MOU -County HHSA-HSEC-OHS and Cities of El Cajon, La Mesa, Lemon Grove, and Santee April 2022
6. County of San Diego Objectives:
6.1 To identify locations within the unincorporated areas of the County of San Diego for the siting of low barrier emergency housing and facilities, either as a single building, individual rooms or units, or other suitable emergency housing and facilities for associated on site services and to site such emergency housing and facilities in the unincorporated area covered by this MOU in the East County communities of the County of San Diego. Site approval, along with any required entitlement actions, shall be subject to the final approval or concurrence of the County of San Diego Board of Supervisors.
6.2 To coordinate with other Parties on determining the equitable financial share of RFP contributions based on formula of persons experiencing homelessness in each jurisdiction, availability of external state/federal resources, and other non-monetary contributions.
6.3 To continue to collaborate on homeless outreach and social work street outreach services by engaging, connecting, and referring persons experiencing homelessness in the Cities’ jurisdictions for the purpose of providing assessment, support, and housing appropriate for the individual’s needs.
6.4 To work collaboratively with jurisdictions of the Cities upon identification of need for behavioral health services within the participating jurisdictions to maximize efficient availability of, and connection to, appropriate services for people experiencing homelessness.
6.5 To seek the establishment of permanent and permanent supportive housing within the unincorporated areas of the County of San Diego in sufficient number to house persons identified as experiencing unsheltered homelessness within the Cities’ jurisdictions.
6.6 Project the needs of low barrier emergency housing and facilities according to the data available for the jurisdictions of the Cities.
6.7 Administer federal, state, and local funded housing programs that are awarded to the County, throughout the region as dictated by each funding source in a manner consistent with the MOU.
6.8 As funding is available, solicit proposals from qualified housing developers for the creation of affordable housing, permanent housing, and permanent supportive housing in a manner consistent with the MOU.
6.9 In accordance with applicable state laws, consider making surplus property in the unincorporated area available for the production of low barrier emergency housing and facilities, and in accordance with applicable laws and ordinances, consider means to streamline processes for zoning and or General Plan Amendment(s) when possible.
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RESOLUTION NO.
RESOLUTION OF THE CITY COUNCIL OF THE CITY OF SANTEE, CALIFORNIA SUPPORTING SENATE BILL 1338 FOR A COMMUNITY ASSISTANCE, RECOVERY,
AND EMPOWERMENT (CARE) COURT PROGRAM
WHEREAS, one of the City’s current priorities is to increase focus on services and safety for those experiencing homelessness; and
WHEREAS, mental illness and drug addiction are oftentimes root causes for many individuals experiencing homelessness; and
WHEREAS, until the challenges of mental illness and drug addiction are addressed, homelessness will remain a challenge for the City of Santee and other communities in California; and
WHEREAS, Governor Gavin Newsom has presented legislation, known as Senate Bill 1338, which would establish a Community Assistance, Recovery, and Empowerment (CARE) Court Program to help address mental illness of those experiencing homelessness; and
WHEREAS, Senate Bill 1338 would provide individuals with a clinically appropriate, community-based, court-ordered care plan, including behavioral health care, stabilization medication, and housing support to adults who are suffering from specified mental health disorders (schizophrenia spectrum and psychotic disorders) and who lack medical decision making capacity; and
WHEREAS, this legislation could serve as an important tool to help in the City’s effort to help address the challenges of homelessness and increase services and safety for those experiencing homelessness.
NOW, THEREFORE, BE IT RESOLVED that the City Council of the City of Santee, California, hereby supports Senate Bill 1338.
ADOPTED by the City Council of the City of Santee, California, at a Regular meeting thereof held this 25th day of May, 2022, by the following roll call vote to wit:
AYES:
NOES:
ABSENT:
APPROVED:
JOHN W. MINTO, MAYOR
ATTEST:
ANNETTE ORTIZ, CMC, CITY CLERK
AMENDED IN SENATE APRIL 7, 2022
AMENDED IN SENATE MARCH 16, 2022
SENATE BILL No. 1338
Introduced by Senators Umberg and Eggman
February 18, 2022
An act to add Part 1.3 (commencing with Section 5565) to Division 5 of Section 1374.723 to the Health and Safety Code, to amend Section 1370.01 of the Penal Code, and to add Part 8 (commencing with Section 5970) to Division 5 of the Welfare and Institutions Code, relating to mental health.
legislative counsel’s digest
SB 1338, as amended, Umberg. Community Assistance, Recovery, and Empowerment (CARE) Court Program.
Existing
(1) Existing law, the Assisted Outpatient Treatment Demonstration Project Act of 2002, known as Laura’s Law, requires each county to offer specified mental health programs, unless a county or group of counties opts out by a resolution passed by the governing body, as specified. Existing law defines “assisted outpatient treatment” to mean categories of outpatient services that have been ordered by a court, as prescribed. law, the Lanterman-Petris-Short Act, provides for short-term and longer-term involuntary treatment and conservatorships for people who are determined to be gravely disabled.
This bill would establish the Community Assistance, Recovery, and Empowerment (CARE) Court Program to connect a person struggling with untreated mental illness and substance use disorders with a court-ordered CARE plan. The bill would authorize a court to order an adult person who is suffering from a mental illness and a substance use
97 disorder and who lacks medical decisionmaking capacity to obtain treatment and services under a CARE plan that is managed by a CARE team, as specified. The bill would require each county to participate in providing services under the program. By imposing new duties on counties, the bill would impose a state-mandated local program.
The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state.
Statutory provisions establish procedures for making that reimbursement.
This bill would provide that, if the Commission on State Mandates determines that the bill contains costs mandated by the state, reimbursement for those costs shall be made pursuant to the statutory provisions noted above.
