7920.000) of Title 1 of the Government Code).
(C)Disclosure of information under this part shall not be deemed to in any way alter the duties or responsibilities of a county behavioral health agency, of a provider of health care, as defined in Section 56.05 of the Civil Code, or of a covered entity, as defined in Section 160.103 of Title 45 of the Code of Federal Regulations, with respect to the disclosed information under the Confidentiality of Medical Information Act (Part 2.6 (commencing with Section 56) of Division 1 of the Civil Code), or the federal Health Insurance Portability and Accountability Act of 1996 (Public Law 104-191).
SEC. 17.SEC. 18.Section 5978 of the Welfare and Institutions Code is amended to read:5978.(a)A court may refer an individual from assisted outpatient treatment, as well as from conservatorship proceedings pursuant Chapter 3 (commencing with Section 5350) of Part 1 of Division 5 (LPS conservatorship) to CARE Act proceedings. If the individual is referred from assisted outpatient treatment, the county behavioral health director or their designee shall be the petitioner. If the individual is referred from LPS conservatorship proceedings, the conservator or proposed conservator shall be the petitioner pursuant to Section 5974.
(b)A court may refer an individual from misdemeanor proceedings pursuant to Section 1370.01 of the Penal Code to CARE Act proceedings. The county behavioral health director or their designee shall be the petitioner.
SEC. 18.SEC. 19.Section 5981.5 of the Welfare and Institutions Code is amended to read:5981.5.(a)The Legal Services Trust Fund Commission at the State Bar shall provide funding to qualified legal services projects, as defined in Sections 6213 to 6214.5, inclusive, of the Business and Professions Code, to be used to provide legal counsel appointed pursuant to subdivision (c) of Section 5976, for representation in CARE Act proceedings, matters related to CARE agreements and CARE plans, and to qualified support centers, as defined in subdivision (b) of Section 6213 of, and Section 6215 of, the Business and Professions Code, for training, support, and coordination.
(b)For purposes of implementing this part, the Legal Services Trust Fund Commission may enter into exclusive or nonexclusive contracts, or amend existing contracts, on a bid or negotiated basis, or award grants, provided that they make a finding that both of the following are satisfied:
(1)The Legal Services Trust Fund Commission shall retain control over the distribution of funds to the contractor or grantee.
(2)The contract or grant includes provisions to ensure transparency, accountability, and oversight in delivering the services, including measurement of outcomes established pursuant to Sections 5984, 5985, and 5986.
SEC. 19.SEC. 20.Section 5982 of the Welfare and Institutions Code is amended to read:5982.(a)The CARE plan may include only the following:
(1)Behavioral health services funded through the 1991 and 2011 Realignment, Medi-Cal behavioral health, health care plans and insurers, and services supported by the Mental Health Services Act pursuant to Part 3 (commencing with Section 5800).
(2)Medically necessary stabilization medications, to the extent not described in paragraph (1).
(3)Housing resources funded through the No Place Like Home Program (Part 3.9 (commencing with Section 5849.1) of Division 5 of the Welfare and Institutions Code); California Housing Accelerator (Chapter 6.6 (commencing with Section 50672) of Part 2 of Division 31 of the Health and Safety Code); the Multifamily Housing Program (Chapter 6.7 (commencing with Section 50675) of Part 2 of Division 31 of the Health and Safety Code); the Homeless Housing, Assistance, and Prevention Program (Chapter 6 (commencing with Section 50216) of Part 1 of Division 31 of the Health and Safety Code); the Encampment Resolution Funding Program (Chapter 7 (commencing with Section 50250) of Part 1 of Division 31 of the Health and Safety Code); the Project Roomkey and Rehousing Program pursuant to Provision 22 of Item 5180-151-0001 of the Budget Act of 2021 (Ch. 21, Stats. 2021); the Community Care Expansion Program (Chapter 20 (commencing with Section 18999.97) of Part 6 of Division 9 of the Welfare and Institutions Code); the CalWORKs Housing Support Program (Article 3.3 (commencing with Section 11330) of Chapter 2 of Part 3 of Division 9 of the Welfare and Institutions Code); the CalWORKs Homeless Assistance pursuant to clause (i) of subparagraph (A) of paragraph (2) of subdivision (f) of Section 11450 of Article 6 of Chapter 2 of Part 3 of Division 9 of the Welfare and Institutions Code; the Housing and Disability Advocacy Program (Chapter 17 (commencing with Section 18999) of Part 6 of Division 9 of the Welfare and Institutions Code); the Home Safe Program (Chapter 14 (commencing with Section 15770) of Part 3 of Division 9 of the Welfare and Institutions Code); the Bringing Families Home Program (Article 6 (commencing with Section 16523) of Chapter 5 of Part 4 of Division 9 of the Welfare and Institutions Code); the Transitional Housing Placement program for nonminor dependents (Article 4 (commencing with Section 16522) of Chapter 5 of Part 4 of Division 9 of the Welfare and Institutions Code); the Transitional Housing Program-Plus pursuant to subdivision (s) of Section 11400 and paragraph (2) of subdivision (a) of Section 11403.2 of Article 5 of Chapter 2 of Part 3 of Division 9 of the Welfare and Institutions Code and Article 4 (commencing with Section 16522) of Chapter 5 of Part 4 of Division 9 of the Welfare and Institutions Code; the Behavioral Health Continuum Infrastructure Program (Chapter 1 (commencing with Section 5960) of Part 7 of Division 5 of the Welfare and Institutions Code); the Behavioral Health Bridge Housing Program; HUD-Veterans Affairs Supportive Housing Program (Section 8(o)(19) of the United States Housing Act of 1937 [42 U.S.C. Section 1437f(o)(19)]); Supportive Services for Veteran Families (Section 604 of the Veterans Mental Health and Other Care Improvements Act of 2008 [38 U.S.C. Sec. 2044]); HUD Continuum of Care program (Section 103 of the McKinney-Vento Homeless Assistance Act [42 U.S.C. Sec. 11302]); the Emergency Solutions Grant (Subtitle B of Title IV of the McKinney-Vento Homeless Assistance Act [42 U.S.C. Secs. 11371-11378]); HUD Housing Choice Voucher program (Section 8 of the United States Housing Act of 1937 [42 U.S.C. Sec. 1437f]); the Emergency Housing Vouchers (Section 3202 of the American Rescue Plan Act of 2021 [Public Law 117-2]; Section 8(o) of the United States Housing Act of 1937 [42 U.S.C. Sec. 1437f(o)]); HOME Investment Partnerships Program (Title II of the Cranston-Gonzalez National Affordable Housing Act [42 U.S.C. Sec. 12721 et seq.]); the Community Development Block Grant Program (Title 1 of the Housing and Community Development Act of 1974 [42 U.S.C. Sec. 5301 et seq.]); housing supported by the Mental Health Services Act pursuant to Part 3 (commencing with Section 5800); community development block grants; and other state and federal housing resources.
(4)Social services funded through Supplemental Security Income/State Supplementary Payment (SSI/SSP), Cash Assistance Program for Immigrants (CAPI), CalWORKs, California Food Assistance Program, In-Home Supportive Services program, and CalFresh.
(5)Services provided pursuant to Part 5 (commencing with Section 17000) of Division 9.
(b)Individuals who are CARE process participants shall be prioritized for any appropriate bridge housing funded by the Behavioral Health Bridge Housing program.
(c)If the county behavioral health agency elects not to enroll the respondent into a full service partnership, as defined in Section 3620 of Title 9 of the California Code of Regulations, the court may request information on the reasons for this and any barriers to enrollment.
(d)All CARE plan services and supports ordered by the court are subject to available funding and all applicable federal and state statutes and regulations, contractual provisions, and policy guidance governing initial and ongoing program eligibility. In addition to the resources funded through programs listed in subdivision (a), the State Department of Health Care Services may identify other adjacent covered Medi-Cal services, including, but not limited to, enhanced care management and available community supports, which may be suggested, although not ordered, by the court, subject to all applicable federal and state statutes, regulations, contractual provisions, and policy guidance.
(e)This section does not prevent a county or other local governmental entity from recommending their own services that are their own responsibility not listed in subdivision (a) or (c). Any such recommendation is not required by this section and shall be made at the request of the county for the purposes of Section 6 of Article XIIIB, and Sections 6 and 36 of Article XIII of the California Constitution.
(f)(1)For respondents who are Medi-Cal beneficiaries, the county in which the respondent resides is the county of responsibility as defined in Section 1810.228 of Title 9 of the California Code of Regulations.
(2)If a proceeding commences in a county where the respondent is found or is facing criminal or civil proceedings that is different than the county in which the respondent resides, the county in which the respondent is found or is facing criminal or civil proceedings shall not delay proceedings under this part and is the responsible county behavioral health agency for providing or coordinating all components of the CARE agreement or CARE plan.
(3)The county in which the respondent resides, as defined in paragraph (1), shall be responsible for the costs of providing all CARE agreement or CARE plan behavioral health services, as defined in paragraph (1) of subdivision (a).
(4)In the event of a dispute over responsibility for any costs of providing components of the CARE agreement or CARE plan, the impacted counties shall resolve the dispute in accordance with the arbitration process established in Section 1850.405 of Title 9 of the California Code of Regulations for county mental health plans, including for respondents who are not Medi-Cal beneficiaries, and pursuant to any related guidance issued pursuant to subdivision (b) of Section 5984.
SEC. 20.SEC. 21.Section 5983 of the Welfare and Institutions Code is amended to read:5983.(a)The California Health and Human Services Agency, or a designated department within the agency, shall do both of the following:
(1)Engage an independent, research-based entity, as described in Section 5986, to advise on the development of data-driven process and outcome measures to guide the planning, collaboration, reporting, and evaluation of the CARE Act pursuant to this part.
(2)Convene a working group to provide coordination and on-going engagement with, and support collaboration among, relevant state and local partners and other stakeholders throughout the phases of county implementation to support the successful implementation of the CARE Act. The working group shall meet no more than quarterly. The working group shall meet during the implementation and shall end no later than December 31, 2026.
(b)The department shall provide training and technical assistance to county behavioral health agencies to support the implementation of this part, including training regarding the CARE process, CARE agreement and plan services and supports, supported decisionmaking, the supporter role, trauma-informed care, elimination of bias, psychiatric advance directives, family psychoeducation, and data collection.
(c)The Judicial Council, in consultation with the department, other relevant state entities, and the County Behavioral Health Directors Association, shall provide training and technical assistance to judicial officers to support the implementation of this part, including training regarding the CARE process, CARE agreement and plan services and supports, working with the supporter, supported decisionmaking, the supporter role, the family role, trauma-informed care, elimination of bias, best practices, and evidence-based models of care for people with severe behavioral health conditions.
(d)The department, in consultation with other relevant state departments and the California Interagency Council on Homelessness, shall provide training to counsel regarding the CARE process and CARE agreement and plan services and supports.
SEC. 21.SEC. 22.Section 5986 of the Welfare and Institutions Code is amended to read:5986.(a)An independent, research-based entity shall be retained by the department to develop, in consultation with county behavioral health agencies, county CARE courts, racial justice experts, and other appropriate stakeholders, including providers and CARE court participants, an independent evaluation of the effectiveness of the CARE Act. The independent evaluation shall employ statistical research methodology and include a logic model, hypotheses, comparative or quasi-experimental analyses, and conclusions regarding the extent to which the CARE Act model is associated, correlated, and causally related with the performance of the outcome measures included in the annual reports. The independent evaluation shall include results from a survey conducted of program participants. The independent evaluation shall highlight racial, ethnic, and other demographic disparities, and include causal inference or descriptive analyses regarding the impact of the CARE Act on disparity reduction efforts.
(b)The department shall provide a preliminary report to the Legislature by December 31, 2026, and a final report to the Legislature by December 31, 2028. The department shall post the preliminary and final reports on its internet website.
(c)Each county behavioral health department, each county CARE court, and any other state or local governmental entity, as determined by the department, shall provide the required data to the department, in a format and frequency as directed by the department.
(d)A report to be submitted pursuant to this section shall be submitted in compliance with Section 9795 of the Government Code.
SEC. 23.The Legislature finds and declares that Sections 13 and 17 of this act, which amend Sections 5977 and 5977.4 of the Welfare and Institutions Code, impose a limitation on the publics right of access to the meetings of public bodies or the writings of public officials and agencies within the meaning of Section 3 of Article I of the California Constitution. Pursuant to that constitutional provision, the Legislature makes the following findings to demonstrate the interest protected by the limitation and the need for protecting that interest:
In order to protect the highly sensitive personal information, including protected health information, of a respondent that is in the possession of public entities under the CARE Act, it is in the states interest to limit public access to information.
SEC. 22.SEC. 24.If the Commission on State Mandates determines that this act contains costs mandated by the state, reimbursement to local agencies and school districts for those costs shall be made pursuant to Part 7 (commencing with Section 17500) of Division 4 of Title 2 of the Government Code.
SEC. 23.SEC. 25.This act is an urgency statute necessary for the immediate preservation of the public peace, health, or safety within the meaning of Article IV of the California Constitution and shall go into immediate effect. The facts constituting the necessity are:
The CARE Act takes effect in October 2023, and therefore important changes to the act must take effect immediately to ensure the CARE Acts success.
(a)If the defendant is found mentally competent, the criminal process shall resume, and the trial on the offense charged or hearing on the alleged violation shall proceed.
(b)If the defendant is found mentally incompetent, the trial, judgment, or hearing on the alleged violation shall be suspended and the court may do either of the following:
(1)(A)Conduct a hearing, pursuant to Chapter 2.8A (commencing with Section 1001.35) of Title 6, and, if the court deems the defendant eligible, grant diversion pursuant to Section 1001.36 for a period not to exceed one year from the date the individual is accepted into diversion or the maximum term of imprisonment provided by law for the most serious offense charged in the misdemeanor complaint, whichever is shorter.
(B)If the court opts to conduct a hearing pursuant to this paragraph, the hearing shall be held no later than 30 days after the finding of incompetence. If the hearing is delayed beyond 30 days, the court shall order the defendant to be released on their own recognizance pending the hearing.
(C)If the defendant performs satisfactorily on diversion pursuant to this section, at the end of the period of diversion, the court shall dismiss the criminal charges that were the subject of the criminal proceedings at the time of the initial diversion.
(D)If the court finds the defendant ineligible for diversion based on the circumstances set forth in subdivision (b), (c), (d), or (g) of Section 1001.36, the court may, after notice to the defendant, defense counsel, and the prosecution, hold a hearing to determine whether to do any of the following:
(i)Order modification of the treatment plan in accordance with a recommendation from the treatment provider.
(ii)Refer the defendant to assisted outpatient treatment pursuant to Section 5346 of the Welfare and Institutions Code. A referral to assisted outpatient treatment may only occur in a county where services are available pursuant to Section 5348 of the Welfare and Institutions Code, and the agency agrees to accept responsibility for treatment of the defendant. A hearing to determine eligibility for assisted outpatient treatment shall be held within 45 days after the date of the referral. If the hearing is delayed beyond 45 days, the court shall order the defendant, if confined in county jail, to be released on their own recognizance pending that hearing. If the defendant is accepted into assisted outpatient treatment, the charges shall be dismissed pursuant to Section 1385.
(iii)Refer the defendant to the county conservatorship investigator in the county of commitment for possible conservatorship proceedings for the defendant pursuant to Chapter 3 (commencing with Section 5350) of Part 1 of Division 5 of the Welfare and Institutions Code. A defendant shall only be referred to the conservatorship investigator if, based on the opinion of a qualified mental health expert, the defendant appears to be gravely disabled, as defined in subparagraph (A) of paragraph (1) of subdivision (h) of Section 5008 of the Welfare and Institution Code. Any hearings required in the conservatorship proceedings shall be held in the superior court in the county of commitment. The court shall transmit a copy of the order directing initiation of conservatorship proceedings to the county mental health director or the directors designee and shall notify the county mental health director or their designee of the outcome of the proceedings. Before establishing a conservatorship, the public guardian shall investigate all available alternatives to conservatorship pursuant to Section 5354 of the Welfare and Institutions Code. If a petition is not filed within 60 days of the referral, the court shall order the defendant, if confined in county jail, to be released on their own recognizance pending conservatorship proceedings. If the outcome of the conservatorship proceedings results in the establishment of conservatorship, the charges shall be dismissed pursuant to Section 1385.
(iv)Refer the defendant to the CARE program pursuant to Section 5978 of the Welfare and Institutions Code. A hearing to determine eligibility for CARE shall be held within 14 30 days after the date of the referral. If the hearing is delayed beyond 14 30 days, the court shall order the defendant, if confined in county jail, to be released on their own recognizance pending that hearing. If the defendant is accepted into CARE, the charges shall be dismissed pursuant to Section 1385.
(2)Dismiss the charges pursuant to Section 1385. If the criminal action is dismissed, the court shall transmit a copy of the order of dismissal to the county behavioral health director or the directors designee.
(c)If the defendant is found mentally incompetent and is on a grant of probation for a misdemeanor offense, the court shall dismiss the pending revocation matter and may return the defendant to supervision. If the revocation matter is dismissed pursuant to this subdivision, the court may modify the terms and conditions of supervision to include appropriate mental health treatment.
(d)It is the intent of the Legislature that a defendant subject to the terms of this section receive mental health treatment in a treatment facility and not a jail. A term of four days will be deemed to have been served for every two days spent in actual custody against the maximum term of diversion. A defendant not in actual custody shall otherwise receive day for day credit against the term of diversion from the date the defendant is accepted into diversion. Actual custody has the same meaning as in Section 4019.
(e)This section shall apply only as provided in subdivision (b) of Section 1367.
SECTION 1.SEC. 2.Section 5970 of the Welfare and Institutions Code is amended to read:5970.This part shall be known, and may be cited, as the Community Assistance, Recovery, and Empowerment (CARE) Act.
SEC. 2.SEC. 3.Section 5970.5 of the Welfare and Institutions Code is amended to read:5970.5.This part shall be implemented as follows, with technical assistance and continuous quality improvement, pursuant to Section 5983:
(a)A first cohort of counties, which shall include the Counties of Glenn, Orange, Riverside, San Diego, Stanislaus, and Tuolumne, and the City and County of San Francisco, shall begin no later than October 1, 2023, unless the county is provided additional time pursuant to paragraph (2) of subdivision (c).
(b)A second cohort of counties, representing the remaining population of the state, shall begin no later than December 1, 2024, unless the county is provided additional time pursuant to paragraph (2) of subdivision (c).
(c)(1)The department shall issue guidelines under which counties can apply for, and be provided, additional time to implement this part. The guidelines shall not be subject to the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code).
(2)The department shall approve implementation delay for the first or second cohort if the county experiences a state or local emergency and the delay of the provision of the CARE process is necessary as a result of the emergency.
(3)The department shall only grant one extension per county and the final date for counties to implement under any circumstances shall be December 1, 2025.
(d)This part shall become operative only upon the department, in consultation with county stakeholders, developing a CARE Act allocation to provide state financial assistance to counties to implement the care process in this act.
SEC. 3.SEC. 4.Section 5971 of the Welfare and Institutions Code is amended to read:5971.Unless the context otherwise requires, the following definitions shall govern the construction of this part.
(a)CARE agreement means a voluntary settlement agreement entered into by the parties. A CARE agreement includes the same elements as a CARE plan to support the respondent in accessing community-based services and supports.
(b)CARE plan means an individualized, appropriate range of community-based services and supports, as set forth in this part, which include clinically appropriate behavioral health care and stabilization medications, housing, and other supportive services, as appropriate, pursuant to Section 5982.
(c)CARE process means the court and related proceedings to implement the CARE Act.
(d)Counsel means the attorney representing the respondent, appointed pursuant to Section 5977, or chosen by the respondent, in CARE Act proceedings and matters related to CARE agreements and CARE plans. Counsels representation shall be consistent with subdivision (e) of Section 6068 of the Business and Professions Code and the California Rules of Professional Conduct. Representation of a respondent in these matters does not alter counsels obligations under the State Bar Act and the Rules of Professional Conduct, including subdivision (e) of Section 6068 of the Business and Professions Code and rule 1.6 of the Rules of Professional Conduct.
(e)County behavioral health agency means the local director of mental health services described in Section 5607, the local behavioral health director, or both as applicable, or their designee.
(f)Court-ordered evaluation means an evaluation ordered by a superior court pursuant to Section 5977.1.
(g)Department means the State Department of Health Care Services.
(h)Graduation plan means a voluntary agreement entered into by the parties at the end of the CARE program that includes a strategy to support a successful transition out of court jurisdiction and that may include a psychiatric advance directive. A graduation plan includes the same elements as a CARE plan to support the respondent in accessing community-based services and supports. The graduation plan shall not place additional requirements on the local government entities and is not enforceable by the court.
(i)Homeless outreach worker means a person who engages people experiencing homelessness to assess for unmet needs, offer information, services, or other assistance, or provide care coordination.
(j)Indian health care provider means a health care program operated by the Indian Health Service, an Indian tribe, a tribal organization, or urban Indian organization (I/T/U) as those terms are defined in Section 4 of the Indian Health Care Improvement Act (25 U.S.C. Sec. 1603).
(k)Licensed behavioral health professional means either of the following:
(1)A licensed mental health professional, as defined in subdivision (j) of Section 4096.
(2)A person who has been granted a waiver of licensure requirements by the department pursuant to Section 5751.2.
(l)Parties means the petitioner, the respondent, the county behavioral health agency in the county where proceedings under this part are pending, and any local governmental entity added by the court pursuant to paragraph (4) of subdivision (d) of Section 5977.1.
(m)Petitioner means the person who files the CARE Act petition with the court. Additionally, if the petitioner is a person listed in Section 5974 other than the director of a county behavioral health agency, or their designee, the petitioner shall have the right to file a petition with the court, but at the initial hearing the court shall substitute the director of a county behavioral health agency, or their designee, of the county in which the proceedings are filed as petitioner. The original petitioner may, at the courts discretion and in furtherance of the interests of the respondent, retain rights as described in subparagraph (A) of paragraph (6) of subdivision (b) of Section 5977.
(n)Psychiatric advance directive means a legal document, executed on a voluntary basis in accordance with the requirements for advance health care directives in Division 4.7 (commencing with Section 4600) of the Probate Code, by a person who has the capacity to make medical decisions, that allows a person with mental illness to protect their autonomy and ability to direct their own care by documenting their preferences for treatment in advance of a mental health crisis.
(o)Respondent means the person who is the subject of the petition for the CARE process.
(p)Stabilization medications means medications included in the CARE plan that primarily consist of antipsychotic medications to reduce symptoms of hallucinations, delusions, and disorganized thinking. Stabilization medications may be administered as long-acting injections if clinically indicated. Stabilization medications shall not be forcibly administered.
(q)Supporter means an adult designated by the respondent who assists the person who is the subject of the petition, which assistance may include supporting the person to understand, make, communicate, implement, or act on their own life decisions during the CARE process, including a CARE agreement, a CARE plan, and developing a graduation plan. A supporter shall not act independently.
SEC. 4.SEC. 5.Section 5972 of the Welfare and Institutions Code is amended to read:5972.An individual shall qualify for the CARE process only if all of the following criteria are met:
(a)The person is 18 years of age or older.
(b)The person is currently experiencing a serious mental disorder, as defined in paragraph (2) of subdivision (b) of Section 5600.3 and has a diagnosis identified in the disorder class: schizophrenia spectrum and other psychotic disorders, as defined in the most current version of the Diagnostic and Statistical Manual of Mental Disorders. This section does not establish respondent eligibility based upon a psychotic disorder that is due to a medical condition or is not primarily psychiatric in nature, including, but not limited to, physical health conditions such as traumatic brain injury, autism, dementia, or neurologic conditions. A person who has a current diagnosis of substance use disorder as defined in paragraph (2) of subdivision (a) of Section 1374.72 of the Health and Safety Code but who does not also meet the required criteria in this section shall not qualify for the CARE process.
(c)The person is not clinically stabilized in on-going voluntary treatment.
(d)At least one of the following is true:
(1)The person is unlikely to survive safely in the community without supervision and the persons condition is substantially deteriorating.
(2)The person is in need of services and supports in order to prevent a relapse or deterioration that would be likely to result in grave disability or serious harm to the person or others, as used in Section 5150.
(e)Participation in a CARE plan or CARE agreement would be the least restrictive alternative necessary to ensure the persons recovery and stability.
(f)It is likely that the person will benefit from participation in a CARE plan or CARE agreement.
SEC. 5.SEC. 6.Section 5973 of the Welfare and Institutions Code is amended to read:5973.(a)Proceedings under this part may be commenced in any of the following:
(1)The county in which the respondent resides.
(2)The county where the respondent is found.
(3)The county where the respondent is facing criminal or civil proceedings.
(b)If the respondent does not reside in the county in which proceedings are initiated under this subdivision, as determined in accordance with Section 244 of the Government Code, except as provided in subdivision (f) of Section 5982, and this part is operative in the respondents county of residence, the proceeding shall, with the respondents consent, be transferred to the county of residence as soon as reasonably feasible. Should the respondent not consent to the transfer, the proceedings shall continue in the county where the respondent was found.
SEC. 6.SEC. 7.Section 5974 of the Welfare and Institutions Code is amended to read:5974.The following adult persons may file a petition to commence the CARE process:
(a)A person with whom the respondent resides.
(b)A spouse, parent, sibling, child, or grandparent or an individual who stands in loco parentis to the respondent.
(c)The director of a hospital in which the respondent is hospitalized, including hospitalized pursuant to Section 5150 or 5250, or the directors designee.
(d)The director of a public or charitable organization, agency, or home, or their designee, who has, within the previous 30 days, provided or who is currently providing behavioral health services to the respondent or in whose institution the respondent resides.
(e)A licensed behavioral health professional, or their designee, who is, or has been within the previous 30 days, either supervising the treatment of, or treating the respondent for a mental illness.
(f)A first responder, including a peace officer, firefighter, paramedic, emergency medical technician, mobile crisis response worker, or homeless outreach worker, who has had repeated interactions with the respondent in the form of multiple arrests, multiple detentions and transportation pursuant to Section 5150, multiple attempts to engage the respondent in voluntary treatment, or other repeated efforts to aid the respondent in obtaining professional assistance.
(g)The public guardian or public conservator, or their designee, of the county in which the respondent resides or is found.
(h)The director of a county behavioral health agency, or their designee, of the county in which the respondent resides or is found.
(i)The director of county adult protective services, or their designee, of the county in which the respondent resides or is found.
(j)The director of a California Indian health services program, California tribal behavioral health department, who has, within the previous 30 days, provided or who is currently providing behavioral health services to the respondent, or the directors designee.
(k)The judge of a tribal court located in California before which the respondent has appeared within the previous 30 days, or the judges designee.
(l)The respondent.
SEC. 7.SEC. 8.Section 5975.2 is added to the Welfare and Institutions Code, to read:5975.2.CARE Act proceedings may be conducted by a superior court judge or by a court-appointed commissioner or other subordinate judicial officer.
SEC. 8.SEC. 9.Section 5975.3 is added to the Welfare and Institutions Code, to read:5975.3.There shall be no fee for filing under this chapter nor shall any fees be charged by any public officer for services in filing or serving papers or for the performance of any duty enjoined by the CARE Act.
SEC. 9.SEC. 10.Section 5976 of the Welfare and Institutions Code is amended to read:5976.The respondent shall:
(a)Receive notice of the hearings.
(b)Receive a copy of the court-ordered evaluation.
(c)Be entitled to be represented by counsel at all stages of a proceeding commenced under this chapter, regardless of the ability to pay.
(d)Be allowed to have a supporter be present with them to perform the functions described in Sections 5980 and 5981, subject to the limits provided in those sections.
(e)Have the right to be present at the hearing unless the respondent waives that right.
(f)Have the right to present evidence.
(g)Have the right to call witnesses.
(h)Have the right to cross-examine witnesses.
(i)Have the right to appeal decisions, and to be informed of the right to appeal.
(j)Have the right to an interpreter in all proceedings if necessary for the respondent to fully participate.
SEC. 10.SEC. 11.Section 5976.5 of the Welfare and Institutions Code is amended to read:5976.5.(a)Notwithstanding any other law, and except as otherwise provided in this section, a hearing held under this part is presumptively closed to the public.
(b)The respondent may demand that the hearing be public and be held in a place suitable for attendance by the public.
(c)The respondent may request the presence of any family member or friend without waiving the right to keep the hearing closed to the rest of the public.
(d)A request by any other party to the proceeding to make the hearing public may be granted if the judicial officer conducting the hearing finds that the public interest in an open hearing clearly outweighs the respondents interest in privacy.
(e)All reports, evaluations, diagnoses, or other information related to the respondents health shall be confidential.
(f)Before commencing a hearing, the judicial officer shall inform the respondent of their rights under this section.
SEC. 11.SEC. 12.Section 5977 of the Welfare and Institutions Code is amended to read:5977.(a)(1)The court shall promptly review the petition to determine if the petitioner has made a prima facie showing that the respondent is, or may be, a person described in Section 5972.
(2)If the court finds that the petitioner has not made a prima facie showing that the respondent is, or may be, a person described in Section 5972, the court may dismiss the case without prejudice subject to consideration of Section 5975.1.
(3)If the court finds that the petitioner has made a prima facie showing that the respondent is, or may be, a person described in Section 5972, the court shall do one of the following:
(A)If the petitioner is the director of a county behavioral health agency, or their designee, the court shall do the following:
(i)Set the matter for an initial appearance on the petition within 14 court days.
(ii)Appoint a qualified legal services project, as defined in Sections 6213 to 6214.5, inclusive, of the Business and Professions Code, to represent the respondent. If no legal services project has agreed to accept these appointments, a public defender or other counsel working in that capacity shall be appointed to represent the respondent.
(iii)Determine whether the petition includes all of the following information and, if it does not, order the county behavioral health agency to submit a report within 14 court days that includes all of the following:
(I)A determination as to whether the respondent meets, or is likely to meet, the criteria for the CARE process.
(II)The outcome of efforts made to voluntarily engage the respondent prior to the filing of the petition.
(III)Conclusions and recommendations about the respondents ability to voluntarily engage in services.
(iv)Order the county behavioral health agency to provide notice to the respondent, the appointed counsel, and the county behavioral health agency in the county where the respondent resides, if different from the county where the CARE process has commenced.
(B)If the petitioner is a person other than the director of a county behavioral health agency, or their designee, the court shall order a county agency, or their designee, as determined by the court, to investigate, as necessary, and file a written report with the court within 14 court days and provide notice to the respondent and petitioner that a report has been ordered. The written report shall include all of the following:
(i)A determination as to whether the respondent meets, or is likely to meet, the criteria for the CARE process.
(ii)The outcome of efforts made to voluntarily engage the respondent during the 14-day report period.
(iii)Conclusions and recommendations about the respondents ability to voluntarily engage in services.
(iv)The information, including protected health information, necessary to support the determinations, conclusions, and recommendations in the report.
(4)If, upon a request by the county agency ordered to investigate and file a report under subparagraph (B) of paragraph (3), the court finds that the county agency is making progress to engage the respondent, the court may, in its discretion, grant the county agency no more than 30 additional days to continue to work with, engage, and enroll the individual in voluntary treatment and services. The county agency shall provide notice to the respondent and petitioner that an extension for filing a report has been granted.
(5)Upon receipt of the report described in subparagraph (B) of paragraph (3), the court shall, within five days, take one of the following actions:
(A)If the court determines that voluntary engagement with the respondent is effective, and that the individual has enrolled or is likely to enroll in voluntary behavioral health treatment, the court shall dismiss the matter.
(B)If the court determines that the county agencys report does not support the petitions prima facie showing that the respondent is is, or may be, a person described in Section 5972, the court shall dismiss the matter. This section shall not prevent a county behavioral health agency from continuing to voluntarily engage with a person not described in Section 5972 but who is in need of services and supports.
(C)If the court determines that the county agencys report does support the petitions prima facie showing that the respondent is, or may be, a person described in Section 5972, and engagement with the county agency was not effective, the court shall do all of the following:
(i)Set an initial appearance on the petition within 14 court days.
(ii)Appoint a qualified legal services project, as defined in Sections 6213 to 6214.5, inclusive, of the Business and Professions Code or, if no legal services project has agreed to accept these appointments, a public defender or other counsel working in that capacity to represent the respondent.
(iii)Order the county agency to provide notice of the initial appearance to the petitioner, the respondent, the appointed counsel, the county behavioral health agency in the county where the respondent resides, and, if different, the county where the CARE court proceedings have commenced.
(b)At the initial appearance on the petition, all of the following shall apply:
(1)The court shall permit the respondent to substitute their own counsel.
(2)Petitioner shall be present. If the petitioner is not present, the matter may be dismissed.
(3)Respondent may waive personal appearance and appear through counsel. If the respondent does not waive personal appearance and does not appear at the hearing, and the court makes a finding on the record in open court that reasonable attempts to elicit the attendance of the respondent have failed, the court may conduct the hearing in the respondents absence if the court makes a finding on the record in open court that conducting the hearing without the participation or presence of the respondent would be in the respondents best interest.
(4)A representative from the county behavioral health agency shall be present.
(5)If the respondent asserts that they are enrolled in a federally recognized Indian tribe or are receiving services from an Indian health care provider, a tribal court, or a tribal organization, a representative from the program, the tribe, or the tribal court shall be allowed to be present, subject to the consent of the respondent. The tribal representative shall be entitled to notice by the county of the initial appearance.
(6)(A)If the petitioner is a person other than the director of a county behavioral health agency, or their designee, the court shall issue an order relieving the original petitioner and appointing the director of the county behavioral health agency or their designee as the successor petitioner.
(B)If the original petitioner is described in subdivision (a) or (b) of Section 5974, all of the following apply:
(i)The original petitioner shall have the right to be present and make a statement at the initial hearing on the merits of the petition held pursuant to paragraph (7).
(ii)The court may, in its discretion, assign ongoing rights of notice to the original petitioner.
(iii)To the extent that the respondent consents, the court may allow the original petitioner to participate in the respondents CARE proceedings.
(iv)The original petitioner may file a new petition with the court, pursuant to Section 5974, if the matter is dismissed and there is a change in circumstances.
(C)If the original petitioner is not described in subparagraph subdivision (a) or (b) of Section 5974, the court shall not assign ongoing rights to the original petitioner, other than the right to be present and make a statement at the hearing on the merits of the petition held pursuant to paragraph (7).
(7)(A)The court shall set a hearing on the merits of the petition within 10 days, at which time the court shall determine whether, by clear and convincing evidence, the respondent meets the CARE criteria in Section 5972. In making this determination, the court shall consider all evidence properly before it, including any report from the county behavioral health agency ordered pursuant to paragraph (3) of subdivision (a) and any additional admissible evidence presented by the parties, including the petition submitted and any statement given by the original petitioner.
(B)The hearing on the merits of the petition may be conducted concurrently with the initial appearance upon stipulation of the successor petitioner and the respondent, subject to the approval by the court.
(c)(1)If, at the hearing on the merits of the petition, the court finds there is not clear and convincing evidence that the respondent meets the CARE criteria in Section 5972, the court shall dismiss the case without prejudice, unless the court makes a finding, on the record, in open court, that the original petitioners filing was not in good faith, in which case the dismissal shall be with prejudice.
(2)If, at the hearing on the merits of the petition, the court finds by clear and convincing evidence that the respondent meets the CARE criteria in Section 5972, the court shall order the county behavioral health agency to work with the respondent, the respondents counsel, and the supporter to engage the respondent in behavioral health treatment and attempt to enter into a CARE agreement. The court shall set a case management hearing within 14 days.
(3)If the respondent is enrolled in a federally recognized Indian tribe, the respondent shall provide notice of the case management hearing to the tribe, subject to the consent of the respondent.
SEC. 12.SEC. 13.Section 5977.1 of the Welfare and Institutions Code is amended to read:5977.1.(a)(1)At the case management hearing, the court shall hear evidence as to whether the parties have entered, or are likely to enter, into a CARE agreement.
(2)If the court finds that the parties have entered, or are likely to enter, into a CARE agreement, the court shall do both one of the following:
(A)Approve the terms of the CARE agreement or modify the terms of the CARE agreement and approve the agreement as modified by the court. court, and continue the matter and set a progress hearing for 60 days.
(B)Continue the matter and set a progress hearing for 60 days.(B)Continue the matter for 14 days to allow the parties additional time to enter into a CARE agreement, upon stipulation of the parties.
(b)If the court finds that the parties have not entered into a CARE agreement, and are not likely to enter into a CARE agreement, the court shall order the county behavioral health agency, through a licensed behavioral health professional, to conduct a clinical evaluation of the respondent, unless there is an existing clinical evaluation of the respondent completed within the last 30 days and the parties stipulate to the use of that evaluation. The evaluation shall address, at a minimum, the following:
(1)A clinical diagnosis of the respondent.
(2)Whether the respondent has the legal capacity to give informed consent regarding psychotropic medication.
(3)Any other information as ordered by the court or that the licensed behavioral health professional conducting the evaluation determines would help the court make future informed decisions about the appropriate care and services the respondent should receive.
(4)An analysis of recommended services, programs, housing, medications, and interventions that support the recovery and stability of the respondent.
(c)(1)The court shall set a clinical evaluation hearing to review the evaluation within 21 days. The court shall order the county to file the evaluation with the court and provide the evaluation to the respondents counsel no later than five days prior to the scheduled clinical evaluation hearing. The clinical evaluation hearing may be continued for a maximum of 14 days upon stipulation of the respondent and the county behavioral health agency, unless there is good cause for a longer extension.
(2)At the clinical evaluation review hearing, the court shall review the evaluation and other evidence from the county behavioral health agency and the respondent. The county behavioral health agency and the respondent may present evidence and call witnesses, including the person who conducted the evaluation. Only relevant and admissible evidence that fully complies with the rules of evidence may be considered by the court.
(3)At the conclusion of the hearing, the court shall determine whether the respondent, by clear and convincing evidence, meets the CARE criteria in Section 5972 and make orders as follows:
(A)If the court finds that the respondent meets the CARE criteria, the court shall order the county behavioral health agency, the respondent, and the respondents counsel and supporter to jointly develop a CARE plan within 14 days.
(B)If the court does not find that clear and convincing evidence establishes that the respondent meets the CARE criteria, the court shall dismiss the petition.
(4)If the respondent is a self-identified American Indian or Alaska Native individual, as defined in Sections 1603(13), 1603(28), and 1679(a) of Title 25 of the United States Code, has been determined eligible as an Indian under Section 136.12 of Title 42 of the Code of Federal Regulations, or is currently receiving services from an Indian health care provider or tribal court, the county behavioral health agency shall use its best efforts to meaningfully consult with and incorporate the Indian health care provider or tribal court available to the respondent to develop the CARE plan.
(5)The evaluation and all reports, documents, and filings submitted to the court shall be confidential.
(6)The date for the hearing to review and consider approval of the proposed CARE plan shall be set not more than 14 days from the date of the order to develop a CARE plan, unless the court finds good cause for an extension. The party requesting an extension of time for the CARE plan review hearing shall provide notice to the opposing party and their counsel of the request for extension of time, and the courts order if the request is granted.
(d)(1)At the CARE plan review hearing, the parties shall present their plan or plans to the court. The county behavioral health agency or the respondent, or both, may present a proposed CARE plan.
(2)After consideration of the plans proposed by the parties, the court shall adopt the elements of a CARE plan that support the recovery and stability of the respondent. The court may issue any orders necessary to support the respondent in accessing appropriate services and supports, including prioritization for those services and supports, subject to applicable laws and available funding pursuant to Section 5982. These orders shall constitute the CARE plan.
(3)A court may order medication if it finds, upon review of the court-ordered evaluation and hearing from the parties, that, by clear and convincing evidence, the respondent lacks the capacity to give informed consent to the administration of medically necessary stabilization medication. To the extent the court orders medically necessary stabilization medication, the medication shall not be forcibly administered and the respondents failure to comply with a medication order shall not result in a penalty, including, but not limited to, contempt or termination of the CARE plan pursuant to Section 5979.
(4)If the proposed CARE plan includes services and supports, such as housing, provided directly or indirectly through another local governmental entity, that local entity may agree to provide the service or support, or the court may consider a motion by either of the parties to add the local entity as a party to the CARE proceeding. If the local entity agrees to provide the service or support, it may request to be added as a party by the court.
(5)If, after presentation of the CARE plan or plans, the court determines that additional information is needed, including from a licensed behavioral health professional, the court shall order a supplemental report to be filed by the county behavioral health agency for which the court may grant a continuance of no more than 14 days, unless there is good cause for a longer extension.
(6)If there is no CARE plan because the parties have not had sufficient time to complete it, the court may grant a continuance of no more than 14 days, unless there is good cause for a longer extension.
(e)The issuance of an order approving a CARE plan pursuant to paragraph (2) of subdivision (d) begins the CARE process timeline, which shall not exceed one year.
SEC. 13.SEC. 14.Section 5977.2 of the Welfare and Institutions Code is amended to read:5977.2.(a)(1)At intervals set by the court and not less frequently than every 60 days after the court orders the CARE plan, the court shall hold a status review hearing. The county behavioral health agency shall file with the court and serve on the respondent, and the respondents counsel and supporter, a report no fewer than five court days prior to the review hearing with the following information:
(A)The progress that the respondent has made on the CARE plan.
(B)What services and supports in the CARE plan were provided, and what services and supports were not provided.
(C)Any issues the respondent expressed or exhibited in adhering to the CARE plan.
(D)Recommendations for changes to the services and supports to make the CARE plan more successful.
(2)The respondent shall be permitted to respond to the report submitted by the county behavioral health agency and to the county behavioral health agencys testimony. The respondent shall be permitted to introduce their own information and recommendations.
(3)Subject to applicable law, intermittent lapses or setbacks described in this section of the report shall not impact access to services, treatment, or housing.
(b)The county behavioral health agency or the respondent may request, or the court upon its own motion may set, a hearing to occur at any time during the CARE process to address a change of circumstances.
SEC. 14.SEC. 15.Section 5977.3 of the Welfare and Institutions Code is amended to read:5977.3.(a)(1)In the 11th month of the process timeline, the court shall hold a one-year status hearing. Not fewer than five court days prior to the one-year status hearing, the county behavioral health agency shall file a report with the court and shall serve the report on the respondent and the respondents counsel and supporter. The report shall include the following information:
(A)The progress that the respondent has made on the CARE plan, including a final assessment of the respondents stability.
(B)What services and supports in the CARE plan were provided, and what services and supports were not provided, over the life of the program.
(C)Any issues the respondent expressed or exhibited in adhering to the CARE plan.
(D)Recommendations for next steps, including what ongoing and additional services would benefit the respondent that the county behavioral health agency can facilitate or provide.
(2)At an evidentiary hearing, the respondent shall be permitted to respond to the report submitted by the county behavioral health agency and to the county behavioral health agencys testimony. Respondent shall be permitted to introduce their own information and recommendations. The respondent shall have the right at the hearing to call witnesses and to present evidence as to whether the respondent agrees with the report. The respondent may request either to be graduated from the program or to remain in the program.
(3)The court shall issue an order as follows:
(A)If the respondent elects to be graduated from the program, the court shall order the county behavioral health agency and the respondent to work jointly on a voluntary graduation plan. The court shall schedule a hearing in the 12th month after adoption of the CARE plan for presentation of the graduation plan. The court shall review the graduation plan and recite the terms on the record. in open court. The graduation plan shall not place additional requirements on local governmental entities and is not enforceable by the court, except that the graduation plan may, at the respondents election, include a psychiatric advance directive, which shall have the force of law. Upon completion of the hearing, the respondent shall be officially graduated from the program.
(B)If the respondent elects to remain in the CARE process, respondent may request any amount of time, up to and including one additional year. The court may permit the ongoing voluntary participation of the respondent if the court finds both of the following:
(i)The respondent did not successfully complete the CARE plan.
(ii)The respondent would benefit from continuation of the CARE plan.
(C)The court shall issue an order permitting the respondent to continue in the CARE plan or denying respondents request to remain in the CARE plan, and state its reasons in open court.
(b)The respondent may be involuntarily reappointed to the program only if the court finds, by clear and convincing evidence, that all of the following conditions apply:
(1)The respondent did not successfully complete the CARE process.
(2)All services and supports required through the CARE process were provided to the respondent.
(3)The respondent would benefit from continuation in the CARE process.
(4)The respondent currently meets the requirements in Section 5972.
(c)A respondent may only be reappointed to the CARE process once, for up to one additional year.
SEC. 15.SEC. 16.Section 5977.4 of the Welfare and Institutions Code is amended to read:5977.4.(a)In all CARE Act proceedings, the judicial officer shall control the proceedings during the hearings with a view to the expeditious and effective ascertainment of the jurisdictional facts and the ascertainment of all information relative to the present condition and future welfare of the respondent. Except when there is a contested issue of fact or law, the proceedings shall be conducted in an informal nonadversarial atmosphere with a view to obtaining the maximum cooperation of the respondent, all persons interested in the respondents welfare, and all other parties, with any provisions that the court may make for the disposition and care of the respondent. All evaluations and reports, documents, and filings submitted to the court pursuant to CARE Act proceedings shall be confidential.
(b)The hearings described in this chapter shall occur in person unless the court, in its discretion, allows a party or witness to appear remotely through the use of remote technology. The respondent shall have the right to be in person for all hearings.
(c)Consistent with its constitutional rulemaking authority, the Judicial Council shall adopt rules to implement the policies and provisions in this section and in Sections 5977, 5977.1, 5977.2, and 5977.3 to promote statewide consistency, including, but not limited to, what is included in the petition form packet packet, communications between the CARE Act court and the juvenile court, if applicable, and the process by which counsel will be appointed.
(d)(1)Notwithstanding any other law, the county behavioral health agency shall include in any report evaluation, or other document filed with the court, the information, including protected health information, necessary to support the determinations, conclusions, and recommendations in the filing. The county behavioral health agency shall not, unless ordered to do so by the court, submit to the court original or photocopied records underlying the information in a report evaluation or other document required or ordered under this subdivision. The county behavioral health agency shall serve an unredacted copy of any report evaluation, or other document filed with the court on the respondent and the respondents counsel and, with the consent of the respondent, on the supporter in a manner authorized by law. Neither a county nor an employee or agent thereof shall be held civilly or criminally liable for any disclosure authorized or required by this paragraph.
(2)(A)Notwithstanding any other law, a provider of health care, as defined in Section 56.05 of the Civil Code, or a covered entity, as defined in Section 160.103 of Title 45 of the Code of Federal Regulations, may disclose to the county behavioral health agency any information, including protected health information, mental health records excluding psychotherapy notes, and substance use disorder patient records, to the extent permitted by Part 2 (commencing with Section 2.1) of Title 42 of the Code of Federal Regulations, in its possession about the respondent that is relevant to the county behavioral health agencys provision, coordination, or management of services and supports under this section, including, but not limited to, the preparation of any required investigations, evaluations, or reports. Such a disclosure is a disclosure for treatment purposes under Section 164.506 of Title 45 of the Code of Federal Regulations.
(B)Notwithstanding any other law, a provider of health care, as defined in Section 56.05 of the Civil Code, or a covered entity, as defined in Section 160.103 of Title 45 of the Code of Federal Regulations, that filed a CARE Act petition or executed an affidavit included with a CARE Act petition pursuant to paragraph (1) of subdivision (d) of Section 5975 shall provide to the county behavioral health agency any information, including protected health information, mental health records excluding psychotherapy notes, and substance use disorder patient records, to the extent permitted by Part 2 (commencing with Section 2.1) of Title 42 of the Code of Federal Regulations, in its possession about the respondent that may be relevant in connection with an investigation, evaluation, or other report or hearing under this section, or with the provision of services and supports under this section.
(C)The county behavioral health agency may apply to the court ex parte for an order requiring any provider of health care, as defined in Section 56.05 of the Civil Code, or any covered entity, as defined in Section 160.103 of Title 45 of the Code of Federal Regulations, to provide to the county behavioral health agency, to the court, or both, any information, including, but not limited to, protected health information, mental health records excluding psychotherapy notes, and substance use disorder patient records, to the extent permitted by Part 2 (commencing with Section 2.1) of Title 42 of the Code of Federal Regulations, in its possession about the respondent that may be relevant in connection with an investigation, evaluation, or other report or hearing under this section, or with the provision of services and supports under this section.
(D)A provider of health care or covered entity shall not be held civilly or criminally liable for any disclosure authorized or required by this section.
(E)All information, including the facts and records, or summary thereof, shared under this subdivision shall further be disclosed to the respondent and the respondents counsel, and with the consent of the respondent, to the supporter.
(3)Except as expressly provided, no further disclosure or redisclosure of information is authorized by this subdivision.
SEC. 16.SEC. 17.Section 5978 of the Welfare and Institutions Code is amended to read:5978.(a)A court may refer an individual from assisted outpatient treatment, as well as from conservatorship proceedings pursuant Chapter 3 (commencing with Section 5350) of Part 1 of Division 5 (LPS conservatorship) to CARE Act proceedings. If the individual is referred from assisted outpatient treatment, the county behavioral health director or their designee shall be the petitioner. If the individual is referred from LPS conservatorship proceedings, the conservator or proposed conservator shall be the petitioner pursuant to Section 5974.
(b)A court may refer an individual from misdemeanor proceedings pursuant to Section 1370.01 of the Penal Code to CARE Act proceedings. The county behavioral health director or their designee shall be the petitioner.
