Amended in Senate April 22, 2015

Senate Bill No. 484

Introduced by Senator Beall

(Principal coauthor: Assembly Member Chiu)

(Coauthors: Senators Mitchell and Monning)

February 26, 2015

An act to amend Section 1536 of, and to add begin delete Section 1538.8 end delete begin insert Sections 1538.8 and 1538.9 end insert to, the Health and Safety Code, and to amend Section 11469 of the Welfare and Institutions Code, relating to juveniles.

LEGISLATIVE COUNSEL’S DIGEST

SB 484, as amended, Beall. Juveniles.

(1) The California Community Care Facilities Act provides for the licensure and regulation of community care facilities, including foster family homes and group homes, by the State Department of Social Services. A violation of this act is a misdemeanor.

Existing law requires the department director, at least annually, to publish and make available to interested persons a list covering all licensed community care facilities, except as specified, and the services for which each facility has been licensed or issued a special permit.

This bill would require the department director to begin delete include in that list end delete begin insert compile end insert specified information regarding administering psychotropic medications to children in those facilities begin insert and to post that information to the department’s Internet Web site end insert . begin insert The bill would require the department to establish a methodology to identify those group homes that have disproportionately high levels of psychotropic drug usage. end insert The bill would also require the department, begin delete if it determines based on that information that a facility is administering psychotropic medications to children at a rate exceeding the average authorization for all group homes, to inspect that facility end delete begin insert for the facilities identified by the methodology that it establishes, to visit those facilities end insert at least once a year to examine specified factors that contribute to the high utilization of psychotropic medications. The bill would require begin delete an inspected facility to submit to the department, within 60 days of that inspection, end delete begin insert a facility that is found to have a high utilization of dangerous psychotropic medication regimens and inadequate alternative, less invasive psychosocial, crisis management, and other services, to submit end insert a begin delete corrective action end delete plan begin delete including end delete begin insert to address end insert steps the facility shall take to reduce begin delete the utilization of psychotropic medications. end delete begin insert inappropriate prescribing and treatment regimens within 60 days of the visit. end insert The bill would require the department to monitor the facility’s implementation of that plan and make a report, as provided. Because this bill would create a new crime, the bill would impose a state-mandated local program.

(2) Existing law requires the department, on or before January 1, 2016, in consultation with specified associations and other stakeholders, to develop additional performance standards and outcome measures that require group homes to implement programs and services to minimize law enforcement contacts with minors in group homes or under supervision of group home staff.

This bill would require the department, on or before January 1, 2017, in consultation with specified associations and other stakeholders, to develop additional performance standards and outcome measures that require group homes to implement programs and services to reduce utilization of psychotropic medications for children in group homes. The bill would also delete an obsolete provision.

(3) 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:

SECTION 1.  

Section 1536 of the Health and Safety Code is
amended to read:

1536.  

(a) (1) At least annually, the director shall publish and
make available to interested persons a list or lists covering all
licensed community care facilities, other than foster family homes
and certified family homes of foster family agencies providing
24-hour care for six or fewer foster children, and the services for
which each facility has been licensed or issued a special permit.

(2) For a group home, transitional housing placement provider,
community treatment facility, or runaway and homeless youth
shelter, the list shall include begin delete all end delete begin insert both end insert of the following:

(A) The number of licensing complaints, types of complaint,
and outcomes of complaints, including citations, fines, exclusion
orders, license suspensions, revocations, and surrenders.

(B) The number, types, and outcomes of law enforcement
contacts made by the facility staff or children, as reported pursuant
to subdivision (a) of Section 1538.7.

begin delete

(C) The number of children administered psychotropic
medications in the facility, and all off the following information
pertaining to those children:

end delete begin delete

(1) The number of children for whom the juvenile court
preauthorized the administration of the psychotropic medication.

end delete begin delete

(2) The number of children administered psychotropic
medication on an emergency basis.

end delete begin delete

(3) The number of those children who are 6 to 11 years of age,
inclusive.

end delete begin delete

(4) The number of those children who are 12 to 17 years of age,
inclusive.

end delete begin delete

(5) The number of children administered an antipsychotic, mood
stabilizing, or antidepressant medication.

end delete begin delete

(6) The number of children administered two or more drugs
from the same class, including, but not limited to, antidepressants,
antipsychotics, antianxiety medications.

end delete begin delete

(7) The number of children administered two, three, four, or
more psychotropic medications concurrently.

end delete begin delete

(8) The number of children administered one or more
medications for longer than 90 days.

end delete begin delete

(9) The number of children terminated from the program due
to the child’s refusal to take psychotropic medication.

