SECTIONS 4094-4096.5 - California Statutes

WELFARE AND INSTITUTIONS CODE

SECTION 4094-4096.5

4094. (a) The State Department of Mental Health shall establish, by
regulations adopted at the earliest possible date, but no later than
December 31, 1994, program standards for any facility licensed as a
community treatment facility. This section shall apply only to
community treatment facilities described in this subdivision.
(b) A certification of compliance issued by the State Department
of Mental Health shall be a condition of licensure for the community
treatment facility by the State Department of Social Services. The
department may, upon the request of a county, delegate the
certification and supervision of a community treatment facility to
the county department of mental health.
(c) The State Department of Mental Health shall adopt regulations
to include, but not be limited to, the following:
(1) Procedures by which the Director of Mental Health shall
certify that a facility requesting licensure as a community treatment
facility pursuant to Chapter 3 (commencing with Section 1500) of
Division 2 of the Health and Safety Code is in compliance with
program standards established pursuant to this section.
(2) Procedures by which the Director of Mental Health shall deny a
certification to a facility or decertify a facility that is licensed
as a community treatment facility pursuant to Chapter 3 (commencing
with Section 1500) of Division 2 of the Health and Safety Code, but
no longer complying with program standards established pursuant to
this section, in accordance with Chapter 5 (commencing with Section
11500) of Part 1 of Division 3 of Title 2 of the Government Code.
(3) Provisions for site visits by the State Department of Mental
Health for the purpose of reviewing a facility's compliance with
program standards established pursuant to this section.
(4) Provisions for the community care licensing staff of the State
Department of Social Services to report to the State Department of
Mental Health when there is reasonable cause to believe that a
community treatment facility is not in compliance with program
standards established pursuant to this section.
(5) Provisions for the State Department of Mental Health to
provide consultation and documentation to the State Department of
Social Services in any administrative proceeding regarding denial,
suspension, or revocation of a community treatment facility license.
(d) The standards adopted by regulations pursuant to subdivision
(a) shall include, but not be limited to, standards for treatment,
staffing, and for the use of psychotropic medication, discipline, and
restraints in the facilities. The standards shall also meet the
requirements of Section 4094.5.
(e) (1) Until January 1, 2013, all of the following are
applicable:
(A) A community treatment facility shall not be required by the
State Department of Mental Health to have 24-hour onsite licensed
nursing staff, but shall retain at least one full-time, or
full-time-equivalent, registered nurse onsite if both of the
following are applicable:
(i) The facility does not use mechanical restraint.
(ii) The facility only admits children who have been assessed, at
the point of admission, by a licensed primary care provider and a
licensed psychiatrist, who have concluded, with respect to each
child, that the child does not require medical services that require
24-hour nursing coverage. For purposes of this section, a "primary
care provider" includes a person defined in Section 14254, or a nurse
practitioner who has the responsibility for providing initial and
primary care to patients, for maintaining the continuity of care, and
for initiating referral for specialist care.
(B) Other medical or nursing staff shall be available on call to
provide appropriate services, when necessary, within one hour.
(C) All direct care staff shall be trained in first aid and
cardiopulmonary resuscitation, and in emergency intervention
techniques and methods approved by the Community Care Licensing
Division of the State Department of Social Services.
(2) The State Department of Mental Health may adopt emergency
regulations as necessary to implement this subdivision. The adoption
of these regulations shall be deemed to be an emergency and necessary
for the immediate preservation of the public peace, health and
safety, and general welfare. The regulations shall be exempt from
review by the Office of Administrative Law and shall become effective
immediately upon filing with the Secretary of State. The regulations
shall not remain in effect more than 180 days unless the adopting
agency complies with all the provisions of Chapter 3.5 (commencing
with Section 11340) of Part 1 of Division 3 of Title 2 of the
Government Code, as required by subdivision (e) of Section 11346.1 of
the Government Code.
(f) During the initial public comment period for the adoption of
the regulations required by this section, the community care facility
licensing regulations proposed by the State Department of Social
Services and the program standards proposed by the State Department
of Mental Health shall be presented simultaneously.
(g) A minor shall be admitted to a community treatment facility
only if the requirements of Section 4094.5 and either of the
following conditions are met:
(1) The minor is within the jurisdiction of the juvenile court,
and has made voluntary application for mental health services
pursuant to Section 6552.
(2) Informed consent is given by a parent, guardian, conservator,
or other person having custody of the minor.
(h) Any minor admitted to a community treatment facility shall
have the same due process rights afforded to a minor who may be
admitted to a state hospital, pursuant to the holding in In re Roger
S. (1977) 19 Cal.3d 921. Minors who are wards or dependents of the
court and to whom this subdivision applies shall be afforded due
process in accordance with Section 6552 and related case law,
including In re Michael E. (1975) 15 Cal.3d 183. Regulations adopted
pursuant to Section 4094 shall specify the procedures for ensuring
these rights, including provisions for notification of rights and the
time and place of hearings.
(i) Notwithstanding Section 13340 of the Government Code, the sum
of forty-five thousand dollars ($45,000) is hereby appropriated
annually from the General Fund to the State Department of Mental
Health for one personnel year to carry out the provisions of this
section.

