Bills

SB 28: Community Assistance, Recovery, and Empowerment (CARE) court program.

Session Year: 2025-2026
House: Senate
Latest Version Date: 2026-07-02

Current Status:

In Progress

(2026-08-13: August 13 hearing: Held in committee and under submission.)

Introduced

In Committee

Awaiting First Chamber Vote

Passed First Chamber

In Committee

Awaiting Second Chamber Vote

Passed Second Chamber

Enacted

Version:

(1)Existing law, the Community Assistance, Recovery, and Empowerment (CARE) Act (the act), authorizes specified persons, including a person with whom the respondent resides, family members, and first responders, among others, 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, the Lanterman-Petris-Short Act, authorizes a conservator of the person, of the estate, or of the person and the estate to be appointed for a person who is gravely disabled as a result of a mental health disorder or impairment by chronic alcoholism. Existing law requires the officer providing the conservatorship investigation, which may include a public guardian or a county mental health program, to investigate all available alternatives to conservatorship and to recommend conservatorship to the court only if no suitable alternatives are available. Existing law requires a conservatorship under these provisions to terminate after one year and specifies procedures if the conservator determines conservatorship is still required.

This bill would authorize a conservator to, upon the termination of a conservatorship, request the court refer the conservatee to CARE court, as specified.

(2)The act authorizes services and supports to be provided to adults who are currently experiencing a qualifying severe mental illness and who meet other specified criteria, including that the person is not clinically stabilized in ongoing voluntary treatment and is either unlikely to survive safely in the community without ongoing supervision and the persons condition is substantially deteriorating or the person is in need of services and supports to prevent a relapse or deterioration that would likely result in grave disability or serious harm to the person or others.

This bill would authorize the court, beginning July 1, 2028, and if it dismisses a CARE petition because a respondent needs a higher level of services, to order the county to develop an exit plan for the respondent. The bill would require the State Department of Health Care Services, by July 1, 2028, to develop, with input from certain stakeholder groups, a CARE Act model exit plan that identifies appropriate services and ongoing monitoring of an individual with a petition dismissed because the individual needed a higher level of services.

This bill would update the definition of a petitioner for the purposes of the act.

(3)Existing law requires the Judicial Council to develop a mandatory form or forms to use to file a CARE process petition. Existing law requires the petition to be signed under the penalty of perjury and to contain specified information, including the petitioners relationship to the respondent and either an affidavit of a licensed behavioral health professional stating the licensed behavioral health professional or their designee has examined or made multiple unsuccessful attempts to examine the respondent within 60 days of submission of the petition, or that the respondent was detained for a minimum of 2 intensive treatments pursuant to state law.

This bill would extend the 60-day period for examination of the respondent to 120 days. The bill would also authorize a petition to include evidence that the respondent was either detained for a minimum of 2 involuntary holds in the last 120 days or that they were referred to a full service partnership program more than once, but was not enrolled due to inability or unwillingness to engage in the previous 120 days.

(4)Existing law authorizes a court to terminate a respondents participation in the CARE process if the court determines that the respondent is not participating in the CARE process or is not adhering to their CARE plan, as specified. Existing law authorizes the court to order an evaluation under the Lanterman-Petris-Short Act, as specified, to ensure the respondents safety. Existing law requires the court to consider the respondents failure to successfully complete their CARE plan and the reasons for that failure in a subsequent hearing under the Lanterman-Petris-Short Act, provided that the hearing occurs within 6 months of the termination of the CARE plan, and creates a presumption that the respondent needs additional intervention beyond the supports and services provided by the CARE plan.

This bill would prohibit the court from terminating a respondents participation in the CARE process solely due to a failure of the county or other local government entity to properly engage with the CARE process.

(5)Existing law requires CARE Act proceedings to occur in person unless the court, in its discretion, allows a party or witness to appear remotely through the use of remote technology. Existing law authorizes the respondent to be in person for all hearings.

This bill would instead authorize all parties and witnesses to appear remotely through the use of remotely technology. The bill would authorize the court with discretion to order a party or witness to appear in person if necessary.

This bill would authorize the parties to agree to an alternative method of service for all subsequent reports and notices after the notice of initial appearance.

This bill would require, by January 1, 2028, all counties to establish a process for electronic submission of CARE Act documents using a secured portal. By increasing the duties on county behavioral health agencies, the bill would create a state-mandated local program.

(6)Existing law authorizes a provider of health care or a covered entity, as defined, to 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 or services or supports. Existing law specifies protections for this information and required procedures when such a disclosure is made.

This bill would authorize a county behavioral health agency to disclose to a provider of health care or a covered entity any information, including protected health information, and mental health records, excluding psychotherapy notes, in its possession about the respondent that is relevant to the provider or entitys provision, coordination, or management of services and supports. The bill would also specify protections for this information and required procedures when such a disclosure is made.

(7)Existing law requires the department to develop, in consultation with specified entities, an annual CARE Act report that includes specified information on CARE Act petitions, including the number of initial appearances, and information compiled from county behavioral health departments and courts.

This bill would expand the information on CARE Act petitions to include the number of petitions submitted electronically as well as other specified information. The bill would also expand the data to be compiled from county behavioral health departments and courts to include the number of individuals who were enrolled in a Full Service Partnership program postreferral, among other things. The bill would also require the data collected from county behavioral health departments and courts to be collected for cases involving dismissed respondents, where available.

(8)Existing law requires the California Health and Human Services Agency, or a designated department within the agency, to perform specified functions, including engaging 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.

This bill would require the agency to annually release a list of overperforming and underperforming counties to receive additional support through the CARE Improvement and Coordination Unit. counties and shall annually provide written notice identifying areas of concern and opportunities for improvement to underperforming counties. This bill would also establish within the California Health and Human Services Agency the position of a CARE Court Ombudsperson, as specified.

(9)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 authorize a conservator to, upon the termination of a conservatorship, request the court refer the conservatee to CARE court, as specified.

This bill, instead, would authorize an individual to qualify for the CARE program if, among the other existing requirements, the person has not been clinically stabilized in ongoing voluntary treatment for more than 90 days prior to the CARE court filing, as specified, and if supervision is required to allow for services and supports to be effective and prevent substantial deterioration or relapse.As part of the petition review process, this bill would authorize the county behavioral health agency, their designee, or the court to recommend the respondent be considered for alternative treatment, including, but not limited to, assisted outpatient treatment program or a grave disability evaluation under the Lanterman-Petris-Short Act, if the respondent requires a higher level of care than the CARE process. The bill would prohibit a determination that the respondent requires a higher level of care than the CARE process if the respondent meets, or is likely to meet, the criteria for the CARE process.

This bill would update various definitions applying to the definition of a petitioner for the purposes of the act.

