Bill Text: CA SB1238 | 2023-2024 | Regular Session | Amended
NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Health facilities.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Passed) 2024-09-27 - Chaptered by Secretary of State. Chapter 644, Statutes of 2024. [SB1238 Detail]
Download: California-2023-SB1238-Amended.html
SEC. 4. Section 5401 is added to the Welfare and Institutions Code , to read: 5401.
Section 5675.5 is added to the Welfare and Institutions Code, to read:
Bill Title: Health facilities.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Passed) 2024-09-27 - Chaptered by Secretary of State. Chapter 644, Statutes of 2024. [SB1238 Detail]
Download: California-2023-SB1238-Amended.html
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Amended
IN
Senate
April 01, 2024 |
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Amended
IN
Senate
March 18, 2024 |
CALIFORNIA LEGISLATURE—
2023–2024 REGULAR SESSION
Senate Bill
No. 1238
| Introduced by Senator Eggman |
February 15, 2024 |
An act to amend Section 1250.2 of the Health and Safety Code, to amend Section 5008 of, and to add Sections 5152.5, 5401, 5152.5 and 5675.5 to, the Welfare and Institutions Code, relating to behavioral health.
LEGISLATIVE COUNSEL'S DIGEST
SB 1238, as amended, Eggman.
Lanterman-Petris-Short Act. Act: designated facilities.
Under existing law, the Lanterman-Petris-Short Act, Act (act), when a person, as a result of a mental health disorder, is a danger to others or to themselves, or gravely disabled, as defined, the person may, upon probable cause, be taken into custody for a period of up to 72 hours for assessment, evaluation, and crisis intervention, or placement for evaluation and treatment in a facility designated by the county for evaluation and treatment and approved by the State Department of Health Care Services. The act also authorizes a conservator of the person, of the estate, or of both, to be appointed for a person who is gravely disabled as a result of a mental health disorder. Existing law requires the Director of Health Care Services to administer the act and to adopt rules, regulations, and standards as necessary.
This bill would authorize the State
Department of Health Care Services to implement, interpret, or make specific the act, in whole or in part, by means of information notices, provider bulletins, or other similar instructions, without taking any further regulatory action.
Existing law defines the above-described designated facility as a facility that is licensed or certified as a mental health treatment facility or a hospital by the State Department of Public Health, and may include, but is not limited to, a licensed psychiatric hospital, a licensed psychiatric health facility, and a certified crisis stabilization unit.
This bill would expand the definition of a “facility designated by the county for evaluation and treatment” or “designated facility” by specifying that it may also include a facility that both (1) has appropriate services, personnel, and security to safely treat individuals being held involuntarily and (2) is licensed or certified as a skilled nursing facility, mental health rehabilitation center, social rehabilitation facility, or as a facility capable of providing
treatment at American Society of Addiction Medicine levels of care 3.7 to 4.0, inclusive. The bill would authorize a county to designate a facility for the purpose of providing one or more specified treatments required by the act.
Existing regulations prohibit a licensed psychiatric health facility or licensed mental health rehabilitation center from admitting an individual who is diagnosed only with a substance use disorder.
This bill would require the State Department of Health Care Services to authorize licensed psychiatric health facilities and licensed mental health rehabilitation centers to admit those individuals an individual who is diagnosed
only with a severe substance use disorder, as defined.
Existing law requires a person admitted to a facility for 72-hour treatment and evaluation to receive an evaluation as soon as possible after the person is admitted and to receive whatever treatment and care the person’s condition requires for the full period that they are held, as specified.
This bill would require the State Department of Health Care Services to ensure that designated facilities are reimbursed for evaluation and treatment of stand-alone substance use disorders at reimbursement rates equivalent to those provided for evaluation and treatment of mental health disorders.
This bill would authorize the State Department of Health Care Services to implement, interpret, or make specific these provisions, in whole
or in part, by means of information notices, provider bulletins, or other similar instructions, without taking any further regulatory action.
Digest Key
Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: NOBill Text
The people of the State of California do enact as follows:
SECTION 1.
Section 1250.2 of the Health and Safety Code is amended to read:1250.2.
