Article
1.5. Augmented Residential Care Facility Licensing
5677.
The following definitions apply for purposes of this article:(a) “Augmented residential care facility” or “ARCF” means a facility certified by the State Department of Health Care Services and licensed by the State Department of Social Services that provides 24-hour nonmedical care to individuals with serious mental illness who require augmented supports, staffing, and supervision in a homelike setting, with other facility characteristics to address a consumer’s complex behavioral health needs that are beyond what is typically available in other community facilities licensed as an adult residential facility or a residential care facility for the elderly.
(b) “Individual supports plan” means the plan that identifies and documents the support and service needs of a consumer and details the strategies to be employed and services to be provided to address those needs, and includes the entity responsible for providing those services and timelines for when each identified support will commence.
(c) “Individual supports team” means those individuals who develop, monitor, and revise the individual supports plan for consumers residing in an augmented residential care facility. The team shall, at a minimum, be composed of all of the following individuals:
(1) The local mental or behavioral health agency coordinator and other local mental or behavioral health agency
representatives, as necessary.
(2) The consumer and, where appropriate, the consumer’s conservator or authorized representative.
(3) The augmented residential care facilities administrator.
(4) The patients’ rights advocate, unless the consumer objects on their own behalf to participation by the patients’ rights advocate.
(5) Family members or natural support systems, unless the consumer objects on their own behalf to participation by those social supports.
(6) Others deemed necessary by the consumer, or the consumer’s conservator or authorized representative, for developing a comprehensive and
effective individual supports plan.
(d)“Intensive support needs” means the consumer requires physical assistance in performing four or more of
the following activities of daily living:
(1)Eating.
(2)Dressing.
(3)Bathing.
(4)Transferring.
(5)Toileting.
(6)Continence.
(e)“Special health care needs” means the consumer has health conditions that
are predictable and stable, as determined by the individual supports team, and for which the individual requires nursing supports for any of the following types of care:
(1)Nutrition support, including total parenteral feeding and gastrostomy feeding, and hydration.
(2)Cardiorespiratory monitoring.
(3)Oxygen support, including continuous positive airway pressure and bilevel positive airway pressure, and use of other inhalation-assistive devices.
(4)Nursing interventions for tracheostomy care and suctioning.
(5)Nursing interventions for colostomy, ileostomy, or other medical or surgical procedures.
(6)Special medication regimes, including injection and intravenous medications.
(7)Management of insulin-dependent diabetes.
(8)Bowel care management, including enemas or suppositories.
(9)Indwelling urinary catheter/catheter procedure.
(10)Treatment for antimicrobial-resistant infections.
(11)Treatment for wounds or pressure injuries.
(12)Postoperative care and rehabilitation.
(13)Pain management and palliative care.
(14)Renal dialysis.
(15)Treatment for substance use and addiction disorders.
(16)Administration and monitoring of medication-assisted treatment medications, including, but not limited to, methadone, antabuse, and suboxone.
5677.1.
(a) The State Department of Health Care Services shall, jointly with the County Behavioral Health Directors Association of California, implement a certification program to provide augmented services to adults with serious mental illness in homelike community settings, which shall be licensed by the State Department of Social Services as described in this article.(b) The State Department of Social Services may license an augmented residential care facility, pursuant to Section 1567.62 of the Health and Safety Code as an adult residential facility or pursuant to Section 1569.15 of the Health and Safety Code as a residential care facility for the elderly, subject
to the requirements of this section, to provide 24-hour services to up to six adults who have mental health care and intensive support needs, as defined in Section 5677. adult residential facility or a residential care facility for the elderly as an augmented residential care facility to provide 24-hour nonmedical services to up to six adults who have serious mental illness. An augmented residential care facility shall conform to Section 441.530(a)(1) of Title 42 of the Code of Federal Regulations.
(c) The State Department of Health Care Services shall be responsible for granting the certificate of program approval for an ARCF. The State Department of Social Services shall not issue a license unless the applicant has obtained a
certification of program approval from the department.
(d) (1) The State Department of Social Services shall ensure that an ARCF meets the administration requirements under Article 2 (commencing with Section 1520) of Chapter 3 of Division 2 of the Health and Safety Code, including, but not limited to, requirements relating to fingerprinting and criminal records under Section 1522 of the Health and Safety Code, and administrator certification requirements of an adult residential facility pursuant Section 1562.3 of the Health and Safety Code, including, but not limited to, all of the following:
(A) Successfully complete a department-approved administrator certification training program requiring a minimum of 35 hours of instruction conducive to learning in which
participants are able to simultaneously interact with each other as well as with the instructor, and that provides training on a uniform core of knowledge under Section 1562.3 of the Health and Safety Code.