This bill would extend the 60-day period for examination of the respondent to 270 120 days. The bill would also authorize a petition to include evidence that the respondent was either detained for a minimum of 2 involuntary holds in the last 6 months 120 days or that they were referred to a full service partnership program more than once, but was not enrolled due to inability or unwillingness to engage. engage in the previous 120 days.

(4)Existing law, the Lanterman-Petris-Short Act, provides generally for the evaluation, treatment, and civil commitment of persons with mental health disorders and other specified persons. The act authorizes the detention for evaluation for up to 72 hours of a person who is found to be, as a result of a mental disorder, a danger to others or to self, or gravely disabled.Under the CARE Act, existing law requires a court to hold a status review hearing at specified intervals after the court orders the CARE plan. Existing law authorizes the county behavioral health agency or respondent to request, or the court upon its own motion to set, a hearing to occur at any time during the CARE process to address a change in circumstances.This bill would, to ensure the respondents safety, require the county behavioral health agency to request a status hearing to address a change in circumstances and request the court to order an evaluation under the Lanterman-Petris-Short Act of the respondent if prescribed conditions are met, including that the respondents nonadherence to the CARE plan has resulted in behavior consistent with an established pattern of psychiatric deterioration or symptoms of decompensation. By creating a new requirement for county behavioral health agencies, the bill would create a state-mandated local program.(5)

This bill would instead require the court to order an evaluation if the court terminates the respondents participation in the process and would authorize a court to order a grave disability evaluation, on its own motion or by motion from the county. The bill would also delete the above-described 6 month limitation, thereby requiring the court to consider the respondents failure to successfully complete their CARE plan and reasons for that failure in any subsequent hearings under the Lanterman-Petris-Short Act and extending the presumption.(6)Existing law requires that the court hold a one-year status meeting 11 months into the process timeline and requires the county behavioral health agency to file a report including specified information, including what progress the respondent has made on the CARE plan. Existing law authorizes a respondent to be involuntarily reappointed to the program only if specified conditions apply. Existing law also authorizes a court to use existing legal authority to ensure the respondents safety.If the court finds that involuntary reappointment is unlikely to stabilize the respondent and supervision is necessary, or if the court finds it is in the best interest of the respondent, this bill would authorize the court to order a grave disability evaluation on its own motion or by motion from the county.

(7)

This bill would authorize the parties to agree to an alternative method of service for all subsequent reports and notices after the notice of initial appearance.

(8)

(9)

(10)

This bill would require the Governors office agency to annually release a list of overperforming and underperforming counties to receive additional support through the CARE Improvement and Coordination Unit. This bill would also establish within the California Health and Human Services Agency the position of a CARE Court Ombudsperson, as specified.

(11)

This bill would authorize a conservator to, upon the termination of a conservatorship, request the court refer the conservatee to CARE court, as specified.

As part of the petition review process, this bill would authorize the county behavioral health agency, their designee, or the court to recommend the respondent be considered for alternative treatment, including, but not limited to, assisted outpatient treatment program or a grave disability evaluation under the Lanterman-Petris-Short Act, if the respondent requires a higher level of care than the CARE process. The bill would prohibit a determination that the respondent requires a higher level of care than the CARE process if the respondent meets, or is likely to meet, the criteria for the CARE process.

This bill would update various definitions applying to the act.

This bill would extend the 60-day period for examination of the respondent to 270 days. The bill would also authorize a petition to include evidence that the respondent was either detained for a minimum of 2 involuntary holds in the last 6 months or that they were referred to a full service partnership program more than once, but was not enrolled due to inability or unwillingness to engage.

Under the CARE Act, existing law requires a court to hold a status review hearing at specified intervals after the court orders the CARE plan. Existing law authorizes the county behavioral health agency or respondent to request, or the court upon its own motion to set, a hearing to occur at any time during the CARE process to address a change in circumstances.

This bill would, to ensure the respondents safety, require the county behavioral health agency to request a status hearing to address a change in circumstances and request the court to order an evaluation under the Lanterman-Petris-Short Act of the respondent if prescribed conditions are met, including that the respondents nonadherence to the CARE plan has resulted in behavior consistent with an established pattern of psychiatric deterioration or symptoms of decompensation. By creating a new requirement for county behavioral health agencies, the bill would create a state-mandated local program.

(5)Existing law authorizes a court to terminate a respondents participation in the CARE process if the court determines that the respondent is not participating in the CARE process or is not adhering to their CARE plan, as specified. Existing law authorizes the court to order an evaluation under the Lanterman-Petris-Short Act, as specified, to ensure the respondents safety. Existing law requires the court to consider the respondents failure to successfully complete their CARE plan and the reasons for that failure in a subsequent hearing under the Lanterman-Petris-Short Act, provided that the hearing occurs within 6 months of the termination of the CARE plan, and creates a presumption that the respondent needs additional intervention beyond the supports and services provided by the CARE plan.

(6)Existing law requires that the court hold a one-year status meeting 11 months into the process timeline and requires the county behavioral health agency to file a report including specified information, including what progress the respondent has made on the CARE plan. Existing law authorizes a respondent to be involuntarily reappointed to the program only if specified conditions apply. Existing law also authorizes a court to use existing legal authority to ensure the respondents safety.

If the court finds that involuntary reappointment is unlikely to stabilize the respondent and supervision is necessary, or if the court finds it is in the best interest of the respondent, this bill would authorize the court to order a grave disability evaluation on its own motion or by motion from the county.

(7)Existing law requires CARE Act proceedings to occur in person unless the court, in its discretion, allows a party or witness to appear remotely through the use of remote technology. Existing law authorizes the respondent to be in person for all hearings.

This bill would authorize the parties to agree to an alternative method of service for all subsequent reports and notices after the notice of initial appearance.

This bill would require, by January 1, 2028, all counties to establish a process for electronic submission of CARE Act documents using a secured portal.

(8)Existing law authorizes a provider of health care or a covered entity, as defined, to 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 or services or supports. Existing law specifies protections for this information and required procedures when such a disclosure is made.

(9)Existing law requires the department to develop, in consultation with specified entities, an annual CARE Act report that includes specified information on CARE Act petitions, including the number of initial appearances, and information compiled from county behavioral health departments and courts.

(10)Existing law requires the California Health and Human Services Agency, or a designated department within the agency, to perform specified functions, including engaging 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.

This bill would require the Governors office to annually release a list of overperforming and underperforming counties to receive additional support through the CARE Improvement and Coordination Unit. This bill would also establish within the California Health and Human Services Agency the position of a CARE Court Ombudsperson, as specified.

(11)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.

