Bill Text: CA AB77 | 2021-2022 | Regular Session | Amended
Bill Title: Substance use disorder treatment services.
Spectrum: Partisan Bill (Democrat 2-0)
Status: (Introduced) 2021-03-26 - Re-referred to Com. on HEALTH. [AB77 Detail]
Download: California-2021-AB77-Amended.html
|
Amended
IN
Assembly
March 25, 2021 |
CALIFORNIA LEGISLATURE—
2021–2022 REGULAR SESSION
Assembly Bill
No. 77
| Introduced by Assembly Member Petrie-Norris (Principal coauthor: Senator Stern) |
December 07, 2020 |
An act relating to to add Chapter 7.6 (commencing with Section 11834.56) to Part 2 of Division 10.5 of the Health and Safety Code, relating to substance use disorder treatment services.
LEGISLATIVE COUNSEL'S DIGEST
AB 77, as amended, Petrie-Norris.
Substance use disorder treatment services.
Existing law requires the State Department of Health Care Services to license and regulate alcoholism or drug abuse recovery or treatment facilities serving adults. Existing law authorizes the department to certify qualified alcoholism or drug abuse recovery or treatment programs, as prescribed. Under existing law, the department regulates the quality of these programs, taking into consideration the significance of community-based programs to alcohol and other drug abuse recovery and the need to encourage opportunities for low-income and special needs populations to receive alcohol and other drug abuse recovery or treatment services.
This bill, commencing January 1, 2026, would require any substance use disorder treatment program to be licensed by the
department, except as specified. The bill would require the department, in administering these provisions, to issue licenses for a period of 2 years for substance use disorder treatment programs that meet the requirements in these provisions. The bill would require the department to issue a license to a substance use disorder program once various requirements have been met, including an onsite review. The bill would authorize the department to renew a license, as provided. The bill would prohibit providing substance use disorder treatment services to individuals without a license.
The bill would require a substance use disorder program licensed pursuant to these provisions to adopt written policies and procedures, as specified. The bill would require a person or entity applying for a license to submit, among other things, a licensure fee to the department. The bill would require various quality parameters of licensed substance use disorder treatment programs,
including, among others, that patients admitted for treatment meet specified medical necessity criteria. The bill would require the department to conduct a site visit if a program is alleged to be in violation of those quality parameters and to provide written notice to the program, as specified.
The bill would authorize a licensed substance use disorder treatment program to treat persons 12 to 17 years of age, inclusive, provided certain additional requirements are met, including that assessments include documentation of the person’s unique abilities and strengths in the patient treatment plan.
The bill would require certain minimum requirements for substance use disorder program administrators and staff who provide services pursuant to these provisions and would grant the department sole authority to establish qualifications that exceed those requirements.
The bill would require
the department to conduct onsite visits to ensure compliance at least once during the licensure period. The bill would authorize the department to conduct announced or unannounced site visits at any time. The bill would authorize the department to enter any building and inspect the premises and any records of a substance use disorder program to secure information regarding compliance with these provisions.
The bill would authorize the Director of Health Care Services to suspend or revoke the license of a substance use disorder program for, among other things, a violation by the program. The bill would require that proceedings for the suspension, revocation, or denial of a license be conducted under specified procedures. The bill would terminate a license if various conditions occur, including, that the substance use program is sold or otherwise transferred.
The bill would authorize the department to levy a civil penalty of
not less than $250 and no more than $500 per day for each violation, except as specified. The bill would require additional penalties for a program with repeated violations, as specified. The bill would require the department to provide the substance use program with notice and an opportunity to correct the violation prior to assessing the civil penalty.
The bill would require that all fees, fines, and penalties collected from substance use disorder programs be deposited in the Residential and Outpatient Program Licensing Fund, to be available upon appropriation by the Legislature. The bill would state that it is the intent of the Legislature to make General Fund money available for purposes of the program if moneys in the Residential and Outpatient Program Licensing Fund are insufficient to fund the regulatory functions of the department.
The bill would require the department to adopt regulations to implement these
provisions.
Existing law consolidated within the State Department of Health Care Services all substance use disorder functions and programs from the former State Department of Alcohol and Drug Programs.
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. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Existing law provides for various benefits under the Medi-Cal program, including substance use disorder treatment and mental health services that are delivered through the Drug Medi-Cal Treatment Program, the Drug Medi-Cal organized delivery system, and the Medi-Cal Specialty Mental Health Services Program.
This bill would declare the intent of the Legislature to enact Jarrod’s Law, a licensure program for inpatient and outpatient programs providing substance use disorder treatment services, under the administration of the department.
Digest Key
Vote: MAJORITY Appropriation: NO Fiscal Committee:Bill Text
The people of the State of California do enact as follows:
SECTION 1.
This act shall be known, and may be cited, as the Jarrod’s Law.SEC. 2.
The Legislature finds and declares all of the following:(a) Prior to January 1, 2020, the nation faced a growing opioid epidemic, rising addiction rates, and an exponential growth in deaths caused by alcohol abuse, drug overdose, and suicide.
(b) In 2017, life expectancy decreased in the United States for the third year in a row, in part, due to increases in death rates for
alcohol, drugs, and suicide.
(c) Alcohol-induced deaths have reached a 35-year high, growing by 37 percent from 2000 to 2014, with 33,200 Americans dying from liver diseases, alcohol poisoning, and other diseases as of 2015.
(d) In 2014, the yearly health care cost for the average Californian was $7,549, while the cost of health care for individuals with alcohol, drug, or suicide diagnoses was $18,873, two and one-half times the rate of the general population, making these three factors one of the predominant accelerators of costs to the health care system.
(e) In 2018, 2,487,000 Californians met criteria for illicit drug or alcohol dependence or abuse based on definitions found in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).
(f) The Berkeley Research Group compiled historic and trend data specific to each state regarding alcohol and drug deaths rates and has indicated that from 1999 to 2025, alcohol deaths will have increased by 69 percent and drug deaths will have increased by 130 percent.
(g) California’s statute regarding the regulation of all modalities of substance use disorder treatment is antiquated and contains few requirements for patient safety and quality of services being delivered.
(h) There is no mandatory licensure for outpatient substance use disorder treatment services.
(i) Consumers searching for care are confused about which programs have demonstrated quality requirements because California’s “certification” standards for substance use disorder treatment
programs are higher than license requirements are and are voluntary agreements that can be ignored if an entity chooses not to abide by them.
(j) The Attorney General has reported that within the last two years, there has been a 25-percent increase in drug overdose deaths in California and that the City of San Diego has reported a 50-percent increase in overdose deaths in July and August, compared to the months leading up to the pandemic.
(k) Demand for substance use disorder treatment services is expected to dramatically increase as the pandemic worsens, unemployment causes despair, and national trauma impacts communities and families, which will create avenues for unscrupulous treatment providers to enter a system with weak regulation and insufficient statutes to efficiently bar their entry and operation in the state.
SEC. 3.
It is the intent of the Legislature that the reformulation of statutory requirements for the provision of substance use disorder treatment services established under this measure shall achieve all of the following:(a) An increased level of patient protection and higher treatment outcomes.
(b) Consistent terminology that allows consumers to identify high-quality programs.
