Existing law requires laboratories or certified outpatient treatment programs that lease, manage, or own housing that is offered to individuals using the laboratory or outpatient treatment services to maintain separate housing contracts stating that payment for the housing is the patients responsibility and does not depend on insurance benefits. Existing law requires alcoholism or drug abuse recovery or treatment facilities to only offer discounted postdischarge housing and specified transportation services under certain conditions, including that the patient enters into a repayment plan for any subsidized rent.

This bill would authorize a city attorney of a city in which the housing units are located or the district attorney of a county a county counsel or a county behavioral health agency if the housing units are located in the unincorporated area of the county, with the consent of the State Department of Health Care Services, to enforce the above provisions.

Existing law grants the sole authority in state government to the State Department of Health Care Services to license adult alcoholism or drug abuse recovery or treatment facilities, and authorizes the department to conduct site visits to licensed facilities for the purpose of determining compliance with applicable statutes and regulations.

This bill would additionally authorize a city, or a county if a facility is located within the unincorporated area of the county, with the approval of the department, to conduct site visits, and would require the department to develop a process that allows a city or county to request approval from the department for the city or county to conduct a site visit, or to request that the department conduct a site visit, as specified.

Existing law requires laboratories or certified outpatient treatment programs that lease, manage, or own housing that is offered to individuals using the laboratory or outpatient treatment services to maintain separate housing contracts stating that payment for the housing is the patients responsibility and does not depend on insurance benefits. Existing law requires alcoholism or drug abuse recovery or treatment facilities to only offer discounted postdischarge housing and specified transportation services under certain conditions, including that the patient enters into a repayment plan for any subsidized rent.

This bill would authorize a city attorney of a city in which the housing units are located or the district attorney of a county if the housing units are located in the unincorporated area of the county county, with the consent of the State Department of Health Care Services, to enforce the above provisions.

Existing law grants the sole authority in state government to the State Department of Health Care Services to license adult alcoholism or drug abuse recovery or treatment facilities, and authorizes the department to conduct site visits to licensed facilities for the purpose of determining compliance with applicable statutes and regulations.

This bill would additionally authorize a city, or a county if a facility is located within the unincorporated area of the county, with the approval of the department, to conduct site visits, and would require the department to develop a process that allows a city or county to request approval from the department for the city or county to conduct a site visit, or to request that the department conduct a site visit, as specified.

Existing law authorizes the State Department of Public Health to establish a program designed to provide eligible individuals with coupons that may be exchanged for fresh, nutritious foods at farmers markets pursuant to a program established under federal law, the WIC Farmers Market Nutrition Act of 1992.

This bill would make a technical, nonsubstantive change to these provisions.

SENATE COMMITTEE ON APPROPRIATIONS

Senator Anna Caballero, Chair

2023 - 2024 Regular Session

SB 913 (Umberg) - Substance use disorder treatment: facilities

Bill Summary:

SB 913 would permit specified city and county entities, with the consent or approval from the Department of Health Care Services (DHCS), to enforce specified provisions related to the oversight of licensed treatment facilities.

Fiscal Impact:

Unknown, ongoing General Fund cost pressures, likely hundreds of thousands, for DHCS for state administration.

Background:

DHCS licenses residential treatment facilities (RTFs) that, based on what is commonly referred to as the “social model,” provide recovery, treatment, or detoxification services for alcoholism or substance abuse. The services provided by social model RTFs include group and individual counseling, educational sessions, and alcoholism or drug abuse recovery and treatment planning. Social model RTFs are allowed to provide clients first aid and emergency care, and can apply to DHCS for an additional license to provide incidental medical services by a licensed physician or other health care practitioner. DHCS also is responsible for certification of a business entity with a physical location in the state that provides one or more of the following services to clients: treatment, recovery, or detoxification services, or medications for addiction treatment. DHCS also provides program certification for facilities that are licensed by the Department of Social Services that serve adolescents.

As part of their licensing and certification functions, DHCS conducts reviews of licensed and certified programs every two years, or as necessary; checks for compliance with statute, regulations, and certification standards to ensure the health and safety of clients; investigates all complaints; and has the authority to suspend or revoke a program’s license or certification for a violation of statute, regulations, and certification standards. DHCS states that they have the sole authority to conduct site visits to their licensed and certified facilities. As compliance reviews require DHCS to review resident or client information and files, which is protected information to ensure confidentiality under federal regulations, any onsite visits by any other entity to ensure licensure or certification compliance could violate these protections.

Current law requires that a laboratory or certified outpatient treatment program that leases, manages, or owns housing units that are offered to individuals who concurrently utilize laboratory or outpatient services must maintain separate contracts for the housing. Current law requires a licensed alcoholism or drug abuse recovery or treatment facility to only offer an individual discounted housing following discharge from the facility or to only offer transportation services to an individual who is seeking recovery or treatment services, if certain conditions are met.

Proposed Law:

Specific provisions of the bill would:

• Provide that the provisions in law related to licensed treatment facilities that offer housing or transportation services may be enforced, with the consent of DHCS, by the city attorney of a city in which the housing units are located or by the county counsel or the county behavioral health agency if the housing units are located in the unincorporated area of the county.
• Require DHCS to adopt a process that allows a city or county to request approval from DHCS to conduct a site visit to licensed adult alcoholism or drug abuse recovery or treatment facilities for the purpose of reviewing for compliance with all applicable statutes and regulations, as specified.

Related Legislation:

SB 1334 (Newman) would specify that a recovery residence is not required to be licensed, as described. The bill was not heard in the Senate Health Committee.

SB 1339 (Allen) would establish and provide for the administration of a voluntary certification program for supportive community residences. The bill is currently on the suspense file in this committee.

AB 2893 (Ward) would provide for the certification of recovery houses, as specified. This bill is currently in the Assembly Appropriations Committee.

