BILL ANALYSIS Ó
SENATE COMMITTEE ON APPROPRIATIONS
Senator Ricardo Lara, Chair
2015 - 2016 Regular Session
SB 319 (Beall) - Child welfare services: public health nursing
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|Version: March 26, 2015 |Policy Vote: HUMAN S. 5 - 0, |
| | HEALTH 9 - 0 |
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|Urgency: No |Mandate: Yes |
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|Hearing Date: May 28, 2015 |Consultant: Brendan McCarthy |
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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
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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
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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
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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.
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