(B) Unless an extension is granted to the applicant by the department, pass the examination provided for in Section 1562.3 of the Health and Safety Code within 60 days of the applicant’s completion of instruction.
(C) Submit an application for administrator certification to the department to include:
(i) An administrator certification application.
(ii) A certificate of completion of the administrator certification training program required pursuant to this
section.
(iii) The fee for processing an administrator certification application, including the issuance of the administrator certificate, as specified in Section 1562.3 of the Health and Safety Code.
(D) Provide documentation that the applicant has passed the examination.
(2) (A) An administrator certificate issued under this subdivision shall expire every two years, on the anniversary date of the initial issuance of the certificate.
(B) An administrator certificate issued under this paragraph shall be renewed every two years and renewal shall be conditional upon the certificate holder submitting documentation of completion of 40
hours of continuing education related to the uniform core of knowledge specified in Section 1562.3 of the Health and Safety Code. No more than one-half of the required 40 hours of continuing education necessary to renew the certificate may be satisfied through self-paced courses. All other continuing education hours shall be completed in an instructional setting conducive to learning in which participants must be able to simultaneously interact with each other as well as with the instructor. For purposes of this section, an individual who is an adult residential facility administrator and who is required to complete the continuing education hours required by the regulations of the department, and approved by the local mental or behavioral health agency, shall be permitted to have up to 24 hours of the required continuing education course hours credited toward the 40-hour continuing education requirement of
this section. Community college course hours approved by the regional centers shall be accepted by the department for certification.
(3) The licensee shall provide documentation that the administrator of an ARCF, prior to employment, has completed a minimum of 35 hours of initial training in the general laws, regulations and policies, and procedural standards applicable to facilities licensed by the State Department of Social Services under Article 2 (commencing with Section 1520) of Chapter 3 of Division 2 of the Health and Safety Code.
(4) The training specified in this subdivision shall be provided by a vendor approved by the State Department of Social Services and the cost of the training shall be borne by the administrator or licensee.
(e) The State Department of Social Services shall administer employee actions under Article 5.5 (commencing with Section 1558) of Chapter 3 of Division 2 of the Health and Safety Code.
(f) The local mental or behavioral health agency shall monitor and enforce compliance of the program and health and safety requirements, including monitoring and evaluating the quality of care and support services. The department shall ensure that the local mental or behavioral health agency performs these functions.
(g) (1) The State Department of Health Care Services may decertify an ARCF that does not comply with program requirements. When the department determines that urgent action is necessary to protect clients of
the ARCF from physical or mental abuse, abandonment, or any other substantial threat to their health and safety, the State Department of Health Care Services may request the local mental or behavioral health agency or agencies to remove the clients from the ARCF or direct the local mental or behavioral health agency or agencies to obtain alternative services for the clients within 24 hours.
(2) The State Department of Social Services may initiate proceedings for temporary suspension of an ARCF license pursuant to Section 1550.5 of the Health and Safety Code.
(3) The department, upon its decertification, shall inform the State Department of Social Services of the licensee’s decertification, with its recommendation concerning revocation of the license, for which the State Department
of Social Services may initiate proceedings pursuant to Section 1550 of the Health and Safety Code.
(4) The State Department of Health Care Services and the local mental or behavioral health agencies shall provide the State Department of Social Services all available documentation and evidentiary support necessary for any enforcement proceedings to suspend the license pursuant to Section 1550.5 of, to revoke or deny a license pursuant to Section 1551 of, or to exclude an individual pursuant to Section 1558 of, the Health and Safety Code.
(i) The State Department of Social Services, Community Care Licensing Division, shall enter into a memorandum of understanding with the State Department of Health Care Services to outline a formal protocol to address shared responsibilities, including
monitoring responsibilities, complaint investigations, administrative actions, and closures.
5677.2.
(a) The State Department of Health Care Services shall establish by regulation a rate methodology for ARCFs that includes a fixed facility component for residential services and an individualized services and supports component based on each consumer’s needs as determined through the individual supports plan process, which may include assistance with transitioning to a less restrictive community residential setting.(b) (1) The established facility rate for a full month of service, as defined in regulations adopted pursuant to this article, shall be paid based on the licensed capacity of the facility once the facility reaches maximum capacity,
despite the temporary absence of one or more consumers from the facility or subsequent temporary vacancies created by consumers moving from the facility. Prior to the facility reaching licensed capacity, the facility rate shall be prorated based on the number of consumers residing in the facility.
