Bill Text: CA AB459 | 2023-2024 | Regular Session | Amended

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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Bill Title: Peace officers: Attorney General: reports.

Spectrum: Partisan Bill (Democrat 2-0)

Status: (Engrossed) 2024-08-15 - In committee: Held under submission. [AB459 Detail]

Download: California-2023-AB459-Amended.html

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Amended  IN  Assembly  March 16, 2023

CALIFORNIA LEGISLATURE— 2023–2024 REGULAR SESSION

Assembly Bill

No. 459

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Introduced by Assembly Member Haney

February 06, 2023

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An act to amend Section 5600.4 of add Chapter 3.7 (commencing with Section 5740) to Part 2 of Division 5 of the Welfare and Institutions Code, relating to behavioral health.

LEGISLATIVE COUNSEL'S DIGEST

AB 459, as amended, Haney. Behavioral health. The Behavioral Health Rights Act.

Existing law, the Bronzan-McCorquodale Act, contains provisions governing the operation 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 further provides that, to the extent resources are available, community mental health services should be organized to provide an array of treatment options in specified areas, including, among others, precrisis and crisis services and case management.

This bill, the Behavioral Health Rights Act, would enumerate rights for people seeking or receiving behavioral health care in California, including a person’s right to receive recovery-oriented and culturally appropriate care from a licensed, certified, or qualified mental health or substance use professional of their choosing, the right to appropriate housing, and a person’s right to be guaranteed the protection of the confidentiality of their relationship with their mental health and substance abuse professional, as specified. The bill would guarantee behavioral health services for Californians, including intensive case management, peer support services, and supportive housing services, provided by their county behavioral health department or public or private health plan, based on specific standards of care.

Existing law, the Mental Health Services Act (MHSA), an initiative measure enacted by the voters as Proposition 63 in the November 2, 2004, statewide general election, establishes the continuously appropriated Mental Health Services Fund to fund various county mental health programs, including prevention and early intervention programs.

This bill would require the California Health and Human Services Agency, by July 1, 2026, to establish the California Behavioral Health Outcomes and Accountability Review (CBH-OAR), consisting of performance indicators, county self-assessments, and county and health plan improvement plans, to facilitate an accountability system that fosters continuous quality improvement in county and commercial behavioral health services and in the collection and dissemination of best practices in service delivery by the agency. The bill would require the agency to convene a workgroup, as specified, to establish a workplan by which the CBH-OAR shall be conducted. The bill would require the agency to establish specific process measures and uniform elements for the county and health plan improvement plan updates. The bill would require the agency to report to the Legislature, as specified. By imposing new requirements on counties, this bill would impose a state-mandated local program.

This bill would require the agency to request the University of California to enter into a contract with the state to provide specific services, including preparing an analysis of how data pertaining to the provision of behavioral health services and client outcomes collected by the counties and health plans may be used to demonstrate the impact of services on life outcomes. The bill would require the analysis to be delivered to the agency, the Legislature, and the workgroup on or before July 1, 2026.

The bill would require the agency to establish a risk corridor structure, as specified, that applies to all health payers who provide behavioral health services in California. The bill would require those health payers to spend at least 20% of their provider health payments, to be adjusted annually, on behavioral health services.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that, if the Commission on State Mandates determines that the bill contains costs mandated by the state, reimbursement for those costs shall be made pursuant to the statutory provisions noted above.

This bill would make a technical, nonsubstantive change to those provisions.

Digest Key

Vote: MAJORITY   Appropriation: NO   Fiscal Committee: NOYES   Local Program: NOYES  

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Bill Text

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

SECTION 1.

 The Legislature finds and declares all of the following:

(a) Mental illnesses and substance use disorders do not diminish a person’s right to fully participate in all aspects of society, yet many people with mental illnesses and substance use disorders have been precluded from doing so because of a lack of accessible and high-quality health care, services, and supports.

