Existing law grants the sole authority in state government to the State Department of Health Care Services to certify alcohol or other drug programs and to license adult alcohol or other drug abuse recovery or treatment facilities. Existing law requires the department to adopt the American Society of Addiction Medicine (ASAM) treatment criteria, or an equivalent evidence-based standard, as the minimum standard of care for licensed facilities and requires a licensee to maintain those standards with respect to the level of care to be provided by the licensee.

This bill would similarly require the department to adopt the American Society of Addiction Medicine ASAM treatment criteria, or an equivalent evidence-based standard, as the minimum standard of care for alcohol or other drug programs certified by the department. The bill would also require certified programs to maintain those standards with respect to the level of care to be provided by the certified program. The

The bill would authorize the department to implement, interpret, or make specific this section implement these provisions by means of plan or provider bulletins or similar instructions until regulations are adopted and would require that regulations be adopted by January 1, 2026. 2027.

Existing law grants the sole authority in state government to the State Department of Health Care Services to certify alcohol or other drug programs and to license adult alcohol or other drug abuse recovery or treatment facilities. Existing law requires the department to adopt the American Society of Addiction Medicine treatment criteria, or an equivalent evidence-based standard, as the minimum standard of care for licensed facilities and requires a licensee to maintain those standards with respect to the level of care to be provided by the licensee.

This bill would similarly require the department to adopt the American Society of Addiction Medicine treatment criteria, or an equivalent evidence-based standard, as the minimum standard of care for alcohol or other drug programs certified by the department. The bill would also require certified programs to maintain those standards with respect to the level of care to provided by the certified program. The bill would authorize the department to implement, interpret, or make specific this section by means of plan or provider bulletins or similar instructions until regulations are adopted and require that regulations be adopted by January 1, 2026.

Date of Hearing: May 14, 2025

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Buffy Wicks, Chair

ABPCA Bill Id:AB 425

Author:(Davies) – As Amended Ver:April 24, 2025

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

SUMMARY:

This bill requires the State Department of Health Care Services (DHCS) to adopt the American Society of Addiction Medicine (ASAM) treatment criteria, or an equivalent evidence-based standard, as the minimum standard of care for certified alcohol or other drug (AOD) programs, and requires certified programs to maintain those standards in the level of care they provide.

The bill requires DHCS to adopt regulations by January 1, 2027, and allows DHCS to implement, interpret, or make specific the provisions of this bill by means of plan or provider bulletins, or similar instructions until it adopts regulations.

FISCAL EFFECT:

One-time General Fund costs of an unknown amount, potentially in the hundreds of thousands of dollars per year for several years, for DHCS to adopt regulations and communicate the new requirements to AOD programs. At the time this analysis was prepared, DHCS had not provided a cost estimate.

COMMENTS:

Purpose. This bill is sponsored by Advocates for Responsible Treatment. According to the author:

AB 425 raises the minimum standard of treatment for certified substance use disorder facilities in California. This bill will standardize treatment, but will also help to increase retention rates for treatment. By codifying evidence-based standards we set a strong baseline of expectations for the care our patients should receive.

Background. AOD Treatment Program Certification. Prior to January 1, 2025, AOD programs were allowed to seek certification from DHCS. AB 118 (Committee on Budget), Chapter 42, Statutes of 2023, now requires certification for many AOD programs, with exceptions for various licensed facility types, such as schools, jails, and prisons.

ASAM Criteria. The ASAM criteria include a six dimension assessment and a corresponding continuum of care with five broad levels of care (zero to four). SB 823 (Hill) Chapter 781, Statutes of 2018, required DHCS to adopt the ASAM treatment criteria, or an equivalent evidence-based standard, as the minimum standard of care for licensed AOD residential treatment facilities (RTFs) and required licensees to maintain those standards with respect to the level of care (LOC). DHCS adopted the ASAM treatment criteria as the standard of care for licensed RTFs. ASAM also has lower LOCs, which would be the basis for the AOD certification requirements under this bill. The ASAM lower LOCs are as follows:

1. ASAM 0.5 – Early Intervention: Assessment and education for at-risk individuals who do not meet diagnostic criteria for substance use disorder.
2. ASAM 1 – Outpatient Services: Less than nine hours of service per week (for adults) for recovery or motivational enhancement therapies/strategies.
3. ASAM 2.1 – Intensive Outpatient: Nine or more hours of service per week (for adults) to treat multidimensional instability.
4. ASAM 2.5 – Partial Hospitalization: 20 or more hours of service per week for multidimensional instability not requiring 24-hour care.

