Bill Text: CA AB2317 | 2021-2022 | Regular Session | Introduced
NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Children’s psychiatric residential treatment facilities.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Passed) 2022-09-27 - Chaptered by Secretary of State - Chapter 589, Statutes of 2022. [AB2317 Detail]
Download: California-2021-AB2317-Introduced.html
Bill Title: Children’s psychiatric residential treatment facilities.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Passed) 2022-09-27 - Chaptered by Secretary of State - Chapter 589, Statutes of 2022. [AB2317 Detail]
Download: California-2021-AB2317-Introduced.html
CALIFORNIA LEGISLATURE—
2021–2022 REGULAR SESSION
Assembly Bill
No. 2317
| Introduced by Assembly Member Ramos |
February 16, 2022 |
An act to add Section 1250.10 to the Health and Safety Code, relating to care facilities.
LEGISLATIVE COUNSEL'S DIGEST
AB 2317, as introduced, Ramos.
Children’s psychiatric residential treatment facilities.
Existing law, the California Community Care Facilities Act, provides for the licensing and regulation of community care facilities, including a children’s crisis residential program, by the State Department of Social Services, and defines a children’s crisis residential program to mean a facility licensed as a short-term residential therapeutic program and approved by the State Department of Health Care Services, or a county mental health plan, to operate a children’s crisis residential mental health program to serve children experiencing mental health crises as an alternative to psychiatric hospitalization.
Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services, including specified mental health and substance
use disorder services. The Medi-Cal program is, in part, governed and funded by federal Medicaid provisions. Existing federal Medicaid regulations provide for inpatient psychiatric services for individuals under 21 years of age in psychiatric facilities, as prescribed.
The bill would require the State Department of Health Care Services to license and establish regulations for psychiatric residential treatment facilities, which the bill would define as a licensed residential facility operated by a public agency or private organization that provides psychiatric services, as prescribed under the Medicaid regulations, to individuals under 21 years of age, in an inpatient setting. The bill would require the department’s regulations and certifications to be consistent with applicable Medicaid regulations governing psychiatric residential treatment facilities, in order to maximize federal financial participation, as specified. The bill would include inpatient psychiatric
services to individuals under 21 years of age provided in a licensed children’s crisis psychiatric residential treatment facility as mental health services provided under the Medi-Cal program.
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.
The Legislature finds and declares all of the following:(a) There is an urgent need to provide more alternatives to hospitals for children and youth experiencing mental health crises.
(b) The problems are especially acute for children and youth who may have to wait for days for a hospital bed and who may be transported, without a parent, to the nearest facility hundreds of miles away.
(c) Under Early and Periodic Screening, Diagnostic and Treatment and California’s Medicaid state plan, all Medi-Cal beneficiaries under 21 years of age must receive the inpatient psychiatric under 21 benefit (psych under 21) so
long as these services are determined to be medically necessary.
(d) California must establish psychiatric residential treatment facilities (PRTFs), which the Centers for Medicare and Medicaid Services (CMS) defines as the least restrictive setting for those in need of the psych under 21 benefit, to ensure that children who are determined to meet state and federal medical necessity requirements for the Medicaid psych under 21 benefit are cared for.
(e) A PRTF is any nonhospital facility with a provider agreement with a state Medicaid agency to provide the inpatient services benefit to Medicaid-eligible individuals under 21 years of age (psych under 21 benefit). Without PRTFs, children in Medi-Cal determined under state and federal laws to meet medical necessity requirements for the psych under 21 benefit will continue to be served in psychiatric hospitals and psychiatric units if
there are no other options for these children, according to CMS.
(f) Today, if beds in a psychiatric hospital or unit are unavailable for a child needing this level of care, children often linger in emergency rooms or other facilities with limited capacity to fully address the critical needs of these children. Suicide rates for children 10 to 18 years of age, inclusive, increased by 20 percent in 2020 compared to 2019.
(g) PRTFs must meet rigorous federal regulatory requirements to ensure the rights of youth are protected, including:
(1) For admission into a PRTF, an interdisciplinary team, including a physician must certify all of the following:
(A) Programs and services available in the community do not meet the treatment needs of the youth.
(B) Proper treatment of the youth’s psychiatric condition requires services on an inpatient basis under the direction of a physician.
(C) The services can reasonably be expected to improve the youth’s condition or prevent further regression so that the services will no longer be needed.
(2) Inpatient psychiatric services in a PRTF must involve “active treatment,” which means implementation of a professionally developed and supervised individual plan of care that is both of the following:
(A) Developed and implemented no later than 14 days after admission.
(B) Designed to achieve the youth’s discharge from inpatient status (step-down service) at the earliest possible time or as a diversion to
admittance to a psychiatric hospital.
(C) The individual plan of care must be based on a diagnostic evaluation that includes examination of the medical, psychosocial, and behavioral aspects of the youth’s situation, developed by a treatment team in consultation with the youth and their parents, legal guardians, or others in whose care they will be released after discharge, and include discharge plans and after care resources such as community services to ensure continuity of care with the youth’s family, school, and community upon discharge.
