CHAPTER
1. General Provisions
5970.
This part shall be known, and may be cited, as Community Assistance, Recovery, and Empowerment (CARE) Act.5970.5.
This part shall be implemented as follows, with technical assistance and continuous quality improvement, pursuant to Section 5983:(a) A first cohort of counties, representing at least one-half of the population of the state, which shall include the Counties of Glenn, Orange, Riverside, San Diego, Stanislaus, and Tuolumne, and the City and County of San Francisco, shall begin no later than October 1, 2023,
unless the county is provided additional time pursuant to paragraph (2) of subdivision (c).
(b) A second cohort of counties, representing the remaining population of the state, shall begin no later than December 1, 2024, unless the county is provided additional time pursuant to paragraph (2) of subdivision (c).
(c) (1) The department shall issue guidelines under which counties can apply for, and be provided, additional time to implement this part. The guidelines shall not be subject to the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code).
(2) The department shall approve implementation delay for
the first or second cohort if the county experiences a state or local emergency and the delay of the provision of the CARE process is necessary to respond to as a result of the emergency.
(3) The department shall only grant extensions once and no later than December 1, 2025.
(d) This part shall become operative only upon the department, in consultation with county stakeholders, developing a CARE Act allocation to provide state financial assistance to counties to implement the care process in this act.
5971.
Unless the context otherwise requires, the following definitions shall govern the construction of this part.(a) “CARE agreement” means a voluntary settlement agreement entered into by the parties. A CARE agreement includes the same elements as a CARE plan to support the respondent in accessing community-based services and supports.
(b) “CARE plan” means an individualized, appropriate range of community-based services and supports, as set forth in this part, which include clinically appropriate behavioral health care and stabilization medications, housing, and other supportive services, as appropriate, pursuant to Section 5982.
(c) “CARE process” means the court and related proceedings to implement the CARE Act.
(d) “Counsel” means the attorney representing the respondent, provided pursuant to Section 5980, or chosen by the respondent, in CARE Act proceedings and matters related to CARE agreements and CARE plans.
(e) “County behavioral health agency” means the local director of mental health services described in Section 5607, the local behavioral health director, or both as applicable, or their designee.
(f) “Court-ordered evaluation” means an evaluation ordered by a superior court pursuant to Section 5977.
(g) “Department” means the State Department of Health Care Services.
(h) “Graduation plan” means a voluntary agreement entered into by the parties at the end of the CARE program that includes a strategy to support a successful transition out of court jurisdiction and that may include a psychiatric advance directive. A graduation plan includes the same elements as a CARE plan to support the respondent in accessing community-based services and supports. The graduation plan shall not place additional requirements on the local government entities and is not enforceable by the court.
(i) “Homeless outreach worker” means a person who engages people experiencing homelessness to assess for unmet needs, offer information,
services, or other assistance, or provide care coordination.
(i)
(j) “Indian health care provider” means a health care program operated by the Indian Health Service, an Indian tribe, a tribal organization, or urban Indian organization (I/T/U) as those terms are defined in Section 4 of the Indian Health Care Improvement Act (25 U.S.C. Sec. 1603).
(j)
(k) “Licensed behavioral health professional” means either of the following:
(1) A licensed mental health professional, as defined in subdivision (j) of Section 4096.
(2) A person who has been granted a waiver of licensure requirements by the department pursuant to Section 5751.2.
(k)
(l) “Parties” means the petitioner, respondent, the county behavioral health agency in the county where proceedings under this part are pending, and other parties added by the
court pursuant to clause (ii) of subparagraph (B) of paragraph (3) paragraph (4) of subdivision (d) of Section 5977. 5977.1.
(l)
(m) “Petitioner” means the entity who files the CARE Act petition with the court. Additionally, if the petitioner is a person
listed in Section 5974 other than the director of a county behavioral health agency, or their designee, the petitioner shall have the right to file a petition with the court, but at the initial hearing the court shall substitute the director of a county behavioral health agency, or their designee, of the county in which the proceedings are filed as petitioner. The petitioner who filed the petition may, at the court’s discretion and in furtherance of the interests of the respondent, retain rights as described in subparagraph (A) of paragraph (7) of subdivision (b) of Section 5977.
(m)
(n) “Psychiatric advance directive” means a legal document, executed on a voluntary basis by a person who has the capacity to make medical decisions, that allows a person with mental illness to protect their autonomy and ability to self-direct care by documenting their preferences for treatment in advance of a mental health crisis.
(n)
(o) “Respondent” means the person who is subject to the petition for the CARE process.
(o)
(p) “Stabilization medications” means medications included in the CARE plan that primarily consist of antipsychotic medications, to reduce symptoms of hallucinations, delusions, and disorganized thinking. Stabilization medications may be administered as long-acting injections if clinically indicated. Stabilization medications shall not be forcibly administered.
(p)
(q) “Supporter” means an adult, designated pursuant to Chapter 4 (commencing with
Section 5980), who assists the person who is the subject of the petition, which may include supporting the person to understand, make, communicate, implement, or act on their own life decisions during the CARE process, including a CARE agreement, a CARE plan, and developing a graduation plan. A supporter shall not act independently.
5972.
An individual shall qualify for the CARE process only if all of the following criteria are met:(a) The person is 18 years of age or older.