Existing law, the Drug Court Programs Act, authorizes counties to implement a drug court program, that, if implemented, requires a county alcohol and drug program administrator and the presiding judge in the county to develop a plan that includes, among other things, drug courts for juvenile offenders and drug courts for parents of children in certain family law cases. Existing law requires counties and courts that opt to have treatment court programs to design and operate the programs in accordance with state and national guidelines. Existing law requires the Judicial Council to, by no later than January 1, 2026, revise the standards of judicial administration to reflect state and nationally recognized best practices and guidelines for collaborative programs including those described in these provisions.Existing law, the Treatment-Mandated Felony Act, an initiative measure enacted by the voters as Proposition 36 at the November 5, 2024, statewide general election, authorizes certain defendants convicted of specified felonies or misdemeanors to participate in a treatment program, upon court approval, in lieu of a jail or prison sentence, or grant of probation with jail as a condition of probation, if specified criteria are met. The Legislature may amend this initiative by a statute passed in each house by a rollcall vote entered in the journal, ²/₃ of the membership concurring, or by a statute that becomes effective only when approved by the voters.This bill would include a new standard that, as part of the treatment court program, a drug addiction expert, as defined, conducts a substance abuse and mental health evaluation of the defendant, and submits the report to the court and the parties. The bill would remove the requirement that the Judicial Council revise the standards of judicial administration. The bill would require that a treatment program that complies with existing judicial standards be offered to a person that is eligible for treatment pursuant to the Treatment-Mandated Felony Act. By requiring the court to implement a treatment program that complies with existing judicial standards, the bill would amend that initiative statute.This bill would declare that it is to take effect immediately as an urgency statute.

Existing law, the Treatment-Mandated Felony Act, an initiative measure enacted by the voters as Proposition 36 at the November 5, 2024, statewide general election, authorizes certain defendants convicted of specified felonies or misdemeanors to participate in a treatment program, upon court approval, in lieu of a jail or prison sentence, or grant of probation with jail as a condition of probation, if specified criteria are met. The Legislature may amend this initiative by a statute passed in each house by a rollcall vote entered in the journal, ²/₃ of the membership concurring, or by a statute that becomes effective only when approved by the voters.

This bill would instead require that treatment court programs be available to all eligible California defendants. The bill would include a new standard that, as part of the treatment court program, a drug addiction expert, as defined, conducts a substance abuse and mental health evaluation of the defendant, and submits the report to the court and the parties. The bill would remove the requirement that the Judicial Council revise the standards of judicial administration. The bill would require that a treatment program that complies with existing judicial standards be offered to a person that is eligible for treatment pursuant to the Treatment-Mandated Felony Act. By requiring the court to implement a treatment program that complies with existing judicial standards, the bill would amend that initiative statute.

This bill would declare that it is to take effect immediately as an urgency statute.

This bill would instead require that treatment court programs be available to all eligible California defendants. The bill would remove the requirement that the Judicial Council revise the standards of judicial administration. The bill would require that a treatment program that complies with existing judicial standards be offered to a person that is eligible for treatment pursuant to the Treatment-Mandated Felony Act. By requiring the court to implement a treatment program that complies with existing judicial standards, the bill would amend that initiative statute.

This bill would declare that it is to take effect immediately as an urgency statute.

Version:

The people of the State of California do enact as follows:SECTION 1.Section 5361 of the Welfare and Institutions Code is amended to read:5361.

(a)Conservatorship initiated pursuant to this chapter shall automatically terminate one year after the appointment of the conservator by the superior court. The period of service of a temporary conservator shall not be included in the one-year period. When the conservator has been appointed as conservator of the estate, the conservator shall, for a reasonable time, continue to have the authority over the estate that the superior court, on petition by the conservator, deems necessary for (1) the collection of assets or income that accrued during the period of conservatorship, but were uncollected before the date of termination, (2) the payment of expenses that accrued during period of conservatorship and of which the conservator was notified prior to termination, but were unpaid before the date of termination, and (3) the completion of sales of real property when the only act remaining at the date of termination is the actual transfer of title.

(b)If, upon the termination of an initial or a succeeding period of conservatorship, the conservator determines that conservatorship is no longer required but additional help is still warranted, the conservator may request the court to refer the conservatee to the CARE Act court pursuant to Section 5978. Documentation of the authority for a referral pursuant to this subdivision shall be signed by a physician or licensed psychologist and shall confirm that the conservatee is no longer gravely disabled as a result of mental disorder or impairment by chronic alcoholism and meets, or is likely to meet, criteria to qualify for the CARE process, as described in Section 5972.

(c)If, upon the termination of an initial or a succeeding period of conservatorship, the conservator determines that conservatorship is still required, the conservator may petition the superior court for reappointment as conservator for a succeeding one-year period. The petition shall include the opinion of two physicians or licensed psychologists who have a doctoral degree in psychology and at least five years of postgraduate experience in the diagnosis and treatment of emotional and mental disorders that the conservatee is still gravely disabled as a result of mental disorder or impairment by chronic alcoholism. If the conservator is unable to obtain the opinion of two physicians or psychologists, the conservator shall request that the court appoint them. The petition shall also include an attestation by the conservator that they have considered all available alternatives to conservatorship, including, but not limited to, assisted outpatient treatment pursuant to Section 5346 and the CARE Act program pursuant to Section 5978, as applicable, and that reappointment of a conservator is recommended because no suitable alternatives are available.

(d)(1)A facility in which a conservatee is placed shall release the conservatee at the conservatees request when the conservatorship terminates. A petition for reappointment filed by the conservator or a petition for appointment filed by a public guardian shall be transmitted to the facility at least 30 days before the automatic termination date. The facility may detain the conservatee after the end of the termination date only if the conservatorship proceedings have not been completed and the court orders the conservatee to be held until the proceedings have been completed.

(2)A care coordination plan shall be developed by, at a minimum, the individual, the facility, the county behavioral health department, the health care payer, if different from the county, and other individuals designated by the individual as appropriate, and shall be provided to the conservatee prior to their release. The care coordination plan shall include a first followup appointment with an appropriate behavioral health professional. The appointment information shall be provided to the individual before the individual is released. In no event may the individual be involuntarily held based on the requirements of this paragraph beyond when they would otherwise qualify for release. All care and treatment after release shall be voluntary.

(3)For purposes of care coordination and to schedule a followup appointment, the health plan, mental health plan, primary care provider, or other appropriate provider to whom an individual leaving a facility has been referred pursuant to paragraph (2) of subdivision (c) shall make a good faith effort to contact the referred individual no less than three times, either by email, telephone, mail, or in-person outreach, whichever method or methods are most likely to reach the individual.

(4)The requirement to develop a care coordination plan under this subdivision shall take effect immediately, without waiting for the department to create a model care coordination plan, as required pursuant to Section 5402.5.