This bill would enact the Community Assistance, Recovery, and Empowerment (CARE) Act, which would authorize specified people to petition a civil court to create a CARE plan and implement services, to be provided by county behavioral health agencies, to provide behavioral health care, stabilization medication, and housing support to adults who are suffering from schizophrenia spectrum and psychotic disorders and who lack medical decisionmaking capacity. The bill would specify the process by which the petition is filed and reviewed, including requiring the petition to be signed under penalty of perjury, and to contain specified information, including the acts that support the petitioner’s belief that the respondent meets the CARE criterion. The bill would also specify the schedule of review hearings required if the respondent is ordered to comply with a one-year CARE plan by the court. The bill would authorize the CARE plan to be extended for up to one year and prescribes the requirement for the graduation plan that is required upon leaving the CARE program. By expanding the crime of perjury and imposing additional duties on the county behavioral health agencies, this bill would impose a state-mandated local program.
This bill would include in the CARE program the respondent’s right to have a supporter and counsel at all proceedings. The bill would require the California Health and Human Services Agency, subject to appropriation, to administer the CARE Supporter program, which would make available a trained supporter to each respondent.
This bill would authorize the court, at any time during the proceedings if it finds the county not complying with court orders, to fine the county up to $1,000 per day and, if the court finds persistent noncompliance, to appoint a receiver to secure court-ordered care for the respondent at the county’s cost.
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(2) Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care. Existing law requires health care service plans to provide coverage for medically necessary treatment of mental health and substance use disorders. Violation of the Knox-Keene Act is a crime.
This bill would require health care service plans to cover the cost of developing an evaluation for CARE services and the provision of all health care services for an enrollee when required or recommended for the enrollee pursuant to a CARE plan, as specified, without cost sharing. By creating a new crime, this bill would impose a state-mandated local program.
(3) Existing law prohibits a person from being tried or adjudged to punishment while that person is mentally incompetent. Existing law establishes a process by which a defendant’s mental competency is evaluated and by which the defendant receives treatment, with the goal of returning the defendant to competency. Existing law suspends a criminal action pending restoration to competency.
This bill, for misdemeanor defendants who have been determined to be incompetent to stand trial, would authorize the court to refer the defendant to the CARE program.
(4) The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state.
Statutory provisions establish procedures for making that reimbursement.
This bill would provide that with regard to certain mandates no reimbursement is required by this act for a specified reason.
With regard to any other mandates, this bill would provide that, if the Commission on State Mandates determines that the bill contains costs so mandated by the state, reimbursement for those costs shall be made pursuant to the statutory provisions noted above.
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: yes.
The people of the State of California do enact as follows:
line 1 SECTION 1. The Legislature finds and declares all of the line 2 following:
line 3 (a) Thousands of Californians are suffering from untreated line 4 schizophrenia spectrum and psychotic disorders, leading to risks 97 — 3 — SB 1338
line 1 to their health and safety and increased homelessness, line 2 incarceration, hospitalization, conservatorship, and premature line 3 death. These individuals, families, and communities deserve a path line 4 to care and wellness.
line 5 (b) With advancements in behavioral health treatments, many line 6 people with untreated schizophrenia spectrum and psychotic line 7 disorders can stabilize, begin healing, and thrive in line 8 community-based settings, with the support of behavioral health line 9 services, stabilizing medications, and housing. But too often this line 10 comprehensive care is only provided after arrest, conservatorship, line 11 or institutionalization.
line 12 (c) A new approach is needed to act earlier and to provide line 13 support and accountability, both to individuals with these untreated line 14 severe mental illnesses and to local governments with the line 15 responsibility to provide behavioral health services. California’s line 16 civil courts will provide a new process for earlier action, support, line 17 and accountability, through a new Community Assistance, line 18 Recovery, and Empowerment (CARE) Court Program. line 19 (d) Self-determination and civil liberties are important line 20 California values that can be advanced and protected for line 21 individuals with these untreated severe mental illnesses and without line 22 current capacity for medical decisionmaking, with the line 23 establishment of a new CARE Supporter role, in addition to legal line 24 counsel, for CARE proceedings.
line 25 (e) California continues to act with urgency to expand line 26 behavioral health services and to increase housing choices and line 27 end homelessness for all Californians. CARE provides a vital line 28 solution for some of the most ill and most vulnerable Californians. line 29 SEC. 2. Section 1374.723 is added to the Health and Safety line 30 Code, to read:
line 31 1374.723. (a) A health care service plan contract issued, line 32 amended, renewed, or delivered on or after July 1, 2023, that line 33 covers hospital, medical, or surgical expenses shall cover the cost line 34 of developing an evaluation pursuant to Section 5977 of the line 35 Welfare and Institutions Code and the provision of all health care line 36 services for an enrollee when required or recommended for the line 37 enrollee pursuant to a care plan approved by a court in accordance line 38 with the court’s authority under Sections 5977 and 5982 of the line 39 Welfare and Institutions Code.
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line 1 (b) (1) A health care service plan shall not require prior line 2 authorization for services provided pursuant to a care plan line 3 approved by a court under the CARE program.
line 4 (2) A health care service plan may conduct a postclaim review line 5 to determine appropriate payment of a claim. Payment for services line 6 subject to this section may be denied only if the health care service line 7 plan reasonably determines the enrollee was not enrolled with the line 8 plan at the time the services were rendered, the services were never line 9 performed, or the services were not provided by a health care line 10 provider appropriately licensed or authorized to provide the line 11 services.
line 12 (3) Notwithstanding paragraph (1), a health care service plan line 13 may require prior authorization for services as permitted by the line 14 department pursuant to subdivision (e).