(b) The person is currently experiencing a severe mental illness, as defined in paragraph (2) of subdivision (b) of Section 5600.3 and has a diagnosis
identified in the disorder class: schizophrenia spectrum and other psychotic disorders, as defined in the most current version of the Diagnostic and Statistical Manual of Mental Disorders. This section does not establish respondent eligibility based upon a psychotic disorder that is due to a medical condition or is not primarily psychiatric in nature, including, but not limited to, physical health conditions such as traumatic brain injury, autism, dementia, or neurologic conditions. A person who has a current diagnosis of substance use disorder as defined in paragraph (2) of subdivision (a) of Section 1374.72 of the Health and Safety Code, but who does not meet the required criteria in this section shall not qualify for the CARE process.
(c) The person is not clinically stabilized in on-going voluntary treatment.
(d) At least one of the following is true:
(1) The person is unlikely to survive safely in the community without supervision and the person’s condition is substantially deteriorating.
(2) The person is in need of services and supports in order to prevent a relapse or deterioration that would be likely to result in grave disability or serious harm to the person or others, as defined in Section 5150.
(e) Participation in a CARE plan or CARE agreement would be the least restrictive alternative necessary to ensure the person’s recovery and stability.
(f) It is likely that the person will benefit from
participation in a CARE plan or CARE agreement.
5973.
(a) Proceedings under this part may be commenced in any of the following:(1) The county in which the respondent resides.
(2) The county where the respondent is found.
(3) The county where the respondent is facing criminal or civil proceedings.
(b) If the respondent does not reside in the county in which proceedings are initiated under this subdivision, as determined in accordance with Section 244 of the Government Code, except as provided in subdivision (e) of Section 5982, and this
part is operative in the respondent’s county of residence, the proceeding shall, with the respondent’s consent, be transferred to the county of residence as soon as reasonably feasible. Should the respondent not consent to the transfer, the proceedings shall continue in the county where the respondent was found.
5974.
The following adult persons may file a petition to initiate the CARE process:(a) A person with whom the respondent resides.
(b) A spouse, parent, sibling, child, or grandparent or other individual who stands in loco parentis to the respondent.
(c) The director of a hospital, or their designee, in which the respondent is hospitalized, including hospitalization pursuant to Section 5150 or 5250.
(d) The director of a public or charitable organization, agency, or home, or their designee,
who has, within the previous 30 days, provided or who is currently providing behavioral health services to the respondent or in whose institution the respondent resides.
(e) A licensed behavioral health professional, or their designee, who is, or has been within the previous 30 days, either supervising the treatment of, or treating the respondent for a mental illness.
(f) A first responder, including a peace officer, firefighter, paramedic, emergency medical technician, mobile crisis response worker, or homeless outreach worker, who has had repeated interactions with the respondent in the form of multiple arrests, multiple detentions and transportation pursuant to Section 5150, multiple attempts to engage the respondent in voluntary treatment, or other repeated efforts to aid the respondent in
obtaining professional assistance.
(g) The public guardian or public conservator, or their designee, of the county in which the respondent is present or reasonably believed to be present.
(h) The director of a county behavioral health agency, or their designee, of the county in which the respondent resides or is found.
(i) The director of county adult protective services, or their designee, of the county in which the respondent resides or is found.
(j) The director of a California Indian health services program, California tribal behavioral health department, or their designee.
(k) The judge of a tribal
court that is located in California, or their designee.
(l) The respondent.
5975.
The Judicial Council shall develop a mandatory form for use to file a CARE process petition with the court and any other forms necessary for the CARE process. The petition shall be signed under the penalty of perjury and contain all of the following: (a) The name of the respondent and, if known, the respondent’s address.
(b) The petitioner’s relationship to the respondent.
(c) Facts that support the petitioner’s assertion that the respondent meets the CARE criteria in Section 5972.
(d) Either of the
following:
(1) An affidavit of a licensed behavioral health professional, stating that the licensed behavioral health professional or their designee has examined the respondent within 60 days of the submission of the petition, or has made multiple attempts to examine, but has not been successful in eliciting the cooperation of the respondent to submit to an examination, within 60 days of the petition, and that the licensed behavioral health professional had determined that the respondent meets, or has reason to believe, explained with specificity in the affidavit, that the respondent meets the diagnostic criteria for CARE proceedings.
(2) Evidence that the respondent was detained for a minimum of two intensive treatments pursuant to Article 4 (commencing with Section 5250) of
Chapter 2 of Part 1, the most recent one within the previous 60 days.
5975.1.
Notwithstanding Section 391 of the Code of Civil Procedure, if a person other than the respondent files a petition for CARE Act proceedings that is without merit or is intended to harass or annoy the respondent, and the person has previously filed a pleading in CARE Act proceedings that was without merit or was intended to harass or annoy the respondent, the petition shall be grounds for the court to determine that the person is a vexatious litigant for the purposes of Title 3A (commencing with Section 391) of Part 2 of the Code of Civil Procedure. 5976.
The respondent shall:(a) Receive notice of the hearings.
(b) Receive a copy of the court-ordered evaluation.
(c) Be entitled to be represented by counsel at all stages of a proceeding commenced under this chapter, regardless of the ability to pay.
(d) Be allowed to have a supporter, as described in Section 5982.
(e) Be present at the hearing unless the respondent waives the right to be present.
(f) Have the right to present evidence.
(g) Have the right to call witnesses.
(h) Have the right to cross-examine witnesses.
(i) Have the right to appeal decisions, and to be informed of the right to appeal.
5976.5.
(a) Notwithstanding any other law, and except as otherwise provided in this section, a hearing held under this part is presumptively closed to the public.(b) The respondent may demand that the hearing be public and be held in a place suitable for attendance by the public.