SEC. 17.SEC. 18.Section 5981.5 of the Welfare and Institutions Code is amended to read:5981.5.(a)The Legal Services Trust Fund Commission at the State Bar shall provide funding to qualified legal services projects, as defined in Sections 6213 to 6214.5, inclusive, of the Business and Professions Code, to be used to provide legal counsel appointed pursuant to subdivision (c) of Section 5976, for representation in CARE Act proceedings, matters related to CARE agreements and CARE plans, and to qualified support centers, as defined in subdivision (b) of Section 6213 of, and Section 6215 of, the Business and Professions Code, for training, support, and coordination.
(b)For purposes of implementing this part, the Legal Services Trust Fund Commission may enter into exclusive or nonexclusive contracts, or amend existing contracts, on a bid or negotiated basis, or award grants, provided that they make a finding that both of the following are satisfied:
(1)The Legal Services Trust Fund Commission shall retain control over the distribution of funds to the contractor or grantee.
(2)The contract or grant includes provisions to ensure transparency, accountability, and oversight in delivering the services, including measurement of outcomes established pursuant to Sections 5984, 5985, and 5986.
SEC. 18.SEC. 19.Section 5982 of the Welfare and Institutions Code is amended to read:5982.(a)The CARE plan may include only the following:
(1)Behavioral health services funded through the 1991 and 2011 Realignment, Medi-Cal behavioral health, health care plans and insurers, and services supported by the Mental Health Services Act pursuant to Part 3 (commencing with Section 5800).
(2)Medically necessary stabilization medications, to the extent not described in paragraph (1).
(3)Housing resources funded through the No Place Like Home Program (Part 3.9 (commencing with Section 5849.1) of Division 5 of the Welfare and Institutions Code); California Housing Accelerator (Chapter 6.6 (commencing with Section 50672) of Part 2 of Division 31 of the Health and Safety Code); the Multifamily Housing Program (Chapter 6.7 (commencing with Section 50675) of Part 2 of Division 31 of the Health and Safety Code); the Homeless Housing, Assistance, and Prevention Program (Chapter 6 (commencing with Section 50216) of Part 1 of Division 31 of the Health and Safety Code); the Encampment Resolution Funding Program (Chapter 7 (commencing with Section 50250) of Part 1 of Division 31 of the Health and Safety Code); the Project Roomkey and Rehousing Program pursuant to Provision 22 of Item 5180-151-0001 of the Budget Act of 2021 (Ch. 21, Stats. 2021); the Community Care Expansion Program (Chapter 20 (commencing with Section 18999.97) of Part 6 of Division 9 of the Welfare and Institutions Code); the CalWORKs Housing Support Program (Article 3.3 (commencing with Section 11330) of Chapter 2 of Part 3 of Division 9 of the Welfare and Institutions Code); the CalWORKs Homeless Assistance pursuant to clause (i) of subparagraph (A) of paragraph (2) of subdivision (f) of Section 11450 of Article 6 of Chapter 2 of Part 3 of Division 9 of the Welfare and Institutions Code; the Housing and Disability Advocacy Program (Chapter 17 (commencing with Section 18999) of Part 6 of Division 9 of the Welfare and Institutions Code); the Home Safe Program (Chapter 14 (commencing with Section 15770) of Part 3 of Division 9 of the Welfare and Institutions Code); the Bringing Families Home Program (Article 6 (commencing with Section 16523) of Chapter 5 of Part 4 of Division 9 of the Welfare and Institutions Code); the Transitional Housing Placement program for nonminor dependents (Article 4 (commencing with Section 16522) of Chapter 5 of Part 4 of Division 9 of the Welfare and Institutions Code); the Transitional Housing Program-Plus pursuant to subdivision (s) of Section 11400 and paragraph (2) of subdivision (a) of Section 11403.2 of Article 5 of Chapter 2 of Part 3 of Division 9 of the Welfare and Institutions Code and Article 4 (commencing with Section 16522) of Chapter 5 of Part 4 of Division 9 of the Welfare and Institutions Code; the Behavioral Health Continuum Infrastructure Program (Chapter 1 (commencing with Section 5960) of Part 7 of Division 5 of the Welfare and Institutions Code); the Behavioral Health Bridge Housing Program; HUD-Veterans Affairs Supportive Housing Program (Section 8(o)(19) of the United States Housing Act of 1937 [42 U.S.C. Section 1437f(o)(19)]); Supportive Services for Veteran Families (Section 604 of the Veterans Mental Health and Other Care Improvements Act of 2008 [38 U.S.C. Sec. 2044]); HUD Continuum of Care program (Section 103 of the McKinney-Vento Homeless Assistance Act [42 U.S.C. Sec. 11302]); the Emergency Solutions Grant (Subtitle B of Title IV of the McKinney-Vento Homeless Assistance Act [42 U.S.C. Secs. 11371-11378]); HUD Housing Choice Voucher program (Section 8 of the United States Housing Act of 1937 [42 U.S.C. Sec. 1437f]); the Emergency Housing Vouchers (Section 3202 of the American Rescue Plan Act of 2021 [Public Law 117-2]; Section 8(o) of the United States Housing Act of 1937 [42 U.S.C. Sec. 1437f(o)]); HOME Investment Partnerships Program (Title II of the Cranston-Gonzalez National Affordable Housing Act [42 U.S.C. Sec. 12721 et seq.]); the Community Development Block Grant Program (Title 1 of the Housing and Community Development Act of 1974 [42 U.S.C. Sec. 5301 et seq.]); housing supported by the Mental Health Services Act pursuant to Part 3 (commencing with Section 5800); community development block grants; and other state and federal housing resources.
(4)Social services funded through Supplemental Security Income/State Supplementary Payment (SSI/SSP), Cash Assistance Program for Immigrants (CAPI), CalWORKs, California Food Assistance Program, In-Home Supportive Services program, and CalFresh.
(5)Services provided pursuant to Part 5 (commencing with Section 17000) of Division 9.
(b)Individuals who are CARE process participants shall be prioritized for any appropriate bridge housing funded by the Behavioral Health Bridge Housing program.
(c)If the county behavioral health agency elects not to enroll the respondent into a full service partnership, as defined in Section 3620 of Title 9 of the California Code of Regulations, the court may request information on the reasons for this and any barriers to enrollment.
(d)All CARE plan services and supports ordered by the court are subject to available funding and all applicable federal and state statutes and regulations, contractual provisions, and policy guidance governing initial and ongoing program eligibility. In addition to the resources funded through programs listed in subdivision (a), the State Department of Health Care Services may identify other adjacent covered Medi-Cal services, including, but not limited to, enhanced care management and available community supports, which may be suggested, although not ordered, by the court, subject to all applicable federal and state statutes, regulations, contractual provisions, and policy guidance.
(e)This section does not prevent a county or other local governmental entity from recommending their own services that are their own responsibility not listed in subdivision (a) or (c). Any such recommendation is not required by this section and shall be made at the request of the county for the purposes of Section 6 of Article XIIIB, and Sections 6 and 36 of Article XIII of the California Constitution.
(f)(1)For respondents who are Medi-Cal beneficiaries, the county in which the respondent resides is the county of responsibility as defined in Section 1810.228 of Title 9 of the California Code of Regulations.
(2)If a proceeding commences in a county where the respondent is found or is facing criminal or civil proceedings that is different than the county in which the respondent resides, the county in which the respondent is found or is facing criminal or civil proceedings shall not delay proceedings under this part and is the responsible county behavioral health agency for providing or coordinating all components of the CARE agreement or CARE plan.
(3)The county in which the respondent resides, as defined in paragraph (1), shall be responsible for the costs of providing all CARE agreement or CARE plan behavioral health services, as defined in paragraph (1) of subdivision (a).
(4)In the event of a dispute over responsibility for any costs of providing components of the CARE agreement or CARE plan, the impacted counties shall resolve the dispute in accordance with the arbitration process established in Section 1850.405 of Title 9 of the California Code of Regulations for county mental health plans, including for respondents who are not Medi-Cal beneficiaries, and pursuant to any related guidance issued pursuant to subdivision (b) of Section 5984.
SEC. 19.SEC. 20.Section 5983 of the Welfare and Institutions Code is amended to read:5983.(a)The California Health and Human Services Agency, or a designated department within the agency, shall do both of the following:
(1)Engage an independent, research-based entity, as described in Section 5986, to advise on the development of data-driven process and outcome measures to guide the planning, collaboration, reporting, and evaluation of the CARE Act pursuant to this part.
(2)Convene a working group to provide coordination and on-going engagement with, and support collaboration among, relevant state and local partners and other stakeholders throughout the phases of county implementation to support the successful implementation of the CARE Act. The working group shall meet no more than quarterly. The working group shall meet during the implementation and shall end no later than December 31, 2026.
(b)The department shall provide training and technical assistance to county behavioral health agencies to support the implementation of this part, including training regarding the CARE process, CARE agreement and plan services and supports, supported decisionmaking, the supporter role, trauma-informed care, elimination of bias, psychiatric advance directives, family psychoeducation, and data collection.
(c)The Judicial Council, in consultation with the department, other relevant state entities, and the County Behavioral Health Directors Association, shall provide training and technical assistance to judicial officers to support the implementation of this part, including training regarding the CARE process, CARE agreement and plan services and supports, working with the supporter, supported decisionmaking, the supporter role, the family role, trauma-informed care, elimination of bias, best practices, and evidence-based models of care for people with severe behavioral health conditions.
(d)The department, in consultation with other relevant state departments and the California Interagency Council on Homelessness, shall provide training to counsel regarding the CARE process and CARE agreement and plan services and supports.
SEC. 20.SEC. 21.Section 5986 of the Welfare and Institutions Code is amended to read:5986.(a)An independent, research-based entity shall be retained by the department to develop, in consultation with county behavioral health agencies, county CARE courts, racial justice experts, and other appropriate stakeholders, including providers and CARE court participants, an independent evaluation of the effectiveness of the CARE Act. The independent evaluation shall employ statistical research methodology and include a logic model, hypotheses, comparative or quasi-experimental analyses, and conclusions regarding the extent to which the CARE Act model is associated, correlated, and causally related with the performance of the outcome measures included in the annual reports. The independent evaluation shall include results from a survey conducted of program participants. The independent evaluation shall highlight racial, ethnic, and other demographic disparities, and include causal inference or descriptive analyses regarding the impact of the CARE Act on disparity reduction efforts.
(b)The department shall provide a preliminary report to the Legislature by December 31, 2026, and a final report to the Legislature by December 31, 2028. The department shall post the preliminary and final reports on its internet website.
(c)Each county behavioral health department, each county CARE court, and any other state or local governmental entity, as determined by the department, shall provide the required data to the department, in a format and frequency as directed by the department.
(d)A report to be submitted pursuant to this section shall be submitted in compliance with Section 9795 of the Government Code.
SEC. 22.If the Commission on State Mandates determines that this act contains costs mandated by the state, reimbursement to local agencies and school districts for those costs shall be made pursuant to Part 7 (commencing with Section 17500) of Division 4 of Title 2 of the Government Code.
SEC. 21.SEC. 23.This act is an urgency statute necessary for the immediate preservation of the public peace, health, or safety within the meaning of Article IV of the California Constitution and shall go into immediate effect. The facts constituting the necessity are:
The CARE Act takes effect in October 2023, and therefore important changes to the act must take effect immediately to ensure the CARE Acts success.
This part shall be known, and may be cited, as the Community Assistance, Recovery, and Empowerment (CARE) Act.
SEC. 2.Section 5970.5 of the Welfare and Institutions Code is amended to read:5970.5.This part shall be implemented as follows, with technical assistance and continuous quality improvement, pursuant to Section 5983:
(a)A first cohort of counties, which shall include the Counties of Glenn, Orange, Riverside, San Diego, Stanislaus, and Tuolumne, and the City and County of San Francisco, shall begin no later than October 1, 2023, unless the county is provided additional time pursuant to paragraph (2) of subdivision (c).
(b)A second cohort of counties, representing the remaining population of the state, shall begin no later than December 1, 2024, unless the county is provided additional time pursuant to paragraph (2) of subdivision (c).
(c)(1)The department shall issue guidelines under which counties can apply for, and be provided, additional time to implement this part. The guidelines shall not be subject to the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code).
(2)The department shall approve implementation delay for the first or second cohort if the county experiences a state or local emergency and the delay of the provision of the CARE process is necessary as a result of the emergency.
(3)The department shall only grant one extension per county and the final date for counties to implement under any circumstances shall be December 1, 2025.
(d)This part shall become operative only upon the department, in consultation with county stakeholders, developing a CARE Act allocation to provide state financial assistance to counties to implement the care process in this act.
SEC. 3.Section 5971 of the Welfare and Institutions Code is amended to read:5971.Unless the context otherwise requires, the following definitions shall govern the construction of this part.
(a)CARE agreement means a voluntary settlement agreement entered into by the parties. A CARE agreement includes the same elements as a CARE plan to support the respondent in accessing community-based services and supports.
(b)CARE plan means an individualized, appropriate range of community-based services and supports, as set forth in this part, which include clinically appropriate behavioral health care and stabilization medications, housing, and other supportive services, as appropriate, pursuant to Section 5982.
(c)CARE process means the court and related proceedings to implement the CARE Act.
(d)Counsel means the attorney representing the respondent, appointed pursuant to Section 5977, or chosen by the respondent, in CARE Act proceedings and matters related to CARE agreements and CARE plans. Counsels representation shall be consistent with subdivision (e) of Section 6068 of the Business and Professions Code and the California Rules of Professional Conduct.
(e)County behavioral health agency means the local director of mental health services described in Section 5607, the local behavioral health director, or both as applicable, or their designee.
(f)Court-ordered evaluation means an evaluation ordered by a superior court pursuant to Section 5977.1.
(g)Department means the State Department of Health Care Services.
(h)Graduation plan means a voluntary agreement entered into by the parties at the end of the CARE program that includes a strategy to support a successful transition out of court jurisdiction and that may include a psychiatric advance directive. A graduation plan includes the same elements as a CARE plan to support the respondent in accessing community-based services and supports. The graduation plan shall not place additional requirements on the local government entities and is not enforceable by the court.
(i)Homeless outreach worker means a person who engages people experiencing homelessness to assess for unmet needs, offer information, services, or other assistance, or provide care coordination.
(j)Indian health care provider means a health care program operated by the Indian Health Service, an Indian tribe, a tribal organization, or urban Indian organization (I/T/U) as those terms are defined in Section 4 of the Indian Health Care Improvement Act (25 U.S.C. Sec. 1603).
(k)Licensed behavioral health professional means either of the following:
(1)A licensed mental health professional, as defined in subdivision (j) of Section 4096.
(2)A person who has been granted a waiver of licensure requirements by the department pursuant to Section 5751.2.
(l)Parties means the petitioner, the respondent, the county behavioral health agency in the county where proceedings under this part are pending, and any local governmental entity added by the court pursuant to paragraph (4) of subdivision (d) of Section 5977.1.
(m)Petitioner means the person who files the CARE Act petition with the court. Additionally, if the petitioner is a person listed in Section 5974 other than the director of a county behavioral health agency, or their designee, the petitioner shall have the right to file a petition with the court, but at the initial hearing the court shall substitute the director of a county behavioral health agency, or their designee, of the county in which the proceedings are filed as petitioner. The original petitioner may, at the courts discretion and in furtherance of the interests of the respondent, retain rights as described in subparagraph (A) of paragraph (6) of subdivision (b) of Section 5977.
(n)Psychiatric advance directive means a legal document, executed on a voluntary basis in accordance with the requirements for advance health care directives in Division 4.7 (commencing with Section 4600) of the Probate Code, by a person who has the capacity to make medical decisions, that allows a person with mental illness to protect their autonomy and ability to direct their own care by documenting their preferences for treatment in advance of a mental health crisis.
(o)Respondent means the person who is the subject of the petition for the CARE process.
(p)Stabilization medications means medications included in the CARE plan that primarily consist of antipsychotic medications to reduce symptoms of hallucinations, delusions, and disorganized thinking. Stabilization medications may be administered as long-acting injections if clinically indicated. Stabilization medications shall not be forcibly administered.
(q)Supporter means an adult designated by the respondent who assists the person who is the subject of the petition, which assistance may include supporting the person to understand, make, communicate, implement, or act on their own life decisions during the CARE process, including a CARE agreement, a CARE plan, and developing a graduation plan. A supporter shall not act independently.
SEC. 4.Section 5972 of the Welfare and Institutions Code is amended to read:5972.An individual shall qualify for the CARE process only if all of the following criteria are met:
(a)The person is 18 years of age or older.
(b)The person is currently experiencing a serious mental disorder, as defined in paragraph (2) of subdivision (b) of Section 5600.3 and has a diagnosis identified in the disorder class: schizophrenia spectrum and other psychotic disorders, as defined in the most current version of the Diagnostic and Statistical Manual of Mental Disorders. This section does not establish respondent eligibility based upon a psychotic disorder that is due to a medical condition or is not primarily psychiatric in nature, including, but not limited to, physical health conditions such as traumatic brain injury, autism, dementia, or neurologic conditions. A person who has a current diagnosis of substance use disorder as defined in paragraph (2) of subdivision (a) of Section 1374.72 of the Health and Safety Code but who does not also meet the required criteria in this section shall not qualify for the CARE process.
(c)The person is not clinically stabilized in on-going voluntary treatment.
(d)At least one of the following is true:
(1)The person is unlikely to survive safely in the community without supervision and the persons condition is substantially deteriorating.
(2)The person is in need of services and supports in order to prevent a relapse or deterioration that would be likely to result in grave disability or serious harm to the person or others, as used in Section 5150.
(e)Participation in a CARE plan or CARE agreement would be the least restrictive alternative necessary to ensure the persons recovery and stability.
(f)It is likely that the person will benefit from participation in a CARE plan or CARE agreement.
SEC. 5.Section 5973 of the Welfare and Institutions Code is amended to read:5973.(a)Proceedings under this part may be commenced in any of the following:
(1)The county in which the respondent resides.
(2)The county where the respondent is found.
(3)The county where the respondent is facing criminal or civil proceedings.
(b)If the respondent does not reside in the county in which proceedings are initiated under this subdivision, as determined in accordance with Section 244 of the Government Code, except as provided in subdivision (f) of Section 5982, and this part is operative in the respondents county of residence, the proceeding shall, with the respondents consent, be transferred to the county of residence as soon as reasonably feasible. Should the respondent not consent to the transfer, the proceedings shall continue in the county where the respondent was found.
SEC. 6.Section 5974 of the Welfare and Institutions Code is amended to read:5974.The following adult persons may file a petition to commence the CARE process:
(a)A person with whom the respondent resides.
(b)A spouse, parent, sibling, child, or grandparent or an individual who stands in loco parentis to the respondent.
(c)The director of a hospital in which the respondent is hospitalized, including hospitalized pursuant to Section 5150 or 5250, or the directors designee.
(d)The director of a public or charitable organization, agency, or home, or their designee, who has, within the previous 30 days, provided or who is currently providing behavioral health services to the respondent or in whose institution the respondent resides.
(e)A licensed behavioral health professional, or their designee, who is, or has been within the previous 30 days, either supervising the treatment of, or treating the respondent for a mental illness.
(f)A first responder, including a peace officer, firefighter, paramedic, emergency medical technician, mobile crisis response worker, or homeless outreach worker, who has had repeated interactions with the respondent in the form of multiple arrests, multiple detentions and transportation pursuant to Section 5150, multiple attempts to engage the respondent in voluntary treatment, or other repeated efforts to aid the respondent in obtaining professional assistance.
(g)The public guardian or public conservator, or their designee, of the county in which the respondent resides or is found.
(h)The director of a county behavioral health agency, or their designee, of the county in which the respondent resides or is found.
(i)The director of county adult protective services, or their designee, of the county in which the respondent resides or is found.
(j)The director of a California Indian health services program, California tribal behavioral health department, who has, within the previous 30 days, provided or who is currently providing behavioral health services to the respondent, or the directors designee.
(k)The judge of a tribal court located in California before which the respondent has appeared within the previous 30 days, or the judges designee.
(l)The respondent.
SEC. 7.Section 5975.2 is added to the Welfare and Institutions Code, to read:5975.2.CARE Act proceedings may be conducted by a superior court judge or by a court-appointed commissioner or other subordinate judicial officer.
SEC. 8.Section 5975.3 is added to the Welfare and Institutions Code, to read:5975.3.There shall be no fee for filing under this chapter nor shall any fees be charged by any public officer for services in filing or serving papers or for the performance of any duty enjoined by the CARE Act.
SEC. 9.Section 5976 of the Welfare and Institutions Code is amended to read:5976.The respondent shall:
(a)Receive notice of the hearings.
(b)Receive a copy of the court-ordered evaluation.
(c)Be entitled to be represented by counsel at all stages of a proceeding commenced under this chapter, regardless of the ability to pay.
(d)Be allowed to have a supporter be present with them to perform the functions described in Sections 5980 and 5981, subject to the limits provided in those sections.
(e)Have the right to be present at the hearing unless the respondent waives that right.
(f)Have the right to present evidence.
(g)Have the right to call witnesses.
(h)Have the right to cross-examine witnesses.
(i)Have the right to appeal decisions, and to be informed of the right to appeal.
(j)Have the right to an interpreter in all proceedings if necessary for the respondent to fully participate.
SEC. 10.Section 5976.5 of the Welfare and Institutions Code is amended to read:5976.5.(a)Notwithstanding any other law, and except as otherwise provided in this section, a hearing held under this part is presumptively closed to the public.
(b)The respondent may demand that the hearing be public and be held in a place suitable for attendance by the public.
(c)The respondent may request the presence of any family member or friend without waiving the right to keep the hearing closed to the rest of the public.
(d)A request by any other party to the proceeding to make the hearing public may be granted if the judicial officer conducting the hearing finds that the public interest in an open hearing clearly outweighs the respondents interest in privacy.
(e)All reports, evaluations, diagnoses, or other information related to the respondents health shall be confidential.
(f)Before commencing a hearing, the judicial officer shall inform the respondent of their rights under this section.
SEC. 11.Section 5977 of the Welfare and Institutions Code is amended to read:5977.(a)(1)The court shall promptly review the petition to determine if the petitioner has made a prima facie showing that the respondent is, or may be, a person described in Section 5972.
(2)If the court finds that the petitioner has not made a prima facie showing that the respondent is, or may be, a person described in Section 5972, the court may dismiss the case without prejudice subject to consideration of Section 5975.1.
(3)If the court finds that the petitioner has made a prima facie showing that the respondent is, or may be, a person described in Section 5972, the court shall do one of the following:
(A)If the petitioner is the director of a county behavioral health agency, or their designee, the court shall do the following:
(i)Set the matter for an initial appearance on the petition within 14 court days.
(ii)Appoint a qualified legal services project, as defined in Sections 6213 to 6214.5, inclusive, of the Business and Professions Code, to represent the respondent. If no legal services project has agreed to accept these appointments, a public defender or other counsel working in that capacity shall be appointed to represent the respondent.
(iii)Determine whether the petition includes all of the following information and, if it does not, order the county behavioral health agency to submit a report within 14 court days that includes all of the following:
(I)A determination as to whether the respondent meets, or is likely to meet, the criteria for the CARE process.
(II)The outcome of efforts made to voluntarily engage the respondent prior to the filing of the petition.
(III)Conclusions and recommendations about the respondents ability to voluntarily engage in services.
(iv)Order the county behavioral health agency to provide notice to the respondent, the appointed counsel, and the county behavioral health agency in the county where the respondent resides, if different from the county where the CARE process has commenced.
(B)If the petitioner is a person other than the director of a county behavioral health agency, or their designee, the court shall order a county agency, or their designee, as determined by the court, to investigate, as necessary, and file a written report with the court within 14 court days and provide notice to the respondent and petitioner that a report has been ordered. The written report shall include all of the following:
(i)A determination as to whether the respondent meets, or is likely to meet, the criteria for the CARE process.
(ii)The outcome of efforts made to voluntarily engage the respondent during the 14-day report period.
(iii)Conclusions and recommendations about the respondents ability to voluntarily engage in services.
(4)If, upon a request by the county agency ordered to investigate and file a report under subparagraph (B) of paragraph (3), the court finds that the county agency is making progress to engage the respondent, the court may, in its discretion, grant the county agency no more than 30 additional days to continue to work with, engage, and enroll the individual in voluntary treatment and services. The county agency shall provide notice to the respondent and petitioner that an extension for filing a report has been granted.
(5)Upon receipt of the report described in subparagraph (B) of paragraph (3), the court shall, within five days, take one of the following actions:
(A)If the court determines that voluntary engagement with the respondent is effective, and that the individual has enrolled or is likely to enroll in voluntary behavioral health treatment, the court shall dismiss the matter.
(B)If the court determines that the county agencys report does not support the petitions prima facie showing that the respondent is a person described in Section 5972, the court shall dismiss the matter. This section shall not prevent a county behavioral health agency from continuing to voluntarily engage with a person not described in Section 5972 but who is in need of services and supports.
(C)If the court determines that the county agencys report does support the petitions prima facie showing that the respondent is, or may be, a person described in Section 5972, and engagement with the county agency was not effective, the court shall do all of the following:
(i)Set an initial appearance on the petition within 14 court days.
(ii)Appoint a qualified legal services project, as defined in Sections 6213 to 6214.5, inclusive, of the Business and Professions Code or, if no legal services project has agreed to accept these appointments, a public defender or other counsel working in that capacity to represent the respondent.
(iii)Order the county agency to provide notice of the initial appearance to the petitioner, the respondent, the appointed counsel, the county behavioral health agency in the county where the respondent resides, and, if different, the county where the CARE court proceedings have commenced.
(b)At the initial appearance on the petition, all of the following shall apply:
(1)The court shall permit the respondent to substitute their own counsel.
(2)Petitioner shall be present. If the petitioner is not present, the matter may be dismissed.
(3)Respondent may waive personal appearance and appear through counsel. If the respondent does not waive personal appearance and does not appear at the hearing, and the court makes a finding on the record that reasonable attempts to elicit the attendance of the respondent have failed, the court may conduct the hearing in the respondents absence if the court makes a finding on the record that conducting the hearing without the participation or presence of the respondent would be in the respondents best interest.
(4)A representative from the county behavioral health agency shall be present.
(5)If the respondent asserts that they are enrolled in a federally recognized Indian tribe or are receiving services from an Indian health care provider, a tribal court, or a tribal organization, a representative from the program, the tribe, or the tribal court shall be allowed to be present, subject to the consent of the respondent. The tribal representative shall be entitled to notice by the county of the initial appearance.
(6)(A)If the petitioner is a person other than the director of a county behavioral health agency, or their designee, the court shall issue an order relieving the original petitioner and appointing the director of the county behavioral health agency or their designee as the successor petitioner.
(B)If the original petitioner is described in subdivision (a) or (b) of Section 5974, all of the following apply:
(i)The original petitioner shall have the right to be present and make a statement at the initial hearing on the merits of the petition held pursuant to paragraph (7).
(ii)The court may, in its discretion, assign ongoing rights of notice to the original petitioner.
(iii)To the extent that the respondent consents, the court may allow the original petitioner to participate in the respondents CARE proceedings.
(iv)The original petitioner may file a new petition with the court, pursuant to Section 5974, if the matter is dismissed and there is a change in circumstances.
(C)If the original petitioner is not described in subparagraph (a) or (b) of Section 5974, the court shall not assign ongoing rights to the original petitioner, other than the right to be present and make a statement at the hearing on the merits of the petition held pursuant to paragraph (7).
(7)(A)The court shall set a hearing on the merits of the petition within 10 days, at which time the court shall determine whether, by clear and convincing evidence, the respondent meets the CARE criteria in Section 5972. In making this determination, the court shall consider all evidence properly before it, including any report from the county behavioral health agency ordered pursuant to paragraph (3) of subdivision (a) and any additional admissible evidence presented by the parties, including the petition submitted and any statement given by the original petitioner.
(B)The hearing on the merits of the petition may be conducted concurrently with the initial appearance upon stipulation of the successor petitioner and the respondent, subject to the approval by the court.
(c)(1)If, at the hearing on the merits of the petition, the court finds there is not clear and convincing evidence that the respondent meets the CARE criteria in Section 5972, the court shall dismiss the case without prejudice, unless the court makes a finding, on the record, that the original petitioners filing was not in good faith, in which case the dismissal shall be with prejudice.
(2)If, at the hearing on the merits of the petition, the court finds by clear and convincing evidence that the respondent meets the CARE criteria in Section 5972, the court shall order the county behavioral health agency to work with the respondent, the respondents counsel, and the supporter to engage the respondent in behavioral health treatment and attempt to enter into a CARE agreement. The court shall set a case management hearing within 14 days.
(3)If the respondent is enrolled in a federally recognized Indian tribe, the respondent shall provide notice of the case management hearing to the tribe, subject to the consent of the respondent.
SEC. 12.Section 5977.1 of the Welfare and Institutions Code is amended to read:5977.1.(a)(1)At the case management hearing, the court shall hear evidence as to whether the parties have entered, or are likely to enter, into a CARE agreement.
(2)If the court finds that the parties have entered, or are likely to enter, into a CARE agreement, the court shall do both of the following:
(A)Approve the terms of the CARE agreement or modify the terms of the CARE agreement and approve the agreement as modified by the court.
(B)Continue the matter and set a progress hearing for 60 days.
(b)If the court finds that the parties have not entered into a CARE agreement, and are not likely to enter into a CARE agreement, the court shall order the county behavioral health agency, through a licensed behavioral health professional, to conduct a clinical evaluation of the respondent, unless there is an existing clinical evaluation of the respondent completed within the last 30 days and the parties stipulate to the use of that evaluation. The evaluation shall address, at a minimum, the following:
(1)A clinical diagnosis of the respondent.
(2)Whether the respondent has the legal capacity to give informed consent regarding psychotropic medication.
(3)Any other information as ordered by the court or that the licensed behavioral health professional conducting the evaluation determines would help the court make future informed decisions about the appropriate care and services the respondent should receive.
(4)An analysis of recommended services, programs, housing, medications, and interventions that support the recovery and stability of the respondent.
(c)(1)The court shall set a clinical evaluation hearing to review the evaluation within 21 days. The court shall order the county to file the evaluation with the court and provide the evaluation to the respondents counsel no later than five days prior to the scheduled clinical evaluation hearing. The clinical evaluation hearing may be continued for a maximum of 14 days upon stipulation of the respondent and the county behavioral health agency, unless there is good cause for a longer extension.
(2)At the clinical evaluation review hearing, the court shall review the evaluation and other evidence from the county behavioral health agency and the respondent. The county behavioral health agency and the respondent may present evidence and call witnesses, including the person who conducted the evaluation. Only relevant and admissible evidence that fully complies with the rules of evidence may be considered by the court.
(3)At the conclusion of the hearing, the court shall determine whether the respondent, by clear and convincing evidence, meets the CARE criteria in Section 5972 and make orders as follows:
(A)If the court finds that the respondent meets the CARE criteria, the court shall order the county behavioral health agency, the respondent, and the respondents counsel and supporter to jointly develop a CARE plan within 14 days.
(B)If the court does not find that clear and convincing evidence establishes that the respondent meets the CARE criteria, the court shall dismiss the petition.
(4)If the respondent is a self-identified American Indian or Alaska Native individual, as defined in Sections 1603(13), 1603(28), and 1679(a) of Title 25 of the United States Code, has been determined eligible as an Indian under Section 136.12 of Title 42 of the Code of Federal Regulations, or is currently receiving services from an Indian health care provider or tribal court, the county behavioral health agency shall use its best efforts to meaningfully consult with and incorporate the Indian health care provider or tribal court available to the respondent to develop the CARE plan.
(5)The evaluation and all reports, documents, and filings submitted to the court shall be confidential.
(6)The date for the hearing to review and consider approval of the proposed CARE plan shall be set not more than 14 days from the date of the order to develop a CARE plan, unless the court finds good cause for an extension. The party requesting an extension of time for the CARE plan review hearing shall provide notice to the opposing party and their counsel of the request for extension of time, and the courts order if the request is granted.
(d)(1)At the CARE plan review hearing, the parties shall present their plan or plans to the court. The county behavioral health agency or the respondent, or both, may present a proposed CARE plan.
(2)After consideration of the plans proposed by the parties, the court shall adopt the elements of a CARE plan that support the recovery and stability of the respondent. The court may issue any orders necessary to support the respondent in accessing appropriate services and supports, including prioritization for those services and supports, subject to applicable laws and available funding pursuant to Section 5982. These orders shall constitute the CARE plan.
(3)A court may order medication if it finds, upon review of the court-ordered evaluation and hearing from the parties, that, by clear and convincing evidence, the respondent lacks the capacity to give informed consent to the administration of medically necessary stabilization medication. To the extent the court orders medically necessary stabilization medication, the medication shall not be forcibly administered and the respondents failure to comply with a medication order shall not result in a penalty, including, but not limited to, contempt or termination of the CARE plan pursuant to Section 5979.
(4)If the proposed CARE plan includes services and supports, such as housing, provided directly or indirectly through another local governmental entity, that local entity may agree to provide the service or support, or the court may consider a motion by either of the parties to add the local entity as a party to the CARE proceeding. If the local entity agrees to provide the service or support, it may request to be added as a party by the court.
(5)If, after presentation of the CARE plan or plans, the court determines that additional information is needed, including from a licensed behavioral health professional, the court shall order a supplemental report to be filed by the county behavioral health agency for which the court may grant a continuance of no more than 14 days, unless there is good cause for a longer extension.
(6)If there is no CARE plan because the parties have not had sufficient time to complete it, the court may grant a continuance of no more than 14 days, unless there is good cause for a longer extension.
(e)The issuance of an order approving a CARE plan pursuant to paragraph (2) of subdivision (d) begins the CARE process timeline, which shall not exceed one year.
SEC. 13.Section 5977.2 of the Welfare and Institutions Code is amended to read:5977.2.(a)(1)At intervals set by the court and not less frequently than every 60 days after the court orders the CARE plan, the court shall hold a status review hearing. The county behavioral health agency shall file with the court and serve on the respondent, and the respondents counsel and supporter, a report no fewer than five court days prior to the review hearing with the following information:
(A)The progress that the respondent has made on the CARE plan.
(B)What services and supports in the CARE plan were provided, and what services and supports were not provided.
(C)Any issues the respondent expressed or exhibited in adhering to the CARE plan.
(D)Recommendations for changes to the services and supports to make the CARE plan more successful.
(2)The respondent shall be permitted to respond to the report submitted by the county behavioral health agency and to the county behavioral health agencys testimony. The respondent shall be permitted to introduce their own information and recommendations.
(3)Subject to applicable law, intermittent lapses or setbacks described in this section of the report shall not impact access to services, treatment, or housing.
(b)The county behavioral health agency or the respondent may request, or the court upon its own motion may set, a hearing to occur at any time during the CARE process to address a change of circumstances.
SEC. 14.Section 5977.3 of the Welfare and Institutions Code is amended to read:5977.3.(a)(1)In the 11th month of the process timeline, the court shall hold a one-year status hearing. Not fewer than five court days prior to the one-year status hearing, the county behavioral health agency shall file a report with the court and shall serve the report on the respondent and the respondents counsel and supporter. The report shall include the following information:
(A)The progress that the respondent has made on the CARE plan, including a final assessment of the respondents stability.
(B)What services and supports in the CARE plan were provided, and what services and supports were not provided, over the life of the program.
(C)Any issues the respondent expressed or exhibited in adhering to the CARE plan.
(D)Recommendations for next steps, including what ongoing and additional services would benefit the respondent that the county behavioral health agency can facilitate or provide.
(2)At an evidentiary hearing, the respondent shall be permitted to respond to the report submitted by the county behavioral health agency and to the county behavioral health agencys testimony. Respondent shall be permitted to introduce their own information and recommendations. The respondent shall have the right at the hearing to call witnesses and to present evidence as to whether the respondent agrees with the report. The respondent may request either to be graduated from the program or to remain in the program.
(3)The court shall issue an order as follows:
(A)If the respondent elects to be graduated from the program, the court shall order the county behavioral health agency and the respondent to work jointly on a voluntary graduation plan. The court shall schedule a hearing in the 12th month after adoption of the CARE plan for presentation of the graduation plan. The court shall review the graduation plan and recite the terms on the record. The graduation plan shall not place additional requirements on local governmental entities and is not enforceable by the court, except that the graduation plan may, at the respondents election, include a psychiatric advance directive, which shall have the force of law. Upon completion of the hearing, the respondent shall be officially graduated from the program.
(B)If the respondent elects to remain in the CARE process, respondent may request any amount of time, up to and including one additional year. The court may permit the ongoing voluntary participation of the respondent if the court finds both of the following:
(i)The respondent did not successfully complete the CARE plan.
(ii)The respondent would benefit from continuation of the CARE plan.
(C)The court shall issue an order permitting the respondent to continue in the CARE plan or denying respondents request to remain in the CARE plan, and state its reasons in open court.
(b)The respondent may be involuntarily reappointed to the program only if the court finds, by clear and convincing evidence, that all of the following conditions apply:
(1)The respondent did not successfully complete the CARE process.
(2)All services and supports required through the CARE process were provided to the respondent.
(3)The respondent would benefit from continuation in the CARE process.
(4)The respondent currently meets the requirements in Section 5972.
(c)A respondent may only be reappointed to the CARE process once, for up to one additional year.
SEC. 15.Section 5977.4 of the Welfare and Institutions Code is amended to read:5977.4.(a)In all CARE Act proceedings, the judicial officer shall control the proceedings during the hearings with a view to the expeditious and effective ascertainment of the jurisdictional facts and the ascertainment of all information relative to the present condition and future welfare of the respondent. Except when there is a contested issue of fact or law, the proceedings shall be conducted in an informal nonadversarial atmosphere with a view to obtaining the maximum cooperation of the respondent, all persons interested in the respondents welfare, and all other parties, with any provisions that the court may make for the disposition and care of the respondent. All evaluations and reports, documents, and filings submitted to the court pursuant to CARE Act proceedings shall be confidential.
(b)The hearings described in this chapter shall occur in person unless the court, in its discretion, allows a party or witness to appear remotely through the use of remote technology. The respondent shall have the right to be in person for all hearings.
(c)Consistent with its constitutional rulemaking authority, the Judicial Council shall adopt rules to implement the policies and provisions in this section and in Sections 5977, 5977.1, 5977.2, and 5977.3 to promote statewide consistency, including, but not limited to, what is included in the petition form packet and the process by which counsel will be appointed.
SEC. 16.Section 5978 of the Welfare and Institutions Code is amended to read:5978.(a)A court may refer an individual from assisted outpatient treatment, as well as from conservatorship proceedings pursuant Chapter 3 (commencing with Section 5350) of Part 1 of Division 5 (LPS conservatorship) to CARE Act proceedings. If the individual is referred from assisted outpatient treatment, the county behavioral health director or their designee shall be the petitioner. If the individual is referred from LPS conservatorship proceedings, the conservator or proposed conservator shall be the petitioner pursuant to Section 5974.
(b)A court may refer an individual from misdemeanor proceedings pursuant to Section 1370.01 of the Penal Code to CARE Act proceedings. The county behavioral health director or their designee shall be the petitioner.
SEC. 17.Section 5981.5 of the Welfare and Institutions Code is amended to read:5981.5.(a)The Legal Services Trust Fund Commission at the State Bar shall provide funding to qualified legal services projects, as defined in Sections 6213 to 6214.5, inclusive, of the Business and Professions Code, to be used to provide legal counsel appointed pursuant to subdivision (c) of Section 5976, for representation in CARE Act proceedings, matters related to CARE agreements and CARE plans, and to qualified support centers, as defined in subdivision (b) of Section 6213 of, and Section 6215 of, the Business and Professions Code, for training, support, and coordination.
(b)For purposes of implementing this part, the Legal Services Trust Fund Commission may enter into exclusive or nonexclusive contracts, or amend existing contracts, on a bid or negotiated basis, or award grants, provided that they make a finding that both of the following are satisfied:
(1)The Legal Services Trust Fund Commission shall retain control over the distribution of funds to the contractor or grantee.
(2)The contract or grant includes provisions to ensure transparency, accountability, and oversight in delivering the services, including measurement of outcomes established pursuant to Sections 5984, 5985, and 5986.
SEC. 18.Section 5982 of the Welfare and Institutions Code is amended to read:5982.(a)The CARE plan may include only the following:
(1)Behavioral health services funded through the 1991 and 2011 Realignment, Medi-Cal behavioral health, health care plans and insurers, and services supported by the Mental Health Services Act pursuant to Part 3 (commencing with Section 5800).
(2)Medically necessary stabilization medications, to the extent not described in paragraph (1).
(3)Housing resources funded through the No Place Like Home Program (Part 3.9 (commencing with Section 5849.1) of Division 5 of the Welfare and Institutions Code); California Housing Accelerator (Chapter 6.6 (commencing with Section 50672) of Part 2 of Division 31 of the Health and Safety Code); the Multifamily Housing Program (Chapter 6.7 (commencing with Section 50675) of Part 2 of Division 31 of the Health and Safety Code); the Homeless Housing, Assistance, and Prevention Program (Chapter 6 (commencing with Section 50216) of Part 1 of Division 31 of the Health and Safety Code); the Encampment Resolution Funding Program (Chapter 7 (commencing with Section 50250) of Part 1 of Division 31 of the Health and Safety Code); the Project Roomkey and Rehousing Program pursuant to Provision 22 of Item 5180-151-0001 of the Budget Act of 2021 (Ch. 21, Stats. 2021); the Community Care Expansion Program (Chapter 20 (commencing with Section 18999.97) of Part 6 of Division 9 of the Welfare and Institutions Code); the CalWORKs Housing Support Program (Article 3.3 (commencing with Section 11330) of Chapter 2 of Part 3 of Division 9 of the Welfare and Institutions Code); the CalWORKs Homeless Assistance pursuant to clause (i) of subparagraph (A) of paragraph (2) of subdivision (f) of Section 11450 of Article 6 of Chapter 2 of Part 3 of Division 9 of the Welfare and Institutions Code; the Housing and Disability Advocacy Program (Chapter 17 (commencing with Section 18999) of Part 6 of Division 9 of the Welfare and Institutions Code); the Home Safe Program (Chapter 14 (commencing with Section 15770) of Part 3 of Division 9 of the Welfare and Institutions Code); the Bringing Families Home Program (Article 6 (commencing with Section 16523) of Chapter 5 of Part 4 of Division 9 of the Welfare and Institutions Code); the Transitional Housing Placement program for nonminor dependents (Article 4 (commencing with Section 16522) of Chapter 5 of Part 4 of Division 9 of the Welfare and Institutions Code); the Transitional Housing Program-Plus pursuant to subdivision (s) of Section 11400 and paragraph (2) of subdivision (a) of Section 11403.2 of Article 5 of Chapter 2 of Part 3 of Division 9 of the Welfare and Institutions Code and Article 4 (commencing with Section 16522) of Chapter 5 of Part 4 of Division 9 of the Welfare and Institutions Code; the Behavioral Health Continuum Infrastructure Program (Chapter 1 (commencing with Section 5960) of Part 7 of Division 5 of the Welfare and Institutions Code); the Behavioral Health Bridge Housing Program; HUD-Veterans Affairs Supportive Housing Program (Section 8(o)(19) of the United States Housing Act of 1937 [42 U.S.C. Section 1437f(o)(19)]); Supportive Services for Veteran Families (Section 604 of the Veterans Mental Health and Other Care Improvements Act of 2008 [38 U.S.C. Sec. 2044]); HUD Continuum of Care program (Section 103 of the McKinney-Vento Homeless Assistance Act [42 U.S.C. Sec. 11302]); the Emergency Solutions Grant (Subtitle B of Title IV of the McKinney-Vento Homeless Assistance Act [42 U.S.C. Secs. 11371-11378]); HUD Housing Choice Voucher program (Section 8 of the United States Housing Act of 1937 [42 U.S.C. Sec. 1437f]); the Emergency Housing Vouchers (Section 3202 of the American Rescue Plan Act of 2021 [Public Law 117-2]; Section 8(o) of the United States Housing Act of 1937 [42 U.S.C. Sec. 1437f(o)]); HOME Investment Partnerships Program (Title II of the Cranston-Gonzalez National Affordable Housing Act [42 U.S.C. Sec. 12721 et seq.]); the Community Development Block Grant Program (Title 1 of the Housing and Community Development Act of 1974 [42 U.S.C. Sec. 5301 et seq.]); housing supported by the Mental Health Services Act pursuant to Part 3 (commencing with Section 5800); community development block grants; and other state and federal housing resources.
(4)Social services funded through Supplemental Security Income/State Supplementary Payment (SSI/SSP), Cash Assistance Program for Immigrants (CAPI), CalWORKs, California Food Assistance Program, In-Home Supportive Services program, and CalFresh.
(5)Services provided pursuant to Part 5 (commencing with Section 17000) of Division 9.
(b)Individuals who are CARE process participants shall be prioritized for any appropriate bridge housing funded by the Behavioral Health Bridge Housing program.
(c)If the county behavioral health agency elects not to enroll the respondent into a full service partnership, as defined in Section 3620 of Title 9 of the California Code of Regulations, the court may request information on the reasons for this and any barriers to enrollment.
(d)All CARE plan services and supports ordered by the court are subject to available funding and all applicable federal and state statutes and regulations, contractual provisions, and policy guidance governing initial and ongoing program eligibility. In addition to the resources funded through programs listed in subdivision (a), the State Department of Health Care Services may identify other adjacent covered Medi-Cal services, including, but not limited to, enhanced care management and available community supports, which may be suggested, although not ordered, by the court, subject to all applicable federal and state statutes, regulations, contractual provisions, and policy guidance.
(e)This section does not prevent a county or other local governmental entity from recommending their own services that are their own responsibility not listed in subdivision (a) or (c). Any such recommendation is not required by this section and shall be made at the request of the county for the purposes of Section 6 of Article XIIIB, and Sections 6 and 36 of Article XIII of the California Constitution.
(f)(1)For respondents who are Medi-Cal beneficiaries, the county in which the respondent resides is the county of responsibility as defined in Section 1810.228 of Title 9 of the California Code of Regulations.
(2)If a proceeding commences in a county where the respondent is found or is facing criminal or civil proceedings that is different than the county in which the respondent resides, the county in which the respondent is found or is facing criminal or civil proceedings shall not delay proceedings under this part and is the responsible county behavioral health agency for providing or coordinating all components of the CARE agreement or CARE plan.
(3)The county in which the respondent resides, as defined in paragraph (1), shall be responsible for the costs of providing all CARE agreement or CARE plan behavioral health services, as defined in paragraph (1) of subdivision (a).
(4)In the event of a dispute over responsibility for any costs of providing components of the CARE agreement or CARE plan, the impacted counties shall resolve the dispute in accordance with the arbitration process established in Section 1850.405 of Title 9 of the California Code of Regulations for county mental health plans, including for respondents who are not Medi-Cal beneficiaries, and pursuant to any related guidance issued pursuant to subdivision (b) of Section 5984.
SEC. 19.Section 5983 of the Welfare and Institutions Code is amended to read:5983.(a)The California Health and Human Services Agency, or a designated department within the agency, shall do both of the following:
(1)Engage an independent, research-based entity, as described in Section 5986, to advise on the development of data-driven process and outcome measures to guide the planning, collaboration, reporting, and evaluation of the CARE Act pursuant to this part.
(2)Convene a working group to provide coordination and on-going engagement with, and support collaboration among, relevant state and local partners and other stakeholders throughout the phases of county implementation to support the successful implementation of the CARE Act. The working group shall meet no more than quarterly. The working group shall meet during the implementation and shall end no later than December 31, 2026.
(b)The department shall provide training and technical assistance to county behavioral health agencies to support the implementation of this part, including training regarding the CARE process, CARE agreement and plan services and supports, supported decisionmaking, the supporter role, trauma-informed care, elimination of bias, psychiatric advance directives, family psychoeducation, and data collection.
(c)The Judicial Council, in consultation with the department, other relevant state entities, and the County Behavioral Health Directors Association, shall provide training and technical assistance to judicial officers to support the implementation of this part, including training regarding the CARE process, CARE agreement and plan services and supports, working with the supporter, supported decisionmaking, the supporter role, the family role, trauma-informed care, elimination of bias, best practices, and evidence-based models of care for people with severe behavioral health conditions.
(d)The department, in consultation with other relevant state departments and the California Interagency Council on Homelessness, shall provide training to counsel regarding the CARE process and CARE agreement and plan services and supports.
SEC. 20.Section 5986 of the Welfare and Institutions Code is amended to read:5986.(a)An independent, research-based entity shall be retained by the department to develop, in consultation with county behavioral health agencies, county CARE courts, racial justice experts, and other appropriate stakeholders, including providers and CARE court participants, an independent evaluation of the effectiveness of the CARE Act. The independent evaluation shall employ statistical research methodology and include a logic model, hypotheses, comparative or quasi-experimental analyses, and conclusions regarding the extent to which the CARE Act model is associated, correlated, and causally related with the performance of the outcome measures included in the annual reports. The independent evaluation shall include results from a survey conducted of program participants. The independent evaluation shall highlight racial, ethnic, and other demographic disparities, and include causal inference or descriptive analyses regarding the impact of the CARE Act on disparity reduction efforts.
(b)The department shall provide a preliminary report to the Legislature by December 31, 2026, and a final report to the Legislature by December 31, 2028. The department shall post the preliminary and final reports on its internet website.
(c)Each county behavioral health department, each county CARE court, and any other state or local governmental entity, as determined by the department, shall provide the required data to the department, in a format and frequency as directed by the department.
(d)A report to be submitted pursuant to this section shall be submitted in compliance with Section 9795 of the Government Code.
SEC. 21.This act is an urgency statute necessary for the immediate preservation of the public peace, health, or safety within the meaning of Article IV of the California Constitution and shall go into immediate effect. The facts constituting the necessity are:
The CARE Act takes effect in October 2023, and therefore important changes to the act must take effect immediately to ensure the CARE Acts success.