SEC. 2.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)Clinically stabilized in ongoing voluntary treatment means both of the following:

(1)The persons condition is stable and not deteriorating.

(2)The person is currently engaged in treatment and managing symptoms through medication or other therapeutic interventions. Enrollment in treatment alone shall not be considered clinically stabilized in ongoing voluntary treatment.

(e)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.

(f)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.

(g)Court-ordered evaluation means an evaluation ordered by a superior court pursuant to Section 5977.1.

(h)Department means the State Department of Health Care Services.

(i)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.

(j)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.

(k)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).

(l)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) to (4), inclusive.

(m)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.

(n)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.

(o)Petitioner means the person or agency that 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 paragraph (6) of subdivision (b) of Section 5977.

(p)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.

(q)Respondent means the person who is the subject of the petition for the CARE process.

(r)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.

(s)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. 3.Section 5975 of the Welfare and Institutions Code is amended to read:5975.

The Judicial Council shall develop a mandatory form for use to file a CARE process petition with the court and any other forms necessary for the CARE process. The petition shall be signed under the penalty of perjury and contain all of the following:

(a)The name of the respondent and, if known, the respondents address.

(b)The petitioners relationship to the respondent.

(c)Facts that support the petitioners assertion that the respondent meets the CARE criteria in Section 5972.

(d)Any of the following:

(1)An affidavit of a licensed behavioral health professional, including, for purposes of this section only, nurse practitioners as defined in Section 2835 of the Business and Professions Code and physician assistants as defined in subdivision (d) of Section 3501 of the Business and Professions Code, stating that the licensed behavioral health professional or their designee has examined the respondent within 120 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 120 days 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.

(2)Evidence that the respondent was detained for a minimum of two intensive treatments pursuant to Article 4 (commencing with Section 5250) of Chapter 2 of Part 1, the most recent one within the previous 120 days. Evidence may include, but is not limited to, documentary evidence from the facility where the respondent was detained, or a signed declaration from the petitioner if the petitioner had personal knowledge of the detentions.

(3)Evidence that the respondent was detained for a minimum of two involuntary holds pursuant to Section 5150 in the previous 120 days.

(4)Evidence that the respondent was referred to a full-service partnership program more than once, but was not enrolled due to inability or unwillingness to engage in the previous 120 days.

SEC. 4.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)(1)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.

(2)Notwithstanding paragraph (1), and consistent with the requirements of subdivision (d) of Section 5977.4, reports generated by the county behavioral health agency during the CARE process may be disclosed to 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, if necessary to assist with ongoing treatment of the respondent.

(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 at the respondents first court appearance, the judicial officer shall inform the respondent of their rights under this section. At subsequent hearings, the court is not required to advise the respondent of their rights under this section upon finding that the respondent understands and waives the additional advisement of their rights.

SEC. 5.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. The court may make a prima facie determination without conducting a hearing.

(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 and, if the court does so, it shall order that the dismissal is without prejudice, unless Section 5975.1 applies. Nothing other than Section 5975.1 prevents a petitioner whose petition was dismissed without prejudice from refiling the petition with amended information.

(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 efforts, timeframes of efforts, and outcome of efforts made by county and noncounty providers 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, documenting how attempts in the prior 120 days failed, cognitive deficits, and unmet mental health needs were assessed.

(iv)Order the county behavioral health agency to provide notice to the respondent, the appointed counsel, the petitioner, the supporter, and the county behavioral health agency in the county where the respondent resides, if different from the county where the CARE process has commenced.

(v)The evaluation may be provided to the petitioner and the licensed behavioral health professional who submitted a declaration pursuant to form prepared by Judicial Council.

(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, file a written report with the court as soon as practicable, but within 30 court days, and provide notice to the respondent and petitioner that a report has been ordered. Parties shall complete the investigation with appropriate urgency. 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 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 in voluntary behavioral health treatment, the court shall dismiss the matter.

(B)If the court determines, based on the county agencys report, that the evidence does not support a 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, based on the county agencys report, that the evidence does support a 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 in person or remotely through remote technology. 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 in person or remotely through remote technology.

(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)(I)Until July 1, 2025, the court may, in its discretion, assign ongoing rights of notice to the original petitioner.

(II)Commencing July 1, 2025, unless the court determines, either upon its own motion or upon the motion of the respondent, at any point in the proceedings, that it likely would be detrimental to the treatment or well-being of the respondent, the court shall provide ongoing notice of proceedings to the original petitioner throughout the CARE proceedings, including notice of when a continuance is granted or when a case is dismissed. If a continuance is granted, the notice shall provide a general reason for the continuance, including the absence of the respondent or one of the grounds pursuant to Rule 3.1332 of the California Rules of Court. If a case is dismissed, the notice shall specify the statutory basis for the dismissal. A notice pursuant to this clause shall not disclose any patient information that is protected under the federal Health Insurance Portability and Accountability Act of 1996 (Public Law 104-191), the Confidentiality of Medical Information Act (Part 2.6 (commencing with Section 56) of Division 1 of the Civil Code), or this act, without the respondents consent.

(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).

(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 county 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, except when the respondent consents to the release of the report.

(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.

(e)(1)Beginning July 1, 2028, if the court dismisses a CARE petition because a respondent needs a higher level of services, the court may order the county to develop an exit plan for the respondent.

(2)No later than July 1, 2028, the department shall develop, with input from a stakeholder group, a CARE Act model exit plan that identifies appropriate services and ongoing monitoring of an individual with a petition dismissed from the CARE Act because the court determined that they need a higher level of services. The stakeholder group shall include, at a minimum, county behavioral health agencies, county CARE courts, racial justice experts, and other appropriate stakeholders, including providers and CARE court participants.

SEC. 6.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.

(3)Nothing in this subdivision shall prohibit the parties from agreeing to, and the court from approving, amendments to the CARE agreement.

(4)The court may, in its discretion, call additional progress hearings beyond the hearing set at 60 days, for the duration of the CARE agreement.

(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. The evaluation may be provided to the original petitioner, if participating in ongoing proceedings, if the respondent consents.

(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, their counsel, and the supporter 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 and may be amended.

(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.

(7)This subdivision does not prohibit the parties from agreeing to, and the court from approving, amendments to the CARE plan. The court may also approve amendments to the CARE plan upon the finding that those amendments are necessary to support the respondent in accessing appropriate services and supports, following a hearing on the issue.

(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.

(f)(1)The court may adopt the CARE agreement as a CARE plan if all of the following are true:

(A)The respondent has stopped engaging with the CARE process for 60 days or more despite documented attempts by the county, local agency, or treatment providers to maintain engagement with the respondent.