4094.1. (a) (1) The department and the State Department of Social
Services, in consultation with community treatment providers, local
mental health departments, and county welfare departments, shall
develop joint protocols for the oversight of community treatment
facilities.
(2) Subject to subdivision (b), until the protocols and regulatory
changes required by paragraph (1) are implemented, entities
operating community treatment facilities shall comply with the
current reporting requirements and other procedural and
administrative mandates established in State Department of Mental
Health regulations governing community treatment facilities.
(b) In accordance with all of the following, the State Department
of Social Services shall modify existing regulations governing
reporting requirements and other procedural and administrative
mandates, to take into account the seriousness and frequency of
behaviors that are likely to be exhibited by children placed in
community treatment facilities. The modifications required by this
subdivision shall apply for the entire 2000-01 fiscal year.
(1) Notwithstanding existing regulations, the State Department of
Social Services shall issue alternative training and education
requirements for community treatment facility managers and staff,
which shall be developed in consultation with the State Department of
Mental Health, patients' rights advocates, local mental health
departments, county welfare offices, and providers.
(2) The department and the State Department of Social Services
shall conduct joint bimonthly visits to licensed community treatment
facilities to monitor operational progress and to provide technical
assistance.
(3) The appropriate department shall centrally review any
certification or licensure deficiency before notice of the citation
is issued to the community care facility.
(4) A community treatment facility shall be exempt from reporting
any occurrence of the use of restraint to the State Department of
Social Services, unless physical injury is sustained or
unconsciousness or other medical conditions arise from the restraint.
All other reporting requirements shall apply.

