§ 20.20

(a) The Human Services Agency (“HSA”) administers the City’s County Adult Assistance Programs (“CAAP”), consisting of General Assistance, Personal Assisted Employment Services Program, Cash Assistance Linked to Medi-Cal Program, and Supplemental Security Income Pending Program, which together provide financial assistance and social services to eligible indigent adults who have no other source of income or benefits.

(b) The incidence of substance use disorders among San Francisco’s CAAP population is higher than among the general population. According to HSA, from 2018 to 2020, approximately 20% of CAAP recipients self-disclosed in an initial interview with HSA staff that they have substance abuse issues. By comparison, the federal Substance Abuse and Mental Health Services Administration reported that, from 2005 to 2010, 10.8% of the San Francisco-Oakland-Fremont metropolitan statistical area had a substance use disorder. Based on publicly available information, the incidence of substance use disorder among CAAP recipients who are experiencing homelessness is concerning. Further, in 2022, the San Francisco Homeless Count and Survey released by the Department of Homelessness and Supportive Housing found that 52% of individuals experiencing homelessness reported their drug or alcohol use as a disabling health condition, representing a 10% increase from 2019. In its Accidental Drug Overdose Reports for 2020 through 2023, the Office of the Chief Medical Examiner has determined that at least 25% of drug overdose decedents have no fixed address.

(c) Among programs intended to support recovery from substance use disorders, medical literature widely supports contingency management strategies as effective treatments. In contingency management strategies, patients receive tangible incentives to reinforce positive behaviors such as abstinence from addictive substances or behaviors, or adherence to Medication-Assisted Treatment (“MAT”) where patients are prescribed medications, such as buprenorphine, methadone, and naltrexone, to treat opioid use disorders.

(d) The San Francisco Department of Public Health (“DPH”) currently offers contingency management programs, including programs authorized by the California Department of Health Care Services. DPH’s 2022 Overdose Prevention Plan proposed to increase the number of programs offering contingency management from three to five, and increase the number of people participating in contingency management programs by 25%.

ancisco Department of Public Health (“DPH”) currently offers contingency management programs, including programs authorized by the California Department of Health Care Services. DPH’s 2022 Overdose Prevention Plan proposed to increase the number of programs offering contingency management from three to five, and increase the number of people participating in contingency management programs by 25%.

(e) On March 5, 2024, the voters passed Proposition F, which, as of January 1, 2025, will require all adult CAAP recipients to undergo screening for substance abuse when HSA determines that there is reasonable suspicion to believe that an individual is dependent upon illegal drugs. If the screening indicates there is reason to believe the recipient is abusing or dependent on illegal drugs, Proposition F will require that recipient to undergo a professional evaluation for substance abuse to receive further CAAP benefits. If, as a result of the professional evaluation, a provider determines the recipient requires substance abuse treatment, the provider will refer the recipient to a treatment program.

(f) The purpose of the Pilot Program established in this Article XX is to incentivize both drug-free and medically-assisted recovery from substance use disorders for those individuals who, under Proposition F, must undergo substance abuse treatment, and to strengthen drug overdose prevention efforts using contingency management methods.

(Added by Ord. 257-24, File No. 240799, App. 11/14/2024, Eff. 12/15/2024)

For purposes of this Article XX, the following terms have the following meanings:

“CAAP” means the County Adult Assistance Programs, set forth in Article VII of Chapter 20 of the Administrative Code.

“City” means the City and County of San Francisco.

“CLIA” means the Clinical Laboratory Improvement Amendments, codified at 42 U.S.C. § 263a, as may be amended from time to time, and including any implementing regulations.

“CND Participant” means a person participating in the Cash Not Drugs Pilot Program and meeting the eligibility criteria in Section 20.20-3.

“DPH” means the San Francisco Department of Public Health.

“Drug Test” means a test that detects the presence of illicit substances without referral to or analysis by a CLIA laboratory, such as but not limited to a rapid, at-home test or testing by a non-CLIA certified forensic laboratory.

“Executive Director” means the Executive Director of HSA or the Executive Director’s designee.

“HSA” means the San Francisco Human Services Agency.

“MAT” means Medication-Assisted Treatment.

“Negative Drug Test” means a Drug Test that is negative for any of the controlled substances listed in California Health and Safety Code Section 11054, as may be amended from time to time, with the exception of the following substances: Cannabis; Psilocybin; Psilocyn; Dimethyltryptamine (DMT); Mescaline; or any controlled substance used in connection with a prescribed MAT program, including, but not limited to, Buprenorphine and Methadone.

“Pilot Program” means the Cash Not Drugs Pilot Program, as set forth in this Article XX.

(Added by Ord. 257-24, File No. 240799, App. 11/14/2024, Eff. 12/15/2024)

(a) HSA, in collaboration with DPH, shall establish the Cash Not Drugs Pilot Program as a three-year pilot program.

(b) To establish initial eligibility for assistance under the Pilot Program, a person must:

(1) receive financial assistance through CAAP;

(2) be evaluated and determined to need substance abuse treatment as required by Section 20.7-26.5(c) of the Administrative Code to receive further CAAP benefits; and

(3) enroll in the Pilot Program, subject to program availability, by producing an initial Negative Drug Test.

(c) To maintain eligibility for weekly assistance under the Pilot Program, a person must:

(1) have established initial eligibility under subsection (b);

(2) thereafter produce one Negative Drug Test per week;

(3) participate in a contingency management substance use treatment program; and

(4) meet any additional requirements established by HSA, in collaboration with DPH, in its discretion, that are reasonably necessary or appropriate to implement the Pilot Program.