-- END --

SENATE JUDICIARY COMMITTEE

Senator Thomas Umberg, Chair

2023-2024 Regular Session

Bill No: SB 913 (Author:Umberg)

Version: April 15, 2024

Hearing Date: April 23, 2024

Fiscal: Yes

Urgency: No

Consultant: ID

SUBJECT

Substance use disorder treatment: facilities

DIGEST

This bill permits city attorneys or district attorneys, and city or counties, as specified and with the consent or approval of the Department of Health Care Services (DHCS), to enforce specified provisions or conduct announced or unannounced site visits of licensed alcohol or drug recovery or treatment facilities (RTFs).

EXECUTIVE SUMMARY

Substance use disorders (SUD) are a serious concern that many Californians struggle with across the state. One form of treatment and services for those with SUDs is through alcohol or drug recovery or treatment facilities (RTFs), which provide nonmedical detoxification, individual sessions, group sessions, educational sessions, alcoholism or drug abuse recovery or treatment planning, or incidental medical services in a residential setting. RTFs must be licensed by the Department of Health Care Services (DHCS), which has the sole state authority to license such programs and enforce state law regarding such programs and facilities. DHCS also certifies alcohol or other drug programs, which include treatment services, recovery services, detoxification services, and medications for addiction treatment. Such programs must be in compliance with state alcohol or drug certification standards. In recent years, concerns have been raised by local residents and journalists that licensed and unlicensed RTFs are not providing quality services and are not complying with the rules regarding those entities. To address this issue, SB 913 provides cities and counties the ability, with the consent of DHCS, to enforce the laws regarding standards and licensure for RTFs, and to conduct announced or unannounced site visits of licensed RTFs with DHCS approval. SB 913 is sponsored by the League of California Cities, and is supported by a variety of California cities, and is opposed by the California Association of Alcohol and Drug Program Executives, the California Consortium of Addiction Programs and Professionals, and the Steinberg Institute. This bill passed out of the Senate Health Committee on a vote of 10 to 0.

PROPOSED CHANGES TO THE LAW

Existing law:

1. Provides that the Department of Health Care Services (DHCS) has the sole authority in state government to license adult alcoholism or drug abuse recovery or treatment facilities (RTF’s) and to certify alcohol or other drug programs. (Health & Saf. Code §§ 11834.01, 11832.)
2. Defines an “alcohol or drug abuse recovery or treatment facility” to mean any premises, place, or building that provides residential non-medical services to adults who are recovering from problems related to alcohol, drug, or alcohol and drug misuse or abuse, and who need alcohol, drug, or alcohol and drug recovery treatment or detoxification services. A RTF may serve adolescents with a waiver from DHCS, as specified. (Health & Saf. Code § 11834.02.)
3. Defines an “alcohol or other drug program” or “program” as a business entity with a physical location in the state that provides one or more of the following: treatment services; recovery services; detoxification services; or medications for addiction treatment. (Health & Saf. Code § 11832.2.)
4. Provides a process and standards for the licensure of RTF’s, providing RTF’s with two-year licenses, with the ability to renew licenses. (Health & Saf. Code § 11834.01 et seq.)
5. Requires that DHCS make onsite program visits for compliance at least once during the two-year period of licensure, and permits DHCS to conduct announced or unannounced site visits to licensed RTF’s for the purpose of reviewing for compliance of applicable statutes and regulations. (Health & Saf. Code § 11834.01.)
6. Requires that any alcohol or other drug program be certified by DHCS, and specifies the process for certification. Specifies that certification shall be for a two-year period, if a program submits a written renewal application before the expiration of the certification and remains in compliance. (Health & Saf. Code §§ 11832.3, 11832.6.)
7. Requires that laboratory or certified outpatient treatment programs that lease, manage, or own housing units that are offered to individuals concurrently utilizing the laboratory or outpatient services maintain separate contracts for the housing, and requires that the offer of housing not depend on the individual’s agreement to receive services from either the laboratory or certified outpatient treatment program. (Health & Saf. Code § 11831.65.)
8. Provides that DHCS may investigate allegations of violations of the applicable provisions of the Health and Safety Code related to residential treatment facilities and referral services, and allows the department to assess a penalty, suspend or revoke an RTFs license or the certification of an outpatient program, deny a RTFs application for licensure or for extension or modification of a license, or suspend or revoke the certification of a counselor for any violations. (Health & Saf. Code § 11831.7.)
9. Prohibits a licensed recovery or treatment facility (RTF) or a certified alcohol or drug program from:
   1. Making a false or misleading statement or providing false or misleading information about an entity’s products, goods, services, or geographical locations in its advertising materials, or media, as defined;
   2. Making false or misleading statement or providing false or misleading information about medical treatments or medical services offered in its marketing, advertising, or media, as defined;
   3. Including on its website a picture, description, staff information, or the location of an entity, along with false contact information, that surreptitiously directs the reader to a business that does not have a contract with the entity;
   4. Including on its website false information or an electronic link that provides false information or surreptitiously directs the reader to another internet site.
10. Prohibits a licensed alcoholism or drug abuse recovery or treatment facility, an owners or similar person with an interest of 10 percent or more in a RTF, as specified, an employee of an RTF, an alcohol or other drug program, an owner or similar person with a 10 percent or more interest in a certified alcohol or other drug program, or an employee of a certified alcohol or other drug program from giving or receiving remuneration or anything of value for the referral of a person who is seeking alcoholism or drug abuse recovery treatment services. (Health & Saf. Code § 11831.6.)

