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AB-2025 Mental illness and substance use disorder: restorative care program: pilot projects.(2019-2020)

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Date Published: 06/04/2020 09:00 PM
AB2025:v97#DOCUMENT

Amended  IN  Assembly  June 04, 2020
Amended  IN  Assembly  May 04, 2020

CALIFORNIA LEGISLATURE— 2019–2020 REGULAR SESSION

Assembly Bill
No. 2025


Introduced by Assembly Member Gipson

January 30, 2020


An act to amend Section 5768 of, and to add and repeal Section 5675.3 of, the Welfare and Institutions Code, relating to public social services, and declaring the urgency thereof, to take effect immediately.


LEGISLATIVE COUNSEL'S DIGEST


AB 2025, as amended, Gipson. Mental illness and substance use disorder: restorative care program: pilot projects.
Existing law, the Bronzan-McCorquodale Act, governs the organization and financing of community mental health services for persons with mental disorders in every county through locally administered and locally controlled community mental health programs. Existing law authorizes the State Department of Health Care Services, in its discretion, to permit new programs to be developed and implemented without complying with licensure requirements established pursuant to existing state law, except for requirements relating to fire and life safety of persons with mental illness.
This bill would also include within that exception exception, requirements relating to fire and life safety of persons with alcohol or substance use disorder. The bill would, subject to the above licensing provisions, authorize the County of Los Angeles to establish a pilot project for up to 6 years to develop a restorative care program for community-based care and treatment that addresses the interrelated and complex needs of individuals suffering from mental illness and substance use disorder, along with other medical comorbidities, and homelessness. The bill would authorize the department to require the County of Los Angeles to remit a specified fee in lieu of licensure or certification fees for a facility or program licensed or certified by the department as part of the pilot project. The bill would require the department, in conjunction with the Los Angeles County Director of Mental Health, to report to the Legislature within 2 years of the commencement of the operation of the initial facility regarding the progress and cost-effectiveness demonstrated by the pilot project. Under the bill, authorization for the pilot projects would be repealed as of January 1, 2026.
This bill would declare that it is to take effect immediately as an urgency statute.
Vote: 2/3   Appropriation: NO   Fiscal Committee: YES   Local Program: NO  

The people of the State of California do enact as follows:


SECTION 1.

 The Legislature finds and declares all of the following:
(a) There is an overrepresentation of individuals in our communities who suffer from untreated severe persistent mental illness (SPMI) and, in many cases, comorbid substance use disorders (SUD). Instead of engaging in and receiving treatment within the community, many of these individuals languish in the streets or are inappropriately routed into the criminal justice system. Proper treatment is neither possible nor appropriate in either of these settings. Furthermore, incarcerated individuals suffering from SPMI or SUD tend to stay in jail longer as a result of their health conditions and, upon release, are at much higher risk of returning to jail or experiencing episodes of homelessness.
(b) Establishing up to five restorative care program pilot projects in the County of Los Angeles will provide a continuum of care with fully integrated residential, intensive outpatient, supportive, and community reentry services for the counties’ county’s most vulnerable populations, including those struggling with SPMI, SUD, homelessness, and those who are involved in the criminal justice system. The pilot projects will allow these individuals to enter into and transition across appropriate levels of health care while receiving critical social services, including peer support, probationary supervision, and workforce development. The goal of the pilot projects is to help individuals successfully reintegrate into their communities with ongoing outpatient services that break the cycle of incarceration and homelessness.
(c) The County of Los Angeles and other counties continue to experience a significant shortage of various types of treatment beds and intensive services for those suffering from SPMI or SUD. Timely treatment of these conditions through the creation of a restorative care program pilot project will help divert these individuals from the streets and jails.

SEC. 2.

 Section 5675.3 is added to the Welfare and Institutions Code, to read:

5675.3.
 (a) Subject to the requirements of Section 5768, the County of Los Angeles may establish a pilot project for up to six years to develop a restorative care program for the provision of community-based care and treatment that addresses the interrelated and complex needs of those individuals suffering from mental illness and substance use disorder, along with other medical comorbidities, and homelessness. The program shall include, but not be limited to, services normally provided by mental health rehabilitation centers, psychiatric health facilities, crisis residential treatment programs, and nonmedical residential alcohol and other drug treatment facilities.
(b) The department, in consultation with the County of Los Angeles, may establish, by emergency regulations, the standards for the pilot project and shall review the pilot project in accordance with subdivision (b) of Section 5768.
(c) In lieu of licensure or certification fees for a facility or program licensed or certified by the department as part of the pilot project, the department may require the County of Los Angeles to remit a fee in an amount not to exceed the reasonable administrative costs to the department associated with developing, overseeing, and evaluating the pilot program.