(c) The respondent may request the presence of any family member or friend without waiving the right to keep the hearing closed to the rest of the public.
(d) A request by any other party to the proceeding to make the hearing public may be granted if the judge conducting the
hearing finds that the public interest in an open hearing clearly outweighs the respondent’s interest in privacy.
(e) All reports, evaluations, diagnoses, or other information related to the respondent’s health shall be confidential.
(f) Before commencing a hearing, the judge shall inform the respondent of their rights under this section.
5977.
(a) (1) The court shall promptly review the petition to determine if the petitioner has made a prima facie showing that the respondent is, or may be, a person described in Section 5972.(2) If the court finds that the petitioner has not made a prima facie showing that the respondent is, or may be, a person described in Section 5972, the court may dismiss the case without prejudice subject to consideration of Section 5975.1.
(3) If the court finds that the petitioner has made a prima facie showing that the respondent is, or may be, a person described in Section 5972, the court shall do
one of the following:
(A) If the petitioner is the director of a county behavioral health agency, or their designee, the court shall do the following:
(i) Set the matter for an initial appearance on the petition within 14 court days.
(ii) Appoint a qualified legal services project, as defined in Sections 6213 to 6214.5, inclusive, of the Business and Professions Code, to represent the respondent. If no legal services project has agreed to accept these appointments, a public defender shall be appointed to represent the respondent. Unless replaced by respondent’s own counsel, appointed counsel shall represent the respondent in any proceeding under this part, and shall represent the individual, as needed, in matters
related to CARE agreements and CARE plans, including appeals.
(iii) Determine if the petition includes all of the following information, or order the county to submit a report within 10 14 court days that addresses all the following:
(I) A determination as to whether the respondent meets, or is likely to meet, the criteria for the CARE process.
(II) The outcome of efforts made to voluntarily engage the respondent prior to the filing of the petition.
(III) Conclusions and recommendations about the
respondent’s ability to voluntarily engage in services.
(iv) Order the county behavioral health director or their designee to provide notice to the respondent, the appointed counsel, and the county behavioral health agency in the county where the respondent resides, if different from the county where the CARE
process has commenced.
(B) If the petitioner is a person other than the director of a county behavioral health agency, or their designee, the court shall order a county agency, or their designee, as determined by the presiding judge, court, to investigate, as necessary, and file a written report with the court within 10 14 court days and provide notice to the respondent and petitioner that a report has been ordered. The written report shall include all of the following:
(i) A determination as to whether the respondent meets, or is likely to meet, the criteria for the CARE process.
(ii) The outcome of efforts made to voluntarily engage the respondent during the 10-day 14-day report period.
(iii) Conclusions and recommendations about the respondent’s ability to voluntarily engage in services.
(4) If, upon a request by the county, the court finds that the county agency is making progress to engage the respondent, the court may, in its discretion, grant the county no
more than 30 additional days to continue to work with, engage, and enroll the individual in voluntary treatment and services. The county shall provide notice to the respondent and petitioner that an extension for filing a report has been granted.
(5) Upon receipt of the report described in subparagraph (B) of paragraph (3), the court shall, within five days, take one of the following actions:
(A) If the court determines that voluntary engagement with the respondent is effective, and that the individual has enrolled or is likely to enroll in voluntary behavioral health treatment, the court shall dismiss the matter.
(B) If the court determines that
county’s report does not support the petition’s prima facie showing that the respondent is a person described in Section 5972, the court shall dismiss the matter. This section shall not prevent a county behavioral health agency from continuing to voluntarily engage with individuals who do not meet CARE criteria, but who are in need of services and supports.
(B)
(C) If the court determines that county’s report makes a does support the petition’s
prima facie showing that the respondent is, or may be, a person described in Section 5972, and engagement with the county was not effective, the court shall do all of the following:
(i) Set an initial appearance on the petition within 14 court days.
(ii) Appoint a qualified legal services project, as defined in Sections 6213 to 6214.5, inclusive, of the Business and Professions Code or, if no legal services project has agreed to accept these appointments, a public defender to represent the respondent for all purposes related to this part, including appeals, unless the respondent has retained their own counsel. Unless replaced by respondent’s own counsel, appointed counsel shall represent the respondent in any proceeding under this part, and shall represent the
individual, as needed, in matters related to CARE agreements and CARE plans.
(iii) Order the county to provide notice of the hearing to the petitioner, the respondent, the appointed counsel, the county behavioral health agency in the county where the respondent resides, and, if different, the county where the CARE court proceedings have commenced.
(6)If the court determines that the county’s report does not make a prima facie showing that the respondent is, or may be, a person described in Section 5972, the court shall dismiss the matter. This section shall not prevent a county behavioral health agency from continuing to voluntarily engage with individuals who do not meet CARE criteria, but who are in need of services and supports.
(b) At the initial appearance on the petition, all of the following
shall apply:
(1) The court shall permit the respondent to substitute their own counsel.
(2) Petitioner shall be present. If the petitioner is not present, the matter may be dismissed.
(3) Respondent may waive personal appearance and appear through counsel. If the respondent does not waive personal appearance and does not appear at the hearing, and the court makes a finding on the record that reasonable attempts to elicit the attendance of the respondent have failed, the court may conduct the hearing in the respondent’s absence if the court makes a finding on the record that conducting the hearing without the participation or presence of the respondent would be in the respondent’s best interest.
