Amended in Senate March 26, 2015

Senate Bill No. 319

Introduced by Senator Beall

begin insert

(Principal coauthor: Senator Mitchell)

end insert begin insert

(Principal coauthor: Assembly Member Chiu)

end insert

(Coauthor: Senator Monning)

begin insert

(Coauthor: Assembly Member Gatto)

end insert

February 23, 2015

An act to amend Section begin insert 56.103 of the Civil Code, and to amend Sections 5328.04 and end insert 16501.3 of the Welfare and Institutions Code, relating to child welfare services.

LEGISLATIVE COUNSEL’S DIGEST

SB 319, as amended, Beall. Child welfare services: public health nursing.

Existing law requires the State Department of Social Services to establish a program of public health nursing in the child welfare services program, and requires counties to use the services of the foster care public health nurse under this program. Existing law requires the foster care public health nurse to perform specified duties, including participating in medical care planning and coordinating for a child in foster care. Existing law also requires a county to establish a community child health and disability prevention program to provide early and periodic assessments of the health status of children in the county.

This bill would require a county to provide the services of a foster care public health nurse to children in foster care by contracting with the community child health and disability prevention program established in that county. The bill would require a foster care public health nurse to monitor begin delete and oversee end delete each child in foster care who is administered one or more psychotropic medications, as specified. begin delete The bill would give the foster care public health nurse access to the child’s medical, dental, and mental health care information in order to fulfill these duties. end delete By imposing these additional duties on foster care public health nurses, this bill would impose a state-mandated local program.

begin delete

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.

end delete begin delete

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 these statutory provisions.

end delete begin insert

Existing law restricts the disclosure of medical and mental health information by providers of health care and mental health care services, but authorizes disclosure of this information to county social workers, probation officers, or any other person who is legally authorized to have custody and care of a minor who is in temporary custody or subject to the jurisdiction of the juvenile court, for the purpose of coordinating medical treatment and health care, mental health, and developmental disability services for the minor.

end insert begin insert

This bill would authorize the disclosure of this health care and mental health care information to a foster care public health nurse, as specified.

end insert begin insert

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.

end insert begin insert

This bill would provide that no reimbursement is required by this act for a specified reason.

end insert

Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: yes.

The people of the State of California do enact as follows:

begin insert

begin insert SECTION 1. end insert   

end insert

begin insert Section 56.103 of the end insert begin insert Civil Code end insert begin insert is amended to
read: end insert

56.103.  

(a) A provider of health care may disclose medical
information to a county social worker, a probation officer, begin insert a foster
care public health nurse acting pursuant to Section 16501.3 of the
Welfare and Institutions Code, end insert or any other person who is legally
authorized to have custody or care of a minor for the purpose of
coordinating health care services and medical treatment provided
to the minor begin insert , including, but not limited to, the sharing of
information related to screenings, assessments, and laboratory
tests necessary to monitor the administration of psychotropic
medications end insert .

(b) For purposes of this section, health care services and medical
treatment includes one or more providers of health care providing,
coordinating, or managing health care and related services,
including, but not limited to, a provider of health care coordinating
health care with a third party, consultation between providers of
health care and medical treatment relating to a minor, or a provider
of health care referring a minor for health care services to another
provider of health care.

(c) For purposes of this section, a county social worker, a
probation officer, begin insert foster care public health nurse, end insert or any other
person who is legally authorized to have custody or care of a minor
shall be considered a third party who may receive any of the
following:

(1) Medical information described in Sections 56.05 and 56.10.

(2) Protected health information described in Section 160.103
of Title 45 of the Code of Federal Regulations.

(d) Medical information disclosed to a county social worker,
probation officer, begin insert foster care public health nurse, end insert or any other
person who is legally authorized to have custody or care of a minor
shall not be further disclosed by the recipient unless the disclosure
is for the purpose of coordinating health care services and medical
treatment of the minor and the disclosure is authorized by law.
Medical information disclosed pursuant to this section may not be
admitted into evidence in any criminal or delinquency proceeding
against the minor. Nothing in this subdivision shall prohibit
identical evidence from being admissible in a criminal proceeding
if that evidence is derived solely from lawful means other than
this section and is permitted by law.

(e) (1) Notwithstanding Section 56.104, if a provider of health
care determines that the disclosure of medical information
concerning the diagnosis and treatment of a mental health condition
of a minor is reasonably necessary for the purpose of assisting in
coordinating the treatment and care of the minor, that information
may be disclosed to a county social worker, probation officer,
begin insert foster care public health nurse, end insert or any other person who is legally
authorized to have custody or care of the minor. The information
shall not be further disclosed by the recipient unless the disclosure
is for the purpose of coordinating mental health services and
treatment of the minor and the disclosure is authorized by law.

(2) As used in this subdivision, “medical information” does not
include psychotherapy notes as defined in Section 164.501 of Title
45 of the Code of Federal Regulations.

(f) The disclosure of information pursuant to this section is not
intended to limit the disclosure of information when that disclosure
is otherwise required by law.

