Section 4081 - Licensing requirements; patient criteria; services; individual plan of care; length of stay(a)(1) Psychiatric residential treatment facilities, as defined in Section 1250.10 of the Health and Safety Code, shall be licensed by the State Department of Health Care Services subsequent to application by counties, county contract providers, or other organizations as defined by the State Department of Health Care Services. The State Department of Health Care Services shall approve or deny each psychiatric residential treatment facility application for licensure or renewal of a license.(2) Each psychiatric residential treatment facility's initial license shall be provisional for a period of up to one year from the date the department specifies on the provisional license. A psychiatric residential treatment facility with a provisional license may be subject to facility-specific enhanced monitoring requirements, as established by the department, during the period that the provisional license is effective.(3)(A) A psychiatric residential treatment facility shall not serve involuntarily detained patients pursuant to the Children's Civil Commitment and Mental Health Treatment Act of 1988 and the Lanterman-Petris-Short Act unless the county designates the facility and the State Department of Health Care Services approves the designation of the facility pursuant to the Lanterman-Petris-Short Act (Part 1 (commencing with Section 5000) of Division 5).(B) For voluntary admission of a minor patient subject to the jurisdiction of the juvenile court, the facility shall obtain court authorization for the admission pursuant to Section 361.23 or 727.13, as applicable, and Section 6552. Whenever consent for admission of a patient who is subject to the jurisdiction of the juvenile court is revoked, the facility shall immediately contact the county child welfare agency or probation department, as applicable, to arrange for the patient's discharge.(4) The department shall set a statewide bed limit based on an analysis to ensure that inpatient psychiatric services for individuals under 21 years of age are available and sufficient in amount, duration, and scope to reasonably achieve the purpose for which services are provided. The statewide bed limit shall comply with state and federal Medicaid requirements. The department shall notify the Legislature when the total number of beds in licensed psychiatric residential treatment facilities in the state reaches 250 beds, 500 beds, and 750 beds.(b) Licensed psychiatric residential treatment facilities shall meet all licensing requirements, as determined by the State Department of Health Care Services. Psychiatric residential treatment facilities shall comply with their approved policies and procedures. A licensed psychiatric residential treatment facility shall not amend their policies and procedures without the State Department of Health Care Services' approval.(c) For purposes of admission and continued stay at a psychiatric residential treatment facility, a patient shall meet all of the following criteria:(1) The patient's psychiatric condition requires services on an inpatient basis under the direction of a physician.(2) The services can reasonably be expected to improve the patient's condition or prevent further regression such that inpatient services at a psychiatric residential treatment facility will no longer be needed.(3) The psychiatric residential treatment facility is the least restrictive setting for treatment of the patient's psychiatric condition.(d) Services provided at a psychiatric residential treatment facility shall involve active treatment. "Active treatment" means implementation of an individual plan of care.(e) A psychiatric residential treatment facility shall have an individual plan of care for each patient. An individual plan of care is a written plan developed for each patient within 72 hours of the patient's admission to the facility. The individual plan of care shall be designed to do all of the following:(1) Improve the patient's condition.(2) Achieve the patient's discharge from inpatient status at a psychiatric residential treatment facility at the earliest possible time.(3) Examine and document the medical, psychological, social, behavioral, and developmental aspects of the patient's situation.(4) Document the need for inpatient psychiatric care at a psychiatric residential treatment facility, including anticipated lengths of stay.(5) Prescribe and document active treatment.(f)(1) A patient's length of stay at a psychiatric residential treatment facility shall be based on criteria to access inpatient psychiatric services, including medical necessity, and shall be consistent with the individual plan of care developed by the interdisciplinary team.(2) A patient certification or recertification of need shall comply with Subpart D of Part 441 of Subchapter C of Chapter IV of Title 42 of the Code of Federal Regulations, including, but not limited to, recertifying a patient's need for inpatient care at least every 60 days.(g) The interdisciplinary team shall review the individual plan of care every 10 days, at a minimum, and shall review the plan more frequently as indicated by the patient's condition. Reviews shall address both of the following:(1) Determine that inpatient services provided at a psychiatric residential treatment facility are necessary.(2) Recommend changes to the individual plan of care as indicated by the patient's overall adjustment as an inpatient.(h)(1) The interdisciplinary team shall include one of the following:(A) A board-eligible or board-certified psychiatrist.(B) A clinical psychologist who has a doctoral degree and a physician licensed to practice medicine or osteopathy.(C) A physician licensed to practice medicine or osteopathy with specialized training and experience in the diagnosis and treatment of mental diseases, and a psychologist who has a master's degree in clinical psychology or who has been certified by the state or by the state psychological association.