(c) Increased barriers to prevent poorly run and fraudulent providers from entering and remaining in California’s substance use disorder treatment system.
(d) The elimination of unlicensed treatment providers who victimize vulnerable patients and their families.
(e) An increase in the number of high-quality treatment programs.
(f) A reduction in the number of deaths related to substance use disorder, in part exacerbated by weak and unenforceable quality parameters for treatment programs.
(g) An increase in the quality, skills, and education levels of staff who work within state-licensed treatment facilities.
(h) Give the
department appropriate statutory authority to regulate outpatient substance use disorder programs without giving it responsibility or authority to license or regulate individual providers of substance use disorder services who are unaffiliated with other individual providers or programs.
SEC. 4.
Chapter 7.6 (commencing with Section 11834.56) is added to Part 2 of Division 10.5 of the Health and Safety Code, to read:CHAPTER 7.6. Substance Use Disorder Programs
11834.56.
As used in this chapter, the following definitions have the following meanings:(a) “Administration of medication” means providing medication to a patient, and includes all of the following tasks, performed in the following order:
(1) Checking the patient’s medication record.
(2) Preparing the medication for administration.
(3) Administering the medication to the patient.
(4) Documenting the administration of the medication, or the reason for not administering a medication as prescribed.
(5) Reporting information to a licensed practitioner or a nurse regarding a problem with the administration of medication or the patient’s refusal to take the medication, if applicable.
(b) “Administrative intake” means the nonclinical function of gathering basic demographic information from a patient or potential patient being considered for entry to treatment.
(c) “Administrative screening” means the nonclinical function of gathering basic information to determine if a patient is eligible for clinical evaluation for appropriate placement.
(d) “Admission” means that a program determines that the patient meets the admission and medical necessity criteria and the patient signs a consent to treatment form in addition to completing the required intake
procedure.
(e) “Applicant” means an entity applying for licensure under this chapter.
(f) “Approved certifying organization” means an entity approved by the State Department of Health Care Services to certify alcohol and drug counselors on or before January 1, 2020, pursuant to Section 13035 of Title 9 of the California Code of Regulations, which is in good standing upon implementation of this chapter.
(g) “ASAM Criteria” means the most current set of criteria published by the American Society of Addiction Medicine (ASAM) that provides objective guidelines that give clinicians a way to standardize treatment planning and where patients are placed in treatment, as well as how to provide continuing, integrated care and ongoing service planning.
(h) “Certified alcohol and drug counselor” means a counselor who is currently certified by an approved certifying organization.
(i) “Patient” means an individual accepted by a licensed substance use disorder treatment provider for assessment or treatment of a substance use disorder. An individual remains a patient until the licensed substance use disorder treatment provider no longer provides or intends to provide the individual with treatment service.
(j) “Core functions” means the services described in Section 11834.64.
(k) “Day of service initiation” means the day the licensed substance use disorder treatment provider begins the provision of a treatment service identified in Section 11834.64.
(l) “Direct contact” means providing
face-to-face care, training, supervision, counseling, consultation, or medication assistance to patients.
(m) “Documentation” means the administrative function of recording, processing, and managing patient information consistent with state and federal privacy stipulations and does not include charting or clinical notetaking but can include notations regarding monitoring patient safety at designated time periods.
(n) “Face-to-face” means two-way, real-time, interactive and visual communication between a patient and a treatment service provider and includes services delivered in person or via telemedicine.
(o) “Group counseling” means a professionally led psychotherapeutic substance use disorder treatment that is delivered in an interactive group setting.
(p) “Licensed substance use disorder treatment provider” means an entity licensed under this chapter.
(q) “Paraprofessional” means an employee, agent, or independent contractor of the licensed substance use disorder treatment provider who performs tasks to support treatment service. If currently a patient of the licensed substance use disorder treatment provider, the patient cannot be a paraprofessional for the licensed substance use disorder treatment provider.
(r) “Person centered” means a patient actively participates in the patient‘s treatment planning of services. This includes a patient making meaningful and informed choices about the patient’s own goals, objectives, and services the patient receives in collaboration with the patient’s identified natural supports.
(s) “Program director” means an
individual who meets the qualifications specified in Section 11834.66 and is designated by the licensed substance use disorder treatment provider to be responsible for all aspects of the delivery of treatment service.
(t) “Registered intern” means a counselor who is currently registered by an approved certifying organization and performing clinical duties while accruing supervised hours for a credential.
(u) “Registered technician” means a staff person who is currently registered by an approved certifying organization to perform nonclinical, supportive duties.
(v) “Staff” or “staff member” means an individual who works under the direction of the licensed substance use disorder treatment provider regardless of the individual’s employment status including, but not limited to, an intern, consultant, individual who works
part time, or individual who does not provide direct care services.
(w) “Supervisee” means an individual whose supervision is required to obtain credentialing by a licensure board or certification organization, or to comply with this chapter.
(x) “Substance” means alcohol, solvents, controlled substances, and other mood-altering substances.
(y) “Substance use disorder” means the recurrent use of alcohol or drugs that causes clinically significant impairment, including health problems, disability, and failure to meet major responsibilities at work, school, or home as classified by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) or a subsequent edition.
(z) “Substance use disorder treatment” means treatment of a substance
use disorder, including the process of assessment of a patient’s needs, development of planned methods, including interventions or the provision of core functions in Section 11834.64 to address a patient’s needs, provision of services, facilitation of services provided by other service providers, and ongoing reassessment by a qualified professional when indicated. The goal of substance use disorder treatment is to assist or support the patient’s efforts to recover from a substance use disorder.
(aa) “Telemedicine” means the delivery of a substance use disorder treatment service while the patient is at an originating site and the licensed health care provider is at a distant site.
(ab) “Treatment determination” means a determination made by a licensed professional or a certified alcohol drug counselor IV that a person meets the criteria of the DSM-V, or a subsequent edition, as
having mild, moderate, or severe substance use disorder based on the licensed or certified professional’s evaluation of and training in the criteria contained in the DSM-V or a subsequent edition.
(ac) “Volunteer” means an individual who, under the direction of the licensed substance use disorder treatment provider, provides services or an activity to a patient without compensation.
11834.57.
(a) The department has the sole authority in state government to license substance use disorder treatment programs.(b) In administering this chapter, the department shall issue licenses for a period of two years to those substance use disorder treatment programs that meet the requirements set forth in this chapter.
11834.58.
(a) Except as provided in subdivision (b), any substance use disorder treatment program shall be licensed by the department in accordance with this chapter.(b) A substance use disorder treatment program operating in any of the following settings shall be exempt from mandatory licensure under this chapter:
(1) Adult alcoholism or drug abuse treatment facilities that have applied for and received an exemption from licensure requirements.
(2) Driving-under-the-influence programs exclusively serving driving-under-the influence participants, and narcotic treatment programs exclusively serving persons receiving
medication when licensed by the department.
(3) Clinics licensed by the State Department of Public Health in accordance with Division 2 (commencing with Section 1200).
(4) Health facilities licensed by the State Department of Public Health in accordance with Chapter 2 (commencing with Section 1250) of Division 2.
(5) Community care facilities licensed by the State Department of Social Services in accordance with Chapter 3 (commencing with Section 1500) of Division 2.
