BILL ANALYSIS                                                                                                                                                                                                    Ó



          SENATE COMMITTEE ON APPROPRIATIONS
                             Senator Ricardo Lara, Chair
                            2015 - 2016  Regular  Session

          SB 319 (Beall) - Child welfare services:  public health nursing
          
           ----------------------------------------------------------------- 
          |                                                                 |
          |                                                                 |
          |                                                                 |
           ----------------------------------------------------------------- 
          |--------------------------------+--------------------------------|
          |                                |                                |
          |Version: March 26, 2015         |Policy Vote: HUMAN S. 5 - 0,    |
          |                                |          HEALTH 9 - 0          |
          |                                |                                |
          |--------------------------------+--------------------------------|
          |                                |                                |
          |Urgency: No                     |Mandate: Yes                    |
          |                                |                                |
          |--------------------------------+--------------------------------|
          |                                |                                |
          |Hearing Date: May 28, 2015      |Consultant: Brendan McCarthy    |
          |                                |                                |
           ----------------------------------------------------------------- 

          SUSPENSE FILE. AS AMENDED.



          


          Bill  
          Summary:  SB 319 would require counties to contract with the  
          local Child Health and Disability Prevention program to provide  
          foster care public health nursing services. The bill would  
          expand the duties required of foster care public health nurses.


          Fiscal Impact (as approved on May 28,  
          2015):  
           Annual costs of $4.5 million per year to provide additional  
            services to foster youth who are administered psychotropic  
            drugs (25% General Fund and 75% federal funds). The bill would  
            require additional PHN services for foster youth who are  
            administered psychotropic mediations. This analysis assumes  
            that counties would need additional public health nurses to  
            provide those additional services, at an average caseload of  







          SB 319 (Beall)                                         Page 1 of  
          ?
          
          
            1:200.


          Background:  Under current law, counties are required to provide foster  
          care public health nursing services, in order to promote the  
          health and wellbeing of foster youth. Services provided by  
          foster care public health nurses are limited to health-related  
          case management and may not include direct health care services.  
          Services provided by foster care public health nurses are  
          eligible for enhanced federal matching funds of 75%.
          Under current law, only a juvenile court judicial officer may  
          order the administration of psychotropic medications for a minor  
          who is a dependent of the court (i.e. a foster youth). Foster  
          youth are categorically eligible for Medi-Cal benefits and hence  
          Medi-Cal provides coverage for those psychotropic medications. 


          Psychotropic medications are intended to treat a variety of  
          mental health conditions. While many patients benefit from the  
          use of psychotropic medications, there are often serious side  
          effects, particularly when taken in combination. In general, the  
          use of psychotropic medications on children and adolescents is  
          "off label" meaning that those drugs have not been specifically  
          approved for use in children or adolescents. According to the  
          Department of Social Services, about 11% of foster youth under  
          age 17 are authorized to receive psychotropic medications.  
          Concerns have been raised by advocates for foster youth that  
          many foster youth are being prescribed these medications to  
          sedate them, rather than to appropriately address their mental  
          health and behavioral health needs.


          The Child Health and Disability Prevention program delivers  
          periodic health assessments and services to low income children  
          and youth.  The program provides care coordination to assist  
          with medical appointment scheduling, transportation, and access  
          to diagnostic and treatment services.  


          In response to concerns about the high rate of psychotropic  
          drugs administered to foster youth, the Department of Health  
          Care Services expanded its existing policy requiring treatment  
          authorization requests for psychotropic drugs for Medi-Cal  
          beneficiaries. Previously, the Department required a prior  








          SB 319 (Beall)                                         Page 2 of  
          ?
          
          
          treatment authorization request before Medi-Cal would authorize  
          psychotropic drugs for Medi-Cal beneficiaries under age six. In  
          October 2014, the Department expanded this requirement for  
          children and adolescents up to age 17. The treatment  
          authorization request process allows for emergency prescriptions  
          while the request is under review. In addition, in April 2015  
          the Department of Health Care Services and the Department of  
          Social Services released guidelines for the use of psychotropic  
          medications in foster youth.




          Proposed Law:  
            SB 319 would require counties to contract with the local Child  
          Health and Disability Prevention program to provide foster care  
          public health nursing services. The bill would expand the duties  
          required of foster care public health nurses.
          Specific provisions of the bill would:
           Add foster care public health nurses to the list of officials  
            who can receive and disclose medical information relating to a  
            foster youth;
           Require counties to provide the services of a foster care  
            public health nurse by contracting with the local Child Health  
            and Disability Prevention program. (Counties are currently  
            required to provide foster care public health nursing  
            services.);
           Require foster care public health nurses and social workers to  
            collaborate to ensure a foster youth's health needs are met;
           Require foster care public health nurses to provide  
            educational materials to nonminor foster youths, upon request;
           Expand the existing responsibilities of public health nurses,  
            to require monitoring of each child in foster care who is  
            administered psychotropic medications. Specified monitoring  
            responsibilities include reviewing requests for medication,  
            ensuring that tests and evaluations required to meet standards  
            of medical practice are complete, ensuring that the required  
            court approvals have been granted, assessing the response of  
            the foster youth to the medication, and ensuring that adverse  
            side effects of the medication are addressed.


          Related  
          Legislation:  








          SB 319 (Beall)                                         Page 3 of  
          ?
          
          
           SB 484 (Beall) would require the Department of Social Services  
            to compile information on group homes in the foster care  
            system that inappropriately administer psychotropic  
            medications, to inspect those group homes, and develop plans  
            for those group homes to reduce inappropriate administration  
            of psychotropic drugs. That bill will be heard in this  
            committee.
           SB 238 (Mitchell) would require additional training regarding  
            psychotropic drugs and mental health issues for a variety of  
            groups who have responsibility for foster youth. That bill is  
            on this committee's Suspense File.
           SB 253 (Monning) would modify the judicial requirements and  
            practices for authorizing psychotropic drugs for foster youth.  
            That bill will be heard in this committee.


          Staff  
          Comments:  Proposition 30, passed by the voters in November 2012, among  
          other provisions, eliminated any potential mandate funding  
          liability for any new program or higher level of service  
          provided by counties related to realigned programs. Although the  
          provisions of this bill are a mandate on local agencies, any  
          increased costs would not be subject to reimbursement by the  
          state. Rather, Proposition 30 specifies that for legislation  
          enacted after September 30, 2012, that has an overall effect of  
          increasing the costs already borne by a local agency for  
          realigned programs such as child welfare services, the  
          provisions shall apply to local agencies only to the extent that  
          the state provides annual funding for the cost increase. 

          Author's amendments (as adopted May 28, 2015): clarify the  
          expanded duties of public health nurses.

          Committee amendments (as adopted May 28, 2015): delete the  
          requirement that counties contract for public health nurses.


                                      -- END --