Amended in Assembly September 3, 2015

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 Members Gatto, Gipson, and Lopez)

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 would 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. By imposing this additional duty 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.

begin insert

This bill would incorporate changes to Section 16501.3 of the Welfare and Institutions Code proposed by both this bill and SB 238, which would become operative only if both bills are enacted and become effective on or before January 1, 2016, and this bill is chaptered last.

end 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.

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
P3    1to the minor, including, but not limited to, the sharing of
2information related to screenings, assessments, and laboratory tests
3necessary to monitor the administration of psychotropic
4medications.

5(b) For purposes of this section, health care services and medical
6treatment includes one or more providers of health care providing,
7coordinating, or managing health care and related services,
8including, but not limited to, a provider of health care coordinating
9health care with a third party, consultation between providers of
10health care and medical treatment relating to a minor, or a provider
11of health care referring a minor for health care services to another
12provider of health care.

13(c) For purposes of this section, a county social worker, a
14probation officer, foster care public health nurse, or any other
15person who is legally authorized to have custody or care of a minor
16shall be considered a third party who may receive any of the
17following:

18(1) Medical information described in Sections 56.05 and 56.10.

19(2) Protected health information described in Section 160.103
20of Title 45 of the Code of Federal Regulations.

21(d) Medical information disclosed to a county social worker,
22probation officer, foster care public health nurse, or any other
23person who is legally authorized to have custody or care of a minor
24shall not be further disclosed by the recipient unless the disclosure
25is for the purpose of coordinating health care services and medical
26treatment of the minor and the disclosure is authorized by law.
27Medical information disclosed pursuant to this section may not be
28admitted into evidence in any criminal or delinquency proceeding
29against the minor. Nothing in this subdivision shall prohibit
30identical evidence from being admissible in a criminal proceeding
31if that evidence is derived solely from lawful means other than
32this section and is permitted by law.

33(e) (1) Notwithstanding Section 56.104, if a provider of health
34care determines that the disclosure of medical information
35concerning the diagnosis and treatment of a mental health condition
36of a minor is reasonably necessary for the purpose of assisting in
37coordinating the treatment and care of the minor, that information
38may be disclosed to a county social worker, probation officer,
39foster care public health nurse, or any other person who is legally
40authorized to have custody or care of the minor. The information
P4    1shall not be further disclosed by the recipient unless the disclosure
2is for the purpose of coordinating mental health services and
3treatment of the minor and the disclosure is authorized by law.

4(2) As used in this subdivision, “medical information” does not
5include psychotherapy notes as defined in Section 164.501 of Title
645 of the Code of Federal Regulations.

7(f) The disclosure of information pursuant to this section is not
8intended to limit the disclosure of information when that disclosure
9is otherwise required by law.

10(g) For purposes of this section, “minor” means a minor taken
11into temporary custody or as to whom a petition has been filed
12with the court, or who has been adjudged to be a dependent child
13or ward of the juvenile court pursuant to Section 300 or 601 of the
14Welfare and Institutions Code.

15(h) (1) Except as described in paragraph (1) of subdivision (e),
16nothing in this section shall be construed to limit or otherwise
17affect existing privacy protections provided for in state or federal
18law.

19(2) Nothing in this section shall be construed to expand the
20authority of a social worker, probation officer, foster care public
21health nurse, or custodial caregiver beyond the authority provided
22under existing law to a parent or a patient representative regarding
23access to medical information.

24

SEC. 2.  

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

26

5328.04.  

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

35(b) Information disclosed under subdivision (a) shall not be
36further disclosed by the recipient unless the disclosure is for the
37purpose of coordinating health care services and medical treatment,
38or mental health or developmental disability services, for the minor
39and only to a person who would otherwise be able to obtain the
40information 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 shall use the services of a foster
40care public health nurse. The foster care public health nurse shall
P6    1work with the appropriate child welfare services workers to
2coordinate health care services and serve as a liaison with health
3care professionals and other providers of health-related services.
4This shall include coordination with county mental health plans
5and local health jurisdictions, as appropriate. In order to fulfill
6these duties, the foster care public health nurse shall have access
7to the child’s medical, dental, and mental health care information,
8in a manner that is consistent with all relevant privacy
9requirements.