(d) Subject to the fiscal and budgetary provisions of the Charter, HSA shall collaborate with DPH to implement the Pilot Program as follows:

(1) HSA shall administer the Pilot Program as a voluntary program. The Executive Director may limit eligibility for the Pilot Program, including, but not limited to, offering the Pilot Program on a first-come, first-served basis and capping participation in the Pilot Program. In designing and implementing the Pilot Program, HSA shall partner with DPH to incorporate the seven core principles of contingency management, which are target behavior, target population, type of reinforcer, magnitude (or amount) of reinforcer, frequency of reinforcement distribution, timing of reinforcement distribution, and duration of reinforcement.

(2) Subject to the civil service provisions of the Charter, HSA or DPH may contract for the administration of the Pilot Program through a competitive bidding process, provided that, the contractor shall have experience in recovery supporting services and substance use disorder treatment

programs.

(3) Starting the first full week after a CND Participant satisfies the initial eligibility criteria set forth in subsection (b), HSA may, in its discretion, provide to such person payments in an amount of up to $100 per week for as long as such CND Participant maintains eligibility in the Pilot Program. HSA may provide payments using methods to safeguard against fraud and abuse, including but not limited to, smart debit cards with anti-relapse protections.

(4) HSA, in coordination with DPH, may offer CND Participants in the Pilot Program access to a protocol-driven and evidence-based treatment recovery program that includes an abstinence-based or MAT program for substance use disorder.

(5) HSA may, in its discretion, disenroll from the Pilot Program CND Participants who fail to meet the Pilot Program eligibility requirements in subsection (c), provided that, if HSA determines, in its discretion, that the CND Participant is making a good-faith effort to maintain or achieve sobriety, HSA may continue the CND Participant’s eligibility in the Pilot Program. Disenrolled CND Participants shall not have the right to appeal HSA’s decision. Disenrolled CND Participants may re-enter the Pilot Program at any time provided that they meet the initial eligibility criteria set forth in subsection (b).

(6) CND Participants may only participate in the Pilot Program using Drug Tests funded exclusively by the City and may not seek reimbursement for the Drug Tests from any other payer source. Any Drug Test used in the Pilot Program may not be sent to a CLIA laboratory for testing.

(e) Notwithstanding subsections (b) and (c), CND Participants shall be ineligible for further participation in the Pilot Program if HSA determines the CND Participant has, by means of fraud or willful noncompliance with Pilot Program requirements, obtained payments under the Pilot Program.

(Added by Ord. 257-24, File No. 240799, App. 11/14/2024, Eff. 12/15/2024)

(a) By no later than six months from the effective date of this ordinance, HSA shall work with the City Attorney, City Controller, DPH, and other relevant City agencies as necessary to prepare an implementation plan (“Implementation Plan”) for the Pilot Program. Before implementing the Pilot Program, HSA shall provide a copy of the Implementation Plan to the Mayor and the Board of Supervisors.

(b) The Implementation Plan shall include, but is not limited to, the following elements:

(1) An implementation timeline and operative date;

(2) An initial numerical cap on CND participants, if necessary and appropriate, together with an analysis of factors that may allow for expanded participation in the Pilot Program during the operative period;

(3) The Pilot Program’s plan to conduct Drug Tests, together with details on any necessary interdepartmental work orders or outside contractors for implementation and possible expansion;

(4) Estimated costs to conduct Drug Tests and payments for successful CND Participants, with an estimation of funds available to the Pilot Program from the Homelessness and Supportive Housing Fund, codified at Administrative Code Section 10.100-77 or other eligible funding sources;

(5) Estimated costs to administer the substance abuse treatment program and associated staffing, with an estimation of funds available to the Pilot Program from the CAAP Treatment Fund, in accordance with Proposition F, adopted by the voters at the March 5, 2024 election, which becomes

operative on January 1, 2025 and to be codified at Administrative Code Section 10.100-45.5; and

(6) Implementation and incorporation of the seven core principles of contingency management, referenced in subsection(d)(1) of Section 20.20-3, into the Pilot Program.

(Added by Ord. 257-24, File No. 240799, App. 11/14/2024, Eff. 12/15/2024)

HSA may work with a clinical research partner to prepare periodic assessments to submit to the Board of Supervisors and the Mayor no less than annually. Each such report shall describe the number of individuals who received benefits under the Pilot Program and evaluate the effectiveness of the Pilot Program at incentivizing drug-free recovery, MAT, and drug-use prevention, and include recommendations for further changes to the Pilot Program as appropriate. HSA shall submit the first report no later than 12 months after the start date of the Pilot Program and the second report no later than 12 months after the first report. A report shall be submitted between six and eight months prior to the sunset date for the Pilot Program, as stated in Section 20.20-7, so that the Mayor and Board of Supervisors will have adequate time to consider whether to transform the Pilot Program into a permanent program.

(Added by Ord. 257-24, File No. 240799, App. 11/14/2024, Eff. 12/15/2024)

In establishing the Pilot Program, the City is assuming an undertaking only to promote the general welfare. It is not assuming, nor is it imposing on its officers and employees, an obligation for breach of which it is liable in money damages to any person who claims that such a breach proximately caused injury.

(Added by Ord. 257-24, File No. 240799, App. 11/14/2024, Eff. 12/15/2024)

Unless the Board of Supervisors by ordinance extends the term of the Pilot Program, this Article XX and subsection (j) of Section 20.7-14 of Article VII of Chapter 20 of the Administrative Code shall expire by operation of law three years after the effective date of the ordinance in Board File No. 240799 enacting this Article and Section 20.7-14(j). Upon expiration of Article XX and Subsection (j) of Section 20.7-14, the City Attorney is authorized to cause such provisions to be removed from the Administrative Code.

(Added by Ord. 257-24, File No. 240799, App. 11/14/2024, Eff. 12/15/2024)