(2) The team shall also include one of the following:(A) A psychiatric social worker, as defined by the department.(B) A registered nurse with specialized training in mental health or one year of experience in treating individuals with mental illness.(C) A licensed occupational therapist who has specialized training or one year of experience in treating individuals with mental illness.(D) A psychologist who has a doctoral degree in clinical psychology, as defined by the department, or who has been licensed by the state.(i) The interdisciplinary team shall be responsible for all of the following:(1) Making admission, continued stay, and discharge determinations.(2) Developing an individual plan of care for each patient, as defined in subdivision (e), in consultation with the patient, parents, legal guardians, or others in whose care the patient will be released after discharge.(3) Assessing the patient's immediate and long-range therapeutic needs, developmental priorities, and personal strengths and liabilities.(4) Assessing the potential resources of the patient's family or social networks.(5) Setting treatment objectives to improve the patient's condition.(6) Prescribing an integrated program of therapies, activities, and experiences, including community-based mental health services.(7) Coordinating with the county child welfare agency or county probation department, as applicable, for patients under the jurisdiction of the juvenile court, including, but not limited to, discharge and transition planning, and continuity of care with the patient's family, school, and community upon discharge.(8) Developing and complying with the psychiatric residential treatment facility's policies and procedures for ensuring that the provision of services, supports, supervision, or other resources necessary for the patient are designed to support the patient's transition to a less restrictive setting.(9) Developing aftercare plans pursuant to Section 1262 of the Health and Safety Code.(j) For patients under the jurisdiction of the juvenile court, a psychiatric residential treatment facility shall do all of the following:(1) Provide the patient's counsel, social worker, and probation officer, as applicable, notice of the patient's continued stay at the facility every 30 days for the first 60 days and every 15 days thereafter.(2) Provide the patient with a reasonable opportunity to confer with counsel in a private setting within 48 hours of a request from the patient or counsel.(k) The State Department of Health Care Services shall conduct an initial licensing inspection and annual licensing inspections of psychiatric residential treatment facilities.(l) Any officer, employee, or agent of the State Department of Health Care Services may, upon presentation of proper identification, enter or inspect any psychiatric residential treatment facility at any time to investigate compliance with any applicable requirements. Inspections may be announced or unannounced.(m) Psychiatric residential treatment facilities shall furnish all information, records, and documentation requested by the State Department of Health Care Services. A psychiatric residential treatment facility shall preserve and provide any information, including books, records, papers, accounts, documents, video, and any writing, as defined in Section 250 of the Evidence Code, that the department deems necessary to review compliance with applicable laws. A psychiatric residential treatment facility shall provide any information the department deems necessary within 15 calendar days from the date of the department's request unless the department permits an extension.(n)(1) Psychiatric residential treatment facilities shall report serious occurrences in accordance with Section 483.374 of Title 42 of the Code of Federal Regulations to the entities specified therein. A certified facility shall also report serious occurrences to the State Department of Public Health as the State Survey Agency in a form and manner prescribed by the State Department of Public Health.(2) Psychiatric residential treatment facilities shall report unusual occurrences to the State Department of Health Care Services within 24 hours of the occurrence and in a form and manner determined by the department. The department shall identify the unusual occurrences that a facility is required to report in future guidance pursuant to subdivision (w).(3) Psychiatric residential treatment facilities shall report use of restraint or seclusion to the State Department of Health Care Services within 24 hours of the occurrence and in a form and manner determined by the department. The department shall provide future guidance regarding the reporting of the use of restraint or seclusion pursuant to subdivision (w).(4) Within 24 hours of a serious occurrence, unusual occurrence, or use of restraint or seclusion, psychiatric residential treatment facilities shall report the occurrence to the authorized representative for the patient and the patient's attorney, if any, or, when a patient is under the jurisdiction of the juvenile court, to the State Department of Social Services and county child welfare agency or county probation department with responsibility for the child and the patient's social worker or probation officer and attorney, if any, and, if the child is an Indian child, as defined in subdivisions (a) and (b) of Section 224.1, the child's tribe.(o)(1) The State Department of Health Care Services may require a psychiatric residential treatment facility to take specified actions to correct any noncompliance. The psychiatric residential treatment facility shall submit a corrective action plan to the State Department of Health Care Services for approval, and shall comply with an approved corrective action plan. The State Department of Health Care Services may specify timeframes and deadlines for submission of a corrective action plan and for correction of noncompliance.