(6) Residential care facilities for persons with chronic, life-threatening illness licensed by the State Department of Social Services in accordance with Chapter 3.01 (commencing with Section 1568.01) of Division 2.
(7) Residential care facilities for the elderly licensed by the State Department of Social Services in accordance with Chapter 3.2 (commencing with Section 1569) of Division 2.
(8) Adult day health care center licensed by the State Department of Social Services in accordance with Chapter 3.3 (commencing with Section 1570) of Division 2.
(9) Public elementary and secondary schools, as defined in the Education Code.
(10) County jails and state correctional institutions.
(11) This chapter shall not apply to an organization whose primary functions are information, referral, diagnosis, case management, and assessment for the purposes of patient placement, education, support group services, or self-help programs. This chapter shall not apply to
nonclinical recovery services. This chapter shall not apply to the activities of a licensed professional in private practice.
(12) This chapter does not apply to a recovery residence as defined by Section 11833.05, if that residence does not provide the core function services in Section 11834.64. A recovery residence may provide peer-led education and peer-led referral to treatment or reintegration to work and community without a license pursuant to this chapter provided these items are provided by nonclinicians from a mutual aid perspective.
11834.59.
A person or entity applying for licensure shall submit to the department all of the following:(a) A complete written application.
(b) A licensure fee, as established in accordance with Chapter 7.3 (commencing Section 11833.01).
(c) An initial application fee, not to exceed the reasonable regulatory costs to the department.
(d) Any other documentation specified by the department.
11834.60.
(a) The department shall issue a license to a substance use disorder program once all of the following have been completed:(1) Submission of a complete application, fees, and documentation in accordance with Section 11834.59.
(2) An onsite review.
(3) Determination that the applicant can comply with this chapter and any regulations adopted pursuant to this chapter.
(b) The department shall terminate review of an application for either of the following reasons:
(1) Failure to comply
with Section 11834.59.
(2) Prior revocation of an applicant’s licensure, or an adult alcoholism or drug abuse treatment facility license, within five years from the date of the application submission.
(c) Termination of review shall require submission of a new application.
(d) The department may deny the issuance of a license for any of the following reasons:
(1) Failure of the applicant to demonstrate the ability to comply with this chapter or the regulations adopted pursuant to this chapter.
(2) Failure of the applicant to remedy any deficiency identified pursuant to this chapter or the regulations adopted pursuant to this chapter.
(3) Failure of the applicant to comply with this division or Division 4 of Title 9 of the California Code of Regulations.
(4) Any other reason specified by the department.
11834.61.
(a) A license shall be valid for a period of up to two years from the date of issuance.(b) The department may renew a license for subsequent two-year periods if, prior to the expiration date on the license, a substance use disorder program submits a completed written application for renewal, pays the required fees, and remains in compliance with this chapter and any regulations adopted pursuant to this chapter.
(c) Failure to submit to the department the required written application for renewal, or failure to submit to the department the required fees prior to the expiration date on the license, shall result in the automatic expiration of the license at the end of the
two-year period.
11834.62.
(a) A group of persons, corporation, partnership, voluntary association, or other organization shall not provide substance use disorder treatment services to an individual with a substance use disorder unless they are licensed by the department or hold a license from a licensing board that includes substance use disorder treatment in its scope of practice.(b) This chapter shall not apply to an organization whose primary functions are information, referral, diagnosis, case management, and assessment for the purposes of patient placement, education, support group services, or self-help programs. This chapter shall not apply to nonclinical recovery services. This chapter shall not apply to the activities of a licensed professional in
private practice or a person exempted by a licensing board to provide services without a license.
11834.63.
(a) A substance use disorder program shall adopt policies and procedures that are consistent with this chapter and any regulations adopted pursuant to this chapter.(b) All policies and procedures shall be kept in an operation manual and address, at a minimum, all of the following:
(1) Admission and discharge.
(2) Patient rights.
(3) Services.
(4) Medications.
(5) Staff and patient code of conduct.
(6) Any other topic specified by the department.
11834.64.
Licensed substance use disorder treatment programs shall abide by all of the following quality parameters regarding the appropriate provision of medically necessary services, confidential and accurate documentation, and proficient staffing necessary in order to deliver services that are high in quality and protect consumers:(a) Patients admitted for treatment shall meet medical necessity criteria as follows:
(1) Have one diagnosis from the DSM-V for substance-related and addictive disorders with the exception of tobacco-related disorders and non-substance-related disorders.
(2) Meet the ASAM Criteria definition of medical
necessity for services based on the ASAM Criteria.
(b) Patients admitted for treatment shall undergo a treatment determination and comprehensive assessment as follows:
(1) A comprehensive assessment of the patient’s substance use disorder shall be administered face-to-face by an alcohol and drug counselor within three calendar days from the day of service initiation for a residential program or within three calendar days from which a treatment session has been provided or the day of service initiation for a patient in a nonresidential program.
(2) If the comprehensive assessment is not completed within the required timeframe, the person-centered reason for the delay and the planned completion date shall be documented in the patient’s file. The comprehensive assessment is complete upon a qualified staff member’s dated
signature.
(3) If the patient received a comprehensive assessment that authorized the treatment service, an alcohol and drug counselor may use the comprehensive assessment for requirements of this subdivision but shall document a review of the comprehensive assessment and update the comprehensive assessment as clinically necessary to ensure compliance with this subdivision within applicable timelines.
(4) The comprehensive assessment shall include sufficient information to complete the assessment summary and the individual treatment plan.
(5) Information from a collateral contact may be included, but is not required.
(6) If the patient is identified as having opioid use disorder or seeking treatment for opioid use disorder, the program shall provide
educational information to the patient concerning all of the following:
(A) Risks for opioid use disorder and dependence.
(B) Treatment options, including the use of a medication for opioid use disorder.
(C) The risk of and recognizing opioid overdose.
(D) The use, availability, and administration of naloxone to respond to opioid overdose.
(7) If the comprehensive assessment is completed to authorize treatment service for the patient, at the earliest opportunity during the assessment interview the assessor shall determine if any of the following apply:
(A) The patient is in severe withdrawal and likely to be a danger to self
or others.
(B) The patient has severe medical problems that require immediate attention.
(C) The patient has severe emotional or behavioral symptoms that place the patient or others at risk of harm.
(D) If one or more of the conditions specified in this paragraph are present, the assessor shall end the assessment interview and follow the procedures in the program’s medical services plan to help the patient obtain the appropriate services. The assessment interview may resume when the condition is resolved.
(c) Patients admitted for treatment shall have an assessment summary prepared according to the following:
(1) A comprehensive assessment of the patient’s substance use disorder shall be
administered face-to-face by an alcohol and drug counselor within three calendar days from the day of service initiation for a residential program or within three calendar days from which a treatment session has been provided or the day of service initiation for a patient in a nonresidential program. The comprehensive assessment summary is complete upon a qualified staff member’s dated signature. If the comprehensive assessment is used to authorize the treatment service, the alcohol and drug counselor shall prepare an assessment summary on the same date the comprehensive assessment is completed. If the comprehensive assessment and assessment summary are to authorize treatment services, the assessor shall determine appropriate services for the patient using the dimensions of the ASAM Criteria and document the recommendations.