4094.2. (a) For the purpose of establishing payment rates for
community treatment facility programs, the private nonprofit agencies
selected to operate these programs shall prepare a budget that
covers the total costs of providing residential care and supervision
and mental health services for their proposed programs. These costs
shall include categories that are allowable under California's Foster
Care program and existing programs for mental health services. They
shall not include educational, nonmental health medical, and dental
costs.
(b) Each agency operating a community treatment facility program
shall negotiate a final budget with the local mental health
department in the county in which its facility is located (the host
county) and other local agencies, as appropriate. This budget
agreement shall specify the types and level of care and services to
be provided by the community treatment facility program and a payment
rate that fully covers the costs included in the negotiated budget.
All counties that place children in a community treatment facility
program shall make payments using the budget agreement negotiated by
the community treatment facility provider and the host county.
(c) A foster care rate shall be established for each community
treatment facility program by the State Department of Social
Services. These rates shall be established using the existing foster
care ratesetting system for group homes, with modifications designed
as necessary. It is anticipated that all community treatment facility
programs will offer the level of care and services required to
receive the highest foster care rate provided for under the current
group home ratesetting system.
(d) For the 2001-02 fiscal year, the 2002-03 fiscal year, the
2003-04 fiscal year, and the 2004-05 fiscal year, community treatment
facility programs shall also be paid a community treatment facility
supplemental rate of up to two thousand five hundred dollars ($2,500)
per child per month on behalf of children eligible under the foster
care program and children placed out of home pursuant to an
individualized education program developed under Section 7572.5 of
the Government Code. Subject to the availability of funds, the
supplemental rate shall be shared by the state and the counties.
Counties shall be responsible for paying a county share of cost equal
to 60 percent of the community treatment rate for children placed by
counties in community treatment facilities and the state shall be
responsible for 40 percent of the community treatment facility
supplemental rate. The community treatment facility supplemental rate
is intended to supplement, and not to supplant, the payments for
which children placed in community treatment facilities are eligible
to receive under the foster care program and the existing programs
for mental health services.
(e) For initial ratesetting purposes for community treatment
facility funding, the cost of mental health services shall be
determined by deducting the foster care rate and the community
treatment facility supplemental rate from the total allowable cost of
the community treatment facility program. Payments to certified
providers for mental health services shall be based on eligible
services provided to children who are Medi-Cal beneficiaries, up to
the statewide maximum allowances for these services.
(f) The department shall provide the community treatment facility
supplemental rates to the counties for advanced payment to the
community treatment facility providers in the same manner as the
regular foster care payment and within the same required payment time
limits.
(g) In order to facilitate the study of the costs of community
treatment facilities, licensed community treatment facilities shall
provide all documents regarding facility operations, treatment, and
placements requested by the department.
(h) It is the intent of the Legislature that the department and
the State Department of Social Services work to maximize federal
financial participation in funding for children placed in community
treatment facilities through funds available pursuant to Titles IV-E
and XIX of the federal Social Security Act (Title 42 U.S.C. Sec. 670
and following and Sec. 1396 and following) and other appropriate
federal programs.
(i) The department and the State Department of Social Services may
adopt emergency regulations necessary to implement joint protocols
for the oversight of community treatment facilities, to modify
existing licensing regulations governing reporting requirements and
other procedural and administrative mandates to take into account the
seriousness and frequency of behaviors that are likely to be
exhibited by the seriously emotionally disturbed children placed in
community treatment facility programs, to modify the existing foster
care ratesetting regulations, and to pay the community treatment
facility supplemental rate. The adoption of these regulations shall
be deemed to be an emergency and necessary for the immediate
preservation of the public peace, health and safety, and general
welfare. The regulations shall become effective immediately upon
filing with the Secretary of State. The regulations shall not remain
in effect more than 180 days unless the adopting agency complies with
all the provisions of Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code, as required
by subdivision (e) of Section 11346.1 of the Government Code.

4094.5. Regulations for community treatment facilities adopted
pursuant to Section 4094 shall include, but not be limited to, the
following:
(a) Only seriously emotionally disturbed children, as defined in
Section 5699.2, for whom other less restrictive mental health
interventions have been tried, as documented in the case plan, or who
are currently placed in an acute psychiatric hospital or state
hospital or in a facility outside the state for mental health
treatment, and who may require periods of containment to participate
in, and benefit from, mental health treatment, shall be placed in a
community treatment facility. For purposes of this subdivision,
lesser restrictive interventions shall include, but are not limited
to, outpatient therapy, family counseling, case management, family
preservation efforts, special education classes, or nonpublic
schooling.
(b) A facility shall have the capacity to provide secure
containment. For purposes of this section, a facility or an area of a
facility shall be defined as secure if residents are not permitted
to leave the premises of their own volition. All or part of a
facility, including its perimeter, but not a room alone, may be
locked or secure. If a facility uses perimeter fencing, all beds
within the perimeter shall be considered secure beds. All beds
outside of a locked or secure wing or facility shall be considered
nonsecure beds.
(c) A locked or secure program in a facility shall not be used for
disciplinary purposes, but shall be used for the protection of the
minor. It may be used as a treatment modality for a child needing
that level of care. The use of the secure facility program shall be
for as short a period as possible, consistent with the child's case
plan and safety. The department shall develop regulations governing
the oversight, review, and duration of the use of secure beds.
(d) Fire clearance approval shall be obtained pursuant to Section
1531.2 of the Health and Safety Code.
(e) (1) Prior to admission, any child admitted to a community
treatment facility shall have been certified as seriously emotionally
disturbed, as defined in Section 5699.2, by a licensed mental health
professional. The child shall, prior to admission, have been
determined to be in need of the level of care provided by a community
treatment facility, by a county interagency placement committee, as
prescribed by Section 4096.
(2) Any county cost associated with the certification and the
determination provided for in paragraph (1) may be billed as a
utilization review expense.