This bill:

1. Provides that the provisions relating to a laboratory or certified outpatient treatment program that leases, manages, or owns housing units that are offered to individuals concurrently utilizing the laboratory or outpatient services may be enforced, with the consent of DHCS, by a city attorney or a district attorney of the appropriate city or unincorporated area in which the housing units are located.
   1. Provides that its provisions do not supersede DHCS’s authority to enforce the applicable sections.
2. Requires that DHCS adopt a process by which a city or county may request approval from the DHCS to conduct site visits of RTF’s, as described.
3. Permits a city, or a county if the facility is located in an unincorporated area, to request permission from DHCS to conduct a site visit pursuant to DHCS’s prescribed process, and to conduct an announced or unannounced site visit upon approval by DHCS.
4. Requires that a request to conduct site visits include reasonable grounds that the facility is not in compliance with this chapter.
5. Specifies that its provisions allowing a city or county to conduct site visits, as specified, do not supersede DHCS’s authority.

COMMENTS

1. Author’s statement

According to the author:

SB 913 directly confronts the burgeoning issue of unlicensed sober living homes and Substance Use Disorder (SUD) treatment facilities, especially those engaging in unethical practices like patient brokering. This bill aims to establish a robust framework for oversight and enforcement, ensuring that these entities operate with integrity and provide evidence-based care. By empowering cities with the authority to conduct site visits and enabling the enforcement of compliance laws against patient brokering, SB 913 strives to create a safe and dignified recovery environment. This legislation is a crucial step in safeguarding individuals in recovery from exploitation and in promoting high standards of care within sober living and SUD treatment facilities.

1. Substance Use Disorder (SUD) treatment facilities and their regulation

Substance use disorders (SUD) and addiction are a serious issue for many Californians. Reports suggest that as many as nine percent of Californians are dealing with an SUD.^[1] The issue has become a focus of public policy discussions and public discourse in recent years with the rise of the dangerous drug fentanyl, as the death rate from fentanyl has increased dramatically in the last decade.^[2] In the wake of this issue, many institutions and treatment facilities in the state work to treat and support those dealing with addiction. Some of these treatments include cognitive behavioral therapy and family therapy, and others include medication-assisted treatment. Some treatment can be accomplished as outpatient services, in that the individual receives the treatment and services in clinics or primary care offices, and do not require hospitalization. Other types of treatment entail treatment or detoxification services in general acute care hospitals or other similar facilities, and residential programs in which clinically managed SUD treatment and recovery services are provided in a supportive living setting.^[3]

DHCS regulates and licenses residential facilities that provide certain services for SUD recovery in a residential setting. It has the sole authority in state government to license adult alcoholism or drug abuse recovery or treatment facilities. (Health & Saf. Code § 11834.01.) Licensure is required when a facility provides detoxification, individual sessions, group sessions, educational sessions, alcoholism or drug abuse recovery or treatment planning, or incidental medical services.^[4] DHCS issues licenses for two-year periods, is required to complete onsite program visits for compliance at least once during the two-year period, and has the authority to conduct announced or unannounced site visits to licensed facilities for the purpose of reviewing the facility for compliance. (Health & Saf. Code § 11834.01.) To become licensed, RTFs must meet certain criteria for their services and programs, and follow specific minimum standards of care for treatment and acceptance of patients. DHCS also has the sole authority in state government to certify alcohol or other drug programs, which include treatment services, recovery services, detoxification services, and medications for addiction treatment. (Health & Saf. Code §§ 11832, 11832.2.) Such programs must be in compliance with state alcohol or drug certification standards. Many facilities licensed by DHCS as RTFs are also certified.

The law provides DHCS a variety of tools for enforcing this licensing regime. DHCS is empowered to investigate allegations of violations, and as previously mentioned, may make announced and unannounced site visits as part of this authority. It may, upon finding a violation by an RTF, assess a penalty, suspend or revoke the license of the facility, or deny an application for a license or a license renewal. (Health & Saf. Code § 11831.7.) It may also enforce the certification of alcohol or drug programs provisions through similar penalty or suspension or revocation of the certification.

1. SB 913 aims to increase regulation and inspection of RTFs through enforcement by local enforcement officials

In recent years, as the number of RTFs in the state has increased, concerns have been raised that these RTFs are not adequately regulated to prevent fraud and ensure high standards of care.^[5] SB 913 proposes to address this issue by providing mechanisms for DHCS to provide guidance and approval for local city officers to conduct enforcement of and investigation into licensed RTFs. It specifically does this by providing that a city attorney or county may enforce certain provisions relating to RTFs with the approval or consent of DHCS, and by requiring regulations from DHCS for the process through which cities and counties would request the required approval.

The first provision of SB 913 allows that a city attorney or district attorney of a city or unincorporated area in which an RTF exists may enforce the provisions at Health and Safety Code Section 11831.65 that provide specified requirements to keep housing and treatment services separate. A city attorney or district attorney may only enforce those provisions with the consent of DHCS, and SB 913 explicitly states that its provisions allowing local enforcement do not supersede DHCS’s authority to enforce the section.

In addition, SB 913 allows a city or a county in which an RTF resides to request permission from DHCS to conduct announced or unannounced site visits of RTFs. SB 913 requires that the request for permission must be approved by DHCS, and that the request must include reasonable grounds that the facility is not in compliance with the licensure requirements for RTFs. Again, SB 913 clarifies that its provisions do not supersede the department’s authority to issue licenses, complete onsite program visits, and conduct announced or unannounced site visits. Lastly, to implement the process for cities or counties to request permission, SB 913 requires that DHCS adopt a process that allows a city or county to make the request for approval to DHCS to conduct a site visit. Through these provisions, SB 913 provides the opportunity for local government officials to enforce the state’s laws on RTFs and their licensure, through the consent or approval by DHCS through a specified process.

1. Amendments

To address concerns raised previously in the Senate Health Committee, the author has agreed to accept amendments that eliminate the District Attorney from enforcement provisions under Section 1. A full mock-up of the proposed committee amendments are attached at the end of this analysis.