(2) An assessment summary shall include all of the following:
(A) A risk description according to ASAM Criteria for each dimension.
(B) A narrative summary supporting the risk descriptions.
(C) A determination of whether the patient has a substance use disorder.
(D) An individual treatment plan.
(d) The licensed substance use disorder treatment provider shall prepare an individual treatment plan according to both of the following:
(1) The plan shall be in writing, based upon information obtained in the intake and assessment process. The individual treatment plan will be completed upon intake and then updated every subsequent 90 days unless there is a change in treatment modality or a significant event that would necessitate a new
treatment plan.
(2) The individual treatment plan shall include all of the following:
(A) A statement of problems to be addressed.
(B) Goals to be reached that address each problem pursuant to subparagraph (A).
(C) Action steps that will be taken by the licensed substance use disorder treatment provider and patient to accomplish identified goals.
(D) Target dates for accomplishment of action steps and goals and a description of services, including the type of counseling to be provided and the frequency of that counseling.
(E) Identification of the proposed type or types of interventions or modalities, including a proposed
frequency and duration of those services.
(F) The individual treatment plan shall be consistent with the qualifying diagnosis and will be signed by the patient and the program director, certified alcohol drug counselor IV, or licensed professional of healing arts (LPHA).
(e) Patients admitted for treatment shall have their services documented and reviewed according to all of the following requirements:
(1) A review of all treatment services shall be documented weekly and include a review of all of the following:
(A) Care coordination activities.
(B) Medical and other appointments the patient attended.
(C) Issues related to
medications that are not documented in the medication administration record.
(D) Issues related to attendance for treatment services, including the reason for any patient absence from a treatment service.
(2) A note shall be entered immediately following any significant event. A significant event is an event that impacts the patient’s relationship with other patients, staff, the patient’s family, or the patient’s individual treatment plan.
(3) An individual treatment plan review shall be entered in a patient’s file weekly or after each treatment service, whichever is less frequent, by the staff member providing the service. The review shall indicate the span of time covered by the review. The review shall do all of the following:
(A) Indicate the date,
type, and amount of each treatment service provided and the patient’s response to each service.
(B) Address each goal in the treatment plan and whether the methods to address the goals are effective.
(C) Include monitoring of any physical and mental health problems.
(D) Document the participation of others.
(E) Document staff recommendations for changes in the methods identified in the individual’s treatment plan and whether the patient agrees with the change.
(4) Each entry in a patient’s record shall be accurate, legible, signed, and dated. A late entry shall be clearly labeled “late entry.” A correction to an entry shall be made in a way in which the original entry can still be
read.
(f) An alcohol and drug counselor shall write a service discharge summary for each patient and according to both of the following:
(1) The service discharge summary shall be completed within five days of the patient’s service termination. A copy of the patient’s service discharge summary shall be provided to the patient upon the patient’s request.
(2) The service discharge summary shall include all of the following information:
(A) The patient’s issues, strengths, and needs while participating in treatment, including services provided.
(B) The patient’s progress toward achieving each goal identified in the individual treatment plan.
(C) A risk description.
(D) Current alcohol or drug use or both.
(E) Vocational and educational achievements.
(F) Transfers and referrals.
(G) The reasons for and circumstances of service termination. If a program discharges a patient at staff request, the reason for discharge and the procedure followed for the decision to discharge shall be documented and comply with the requirements pursuant to this chapter.
(H) The patient’s living arrangements at service termination.
(I) Continuing care recommendations, including transitions between more or less intense services, or more frequent to less frequent services,
and referrals made with specific attention to continuity of care for mental health, as needed.
(J) Service termination diagnosis.
(K) Patient’s comments.
(g) A licensed residential treatment program shall offer the following treatment services unless it is clinically inappropriate and the justifying clinical rationale is documented:
(1) Services are provided to patients when determined by a program director, certified alcohol drug counselor IV, or LPHA to be medically necessary and in accordance with an individual treatment plan. Services may be provided by a licensed professional or a certified or registered counselor in any appropriate setting in the community. Services may be provided in person, by telephone, or by telehealth.
(2) The core functions of treatment services are the following:
(A) An intake process to determine that a patient meets the medical necessity criteria and is admitted into a substance use disorder treatment program. Intake shall include the evaluation or analysis of substance use disorders, the diagnosis of substance use disorders, and the assessment of treatment needs to provide medically necessary services. Intake may include a physical examination and laboratory testing necessary for substance use disorder treatment.
(B) Individual counseling consisting of contact between a patient and a therapist or counselor. Services provided in person, by telephone, or by telehealth shall qualify as Medi-Cal reimbursable units of service and shall be reimbursed without distinction between the form of service for Medi-Cal eligible
beneficiaries.
(C) Group counseling which shall consist of face-to-face contacts in which one or more therapists or counselors treat two or more patients at the same time with a maximum of 16 patients in the group, focusing on the needs of the individuals served.
(D) (i) Family counseling to address the far-reaching effects of addiction.
(ii) It is the intent of the Legislature that, by including family members in the treatment process, education about factors that are important to the patient’s recovery as well as their own recovery can be conveyed. Family members can provide social support to the patient, help motivate their loved one to remain in treatment, and receive help and support for their own family recovery as well.
(E) Patient education to provide research-based education on addiction, treatment, recovery, and associated health risks.
(F) The prescription or administration of medication related to substance use disorder treatment services, or the assessment of the side effects or results of that medication conducted by staff lawfully authorized to provide those services or order laboratory testing within their scope of practice or licensure.
(G) (i) Collateral services that shall consist of sessions with therapists or counselors and significant persons in the life of the patient and be focused on the treatment needs of the patient in terms of supporting the achievement of the patient’s treatment goals.
(ii) Significant persons are individuals that have a personal, not official or professional,
relationship with the patient.
(H) (i) Crisis intervention services that shall include contact between a therapist or counselor and a patient in crisis. Services shall focus on alleviating crisis problems. Crisis intervention services shall be limited to the stabilization of the patient’s emergency situation.
(ii) “Crisis” means an actual relapse or an unforeseen event or circumstance that presents to the patient an imminent threat of relapse.
(I) The provider shall prepare an individual treatment plan, in writing, based upon information obtained in the intake and assessment process. The individual treatment plan shall be completed upon intake and then updated every subsequent 90 days unless there is a change in treatment modality or significant event that would then require a new treatment
plan. The treatment plan shall include all of the following:
(i) A statement of problems to be addressed.
(ii) Goals to be reached that address each problem.
(iii) Action steps that shall be taken by the licensed substance use disorder treatment provider or patient or both to accomplish identified goals.
(iv) Target dates for accomplishing the action steps and goals and a description of services, including the type of counseling to be provided and the frequency of those services and counseling.
(v) Specific, quantifiable goals or treatment objectives related to the patient’s substance use disorder diagnosis and multidimensional assessment.
(vi) An identification of the proposed type or types of interventions and modalities that includes a proposed frequency and duration plan.
(vii) A plan consistent with the qualifying diagnosis and signature of the patient and the program director, certified alcohol drug counselor IV, or LPHA.