(4) A representative from the county behavioral health agency shall be present.
(5) A supporter may be appointed.
(6) If the respondent self-identifies that they are enrolled in a federally recognized Indian tribe or otherwise receiving services from an Indian health care provider, a tribal court, or a tribal organization, a representative from the program, the tribe, or the tribal court shall be allowed to be present, subject to the consent of the respondent. The tribal representative shall be entitled to notice by the county. county of the initial appearance.
(7) (A) If the petitioner is a person described in Section 5974 other than the director of a county behavioral health agency, or their designee, the court shall issue an order relieving the petitioner and appointing the director of the county behavioral health agency or their designee as the substitute petitioner.
(B) If the petitioner who is relieved pursuant to this paragraph is described in subdivision (a) or (b) of Section 5974, the all of the following apply:
(i) The
petitioner shall have the right to participate in the initial hearing to determine the merits of the petition, pursuant to subparagraphs (A) and (B) of paragraph (8).
(ii) The court may, in its discretion, assign ongoing rights of notice. The
(iii) The
court may, additionally, allow for participation and engagement in the respondent’s CARE proceedings if the respondent consents.
(iv) The petitioner may file a new petition with the court, pursuant to Section 5974, if the matter is dismissed and there is a change in circumstances.
(C) If the petitioner who is relieved pursuant this paragraph is described in Section 5974, other than persons described in subparagraph (a) or (b) of that section, the court shall not assign ongoing rights to the entity that originally filed the CARE petition.
petition, other than the right to make a statement at the hearing on the merits of the petition as provided in subparagraphs (A) and (B) of paragraph (8).
(D)Notwithstanding subparagraphs (B) and (C), a petitioner who is relieved shall have the right to make a statement at the hearing on the merits of the petition.
(8) (A) The court shall set a hearing on the merits of the petition within 10 days, at which time the court shall determine by clear and convincing evidence if the petitioner has shown that
the respondent meets the CARE criteria in Section 5972. In making this determination, the court shall consider all evidence properly before it, including the report from the county required pursuant to paragraph (3) of subdivision (a) and any additional evidence presented by the parties.
parties, including the petition submitted by the petitioner who is relieved.
(c)(1)The
(B) The hearing on the merits of the petition may be conducted concurrently with the initial appearance on the petition upon stipulation of the petitioner and respondent and agreement by the court.
(2)
(c) (1) If, at the hearing on the merits of the petition, the court finds that the petitioner has not shown, finds, by clear and convincing evidence, that the respondent meets
does not meet the CARE criteria in Section 5972, the court shall dismiss the case without prejudice, unless the court makes a finding, on the record, that the initial petitioner’s filing was not in good faith.
(3)
(2) If, at the hearing on the merits of the petition, the court finds that the petitioner has shown by clear and convincing evidence that the respondent meets the CARE criteria in Section 5972, the court shall order the county behavioral health agency
to work with the respondent, the respondent’s counsel, and the supporter to engage in behavioral health treatment and determine if the parties will be able to enter into a CARE agreement. The court shall set a case management hearing within 14 days.
(4)
(3) If the respondent is enrolled in a federally recognized Indian tribe, the respondent shall provide notice of the case management hearing to the tribe, subject to the consent of the respondent.
5977.1.
(a) (1) At the case management hearing, the court shall hear evidence as to whether the parties have entered, or are likely to enter, into a CARE agreement.(2) If the court finds that the parties have entered, or are likely to enter, into a CARE agreement, the court shall do both of the following:
(A) Approve the terms of the CARE agreement or modify the terms of the CARE agreement and approve the agreement as modified by the court.
(B) Stay Continue
the matter and set a progress hearing for 60 days.
(b) If the court finds that the parties have not entered into a CARE agreement, and are not likely to enter into a CARE agreement, the court shall order the county behavioral health agency, through a licensed behavioral health professional, to conduct a clinical evaluation of the respondent, unless there is an existing clinical evaluation of the respondent completed within the last 30 days and the parties stipulate to the use of that evaluation. The evaluation shall address, at a minimum, the following:
(1) A clinical diagnosis of the respondent.
(2) Whether the respondent has the legal capacity to give informed consent regarding psychotropic
medication.
(3) Any other information as ordered by the court or that the licensed behavioral health professional conducting the evaluation determines would help the court make future informed decisions about the appropriate care and services the respondent should receive.
(4) An analysis of recommended services, programs, housing, medications, and interventions that support the recovery and stability of the respondent.
(c) (1) The court shall set a clinical evaluation hearing to review the evaluation within 14 21 days. The court
shall order the county to file the evaluation with the court and provide the evaluation to the respondent’s counsel no later than five days prior to the scheduled clinical evaluation hearing. The clinical evaluation hearing may be continued for a maximum of 14 days upon stipulation of the respondent and the county behavioral health agency, unless there is good cause for a longer extension.
(2) At the clinical evaluation review hearing, the court shall review the evaluation and any other evidence from the county behavioral health agency and the respondent. The petitioner county behavioral health agency and the respondent may present evidence and call witnesses, including the
person who conducted the evaluation. Only relevant and admissible evidence that fully complies with the rules of evidence may be considered by the court.
(3) At the conclusion of the hearing, the court shall make orders as follows:
(A) If the court finds by clear and convincing evidence, after review of the evaluation and other evidence, that the respondent meets the CARE criteria, the court shall order the county behavioral health agency, the respondent, and the respondent’s counsel and supporter to jointly develop a CARE plan within 14 days.