line 15 (c) (1) A health care service plan shall provide for line 16 reimbursement of services provided to an enrollee pursuant to this line 17 section at the greater of either of the following amounts:
line 18 (A) The health plan’s contracted rate with the provider. line 19 (B) The fee-for-service or case reimbursement rate paid in the line 20 Medi-Cal program for the same or similar services, including line 21 prescription drugs, as identified by the State Department of Health line 22 Care Services.
line 23 (2) A health care service plan shall provide reimbursement for line 24 services provided pursuant to this section in compliance with the line 25 requirements for timely payment of claims, as required by this line 26 chapter.
line 27 (d) Services provided to an enrollee pursuant to a CARE plan line 28 shall not be subject to copayment, coinsurance, deductible, or any line 29 other form of cost sharing. An individual or entity shall not bill line 30 the enrollee or subscriber, nor seek reimbursement from the line 31 enrollee or subscriber, for services provided pursuant to a CARE line 32 plan.
line 33 (e) No later than July 1, 2023, the director of the Department line 34 of Managed Health Care may issue guidance to health care service line 35 plans regarding compliance with this section. This guidance shall line 36 not be subject to the Administrative Procedure Act (Chapter 3.5 line 37 (commencing with Section 11340) of Part 1 of Division 3 of Title line 38 2 of the Government Code). Guidance issued pursuant to this line 39 subdivision shall be effective only until the director adopts line 40 regulations pursuant to the Administrative Procedure Act. 97 — 5 — SB 1338
line 1 (f) This section does not apply to Medi-Cal managed care line 2 contracts entered pursuant to Chapter 7 (commencing with Section line 3 14000), Chapter 8 (commencing with Section 14200), or Chapter line 4 8.75 (commencing with Section 14591) of Part 3 of Division 9 of line 5 the Welfare and Institutions Code, between the State Department line 6 of Health Care Services and a health care service plan for enrolled line 7 Medi-Cal beneficiaries.
line 8 (g) This section shall become operative on July 1, 2023. line 9 SEC. 3. Section 1370.01 of the Penal Code is amended to read:
line 10 1370.01. (a) If the defendant is found mentally competent, the line 11 criminal process shall resume, and the trial on the offense charged line 12 or hearing on the alleged violation shall proceed. line 13 (b) If the defendant is found mentally incompetent, the trial, line 14 judgment, or hearing on the alleged violation shall be suspended line 15 and the court may do either of the following:
line 16 (1) (A) Conduct a hearing, pursuant to Chapter 2.8A line 17 (commencing with Section 1001.35) of Title 6, and, if the court line 18 deems the defendant eligible, grant diversion pursuant to Section line 19 1001.36 for a period not to exceed one year from the date the line 20 individual is accepted into diversion or the maximum term of line 21 imprisonment provided by law for the most serious offense charged line 22 in the misdemeanor complaint, whichever is shorter. line 23 (B) If the court opts to conduct a hearing pursuant to this line 24 paragraph, the hearing shall be held no later than 30 days after the line 25 finding of incompetence. If the hearing is delayed beyond 30 days, line 26 the court shall order the defendant to be released on their own line 27 recognizance pending the hearing.
line 28 (C) If the defendant performs satisfactorily on diversion pursuant line 29 to this section, at the end of the period of diversion, the court shall line 30 dismiss the criminal charges that were the subject of the criminal line 31 proceedings at the time of the initial diversion. line 32 (D) If the court finds the defendant ineligible for diversion based line 33 on the circumstances set forth in subdivision (b) or (d) of Section line 34 1001.36, the court may, after notice to the defendant, defense line 35 counsel, and the prosecution, hold a hearing to determine whether line 36 to do any of the following:
line 37 (i) Order modification of the treatment plan in accordance with line 38 a recommendation from the treatment provider.
line 39 (ii) Refer the defendant to assisted outpatient treatment pursuant line 40 to Section 5346 of the Welfare and Institutions Code. A referral 97 SB 1338 — 6 —
line 1 to assisted outpatient treatment may only occur in a county where line 2 services are available pursuant to Section 5348 of the Welfare and line 3 Institutions Code, and the agency agrees to accept responsibility line 4 for treatment of the defendant. A hearing to determine eligibility line 5 for assisted outpatient treatment shall be held within 45 days after line 6 the date of the referral. If the hearing is delayed beyond 45 days, line 7 the court shall order the defendant, if confined in county jail, to line 8 be released on their own recognizance pending that hearing. If the line 9 defendant is accepted into assisted outpatient treatment, the charges line 10 shall be dismissed pursuant to Section 1385.
line 11 (iii) Refer the defendant to the county conservatorship line 12 investigator in the county of commitment for possible line 13 conservatorship proceedings for the defendant pursuant to Chapter line 14 3 (commencing with Section 5350) of Part 1 of Division 5 of the line 15 Welfare and Institutions Code. A defendant shall only be referred line 16 to the conservatorship investigator if, based on the opinion of a line 17 qualified mental health expert, the defendant appears to be gravely line 18 disabled, as defined in subparagraph (A) of paragraph (1) of line 19 subdivision (h) of Section 5008 of the Welfare and Institution line 20 Code. Any hearings required in the conservatorship proceedings line 21 shall be held in the superior court in the county of commitment. line 22 The court shall transmit a copy of the order directing initiation of line 23 conservatorship proceedings to the county mental health director line 24 or the director’s designee and shall notify the county mental health line 25 director or their designee of the outcome of the proceedings. Before line 26 establishing a conservatorship, the public guardian shall investigate line 27 all available alternatives to conservatorship pursuant to Section line 28 5354 of the Welfare and Institutions Code. If a petition is not filed line 29 within 60 days of the referral, the court shall order the defendant, line 30 if confined in county jail, to be released on their own recognizance line 31 pending conservatorship proceedings. If the outcome of the line 32 conservatorship proceedings results in the establishment of line 33 conservatorship, the charges shall be dismissed pursuant to Section line 34 1385.