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

Date of Hearing: April 22, 2025

ASSEMBLY COMMITTEE ON HEALTH

Mia Bonta, Chair

ABPCA Bill Id:AB 425

Author:(Davies) – As Introduced Ver:February 5, 2025

SUBJECT: Certification of alcohol and other drug programs.

SUMMARY: This bill would require the State Department of Health Care Services (DHCS) to adopt the American Society of Addiction Medicine (ASAM) treatment criteria, or an equivalent evidence-based standard, as the minimum standard of care for alcohol or other drug (AOD) programs certified by the DHCS, and would require certified programs to maintain those standards. Specifically, this bill:

1. Requires DHCS to adopt the ASAM treatment criteria, or an equivalent evidence-based standard, as the minimum standard of care for certified AOD programs and requires a program to maintain those standards with respect to the level of care to be provided.
2. Requires DHCS to adopt regulations by January 1, 2026.
3. Permits DHCS to implement, interpret, or make specific the provisions of this bill by means of plan or provider bulletins, or similar instructions until regulations are adopted.
4. Makes Legislative findings and declarations regarding the importance of meeting or exceeding ASAM criteria.

EXISTING LAW:

1. Establishes DHCS as the sole certifying authority for AOD programs. Requires new certifications to be issued for a period of two years to programs meeting statutory and regulatory requirements. [Health and Safety Code (HSC) § 11832]
2. Exempts specific settings from the certification requirement, including but not limited to: licensed adult alcoholism or drug abuse recovery or treatment facilities (RTF), clinics licensed by the State Department of Public Health (DPH), community care facilities licensed by the State Department of Social Services, public elementary and secondary schools, and county jails and state correctional institutions, including juvenile justice facilities. [HSC § 11832.3]
3. Requires an entity applying for certification to submit a written application, a certification fee, an initial application fee, and any other documentation specified by DHCS. [HSC § 11832.4]
4. Specifies the conditions under which DHCS may issue a certification, terminate review of an application, or deny certification. [HSC § 11832.5]
5. Requires certified programs to adopt policies and procedures consistent with statute and regulations that address, at a minimum: admission and discharge, client rights, services, medications, and staff and client code of conduct. Requires programs to either offer medications for addiction treatment (MAT) directly to clients, or have an effective referral process in place, as defined. [HSC § 11832.8 and § 11832.9]
6. Requires DHCS to conduct onsite visits for compliance at least once during each certification period. [HSC § 11832.12]
7. Establishes DHCS as the sole licensing authority for RTFs. Permits new licenses to be issued for a period of two years and requires DHCS to conduct onsite program visits for compliance at least once during the two-year licensing period. [HSC § 11834.01]
8. Requires DHCS to adopt the ASAM treatment criteria, or an equivalent evidence-based standard, as the minimum standard of care for licensed facilities and requires a licensee to maintain those standards with respect to the level of care to be provided by the licensee. [HSC § 11834.015]

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

COMMENTS:

1. PURPOSE OF THIS BILL. According to the author, this bill raises the minimum standard of treatment for certified substance use disorder (SUD) facilities in California. The author argues that the bill will standardize treatment, but will also help to increase retention rates for treatment. By codifying evidence-based standards we set a strong baseline of expectations for the care our patients should receive.
2. BACKGROUND.
   1. Prevalence of Substance Use Disorders (SUD) in California. A 2024 publication from Health Management Associates and the California Health Care Foundation titled, “Substance Use Disorder in California — a Focused Landscape Analysis” reported that approximately 9% of Californians ages 12 years and older met the criteria for SUD in 2022. According to the report, the prevalence of SUD among individuals 12 years of age and older increased to 8.8% in 2022 from 8.1% in 2015. While the health care system is moving toward acknowledging SUD as a chronic illness, only 6% of Americans and 10% of Californians ages 12 and older with an SUD received treatment for their condition in 2021. More than 19,335 Californians ages 12 years and older died from the effects of alcohol from 2020 to 2021, and the total annual number of alcohol-related deaths increased by approximately 18% in the state from 2020 and 2021. Overdose deaths from both opioids and psychostimulants (such as amphetamines), are soaring. This issue, compounded by the increased availability of fentanyl, has resulted in a 10-fold increase in fentanyl related deaths between 2015 and 2019. According to the California Department of Public Health’s Overdose Prevention Initiative, 7,847 opioid-related overdose deaths occurred in California in 2023. In the first two quarters of 2024, 2,975 opioid-related overdose deaths were recorded in California.
   2. ASAM. ASAM established a six dimension assessment (the ASAM criteria) and a corresponding continuum of care with five broad levels of care (zero to four). Current law requires DHCS to adopt the ASAM treatment criteria, or an equivalent evidence-based standard, as the minimum standard of care for licensed RTFs and requires licensees to maintain those standards with respect to the level of care. DHCS has adopted the ASAM treatment criteria as the standard of care required of all licensed RTFs. To ensure that all licensed facilities are capable of delivering care consistent with the ASAM treatment criteria and meet all of DHCS’ requirements, DHCS has developed a level of care (LOC) designation program for RTFs. The levels of care for residential facilities are as follows:
      1. Clinically Managed Low-Intensity Residential – ASAM 3.1/ DHCS 3.1
      2. Clinically Managed Residential Withdrawal Management – DHCS 3.2
      3. Clinically Managed Population-specific Low-intensity Residential – ASAM 3.3/ DHCS 3.3
      4. Clinically Managed High-Intensity Residential – ASAM 3.5/ DHCS 3.5

DHCS also notes in a disclaimer on their licensing website: “An approval for a DHCS LOC Designation does not guarantee eligibility for an ASAM LOC Certification. However, an approved residential ASAM LOC Certification is sufficient to meet the DHCS requirement. Licensees must directly contact ASAM to obtain information regarding its certification process and requirements to obtain ASAM LOC Certification.”

ASAM also has lower LOCs, which would be the basis for the AOD certification requirements under this bill. Those levels are as follows:

• • 1. Early Intervention – ASAM 0.5, Assessment and education for at-risk individuals who do not meet diagnostic criteria for substance use disorder.
    2. Outpatient Services – ASAM 1, Less than nine hours of service/week (for adults) for recovery or motivational enhancement therapies/strategies.
    3. Intensive Outpatient – ASAM 2.1, nine or more hours of service/week (for adults) to treat multidimensional instability.
    4. Partial Hospitalization – ASAM 2.5, 20 or more hours of service/week for multidimensional instability not requiring 24-hour care.
  1. Alcohol and Drug Treatment Facility Licensing and Certification. DHCS has sole authority to license RTFs in the state. Licensure is required when at least one of the following services is provided: detoxification; group sessions; individual sessions; educational sessions; or, alcoholism or other drug abuse recovery or treatment planning. Additionally, facilities may be subject to other types of permits, clearances, business taxes, or local fees that may be required by the cities or counties in which the facilities are located.

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

Prior to January 1, 2025, AOD programs were permitted to seek certification from DHCS. Under AB 118 (Committee on Budget), Chapter 42, Statutes of 2023, certification is now a requirement for many alcohol and drug programs, with exceptions for various licensed facility types, such as schools, jails, and prisons. DHCS certification regulations contain a frequency of service standard for outpatient services as a maximum of nine hours per week and intensive outpatient with a 9-19 hour per week range, similar to the ASAM designation.