(c)

(d) (1) The department, in conjunction with the Los Angeles County Director of Mental Health, shall report to the Legislature within two years of the commencement of operation of the initial facility authorized pursuant to this section regarding the progress and cost-effectiveness demonstrated by the pilot project. The report shall evaluate whether the pilot project is effective based on clinical indicators and is successful in preventing future placement of clients in jail, state hospitals, or other institutional long-term facilities, and shall report whether the cost of care in the pilot facility is less than the cost of care in jail, state hospitals, or other institutional long-term facility options. The report shall include, but not be limited to, an evaluation of the selected method and the effectiveness of the pilot project staffing, number of clients served, types of services provided, and an analysis of the effectiveness of the pilot project at meeting all of the following objectives:
(A) Improved reintegration of individuals with mental illness or substance use disorder in the community with the need of outpatient care.
(B) Reduced incarceration and homelessness for individuals with mental illness or substance use disorder.
(C) Reduced length of hospital stays for individuals with mental illness or substance use disorder.
(2) The pilot project shall be deemed successful if it demonstrates both of the following:
(A) The cost of the pilot project is no greater than public expenditures for providing alternative services to the clients served by the pilot project.
(B) The benefits to the clients, as described in this subdivision, are improved by the pilot project.
(3) The report required by this subdivision shall be submitted in compliance with Section 9795 of the Government Code.

(d)

(e) The pilot project shall be subject to existing department regulations applicable to licensed facilities that the department identifies and deems necessary for fire and life safety of persons with mental illness or alcohol or substance use disorder.

(e)

(f) (1) Notwithstanding any other law, clients served by the pilot project shall have all of the protections and rights guaranteed to mental health and substance use disorder patients.
(2) Clients shall have access to the services of a county patients’ rights advocate as provided in Chapter 6.2 (commencing with Section 5500) of Part 1.

(f)

(g) For purposes of this section, “restorative care program” means a program that provides a continuum of clinical care with integrated urgent care, residential, inpatient and outpatient behavioral health treatment, and recovery and supportive services designed to prevent those with serious mental illness, substance use disorder, or a combination of those conditions from experiencing incarceration, homelessness, or unnecessarily extended institutional care, and to promote successful reintegration into the community.

(g)

(h) This section shall remain in effect only until January 1, 2026, and as of that date is repealed.

SEC. 3.

 Section 5768 of the Welfare and Institutions Code is amended to read:

5768.
 (a) Notwithstanding any other law, except as to requirements relating to fire and life safety of persons with mental illness or alcohol or substance use disorder, the State Department of Health Care Services, in its discretion, may permit new programs to be developed and implemented without complying with licensure requirements established pursuant to existing state law.
(b) A program developed and implemented pursuant to subdivision (a) shall be reviewed at least once each six months, as determined by the department.
(c) The department may establish appropriate licensing requirements for these new programs upon a determination that the programs should be continued.
(d) Within six years, a program shall require a licensure category if it is to be continued. However, if any agency other than the department is responsible for developing a licensure category and fails to do so within the six years, the program may continue to be developed and implemented pursuant to subdivisions (a) and (b) until the time that the licensure category is established.
(e) (1) A nongovernmental entity proposing a program shall submit a program application and plan to the local mental health director that describes at least all of the following components: clinical treatment programs, activity programs, administrative policies and procedures, admissions, discharge planning, health records content, health records service, interdisciplinary treatment teams, client empowerment, patient rights, pharmaceutical services, program space requirements, psychiatric and psychological services, rehabilitation services, restraint and seclusion, space, supplies, equipment, and staffing standards. If the local mental health director determines that the application and plan are consistent with local needs and satisfactorily address the above components, the director may approve the application and plan and forward them to the department.
(2) Upon the department’s approval, the local mental health director shall implement the program and shall be responsible for regular program oversight and monitoring. The department shall be notified in writing of the outcome of each review of the program by the local mental health director, or the director’s designee, for compliance with program requirements. The department shall retain ultimate responsibility for approving the method for review of each program, and the authority for determining the appropriateness of the local program’s oversight and monitoring activities.
(f) Governmental entities proposing a program shall submit a program application and plan to the department that describes at least the components described in subdivision (e). Upon approval, the department shall be responsible for program oversight and monitoring.
(g) Implementation of a program shall be contingent upon the department’s approval, and the department may reject applications or require modifications as it deems necessary. The department shall respond to each proposal within 90 days of receipt.
(h) The department shall submit an evaluation to the Legislature of all pilot projects authorized pursuant to this section within five years of the commencement of operation of the pilot project, determining the effectiveness of that program or facility, or both, based on, but not limited to, changes in clinical indicators with respect to client functions.

SEC. 4.

 This act is an urgency statute necessary for the immediate preservation of the public peace, health, or safety within the meaning of Article IV of the California Constitution and shall go into immediate effect. The facts constituting the necessity are:
There exists a significant shortage of the various types of treatment beds for individuals with serious mental illness and substance use disorder. In order to provide for the expeditious correction of this condition and to provide for the diversion of these individuals from the streets and jails as soon as possible, it is necessary that this act take effect immediately.