Amended in Assembly August 28, 2015

Amended in Assembly July 7, 2015

Amended in Senate June 2, 2015

Amended in Senate March 26, 2015

Senate BillNo. 319


Introduced by Senator Beall

(Principal coauthor: Senator Mitchell)

(Principal coauthor: Assembly Member Chiu)

(Coauthor: Senator Monning)

(Coauthors: Assembly Membersbegin delete Gatto and Gipsonend deletebegin insert Gatto, Gipson, and Lopezend insert)

February 23, 2015


An act to amend Section 56.103 of the Civil Code, and to amend Sections 5328.04 and 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.

This bill wouldbegin delete require a county to provide the services of a foster care public health nurse to children in foster care. The bill would require a foster care public health nurse to monitor each child in foster care who is administered one or more psychotropic medications, as specified.end deletebegin insert authorize a foster care public health nurse, as part of his or her requirement to participate in medical care planning and coordinating for a child, to monitor and oversee the child’s use of psychotropic medications. The bill would also require a foster care public health nurse to assist a nonminor dependent to make informed decisions about his or her health care.end insert By imposingbegin delete these additional dutiesend deletebegin insert this additional dutyend insert on foster care public health nurses, this bill would impose a state-mandated local program.

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.

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

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 no reimbursement is required by this act for a specified reason.

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

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

P2    1

SECTION 1.  

Section 56.103 of the Civil Code is amended to
2read:

3

56.103.  

(a) A provider of health care may disclose medical
4information to a county social worker, a probation officer, a foster
5care public health nurse acting pursuant to Section 16501.3 of the
6Welfare and Institutions Code, or any other person who is legally
7authorized to have custody or care of a minor for the purpose of
8coordinating health care services and medical treatment provided
9to the minor, including, but not limited to, the sharing of
10information related to screenings, assessments, and laboratory tests
P3    1necessary to monitor the administration of psychotropic
2medications.

3(b) For purposes of this section, health care services and medical
4treatment includes one or more providers of health care providing,
5coordinating, or managing health care and related services,
6including, but not limited to, a provider of health care coordinating
7health care with a third party, consultation between providers of
8health care and medical treatment relating to a minor, or a provider
9of health care referring a minor for health care services to another
10provider of health care.

11(c) For purposes of this section, a county social worker, a
12probation officer, foster care public health nurse, or any other
13person who is legally authorized to have custody or care of a minor
14shall be considered a third party who may receive any of the
15following:

16(1) Medical information described in Sections 56.05 and 56.10.

17(2) Protected health information described in Section 160.103
18of Title 45 of the Code of Federal Regulations.

19(d) Medical information disclosed to a county social worker,
20probation officer, foster care public health nurse, or any other
21person who is legally authorized to have custody or care of a minor
22shall not be further disclosed by the recipient unless the disclosure
23is for the purpose of coordinating health care services and medical
24treatment of the minor and the disclosure is authorized by law.
25Medical information disclosed pursuant to this section may not be
26admitted into evidence in any criminal or delinquency proceeding
27against the minor. Nothing in this subdivision shall prohibit
28identical evidence from being admissible in a criminal proceeding
29if that evidence is derived solely from lawful means other than
30this section and is permitted by law.

31(e) (1) Notwithstanding Section 56.104, if a provider of health
32care determines that the disclosure of medical information
33concerning the diagnosis and treatment of a mental health condition
34of a minor is reasonably necessary for the purpose of assisting in
35coordinating the treatment and care of the minor, that information
36may be disclosed to a county social worker, probation officer,
37foster care public health nurse, or any other person who is legally
38authorized to have custody or care of the minor. The information
39shall not be further disclosed by the recipient unless the disclosure
P4    1is for the purpose of coordinating mental health services and
2treatment of the minor and the disclosure is authorized by law.

3(2) As used in this subdivision, “medical information” does not
4include psychotherapy notes as defined in Section 164.501 of Title
545 of the Code of Federal Regulations.

6(f) The disclosure of information pursuant to this section is not
7intended to limit the disclosure of information when that disclosure
8is otherwise required by law.

9(g) For purposes of this section, “minor” means a minor taken
10into temporary custody or as to whom a petition has been filed
11with the court, or who has been adjudged to be a dependent child
12or ward of the juvenile court pursuant to Section 300 or 601 of the
13Welfare and Institutions Code.