(b) Historically, individuals living with mental illness and substance use disorders have been subjected to inhumane treatment, including institutionalization for indefinite periods of time where they were forced to undergo cruel and unusual treatments that were more traumatizing than recuperative.

(c) Despite progress to deinstitutionalize our behavioral health system and invest in community behavioral health alternatives, in 2023, the 60th anniversary of the Community Mental Health Act and the 15th anniversary of the Mental Health Parity and Addiction Equity Act, federal and state governments have failed to properly invest in a full continuum of behavioral services, resulting in an inaccessible, paternalistic, and discriminatory system of care.

(d) While limited entitlements to services have been established for some subpopulations of individuals with mental illnesses and substance use disorders, failure to meaningfully measure the impact of care, enforce these entitlements, and invest the necessary resources in the services has resulted in these limited entitlements rarely being realized.

(e) Despite the disease burden for individuals with mental illnesses and substance use disorders being significantly higher on average than for individuals with physical health diagnoses, Medi-Cal and health plans spend significantly less on behavioral health services than physical health services, which results in low penetration rates and poor outcomes.

(f) Studies have documented that, due to this lack of accessible care, people with mental illnesses and substance use disorders, as a group, occupy an inferior status in our society and are severely disadvantaged physically, socially, vocationally, economically, and educationally.

(g) The state’s goals are to ensure access to high-quality care, services, and supports is available to individuals with mental illnesses and substance use disorders when they need it and for as long as they need it and to ensure equality of opportunity, full participation, independent living, and economic self-sufficiency for those individuals.

(h) It is the intent of the Legislature to do all of the following:

(1) Provide a clear and comprehensive mandatory minimum set of services that are universally accessible to all Californians in need of behavioral health care.

(2) Ensure these minimum services are high quality, culturally competent, equitable, recovery- and resiliency-focused, and have the effect of improving quality of life outcomes for Californians with mental illnesses and substance use disorders.

(3) Fulfill the vision of this act to ensure high-quality care for all by collecting and disseminating relevant data, enforcing the provision of these services, and establishing necessary investments into these services.

SEC. 2.

 Chapter 3.7 (commencing with Section 5740) is added to Part 2 of Division 5 of the Welfare and Institutions Code, to read:

CHAPTER  3.7. Behavioral Health Rights Act

5740.

 This chapter shall be known, and may be cited, as the Behavioral Health Rights Act.

5741.

 A person seeking or receiving behavioral health care in California has all of the following rights:

(a) The right to live in a safe, healthy, and comfortable home that supports an individual’s mental health and substance use challenges. This includes, but is not limited to, affordable housing, temporary housing, adult residential facilities, permanent supportive housing, financial assistance to keep an individual in their current home or housing services, or other services needed to obtain or retain housing.

(b) (1) The right to be provided information from their purchasing entity, such as an insurer, third-party payer, public purchaser, or county provided service, describing the nature and extent of behavioral health treatment benefits available to the individual.

(2) This information shall describe the availability of services, procedures for accessing services, process for complaints, and appeal rights.

(3) The information shall be presented clearly in writing with language the individual can understand.

(c) The right to receive recovery-oriented and culturally appropriate care from a licensed, certified, or qualified mental health or substance use professional of their choosing.

(1) This right allows an individual to be placed in the least restrictive setting possible, regardless of age, physical health, mental health, sexual orientation, and gender identity and expression.

(2) To ensure an individual is making an informed decision about appropriate care, this right includes the ability to receive full information on the education and training of the treating professionals, treatment options, the risks and benefits of a particular treatment option, and cost implications of the services provided.

(3) If medication is used, the risks and benefits of medication shall be explained in a way a person can understand, including, but not limited to, how the medication may interact with other medications, food, or underlying health conditions.

(d) The right to receive benefits for behavioral health treatment on the same basis as any other illness, with the same copayments, lifetime benefits, and catastrophic coverage in insurer, third-party payer, or public purchaser health plans.