4094.6. The patients' rights provisions contained in Sections 5325,
5325.1, 5325.2, and 5326 shall be available to any child admitted
to, or eligible for admission to, a community treatment facility.
Every child placed in a community treatment facility shall have a
right to a hearing by writ of habeas corpus, within two judicial days
of the filing of a petition for the writ of habeas corpus with the
superior court of the county in which the facility is located, for
his or her release. Regulations adopted pursuant to Section 4094
shall specify the procedures by which this right shall be ensured.
These regulations shall generally be consistent with the procedures
contained in Section 5275 et seq., concerning habeas corpus for
individuals, including children, subject to various involuntary
holds.

4094.7. (a) A community treatment facility may have both secure and
nonsecure beds. However, the State Department of Mental Health shall
limit the total number of beds in community treatment facilities to
not more than 400 statewide. The State Department of Mental Health
shall certify community treatment facilities in such a manner as to
ensure an adequate dispersal of these facilities within the state.
The State Department of Mental Health shall ensure that there is at
least one facility in each of the State Department of Social Services'
four regional licensing divisions.
(b) The State Department of Mental Health shall notify the State
Department of Social Services when a facility has been certified and
has met the program standards pursuant to Section 4094. The State
Department of Social Services shall license a community treatment
facility for a specified number of secure beds and a specified number
of nonsecure beds. The number of secure and nonsecure beds in a
facility shall be modified only with the approval of both the State
Department of Social Services and the State Department of Mental
Health.
(c) The State Department of Mental Health shall develop, with the
advice of the State Department of Social Services, county
representatives, providers, and interested parties, the criteria to
be used to determine which programs among applicant providers shall
be licensed. The State Department of Mental Health shall determine
which agencies best meet the criteria, certify them in accordance
with Section 4094, and refer them to the State Department of Social
Services for licensure.
(d) Any community treatment facility proposing to serve seriously
emotionally disturbed foster children shall be incorporated as a
nonprofit organization.
(e) No later than January 1, 1996, the State Department of Mental
Health shall submit its recommendation to the appropriate policy
committees of the Legislature relative to the limitation on the
number of beds set forth in this section.

4095. (a) It is the intent of the Legislature that essential and
culturally relevant mental health assessment, case management, and
treatment services be available to wards of the court and dependent
children of the court placed out of home or who are at risk of
requiring out-of-home care. This can be best achieved at the
community level through the active collaboration of county social
service, probation, education, mental health agencies, and foster
care providers.
(b) Therefore, using the Children's Mental Health Services Act
(Part 4 (commencing with Section 5850) of Division 5) as a guideline,
the State Department of Mental Health, in consultation with the
California Conference of Local Mental Health Directors, the State
Department of Social Services, the County Welfare Directors
Association, the Chief Probation Officer's Association, county
alcohol and drug program administrators, and foster care providers,
shall do all of the following:
(1) By July 1, 1994, develop an individualized mental health
treatment needs assessment protocol for wards of the court and
dependent children of the court.
(2) Define supplemental services to be made available to the
target population, including, but not limited to, services defined in
Section 540 and following of Title 9 of the California Code of
Regulations as of January 1, 1994, family therapy, prevocational
services, and crisis support activities.
(3) Establish statewide standardized rates for the various types
of services defined by the department in accordance with paragraph
(2), and provided pursuant to this section. The rates shall be
designed to reduce the impact of competition for scarce treatment
resources on the cost and availability of care. The rates shall be
implemented only when the state provides funding for the services
described in this section.
(4) By January 1, 1994, to the extent state funds are available to
implement this section, establish, by regulation, all of the
following:
(A) Definitions of priority ranking of subsets of the court wards
and dependents target population.
(B) A procedure to certify the mental health programs.
(c) (1) Only those individuals within the target population as
defined in regulation and determined to be eligible for services as a
result of a mental health treatment needs assessment may receive
services pursuant to this section.
(2) Allocation of funds appropriated for the purposes of this
section shall be based on the number of wards and dependents and may
be adjusted in subsequent fiscal years to reflect costs.
(3) The counties shall be held harmless for failure to provide any
assessment, case management, and treatment services to those
children identified in need of services for whom there is no funding.
(d) (1) The department shall make information available to the
Legislature, on request, on the service populations provided mental
health treatment services pursuant to this section, the types and
costs of services provided, and the number of children identified in
need of treatment services who did not receive the services.
(2) The information required by paragraph (1) may include
information on need, cost, and service impact experience from the
following:
(A) Family preservation pilot programs.
(B) Pilot programs implemented under the former Children's Mental
Health Services Act, as contained in Chapter 6.8 (commencing with
Section 5565.10) of Part 1 of Division 5.
(C) Programs implemented under Chapter 26 (commencing with Section
7570) of Division 7 of Title 1 of the Government Code and Section
11401.
(D) County experience in the implementation of Section 4096.