(2) The State Department of Health Care Services may place a facility on probation for a repeated noncompliance, failure to submit a corrective action plan as required, or failure to comply with an approved corrective action plan.(3) When a facility is placed on probation pursuant to paragraph (2), the State Department of Health Care Services shall notify the county behavioral health department and State Department of Social Services.(p) The State Department of Health Care Services may enforce psychiatric residential treatment facility requirements by taking any of the following actions:(1) Cease and desist order.(2) Impose monetary penalties.(3) Suspend or revoke a psychiatric residential treatment facility's license.(q) The license of a psychiatric residential treatment facility shall be immediately suspended if certification for participation in the Medicaid program is denied or revoked, as specified in subdivision (b) of Section 1250.10 of the Health and Safety Code.(r) The State Department of Health Care Services shall provide psychiatric residential treatment facilities with due process pursuant to Section 100171 of the Health and Safety Code when taking any of the actions described in paragraph (2) or (3) of subdivision (p).(s) The State Department of Health Care Services has sole authority to grant program flexibility.(t) Psychiatric residential treatment facilities shall be stand-alone facilities and shall not be in the same building as another facility serving individuals receiving other levels or types of care.(u)(1) The psychiatric residential treatment facility's application for licensure shall indicate whether the facility shall be unlocked staff-secured, locked, or a combination of both.(2) "Staff-secured" means that 24 hours a day, seven days a week, all unlocked building entrances and exits are continuously monitored and controlled by staff. Residents are not permitted to leave the premises of their own volition.(3) "Locked" means entrances and exits, including windows, which are controlled with locking mechanisms that are inaccessible to the patients. Any additional outside spaces and recreational areas shall similarly be enclosed to preclude egress or ingress from the premises.(v)(1) Psychiatric residential treatment facilities shall only be licensed to serve individuals who are admitted prior to 21 years of age.(2) Psychiatric residential treatment facilities shall ensure separation of minors from adults, consistent with requirements established by the State Department of Health Care Services.(3) Psychiatric residential treatment facilities' accommodations and patient's bed assignments shall be based on the patient's diagnosis and acuity, adjusted developmental age, mental health history, behavioral history, history of violent behavior, history of abuse, age, gender, sexual orientation, gender identity, language, cultural background, reason for the referral, need to accommodate a natural support, and any other factors relevant to the patient's admission and bedroom assignment.(4)(A) The State Department of Health Care Services shall establish licensing requirements for homelike and age-appropriate patient rooms and common areas.(B) The established number of beds in the facility shall be consistent with the individual treatment needs of the clients served at the facility and shall meet the requirements developed pursuant to this section. At least 50 percent of the beds shall be in single-occupancy rooms.(C) The State Department of Health Care Services shall establish additional licensing requirements for facilities with more than 25 beds to ensure that these facilities establish and maintain a homelike and age-appropriate environment pursuant to subparagraph (A), providing for the comfort and privacy of patients such that patients are nurtured in a developmentally appropriate, organized environment that promotes the individual patient's recovery and growth, meeting their individual needs and interests.(w)(1) Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the State Department of Health Care Services may implement, interpret, or make specific the provisions applicable to psychiatric residential treatment facilities in this section and Section 5405 by means of plan or county letters, information notices, plan or provider bulletins, or other similar instructions, without taking any further regulatory action.(2) Notwithstanding any other law, the State Department of Public Health may, without taking any regulatory actions pursuant to Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, implement, interpret, or make specific this section by means of an All Facilities Letter or similar instruction.(3) No later than December 31, 2027, the State Department of Health Care Services shall adopt any regulations necessary to implement the provisions applicable to psychiatric residential treatment facilities in this section and Section 5405 in accordance with the requirements of Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code.(4)(A) In order to maximize federal financial participation, regulations established by the State Department of Health Care Services pursuant to this chapter shall be consistent with applicable Medicaid regulations governing psychiatric residential treatment facilities in Subpart D of Part 441 of Subchapter C of Chapter IV of Title 42 of the Code of Federal Regulations.(B) Future regulations established by the State Department of Health Care Services may consider, and provide flexibility regarding, the appropriateness of age groups served within a facility.Ca. Welf. and Inst. Code § 4081
Amended by Stats 2023 ch 191 (SB 137),s 8, eff. 9/13/2023.Added by Stats 2022 ch 589 (AB 2317),s 9, eff. 1/1/2023.