(J) Discharge services that shall consist of the process to prepare the patient for referral into another level of care, post-treatment return, or reentry into the community, and the referral of the individual to essential community treatment, housing, and human services.
(K) A nonresidential treatment program shall offer all treatment services specified in this section and document in the individual treatment plan the specific services for which a patient has an
assessed need and the plan to provide the services.
(h) (1) Withdrawal management services shall be provided in a continuum of withdrawal management services as per the five levels of withdrawal management in the ASAM Criteria when determined by a program director, certified alcohol drug counselor IV, or LPHA as medically necessary and in accordance with an individual patient plan. Each patient shall reside at the facility if receiving a residential service and shall be monitored during the detoxification process. Medically necessary habilitative and rehabilitative services shall be provided in accordance with an individual treatment plan prescribed by a licensed physician or licensed prescriber and approved and authorized according to other law.
(2) The components of withdrawal management services shall include all of the following:
(A) Intake, which shall include the process of admitting a patient into a substance use disorder treatment program. Intake shall also include the evaluation or analysis of substance use disorders, the diagnosis of substance use disorders, and the assessment of treatment needs to provide medically necessary services. Intake may include a physical examination and laboratory testing necessary for substance use disorder treatment.
(B) Observation, which shall include the process of monitoring the patient’s course of withdrawal. Observation shall be conducted as frequently as deemed appropriate for the patient and the level of care the patient is receiving. This may include, but is not limited to, observation of the patient’s health status.
(C) Medication services, which shall include the prescription or administration
related to substance use disorder treatment services, or the assessment of the side effects or results of that medication, conducted by staff lawfully authorized to provide those services within their scope of practice or license.
(D) Discharge services, which shall include the process to prepare the patient for referral into another level of care, post-treatment return, or reentry into the community, or the referral of the individual to essential community treatment, housing, and human services.
(i) Detoxification services staff shall meet all of the following requirements:
(1) Each patient shall be monitored closely, observed, and physically checked at least every 30 minutes during the first 12 hours following admission by a staff person or volunteer. The close observation and physical checks shall continue beyond
the initial 12-hour period for as long as the withdrawal signs and symptoms warrant. Documentation of the information that supports a decrease in observation and physical checks shall be recorded in the patient’s file by a staff person or volunteer.
(2) Documentation of observations and physical checks shall be recorded in a systematic manner.
(3) Licensed substance use disorder treatment providers shall have program staff who have been trained to provide evaluation, detoxification, and referral services.
(4) At least one staff member shall be assigned to observe detoxification residents at all times.
(5) Staff shall physically check each participant for breathing by a face-to-face observation at least every 30 minutes.
(6) In a program with 15 or fewer patients who are receiving detoxification services, there shall be at least one staff member or volunteer on duty and awake at all times with a current cardiopulmonary resuscitation (CPR) certificate and current first aid training.
(7) In a program with more than 15 patients who are receiving detoxification services, there shall be at least two staff members or volunteers on duty and awake at all times, one of whom shall have a current CPR certificate and current first aid training.
(8) Patients shall not be used to fulfill the requirements of this section.
(j) (1) A licensed substance use disorder treatment provider may also provide or arrange the following recovery services as a part of the
patient’s individual treatment plan:
(A) Therapeutic recreation to allow the patient to participate in recreational activities without the use of mood-altering chemicals and to plan and select leisure activities that do not involve the inappropriate use of chemicals.
(B) Stress management and physical well-being skills to help the patient reach and maintain an appropriate level of health, physical fitness, and well-being.
(C) Development of living skills to help the patient learn basic skills necessary for independent living.
(D) Development of socialization skills to help the patient live and interact with others in a positive and productive manner.
(E) For residential programs, room,
board, and supervision at the treatment site to provide the patient with a safe and appropriate environment to gain and practice new skills.
(F) Recovery monitoring, including recovery coaching and monitoring via telephone and internet.
(G) Substance use disorder relapse prevention.
(H) Education and job skills, such as connections to life skills, employment services, job training, and education services.
(I) Family support, including connections to childcare, parent education, child development support services, and family or marriage or both education.
(J) Support groups, including connections to self-help and support and spiritual- and faith-based support.
(K) Ancillary services, including connections to housing assistance, transportation, case management, and individual services coordination.
(L) Peer recovery support services provided one-on-one by a peer support specialist.
(2) Recovery services provided outside of a licensed program, where core functions are not provided, do not require licensure.
(k) A licensed substance use disorder treatment provider shall maintain a supply of naloxone available for emergency treatment of opioid overdose and shall require staff to undergo training in the specific mode of administration used at the program, which may include intranasal administration, intramuscular injection, or both.
(l) The licensed
substance use disorder treatment provider shall have access to and document the availability of a licensed mental health professional to provide diagnostic assessment and treatment planning assistance.
(m) Administration of medication and assistance with self-medication shall meet all of the following requirements:
(1) A licensed substance use disorder treatment provider shall develop policies and procedures for the administration of medication and shall meet the requirements in this paragraph if a service provided includes the administration of medication.
(2) A staff member, other than a licensed practitioner or nurse, who is delegated by a licensed practitioner or a registered nurse the task of administration of medication or assisting with self-medication, shall successfully complete a medication administration
training program for unlicensed personnel through an educational institution accepted by a certifying organization approved by the department.
(3) The staff member’s completion of the course shall be documented in writing and placed in the staff member’s personnel file.
(4) Delegation of administration of medication is limited to the administration of a medication that is administered orally, topically, as a suppository, or by means of an eye drop, an ear drop, or an inhalant.
(5) Each patient’s file shall include documentation indicating whether staff are required to conduct the administration of medication or the patient is required to self-administer medication, or both.
(6) If a patient self-administers medication when the patient is present in the
facility, the patient shall self-administer medication under the observation of a trained staff member.
(7) The policies and procedures developed pursuant to paragraph (1) shall include all of the following:
(A) A requirement that if a licensed substance use disorder treatment provider serves a patient who is a parent with a child, the parent shall only administer medication to the child under a staff member’s supervision.
(B) A requirement for recording the patient’s use of medication, including staff signatures with date and time.
(C) Guidelines for when to inform medical personnel of problems with self-administration of medication, including a patient’s failure to administer, refusal of a medication, adverse reaction, or error.
(D) Procedures for acceptance, documentation, and implementation of a prescription, whether written, verbal, telephonic, or electronic.
(n) A licensed substance use disorder treatment provider shall have and implement written policies and procedures to control controlled substances that contain all of the following requirements:
(1) A requirement that each drug shall be stored in a locked compartment. A Schedule II controlled substance shall be stored in a separately locked compartment, permanently affixed to the physical plant or medication cart.
(2) A system that accounts for all controlled substances for each shift.
(3) A procedure for recording the patient’s use of medication, including
the signature of the staff member who completed the administration of the medication with the time and date.
(4) A procedure to destroy discontinued, outdated, or deteriorated medication.
(5) A requirement that only authorized personnel are permitted access to the keys to a locked compartment.
(6) A statement that no legend drug supply for one patient shall be given to another patient.
(7) A procedure for monitoring the available supply of naloxone on site, replenishing the naloxone supply when needed, and destroying naloxone according to the procedures established pursuant to this paragraph.