This part shall be known, and may be cited, as the Community Assistance, Recovery, and Empowerment (CARE) Act.
SECTION 1.SEC. 2.Section 5970.5 of the Welfare and Institutions Code is amended to read:5970.5.This part shall be implemented as follows, with technical assistance and continuous quality improvement, pursuant to Section 5983:
(a)A first cohort of counties, which shall include the Counties of Glenn, Orange, Riverside, San Diego, Stanislaus, and Tuolumne, and the City and County of San Francisco, shall begin no later than October 1, 2023, unless the county is provided additional time pursuant to paragraph (2) of subdivision (c).
(b)A second cohort of counties, representing the remaining population of the state, shall begin no later than December 1, 2024, unless the county is provided additional time pursuant to paragraph (2) of subdivision (c).
(c)(1)The department shall issue guidelines under which counties can apply for, and be provided, additional time to implement this part. The guidelines shall not be subject to the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code).
(2)The department shall approve implementation delay for the first or second cohort if the county experiences a state or local emergency and the delay of the provision of the CARE process is necessary as a result of the emergency.
(3)The department shall only grant extensions once and no later than December 15, 2025. one extension per county and the final date for counties to implement under any circumstances shall be December 1, 2025.
(d)This part shall become operative only upon the department, in consultation with county stakeholders, developing a CARE Act allocation to provide state financial assistance to counties to implement the care process in this act.
SEC. 3.Section 5971 of the Welfare and Institutions Code is amended to read:5971.Unless the context otherwise requires, the following definitions shall govern the construction of this part.
(a)CARE agreement means a voluntary settlement agreement entered into by the parties. A CARE agreement includes the same elements as a CARE plan to support the respondent in accessing community-based services and supports.
(b)CARE plan means an individualized, appropriate range of community-based services and supports, as set forth in this part, which include clinically appropriate behavioral health care and stabilization medications, housing, and other supportive services, as appropriate, pursuant to Section 5982.
(c)CARE process means the court and related proceedings to implement the CARE Act.
(d)Counsel means the attorney representing the respondent, provided appointed pursuant to Section 5980, 5977, or chosen by the respondent, in CARE Act proceedings and matters related to CARE agreements and CARE plans. Counsels representation shall be consistent with subdivision (e) of Section 6068 of the Business and Professions Code and the California Rules of Professional Conduct.
(e)County behavioral health agency means the local director of mental health services described in Section 5607, the local behavioral health director, or both as applicable, or their designee.
(f)Court-ordered evaluation means an evaluation ordered by a superior court pursuant to Section 5977. 5977.1.
(g)Department means the State Department of Health Care Services.
(h)Graduation plan means a voluntary agreement entered into by the parties at the end of the CARE program that includes a strategy to support a successful transition out of court jurisdiction and that may include a psychiatric advance directive. A graduation plan includes the same elements as a CARE plan to support the respondent in accessing community-based services and supports. The graduation plan shall not place additional requirements on the local government entities and is not enforceable by the court.
(i)Homeless outreach worker means a person who engages people experiencing homelessness to assess for unmet needs, offer information, services, or other assistance, or provide care coordination.
(j)Indian health care provider means a health care program operated by the Indian Health Service, an Indian tribe, a tribal organization, or urban Indian organization (I/T/U) as those terms are defined in Section 4 of the Indian Health Care Improvement Act (25 U.S.C. Sec. 1603).
(k)Licensed behavioral health professional means either of the following:
(1)A licensed mental health professional, as defined in subdivision (j) of Section 4096.
(2)A person who has been granted a waiver of licensure requirements by the department pursuant to Section 5751.2.
(l)Parties means the petitioner, the respondent, the county behavioral health agency in the county where proceedings under this part are pending, and other parties any local governmental entity added by the court pursuant to paragraph (4) of subdivision (d) of Section 5977.1.
(m)Petitioner means the entity person who files the CARE Act petition with the court. Additionally, if the petitioner is a person listed in Section 5974 other than the director of a county behavioral health agency, or their designee, the petitioner shall have the right to file a petition with the court, but at the initial hearing the court shall substitute the director of a county behavioral health agency, or their designee, of the county in which the proceedings are filed as petitioner. The original petitioner who filed the petition may, at the courts discretion and in furtherance of the interests of the respondent, retain rights as described in subparagraph (A) of paragraph (7) (6) of subdivision (b) of Section 5977.
(n)Psychiatric advance directive means a legal document, executed on a voluntary basis in accordance with the requirements for advance health care directives in Division 4.7 (commencing with Section 4600) of the Probate Code, by a person who has the capacity to make medical decisions, that allows a person with mental illness to protect their autonomy and ability to self-direct direct their own care by documenting their preferences for treatment in advance of a mental health crisis.
(o)Respondent means the person who is the subject to of the petition for the CARE process.
(p)Stabilization medications means medications included in the CARE plan that primarily consist of antipsychotic medications, medications to reduce symptoms of hallucinations, delusions, and disorganized thinking. Stabilization medications may be administered as long-acting injections if clinically indicated. Stabilization medications shall not be forcibly administered.
(q)Supporter means an adult, adult designated pursuant to Chapter 4 (commencing with Section 5980), by the respondent who assists the person who is the subject of the petition, which assistance may include supporting the person to understand, make, communicate, implement, or act on their own life decisions during the CARE process, including a CARE agreement, a CARE plan, and developing a graduation plan. A supporter shall not act independently.
SEC. 4.Section 5972 of the Welfare and Institutions Code is amended to read:5972.An individual shall qualify for the CARE process only if all of the following criteria are met:
(a)The person is 18 years of age or older.
(b)The person is currently experiencing a severe mental illness, serious mental disorder, as defined in paragraph (2) of subdivision (b) of Section 5600.3 and has a diagnosis identified in the disorder class: schizophrenia spectrum and other psychotic disorders, as defined in the most current version of the Diagnostic and Statistical Manual of Mental Disorders. This section does not establish respondent eligibility based upon a psychotic disorder that is due to a medical condition or is not primarily psychiatric in nature, including, but not limited to, physical health conditions such as traumatic brain injury, autism, dementia, or neurologic conditions. A person who has a current diagnosis of substance use disorder as defined in paragraph (2) of subdivision (a) of Section 1374.72 of the Health and Safety Code, Code but who does not also meet the required criteria in this section shall not qualify for the CARE process.
(c)The person is not clinically stabilized in on-going voluntary treatment.
(d)At least one of the following is true:
(1)The person is unlikely to survive safely in the community without supervision and the persons condition is substantially deteriorating.
(2)The person is in need of services and supports in order to prevent a relapse or deterioration that would be likely to result in grave disability or serious harm to the person or others, as defined used in Section 5150.
(e)Participation in a CARE plan or CARE agreement would be the least restrictive alternative necessary to ensure the persons recovery and stability.
(f)It is likely that the person will benefit from participation in a CARE plan or CARE agreement.
SEC. 5.Section 5973 of the Welfare and Institutions Code is amended to read:5973.(a)Proceedings under this part may be commenced in any of the following:
(1)The county in which the respondent resides.
(2)The county where the respondent is found.
(3)The county where the respondent is facing criminal or civil proceedings.
(b)If the respondent does not reside in the county in which proceedings are initiated under this subdivision, as determined in accordance with Section 244 of the Government Code, except as provided in subdivision (e) (f) of Section 5982, and this part is operative in the respondents county of residence, the proceeding shall, with the respondents consent, be transferred to the county of residence as soon as reasonably feasible. Should the respondent not consent to the transfer, the proceedings shall continue in the county where the respondent was found.
SEC. 6.Section 5974 of the Welfare and Institutions Code is amended to read:5974.The following adult persons may file a petition to initiate commence the CARE process:
(a)A person with whom the respondent resides.
(b)A spouse, parent, sibling, child, or grandparent or other an individual who stands in loco parentis to the respondent.
(c)The director of a hospital, or their designee, hospital in which the respondent is hospitalized, including hospitalization hospitalized pursuant to Section 5150 or 5250. 5250, or the directors designee.
(d)The director of a public or charitable organization, agency, or home, or their designee, who has, within the previous 30 days, provided or who is currently providing behavioral health services to the respondent or in whose institution the respondent resides.
(e)A licensed behavioral health professional, or their designee, who is, or has been within the previous 30 days, either supervising the treatment of, or treating the respondent for a mental illness.
(f)A first responder, including a peace officer, firefighter, paramedic, emergency medical technician, mobile crisis response worker, or homeless outreach worker, who has had repeated interactions with the respondent in the form of multiple arrests, multiple detentions and transportation pursuant to Section 5150, multiple attempts to engage the respondent in voluntary treatment, or other repeated efforts to aid the respondent in obtaining professional assistance.
(g)The public guardian or public conservator, or their designee, of the county in which the respondent is present or reasonably believed to be present. resides or is found.
(h)The director of a county behavioral health agency, or their designee, of the county in which the respondent resides or is found.
(i)The director of county adult protective services, or their designee, of the county in which the respondent resides or is found.
(j)The director of a California Indian health services program, California tribal behavioral health department, or their designee. who has, within the previous 30 days, provided or who is currently providing behavioral health services to the respondent, or the directors designee.
(k)The judge of a tribal court that is located in California, or their designee. located in California before which the respondent has appeared within the previous 30 days, or the judges designee.
(l)The respondent.
SEC. 7.Section 5975.2 is added to the Welfare and Institutions Code, to read:5975.2.CARE Act proceedings may be conducted by a superior court judge or by a court-appointed commissioner or other subordinate judicial officer.
SEC. 8.Section 5975.3 is added to the Welfare and Institutions Code, to read:5975.3.There shall be no fee for filing under this chapter nor shall any fees be charged by any public officer for services in filing or serving papers or for the performance of any duty enjoined by the CARE Act.
SEC. 9.Section 5976 of the Welfare and Institutions Code is amended to read:5976.The respondent shall:
(a)Receive notice of the hearings.
(b)Receive a copy of the court-ordered evaluation.
(c)Be entitled to be represented by counsel at all stages of a proceeding commenced under this chapter, regardless of the ability to pay.
(d)Be allowed to have a supporter, as supporter be present with them to perform the functions described in Section 5982. Sections 5980 and 5981, subject to the limits provided in those sections.
(e)Be Have the right to be present at the hearing unless the respondent waives the right to be present. that right.
(f)Have the right to present evidence.
(g)Have the right to call witnesses.
(h)Have the right to cross-examine witnesses.
(i)Have the right to appeal decisions, and to be informed of the right to appeal.
(j)Have the right to an interpreter in all proceedings if necessary for the respondent to fully participate.
SEC. 10.Section 5976.5 of the Welfare and Institutions Code is amended to read:5976.5.(a)Notwithstanding any other law, and except as otherwise provided in this section, a hearing held under this part is presumptively closed to the public.
(b)The respondent may demand that the hearing be public and be held in a place suitable for attendance by the public.
(c)The respondent may request the presence of any family member or friend without waiving the right to keep the hearing closed to the rest of the public.
(d)A request by any other party to the proceeding to make the hearing public may be granted if the judge judicial officer conducting the hearing finds that the public interest in an open hearing clearly outweighs the respondents interest in privacy.
(e)All reports, evaluations, diagnoses, or other information related to the respondents health shall be confidential.
(f)Before commencing a hearing, the judge judicial officer shall inform the respondent of their rights under this section.
SEC. 11.Section 5977 of the Welfare and Institutions Code is amended to read:5977.(a)(1)The court shall promptly review the petition to determine if the petitioner has made a prima facie showing that the respondent is, or may be, a person described in Section 5972.
(2)If the court finds that the petitioner has not made a prima facie showing that the respondent is, or may be, a person described in Section 5972, the court may dismiss the case without prejudice subject to consideration of Section 5975.1.
(3)If the court finds that the petitioner has made a prima facie showing that the respondent is, or may be, a person described in Section 5972, the court shall do one of the following:
(A)If the petitioner is the director of a county behavioral health agency, or their designee, the court shall do the following:
(i)Set the matter for an initial appearance on the petition within 14 court days.
(ii)Appoint a qualified legal services project, as defined in Sections 6213 to 6214.5, inclusive, of the Business and Professions Code, to represent the respondent. If no legal services project has agreed to accept these appointments, a public defender or other counsel working in that capacity shall be appointed to represent the respondent. Unless replaced by respondents own counsel, appointed counsel shall represent the respondent in any proceeding under this part, and shall represent the individual, as needed, in matters related to CARE agreements and CARE plans, including appeals.
(iii)Determine if whether the petition includes all of the following information, or information and, if it does not, order the county behavioral health agency to submit a report within 14 court days that addresses includes all of the following:
(I)A determination as to whether the respondent meets, or is likely to meet, the criteria for the CARE process.
(II)The outcome of efforts made to voluntarily engage the respondent prior to the filing of the petition.
(III)Conclusions and recommendations about the respondents ability to voluntarily engage in services.
(iv)Order the county behavioral health director or their designee agency to provide notice to the respondent, the appointed counsel, and the county behavioral health agency in the county where the respondent resides, if different from the county where the CARE process has commenced.
(B)If the petitioner is a person other than the director of a county behavioral health agency, or their designee, the court shall order a county agency, or their designee, as determined by the court, to investigate, as necessary, and file a written report with the court within 14 court days and provide notice to the respondent and petitioner that a report has been ordered. The written report shall include all of the following:
(i)A determination as to whether the respondent meets, or is likely to meet, the criteria for the CARE process.
(ii)The outcome of efforts made to voluntarily engage the respondent during the 14-day report period.
(iii)Conclusions and recommendations about the respondents ability to voluntarily engage in services.
(4)If, upon a request by the county, county agency ordered to investigate and file a report under subparagraph (B) of paragraph (3), the court finds that the county agency is making progress to engage the respondent, the court may, in its discretion, grant the county agency no more than 30 additional days to continue to work with, engage, and enroll the individual in voluntary treatment and services. The county agency shall provide notice to the respondent and petitioner that an extension for filing a report has been granted.
(5)Upon receipt of the report described in subparagraph (B) of paragraph (3), the court shall, within five days, take one of the following actions:
(A)If the court determines that voluntary engagement with the respondent is effective, and that the individual has enrolled or is likely to enroll in voluntary behavioral health treatment, the court shall dismiss the matter.
(B)If the court determines that countys the county agencys report does not support the petitions prima facie showing that the respondent is a person described in Section 5972, the court shall dismiss the matter. This section shall not prevent a county behavioral health agency from continuing to voluntarily engage with individuals who do not meet CARE criteria, but who are a person not described in Section 5972 but who is in need of services and supports.
(C)If the court determines that countys the county agencys report does support the petitions prima facie showing that the respondent is, or may be, a person described in Section 5972, and engagement with the county agency was not effective, the court shall do all of the following:
(i)Set an initial appearance on the petition within 14 court days.
(ii)Appoint a qualified legal services project, as defined in Sections 6213 to 6214.5, inclusive, of the Business and Professions Code or, if no legal services project has agreed to accept these appointments, a public defender or other counsel working in that capacity to represent the respondent for all purposes related to this part, including appeals, unless the respondent has retained their own counsel. Unless replaced by respondents own counsel, appointed counsel shall represent the respondent in any proceeding under this part, and shall represent the individual, as needed, in matters related to CARE agreements and CARE plans. respondent.
(iii)Order the county agency to provide notice of the hearing initial appearance to the petitioner, the respondent, the appointed counsel, the county behavioral health agency in the county where the respondent resides, and, if different, the county where the CARE court proceedings have commenced.
(b)At the initial appearance on the petition, all of the following shall apply:
(1)The court shall permit the respondent to substitute their own counsel.
(2)Petitioner shall be present. If the petitioner is not present, the matter may be dismissed.
(3)Respondent may waive personal appearance and appear through counsel. If the respondent does not waive personal appearance and does not appear at the hearing, and the court makes a finding on the record that reasonable attempts to elicit the attendance of the respondent have failed, the court may conduct the hearing in the respondents absence if the court makes a finding on the record that conducting the hearing without the participation or presence of the respondent would be in the respondents best interest.
(4)A representative from the county behavioral health agency shall be present.
(5)A supporter may be appointed.(6)(5)If the respondent self-identifies asserts that they are enrolled in a federally recognized Indian tribe or otherwise are receiving services from an Indian health care provider, a tribal court, or a tribal organization, a representative from the program, the tribe, or the tribal court shall be allowed to be present, subject to the consent of the respondent. The tribal representative shall be entitled to notice by the county of the initial appearance.
(7)(6)(A)If the petitioner is a person described in Section 5974 other than the director of a county behavioral health agency, or their designee, the court shall issue an order relieving the original petitioner and appointing the director of the county behavioral health agency or their designee as the substitute successor petitioner.
(B)If the original petitioner who is relieved pursuant to this paragraph is described in subdivision (a) or (b) of Section 5974, all of the following apply:
(i)The original petitioner shall have the right to participate in the initial hearing to determine be present and make a statement at the initial hearing on the merits of the petition, petition held pursuant to subparagraphs (A) and (B) of paragraph (8). (7).
(ii)The court may, in its discretion, assign ongoing rights of notice. notice to the original petitioner.
(iii)The court may, additionally, allow for participation and engagement in the respondents CARE proceedings if the respondent consents.(iii)To the extent that the respondent consents, the court may allow the original petitioner to participate in the respondents CARE proceedings.
(iv)The original petitioner may file a new petition with the court, pursuant to Section 5974, if the matter is dismissed and there is a change in circumstances.
(C)If the original petitioner who is relieved pursuant this paragraph is described in Section 5974, other than persons is not described in subparagraph (a) or (b) of that section, of Section 5974, the court shall not assign ongoing rights to the entity that originally filed the CARE petition, original petitioner, other than the right to be present and make a statement at the hearing on the merits of the petition as provided in subparagraphs (A) and (B) of held pursuant to paragraph (8). (7).
(8)(7)(A)The court shall set a hearing on the merits of the petition within 10 days, at which time the court shall determine whether, by clear and convincing evidence if evidence, the respondent meets the CARE criteria in Section 5972. In making this determination, the court shall consider all evidence properly before it, including the any report from the county required behavioral health agency ordered pursuant to paragraph (3) of subdivision (a) and any additional admissible evidence presented by the parties, including the petition submitted by the petitioner who is relieved. submitted and any statement given by the original petitioner.
(B)The hearing on the merits of the petition may be conducted concurrently with the initial appearance on the petition upon stipulation of the successor petitioner and respondent and agreement by the respondent, subject to the approval by the court.
(c)(1)If, at the hearing on the merits of the petition, the court finds, by finds there is not clear and convincing evidence, evidence that the respondent does not meet meets the CARE criteria in Section 5972, the court shall dismiss the case without prejudice, unless the court makes a finding, on the record, that the initial original petitioners filing was not in good faith. faith, in which case the dismissal shall be with prejudice.
(2)If, at the hearing on the merits of the petition, the court finds that the petitioner has shown by clear and convincing evidence that the respondent meets the CARE criteria in Section 5972, the court shall order the county behavioral health agency to work with the respondent, the respondents counsel, and the supporter to engage the respondent in behavioral health treatment and determine if the parties will be able attempt to enter into a CARE agreement. The court shall set a case management hearing within 14 days.
(3)If the respondent is enrolled in a federally recognized Indian tribe, the respondent shall provide notice of the case management hearing to the tribe, subject to the consent of the respondent.
SEC. 12.Section 5977.1 of the Welfare and Institutions Code is amended to read:5977.1.(a)(1)At the case management hearing, the court shall hear evidence as to whether the parties have entered, or are likely to enter, into a CARE agreement.
(2)If the court finds that the parties have entered, or are likely to enter, into a CARE agreement, the court shall do both of the following:
(A)Approve the terms of the CARE agreement or modify the terms of the CARE agreement and approve the agreement as modified by the court.
(B)Continue the matter and set a progress hearing for 60 days.
(b)If the court finds that the parties have not entered into a CARE agreement, and are not likely to enter into a CARE agreement, the court shall order the county behavioral health agency, through a licensed behavioral health professional, to conduct a clinical evaluation of the respondent, unless there is an existing clinical evaluation of the respondent completed within the last 30 days and the parties stipulate to the use of that evaluation. The evaluation shall address, at a minimum, the following:
(1)A clinical diagnosis of the respondent.
(2)Whether the respondent has the legal capacity to give informed consent regarding psychotropic medication.
(3)Any other information as ordered by the court or that the licensed behavioral health professional conducting the evaluation determines would help the court make future informed decisions about the appropriate care and services the respondent should receive.
(4)An analysis of recommended services, programs, housing, medications, and interventions that support the recovery and stability of the respondent.
(c)(1)The court shall set a clinical evaluation hearing to review the evaluation within 21 days. The court shall order the county to file the evaluation with the court and provide the evaluation to the respondents counsel no later than five days prior to the scheduled clinical evaluation hearing. The clinical evaluation hearing may be continued for a maximum of 14 days upon stipulation of the respondent and the county behavioral health agency, unless there is good cause for a longer extension.
(2)At the clinical evaluation review hearing, the court shall review the evaluation and any other evidence from the county behavioral health agency and the respondent. The county behavioral health agency and the respondent may present evidence and call witnesses, including the person who conducted the evaluation. Only relevant and admissible evidence that fully complies with the rules of evidence may be considered by the court.
(3)At the conclusion of the hearing, the court shall determine whether the respondent, by clear and convincing evidence, meets the CARE criteria in Section 5972 and make orders as follows:
(A)If the court finds by clear and convincing evidence, after review of the evaluation and other evidence, that the respondent meets the CARE criteria, the court shall order the county behavioral health agency, the respondent, and the respondents counsel and supporter to jointly develop a CARE plan within 14 days.
(B)If the court finds, in reviewing the evaluation, does not find that clear and convincing evidence does not support establishes that the respondent meets the CARE criteria, the court shall dismiss the petition.
(4)If the respondent is a self-identified American Indian or Alaska Native individual, as defined in Sections 1603(13), 1603(28), and 1679(a) of Title 25 of the United States Code, has been determined eligible as an Indian under Section 136.12 of Title 42 of the Code of Federal Regulations, or is otherwise currently receiving services from an Indian health care provider or tribal court, the county behavioral health agency shall use its best efforts to meaningfully consult with and incorporate the Indian health care provider or tribal court available to the respondent to develop the CARE plan.
(5)The evaluation and all reports, documents, and filings submitted to the court shall be confidential.
(6)The date for the hearing to review and consider approval of the proposed CARE plan shall be set not more than 14 days from the date of the order to develop a CARE plan, unless the court finds good cause for an extension. The party requesting an extension of time for the CARE plan review hearing shall provide notice to the opposing party and their counsel of the request for extension of time, and the courts order if the request is granted.
(d)(1)At the CARE plan review hearing, the parties shall present their plan or plans to the court. The county behavioral health agency or the respondent, or both, may present a proposed CARE plan.
(2)After consideration of the plans proposed by the parties, the court shall adopt the elements of a CARE plan that support the recovery and stability of the respondent. The court may issue any orders necessary to support the respondent in accessing appropriate services and supports, including prioritization for those services and supports, subject to applicable laws and available funding pursuant to Section 5982. These orders shall constitute the CARE plan.
(3)A court may order medication if it finds, upon review of the court-ordered evaluation and hearing from the parties, that, by clear and convincing evidence, the respondent lacks the capacity to give informed consent to the administration of medically necessary stabilization medication. To the extent the court orders medically necessary stabilization medication, the medication shall not be forcibly administered and the respondents failure to comply with a medication order shall not result in a penalty, including, but not limited to, contempt or termination of the CARE plan pursuant to Section 5979.
(4)If the proposed CARE plan includes services and supports, such as housing, provided directly or indirectly through another local governmental entity, that local entity may agree to provide the service or support, or the court may consider a motion by either of the parties to add the local entity as a party to the CARE proceeding. If the local entity agrees to provide the service or support, it may request to be added as a party by the court.
(5)If, after presentation of the CARE plan or plans, the court determines that additional information is needed, including from a licensed behavioral health professional, the court shall order a supplemental report to be filed by the county behavioral health agency for which the court may grant a continuance of no more than 14 days, unless there is good cause for a longer extension.
(6)If there is no CARE plan because the parties have not had sufficient time to complete it, the court may grant a continuance of no more than 14 days, unless there is good cause for a longer extension.
(e)The issuance of an order approving a CARE plan pursuant to paragraph (2) of subdivision (d) begins the CARE process timeline, which shall not exceed one year.
SEC. 13.Section 5977.2 of the Welfare and Institutions Code is amended to read:5977.2.(a)(1)At intervals set by the court, but court and not less frequently than every 60 days after the court orders the CARE plan, the court shall hold a status review hearing. The county behavioral health agency shall file with the court and serve on the respondent, and the respondents counsel and supporter, a report not no fewer than five court days prior to the review hearing with the following information:
(A)Progress The progress that the respondent has made on the CARE plan.
(B)What services and supports in the CARE plan were provided, and what services and supports were not provided.
(C)Any issues the respondent expressed or exhibited in adhering to the CARE plan.
(D)Recommendations for changes to the services and supports to make the CARE plan more successful.
(2)The respondent shall be permitted to respond to the report submitted by the county behavioral health agency and to the county behavioral health agencys testimony. The respondent shall be permitted to introduce their own information and recommendations.
(3)Subject to applicable law, intermittent lapses or setbacks described in this section of the report shall not impact access to services, treatment, or housing.
(b)The county behavioral health agency or the respondent may request, or the court upon its own motion may set, a hearing to occur at any time during the CARE process to address a change of circumstances.
SEC. 14.Section 5977.3 of the Welfare and Institutions Code is amended to read:5977.3.(a)(1)In the 11th month of the program process timeline, the court shall hold a one-year status hearing. Not fewer than five court days prior to the one-year status hearing, the county behavioral health agency shall file a report with the court and shall serve the report on the respondent and the respondents counsel and supporter. The report shall include the following information:
(A)Progress The progress that the respondent has made on the CARE plan plan, including a final assessment of the respondents stability.
(B)What services and supports in the CARE plan were provided, and what services and supports were not provided, over the life of the program.
(C)Any issues the respondent expressed or exhibited in adhering to the CARE plan.
(D)Recommendations for next steps, including what ongoing and additional services would benefit the respondent that the county behavioral health agency can facilitate or provide.
(2)At an evidentiary hearing, the respondent shall be permitted to respond to the report submitted by the county behavioral health agency and to the county behavioral health agencys testimony. Respondent shall be permitted to introduce their own information and recommendations. The respondent shall have the right at the hearing to call witnesses and to present evidence as to whether the respondent agrees with the report. The respondent may request either to be graduated from the program or to remain in the program.
(3)The court shall issue an order as follows:
(A)If the respondent elects to be graduated from the program, the court shall order the county behavioral health agency and the respondent to work jointly on a voluntary graduation plan. The court shall schedule a hearing in the 12th month after adoption of the CARE plan for presentation of the graduation plan. The court shall review the voluntary graduation plan and recite the terms on the record. The graduation plan shall not place additional requirements on local government governmental entities and is not enforceable by the court, except that the graduation plan may, at the respondents election, include a psychiatric advance directive, which shall have the force of law. Upon completion of the hearing, the respondent shall be officially graduated from the program.
(B)If the respondent elects to remain in the CARE process, respondent may request any amount of time, up to and including one additional year. The court may permit the ongoing voluntary participation of the respondent if the court finds both of the following:
(i)The respondent did not successfully complete the CARE plan.
(ii)The respondent would benefit from continuation of the CARE plan.
(C)The court shall issue an order permitting the respondent to continue in the CARE plan or denying respondents request to remain in the CARE plan, and state its reasons on the record. in open court.
(b)The respondent may be involuntarily reappointed to the program only if the court finds, by clear and convincing evidence, that all of the following conditions apply:
(1)The respondent did not successfully complete the CARE process.
(2)All services and supports required through the CARE process were provided to the respondent.
(3)The respondent would benefit from continuation in the CARE process.
(4)The respondent currently meets the requirements in Section 5972.
(c)A respondent may only be reappointed to the CARE process once, for up to one additional year.
SEC. 15.Section 5977.4 of the Welfare and Institutions Code is amended to read:5977.4.(a)In all CARE Act proceedings, the judge judicial officer shall control the proceedings during the hearings with a view to the expeditious and effective ascertainment of the jurisdictional facts and the ascertainment of all information relative to the present condition and future welfare of the respondent. Except when there is a contested issue of fact or law, the proceedings shall be conducted in an informal nonadversarial atmosphere with a view to obtaining the maximum cooperation of the respondent, all persons interested in the respondents welfare, and all other parties, with any provisions that the court may make for the disposition and care of the respondent. All evaluations and reports, documents, and filings submitted to the court pursuant to CARE Act proceedings shall be confidential.
(b)The hearings described in this chapter shall occur in person unless the court, in its discretion, allows a party or witness to appear remotely through the use of remote technology. The respondent shall have the right to be in person for all hearings.
(c)Consistent with its constitutional rulemaking authority, the Judicial Council shall adopt rules to implement the policies and provisions in this section and in Sections 5977, 5977.1, 5977.2, and 5977.3 to promote statewide consistency, including, but not limited to, what is included in the petition form packet, the clerks review of the petition, packet and the process by which counsel will be appointed.
SEC. 16.Section 5978 of the Welfare and Institutions Code is amended to read:5978.(a)A court may refer an individual from assisted outpatient treatment, as well as from conservatorship proceedings pursuant Chapter 3 (commencing with Section 5350) of Part 1 of Division 5 (LPS conservatorship) to CARE Act proceedings. If the individual is being referred from assisted outpatient treatment, the county behavioral health director or their designee shall be the petitioner. If the individual is being referred from LPS conservatorship proceedings, the conservator or proposed conservator shall be the petitioner pursuant to Section 5974.
(b)A court may refer an individual from misdemeanor proceedings pursuant to Section 1370.01 of the Penal Code. Code to CARE Act proceedings. The county behavioral health director or their designee shall be the petitioner.
SEC. 17.Section 5981.5 of the Welfare and Institutions Code is amended to read:5981.5.(a)The Legal Services Trust Fund Commission at the State Bar shall provide funding to qualified legal services projects, as defined in Sections 6213 to 6214.5, inclusive, of the Business and Professions Code, to be used to provide legal counsel appointed pursuant to subdivision (c) of Section 5976, for representation in CARE Act proceedings, matters related to CARE agreements and CARE plans, and to qualified support centers, as defined in subdivision (b) of Section 6213 of, and Section 6215 of, the Business and Professions Code, for training, support, and coordination.
(b)For purposes of implementing this part, the Legal Services Trust Fund Commission may enter into exclusive or nonexclusive contracts, or amend existing contracts, on a bid or negotiated basis, or award grants, provided that they make a finding that both of the following are satisfied:
(1)The state agency will Legal Services Trust Fund Commission shall retain control over the distribution of funds to the contractor or grantee.
(2)The contract or grant includes provisions to ensure transparency, accountability, and oversight in delivering the services, including measurement of outcomes established pursuant to Sections 5984, 5985, and 5986.
SEC. 18.Section 5982 of the Welfare and Institutions Code is amended to read:5982.(a)The CARE plan may include only the following:
(1)Behavioral health services funded through the 1991 and 2011 Realignment, Medi-Cal behavioral health, health care plans and insurers, and services supported by the Mental Health Services Act pursuant to Part 3 (commencing with Section 5800).
(2)Medically necessary stabilization medications, to the extent not described in paragraph (1).
(3)Housing resources funded through the No Place Like Home Program (Part 3.9 (commencing with Section 5849.1) of Division 5 of the Welfare and Institutions Code); California Housing Accelerator (Chapter 6.6 (commencing with Section 50672) of Part 2 of Division 31 of the Health and Safety Code); the Multifamily Housing Program (Chapter 6.7 (commencing with Section 50675) of Part 2 of Division 31 of the Health and Safety Code); the Homeless Housing, Assistance, and Prevention Program (Chapter 6 (commencing with Section 50216) of Part 1 of Division 31 of the Health and Safety Code); the Encampment Resolution Funding Program (Chapter 7 (commencing with Section 50250) of Part 1 of Division 31 of the Health and Safety Code); the Project Roomkey and Rehousing Program pursuant to Provision 22 of Item 5180-151-0001 of the Budget Act of 2021 (Ch. 21, Stats. 2021); the Community Care Expansion Program (Chapter 20 (commencing with Section 18999.97) of Part 6 of Division 9 of the Welfare and Institutions Code); the CalWORKs Housing Support Program (Article 3.3 (commencing with Section 11330) of Chapter 2 of Part 3 of Division 9 of the Welfare and Institutions Code); the CalWORKs Homeless Assistance pursuant to clause (i) of subparagraph (A) of paragraph (2) of subdivision (f) of Section 11450 of Article 6 of Chapter 2 of Part 3 of Division 9 of the Welfare and Institutions Code; the Housing and Disability Advocacy Program (Chapter 17 (commencing with Section 18999) of Part 6 of Division 9 of the Welfare and Institutions Code); the Home Safe Program (Chapter 14 (commencing with Section 15770) of Part 3 of Division 9 of the Welfare and Institutions Code); the Bringing Families Home Program (Article 6 (commencing with Section 16523) of Chapter 5 of Part 4 of Division 9 of the Welfare and Institutions Code); the Transitional Housing Placement program for nonminor dependents (Article 4 (commencing with Section 16522) of Chapter 5 of Part 4 of Division 9 of the Welfare and Institutions Code); the Transitional Housing Program-Plus pursuant to subdivision (s) of Section 11400 and paragraph (2) of subdivision (a) of Section 11403.2 of Article 5 of Chapter 2 of Part 3 of Division 9 of the Welfare and Institutions Code and Article 4 (commencing with Section 16522) of Chapter 5 of Part 4 of Division 9 of the Welfare and Institutions Code; the Behavioral Health Continuum Infrastructure Program (Chapter 1 (commencing with Section 5960) of Part 7 of Division 5 of the Welfare and Institutions Code); the Behavioral Health Bridge Housing Program; HUD-Veterans Affairs Supportive Housing Program (Section 8(o)(19) of the United States Housing Act of 1937 [42 U.S.C. Section 1437f(o)(19)]); Supportive Services for Veteran Families (Section 604 of the Veterans Mental Health and Other Care Improvements Act of 2008 [38 U.S.C. Sec. 2044]); HUD Continuum of Care program (Section 103 of the McKinney-Vento Homeless Assistance Act [42 U.S.C. Sec. 11302]); the Emergency Solutions Grant (Subtitle B of Title IV of the McKinney-Vento Homeless Assistance Act [42 U.S.C. Secs. 11371-11378]); HUD Housing Choice Voucher program (Section 8 of the United States Housing Act of 1937 [42 U.S.C. Sec. 1437f]); the Emergency Housing Vouchers (Section 3202 of the American Rescue Plan Act of 2021 [Public Law 117-2]; Section 8(o) of the United States Housing Act of 1937 [42 U.S.C. Sec. 1437f(o)]); HOME Investment Partnerships Program (Title II of the Cranston-Gonzalez National Affordable Housing Act [42 U.S.C. Sec. 12721 et seq.]); the Community Development Block Grant Program (Title 1 of the Housing and Community Development Act of 1974 [42 U.S.C. Sec. 5301 et seq.]); housing supported by the Mental Health Services Act pursuant to Part 3 (commencing with Section 5800); community development block grants; and other state and federal housing resources.
(4)Social services funded through Supplemental Security Income/State Supplementary Payment (SSI/SSP), Cash Assistance Program for Immigrants (CAPI), CalWORKs, California Food Assistance Program, In-Home Supportive Services program, and CalFresh.
(5)Services provided pursuant to Part 5 (commencing with Section 17000) of Division 9.
(b)Individuals who are CARE process participants shall be prioritized for any appropriate bridge housing funded by the Behavioral Health Bridge Housing program.
(c)If the county behavioral health agency elects not to enroll the respondent into a full service partnership, as defined in Section 3620 of Title 9 of the California Code of Regulations, the court may request information on the reasons for this and any barriers to enrollment.
(d)All CARE plan services and supports ordered by the court are subject to available funding and all applicable federal and state statutes and regulations, contractual provisions, and policy guidance governing initial and ongoing program eligibility. In addition to the resources funded through programs listed in subdivision (a), the State Department of Health Care Services may identify other adjacent covered Medi-Cal services, including, but not limited to, enhanced care management and available community supports, which may be suggested, although not ordered, by the court, subject to all applicable federal and state statutes, regulations, contractual provisions, and policy guidance.
(e)This section does not prevent a county or other local government governmental entity from recommending their own services that are their own responsibility not listed in subdivision (a) or (c). Any such recommendation is not required by this section and shall be made at the request of the county for the purposes of Section 6 of Article XIIIB, and Sections 6 and 36 of Article XIII of the California Constitution.
(f)(1)For respondents who are Medi-Cal beneficiaries, the county in which the respondent resides is the county of responsibility as defined in Section 1810.228 of Title 9 of the California Code of Regulations.
(2)If a proceeding commences in a county where the respondent is found or is facing criminal or civil proceedings that is different than the county in which the respondent resides, the county in which the respondent is found or is facing criminal or civil proceedings shall not delay proceedings under this part and is the responsible county behavioral health agency for providing or coordinating all components of the CARE agreement or CARE plan.
(3)The county in which the respondent resides, as defined in paragraph (1), shall be responsible for the costs of providing all CARE agreement or CARE plan behavioral health services, as defined in paragraph (1) of subdivision (a).
(4)In the event of a dispute over responsibility for any costs of providing components of the CARE agreement or CARE plan, the impacted counties shall resolve the dispute in accordance with the arbitration process established in Section 1850.405 of Title 9 of the California Code of Regulations for county mental health plans, including for respondents who are not Medi-Cal beneficiaries, and pursuant to any related guidance issued pursuant to subdivision (b) of Section 5984.
SEC. 19.Section 5983 of the Welfare and Institutions Code is amended to read:5983.(a)The California Health and Human Services Agency, or a designated department within the agency, shall do both of the following:
(1)Engage an independent, research-based entity, as described in Section 5986, to advise on the development of data-driven process and outcome measures to guide the planning, collaboration, reporting, and evaluation of the CARE Act pursuant to this part.
(2)Convene a working group to provide coordination and on-going engagement with, and support collaboration among, relevant state and local partners and other stakeholders throughout the phases of county implementation to support the successful implementation of the CARE Act. The working group shall meet no more than quarterly. The working group shall meet during the implementation and shall end no later than December 31, 2026.
(b)The department shall provide training and technical assistance to county behavioral health agencies to support the implementation of this part, including training regarding the CARE process, CARE agreement and plan services and supports, supported decisionmaking, the supporter role, trauma-informed care, elimination of bias, psychiatric advance directives, family psychoeducation, and data collection.
(c)The Judicial Council, in consultation with the department, other relevant state entities, and the County Behavioral Health Directors Association, shall provide training and technical assistance to judges judicial officers to support the implementation of this part, including training regarding the CARE process, CARE agreement and plan services and supports, working with the supporter, supported decisionmaking, the supporter role, the family role, trauma-informed care, elimination of bias, best practices, and evidence-based models of care for people with severe behavioral health conditions.
(d)The department, in consultation with other relevant state departments and the California Interagency Council on Homelessness, shall provide training to counsel regarding the CARE process and CARE agreement and plan services and supports.
SEC. 20.Section 5986 of the Welfare and Institutions Code is amended to read:5986.(a)An independent, research-based entity shall be retained by the department to develop, in consultation with county behavioral health agencies, county CARE courts, racial justice experts, and other appropriate stakeholders, including providers and CARE court participants, an independent evaluation of the effectiveness of the CARE Act. The independent evaluation shall employ statistical research methodology and include a logic model, hypotheses, comparative or quasi-experimental analyses, and conclusions regarding the extent to which the CARE Act model is associated, correlated, and causally related with the performance of the outcome measures included in the annual reports. The independent evaluation shall include results from a survey conducted of program participants. The independent evaluation shall highlight racial, ethnic, and other demographic disparities, and include causal inference or descriptive analyses regarding the impact of the CARE Act on disparity reduction efforts.
(b)The department shall provide a preliminary report to the Legislature three years after the implementation date of the CARE Act by December 31, 2026, and a final report to the Legislature five years after the implementation date of CARE Act. by December 31, 2028. The department shall post the preliminary and final reports on its internet website.
(c)Each county behavioral health department, each county CARE court, and any other state or local governmental entity, as determined by the department, shall provide the required data to the department, in a format and frequency as directed by the department.
(d)A report to be submitted pursuant to this section shall be submitted in compliance with Section 9795 of the Government Code.
This part shall be implemented as follows, with technical assistance and continuous quality improvement, pursuant to Section 5983:
(a)A first cohort of counties, which shall include the Counties of Glenn, Orange, Riverside, San Diego, Stanislaus, and Tuolumne, and the City and County of San Francisco, shall begin no later than October 1, 2023, unless the county is provided additional time pursuant to paragraph (2) of subdivision (c).
(b)A second cohort of counties, representing the remaining population of the state, shall begin no later than December 1, 2024, unless the county is provided additional time pursuant to paragraph (2) of subdivision (c).
(c)(1)The department shall issue guidelines under which counties can apply for, and be provided, additional time to implement this part. The guidelines shall not be subject to the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code).
(2)The department shall approve implementation delay for the first or second cohort if the county experiences a state or local emergency and the delay of the provision of the CARE process is necessary as a result of the emergency.
(3)The department shall only grant extensions once and no later than December 1, December 15, 2025.
(d)This part shall become operative only upon the department, in consultation with county stakeholders, developing a CARE Act allocation to provide state financial assistance to counties to implement the care process in this act.
SECTION 1.Section 5973 of the Welfare and Institutions Code, as added by Chapter 319 of the Statutes of 2022, is amended to read:5973.(a)A proceeding under this part may be commenced in any of the following:(1)The county in which the respondent resides.(2)The county where the respondent is found.(3)The county where the respondent is facing criminal or civil proceedings.(b)If the respondent does not reside in the county in which a proceeding is initiated under this subdivision, as determined in accordance with Section 244 of the Government Code, except as provided in subdivision (e) of Section 5982, and this part is operative in the respondents county of residence, the proceeding shall, with the respondents consent, be transferred to the county of residence as soon as reasonably feasible. Should the respondent not consent to the transfer, the proceedings shall continue in the county where the respondent was found.(a)Proceedings A proceeding under this part may be commenced in any of the following:
(1)The county in which the respondent resides.
(2)The county where the respondent is found.
(3)The county where the respondent is facing criminal or civil proceedings.
(b)If the respondent does not reside in the county in which proceedings are a proceeding is initiated under this subdivision, as determined in accordance with Section 244 of the Government Code, except as provided in subdivision (e) of Section 5982, and this part is operative in the respondents county of residence, the proceeding shall, with the respondents consent, be transferred to the county of residence as soon as reasonably feasible. Should the respondent not consent to the transfer, the proceedings shall continue in the county where the respondent was found.
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Date
|
Status
|
|---|---|
| Sep 30, 2023 | Chaptered by Secretary of State. Chapter 283, Statutes of 2023. |
| Sep 30, 2023 | Approved by the Governor. |
| Sep 21, 2023 | Enrolled and presented to the Governor at 4 p.m. |
| Sep 14, 2023 | Urgency clause adopted. |
| Sep 14, 2023 | Assembly amendments concurred in. (Ayes 40. Noes 0. Page 2795.) Ordered to engrossing and enrolling. |
| Sep 13, 2023 | From committee: That the Assembly amendments be concurred in. (Ayes 9. Noes 0. Page 2770.) |
| Sep 12, 2023 | From committee: Be re-referred to Com. on JUD. pursuant to Senate Rule 29.10(d). (Ayes 4. Noes 0. Page 2683.) Re-referred to Com. on JUD. |
| Sep 12, 2023 | Re-referred to Com. on RLS pursuant to Senate Rule 29.10(d). |
| Sep 12, 2023 | In Senate. Concurrence in Assembly amendments pending. |
| Sep 12, 2023 | Read third time. Urgency clause adopted. Passed. (Ayes 78. Noes 0. Page 3290.) Ordered to the Senate. |
| Sep 11, 2023 | Read second time. Ordered to third reading. |
| Sep 8, 2023 | Read second time and amended. Ordered to second reading. |
| Sep 7, 2023 | From committee: Do pass as amended. (Ayes 16. Noes 0.) (September 7). |
| Sep 6, 2023 | Joint Rule 62(a) suspended. |
| Sep 6, 2023 | Assembly Rule 56 suspended. |
| Sep 5, 2023 | From committee: Do pass and re-refer to Com. on APPR. (Ayes 11. Noes 0.) (September 5). Re-referred to Com. on APPR. |
| Aug 28, 2023 | Read third time and amended. |
| Aug 28, 2023 | Re-referred to Coms. on P. & C.P. and APPR. pursuant to Assembly Rule 77.2. |
| Aug 28, 2023 | Ordered to third reading. |
| Aug 24, 2023 | From consent calendar on motion of Assembly Member Bryan. |
| Aug 24, 2023 | Ordered to third reading. |
| Aug 24, 2023 | Read second time. Ordered to consent calendar. |
| Aug 23, 2023 | From committee: Do pass. Ordered to consent calendar. (Ayes 15. Noes 0.) (August 23). |
| Jul 12, 2023 | Read second time and amended. Re-referred to Com. on APPR. |
| Jul 11, 2023 | From committee: Do pass as amended and re-refer to Com. on APPR. (Ayes 10. Noes 0.) (July 11). |
| Jun 15, 2023 | Re-referred to Com. on JUD. pursuant to Assembly Rule 96. |
| Jun 12, 2023 | From committee with author's amendments. Read second time and amended. Re-referred to Com. on HEALTH. |
| May 11, 2023 | Referred to Com. on HEALTH. |
| May 4, 2023 | In Assembly. Read first time. Held at Desk. |
| May 4, 2023 | Read third time. Passed. (Ayes 37. Noes 0. Page 1003.) Ordered to the Assembly. |
| May 2, 2023 | Read second time. Ordered to consent calendar. |
| May 1, 2023 | From committee: Be ordered to second reading pursuant to Senate Rule 28.8 and ordered to consent calendar. |
| Apr 21, 2023 | Set for hearing May 1. |
| Apr 20, 2023 | From committee: Do pass and re-refer to Com. on APPR with recommendation: To consent calendar. (Ayes 11. Noes 0. Page 831.) (April 19). Re-referred to Com. on APPR. |
| Apr 3, 2023 | Set for hearing April 19. |
| Mar 29, 2023 | Re-referred to Com. on HEALTH. |
| Mar 21, 2023 | From committee with author's amendments. Read second time and amended. Re-referred to Com. on RLS. |
| Jan 18, 2023 | Referred to Com. on RLS. |
| Dec 6, 2022 | From printer. May be acted upon on or after January 5. |
| Dec 5, 2022 | Introduced. Read first time. To Com. on RLS. for assignment. To print. |
|
Date
|
Description
|
Location
|
Votes
|
|
|---|---|---|---|---|
| Sep 14, 2023 | Unfinished Business SB35 Umberg Urgency Clause Concurrence | Senate Floor |
Passed |
|
| Sep 13, 2023 | That the Assembly amendments be concurred in | Senate Standing Committee on Judiciary |
Passed |
|
| Sep 12, 2023 | SB 35 Umberg Third Reading Urgency By Gipson | Assembly Floor |
Passed |
|
| Sep 7, 2023 | Do pass as amended. | Assembly Standing Committee on Appropriations |
Passed |
|
| Sep 5, 2023 | Do pass and be re-referred to the Committee on [Appropriations] | Assembly Standing Committee on Privacy and Consumer Protection |
Passed |
|
| Aug 23, 2023 | Do pass. To Consent Calendar. | Assembly Standing Committee on Appropriations |
Passed |
|
| Jul 11, 2023 | Do pass as amended and be re-referred to the Committee on [Appropriations] | Assembly Standing Committee on Judiciary |
Passed |
|
| May 4, 2023 | Consent Calendar SB35 Umberg | Senate Floor |
Passed |
|
| Apr 19, 2023 | Do pass, but first be re-referred to the Committee on [Appropriations] with the recommendation: To Consent Calendar | Senate Standing Committee on Health |
Passed |
This list shows positions taken on this bill by organizations on the date displayed, which is linked to the original source.
Positions by individuals are not included.
|
Organization
|
Position
|
Date
|
|---|---|---|
| Aclu California Action | ** Against | |
| California State ASsociaiton of Counties | * Support | Sep 13, 2023 |
| California State Association Of Counties | ** Support | |
| Dbsa California | ** Against | |
| Depression and Bipolar Support Alliance of California | * Against | Sep 5, 2023 |
| Disability Rights California | ** Against | |
| Electronic Frontier Foundation | ** Against | |
| Families Advocating for the Seriously Mentally Ill | ** Support | |
| National Alliance on Mental Illness, NAMI California | * Against | Jul 11, 2023 |
| Rural County Representatives of California | ** Support | |
| University of California Berkeley | * Against | Jul 11, 2023 |
| Urban Counties of California | ** Support |
Senator Thomas Umberg, Chair
2023-2024 Regular Session
Bill No: SB 35 (Author:Umberg)
Version: September 8, 2023
Hearing Date: September 13, 2023
Fiscal: Yes
Urgency: Yes
Consultant: AWM
PURSUANT TO SENATE RULE 29.10(d)
SUBJECT
Community Assistance, Recovery, and Empowerment (CARE) Court Program
DIGEST
This bill modifies the Community, Assistance, Recovery, and Empowerment (CARE) Act, which requires certain counties to implement the CARE Court Program beginning October 1, 2023.
