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 --