2009 California Welfare and Institutions Code - Section 4080 :: Article 3. Psychiatric Health Facilities

4080.  (a) Psychiatric health facilities, as defined in Section
1250.2 of the Health and Safety Code, shall only be licensed by the
State Department of Mental Health subsequent to application by
counties, county contract providers, or other organizations pursuant
to this part.
   (b) (1) For counties or county contract providers that choose to
apply, the local mental health director shall first present to the
local mental health advisory board for its review an explanation of
the need for the facility and a description of the services to be
provided. The local mental health director shall then submit to the
governing body the explanation and description. The governing body,
upon its approval, may submit the application to the State Department
of Mental Health.
   (2) Other organizations that will be applying for licensure and do
not intend to use any Bronzan-McCorquodale funds pursuant to Section
5707 shall submit to the local mental health director and the
governing body in the county in which the facility is to be located a
written and dated proposal of the services to be provided. The local
mental health director and governing body shall have 30 days during
which to provide any advice and recommendations regarding licensure,
as they deem appropriate. At any time after the 30-day period, the
organizations may then submit their applications, along with the
mental health director's and governing body's advice and
recommendations, if any, to the State Department of Mental Health.
   (c) The State Fire Marshal and other appropriate state agencies,
to the extent required by law, shall cooperate fully with the State
Department of Mental Health to ensure that the State Department of
Mental Health approves or disapproves the licensure applications not
later than 90 days after the application submission by a county,
county contract provider, or other organization.
   (d) Every psychiatric health facility and program for which a
license has been issued shall be periodically inspected by a
multidisciplinary team appointed or designated by the State
Department of Mental Health. The inspection shall be conducted no
less than once every two years and as often as necessary to ensure
the quality of care provided. During the inspections the review team
shall offer such advice and assistance to the psychiatric health
facility as it deems appropriate.
   (e) (1) The program aspects of a psychiatric health facility that
shall be reviewed and may be approved by the State Department of
Mental Health shall include, but not be limited to:
   (A) Activities programs.
   (B) Administrative policies and procedures.
   (C) Admissions, including provisions for a mental evaluation.
   (D) Discharge planning.
   (E) Health records content.
   (F) Health records services.
   (G) Interdisciplinary treatment teams.
   (H) Nursing services.
   (I) Patient rights.
   (J) Pharmaceutical services.
   (K) Program space requirements.
   (L) Psychiatrist and clinical psychological services.
   (M) Rehabilitation services.
   (N) Restraint and seclusion.
   (O) Social work services.
   (P) Space, supplies, and equipment.
   (Q) Staffing standards.
   (R) Unusual occurrences.
   (S) Use of outside resources, including agreements with general
acute care hospitals.
   (T) Linguistic access and cultural competence.
   (U) Structured outpatient services to be provided under special
permit.
   (2) The State Department of Mental Health has the sole authority
to grant program flexibility.
   (f) The State Department of Mental Health shall adopt regulations
that shall include, but not be limited to, all of the following:
   (1) Procedures by which the State Department of Mental Health
shall review and may approve the program and facility requesting
licensure as a psychiatric health facility as being in compliance
with program standards established by the department.
   (2) Procedures by which the Director of Mental Health shall
approve, or deny approval of, the program and facility licensed as a
psychiatric health facility pursuant to this section.
   (3) Provisions for site visits by the State Department of Mental
Health for the purpose of reviewing a facility's compliance with
program and facility standards.
   (4) Provisions for the State Department of Mental Health for any
administrative proceeding regarding denial, suspension, or revocation
of a psychiatric health facility license.
   (5) Procedures for the appeal of an administrative finding or
action pursuant to paragraph (4) of this subdivision and subdivision
(j).
   (g) Regulations shall be adopted by the State Department of Mental
Health, which shall establish standards for pharmaceutical services
in psychiatric health facilities. Licensed psychiatric health
facilities shall be exempt from requirements to obtain a separate
pharmacy license or permit.
   (h) (1) It is the intent of the Legislature that the State
Department of Mental Health shall license the facility in order to
establish innovative and more competitive and specialized acute care
services.
   (2) The State Department of Mental Health shall review and may
approve the program aspects of public or private facilities, with the
exception of those facilities that are federally certified or
accredited by a nationally recognized commission that accredits
health care facilities, only if the average per diem charges or costs
of service provided in the facility is approximately 60 percent of
the average per diem charges or costs of similar psychiatric services
provided in a general hospital.