1. Arguments in support

According to the League of California Cities, which is the sponsor of SB 913:

Residential recovery housing provides a range of benefits to some of California’s most vulnerable residents, and it is critical their needs are prioritized over profits. Compliance with state licensing laws administered through the Department of Health Care Services is essential to safeguarding residents’ well-being and maintaining quality care.

SB 913 would augment state licensing efforts by requiring the Department of Health Care Services to adopt a process that allows cities to request approval to conduct site visits and enforce compliance with existing state licensing laws. By collaborating with cities, the state can leverage local resources to supplement its regulatory efforts.

Cities are positioned to respond promptly to emerging issues or changes in their communities. Allowing them to partner with the state to conduct site inspections and enforce licensing laws enables swift action to address violations, ensure compliance, and protect public health and safety. SB 913 would help meet our shared goals of ensuring treatment facilities meet standards for patient care, which is central to effective treatment outcomes and community well-being.

1. Arguments in opposition

According to the California Association of Alcohol and Drug Program Executives, which is opposed to this bill:

Expanding city attorneys' authority to enforce DHCS licensing laws would establish a truly perilous precedent; one that would not only jeopardize the integrity of the regulatory process, but also endanger the well-being of vulnerable individuals receiving SUD treatment. Entrusting such crucial oversight responsibilities to local entities lacking specialized expertise in substance use disorder treatment and recovery could result in inconsistent enforcement practices at best and completely erode the effectiveness of regulatory enforcement at worst.

This proposal not only undermines the established regulatory framework but also poses a significant threat to the efficiency and effectiveness of the complaint process. DHCS has made substantial strides in enhancing its procedures to expedite the review and resolution of complaints. In the last two years alone, the average time to close a complaint has been nearly halved, plummeting from 245 days to just 114 days. Entrusting city attorneys with oversight of the complaint process would not only overlook these remarkable improvements but also disregard the specialized expertise and knowledge possessed by DHCS in regulating licensed SUD facilities.

Handing over such critical responsibilities to entities lacking the requisite experience and resources would jeopardize the safety and well-being of individuals receiving treatment. It is imperative to uphold the authority of DHCS and maintain its role in overseeing the complaint process to ensure timely and thorough enforcement of regulatory standards within the SUD treatment landscape.

In conclusion, while we share the goal of ensuring safe and effective treatment for individuals in recovery from a substance use disorder, SB 913, in its current form, would create unsafe, hostile environments by green lighting “no knock” warrants by city officials who have no expertise in the DHCS regulatory process. This bill raises significant legal, practical, and ethical concerns around how California regulates licensed SUD facilities.

SUPPORT

League of California Cities (sponsor)
City of Fountain Valley (sponsor)

UNB Community (sponsor)

City of Cypress

City of Garden Grove

City of Mission Viejo

City of Laguna Beach

City of Placentia

OPPOSITION

California Association of Alcohol and Drug Program Executives

California Consortium of Addiction Programs and Professionals

Steinberg Institute

RELATED LEGISLATION

Pending Legislation:

AB 2081 (Davies, 2024) requires an operator of a licensed RTF or certified alcohol or drug program to include on its website and intake paperwork a disclosure that the individual may confirm the status of the facility’s licensure on DHCS’s website. AB 2081 is currently in the Assembly Appropriations Committee.

AB 2121 (Dixon, 2024) requires an RTF to confirm that it is located more than 300 feet from any RTF or any community care facility, and would require DHCS to notify in writing the city or county in which the facility is located of the issuance of the license. AB 2121 is currently in Assembly Committee on Health.

Prior Legislation:

SB 1165 (Bates, Ch. 172, Stats. 2021) prohibited licensed RTF operators from making or providing false or misleading statements or information about medical treatments and services in their marketing, advertising material, internet website, or media or social media.

AB 1967 (Daly, 2022) would have authorized local agencies to require a conditional use permit for transitional or supportive housing with seven or more residents, and would also authorize a local agency to require a specified distance between two or more housing development projects, including between a residential care facility or sober living home. AB 1967 died in the Assembly Housing and Community Development Committee.

SB 1087 (Moorlach, 2020) would have required licensed RTF’s to have at least one fire extinguisher and smoke alarms within specified areas of the recovery home. SB 1087 died in the Senate Rules Committee.

SB 1144 (Bates, 2020) would have required DHCS to take action against unlicensed facilities that are disclosed as a recovery residence, and would have authorized DHCS to refer a substantiated complaint to other enforcement agencies, as appropriate. SB 1144 died in the Senate Health Committee.

SB 1228 (Lara, Ch. 792, Stats. 2018) prohibited specified persons, programs, or entities, including a licensed RTF, from giving or receiving remuneration or anything of value for referring a person seeking recovery or treatment services, and authorized DHCS to investigate and impose sanctions for violations of the prohibition.

SB 1268 (Bradford, 2018) would have prohibited certain persons, programs, or entities, including an RTF, from giving or receiving remuneration or anything of value for the referral of a person seeking recovery and treatment services, and would have made the violation a misdemeanor. SB 1268 died in the Assembly Appropriations Committee.

SB 1290 (Bates, 2018) would have made it unlawful for any licensee, operators, employee, or patient of an RTF or other person to offer or pay a commission or other benefit to induce the referral of a patient or patronage to or from an RTF, and would have established the Commission on Substance Abuse and Recovery. SB 1290 died in the Senate Appropriations Committee.

AB 3162 (Friedman, Ch. 775, Stats. 2018) made an initial license for a new RTF a provisional license for one year and revocable for good cause, would have required services provided be specified on the license, and would have increased civil penalties for a violation of the licensing and regulatory provisions.

SB 786 (Mendoza, 2017) would have required that DHCS deny an application for a new RTF facility, if the proposed facility is in proximity to an existing facility in a residentially-zoned area, and would have made initial licensees provisional and revocable for good cause. SB 786 died in the Senate Health Committee.