(g) For purposes of this section, “minor” means a minor taken
into temporary custody or as to who a petition has been filed with
the court, or who has been adjudged to be a dependent child or
ward of the juvenile court pursuant to Section 300 or 601 of the
Welfare and Institutions Code.

(h) (1) Except as described in paragraph (1) of subdivision (e),
nothing in this section shall be construed to limit or otherwise
affect existing privacy protections provided for in state or federal
law.

(2) Nothing in this section shall be construed to expand the
authority of a social worker, probation officer, begin insert foster care public
health nurse, end insert or custodial caregiver beyond the authority provided
under existing law to a parent or a patient representative regarding
access to medical information.

begin insert

begin insert SEC. 2. end insert   

end insert

begin insert Section 5328.04 of the end insert begin insert Welfare and Institutions Code end insert
begin insert is amended to read: end insert

5328.04.  

(a) Notwithstanding Section 5328, information and
records made confidential under that section may be disclosed to
a county social worker, a probation officer, begin insert a foster care public
health nurse end insert begin insert acting pursuant to Section 16501.3 end insert begin insert , end insert or any other
person who is legally authorized to have custody or care of a minor,
for the purpose of coordinating health care services and medical
treatment, as defined in subdivision (b) of Section 56.103 of the
Civil Code, mental health services, or services for developmental
disabilities, for the minor.

(b) Information disclosed under subdivision (a) shall not be
further disclosed by the recipient unless the disclosure is for the
purpose of coordinating health care services and medical treatment,
or mental health or developmental disability services, for the minor
and only to a person who would otherwise be able to obtain the
information under subdivision (a) or any other provision of law.

(c) Information disclosed pursuant to this section shall not be
admitted into evidence in any criminal or delinquency proceeding
against the minor. Nothing in this subdivision shall prohibit
identical evidence from being admissible in a criminal proceeding
if that evidence is derived solely from lawful means other than
this section and is permitted by law.

(d) Nothing in this section shall be construed to compel a
physician and surgeon, licensed psychologist, social worker with
a master’s degree in social work, licensed marriage and family
therapist, licensed professional clinical counselor, nurse, attorney,
or other professional person to reveal information, including notes,
that has been given to him or her in confidence by the minor or
members of the minor’s family.

(e) The disclosure of information pursuant to this section is not
intended to limit disclosure of information when that disclosure
is otherwise required by law.

(f) Nothing in this section shall be construed to expand the
authority of a social worker, probation officer, begin insert foster care public
health nurse, end insert or custodial caregiver beyond the authority provided
under existing law to a parent or a patient representative regarding
access to confidential information.

(g) As used in this section, “minor” means a minor taken into
temporary custody or for whom a petition has been filed with the
court, or who has been adjudged a dependent child or ward of
juvenile court pursuant to Section 300 or 601.

(h) Information and records that may be disclosed pursuant to
this section do not include psychotherapy notes, as defined in
Section 164.501 of Title 45 of the Code of Federal Regulations.

begin delete SECTION 1. end delete
begin insert SEC. 3. end insert   

Section 16501.3 of the Welfare and Institutions Code
is amended to read:

16501.3.  

(a) The State Department of Social Services shall
establish and maintain a program of public health nursing in the
child welfare services program that meets the federal requirements
for the provision of begin delete healthcare end delete begin insert health care end insert to minor and nonminor
dependents in foster care consistent with Section 30026.5 of the
Government Code. The purpose of the public health nursing
program shall be to promote and begin delete protect end delete begin insert enhance end insert the physical,
mental, dental, and developmental well-being of children in the
child welfare system.

(b) Under this program, counties shall provide the services of
a foster care public health nurse to children in foster care by
contracting with the community child health and disability
prevention program established in that county pursuant to Section
124040 of the Health and Safety Code. The foster care public
health nurse and the child’s social worker shall consult begin delete and end delete begin insert , end insert
collaborate begin insert , and share information in a timely manner end insert to ensure
that the child’s physical, mental, dental, and developmental needs
are met. The foster care public health nurse shall serve as a liaison
with health care professionals and other providers of health-related
services. In order to fulfill these duties, the foster care public health
nurse shall have access to the child’s medical, dental, and mental
health care information.

(c) The duties of a foster care public health nurse shall include,
but need not be limited to, the following:

(1) Documenting that each child in foster care receives initial
and followup health screenings that meet reasonable standards of
medical practice.

(2) Collecting health information and other relevant data on
each foster child as available, receiving all collected information
to determine appropriate referral and services, and expediting
referrals to providers in the community for early intervention
services, specialty services, dental care, mental health services,
and other health-related services necessary for the child.

(3) Participating in medical care planning and coordinating for
the child. This may include, but is not limited to, assisting case
workers in arranging for comprehensive health and mental health
assessments, interpreting the results of health assessments or
evaluations for the purpose of case planning and coordination,
facilitating the acquisition of any necessary court authorizations
for procedures or medications, advocating for the health care needs
of the child and ensuring the creation of linkage among various
providers of care.