(B)All elements of the CARE agreement have been provided to the respondent by the county or other local agency, as required.

(C)The court finds that a CARE plan would be a more effective alternative than potential dismissal from the CARE process.

(2)The adoption of the CARE agreement as a CARE plan shall not reset the one-year timeline in the CARE process.

(3)This subdivision does not limit or alter the courts authority to adopt a CARE plan pursuant to paragraph (2) of subdivision (d).

SEC. 7.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. The 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 requests to be graduated from the program, and the respondent has successfully completed the CARE process, the court shall order the county behavioral health agency, the respondent, and the supporter to work together on a voluntary graduation plan and 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 requests to remain in the CARE process, the respondent may request any amount of time, up to and including one additional year. The court may approve the request and thereby 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 the 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. 8.Section 5977.4 of the Welfare and Institutions Code is amended to read:5977.4.

(a)(1)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. The court and relevant local public agencies, including, but not limited to, cities and first responder agencies, shall cooperate to develop a comprehensive set of objectives established to improve performance of the CARE system in a vigorous and ongoing manner. The court is authorized to coordinate and participate in meetings to improve system performance. All evaluations and reports, documents, and filings submitted to the court pursuant to CARE Act proceedings shall be confidential.

(2)Notwithstanding paragraph (1), and consistent with the requirements of subdivision (d), reports generated by the county behavioral health agency during the CARE process may be disclosed to 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, if necessary to assist with ongoing treatment of the respondent.

(b)Parties and witnesses may appear remotely through the use of remote technology for the hearings described in this chapter. The court shall have the discretion to order a party or witness to appear in person if necessary. 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 to 5977.4, inclusive, 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, the role of the judiciary to improve system performance, 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 ongoing proceedings, 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 pursuant to this paragraph shall further be disclosed to the respondent and the respondents counsel, and with the consent of the respondent, to the supporter.

(3)(A)Consistent with paragraph (1) of subdivision (c) of Section 56.10 of the Civil Code, the county behavioral health agency may disclose to 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, any information, including protected health information, and mental health records excluding psychotherapy notes, in its possession about the respondent that is relevant to the provider or entitys 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)The county behavioral health agency shall not be held civilly or criminally liable for any disclosure authorized or required by this section.

(C)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.

(D)All information, including the facts and records, or summary thereof, shared pursuant to this paragraph shall further be disclosed to the respondent and the respondents counsel, and with the consent of the respondent, to the supporter, and the original petitioner, if participating in ongoing proceedings.

(4)(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)Information disclosed to 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, by a county behavioral health agency 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).

(D)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).

(e)(1)The notice of the initial appearance required by Section 5977 shall be served in accordance with the requirements of Section 5977.

(2)All subsequent reports and notices may be served through an alternative method of service agreed to by the parties.

(f)By January 1, 2028, all counties shall establish a process for electronic submission of CARE Act documents using a secured portal.

SEC. 9.Section 5978.1 of the Welfare and Institutions Code is amended to read:5978.1.

(a)For purposes of this section, facility means a facility that provides assessment, evaluation, and crisis intervention pursuant to subdivision (a) of Section 5150, or a designated facility as defined in subdivision (n) of Section 5008.

(b)A facility may refer an individual treated under an involuntary hold pursuant to Articles 1 to 4.7, inclusive, and Article 6 of Chapter 2 of Part 1 of this Division to the county behavioral health agency of the county in which the individual resides, or the county in which the individual is receiving involuntary treatment, if they believe that the individual meets or is likely to meet criteria to qualify for the CARE process, as described in Section 5972.

(1)Referrals pursuant to this section shall be authorized by a licensed behavioral health professional, employed, by or contracted by the facility, who has knowledge of the individuals case and has been involved in the individuals treatment during their involuntary hold. Documentation of the authority for a referral pursuant to this paragraph shall be signed by the licensed behavioral health professional or their designee, and shall confirm that they believe that the individual meets, or is likely to meet, criteria to qualify for the CARE process, as described in Section 5972.

(2)If the facility chooses to make a referral pursuant to subdivision (b), the facility shall make the referral pursuant to this section as soon as clinically indicated as part of the individuals discharge planning process.

(3)The facility referral shall include contact information for the referred individual, including a telephone number and address, if available, and other information as specified by the department.

(c)Within 14 business days of the referral by the facility, the county behavioral health agency shall complete assessment of the individual referred pursuant to this section and shall file a petition pursuant to Section 5975 if the county behavioral health agency determines that the individual meets or is likely to meet criteria for the CARE process and the individual does not engage in voluntary treatment. An expedited assessment may be necessary where there is concern of imminent discharge and foreseeable challenges with locating the respondent. The behavioral health agency shall provide guidelines to facilities on requesting an expedited assessment.

(d)In accordance with subdivision (b) of Section 5984, the department shall develop a referral form to be used by the facility and issue guidance regarding the following:

(1)The procedure for a facility to refer an individual to a county behavioral health agency pursuant to this section.

(2)County behavioral health agency data reporting requirements regarding referrals made pursuant to this section include, but are not limited to, total referrals, referrals where in-person contact was made, outcomes of referrals, reason for not filing a petition, length of time from referral to initial in-person contact, length of time from referral to outcome, and services provided for those engaged voluntarily.

(e)The department shall include data regarding referrals made pursuant to this section as part of the annual CARE Act report required by Section 5985.

(f)This section does not authorize a facility to continue an involuntary hold on a referred individual who no longer meets the criteria for involuntary treatment solely for the purpose of allowing the county behavioral health agency to complete its assessment pursuant to subdivision (b).

(g)This section does not affect the ability of a facility to make a referral for assisted outpatient treatment pursuant to Section 5346.

SEC. 10.Section 5979 of the Welfare and Institutions Code is amended to read:5979.

(a)(1)(A)If, at any time during the proceedings, the court determines by clear and convincing evidence that the respondent is not participating in the CARE process, after the respondent receives notice, or is not adhering to their CARE plan, after the respondent receives notice, the court may terminate the respondents participation in the CARE process. The court shall make findings on the record about the basis for termination of the respondents participation in the CARE process.

(B)The court shall not terminate the respondents participation in the CARE process solely due to a failure of the county or other local government entity to properly engage with the CARE process.

(2)To ensure the respondents safety, the court may utilize existing legal authority pursuant to Article 2 (commencing with Section 5200) of Chapter 2 of Part 1. The court shall provide notice to the county behavioral health agency and the Office of the Public Conservator and Guardian if the court utilizes that authority.

(3)If the respondent was timely provided 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 reasons for that failure, shall be a fact considered by the court in a subsequent hearing under the Lanterman-Petris-Short Act (Part 1 (commencing with Section 5000)), if that hearing occurs within six months of the termination of the CARE plan, and shall create a presumption at that hearing that the respondent needs additional intervention beyond the supports and services provided by the CARE plan.