end delete

(b) Subject to subdivision (c), to encourage the recruitment of
foster family homes and certified family homes of foster family
agencies, protect their personal privacy, and to preserve the security
and confidentiality of the placements in the homes, the names,
addresses, and other identifying information of facilities licensed
as foster family homes and certified family homes of foster family
agencies providing 24-hour care for six or fewer children shall be
considered personal information for purposes of the Information
Practices Act of 1977 (Chapter 1 (commencing with Section 1798)
of Title 1.8 of Part 4 of Division 3 of the Civil Code). This
information shall not be disclosed by any state or local agency
pursuant to the California Public Records Act (Chapter 3.5
(commencing with Section 6250) of Division 7 of Title 1 of the
Government Code), except as necessary for administering the
licensing program, facilitating the placement of children in these
facilities, and providing names and addresses only to bona fide
professional foster parent organizations upon request.

(c) Notwithstanding subdivision (b), the department, a county,
or a foster family agency may request information from, or divulge
information to, the department, a county, or a foster family agency,
regarding a prospective certified parent, foster parent, or relative
caregiver for the purpose of, and as necessary to, conduct a
reference check to determine whether it is safe and appropriate to
license, certify, or approve an applicant to be a certified parent,
foster parent, or relative caregiver.

(d) The department may issue a citation and, after the issuance
of that citation, may assess a civil penalty of fifty dollars ($50) per
day for each instance of a foster family agency’s failure to provide
the department with the information required by subdivision (h)
of Section 88061 of Title 22 of the California Code of Regulations.

(e) The Legislature encourages the department, when funds are
available for this purpose, to develop a database that would include
all of the following information:

(1) Monthly reports by a foster family agency regarding family
homes.

(2) A log of family homes certified and decertified, provided
by a foster family agency to the department.

(3) Notification by a foster family agency to the department
informing the department of a foster family agency’s determination
to decertify a certified family home due to any of the following
actions by the certified family parent:

(A) Violating licensing rules and regulations.

(B) Aiding, abetting, or permitting the violation of licensing
rules and regulations.

(C) Conducting oneself in a way that is inimical to the health,
morals, welfare, or safety of a child placed in that certified family
home.

(D) Being convicted of a crime while a certified family parent.

(E) Knowingly allowing any child to have illegal drugs or
alcohol.

(F) Committing an act of child abuse or neglect or an act of
violence against another person.

begin insert

(f) At least annually, the department shall post to its Internet
Web site a summary progress report with data that excludes
personally identifiable information of the information gathered
pursuant to Section 1538.8.

end insert

begin insert

begin insert SEC. 2. end insert   

end insert

begin insert Section 1538.8 is added to the end insert begin insert Health and Safety Code end insert begin insert ,
to read: end insert

begin insert

begin insert 1538.8. end insert   

(a) In order to identify group homes in which
psychotropic medications may be inappropriately administered to
children the director shall compile, at least annually, the following
information concerning each home:

(1) The number of children in the facility to whom psychotropic
medications were administered.

(2) The number of children in the facility who are 6 to 11 years
of age, inclusive, to whom psychotropic medications were
administered.

(3) The number of children in the facility who are 12 to 17 years
of age, inclusive, to whom psychotropic medications were
administered.

(4) The number of children for whom the juvenile court
preauthorized the administration of psychotropic medication.

(5) The number of children to whom psychotropic medications
were administered on an emergency basis.

(6) The number of children to whom antipsychotic, mood
stabilizing, or antidepressant medications were administered.

(7) The number of children who received two or more drugs
from the same class, including, but not limited to, antidepressants,
antipsychotics, and antianxiety medications.

(8) The number of children who received two or more
psychotropic medications concurrently, and whether those children
received two, three, four, or more than four psychotropic
medications concurrently.

(9) The number of children who received one or more
medications for more than 90 days.

(10) The number of children who received psychosocial services
while in a group home placement while they received a
psychotropic medication.

(11) The number of children who received a dosage of a
psychotropic medication at a dosage above the maximum dosage
approved by the federal Food and Drug Administration.

(12) The number of children who received metabolic monitoring
in accordance with professional standards of care while they
received psychotropic medication.

(13) The number of children who were prescribed antipsychotic
medications for a use not approved by the federal Food and Drug
Administration.

(b) The data in subdivision (a) concerning psychotropic
medication, mental health services, and placement shall be drawn
from existing data systems, including, but not limited to, the
Medicaid Management Information System’s medical and
pharmacy claims data, and the Child Welfare Services/Case
Management System, through the data sharing agreement between
the State Department of Health Care Services and the State
Department of Social Services.

end insert

begin delete SEC. 2. end delete
begin insert SEC. 3. end insert   

Section begin delete 1538.8 end delete begin insert 1538.9 end insert is added to the Health and Safety
Code, to read:

begin delete

1538.8.  