EXECUTIVE SUMMARY
In 2022, the Legislature enacted, and the Governor signed, SB 1338 (Umberg, Ch. 319, Stats. 2022), known as the CARE Act, which is intended to deliver mental health and substance use disorder services for persons with certain severe mental illness diagnoses as an alternative to incarceration in a jail or psychiatric facility or to being subjected to a conservatorship under the Lanterman-Petris-Short (LPS) Act (Welf. & Inst. Code, div. 5, pt. 1, §§ 5000 et seq.). The CARE Act provides for court-ordered CARE Plans for qualified persons suffering from a mental health or substance abuse disorder crisis for up to 12 months, with possible extensions. The plan is supposed to provide individuals with clinically appropriate, community-based services. A cohort of seven counties will implement the CARE Act by October 1, 2023; the remaining counties will implement the CARE Act by December 1, 2024.
This bill is intended to clean up the CARE Act and address concerns raised by certain stakeholders in advance of the implementation date. Among other things, the bill is intended to provide protections for county entities that are obligated to obtain medical information about CARE Act respondents and ensure that the CARE Act does not inadvertently run afoul of state and federal law. When this bill left the Senate, it did not include matter within the jurisdiction of this Committee. The bill was then amended in the Assembly to add changes to the CARE Court process and provisions relating to the disclosure of medical records, which are matters within this Committee’s jurisdiction. Accordingly, this bill was referred to this Committee pursuant to Senate Rule 29.10(d) when it returned to the Senate.
This bill is sponsored by the author and is supported by the California State Association of Counties, Rural County Representatives of California, and Urban Counties of California. This bill is opposed by ACLU California Action, Disability Rights California, and the Electronic Frontier Foundation.
PROPOSED CHANGES TO THE LAW
Existing state law:
- Establishes the CARE Act. (Welf. & Inst. Code, div. 5, pt. 8, §§ 5970 et seq.)
- Defines the following relevant terms:
- “Care agreement” is a voluntary settlement agreement entered into by the parties, and includes the same elements as a CARE plan to support the respondent in accessing community-based services and supports.
- “Care plan” is an individualized, appropriate range of community-based services and supports, which include clinically appropriate behavioral health care and stabilization medications, housing, and other supportive services, as appropriate.
- “CARE process” is the court and related proceedings to implement the CARE Act.
- “Department” is the State Department of Health Care Services (DHCS).
- “Petitioner” is the entity who files a CARE Act petition with the court; if the petitioner is a person other than the director of a county behavioral health agency (CBHA), or their designee, the court shall substitute the director or their designee for the county in which the proceedings are filed as the petitioner at the first hearing.
- “Psychiatric advance directive” is a legal document, executed on a voluntary basis by a person who has the capacity to make medical decisions, that allows a person with mental illness to protect their autonomy and ability to self-direct care by documenting their preferences for treatment in advance of a mental health crisis.
- “Respondent” is the person who is subject to the petition for the CARE process.
- “Supporter” is an adult, designated as specified, who assists the person who is the subject of the petition, which may include supporting the person to understand, make, communicate, implement, or act on their own life decisions during the CARE process; a supporter may not act independently. (Welf. & Inst. Code, § 5971.)
- Provides that the CARE Act shall be implemented as follows:
- A first cohort of counties, including Glenn, Orange, Riverside, San Diego, Stanislaus, Tuolumne, and the City and County of San Francisco, shall begin no later than October 1, 2023.
- A second cohort of counties, representing the remaining counties in the state, shall begin no later than December 1, 2024.
- DHCS shall issue guidelines under which counties can apply for, and be provided, additional time in which to implement the CARE Act, subject to certain conditions and restrictions. (Welf. & Inst. Code, § 5970.5.)
- Establishes criteria for a person to qualify for the CARE process, including that the person is 18 years of age or older; the person is experiencing a severe mental illness and has a diagnosis in the disorder class of schizophrenia spectrum and other psychotic disorders; the person is not clinically stabilized in ongoing voluntary treatment; and participation in a CARE plan or agreement would be the least restrictive alternative necessary to ensure the person’s recovery and stability. (Welf. & Inst. Code, § 5972.)
- Provides that the following adult persons may file a petition to initiate the CARE process:
- A person with whom the respondent resides.
- A spouse, parent, sibling, child, or grandparent or other individual who stands in loco parentis to the respondent.
- The director of a hospital, or their designee, in which the respondent is hospitalized, including pursuant to certain temporary holds under the LPS Act.
- The director of a public or charitable home, or a licensed behavioral health professional, or their designee, who has had a specified interaction with the respondent within the previous 30 days.
- A first responder, as specified, who has had repeated interactions with the respondent in the form of multiple arrests, multiple detentions and transportations pursuant to the LPS Act, multiple attempts to engage the respondent in the form of voluntary treatment, or other repeated efforts to aid the respondent in obtaining professional assistance.
- The public guardian or public conservator, or their designee, of the county in which the respondent is present or reasonably believed to be present.
- The director of a CBHA or county adult protective services, or their designee, of the county in which the respondent resides or is found.
- The director of a California Indian health services program, California tribal behavioral health department, or their designee.
- The judge of a tribal court that is located in California, or their designee.
- The respondent. (Welf. & Inst. Code, § 5974.)
- Allows a court, if a criminal defendant is found to be mentally incompetent and ineligible for a diversion, to refer the defendant to the CARE program, as provided. (Pen. Code, § 1370.1(b)(1)(D)(iv).)
- Requires the Judicial Council to create a mandatory court form to file a CARE process petition, together with any other forms necessary during the CARE process. The petition must be signed under penalty of perjury and set forth specified information, including either an affidavit of a licensed behavioral health professional setting forth specified information about the respondent, or evidence that the respondent was detained for a minimum of two intensive treatments pursuant to the LPS Act, the most recent of which was no more than 60 days prior to the date of the petition. (Welf. & Inst. Code, § 5975.)
- Establishes requirements for the jurisdiction in which a CARE Act petition may be filed, for the filing of a CARE Act petition, and for instances in which a CARE Act petition is filed to harass the respondent. (Welf. & Inst. Code, §§ 5973, 5975, 5975.1.)
- Establishes the rights of the respondent, including the right to be represented by counsel at all stages of a CARE proceeding, regardless of ability to pay. (Welf. & Inst. Code, § 5976.)
- Establishes that the respondent has the following rights:
- To receive notice of the CARE hearings.
- To receive a copy of the court-ordered evaluation.
- To be represented by counsel at all stages of a proceeding commenced under this chapter, regardless of the ability to pay.
- To be allowed to have a supporter.
- To be present at the hearing unless they waive the right to be present.
- To present evidence.
- To call witnesses.
- To cross-examine witnesses.
- To appeal decisions, and to be informed of the right to appeal. (Welf. & Inst. Code, § 5976.)
- Provides for the following regarding CARE Act hearings:
- Establishes that hearings are presumptively closed to the public, but permits the respondent to demand that the hearings be public.
- Permits the respondent to request the presence of a family member or friend without waiving the right to keep the hearing closed to the rest of the public.
- Permits the court to grant a request by another party to make a hearing public if the judge conducting the hearing finds that the public interest clearly outweighs the respondent’s interest in privacy.
- Declares that all reports, evaluations, diagnoses, or other information related to the respondent’s health shall be confidential.
- Requires the judge, before commencing a hearing, to inform the respondent of their rights under this section. (Welf. & Inst. Code, § 5976.5.)
- Requires the court, upon receipt of a CARE Act petition, to promptly review it to determine whether a prima facie showing has been made that the respondent is or may be a person described in 6), and then do one of the following:
- If the court finds the petitioner has not made the required prima facie showing, then dismiss the case without prejudice. (Welf. & Inst. Code § 5977(a)(2).)
- If the court finds the petitioner has made the required prima facie showing, and the petitioner is the director of a CBHA, then the court must do all of the following:
- Set the matter for initial hearing within 14 court days.
- Appoint counsel.
- Determine if the petition includes a determination as to whether the respondent meets the criteria for the CARE process and is willing to engage voluntarily with services, and, if not, order the county to submit a report containing this information within 14 court days.
- Require notice be provided to the respondent, respondent’s counsel, and the CBHA where the respondent resides. (Welf. & Inst. Code § 5977(a)(3)(A).)
- If the court finds the petitioner has made the required prima facie showing, but the petitioner is not a CBHA, then the court must do all of the following:
- Order a county agency to investigate whether the respondent meets the criteria for the CARE process and is willing to engage voluntarily with services.
- File a written report with the court within 14 court days.
- Provide notice to the respondent and the petitioner that a report has been ordered.
- Upon receipt of the report, within 5 days, do one of the following:
- If the county’s report does not support a prima facie showing under 6), or if the county determines that the respondent has enrolled or is likely to enroll in voluntary behavioral health treatment, dismiss the matter.
- If the county’s report does support a prima facie showing under 6), set the matter for initial hearing within 14 court days, appoint counsel, and order the county to provide notice of the hearing as specified. (Welf. & Inst. Code § 5977 (a)(3)(B).)
- Establishes procedures and requirements for the following:
- Initial hearing on a CARE Act petition. (Welf. & Inst. Code, § 5977(b).)
- Hearing on the merits of the petition. (Welf. & Inst. Code, § 5977(c).)
- Case management hearing. (Welf. & Inst. Code, § 5977.1(a).)
- Clinical evaluation review hearing. (Welf. & Inst. Code, § 5977.1(c).)
- Hearing to review proposed CARE plans. (Welf. & Inst. Code, § 5977.1(d).)
- Status review hearing that occurs at least every 60 days during the one-year (potentially two-year) CARE plan implementation. (Welf. & Inst. Code, §§ 5977.2, 5977.3.)
- Allows the court, at any point during CARE proceedings, if it determines, by clear and convincing evidence, that the respondent, after receiving notice, is not participating in the CARE process or is not adhering to their CARE plan, to terminate respondent’s participation. The court is then permitted to make a referral under the LPS Act, as provided. (Welf. & Inst. Code § 5979(a).)
- Provides that, if a respondent was timely provided with all services and supports required by their CARE plan, the fact that the respondent failed to successfully complete the plan and reasons for that failure (a) are facts to be considered by a court in a subsequent hearing under the LPS Act, provided that the hearing occurs within six months of termination of the CARE plan; and (b) create a presumption at that hearing that the respondent needs additional interventions beyond the supports and services provided by the CARE plan. (Welf. & Inst. Code, § 5979(a)(3).)
- Creates a process for penalizing counties or other local government entities that do not comply with CARE court orders. (Welf. & Inst. Code § 5979(b).)
- Provides that either a respondent or a CBHA may appeal an adverse court determination. (Welf. & Inst. Code, § 5979(c).)
- Establishes the LPS Act to end inappropriate, indefinite, and involuntary commitment of mentally disordered persons, developmentally disabled persons, and persons impaired by chronic alcoholism, and to provide prompt evaluation and treatment of those with mental health disorders or impaired by chronic alcoholism. (Welf. & Inst. Code, div. 5, pt. 1, §§ 5000 et seq.)
- Establishes the Confidentiality of Medical Information Act (CMIA). (Civ. Code, §§ 56-56.37.)
- Defines the term “provider of health care” under CMIA to include medical practitioners licensed under state law, as specified, or a clinic, health dispensary, or health facility licensed under state law, as specified. (Civ. Code, § 56.05(o).)
- Prohibits a provider of health care, health care service plan, or contractor from disclosing medical information regarding a patient without first obtaining an authorization, subject to specified exceptions, including where disclosure is compelled by a court order, a subpoena, the patient, or otherwise specifically required by law. (Civ. Code, § 56.10.)
Existing federal law:
- Establishes the Health Insurance Portability and Accountability Act of 1996 (HIPAA), which, among other things, sets standards for the privacy of individually identifiable health information and security standards for the protection of electronically transmitted health information. (Pub. L. 104-191, 110 Stat. 1936.)
- Provides that if a HIPAA provision conflicts with state law, the provision that is most protective of patient privacy prevails. (45 C.F.R. 160.203.)
- Defines the term “covered entity” under HIPAA as a health plan, a health care clearinghouse, or a health care provider who transmits any health information in electronic form in connection with a transaction covered by HIPAA. (45 C.F.R. § 160.103.)
This bill:
- Requires, after a criminal court has referred a defendant to the CARE program, the hearing to determine the defendant’s eligibility to be held within 14 court days after the date on which the petition for the referral is filed.
- Specifies that a county shall be granted only one extension for implementing the CARE Act. The final date for implementation under any circumstances is December 1, 2025.
- Clarifies that legal representation of a respondent in CARE Act proceedings, and in matters related to CARE agreements and CARE plans, does not alter an attorney’s obligations under the State Bar Act and the California Rules of Professional Conduct, including obligations relating to the attorney’s duty of confidentiality.
- Defines “legal proceeding” as any administrative, civil, or criminal proceeding, including, but not limited to, juvenile courts and family court proceedings and services, and any form of alternative dispute resolution, including arbitration and mediation, except for: (1) a CARE Act proceeding; (2) an LPS Act proceeding; (3) a proceeding from which the respondent was referred to CARE Act proceedings, as specified; (4) an attorney disciplinary hearing, as defined; or (5) an appeal of any of the proceedings identified in (1)-(4).
- Makes clarifications regarding the parties, as follows:
- “Parties” include any local government entity added by the court, as specified.
- “Petitioner” means the person who files the initial CARE petition; the original petitioner may retain specified rights, at the court’s discretion.
- Clarifies when certain individuals may file a CARE petition, including:
- A public guardian or public conservator, or their designee, of a county may file a petition if the respondent resides or is found in that county.
- The director or a Californian Indian health services program, California tribal behavioral health department, or their designee may file a petition if they have provided, within the previous 30 days, or are providing behavioral services to the respondent.
- The judge of a tribal court, or their designee, located in California may file a petition if the respondent has appeared before the judge within the prior 30 days.
- Provides that, if a person other than the respondent files a petition for a CARE Act proceeding in order to gain an advantage over the respondent in another legal proceeding, then, notwithstanding any other provision of the CARE Act, it is cause for suspension, disbarment, or other discipline if a member of the State Bar is found to have filed the petition or assisted in the filing of the petition with knowledge that the filing was being made in order to gain that advantage. For purposes of this provision, “legal provision” does not include a proceeding under the LPS Act or a dependency proceeding.
- Authorizes a CARE Act proceeding to be conducted by a superior court judge, a court-appointed commissioner, or other subordinate juvenile officer.
- Provides that there shall be no filing fee for any CARE Act filing, nor shall any fees by charged by any public officer for services in filing or serving papers or for the performance of any duty enjoined by the CARE Act.
- Adds and clarifies, to the list rights held by a respondent in a CARE proceeding, the rights to:
- Have a supporter be present with them to perform the functions of a supporter as provided for in the CARE Act.
- Have an interpreter present in all proceedings if necessary for the respondent to fully participate.
- Clarifies that all reports, evaluations, or other information filed with the court related to the respondent’s health shall be confidential, and permits the respondent, at any time, to petition the court for an order sealing those records or any other court records in a CARE Act proceeding. Notwithstanding any rule of court prohibiting records kept confidential by law from consideration for sealing, there is a presumption in favor of sealing the records if such a petition is filed.
- Provides that the fact that evidence is admitted at a proceeding held under the CARE Act shall not be the basis for admission of that evidence in any subsequent legal proceeding.
- Provides that photographs, recordings, transcripts, other records of proceedings held under the CARE Act, and testimony regarding proceedings held pursuant to the CARE Act, shall not be admissible in any subsequent legal proceeding except upon motion by one of the following in that subsequent legal proceeding:
- The respondent; or
- The CBHA, the public guardian, or the public conservator.
- Provides that, in a CARE Act proceeding, the provisions relating to confidentiality of records and their use in subsequent proceedings do not affect the applicability of Welfare and Institutions Code section 5977.1(c)(2), make admissible any evidence that is not otherwise admissible, or permit a witness to base an opinion on any matter that is not a proper basis for that opinion. The admission or exclusion of evidence shall be pursuant to the rules of evidence established by the Evidence Code, including, but not limited to, Section 352 of the Evidence Code, and by judicial decision.
- Allows, in lieu of the appointment of a public defender to represent the respondent, for the appointment of counsel “working in [the] capacity” of a public defender to represent the respondent.
- Requires, when a petition has been filed by an individual other than a CBHA and the court orders the CBHA to investigate the respondent and file a report with the court, the CBHA’s report to the court to include the information, including protected health information, necessary to support the determinations, conclusions, and recommendations in the report.
- Clarifies the following regarding an original petitioner who is a person who lives with the respondent or an eligible family member of the respondent:
- They have the right to be present and make a statement at the initial hearing on the merits of the petition.
- The court may, at its discretion, assign ongoing rights of notice.
- The court may allow them to participate in the respondent’s CARE proceedings to the extent that the respondent consents to their participation.
- Clarifies that, if the original petitioner is not a person who lives with the respondent or eligible family member of the respondent, the original petitioner does not have ongoing rights other than the right to be present and make a statement at the initial hearing on the merits of the petition.
- Requires additional evidence presented at the hearing on the merits of a petition to be “admissible” evidence.
- Clarifies that if, at the hearing on the merits of the petition, the court finds there is not clear and convincing evidence that the respondent meets the specified CARE criteria, the court shall dismiss the case without prejudice, unless the court makes a finding, on the record, that the original petitioner’s filing was not in good faith, in which case the dismissal shall be with prejudice.
- Provides that the following shall apply to any written report submitted by a CBHA to the court:
- The report is confidential and not subject to disclosure under the California Public Records Act (Gov. Code, tit. 1, div. 10, §§ 7920.000 et seq.) (CPRA).
- The report is inadmissible in any subsequent legal proceeding, except upon motion of the respondent in that subsequent legal proceeding.
- The report is confidential, as specified.
- These limitations do not affect the applicability of Welfare and Institutions Code section 5977.1(c)(2), make admissible any evidence that is not otherwise admissible, or permit a witness to base an opinion on any matter that is not a proper basis for that opinion. The admission or exclusion of evidence shall be pursuant to the rules of evidence established by the Evidence Code, including, but not limited to, Section 352 of the Evidence Code, and by judicial decision.
- Clarifies that if, at the case management hearing, the court finds that the parties have entered, or are likely to enter, into a CARE agreement, the court shall either:
- Approve the terms of the CARE agreement or modify it and approve the agreement as modified, continue the matter, and set a progress hearing for 60 days; or
- Continue the matter for 14 days to allow the parties additional time to enter into a CARE agreement upon stipulation of the parties.
- Requires the Judicial Council to develop rules regarding communications between the CARE Court and the juvenile courts, if applicable.
- Provides that, consistent with Civil Code section 56.10(b)(9), the CBHA shall include in any report evaluation, or other document filed with the court, the information, including protected health information, necessary to support the determinations, conclusions, and recommendations in the filing. The CBHA shall not, unless ordered to do so by the court, submit to the court original or photocopied records underlying the information in a report evaluation or other document required or ordered under this subdivision. The CBHA shall serve an unredacted copy of any report evaluation, or other document filed with the court on the respondent and the respondent’s counsel and, with the consent of the respondent, on the supporter in a manner authorized by law. Neither a county nor an employee or agent thereof shall be held civilly or criminally liable for any disclosure authorized or required by this paragraph.
- Provides that, consistent with Civil Code section 56.10(b)(9), a provider of health care, as defined, or a covered entity, as defined, may disclose to the CBHA any information, including protected health information, and mental health records excluding psychotherapy notes, in its possession about the respondent that is relevant to the CBHA’s provision, coordination, or management of services and supports under the CARE Act, including, but not limited to, the preparation of any required investigations, evaluations, or reports. Such a disclosure is a disclosure for treatment purposes, which may be made only to the extent permitted under federal regulations, as specified, and the information disclosed may include substance use disorder patient records only to the extent permitted by federal regulations, as specified.
- Provides that, consistent with Civil Code section 56.10(b)(9), a provider of health care, as defined, or a covered entity, as defined, that filed a CARE Act petition or executed an affidavit included with a CARE Act petition shall provide to the CBHA any information, including protected health information, and mental health records excluding psychotherapy notes, in its possession about the respondent that may be relevant in connection with an investigation, evaluation, or other report or hearing under this part, or with the provision of services and supports under this part. The provision of information under this paragraph is a disclosure required by law, which may be made only to the extent permitted under federal regulations, as specified, and the information disclosed shall include substance use disorder patient records only to the extent permitted by federal regulations, as specified.
- Authorizes a CBHA to apply to the court ex parte for an order requiring any provider of health care, as defined, or any covered entity, as defined, to provide to the county behavioral health agency, to the court, or both, any information, including, but not limited to, protected health information, and mental health records excluding psychotherapy notes, in its possession about the respondent that may be relevant in connection with an investigation, evaluation, or other report or hearing under this part, or with the provision of services and supports under this part. The provision of information under this paragraph is a disclosure required by law, which may be made only to the extent permitted under federal regulations, as specified, and the information ordered to be disclosed may include substance use disorder patient records only to the extent permitted by federal regulations, as specified.
- Provides that a provider of health care or covered entity shall not be held civilly or criminally liable for any disclosure required or authorized under Welfare and Institutions Code section 59774.
- Requires a CBHA to notify the respondent of a disclosure under 24)-27) as follows:
- By mail at the respondent’s last known address, if any.
- To respondent’s counsel.
- By including a copy of the notification under (a) or (b) with the next notice of hearing served upon the respondent, if any.
- Provides that all information shared under 24)-29), including facts and records, or summary thereof, shall further be disclosed to the respondent and their counsel, and with the consent of the respondent, to the supporter.
- Provides that, except as expressly provided, further disclosure or redisclosure of information is not authorized by 24)-30).
- Information disclosed to a CBHA by a provider of health care, as defined, or a covered entity, as defined, is confidential and not subject to disclosure or inspection under the CPRA.
- Disclosure of information under the CARE Act shall not be deemed in any way to alter the duties or responsibilities of a CBHA, or a provider of health care, as defined, or of a covered entity, as defined, with respect to the disclosed information under the CMIA or HIPAA.
- Clarifies that, when an individual is referred to CARE Court from an LPS Act proceeding, the conservator or proposed conservator shall be the petitioner; and when an individual is referred to CARE Court from a misdemeanor proceeding, the CBHA or their designee shall be the petitioner.
- Clarifies the timing of the information that DHCS must provide to the Legislature evaluating the effectiveness of the CARE Act, by specifying that the preliminary report is due to the Legislature by December 31, 2026, and the final report is due to the Legislature by December 31, 2028.
- Makes technical and nonsubstantive conforming changes.
- Includes an urgency clause.
COMMENTS
- Author’s comment
According to the author:
SB 1338 (Umberg 2022) created the CARE Act (also known as CARE Court) as a response to the urgent need for innovative solutions for individuals who are suffering with untreated schizophrenia spectrum and psychotic disorders, often unhoused in our communities, and who face high risks for repeated hospitalization, incarceration, institutionalization, mental health conservatorship, and premature death. Since the passage of SB 1338, California Health and Human Services (CalHHS) & Judicial Council of California (JCC) have worked diligently with counties and stakeholders to ensure that CARE Court is implemented successfully. However, during this process, CalHHS and JCC have identified a few urgent changes needed to make CARE Court work better for the people that need it most. Therefore, SB 35 would modify various parts of CARE Court ahead of its implementation in October of 2023. For example, this bill eliminates the filing fee to support equitable access to petitioners with limited resources, allows proceedings to be conducted by subordinate judicial officers to ensure timely access for court proceedings to protect due process, and clarifies the due dates of the program’s preliminary and final evaluations. Changes like these are urgently needed to help CARE Court succeed.
2. Background on the CARE Act
Last year’s SB 1338 (Umberg, Ch. 319, Stats. 2022) established the Community Assistance, Recovery, and Empowerment (CARE) Act. The CARE Act is intended to provide essential mental health and substance use disorder services to severely mentally ill Californians—many of whom are homeless or incarcerated—while also preserving these individuals’ self-determination to the greatest extent possible.
The CARE Act will be implemented in two phases. The first cohort of counties—comprised of the Counties of Glenn, Orange, Riverside, San Diego, Stanislaus, and Tuolumne, and the City and County of San Francisco—must begin the CARE process no later than October 1 of this year.[1] The remaining counties must begin the CARE process no later than December 1, 2024.[2] DHCS may approve an implementation delay if a county experiences a state or local emergency and the implementation is necessary as a result of that emergency; an extension may be granted only once, and no later than December 1, 2025.[3] The County of Los Angeles has announced that, despite being in the second cohort, it intends to implement the CARE Act by December 1, 2023.[4]
The CARE process will be largely overseen by the courts, which are trusted with ensuring that eligible individuals—termed “respondents”—are delivered mental health and substance use disorder services, as an alternative to involuntary conservatorship or imprisonment. The California Health and Human Services Agency (CalHHS) describes the CARE process as “an upstream diversion to prevent more restrictive conservatorship or incarceration.”[5]
The CARE process is unique within the state insofar as the court process can be initiated by a person who has a relationship with the potential respondent; other mental health procedures that go through the courts require a county actor to initiate the process.[6] Eligible petitioners include the CBHA; a spouse, parent, sibling, child, or grandparent; a treating behavioral health professional; the county public guardian or public conservator; and other enumerated persons and entities.[7]
There are strict criteria for CARE Act eligibility, including that the respondent suffer from severe mental illness, as defined; not be currently clinically stabilized in on-going voluntary treatment; and either be unlikely to survive safely in the community, or need services and supports to avoid grave disability or the risk of serious harm to themselves or others.[8] The CARE Act also imposes strict, and short, deadlines for the CARE process; for example, after a petition is filed, the court must set the matter for an initial appearance on the petition within 14 days if the petition establishes a prima facie case for CARE eligibility;[9] and if the court orders a clinical evaluation of the respondent, the hearing to review the evaluation must be held within 21 days, and the evaluation must be provided to the respondent’s counsel no later than five days before that hearing.[10]
If the respondent and the CBHA ultimately agree to a CARE Plan, the CARE Plan becomes a court order that lasts for up to one year.[11] The CARE Plan may provide for behavioral health services and housing supports, as well as other services.[12] The court may order medication only if it finds, by clear and convincing evidence, that the respondent lacks the capacity to give informed consent to the administration of medically necessary stabilization medication; to the extent such medication is administered, the medication may not be forcibly administered, and the respondent’s failure to comply with a medication order shall not result in a penalty, such as terminating the CARE process.[13]
Eleven months after the CARE Plan was put in place, the court shall hold a hearing to determine whether to graduate the respondent from the CARE Plan or whether, with or without the consent of the respondent, as specified, to keep the respondent in the CARE program.[14] A respondent may be appointed to the CARE process only once, for up to one additional year.[15]
3. Concerns about the CARE Act leading up to implementation
As noted above, seven counties must implement the CARE Act on or before October 1, 2023. While a coalition of disability and civil rights groups petitioned for a writ of mandate to have the CARE Act declared unconstitutional prior to the implementation, the California Supreme Court rejected the petition without comment.[16] Disability Rights California and the ACLU continue to argue that the CARE Act will do more harm than good (see Comment 7 of this analysis for their arguments in opposition).
As the implementation date draws closer, other concerns have been raised about putting the CARE Act into practice. Counties have expressed concern that they will be overwhelmed by the number of CARE petitions filed and by the number of families who are frustrated that their loved ones do not satisfy the eligibility for CARE court participation.[17] Orange County, for example, estimates that it will receive 1,500 petitions in the first year of implementation.[18] Counties have also expressed concern that the allocated startup funds for implementation are insufficient, and that the state will not continue to adequately fund the CARE program as time goes on.[19] Some counties have tried to temper expectations, explaining that change brought on by the CARE Act will likely be incremental.[20]
Ironically, stakeholders also argue that the CARE Act both gives too small and too large a role for the family members of persons who may be eligible for the CARE Act. Some family members of persons experiencing mental illnesses have expressed dismay that the CARE Act allows respondents to limit participation by their family members, for example, by choosing a supporter who is not a family member.[21] Some family members also argue that the CARE Act grants respondents too much autonomy.[22] On the other side, some mental health advocates argue that bringing persons with mental illnesses before a court will be inherently traumatic to the respondents and will ultimately lead to more persons being treated involuntarily.[23]
Finally, counties raised concerns that CBHAs’ obligations to conduct evaluations of respondents and report on respondents’ health to the courts would inadvertently violate existing privacy laws. This issue, as well as several other modifications to clean up the CARE process in advance of implementation, are addressed in this bill.
4. SB 35’s path through the Legislature
This bill left the Senate as a minor clean-up bill that allowed DHCS to grant implementation delays through December 15, 2025—a two-week extension from the current December 1, 2025, date. At that time, the bill did not alter the CARE process itself.
Once the bill reached the Assembly, however, the bill was amended to incorporate many new provisions, including ones allowing CARE Act proceedings to be conducted by court-appointed commissioners, and requiring respondents to be provided an interpreter if needed. The Assembly Judiciary committee subsequently amended the bill to add an urgency clause, and on August 28, 2023, SB 35 was amended again in order to allow health care providers, and others with medical information relevant to the determination of CARE Act eligibility, to share such information with CBHAs. Under the August 28 amendments, this information, in turn, can then be shared with the courts.
Following the August 28 amendments, the bill was re-referred to the Assembly Privacy and Consumer Protection Committee and the Assembly Appropriations Committee. The analysis of the Assembly Privacy and Consumer Protection Committee raised concerns that, as amended, SB 35’s provisions regarding a CBHA’s obligation to share health information could create a tension with HIPAA or other privacy protections. The author, therefore, accepted amendments to ensure the confidentiality of information submitted to the courts and compliance with applicable privacy laws, which were taken in the Assembly Appropriations Committee. After the Assembly passed the bill with a vote of 56-0, the bill was referred to this Committee pursuant to Senate Rule 29.10(d), for the Committee to vote on whether to concur in the Assembly amendments.
5. This bill makes a number of changes to the CARE Act on an urgency basis
In anticipation of the first cohort of counties’ October 1, 2023, deadline for implementing the CARE Act, this bill makes a number of tweaks and modifications to the CARE Act on an urgency basis. The relevant modifications are set forth below.
Clarification of the availability of extensions of the implementation date. SB 35 clarifies that DHCS may grant a county only one extension of their implementation date. According to the Assembly Judiciary Committee’s analysis, “[t]his change is apparently intended to push counties to implement the program, notwithstanding the fact that they may lack resources such as courtrooms, social workers, public defenders, mental health beds, drug treatment services, etc.” The bill retains the existing due date for implementation, notwithstanding any extensions, at December 1, 2025.
Clarification regarding counsel. SB 35 makes modifications relating to the appointment and conduct of counsel in a CARE proceeding. These include:
- Clarifying that the representation of an attorney appointed or chosen by the respondent to represent the respondent must comply with specified state law and the California Rules of Professional Conduct. Given that all licensed attorneys must already apply with these provisions, this does not appear to affect a change in the law.
- Permitting the appointment of counsel “working in the capacity” of a public defender, rather than a public defender, to be appointed to represent the respondent.
- Providing that, if a person other than the respondent files a petition for CARE Act proceedings in order to gain an advantage over the respondent in another legal proceeding, as defined, it is cause for suspension, disbarment, or other discipline if a member of the State Bar is found to have filed the petition or assisted in the filing of the petition with knowledge that the filing was being made in order to gain that advantage. This provision is intended to bolster the existing provisions allowing a person to be declared a vexatious litigant if they repeatedly file frivolous or harassing CARE petitions.
Clarification regarding who may file a petition and the rights of original petitioners. This bill tightens up the provisions regarding who may file a CARE petition and the rights of an original petitioner after the CBHA has been substituted in as the petitioner. Specifically, the bill clarifies that:
- A public guardian or public conservator, or their designee, may file a petition for a respondent who resides or is found in their county.
- The director of a California Indian health services program or California tribal behavioral health department may file a petition for a respondent for whom they have provided within the previous 30 days, or for whom they are currently providing, behavioral health services.
- The judge of a tribal court located in California may file a petition for a respondent when the respondent has appeared before the court within the previous 30 days.
- When an original petitioner resides with, or is an eligible family member of, the respondent, the original petitioner has the right to be present and make a statement at the initial hearing on the merits; the court may, at its discretion, assign notice rights to the original petitioner, and may allow the original petitioner to participate in the respondent’s CARE process to the extent the respondent consents.
- When an original petitioner is not a person who resides with, or is an eligible family member of, the respondent, the original petitioner has no ongoing rights other than to be present and make a statement at the hearing on the merits of the petition.
Confidentiality and Privacy Protections. If a court determines that a CARE petition makes a prima facie showing that a respondent satisfies the criteria for CARE court eligibility, the CBHA may be required to submit a report to the court, within 14 days, that includes all of the following information:
- A determination as to whether the respondent meets, or is likely to meet, the criteria for the CARE process.
- The outcome of efforts made to voluntarily engage the respondent during the 14-day report period.
- Conclusions and recommendations about the respondent’s ability to voluntarily engage in services.[24]
Based on this report, the court then determines whether to set an initial hearing on the petition and appoint counsel for the respondent.[25]
As explained by the Assembly Privacy and Consumer Protection Committee:
The privacy of medical information is largely governed by the federal Health Insurance Portability and Accountability Act (HIPAA) and California’s Confidentiality of Medical Information Act (CMIA). Disclosure of medical information generally requires a patient’s informed consent.
However, respondents who are eligible for the CARE process may not be able to grant informed consent for the release of information, due to the very circumstances that make them eligible for the CARE Act. Any disclosure must therefore be made on the basis of another valid exemption from medical privacy laws. Disclosure of medical information under the CARE Act is necessary because of the short time frame (14 court days) that county behavioral health agencies have to provide a written report as to a respondent’s eligibility for the process. The Act explicitly excludes individuals with “a psychotic disorder that is due to a medical condition or is not primarily psychiatric in nature, including, but not limited to, physical health conditions such as traumatic brain injury, autism, dementia, or neurologic conditions.”[26] As explained to Committee staff, acute psychosis may be precipitated even by something as simple as an untreated urinal tract infection, which, of course, would not be eligible for the CARE process. Yet there may be no way for a county behavioral health agency to rule out medical causes that do not give rise to CARE eligibility without first examining the respondent’s medical records. (In addition, significant financial penalties can be levied against a county that fails to comply with court orders under the CARE Act.)
Amendments taken to the bill in the Assembly are intended to facilitate the sharing of information by health care providers and other entities covered by HIPAA and the MCIA with CBHAs, including by specifying that information may be disclosed consistent with these state and federal laws. The bill also requires the respondent and the respondent’s counsel to be notified by the CBHA when there has been a disclosure of their health information. Additionally, the bill adds protections for information filed with the court in a CARE proceeding, including permitting a respondent to seek to have the information filed in their case placed under seal and granting a presumption in favor of sealing.
Evidentiary matters. SB 35 makes a number of clarifications and changes regarding what evidence may be offered in CARE proceedings as well as to how a party may use evidence or testimony given in a CARE proceeding. These measures include:
- Specifying that any evidence offered in addition to the CBHA’s report on whether the respondent meets the CARE court criteria must be admissible evidence. This should provide additional protections to the respondent, for example, by preventing hearsay testimony for which there is no exception being offered at the hearing on the merits of the petition.
- Providing that the fact that evidence is admitted in a CARE proceeding shall not be the basis for admitting the evidence in any subsequent legal proceeding.
- Providing that photographs, transcripts, other records of CARE proceedings, and testimony given in CARE proceedings shall not be admissible in any subsequent legal proceeding except upon a motion from the respondent, the CBHA, the public guardian, or the public conservator.
- Clarifying that all applicable rules of evidence, including the Evidence Code, apply in CARE proceedings.
Expanding and clarifying the rights of the respondent. This bill provides the respondent with the right to an interpreter in all proceedings if necessary for the respondent to fully participate. Additionally, the bill clarifies that the respondent may have their supporter present with them and to perform the functions of a supporter, as specified.
Additional procedural provisions and changes. In addition to the changes above, SB 35 makes a number of changes to the CARE court procedures and similar matters. These include:
- Authorizing CARE proceedings to be conducted by a superior court judge or by a court-appointed commissioner or other subordinate judicial officer. “Subordinate judicial officers” are referees, commissioners, and hearing officers appointed by the courts pursuant to the California Constitution.[27] California Rules of Court require a subordinate judicial officer to be a member of the state bar and have been admitted to practice law in California for at least 10 years.[28] According to the author, this provision is intended to allow the courts to satisfy their CARE court obligations without overwhelming the courts. Opponents of the bill argue that this measure insufficiently protects the respondents who will be appearing before subordinate judicial officers instead of judges.
- Eliminating filing fees for filing under the CARE Act, and prohibiting any fees from being charged by any public officer for services in filing or serving papers or for the performance of any duty enjoined by the CARE Act. This measure will, presumably, eliminate financial barriers to filing a CARE petition; opponents of the bill argue that the lack of a filing fee will result in increased exposure of people with mental disabilities to the CARE process, causing undue harm.
- Clarifying that if, at a hearing on the merits of the petition, the court finds there is not clear and convincing evidence that the respondent meets the criteria for CARE court eligibility, the court shall dismiss the case without prejudice, unless the court makes an on-the-record finding that the original petitioner’s filing was not in good faith, in which case the case shall be dismissed with prejudice.
6. Arguments in support
According to the California State Association of Counties, Rural County Representatives of California, and Urban Counties of California:
Last year, the Legislature passed and the Governor signed SB 1338 (Chapter 319, Statutes of 2022), which creates a new court process authorizing specified individuals to petition a civil court to create a voluntary CARE agreement or court-ordered CARE plan to provide behavioral health care, including stabilization medication, housing, and other enumerated services, to adults who are currently experiencing a severe mental illness and have a diagnosis identified in the disorder class schizophrenia and other psychotic disorders, and who meet other specified criteria.
Fulfillment of county behavioral health agencies’ responsibilities under the CARE Act will require communication of detailed information regarding a respondent’s behavioral health condition and treatment to the court. Such information is generally confidential under state and federal law and cannot be disclosed by any health care provider – including county behavioral health – without the respondent's consent. A respondent may decline to consent to release of their confidential medical and mental health information to the court – particularly during early phases of the case, when county behavioral health is preparing the initial report to the court required under the provisions of the CARE Act. As a result, express legal authority will be required for county behavioral health agencies to provide the court with the information contemplated by the CARE Act.
We appreciate the [Assembly Privacy and Consumer Privacy] Committee’s engagement with our organizations to develop additional amendments to ensure the data sharing provisions included in the CARE Act maintain the necessary confidentiality requirements as required by existing state and federal law.
7. Arguments in opposition
According to ACLU California Action and Disability Rights California:
First, SB 35 will expand the number of CARE Court petitions by prohibiting a filing fee. Research shows that fees reduce filings. For example, in eviction cases, the larger the filing fee in a jurisdiction the lower the eviction rate—an effect that is disproportionately large in majority-Black neighborhoods. The lack of a filing fee will therefore increase exposure of people with mental health disabilities to CARE Court.
Second, SB 35 would give additional rights to the petitioners, thus weakening the rights of respondents. For example, the bill gives petitioners “the right to be present and make a statement on the merits of the petition at the initial hearing,” and extends those rights if the petitioner is “a spouse, parent, sibling, child, or grandparent or other person who stands in loco parentis to the respondent.”
Finally, SB 35 loosens criteria for who can be appointed as counsel and authorizes a “court-appointed commissioner or other subordinate judicial officer” to conduct proceedings in lieu of a superior court judge. This change eases the ability of counties to implement the CARE Act while doing nothing to safeguard the rights of respondents.
CARE Court is likely to do real harm to the populations the CARE Act intended to help, setting back decades of recovery tools designed to help those most marginalized. CARE Court will contribute to the re-institutionalization of people with disabilities, repeating a horrific history of civil rights abuses.
SB 35 will deepen the threat CARE Court poses to racial and economic justice. It will increase the harm and stigmatization of people with mental health disabilities, especially people within communities of color. Studies show Black, Indigenous and People of Color will disproportionately experience the harms that CARE Court poses. SB 35 will increase CARE Court’s exploitation of poor people who need mental health care. It is those people with low incomes and/or from communities of color who will be most victim to the chilling effects CARE Court will have in preventing people from seeking treatment and care.
SUPPORT
California State Association of Counties
Rural County Representatives of California
Urban Counties of California
OPPOSITION
ACLU California Action
Disability Rights California
Electronic Frontier Foundation
RELATED LEGISLATION
Pending Legislation: SB 43 (Eggman, 2023) expands the definition of “gravely disabled” for purposes of who may be involuntarily detained and treated under the LPS Act. SB 43 is pending on the Assembly Floor.
Prior Legislation: SB 1338 (Umberg, Ch. 319, Stats. 2022) enacted the CARE Act and implements the CARE Court framework in a two-phased rollout, with the first cohort of counties to commence implementation on October 1, 2023, and the second cohort of counties to commence implementation on December 1, 2024.
PRIOR VOTES:
Assembly Floor (Ayes 56, Noes 0)
Assembly Appropriations Committee (Ayes 16, Noes 0)
Assembly Privacy and Consumer Protection Committee (Ayes 11, Noes 0)
Assembly Appropriations Committee (Ayes 15, Noes 1)
Assembly Judiciary Committee (Ayes 10, Noes 0)
Senate Floor (Ayes 37, Noes 0)
Senate Health Committee (Ayes 11, Noes 0)
**************
Welf. & Inst. Code, § 5970.5(a). ↑
Id., § 5970.5(b). ↑
Id., § 5970.5(c). ↑
E.g., Wiley & Curran, L.A. County on track to join Newsom’s sweeping mental health plan a year early, Los Angeles Times (Jan. 13, 2023), available at https://www.latimes.com/california/story/2023-01-13/la-county-care-court-2023-newsom-mental-health-los-angeles. All links in this analysis are current as of September 12, 2023. ↑
See CalHHS, Community Assistance, Recovery & Empowerment Act, https://www.chhs.ca.gov/care-act/. ↑
E.g., Welf. & Inst. Code, § 5346 (assisted outpatient treatment petition must be filed by a county behavioral health director or their designee; specified family members or other persons may request that a petition be filed, but may not file the petition themselves). ↑
Welf. & Inst. Code, § 5974. ↑
Id., § 5972. ↑
Id., § 5977. ↑
Id., § 5977.1(b). The court may continue the evaluation hearing for a maximum of 14 days upon stipulation of the respondent and the CBHA, unless there is good cause for a longer extension. ↑
Id., § 5977.1(d). ↑
Id., § 5982. ↑
Id., § 5977.1(d)(3). ↑
Id., § 5977.3. ↑
Ibid. ↑
See Disability Rights California v. Newsom, Case No. S278330; Wiley, California Supreme Court rejects lawsuit challenging Newsom’s plan to treat mental illness, L.A. Times (Apr. 22, 2023), available at https://www.latimes.com/california/story/2023-04-22/california-supreme-court-newsom-care-court-mentally-ill-homeless-substance-disorder. ↑
E.g., Curwen, ‘Deep in the weeds’: California counties face unknowns in launching mental illness court, L.A. Times (May 21, 2023), available at https://www.latimes.com/california/story/2023-05-21/counties-scramble-care-court-preparations. ↑
Ibid. ↑
Ibid. ↑
Curwen, Why California’s much-touted CARE Court is no ‘one and done’ program, L.A. Times (Jan. 1, 2023), available at https://www.latimes.com/california/story/2023-01-01/care-court-challenges-orange-san-diego-counties. ↑
Curwen, CARE courts open in a month, promising hope for families. Not everyone is so sure, L.A. Times (Sept. 4, 2023), available at https://www.latimes.com/california/story/2023-09-04/care-courts-families-voluntary-compliance. ↑
Ibid. ↑
Ibid. If a court finds, by clear and convincing evidence, that respondent is failing to participate in the CARE process or is not adhering to their CARE plan, the court may refer the respondent for an evaluation for involuntary detention and treatment under the LPS Act. (Welf. & Inst. Code, § 5979.) A respondent’s failure to successfully complete a CARE also gives rise to a presumption in an LPS Act hearing that a respondent needs additional intervention, if the LPS Act hearing occurs within six months of the termination of the CARE plan. (Ibid.) Relatedly, pending legislation would lower the bar for a county to involuntarily detain and treat a person and, ultimately, place them in a conservatorship pursuant to the LPS Act (see SB 43 (Eggman, 2023)); together with the evidentiary presumption, respondents who failed to complete the CARE Act process will have fewer protections against involuntary treatment since the implementation of the LPS Act. ↑
Welf. & Inst. Code § 5977(a)(3). ↑
Id., § 5977(a)(5). ↑
Id., § 5972(b). ↑
Cal. Const. art.VI, § 22. ↑
Cal. Rules of Court, r. 10.701(b). There are exceptions to these qualification criteria for subordinate judicial officers who were acting in that role as 2003 (see ibid.) and for judicial officers serving under specific statutory schemes that do not apply here (see id., r. 10.701(d); Welf. & Inst. Code, §§ 255, 5256.1.). ↑
Senator Thomas Umberg, Chair
2023-2024 Regular Session
Bill No: SB 35 (Author:Umberg)
Version: September 8, 2023
Hearing Date: September 13, 2023
Fiscal: Yes
Urgency: Yes
Consultant: AWM
PURSUANT TO SENATE RULE 29.10(d)
SUBJECT
Community Assistance, Recovery, and Empowerment (CARE) Court Program
DIGEST
This bill modifies the Community, Assistance, Recovery, and Empowerment (CARE) Act, which requires certain counties to implement the CARE Court Program beginning October 1, 2023.
EXECUTIVE SUMMARY
In 2022, the Legislature enacted, and the Governor signed, SB 1338 (Umberg, Ch. 319, Stats. 2022), known as the CARE Act, which is intended to deliver mental health and substance use disorder services for persons with certain severe mental illness diagnoses as an alternative to incarceration in a jail or psychiatric facility or to being subjected to a conservatorship under the Lanterman-Petris-Short (LPS) Act (Welf. & Inst. Code, div. 5, pt. 1, §§ 5000 et seq.). The CARE Act provides for court-ordered CARE Plans for qualified persons suffering from a mental health or substance abuse disorder crisis for up to 12 months, with possible extensions. The plan is supposed to provide individuals with clinically appropriate, community-based services. A cohort of seven counties will implement the CARE Act by October 1, 2023; the remaining counties will implement the CARE Act by December 1, 2024.
This bill is intended to clean up the CARE Act and address concerns raised by certain stakeholders in advance of the implementation date. Among other things, the bill is intended to provide protections for county entities that are obligated to obtain medical information about CARE Act respondents and ensure that the CARE Act does not inadvertently run afoul of state and federal law. When this bill left the Senate, it did not include matter within the jurisdiction of this Committee. The bill was then amended in the Assembly to add changes to the CARE Court process and provisions relating to the disclosure of medical records, which are matters within this Committee’s jurisdiction. Accordingly, this bill was referred to this Committee pursuant to Senate Rule 29.10(d) when it returned to the Senate.
This bill is sponsored by the author and is supported by the California State Association of Counties, Rural County Representatives of California, and Urban Counties of California. This bill is opposed by ACLU California Action, Disability Rights California, and the Electronic Frontier Foundation.
PROPOSED CHANGES TO THE LAW
Existing state law:
- Establishes the CARE Act. (Welf. & Inst. Code, div. 5, pt. 8, §§ 5970 et seq.)
- Defines the following relevant terms:
- “Care agreement” is a voluntary settlement agreement entered into by the parties, and includes the same elements as a CARE plan to support the respondent in accessing community-based services and supports.
- “Care plan” is an individualized, appropriate range of community-based services and supports, which include clinically appropriate behavioral health care and stabilization medications, housing, and other supportive services, as appropriate.
- “CARE process” is the court and related proceedings to implement the CARE Act.
- “Department” is the State Department of Health Care Services (DHCS).
- “Petitioner” is the entity who files a CARE Act petition with the court; if the petitioner is a person other than the director of a county behavioral health agency (CBHA), or their designee, the court shall substitute the director or their designee for the county in which the proceedings are filed as the petitioner at the first hearing.
- “Psychiatric advance directive” is a legal document, executed on a voluntary basis by a person who has the capacity to make medical decisions, that allows a person with mental illness to protect their autonomy and ability to self-direct care by documenting their preferences for treatment in advance of a mental health crisis.
- “Respondent” is the person who is subject to the petition for the CARE process.
- “Supporter” is an adult, designated as specified, who assists the person who is the subject of the petition, which may include supporting the person to understand, make, communicate, implement, or act on their own life decisions during the CARE process; a supporter may not act independently. (Welf. & Inst. Code, § 5971.)
- Provides that the CARE Act shall be implemented as follows:
- A first cohort of counties, including Glenn, Orange, Riverside, San Diego, Stanislaus, Tuolumne, and the City and County of San Francisco, shall begin no later than October 1, 2023.
- A second cohort of counties, representing the remaining counties in the state, shall begin no later than December 1, 2024.
- DHCS shall issue guidelines under which counties can apply for, and be provided, additional time in which to implement the CARE Act, subject to certain conditions and restrictions. (Welf. & Inst. Code, § 5970.5.)
- Establishes criteria for a person to qualify for the CARE process, including that the person is 18 years of age or older; the person is experiencing a severe mental illness and has a diagnosis in the disorder class of schizophrenia spectrum and other psychotic disorders; the person is not clinically stabilized in ongoing voluntary treatment; and participation in a CARE plan or agreement would be the least restrictive alternative necessary to ensure the person’s recovery and stability. (Welf. & Inst. Code, § 5972.)
- Provides that the following adult persons may file a petition to initiate the CARE process:
- A person with whom the respondent resides.
- A spouse, parent, sibling, child, or grandparent or other individual who stands in loco parentis to the respondent.
- The director of a hospital, or their designee, in which the respondent is hospitalized, including pursuant to certain temporary holds under the LPS Act.