(a) (1) As defined in Section 1250, “health facility” includes a “psychiatric health facility,” defined to mean a health facility, licensed by the State Department of Health Care Services, that provides 24-hour inpatient care for people with mental health disorders or other persons described in Division 5 (commencing with Section 5000) or Division 6 (commencing with Section 6000) of the Welfare and Institutions Code. This care shall include, but not be limited to, the following basic services: psychiatry, clinical psychology, psychiatric nursing, social work, rehabilitation, drug administration, and appropriate food services for those persons whose physical health needs can be met in an affiliated hospital or in outpatient settings.(2) It is the intent of the Legislature that the psychiatric health facility shall provide a distinct type of service to psychiatric patients in a 24-hour acute inpatient setting. The State Department of Health Care Services shall require regular utilization reviews of admission and discharge criteria and lengths of stay in order to ensure that these patients are moved to less restrictive levels of care as soon as appropriate.
(b) (1) The State Department of Health Care Services may issue a special permit to a psychiatric health facility for it to provide structured outpatient services (commonly referred to as SOPS) consisting of morning, afternoon, or full daytime organized programs, not exceeding 10 hours, for acute daytime care for patients
admitted to the facility. This subdivision shall not be construed as requiring a psychiatric health facility to apply for a special permit to provide these alternative levels of care.
(2) The Legislature recognizes that, with access to structured outpatient services, as an alternative to 24-hour inpatient care, certain patients would be provided with effective intervention and less restrictive levels of care. The Legislature further recognizes that, for certain patients, the less restrictive levels of care eliminate the need for inpatient care, enable earlier discharge from inpatient care by providing a continuum of care with effective aftercare services, or reduce or prevent the need for a subsequent readmission to inpatient care.
(c) Any reference in any statute to Section 1250 of the
Health and Safety Code shall be deemed and construed to also be a reference to this section.
(d) Notwithstanding any other law, and to the extent consistent with federal law, a psychiatric health facility shall be eligible to participate in the medicare Medicare program under Title XVIII of the federal Social Security Act (42 U.S.C. Sec. 1395 et seq.), and the medicaid Medicaid program under Title XIX of the federal Social Security Act (42 U.S.C. Sec. 1396 et seq.), if all of the following conditions are met:
(1) The facility is a licensed facility.
(2) The facility is in compliance with all related statutes and regulations enforced by the State Department of Health Care Services, including regulations contained in Chapter 9 (commencing with Section 77001) of Division 5 of Title 22 of the California Code of Regulations.
(3) The facility meets the definitions and requirements contained in subdivisions (e) and (f) of Section 1861 of the federal Social Security Act (42 U.S.C. Sec. 1395x(e) and (f)), including the approval process specified in Section 1861(e)(7)(B) of the federal Social Security Act (42 U.S.C. Sec. 1395x(e)(7)(B)), which requires that the state agency responsible for licensing hospitals has ensured that the
facility meets licensing requirements.
(4) The facility meets the conditions of participation for hospitals pursuant to Part 482 of Title 42 of the Code of Federal Regulations.
(e) (1) The State Department of Health Care Services shall authorize licensed psychiatric health facilities to admit patients who are diagnosed only with a severe substance use disorder.
(2) For purposes of this subdivision, “severe substance use disorder” has the same meaning as defined
in Section 5008 of the Welfare and Institutions Code.
SEC. 2.
Section 5008 of the Welfare and Institutions Code is amended to read:5008.
Unless the context otherwise requires, the following definitions shall govern the construction of this part:(a) “Evaluation” consists of multidisciplinary professional analyses of a person’s medical, psychological, educational, social, financial, and legal conditions as may appear to constitute a problem. Persons providing evaluation services shall be properly qualified professionals and may be full-time employees of an agency providing face-to-face, which includes telehealth, evaluation services or may be part-time employees or may be employed on a contractual basis.
(b) “Court-ordered evaluation” means an evaluation ordered by a superior
court pursuant to Article 2 (commencing with Section 5200) of Chapter 2 or by a superior court pursuant to Article 3 (commencing with Section 5225) of Chapter 2.
(c) “Intensive treatment” consists of such hospital and other services as may be indicated. Intensive treatment shall be provided by properly qualified professionals and carried out in facilities qualifying for reimbursement under the California Medical Assistance Program (Medi-Cal) set forth in Chapter 7 (commencing with Section 14000) of Part 3 of Division 9, or under Title XVIII of the federal Social Security Act and regulations thereunder. Intensive treatment may be provided in hospitals of the United States government by properly qualified professionals. This part does not prohibit an intensive treatment facility from also providing 72-hour evaluation and treatment.