(a) If the department, based upon the information
gathered pursuant to Section 1536, determines that the children
and adolescents in a facility are administered psychotropic
medications at a rate that exceeds the average authorization for all
group homes, the department shall inspect the facility at least once
a year to examine the policies, procedures, practices, child-to-staff
ratios, staff training, and other factors that the department
determines contribute to the high utilization of psychotropic
medications.

(b) A facility inspected pursuant to subdivision (a) shall submit
to the department a corrective action plan within 60 days of that
inspection. The plan shall address the steps that the facility shall
take to reduce the utilization of psychotropic medications among
residents.

end delete

begin insert

begin insert 1538.9. end insert   

end insert begin insert

(a) (1) The department, based upon the information
compiled pursuant to Section 1538.8, shall consult with the foster
care ombudsman and stakeholder quality improvement workgroups
to establish a methodology to identify those group homes that have
disproportionately high levels of psychotropic drug usage
warranting additional review of the facility.

end insert begin insert

(2) The department shall visit facilities identified in paragraph
(1) at least once a year to review the facilities plan of operation,
policies, procedures, practices, child-to-staff ratios, staff
qualifications and training, implementation of children’s needs
and services plan, and other factors that the department determines
contribute to the high utilization of dangerous psychotropic
medication regimens and low utilization of monitoring and
psychosocial services.

end insert begin insert

(3) The department shall perform visits pursuant to paragraph
(2) with input from stakeholders, including, but not limited to, the
foster care ombudsman and foster care mental health ombudsman,
foster youth, foster youth advocates, county welfare departments,
and county mental health departments.

end insert begin insert

(4) The department shall include in each visit confidential
discussions with current and former foster youth placed in the
facility’s care and confidential discussions with physicians
identified as prescribing the medications. The State Department
of Health Care Services and the State Department of Social
Services shall, using existing data systems, identify prescribers’
names, addresses, and contact information in order to facilitate
interviews with providers.

end insert begin insert

(b) If, during a visit pursuant to subdivision (a), the department
finds that the facility has a high utilization of dangerous
psychotropic medication regimens, based on measures established
pursuant to this section and inadequate alternative, less invasive
psychosocial, crisis management, and other services, the facility
shall submit to the department a plan to address the steps that the
facility shall take to reduce inappropriate prescribing and
treatment regimens within 60 days of the visit. The plan shall do
the following:

end insert begin insert

(1) Include an improved crisis management plan, including
deescalation techniques and procedures in which their staff will
be trained.

end insert begin insert

(2) Include an overall behavioral management plan which shall
be a trauma-informed plan.

end insert begin insert

(3) Identify a quantifiable goal to decrease the use of
antipsychotic medications for behavioral control, to decrease
polypharmacy, and to decrease the use of pro re nata medications.

end insert begin insert

(4) Identify a quantifiable goal of appropriate metabolic
monitoring as set forth in the state prescribing guidelines and
psychosocial, physical, mental, behavioral, and nutritional services
for children previously or currently prescribed psychotropic
medications while placed in that facility.

end insert

(c) The department shall monitor a facility’s implementation of
begin delete its corrective action end delete begin insert the end insert plan begin insert submitted pursuant to subdivision (b) end insert
to determine begin delete both end delete begin insert all end insert of the following:

(1) Whether the facility has reduced the rate at which residents
are administered begin insert pro re nata, multiple, and off-label end insert psychotropic
medications, and, if so, the percentage decrease in the
administration of those medications.

(2) Whether and to what extent alternative, less invasive
treatments are being provided to begin delete residents. end delete begin insert residents, and, if so,
the percentage increase in the provision of those services. end insert

begin insert

(3) Whether and to what extent appropriate metabolic
monitoring is being conducted and, if so, the percentage increase
in the provision of appropriate monitoring.

end insert

(d) Following an inspection pursuant to subdivision (a), the
Community Care Licensing Division shall provide a report to the
department’s Children and Family Services Division and to any
other public agency that has certified the facility’s program or any
component of the facility’s program, including, but not limited to,
the State Department of Health Care Services, which certifies
group homes pursuant to Section 4096.5 of the Welfare and
Institutions Code.

begin insert

(e) (1) Notwithstanding the rulemaking provisions of the
Administrative Procedure Act (Chapter 3.5 (commencing with
Section 11340) of Part 1 of Division 3 of Title 2 of the Government
Code), until emergency regulations are filed with the Secretary of
State, the department may implement this section through
all-county letters or similar instructions from the director.

end insert begin insert

(2) On or before January 1, 2017, the department shall adopt
regulations to implement this section. The initial adoption,
amendment, or repeal of a regulation authorized by this subdivision
is deemed to address an emergency, for purposes of Sections
11346.1 and 11349.6 of the Government Code, and the department
is hereby exempted for that purpose from the requirements of
subdivision (b) of Section 11346.1 of the Government Code. After
the initial adoption, amendment, or repeal of an emergency
regulation pursuant to this section, the department may twice
request approval from the Office of Administrative Law to readopt
the regulation as an emergency regulation pursuant to Section
11346.1 of the Government Code. The department shall adopt final
regulations on or before January 1, 2018.

end insert

begin delete SEC. 3. end delete
begin insert SEC. 4. end insert   

Section 11469 of the Welfare and Institutions Code is
amended to read:

11469.  