AB 2255 (Melendez, 2016) would have required the certification of sober living homes not required to be licensed RTF’s, and would have required DHCS to maintain and post on its website a registry of each certified drug and alcohol free residence. AB 2255 died in the Assembly Appropriations Committee.

AB 2403 (Bloom, 2016) would have authorized DHCS to deny an RTF’s application for a facility license if the facility would result in overconcentration in the area in which it is to be located, as specified, and would have authorized a city or county to request a license application be denied for overconcentration. AB 2403 died to the Assembly Appropriations Committee.

PRIOR VOTES:

Senate Health Committee (Ayes 10, Noes 0)

**************

PROPOSED COMMITTEE AMENDMENTS TO SB 913

SECTION 1.

 Section 11831.65 of the Health and Safety Code is amended to read:

11831.65.

 (a) A laboratory or certified outpatient treatment program that leases, manages, or owns housing units that are offered to individuals who concurrently utilize laboratory or outpatient services shall maintain separate contracts for the housing. The contract shall clearly state that payment for housing is the responsibility of the individual and does not depend on insurance benefits. The contract shall include a repayment plan for any subsidized rent, and the laboratory or certified outpatient treatment program shall make a good faith effort to collect the debt. The offer for housing shall not depend on the individual’s agreement to receive services from either the laboratory or the certified outpatient treatment program.

(b) An alcoholism or drug abuse recovery or treatment facility licensed under this part shall only offer an individual discounted housing following discharge from the facility if all of the following conditions are met:

(1) The alcoholism or drug abuse recovery or treatment facility and the individual enter into a written contract for housing that is separate from the contract for treatment, if the individual also pursues outpatient treatment.

(2) The contract described in paragraph (1) includes a repayment plan for any subsidized rent, and the alcoholism or drug abuse recovery or treatment facility makes a good faith effort to collect the debt.

(3) The offer for housing is not dependent upon the individual’s agreement to attend outpatient treatment at a program that is owned or operated by the alcoholism or drug abuse recovery or treatment facility.

(c) An alcoholism or drug abuse recovery or treatment facility licensed under this part shall only offer transportation services to an individual who is seeking recovery or treatment services if all of the following conditions are met:

(1) Any ground transportation provided to an individual who is seeking recovery or treatment services is for a distance of less than 125 miles.

(2) Any air transportation provided to an individual who is seeking recovery or treatment services includes a return ticket that may be used by the individual upon discharge.

(3) A return ticket not used by an individual upon discharge is made available to the individual upon request for a period of one year following the individual’s discharge.

(d) This section does not prohibit a person, program, or entity from providing an individual educational or informational materials about community resources, including, but not limited to, housing assistance.

(e) (1) The provisions of this section may be enforced, with the consent of the department, by the city attorney of a city in which the housing units are located or by the district attorney if the housing units are located in the unincorporated area of the county.

(e) (1) The provisions of this section may be enforced, with the consent of the department, by the city attorney of a city in which the housing units are located or by County Counsel and the County Behavioral Health Agency if the housing units are located in the unincorporated area of the county.

(2) This subdivision does not supersede the department’s authority to enforce this section.

SEC. 2.

 Section 11834.01 of the Health and Safety Code is amended to read:

11834.01.

 The department has the sole authority in state government to license adult alcoholism or drug abuse recovery or treatment facilities, consistent with all of the following:

(a) In administering this chapter, the department shall issue new licenses for a period of two years to those programs that meet the criteria for licensure set forth in Section 11834.03.

(b) Onsite program visits for compliance shall be conducted at least once during the license period.

(c) The department may conduct announced or unannounced site visits to facilities licensed pursuant to this chapter for the purpose of reviewing for compliance with all applicable statutes and regulations.

(d) (1) The department shall adopt a process that allows a city or county to request approval from the department to conduct a site visit as described in subdivision (c).

(2) A city, or a county if the facility is located within the unincorporated area of the county, may request permission from the department to conduct a site visit pursuant to the process described in paragraph (1) and, upon the approval of the department, may conduct an announced or unannounced site visit as described in subdivision (c).

(3) The request described in paragraph (2) shall include reasonable grounds that the facility is not in compliance with this chapter.

(4) This subdivision does not supersede the department’s authority pursuant to this section.

1. California Healthcare Foundation, Substance Use in California Almanac: Prevalence and Treatment, (Jan. 2022), available at https://www.chcf.org/publication/2022-edition-substance-use-california/#related-links-and-downloads. ↑

2. Id.; Ana B. Ibarra et al, California’s opioid deaths increased by 121% in 3 years. What’s driving the crisis?, CalMatters (Jul. 25, 2023), available at https://calmatters.org/explainers/california-opioid-crisis. ↑

3. California Healthcare Foundation, supra note 1 p. 34. ↑

4. Dept. of Health Care Services, Facility Licensing (accessed Apr. 16, 2024), available at https://www.dhcs.ca.gov/provgovpart/Pages/Licensing-and-Certification-Facility-Licensing.aspx. ↑

5. Caroline Grinder, Cal Cities moves recovery housing reform forward, League of California Cities (Mar. 27, 2024), available at https://www.calcities.org/news/post/2024/03/27/cal-cities-moves-recovery-housing-reform-forward. ↑

SENATE COMMITTEE ON HEALTH

Senator Richard Roth, Chair

BILL NO: SB 913

SUBJECT: Substance use disorder treatment: facilities

SUMMARY:

Permits a city attorney of a city in which housing units are located or a district attorney, if the units are located in the unincorporated area of the county, to enforce parts of the Department of Health Care Services (DHCS) licensing laws, as specified. Requires DHCS to adopt a process that permits a city or county to conduct announced and/or unannounced site visits to facilities licensed by DHCS and to sober living homes/recovery residences that do not require DHCS licensure.