(e) (1) The right to treatment review processes that are fair and valid and the right to be guaranteed that a review of their behavioral health treatment will involve a professional having the training, credentials, or licensure to provide the treatment in the jurisdiction in which it will be provided.

(2) The reviewer shall not have a financial interest in the decision and is subject to the requirements in subdivision (f) on confidentiality.

(f) (1) The right to be guaranteed the protection of the confidentiality of their relationship with their mental health and substance abuse professional, except when laws or ethics dictate otherwise.

(2) A disclosure to another party shall be time limited and made with the full written, informed consent of the individual to whom the information relates.

(3) An individual need not disclose confidential, privileged, or other information other than diagnosis, prognosis, type of treatment, time and length of treatment, and cost.

(4) An entity receiving information for the purposes of benefits determination, a public agency receiving information for health care planning, or an organization with a legitimate right to information shall maintain clinical information in confidence with the same rigor and be subject to the same penalties for violation as is the direct provider of care.

(5) (A) Information technology shall be used for data transmission, storage, or management only with methodologies that remove individual identifying information and ensure the protection of the individual’s privacy.

(B) Information shall not be transferred, sold, or otherwise used except as specified in this paragraph.

(g) The right to continue receiving mental health treatment when their placement changes, including, but not limited to, when a person is moved to a different county, treatment facility, housing service, or other treatment provider.

(h) The right to learn about the methods an individual can use to submit complaints or grievances regarding care by the treating professional or entity to that person’s or entity’s regulatory board, professional association, or oversight body.

(i) (1) The right to hold treating professionals, systems, and entities accountable and liable to the individual for a violation of these rights or injuries caused by gross incompetence or negligence on the part of the professional or treating entity.

(2) The treating professional shall advocate for the individual, document necessity of care for the individual, and advise the individual of options if payment authorization is denied.

(3) Payers and other third parties may be held accountable and liable to an individual for an injury caused by gross incompetence or negligence or by their clinically unjustified decisions.

5742.

 (a) All Californians in need of behavioral health services are entitled to behavioral health services that shall be provided by their county behavioral health department or public or private health plan based on the generally accepted standards of care described in subdivision (b). These behavioral health services shall include, but are not limited to, all of the following:

(1) Community-based services including outreach and engagement services.

(2) Outpatient and intensive outpatient services, including individual therapy, group therapy, family therapy, and coordinated specialty care.

(3) Intensive case management.

(4) Peer support services.

(5) Intensive home- and community-based services, including wrap-around services, full-service partnerships, and assertive community treatment.

(6) Supportive housing services.

(7) Supportive employment services.

(8) Short-term residential settings, including crisis residential services.

(9) Partial hospitalization.

(10) Placement in a psychiatric health facility.

(11) Inpatient psychiatric hospitalization.

(12) Placement in an institute for mental disease.

(13) Crisis services, including crisis counseling, mobile crisis teams, and crisis receiving and stabilization services.

(14) Placement in a sobering center.

(15) Detoxification services.

(16) Medically assisted treatment.

(b) All Californians in need of behavioral health services are entitled to receive the services provided in subdivision (a) upon determination of medical necessity based on current generally accepted standards of mental health and substance use disorder care, including all of the following:

(1) For a primary substance use disorder diagnosis in adolescents and adults, the Treatment Criteria for Addictive, Substance-Related, and Co-Occurring Conditions by the American Society of Addiction Medicine.

(2) For a primary mental health diagnosis in adults 19 years of age and older, Level of Care Utilization System by the American Association for Community Psychiatry.

(3) For a primary mental health diagnosis in children 6 to 18 years of age, inclusive, the Child and Adolescent Level of Care/Service Intensity Utilization System by the American Association for Community Psychiatry and the American Academy of Child and Adolescent Psychiatry.

(4) For a primary mental health diagnosis in children five years of age and younger, Early Child Service Intensity Instrument by the American Academy of Child and Adolescent Psychiatry.