(2) When a consumer is temporarily absent from the facility, including when a consumer is in need of inpatient care in a health facility, as defined in subdivision (a), (b), or (c) of Section 1250 of the Health and Safety Code, the local mental or behavioral health agency may, based on consumer need, continue to fund individual services, in addition to paying the facility rate. Individual consumer services funded by the local mental or behavioral health agency during a consumer’s absence from the facility shall be approved by the local mental or
behavioral health agency director and shall only be approved in 14-day increments. The local mental or behavioral health agency shall maintain documentation of the need for these services and the local mental or behavioral health agency director’s approval.
5677.3.
(a) A local mental or behavioral health agency shall not pay a rate to an ARCF for a consumer that exceeds the rate in the approved ARCF placement plan for that facility unless the local mental or behavioral health agency demonstrates that a higher rate is necessary to protect a consumer’s health and safety, and the State Department of Health Care Services has granted prior written authorization.(b) The payment rate for ARCF services shall be negotiated between the local mental or behavioral health agency and the ARCF.
(c) The established rate for a full month of service shall be made by the
local mental or behavioral health agency if a consumer is temporarily absent from the ARCF for 14 days or less per month. If the consumer’s temporary absence is due to the need for inpatient care in a health facility, as defined in subdivision (a), (b), or (c) of Section 1250 of the Health and Safety Code, the local mental or behavioral health agency shall continue to pay the established rate as long as no other consumer occupies the vacancy created by the consumer’s temporary absence, or until the individual supports team has determined that the consumer will not return to the facility. In all other cases, the established rate shall be prorated for a partial month of service by dividing the established rate by 30.44, then multiplying the quotient by the number of days the consumer resided in the facility.
5677.4.
(a) The local mental or behavioral health agency may recommend for participation to the State Department of Health Care Services an applicant to provide services as part of an approved community placement plan if the applicant meets all of the following requirements:(1) The applicant employs or contracts with a program administrator who has a successful record of administering residential services for at least two years, as evidenced by substantial compliance with the applicable state licensing requirements.
(2) The applicant prepares and submits to the mental or behavioral health agency a
complete facility program plan that includes, but is not limited to, all of the following:
(A) The total number of the consumers to be served.
(B) A profile of the consumer population to be served, including their health care and intensive support needs.
(C) A description of the program components, including a description of the health care and intensive support services to be provided.
(D) A week’s program schedule, including proposed consumer day and community integration activities.
(E) A week’s proposed program staffing pattern, including licensed, unlicensed, and support personnel and the number
and distribution of hours for those personnel.
(F) An organizational chart, including identification of lead and supervisory personnel.
(G) The consultants to be utilized, including their professional disciplines and hours to be worked per week or month, as appropriate.
(H) The plan for accessing and retaining consultant and health care services, including assessments, in the areas of physical therapy, occupational therapy, respiratory therapy, speech pathology, audiology, pharmacy, dietary and nutrition, dental, and other areas required for meeting the needs identified in consumers’ individual supports plans.
(I) A description, including the size,
layout, location, and condition, of the proposed home.
(J) A description of the equipment and supplies available, or to be obtained, for programming and care.
(K) The type, location, and response time of emergency medical service personnel.
(L) The inservice training program plan for at least the next 12 months, which shall include the plan for ensuring that the direct care personnel understand their roles and responsibilities related to implementing individual supports plans, prior to, or within, the first seven days of providing direct care in the home and for ensuring the administrator understands the unique roles, responsibilities, and expectations for administrators of community-based facilities.
(M) The plan for ensuring that outside services are coordinated, integrated, and consistent with those provided by the ARCF.
(3) The applicant submits a proposed budget itemizing direct and indirect costs, total costs, and the rate for services.
(4) The applicant submits written certification that they have the ability to comply with all of the requirements of Section 1520 of the Health and Safety Code.
(b) The local mental or behavioral health agency shall provide all documentation specified in paragraphs (2) to (4), inclusive, of subdivision (a) and a letter recommending program certification to the State Department of Health Care Services.
(c) The State Department of Health Care Services shall either approve or deny the recommendation and transmit its written decision to the local mental or behavioral health agency and to the State Department of Social Services within 30 days of its decision. The decision of the State Department of Health Care Services not to approve an application for program certification shall be the final administrative decision.
(d) Any change in the ARCF operation that alters the contents of the approved program plan shall be reported to the State Department of Health Care Services and the local mental or behavioral health agency, and approved by both agencies, prior to implementation.
5677.5.
This article shall be implemented only to the extent that funds for its purposes are made available through an appropriation in the annual Budget Act.