- The director of a public or charitable home, or a licensed behavioral health professional, or their designee, who has had a specified interaction with the respondent within the previous 30 days.
- A first responder, as specified, who has had repeated interactions with the respondent in the form of multiple arrests, multiple detentions and transportations pursuant to the LPS Act, multiple attempts to engage the respondent in the form of voluntary treatment, or other repeated efforts to aid the respondent in obtaining professional assistance.
- The public guardian or public conservator, or their designee, of the county in which the respondent is present or reasonably believed to be present.
- The director of a CBHA or county adult protective services, or their designee, of the county in which the respondent resides or is found.
- The director of a California Indian health services program, California tribal behavioral health department, or their designee.
- The judge of a tribal court that is located in California, or their designee.
- The respondent. (Welf. & Inst. Code, § 5974.)
- Allows a court, if a criminal defendant is found to be mentally incompetent and ineligible for a diversion, to refer the defendant to the CARE program, as provided. (Pen. Code, § 1370.1(b)(1)(D)(iv).)
- Requires the Judicial Council to create a mandatory court form to file a CARE process petition, together with any other forms necessary during the CARE process. The petition must be signed under penalty of perjury and set forth specified information, including either an affidavit of a licensed behavioral health professional setting forth specified information about the respondent, or evidence that the respondent was detained for a minimum of two intensive treatments pursuant to the LPS Act, the most recent of which was no more than 60 days prior to the date of the petition. (Welf. & Inst. Code, § 5975.)
- Establishes requirements for the jurisdiction in which a CARE Act petition may be filed, for the filing of a CARE Act petition, and for instances in which a CARE Act petition is filed to harass the respondent. (Welf. & Inst. Code, §§ 5973, 5975, 5975.1.)
- Establishes the rights of the respondent, including the right to be represented by counsel at all stages of a CARE proceeding, regardless of ability to pay. (Welf. & Inst. Code, § 5976.)
- Establishes that the respondent has the following rights:
- To receive notice of the CARE hearings.
- To receive a copy of the court-ordered evaluation.
- To be represented by counsel at all stages of a proceeding commenced under this chapter, regardless of the ability to pay.
- To be allowed to have a supporter.
- To be present at the hearing unless they waive the right to be present.
- To present evidence.
- To call witnesses.
- To cross-examine witnesses.
- To appeal decisions, and to be informed of the right to appeal. (Welf. & Inst. Code, § 5976.)
- Provides for the following regarding CARE Act hearings:
- Establishes that hearings are presumptively closed to the public, but permits the respondent to demand that the hearings be public.
- Permits the respondent to request the presence of a family member or friend without waiving the right to keep the hearing closed to the rest of the public.
- Permits the court to grant a request by another party to make a hearing public if the judge conducting the hearing finds that the public interest clearly outweighs the respondent’s interest in privacy.
- Declares that all reports, evaluations, diagnoses, or other information related to the respondent’s health shall be confidential.
- Requires the judge, before commencing a hearing, to inform the respondent of their rights under this section. (Welf. & Inst. Code, § 5976.5.)
- Requires the court, upon receipt of a CARE Act petition, to promptly review it to determine whether a prima facie showing has been made that the respondent is or may be a person described in 6), and then do one of the following:
- If the court finds the petitioner has not made the required prima facie showing, then dismiss the case without prejudice. (Welf. & Inst. Code § 5977(a)(2).)
- If the court finds the petitioner has made the required prima facie showing, and the petitioner is the director of a CBHA, then the court must do all of the following:
- Set the matter for initial hearing within 14 court days.
- Appoint counsel.
- Determine if the petition includes a determination as to whether the respondent meets the criteria for the CARE process and is willing to engage voluntarily with services, and, if not, order the county to submit a report containing this information within 14 court days.
- Require notice be provided to the respondent, respondent’s counsel, and the CBHA where the respondent resides. (Welf. & Inst. Code § 5977(a)(3)(A).)
- If the court finds the petitioner has made the required prima facie showing, but the petitioner is not a CBHA, then the court must do all of the following:
- Order a county agency to investigate whether the respondent meets the criteria for the CARE process and is willing to engage voluntarily with services.
- File a written report with the court within 14 court days.
- Provide notice to the respondent and the petitioner that a report has been ordered.
- Upon receipt of the report, within 5 days, do one of the following:
- If the county’s report does not support a prima facie showing under 6), or if the county determines that the respondent has enrolled or is likely to enroll in voluntary behavioral health treatment, dismiss the matter.
- If the county’s report does support a prima facie showing under 6), set the matter for initial hearing within 14 court days, appoint counsel, and order the county to provide notice of the hearing as specified. (Welf. & Inst. Code § 5977 (a)(3)(B).)
- Establishes procedures and requirements for the following:
- Initial hearing on a CARE Act petition. (Welf. & Inst. Code, § 5977(b).)
- Hearing on the merits of the petition. (Welf. & Inst. Code, § 5977(c).)
- Case management hearing. (Welf. & Inst. Code, § 5977.1(a).)
- Clinical evaluation review hearing. (Welf. & Inst. Code, § 5977.1(c).)
- Hearing to review proposed CARE plans. (Welf. & Inst. Code, § 5977.1(d).)
- Status review hearing that occurs at least every 60 days during the one-year (potentially two-year) CARE plan implementation. (Welf. & Inst. Code, §§ 5977.2, 5977.3.)
- Allows the court, at any point during CARE proceedings, if it determines, by clear and convincing evidence, that the respondent, after receiving notice, is not participating in the CARE process or is not adhering to their CARE plan, to terminate respondent’s participation. The court is then permitted to make a referral under the LPS Act, as provided. (Welf. & Inst. Code § 5979(a).)
- Provides that, if a respondent was timely provided with all services and supports required by their CARE plan, the fact that the respondent failed to successfully complete the plan and reasons for that failure (a) are facts to be considered by a court in a subsequent hearing under the LPS Act, provided that the hearing occurs within six months of termination of the CARE plan; and (b) create a presumption at that hearing that the respondent needs additional interventions beyond the supports and services provided by the CARE plan. (Welf. & Inst. Code, § 5979(a)(3).)
- Creates a process for penalizing counties or other local government entities that do not comply with CARE court orders. (Welf. & Inst. Code § 5979(b).)
- Provides that either a respondent or a CBHA may appeal an adverse court determination. (Welf. & Inst. Code, § 5979(c).)
- Establishes the LPS Act to end inappropriate, indefinite, and involuntary commitment of mentally disordered persons, developmentally disabled persons, and persons impaired by chronic alcoholism, and to provide prompt evaluation and treatment of those with mental health disorders or impaired by chronic alcoholism. (Welf. & Inst. Code, div. 5, pt. 1, §§ 5000 et seq.)
- Establishes the Confidentiality of Medical Information Act (CMIA). (Civ. Code, §§ 56-56.37.)
- Defines the term “provider of health care” under CMIA to include medical practitioners licensed under state law, as specified, or a clinic, health dispensary, or health facility licensed under state law, as specified. (Civ. Code, § 56.05(o).)
- Prohibits a provider of health care, health care service plan, or contractor from disclosing medical information regarding a patient without first obtaining an authorization, subject to specified exceptions, including where disclosure is compelled by a court order, a subpoena, the patient, or otherwise specifically required by law. (Civ. Code, § 56.10.)
Existing federal law:
- Establishes the Health Insurance Portability and Accountability Act of 1996 (HIPAA), which, among other things, sets standards for the privacy of individually identifiable health information and security standards for the protection of electronically transmitted health information. (Pub. L. 104-191, 110 Stat. 1936.)
- Provides that if a HIPAA provision conflicts with state law, the provision that is most protective of patient privacy prevails. (45 C.F.R. 160.203.)
- Defines the term “covered entity” under HIPAA as a health plan, a health care clearinghouse, or a health care provider who transmits any health information in electronic form in connection with a transaction covered by HIPAA. (45 C.F.R. § 160.103.)
This bill:
- Requires, after a criminal court has referred a defendant to the CARE program, the hearing to determine the defendant’s eligibility to be held within 14 court days after the date on which the petition for the referral is filed.
- Specifies that a county shall be granted only one extension for implementing the CARE Act. The final date for implementation under any circumstances is December 1, 2025.
- Clarifies that legal representation of a respondent in CARE Act proceedings, and in matters related to CARE agreements and CARE plans, does not alter an attorney’s obligations under the State Bar Act and the California Rules of Professional Conduct, including obligations relating to the attorney’s duty of confidentiality.
- Defines “legal proceeding” as any administrative, civil, or criminal proceeding, including, but not limited to, juvenile courts and family court proceedings and services, and any form of alternative dispute resolution, including arbitration and mediation, except for: (1) a CARE Act proceeding; (2) an LPS Act proceeding; (3) a proceeding from which the respondent was referred to CARE Act proceedings, as specified; (4) an attorney disciplinary hearing, as defined; or (5) an appeal of any of the proceedings identified in (1)-(4).
- Makes clarifications regarding the parties, as follows:
- “Parties” include any local government entity added by the court, as specified.
- “Petitioner” means the person who files the initial CARE petition; the original petitioner may retain specified rights, at the court’s discretion.
- Clarifies when certain individuals may file a CARE petition, including:
- A public guardian or public conservator, or their designee, of a county may file a petition if the respondent resides or is found in that county.
- The director or a Californian Indian health services program, California tribal behavioral health department, or their designee may file a petition if they have provided, within the previous 30 days, or are providing behavioral services to the respondent.
- The judge of a tribal court, or their designee, located in California may file a petition if the respondent has appeared before the judge within the prior 30 days.
- Provides that, if a person other than the respondent files a petition for a CARE Act proceeding in order to gain an advantage over the respondent in another legal proceeding, then, notwithstanding any other provision of the CARE Act, it is cause for suspension, disbarment, or other discipline if a member of the State Bar is found to have filed the petition or assisted in the filing of the petition with knowledge that the filing was being made in order to gain that advantage. For purposes of this provision, “legal provision” does not include a proceeding under the LPS Act or a dependency proceeding.
- Authorizes a CARE Act proceeding to be conducted by a superior court judge, a court-appointed commissioner, or other subordinate juvenile officer.
- Provides that there shall be no filing fee for any CARE Act filing, nor shall any fees by charged by any public officer for services in filing or serving papers or for the performance of any duty enjoined by the CARE Act.
- Adds and clarifies, to the list rights held by a respondent in a CARE proceeding, the rights to:
- Have a supporter be present with them to perform the functions of a supporter as provided for in the CARE Act.
- Have an interpreter present in all proceedings if necessary for the respondent to fully participate.
- Clarifies that all reports, evaluations, or other information filed with the court related to the respondent’s health shall be confidential, and permits the respondent, at any time, to petition the court for an order sealing those records or any other court records in a CARE Act proceeding. Notwithstanding any rule of court prohibiting records kept confidential by law from consideration for sealing, there is a presumption in favor of sealing the records if such a petition is filed.
- Provides that the fact that evidence is admitted at a proceeding held under the CARE Act shall not be the basis for admission of that evidence in any subsequent legal proceeding.
- Provides that photographs, recordings, transcripts, other records of proceedings held under the CARE Act, and testimony regarding proceedings held pursuant to the CARE Act, shall not be admissible in any subsequent legal proceeding except upon motion by one of the following in that subsequent legal proceeding:
- The respondent; or
- The CBHA, the public guardian, or the public conservator.
- Provides that, in a CARE Act proceeding, the provisions relating to confidentiality of records and their use in subsequent proceedings do not affect the applicability of Welfare and Institutions Code section 5977.1(c)(2), make admissible any evidence that is not otherwise admissible, or permit a witness to base an opinion on any matter that is not a proper basis for that opinion. The admission or exclusion of evidence shall be pursuant to the rules of evidence established by the Evidence Code, including, but not limited to, Section 352 of the Evidence Code, and by judicial decision.
- Allows, in lieu of the appointment of a public defender to represent the respondent, for the appointment of counsel “working in [the] capacity” of a public defender to represent the respondent.
- Requires, when a petition has been filed by an individual other than a CBHA and the court orders the CBHA to investigate the respondent and file a report with the court, the CBHA’s report to the court to include the information, including protected health information, necessary to support the determinations, conclusions, and recommendations in the report.
- Clarifies the following regarding an original petitioner who is a person who lives with the respondent or an eligible family member of the respondent:
- They have the right to be present and make a statement at the initial hearing on the merits of the petition.
- The court may, at its discretion, assign ongoing rights of notice.
- The court may allow them to participate in the respondent’s CARE proceedings to the extent that the respondent consents to their participation.
- Clarifies that, if the original petitioner is not a person who lives with the respondent or eligible family member of the respondent, the original petitioner does not have ongoing rights other than the right to be present and make a statement at the initial hearing on the merits of the petition.
- Requires additional evidence presented at the hearing on the merits of a petition to be “admissible” evidence.
- Clarifies that if, at the hearing on the merits of the petition, the court finds there is not clear and convincing evidence that the respondent meets the specified CARE criteria, the court shall dismiss the case without prejudice, unless the court makes a finding, on the record, that the original petitioner’s filing was not in good faith, in which case the dismissal shall be with prejudice.
- Provides that the following shall apply to any written report submitted by a CBHA to the court:
- The report is confidential and not subject to disclosure under the California Public Records Act (Gov. Code, tit. 1, div. 10, §§ 7920.000 et seq.) (CPRA).
- The report is inadmissible in any subsequent legal proceeding, except upon motion of the respondent in that subsequent legal proceeding.
- The report is confidential, as specified.
- These limitations do not affect the applicability of Welfare and Institutions Code section 5977.1(c)(2), make admissible any evidence that is not otherwise admissible, or permit a witness to base an opinion on any matter that is not a proper basis for that opinion. The admission or exclusion of evidence shall be pursuant to the rules of evidence established by the Evidence Code, including, but not limited to, Section 352 of the Evidence Code, and by judicial decision.
- Clarifies that if, at the case management hearing, the court finds that the parties have entered, or are likely to enter, into a CARE agreement, the court shall either:
- Approve the terms of the CARE agreement or modify it and approve the agreement as modified, continue the matter, and set a progress hearing for 60 days; or
- Continue the matter for 14 days to allow the parties additional time to enter into a CARE agreement upon stipulation of the parties.
- Requires the Judicial Council to develop rules regarding communications between the CARE Court and the juvenile courts, if applicable.
- Provides that, consistent with Civil Code section 56.10(b)(9), the CBHA shall include in any report evaluation, or other document filed with the court, the information, including protected health information, necessary to support the determinations, conclusions, and recommendations in the filing. The CBHA shall not, unless ordered to do so by the court, submit to the court original or photocopied records underlying the information in a report evaluation or other document required or ordered under this subdivision. The CBHA shall serve an unredacted copy of any report evaluation, or other document filed with the court on the respondent and the respondent’s counsel and, with the consent of the respondent, on the supporter in a manner authorized by law. Neither a county nor an employee or agent thereof shall be held civilly or criminally liable for any disclosure authorized or required by this paragraph.
- Provides that, consistent with Civil Code section 56.10(b)(9), a provider of health care, as defined, or a covered entity, as defined, may disclose to the CBHA any information, including protected health information, and mental health records excluding psychotherapy notes, in its possession about the respondent that is relevant to the CBHA’s provision, coordination, or management of services and supports under the CARE Act, including, but not limited to, the preparation of any required investigations, evaluations, or reports. Such a disclosure is a disclosure for treatment purposes, which may be made only to the extent permitted under federal regulations, as specified, and the information disclosed may include substance use disorder patient records only to the extent permitted by federal regulations, as specified.
- Provides that, consistent with Civil Code section 56.10(b)(9), a provider of health care, as defined, or a covered entity, as defined, that filed a CARE Act petition or executed an affidavit included with a CARE Act petition shall provide to the CBHA any information, including protected health information, and mental health records excluding psychotherapy notes, in its possession about the respondent that may be relevant in connection with an investigation, evaluation, or other report or hearing under this part, or with the provision of services and supports under this part. The provision of information under this paragraph is a disclosure required by law, which may be made only to the extent permitted under federal regulations, as specified, and the information disclosed shall include substance use disorder patient records only to the extent permitted by federal regulations, as specified.
- Authorizes a CBHA to apply to the court ex parte for an order requiring any provider of health care, as defined, or any covered entity, as defined, to provide to the county behavioral health agency, to the court, or both, any information, including, but not limited to, protected health information, and mental health records excluding psychotherapy notes, in its possession about the respondent that may be relevant in connection with an investigation, evaluation, or other report or hearing under this part, or with the provision of services and supports under this part. The provision of information under this paragraph is a disclosure required by law, which may be made only to the extent permitted under federal regulations, as specified, and the information ordered to be disclosed may include substance use disorder patient records only to the extent permitted by federal regulations, as specified.
- Provides that a provider of health care or covered entity shall not be held civilly or criminally liable for any disclosure required or authorized under Welfare and Institutions Code section 59774.
- Requires a CBHA to notify the respondent of a disclosure under 24)-27) as follows:
- By mail at the respondent’s last known address, if any.
- To respondent’s counsel.
- By including a copy of the notification under (a) or (b) with the next notice of hearing served upon the respondent, if any.
- Provides that all information shared under 24)-29), including facts and records, or summary thereof, shall further be disclosed to the respondent and their counsel, and with the consent of the respondent, to the reporter.
- Provides that, except as expressly provided, further disclosure or redisclosure of information is not authorized by 24)-30).
- Information disclosed to a CBHA by a provider of health care, as defined, or a covered entity, as defined, is confidential and not subject to disclosure or inspection under the CPRA.
- Disclosure of information under the CARE Act shall not be deemed in any way to alter the duties or responsibilities of a CBHA, or a provider of health care, as defined, or of a covered entity, as defined, with respect to the disclosed information under the CMIA or HIPAA.
- Clarifies that, when an individual is referred to CARE Court from an LPS Act proceeding, the conservator or proposed conservator shall be the petitioner; and when an individual is referred to CARE Court from a misdemeanor proceeding, the CBHA or their designee shall be the petitioner.
- Clarifies the timing of the information that DHCS must provide to the Legislature evaluating the effectiveness of the CARE Act, by specifying that the preliminary report is due to the Legislature by December 31, 2026, and the final report is due to the Legislature by December 31, 2028.
- Makes technical and nonsubstantive conforming changes.
- Includes an urgency clause.
COMMENTS
- Author’s comment
According to the author:
SB 1338 (Umberg 2022) created the CARE Act (also known as CARE Court) as a response to the urgent need for innovative solutions for individuals who are suffering with untreated schizophrenia spectrum and psychotic disorders, often unhoused in our communities, and who face high risks for repeated hospitalization, incarceration, institutionalization, mental health conservatorship, and premature death. Since the passage of SB 1338, California Health and Human Services (CalHHS) & Judicial Council of California (JCC) have worked diligently with counties and stakeholders to ensure that CARE Court is implemented successfully. However, during this process, CalHHS and JCC have identified a few urgent changes needed to make CARE Court work better for the people that need it most. Therefore, SB 35 would modify various parts of CARE Court ahead of its implementation in October of 2023. For example, this bill eliminates the filing fee to support equitable access to petitioners with limited resources, allows proceedings to be conducted by subordinate judicial officers to ensure timely access for court proceedings to protect due process, and clarifies the due dates of the program’s preliminary and final evaluations. Changes like these are urgently needed to help CARE Court succeed.
2. Background on the CARE Act
Last year’s SB 1338 (Umberg, Ch. 319, Stats. 2022) established the Community Assistance, Recovery, and Empowerment (CARE) Act. The CARE Act is intended to provide essential mental health and substance use disorder services to severely mentally ill Californians—many of whom are homeless or incarcerated—while also preserving these individuals’ self-determination to the greatest extent possible.
The CARE Act will be implemented in two phases. The first cohort of counties—comprised of the Counties of Glenn, Orange, Riverside, San Diego, Stanislaus, and Tuolumne, and the City and County of San Francisco—must begin the CARE process no later than October 1 of this year.[1] The remaining counties must begin the CARE process no later than December 1, 2024.[2] DHCS may approve an implementation delay if a county experiences a state or local emergency and the implementation is necessary as a result of that emergency; an extension may be granted only once, and no later than December 1, 2025.[3] The County of Los Angeles has announced that, despite being in the second cohort, it intends to implement the CARE Act by December 1, 2023.[4]
The CARE process will be largely overseen by the courts, which are trusted with ensuring that eligible individuals—termed “respondents”—are delivered mental health and substance use disorder services, as an alternative to involuntary conservatorship or imprisonment. The California Health and Human Services Agency (CalHHS) describes the CARE process as “an upstream diversion to prevent more restrictive conservatorship or incarceration.”[5]
The CARE process is unique within the state insofar as the court process can be initiated by a person who has a relationship with the potential respondent; other mental health procedures that go through the courts require a county actor to initiate the process.[6] Eligible petitioners include the CBHA; a spouse, parent, sibling, child, or grandparent; a treating behavioral health professional; the county public guardian or public conservator; and other enumerated persons and entities.[7]
There are strict criteria for CARE Act eligibility, including that the respondent suffer from severe mental illness, as defined; not be currently clinically stabilized in on-going voluntary treatment; and either be unlikely to survive safely in the community, or need services and supports to avoid grave disability or the risk of serious harm to themselves or others.[8] The CARE Act also imposes strict, and short, deadlines for the CARE process; for example, after a petition is filed, the court must set the matter for an initial appearance on the petition within 14 days if the petition establishes a prima facie case for CARE eligibility;[9] and if the court orders a clinical evaluation of the respondent, the hearing to review the evaluation must be held within 21 days, and the evaluation must be provided to the respondent’s counsel no later than five days before that hearing.[10]
If the respondent and the CBHA ultimately agree to a CARE Plan, the CARE Plan becomes a court order that lasts for up to one year.[11] The CARE Plan may provide for behavioral health services and housing supports, as well as other services.[12] The court may order medication only if it finds, by clear and convincing evidence, that the respondent lacks the capacity to give informed consent to the administration of medically necessary stabilization medication; to the extent such medication is administered, the medication may not be forcibly administered, and the respondent’s failure to comply with a medication order shall not result in a penalty, such as terminating the CARE process.[13]
Eleven months after the CARE Plan was put in place, the court shall hold a hearing to determine whether to graduate the respondent from the CARE Plan or whether, with or without the consent of the respondent, as specified, to keep the respondent in the CARE program.[14] A respondent may be appointed to the CARE process only once, for up to one additional year.[15]
3. Concerns about the CARE Act leading up to implementation
As noted above, seven counties must implement the CARE Act on or before October 1, 2023. While a coalition of disability and civil rights groups petitioned for a writ of mandate to have the CARE Act declared unconstitutional prior to the implementation, the California Supreme Court rejected the petition without comment.[16] Disability Rights California and the ACLU continue to argue that the CARE Act will do more harm than good (see Comment 7 of this analysis for their arguments in opposition).
As the implementation date draws closer, other concerns have been raised about putting the CARE Act into practice. Counties have expressed concern that they will be overwhelmed by the number of CARE petitions filed and by the number of families who are frustrated that their loved ones do not satisfy the eligibility for CARE court participation.[17] Orange County, for example, estimates that it will receive 1,500 petitions in the first year of implementation.[18] Counties have also expressed concern that the allocated startup funds for implementation are insufficient, and that the state will not continue to adequately fund the CARE program as time goes on.[19] Some counties have tried to temper expectations, explaining that change brought on by the CARE Act will likely be incremental.[20]
Ironically, stakeholders also argue that the CARE Act both gives too small and too large a role for the family members of persons who may be eligible for the CARE Act. Some family members of persons experiencing mental illnesses have expressed dismay that the CARE Act allows respondents to limit participation by their family members, for example, by choosing a supporter who is not a family member.[21] Some family members also argue that the CARE Act grants respondents too much autonomy.[22] On the other side, some mental health advocates argue that bringing persons with mental illnesses before a court will be inherently traumatic to the respondents and will ultimately lead to more persons being treated involuntarily.[23]
Finally, counties raised concerns that CBHAs’ obligations to conduct evaluations of respondents and report on respondents’ health to the courts would inadvertently violate existing privacy laws. This issue, as well as several other modifications to clean up the CARE process in advance of implementation, are addressed in this bill.
4. SB 35’s path through the Legislature
This bill left the Senate as a minor clean-up bill that allowed DHCS to grant implementation delays through December 15, 2025—a two-week extension from the current December 1, 2025, date. At that time, the bill did not alter the CARE process itself.
Once the bill reached the Assembly, however, the bill was amended to incorporate many new provisions, including ones allowing CARE Act proceedings to be conducted by court-appointed commissioners, and requiring respondents to be provided an interpreter if needed. The Assembly Judiciary committee subsequently amended the bill to add an urgency clause, and on August 28, 2023, SB 35 was amended again in order to allow health care providers, and others with medical information relevant to the determination of CARE Act eligibility, to share such information with CBHAs. Under the August 28 amendments, this information, in turn, can then be shared with the courts.
Following the August 28 amendments, the bill was re-referred to the Assembly Privacy and Consumer Protection Committee and the Assembly Appropriations Committee. The analysis of the Assembly Privacy and Consumer Protection Committee raised concerns that, as amended, SB 35’s provisions regarding a CBHA’s obligation to share health information could create a tension with HIPAA or other privacy protections. The author, therefore, accepted amendments to ensure the confidentiality of information submitted to the courts and compliance with applicable privacy laws, which were taken in the Assembly Appropriations Committee. After the Assembly passed the bill with a vote of 56-0, the bill was referred to this Committee pursuant to Senate Rule 29.10(d), for the Committee to vote on whether to concur in the Assembly amendments.
5. This bill makes a number of changes to the CARE Act on an urgency basis
In anticipation of the first cohort of counties’ October 1, 2023, deadline for implementing the CARE Act, this bill makes a number of tweaks and modifications to the CARE Act on an urgency basis. The relevant modifications are set forth below.
Clarification of the availability of extensions of the implementation date. SB 35 clarifies that DHCS may grant a county only one extension of their implementation date. According to the Assembly Judiciary Committee’s analysis, “[t]his change is apparently intended to push counties to implement the program, notwithstanding the fact that they may lack resources such as courtrooms, social workers, public defenders, mental health beds, drug treatment services, etc.” The bill retains the existing due date for implementation, notwithstanding any extensions, at December 1, 2025.
Clarification regarding counsel. SB 35 makes modifications relating to the appointment and conduct of counsel in a CARE proceeding. These include:
- Clarifying that the representation of an attorney appointed or chosen by the respondent to represent the respondent must comply with specified state law and the California Rules of Professional Conduct. Given that all licensed attorneys must already apply with these provisions, this does not appear to affect a change in the law.
- Permitting the appointment of counsel “working in the capacity” of a public defender, rather than a public defender, to be appointed to represent the respondent.
- Providing that, if a person other than the respondent files a petition for CARE Act proceedings in order to gain an advantage over the respondent in another legal proceeding, as defined, it is cause for suspension, disbarment, or other discipline if a member of the State Bar is found to have filed the petition or assisted in the filing of the petition with knowledge that the filing was being made in order to gain that advantage. This provision is intended to bolster the existing provisions allowing a person to be declared a vexatious litigant if they repeatedly file frivolous or harassing CARE petitions.
Clarification regarding who may file a petition and the rights of original petitioners. This bill tightens up the provisions regarding who may file a CARE petition and the rights of an original petitioner after the CBHA has been substituted in as the petitioner. Specifically, the bill clarifies that:
- A public guardian or public conservator, or their designee, may file a petition for a respondent who resides or is found in their county.
- The director of a California Indian health services program or California tribal behavioral health department may file a petition for a respondent for whom they have provided within the previous 30 days, or for whom they are currently providing, behavioral health services.
- The judge of a tribal court located in California may file a petition for a respondent when the respondent has appeared before the court within the previous 30 days.
- When an original petitioner resides with, or is an eligible family member of, the respondent, the original petitioner has the right to be present and make a statement at the initial hearing on the merits; the court may, at its discretion, assign notice rights to the original petitioner, and may allow the original petitioner to participate in the respondent’s CARE process to the extent the respondent consents.
- When an original petitioner is not a person who resides with, or is an eligible family member of, the respondent, the original petitioner has no ongoing rights other than to be present and make a statement at the hearing on the merits of the petition.
Confidentiality and Privacy Protections. If a court determines that a CARE petition makes a prima facie showing that a respondent satisfies the criteria for CARE court eligibility, the CBHA may be required to submit a report to the court, within 14 days, that includes all of the following information:
- A determination as to whether the respondent meets, or is likely to meet, the criteria for the CARE process.
- The outcome of efforts made to voluntarily engage the respondent during the 14-day report period.
- Conclusions and recommendations about the respondent’s ability to voluntarily engage in services.[24]
Based on this report, the court then determines whether to set an initial hearing on the petition and appoint counsel for the respondent.[25]
As explained by the Assembly Privacy and Consumer Protection Committee:
The privacy of medical information is largely governed by the federal Health Insurance Portability and Accountability Act (HIPAA) and California’s Confidentiality of Medical Information Act (CMIA). Disclosure of medical information generally requires a patient’s informed consent.
However, respondents who are eligible for the CARE process may not be able to grant informed consent for the release of information, due to the very circumstances that make them eligible for the CARE Act. Any disclosure must therefore be made on the basis of another valid exemption from medical privacy laws. Disclosure of medical information under the CARE Act is necessary because of the short time frame (14 court days) that county behavioral health agencies have to provide a written report as to a respondent’s eligibility for the process. The Act explicitly excludes individuals with “a psychotic disorder that is due to a medical condition or is not primarily psychiatric in nature, including, but not limited to, physical health conditions such as traumatic brain injury, autism, dementia, or neurologic conditions.”[26] As explained to Committee staff, acute psychosis may be precipitated even by something as simple as an untreated urinal tract infection, which, of course, would not be eligible for the CARE process. Yet there may be no way for a county behavioral health agency to rule out medical causes that do not give rise to CARE eligibility without first examining the respondent’s medical records. (In addition, significant financial penalties can be levied against a county that fails to comply with court orders under the CARE Act.)
Amendments taken to the bill in the Assembly are intended to facilitate the sharing of information by health care providers and other entities covered by HIPAA and the MCIA with CBHAs, including by specifying that information may be disclosed consistent with these state and federal laws. The bill also requires the respondent and the respondent’s counsel to be notified by the CBHA when there has been a disclosure of their health information. Additionally, the bill adds protections for information filed with the court in a CARE proceeding, including permitting a respondent to seek to have the information filed in their case placed under seal and granting a presumption in favor of sealing.
Evidentiary matters. SB 35 makes a number of clarifications and changes regarding what evidence may be offered in CARE proceedings as well as to how a party may use evidence or testimony given in a CARE proceeding. These measures include:
- Specifying that any evidence offered in addition to the CBHA’s report on whether the respondent meets the CARE court criteria must be admissible evidence. This should provide additional protections to the respondent, for example, by preventing hearsay testimony for which there is no exception being offered at the hearing on the merits of the petition.
- Providing that the fact that evidence is admitted in a CARE proceeding shall not be the basis for admitting the evidence in any subsequent legal proceeding.
- Providing that photographs, transcripts, other records of CARE proceedings, and testimony given in CARE proceedings shall not be admissible in any subsequent legal proceeding except upon a motion from the respondent, the CBHA, the public guardian, or the public conservator.
- Clarifying that all applicable rules of evidence, including the Evidence Code, apply in CARE proceedings.
Expanding and clarifying the rights of the respondent. This bill provides the respondent with the right to an interpreter in all proceedings if necessary for the respondent to fully participate. Additionally, the bill clarifies that the respondent may have their supporter present with them and to perform the functions of a supporter, as specified.
Additional procedural provisions and changes. In addition to the changes above, SB 35 makes a number of changes to the CARE court procedures and similar matters. These include:
- Authorizing CARE proceedings to be conducted by a superior court judge or by a court-appointed commissioner or other subordinate judicial officer. “Subordinate judicial officers” are referees, commissioners, and hearing officers appointed by the courts pursuant to the California Constitution.[27] California Rules of Court require a subordinate judicial officer to be a member of the state bar and have been admitted to practice law in California for at least 10 years.[28] According to the author, this provision is intended to allow the courts to satisfy their CARE court obligations without overwhelming the courts. Opponents of the bill argue that this measure insufficiently protects the respondents who will be appearing before subordinate judicial officers instead of judges.
- Eliminating filing fees for filing under the CARE Act, and prohibiting any fees from being charged by any public officer for services in filing or serving papers or for the performance of any duty enjoined by the CARE Act. This measure will, presumably, eliminate financial barriers to filing a CARE petition; opponents of the bill argue that the lack of a filing fee will result in increased exposure of people with mental disabilities to the CARE process, causing undue harm.
- Clarifying that if, at a hearing on the merits of the petition, the court finds there is not clear and convincing evidence that the respondent meets the criteria for CARE court eligibility, the court shall dismiss the case without prejudice, unless the court makes an on-the-record finding that the original petitioner’s filing was not in good faith, in which case the case shall be dismissed with prejudice.
6. Arguments in support
According to the California State Association of Counties, Rural County Representatives of California, and Urban Counties of California:
Last year, the Legislature passed and the Governor signed SB 1338 (Chapter 319, Statutes of 2022), which creates a new court process authorizing specified individuals to petition a civil court to create a voluntary CARE agreement or court-ordered CARE plan to provide behavioral health care, including stabilization medication, housing, and other enumerated services, to adults who are currently experiencing a severe mental illness and have a diagnosis identified in the disorder class schizophrenia and other psychotic disorders, and who meet other specified criteria.
Fulfillment of county behavioral health agencies’ responsibilities under the CARE Act will require communication of detailed information regarding a respondent’s behavioral health condition and treatment to the court. Such information is generally confidential under state and federal law and cannot be disclosed by any health care provider – including county behavioral health – without the respondent's consent. A respondent may decline to consent to release of their confidential medical and mental health information to the court – particularly during early phases of the case, when county behavioral health is preparing the initial report to the court required under the provisions of the CARE Act. As a result, express legal authority will be required for county behavioral health agencies to provide the court with the information contemplated by the CARE Act.
We appreciate the [Assembly Privacy and Consumer Privacy] Committee’s engagement with our organizations to develop additional amendments to ensure the data sharing provisions included in the CARE Act maintain the necessary confidentiality requirements as required by existing state and federal law.
7. Arguments in opposition
According to ACLU California Action and Disability Rights California:
First, SB 35 will expand the number of CARE Court petitions by prohibiting a filing fee. Research shows that fees reduce filings. For example, in eviction cases, the larger the filing fee in a jurisdiction the lower the eviction rate—an effect that is disproportionately large in majority-Black neighborhoods. The lack of a filing fee will therefore increase exposure of people with mental health disabilities to CARE Court.
Second, SB 35 would give additional rights to the petitioners, thus weakening the rights of respondents. For example, the bill gives petitioners “the right to be present and make a statement on the merits of the petition at the initial hearing,” and extends those rights if the petitioner is “a spouse, parent, sibling, child, or grandparent or other person who stands in loco parentis to the respondent.”
Finally, SB 35 loosens criteria for who can be appointed as counsel and authorizes a “court-appointed commissioner or other subordinate judicial officer” to conduct proceedings in lieu of a superior court judge. This change eases the ability of counties to implement the CARE Act while doing nothing to safeguard the rights of respondents.
CARE Court is likely to do real harm to the populations the CARE Act intended to help, setting back decades of recovery tools designed to help those most marginalized. CARE Court will contribute to the re-institutionalization of people with disabilities, repeating a horrific history of civil rights abuses.
SB 35 will deepen the threat CARE Court poses to racial and economic justice. It will increase the harm and stigmatization of people with mental health disabilities, especially people within communities of color. Studies show Black, Indigenous and People of Color will disproportionately experience the harms that CARE Court poses. SB 35 will increase CARE Court’s exploitation of poor people who need mental health care. It is those people with low incomes and/or from communities of color who will be most victim to the chilling effects CARE Court will have in preventing people from seeking treatment and care.
SUPPORT
California State Association of Counties
Rural County Representatives of California
Urban Counties of California
OPPOSITION
ACLU California Action
Disability Rights California
Electronic Frontier Foundation
RELATED LEGISLATION
Pending Legislation: SB 43 (Eggman, 2023) expands the definition of “gravely disabled” for purposes of who may be involuntarily detained and treated under the LPS Act. SB 43 is pending on the Assembly Floor.
Prior Legislation: SB 1338 (Umberg, Ch. 319, Stats. 2022) enacted the CARE Act and implements the CARE Court framework in a two-phased rollout, with the first cohort of counties to commence implementation on October 1, 2023, and the second cohort of counties to commence implementation on December 1, 2024.
PRIOR VOTES:
Assembly Floor (Ayes 56, Noes 0)
Assembly Appropriations Committee (Ayes 16, Noes 0)
Assembly Privacy and Consumer Protection Committee (Ayes 11, Noes 0)
Assembly Appropriations Committee (Ayes 15, Noes 1)
Assembly Judiciary Committee (Ayes 10, Noes 0)
Senate Floor (Ayes 37, Noes 0)
Senate Health Committee (Ayes 11, Noes 0)
**************
Welf. & Inst. Code, § 5970.5(a). ↑
Id., § 5970.5(b). ↑
Id., § 5970.5(c). ↑
E.g., Wiley & Curran, L.A. County on track to join Newsom’s sweeping mental health plan a year early, Los Angeles Times (Jan. 13, 2023), available at https://www.latimes.com/california/story/2023-01-13/la-county-care-court-2023-newsom-mental-health-los-angeles. All links in this analysis are current as of September 12, 2023. ↑
See CalHHS, Community Assistance, Recovery & Empowerment Act, https://www.chhs.ca.gov/care-act/. ↑
E.g., Welf. & Inst. Code, § 5346 (assisted outpatient treatment petition must be filed by a county behavioral health director or their designee; specified family members or other persons may request that a petition be filed, but may not file the petition themselves). ↑
Welf. & Inst. Code, § 5974. ↑
Id., § 5972. ↑
Id., § 5977. ↑
Id., § 5977.1(b). The court may continue the evaluation hearing for a maximum of 14 days upon stipulation of the respondent and the CBHA, unless there is good cause for a longer extension. ↑
Id., § 5977.1(d). ↑
Id., § 5982. ↑
Id., § 5977.1(d)(3). ↑
Id., § 5977.3. ↑
Ibid. ↑
See Disability Rights California v. Newsom, Case No. S278330; Wiley, California Supreme Court rejects lawsuit challenging Newsom’s plan to treat mental illness, L.A. Times (Apr. 22, 2023), available at https://www.latimes.com/california/story/2023-04-22/california-supreme-court-newsom-care-court-mentally-ill-homeless-substance-disorder. ↑
E.g., Curwen, ‘Deep in the weeds’: California counties face unknowns in launching mental illness court, L.A. Times (May 21, 2023), available at https://www.latimes.com/california/story/2023-05-21/counties-scramble-care-court-preparations. ↑
Ibid. ↑
Ibid. ↑
Curwen, Why California’s much-touted CARE Court is no ‘one and done’ program, L.A. Times (Jan. 1, 2023), available at https://www.latimes.com/california/story/2023-01-01/care-court-challenges-orange-san-diego-counties. ↑
Curwen, CARE courts open in a month, promising hope for families. Not everyone is so sure, L.A. Times (Sept. 4, 2023), available at https://www.latimes.com/california/story/2023-09-04/care-courts-families-voluntary-compliance. ↑
Ibid. ↑
Ibid. If a court finds, by clear and convincing evidence, that respondent is failing to participate in the CARE process or is not adhering to their CARE plan, the court may refer the respondent for an evaluation for involuntary detention and treatment under the LPS Act. (Welf. & Inst. Code, § 5979.) A respondent’s failure to successfully complete a CARE also gives rise to a presumption in an LPS Act hearing that a respondent needs additional intervention, if the LPS Act hearing occurs within six months of the termination of the CARE plan. (Ibid.) Relatedly, pending legislation would lower the bar for a county to involuntarily detain and treat a person and, ultimately, place them in a conservatorship pursuant to the LPS Act (see SB 43 (Eggman, 2023)); together with the evidentiary presumption, respondents who failed to complete the CARE Act process will have fewer protections against involuntary treatment since the implementation of the LPS Act. ↑
Welf. & Inst. Code § 5977(a)(3). ↑
Id., § 5977(a)(5). ↑
Id., § 5972(b). ↑
Cal. Const. art.VI, § 22. ↑
Cal. Rules of Court, r. 10.701(b). There are exceptions to these qualification criteria for subordinate judicial officers who were acting in that role as 2003 (see ibid.) and for judicial officers serving under specific statutory schemes that do not apply here (see id., r. 10.701(d); Welf. & Inst. Code, §§ 255, 5256.1.). ↑
SENATE RULES COMMITTEE Office of Senate Floor Analyses (916) 651-1520 Fax: (916) 327-4478 | SB 35 |
UNFINISHED BUSINESS
Bill No: SB 35
Author: Umberg (D)
Amended: 9/8/23
Vote: 27 - Urgency
SENATE HEALTH COMMITTEE: 11-0, 4/19/23
AYES: Eggman, Nguyen, Dahle, Glazer, Gonzalez, Limón, Menjivar, Roth, Rubio, Wahab, Wiener
NO VOTE RECORDED: Hurtado
SENATE APPROPRIATIONS COMMITTEE: Senate Rule 28.8
SENATE FLOOR: 37-0, 5/4/23 (Consent)
AYES: Allen, Alvarado-Gil, Archuleta, Ashby, Atkins, Becker, Bradford, Caballero, Cortese, Dahle, Dodd, Durazo, Eggman, Glazer, Grove, Hurtado, Jones, Laird, McGuire, Menjivar, Min, Newman, Nguyen, Niello, Ochoa Bogh, Padilla, Portantino, Roth, Rubio, Seyarto, Skinner, Smallwood-Cuevas, Stern, Umberg, Wahab, Wiener, Wilk
NO VOTE RECORDED: Blakespear, Gonzalez, Limón
SENATE JUDICIARY COMMITTEE: 9-0, 9/13/23 (Pursuant to Senate Rule 29.10)
AYES: Umberg, Wilk, Allen, Ashby, Durazo, Min, Niello, Stern, Wiener
NO VOTE RECORDED: Caballero, Laird
ASSEMBLY FLOOR: 78-0, 9/12/23 - See last page for vote
SUBJECT: Community Assistance, Recovery, and Empowerment (CARE) Court Program
SOURCE: Author
DIGEST:
This bill modifies the Community, Assistance, Recovery, and Empowerment (CARE) Act, which requires certain counties to implement the CARE Court Program beginning October 1, 2023.
Assembly Amendments
expand the bill to clarify and modify the CARE Court process, the obligations and responsibilities of CARE petitioners and county behavioral health agencies (CBHAs), and the provisions relating to a respondent’s privacy and the circumstances under which a health care provider may share the respondent’s health care information with a CBHA in the course of the CARE process.
ANALYSIS:
Existing law:
- Establishes the CARE Act. (Welf. & Inst. Code, div. 5, pt. 8, §§ 5970 et seq.)
- Defines a number of relevant terms. (Welf. & Inst. Code, § 5971.)
- Provides that the CARE Act shall be implemented as follows:
- A first cohort of counties, including Glenn, Orange, Riverside, San Diego, Stanislaus, Tuolumne, and the City and County of San Francisco, shall begin no later than October 1, 2023.
- A second cohort of counties, representing the remaining counties in the state, shall begin no later than December 1, 2024.
- The Department of Health Care Services (DHCS) shall issue guidelines under which counties can apply for, and be provided, additional time in which to implement the CARE Act, subject to certain conditions and restrictions. (Welf. & Inst. Code, § 5970.5.)
- Establishes criteria for a person to qualify for the CARE process, as specified. (Welf. & Inst. Code, § 5972.)
- Establishes who may file a petition to initiate the CARE process, including a person with whom the respondent resides, a spouse, parent, sibling, child, or grandparent or other individual who stands in loco parentis to the respondent, or the director of a CBHA or county adult protective services, or their designee, of the county in which the respondent resides or is found. (Welf. & Inst. Code, § 5974.)
- Allows a court, if a criminal defendant is found to be mentally incompetent and ineligible for a diversion, to refer the defendant to the CARE program, as provided. (Pen. Code, § 1370.1(b)(1)(D)(iv).)
- Requires the Judicial Council to create a mandatory court form to file a CARE process petition, together with any other forms necessary during the CARE process, as specified. (Welf. & Inst. Code, § 5975.)
- Establishes requirements for the jurisdiction in which a CARE Act petition may be filed, for the filing of a CARE Act petition, and for instances in which a CARE Act petition is filed to harass the respondent. (Welf. & Inst. Code, §§ 5973, 5975, 5975.1.)
- Establishes the rights of the respondent, including the right to be represented by counsel at all stages of a CARE proceeding, regardless of ability to pay. (Welf. & Inst. Code, § 5976.)
- Provides for the following regarding CARE Act hearings:
- Establishes that hearings are presumptively closed to the public, but permits the respondent to demand that the hearings be public.
- Permits the respondent to request the presence of a family member or friend without waiving the right to keep the hearing closed to the rest of the public.
- Permits the court to grant a request by another party to make a hearing public if the judge conducting the hearing finds that the public interest clearly outweighs the respondent’s interest in privacy.
- Declares that all reports, evaluations, diagnoses, or other information related to the respondent’s health shall be confidential.
- Requires the judge, before commencing a hearing, to inform the respondent of their rights under this section. (Welf. & Inst. Code, § 5976.5.)
- Establishes the CARE Court process, wherein the court:
- Upon receipt of a CARE Act petition, must promptly review a CARE petition to determine whether a prima facie showing has been made that the respondent is or may be eligible for CARE Court, and, if so, take certain steps within specified timelines, including appointing counsel for the respondent, directing a CBHA to conduct an investigation into whether the respondent meets the CARE Court criteria, and, if the court determines by clear and convincing evidence, after a hearing on the merits, that the respondent meets the CARE Court criteria, directing the CBHA to work with the respondent to develop a CARE agreement. (Welf. & Inst. Code § 5977.)
- After ordering the CBHA and respondent to develop a CARE agreement, must conduct a case management to determine whether the parties have entered, or are likely to enter a CARE agreement; if the parties have entered into an agreement, the court must approve the agreement (as modified by the court, where applicable), or give the parties additional time to reach an agreement. If the parties are not likely to reach an agreement, the court must order the CBHA to conduct a clinical evaluation of the respondent to determine whether the respondent meets the CARE criteria, the court shall order the parties to develop a CARE plan. (Welf. & Inst. Code, § 5977.1.)
- After the entry of a CARE plan, the court shall hold regular status agreements and, 11 months after the entry of a CARE plan, determine whether to graduate the respondent or order the respondent, voluntarily or involuntarily, to remain in the CARE process for up to one more year. (Welf. & Inst. Code, §§ 5799.2, 5977.3.)
- Allows the court, at any point during CARE proceedings, if it determines, by clear and convincing evidence, that the respondent, after receiving notice, is not participating in the CARE process or is not adhering to their CARE plan, to terminate respondent’s participation. The court is then permitted to make a referral under the Lanterman-Petris-Short Act (LPS Act), as provided. (Welf. & Inst. Code § 5979(a).)
- Provides that, if a respondent was timely provided with all services and supports required by their CARE plan, the fact that the respondent failed to successfully complete the plan and reasons for that failure (a) are facts to be considered by a court in a subsequent hearing under the LPS Act, provided that the hearing occurs within six months of termination of the CARE plan; and (b) create a presumption at that hearing that the respondent needs additional interventions beyond the supports and services provided by the CARE plan. (Welf. & Inst. Code, § 5979(a)(3).)
- Creates a process for penalizing counties or other local government entities that do not comply with CARE court orders. (Welf. & Inst. Code § 5979(b).)
- Provides that either a respondent or a CBHA may appeal an adverse court determination. (Welf. & Inst. Code, § 5979(c).)
- Establishes the LPS Act to end inappropriate, indefinite, and involuntary commitment of mentally disordered persons, developmentally disabled persons, and persons impaired by chronic alcoholism, and to provide prompt evaluation and treatment of those with mental health disorders or impaired by chronic alcoholism. (Welf. & Inst. Code, div. 5, pt. 1, §§ 5000 et seq.)
- Establishes the Confidentiality of Medical Information Act (CMIA). (Civ. Code, §§ 56-56.37.)
This bill:
- Requires, after a criminal court has referred a defendant to the CARE program, the hearing to determine the defendant’s eligibility to be held within 14 court days after the date on which the petition for the referral is filed.
- Specifies that a county shall be granted only one extension for implementing the CARE Act. The final date for implementation under any circumstances is December 1, 2025.
- Clarifies that legal representation of a respondent in CARE Act proceedings, and in matters related to CARE agreements and CARE plans, does not alter an attorney’s obligations under the State Bar Act and the California Rules of Professional Conduct, including obligations relating to the attorney’s duty of confidentiality.
- Clarifies when certain individuals may file a CARE petition, including:
- A public guardian or public conservator, or their designee, of a county may file a petition if the respondent resides or is found in that county.
- The director or a Californian Indian health services program, California tribal behavioral health department, or their designee may file a petition if they have provided, within the previous 30 days, or are providing behavioral services to the respondent.
- The judge of a tribal court, or their designee, located in California may file a petition if the respondent has appeared before the judge within the prior 30 days.
- Provides that, if a person other than the respondent files a petition for a CARE Act proceeding in order to gain an advantage over the respondent in another legal proceeding, then, notwithstanding any other provision of the CARE Act, it is cause for suspension, disbarment, or other discipline if a member of the State Bar is found to have filed the petition or assisted in the filing of the petition with knowledge that the filing was being made in order to gain that advantage. For purposes of this provision, “legal provision” does not include a proceeding under the LPS Act or a dependency proceeding.