line 35 (iv) Refer the defendant to the CARE program pursuant to line 36 Section 5978 of the Welfare and Institutions Code. A hearing to line 37 determine eligibility for CARE shall be held within 14 days after line 38 the date of the referral. If the hearing is delayed beyond 14 days, line 39 the court shall order the defendant, if confined in county jail, to line 40 be released on their own recognizance pending that hearing. If 97 — 7 — SB 1338
line 1 the defendant successfully completes CARE, the charges shall be line 2 dismissed pursuant to Section 1385.
line 3 (2) Dismiss the charges pursuant to Section 1385. If the criminal line 4 action is dismissed, the court shall transmit a copy of the order of line 5 dismissal to the county mental health director or the director’s line 6 designee.
line 7 (c) If the defendant is found mentally incompetent and is on a line 8 grant of probation for a misdemeanor offense, the court shall line 9 dismiss the pending revocation matter and may return the defendant line 10 to supervision. If the revocation matter is dismissed pursuant to line 11 this subdivision, the court may modify the terms and conditions line 12 of supervision to include appropriate mental health treatment. line 13 (d) It is the intent of the Legislature that a defendant subject to line 14 the terms of this section receive mental health treatment in a line 15 treatment facility and not a jail. A term of four days will be deemed line 16 to have been served for every two days spent in actual custody line 17 against the maximum term of diversion. A defendant not in actual line 18 custody shall otherwise receive day for day credit against the term line 19 of diversion from the date the defendant is accepted into diversion. line 20 “Actual custody” has the same meaning as in Section 4019. line 21 (e) This section shall apply only as provided in subdivision (b) line 22 of Section 1367.
line 23 SEC. 4. Part 8 (commencing with Section 5970) is added to line 24 Division 5 of the Welfare and Institutions Code, to read:
line 25
line 26 PART 8. THE COMMUNITY ASSISTANCE, RECOVERY, AND line 27 EMPOWERMENT ACT
line 28
line 29 Chapter 1. General Provisions
line 30
line 31 5970. This part shall be known, and may be cited, as line 32 Community Assistance, Recovery, and Empowerment (CARE) Act. line 33 5971. Unless the context otherwise requires, the following line 34 definitions shall govern the construction of this part. line 35 (a) “Court-ordered evaluation” means an evaluation ordered line 36 by a superior court pursuant to Section 5977.
line 37 (b) “CARE plan” means an individualized, clinically line 38 appropriate range of behavioral health related services and line 39 supports provided by a county behavioral health agency, including, 97 SB 1338 — 8 —
line 1 but not limited to, clinical care, stabilization medications, and a line 2 housing plan, pursuant to Section 5982.
line 3 (c) “Graduation plan” means a plan that is developed by the line 4 person who is the subject of the petition, with assistance from a line 5 supporter, as needed, and the person’s treatment team. The line 6 graduation plan shall include a strategy to support a successful line 7 transition out of court jurisdiction and may include a psychiatric line 8 advance directive. The graduation plan may also include, but is line 9 not limited to, on-going behavioral health services, including line 10 medication management, peer support services, housing and line 11 related support services, vocational or educational services, and line 12 psychoeducation.
line 13 (d) “Psychiatric advance directive” means a legal document line 14 that allows a person with mental illness to protect their autonomy line 15 and ability to self-direct care by documenting their preferences line 16 for treatment in advance of a mental health crisis. line 17 (e) “Respondent” means the person who is subject to the petition line 18 for CARE court proceedings.
line 19 (f) “Supporter” means an adult, trained pursuant to Chapter line 20 4 (commencing with Section 5980), who assists the person who is line 21 the subject of the petition, which may include supporting the person line 22 to understand, make, communicate, implement, or act on their own line 23 life decisions.
line 24
line 25 Chapter 2. Process
line 26
line 27 5972. A court may order a respondent to participate in CARE line 28 proceedings if the court finds, by clear and convincing evidence, line 29 that the facts stated in the petition are true and establish that the line 30 requisite criteria set forth in this section are met, including all of line 31 the following:
line 32 (a) The person is 18 years of age or older.
line 33 (b) The person has a diagnosis of schizophrenia spectrum or line 34 other psychotic disorder, as defined in the most current version line 35 of the Diagnostic and Statistical Manual of Mental Disorders. line 36 (c) The person is not clinically stabilized in on-going treatment line 37 with the county behavioral health agency.
line 38 (d) The person currently lacks medical decisionmaking capacity. line 39 5973. Proceedings under this part may be commenced in any line 40 of the following:
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line 1 (a) The county in which the respondent resides. line 2 (b) The county where the respondent is found.
line 3 (c) The county where the respondent is facing criminal or civil line 4 proceedings.
line 5 5974. The following persons may file a petition to initiate CARE line 6 proceedings:
line 7 (a) A person 18 years of age or older with whom the respondent line 8 resides.
line 9 (b) A spouse, parent, sibling, or adult child of the respondent. line 10 (c) The director of a hospital, or their designee, in which the line 11 respondent is hospitalized, including hospitalization pursuant to line 12 Section 5150 or 5250.
line 13 (d) The director of a public or charitable organization, agency, line 14 or home, or their designee, currently or previously providing line 15 behavioral health services to the respondent or in whose institution line 16 the respondent resides.
line 17 (e) A qualified behavioral health professional, or their designee, line 18 who is, or has been, either supervising the treatment of, or treating line 19 the respondent for a mental illness.
line 20 (f) A first responder, including a peace officer, firefighter, line 21 paramedic, emergency medical technician, mobile crisis response line 22 worker, or homeless outreach worker.
line 23 (g) The public guardian or public conservator, or their designee, line 24 of the county in which the respondent is present or reasonably line 25 believed to be present.
line 26 (h) The director of a county behavioral health agency, or their line 27 designee, of the county in which the respondent is present or line 28 reasonably believed to be present.
line 29 5975. The petition shall be signed under the penalty of perjury line 30 and contain all of the following:
line 31 (a) The name of the court to which it is addressed. line 32 (b) The title of the proceeding.
line 33 (c) The name, age, and address, if any, of the respondent. line 34 (d) The code section and the subdivision under which the line 35 proceedings are instituted.
line 36 (e) The petitioner’s relationship with the respondent. line 37 (f) Facts that support the petitioner’s belief that the respondent line 38 meets the CARE criterion, including identification of the county line 39 behavioral health agency with responsibility for providing care line 40 to the respondent, if known.