10(c) The duties of a foster care public health nurse shall include,
11but need not be limited to, the following:

12(1) Documenting that each child in foster care receives initial
13and followup health screenings that meet reasonable standards of
14medical practice.

15(2) Collecting health information and other relevant data on
16each foster child as available, receiving all collected information
17to determine appropriate referral and services, and expediting
18referrals to providers in the community for early intervention
19services, specialty services, dental care, mental health services,
20and other health-related services necessary for the child.

21(3) Participating in medical care planning and coordinating for
22the child. This may include, but is not limited to, assisting case
23workers in arranging for comprehensive health and mental health
24assessments, interpreting the results of health assessments or
25evaluations for the purpose of case planning and coordination,
26facilitating the acquisition of any necessary court authorizations
27for procedures or medications, monitoring and oversight of
28psychotropic medications, advocating for the health care needs of
29the child, and ensuring the creation of linkage among various
30providers of care.

31(4) Providing followup contact to assess the child’s progress in
32meeting treatment goals.

33(5) At the request of and under the direction of a nonminor
34dependent, as described in subdivision (v) of Section 11400,
35 assisting the nonminor dependent in accessing physical health and
36mental health care, coordinating the delivery of health and mental
37health care services, advocating for the health and mental health
38care that meets the needs of the nonminor dependent, assisting the
39nonminor dependent to make informed decisions about his or her
40health care by, at a minimum, providing educational materials,
P7    1 and assisting the nonminor dependent to assume responsibility for
2his or her ongoing physical and mental health care management.

3(d) The services provided by foster care public health nurses
4under this section shall be limited to those for which reimbursement
5may be claimed under Title XIX of the federal Social Security Act
6 at an enhanced rate for services delivered by skilled professional
7medical personnel. Notwithstanding any other law, this section
8shall be implemented only if, and to the extent that, the department
9determines that federal financial participation, as provided under
10Title XIX of the federal Social Security Act (42 U.S.C. Sec. 1396
11et seq.), is available.

12(e) (1) The State Department of Health Care Services shall seek
13any necessary federal approvals for child welfare agencies to
14appropriately claim enhanced federal Title XIX funds for services
15provided pursuant to this section.

16(2) Commencing in the fiscal year immediately following the
17fiscal year in which the necessary federal approval pursuant to
18paragraph (1) is secured, county child welfare agencies shall
19provide health care oversight and coordination services pursuant
20to this section, and may accomplish this through agreements with
21local public health agencies.

22(f) (1) Notwithstanding Section 10101, prior to the 2011-12
23fiscal year, there shall be no required county match of the
24nonfederal cost of this program.

25(2) Commencing in the 2011-12 fiscal year, and each fiscal
26year thereafter, funding and expenditures for programs and
27activities under this section shall be in accordance with the
28requirements provided in Sections 30025 and 30026.5 of the
29Government Code.

30begin insert

begin insertSEC. 3.5.end insert  

end insert

begin insertSection 16501.3 of the end insertbegin insertWelfare and Institutions Codeend insert
31begin insert is amended to read:end insert

32

16501.3.  

(a) The State Department of Social Services shall
33establish and maintain a program of public health nursing in the
34child welfare services program that meets the federal requirements
35for the provision ofbegin delete healthcareend deletebegin insert health careend insert to minor and nonminor
36dependents in foster care consistent with Section 30026.5 of the
37Government Code. The purpose of the public health nursing
38program shall be tobegin delete identify, respond to,end deletebegin insert promoteend insert and enhance the
39physical, mental, dental, and developmental well-being of children
40in the child welfare system.

P8    1(b) Under this program, counties shall use the services of a foster
2care public health nurse. The foster care public health nurse shall
3work with the appropriate child welfare services workers to
4coordinate health care services and serve as a liaison with health
5care professionals and other providers of health-related services.
6This shall include coordination with county mental health plans
7and local health jurisdictions, as appropriate.begin insert In order to fulfill
8these duties, the foster care public health nurse shall have access
9to the child’s medical, dental, and mental health care information,
10in a manner that is consistent with all relevant privacy
11requirements.end insert

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

14(1) Documenting that each child in foster care receives initial
15and followup health screenings that meet reasonable standards of
16medical practice.