- Authorizes a CARE Act proceeding to be conducted by a superior court judge, a court-appointed commissioner, or other subordinate juvenile officer.
- Provides that there shall be no filing fee for any CARE Act filing, nor shall any fees by charged by any public officer for services in filing or serving papers or for the performance of any duty enjoined by the CARE Act.
- Adds and clarifies, to the list rights held by a respondent in a CARE proceeding, the rights to (a) have a supporter be present with them to perform the functions of a supporter as provided for in the CARE Act, and (b) have an interpreter present in all proceedings if necessary for the respondent to fully participate.
- Clarifies that all reports, evaluations, or other information filed with the court related to the respondent’s health shall be confidential, and permits the respondent, at any time, to petition the court for an order sealing those records or any other court records in a CARE Act proceeding. Notwithstanding any rule of court prohibiting records kept confidential by law from consideration for sealing, there is a presumption in favor of sealing the records if such a petition is filed.
- Provides that the fact that evidence is admitted at a proceeding held under the CARE Act shall not be the basis for admission of that evidence in any subsequent legal proceeding.
- Provides that photographs, recordings, transcripts, other records of proceedings held under the CARE Act, and testimony regarding proceedings held pursuant to the CARE Act, shall not be admissible in any subsequent legal proceeding except upon motion by the respondent, the CBHA, the public guardian, or the public conservator in that subsequent legal proceeding:
- Provides that, in a CARE Act proceeding, the provisions relating to confidentiality of records and their use in subsequent proceedings do not affect the applicability of Welfare and Institutions Code Section 5977.1(c)(2), make admissible any evidence that is not otherwise admissible, or permit a witness to base an opinion on any matter that is not a proper basis for that opinion. The admission or exclusion of evidence shall be pursuant to the rules of evidence established by the Evidence Code, including, but not limited to, Section 352 of the Evidence Code, and by judicial decision.
- Allows, in lieu of the appointment of a public defender to represent the respondent, for the appointment of counsel “working in [the] capacity” of a public defender to represent the respondent.
- Requires, when a petition has been filed by an individual other than a CBHA and the court orders the CBHA to investigate the respondent and file a report with the court, the CBHA’s report to the court to include the information, including protected health information, necessary to support the determinations, conclusions, and recommendations in the report.
- Clarifies the following regarding an original petitioner who is a person who lives with the respondent or an eligible family member of the respondent:
- They have the right to be present and make a statement at the initial hearing on the merits of the petition.
- The court may, at its discretion, assign ongoing rights of notice.
- The court may allow them to participate in the respondent’s CARE proceedings to the extent that the respondent consents to their participation.
- Clarifies that, if the original petitioner is not a person who lives with the respondent or eligible family member of the respondent, the original petitioner does not have ongoing rights other than the right to be present and make a statement at the initial hearing on the merits of the petition.
- Requires additional evidence presented at the hearing on the merits of a petition to be “admissible” evidence.
- Clarifies that if, at the hearing on the merits of the petition, the court finds there is not clear and convincing evidence that the respondent meets the specified CARE criteria, the court shall dismiss the case without prejudice, unless the court makes a finding, on the record, that the original petitioner’s filing was not in good faith, in which case the dismissal shall be with prejudice.
- Provides that the following shall apply to any written report submitted by a CBHA to the court:
- The report is confidential and not subject to disclosure under the California Public Records Act (Gov. Code, tit. 1, div. 10, §§ 7920.000 et seq.) (CPRA).
- The report is inadmissible in any subsequent legal proceeding, except upon motion of the respondent in that subsequent legal proceeding.
- The report is confidential, as specified.
- These limitations do not affect the applicability of Welfare and Institutions Code Section 5977.1(c)(2), make admissible any evidence that is not otherwise admissible, or permit a witness to base an opinion on any matter that is not a proper basis for that opinion. The admission or exclusion of evidence shall be pursuant to the rules of evidence established by the Evidence Code, including, but not limited to, Section 352 of the Evidence Code, and by judicial decision.
- Clarifies that if, at the case management hearing, the court finds that the parties have entered, or are likely to enter, into a CARE agreement, the court shall either:
- Approve the terms of the CARE agreement or modify it and approve the agreement as modified, continue the matter, and set a progress hearing for 60 days; or
- Continue the matter for 14 days to allow the parties additional time to enter into a CARE agreement upon stipulation of the parties.
- Requires the Judicial Council to develop rules regarding communications between the CARE Court and the juvenile courts, if applicable.
- Provides that a CHBA may include in its report and evaluations, and a provider of health care may disclose to a CBHA, protected health information consistent with Civil Code Section 56.10(b)(9), as provided and subject to specified limitations. Neither a county nor an employee or agent thereof shall be held civilly or criminally liable for any disclosure authorized or required by provision.
- Authorizes a CBHA to apply to the court ex parte for an order requiring any provider of health care, as defined, or any covered entity, as defined, to provide to the county behavioral health agency, to the court, or both, any information, including, but not limited to, protected health information, and mental health records excluding psychotherapy notes, in its possession about the respondent that may be relevant in connection with an investigation, evaluation, or other report or hearing under this part, or with the provision of services and supports under this part. The provision of information under this paragraph is a disclosure required by law, which may be made only to the extent permitted under federal regulations, as specified, and the information ordered to be disclosed may include substance use disorder patient records only to the extent permitted by federal regulations, as specified.
- Provides that a provider of health care or covered entity shall not be held civilly or criminally liable for any disclosure required or authorized under Welfare and Institutions Code Section 5977.4.
- Requires a CBHA to notify the respondent of a disclosure under 22) and provide the information to the respondent and their counsel, as specified.
- Provides that, except as expressly provided, further disclosure or redisclosure of information is not permitted.
- Clarifies that, when an individual is referred to CARE Court from an LPS Act proceeding, the conservator or proposed conservator shall be the petitioner; and when an individual is referred to CARE Court from a misdemeanor proceeding, the CBHA or their designee shall be the petitioner.
- Clarifies the timing of the information that DHCS must provide to the Legislature evaluating the effectiveness of the CARE Act, by specifying that the preliminary report is due to the Legislature by December 31, 2026, and the final report is due to the Legislature by December 31, 2028.
- Makes technical and nonsubstantive conforming changes.
- Includes an urgency clause.
Comments
In 2022, the Legislature enacted, and the Governor signed, SB 1338 (Umberg, Chapter 319, Statutes of 2022), known as the CARE Act, which is intended to deliver mental health and substance use disorder services for persons with certain severe mental illness diagnoses as an alternative to incarceration in a jail or psychiatric facility or to being subjected to a conservatorship under the LPS Act (Welf. & Inst. Code, div. 5, pt. 1, §§ 5000 et seq.). The CARE Act provides for court-ordered CARE Plans for qualified persons suffering from a mental health or substance abuse disorder crisis for up to 12 months, with possible extensions. The plan is supposed to provide individuals with clinically appropriate, community-based services. A cohort of seven counties will implement the CARE Act by October 1, 2023; the remaining counties will implement the CARE Act by December 1, 2024.
This bill is intended to clean up and improve the CARE Act and address concerns raised by certain stakeholders in advance of the implementation date. Among other things, the bill is intended to provide protections for county entities that are obligated to obtain medical information about CARE Act respondents and ensure that the CARE Act does not inadvertently run afoul of state and federal law; ensure that respondents are provided with an interpreter when necessary for the respondent to participate fully in the proceedings; and clarify the rights of the individual or entity that files an original CARE petition.
FISCAL EFFECT: Appropriation: No Fiscal Com.: Yes Local: Yes
According to the Assembly Appropriations Committee:
- Costs (Trial Court Trust Fund, General Fund) to the courts of an unknown but potentially significant amount. Judicial Council reports minor and absorbable costs to accept petitions without filing fees, provide interpreters, conduct hearings using commissioners or other subordinate officers, and implement other changes included in the version of this bill dated July 12. To the extent the subsequent amendments require the court to consider additional orders or conduct additional hearings, the courts may experience additional workload costs. Although courts are not funded on the basis of workload, increased pressure on the Trial Court Trust Fund may create a need for increased funding for courts from the General Fund. The 2023-24 Budget includes $105 million from the General Fund to backfill declining revenue to the Trial Court Trust Fund.
- Costs (local funds, General Fund) of an unknown but likely significant amount to county behavioral health agencies, potentially in the millions of dollars annually. Under this bill, a county behavioral health agency must obtain a CARE respondent’s health care information, incorporate relevant information into reports and evaluations submitted to the court, and provide notice to the respondent and respondent’s counsel of any disclosure of the respondent’s health care information. Actual costs will depend on the number of CARE Act cases filed and the amount of additional workload incurred by a county behavioral health agency in complying with this bill’s requirements. General Fund costs will depend on whether the duties imposed by this bill constitute a reimbursable state mandate, as determined by the Commission on State Mandates.
The 2023-24 Budget provides $55.5 million to the courts to implement the CARE Act, with $133 million to the courts ongoing starting in fiscal year 2025-26, plus additional funding for related IT improvements and the CARE Act Supporter Program.
SUPPORT: (Verified 9/13/23)
California State Association of Counties
Rural County Representatives of California
Urban Counties of California
OPPOSITION: (Verified 9/13/23)
ACLU California Action
Disability Rights California
Electronic Frontier Foundation
ARGUMENTS IN SUPPORT: According to the California State Association of Counties, Rural County Representatives of California, and Urban Counties of California:
Last year, the Legislature passed and the Governor signed SB 1338 (Chapter 319, Statutes of 2022), which creates a new court process authorizing specified individuals to petition a civil court to create a voluntary CARE agreement or court-ordered CARE plan to provide behavioral health care, including stabilization medication, housing, and other enumerated services, to adults who are currently experiencing a severe mental illness and have a diagnosis identified in the disorder class schizophrenia and other psychotic disorders, and who meet other specified criteria.
Fulfillment of county behavioral health agencies’ responsibilities under the CARE Act will require communication of detailed information regarding a respondent’s behavioral health condition and treatment to the court. Such information is generally confidential under state and federal law and cannot be disclosed by any health care provider – including county behavioral health – without the respondent's consent. A respondent may decline to consent to release of their confidential medical and mental health information to the court – particularly during early phases of the case, when county behavioral health is preparing the initial report to the court required under the provisions of the CARE Act. As a result, express legal authority will be required for county behavioral health agencies to provide the court with the information contemplated by the CARE Act.
We appreciate the [Assembly Privacy and Consumer Privacy] Committee’s engagement with our organizations to develop additional amendments to ensure the data sharing provisions included in the CARE Act maintain the necessary confidentiality requirements as required by existing state and federal law.
ARGUMENTS IN OPPOSITION: According to ACLU California Action and Disability Rights California:
CARE Court is likely to do real harm to the populations the CARE Act intended to help, setting back decades of recovery tools designed to help those most marginalized. CARE Court will contribute to the re-institutionalization of people with disabilities, repeating a horrific history of civil rights abuses.
SB 35 will deepen the threat CARE Court poses to racial and economic justice. It will increase the harm and stigmatization of people with mental health disabilities, especially people within communities of color. Studies show Black, Indigenous and People of Color will disproportionately experience the harms that CARE Court poses. SB 35 will increase CARE Court’s exploitation of poor people who need mental health care. It is those people with low incomes and/or from communities of color who will be most victim to the chilling effects CARE Court will have in preventing people from seeking treatment and care
ASSEMBLY FLOOR: 78-0, 9/12/23
AYES: Addis, Aguiar-Curry, Alanis, Alvarez, Arambula, Bains, Bauer-Kahan, Bennett, Berman, Boerner, Bonta, Bryan, Calderon, Juan Carrillo, Wendy Carrillo, Cervantes, Chen, Connolly, Megan Dahle, Davies, Dixon, Essayli, Flora, Mike Fong, Vince Fong, Friedman, Gabriel, Gallagher, Garcia, Gipson, Grayson, Haney, Hart, Holden, Hoover, Irwin, Jones-Sawyer, Lackey, Lee, Low, Lowenthal, Maienschein, Mathis, 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: Jackson, Kalra
Prepared by: Allison Whitt Meredith / JUD. / (916) 651-4113
9/13/23 18:28:19
**** END ****
SENATE THIRD READING
STR Bill Id:SB 35
Author:(Umberg)
As Amended Ver:September 8, 2023
2/3 vote. Urgency
SUMMARY
Makes numerous changes to the yet-to-be-implemented Community Assistance, Recovery, and Empowerment (CARE) Act, including but not limited to, allowing a subordinate judicial officer to preside over CARE Court proceedings and prohibiting a fee to file a CARE Court petition.
Major Provisions
- Specifies that a county shall be granted only one extension for implementation of the CARE Act and that the final date for counties to implement under any circumstances shall be December 1, 2025.
- Clarifies that in order for the director of an California Indian health services program or California tribal behavioral health department to be able to file a petition regarding a respondent, the program must have, within the previous 30 days, provided or who is currently providing behavioral health services to the respondent, or the director's designee.
- Clarifies that in order for a judge of a tribal court to be able to file a petition regarding a respondent, the court must be located in California and the respondent must have appeared in the court within the previous 30 days.
- Authorizes CARE Act proceedings to be conducted by a superior court judge or by a court-appointed commissioner or other subordinate judicial officer.
- Requires that there is no fee for filing a petition nor any fees charged by any public officer for services in filing or serving papers or for the performance of any duty enjoined by the CARE Act.
- Provides that the respondent has the right have an interpreter in all proceedings if necessary for the respondent's full participation.
- Allows for the appointment of counsel "working in [the] capacity" of a public defender, rather than a public defender to be appointed to represent the respondent.
- Clarifies the following regarding the rights of the original petitioner:
- They have a right to be present and make a statement at the initial hearing on the merits of the petition.
- In order to be allowed by a court to participate in the respondent's CARE proceedings, the respondent must consent to their participation.
- Requires additional evidence presented at the hearing on the merits of a petition to be "admissible" evidence.
- Provides that notwithstanding any other law, the county behavioral health agency shall include in any report evaluation, or other document filed with the court, the information, including protected health information, necessary to support the determinations, conclusions, and recommendations in the filing.
- Defines "legal proceeding" to mean any administrative, civil, or criminal proceeding, including, but not limited to, juvenile court proceedings and family court proceedings and services, and any form of alternative dispute resolution, including arbitration and mediation, except for specified proceedings, including a proceeding under the Lanterman-Petris-Short Act, the CARE Act, the State Bar Act, or an appeal from any of those proceedings.
- Requires that all written reports submitted to the courts comply with the following:
- The report is confidential and not subject to disclosure or inspection under the California Public Records Act.
- The report is inadmissible in any subsequent legal proceeding, except upon motion of the respondent in that subsequent legal proceeding.
- The report shall be confidential.
- Clarifies applicable exceptions from medical privacy laws.
- Provides that if a person other than the respondent files a petition for CARE Act proceedings in order to gain an advantage over the respondent in another legal proceeding, then, notwithstanding any other provision of this part, it is cause for suspension, disbarment, or other discipline if a member of the State Bar is found to have filed the petition or assisted in the filing of the petition with knowledge that the filing was being made in order to gain that advantage.
- Requires, for a respondent who is in custody on misdemeanor criminal charges and determined to be incompetent to stand trial, that a hearing to determine eligibility for CARE shall be held within 14 court days after the date when the petition for the referral is filed. If the hearing is delayed beyond 14 court days, the court shall order the defendant, if confined in county jail, to be released on their own recognizance pending that hearing.
COMMENTS
SB 1338 (Umberg), Chapter 319, Statutes of 2022, established the Community Assistance, Recovery, and Empowerment (CARE) Act. The CARE Act must be implemented by Glenn, Orange, Riverside, San Diego, San Francisco, Stanislaus, and Tuolumne Counties by October 1, 2023, and by the remaining counties by December 1, 2024. (However, under certain circumstances the Department of Health Care Services (DHCS) can delay implementation until December 1, 2025.) The CARE Act only becomes operative upon DHCS, in consultation with county stakeholders, developing a CARE Act allocation to provide state financial assistance to counties to implement the CARE process.
A central feature of the CARE Act are "CARE Courts," intended to deliver mental health and substance use disorder (SUD) services as an alternative to incarceration in a jail or psychiatric facility of a person with schizophrenia or another psychotic disorder, or that person becoming subject to an LPS conservatorship. The CARE Act provides for court-ordered CARE Plans for a person suffering from a mental health or SUD crisis for up to 12 months, with possible extensions. The plan is supposed to provide individuals with clinically appropriate, community-based services. These might include court-ordered stabilization medications, wellness and recovery support, help with finding social services and housing. While "court-ordered stabilization medication" cannot be forcibly administered, a person's failure to voluntarily participate in the medication treatment could lead to their referral to an LPS conservatorship. (Welfare and Institutions Code Section 5979 (a)(3) to (5).)
The bill makes a number of changes to the CARE Act, including the following:
- Specifies that a county shall be granted only one extension for implementation of the CARE Act and that the final date for counties to implement under any circumstances shall be December 1, 2025.
This change is apparently intended to push counties to implement the program. Given that new and ongoing funding ($29.9 million General Fund in 2023‑24 and increasing to $100 million annually in 2025‑26) has been allocated to support court‑specific costs related to the implementation of the CARE Program, counties are expected to find all of the resources they need to implement the program.
- Authorizes CARE Act proceedings to be conducted by a superior court judge or by a court-appointed commissioner or other subordinate judicial officer.
The California Rules of Court define a "subordinate judicial officer" (SJO) to mean "an attorney employed by a court to serve as a commissioner, referee, or hearing officer, whether the attorney is acting as a commissioner, referee, hearing officer, or temporary judge." (Rule 10.603 (b)(1).) According to the author, the bill "allows proceedings to be conducted by subordinate judicial officers to ensure timely access for court proceedings to protect due process[.]" While this provision likely will help the courts meet their CARE Court responsibilities, it is unknown whether an SJO will have the longevity and experience to fill the place of a superior court judge in CARE Court. ACLU California Action argues that, "This change eases the ability of counties to implement the CARE Act while doing nothing to safeguard the rights of respondents."
- Requires that there is no fee for filing a petition nor any fees charged by any public officer for services in filing or serving papers or for the performance of any duty enjoined by the CARE Act.
It is very unusual for original filing fees to be waived. Other than petitions to prevent domestic violence, abuse of an elder or dependent adult, civil harassment (involving violence, threats of violence, or stalking), workplace violence (involving violence, threats of violence, or stalking), virtually no petitions can be filed with no fee. (https://www.stanislaus.courts.ca.gov/system/files/general/local-civil-fee-schedule-2023.pdf.)
- Clarifies that the original petitioner has a right to be present and make a statement at the initial hearing on the merits of the petition; and in order to be allowed by a court to participate in the respondent's CARE proceedings, the respondent must consent to their participation.
Although one group representing families of the mentally ill objects to this provision (see below), the provision seems appropriate. Not all people want their families to be involved in their mental or physical health care. The same will likely be true for respondents and petitioners in CARE Court.
- Provides that notwithstanding any other law, the county behavioral health agency shall include in any report evaluation, or other document filed with the court, the information, including protected health information, necessary to support the determinations, conclusions, and recommendations in the filing; and makes numerous related changes to the law affecting the privacy and confidentiality of medical information introduced in CARE proceedings and considered by the court in such proceedings.
This provision requires a county to include, in the written report it must submit to the court, "information, including protected health information, necessary to support the determinations, conclusions, and recommendations in the report." Sharing of protected health information is largely governed by the federal Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the state Confidentiality of Medical Information Act (CMIA). This bill allows health care providers to share with county behavioral health agencies, and county behavioral health agencies to share with the court, protected health information as needed for the operation of the CARE Act. All sharing must nonetheless be consistent with state and federal privacy laws, including HIPAA and the CMIA and their limits on the sharing and distribution of confidential medical information.
According to the Author
SB 35 would modify various parts of CARE Court ahead of its implementation in October of 2023. For example, this bill eliminates the filing fee to support equitable access to petitioners with limited resources, allows proceedings to be conducted by subordinate judicial officers to ensure timely access for court proceedings to protect due process, and clarifies the due dates of the program's preliminary and final evaluations. Changes like these are urgently needed to help CARE Court succeed.
Arguments in Support
Families Advocating for the Seriously Mentally Ill (FASMI) write the following to explain why they support the bill if amended:
The exclusion of bipolar disorder is not in the spirit of the CARE Act. . . . [L]anguage has been added to the bill recently that allows CARE Court candidates (who are likely suffering from anosognosia and delusions) to veto the participation of family members. This provision is harmful to both candidates and their families. . . . Please remove this language, which was added in the June 12 amendments, from Section 5977(b)(6)(B)(iii): "To the extent that the respondent consents."
Arguments in Opposition
The Depression and Bipolar Support Alliance (DBSA), which describes itself as "the leading peer-directed national organization focusing on the two most prevalent mental health conditions, depression and bipolar disorder," writes the following about its reasons for opposing the bill:
This bill seems to make unneeded, damaging and inappropriate Care Court petitions even easier to perform, making many of the negative and traumatic effects even more widespread. DBSA California is not opposed to involuntary commitment in all cases, but we believe it should be safe, legal and rare. This program is neither safe to the consumer, but will make it much less rare.
FISCAL COMMENTS
According to the Assembly Appropriations Committee:
- Costs (Trial Court Trust Fund, General Fund) to the courts of an unknown but potentially significant amount. Judicial Council reports minor and absorbable costs to accept petitions without filing fees, provide interpreters, conduct hearings using commissioners or other subordinate officers, and implement other changes included in the version of this bill dated July 12. To the extent the subsequent amendments require the court to consider additional orders or conduct additional hearings, the courts may experience additional workload costs. Although courts are not funded on the basis of workload, increased pressure on the Trial Court Trust Fund may create a need for increased funding for courts from the General Fund. The 2023-24 budget includes $105 million from the General Fund to backfill declining revenue to the Trial Court Trust Fund.
- Costs (local funds, General Fund) of an unknown but likely significant amount to county behavioral health agencies, potentially in the millions of dollars annually. Under this bill, a county behavioral health agency must obtain a CARE respondent's health care information, incorporate relevant information into reports and evaluations submitted to the court, and provide notice to the respondent and respondent's counsel of any disclosure of the respondent's health care information. Actual costs will depend on the number of CARE Act cases filed and the amount of additional workload incurred by a county behavioral health agency in complying with this bill's requirements. General Fund costs will depend on whether the duties imposed by this bill constitute a reimbursable state mandate, as determined by the Commission on State Mandates.
- The 2023-24 budget provides $55.5 million to the courts to implement the CARE Act, with $133 million to the courts ongoing starting in fiscal year 2025-26, plus additional funding for related IT improvements and the CARE Act Supporter Program.
VOTES
SENATE FLOOR: 37-0-3
YES: Allen, Alvarado-Gil, Archuleta, Ashby, Atkins, Becker, Bradford, Caballero, Cortese, Dahle, Dodd, Durazo, Eggman, Glazer, Grove, Hurtado, Jones, Laird, McGuire, Menjivar, Min, Newman, Nguyen, Niello, Ochoa Bogh, Padilla, Portantino, Roth, Rubio, Seyarto, Skinner, Smallwood-Cuevas, Stern, Umberg, Wahab, Wiener, Wilk
ABS, ABST OR NV: Blakespear, Gonzalez, Limón
ASM JUDICIARY: 10-0-1
YES: Maienschein, Essayli, Connolly, Dixon, Haney, Pacheco, Papan, Reyes, Sanchez, McKinnor
ABS, ABST OR NV: Kalra
ASM APPROPRIATIONS: 15-0-1
YES: Holden, Megan Dahle, Bryan, Calderon, Wendy Carrillo, Dixon, Mike Fong, Hart, Mathis, Papan, Pellerin, Sanchez, Soria, Weber, Wilson
ABS, ABST OR NV: McCarty
ASM PRIVACY AND CONSUMER PROTECTION: 11-0-0
YES: Gabriel, Joe Patterson, Bauer-Kahan, Bennett, Essayli, Vince Fong, Irwin, Lowenthal, Papan, Wicks, Wilson
ASM APPROPRIATIONS: 16-0-0
YES: Holden, Megan Dahle, Bryan, Calderon, Wendy Carrillo, Dixon, Mike Fong, Hart, Lowenthal, Mathis, Papan, Pellerin, Sanchez, Friedman, Weber, Wilson
UPDATED
VERSION: September 8, 2023
CONSULTANT: Alison Merrilees / JUD. / (916) 319-2334 FN: 0001979
Date of Hearing: September 7, 2023
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Chris Holden, Chair
SBPCA Bill Id:SB 35
Author:(Umberg) – As Amended Ver:August 28, 2023 (As Proposed to be Amended)
Policy Committee: | Judiciary | Vote: | 10 - 0 |
Privacy and Consumer Protection | 11 - 0 | ||
|
|
Urgency: Yes State Mandated Local Program: Yes Reimbursable: Yes
SUMMARY:
This bill amends the Community Assistance, Recovery, and Empowerment (CARE) Act to make clarifications and technical changes, and to facilitate the exchange of respondents’ confidential information between health care providers, county behavioral health agencies, and the courts.
Specifically, as proposed to be amended, this bill, among other provisions:
- Requires a county behavioral health agency to include in any report, evaluation, or other document filed with the court relating to a CARE Act petition, information, including protected health information, necessary to support the agency’s determinations, conclusions, and recommendations.
- Requires the county behavioral health agency to serve an unredacted copy of any report, evaluation, or other document filed with the court by the agency on the respondent and the respondent’s counsel and, if the respondent consents, on the supporter.
- Specifies the circumstances in which a health care provider or other covered entity may or must provide to the county behavioral health agency any information about the respondent, including protected health information, mental health records excluding psychotherapy notes, and substance use disorder patient records, to the extent permitted by applicable Health Insurance Portability and Accountability Act (HIPAA) regulations, that is in the provider or covered entity’s possession about the respondent and that may be relevant to an investigation, evaluation, or other report or hearing, or to the provision of services and support.
- Permits a county behavioral health agency to apply to the court ex parte for an order requiring a health care provider or a covered entity to provide the agency or the court with the protected health information described in 3), above.
- Specifies that a written report submitted by a county behavioral health agency to the court may not be disclosed under the Public Records Act, is inadmissible in any subsequent legal proceeding except upon motion by the respondent, and is confidential under the CARE Act.
- Requires a county behavioral health agency to notify a respondent and respondent’s counsel of any disclosure of the respondent’s medical information under the CARE Act.
- Permits a respondent to petition the court for an order sealing records relating to the respondent’s health, or any other records in a CARE Act proceeding.
- Specifies that a county shall be granted only one extension for implementation of the CARE Act and that the final date for counties to implement the CARE Act is December 1, 2025.
- Authorizes CARE Act proceedings to be conducted by a superior court judge or by a court-appointed commissioner or other subordinate judicial officer.
- States that there is no fee for filing a petition nor any fees charged by any public officer for services in filing or serving papers or for the performance of any duty enjoined by the CARE Act.
- Provides that the respondent has the right to have an interpreter in all proceedings if necessary for the respondent’s full participation.
FISCAL EFFECT:
- Costs (Trial Court Trust Fund, General Fund) to the courts of an unknown but potentially significant amount. Judicial Council reports minor and absorbable costs to accept petitions without filing fees, provide interpreters, conduct hearings using commissioners or other subordinate officers, and implement other changes included in the version of this bill dated July 12. To the extent the subsequent amendments require the court to consider additional orders or conduct additional hearings, the courts may experience additional workload costs. Although courts are not funded on the basis of workload, increased pressure on the Trial Court Trust Fund may create a need for increased funding for courts from the General Fund. The 2023-24 budget includes $105 million from the General Fund to backfill declining revenue to the Trial Court Trust Fund.
- Costs (local funds, General Fund) of an unknown but likely significant amount to county behavioral health agencies, potentially in the millions of dollars annually. Under this bill, a county behavioral health agency must obtain a CARE respondent’s health care information, incorporate relevant information into reports and evaluations submitted to the court, and provide notice to the respondent and respondent’s counsel of any disclosure of the respondent’s health care information. Actual costs will depend on the number of CARE Act cases filed and the amount of additional workload incurred by a county behavioral health agency in complying with this bill’s requirements. General Fund costs will depend on whether the duties imposed by this bill constitute a reimbursable state mandate, as determined by the Commission on State Mandates.
The 2023-24 budget provides $55.5 million to the courts to implement the CARE Act, with $133 million to the courts ongoing starting in fiscal year 2025-26, plus additional funding for related IT improvements and the CARE Act Supporter Program.
COMMENTS:
- Purpose. According to the author:
SB 1338 (Umberg 2022) created the CARE Act (also known as CARE Court) as a response to the urgent need for innovative solutions for individuals who are suffering with untreated schizophrenia spectrum and psychotic disorders, often unhoused in our communities, and who face high risks for repeated hospitalization, incarceration, institutionalization, mental health conservatorship, and premature death. Since the passage of SB 1338, California Health and Human Services (CalHHS) & Judicial Council of California (JCC) have worked diligently with counties and stakeholders to ensure that CARE Court is implemented successfully. However, during this process, CalHHS and JCC have identified a few urgent changes needed to make CARE Court work better for the people that need it most.
- Background.
CARE Act. In 2022, the Governor signed SB 1338 (Umberg), Chapter 319, Statutes of 2022, known as the CARE Act. SB 1338 established the CARE court program, which will provide mental health and substance abuse disorder services to qualifying individuals through court-ordered CARE plans. The goal of the CARE court program is to provide these services without requiring incarceration in jail, detention in a psychiatric facility, or a Lanterman-Petris-Short Act conservatorship. The CARE Act requires seven counties to begin implementation by October 1, 2023, and requires the remaining counties to begin implementation by December 1, 2024.
The CARE court process begins when a person (“petitioner”) files a petition with the court seeking services for a qualifying person with a serious mental disorder (“respondent”). The court orders a clinical evaluation and appoints a public defender and a support person to represent the respondent in legal proceedings and help the respondent navigate the CARE court process. If the court finds that the respondent meets the statutory criteria, the court orders the parties and the county behavioral health agency to develop a proposed CARE treatment plan for the respondent. Once the court approves the plan, it becomes a court-ordered treatment plan that requires the respondent to participate in specified clinically-appropriate, community-based services for a set period of time.
This Bill. Although the CARE courts are not yet operating, this bill makes a number of technical changes and clarifications to provisions governing CARE court procedures, filing fees, and extension dates for county implementation. The bill was amended on June 28, 2023, to add a framework in which health care providers and county behavioral health agencies will share protected health care information about CARE court respondents. Additional, related amendments proposed by the Assembly Committee on Privacy and Consumer Protection will be adopted in this committee due to timing considerations.
The privacy of medical information is largely governed by the federal HIPAA and California’s Confidentiality of Medical Information Act. Disclosure of medical information generally requires a patient’s informed consent. However, a respondent who is the subject of a CARE court petition may refuse to provide consent or may not be able to provide informed consent due to the serious mental disorder that qualifies them for CARE Act proceedings. Counties have expressed that under existing law, they cannot access the protected health care information they need to fulfill their CARE Act obligations, including providing information to the courts and making treatment recommendations about CARE respondents. There is also a need to ensure that, once obtained by a county and shared with the court, sensitive medical information about CARE respondents is maintained as confidential. As amended, this bill establishes a framework that allows a health care provider to give relevant, otherwise protected health care information to a county behavioral health agency so the agency may carry out its duties under the CARE Act and share relevant health information with the court. The bill will also include privacy protections for health care information exchanged as a result of CARE court proceedings, ensure the confidentiality of reports submitted to the court by a county behavioral health agency, and limit the extent to which this information may be used in other legal proceedings.
Analysis Prepared by: Annika Carlson / APPR. / (916) 319-2081
Date of Hearing: September 5, 2023
ASSEMBLY COMMITTEE ON PRIVACY AND CONSUMER PROTECTION
Jesse Gabriel, Chair
SBPCA Bill Id:SB 35
Author:(Umberg) – As Amended Ver:August 28, 2023
SENATE VOTE: 35-0
SUBJECT: Community Assistance, Recovery, and Empowerment (CARE) Court Program
SYNOPSIS
Last year’s SB 1338 (Umberg, Chap. 319, Stats. 2022) established the Community Assistance, Recovery, and Empowerment (CARE) Act. The CARE Act is intended to provide essential mental health and substance use disorder services to severely mentally ill Californians—many of whom are homeless or incarcerated—while also preserving these individuals’ self-determination to the greatest extent possible. The CARE process is largely overseen by the courts, which are trusted with ensuring that eligible individuals—termed “respondents”—are delivered mental health and substance use disorder services, as an alternative to involuntary conservatorship or imprisonment.
On August 28, this bill was amended in order to allow health care providers, and others with medical information relevant to the determination of CARE Act eligibility, to share such information with county behavioral health agencies and the courts. Disclosure of medical information under the CARE Act is necessary because of the short time frame (14 court days) that county behavioral health agencies have to provide a written report as to a respondent’s eligibility for the process. These amendments triggered referral to this Committee.
The privacy of medical information is largely governed by the federal Health Insurance Portability and Accountability Act (HIPAA) and California’s Confidentiality of Medical Information Act (CMIA). Disclosure of medical information generally requires a patient’s informed consent. However, respondents who are eligible for the CARE process may not be able to grant informed consent for the release of information, due to the very circumstances that make them eligible for the CARE Act. Any disclosure must therefore be made on the basis of another valid exemption from medical privacy laws.
Proposed bill amendments set forth and discussed in this analysis are meant to strengthen privacy protections under the CARE Act, while still ensuring that the Act can function as intended. Amendment language was developed in consultation with the Assembly Health and Judiciary Committees, the California Health and Human Services Agency, the Judicial Council of California, and numerous county representatives. Due to timing considerations, these amendments will not be adopted in this Committee, but rather in the Assembly Appropriations Committee, which will hear the bill if it passes this Committee.
This bill was previously heard by the Assembly Judiciary Committee, where it passed on a 10-0-1 vote.
SUMMARY: Amends the soon-to-be implemented CARE Act in order to facilitate information exchange between health care providers, county behavioral health agencies, and the courts necessary for the Act to function. Specifically, this bill:
- Specifies that a county shall be granted only one extension for implementing the CARE Act. The final date for counties to implement under any circumstances is December 1, 2025.
- Provides that legal representation of a respondent in CARE Act proceedings, and in matters related to CARE agreements and CARE plans, does not alter an attorney’s obligations under the State Bar Act and the California Rules of Professional Conduct, including obligations relating to the attorney’s duty of confidentiality.
- Requires that if a person other than the director of a county behavioral health agency files a CARE Act petition, that the written report provided to the court by the appropriate agency (which includes a determination as to whether the respondent meets, or is likely to meet, the criteria for the CARE process) must include information, including protected health information, necessary to support the determinations, conclusions, and recommendations in the report.
- Provides, notwithstanding any other law, that a county behavioral health agency must include in any report evaluation, or other document filed with the court, the information, including protected health information necessary to support the determinations, conclusions, and recommendations in the filing.
- Prohibits a county behavioral health agency from submitting to the court (except by court order) original or photocopied records underlying the information in a report evaluation or other document.
- Requires the county behavioral health agency to serve an unredacted copy of any report evaluation, or other document filed with the court, on the respondent and the respondent’s counsel and, if the respondent consents, on the supporter.
- Provides that, notwithstanding any other law, a provider of health care (as defined under the state Confidentiality of Medical Information Act (CMIA)) or a covered entity (as defined under the federal Health Insurance Portability and Accountability Act (HIPAA)), may disclose to the county behavioral health agency any information, including protected health information, mental health records excluding psychotherapy notes, and substance use disorder patient records, to the extent permitted by applicable HIPAA regulations, that is (i) in its possession about the respondent and (ii) relevant to the county behavioral health agency’s provision, coordination, or management of services and supports, including, but not limited to, the preparation of any required investigations, evaluations, or reports. Deems this a disclosure for treatment purposes under applicable HIPAA regulations.
- Provides that, notwithstanding any other law, a provider of health care (as defined under the CMIA) or a covered entity (as defined under HIPAA)—if either filed a CARE Act petition or executed an affidavit included with a CARE Act petition—must provide to the county behavioral health agency any information about the respondent, including protected health information, mental health records excluding psychotherapy notes, and substance use disorder patient records, to the extent permitted by applicable HIPAA regulations, that is in its possession about the respondent and may be relevant in connection with an investigation, evaluation, or other report or hearing, or with the provision of services and supports.
- Permits a county behavioral health agency to apply to the court ex parte for an order requiring a provider of health care (as defined under the CMIA) or a covered entity (as defined under HIPAA) to provide to the agency, to the court, or to both, protected health information, mental health records excluding psychotherapy notes, and substance use disorder patient records, to the extent permitted by applicable HIPAA regulations, in its possession about the respondent that may be relevant in connection with an investigation, evaluation, or other report or hearing, or with the provision of services and supports.
- Requires that all information shared under 4) – 9) be disclosed to the respondent and the respondent’s counsel, and if the respondent consents, to the supporter.
- Provides that any provider of health care or covered entity shall not be held civilly or criminally liable for any disclosure authorized or required under 4) – 9).
- Clarifies that, except as expressly provided, 4) – 9) do not authorize any further disclosure or redisclosure of information.
- Clarifies that in order for the director of a California Indian health services program or California tribal behavioral health department to be able to file a petition regarding a respondent, the program or department must have, within the previous 30 days, provided, or currently be providing, the respondent with behavioral health services.
- Clarifies that in order for a judge of a tribal court to be able to file a petition regarding a respondent, the court must be located in California and the respondent must have appeared in the court within the previous 30 days.
- Authorizes CARE Act proceedings to be conducted by a superior court judge or by a court-appointed commissioner or other subordinate judicial officer.
- Specifies that there is no court fee for filing a CARE petition nor may any fees be charged by any public officer for services in filing or serving papers or for the performance of any duty enjoined by the CARE Act.
- Specifies that a supporter of the respondent who is present with the respondent is allowed to perform the functions described in Welfare and Institutions Code sections 5980 and 5981 (which are part of the CARE Act), subject to the limits provided in those sections.
- Provides that the respondent has the right to an interpreter in all proceedings if necessary for the respondent’s full participation.
- Allows for the appointment of counsel “working in [the] capacity” of a public defender, rather than a public defender to be appointed to represent the respondent.
- Clarifies the following regarding the rights of the original petitioner:
- The original petitioner has a right to be present and make a statement at the initial hearing on the merits of the petition.
- The court may permit the original petitioner to continue to participate in CARE proceedings only to the extent the respondent consents to the petitioner’s participation.
- Requires additional evidence presented at the hearing on the merits of a petition to be “admissible” evidence.
- Clarifies the following regarding the hearing on the merits of the CARE petition: if, at the hearing, the court finds there is not clear and convincing evidence that the respondent meets the CARE criteria in Welfare and Institutions Code section 5972, the court must dismiss the case without prejudice, unless the court makes a finding, on the record, that the original petitioner’s filing was not in good faith, in which case the dismissal shall be with prejudice.
- Requires the court, upon finding at a case management hearing that the parties have entered, or are likely to enter, a CARE agreement, to do one of the following:
- Approve or modify the terms of the CARE agreement, and set a progress hearing for 60 days.
- Continue the hearing by 14 days, upon stipulation of the parties, in order to allow additional time to enter into a CARE agreement.
- Adds the following due dates for reports to be submitted by the Department of Health Care Services to the Legislature: the preliminary report is due by December 31, 2026 and the final report by December 31, 2028.
- Makes technical and non-substantive conforming changes.
- Contains an urgency clause. States that it is necessary that this measure take immediate effect because the CARE Act takes effect in October 2023, and therefore important changes to the Act must take effect immediately to ensure its success.
EXISTING STATE LAW:
- Establishes the Community Assistance, Recovery, and Empowerment (CARE) Act. (Welf. & Inst. Code §§ 5970-5987.)
- Directs Glenn, Orange, Riverside, San Diego, San Francisco, Stanislaus, and Tuolumne Counties to begin implementing the CARE Act no later than October 1, 2023. (Welf. & Inst. Code § 5970.5(a).)
- Provides that the state’s remaining counties must begin implementing the CARE Act no later than December 1, 2024. (Welf. & Inst. Code § 5970.5(b).)
- Authorizes a one-time delay in CARE Act implementation by a county, upon application to the Department of Health Care Services. Under no circumstances may the final date of implementation be later than December 1, 2025. (Welf. & Inst. Code § 5970.5(c).)
- Defines the following terms under the CARE Act:
- “CARE plan” means an individualized, appropriate range of services and supports, which include behavioral health care, stabilization medications, housing, and other supportive services, as appropriate. (Welf. & Inst. Code § 5971(b).)
- “County behavioral health agency” means the local director of mental health services, the local behavioral health director, or both (as applicable), or their designee. (Welf. & Inst. Code § 5971(3).)
- “Petitioner” means the person or entity who first files a CARE Act petition with the court. If the petitioner is not the county behavioral health agency, the court is required, at the initial hearing, to substitute the director of a county behavioral health agency or the director’s designee as the petitioner. (Welf. & Inst. Code § 5971(m).)
- “Respondent” means the person who is subject to the petition for the CARE process. (Welf. & Inst. Code § 5971(o).)
- “Parties” means the petitioner, the respondent, the county behavioral health agency, and any other local entity that the court may add to the proceeding which is providing services or supports to the respondent. (Welf. & Inst. Code § 5971(l).)
- “CARE agreement” means a voluntary settlement agreement entered into by the parties, and that includes the same elements as a CARE plan to support the respondent in accessing community-based services. (Welf. & Inst. Code § 5971(a).)
- “Graduation plan” means a voluntary agreement entered into by the parties at the end of the CARE program. It includes a strategy to support a successful transition out of court jurisdiction and may include a psychiatric advance directive. A graduation plan includes the same elements as a CARE plan, to support the respondent in accessing services and supports. A graduation plan may not place additional requirements on local government entities and is not enforceable by the court. (Welf. & Inst. Code § 5971(h).)
- “Supporter” means an adult who assists the respondent. Assistance may include supporting the person to understand, make, communicate, implement, or act on their own life decisions during the CARE process, including a CARE agreement, a CARE plan, and developing a graduation plan. (Welf. & Inst. Code § 5971(q).)
- Provides that a respondent may qualify for the CARE process only if all of the following criteria are met:
- The person is 18 years of age or older.
- The person is currently experiencing a severe mental illness, as defined, and has a diagnosis identified in the disorder class: schizophrenia spectrum and other psychotic disorders, as defined in the most current version of the Diagnostic and Statistical Manual of Mental Disorders. Specifically exempts specified other conditions or disorders.
- The person is not clinically stabilized in on-going voluntary treatment.
- At least one of the following is true:
- The person is unlikely to survive safely in the community without supervision and the person’s condition is substantially deteriorating.
- The person is in need of services and supports in order to prevent a relapse or deterioration that would likely to result in grave disability or serious harm to the person or to others.
- Participation in a CARE plan or agreement would be the least restrictive alternative necessary to ensure the person's recovery and stability.
- It is likely that the person will benefit from participation in a CARE plan or agreement. (Welf. & Inst. Code § 5972.)
- Permits any of the following adults to file a petition to initiate a CARE Act proceeding:
- A person with whom the respondent resides.
- A spouse, parent, sibling, child, or grandparent of the respondent, or another individual who stands in loco parentis to the respondent.
- The director of a hospital, or their designee, in which the respondent is hospitalized, including pursuant to the LPS Act.
- The director of a public or charitable organization, agency, or home that is currently providing, or within the previous 30 days has provided, behavioral health services to the respondent, or in whose institution the respondent resides, or the director’s designee.
- A licensed behavioral health professional, or their designee, who is treating, or has been treating within the last 30 days, the respondent for a mental illness.
- A first responder, including a peace officer, firefighter, paramedic, emergency medical technician, mobile crisis response worker, or homeless outreach worker who has had repeated interactions with the respondent in the form of multiple arrests, multiple detentions, as provided, multiple attempts to engage the respondent in voluntary treatment, or other repeated efforts to aid the respondent in obtaining professional assistance.
- The public guardian or public conservator, or their designee. A respondent may be referred from conservatorship proceedings.
- The director of a county behavioral health agency of the county in which the respondent reside or is present. A respondent may be referred from assisted outpatient treatment proceedings.
- The director of the county Adult Protective Services or their designee.
- The director of a California Indian health services program, California tribal behavioral health department, or their designee.
- The judge of a tribal court that is located in California, or their designee.
- The respondent. (Welf. & Inst. Code § 5974.)
- Allows a court, if a criminal defendant is found to be mentally incompetent and ineligible for a diversion, to refer the defendant to the CARE program, as provided. (Penal Code § 1370.1 (b)(1)(D)(iv).)
- Requires the Judicial Council to create a mandatory court form to file a CARE process petition, together with any other forms necessary during the CARE process. The petition form must be signed under penalty of perjury and include:
- The name of the respondent and their address, if known.
- The petitioner’s relationship with the respondent.
- Facts that support petitioner's allegation that the respondent meets the CARE criteria in 6).
- Either of the following:
- An affidavit of a licensed behavioral health professional stating, first, that the health professional or their designee has examined the respondent within 60 days of the submission of the petition, or has made multiple attempts to examine, but has not been successful in eliciting the cooperation of the respondent to submit to an examination, within 60 days of submission of the petition; and second, that the licensed behavioral health professional has determined that the respondent meets, or has reason to believe, explained with specificity in the affidavit, that the respondent meets, the diagnostic criteria for CARE proceedings.
- Evidence that the respondent was detained for a minimum of two intensive treatments pursuant to the LPS Act, the most recent of which must have been no more than 60 days before the date of the petition. (Welf. & Inst. Code § 5975.)
- Provides that if a person other than the respondent files a petition for CARE Act proceedings that is unmeritorious or intended to harass or annoy the respondent, and that person had previously filed a petition for CARE Act proceedings that was unmeritorious or intended to harass or annoy the respondent, the second petition is grounds to declare the person a vexatious litigant. (Welf. & Inst. Code § 5975.1.)
- Establishes that the respondent has the following rights:
- To receive notice of the hearings.
- To receive a copy of the court-ordered evaluation.
- To be represented by counsel at all stages of a proceeding commenced under this chapter, regardless of the ability to pay.
- To be allowed to have a supporter.
- To be present at the hearing unless they waive the right to be present.
- To present evidence.
- To call witnesses.
- To cross-examine witnesses.
- To appeal decisions, and to be informed of the right to appeal. (Welf. & Inst. Code § 5976.)
- Provides for the following regarding CARE Act hearings:
- Establishes that hearings are presumptively closed to the public, but permits the respondent to demand that the hearings be public.
- Permits the respondent to request the presence of a family member or friend without waiving the right to keep the hearing closed to the rest of the public.
- Permits the court to grant a request by another party to make a hearing public if the judge conducting the hearing finds that the public interest clearly outweighs the respondent’s interest in privacy.
- Declares that all reports, evaluations, diagnoses, or other information related to the respondent’s health shall be confidential.
- Requires the judge, before commencing a hearing, to inform the respondent of their rights under this section. (Welf. & Inst. Code § 5976.5.)
- Requires the court, upon receipt of a CARE Act petition, to promptly review it to determine whether a prima facie showing has been made that the respondent is or may be a person described in 6), and then do one of the following:
- If the court finds the petitioner has not made the required prima facie showing, then dismiss the case without prejudice. (Welf. & Inst. Code § 5977(a)(2).)
- If the court finds the petitioner has made the required prima facie showing, and the petitioner is the director of a county behavioral health agency, then the court must do all of the following:
- Set the matter for initial hearing within 14 court days.
- Appoint counsel.
- Determine if the petition includes a determination as to whether the respondent meets the criteria for the CARE process and is willing to engage voluntarily with services, and, if not, order the county to submit a report containing this information within 14 court days.
- Require notice be provided to the respondent, respondent’s counsel, and the county behavioral health agency where the respondent resides. (Welf. & Inst. Code § 5977(a)(3)(A).)
- If the court finds the petitioner has made the required prima facie showing, but the petitioner is not a county behavioral health agency, then the court must do all of the following:
- Order a county agency to investigate whether the respondent meets the criteria for the CARE process and is willing to engage voluntarily with services.
- File a written report with the court within 14 court days.
- Provide notice to the respondent and the petitioner that a report has been ordered.
- Upon receipt of the report, within 5 days, do one of the following:
- If the county’s report does not support a prima facie showing under 6), or if the county determines that the respondent has enrolled or is likely to enroll in voluntary behavioral health treatment, dismiss the matter.
- If the county’s report does support a prima facie showing under 6), set the matter for initial hearing within 14 court days, appoint counsel, and order the county to provide notice of the hearing as specified. (Welf. & Inst. Code § 5977 (a)(3)(B).)
- Establishes procedures and requirements for the following:
- Initial hearing on a CARE Act petition. (Welf. & Inst. Code § 5977(b).)
- Hearing on the merits of the petition. (Welf. & Inst. Code § 5977(c).)
- Case management hearing. (Welf. & Inst. Code § 5977.1(a).)
- Clinical evaluation review hearing. (Welf. & Inst. Code § 5977.1(c).)
- Hearing to review proposed CARE plans. (Welf. & Inst. Code § 5977.1(d).)
- Status review hearing that occurs at least every 60 days during the one-year (potentially two-year) CARE plan implementation. (Welf. & Inst. Code §§ 5977.2, 5977.3.)
- Allows the court, at any point during CARE proceedings, if it determines, by clear and convincing evidence, that the respondent, after receiving notice, is not participating in the CARE process, to terminate respondent’s participation. The court is then permitted to make a referral under the LPS Act, as provided. (Welf. & Inst. Code § 5979(a).)