(4) Providing followup contact to assess the child’s progress in
meeting treatment goals.

(5) At the request of and under the direction of a nonminor
dependent, as described in subdivision (v) of Section 11400,
assisting the nonminor dependent in accessing physical health and
mental health care, coordinating the delivery of health and mental
health care services, advocating for the health and mental health
care that meets the needs of the nonminor dependent, assisting the
nonminor dependent to make begin delete an end delete informed begin delete decision to begin or
continue taking psychotropic medications, end delete begin insert end insert begin insert decisions about his or
her health care by, at a minimum, providing educational material end insert begin insert s, end insert
and assisting the nonminor dependent to assume responsibility for
his or her ongoing physical and mental health care management.

(6) Monitoring begin delete and oversight of end delete each child in foster care who
is administered one or more psychotropic medications. This
begin delete oversight end delete begin insert monitoring end insert shall include begin delete the review end delete begin insert , but is not limited
to, all of the following: end insert

begin insert (A) end insert begin insert   end insert begin insert The review end insert of each request for psychotropic medication
filed pursuant to Section 369.5 to ensure that begin delete lab tests, end delete begin insert all required
information is provided in the application to the court. end insert

begin insert (B) end insert begin insert   end insert begin insert Ensuring that laboratory tests, end insert other screenings and
measurements, evaluations, and assessments required to meet
reasonable standards of medical practice have been completed.
begin delete The foster care public health nurse shall also ensure that all of the
following occur: end delete

begin delete

(A) The

end delete

begin insert (C) end insert begin insert   end insert begin insert Ensuring that the end insert juvenile court has authorized the
psychotropic medication to be administered to the child.

begin delete

(B) Periodic

end delete

begin insert (D) end insert begin insert   end insert begin insert Ensuring that periodic end insert followup visits with the prescribing
physician, lab work, and other measurements are begin insert scheduled and end insert
completed.

begin delete

(C) The

end delete

begin insert (E) end insert begin insert   end insert begin insert Ensuring that the end insert child’s health and education passport, as
described in Section 16010, includes accurate documentation
concerning the psychotropic medications authorized for and
administered to the child.

begin delete

(D) The medication’s efficacy in addressing the illness or
symptoms for which it was prescribed are documented.

end delete begin insert

(F) Assessing, monitoring, and documenting the response of
the child to the administration of psychotropic medication through
review and interpretation of the laboratory tests, reports by the
child and caregiver, and other screenings.

end insert begin delete

(E) Any

end delete

begin insert (G) end insert begin insert   end insert begin insert Ensuring that any end insert adverse effects of the medication reported
by the begin insert child or end insert child’s caregiver are promptly addressed, and, if
necessary, brought to the attention of the court begin insert , the child’s social
worker, or both end insert .

(d) The services provided by foster care public health nurses
under this section shall be limited to those for which reimbursement
may be claimed under Title XIX begin insert of the federal Social Security Act end insert
at an enhanced rate for services delivered by skilled professional
medical personnel. Notwithstanding any other law, this section
shall be implemented only if, and to the extent that, the department
determines that federal financial participation, as provided under
Title XIX of the federal Social Security Act (42 U.S.C. Sec. 1396
et seq.), is available.

(e) (1) The State Department of Health Care Services shall seek
any necessary federal approvals for child welfare agencies to
appropriately claim enhanced federal Title XIX funds for services
provided pursuant to this section.

(2) Commencing in the fiscal year immediately following the
fiscal year in which the necessary federal approval pursuant to
paragraph (1) is secured, county child welfare agencies shall
provide health care oversight and coordination services pursuant
to this section, and may accomplish this through agreements with
local public health agencies.

(f) (1) Notwithstanding Section 10101, prior to the 2011-12
fiscal year, there shall be no required county match of the
nonfederal cost of this program.

(2) Commencing in the 2011-12 fiscal year, and each fiscal
year thereafter, funding and expenditures for programs and
activities under this section shall be in accordance with the
requirements provided in Sections 30025 and 30026.5 of the
Government Code.

begin delete

SEC. 2.  

If the Commission on State Mandates determines that
this act contains costs mandated by the state, reimbursement to
local agencies and school districts for those costs shall be made
pursuant to Part 7 (commencing with Section 17500) of Division
4 of Title 2 of the Government Code.

end delete

begin insert

begin insert SEC. 4. end insert   

end insert

begin insert To the extent that this act has an overall effect of
increasing the costs already borne by a local agency for programs
or levels of service mandated by the 2011 Realignment Legislation
within the meaning of Section 36 of Article XIII of the California
Constitution, it shall apply to local agencies only to the extent that
the state provides annual funding for the cost increase. Any new
program or higher level of service provided by a local agency
pursuant to this act above the level for which funding has been
provided shall not require a subvention of funds by the state nor
otherwise be subject to Section 6 of Article XIII B of the California
Constitution. end insert