17(2) Collecting health information and other relevant data on
18each foster child as available, receiving all collected information
19to determine appropriate referral and services, and expediting
20referrals to providers in the community for early intervention
21services, specialty services, dental care, mental health services,
22and other health-related services necessary for the child.

23(3) Participating in medical care planning and coordinating for
24the child. This may include, but is not limited to, assisting case
25workers in arranging for comprehensive health and mental health
26assessments, interpreting the results of health assessments or
27evaluations for the purpose of case planning and coordination,
28facilitating the acquisition of any necessary court authorizations
29for procedures or medications,begin insert monitoring and oversight of
30psychotropic medications,end insert
advocating for the health care needs of
31thebegin delete childend deletebegin insert child,end insert and ensuring the creation of linkage among various
32providers of care.

33(4) Providing followup contact to assess the child’s progress in
34meeting treatment goals.

35(5) At the request of and under the direction of a nonminor
36dependent, as described in subdivision (v) of Section 11400,begin delete assistend delete
37begin insert assistingend insert the nonminor dependent in accessing physical health and
38 mental health care, coordinating the delivery of health and mental
39health care services, advocating for the health and mental health
40care that meets the needs of the nonminor dependent,begin delete and to assistend deletebegin insert end insert
P9    1begin insertassisting the nonminor dependent to make informed decisions
2about his or her health care by, at a minimum, providing
3educational materials, and assistingend insert
the nonminor dependent to
4assume responsibility for his or her ongoing physical and mental
5health care management.

6(d) The services provided by foster care public health nurses
7under this section shall be limited to those for which reimbursement
8may be claimed under Title XIXbegin insert of the federal Social Security Actend insert
9 at an enhanced rate for services delivered by skilled professional
10medical personnel. Notwithstanding any otherbegin delete provision ofend delete law,
11this section shall be implemented only if, and to the extent that,
12the department determines that federal financial participation, as
13provided under Title XIX of the federal Social Security Act (42
14U.S.C. Sec. 1396 et seq.), is available.

15(e) (1) The State Department of Health Care Services shall seek
16any necessary federal approvals for child welfare agencies to
17appropriately claim enhanced federal Title XIX funds for services
18provided pursuant to this section.

19(2) Commencing in the fiscal year immediately following the
20fiscal year in which the necessary federal approval pursuant to
21 paragraph (1) is secured, county child welfare agencies shall
22provide health care oversight and coordination services pursuant
23to this section, and may accomplish this through agreements with
24local public health agencies.

25(f) (1) Notwithstanding Section 10101, prior to the 2011-12
26fiscal year, there shall be no required county match of the
27nonfederal cost of this program.

28(2) Commencing in the 2011-12 fiscal year, and each fiscal
29year thereafter, funding and expenditures for programs and
30activities under this section shall be in accordance with the
31requirements provided in Sections 30025 and 30026.5 of the
32Government Code.

begin insert

33(g) Public health nurses shall receive training developed
34pursuant to subdivision (d) of Section 16501.4.

end insert
35begin insert

begin insertSEC. 4.end insert  

end insert
begin insert

Section 3.5 of this bill incorporates amendments to
36Section 16501.3 of the Welfare and Institutions Code proposed by
37both this bill and Senate Bill 238. It shall only become operative
38if (1) both bills are enacted and become effective on or before
39January 1, 2016, (2) each bill amends Section 16501.3 of the
40Welfare and Institutions Code, and (3) this bill is enacted after
P10   1Senate Bill 238, in which case Section 3 of this bill shall not
2become operative.

end insert
3

begin deleteSEC. 4.end delete
4begin insertSEC. 5.end insert  

To the extent that this act has an overall effect of
5increasing the costs already borne by a local agency for programs
6or levels of service mandated by the 2011 Realignment Legislation
7within the meaning of Section 36 of Article XIII of the California
8Constitution, it shall apply to local agencies only to the extent that
9the state provides annual funding for the cost increase. Any new
10program or higher level of service provided by a local agency
11pursuant to this act above the level for which funding has been
12provided shall not require a subvention of funds by the state nor
13otherwise be subject to Section 6 of Article XIII B of the California
14Constitution.



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