- Provides that, if a respondent was timely provided with all services and supports required by their CARE plan, the fact that the respondent failed to successfully complete the plan, including the reasons for that failure, (i) is a fact to be considered by a court in a subsequent hearing under the LPS Act, provided that the hearing occurs within six months of termination of the CARE plan; and (ii) creates a presumption at that hearing that the respondent needs additional interventions beyond the supports and services provided by the CARE plan. (Welf. & Inst. Code § 5979(a)(3).)
- Creates a process for penalizing counties or other local government entities that do not comply with CARE court orders. (Welf. & Inst. Code § 5979 (b).)
- Establishes the LPS Act to end inappropriate, indefinite, and involuntary commitment of mentally disordered persons, developmentally disabled persons, and persons impaired by chronic alcoholism, and to provide prompt evaluation and treatment of those with mental health disorders or impaired by chronic alcoholism. (Welf. & Inst. Code §§ 5000-5566.)
- Provides, pursuant to the California Constitution, that all people have inalienable rights, including the right to pursue and obtain privacy. (Cal. Const., art. I, § 1.)
- Establishes the Confidentiality of Medical Information Act (CMIA) (Civ. Code §§ 56-56.37.)
- Defines the term “provider of health care” under CMIA. (Civ. Code § 56.05(o).)
EXISTING FEDERAL LAW:
- Establishes under federal law, the Health Insurance Portability and Accountability Act of 1996 (HIPAA), which, among other things, sets standards for the privacy of individually identifiable health information and security standards for the protection of electronic protected health information. (Pub. L. 104-191, 110 Stat. 1936.)
- Provides that if a HIPAA provision conflicts with state law, the provision that is most protective of patient privacy prevails. (45 C.F.R. § 160.203.)
- Defines the term “covered entity” under HIPAA. (45 C.F.R. § 160.103.)
FISCAL EFFECT: As currently in print this bill is keyed fiscal.
COMMENTS:
1) Background. Last year’s SB 1338 (Umberg, Chap. 319, Stats. 2022) established the Community Assistance, Recovery, and Empowerment (CARE) Act. The CARE Act is intended to provide essential mental health and substance use disorder services to severely mentally ill Californians—many of whom are homeless or incarcerated—while also preserving these individuals’ self-determination to the greatest extent possible.
The CARE process is largely overseen by the courts, which are trusted with ensuring that eligible individuals—termed “respondents”—are delivered mental health and substance use disorder services, as an alternative to involuntary conservatorship or imprisonment. The California Health and Human Services Agency (CalHHS) describes the CARE process as “an upstream diversion to prevent more restrictive conservatorship or incarceration.” (See CalHHS, Community Assistance, Recovery & Empowerment Act, available at https://www.chhs.ca.gov/care-act/.)
The CARE process is initiated when an eligible person files a petition under the Act with the superior court. Eligible petitioners include the county behavioral health agency; a spouse, parent, sibling, child, or grandparent; a treating behavioral health professional; the county public guardian or public conservator; and other enumerated persons and entities. (For a complete list of eligible petitioners, see Welf. & Inst. Code § 5974.) There are strict criteria for CARE Act eligibility, including that the respondent suffer from severe mental illness, as defined; not be currently clinically stabilized in on-going voluntary treatment; and either be unlikely to survive safely in the community, or need services and supports to avoid grave disability or the risk of serious harm to themselves or others. (For a complete list of criteria, see Welf. & Inst. Code § 5972.)
Upon receiving a petition, the court must review it and determine whether it shows that the respondent may be eligible for the CARE process. If so, the court must then order the county behavioral health agency to submit a report within 14 court days that includes all of the following information:
(i) A determination as to whether the respondent meets, or is likely to meet, the criteria for the CARE process.
(ii) The outcome of efforts made to voluntarily engage the respondent during the 14-day report period.
(iii) Conclusions and recommendations about the respondent’s ability to voluntarily engage in services. (Welf. & Inst. Code § 5977(a)(3).)
Based on this report, the court then determines whether to set an initial hearing on the petition and appoint counsel for the respondent. (Welf. & Inst. Code § 5977(a)(5).)
It is largely the requirement for this report to be filed with the court that has necessitated the latest amendments to this bill, and consequently, referral to this Committee.
2) Need for hearing by this Committee. As passed by the Senate to the Assembly, SB 35 was a simple bill that would allow a county, if granted an extension by the Department of Health Care Services, additional time to implement the CARE Act. On June 12, 2023, the bill was amended to incorporate many new provisions, including ones allowing CARE Act proceedings to be conducted by court-appointed commissioners, and requiring respondents to be provided an interpreter if needed. In July 2023, this version of the bill was heard by the Assembly Judiciary Committee. (The Judiciary Committee’s analysis describes the June 12 amendments.) On August 28, 2023, SB 35 was amended again in order to allow health care providers, and others with medical information relevant to the determination of CARE Act eligibility, to share such information with county behavioral health agencies. Under the August 28 amendments, this information, in turn, can then be shared with the courts.
The privacy of medical information is largely governed by the federal Health Insurance Portability and Accountability Act (HIPAA) and California’s Confidentiality of Medical Information Act (CMIA). Disclosure of medical information generally requires a patient’s informed consent.
However, respondents who are eligible for the CARE process may not be able to grant informed consent for the release of information, due to the very circumstances that make them eligible for the CARE Act. Any disclosure must therefore be made on the basis of another valid exemption from medical privacy laws. Disclosure of medical information under the CARE Act is necessary because of the short time frame (14 court days) that county behavioral health agencies have to provide a written report as to a respondent’s eligibility for the process. The Act explicitly excludes individuals with “a psychotic disorder that is due to a medical condition or is not primarily psychiatric in nature, including, but not limited to, physical health conditions such as traumatic brain injury, autism, dementia, or neurologic conditions.” (Welf. & Inst. Code § 5972(b).) As explained to Committee staff, acute psychosis may be precipitated even by something as simple as an untreated urinal tract infection, which, of course, would not be eligible for the CARE process. Yet there may be no way for a county behavioral health agency to rule out medical causes that do not give rise to CARE eligibility without first examining the respondent’s medical records. (In addition, significant financial penalties can be levied against a county that fails to comply with court orders under the CARE Act.)
The August 28 amendments, together with several existing provisions of the CARE Act, present a number of privacy-related issues that lie within this Committee’s jurisdiction.
3) Author’s statement. According to the author:
SB 1338 (Umberg 2022) created the CARE Act (also known as CARE Court) as a response to the urgent need for innovative solutions for individuals who are suffering with untreated schizophrenia spectrum and psychotic disorders, often unhoused in our communities, and who face high risks for repeated hospitalization, incarceration, institutionalization, mental health conservatorship, and premature death. Since the passage of SB 1338, California Health and Human Services (CalHHS) & Judicial Council of California (JCC) have worked diligently with counties and stakeholders to ensure that CARE Court is implemented successfully. However, during this process, CalHHS and JCC have identified a few urgent changes needed to make CARE Court work better for the people that need it most. Therefore, SB 35 would modify various parts of CARE Court ahead of its implementation in October of 2023. For example, this bill eliminates the filing fee to support equitable access to petitioners with limited resources, allows proceedings to be conducted by subordinate judicial officers to ensure timely access for court proceedings to protect due process, and clarifies the due dates of the program’s preliminary and final evaluations. Changes like these are urgently needed to help CARE Court succeed.
4) What the August 28 amendments would do. As discussed above, on August 28, 2023, SB 35 was amended to facilitate information sharing between health care providers, other HIPAA-covered entities, county behavioral health agencies and the courts, thereby triggering referral to this Committee. The August 28 amendments to the bill are described in paragraphs 2) – 12) and 22) of the SUMMARY above.
5) Further proposed amendments to the bill. Proposed amendments set forth and discussed below are meant to strengthen privacy protections under the CARE Act in various ways, while still ensuring that the Act can function as intended.
Amendment language was developed in consultation with the Assembly Health and Judiciary Committees, the California Health and Human Services Agency, the Judicial Council of California, and numerous county representatives. Due to timing considerations, these amendments will not be adopted in this Committee, but rather in the Assembly Appropriations Committee, which will hear the bill if it passes this Committee.
6) Proposed amendment—rectifying an inconsistency. The bill in print contains an inconsistency. If the person filing the initial CARE Act petition is a county behavioral health agency director, then the court must order the agency to submit a report that includes a determination as to whether the respondent meets, or is likely to meet the criteria for the CARE process. But if the petitioner is anyone else, then the court must order the agency to submit a written report that contains the same information. (Welfare and Institutions Code § 5977(a).) The report is critical to the CARE process; it is what the court relies on to decide whether to hold an initial hearing on the petition. In order to ensure accountability and verifiability for the court’s decision, it is important that the report be in writing, regardless of whether a county behavioral health agency director filed the initial petition. The amendment below rectifies this inconsistency.
Welfare and Institutions Code 5977. (a) […]
(3) If the court finds that the petitioner has made a prima facie showing that the respondent is, or may be, a person described in Section 5972, the court shall do one of the following:
(A) If the petitioner is the director of a county behavioral health agency, or their designee, the court shall do the following: […]
(iii) Determine whether the petition includes all of the following information and, if it does not, order the county behavioral health agency to submit a written report with the court within 14 court days that includes all of the following:
[…]
(B) If the petitioner is a person other than the director of a county behavioral health agency, or their designee, the court shall order a county agency, or their designee, as determined by the court, to investigate, as necessary, and file a written report with the court within 14 court days and provide notice to the respondent and petitioner that a report has been ordered. The written report shall include all of the following: […]
7) Proposed amendment—defining “legal proceeding.” The following definition is relied upon in other amendments. It is intended to capture all legal proceedings, whether in court, before an administrative body, or through alternative dispute resolution—except those proceedings with which CARE Act proceedings are inextricably linked.
Welfare and Institutions Code 5971. Unless the context otherwise requires, the following definitions shall govern the construction of this part. […]
(k) “Legal proceeding” means any administrative, civil, or criminal proceeding, including, but not limited to, juvenile court proceedings and family court proceedings and services, and any form of alternative dispute resolution, including arbitration and mediation, except for the following:
(1) A proceeding under this part.
(2) A proceeding under the Lanterman-Petris-Short Act described in paragraph (2) or (3) of subdivision (a) of Section 5979.
(3) A proceeding from which the respondent was referred to CARE Act proceedings as described in Section 5978.
(4) A disciplinary proceeding under Chapter 4 (commencing with Section 6000) of Division 3 of the Business and Professions Code.
(5) An appeal from any of the proceedings identified in paragraphs (1) through (4), inclusive.
7) Proposed amendment—ensuring the confidentiality of written reports submitted to the courts. Under the August 28 amendments, the written report that a county behavioral health agency is required to file with the court in response to a CARE Act petition may now include “[t]he information, including protected health information, necessary to support the determinations, conclusions, and recommendations in the report.” (Proposed Welf. & Inst. Code § 5977(a)(3)(B)(iv).) In other words, a document containing medical information (and, potentially, other highly sensitive information) about the respondent will be in the possession of two entities—a county and a court—that are subject to various laws providing for information in their possession to be publicly available, available in subsequent litigation, and so forth.
The amendments below are intended to safeguard the confidentiality of the report and the information it contains. The protection would presumably also extend to drafts of the report, and other documents containing the information within the report, that are in a county’s possession, as, without such an interpretation, this protection might become meaningless.
Welfare and Institutions Code 5977. […]
(d) The following shall apply to any written report submitted by a county behavioral health agency to the court pursuant to this section:
(1) The report is confidential and not subject to disclosure or inspection under the California Public Records Act (Division 10 (commencing with Section 7920.000) of Title 1 of the Government Code).
(2) The report is inadmissible in any subsequent legal proceeding, except upon motion of the respondent in that subsequent legal proceeding.
(3) The report shall be confidential pursuant to subdivision (e) of Section 5976.5.
(4) This subdivision shall not affect the applicability of paragraph (2) of subdivision (c) of Section 5977.1, make admissible any evidence that is not otherwise admissible, or permit a witness to base an opinion on any matter that is not a proper basis for such an opinion. The admission or exclusion of evidence shall be pursuant to the rules of evidence established by the Evidence Code, including but not limited to Section 352 of Evidence Code, and by judicial decision.
8) Proposed amendment—clarifying applicable exceptions from medical privacy laws. As currently in print, this bill uses the phrase “notwithstanding any other law” in order to establish the necessary exemptions from medical privacy laws for disclosure of information to county behavioral health agencies and the courts. The lack of precision in the phrase “notwithstanding any other law” is undesirable, for several reasons. In general, state law cannot authorize an act that is prohibited by federal law. Moreover, the right to privacy is guaranteed under the state Constitution and cannot be waived merely by statutory decree; it is therefore imperative that statutes which depend on an exemption from the constitutional right to privacy rely on a recognized exemption from this guarantee. Further, despite the liability exemption in this bill, providers of health care and covered entities will likely wish to know the specific legal authority on which they should rely for disclosing records protected under medical privacy laws.
Welfare and Institutions Code 5977.4. […]
(d) (1) Notwithstanding any other law, Consistent with paragraph (9) of subdivision (b) of Section 56.10 of the Civil Code, the county behavioral health agency shall include in any report evaluation, or other document filed with the court, the information, including protected health information, necessary to support the determinations, conclusions, and recommendations in the filing. The county behavioral health agency shall not, unless ordered to do so by the court, submit to the court original or photocopied records underlying the information in a report evaluation or other document required or ordered under this subdivision. The county behavioral health agency shall serve an unredacted copy of any report evaluation, or other document filed with the court on the respondent and the respondent’s counsel and, with the consent of the respondent, on the supporter in a manner authorized by law. Neither a county nor an employee or agent thereof shall be held civilly or criminally liable for any disclosure authorized or required by this paragraph.
The provision above governs a county behavioral health agency’s disclosure of medical information to the court. Civil Code § 56.10(b)(9), a CMIA provision, requires “a provider of health care, a health service plan, or a contractor [to] disclose medical information if the disclosure is compelled by any of the following: … (9) When otherwise specifically required by law.”
According to information provided by county representatives to Committee staff:
[County behavioral health agencies] are … “providers of health care” covered under CMIA, because the county staff engaged in treatment activities are “licensed or certified pursuant to Division 2 (commencing with Section 500) of the Business and Professions Code” (e.g., psychologists, [licensed clinical social workers], and [licensed marriage and family therapists]). (See Civ. Code, §§ 56.10, subd. (a) and 56.05, subd. (o) [definition of “provider of health care”].)
This CMIA definition is also the basis for allowing disclosures to county behavioral health agencies under the next three sets of amendments.
(2) (A) Notwithstanding any other law, Consistent with paragraph (1) of subdivision (c) of Section 56.10 of the Civil Code, a provider of health care, as defined in Section 56.05 of the Civil Code, or a covered entity, as defined in Section 160.103 of Title 45 of the Code of Federal Regulations, may disclose to the county behavioral health agency any information, including protected health information, and mental health records excluding psychotherapy notes, and substance use disorder patient records, to the extent permitted by Part 2 (commencing with Section 2.1) of Title 42 of the Code of Federal Regulations, in its possession about the respondent that is relevant to the county behavioral health agency’s provision, coordination, or management of services and supports under this section part, including, but not limited to, the preparation of any required investigations, evaluations, or reports. Such a disclosure is a disclosure for treatment purposes, which may be made only to the extent permitted under Section 164.506 of Title 45 of the Code of Federal Regulations. The information disclosed may include substance use disorder patient records only to the extent permitted by Part 2 (commencing with Section 2.1) of Title 42 of the Code of Federal Regulations.
The provision above governs voluntary disclosures by a provider of health care (as defined under CMIA) or a covered entity (as defined under HIPAA) to a county behavioral health agency. Disclosure is permitted for treatment purposes under 45 C.F.R. § 164.506, which governs uses and disclosures to carry out treatment, payment, or health care operations.
According to information provided by county representatives to Committee staff:
County behavioral health agencies are “covered entities” under HIPAA (or, more accurately, covered components of the “hybrid” county entity) because (1) they are providers of medical or health services, and (2) they transmit health information in electronic form in connection with covered transactions (e.g., for Medi-Cal billing). (45 CFR § 160.103 [definitions of “covered entity,” “health care provider,” and “transaction”]. See also 45 CFR § 164.105 [implementation of HIPAA by "hybrid" legal entities, such as counties, that have both covered and non-covered functions].)
This HIPAA definition is also the basis for allowing disclosures to county behavioral health agencies under the next two sets of amendments.
Title 42, Part 2 of the Code of Federal Regulation, cited in the amendments above and below, governs the confidentiality and disclosure of patients’ substance abuse disorder records.
(B) Notwithstanding any other law, Consistent with paragraph (9) of subdivision (b) of Section 56.10 of the Civil Code, a provider of health care, as defined in Section 56.05 of the Civil Code, or a covered entity, as defined in Section 160.103 of Title 45 of the Code of Federal Regulations, that filed a CARE Act petition or executed an affidavit included with a CARE Act petition pursuant to paragraph (1) of subdivision (d) of Section 5975 shall provide to the county behavioral health agency any information, including protected health information, and mental health records excluding psychotherapy notes, and substance use disorder patient records, to the extent permitted by Part 2 (commencing with Section 2.1) of Title 42 of the Code of Federal Regulations, in its possession about the respondent that may be relevant in connection with an investigation, evaluation, or other report or hearing under this section part, or with the provision of services and supports under this section part. The provision of information under this paragraph is a disclosure required by law, which may be made only to the extent permitted under subdivision (a) of Section 164.512 of Title 45 of the Code of Federal Regulations. The information disclosed shall include substance use disorder patient records only to the extent permitted by Part 2 (commencing with Section 2.1) of Title 42 of the Code of Federal Regulations.
The provision above governs mandatory disclosures by a provider of health care (as defined under CMIA) or a covered entity (as defined under HIPAA) to a county behavioral health agency, in situations where the provider or covered entity either filed a CARE Act petition or executed an affidavit included with a CARE Act petition. Disclosure is permitted under 45 C.F.R. § 164.512(a), which governs uses and disclosures required by law, and Civil Code § 56.10(b)(9), which addresses disclosures “otherwise specifically required by law.”
(C) The county behavioral health agency may apply to the court ex parte for an order requiring any provider of health care, as defined in Section 56.05 of the Civil Code, or any covered entity, as defined in Section 160.103 of Title 45 of the Code of Federal Regulations, to provide to the county behavioral health agency, to the court, or both, any information, including, but not limited to, protected health information, and mental health records excluding psychotherapy notes, and substance use disorder patient records, to the extent permitted by Part 2 (commencing with Section 2.1) of Title 42 of the Code of Federal Regulations, in its possession about the respondent that may be relevant in connection with an investigation, evaluation, or other report or hearing under this section part, or with the provision of services and supports under this section part. The provision of information under this paragraph is a disclosure required by law, which may be made only to the extent permitted under Section 164.512 of Title 45 of the Code of Federal Regulations. The information ordered to be disclosed may include substance use disorder patient records only to the extent permitted by Part 2 (commencing with Section 2.1) of Title 42 of the Code of Federal Regulations.
The provision above permits a county behavioral health agency to obtain a court order ex parte (that is, without the appearance of the respondent or another party to the CARE proceeding) in order to compel disclosure of medical information to the agency and/or to the court. As before, disclosure is permitted under 45 C.F.R. § 164.512(a), which governs uses and disclosures required by law.
While not explicitly cited in the provision above, Civil Code § 56.10(b)(1) permits a provider of health care to disclose medical information under the CMIA if “compelled by…[a] court order.”
9) Proposed amendment—providing notice of disclosure to the respondent.
Welfare and Institutions Code 5977.4. […]
(d) (3) […] (E) The county behavioral health agency shall notify the respondent of a disclosure under this paragraph as follows:
(i) By mail at the respondent’s last known address, if any.
(ii) To the respondent’s counsel.
(iii) By including a copy of the notification under clause (i) or (ii) with the next notice of hearing served upon the respondent, if any.
(E) (F) All information, including the facts and records, or summary thereof, shared under this subdivision shall further be disclosed to the respondent and the respondent’s counsel, and with the consent of the respondent, to the supporter.
The amendments above are intended to ensure that the county behavioral health agency notifies the respondent of any disclosure under the CARE Act of the respondent’s medical information.
10) Proposed amendment— preserving confidentiality of records.
Welfare and Institutions Code 5977.4. […]
(d) (3) […] (B) Information disclosed to a county behavioral health agency by a provider of health care, as defined in Section 56.05 of the Civil Code, or a covered entity, as defined in Section 160.103 of Title 45 of the Code of Federal Regulations is confidential and not subject to disclosure or inspection under the California Public Records Act (Division 10 (commencing with Section 7920.000) of Title 1 of the Government Code).
(C) Disclosure of information under this part shall not be deemed to in any way alter the duties or responsibilities of a county behavioral health agency, of a provider of health care, as defined in Section 56.05 of the Civil Code, or of a covered entity, as defined in Section 160.103 of Title 45 of the Code of Federal Regulations, with respect to the disclosed information under the Confidentiality of Medical Information Act (Part 2.6 (commencing with Section 56) of Division 1 of the Civil Code), or the federal Health Insurance Portability and Accountability Act of 1996 (Public Law 104-191).
Subparagraph (B) above is meant to ensure that the medical information of a respondent that is disclosed under the CARE Act to a county behavioral health agency remains confidential and that it does not inadvertently become subject to the California Public Records Act.
Subparagraph (C) above is meant to ensure that HIPAA and CMIA continue to govern medical information that is disclosed under the CARE Act.
11) Proposed amendment—ensuring the confidentiality of CARE court proceedings.
Welfare and Institutions Code 5976.5. (a) Notwithstanding any other law, and except as otherwise provided in this section, a hearing held under this part is presumptively closed to the public.
(b) The respondent may demand that the hearing be public and be held in a place suitable for attendance by the public.
(c) The respondent may request the presence of any family member or friend without waiving the right to keep the hearing closed to the rest of the public.
(d) A request by any other party to the proceeding to make the hearing public may be granted if the judicial officer conducting the hearing finds that the public interest in an open hearing clearly outweighs the respondent’s interest in privacy.
(e) All reports, evaluations, diagnoses, or other information filed with the court related to the respondent’s health shall be confidential. The respondent may at any time petition the court for an order sealing these records or any other court records in a proceeding held under this part. Notwithstanding any Rule of Court prohibiting records kept confidential by law from consideration for sealing, if such a petition is filed, there shall exist a presumption in favor of sealing.
This provision is meant to allow a respondent to seek sealing of records in their CARE Act proceeding. While confidentiality of court records can be provided for by statute (as here), sealing of records requires an individual petition to the court. (See Cal. Rules of Court, rule 2.550; see also NBC Subsidiary (KNBC-TV), Inc. v. Superior Court (1999) 20 Cal. 4th 1178.)
(f) The fact that evidence is admitted at a proceeding held under this part shall not be the basis for admission of that evidence in any subsequent legal proceeding.
This provision is meant to ensure that the admissibility of evidence in a CARE Act proceeding cannot, in and of itself, be the basis for admitting that evidence in a subsequent legal proceeding. That said, this provision is not meant to impair the admission of evidence in a subsequent legal proceeding on some other basis that is lawful in that proceeding.
Note that the definition of “legal proceeding,” as forth in section 7) above, excludes subsequent LPS proceedings to which the court may refer the respondent using its authority under the CARE Act; in such proceedings, evidence would be admissible on the basis that it was admitted in a CARE proceeding.
(g) Photographs, recordings, transcripts, other records of proceedings held under this part, and testimony regarding proceedings held under this part shall not be admissible in any subsequent legal proceeding except upon motion by one of the following in that subsequent legal proceeding:
(1) The respondent.
(2) The county behavioral health agency, the public guardian, or the public conservator.
This provision ensures that any record of a CARE Act proceeding, including testimony regarding such proceedings, is inadmissible in a subsequent legal proceeding. An exception is made for a limited set of persons—the respondent, the county behavioral health agency, the public guardian, or the public conservator—to nevertheless introduce such a record as evidence on motion.
(h) In a proceeding held under this part, this section shall not affect the applicability of paragraph (2) of subdivision (c) of Section 5977.1, make admissible any evidence that is not otherwise admissible, or permit a witness to base an opinion on any matter that is not a proper basis for that opinion. The admission or exclusion of evidence shall be pursuant to the rules of evidence established by the Evidence Code, including, but not limited to, Section 352 of the Evidence Code, and by judicial decision.
This provision ensures that all applicable evidence laws continue to apply in CARE Act proceedings.
12) Proposed amendment—preventing abuse of the CARE process to gain an advantage in a subsequent legal proceeding. One of the distinctive features of the CARE Act is the extensive list of individuals, including a respondent’s spouse, children, or siblings, who may file a petition with the court in order to initiate a CARE proceeding. This is an important feature of the law, since it potentially makes supports and services available to individuals who are desperately in need, but may not be able to access other or more traditional channels for help. The CARE Act protects against abuse of the petition process by permitting courts to declare a person a vexatious litigant if they file two CARE petitions that are “without merit or…intended to harass or annoy the respondent[.]” (Welf. & Inst. Code § 5975.1.)
That said, it is easy to envision a situation in which a person might seek to gain an advantage in another legal proceeding by filing a CARE petition concerning a respondent. Suppose there is a dispute between siblings over family property or a family business; an attorney for one sibling might suggest filing a CARE petition regarding another sibling who suffers from mental illness. Or a family law attorney, assisting a client with a divorce, might aid them in filing a CARE petition regarding their spouse in order to gain an advantage in gaining child custody. In order to safeguard against such unethical conduct, the following amendment makes clear that it is cause for State Bar discipline for an attorney to file, or assist in filing, a CARE Act petition with knowledge that the filing is being made to gain an advantage in another legal proceeding.
Welfare and Institutions Code 5975.1. (a) […]
(b) (1) If a person other than the respondent files a petition for CARE Act proceedings in order to gain an advantage over the respondent in another legal proceeding, then, notwithstanding any other provision of this part, it is cause for suspension, disbarment, or other discipline if a member of the State Bar is found to have filed the petition or assisted in the filing of the petition with knowledge that the filing was being made in order to gain that advantage.
(2) For purposes of this subdivision, “legal proceeding” shall not include:
(A) A proceeding under Part 1 (commencing with Section 5000) of Division 5.
(B) A proceeding under Section 300.
Paragraph (2) excludes proceedings involving LPS, Assisted Outpatient Treatment (aka “Laura’s Law”), and juvenile dependency, so that public attorneys involved in such proceedings are not inadvertently subjected to State Bar discipline.
13) Proposed amendment—ensuring CARE petitions are not the basis for unnecessarily prolonging jail time. While not within this Committee’s jurisdiction, the amendment set forth below was worked out by CARE Act stakeholders to prevent unnecessarily prolonged incarceration for defendants found incompetent to stand trial in misdemeanor criminal proceedings.
Penal Code 1370.01. […] (b) If the defendant is found mentally incompetent, the trial, judgment, or hearing on the alleged violation shall be suspended and the court may do either of the following:
(1) […]
(D) If the court finds the defendant ineligible for diversion based on the circumstances set forth in subdivision (b), (c), (d), or (g) of Section 1001.36, the court may, after notice to the defendant, defense counsel, and the prosecution, hold a hearing to determine whether to do any of the following:
(iv) Refer the defendant to the CARE program pursuant to Section 5978 of the Welfare and Institutions Code. A hearing to determine eligibility for CARE shall be held within 30 14 court days after the date of on which the petition for the referral. referral is filed. If the hearing is delayed beyond 30 14 court days, the court shall order the defendant, if confined in county jail, to be released on their own recognizance pending that hearing. If the defendant is accepted into CARE, the charges shall be dismissed pursuant to Section 1385.
The current language in the bill would have required such defendants to remain in jail for up to 30 days, solely because they were referred for CARE proceedings. As amended, the maximum time would be reduced to 14 court days.
ARGUMENTS IN SUPPORT: California State Association of Counties, Urban Counties of California, and Rural County Representatives of California applaud the August 28 amendments to this bill, writing:
Fulfillment of county behavioral health agencies’ responsibilities under the CARE Act will require communication of detailed information regarding a respondent’s behavioral health condition and treatment to the court. Such information is generally confidential under state and federal law and cannot be disclosed by any health care provider – including county behavioral health – without the respondent's consent. A respondent may decline to consent to release of their confidential medical and mental health information to the court – particularly during early phases of the case, when county behavioral health is preparing the initial report. to the court required under the provisions of the CARE Act. As a result, express legal authority will be required for county behavioral health agencies to provide the court with the information contemplated by the CARE Act.
ARGUMENTS IN OPPOSITION: ACLU California Action and Disability Rights California caution against disclosure of medical information to substantiate CARE Act petitions:
Allowing county agencies carte blanche to specifically search for and report to the court any information in medical records that substantiates a CARE petition’s allegations raises civil rights, medical privacy, and due process concerns and is likely in conflict with state and federal medical privacy laws. Additionally, it may allow aspects of respondents’ medical records that are outdated and/or written by individuals with minimal behavioral health expertise, to follow the respondent into a process that can restrict their civil rights. Subdivision (d) of Section 5977.4 of the Welfare and Institutions Code may also leave medical providers open to the risk of violating federal medical privacy law in order to follow state law.
REGISTERED SUPPORT / OPPOSITION:
Support
California State Association of Counties
Rural County Representatives of California
Urban Counties of California
Support if Amended
Families Advocating for the Seriously Mentally Ill
Opposition
ACLU California Action
DBSA California
Disability Rights California
Electronic Frontier Foundation
Analysis Prepared by: Jith Meganathan / P. & C.P. / (916) 319-2200
SENATE THIRD READING
STR Bill Id:SB 35
Author:(Umberg)
As Amended Ver:July 12, 2023
2/3 vote. Urgency
SUMMARY
Makes numerous changes to the yet-to-be-implemented Community Assistance, Recovery, and Empowerment (CARE) Act, including but not limited to, allowing a subordinate judicial officer to preside over CARE Court proceedings and prohibiting a fee to file a CARE Court petition.
Major Provisions
- Specifies that a county shall be granted only one extension for implementation of the CARE Act and that the final date for counties to implement under any circumstances shall be December 1, 2025.
- Clarifies that in order for the director of an California Indian health services program or California tribal behavioral health department to be able to file a petition regarding a respondent, the program must have, within the previous 30 days, provided or who is currently providing behavioral health services to the respondent, or the director's designee.
- Clarifies that in order for a judge of a tribal court to be able to file a petition regarding a respondent, the court must be located in California and the respondent must have appeared in the court within the previous 30 days.
- Authorizes CARE Act proceedings to be conducted by a superior court judge or by a court-appointed commissioner or other subordinate judicial officer.
- Requires that there is no fee for filing a petition nor any fees charged by any public officer for services in filing or serving papers or for the performance of any duty enjoined by the CARE Act.
- Provides that the respondent has the right have an interpreter in all proceedings if necessary for the respondent's full participation.
- Allows for the appointment of counsel "working in [the] capacity" of a public defender, rather than a public defender to be appointed to represent the respondent.
- Clarifies the following regarding the rights of the original petitioner:
- They have a right to be present and make a statement at the initial hearing on the merits of the petition.
- In order to be allowed by a court to participate in the respondent's CARE proceedings, the respondent must consent to their participation.
- Requires additional evidence presented at the hearing on the merits of a petition to be "admissible" evidence.
COMMENTS
SB 1338 (Umberg), Chapter 319, Statutes of 2022 established the Community Assistance, Recovery, and Empowerment (CARE) Act. The CARE Act must be implemented by Glenn, Orange, Riverside, San Diego, San Francisco, Stanislaus, and Tuolumne Counties by October 1, 2023, and by the remaining counties by December 1, 2024. (However, under certain circumstances the Department of Health Care Services (DHCS) can delay implementation until December 1, 2025.) The CARE Act only becomes operative upon DHCS, in consultation with county stakeholders, developing a CARE Act allocation to provide state financial assistance to counties to implement the CARE process.
A central feature of the CARE Act are "CARE Courts," intended to deliver mental health and substance use disorder (SUD) services as an alternative to incarceration in a jail or psychiatric facility of a person with schizophrenia or another psychotic disorder, or that person becoming subject to an LPS conservatorship. The CARE Act provides for court-ordered CARE Plans for a person suffering from a mental health or SUD crisis for up to 12 months, with possible extensions. The plan is supposed to provide individuals with clinically appropriate, community-based services. These might include court-ordered stabilization medications, wellness and recovery support, help with finding social services and housing. "Court-ordered stabilization medication" is distinct from involuntary medication in that it cannot be forcibly administered. However, failure of a person to voluntarily participate in the medication treatment could lead to their referral to an LPS conservatorship. (Welfare & Institutions Code Section 5979 (a)(3) – (5).)
The California Health and Human Services Agency describes CARE Court as "an upstream diversion to prevent more restrictive conservatorships or incarceration." ("CARE Court FAQ," at chhs.ca.gov.) CARE Court could be an "appropriate next step" after someone has been placed on a 72-hour hold ("5150") or a 14-day hold ("5250"), an arrest, or those who can otherwise be safely diverted from a criminal proceeding.
The bill makes a number of changes to the CARE Act, including the following:
- Specifies that a county shall be granted only one extension for implementation of the CARE Act and that the final date for counties to implement under any circumstances shall be December 1, 2025.
This change is apparently intended to push counties to implement the program, notwithstanding the fact that they may lack resources such as courtrooms, social workers, public defenders, mental health beds, drug treatment services, etc. Given that new and ongoing funding ($29.9 million General Fund in 2023‑24 and increasing to $100 million annually in 2025‑26) has been allocated to support court‑specific costs related to the implementation of the CARE Program, counties are expected to find all of the resources they need to implement the program.
- Authorizes CARE Act proceedings to be conducted by a superior court judge or by a court-appointed commissioner or other subordinate judicial officer.
The California Rules of Court define a "subordinate judicial officer" (SJO) to mean "an attorney employed by a court to serve as a commissioner, referee, or hearing officer, whether the attorney is acting as a commissioner, referee, hearing officer, or temporary judge." (Rule 10.603 (b)(1).) According to the author, the bill "allows proceedings to be conducted by subordinate judicial officers to ensure timely access for court proceedings to protect due process[.]" While this provision likely will help the courts meet their CARE Court responsibilities, it is unknown whether an SJO will have the longevity and experience to fill the place of a superior court judge in CARE Court. ACLU California Action argues that, "This change eases the ability of counties to implement the CARE Act while doing nothing to safeguard the rights of respondents."
- Requires that there is no fee for filing a petition nor any fees charged by any public officer for services in filing or serving papers or for the performance of any duty enjoined by the CARE Act.
According to the author, this provision "eliminates the filing fee to support equitable access to petitioners with limited resources[.]" It is very unusual for original filing fees to be waived. Other than petitions to prevent domestic violence, abuse of an elder or dependent adult, civil harassment (involving violence, threats of violence, or stalking), workplace violence (involving violence, threats of violence, or stalking), virtually no petitions can be filed with no fee. (https://www.stanislaus.courts.ca.gov/system/files/general/local-civil-fee-schedule-2023.pdf.)
- Provides that the respondent has the right to have an interpreter in all proceedings if necessary for the respondent's full participation.
This provision makes sense. If a respondent cannot understand the language used in CARE Court proceedings, the respondent cannot meaningfully or knowingly participate in the legal process.
- Allows for the appointment of counsel "working in [the] capacity" of a public defender, rather than a public defender to be appointed to represent the respondent.
This provision appears to be consistent with the general rule that even if a person has a right to a court-appointed attorney, they do not have the right to the specific court-appointed attorney of their choice. (Wheat v. United States (1988) 486 U.S. 154, 159.) However, research shows that public defenders generally provide more effective legal representation in criminal matters than other attorneys, including those who are privately retained. (See Maggie Bailey, "Empirical Research on the Effectiveness of Indigent Defense Delivery Systems," UNC School of Government, Criminal Justice Innovation Lab (February 2021).) The same likely will be true in CARE Court proceedings, so arguably this provision will have a negative impact on respondents in CARE Court.
- Clarifies the following regarding the rights of the original petitioner:
- They have a right to be present and make a statement at the initial hearing on the merits of the petition.
- In order to be allowed by a court to participate in the respondent's CARE proceedings, the respondent must consent to their participation.
Although one group representing families of the mentally ill objects to this provision (see below), the provision seems appropriate. Not all people want their families to be involved in their mental or physical health care. The same will likely be true for respondents and petitioners in CARE Court. Once CARE proceedings are initiated, respondents should not be forced to have petitioners be involved in the proceedings.
According to the Author
SB 35 would modify various parts of CARE Court ahead of its implementation in October of 2023. For example, this bill eliminates the filing fee to support equitable access to petitioners with limited resources, allows proceedings to be conducted by subordinate judicial officers to ensure timely access for court proceedings to protect due process, and clarifies the due dates of the program's preliminary and final evaluations. Changes like these are urgently needed to help CARE Court succeed.
Arguments in Support
Families Advocating for the Seriously Mentally Ill (FASMI) write the following to explain why they support the bill if amended:
The exclusion of bipolar disorder is not in the spirit of the CARE Act. . . . Please amend the CARE Act eligibility criteria section 5975 (b) to include severe bipolar disorder. At a minimum, please include bipolar disorder with psychotic features in the eligibility criteria.
. . .[L]anguage has been added to the bill recently that allows CARE Court candidates (who are likely suffering from anosognosia and delusions) to veto the participation of family members. This provision is harmful to both candidates and their families. . . . Please remove this language, which was added in the June 12 amendments, from Section 5977(b)(6)(B)(iii): "To the extent that the respondent consents."
Arguments in Opposition
ACLU California Action writes the following to explain why it opposes this bill:
SB 35 includes several provisions that will increase the harms of CARE Court. First, it will expand the number of CARE Court petitions by clarifying that there will be no fee for petitioners or any filing papers. . . .Second, SB 35 would give additional rights to the petitioners, thus weakening the rights of respondents. For example, the bill gives petitioners "the right to be present and make a statement on the merits of the petition at the initial hearing," and extends those rights if the petitioner is "a spouse, parent, sibling, child, or grandparent or other person who stands in loco parentis to the respondent."
Finally, SB 35 loosens criteria for who can be appointed as counsel and authorizes a "court-appointed commissioner or other subordinate judicial officer" to conduct proceedings in lieu of a superior court judge. This change eases the ability of counties to implement the CARE Act while doing nothing to safeguard the rights of respondents.
The Depression and Bipolar Support Alliance (DBSA), which describes itself as "the leading peer-directed national organization focusing on the two most prevalent mental health conditions, depression and bipolar disorder," writes the following about its reasons for opposing the bill:
This bill seems to make unneeded, damaging and inappropriate Care Court petitions even easier to perform, making many of the negative and traumatic effects even more widespread. DBSA California is not opposed to involuntary commitment in all cases, but we believe it should be safe, legal and rare. This program is neither safe to the consumer, but will make it much less rare.
FISCAL COMMENTS
According to the Assembly Appropriations Committee, no significant state costs. Judicial Council reports no additional workload or cost pressures resulting from the bill. The 2023-24 budget provides $55.5 million to the courts to implement the CARE Act, with $133 million to the courts ongoing starting in fiscal year 2025-26, plus additional funding for related IT improvements and the CARE Act Supporter Program.
VOTES
SENATE FLOOR: 37-0-3
YES: Allen, Alvarado-Gil, Archuleta, Ashby, Atkins, Becker, Bradford, Caballero, Cortese, Dahle, Dodd, Durazo, Eggman, Glazer, Grove, Hurtado, Jones, Laird, McGuire, Menjivar, Min, Newman, Nguyen, Niello, Ochoa Bogh, Padilla, Portantino, Roth, Rubio, Seyarto, Skinner, Smallwood-Cuevas, Stern, Umberg, Wahab, Wiener, Wilk
ABS, ABST OR NV: Blakespear, Gonzalez, Limón
ASM JUDICIARY: 10-0-1
YES: Maienschein, Essayli, Connolly, Dixon, Haney, Pacheco, Papan, Reyes, Sanchez, McKinnor
ABS, ABST OR NV: Kalra
ASM APPROPRIATIONS: 15-0-1
YES: Holden, Megan Dahle, Bryan, Calderon, Wendy Carrillo, Dixon, Mike Fong, Hart, Mathis, Papan, Pellerin, Sanchez, Soria, Weber, Wilson
ABS, ABST OR NV: McCarty
UPDATED
VERSION: July 12, 2023
CONSULTANT: Alison Merrilees / JUD. / (916) 319-2334 FN: 0001347
Date of Hearing: August 23, 2023
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Chris Holden, Chair
SBPCA Bill Id:SB 35
Author:(Umberg) – As Amended Ver:July 12, 2023
Policy Committee: | Judiciary | Vote: | 10 - 0 |
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Urgency: Yes State Mandated Local Program: No Reimbursable: No
SUMMARY:
This bill makes technical changes and clarifications to the Community Assistance, Recovery, and Empowerment (CARE) court program (CARE court or CARE Act), which will provide treatment, housing, and support services to a qualifying person with a serious mental disorder.
Specifically, among other provisions, this bill:
- Specifies that a county shall be granted only one extension for implementation of the CARE Act and that the final date for counties to implement the CARE Act is December 1, 2025.
- Authorizes CARE Act proceedings to be conducted by a superior court judge or by a court-appointed commissioner or other subordinate judicial officer.
- States that there is no fee for filing a petition nor any fees charged by any public officer for services in filing or serving papers or for the performance of any duty enjoined by the CARE Act.
- Provides that the respondent has the right to have an interpreter in all proceedings if necessary for the respondent’s full participation.
- Allows, if no legal services project has agreed to represent the respondent, for the appointment of other counsel working in the capacity of a public defender to represent the respondent.
- Authorizes the court to permit the original petitioner to participate in the respondent’s CARE proceedings to the extent that the respondent consents.
- Requires additional evidence presented at the hearing on the merits of a petition to be “admissible” evidence.
FISCAL EFFECT:
No significant state costs. Judicial Council reports no additional workload or cost pressures resulting from the bill. The 2023-24 budget provides $55.5 million to the courts to implement the CARE Act, with $133 million to the courts ongoing starting in fiscal year 2025-26, plus additional funding for related IT improvements and the CARE Act Supporter Program.
COMMENTS:
- Purpose. According to the author:
SB 1338 (Umberg 2022) created the CARE Act (also known as CARE Court) as a response to the urgent need for innovative solutions for individuals who are suffering with untreated schizophrenia spectrum and psychotic disorders, often unhoused in our communities, and who face high risks for repeated hospitalization, incarceration, institutionalization, mental health conservatorship, and premature death. Since the passage of SB 1338, California Health and Human Services (CalHHS) & Judicial Council of California (JCC) have worked diligently with counties and stakeholders to ensure that CARE Court is implemented successfully. However, during this process, CalHHS and JCC have identified a few urgent changes needed to make CARE Court work better for the people that need it most.
SB 35 would modify various parts of CARE Court ahead of its implementation in October of 2023. For example, this bill eliminates the filing fee to support equitable access to petitioners with limited resources, allows proceedings to be conducted by subordinate judicial officers to ensure timely access for court proceedings to protect due process, and clarifies the due dates of the program’s preliminary and final evaluations. Changes like these are urgently needed to help CARE Court succeed.
- Background. In 2022, the Governor signed SB 1338 (Umberg), Chapter 319, Statutes of 2022, known as the CARE Act. SB 1338 established the CARE court program, which will provide mental health and substance abuse disorder services to qualifying individuals through court-ordered CARE plans. The goal of the CARE court program is to provide these services without requiring incarceration in jail, detention in a psychiatric facility, or a Lanterman-Petris-Short Act conservatorship.
The CARE court process begins when a person (“petitioner”) files a petition with the court seeking services for a qualifying person with a serious mental disorder (“respondent”). The court orders a clinical evaluation and appoints a public defender and a support person to represent the respondent in legal proceedings and help the respondent navigate the CARE court process. If the court finds that the respondent meets the statutory criteria, the court orders the parties and the county behavioral health agency to develop a proposed CARE treatment plan for the respondent. Once the court approves the plan, it becomes a court-ordered treatment plan that requires the respondent to participate in specified clinically-appropriate, community-based services for a set period of time.
The CARE Act requires seven counties to begin implementation by October 1, 2023, and requires the remaining counties to begin implementation by December 1, 2024. Although the CARE courts are not yet operating, this bill makes a number of technical changes and clarifications to provisions governing CARE court procedures, filing fees, and extension dates for county implementation.
Analysis Prepared by: Annika Carlson / APPR. / (916) 319-2081
Date of Hearing: July 11, 2023
ASSEMBLY COMMITTEE ON JUDICIARY
Brian Maienschein, Chair
SBPCA Bill Id:SB 35
Author:(Umberg) – As Amended Ver:June 12, 2023
As Proposed to be Amended (to Add Urgency Clause)
SENATE VOTE: Not Relevant
SUBJECT: COMMUNITY ASSISTANCE, RECOVERY, AND EMPOWERMENT (CARE) COURT PROGRAM
KEY ISSUE: SHOULD THE CARE ACT, WHICH HAS YET TO BE IMPLEMENTED, BE MODIFIED IN SEVERAL WAYS, INCLUDING BY ALLOWING SUBORDINATE JUDICIAL OFFICERS TO PRESIDE OVER CARE COURT PROCEEDINGS AND BY PROHIBITING A FEE TO FILE A CARE COURT PETITION?
SYNOPSIS
Last years’ SB 1338 (Chap. 319, Stats. 2022) established the Community Assistance, Recovery, and Empowerment (CARE) Act, which is intended to deliver mental health and substance use disorder (SUD) services as an alternative to incarceration in a jail or psychiatric facility of a person with schizophrenia or another psychotic disorder, or that person becoming subject to an LPS conservatorship. The CARE Act provides for court-ordered CARE Plans for a person suffering from a mental health or SUD crisis for up to 12 months, with possible extensions. The plan is supposed to provide individuals with clinically appropriate, community-based services.
Although the CARE Act has not yet been implemented, this bill seeks to make a number of changes to the law, including but not limited to, allowing a subordinate judicial officer to preside over CARE Court proceedings and prohibiting a fee to file a CARE Court petition, prior to it taking effect. Given that The CARE Act must be implemented by Glenn, Orange, Riverside, San Diego, San Francisco, Stanislaus, and Tuolumne Counties by October 1, 2023, and by the remaining counties by December 1, 2024, the author proposes to add an Urgency Clause to the bill so that it will take effect immediately.
The bill has no registered support and is opposed by ACLU California Action and DBSA, which advocates for the rights of individuals with depression and bipolar disorder. One group, Families Advocating for the Seriously Mentally Ill, would support the bill if it were amended to remove the ability of a respondent to object to the continuing participation of petitioners in the CARE Court process.
SUMMARY: Makes numerous changes to the yet-to-be-implemented CARE Act, including but not limited to, allowing a subordinate judicial officer to preside over CARE Court proceedings and prohibiting a fee to file a CARE Court petition. Specifically, this bill:
- Specifies that a county shall be granted only one extension for implementation of the CARE Act and that the final date for counties to implement under any circumstances shall be December 1, 2025.
- Requires that the representation of an attorney appointed or chosen by the respondent to represent the respondent shall be consistent with subdivision (e) of Section 6068 of the Business and Professions Code and the California Rules of Professional Conduct.
- Clarifies that in order for the director of an California Indian health services program or California tribal behavioral health department to be able to file a petition regarding a respondent, the program must have, within the previous 30 days, provided or who is currently providing behavioral health services to the respondent, or the director’s designee.
- Clarifies that in order for a judge of a tribal court to be able to file a petition regarding a respondent, the court must be located in California and the respondent must have appeared in the court within the previous 30 days.
- Authorizes CARE Act proceedings to be conducted by a superior court judge or by a court-appointed commissioner or other subordinate judicial officer.
- Requires that there is no fee for filing a petition nor any fees charged by any public officer for services in filing or serving papers or for the performance of any duty enjoined by the CARE Act.
- Specifies that a supporter of the respondent who is present with them is allowed to perform the functions described in Sections 5980 and 5981, subject to the limits provided in those sections.
- Provides that the respondent has the right have an interpreter in all proceedings if necessary for the respondent’s full participation.
- Allows for the appointment of counsel “working in [the] capacity” of a public defender, rather than a public defender to be appointed to represent the respondent.
- Clarifies the following regarding the rights of the original petitioner:
- They have a right to be present and make a statement at the initial hearing on the merits of the petition.
- In order to be allowed by a court to participate in the respondent’s CARE proceedings, the respondent must consent to their participation.
- Requires additional evidence presented at the hearing on the merits of a petition to be “admissible” evidence.
- Clarifies the following about the hearing on the merits of the petition: If, at the hearing on the merits of the petition, the court finds there is not clear and convincing evidence that the respondent meets the CARE criteria in Section 5972, the court shall dismiss the case without prejudice, unless the court makes a finding, on the record, that the original petitioner’s filing was not in good faith, in which case the dismissal shall be with prejudice.
- Clarifies the timing of the evaluation by adding the due dates for preliminary report by December 31, 2026 and final report by December 31, 2028.
- Makes technical and non-substantive conforming changes.
- Provides that the bill is an urgency statute necessary for the immediate preservation of the public peace, health, or safety within the meaning of Article IV of the California Constitution and shall go into immediate effect. The facts constituting the necessity are:
The CARE Act takes effect in October 2023, and therefore important changes to the act must take effect immediately to ensure the CARE Act’s success.
EXISTING LAW:
- Establishes the LPS Act to end inappropriate, indefinite, and involuntary commitment of mentally disordered persons, developmentally disabled persons, and persons impaired by chronic alcoholism, and to provide prompt evaluation and treatment of those with mental health disorders or impaired by chronic alcoholism. (Welfare & Institutions Code Section 5000 et seq. All further statutory references are to this code, unless otherwise indicated.)