(o) A licensed substance use disorder treatment provider shall maintain a file of current and
accurate patient records on the premises where the treatment service is provided or coordinated according to all of the following requirements:
(1) For services provided offsite, patient records shall be available at the program and adhere to the same clinical and administrative policies and procedures as services provided onsite.
(2) The content and format of patient records shall be uniform and entries in each record shall be signed and dated by the staff member making the entry. Patient records shall be protected against loss, tampering, or unauthorized disclosure according to state and federal requirements.
(3) The licensed substance use disorder treatment provider shall have a policy and procedure that identifies how the program will track and record patient attendance at treatment activities, including the
date, duration, and nature of each treatment service provided to the patient.
(4) Patient records shall contain all of the following:
(A) Documentation that the patient was given information on patient rights and responsibilities, grievance procedures, tuberculosis, and HIV, and that the patient was provided an orientation. If the patient has an opioid use disorder, the record shall contain documentation that the patient was provided educational information specific to that disorder.
(B) An initial services plan.
(C) A comprehensive assessment.
(D) An assessment summary.
(E) An individual treatment plan.
(F) Documentation of treatment services and treatment plan review.
(G) A summary at the time of service termination.
(p) (1) The patient records of a discharged patient shall be retained by a licensed substance use disorder treatment provider for seven years.
(2) A licensed substance use disorder treatment provider that ceases to provide treatment service shall retain patient records for seven years from the date of facility closure and shall notify the department of the location of the patient records and the name of the individual responsible for maintaining the patient’s records.
11834.66.
(a) The department shall have the sole authority to establish qualifications that meet or exceed the following minimum requirements for program administrators and staff who provide any of the services pursuant to this chapter:(1) A licensed substance use disorder treatment provider shall have a program director who meets the following requirements:
(A) Has at least one year of work experience in direct service to an individual with substance use disorder or one year of work experience in the management or administration of direct service to an individual with substance use disorder.
(B) Has a baccalaureate
degree or three years of work experience in administration or personnel supervision in human services.
(C) Knows and understands the requirements of this chapter.
(2) A licensed substance use disorder treatment provider shall employ an alcohol and drug counselor supervisor who meets all of the following requirements:
(A) Has three or more years of experience providing individual and group counseling to individuals with substance use disorder.
(B) Is certified by an approved certifying organization.
(C) Knows and understands the requirements of this chapter.
(D) (i) An individual may be simultaneously
employed as a program director, alcohol and drug counselor supervisor, and an alcohol and drug counselor if the individual meets the qualifications for each position.
(ii) If an alcohol and drug counselor is simultaneously employed as an alcohol and drug counselor supervisor or program director, that individual shall be considered a one-half of a full-time equivalent alcohol and drug counselor for staff requirements pursuant to this chapter.
(3) (A) A program director shall designate a staff member who, when present in the facility, is responsible for the delivery or monitoring of treatment services.
(B) A licensed substance use disorder treatment provider shall have a designated staff member during all hours of operation.
(C) A
licensed substance use disorder treatment provider providing room and board and treatment at the same site shall have a responsible staff member on duty 24 hours a day.
(D) The designated staff member shall know and understand the requirements of this chapter.
(4) The requirements for the staffing of group counseling are as follows:
(A) The licensed substance use disorder treatment provider shall determine an acceptable group size based on each patient’s needs.
(B) The number of patients in a group counseling session shall not exceed 16 patients.
(C) The licensed substance use disorder treatment provider shall maintain a record that documents compliance with this paragraph.
(5) (A) When a patient is present, a licensed substance use disorder treatment provider shall have at least one staff member on the premises who has a current American Red Cross standard first aid certificate or an equivalent certificate and at least one staff member on the premises who has a current American Red Cross community, American Heart Association, or equivalent CPR certificate.
(B) A single staff member with both certifications satisfies the requirements in subparagraph (A).
(6) The qualifications for staff are as follows:
(A) All staff members who have direct contact with patients shall be 18 years of age or older.
(B) At the time of employment, each staff
member shall meet the qualifications in this paragraph.
(C) A program director, supervisor, nurse, counselor, registered intern, or other professional shall be free of problematic substance use for at least the two years immediately preceding employment and shall be required to sign a statement attesting to that fact.
(D) A paraprofessional, peer support specialist, registered technician, or any other staff member with direct contact shall be free of problematic substance use for at least one year immediately preceding employment and shall be required to sign a statement attesting to that fact.
(E) A staff member with direct contact shall be free from problematic substance use as a condition of employment, but is not required to sign additional statements.
(F) (i) A staff member with direct contact who is not free from problematic substance use shall be removed from any responsibilities that include direct contact for the relevant time periods specified in subparagraph (A), (B), (C), or (D).
(ii) For purposes of this section, the time period begins on the date of the last incident of problematic substance use as described in the facility’s policies and procedures.
(G) For purposes of this paragraph, “problematic substance use” means a behavior or incident listed by the licensed substance use disorder treatment provider in the personnel policies and procedures developed according to this chapter.
(7) An alcohol and drug counselor shall be a licensed professional of the healing arts, a certified alcohol and drug counselor, or registered
as an alcohol and drug intern by a certifying organization approved by the department.
(A) A certified alcohol and drug counselor shall document to an approved certifying organization both of the following requirements:
(i) The completion of 315 hours of substance use disorder specific education and a 255-hour field practicum approved by the certifying organization.
(ii) The successful passing of a competency exam approved by the certifying organization.
(B) A certified alcohol and drug counselor I shall, in addition to the information required by subparagraph (A), provide proof of 2,000 hours of verified work experience in core functions or domains prescribed by the certifying organization.
(C) A certified alcohol and drug counselor II shall, in addition to the information required by subparagraph (A), provide proof of 4,000 hours of verified work experience in core functions or domains prescribed by the certifying organization and proof of completion of an associate arts degree or science degree, or a certificate program from a regionally accredited college or a private postsecondary institution accepted by an approved certifying organization.
(D) A certified alcohol and drug counselor III shall, in addition to the information required by subparagraph (A), provide proof of 6,000 hours of verified work experience in core functions or domains prescribed by the certifying organization and proof of completion of a bachelor of arts or science degree from a regionally accredited college or a private postsecondary institution accepted by an approved certifying organization.
(E) A certified alcohol drug counselor IV shall, in addition to the information required by subparagraph (A), provide proof of 6,000 hours of verified work experience, proof of completion of a master of arts or science degree, or higher, from a regionally accredited college or a private postsecondary institution accepted by an approved certifying organization, and proof of a passing score on the International Certification and Reciprocity Consortium (IC&RC) Advanced Alcohol and Drug Counselor examination.
(8) (A) A paraprofessional shall have knowledge of patient rights and staff member responsibilities.
(B) A paraprofessional shall not admit, transfer, or discharge a patient, but may be responsible for the delivery of treatment service according to the provisions of this chapter.
(9) A peer support specialist shall have a minimum of one year in recovery from a substance use disorder.
(10) A volunteer may provide treatment service when the volunteer is supervised and can be seen or heard by a staff member meeting the criteria specified above, but shall not practice alcohol and drug counseling unless qualified under the requirements according to this chapter.
