Amended
IN
Assembly
March 02, 2021 |
Introduced by Assembly Member Ramos |
January 11, 2021 |
The California Community Care Facilities Act (act), among other things, licenses and regulates children’s crisis residential programs and requires a children’s crisis residential program to meet specified requirements that include obtaining and
having in good standing a residential mental health program approval that is available to children under the California Work Opportunity and Responsibility to Kids (CalWORKs) program. The CalWORKs program generally provides cash assistance and other benefits to qualified low-income families and individuals and specifically authorizes a children’s crisis residential program to provide a child, under specified conditions, with short-term crisis stabilization, therapeutic intervention, and specialized programming with the goal of supporting the rapid and successful transition of the child back to the community.
This bill would amend the act and related CalWORKs provisions to instead use the term “children’s crisis psychiatric treatment facility.” The bill would delete the requirement for residential mental health program approval and instead require a children’s crisis psychiatric residential treatment facility to obtain and have in good standing a certification that
conforms to federal Medicaid psychiatric residential treatment facility requirements and makes the facility eligible for federal reimbursement as a Medicaid psychiatric residential treatment facility, as specified.
(21)“Children’s crisis psychiatric residential treatment facility” means a facility licensed by the department as a short-term residential therapeutic program pursuant to Section 1562.02 and approved by the State Department of Health Care Services, or a county mental health plan to which the State Department of Health Care Services has delegated approval authority, to operate a children’s crisis psychiatric residential treatment facility certified pursuant to Section 11462.011 of the Welfare and Institutions Code, to serve children experiencing mental health crises as an alternative to psychiatric
hospitalization.
(a)The department may license a short-term residential therapeutic program operating as a children’s crisis psychiatric residential treatment facility to this chapter. A children’s crisis psychiatric residential treatment facility shall meet all of the following requirements:
(1)If the program serves both children who are not experiencing mental health crises and children who are experiencing mental health crises, the program shall have an identifiable and physically separate unit for those children who are
experiencing mental health crises. The separate unit shall be indicated on the short-term residential therapeutic program’s license.
(2)If the short-term residential therapeutic program operates on a single site both a program that serves children who are not experiencing mental health crises and a separate program that only serves children experiencing mental health crises, the short-term residential therapeutic program shall obtain, and have in good standing, a mental health program approval, as described in Section 11462.01 of the Welfare and Institutions Code, and a children’s crisis psychiatric residential treatment facility certification, as described in Section 11462.011 of the Welfare and Institutions Code, both of which are issued by the State Department of Health Care Services, or by a county mental health plan to which the
department has delegated approval authority, that conforms to federal Medicaid psychiatric residential treatment facility (PRTF) requirements and is, therefore, eligible for federal reimbursement as a PRTF. The department may revoke a program’s license pursuant to Section 1550 for a program’s failure to maintain the mental health program approval.
(3)If the short-term residential therapeutic program serves only children experiencing a mental health crisis, the short-term residential therapeutic program shall obtain, and have in good standing, a children’s crisis psychiatric residential treatment facility certification, as described in Section 11462.011 of the Welfare and Institutions Code, which is issued by the State Department of Health Care Services or by a county mental health plan to which the department has
delegated approval authority. The short-term residential therapeutic program shall obtain a mental health program approval before operating as a children’s crisis psychiatric residential treatment facility. The department may revoke a program’s license pursuant to Section 1550 for a program’s failure to maintain the mental health program approval.
(4)Comply with all applicable licensing standards for a short-term residential therapeutic program, unless the department specifies otherwise in regulations that comply with applicable statutory requirements related to licensure.
(b)Contingent upon an appropriation in the annual Budget Act for these purposes, the department shall begin implementation of this section no later than July 1, 2018, and shall commence the licensing
process for children’s crisis
psychiatric residential treatment facilities no later than January 1, 2022.
(a)The department shall establish regulations for short-term residential therapeutic programs that are operated as children’s crisis psychiatric residential treatment facilities. At a minimum, the regulations shall include all of the following:
(1)Therapeutic programming shall be provided seven days a week, including weekends and holidays, with sufficient mental health professional and paraprofessional staff, as required by the facility’s children’s crisis residential mental health program approval in accordance with the standards and procedures
established pursuant to Section 11462.011 of the Welfare and Institutions Code, to maintain an appropriate treatment setting and services, based on individual children’s needs.