Existing federal law: Prohibits, pursuant to the federal Fair Housing Act (FHA), housing discrimination on the basis of race, color, religion, sex, handicap, familial status, and national origin. Defines “handicap” (disability) as a physical or mental impairment that substantially limits one or more major life activities, including having a drug addiction (other than addiction caused by current illegal use of a controlled substance) and alcoholism. [42 USC §3601, et seq.]

Existing state law:

1. Requires DHCS to license and regulate residential alcoholism or drug abuse (or substance use disorder [SUD]) recovery or treatment facilities (RTFs). [HSC §11834.02, et seq.]
2. Prohibits a person, firm, partnership, association, corporation, or local governmental entity from operating, establishing, managing, conducting, or maintaining a RTF to provide recovery, treatment, or detoxification services within this state without first obtaining a current valid license from DHCS. [HSC §11834.30]
3. Requires all programs certified, or RTFs licensed by DHCS, to disclose ownership or control of, or financial interest in, a recovery residence (RR) and any contractual relationship with an entity that regularly provides professional services or addiction treatment or recovery services to clients of programs certified or RTFs licensed by DHCS, if the entity is not part of the certified program or licensed RTF. [HSC §11833.05]
4. Requires a laboratory or certified outpatient treatment program that leases, manages, or owns housing units that are offered to individuals who concurrently utilize laboratory or outpatient services to maintain separate contracts for the housing. Requires a RTF to only offer an individual discounted housing following discharge from the facility if certain conditions are met, such as the RTF and the individual enter into a written contract for housing that is separate from the contract for treatment; if the individual also pursues outpatient treatment; or, the offer for housing is not dependent upon the individual’s agreement to attend outpatient treatment at a program that is owned or operated by the RTF. [HSC §11831.65]
5. Requires DHCS to conduct a site visit to investigate an allegation of an entity operating without a valid RTF license. Requires an employee or agent of DHCS to take the following actions if evidence substantiates that the entity is providing RTF services without a license:
6. Submit the findings of the investigation;
7. Issue a written notice to the entity stating that it is operating in violation DHCS’s licensing law and inform them of the date by which it ceases providing services and notice that DHCS will assess a civil penalty of $2,000 per day for every day they continue to provide services beyond the date specified in the notice;
8. Notice that the case will be referred for civil proceedings in the event the entity continues to provide services beyond the date specified in the notice; and,
9. Inform the entity of the licensing requirements. [HSC §11834.31]
10. Prohibits an entity found to be in violation of DHCS’s licensing law from applying for initial licensure for a period of five years from the date of the notice specified. [HSC §11834.31]

This bill:

1. Permits a city attorney of a city in which housing units are located or a district attorney, if the units are located in the unincorporated area of the county, to enforce DHCS’s licensing statute requiring separate contracts for housing and specified services pursuant to 4) above of existing law.
2. Requires DHCS to adopt a process that allows a city or county to request approval from DHCS that includes reasonable grounds that an entity is operating without a DHCS license to conduct announced and/or unannounced site visits to DHCS-licensed RTFs or to unlicensed sober living homes/recovery residences (SLH/RRs) upon the city or county’s reasonable belief that the home is providing one or more recovery, treatment, or detoxification services that require DHCS licensure.

FISCAL EFFECT:

This bill has not been analyzed by a fiscal committee.

COMMENTS:

1. Author’s statement. According to the author, this bill directly confronts the burgeoning issue of unlicensed sober living homes (SLHs, also known as RRs) and SUD treatment facilities, especially those engaging in unethical practices like patient brokering. This bill aims to establish a robust framework for oversight and enforcement, ensuring that these entities operate with integrity and provide evidence-based care. By empowering cities with the authority to conduct site visits and additional enforcement mechanisms for existing laws preventing patient brokering, this bill strives to create a safe and dignified recovery environment. This legislation is a crucial step in safeguarding individuals in recovery from exploitation and in promoting high standards of care within sober living and SUD treatment facilities.
2. Licensed and certified programs. RTFs licensed by DHCS, based on what is commonly referred to as the “social model,” provide recovery, treatment, or detoxification services. (The Department of Public Health licenses medical model RTFs, known as chemical dependency recovery hospitals.) The services provided by social model RTFs include group and individual counseling, educational sessions, and alcoholism or drug abuse recovery and treatment planning. Social model RTFs are allowed to provide clients first aid and emergency care, and since the passage of AB 848 (Stone, Chapter 744, Statutes of 2015) RTFs can apply to DHCS for an additional license to provide incidental medical services by a licensed physician or other health care practitioner. SB 823 (Hill, Chapter 781, Statutes of 2018) requires DHCS to adopt American Society of Addiction Medicine treatment criteria as the minimum standard of care for licensed RTFs. DHCS also is responsible for certification of a business entity with a physical location in the state that provides one or more of the following services to clients: treatment, recovery, or detoxification services, or medications for addiction treatment. DHCS also provides program certification for facilities that are licensed by the Department of Social Services that serve adolescents. As part of their licensing and certification functions, DHCS conducts reviews of licensed and certified programs every two years, or as necessary; checks for compliance with statute, regulations, and certification standards to ensure the health and safety of clients; investigates all complaints; and has the authority to suspend or revoke a program’s license or certification for a violation of statute, regulations, and certification standards. DHCS states that they have the sole authority to conduct site visits to their licensed and certified facilities. As compliance reviews require DHCS to review resident or client information and files, which is protected information to ensure confidentiality under Title 42, Code of Federal Regulations, Part 2, any onsite visits by any other entity to ensure licensure or certification compliance could violate these protections.
3. Recovery residences/SLHs. A 2010 report on the National Institutes of Health (NIH) website, “Sober Living Houses for Alcohol and Drug Dependence: 18-month Outcomes,” states that SLHs are not formal treatment programs and are not obligated to comply with state or local regulations applicable to treatment. However, NIH does not provide a formal definition of an SLH. The report also mentions that it is difficult to determine how many SLHs there are in California because they are outside of the purview of state licensing authorities. The NIH report cites the protection that the federal FHA affords SLHs to be located in residentially zoned areas, personal privacy under the Fourth Amendment, and the right of people with disabilities to live together for a shared purpose, such as mutually assisted recovery and maintenance of an abstinent lifestyle.