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line 1 (g) Either of the following:
line 2 (1) An affirmation or affidavit of a qualified behavioral health line 3 professional, stating that the qualified behavioral health line 4 professional or their designee has examined the respondent within line 5 three months of the submission of the petition, or has made line 6 appropriate attempts, but has not been successful, in eliciting the line 7 cooperation of the respondent to submit to an examination, and line 8 that the qualified behavioral health professional had determined line 9 that, based on an examination or a review of records and collateral line 10 interviews, the respondent meets, or is likely to meet, the diagnostic line 11 criteria for CARE proceedings.
line 12 (2) Evidence that the respondent was detained for intensive line 13 treatment pursuant to Article 4 (commencing with Section 5250) line 14 of Chapter 2 of Part 1 within the previous 90 days. line 15 5976. The respondent shall have all of the following rights:
line 16 (a) To receive notice of the hearings.
line 17 (b) To receive a copy of the court-ordered evaluation. line 18 (c) To be represented by counsel at all stages of a proceeding line 19 commenced under this chapter.
line 20 (d) To a supporter, as described in Section 5982. line 21 (e) To be present at the hearing unless the respondent waives line 22 the right to be present or the court makes a finding described in line 23 Section 5977 or appears remotely.
line 24 (f) To present evidence.
line 25 (g) To call witnesses.
line 26 (h) To cross-examine witnesses.
line 27 (i) To appeal decisions, and to be informed of the right to line 28 appeal.
line 29 5977. (a) (1) Upon receipt by the court of a petition, the court line 30 shall set an initial hearing not later than 14 days from the date line 31 the petition is filed with the court.
line 32 (2) The court shall appoint counsel and a supporter within five line 33 calendar days of filing.
line 34 (3) The petitioner shall be responsible for providing notice of line 35 the hearing to the respondent, the respondent’s counsel and line 36 supporter, and the county behavioral health agency in the county line 37 where the respondent resides.
line 38 (b) (1) At the initial hearing, which shall occur 14 days after line 39 the petition is filed with the court, the court shall determine if the line 40 respondent meets the CARE criteria.
97 — 11 — SB 1338
line 1 (2) All of the following shall be required for the hearing:
line 2 (A) The petitioner shall be present. If the petitioner is not line 3 present, the matter shall be dismissed.
line 4 (B) The respondent may waive their appearance and appear line 5 through their counsel. If the respondent does not waive their line 6 appearance and does not appear at the hearing, and appropriate line 7 attempts to elicit the attendance of the respondent have failed, the line 8 court may conduct the hearing in the respondent’s absence. If the line 9 hearing is conducted without the respondent present, the court line 10 shall set forth the factual basis for doing so. line 11 (C) A representative from the county behavioral health agency line 12 shall be present.
line 13 (D) The supporter shall be allowed to be present. line 14 (3) (A) The court shall determine if the petitioner has presented line 15 prima facie evidence that respondent meets the CARE criteria. line 16 (B) If the court finds that the petitioner has not presented line 17 sufficient prima facie evidence, the court shall dismiss the case line 18 without prejudice, unless the court makes a finding on the record line 19 that the petitioner’s filing was not in good faith. line 20 (C) If the court finds that the petitioner has submitted prima line 21 facie evidence that the respondent meets the CARE criteria, the line 22 court shall order the county behavioral health agency to work with line 23 the respondent and the respondent’s counsel and supporter to line 24 determine if the respondent shall engage in a treatment plan. A line 25 case management conference shall be set for no later than 14 days line 26 after the court makes its finding.
line 27 (c) (1) At the case management conference hearing, the court line 28 shall determine if a settlement agreement may be entered into by line 29 the parties.
line 30 (2) The case management conference may be continued for up line 31 to 14 days upon stipulation of the respondent and the county line 32 behavioral health agency.
line 33 (3) The court’s findings that a settlement agreement may be line 34 entered into by the parties shall require a recitation of all terms line 35 and conditions on the record.
line 36 (4) If the court finds that parties have agreed to a settlement line 37 agreement, and the court agrees with the terms of the agreement, line 38 the court shall stay the matter and set a progress hearing for 60 line 39 days.
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line 1 (5) (A) If the court finds that the parties are not likely to reach line 2 a settlement agreement, the court shall order a clinical evaluation line 3 of the respondent unless the parties stipulate otherwise. line 4 (B) The court shall order the county behavioral health agency line 5 to conduct the evaluation unless the parties stipulate otherwise. line 6 (C) The court shall set a hearing to review the evaluation within line 7 14 days.
line 8 (D) The evaluation shall be confidential pursuant to Section line 9 5200.
line 10 (d) (1) At the evaluation review hearing, the court shall review line 11 the evaluation and any other evidence from all interested line 12 individuals, including, but not limited to, evidence from the line 13 petitioner, the county behavioral health agency, the respondent, line 14 and the supporter.
line 15 (2) The hearing may be continued a maximum of 14 days upon line 16 stipulation of the respondent and the county behavioral health line 17 agency.