(5) For an individual without a primary mental health or substance use disorder diagnosis, determination processes consistent with existing requirements in the state’s Medi-Cal program, including, but not limited to, designated scores on assessment tools based on adverse childhood experiences and the existing No Wrong Door System for access to Medi-Cal behavioral health services.

(c) This section does not relieve a county or Medi-Cal-managed health plan of its obligation to provide early and periodic screening, diagnosis, and treatment consistent with the requirements of Subchapter XIX (commencing with Section 1396) of Chapter 7 of Title 42 of the United States Code.

(d) (1) This section does not relieve a health plan of its obligation to provide for services otherwise required by Sections 1374.72 and 1374.721 of the Health and Safety Code or Section 10144.52 of the Insurance Code.

(2) This section does not conflict with existing requirements of the Medi-Cal programs.

(e) This section does not prohibit county behavioral health departments or health plans from providing or arranging for additional behavioral health services.

(f) Services guaranteed in this section shall be provided for or arranged in accordance with timely access requirements in Sections 1342.2, 1367.03, and 1367.031 of the Health and Safety Code, Sections 10133.53 and 10133.54 of the Insurance Code, and Section 14197.

5743.

 (a) (1) The California Health and Human Services Agency shall establish, by July 1, 2026, the California Behavioral Health Outcomes and Accountability Review (CBH-OAR) to facilitate an accountability system that fosters continuous quality improvement in county and commercial behavioral health services and in the collection and dissemination by the agency of best practices in service delivery. The CBH-OAR shall cover county recipients and shall include the programmatic elements that each county and health plan offers as part of its behavioral health care service array, and shall consist of performance indicators, including specific processes and outcome measures, a county and health plan system needs assessment process, and a county and health plan system improvement plan.

(2) For purposes of this section, “behavioral health services” includes mental health and substance use disorder services being provided by or arranged by either of the following:

(A) A county behavioral health agency funded through county general funds, 1991 Realignment and 2011 Realignment funds, federal Substance Abuse and Mental Health Services Administration grants, Mental Health Services Act funds, and other sources of local, state, or federal funding dedicated to county behavioral health services.

(B) Health plans, including both public and private health plans.

(b) (1) (A) (i) On or before October 1, 2024, the agency shall convene a workgroup comprised of representatives from the all of the following:

(I) The State Department of Health Care Services.

(II) The Mental Health Services Oversight and Accountability Commission.

(III) The Department of Managed Health Care.

(IV) The Department of Insurance.

(V) The University of California.

(VI) County behavioral health agencies.

(VII) Health plans.

(VIII) Legislative staff.

(IX) Interested behavioral health advocacy and research organizations.

(X) Consumers.

(XI) Organizations that represent county behavioral health agencies and county boards of supervisors.

(XII) Nonprofit community-based organizations.

(XIII) Researchers.

(XIV) Other entities or individuals that the agency deems necessary.

(ii) The workgroup shall establish a workplan by which the CBH-OAR shall be conducted.

(B) The agency shall report annually to the Senate Budget Subcommittee on Health and Human Services and the Assembly Budget Subcommittee on Health and Human Services during the budget process with an update on the schedule for, development of, and future changes to, the CBH-OAR.

(2) In establishing the work plan, the workgroup shall, at minimum, do all of the following:

(A) Consider existing performance indicators being measured.

(B) Consider or develop additional, alternative, or additional and alternative performance indicators to be measured.

(C) Develop uniform elements of the county and health plan system needs assessment process and the county and health plan system improvement plans.

(D) Develop timelines for implementation.

(E) Make recommendations for reducing the existing services data reporting burden.

(F) Make recommendations for financial incentives to counties for achievement on performance measures.

(G) Analyze the county and state workload associated with implementation of the requirements of this section.

(3) The workgroup shall develop the uniform elements for the county and health plan system improvement plans required in subparagraph (C) of paragraph (2). The agency, in consultation with the workgroup, shall develop the uniform elements of the updates to those plans as required pursuant to subparagraph (C) of paragraph (2).

(4) On or after July 1, 2027, the workgroup may, at the discretion of the agency, be disbanded or incorporated into existing advisory bodies.