(2)The program shall be staffed with sufficient personnel to accept children 24 hours per day, seven days a week and to admit children, at a minimum, from 7 a.m. to 11 p.m., seven days a week, 365 days per year. The program shall be sufficiently staffed to discharge children, as appropriate, seven days a week, 365 days per year.
(3)Facilities shall be limited to fewer than 16 beds, with at least 50 percent of those beds in single-occupancy rooms.
(4)Facilities shall include ample physical space for accommodating individuals who
provide daily emotional and physical supports to each child and for integrating family members into the day-to-day care of the youth.
(5)The program shall collaborate with each child’s existing mental health team, if applicable, child and family team, if applicable, and other formal and natural supports within 24 hours of intake and throughout the course of care and treatment as appropriate.
(6)The program shall create and assist with the implementation of a plan for transitioning each admitted child from the program to their home and community, including the establishment of a mental health or child and family team if there is not one already.
(b)The program shall annually provide the department with all of
the following data as it pertains to children in foster care and children not in foster care in conjunction with its application for licensure renewal:
(1)Age and gender of clients served.
(2)Duration of stay.
(3)Professional classification of staff and contracted staff.
(4)Type of placement the client was discharged to.
(a)The department may license a short-term residential therapeutic program operating as a children’s crisis residential program pursuant to this chapter. A children’s crisis residential program shall meet all of the following requirements:
(1)If the program serves both children who are not experiencing mental health crises and children who are experiencing mental health crises, the program shall have an identifiable and physically separate unit for those children who are experiencing mental health crises. The separate unit shall be indicated on the short-term residential therapeutic program’s license.
(2)If the
short-term residential therapeutic program operates on a single site both a program that serves children who are not experiencing mental health crises and a separate program that only serves children experiencing mental health crises, the short-term residential therapeutic program shall obtain, and have in good standing, a mental health program approval, as described in Section 11462.01 of the Welfare and Institutions Code, and a children’s crisis residential mental health program approval, as described in Section 11462.011 of the Welfare and Institutions Code, both of which are issued by the State Department of Health Care Services, or by a county mental health plan to which the department has delegated approval authority. The short-term residential therapeutic program shall obtain a mental health program approval before operating as a children’s crisis residential program. The department may
revoke a program’s license pursuant to Section 1550 for a program’s failure to maintain the mental health program approval.
(3)If the short-term residential therapeutic program serves only children experiencing a mental health crisis, the short-term residential therapeutic program shall obtain, and have in good standing, a children’s crisis residential mental health program approval, as described in Section 11462.011 of the Welfare and Institutions Code, which is issued by the State Department of Health Care Services or by a county mental health plan to which the department has delegated approval authority. The short-term residential therapeutic program shall obtain a mental health program approval before operating as a children’s crisis residential program. The department may revoke a program’s license pursuant to Section 1550 for a
program’s failure to maintain the mental health program approval.
(4)Comply with all applicable licensing standards for a short-term residential therapeutic program, unless the department specifies otherwise in regulations that comply with applicable statutory requirements related to licensure.
(b)Contingent upon an appropriation in the annual Budget Act for these purposes, the department shall begin implementation of this section no later than July 1, 2018, and shall commence the licensing process for children’s crisis residential programs no later than January 1, 2019.
(a)The department shall establish regulations for short-term residential therapeutic programs that are operated as children’s crisis residential programs. At a minimum, the regulations shall include all of the following:
(1)Therapeutic programming shall be provided seven days a week, including weekends and holidays, with sufficient mental health professional and paraprofessional staff, as required by the facility’s children’s crisis residential mental health program approval in
accordance with the standards and procedures established pursuant to Section 11462.011 of the Welfare and Institutions Code, to maintain an appropriate treatment setting and services, based on individual children’s needs.
(2)The program shall be staffed with sufficient personnel to accept children 24 hours per day, seven days a week and to admit children, at a minimum, from 7 a.m. to 11 p.m., seven days a week, 365 days per year. The program shall be sufficiently staffed to discharge children, as appropriate, seven days a week, 365 days per year.
(3)Facilities shall be limited to fewer than 16 beds, with at least 50 percent of those beds in single-occupancy rooms.
(4)Facilities shall include ample
physical space for accommodating individuals who provide daily emotional and physical supports to each child and for integrating family members into the day-to-day care of the youth.