14(h) (1) Except as described in paragraph (1) of subdivision (e),
15nothing in this section shall be construed to limit or otherwise
16affect existing privacy protections provided for in state or federal
17law.

18(2) Nothing in this section shall be construed to expand the
19authority of a social worker, probation officer, foster care public
20health nurse, or custodial caregiver beyond the authority provided
21under existing law to a parent or a patient representative regarding
22access to medical information.

23

SEC. 2.  

Section 5328.04 of the Welfare and Institutions Code
24 is amended to read:

25

5328.04.  

(a) Notwithstanding Section 5328, information and
26records made confidential under that section may be disclosed to
27a county social worker, a probation officer, a foster care public
28health nurse acting pursuant to Section 16501.3, or any other person
29who is legally authorized to have custody or care of a minor, for
30the purpose of coordinating health care services and medical
31treatment, as defined in subdivision (b) of Section 56.103 of the
32Civil Code, mental health services, or services for developmental
33 disabilities, for the minor.

34(b) Information disclosed under subdivision (a) shall not be
35further disclosed by the recipient unless the disclosure is for the
36purpose of coordinating health care services and medical treatment,
37or mental health or developmental disability services, for the minor
38and only to a person who would otherwise be able to obtain the
39information under subdivision (a) or any other law.

P5    1(c) Information disclosed pursuant to this section shall not be
2admitted into evidence in any criminal or delinquency proceeding
3against the minor. Nothing in this subdivision shall prohibit
4identical evidence from being admissible in a criminal proceeding
5if that evidence is derived solely from lawful means other than
6this section and is permitted by law.

7(d) Nothing in this section shall be construed to compel a
8physician and surgeon, licensed psychologist, social worker with
9a master’s degree in social work, licensed marriage and family
10therapist, licensed professional clinical counselor, nurse, attorney,
11or other professional person to reveal information, including notes,
12that has been given to him or her in confidence by the minor or
13members of the minor’s family.

14(e) The disclosure of information pursuant to this section is not
15intended to limit disclosure of information when that disclosure
16is otherwise required by law.

17(f) Nothing in this section shall be construed to expand the
18authority of a social worker, probation officer, foster care public
19health nurse, or custodial caregiver beyond the authority provided
20under existing law to a parent or a patient representative regarding
21access to confidential information.

22(g) As used in this section, “minor” means a minor taken into
23temporary custody or for whom a petition has been filed with the
24court, or who has been adjudged a dependent child or ward of
25juvenile court pursuant to Section 300 or 601.

26(h) Information and records that may be disclosed pursuant to
27this section do not include psychotherapy notes, as defined in
28Section 164.501 of Title 45 of the Code of Federal Regulations.

29

SEC. 3.  

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

31

16501.3.  

(a) The State Department of Social Services shall
32establish and maintain a program of public health nursing in the
33child welfare services program that meets the federal requirements
34for the provision of health care to minor and nonminor dependents
35in foster care consistent with Section 30026.5 of the Government
36Code. The purpose of the public health nursing program shall be
37to promote and enhance the physical, mental, dental, and
38developmental well-being of children in the child welfare system.

39(b) Under this program, counties shallbegin delete provideend deletebegin insert useend insert the services
40of a foster care public health nurse. The foster care public health
P6    1nurse begin delete and the child’s social worker shall consult, collaborate, and
2share information in a timely manner to ensure that the child’s
3physical, mental, dental, and developmental needs are met. The
4foster care public health nurse shallend delete
begin insert shall work with the appropriate
5child welfare services workers to coordinate health care services
6andend insert
serve as a liaison with health care professionals and other
7providers of health-related services.begin insert This shall include coordination
8with county mental health plans and local health jurisdictions, as
9appropriate.end insert
In order to fulfill these duties, the foster care public
10health nurse shall have access to the child’s medical, dental, and
11mental health carebegin delete information.end deletebegin insert information, in a manner that is
12consistent with all relevant privacy requirements.end insert

13(c) The duties of a foster care public health nurse shall include,
14but need not be limited to, the following:

15(1) Documenting that each child in foster care receives initial
16and followup health screenings that meet reasonable standards of
17medical practice.

18(2) Collecting health information and other relevant data on
19each foster child as available, receiving all collected information
20to determine appropriate referral and services, and expediting
21referrals to providers in the community for early intervention
22services, specialty services, dental care, mental health services,
23and other health-related services necessary for the child.

