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 10 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. osteopathy or a nurse practitioner.
(iii) A physician licensed to practice medicine or osteopathy or a nurse practitioner 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.
mental health professional who has a master’s degree in psychology, marriage and family therapy, social work, or counseling who has been certified by the state.
(B) The interdisciplinary team must also include one of the following:
(i)A psychiatric social worker.
(ii)
(i) A registered nurse
or licensed vocational nurse with specialized training in mental health or one year of experience in treating mentally ill individuals.
(iii)
(ii) 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.
(iii) A mental health professional who has a master’s degree in psychology, marriage and family therapy, social work, or counseling who has been certified by the state.