(5)The program shall collaborate with each child’s existing mental health team, if applicable, child and family team, if applicable, and other formal and natural supports within 24 hours of intake and throughout the course of care and treatment as appropriate.
(6)The program shall create and assist with the implementation of a plan for transitioning each admitted child from the program to his or her home and community, including the establishment of a mental health or child and family team if there is not one already.
(b)The
program shall annually provide the department with all of the following data as it pertains to children in foster care and children not in foster care in conjunction with its application for licensure renewal:
(1)Age and gender of clients served.
(2)Duration of stay.
(3)Professional classification of staff and contracted staff.
(4)Type of placement the client was discharged to.
(c)(1)A short-term residential therapeutic program that is operating as a children’s crisis psychiatric residential treatment facility, as defined in Section 1502 of the Health and Safety Code, may accept for admission any child who meets all of the requirements set forth in paragraph (3) of subdivision (c) of Section 11462.011.
(2)The primary function of a children’s crisis
psychiatric residential treatment facility is to provide short-term crisis stabilization, therapeutic intervention, and specialized programming in an unlocked, staff-secured setting with a high degree of supervision and structure and the goal of supporting the rapid and successful transition of the child back to the community.
(d)
(e)
(f)
(g)
(h)
(i)
(j)
(k)
(l)
(m)
(n)
(o)
(a)The State Department of Health Care Services shall, in consultation with the Department of Managed Health Care, the State Department of Social Services, the County Behavioral Health Directors Association of California, the County Welfare Directors Association of California, the Chief Probation Officers of California, provider representatives, and other relevant stakeholders, establish program standards and procedures for oversight, enforcement, and issuance of children’s crisis psychiatric residential treatment facility certifications, including provisional certifications that are effective for a period of less than one year. The State Department of Health Care Services shall also establish due process protections related
to the children’s crisis residential mental health program approval process.
(b)The State Department of Health Care Services shall, in collaboration with the department, the County Behavioral Health Directors Association of California, provider representatives, and other relevant stakeholders, provide guidance to counties for the provision of children’s crisis residential services, including funding for children who are Medi-Cal beneficiaries and who are admitted to a children’s crisis psychiatric residential treatment facility. This subdivision shall only be implemented to the extent that any necessary federal approvals are obtained and federal financial participation is available and is not otherwise jeopardized.
(c)(1)The children’s crisis psychiatric residential
treatment facility shall be used only as a diversion to admittance to a psychiatric hospital.
(2)(A)The length of the initial authorization for admission to a children’s crisis psychiatric residential treatment facility shall be limited to 10 consecutive days.
(B)If a determination is made by a health care professional that a children’s crisis psychiatric residential treatment facility is medically necessary and is the appropriate continued level of care, either of the following shall occur:
(i)In the case of a Medi-Cal beneficiary, the children’s crisis
psychiatric residential treatment facility shall notify the county mental health plan authorizing those services before extending the length of stay beyond 10 consecutive days.
(ii)In the case of non-Medi-Cal beneficiaries, reauthorizations for admission shall be obtained using the process established by the entity providing coverage.
(C)With the exception of clause (ii) of subparagraph (B), this paragraph shall be implemented only to the extent that any necessary federal approvals are obtained and the State Department of Health Care Services determines, in its sole discretion, that federal financial participation is not jeopardized.
(3)A children’s crisis psychiatric residential treatment facility may
accept for admission any child who meets all of the following requirements:
(A)The child is referred by a parent or guardian, physician, or licensed mental health professional, or by the representative of a public or private entity, including, but not limited to, the county probation agency or child welfare services agency with responsibility for the placement of a child in foster care, that has the right to make these decisions on behalf of a child who is in mental health crisis.
(B)The child is under 19, 20, or 21 years of age, depending on a program’s licensing requirements.
(C)The child has a serious behavioral health disorder.
(D)The child requires a
24-hours-a-day, seven-days-a-week, staff-secured, unlocked treatment setting.
(d)A children’s crisis psychiatric residential treatment facility certification issued by the State Department of Health Care Services, or a county mental health plan to which the department has delegated approval authority, shall be a condition of continued licensure for a short-term residential therapeutic program operating as a children’s crisis psychiatric residential treatment facility.
(e)The State Department of Health Care Services, or a county mental health plan to which the department has delegated approval authority, may enforce the children’s crisis
psychiatric residential treatment facility certification standards by taking any of the following actions against a noncompliant children’s crisis psychiatric residential treatment facility:
(1)Suspend or revoke a children’s crisispsychiatric residential treatment facility certification.