- Defines, as a basis for involuntary commitment under the LPS Act, “grave disability” as a condition in which a person, as a result of a mental disorder, or impairment by chronic alcoholism, is unable to provide for their basic personal needs for food, clothing, or shelter, or is found to be mentally incompetent under the Penal Code. Excludes from that definition persons with intellectual disabilities by reason of that disability alone. (Section 5008 (h).)
- Provides that if a person is gravely disabled as a result of mental illness, or a danger to self or others, then a peace officer, staff of a designated treatment facility or crisis team, or other professional person designated by the county, may, upon probable cause, take that person into custody for a period of up to 72 hours for assessment, evaluation, crisis intervention, or placement in a designated treatment facility. (Section 5150.)
- Allows a person who has been detained for 72 hours to be detained for up to 14 days of intensive treatment if the person continues to pose a danger to self or others, or to be gravely disabled, and the person has been unwilling or unable to accept voluntary treatment. (Section 5250.)
- Allows a person to be held at the expiration of a 14-day period of intensive treatment for further intensive treatment of up to 14 days if, during the detention period, a person threatened or attempted to take their own life or was detained because they threatened or attempted to their own life and continues to present an imminent threat of taking their own life and other specified conditions. (Section 5260.)
- Allows a person who has been detained for 14 days of intensive treatment to be detained for up to 30 additional days of intensive treatment if the person remains gravely disabled and is unwilling or unable to voluntarily accept treatment. (Section 5270.15.)
- Requires a certification review hearing to be held within four days of the date on which a person is certified for a 14-day period of intensive treatment or 30 additional days of intensive treatment unless judicial review has been requested or a postponement is requested by a person or their attorney or advocate. (Section 5256.)
- Provides every person detained by certification for intensive treatment with a right to a hearing by writ of habeas corpus for their release. Enumerates specified requirements and procedures for judicial review. (Sections 5275, 5276.)
- Allows the professional person in charge of a facility providing 72-hour, 14-day, or 30-day treatment to recommend an LPS conservatorship to the county conservatorship investigator for a person who is gravely disabled and is unwilling or unable to voluntarily accept treatment; and requires the conservatorship investigator, if they concur with the recommendation, to petition the superior court to establish an LPS conservatorship. Provides that a person for whom an LPS conservatorship is sought has the right to demand a court or jury trial on the issue of whether they are gravely disabled. (Section 5350 et seq.)
- Establishes the CARE Act, which must be implemented by Glenn, Orange, Riverside, San Diego, San Francisco, Stanislaus, and Tuolumne Counties by October 1, 2023, and the remaining counties by December 1, 2024, subject to delays based on a state or local emergency, or discretionary approval by the Department of Health Care Services (DHCS), up until December 1, 2025. Provides that the CARE Act only becomes operative upon DHCS, in consultation with county stakeholders, developing a CARE Act allocation to provide state financial assistance to counties to implement the CARE process. (Section 5970 et seq.)
- Defines, for purposes of the CARE Act, certain terms, including:
- "CARE agreement" is a voluntary settlement agreement, which includes the same elements as a CARE plan.
- "CARE plan" is an individualized, appropriate range of services and supports consisting of behavioral health care, stabilization medications, housing, and other supportive services, as provided.
- "Graduation plan" is a voluntary agreement entered into by the parties at the end of the CARE program that includes a strategy to support a successful transition out of court jurisdiction and may include a psychiatric advance directive. A graduation plan includes the same elements as a CARE plan to support the respondent in accessing services and supports. A graduation plan may not place additional requirements on the local government entities and is not enforceable by the court.
- "Parties" are the person who file the petition, respondent and the county behavioral health agency, along with other parties that the court may add if they are providing services to the respondent.
- "Petitioner" is the entity who files the CARE Act petition, but if other than the county behavioral health agency, the court is required, at the initial hearing, to substitute the director of county behavioral health agency or their designee as the petitioner, limiting the initial petitioner's rights to potentially receiving ongoing notice of the proceedings, and the right to make a statement at the hearing on the merits of the petition, with broader participation rights only if the respondent consents.
- "Respondent" is the person who is subject to the petition for the CARE process.
- "Supporter" is an adult who assists the respondent, which may include supporting the person to understand, make, communicate, implement, or act on their own life decisions during the CARE process, including a CARE agreement, a CARE plan, and developing a graduation plan. (Section 5971.)
- Provides that a respondent may qualify for the CARE process only if all of the following criteria are met:
- The person is 18 years of age or older.
- The person is currently experiencing a severe mental illness, as defined, and has a diagnosis identified in the disorder class: schizophrenia spectrum and other psychotic disorders, as defined in the most current version of the Diagnostic and Statistical Manual of Mental Disorders. Specifically exempts specified other conditions or disorders.
- The person is not clinically stabilized in on-going voluntary treatment.
- At least one of the following is true:
- The person is unlikely to survive safely in the community without supervision and the person's condition is substantially deteriorating.
- The person is in need of services and supports in order to prevent a relapse or deterioration that would be likely to result in grave disability or serious harm to the person or to others.
- Participation in a CARE plan or agreement would be the least restrictive alternative necessary to ensure the person's recovery and stability.
- It is likely that the person will benefit from participation in a CARE plan or agreement. (Section 5972.)
- Provides venue provisions for where CARE Act proceedings may be brought. (Section 5973.)
- Allows a petition to initiate a CARE proceeding to be brought by one of the following adults:
- A person with whom the respondent resides or a spouse, parent, sibling, child, or grandparent of the respondent, or another individual who stands in loco parentis to the respondent.
- The director of a hospital, or their designee, in which the respondent is hospitalized, or the director of a public or charitable organization, agency, or home, or their designee, that is currently, or within the previous 30 days, providing behavioral health services to the respondent or in whose institution the respondent resides.
- A licensed behavioral health professional, or their designee, who is treating, or has been treating within the last 30 days, the respondent for a mental illness.
- A first responder, including a peace officer, firefighter, paramedic, emergency medical technician, mobile crisis response worker, or homeless outreach worker who has had repeated interactions with the respondent in the form of multiple arrests, multiple detentions, as provided, multiple attempts to engage the respondent in voluntary treatment or other repeated efforts to aid the respondent in obtaining professional assistance.
- The public guardian or public conservator, or their designee (and a respondent may be referred from conservatorship proceedings).
- The director of a county behavioral health agency of the county in which the respondent reside or is present (and a respondent may be referred from assisted outpatient treatment proceedings).
- The director of the county Adult Protective Services or their designee.
- The director of a California Indian health services program, California tribal behavioral health department, or their designee.
- The judge of a tribal court that is located in California, or their designee.
- The respondent. (Section 5974.)
- Allows a court, if a criminal defendant is found to be mentally incompetent and ineligible for a diversion, to refer the defendant to the CARE program, as provided. (Penal Code Section 1370.1 (b)(1)(D)(iv).)
- Requires the CARE petition, which must be developed as a mandatory form by the Judicial Council (along with other forms necessary for the CARE process) and must be signed under penalty of perjury, to include, among other things:
- The name of the respondent, their address, if known, and the petitioner's relationship with the respondent.
- Facts that support petitioner's allegation that the respondent meets the criteria in 12).
- Either of the following:
- An affidavit of a licensed behavioral health professional stating that the health professional or their designee has examined the respondent within 60 days of the submission of the petition, or has made multiple attempts to examine, but has not been successful in eliciting the cooperation of the respondent to submit to an examination, within 60 days of submission of the petition, and that the licensed behavioral health professional had determined that the respondent meets, or has reason to believe, explained with specificity in the affidavit, that the respondent meets, the diagnostic criteria for CARE proceedings.
- Evidence that the respondent was detained for a minimum of two intensive treatments pursuant to the Lanterman-Petris-Short (LPS) Act, the most recent of which must be no longer ago than 60 days from the date of the petition. (Section 5975.)
- Provides that if a person other than the respondent files a petition for CARE Act proceedings that is unmeritorious or intended to harass or annoy the respondent, and that person had previously filed a petition for CARE Act proceedings that was unmeritorious or intended to harass or annoy the respondent, the petition is grounds to declare the person a vexatious litigant, as provided. (Section 5975.1.)
- Sets out the respondent's rights, including the right to be represented by counsel at all stages of a CARE proceeding, and requires the court to appoint specified counsel if the respondent does not have their own attorney. (Section 5976.)
- Provides that all CARE Act hearings are presumptively closed to the public. Allows the respondent to demand that the hearings be public or allows them to request the presence of a family member or friend without waiving their right to keep the hearing closed to the rest of the public. A request by another party to make a hearing public may be granted if the court finds that the public interest clearly outweighs the respondent's privacy interest. (Section 5976.5.)
- Requires, for all CARE Act proceedings, that the judge control all hearings with a view to the expeditious and effective ascertainment of the jurisdictional facts and the ascertainment of all information relative to the present condition and future welfare of the respondent. Except where there is a contested issue of fact or law, requires the proceedings to be conducted in an informal, non-adversarial atmosphere with a view to obtaining the maximum cooperation of the respondent, all persons interested in respondent's welfare, and all other parties, with any provisions that the court may make for the disposition and care of the respondent. (Section 5977.4 (a).)
- Requires that all reports, evaluations, diagnoses, or other information related to the respondent's health are confidential. Requires that all evaluations and reports, documents, and filings submitted to the court pursuant to CARE Act proceedings are confidential. (Section 5976.5 (e), 5977.4 (a).)
- Upon receipt of a CARE Act petition, requires that the court shall promptly review the petition to see if it makes a prima facie showing that the respondent is or may be a person described in 12). (Section 5977 (a)(1).)
- If the court finds the petitioner has not made a prima facie showing that the respondent is or may be a person described in 12), the court shall dismiss without prejudice, subject to 8). (Section 5977 (a)(2).)
- If the court finds the petitioner has made a prima facie showing that the respondent is or may be a person described in 12), and the petitioner is the county behavioral health agency, the court shall do all of the following: (i) set the matter for an initial appearance; (ii) appoint counsel; (iii) determine if the petition includes all the required information and, if not, order the county to submit a report with the information; and (iv) require notice be provided. (Section 5977 (a)(3)(A).)
- If the court finds the petitioner has made a prima facie showing that the respondent is or may be a person described in 12), and the petitioner is not the county behavioral health agency, the court shall order the county agency to investigate whether the respondent meets the CARE proceedings criteria and is willing to engage voluntarily with the county, file a written report with the court, and provide notice, as required. (Section 5977 (a)(3)(B).)
- If the county agency is making progress to engage the respondent, allows the agency to request up to an additional 30 days to continue to engage and enroll the individual in treatment and services. (Section 5977 (a)(4).)
- Within five days of the receipt of the report in 22c), requires the court to review the report and do one of the following:
- If the court determines that voluntary engagement with the respondent is effective, as provided, requires the court to dismiss the matter.
- If the court determines that the county's report supports the petition's prima facie showing that the respondent meets the CARE criteria, and engagement is not effective, requires the court to: (i) set an initial hearing within 14 days; (ii) appoint counsel, unless the respondent has their own counsel; and (iii) provide notice of the hearing, as provided.
- If the court determines that the county's report does not support the petition's prima facie showing that the respondent meets the CARE criteria, requires the court to dismiss the matter. (Section 5977 (a)(5).)
- At the initial hearing:
- If the petitioner is not present, allows the court to dismiss the matter.
- If the respondent elects not to waive their appearance and is not present, allows the court to conduct the hearing in the respondent's absence if the court makes a finding on the record that reasonable attempts to elicit the attendance of the respondent have failed, and conducting the hearing without the participation or presence of the respondent would be in the respondent's best interest.
- Requires a county behavioral health agency representative to be present, allows a supporter to be appointed, and allows a tribal representative to attend for a respondent who is a tribal member, as provided, and subject to the respondent's consent.
- If the court finds that there is no reason to believe that the facts stated in the petition are true, requires the court to dismiss the case without prejudice, unless the court makes a finding on the record that the petitioner's filing was not in good faith.
- If the court finds that there is reason to believe that the facts stated in the petition appear to be true, requires the court to order the county behavioral health agency to work with the respondent and the respondent's counsel and CARE supporter to engage in behavioral health treatment. Requires the court to set a case management hearing within 14 days.
- If the petitioner is other than the county behavioral health director, substitutes the county behavioral health director or their designee for the petitioner, as specified.
- Requires the court to set a hearing on the merits of the petition, which may be conducted concurrently with the initial appearance on the petition upon stipulation of the petitioner and respondent and agreement by the court. (Section 5977 (b).)
- At the hearing on the merits:
- If the court finds that the petitioner has not shown, by clear and convincing evidence, that the respondent meets the CARE criteria, requires the court to dismiss the case without prejudice, unless the court makes a finding, on the record, that the petitioner's filing was not in good faith.
- If the court finds that the petitioner has shown by clear and convincing evidence that the respondent meets the CARE criteria, requires the court to order the county behavioral health agency to work with the respondent, the respondent's counsel, and the supporter to engage in behavioral health treatment and determine if the parties will be able to enter into a CARE agreement. Requires the court to set a case management hearing. Requires notice to the tribe, if applicable. (Section 5977 (c).)
- At the case management hearing:
- If the parties have entered, or are likely to enter, a CARE agreement, requires the court to approve or modify and approve the CARE agreement, stay the matter, and set a progress hearing for 60 days.
- If the court finds that the parties have not entered, and are not likely to enter, into a CARE agreement, requires the court to order a clinical evaluation of the respondent, as provided. Requires the evaluation to address, at a minimum, a clinical diagnosis, whether the respondent has capacity to give informed consent regarding psychotropic medication, other information, as provided, and an analysis of recommended services, programs, housing, medications, and interventions that support the respondent's recovery and stability. (Section 5977.1 (a).)
- Requires the court to set a clinical evaluation hearing. (Section 5977.1 (c)(1).)
- At the clinical evaluation review hearing:
- Requires the court to consider the evaluation, and other evidence, including calling witnesses, but only relevant and admissible evidence that fully complies with the rules of evidence may be considered by the court.
- If the court finds, by clear and convincing evidence, after review of the evaluation and other evidence, that the respondent meets the CARE criteria, requires the court to order the county behavioral health agency, the respondent, and the respondent's counsel and supporter to jointly develop a CARE plan.
- If the court finds, in reviewing the evaluation, that clear and convincing evidence does not support that the respondent meets the CARE criteria, requires the court to dismiss the petition. (Section 5977.1 (c).)
- At the hearing to review the proposed CARE plan:
- Either or both parties may present a CARE plan.
- Requires the court to adopt the elements of a CARE plan that support the recovery and stability of the respondent. Allows the court to issue any orders necessary to support the respondent in accessing appropriate services and supports, including prioritization for those services and supports, subject to applicable laws and available funding, as provided. These orders are the CARE plan.
- Allows a court to order medication if it finds, upon review of the court-ordered evaluation and hearing from the parties that, by clear and convincing evidence, the respondent lacks the capacity to give informed consent to the administration of medically necessary stabilization medication. To the extent that the court orders medically necessary stabilization medications, prohibits the medication from being forcibly administered and the respondent's failure to comply with a medication order may not result in a penalty, including but not limited to contempt or the accountability measures in 37) – 38).
- Allows for supplemental information to be provided to the court, as provided. (Section 5977.1 (d).)
- The issuance of any orders in 29b) begins the up to one-year CARE program timeline. (Section 5977.1 (e).)
- Requires that a status review hearing occur at least every 60 days during the CARE plan implementation. (Section 5977.2 (a)(1).)
- Requires the petitioner to file with the court, and serve on the respondent and the respondent's counsel and supporter, a report not less than five court days prior to the hearing, with specified information, including progress the respondent has made on the CARE plan, what services and supports in the CARE plan were provided, and what services and supports were not provided, and any recommendations for changes to the services and supports to make the CARE plan more successful.
- Allows the respondent to respond to the report and introduce their own information and recommendations.
- Allows the petitioner, the respondent, or the court to request more frequent reviews as necessary to address changed circumstances. (Section 5977.2 (a)(1)(A) – (b).)
- Requires the court, in the 11th month, to hold a one-year status hearing, which is an evidentiary hearing, to determine if the respondent graduates from the CARE plan or should be reappointed for another year.
- Requires a report by the petitioner before the status conference, as provided. Allows respondent to call witnesses and present evidence.
- Provides that the respondent may be graduated from the CARE program and may be allowed to enter into a voluntary graduation plan with the county. However, such plan may not place additional requirements on the county and is not enforceable, other than a psychiatric advance directive if included.
- If the respondent elects to accept voluntary reappointment to the program, the respondent may request to be re-appointed to the CARE program for up to one additional year, subject to meeting certain criteria and court approval.
- Allows the court to involuntarily reappoint the respondent to the CARE program for up to one year if the court finds, by clear and convincing evidence, that (i) the respondent did not successfully complete the CARE process; (ii) all of the required services and supports were provided to the respondent; (ii) the respondent would benefit from continuation of the CARE process; and (iv) the respondent currently meets the requirements for initial enrollment in the CARE program.
- Provides that a respondent may only be reappointed to the CARE program for up to one additional year. (Section 5977.3.)
- Provides mandatory timeframes, as well as continuances for good cause, throughout the CARE court proceedings. (Section 5977.1.)
- Requires hearings to occur in person unless the court allows a party or a witness to appear remotely. Provides the respondent with the right to be in-person for all hearings. (Section 5977.4 (b).)
- Allows the respondent and the county behavioral health agency to appeal an adverse court determination. (Section 5979 (c).)
- Requires the Judicial Council to adopt rules to implement the CARE court provisions. (Section 5977.4 (c).)
- Allows the court, at any point in the proceedings, if it determines, by clear and convincing evidence, that the respondent, after receiving notice, is not participating in the CARE proceedings, to terminate respondent's participation in the CARE process. Allows the court to make a referral under the LPS Act, as provided. (Section 5979 (a).)
- Requires that, if a respondent was provided timely with all of the services and supports required by the CARE plan, the fact that the respondent failed to successfully complete their CARE plan, including the reasons for that failure: a) is a fact considered by a court in a subsequent hearing under the LPS Act, provided that hearing occurs within six months of termination of the CARE plan; and b) creates a presumption at that hearing that the respondent needs additional interventions beyond the supports and services provided by the CARE plan. Prohibits a respondent's failure to comply with any order from resulting in any penalty outside of this paragraph, including, but not limited to contempt or failure to appear. Prohibits a respondent's failure to comply with a medication order from resulting in any penalty, including under this paragraph. (Section 5979 (a)(3) – (5).)
- Creates a process for penalizing counties or other local government entities that do not comply with CARE court orders. If the presiding judge or designee of the county finds, by clear and convincing evidence, that a local government entity has substantially failed to comply with an order, the presiding judge or designee may impose a fine of up to $1,000 per day for noncompliance, not to exceed $25,000 for each violation. Requires that any fines be deposited in the CARE Act Accountability Fund and used, upon appropriation, by DHCS to support that local government's efforts that will serve individuals who have schizophrenia or other psychotic disorders and who experience, or are at risk of, homelessness, criminal justice involvement, hospitalization, or conservatorship. Allows the presiding judge or designee, if a county is found to be persistently noncompliant, to appoint a special master to secure court-ordered care for the respondent at the county's cost. In determining the application of the remedies available, requires the court to consider whether there are any mitigating circumstances impairing the ability of the county agency or local government entity to fully comply with the CARE Act requirements. (Section 5979 (b).)
- Requires DHCS, in consultation with specified groups, to provide optional training and technical resources for volunteer supporters. Requires that a CARE supporter do the following:
- Offer the respondent a flexible and culturally responsive way to maintain autonomy and decisionmaking authority over their own life by developing and maintaining voluntary supports to assist them in understanding, making, communicating, and implementing their own informed choices;
- Strengthen the respondent's capacity to engage in and exercise autonomous decision making and prevent or remove the need to use more restrictive protective mechanisms, such as conservatorship; and
- Assist the respondent with understanding, making, and communicating decisions and expressing preferences throughout the CARE court process. (Section 5980.)
- Allows a respondent to have their supporter be in any meeting, judicial proceedings, status hearing, or communication related to an evaluation; creation of the CARE plan; establishing a psychiatric advance directive; and development of a graduation plan. (Section 5981 (a).)
- Sets forth the duties and limitations of the supporter. Bounds a supporter by all existing obligations and prohibitions otherwise applicable by law that protect people with disabilities and the elderly from fraud, abuse, neglect, coercion, or mistreatment. Prohibits a supporter from being subpoenaed or called to testify against the respondent in any CARE Act proceeding, and provides that the supporter's presence at any meeting, proceeding, or communication does not waive confidentiality or any privilege. (Section 5981 (c) – (e).)
- Requires the Legal Services Trust Fund Commission to provide funding to qualified legal services projects to provide appointed legal counsel in CARE proceedings. Allows the Legal Services Trust Fund Commission to enter into no bid contracts. (Section 5981.5.)
- Sets forth the provisions of the CARE plan, which may only include:
- Specified behavioral health services;
- Medically necessary stabilization medications;
- Housing resources, as provided;
- Social services, as provided; and
- General assistance, as provided. (Section 5982 (a).)
- Requires that CARE participants be prioritized for any appropriate bridge housing funded by the Behavioral Health Bridge Housing program. If the county behavioral health agency elects not to enroll the respondent into a full service partnership, as defined, allows the court to review why not. (Section 5982 (b), (c).)
- Provides that all CARE plan services and supports ordered by the court are subject to available funding and all applicable federal and state statutes, regulations, contractual provisions and policy guidance governing program eligibility, as provided. (Section 5982 (d).)
- Sets forth rules by which a county is responsible for the costs of providing services to CARE participants. (Section 5982 (d) – (f).)
- Requires the Health and Human Services Agency, as provided, to (a) engage an independent, research-based entity to advise on the development of data-driven process and outcome measures to guide the planning, collaboration, reporting, and evaluation of the CARE Act; (b) convene a working group to provide coordination and on-going engagement with, and support collaboration among, relevant state and local partners and other stakeholders throughout the phases of county implementation to support the successful implementation of the CARE Act, including during implementation. (Section 5983 (a).)
- Requires DHCS to provide training and technical assistance to county behavioral health agencies to support the implementation of the CARE Act, including trainings regarding the CARE statutes, CARE plan services and supports, supported decisionmaking, the supporter role, trauma-informed care, elimination of bias, psychiatric advance directives, and data collection. (Section 5983 (b).)
- Requires the Judicial Council, in consultation with others, to provide training and technical assistance to judges to support the implementation of the CARE Act. (Section 5983 (c).)
- Requires DHCS, in consultation with others, to provide training to counsel on the CARE statutes, and CARE plan services and supports. (Section 5983 (d).)
- Allows the Health and Human Services Agency and DHCS to enter into exclusive or nonexclusive contracts, or amend existing contracts, on a bid or negotiated basis. (Section 5984 (a).)
- Allows the Health and Human Services Agency and DHCS to implement, interpret, or make specific the CARE Act by means of plan letters, information notices, provider bulletins, or other similar instructions, without taking any further regulatory action. (Section 5984 (b).)
- Requires DHCS, in consultation with specified others, to prepare an annual CARE Act report. Requires state or local governmental entities to provide data required by DHCS. Requires DHCS to provide information on the populations served and demographic data, stratified as specified. Requires that the report include, at a minimum, information on the effectiveness of the CARE Act model in improving outcomes and reducing homelessness, criminal justice involvement, conservatorships, and hospitalization of participants. Requires the annual report to examine data through the lens of health equity to identify racial, ethnic, and other demographic disparities and inform disparity reduction efforts. (Section 5985.)
- Requires DHCS to report on court data, as specified. (Section 5985 (d).)
- Requires an independent, research-based entity retained by DHCS, in consultation with others, to develop an independent evaluation of the effectiveness of the CARE Act. Requires the independent evaluation to employ statistical research methodology and include a logic model, hypotheses, comparative or quasi-experimental analyses, and conclusions regarding the extent to which the CARE Act model is associated, correlated, and causally related with the performance of the outcome measures included in the annual reports, highlighting racial, ethnic, and other demographic disparities, and including causal inference or descriptive analyses regarding the impact of the CARE Act on disparity reduction efforts. Requires DHCS to provide a preliminary evaluation of the effectiveness of the CARE Act to the Legislature three years after its implementation and a final report five years after implementation. (Section 5986.)
- Requires a health care service plan and an insurance policy, after July 1, 2023, to cover various costs under the CARE program. Sets out requirements for health care services plans and insurance policies, effective July 1, 2023, to cover CARE plans, as provided. (Section 1374.723.)
- Provides immunity to a county, or an employee or agent of a county, for any action by a respondent in the CARE process, except when the act or omission of a county, or the employee or agent of a county, constitutes gross negligence, recklessness, or willful misconduct. (Section 5987.)
- Sets forth that it is the duty of an attorney to do a number of things, including: To maintain inviolate the confidence, and at every peril to himself or herself to preserve the secrets, of his or her client. An attorney may, but is not required to, reveal confidential information relating to the representation of a client to the extent that the attorney reasonably believes the disclosure is necessary to prevent a criminal act that the attorney reasonably believes is likely to result in death of, or substantial bodily harm to, an individual. (Business and Professions Code Section 6068 (e).)
FISCAL EFFECT: As currently in print this bill is keyed fiscal.
COMMENTS: SB 1338 (Chap. 319, Stats. 2022) established the Community Assistance, Recovery, and Empowerment (CARE) Act. The CARE Act must be implemented by Glenn, Orange, Riverside, San Diego, San Francisco, Stanislaus, and Tuolumne Counties by October 1, 2023, and by the remaining counties by December 1, 2024. (However, under certain circumstances the Department of Health Care Services (DHCS) can delay implementation until December 1, 2025.) The CARE Act only becomes operative upon DHCS, in consultation with county stakeholders, developing a CARE Act allocation to provide state financial assistance to counties to implement the CARE process.
A central feature of the CARE Act are “CARE Courts,” intended to deliver mental health and substance use disorder (SUD) services as an alternative to incarceration in a jail or psychiatric facility of a person with schizophrenia or another psychotic disorder, or that person becoming subject to an LPS conservatorship. The CARE Act provides for court-ordered CARE Plans for a person suffering from a mental health or SUD crisis for up to 12 months, with possible extensions. The plan is supposed to provide individuals with clinically appropriate, community-based services. These might include court-ordered stabilization medications, wellness and recovery support, help with finding social services and housing. “Court-ordered stabilization medication” is distinct from involuntary medication in that it cannot be forcibly administered. However, failure of a person to voluntarily participate in the medication treatment could lead to their referral to an LPS conservatorship. (Section 5979 (a)(3) – (5).)
CARE Court focuses on the most severely mentally ill, including those with schizophrenia and other psychotic disorders. As noted, while the overall purpose of the CARE Act is to provide essential services to most severely ill, it also is supposed to preserve self-determination to the greatest extent possible. The California Health and Human Services Agency describes CARE Court as “an upstream diversion to prevent more restrictive conservatorships or incarceration.” (“CARE Court FAQ,” at chhs.ca.gov.) CARE Court could be an “appropriate next step” after someone has been placed on a 72-hour hold (“5150”) or a 14-day hold (“5250”), an arrest, or those who can otherwise be safely diverted from a criminal proceeding.
The Process: The first step in the CARE Court process is a “referral” – that is, a petition to the court by a family member, mental health provider, or first responder, among others. The Court then orders a clinical evaluation and appoints both a Public Defender and a “CARE Supporter,” the person assigned to help the individual understand the process so as to provide the individual with as much autonomy as is feasible. If the Court finds that the person meets the criteria for the program, then the Court orders the individual, CARE Supporter, and county behavioral health agency to develop a CARE Plan. The Court then reviews the Plan, and if it approves it, the Plan becomes a court order lasting up to 12 months. In addition to the county behavioral care team, CARE Supporter, and individual participating in the prescribed treatment plan, the CARE team also will develop a Psychiatric Advance Directive which can be used for future crisis, by providing necessary background information by the individual’s history. Eventually, the individual “graduates” from the CARE Court, although they may be provided with ongoing services, including assistance with finding housing.
“Graduation” from CARE is designed to occur with a person in need of CARE services, including those who are mentally ill and unhoused, obtaining housing of some sort. Housing is a critical component of CARE Court– i.e. stable housing that allows the person to stay connected with treatment, if needed.
Criticism of the CARE Act. While CARE Court and the CARE Act was championed by Governor Newsom and largely popular among the Legislature, many civil liberties groups expressed serious concerns about the model, its cost, and its impact on vulnerable communities. ACLU California Action summarizes some of those concerns in its letter of opposition to this bill:
Proponents of CARE Court rely on false premises – that people are rejecting offers of housing; that access to behavioral health services based on one evaluation will solve a person’s mental health, disabilities; and, that a civil court is the least restrictive setting. In reality, low-cost housing stock is at a near record low and affordable housing options have years-long waitlists of people desperate for a home. Moreover, recovery is primarily found to be successful when accessible, affordable housing is combined with community-based treatment settings, surrounded by peers, and provided through voluntary, accessible means. When a person is faced with defending their case before a judge without agency over their own care, the least restrictive setting is not court.
CARE Court is also a costly mistake. Once implemented, this court system is likely to cost in excess of billions of dollars, as estimated by the Assembly Appropriations Committee. This state mandate will fail to deliver on what it promises to accomplish and will divert resources from other urgently needed programs. SB 35 will increase this cost further by increasing the amount of petitions, even though counties already report they do not have enough resources to implement the CARE Court program.
. . . By targeting people with schizophrenia and other psychotic disorders, studies show Black, Indigenous and People of Color will disproportionately experience the harms that CARE Court poses.234 SB 35 will increase CARE Court’s exploitation of poor people who need mental health care. It is those people with low incomes and/or from communities of color who will be most victim to the chilling effects CARE Court will have in preventing people from seeking treatment and care.
Instead of expanding access to CARE Court, the Legislature should fund more community-based mental health care treatment centers, increase housing funds for extremely low-income Californians, and decrease the presence of law enforcement and court involvement in mental health crises.
The bill makes the following changes to the CARE Act:
- Specifies that a county shall be granted only one extension for implementation of the CARE Act and that the final date for counties to implement under any circumstances shall be December 1, 2025.
This change is apparently intended to push counties to implement the program, notwithstanding the fact that they may lack resources such as courtrooms, social workers, public defenders, mental health beds, drug treatment services, etc. Given that new and ongoing funding ($29.9 million General Fund in 2023‑24 and increasing to $100 million annually in 2025‑26) has been allocated to support court‑specific costs related to the implementation of the CARE Program, counties are expected to find all of the resources they need to implement the program.
- Requires that the representation of an attorney appointed or chosen by the respondent to represent the respondent shall be consistent with subdivision (e) of Section 6068 of the Business and Professions Code and the California Rules of Professional Conduct, which governs the obligation of attorneys to maintain the attorney-client privilege.
Given that licensed attorneys must comply with all provisions of Section 6068 of the Business and Professions Code and the California Rules of Professional Conduct, this does not appear to be a substantive change in the law.
- Clarifies that in order for the director of an California Indian health services program or California tribal behavioral health department to be able to file a petition regarding a respondent, the program must have, within the previous 30 days, provided or who is currently providing behavioral health services to the respondent, or the director’s designee.
- Clarifies that in order for a judge of a tribal court to be able to file a petition regarding a respondent, the court must be located in California and the respondent must have appeared in the court within the previous 30 days.
These provisions sensibly require that these petitioners have a recent and meaningful relationship with the person who is the subject of a CARE Court petition in order to file such a petition.
- Authorizes CARE Act proceedings to be conducted by a superior court judge or by a court-appointed commissioner or other subordinate judicial officer.
The California Rules of Court define a “subordinate judicial officer” (SJO) to mean “an attorney employed by a court to serve as a commissioner, referee, or hearing officer, whether the attorney is acting as a commissioner, referee, hearing officer, or temporary judge.” (Rule 10.603 (b)(1).) According to the author, the bill “allows proceedings to be conducted by subordinate judicial officers to ensure timely access for court proceedings to protect due process[.]” While this provision likely will help the courts meet their CARE Court responsibilities, it is unknown whether an SJO will have the longevity and experience to fill the place of a superior court judge in CARE Court. ACLU California Action argues that, “This change eases the ability of counties to implement the CARE Act while doing nothing to safeguard the rights of respondents.”
- Requires that there is no fee for filing a petition nor any fees charged by any public officer for services in filing or serving papers or for the performance of any duty enjoined by the CARE Act.
According to the author, this provision “eliminates the filing fee to support equitable access to petitioners with limited resources[.]” It is very unusual for original filing fees to be waived. Other than petitions to prevent domestic violence, abuse of an elder or dependent adult, civil harassment (involving violence, threats of violence, or stalking), workplace violence (involving violence, threats of violence, or stalking), virtually no petitions can be filed with no fee. (https://www.stanislaus.courts.ca.gov/system/files/general/local-civil-fee-schedule-2023.pdf.)
- Specifies that a supporter of the respondent who is present with them is allowed to perform the functions described in Sections 5980 and 5981, subject to the limits provided in those sections.
Section 5980 specifies that a supporter “shall” do the following:
(1) Offer the respondent a flexible and culturally responsive way to maintain autonomy and decisionmaking authority over their own life by developing and maintaining voluntary supports to assist them in understanding, making, communicating, and implementing their own informed choices.
(2) Strengthen the respondent’s capacity to engage in and exercise autonomous decisionmaking and prevent or remove the need to use more restrictive protective mechanisms, such as conservatorship.
(3) Assist the respondent with understanding, making, and communicating decisions and expressing preferences throughout the CARE process. (Section 5980 (b).)
Similarly, Section 5981 specifies that a supporter is intended to do all the following:
(1) Support the will and preferences of the respondent to the best of their ability and to the extent reasonably possible.
(2) Respect the values, beliefs, and preferences of the respondent.
(3) Act honestly, diligently, and in good faith.
(4) Avoid, to the greatest extent possible, and disclose to the court, the respondent, and the respondent’s counsel, minimize, and manage, conflicts of interest. A court may remove a supporter because of any conflict of interest with the respondent, and shall remove the supporter if the conflict cannot be managed in such a way to avoid any possible harm to the respondent.
Therefore, the goal of this provision in the bill appears to clarify that notwithstanding the mandatory language above, a supporter is not required by law to do any of those things.
- Provides that the respondent has the right to have an interpreter in all proceedings if necessary for the respondent’s full participation.
This provision obviously makes sense. If a respondent cannot understand the language used in CARE Court proceedings, the respondent cannot meaningfully or knowingly participate in the legal process.
- Allows for the appointment of counsel “working in [the] capacity” of a public defender, rather than a public defender to be appointed to represent the respondent.
This provision appears to be consistent with the general rule that even if a person has a right to a court-appointed attorney, they do not have the right to the specific court-appointed attorney of their choice. (Wheat v. United States (1988) 486 U.S. 154, 159.) However, research shows that public defenders generally provide more effective legal representation in criminal matters than other attorneys, including those who are privately retained. (See Maggie Bailey, “Empirical Research on the Effectiveness of Indigent Defense Delivery Systems,” UNC School of Government, Criminal Justice Innovation Lab (February 2021).) The same likely will be true in CARE Court proceedings, so arguably this provision will have a negative impact on respondents in CARE Court.
- Clarifies the following regarding the rights of the original petitioner:
- They have a right to be present and make a statement at the initial hearing on the merits of the petition.
- In order to be allowed by a court to participate in the respondent’s CARE proceedings, the respondent must consent to their participation.
Although one group representing families of the mentally ill objects to this provision (see below), the provision seems appropriate. Not all people want their families to be involved in their mental or physical health care. The same will likely be true for respondents and petitioners in CARE Court. Once CARE proceedings are initiated, respondents should not be forced to have petitioners be involved in the proceedings.
- Requires additional evidence presented at the hearing on the merits of a petition to be “admissible” evidence.
- Clarifies the following about the hearing on the merits of the petition: If, at the hearing on the merits of the petition, the court finds there is not clear and convincing evidence that the respondent meets the CARE criteria in Section 5972, the court shall dismiss the case without prejudice, unless the court makes a finding, on the record, that the original petitioner’s filing was not in good faith, in which case the dismissal shall be with prejudice.
Both of these provisions seem to be helpful and important clarifications of the law governing the CARE Court process that will protect the due process rights of respondents. For example, the first provision will prevent the introduction of hearsay, unless an exception applies. (See Evidence Code Section 1200.)
- Clarifies the timing of the evaluation by adding the due dates for preliminary report by December 31, 2026 and final report by December 31, 2028.
These appear to be sensible and non-controversial changes.
Amendments requested by Families Advocating for the Seriously Mentally Ill (FASMI). FASMI writes the following to explain why they would support the bill if it were amended:
1. The CARE Act eligibility criteria (section 5975 b) should be amended to include severe bipolar disorder. Those diagnosed with bipolar disorder and major depression
often experience severe psychosis and lack of insight. They too should have a right to receive treatment under the CARE Act.
2. Barriers to participation of families should be removed.
We are grateful that SB 35 provides that families will not be charged a fee for filing a petition. But some language has been added to the bill recently that allows CARE Court candidates (who are likely suffering from anosognosia and delusions) to veto the participation of family members. This provision is harmful to both candidates and their families. . . .
Please remove this language, which was added in the June 12 amendments, from Section 5977(b)(6)(B)(iii): “To the extent that the respondent consents.”
Author’s amendments – to add an Urgency Clause. As explained above, the CARE Act will be implemented as early as October of this year. In order for the changes proposed by the bill to be in place prior to that time, this bill must take effect immediately, according to the author. Therefore, the author proposes the following:
Amendment 1: In the title, strike out line 5 and insert: “courts, and declaring the urgency thereof, to take effect immediately.”
Amendment 2: On page 26, below line 32, insert:
SEC. 21. This act is an urgency statute necessary for the immediate preservation of the public peace, health, or safety within the meaning of Article IV of the California Constitution and shall go into immediate effect. The facts constituting the necessity are:
The CARE Act takes effect in October 2023, and therefore important changes to the act must take effect immediately to ensure the CARE Act’s success.
ARGUMENTS IN OPPOSITION: ACLU California Action writes the following to explain why it opposes this bill:
SB 35 includes several provisions that will increase the harms of CARE Court. First, it will expand the number of CARE Court petitions by clarifying that there will be no fee for petitioners or any filing papers. Research shows that fees reduce filings. For example, in eviction cases, the larger the filing fee in a jurisdiction the lower the eviction rate—an effect that is disproportionately large in majority Black neighborhoods. The lack of a filing fee will therefore increase exposure of people with mental health disabilities to CARE Court.
Second, SB 35 would give additional rights to the petitioners, thus weakening the rights of respondents. For example, the bill gives petitioners “the right to be present and make a statement on the merits of the petition at the initial hearing,” and extends those rights if the petitioner is “a spouse, parent, sibling, child, or grandparent or other person who stands in loco parentis to the respondent.”
Finally, SB 35 loosens criteria for who can be appointed as counsel and authorizes a “court-appointed commissioner or other subordinate judicial officer” to conduct proceedings in lieu of a superior court judge. This change eases the ability of counties to implement the CARE Act while doing nothing to safeguard the rights of respondents.
We understand that the CARE Act was intended to address the growing houselessness and mental health crises in California, but CARE Court is not the solution, and once implemented is likely to do real harm to the populations you are trying to help. A court system mandated to oversee the mental health treatment of people will be traumatizing and will set back decades of recovery tools designed to help those most marginalized. CARE Court will contribute to the re-institutionalization of people with disabilities, repeating a horrific history of civil rights abuses.
The Depression and Bipolar Support Alliance (DBSA), which describes itself as “the leading peer-directed national organization focusing on the two most prevalent mental health conditions, depression and bipolar disorder,” writes the following about its reasons for opposing the bill:
This bill seems to make unneeded, damaging and inappropriate Care Court petitions even easier to perform, making many of the negative and traumatic effects even more widespread. DBSA California is not opposed to involuntary commitment in al cases, but we believe it should be safe, legal and rare. This program is neither Safe to the consumer, but will make it much less Rare.
REGISTERED SUPPORT / OPPOSITION:
Support
Families Advocating for the Seriously Mentally Ill (if amended)
Opposition
ACLU California Action
DBSA California
Analysis Prepared by: Alison Merrilees / JUD. / (916) 319-2334
SENATE HEALTH COMMITTEE Office of Senate Floor Analyses (916) 651-1520 Fax: (916) 327-4478 | SB 35 |
CONSENT
Bill No: SB 35
Author: Umberg (D)
Amended: 3/21/23
Vote: 21
SENATE HEALTH COMMITTEE: 11-0, 4/19/23
AYES: Eggman, Nguyen, Dahle, Glazer, Gonzalez, Limón, Menjivar, Roth, Rubio, Wahab, Wiener
NO VOTE RECORDED: Hurtado
SENATE APPROPRIATIONS COMMITTEE: Senate Rule 28.8
SUBJECT: Community Assistance, Recovery, and Empowerment (CARE) Court Program
SOURCE: Author
DIGEST:
This bill extends the date by which the Department of Health Care Services can grant extensions to counties to implement the CARE Court program from December 1, 2025, to December 15, 2025.
ANALYSIS:
Existing law:
- Enacts the CARE Court Act to help connect an individual with a court-ordered care plan for up to 12 months, with the possibility to extend for an additional 12 months, that provides a clinically appropriate, community-based set of services and supports that are culturally and linguistically competent, which include short-term stabilization medications, wellness and recovery supports, a CARE navigator, connection to social services, and a housing plan. [WIC §5970, et seq.]
- Requires the Department of Health Care Services (DHCS) to grant extensions to counties, for implementing CARE Court, only once and no later than December 1, 2025. [WIC §5970.5]
This bill extends the date by which DHCS can grant extensions to counties to implement CARE Court to December 15, 2025.
Comments
- Author’s statement. According to the author, the first cohort of CARE Court is to be implemented with technical assistance and continuous quality improvement starting October 1, 2023. However, CARE Court also allows DHCS to implement guidelines under which counties can apply for and be provided additional time to implement CARE Court. Existing law authorizes DHCS to grant an extension once, and no later than December 1, 2025. This bill instead authorizes DHCS to grant an extension no later than December 15, 2025.
- CARE Court. SB 1338 (Umberg and Eggman, Chapter 319, Statutes of 2022) enacted the CARE Court, as an alternative to amending the Lanterman-Petris-Short (LPS) Act, to help connect a person in crisis with a court-ordered care plan for up to 12 months, with the possibility to extend for an additional 12 months. The framework provides individuals with a clinically appropriate, community-based set of services and supports that are culturally and linguistically competent, which includes short-term stabilization medications, wellness and recovery supports, connection to social services, and a housing plan. According to the California Health and Human Services Agency’s (CHHSA) website, housing is an important component—finding stability and staying connected to treatment, even with the proper supports, is next to impossible while living outdoors, in a tent, or in a vehicle. CHHSA states that CARE Court is an upstream diversion to prevent more restrictive conservatorships or incarceration, based on evidence that demonstrates many people can stabilize, begin healing, and exit homelessness in less restrictive, community-based care settings. With advances in treatment models, new longer-acting antipsychotic treatments, and the right clinical team and housing plan, individuals who have historically suffered tremendously on the streets or during avoidable incarceration can be successfully stabilized and supported in the community. CHHSA further states that CARE Court is not for everyone experiencing homelessness or mental illness; rather it focuses on people with schizophrenia spectrum or other psychotic disorders who lack medical decision-making capacity, before they enter the criminal justice system or become so impaired that they end up in a LPS conservatorship due to mental illness. CHSSA states that although homelessness has many faces in California, among the most tragic is the face of the sickest who suffer from treatable mental health (MH) conditions, and the CARE Court proposal aims to connect these individuals to effective treatment and support, mapping a path to long-term recovery. CARE Court is estimated to help thousands of Californians on their journey to sustained wellness. The first cohort of counties to implement CARE Court include Glenn, Orange, Riverside, San Diego, Stanislaus, and Tuolumne, and the City and County of San Francisco, beginning no later than October 1, 2023. The second cohort of counties, representing the remaining population of the state, is required to begin implementing CARE Court no later than December 1, 2024, unless a county is provided additional time if the county experiences a state or local emergency and the delay of the provision of the CARE Court is necessary as a result of the emergency. Existing law requires DHCS to grant extensions to counties for implementing CARE Court only once and no later than December 1, 2025.
FISCAL EFFECT: Appropriation: No Fiscal Com.: Yes Local: No
SUPPORT: (Verified 5/1/23)
None received
OPPOSITION: (Verified 5/1/23)
None received
Prepared by: Reyes Diaz / HEALTH / (916) 651-4111
5/3/23 15:07:36
**** END ****
SENATE COMMITTEE ON HEALTH
Senator Dr. Susan Talamantes Eggman, Chair
BILL NO: SB 35
AUTHOR: | Umberg | ||
VERSION: | March 21, 2023 | ||
HEARING DATE: | April 19, 2023 | ||
CONSULTANT: | Reyes Diaz | ||
SUBJECT: Community Assistance, Recovery, and Empowerment (CARE) Court Program
SUMMARY:
Extends the date by which the Department of Health Care Services can grant extensions to counties to implement the CARE Court program from December 1, 2025, to December 15, 2025.
Existing law:
- Enacts the CARE Court Act to help connect an individual with a court-ordered care plan for up to 12 months, with the possibility to extend for an additional 12 months, that provides a clinically appropriate, community-based set of services and supports that are culturally and linguistically competent, which include short-term stabilization medications, wellness and recovery supports, a CARE navigator, connection to social services, and a housing plan. [WIC §5970, et seq.]
- Requires the Department of Health Care Services (DHCS) to grant extensions to counties, for implementing CARE Court, only once and no later than December 1, 2025. [WIC §5970.5]
This bill: Extends the date by which DHCS can grant extensions to counties to implement CARE Court to December 15, 2025.
FISCAL EFFECT:
This bill has not been analyzed by a fiscal committee.
COMMENTS:
- Author’s statement. According to the author, the first cohort of CARE Court is to be implemented with technical assistance and continuous quality improvement starting October 1, 2023. However, CARE Court also allows DHCS to implement guidelines under which counties can apply for and be provided additional time to implement CARE Court. Existing law authorizes DHCS to grant an extension once, and no later than December 1, 2025. This bill would instead authorize DHCS to grant an extension no later than December 15, 2025.
- CARE Court. SB 1338 (Umberg and Eggman, Chapter 319, Statutes of 2022) enacted the CARE Court, as an alternative to amending the Lanterman-Petris-Short (LPS) Act, to help connect a person in crisis with a court-ordered care plan for up to 12 months, with the possibility to extend for an additional 12 months. The framework provides individuals with a clinically appropriate, community-based set of services and supports that are culturally and linguistically competent, which includes short-term stabilization medications, wellness and recovery supports, connection to social services, and a housing plan. According to the California Health and Human Services Agency’s (CHHSA) website, housing is an important component—finding stability and staying connected to treatment, even with the proper supports, is next to impossible while living outdoors, in a tent, or in a vehicle. CHHSA states that CARE Court is an upstream diversion to prevent more restrictive conservatorships or incarceration, based on evidence that demonstrates many people can stabilize, begin healing, and exit homelessness in less restrictive, community-based care settings. With advances in treatment models, new longer-acting antipsychotic treatments, and the right clinical team and housing plan, individuals who have historically suffered tremendously on the streets or during avoidable incarceration can be successfully stabilized and supported in the community. CHHSA further states that CARE Court is not for everyone experiencing homelessness or mental illness; rather it focuses on people with schizophrenia spectrum or other psychotic disorders who lack medical decision-making capacity, before they enter the criminal justice system or become so impaired that they end up in a LPS conservatorship due to mental illness. CHSSA states that although homelessness has many faces in California, among the most tragic is the face of the sickest who suffer from treatable mental health (MH) conditions, and the CARE Court proposal aims to connect these individuals to effective treatment and support, mapping a path to long-term recovery. CARE Court is estimated to help thousands of Californians on their journey to sustained wellness. The first cohort of counties to implement CARE Court include Glenn, Orange, Riverside, San Diego, Stanislaus, and Tuolumne, and the City and County of San Francisco, beginning no later than October 1, 2023. The second cohort of counties, representing the remaining population of the state, is required to begin implementing CARE Court no later than December 1, 2024, unless a county is provided additional time if the county experiences a state or local emergency and the delay of the provision of the CARE Court is necessary as a result of the emergency. Existing law requires DHCS to grant extensions to counties for implementing CARE Court only once and no later than December 1, 2025.
- Related legislation. SB 43 (Eggman) expands the definition of “gravely disabled,” for purposes of involuntarily detaining an individual, as a condition that will result in substantial risk of serious harm, as defined, to the physical or mental health of an individual due to a MH or substance use disorder (SUD), as specified. Prohibits the existence of a MH/SUD alone from establishing a substantial risk of serious harm, as specified. Deems statements of specified health practitioners, for purposes of an expert witness in a proceeding relating to the appointment or reappointment of a conservator, as not hearsay, as specified. SB 43 is set to be heard in the Senate Judiciary Committee on April 25, 2023.
- Prior legislation. SB 1338 (Umberg and Eggman, Chapter 319, Statutes of 2022) enacted the CARE Court.
SUPPORT AND OPPOSITION:
Support: None received
Oppose: None received
-- END --
Discussed in Hearing
29SEC
Senate Floor
5MIN
Senate Standing Committee on Judiciary
2MIN
Assembly Floor
2MIN
Assembly Standing Committee on Appropriations
16MIN
Assembly Standing Committee on Privacy and Consumer Protection
1MIN
Assembly Floor
4MIN
Assembly Standing Committee on Judiciary
Bill Author
Bill Co-Author(s):