(B) If the court finds, in reviewing the evaluation, that clear and convincing evidence does not support that the respondent meets the CARE criteria, the court shall
dismiss the petition.
(C)
(4) If the respondent is a self-identified American Indian or Alaska Native individual, as defined in Sections 1603(13), 1603(28), and 1679(a) of Title 25 of the United States Code, has been determined eligible as an Indian under Section 136.12 of Title 42 of the Code of Federal Regulations, or is otherwise receiving services from an Indian health care provider or tribal court, the county behavioral health agency shall use best efforts to meaningfully consult with and incorporate the Indian health care provider or tribal court available to the respondent to develop the
CARE plan.
(4)
(5) The evaluation and all reports, documents, and filings submitted to the court shall be confidential.
(5)
(6) The date for the hearing to review and consider approval of the proposed CARE plan shall be set not more than 14 days from the date of the order to develop a
CARE plan, unless the court finds good cause for an extension. The party requesting an extension of time for the CARE plan review hearing shall provide notice to the opposing party and their counsel of the request for extension of time, and the court’s order if the request is granted.
(d) (1) At the CARE plan review hearing, the parties shall present their plans to the court. The county behavioral health agency or the respondent, or both, may present a proposed CARE plan.
(2) After consideration of the plans proposed by the parties, the court shall adopt the elements of a CARE plan that support the recovery and stability of the respondent. The court may issue any orders necessary to support the respondent in accessing appropriate services and supports,
including prioritization for those services and supports, subject to applicable laws and available funding pursuant to Section 5982. These orders shall constitute the CARE plan.
(3) A court may order medication only if it finds, upon review of the court-ordered evaluation and hearing from the parties, that, by clear and convincing evidence, the respondent lacks the capacity to give informed consent to the administration of medically necessary medication, including antipsychotic stabilization medication. To the extent the court orders medically necessary stabilization medication, the
medication shall not be forcibly administered and the respondent’s failure to comply with a medication order shall not result in a penalty, including, but not limited to, contempt or termination of the CARE plan pursuant to Section 5979.
(4) If the proposed CARE plan includes services and supports, such as housing, provided directly or indirectly through another local governmental entity, that local entity may agree to provide the service or support, or the court may consider a motion by either of the parties to add the local entity as a party to the CARE proceeding. If the local entity agrees to provide the service or support, it may request to be added as a party by the court.
(5) If, after
presentation of the CARE plan or plans, the court determines that additional information is needed, including from a licensed behavioral health professional, the court shall order a supplemental report to be filed by petitioner the county behavioral health agency for which the court may grant a continuance of no more than 14 days, unless there is good cause for a longer extension.
(6) If there is no CARE plan because the parties have not had sufficient time to complete it, the court may grant a continuance of no more than 14 days, unless there is good cause for a longer extension.
(e) The issuance of an order
approving a CARE plan pursuant to paragraph (2) of subdivision (d) begins the CARE process timeline, which shall not exceed one year.
5977.2.
(a) (1) At intervals set by the court, but not less frequently than 60 days after the court orders the CARE plan, the court shall hold a status review hearing. The petitioner county behavioral health agency shall file with the court and serve on the respondent, and the respondent’s counsel and supporter, a report not fewer than five court days prior to the review hearing with the following information:(A) Progress the respondent has made on the CARE plan.
(B) What services and supports in the CARE plan were provided, and what services and supports were not provided.
(C) Any issues the respondent expressed or exhibited in adhering to the CARE plan.
(D) Recommendations for changes to the services and supports to make the CARE plan more successful.
(2) The respondent shall be permitted to respond to the report submitted by petitioner the county behavioral health agency
and to the petitioner’s county behavioral health agency’s testimony. The respondent shall be permitted to introduce their own information and recommendations.
(3) Subject to applicable law, intermittent lapses or setbacks described in this section of the report shall not impact access to services, treatment, or housing.
(b) The petitioner county behavioral health agency or the respondent may request, or the court upon its own
motion may set, a hearing to occur at any time during the CARE
process to address a change of circumstances.
5977.3.
(a) (1) In the 11th month of the program timeline, the court shall hold a one-year status hearing. Not fewer than five court days prior to the one-year status hearing, the petitioner county behavioral health agency shall file a report with the court and shall serve the report on the respondent and the respondent’s counsel and supporter. The report shall include the following information:(A) Progress the respondent has made on the CARE plan including a final
assessment of the respondent’s stability.
(B) What services and supports in the CARE plan were provided, and what services and supports were not provided, over the life of the program.
(C) Any issues the respondent expressed or exhibited in adhering to the CARE plan.
(D) Recommendations for next steps, including what ongoing and additional services would benefit the respondent that the petitioner county behavioral health agency can facilitate or provide.
(2) At an evidentiary hearing, the
respondent shall be permitted to respond to the report submitted by petitioner the county behavioral health agency and to the petitioner’s county behavioral health agency’s testimony. Respondent shall be permitted to introduce their own information and recommendations. The respondent shall have the right at the hearing to call witnesses and to present evidence as to whether the respondent agrees with the report. The respondent may request either to be graduated from the program or to remain in the program.
(3) The
court shall issue an order as follows:
(A) If the respondent elects to be graduated from the program, the court shall order the petitioner county behavioral health agency and the respondent to work jointly on a graduation plan. The court shall schedule a hearing in the 12th month after adoption of the CARE plan for presentation of the graduation plan. The court shall review the voluntary graduation plan and recite the terms on the record. The graduation plan shall not place additional requirements on local government
entities and is not enforceable by the court, except that the graduation plan may, at respondent’s election, include a psychiatric advance directive, which shall have the force of law. Upon completion of the hearing, the respondent shall be officially graduated from the program.