(4)The respondents failure to comply with an order shall not result in a penalty outside of this section, including, but not limited to, contempt or a failure to appear.

(5)The respondents failure to comply with a medication order shall not result in any penalty, including under this section.

(b)(1)If, at any time during the CARE process, the court finds that the county or local government entity is not complying with the court orders, the court shall report that finding to the presiding judge of the superior court, or their designee.

(2)(A) The presiding judge or their designee shall issue an order to show cause why the local government entity should not be fined as set forth in this section. The time set for hearing shall be no earlier than 15 days after the date of the order. The scheduled date of the hearing shall allow adequate time for notice of the hearing to be served upon the local government entity.

(B)The presiding judge, or their designee, shall consider the matter on the record established at the hearing. If the presiding judge or their designee finds, by clear and convincing evidence, that the local government entity has substantially failed to comply with this part, or with lawful orders issued by a court under this part, the presiding judge or their designee may issue an order imposing a fine under this section.

(C)A fine under this section shall be in an amount of up to one thousand dollars ($1,000) per day, not to exceed twenty-five thousand dollars ($25,000) for each individual violation identified in the order imposing fines.

(D)(i) Funds collected pursuant to this subdivision shall be deposited in the CARE Act Accountability Fund, which is hereby created in the State Treasury. Upon appropriation, the department shall administer the funds annually, and shall issue guidance, as necessary, to local government entities, pursuant to subdivision (b) of Section 5984, regarding the distribution and conditions associated with the administered funds.

(ii)All moneys in the fund shall be allocated and distributed to the local government entity that paid the fines, to be used by that entity to serve individuals who have schizophrenia spectrum or other psychotic disorders and who are experiencing, or are at risk of, homelessness, criminal justice involvement, hospitalization, or conservatorship.

(3)If, after notice and hearing as set forth in paragraph (2), the presiding judge or their designee finds, by clear and convincing evidence, that the local government entity is persistently noncompliant with this part, or with lawful orders issued by a court under this part, the presiding judge or their designee may appoint a special master to secure court-ordered care for the respondent at the local government entitys cost. The presiding judge, or their designee, shall not make an order under this paragraph unless they have received five or more reports under paragraph (1) pertaining to the same local government entity within a one-year period.

(4)In determining the application of the remedies available under this section, the court shall consider whether there are any mitigating circumstances impairing the ability of the local government entity to fully comply with the requirements of this part, or with court orders issued under this part. The court may consider whether the local government entity is making a good faith effort to come into substantial compliance or is facing substantial undue hardships.

(c)Either the respondent or the county behavioral health agency may appeal an adverse court determination.

SEC. 11.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, including the Assisted Living Waiver program and the Home- and Community-based Services Waiver program.

(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.

(6)Upon the consent of the respondent and the entity or individual financially responsible for the services, additional services to support the recovery and stability of the respondent.

(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. 12.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, court-ordered evaluations pursuant to Article 2 (commencing with Section 5200) of Part 1, the continuum of adult housing options, 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, court-ordered evaluations pursuant to Article 2 (commencing with Section 5200) of Part 1, 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.

(e)(1)It is the intent of the Legislature to identify appropriate metrics of success to measure counties successfully implementing the CARE Act, known as CARE Champions, Act and counties experiencing challenges with implementation who need technical support and training, known as CARE ICU (Improvement and Coordination Unit) Counties. training. The agency shall annually release a list identifying overperforming and underperforming counties to receive additional support through the CARE ICU. counties, known as CARE Champions. For underperforming counties, the agency shall annually provide a written notice identifying areas of concern and opportunities for improvement.

(2)Nothing in this subdivision shall alter any existing obligations to produce records under the California Public Records Act (Division 10 (commencing with Section 7920.000) of Title 1 of the Government Code).

SEC. 13.Section 5985 of the Welfare and Institutions Code is amended to read:5985.

(a)(1)The department shall develop, in consultation with county behavioral health agencies, other relevant state or local government entities, disability rights groups, individuals with lived experience, families, counsel, racial justice experts, and other appropriate stakeholders, an annual CARE Act report. The department shall post the annual report on its internet website.

(2)The department, in consultation with county behavioral health agencies and courts, shall specify the length of time that data on former participants shall be reported pursuant to subdivision (e), which shall be a minimum of 12 months after completion of and a maximum of 36 months following engagement in CARE Act elective services, a CARE agreement, or CARE plan. The same data shall be tracked for cases involving dismissed respondents.

(3)For the purposes of this section, the following definitions shall apply:

(A)Former participant means an individual who enters into CARE Act elective services, a CARE agreement, or a CARE plan, but who has either graduated from CARE, or for whom CARE Act proceedings were dismissed or terminated. Counties shall not be responsible for reporting on any individual who is privately insured or who no longer resides in California.

(B)Active participants means an individual who is an elective client, or who has a CARE plan or CARE agreement.

(b)County behavioral health agencies and any other state or local governmental entity, as identified by the department, shall provide data related to the CARE Act participants, services, and supports to the department. The department shall determine the data measures and specifications, and shall publish them via guidance issues pursuant to subdivision (b) of Section 5984.

(c)Each county behavioral health department and any other state and local governmental entity, as identified by the department, shall provide the required data to the department, in a format and frequency as directed by the department.

(d)(1)In consultation with the Judicial Council, the department shall develop an annual reporting schedule for the submission of CARE Act data from the trial courts.

(2)Data from the trial courts shall be submitted to the Judicial Council, which shall aggregate the data and submit it to the department consistent with the reporting schedule developed pursuant to paragraph (1).

(3)On an annual basis to be determined by the Judicial Council and consistent with the annual reporting schedule developed pursuant to paragraph (1), the trial courts shall report to the Judicial Council the following data related to CARE Act petitions:

(A)The number of petitions submitted pursuant to Section 5975.

(B)The number of initial appearance hearings on the petition held pursuant to paragraph (3) of subdivision (a) of Section 5977.

(C)The number of petitions submitted electronically.

(D)The number of declarations of licensed behavioral health professionals pursuant to the form prepared by the Judicial Council submitted electronically.

(E)The total number of hearings held pursuant to this part.

(F)The total number of CARE plans ordered and CARE agreements approved.

(G)The total number of court petitions dismissed, as reported by the Judicial Council.

(H)The number of petitions that were dismissed for failure to make a prima facie showing.

(I)The total number of evaluations ordered by the CARE court pursuant to Article 2 (commencing with Section 5200) of Chapter 2 of Part 1.