(c) (1) The CBH-OAR shall consist of the following three components: performance indicators, including specific processes and outcome measures, a county and health plan system needs assessment process, and a county and health plan system improvement plan.

(2) (A) (i) The CBH-OAR performance indicators shall include both process and outcome measures. These measures shall be established to provide baseline and ongoing information about how the state, counties, and health plans are performing over time and to inform and guide each county behavioral health agency’s and health plan’s system needs assessment process and system improvement plan.

(ii) Process measures shall include measures of participant engagement, service delivery, and participation. Specific process measures shall be established by the agency, in consultation with the workgroup, and may include measures of engagement as shown by improvement in program participation, timeliness of service provision, rates of utilization of program components, and referrals and utilization of services.

(iii) If the University of California enters into the contract described in subdivision (f), outcome measures shall be determined based on the recommendations included in the analysis prepared by the University of California pursuant to subdivision (f).

(B) To the extent permitted by existing state and federal privacy laws, performance indicator data available in existing county and health plan data systems shall be collected by counties and health plans and provided to the agency, and performance indicator data available in existing state agency data systems shall be collected by the agency and provided to the counties and health plans. This data shall be reported in a manner and on a schedule determined by the agency, in consultation with the workgroup, but no less frequently than semiannually.

(C) (i) During the first three-year CBH-OAR cycle, performance indicator data reported by each county and health plan shall be used to establish both county and statewide baselines for each performance indicator. The data reported in the first year of the first CBH-OAR cycle shall serve as the county and statewide baselines. After the first review cycle, the agency shall establish standard target thresholds for each performance indicator established by the workgroup.

(ii) The agency, in consultation with the workgroup, shall develop a process for resolving disputes regarding the establishment of standard target thresholds pursuant to clause (i).

(D) (i) For subsequent reviews, based upon availability of additional data through data sharing agreements, the agency shall consider whether to establish additional performance indicators to advance the intent of this chapter.

(ii) Additional performance indicators shall also be subject to the process described in subparagraph (C) and shall include consideration of when data on the additional performance indicators will be available for reporting, if not already available.

(E) If, during subsequent reviews, there is sufficient reason to establish statewide performance standards for one or more outcome measures, the agency may establish those standards for each of the agreed-upon outcome measures.

(3) (A) (i) The county and health plan system needs assessment process component of the CBH-OAR, as established by the workgroup, shall require county behavioral health agencies and health plans to assess their performance on the established performance indicators, identify the strengths and weaknesses in their current practice and resource deployment, and identify and describe how operational decisions and systemic factors affect program outcomes as described in paragraph (4).

(ii) The county and health plan system needs assessment process shall be designed to identify areas of best practices for replication and for system improvement and shall guide the development of the county and health plan system improvement plan.

(B) (i) The county and health plan system needs assessment process shall be completed by the county and health plans, in consultation and collaboration with stakeholders, and submitted to the agency every three years.

(ii) (I) Counties shall convene local stakeholders, including, but not limited to, all of the following:

(ia) County behavioral health directors, supervisors, and caseworkers.

(ib) Consumers and family members of consumers.

(ic) Health plans operating in the county.

(id) Hospitals.

(ie) Local educational agencies.

(if) Law enforcement.

(ig) Child welfare agencies.

(ih) County-contracted providers.

(ii) Other county behavioral health agency partners.

(II) To the extent possible and relevant, local stakeholders shall also include representatives from tribal organizations and the local behavioral health board.

(III) Additional specific county behavioral health agency partners shall be determined by the county and may include, but are not limited to, adult education providers, providers of services for survivors of domestic violence, the local housing continuum of care, county human service departments, county drug and alcohol programs, and community-based service providers, as appropriate.

(iii) Health plans shall convene stakeholders, including, but not limited to, providers, hospitals, enrollees who are or have received behavioral health services in that system, parents of child enrollees who are or have received behavioral health services in that system, and a representative sample of county behavioral health departments from their service area.