(11) (A) A qualified staff member shall supervise and be responsible for a treatment service performed by a registered intern and shall review and sign each assessment, progress note, and individual treatment plan prepared by a registered intern.
(B) A registered intern shall obtain certification within five years of the initial intern registration date and
may be allotted an additional two-year extension if there is a bona fide hardship that prevents the intern from completing the requirements for certification and the hardship exemption is documented and approved by the certifying organization.
(C) On or before January 1, 2027, no more than 40 percent of the treatment staff, excluding registered technicians, may be registered interns.
(12) (A) A registered technician shall meet both of the following requirements:
(i) Have a minimum of one year in recovery from substance use disorder.
(ii) Hold a current credential from an approved certifying organization that demonstrates skills and training in the domains of ethics and boundaries, screening, education, documentation, crisis
intervention, orientation, and intake.
(B) Beginning January 1, 2027, a registered technician may provide all of the following services, with general supervision from certified or licensed staff, within a licensed program:
(i) Administrative screening.
(ii) Administrative intake.
(iii) Orientation.
(iv) Patient education.
(v) Documentation.
(vi) Coordination of referrals.
(C) Other than services in subparagraph (B), registered interns may not provide direct, clinical services to patients without
first registering as an intern.
(D) Registrants may continue to be staff members as long as they remain registered with a certifying organization and are not required to become interns or to apply for certification.
(13) (A) On or before January 1, 2027, the department shall conduct stakeholder meetings and create staffing recommendations, using the certification and licensing levels in this section, for licensed outpatient, licensed inpatient, and withdrawal management programs.
(B) On or before January 1, 2028, the department shall report to the Legislature the staffing recommendations, a timeline for programs to implement recommended staffing levels, any barriers to meeting proposed timelines, any resources deemed necessary to assist programs in reaching the desired staffing recommendations,
and a date by which these recommendations can be made mandatory via regulation.
(C) The report required to be submitted pursuant to subparagraph (B) shall be submitted in compliance with Section 9795 of the Government Code.
(b) (1) A substance use disorder program shall include all of the following information about all staff members on their internet website:
(A) First and last name.
(B) Position within the substance use disorder program.
(C) Credential identifying information.
(2) The substance use disorder program shall also include a link to the internet website of the board or certifying
organization that provided the license specified in subparagraph (C) of paragraph (1).
11834.67.
(a) The department shall conduct onsite visits to ensure compliance with this chapter at least once during the licensure period.(b) The department may conduct announced or unannounced site visits at any time to any substance use disorder program licensed pursuant to this chapter to determine compliance with applicable statutes and regulations.
11834.68.
(a) The department may enter any building, or portion thereof, that contains a substance use disorder program and inspect the premises and the program’s records at a reasonable time, with or without notice, to secure information regarding compliance with, or to prevent a violation of, this chapter or any regulation adopted pursuant to this chapter.(b) Failure of a substance use disorder program to allow the department to enter the building and inspect the premises and records shall result in the department taking legal action to gain entry by an inspection warrant issued pursuant to Title 13 (commencing with Section 1822.50) of Part 3 of the Code of Civil Procedure. The substance use disorder program shall pay for all costs associated
with legal action required to gain entry.
11834.69.
(a) The director may suspend or revoke any license issued under this chapter, as well as any other license issued under this chapter held by the same person or entity, or deny an application for licensure, renewal of a licensure, or modification of a licensure, upon any of the following grounds and in the manner provided in this chapter:(1) Violation by the program of any provision of this chapter or regulations adopted pursuant to this chapter.
(2) Repeated violation by the program of any of the provisions of this chapter or regulations adopted pursuant to this chapter.
(3) Aiding, abetting, or permitting
the violation of, or any repeated violation of, any of the provisions described in paragraph (1) or (2).
(4) Conduct in the operation of a program that is inimical to the health, morals, welfare, or safety of an individual receiving services from the program or to the people of the State of California.
(5) Misrepresentation of any material fact in obtaining licensure, including, but not limited to, providing false information or documentation to the department.
(6) Refusal to allow the department entry into the building to determine compliance with the requirements of this chapter or regulations adopted pursuant to this chapter.
(7) Failure to pay any civil penalties assessed by the department.
(b) (1) The director may temporarily suspend any license, as well as any other substance use disorder program licensure issued under this chapter held by the same person or entity, prior to any hearing when, in the opinion of the director, the action is necessary to protect individuals who receive services from any substantial threat to health or safety.
(2) The director shall notify the program of the temporary suspension and the effective date of the temporary suspension and at the same time shall serve the program with an accusation.
(3) Upon receipt of a notice of defense to the accusation by the program, the director shall, within 15 days, set the matter for hearing, and the hearing shall be held as soon as possible.
(4) (A) The temporary suspension shall
remain in effect until the time the hearing is completed and the director has made a final determination on the merits.
(B) The temporary suspension shall be deemed vacated if the director fails to make a final determination on the merits within 30 days after the department receives the proposed decision from the Office of Administrative Hearings.
(c) The department may terminate review of an application for licensure under this chapter from any person or entity that previously had a license issued under this chapter suspended or revoked for a period of five years from the date of the final decision and order.
(d) The department may terminate review of an application for licensure under this chapter at the time of origination or renewal from any person or entity if the person or entity named in the application is on
the United States Department of Health and Human Services’ exclusions list pursuant to Sections 1128 and 1156 of the Federal Social Security Act.
11834.70.
(a) Proceedings for the suspension, revocation, or denial of a license under this chapter shall be conducted in accordance with the provisions of Chapter 5 (commencing with Section 11500) of Part 1 of Division 3 of Title 2 of the Government Code, and the department shall have all the powers granted by those provisions. In the event of conflict between this chapter and the Government Code, the Government Code shall prevail.(b) In all proceedings conducted in accordance with this section, the standard of proof to be applied shall be by the preponderance of the evidence.
(c) The department shall commence and process license revocations under this chapter in a timely and
expeditious manner.
11834.71.
(a) The withdrawal of an application for a license after it has been filed with the department shall not, unless the department consents in writing to the withdrawal, deprive the department of its authority to institute or continue a proceeding against the applicant for the denial of a license upon any ground provided by law or to enter an order denying a license upon any of these grounds.(b) The suspension, expiration, or forfeiture by operation of law of a license issued by the department, or its suspension, forfeiture, or cancellation by order of the department or by order of a court of law, or its surrender without the written consent of the department, shall not deprive the department of its authority to institute or continue a
disciplinary proceeding against the program upon any ground provided by law or to enter an order suspending or revoking a license or otherwise taking disciplinary action against the program on any ground provided by law.
11834.72.
A license shall terminate by operation of law, prior to its expiration date, if any of the following conditions occur:(a) The program is sold or otherwise transferred.
(b) The program surrenders its license to the department.
(c) The program relocates from the address identified on the license to a different location.
(d) A sole proprietor who owned and operated a licensed substance use disorder program dies.
(e) The program abandons the license or otherwise ceases
operation.
11834.73.
(a) If a program, subject to mandatory licensure under this chapter, is alleged to be in violation of Section 11834.62, the department shall conduct a site visit to investigate the allegation. If the department finds evidence that the program is providing treatment, detoxification, or medication-assisted treatment services without a license, the department shall issue a written notice to the program stating that it is operating in violation Section 11834.62. The notice shall include all of the following:(1) The date by which the program shall cease providing services.