(B) If the respondent elects to remain in the CARE process, respondent may request any amount of time, up to and including one additional year. The court may permit the ongoing voluntary participation of the respondent if the court finds both of the following:
(i) The respondent did not successfully complete the CARE plan.
(ii) The respondent would benefit from continuation of the CARE plan.
(C) The court shall issue an order permitting the respondent to continue in the CARE plan or denying respondent’s request to remain in the CARE plan, and state its reasons on the record.
(b) The respondent may be involuntarily reappointed to the program only if the court finds, by clear and convincing evidence, that all of the following conditions apply:
(1) The respondent did not successfully complete the CARE
process.
(2) All services and supports required through the CARE process were provided to the respondent.
(3) The respondent would benefit from continuation in the CARE process.
(4) The respondent currently meets the requirements in Section 5972.
(c) A respondent may only be reappointed to the CARE process once, for up to one additional year.
5977.4.
(a) In all CARE Act proceedings, the judge shall control the proceedings during the hearings with a view to the expeditious and effective ascertainment of the jurisdictional facts and the ascertainment of all information relative to the present condition and future welfare of the respondent. Except when there is a contested issue of fact or law, the proceedings shall be conducted in an informal nonadversarial atmosphere with a view to obtaining the maximum cooperation of the respondent, all persons interested in the respondent’s welfare, and all other parties, with any provisions that the court may make for the disposition and care of the respondent. All evaluations and reports, documents, and filings submitted to the
court pursuant to CARE Act proceedings shall be confidential.(b) The hearings described in this chapter shall occur in person unless the court, in its discretion, allows a party or witness to appear remotely through the use of remote technology. The respondent shall have the right to be in person for all hearings.
(c) Consistent with its constitutional rulemaking authority, the Judicial Council shall adopt rules to implement the policies and provisions in this section and in Sections 5977, 5977.1, 5977.2, and 5977.3 to promote statewide consistency, including, but not limited to, what is included in the petition form packet, the clerk’s review of the petition, and the process by which counsel will be appointed.
5978.
(a) A court may refer an individual from assisted outpatient treatment, as well as from conservatorship proceedings pursuant Chapter 3 (commencing with Section 5350) of Part 1 of Division 5 (LPS conservatorship) to CARE Act proceedings. If the individual is being referred from assisted outpatient treatment, the county behavioral health director or their designee shall be the petitioner. If the individual is being referred from LPS conservatorship proceedings, the conservator shall be the petitioner pursuant to Section 5974.(b) A court may refer an individual from misdemeanor proceedings pursuant to Section 1370.01 of the Penal
Code.
CHAPTER
4. Supporter and Counsel
5980.
(a) Subject to appropriation, the department, in consultation with disability rights groups, county behavioral health and aging agencies, individuals with lived expertise, families, racial justice experts, and other appropriate stakeholders, shall provide optional training and technical resources for volunteer supporters on
the CARE process, community services and supports, supported decisionmaking, people with behavioral health conditions, trauma-informed care, family psychoeducation, and psychiatric advance directives. The department may consult with other state and national public and nonprofit agencies and organizations and the Judicial Council to align supported decisionmaking training with best practices for persons with mental illnesses, intellectual and developmental disabilities, other disabilities, and older adults. The department may enter into a technical assistance and training agreement for this purpose, pursuant to Section 5984.(b) The supporter shall do all of the following:
(1) Offer the respondent a flexible and culturally responsive way to maintain autonomy and decisionmaking authority over their own life by developing and maintaining voluntary supports to assist them in understanding, making, communicating, and implementing their own informed choices.
(2) Strengthen the respondent’s capacity to engage in and exercise autonomous decisionmaking and prevent or remove the need to use more restrictive protective mechanisms, such as conservatorship.
(3) Assist the respondent with understanding, making, and communicating decisions and expressing preferences throughout the CARE process.
5981.
(a) Notwithstanding any other provision of this part, the respondent may have a supporter present in any meeting, judicial proceeding, status hearing, or communication related to any of the following:(1) An evaluation.
(2) Development of a CARE agreement or CARE plan.
(3) Establishing a psychiatric advance directive.
(4) Development of a graduation plan.
(b) A supporter is intended to do all the following:
(1) Support the will and preferences of the respondent to the best of their ability and to the extent reasonably possible.
(2) Respect the values, beliefs, and preferences of the respondent.
(3) Act honestly, diligently, and in good faith.
(4) Avoid, to the greatest extent possible, and disclose to the court, the respondent, and the respondent’s counsel, minimize, and manage, conflicts of interest. A court may remove a supporter because of any conflict of interest with the respondent, and shall remove the supporter if the conflict cannot be managed in such a way to avoid any possible harm to the respondent.
(c) Unless
explicitly authorized by the respondent with capacity to make that authorization, a supporter shall not do either of the following:
(1) Make decisions for, or on behalf of, the respondent, except when necessary to prevent imminent bodily harm or injury.
(2) Sign documents on behalf of the respondent.