(e)The annual report shall include process measures to examine the scope of impact and monitor the performance of CARE Act model implementation. The measures and reporting requirements shall be developed by the department in consultation with county behavioral health agencies. The report shall include trial court petition data pursuant to paragraph (3) of subdivision (d) and, to the extent administrative data is available, all of the following information compiled from county behavioral health departments and courts:

(1)The demographics of all participants, including, but not limited to, the age, sex, race, ethnicity, disability, languages spoken, sexual orientation, gender identity, housing status, veteran status, immigration status, health coverage status, including Medi-Cal enrollment status, information related to CARE criteria outlined in Section 5972, and county of residence.

(2)The petitioners relationship to the CARE Act respondent as defined in Section 5974.

(3)The services and supports ordered, the services and supports provided, and the services and supports ordered but not provided to all active and former participants.

(4)The housing placements of all active and former participants. Placements include, but are not limited to, transition to a higher level of care, independent living in the persons own house or apartment, community-based housing, community-based housing with services, shelter, and no housing.

(5)Treatments continued and terminated of all active and former participants.

(6)Substance use disorder rates and rates of treatment among all active and former participants.

(7)Detentions and other Lanterman-Petris-Short Act involvement for all active and former participants.

(8)Criminal justice involvement of all active and former participants.

(9)Deaths among all active and former participants, along with the cause of death.

(10)Type, format, and frequency of outreach and engagement activities provided by a county behavioral health agency to engage an individual who is the subject of a referral or petition, including interactions about the individuals eligible or likely to be eligible and outcomes of these efforts.

(11)In consultation with the department and county behavioral health departments, the number, rates, and trends of contacts made to the county behavioral health agency about individuals eligible or likely to be eligible for the CARE process, including outcomes of those contacts.

(12)The number, rates, and source of referrals to county behavioral health departments, including, but not limited to, referrals resulting in a petition or reason for not filing a petition, length of time from referral to outcome, and services provided for those engaged voluntarily without a petition.

(13)The number, rates, and trends of petitions resulting in dismissal and hearings.

(14)Information on petition dispositions, including, but not limited to, disposition recommendations and the number of days from petition to disposition.

(15)The number, rates, and trends of supporters.

(16)The number, rates, and trends of approved CARE agreements.

(17)The number, rates, and trends of ordered and completed CARE plans.

(18)Statistics on the services and supports, including court orders for stabilizing medications.

(19)The rates of adherence to medication.

(20)The number, rates, and trends of psychiatric advance directives created for active participants.

(21)The number, rates, and trends of developed graduation plans.

(22)Outcome measures to assess the effectiveness of the CARE Act model, such as improvement in housing status, including gaining and maintaining housing, reductions in emergency department visits and inpatient hospitalizations, reductions in law enforcement encounters and incarceration, reductions in involuntary treatment and conservatorship, and reductions in substance use.

(23)A health equity assessment of the CARE Act to identify demographic disparities based on demographic data in paragraph (1), and to inform disparity reduction efforts.

(24)Data regarding referrals made pursuant to Section 5978.1, as part of the CARE Act.

(25)The number of individuals who were referred to a full-service partnership program pursuant to Part 4.1 (commencing with Section 5887) after dismissal or termination from the CARE Act program.

(26)The number of individuals who were enrolled in a full-service partnership program postreferral.

(27)The number of individuals who maintained enrollment in a full-service partnership program for a year following the date of enrollment.

(f)(1)The report shall include, at a minimum, information on the effectiveness of the CARE Act model in improving outcomes and reducing disparities, homelessness, criminal justice involvement, conservatorships, and hospitalization of participants. The annual report shall include process measures to examine the scope of impact and monitor the performance of CARE Act model implementation, such as the number and source of petitions filed for CARE Court; the number, rates, and trends of petitions resulting in dismissal and hearings; the number, rates, and trends of supporters; the number, rates, and trends of voluntary CARE agreements; the number, rates, and trends of ordered and completed CARE plans; the services and supports included in CARE plans, including court orders for stabilizing medications; the rates of adherence to medication; the number, rates, and trends of psychiatric advance directives; and the number, rates, and trends of developed graduation plans. The report shall include outcome measures to assess the effectiveness of the CARE Act model, such as improvement in housing status, including gaining and maintaining housing; reductions in emergency department visits and inpatient hospitalizations; reductions in law enforcement encounters and incarceration; reductions in involuntary treatment and conservatorship; and reductions in substance use. The annual report shall examine these data through the lens of health equity to identify racial, ethnic, and other demographic disparities and inform disparity reduction efforts.

(2)Data shall be stratified by age, sex, race, ethnicity, languages spoken, disability, sexual orientation, gender identity, housing status, veteran status, immigration status, health coverage source, and county, to the extent statistically relevant data is available.

(g)The outcomes shall be presented to relevant state oversight bodies, including, but not limited to, the California Interagency Council on Homelessness.

(h)(1)Beginning in 2026, the department shall include in its annual CARE Act report quantitative, deidentified information concerning the operation of this part.

(2)Based on information provided to the department in a form and manner specified by the department, in consultation with the Judicial Council and county behavioral health departments, in accordance with subdivision (b) of Section 5984, the report shall include all of the following information, aggregated by county, compiled from county behavioral health departments, courts, and the department, depending on the source:

(A)The number of contacts to the county behavioral health department about individuals eligible or likely to be eligible for the CARE process, including outcome of contacts.

(B)The number of CARE petitions filed with the superior court.

(C)The petitioner type for each petition filed with the superior court.

(D)Disposition of each petition filed with the superior court.

(E)The number of days between filing each petition and the petitions disposition.

(F)Demographic information of each CARE Act participant or potentially eligible CARE Act participant, including, but not limited to, age, sex, race, ethnicity, disability, languages spoken, sexual orientation, gender identity, housing status, veteran status, immigration status, health coverage status, including Medi-Cal enrollment status, information related to CARE criteria outlined in Section 5972, and county of residence, to the extent administrative data is available and statistically relevant.

(G)The number of referrals of individuals in conservatorship proceedings made pursuant to subdivision (a) of Section 5978, including the disposition of each referral.

(H)The number of referrals made pursuant to Section 5978.1, including the disposition of each referral.

(i)Information publicly released or published pursuant to this part shall not contain data that may lead to the identification of participants or petitioners or information that would otherwise allow an individual to link the published information to a specific person. Data published by the department shall be deidentified in compliance with Section 164.514(a) and (b) of Title 45 of the Code of Federal Regulations.

SEC. 14.Section 5988 is added to the Welfare and Institutions Code, to read:5988.

(a)There is established within the California Health and Human Services Agency the position of CARE Court Ombudsperson. The CARE Court Ombudsperson shall be appointed by the Governor and confirmed by the Senate.