(3) The treatment team must be an interdisciplinary team that must be capable of assessing the beneficiary’s immediate and long-range therapeutic needs, developmental priorities, and personal strengths and liabilities, assessing the potential resources of the beneficiary’s family, setting treatment objectives, and prescribing therapeutic
modalities to achieve the plan’s objectives.
(A) The interdisciplinary team must include, at a minimum, one of the following combinations:
(i) A board eligible or board-certified psychiatrist.
(ii) A clinical psychologist who has a doctoral degree and a physician licensed to practice medicine or osteopathy.
(iii) A physician licensed to practice medicine or osteopathy with specialized training and experience in the diagnosis and treatment of mental diseases, and a psychologist who has a master’s degree in clinical psychology or who has been certified by the state.
(B) The interdisciplinary team must also include one of the following:
(i) A psychiatric social worker.
(ii) A registered nurse with specialized training in mental health or one year of experience in treating mentally ill individuals.
(iii) An occupational therapist who is licensed, and who has specialized training or one year of experience in treating mentally ill individuals.
(iv) A psychologist who has a master’s degree in clinical psychology or who has been certified by the state.
SEC. 2.
Section 1250.10 is added to the Health and Safety Code, to read:1250.10.
(a) “Psychiatric residential treatment facility” means a health facility licensed by the State Department of Health Care Services, that is operated by a public agency or private nonprofit organization that provides psychiatric services, as described in Subpart D (commencing with Section 441.150) of Title 42 of the Code of Federal Regulations, to individuals under 21 years of age, in an inpatient setting. All references to “the department” in this section mean the State Department of Health Care Services.(1) A nonprofit organization that operates a psychiatric residential treatment facility shall be accredited by the Joint Commission on Accreditation of Healthcare Organizations, the Commission on Accreditation of Rehabilitation Facilities, the
Council on Accreditation, or any other accrediting organization with comparable standards that is recognized by the state.
(2) It is the intent of the Legislature that the psychiatric residential treatment facility shall provide a distinct type of service to psychiatric patients under 21 years of age in a nonhospital 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) Any reference in any statute to Section 1250 shall be deemed and construed to also be a reference to this section.
(c) The department shall, in collaboration with the State Department of Social Services, the County Behavioral Health Directors
Association of California, provider representatives, children’s rights advocates, disability rights advocates, and other relevant stakeholders, establish regulations for psychiatric residential treatment facilities. At a minimum, the regulations shall include all of the following:
(1) Therapeutic programming shall be provided seven days per week, including weekends and holidays, with sufficient mental health professional and paraprofessional staff to maintain an appropriate treatment setting and services, based on individual client’s needs.
(2) The established number of beds in the facility shall be consistent with the individual treatment needs of the clients served at the facility.
(3) The length of stay shall conform to the federal Medicaid requirements for a psychiatric residential treatment facility and shall be
consistent with the individual plan of care developed by the interdisciplinary team. The length of the initial authorization for admission shall be limited to 10 consecutive days. If a determination is made by a health care professional that a psychiatric residential treatment facility is medically necessary and is the appropriate level of care, either of the following shall occur:
(A) In the case of a Medi-Cal beneficiary, the psychiatric residential treatment facility shall notify the county mental health plan authorizing those services before extending the length of stay beyond 10 consecutive days.
(B) In the case of non-Medi-Cal beneficiaries, reauthorizations for admission shall be obtained using the process established by the entity providing coverage.
(4) Section 6552 of the Welfare and Institutions Code shall
apply to a youth declared to be within the jurisdiction of the juvenile court and receiving treatment from a psychiatric residential treatment facility.
(5) Facilities shall include ample physical space for accommodating individuals who provide daily emotional and physical supports to each client and for integrating family members into the day-to-day care of the youth.
(6) The facility shall collaborate with each client’s existing mental health team, if applicable, child and family team, if applicable, and other formal and natural supports within three business days of intake and throughout the course of care and treatment, as appropriate.
(7) The facility shall create and assist with the implementation of a plan for transitioning each admitted child from the program to their home and community.
(d) Notwithstanding any other law, and to the extent consistent with federal law, a psychiatric residential treatment facility shall be eligible to participate in the medicare program under Title XVIII of the federal Social Security Act (42 U.S.C. Sec. 1395 et seq.), and the 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 licensed.
(2) The facility is in compliance with all related statutes and regulations enforced by the State Department of Health Care Services, including regulations established pursuant to subdivision (c).
(3) The facility meets the requirements contained in Subpart D (commencing with Section 441.151) of Title 42 the Code of
Federal Regulations, which ensures protections for patients, including that the psychiatric residential treatment facility is the least restrictive setting, mandates standards of care to ensure comprehensive needs are addressed, and ensures that patients are discharged at the earliest possible time.
(e) The facility shall annually provide the department with all of the following data 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.