(d) “Referral” is referral of persons by each agency or facility
providing assessment, evaluation, crisis intervention, or treatment services to other agencies or individuals. The purpose of referral shall be to provide for continuity of care, and may include, but need not be limited to, informing the person of available services, making appointments on the person’s behalf, discussing the person’s problem with the agency or individual to which the person has been referred, appraising the outcome of referrals, and arranging for personal escort and transportation when necessary. Referral shall be considered complete when the agency or individual to whom the person has been referred accepts responsibility for providing the necessary services. All persons shall be advised of available precare services that prevent initial recourse to hospital treatment or aftercare services that support adjustment to community living following hospital treatment. These
services may be provided through county or city mental health departments, state hospitals under the jurisdiction of the
State Department of State Hospitals, regional centers under contract with the State Department of Developmental Services, or other public or private entities.
Each agency or facility providing evaluation services shall maintain a current and comprehensive file of all community services, both public and private. These files shall contain current agreements with agencies or individuals accepting referrals, as well as appraisals of the results of past referrals.
(e) “Crisis intervention” consists of an interview or series of interviews within a brief period of time, conducted by qualified professionals, and designed to alleviate personal or family situations that present a serious and imminent threat to the health or stability of the person or the family. The interview or interviews may
be conducted in the home of the person or family, or on an inpatient or outpatient basis with such therapy, or other services, as may be appropriate. The interview or interviews may include family members, significant support persons, providers, or other entities or individuals, as appropriate and as authorized by law. Crisis intervention may, as appropriate, include suicide prevention, psychiatric, welfare, psychological, legal, or other social services.
(f) “Prepetition screening” is a screening of all petitions for court-ordered evaluation as provided in Article 2 (commencing with Section 5200) of Chapter 2, consisting of a professional review of all petitions; an interview with the petitioner and, whenever possible, the person alleged, as a result of a mental health disorder, to be a danger to others, or to themselves, or to be gravely disabled,
to assess the problem and explain the petition; when indicated, efforts to persuade the person to receive, on a voluntary basis, comprehensive evaluation, crisis intervention, referral, and other services specified in this part.
(g) “Conservatorship investigation” means investigation by an agency appointed or designated by the governing body of cases in which conservatorship is recommended pursuant to Chapter 3 (commencing with Section 5350).
(h) (1) For purposes of Article 1 (commencing with Section 5150), Article 2 (commencing with Section 5200), Article 3 (commencing with Section 5225), and Article 4 (commencing with Section 5250) of Chapter 2, and for purposes of Chapter 3 (commencing with Section 5350), “gravely disabled” means any of the following, as
applicable:
(A) A condition in which a person, as a result of a mental health disorder, a severe substance use disorder, or a co-occurring mental health disorder and a severe substance use disorder, is unable to provide for their basic personal needs for food, clothing, shelter, personal safety, or necessary medical care.
(B) A condition in which a person has been found mentally incompetent under Section 1370 of the Penal Code and all of the following facts exist:
(i) The complaint, indictment, or information pending against the person at the time of commitment charges a felony involving death, great bodily harm, or a serious threat to the physical
well-being of another person.
(ii) There has been a finding of probable cause on a complaint pursuant to paragraph (2) of subdivision (a) of Section 1368.1 of the Penal Code, a preliminary examination pursuant to Section 859b of the Penal Code, or a grand jury indictment, and the complaint, indictment, or information has not been dismissed.
(iii) As a result of a mental health disorder, the person is unable to understand the nature and purpose of the proceedings taken against them and to assist counsel in the conduct of their defense in a rational manner.
(iv) The person represents a substantial danger of physical harm to others by reason of a mental disease, defect, or disorder.
(2) For purposes of Article 3 (commencing with Section 5225) and Article 4 (commencing with Section 5250), of Chapter 2, and for purposes of Chapter 3 (commencing with Section 5350), “gravely disabled” includes a condition in which a person, as a result of impairment by chronic alcoholism, is unable to provide for their basic personal needs for food, clothing, shelter, personal safety, or necessary medical care.
(3) The term “gravely disabled” does not include persons with intellectual disabilities by reason of that disability alone.
(4) A county, by adoption of a resolution of its governing body, may elect to defer implementation of the changes made to this section by Senate Bill 43 of the 2023–2024
2023–24 Regular Session of the Legislature until January 1, 2026.
(i) “Peace officer” means a duly sworn peace officer as that term is defined in Chapter 4.5 (commencing with Section 830) of Title 3 of Part 2 of the Penal Code who has completed the basic training course established by the Commission on Peace Officer Standards and Training, or any parole officer or probation officer specified in Section 830.5 of the Penal Code when acting in relation to cases for which the officer has a legally mandated responsibility.