(d) In addition to the obligations in this section, a supporter shall be bound by all existing obligations and prohibitions otherwise applicable by law that protect people with disabilities and the elderly from fraud, abuse, neglect, coercion, or mistreatment. This section does not limit a supporter’s civil or criminal liability for prohibited conduct against the respondent, including liability for fraud, abuse, neglect,
coercion, or mistreatment, including liability under the Elder Abuse and Dependent Adult Civil Protection Act (Chapter 11 (commencing with Section 15600) of Part 3 of Division 9), including, but not limited to, Sections 15656 and 15657.
(e) The supporter shall not be subpoenaed or called to testify against the respondent in any proceeding relating to this part, and the supporter’s presence at any meeting, proceeding, or communication shall not waive confidentiality or any privilege.
5981.5.
(a) The Legal Services Trust Fund Commission at the State Bar shall provide funding to qualified legal services projects, as defined in Sections 6213 to 6214.5, inclusive, of the Business and Professions Code, to be used to provide legal counsel appointed pursuant to subdivision (c) of Section 5976, for representation in CARE Act proceedings, matters related to CARE agreements and CARE plans, and to qualified support centers, as defined in subdivision (b) of Section 6213 of, and Section 6215 of, the Business and Professions Code, for training, support, and coordination.(b) For purposes of implementing this part, the Legal Services Trust Fund Commission
may enter into exclusive or nonexclusive contracts, or amend existing contracts, on a bid or negotiated basis, or award grants, provided that they make a finding that both of the following are satisfied:
(1) The state agency will retain control over the distribution of funds to the contractor or grantee.
(2) The contract or grant includes provisions to ensure
transparency, accountability, and oversight in delivering the services, including measurement of outcomes. outcomes established pursuant to Sections 5984, 5985, and 5986.
CHAPTER
6. Technical Assistance and Administration
5983.
(a) The California Health and Human Services Agency, or a designated department within the agency, shall do both of the following:(1) Engage an independent, research-based entity, as described in Section 5986, to advise on the development of data-driven process and outcome measures to guide the planning, collaboration, reporting, and evaluation of the CARE Act pursuant to this part.
(2) Convene a working group to provide coordination and on-going engagement with, and support collaboration among, relevant state and local partners and other stakeholders throughout the phases of county implementation to support
the successful implementation of the CARE Act. The working group shall meet no more than quarterly. The working group shall meet during the implementation and shall end no later than December 31, 2026.
(b) The department shall provide training and technical assistance to county behavioral health agencies to support the implementation of this part, including training regarding the CARE process, CARE agreement and plan services and supports, supported decisionmaking, the supporter role, trauma-informed care, elimination of bias, psychiatric advance directives, family psychoeducation, and data collection.
(c) The Judicial Council, in consultation with the
department, other relevant state entities, and the County Behavioral Health Directors Association, shall provide training and technical assistance to judges to support the implementation of this part, including training regarding the CARE process, CARE agreement and plan services and supports, working with the supporter, supported decisionmaking, the supporter role, the family role, trauma-informed care, elimination of bias, best practices, and evidence-based models of care for people with severe behavioral health conditions.
(d) The department, in consultation with other relevant state departments and the California Interagency Council on Homelessness, shall provide training to counsel regarding the CARE
process and CARE agreement and plan services and supports.
5984.
(a) For purposes of implementing this part, the California Health and Human Services Agency and the department may enter into exclusive or nonexclusive contracts, or amend existing contracts, on a bid or negotiated basis. Contracts entered into or amended pursuant to this part shall be exempt from Chapter 6 (commencing with Section 14825) of Part 5.5 of Division 3 of Title 2 of the Government Code, Section 19130 of the Government Code, Part 2 (commencing with Section 10100) of Division 2 of the Public Contract Code, and the State Administrative Manual, and shall be exempt from the review or approval of any division of the Department of General Services.(b) Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the California Health and Human Services Agency and the department may implement, interpret, or make specific this part, in whole or in part, by means of plan letters, information notices, provider bulletins, or other similar instructions, without taking any further regulatory action.
5985.
(a) The department shall develop, in consultation with county behavioral health agencies, other relevant state or local government entities, disability rights groups, individuals with lived experience, families, counsel, racial justice experts, and other appropriate stakeholders, an annual CARE Act report. The department shall post the annual report on its internet website.(b) County behavioral health agencies and any other state or local governmental entity, as identified by the department, shall provide data related to the CARE Act participants, services, and supports to the department. The department shall determine the data measures and specifications, and
shall publish them via guidance issues pursuant to subdivision (b) of Section 5984.
(c) Each county behavioral health department and any other state and local governmental entity, as identified by the department, shall provide the required data to the department, in a format and frequency as directed by the department.
(d) (1) In consultation with the Judicial Council, the department shall develop an annual reporting schedule for the submission of CARE Act data from the trial courts.
(2) Data from the trial courts shall be submitted to the Judicial Council, which shall aggregate the data and submit it to the department consistent with the reporting schedule developed pursuant to paragraph (1).
(3) On an annual basis to be determined by the Judicial Council and consistent with the annual reporting schedule developed pursuant to paragraph (1), the trial courts shall report to the Judicial Council the following data related to CARE Act petitions:
(A) The number of petitions submitted pursuant to Section 5975.
(B) The number of initial appearances on the petition set pursuant to paragraph (3) of subdivision (a) of Section 5977.
(C) The total number of hearings held pursuant to this part.
(e) The annual report shall include process measures to examine the scope of impact and monitor the performance of CARE
Act model implementation. The report shall include, at a minimum, all of the following:
(1) The demographics of participants, including, but not limited to, the age, sex, race, ethnicity, disability, languages spoken, sexual orientation, gender identity, housing status, veteran status, immigration status, health coverage status, including Medi-Cal enrollment status, and county of residence, to the extent statistically relevant data is available.