24(3) Participating in medical care planning and coordinating for
25the child. This may include, but is not limited to, assisting case
26workers in arranging for comprehensive health and mental health
27assessments, interpreting the results of health assessments or
28evaluations for the purpose of case planning and coordination,
29facilitating the acquisition of any necessary court authorizations
30for procedures or medications,begin insert monitoring and oversight of
31psychotropic medications,end insert
advocating for the health care needs of
32thebegin delete childend deletebegin insert child,end insert and ensuring the creation of linkage among various
33providers of care.

34(4) Providing followup contact to assess the child’s progress in
35meeting treatment goals.

36(5) At the request of and under the direction of a nonminor
37dependent, as described in subdivision (v) of Section 11400,
38 assisting the nonminor dependent in accessing physical health and
39mental health care, coordinating the delivery of health and mental
40health care services, advocating for the health and mental health
P7    1care that meets the needs of the nonminor dependent, assisting the
2nonminor dependent to make informed decisions about his or her
3health care by, at a minimum, providing educational materials,
4 and assisting the nonminor dependent to assume responsibility for
5his or her ongoing physical and mental health care management.

begin delete

6(6) Monitoring, in collaboration with the child’s county social
7worker and mental health worker, each child in foster care who is
8administered one or more psychotropic medications. This
9monitoring shall include, but is not limited to, all of the following:

10(A) Reviewing each request for psychotropic medication filed
11pursuant to Section 369.5 to verify that all required information
12is provided in the application to the court.

13(B) Reviewing, monitoring, engaging, and documenting in the
14child’s health and education passport, as described in Section
1516010, that laboratory tests, other screenings and measurements,
16evaluations, and assessments required to meet reasonable standards
17of medical practice have been completed.

18(C) Reviewing, monitoring, and confirming that the juvenile
19court has authorized the psychotropic medication to be
20administered to the child.

21(D) Reviewing, monitoring, engaging with the caregiver, and
22confirming through submitted medical reports received from the
23prescribing physician that periodic followup visits, laboratory
24work, and other measurements are scheduled and completed.

25(E) Documenting in the child’s health and education passport
26accurate documentation concerning the psychotropic medications
27authorized for and administered to the child.

28(F) Reviewing and documenting the response of the child to the
29administration of psychotropic medication through review and
30interpretation of the laboratory tests, screenings, and reports
31containing information from the child and received from the
32 caregiver or social worker, and, if necessary, interpreting, for the
33child’s social worker, health information to be included in court
34reports.

end delete

35(d) The services provided by foster care public health nurses
36under this section shall be limited to those for which reimbursement
37may be claimed under Title XIX of the federal Social Security Act
38 at an enhanced rate for services delivered by skilled professional
39medical personnel. Notwithstanding any other law, this section
40shall be implemented only if, and to the extent that, the department
P8    1determines that federal financial participation, as provided under
2Title XIX of the federal Social Security Act (42 U.S.C. Sec. 1396
3et seq.), is available.

4(e) (1) The State Department of Health Care Services shall seek
5any necessary federal approvals for child welfare agencies to
6appropriately claim enhanced federal Title XIX funds for services
7provided pursuant to this section.

8(2) Commencing in the fiscal year immediately following the
9fiscal year in which the necessary federal approval pursuant to
10paragraph (1) is secured, county child welfare agencies shall
11provide health care oversight and coordination services pursuant
12to this section, and may accomplish this through agreements with
13local public health agencies.

14(f) (1) Notwithstanding Section 10101, prior to the 2011-12
15fiscal year, there shall be no required county match of the
16nonfederal cost of this program.

17(2) Commencing in the 2011-12 fiscal year, and each fiscal
18year thereafter, funding and expenditures for programs and
19activities under this section shall be in accordance with the
20requirements provided in Sections 30025 and 30026.5 of the
21Government Code.

22

SEC. 4.  

To the extent that this act has an overall effect of
23increasing the costs already borne by a local agency for programs
24or levels of service mandated by the 2011 Realignment Legislation
25within the meaning of Section 36 of Article XIII of the California
26Constitution, it shall apply to local agencies only to the extent that
27the state provides annual funding for the cost increase. Any new
28program or higher level of service provided by a local agency
29pursuant to this act above the level for which funding has been
30provided shall not require a subvention of funds by the state nor
31otherwise be subject to Section 6 of Article XIII B of the California
32Constitution.



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