(a) The department, in consultation with group home
providers, the County Welfare Directors begin delete Association, end delete begin insert Association
of California, end insert the Chief Probation Officers of California, the
California Mental Health Directors Association, and the State
Department of Health Care Services, shall develop performance
standards and outcome measures for determining the effectiveness
of the care and supervision, as defined in subdivision (b) of Section
11460, provided by group homes under the AFDC-FC program
pursuant to Sections 11460 and 11462. These standards shall be
designed to measure group home program performance for the
client group that the group home program is designed to serve.

(1) The performance standards and outcome measures shall be
designed to measure the performance of group home programs in
areas over which the programs have some degree of influence, and
in other areas of measurable program performance that the
department can demonstrate are areas over which group home
programs have meaningful managerial or administrative influence.

(2) These standards and outcome measures shall include, but
are not limited to, the effectiveness of services provided by each
group home program, and the extent to which the services provided
by the group home assist in obtaining the child welfare case plan
objectives for the child.

(3) In addition, when the group home provider has identified
as part of its program for licensing, ratesetting, or county placement
purposes, or has included as a part of a child’s case plan by mutual
agreement between the group home and the placing agency,
specific mental health, education, medical, and other child-related
services, the performance standards and outcome measures may
also measure the effectiveness of those services.

(b) Regulations regarding the implementation of the group home
performance standards system required by this section shall be
adopted no later than one year prior to implementation. The
regulations shall specify both the performance standards system
and the manner by which the AFDC-FC rate of a group home
program shall be adjusted if performance standards are not met.

(c) Except as provided in subdivision (d), effective July 1, 1995,
group home performance standards shall be implemented. Any
group home program not meeting the performance standards shall
have its AFDC-FC rate, set pursuant to Section 11462, adjusted
according to the regulations required by this section.

(d) A group home program shall be classified at rate
classification level 13 or 14 only if all of the following are met:

(1) The program generates the requisite number of points for
rate classification level 13 or 14.

(2) The program only accepts children with special treatment
needs as determined through the assessment process pursuant to
paragraph (2) of subdivision (a) of Section 11462.01.

(3) The program meets the performance standards designed
pursuant to this section.

(e) Notwithstanding subdivision (c), the group home program
performance standards system shall not be implemented prior to
the implementation of the AFDC-FC performance standards
system.

(f) On or before January 1, 2016, the department, in consultation
with the County Welfare Directors begin delete Association, end delete begin insert Association of
California, end insert the Chief Probation Officers of California, the
California Mental Health Directors Association, research entities,
foster youth, advocates for foster youth, foster care provider
business entities organized and operated on a nonprofit basis,
Indian tribes, and other stakeholders, shall develop additional
performance standards and outcome measures that require group
homes to implement programs and services to minimize law
enforcement contacts and delinquency petition filings arising from
incidents of allegedly unlawful behavior by minors occurring in
group homes or under the supervision of group home staff,
including individualized behavior management programs,
emergency intervention plans, and conflict resolution processes.

(g) On or before January 1, 2017, the department, in consultation
with the County Welfare Directors begin delete Association, end delete begin insert Association of
California, end insert the Chief Probation Officers of California, the
California Mental Health Directors Association, research entities,
foster youth, advocates for foster youth, foster care provider
business entities organized and operated on a nonprofit basis,
Indian tribes, and other stakeholders, shall develop additional
performance standards and outcome measures that require group
homes to implement programs and services to reduce the utilization
of psychotropic medications for children in group homes, including
individualized behavior management programs, emergency
intervention plans, and conflict resolution processes.

begin delete SEC. 4. end delete
begin insert SEC. 5. end insert   

No reimbursement is required by this act pursuant to
Section 6 of Article XIII B of the California Constitution because
the only costs that may be incurred by a local agency or school
district will be incurred because this act creates a new crime or
infraction, eliminates a crime or infraction, or changes the penalty
for a crime or infraction, within the meaning of Section 17556 of
the Government Code, or changes the definition of a crime within
the meaning of Section 6 of Article XIII B of the California
Constitution.