(2) Notice that the department will assess against the program a civil penalty of two thousand dollars
($2,000) per day for every day the program continues to provide services beyond the date specified in the notice.
(3) Notice that the case will be referred for civil proceedings in the event the program continues to provide services beyond the date specified in the notice.
(4) Notice informing the program of the licensure requirements of this chapter.
(b) A person or entity found to be in violation of Section 11834.62 shall be prohibited from applying for initial licensure for a period of five years from the date of the notice specified in subdivision (a).
11834.74.
(a) The director may bring an action to enjoin the violation of Section 11834.62 in the superior court in and for the county in which the violation occurred. Any proceeding under this section shall conform to the requirements of Chapter 3 (commencing with Section 525) of Title 7 of Part 2 of the Code of Civil Procedure, except that the director shall not be required to allege facts necessary to show or tending to show lack of adequate remedy at law or irreparable damage or loss.(b) With respect to any and all actions brought pursuant to this section alleging actual violation of Section 11834.62, the court shall, if it finds the allegations to be true, issue an order enjoining the program from continuance of the
violation.
11834.75.
(a) In addition to the penalties of suspension or revocation of a license issued under this chapter, the department may also levy a civil penalty for violation of this chapter or the regulations adopted pursuant to this chapter.(1) The amount of the civil penalty, as determined by the department, shall not be less than two hundred fifty dollars ($250) or more than five hundred dollars ($500) per day for each violation, except when the nature or seriousness of the violation or the frequency of the violation warrants a higher penalty or an immediate civil penalty assessment, or both, as determined by the department. In no event shall a civil penalty assessment exceed one thousand dollars ($1,000) per day.
(2) A program that is cited for repeating the same violation within 24 months of the first violation shall be subject to an immediate civil penalty of five hundred dollars ($500) and seven hundred fifty dollars ($750) for each day the violation continues until the deficiency is corrected.
(3) A program that has been assessed a civil penalty pursuant to paragraph (2) that repeats the same violation within 24 months of the violation subject to paragraph (2) is subject to an immediate civil penalty of five hundred dollars ($500) and one thousand dollars ($1,000) for each day the violation continues until the deficiency is corrected.
(b) Prior to the assessment of any civil penalty, the department shall provide the program with notice requiring the program to correct the violation within the period of time specified in the
notice.
11834.76.
The civil and administrative remedies available to the department pursuant to this chapter are not exclusive, and may be sought and employed in any combination deemed advisable by the department to enforce this chapter.11834.77.
(a) Any substance use disorder program operating in a setting that is exempt from mandatory licensure under subdivision (b) of Section 11834.58 may apply to the department for voluntary licensure.(b) Any facility that obtains voluntary licensure pursuant to this section is subject to the requirements of this chapter and any regulations adopted pursuant to this chapter.
(c) Licensure of a facility shall constitute program review for purposes of Section 2626.2 of the Unemployment Insurance Code.
11834.78.
(a) The department shall adopt regulations necessary to implement this chapter.(b) Notwithstanding the rulemaking provisions of the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code), the department may, if it deems appropriate, implement, interpret, or make specific this chapter by means of provider bulletins, written guidelines, or similar instructions from the department, until regulations are adopted.
11834.79.
(a) All fees, fines, and penalties collected from residential and outpatient substance use disorder programs collected in accordance with this chapter shall be deposited in the Residential and Outpatient Program Licensing Fund. The money in the fund shall be available upon appropriation by the Legislature for the purposes of supporting the licensing activities of the department.(b) (1) If the department determines that projected funds in the Residential and Outpatient Program Licensing Fund are insufficient to support the licensing activities under this chapter for a given fiscal year or years, it is the intent of the Legislature that General Fund moneys shall be available to the department for these same purposes
upon appropriation by the Legislature.
(2) If the department projects a deficiency in the Residential and Outpatient Programing Licensing Fund pursuant to paragraph (1), it shall notify the Department of Finance of the projected deficiency and the requested amount of General Fund moneys for inclusion in its annual state operations budget for the applicable fiscal year or years.
(3) General Fund moneys appropriated to the department pursuant to paragraph (1) shall supplement and not supplant existing amounts in the Residential and Outpatient Program Licensing Fund.
11834.80.
(a) A licensed substance use disorder treatment program may treat persons 12 to 17 years of age, inclusive, provided both of the following additional requirements are met:(1) Assessments for adolescents shall be based on the latest edition of the ASAM Criteria multidimensional assessment tool for adolescents.
(2) Using the information from the assessment, a qualified adolescent health professional service provider shall do all of the following:
(A) Diagnose the severity of the substance use condition.
(B) Determine the ASAM level of medical
necessity for the adolescent so that the patient can enter the system at the appropriate level.
(C) Identify and make appropriate referrals based on response to treatment.
(D) Document the adolescent’s unique abilities and strengths in the patient treatment plan.
(b) Staff for adolescent treatment programs shall meet the following requirements:
(1) Each adolescent treatment program shall have at least one of each of the following core staff:
(A) A program director.
(B) An alcohol and drug counselor, who shall be licensed by a state licensing board or certified by an alcohol and drug addiction counselor credentialing
organization.
(C) A family therapist, who shall be licensed as either a Marriage and Family Therapist (MFT), Licensed Clinical Social Worker (LCSW), psychologist, or a registered intern under the supervision of a licensed therapist. The family therapist may be a contracted employee.
(c) The core staff shall, at a minimum, have training, skills, or both in all of the following areas:
(1) Substance use disorder treatment, an understanding of addiction, the intergenerational nature of substance abuse, and the dynamics of adolescent recovery.
(2) Effective and developmentally appropriate interventions and approaches for treating substance-abusing adolescents.
(3) Assessment of substance use
disorders and mental health disorders, including psychotic, mood, anxiety, behavioral, and personality, and cognitive impairments.
(4) Psychoactive medications prescribed to adolescents, their benefits, and their potential side effects and interactions with other medications or substances.
(5) Child development and normal adolescent growth and development.
(6) Therapeutic recreational therapy.
(7) Family dynamics.
(8) Detection of adolescent injury, disease, abuse, and neglect.
(9) HIV/AIDS and other health issues, including sexually transmitted diseases, hepatitis, and smoking.
(10) Cultural competence, including Americans with Disabilities Act (ADA) requirements.
(11) Community resources and other adolescent treatment systems, including schools, child welfare, mental health, and the juvenile justice system.
(12) Methods of drug and alcohol testing, interpreting test results, and the benefits and limitations of the tests.
(13) Legal issues, including informed consent for minors, disclosure of confidential information, child abuse or neglect reporting requirements, and duty-to-warn issues.
(14) Program rules and procedures.
(15) Patient rights and grievance procedures.
(d) The department may require certification from an approved certifying organization to demonstrate staff members have met the requirements of this section.
11834.81.
This chapter shall be operative January 1, 2026.It is the intent of the Legislature to enact Jarrod’s Law, a licensure program for inpatient and outpatient programs providing substance use disorder treatment services, under the administration of the State Department of Health Care Services.