   (3) (A) When a private facility is accredited by a nationally
recognized commission that accredits health care facilities, the
department shall review and may approve the program aspects only if
the average per diem charges or costs of service provided in the
facility do not exceed approximately 75 percent of the average per
diem charges or costs of similar psychiatric service provided in a
psychiatric or general hospital.
   (B) When a private facility serves county patients, the department
shall review and may approve the program aspects only if the
facility is federally certified by the Health Care Financing
Administration and serves a population mix that includes a proportion
of Medi-Cal patients sufficient to project an overall cost savings
to the county, and the average per diem charges or costs of service
provided in the facility do not exceed approximately 75 percent of
the average per diem charges or costs of similar psychiatric service
provided in a psychiatric or general hospital.
   (4) When a public facility is federally certified by the Health
Care Financing Administration and serves a population mix that
includes a proportion of Medi-Cal patients sufficient to project an
overall program cost savings with certification, the department shall
approve the program aspects only if the average per diem charges or
costs of service provided in the facility do not exceed approximately
75 percent of the average per diem charges or costs of similar
psychiatric service provided in a psychiatric or general hospital.
   (5) (A) The State Department of Mental Health may set a lower rate
for private or public facilities than that required by paragraph (3)
or paragraph (4), respectively if so required by the federal Health
Care Financing Administration as a condition for the receipt of
federal matching funds.
   (B) This section does not impose any obligation on any private
facility to contract with a county for the provision of services to
Medi-Cal beneficiaries, and any contract for that purpose is subject
to the agreement of the participating facility.
   (6) (A) In using the guidelines specified in this subdivision, the
department shall take into account local conditions affecting the
costs or charges.
   (B) In those psychiatric health facilities authorized by special
permit to offer structured outpatient services not exceeding 10
daytime hours, the following limits on per diem rates shall apply:
   (i) The per diem charge for patients in both a morning and an
afternoon program on the same day shall not exceed 60 percent of the
facility's authorized per diem charge for inpatient services.
   (ii) The per diem charge for patients in either a morning or
afternoon program shall not exceed 30 percent of the facility's
authorized per diem charge for inpatient services.
   (i) The licensing fees charged for these facilities shall be
credited to the State Department of Mental Health for its costs
incurred in the review of psychiatric health facility programs, in
connection with the licensing of these facilities.
   (j) (1) The State Department of Mental Health shall establish a
system for the imposition of prompt and effective civil sanctions
against psychiatric health facilities in violation of the laws and
regulations of this state pertaining to psychiatric health
facilities. If the State Department of Mental Health determines that
there is or has been a failure, in a substantial manner, on the part
of a psychiatric health facility to comply with the laws and
regulations, the director may impose the following sanctions:
   (A) Cease and desist orders.
   (B) Monetary sanctions, which may be imposed in addition to the
penalties of suspension, revocation, or cease and desist orders. The
amount of monetary sanctions permitted to be imposed pursuant to this
subparagraph shall not be less than fifty dollars ($50) nor more
than one hundred dollars ($100) multiplied by the licensed bed
capacity, per day, for each violation. However, the monetary sanction
shall not exceed three thousand dollars ($3,000) per day. A facility
that is assessed a monetary sanction under this subparagraph, and
that repeats the deficiency, may, in accordance with the regulations
adopted pursuant to this subdivision, be subject to immediate
suspension of its license until the deficiency is corrected.
   (2) The department shall adopt regulations necessary to implement
this subdivision and paragraph (5) of subdivision (f) in accordance
with the Administrative Procedure Act (Chapter 3.5 (commencing with
Section 11340) of Part 1 of Division 3 of Title 2 of the Government
Code). No later than January 1, 1998, the department shall adopt
emergency regulations necessary to implement this subdivision and
paragraph (5) of subdivision (f) in accordance with the
Administrative Procedure Act (Chapter 3.5 (commencing with Section
11340) of Part 1 of Division 3 of Title 2 of the Government Code).
This initial adoption of emergency regulations shall be deemed to be
an emergency and necessary for the immediate preservation of the
public peace, health and safety, or general welfare. These emergency
regulations shall remain in effect for no more than 180 days. The
certificate of compliance, as provided for in subdivision (e) of
Section 11346.1 of the Government Code, for the emergency regulations
adopted pursuant to this paragraph shall be submitted to the Office
of Administrative Law no later than July 1, 1998.
   (k) Proposed changes in the standards or regulations affecting
health facilities that serve the mentally disordered shall be
effected only with the review and coordination of the Health and
Welfare Agency.
   (l) In psychiatric health facilities where the clinical director
is not a physician, a psychiatrist, or if one is temporarily not
available, a physician shall be designated who shall direct those
medical treatments and services that can only be provided by, or
under the direction of, a physician.