4096. (a) (1) Interagency collaboration and children's program
services shall be structured in a manner that will facilitate future
implementation of the goals of the Children's Mental Health Services
Act.
(2) Components shall be added to state-county performance
contracts required in Section 5650 that provide for reports from
counties on how this section is implemented.
(3) The department shall develop performance contract components
required by paragraph (2).
(4) Performance contracts subject to this section shall document
that the procedures to be implemented in compliance with this section
have been approved by the county social services department and the
county probation department.
(b) Funds specified in subdivision (a) of Section 17601 for
services to wards of the court and dependent children of the court
shall be allocated and distributed to counties based on the number of
wards of the court and dependent children of the court in the
county.
(c) A county may utilize funds allocated pursuant to subdivision
(b) only if the county has an established and operational interagency
placement committee, with a membership that includes at least the
county placement agency and a licensed mental health professional
from the county department of mental health. If necessary, the funds
may be used for costs associated with establishing the interagency
placement committee.
(d) Subsequent to the establishment of an interagency placement
committee, funds allocated pursuant to subdivision (b) shall be used
to provide services to wards of the court and dependent children of
the court jointly identified by county mental health, social
services, and probation departments as the highest priority. Every
effort shall be made to match those funds with funds received
pursuant to Title XIX of the federal Social Security Act, contained
in Subchapter 19 (commencing with Section 1396) of Chapter 7 of Title
42 of the United States Code.
(e) (1) Each interagency placement committee shall establish
procedures whereby a ward of the court or dependent child of the
court, or a voluntarily placed child whose placement is funded by the
Aid to Families with Dependent Children-Foster Care Program, who is
to be placed or is currently placed in a group home program at a rate
classification level 13 or rate classification level 14 as specified
in Section 11462.01, is assessed as seriously emotionally disturbed,
as defined in Section 5600.3 and Section 1502.4 of the Health and
Safety Code.
(2) The assessment required by paragraph (1) shall also indicate
that the child is in need of the care and services provided by that
group home program.
(f) The interagency placement committee shall document the results
of the assessment required by subdivision (e) and shall notify the
appropriate group home provider and county placing agency, in
writing, of those results within 10 days of the completion of the
assessment.
(g) If the child's placement is not funded by the Aid to Families
with Dependent Children-Foster Care Program, a licensed mental health
professional, as defined in Sections 629 to 633, inclusive, of Title
9 of the California Code of Regulations, shall certify that the
child is seriously emotionally disturbed, as defined in Section
5600.3 and Section 1502.4 of the Health and Safety Code.

4096.5. (a) The department shall make a determination, within 45
days of receiving a request from a group home to be classified at RCL
13 or RCL 14 pursuant to Section 11462.01, to certify or deny
certification that the group home program includes provisions for
mental health treatment services that meet the needs of seriously
emotionally disturbed children. The department shall issue each
certification for a period of one year and shall specify the
effective date the program met the certification requirements. A
program may be recertified if the program continues to meet the
criteria for certification.
(b) The department shall, in consultation with the Conference of
Local Mental Health Directors and representatives of provider
organizations, develop the criteria for the certification required by
subdivision (a) by July 1, 1992.
(c) (1) The department may, upon the request of a county, delegate
to that county the certification task.
(2) Any county to which the certification task is delegated
pursuant to paragraph (1) shall use the criteria and format developed
by the department.
(d) The department or delegated county shall notify the State
Department of Social Services Community Care Licensing Division
immediately upon the termination of any certification issued in
accordance with subdivision (a).