line 18 (3) (A) If the court finds that the evaluation and other evidence line 19 demonstrate by clear and convincing evidence that the respondent line 20 meets the CARE criteria, the court shall order the county line 21 behavioral health agency, the respondent, and the respondent’s line 22 counsel and supporter to jointly develop a CARE plan. line 23 (B) The respondent and the county behavioral health agency line 24 may request appellate writ review of the order to develop a CARE line 25 plan.
line 26 (C) A hearing to approve the CARE plan shall be set not more line 27 than 14 days from the date of the order to develop a CARE plan. line 28 (4) If the court finds that the evidence does not, by clear and line 29 convincing evidence, support that the respondent meets the CARE line 30 criteria, the court shall dismiss the petition without prejudice. line 31 (e) (1) The plan approval and implementation hearing to line 32 approve the CARE plan shall occur within 14 days after date of line 33 the order to develop a CARE plan.
line 34 (2) The CARE plan may be presented by both or either of the line 35 parties. After presentation, the court may do any of the following:
line 36 (A) Approve the plan as presented and make any orders line 37 necessary for the implementation of the plan.
line 38 (B) Order the plan modified to better meet the needs of the line 39 parties, approve the plan as modified, within the scope of the 97 — 13 — SB 1338
line 1 county behavioral health agency’s services, and make any orders line 2 necessary for the implementation of the plan.
line 3 (C) Reject the plan and order the parties to continue to work line 4 on the plan. The court shall set a subsequent hearing for no more line 5 than 14 days after rejecting the proposed plan.
line 6 (3) (A) If the court rejects the plan or if there is no CARE plan line 7 because the parties have not had sufficient time to complete it, the line 8 court may grant a continuance for no more than 14 days. line 9 (B) At the subsequent CARE plan approval and implementation line 10 hearing, the court shall review the CARE plan, at which time the line 11 court may do either of the following:
line 12 (i) Approve the plan as presented and make any orders line 13 necessary to implement the plan.
line 14 (ii) Order the plan modified, within the scope of the county line 15 behavioral health agency’s services, to better meet the needs of line 16 the parties, approve the plan as modified, and make any orders line 17 necessary to implement the plan.
line 18 (4) Court approval of the CARE plan begins the one-year CARE line 19 program timeline.
line 20 (f) The court shall schedule a status conference for 60 days after line 21 the approval of the CARE plan to review the progress of the CARE line 22 plan’s implementation.
line 23 (g) (1) The 60-day status conference shall be followed by line 24 regular status conferences set by the court, at least every 180 days. line 25 (2) Intermittent lapses or setbacks experienced by the respondent line 26 shall be reviewed by the court.
line 27 (h) (1) In the 11th month of the program timeline, the court line 28 shall hold a one-year status hearing. At that hearing, the court line 29 shall determine whether to graduate the respondent from the line 30 program with a graduation plan or reappoint the respondent to line 31 the program for another term, not to exceed one year. line 32 (2) The one-year status hearing shall be an evidentiary hearing. line 33 All parties shall be permitted to speak, present evidence, and the line 34 court shall hear recommendations from the county behavioral line 35 health agency.
line 36 (3) If the respondent has successfully completed participation line 37 in the one-year CARE program, the respondent shall not be line 38 reappointed to the program.
line 39 (4) At the one-year status hearing, the respondent may request line 40 graduation or reappointment to the CARE program. If the 97 SB 1338 — 14 —
line 1 respondent elects to accept voluntary reappointment to the line 2 program, the respondent may request any amount of time, up to line 3 and including one additional year, to be reappointed to the CARE line 4 program.
line 5 (5) If the respondent requests to be graduated from, or times line 6 out of, the program, the court shall officially graduate the line 7 respondent and terminate its jurisdiction with a graduation plan. line 8 (6) Upon completion, for a respondent who was transferred line 9 from another court, the referring court shall be given notice of line 10 completion and the underlying matter shall be terminated. line 11 (i) The hearings described in this section shall occur in-person line 12 unless the court, in its discretion, determines that a party may line 13 appear remotely through the use of remote technology. line 14 (j) Consistent with its constitutional rulemaking authority, the line 15 Judicial Council shall adopt rules to implement the policies and line 16 provisions in this section to promote statewide consistency, line 17 including, but not limited to, what is included in the petition form line 18 packet, the clerk’s review of the petition, and the process by which line 19 counsel and supporter will be appointed.
line 20 5978. (a) A court may refer an individual from assisted line 21 outpatient treatment and conservatorship proceedings to CARE line 22 proceedings.
line 23 (b) A court may refer an individual from misdemeanor line 24 proceedings pursuant to Section 1370.01 of the Penal Code. line 25
line 26 Chapter 3. Accountability
line 27
line 28 5979. (a) If, at any time during the proceedings, the court line 29 determines by a preponderance of evidence that the respondent is line 30 not participating in CARE proceedings, after the respondent line 31 receives notice, or is failing to comply with their CARE plan, the line 32 court may terminate the respondent’s participation in the CARE line 33 program. The court may utilize existing legal authority pursuant line 34 to Article 4 (commencing with Section 5200) of Chapter 2 of Part line 35 1, to ensure the respondent’s safety. The subsequent proceedings line 36 may use the CARE proceedings as a factual presumption that no line 37 suitable community alternatives are available to treat the line 38 individual.
line 39 (b) If, at any time during the proceedings, the court finds that line 40 the county is not complying with court orders, the court may fine 97 — 15 — SB 1338
line 1 the county up to one thousand dollars ($1,000) per day for line 2 noncompliance. If a county is found to be persistently line 3 noncompliant, the court may appoint a receiver to secure line 4 court-ordered care for the respondent at the county’s cost. line 5 (c) Either the respondent or the county behavioral health agency line 6 may appeal an adverse court determination to the appellate line 7 division of the superior court.