(b)The CARE Court Ombudsperson shall oversee and investigate complaints by petitioners, respondents, participants, and governmental agencies involved in the CARE process, including, but not limited to, judges, county staff, first responders, and city staff.

(c)The CARE Court Ombudsperson shall be considered an administrative agency for purposes of paragraph (2) of subdivision (b) of Section 56.10 of the Civil Code. Disclosures to the CARE Court Ombudsperson shall comply with the requirements of paragraph (1) of subdivision (d) and subdivision (e) of Section 164.512 of Title 45 of the Code of Federal Regulations.

(d)Failure to provide information on a timely basis may be referred by the CARE Court Ombudsperson to the director for proceedings pursuant to Section 10744.

SEC. 15.

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. 16.

Any section of Senate Bill 989, Senate Bill 1016, and Senate Bill 1242 enacted by the Legislature during the 2026 calendar year that takes effect on or before January 1, 2027, and that amends, adds, repeals and adds, or repeals a section that is amended or added by this act, shall prevail over this act, whether that act is enacted before, or subsequent to, the enactment of this act.

The people of the State of California do enact as follows:SECTION 1.Section 5361 of the Welfare and Institutions Code is amended to read:5361.

SEC. 2.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.

(c)CARE process means the court and related proceedings to implement the CARE Act.

(d)Clinically stabilized in ongoing voluntary treatment means both of the following:

(1)The persons condition is stable and not deteriorating.

(f)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.

(g)Court-ordered evaluation means an evaluation ordered by a superior court pursuant to Section 5977.1.

(h)Department means the State Department of Health Care Services.

(j)High utilization of emergency services means utilizing 911 or emergency department services 20 times or more in a 12-month period.(k)

(j)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.

(l)

(m)

(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) to (4), inclusive.

(n)

(m)Licensed behavioral health professional means any 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.

(3)A licensed advance practice provider who renders behavioral health services in accordance with a physician assistant practice agreement.(4)A licensed nurse practitioner specializing in behavioral health.(o)

(p)

(q)

(r)

(q)Respondent means the person who is the subject of the petition for the CARE process.

(s)

(t)

SEC. 3.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)(1)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, or bipolar I disorder with psychotic features, except psychosis related to current intoxication, as defined in the most current version of the Diagnostic and Statistical Manual of Mental Disorders.(2)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.(3)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 has not been clinically stabilized in ongoing voluntary treatment for more than 90 days prior to the CARE court filing. High utilization of emergency services is strong evidence that a person is not clinically stabilized. Current enrollment in a full-service partnership program pursuant to Part 4.1 (commencing with Section 5887) does not automatically exclude a person from the CARE Act program.(d)Supervision is required to allow for services and supports to be effective and to prevent substantial deterioration or relapse.(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. 4.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 director or chief of a governmental agency offering first responder services, as described in subdivision (f), or their designee.(h)The public guardian or public conservator, or their designee, of the county in which the respondent resides or is found.(i)The director of a county behavioral health agency, or their designee, of the county in which the respondent resides or is found.(j)The director of county adult protective services, or their designee, of the county in which the respondent resides or is found.(k)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. (l)The judge of a tribal court located in California before which the respondent has appeared within the previous 30 days, or the judges designee.(m)The respondent.SEC. 5.SEC. 3.Section 5975 of the Welfare and Institutions Code is amended to read:5975.

(a)The name of the respondent and, if known, the respondents address.

(b)The petitioners relationship to the respondent.

(c)Facts that support the petitioners assertion that the respondent meets the CARE criteria in Section 5972.

(d)Any of the following:

(1)An affidavit of a licensed behavioral health professional, including, for purposes of this section only, nurse practitioners as defined in Section 2835 of the Business and Professions Code and physician assistants as defined in subdivision (d) of Section 3501 of the Business and Professions Code, stating that the licensed behavioral health professional or their designee has examined the respondent within 270 120 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 270 120 days 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.

(2)Evidence that the respondent was detained for a minimum of two intensive treatments pursuant to Article 4 (commencing with Section 5250) of Chapter 2 of Part 1, the most recent one within the previous 270 120 days. Evidence may include, but is not limited to, documentary evidence from the facility where the respondent was detained, or a signed declaration from the petitioner if the petitioner had personal knowledge of the detentions.

(3)Evidence that the respondent was detained for a minimum of two involuntary holds pursuant to Section 5150 in the previous six months. 120 days.

(4)Evidence that the respondent was referred to a full-service partnership program more than once, but was not enrolled due to inability or unwillingness to engage. engage in the previous 120 days.

SEC. 6.SEC. 4.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.

(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.

(1)The respondent.

(2)The county behavioral health agency, the public guardian, or the public conservator.

SEC. 7.SEC. 5.Section 5977 of the Welfare and Institutions Code is amended to read:5977.

(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.

(I)A determination as to whether the respondent meets, or is likely to meet, the criteria for the CARE process. As part of this determination, the county behavioral health agency or their designee may recommend that the respondent be considered for alternative treatment, including, but not limited to, an assisted outpatient treatment program under Article 9 (commencing with Section 5345) of Chapter 2 of Part 1, or a grave disability evaluation pursuant to Article 2 (commencing with Section 5200) of Chapter 2 of Part 1, if the agency or their designee determines the respondent requires a higher level of care than the CARE process, but may not determine that the respondent requires a higher level of care if the respondent meets, or is likely to meet, the criteria for the CARE process.

(II)The efforts, timeframes of efforts, and outcome of efforts made by county and noncounty providers 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, documenting how past attempts in the prior 120 days failed, cognitive deficits, and unmet mental health needs were assessed.

(v)The evaluation may be provided to the petitioner and the licensed behavioral health professional who submitted a declaration pursuant to form prepared by Judicial Council.

(B)If the petitioner is a person described in subdivision (a) or (b) of Section 5974 and is not 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, file a written report with the court as soon as practicable, but within 30 court days, and provide notice to the respondent and petitioner that a report has been ordered. Parties shall complete the investigation with appropriate urgency. 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. As part of this determination, the county behavioral health agency or their designee may recommend that the respondent be considered for alternative treatment, including, but not limited to, assisted outpatient treatment program under Article 9 (commencing with Section 5345) of Chapter 2 of Part 1, or a grave disability evaluation pursuant to Article 2 (commencing with Section 5200) of Chapter 2 of Part 1, if the agency or their designee determines the respondent requires a higher level of care than the CARE process, but may not determine that the respondent requires a higher level of care if 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 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.

(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, that the individual has stabilized, and that the individual has enrolled in voluntary behavioral health treatment, the court may shall dismiss the matter. Where there is a documented history of failed attempts with voluntary engagement, a CARE agreement may still be appropriate.