According to DHCS’s website, some types of residences do not provide alcohol and other drug services and therefore do not require licensure by DHCS, including cooperative living arrangements with a commitment or requirement to be free from alcohol and other drugs, sometimes referred to as RRs, SLHs, transitional housing, or alcohol- and drug-free housing. DHCS states that while SLHs are not required to be licensed by DHCS, they may be subject to other types of permits, clearances, business taxes, or local fees, which may be required by the cities or counties in which they are located. If an SLH is providing licensable services to adults, then it must obtain a valid RTF license. Licensable services can include, but are not limited to, detoxification services, group sessions, individual sessions, one-on-one counseling, educational sessions, or recovery, treatment, or discharge planning. If an SLH is providing just one of the mentioned services, then it should be classified as an RTF and must obtain a license from DHCS.

DHCS’s Drug Medi-Cal Organized Delivery System waiver allows counties to use recovery SLHs in their continuum of services if they adhere to the following guidelines: do not provide SUD services that would require licensure by DHCS; all residents of an RR are actively engaged in medically necessary recovery support services to be provided off-site; and each county develops guidelines for contracted RR providers and provide monitoring and oversight.

1. Housing for the disabled. A joint statement issued in November 2016 by the federal Department of Justice (DOJ) and Department of Housing and Urban Development (HUD), which together are responsible for enforcing the FHA, declared that the term “group home” does not have a specific legal meaning, though land use and zoning officials and the courts have referred to some residences for persons with disabilities as group homes, including homes occupied by persons in recovery from alcohol or substance abuse that are commonly called SLHs. DOJ and HUD contend that persons with disabilities have the same FHA protections whether or not their housing is considered a group home, and that a household where two or more persons with disabilities choose to live together, as a matter of association, may not be subject to requirements or conditions that are not imposed on households consisting of persons without disabilities. DOJ and HUD further state that the provision of services (medical, supervisory, supportive, etc.) is not required for a group home to be protected under the FHA. Group homes can also be opened by individuals or organizations, both for-profit (“commercially operated”) and not-for-profit, and still be protected by the FHA. Further, the FHA does not require a person who resides in an SLH to have participated in or be currently participating in a substance abuse treatment program to be considered a person with a disability. The fact that a resident of a SLH may currently be illegally using a controlled substance does not deprive the other residents of the SLH of the protection of the FHA. The DOJ and HUD statement also says that localities and states must ensure that actions to enforce criminal and other laws against SLHs are not taken to target SLHs and are applied equally, regardless of whether the residents of housing are persons with disabilities.
2. Group Home Technical Advisory (GHTA). The California Department of Housing and Community Development (CHCD) Division of Housing Policy Development issued the GHTA in December 2022 and states that group homes are an especially important type of housing for persons with disabilities. By supporting their residents’ individualized needs while providing flexible and affordable housing options, group homes help persons with disabilities live in deinstitutionalized settings that facilitate their integration into local communities. CHCD further states in recent years, some local governments have amended their zoning ordinances to add new regulations for group homes, particularly for SLH/RRs. These amendments have raised concerns that local governments are not complying with their affirmative obligations under state planning and zoning laws to promote more inclusive communities and affirmatively further fair housing (AFFH). These amendments have also generated disputes and confusion over whether local governments are violating fair housing laws by discriminating against persons with disabilities or other protected characteristics. Among other concerns, local land use policies and practices can block new group homes from opening, force existing ones to close, and impose costs, legal fees, and administrative burdens that make it difficult for group homes to operate. These concerns arise in the context of a shortage of adequate housing for persons with disabilities, which is a particularly acute problem within California’s broader housing crisis. CHCD states that with concerns, disputes, and confusion continuing to grow, the GHTA provides guidance on how state planning, zoning, and fair housing laws apply when local governments attempt to regulate group homes through land use policies and practices. It is designed to help local governments comply with their obligations under these state laws, including, for example, the Planning and Zoning Law; Housing Element Law; AFFH provisions; Anti-Discrimination in Land Use Law; and the Fair Employment and Housing Act, collectively “state housing laws.” Taken from the GHTA, local governments can comply with state housing laws regarding group homes, including the following:
3. Discriminatory Purpose or Effect. Ensure that the policy or practice does not discriminate on the basis of disability or other characteristics protected by state law. Apply the GHTA’s analysis on how to determine if a policy or practice has a discriminatory purpose or effect and how to implement flexible reasonable accommodation procedures that promptly and efficiently resolve accommodation requests in compliance with state housing laws and regulations. (pp. 12-20);
4. Supportive and Transitional Housing. Comply with the specific protections for group homes that fall within the definitions of supportive or transitional housing (pp. 20-22);
5. State and Federal Law Distinctions. Confirm that a policy or practice complies with state housing laws even if it complies with federal law, because California law provides broader and different protections than federal law (pp. 22-23);
6. Definition of Single-Family Residence. Avoid restrictive definitions of single housekeeping units or single-family homes that impermissibly constrain group homes from locating in single-family zones. This includes, for example, avoiding definitions that equate group homes with boardinghouses, require all residents to share a common deed or lease, overly scrutinize residents’ living arrangements, or automatically exclude group homes that are owned by for-profit businesses or pay staff to help manage a home’s operations (pp. 24-25);
7. Group Homes that Do Not Provide Licensable Services. Allow group homes that operate as single-family residences and that do not provide licensable services to locate in single-family neighborhoods, subject only to the generally applicable, nondiscriminatory health, safety, and zoning laws that apply to all single-family residences (pp. 25-26) (emphasis added); and,
8. Other Requirements for Group Home Operators and Residents. Avoid the other examples of special requirements for operators and residents discussed that can overly constrain group homes, conflict with the duty to affirmatively support this housing, and discriminate on the basis of disability and other protected characteristics. Examples discussed include, among other things, parking requirements, restrictions on residents or staff, neighborhood notice requirements, and local law enforcement registration requirements (pp. 30-33).
9. Related legislation. SB 1334 (Newman) defines an RR, for purposes of licensing RTFs, as a residential dwelling that provides primary housing for individuals who seek a cooperative living arrangement that supports personal recovery from a substance use disorder, does not require DHCS licensure, and does not provide licensable services, and clarifies that an unlicensed RR may provide services to its residents, including, but not limited to, dining, housekeeping, security, transportation, and recreation. SB 1334 would exempts RRs from being required to be licensed RTFs if the facility does not offer recovery services, as defined, and would allow residents of an RR to actively participate in recovery services outside of the home. SB 1334 would require RRs to be operated as a separate business from a licensed RTF and require RRs to maintain separate agreements with each resident for the housing and services it provides. SB 1334 is set for hearing on April 24, 2024 in this Committee.
10. Prior legislation. SB 992 (Hernandez, Chapter 784, Statutes of 2018) requires programs licensed or certified by DHCS to disclose business relationships with SLH/RRs, as specified; made changes to RTFs licensing law to improve client treatment and provide DHCS more oversight authority over RTFs.