line 8
line 9 Chapter 4. The Supporter
line 10
line 11 5980. (a) Subject to appropriation, the California Department line 12 of Aging shall administer the CARE Supporter program, which line 13 shall make available a trained supporter to the respondent. The line 14 department shall train the supporter on supported decisionmaking line 15 with individuals who have behavioral health conditions and on line 16 the use of psychiatric advance directives, with support and input line 17 from peers, family members, disability groups, providers, and line 18 other relevant stakeholders. The department may enter into a line 19 technical assistance and training agreement to provide trainings line 20 either directly to supporters or to the contracted entities who will line 21 be responsible for hiring and matching supporters to respondents. line 22 The CARE Supporter program contracts shall include labor line 23 standards.
line 24 (b) The CARE Supporter program shall be designed to do all line 25 of the following:
line 26 (1) Offer the respondent a flexible and culturally responsive line 27 way to maintain autonomy and decisionmaking authority over line 28 their own life by developing and maintaining voluntary supports line 29 to assist them in understanding, making, communicating, and line 30 implementing their own informed choices.
line 31 (2) Strengthen the respondent’s capacity and prevent or remove line 32 the need to use more restrictive protective mechanisms, such as line 33 conservatorship.
line 34 (3) Assist the respondent with understanding, making, and line 35 communicating decisions and expressing preferences throughout line 36 the CARE court process.
line 37 (c) If the respondent chooses to have a supporter who was not line 38 trained pursuant to this section, that person may serve as a line 39 supporter without compensation.
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line 1 5981. (a) Notwithstanding any other provision of this part, line 2 the respondent may have their supporter present, if available, in line 3 any meeting, judicial proceeding, or communication related to line 4 any of the following:
line 5 (1) An evaluation.
line 6 (2) Creation of a CARE plan.
line 7 (3) Establishing a psychiatric advance directive. line 8 (4) Development of a graduation plan.
line 9 (b) A supporter shall do all the following, to the best of their line 10 ability and to the extent reasonably possible:
line 11 (1) Support the will and preferences of the respondent. line 12 (2) Respect the values, beliefs, and preferences of the line 13 respondent.
line 14 (3) Act honestly, diligently, and in good faith. line 15 (4) Avoid, to the greatest extent possible, and disclose, minimize, line 16 and manage, conflicts of interest.
line 17 (c) Unless explicitly authorized, a supporter shall not do any line 18 of the following:
line 19 (1) Make decisions for, or on behalf of, the respondent, except line 20 when necessary to prevent imminent bodily harm or injury. line 21 (2) Sign documents on behalf of the respondent. line 22 (3) Substitute their own judgment for the decision or preference line 23 of the respondent.
line 24 (d) In addition to the obligations in this section, a supporter line 25 shall be bound by all existing obligations and prohibitions line 26 otherwise applicable by law that protect people with disabilities line 27 and the elderly from fraud, abuse, neglect, coercion, or line 28 mistreatment. This section does not limit a supporter’s civil or line 29 criminal liability for prohibited conduct against the respondent, line 30 including liability for fraud, abuse, neglect, coercion, or line 31 mistreatment, including liability under the Elder Abuse and line 32 Dependent Adult Civil Protection Act (Chapter 11 (commencing line 33 with Section 15600) of Part 3 of Division 9), including, but not line 34 limited to, Sections 15656 and 15657.
line 35
line 36 Chapter 5. CARE Plan
line 37
line 38 5982. The CARE plan shall be created by the respondent, their line 39 supporter and counsel, and the county behavioral health agency. line 40 The plan shall include all of the following components:
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line 1 (a) (1) Behavioral health treatment, which includes medically line 2 necessary mental health or substance use disorder treatment, or line 3 both.
line 4 (2) If the respondent is enrolled in the Medi-Cal program, the line 5 county shall provide all medically necessary specialty mental line 6 health and substance use disorder treatment services, as those line 7 services are defined in the Medi-Cal program and consistent with line 8 their responsibilities thereunder, to a respondent when included line 9 in their court ordered CARE plan. Specialty mental health services line 10 and substance use disorder treatment services may be included in line 11 the CARE plan if they are determined to be medically necessary line 12 by the clinical evaluation. If the respondent is an enrollee in a line 13 health care service plan, other than a Medi-Cal managed care line 14 plan, the services shall be provided and reimbursed pursuant to line 15 Section 1374.723 of the Health and Safety Code. line 16 (3) Counties are encouraged to employ medically necessary, line 17 evidence-based practices and promising practices supported with line 18 community-defined evidence, which may include assertive line 19 community treatment, peer support services, and psychoeducation. line 20 (b) (1) As part of the provision of behavioral health care, the line 21 care plan may include medically necessary stabilization line 22 medications, including antipsychotic medications. If medically line 23 necessary, medications may be provided as long-acting injections. line 24 (2) Court ordered stabilization medications shall not be forcibly line 25 administered, absent a separate order by the court pursuant to line 26 Sections 5332 to 5336, inclusive.
line 27 (3) Medically necessary stabilization medications may be line 28 prescribed by the treating licensed behavioral health care provider line 29 and medication support services shall be offered. The respondent, line 30 in the development and on-going maintenance of the plan, shall line 31 work with their behavioral health care provider and their supporter line 32 to address medication concerns and make changes to the treatment line 33 plan.
line 34 (c) A housing plan that describes the housing needs of the line 35 respondent and the housing resources that will be considered in line 36 support of an appropriate housing placement. The respondent line 37 shall have diverse housing options, including, but not limited to, line 38 housing in clinically enhanced interim or bridge housing, licensed line 39 adult and senior care settings, and supportive housing. Counties line 40 may offer appropriate housing placements in the region as early 97 SB 1338 — 18 —
line 1 as feasible in the engagement process. This section does not allow line 2 the court to order housing or to require the county to provide line 3 housing.