(2) The services and supports ordered, the services and supports provided, and the services and supports ordered but not provided.
(3) The housing placements of all participants during the program and at least one year following the termination of the CARE plan, to the
extent administrative data are available to report the latter. Placements include, but are not limited to, transition to a higher level of care, independent living in the person’s own house or apartment, community-based housing, community-based housing with services, shelter, and no housing.
(4) Treatments continued and terminated at least one year following termination of the CARE plan, to the extent administrative data are available.
(5) Substance use disorder rates and rates of treatment among active CARE plan participants and former participants at least one year following termination of the CARE plan, to the extent administrative data are available to report the latter.
(6) Detentions and other
Lanterman-Petris-Short Act involvement for participants with an active CARE plan and for former participants at least one year following termination of the CARE plan, to the extent administrative data are available to report the latter.
(7) Criminal justice involvement of participants with an active CARE plan and for former participants at least one year following termination of the CARE plan, to the extent administrative data are available to report the latter.
(8) Deaths among active participants and for former participants at least one year following termination of the CARE plan, along with causes of death, to the extent administrative data are available.
(9) The number, rates, and trends of petitions resulting in dismissal
and hearings.
(10) The number, rates, and trends of supporters.
(11) The number, rates, and trends of voluntary CARE agreements.
(12) The number, rates, and trends of ordered and completed CARE plans.
(13) Statistics on the services and supports included in CARE plans, including court orders for stabilizing medications.
(14) The rates of adherence to medication.
(15) The number, rates, and trends of psychiatric advance directives created for participants with active CARE plans.
(16) The number, rates, and trends of developed graduation plans.
(17) Outcome measures to assess the effectiveness of the CARE Act model, such as improvement in housing status, including gaining and maintaining housing, reductions in emergency department visits and inpatient hospitalizations, reductions in law enforcement encounters and incarceration, reductions in involuntary treatment and conservatorship, and reductions in substance use.
(18) A health equity assessment of the CARE Act to identify demographic disparities based on demographic data in paragraph (1), and to inform disparity reduction efforts.
(f) (1) The report shall include, at a minimum, information on the
effectiveness of the CARE Act model in improving outcomes and reducing disparities, homelessness, criminal justice involvement, conservatorships, and hospitalization of participants. The annual report shall include process measures to examine the scope of impact and monitor the performance of CARE Act model implementation, such as the number and source of petitions filed for CARE Court; the number, rates, and trends of petitions resulting in dismissal and hearings; the number, rates, and trends of supporters; the number, rates, and trends of voluntary CARE agreements; the number, rates, and trends of ordered and completed CARE plans; the services and supports included in CARE plans, including court orders for stabilizing medications; the rates of adherence to medication; the number, rates, and trends of psychiatric advance directives; and the number, rates, and trends of developed graduation plans.
The report shall include outcome measures to assess the effectiveness of the CARE Act model, such as improvement in housing status, including gaining and maintaining housing; reductions in emergency department visits and inpatient hospitalizations; reductions in law enforcement encounters and incarceration; reductions in involuntary treatment and conservatorship; and reductions in substance use. The annual report shall examine these data through the lens of health equity to identify racial, ethnic, and other demographic disparities and inform disparity reduction efforts.
(2) Data shall be stratified by age, sex, race, ethnicity, languages spoken, disability, sexual orientation, gender identity, housing status, veteran status, immigration status, health coverage source, and county, to the extent statistically relevant data is available. Information
released or published pursuant to this section shall not contain data that may lead to the identification of respondents or information that would otherwise allow an individual to link the published information to a specific person. Data published by the department shall be deidentified in compliance with Section 164.514(a) and (b) of Title 45 of the Code of Federal Regulations.
(g) The outcomes shall be presented to relevant state oversight bodies, including, but not limited to, the California Interagency Council on Homelessness.
5986.
(a) An independent, research-based entity shall be retained by the department to develop, in consultation with county behavioral health agencies, county CARE courts, racial justice experts, and other appropriate stakeholders, including providers and CARE court participants, an independent evaluation of the effectiveness of the CARE Act. The independent evaluation shall employ statistical research methodology and include a logic model, hypotheses, comparative or quasi-experimental analyses, and conclusions regarding the extent to which the CARE Act model is associated, correlated, and causally related with the performance of the outcome measures included in the annual reports. The independent evaluation shall include results
from a survey conducted of program participants. The independent evaluation shall highlight racial, ethnic, and other demographic disparities, and include causal inference or descriptive analyses regarding the impact of the CARE Act on disparity reduction efforts.(b) The department shall provide a preliminary report to the Legislature three years after the implementation date of the CARE Act and a final report to the Legislature five years after the implementation date of CARE Act. The department shall post the preliminary and final reports on its internet website.
(c) Each county behavioral health department, each county CARE court, and any other state or local governmental entity, as determined by the department, shall provide the required data to the department, in a format
and frequency as directed by the department.
(d) A report to be submitted pursuant to this section shall be submitted in compliance with Section 9795 of the Government Code.
5987.
A county, or an employee or agent of a county, shall not be held civilly or criminally liable for any action by a respondent in the CARE process, except when the act or omission of a county, or the employee or agent of a county, constitutes gross negligence, recklessness, or willful misconduct. This section does not limit any immunity provided under any other law.