(2)Impose monetary penalties.
(3)Place a children’s crisis psychiatric residential treatment facility on probation.
(4)Require a children’s crisis psychiatric residential treatment facility to prepare and comply with a corrective action plan.
(f)The State Department of Health Care
Services, or a county mental health plan to which the department has delegated approval
authority, shall provide a children’s crisis psychiatric residential treatment facility with due process protections when taking any of the actions described in subdivision (e).
(g)Contingent upon an appropriation in the annual Budget Act for these purposes, the department shall begin implementation of this section no later than July 1, 2018, and shall commence the operation of the approval process for children’s crisispsychiatric residential treatment facility no later than January 1,- 2022.
(a)The State Department of Health Care Services shall, in consultation with the Department of Managed Health Care, the State Department of Social Services, the County Behavioral Health Directors Association of California, the County Welfare Directors Association of California, the Chief Probation Officers of California, provider representatives, and other relevant stakeholders, establish program standards and procedures for oversight, enforcement, and issuance of children’s crisis residential mental health program approvals, including provisional approvals that are effective for a period of less than one year. The State Department of Health Care Services shall also establish due process protections related to the children’s crisis
residential mental health program approval process.
(b)The State Department of Health Care Services shall, in collaboration with the department, the County Behavioral Health Directors Association of California, provider representatives, and other relevant stakeholders, provide guidance to counties for the provision of children’s crisis residential services, including funding for children who are Medi-Cal beneficiaries and who are admitted to a children’s crisis residential program. This subdivision shall only be implemented to the extent that any necessary federal approvals are obtained and federal financial participation is available and is not otherwise jeopardized.
(c)(1)The children’s crisis residential program shall be used only as a diversion to
admittance to a psychiatric hospital.
(2)(A)The length of the initial authorization for admission to a children’s crisis residential program shall be limited to 10 consecutive days.
(B)If a determination is made by a health care professional that a children’s crisis residential program is medically necessary and is the appropriate continued level of care, either of the following shall occur:
(i)In the case of a Medi-Cal beneficiary, the children’s crisis residential program shall notify the county mental health plan authorizing those services before extending the length of stay beyond 10 consecutive days.
(ii)In the case of
non-Medi-Cal beneficiaries, reauthorizations for admission shall be obtained using the process established by the entity providing coverage.
(C)With the exception of clause (ii) of subparagraph (B), this paragraph shall be implemented only to the extent that any necessary federal approvals are obtained and the State Department of Health Care Services determines, in its sole discretion, that federal financial participation is not jeopardized.
(3)A children’s crisis residential program may accept for admission any child who meets all of the following requirements:
(A)The child is referred by a parent or guardian, physician, or licensed mental health professional, or by the representative of a public or private entity,
including, but not limited to, the county probation agency or child welfare services agency with responsibility for the placement of a child in foster care, that has the right to make these decisions on behalf of a child who is in mental health crisis.
(B)The child is under 19, 20, or 21 years of age, depending on a program’s licensing requirements.
(C)The child has a serious behavioral health disorder.
(D)The child requires a 24-hours-a-day, seven-days-a-week, staff-secured, unlocked treatment setting.
(d)A children’s crisis residential mental health program approval issued by the State Department of Health Care Services, or a county mental health plan
to which the department has delegated approval authority, shall be a condition of continued licensure for a short-term residential therapeutic program operating as a children’s crisis residential program.
(e)The State Department of Health Care Services, or a county mental health plan to which the department has delegated approval authority, may enforce the children’s crisis residential mental health program approval standards by taking any of the following actions against a noncompliant children’s crisis residential program:
(1)Suspend or revoke a children’s crisis residential mental health program approval.
(2)Impose monetary penalties.
(3)Place a
children’s crisis residential mental health program on probation.
(4)Require a children’s crisis residential mental health program to prepare and comply with a corrective action plan.
(f)The State Department of Health Care Services, or a county mental health plan to which the department has delegated approval authority, shall provide a children’s crisis residential mental health program with due process protections when taking any of the actions described in subdivision (e).
(g)Contingent upon an appropriation in the annual Budget Act for these purposes, the department shall begin implementation of this section no later than July 1, 2018, and shall commence the operation of the approval process for children’s crisis
residential mental health program approvals no later than January 1, 2019.
Notwithstanding
The