line 4
line 5 Chapter 6. Technical Assistance and Administration line 6
line 7 5983. (a) Subject to appropriation, the State Department of line 8 Health Care Services shall provide technical assistance to county line 9 behavioral health agencies to support the implementation of this line 10 part, including trainings regarding the CARE model and statute line 11 and data collection.
line 12 (b) Subject to appropriation, the State Department of Health line 13 Care Services shall administer the Behavioral Health Bridge line 14 Housing program to provide funding for clinically enhanced bridge line 15 housing settings to serve individuals who are experiencing line 16 homelessness and have behavioral health conditions. Individuals line 17 who are CARE program participants shall be prioritized for any line 18 appropriate bridge housing funded by the Behavioral Health line 19 Bridge Housing program.
line 20 (c) Subject to appropriation, the Judicial Council shall provide line 21 technical assistance to judges to support the implementation of line 22 this part, including trainings regarding the CARE model and line 23 statutes, working with the supporter, best practices, and line 24 evidence-based models of care for people with severe behavioral line 25 health conditions.
line 26 5984. (a) For purposes of implementing this part, the line 27 California Health and Human Services Agency, the State line 28 Department of Health Care Services, and the California line 29 Department of Aging may enter into exclusive or nonexclusive line 30 contracts, or amend existing contracts, on a bid or negotiated line 31 basis. Contracts entered into or amended pursuant to this part line 32 shall be exempt from Chapter 6 (commencing with Section 14825) line 33 of Part 5.5 of Division 3 of Title 2 of the Government Code, Section line 34 19130 of the Government Code, Part 2 (commencing with Section line 35 10100) of Division 2 of the Public Contract Code, and the State line 36 Administrative Manual, and shall be exempt from the review or line 37 approval of any division of the Department of General Services. line 38 (b) Notwithstanding Chapter 3.5 (commencing with Section line 39 11340) of Part 1 of Division 3 of Title 2 of the Government Code, line 40 the California Health and Human Services Agency, the State 97 — 19 — SB 1338
line 1 Department of Health Care Services, and the California line 2 Department of Aging may implement, interpret, or make specific line 3 this part, in whole or in part, by means of plan letters, information line 4 notices, provider bulletins, or other similar instructions, without line 5 taking any further regulatory action.
line 6 SEC. 5. No reimbursement is required by this act pursuant to line 7 Section 6 of Article XIIIB of the California Constitution for certain line 8 costs that may be incurred by a local agency or school district line 9 because, in that regard, this act creates a new crime or infraction, line 10 eliminates a crime or infraction, or changes the penalty for a crime line 11 or infraction, within the meaning of Section 17556 of the line 12 Government Code, or changes the definition of a crime within the line 13 meaning of Section 6 of Article XIII B of the California line 14 Constitution.
line 15 However, if the Commission on State Mandates determines that line 16 this act contains other costs mandated by the state, reimbursement line 17 to local agencies and school districts for those costs shall be made line 18 pursuant to Part 7 (commencing with Section 17500) of Division line 19 4 of Title 2 of the Government Code.
line 20 SECTION 1. Part 1.3 (commencing with Section 5565) is line 21 added to Division 5 of the Welfare and Institutions Code, to read:
line 22
line 23 PART 1.3. COMMUNITY ASSISTANCE, RECOVERY, AND
line 24 EMPOWERMENT (CARE) COURT PROGRAM
line 25
line 26 5565. (a) The Community Assistance, Recovery, and line 27 Empowerment (CARE) Court Program is hereby established to line 28 connect a person struggling with untreated mental illness and line 29 substance use disorders with a court-ordered CARE plan. line 30 (b) (1) A court may order a person who is the subject of a line 31 petition filed pursuant to this section to obtain treatment and line 32 services under a CARE plan if the court finds that the facts stated line 33 in the verified petition are true and established and the criteria set line 34 in this section are met, including, but not limited to, each of the line 35 following:
line 36 (A) The person is 18 years of age or older.
line 37 (B) The person is suffering from a mental illness and a substance line 38 use disorder.
line 39 (C) The person lacks medical decisionmaking capacity. 97 SB 1338 — 20 —
line 1 (2) A court may order the person to have a CARE plan for up line 2 to 12 months, and may renew the plan for up to another 12 months. line 3 The court shall conduct periodic review hearings. line 4 (3) A person who is ordered under a CARE plan who does not line 5 complete the plan may be referred to conservatorship pursuant to line 6 Chapter 3 (commencing with Section 5350) of Part 1, and it shall line 7 be presumed that there are no suitable alternatives to line 8 conservatorship available to the person
line 9 (c) A petition for an order authorizing a CARE plan may be line 10 filed by a family member, county representative, community-based line 11 social services provider, behavioral health provider, or first line 12 responder in the superior court in the county in which the person line 13 who is the subject of the petition is present or reasonably believed line 14 to be present.
line 15 (d) (1) A CARE plan shall be managed by a CARE team in the line 16 community, and may include clinically prescribed and line 17 individualized interventions with several supportive services, line 18 including, but not limited to, medication and housing. line 19 (2) The CARE team shall consist of clinical team members, a line 20 public defender, and a support person to help make self-directed line 21 care decisions.
line 22 (e) (1) Each county shall participate in providing services under line 23 the program.
line 24 (2) The court may order sanctions or appoint an agent to ensure line 25 the county provides services under the program. line 26 SEC. 2. If the Commission on State Mandates determines that line 27 this act contains costs mandated by the state, reimbursement to line 28 local agencies and school districts for those costs shall be made line 29 pursuant to Part 7 (commencing with Section 17500) of Division line 30 4 of Title 2 of the Government Code.
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