(j) “Postcertification treatment” means an additional period of treatment pursuant to Article 6 (commencing with Section 5300) of Chapter 2.
(k) “Court,” unless
otherwise specified, means a court of record.
(l) “Antipsychotic medication” means any medication customarily prescribed for the treatment of symptoms of psychoses and other severe mental and emotional disorders.
(m) “Emergency” means a situation in which action to impose treatment over the person’s objection is immediately necessary for the preservation of life or the prevention of serious bodily harm to the patient or others, and it is impracticable to first gain consent. It is not necessary for harm to take place or become unavoidable prior to treatment.
(n) (1) “Designated facility” or “facility designated by the county for evaluation and treatment” means a facility that is licensed or
certified as a mental health treatment facility or a hospital, as defined in subdivision (a) or (b) of Section 1250 of the Health and Safety Code, by the State Department of Public Health, and may include, but is not limited to, a licensed psychiatric hospital, a licensed psychiatric health facility, and a certified crisis stabilization unit.
(2) “Designated facility” or “facility designated by the county for evaluation and treatment” may also include a facility that meets both of the following requirements:
(A) The facility has appropriate services, personnel, and security to safely treat individuals being held involuntarily.
(B) The facility is licensed or certified as any of the following:
(i) A facility licensed by the State Department of Health Care Services Public Health as a skilled nursing facility, as defined in subdivision (c) of Section 1250 of the Health and Safety Code.
(ii) A facility licensed by the State Department of Health Care Services as a mental health rehabilitation center pursuant to Section 5675.
(iii) A facility licensed or certified by the State Department of Public Health or the State Department of Health Care Services
as capable of providing treatment at American Society of Addiction Medicine levels of care 3.7 to 4.0, inclusive.
(iv) A facility licensed by the State Department of Social Services as a social rehabilitation facility, as defined in Section 1502 of the Health and Safety Code, with a mental health program certified by the State Department of Health Care Services.
(3) Nothing in this section shall be interpreted to preclude a mental health facility or substance use disorder facility from treating either mental health or severe substance use disorders as a primary condition if the facility is appropriate to provide those treatment
services.
(4) (A) A county may designate a facility for the purpose of providing one or more of the following services:
(i) Providing evaluation and treatment required by Article 1 (commencing with Section 5150) of Chapter 2.
(ii) Providing intensive treatment required by Article 4 (commencing with Section 5250) of Chapter 2.
(iii) Providing additional intensive treatment required by Article 4.5 (commencing with Section 5260) of Chapter 2.
(iv) Providing additional intensive treatment required by Article 4.7 (commencing with Section 5270.10) of Chapter 2.
(v) Providing postcertification treatment required by Article 6 (commencing with Section 5300) of Chapter 2.
(B) A county may designate a facility, as is
appropriate and based on capability, for the purpose of providing one or more types of treatment listed in subdivision (a) without designating the facility to provide all treatments.
(o) “Severe substance use disorder” means a diagnosed substance-related disorder that meets the diagnostic criteria of “severe” as defined in the most current version of the Diagnostic and Statistical Manual of Mental Disorders.
(p) “Personal safety” means the ability of one to survive safely in the community without involuntary detention or treatment pursuant to this part.
(q) “Necessary medical care” means care that a licensed health care practitioner, while operating within the scope of their practice, determines to be necessary to
prevent serious deterioration of an existing physical medical condition that, if left untreated, is likely to result in serious bodily injury as defined in Section 15610.67.
SEC. 3.
Section 5152.5 is added to the Welfare and Institutions Code, to read:5152.5.
The State Department of Health Care Services shall ensure that designated facilities are reimbursed for evaluation and treatment of stand-alone severe substance use disorders at reimbursement rates equivalent to those provided for evaluation and treatment of mental health disorders.Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may implement, interpret, or make specific this part, in whole or in part, by means of information notices, provider bulletins, or other similar instructions, without taking any further regulatory action.
SEC. 5.SEC. 4.
Section 5675.5 is added to the Welfare and Institutions Code, to read:5675.5.
(a) The State Department of Health Care Services shall authorize licensed mental health rehabilitation centers to admit clients who are diagnosed only with a severe substance use disorder.(b) For purposes of this section, “severe substance use disorder” has the same meaning as defined in Section 5008.