(4) (A) The county and health plan system improvement plan shall include the uniform elements established by the workgroup pursuant to subparagraph (C) of paragraph (2) of subdivision (b).

(B) (i) The county and health plan system improvement plan shall be completed every three years by the county and health plan.

(ii) A county’s system improvement plan shall be approved in public session by the county’s board of supervisors or chief elected official, as applicable, and be submitted to the agency. Prior to being presented to the county’s board of supervisors or chief elected official, as applicable, for approval, the county’s system improvement plan shall be presented to the local behavioral health board or equivalent body. A health plan’s system improvement plan shall be approved by its board of directors.

(C) (i) A county’s system improvement plan shall include a services peer review element, conducted by peer counties, the purpose of which is to provide additional insight, including collaborative training on best practices and technical assistance by peer counties.

(ii) Health plans are not required to participate in a peer review process.

(D) The county behavioral health agency or health plan shall complete an annual progress report on the status of its system improvement plan and shall submit these reports to the agency.

(d) (1) (A) The agency shall receive, review, and, based on its determination of whether the county or health plan system improvement plan meets the required elements, certify as complete all submitted performance indicator data, county and health plans’ self-assessments, county and health plan system improvement plans, and annual progress reports.

(B) The agency shall identify and promote the replication of best practices in service delivery to achieve the established process and outcome measures.

(C) The agency shall monitor, on an ongoing basis, county performance on the performance indicators developed pursuant to subdivision (c).

(D) The agency may assign the duties outlined in paragraphs (A) through (C), inclusive, to the State Department of Health Care Services, the Department of Managed Health Care, and the Department of Insurance, as appropriate.

(2) The agency shall, on an annual basis, beginning July 1, 2026, submit a report to the Legislature that summarizes county or health plan performance on the established performance indicators during the reporting period, analyzes county performance trends over time, and makes findings and recommendations for common service improvements identified in the county and health plan system assessments and system improvement plans, including information on common statutory, regulatory, or fiscal barriers identified as inhibiting system improvements and recommendations to overcome those barriers.

(3) (A) (i) If the contract is executed pursuant to subdivision (f), the agency shall, in partnership with the University of California, facilitate the provision of technical assistance to county behavioral health agencies and health plans that supports the county’s or health plan’s selected areas for improvement as described in its system improvement plan.

(ii) The agency and the University of California shall not be considered peers in the county peer review element, and their role shall be limited to providing technical assistance.

(B) If the agency determines, in the course of its review of county and health plan system improvement plans and annual updates or in the course of its review of regularly submitted performance indicator data, that a county or health plan is consistently failing to meet the performance indicator standard target thresholds established pursuant to subparagraph (C) of paragraph (2) of subdivision (c), the agency shall engage the county or health plan in a process of targeted technical assistance and support to address and resolve the identified shortcomings.

(e) A county shall execute and fulfill components of its system improvement plan that can be accomplished with existing resources.

(f) The agency shall request the University of California to enter into a contract with the state to provide all of the following services:

(1) (A) (i) Prepare an analysis of how data pertaining to the provision of behavioral health services and client outcomes collected by the counties and health plans and provided to the state may be used to demonstrate the impact of services on life outcomes.

(ii) The analysis shall be delivered to the agency, the Legislature, and the workgroup established pursuant to subparagraph (A) of paragraph (1) of subdivision (b) on or before July 1, 2026, and shall include recommended life outcome measures and measures of the reduction of the negative outcomes described in subdivision (d) of Section 5840 that address prevention and early intervention strategies for mental illness and measures of employment, educational attainment, program exits and program reentries, adherence to treatment plans, attainment of housing, reduction in contacts with law enforcement, reduction in hospitalizations, and reductions in homelessness.

(B) The analysis required to be delivered to the Legislature pursuant to subparagraph (A) shall be submitted in compliance with Section 9795 of the Government Code.