SB 34 (Bates of 2017) would have required DHCS to report to the Legislature regarding the effect of the concentration of RTFs in a community, as specified. SB 34 was held on the Senate Appropriations Suspense file.

1. Support. The sponsors of this bill and other supporters, representing local governments, state that SLH/RRs provide a range of benefits to some of California’s most vulnerable residents, and it is critical that their needs are prioritized over profits. Compliance with state licensing laws administered through DHCS is essential to safeguarding residents’ well-being and maintaining quality care. By collaborating with cities, the state can leverage local resources to supplement its regulatory efforts. Cities are positioned to respond promptly to emerging issues or changes in their communities. Supporters state that this bill would help meet the shared goals of ensuring treatment facilities meet standards for patient care. The County of Orange states that, unfortunately, the increasing number of these facilities makes it challenging for DHCS to monitor and ensure compliance with state and local regulations. Affording cities and counties the ability to conduct site visits in coordination with DHCS provides additional resources to ensure compliance with existing provisions that seek to balance treatment for those seeking help while protecting the surrounding community and our neighborhoods.
2. Opposition. California Consortium of Addiction Programs and Professionals (CCAPP) states that the equivalent of “no-knock warrants” on peoples’ homes is antithetical to the Constitution, common sense, and basic human dignity. To create a law that would allow any local government official to enter persons’ private property for any reason, other than the urgent health and safety needs of the public, is simply unacceptable. Currently, several local ordinances that seek to regulate SLH/RRs at the local level in Orange and San Diego Counties have been determined to be in conflict with California statute, the California Constitution, federal housing law, and the Americans with Disabilities Act. Cities with these ordinances have received enforcement letters from CHCD. CCAP states that despite these “technical assistance” letters being issued to multiple jurisdictions and violations of housing elements for multiple cities, local governments continue to attempt to enforce illegal ordinances. CCAPP has received multiple complaints from citizens living where these ordinances were enacted in which code enforcement is demanding unannounced entry into homes to “interview” people living in them and to “count beds” within a home. Given that local government officials are outright ignoring direction from CHCD regarding the rights of people to live as they wish, enshrining this ability in state code would be disastrous to people living in recovery. Thus, enacting this bill would dramatically reduce the level of recovery housing throughout the state. In addition to basic civil rights, no state government licensing function is in existence that gives state powers to local government, particularly when the actions being sought disrupt a person’s privacy, security, and rights as disabled people. Creating a complaint-driven system for untrained local officials to enter people’s houses in order to satisfy NIMBY pressures in a neighborhood is an alarming proposition. Finally, DHCS asked for and received 12.0 permanent positions and expenditure authority of $2,012,000 from the licensing fund in Fiscal Year (FY) 2023-24 and $1,904,000 in FY 2024-25 and ongoing, and corresponding statutory changes, to strengthen compliance oversight for substance use disorder licensure enforcement. Given this expansive increase in local enforcement, it is premature to direct any further resources to local government to enforce current laws. Orange County will have an office in its vicinity with which to coordinate complaints. There is no need to subjugate state enforcement to local entities as required in this bill.
3. Policy concerns. CHCD has begun to notify local governments of their obligation to uphold fair housing laws in which SLH/RRs are protected in a similar fashion to that any other single-family dwelling is, regardless of whether the group homes are run as for-profit businesses. CHCD mentions in their GHTA that local governments have historically passed unlawful ordinances that effectively intimidate and/or shut down existing SLH/RRs and prohibit new ones from operating, in a time when housing options for those with SUDs and who are in recovery are scarce. Media reports show that some cities are suing the state or ignoring requests to update their housing elements altogether. The Committee may wish to consider whether the Legislature should empower local governments to continue past practices, at a time that another state entity—the one tasked with enforcing housing/fair housing laws—is taking action, solely based on allegations against licensed RTFs and SLH/RRs.

SUPPORT AND OPPOSITION:

Support: League of California Cities (sponsor)

City of Cypress

City of Foundation Valley

County of Orange

Oppose: California Consortium of Addiction Programs and Professionals

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