1. SUPPORT. The City of Los Alamitos states in support of the bill that it will improve public health, ensure high-quality care for residents, and effectively utilize resources to address substance use challenges within the community. Los Alamitos states it is committed to policies that improve the quality of life for its constituents and overall health of the community and this bill aligns with that goal.
2. RELATED LEGISLATION.
   1. AB 423 (Davies) would require a business-operated recovery residence to register its location with DHCS and defines that term as a recovery residence in which a business, in exchange for compensation, provides more than one service beyond those of a typical tenancy arrangement to more than one occupant, including, but not limited to, drug testing, supervision, scheduling, rule setting, rule enforcement, room assignment, entertainment, gym memberships, transportation, laundry, or meal preparation and coordination. AB 423 is pending in the Assembly Health Committee.
   2. AB 492 (Valencia) would require DHCS to notify a city or county, in writing, of the issuance of a new license to an alcohol or other drug recovery or treatment facility within the local government’s jurisdiction. AB 492 is pending in the Assembly Appropriations Committee.
   3. AB 1356 (Dixon) would require an RTF to submit a report within 60 days of the death of a resident that describes the follow-up action plan that was implemented and provides any relevant information that was not known at the time of the initial incident or that was known but was not provided to the department in the initial report. AB 1356 is pending in the Assembly Health Committee.
   4. SB 35 (Umberg) would require DHCS to initiate an investigation into unlicensed operation of an RTF within 10 days of receiving the allegation and complete the investigation within 60 days of initiating the investigation. The bill would require an employee or agent to provide the notice within 10 days of submitting their findings to DHCS and to conduct a follow up site visit to determine whether the facility has ceased providing services. SB 35 would authorize these provisions to be enforced by the city attorney of a city in which the facility is located, or by the county counsel or the county behavioral health agency if the facility is located in the unincorporated area of the county, if DHCS fails to initiate or conclude the investigation in accordance with these time limits. SB 35 is pending in the Senate Health Committee.
   5. SB 43 (Umberg) would require all programs certified and all facilities licensed, no later than July 15, 2026, and annually each July 15 thereafter, to submit to DHCS a report of all money transfers between the program or facility and a recovery residence during the previous fiscal year. This bill is pending in the Senate Health Committee.
   6. SB 329 (Blakespear) would require DHCS to assign a complaint under its jurisdiction regarding an RTF to an analyst for investigation within 10 days of receiving the complaint and to complete an investigation within 60 days of assigning the complaint, unless specified circumstances exist, and notify the complainant if the investigation is not able to be completed within 60 days. SB 329 is pending in the Senate Appropriations Committee.
3. PREVIOUS LEGISLATION.
   1. AB 2081 (Davies), Chapter 376, Statutes of 2024, requires entities licensed or certified by DHCS to include on their websites and intake paperwork a disclosure stating an individual may check DHCS’s website to confirm any actions taken against the entity.
   2. AB 118 (Committee on Budget), Chapter 42, Statutes of 2023, prohibits a program from offering alcohol and other drug treatment recovery services without certification, and establishes procedures for: certification, inspections of certified programs, and for revocation of certification from noncompliant programs.
   3. SB 823 (Hill) Chapter 781, Statutes of 2018, requires DHCS to adopt the ASAM treatment criteria, or an equivalent evidence-based standard, as the minimum standard of care for licensed facilities and requires a licensee to maintain those standards with respect to the level of care to be provided by the licensee.
4. COMMITTEE AMENDMENTS. The committee may wish to delay the requirement of DHCS to adopt regulations to January 1, 2027. As written, the bill would require regulations to be adopted on the same day that the law takes effect, January 1, 2026.

REGISTERED SUPPORT / OPPOSITION:

Support

Advocates for Responsible Treatment

Association of California Cities - Orange County (ACC-OC)

City of Los Alamitos

City of Villa Park

Orange County Board of Supervisors

Five individuals

Opposition

None on file

Analysis Prepared by: Logan Hess / HEALTH / (916) 319-2097