(2) Create and maintain a dashboard modeled after the California Child Welfare Indicators Project to publicly report the data collected by counties and health plans and to report the status of performance indicators as described in this section.

(3) Consult with the agency to provide technical assistance to county behavioral health agencies and health plans as described in subparagraph (A) of paragraph (3) of subdivision (d).

5744.

 (a) Effective no later than July 1, 2026, the California Health and Human Services Agency, in consultation with the Department of Managed Health Care, the State Department of Health Care Services, and the Department of Insurance, shall establish a risk corridor structure applying to all health payers who provide behavioral health services in California. Under this structure, the risk sharing of costs shall include a requirement that these health payers are required to spend at least 20 percent of their provider health payments on behavioral health services.

(b) The above percentage of provider health payments on behavioral health services shall be adjusted annually based on an estimate of the prevalence rate of behavioral health conditions among a health payer’s enrollee population and an estimate of the disease burden as measured by financial cost for this estimated enrollee group.

(c) A health payer specified above can meet its spending obligation on behavioral health services under this risk corridor structure in a variety of ways, including provider reimbursement payments, incentive payments intended to improve the quality of behavioral health service delivery, or other innovative investments in the provision of behavioral health services.

SEC. 3.

 If the Commission on State Mandates determines that this act contains costs mandated by the state, reimbursement to local agencies and school districts for those costs shall be made pursuant to Part 7 (commencing with Section 17500) of Division 4 of Title 2 of the Government Code.

SECTION 1.Section 5600.4 of the Welfare and Institutions Code is amended to read:

5600.4.

Community mental health services should be organized to provide an array of treatment options in the following areas, to the extent resources are available:

(a)Precrisis and Crisis Services. Immediate response to individuals in precrisis and crisis and to members of the individual’s support system, on a 24-hour, seven-day-a-week basis. Crisis services may be provided offsite through mobile services. The focus of precrisis services is to offer ideas and strategies to improve the person’s situation, and help access what is needed to avoid crisis. The focus of crisis services is stabilization and crisis resolution, assessment of precipitating and attending factors, and recommendations for meeting identified needs.

(b)Comprehensive Evaluation and Assessment. Includes, but is not limited to, evaluation and assessment of physical and mental health, income support, housing, vocational training and employment, and social support services needs. Evaluation and assessment may be provided offsite through mobile services.

(c)Individual Service Plan. Identification of the short- and long-term service needs of the individual, advocating for, and coordinating the provision of these services. The development of the plan should include the participation of the client, family members, friends, and providers of services to the client, as appropriate.

(d)Medication Education and Management. Includes, but is not limited to, evaluation of the need for administration of, and education about, the risks and benefits associated with medication. Clients should be provided this information prior to the administration of medications pursuant to state law. To the extent practicable, families and caregivers should also be informed about medications.

(e)Case Management. Client-specific services that assist clients in gaining access to needed medical, social, educational, and other services. Case management may be provided offsite through mobile services.

(f)Twenty-four Hour Treatment Services. Treatment provided in any of the following: an acute psychiatric hospital, an acute psychiatric unit of a general hospital, a psychiatric health facility, a psychiatric residential treatment facility, an institute for mental disease, a community treatment facility, or community residential treatment programs, including crisis, transitional and long-term programs.

(g)Rehabilitation and Support Services. Treatment and rehabilitation services designed to stabilize symptoms, and to develop, improve, and maintain the skills and supports necessary to live in the community. These services may be provided through various modes of services, including, but not limited to, individual and group counseling, day treatment programs, collateral contacts with friends and family, and peer counseling programs. These services may be provided offsite through mobile services.

(h)Vocational Rehabilitation. Services that provide a range of vocational services to assist individuals to prepare for, obtain, and maintain employment.

(i)Residential Services. Room and board and 24-hour care and supervision.

(j)Services for Homeless Persons. Services designed to assist mentally ill persons who are homeless, or at risk of being homeless, to secure housing and financial resources.

(k)Group Services. Services to two or more clients at the same time.