BILL NUMBER: SB 484 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY JULY 8, 2015
AMENDED IN SENATE JUNE 2, 2015
AMENDED IN SENATE APRIL 22, 2015
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 Sections 1538.8 and
1538.9 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 compile
specified information regarding administering
the administration of psychotropic medications to children in
those facilities and to post that information to the department's
Internet Web site. The bill would require the department to establish
a methodology to identify those group homes that have
disproportionately high and inappropriate levels of
psychotropic drug usage. usage, based on
specified criteria. The bill would also require the department,
for the facilities identified by the methodology that it
establishes, to visit those facilities at least once a year to
examine specified factors that contribute to the high
utilization of psychotropic medications. factors.
The bill would require a facility that is found to have
a high utilization of dangerous psychotropic medication
regimens and disproportionately high and inappropriate
levels of psychotropic drug usage, which may be caused by
inadequate alternative, alternative and
less invasive psychosocial, psychosocial
services, crisis management, and other services, to submit a
plan to address steps the facility shall take to reduce inappropriate
prescribing and treatment regimens within 60
30 days of the visit. receiving notice
of the department's determination. 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 both 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.
(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.
(f) At least annually, the department shall post to its Internet
Web site a statewide summary progress
report with of the data that
excludes personally identifiable information of the information
gathered pursuant to Section 1538.8.
Sections 1538. 8 and 1538.9. The summary report shall
exclude all personally identifiable information and shall not
identify individual group homes.
SEC. 2. Section 1538.8 is added to the Health and Safety Code, to
read:
1538.8. (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.
SEC. 3. Section 1538.9 is added to the Health and Safety Code, to
read:
1538.9. (a) (1) (A) The department, based upon the
information compiled pursuant to Section 1538.8,
department shall consult with the foster care ombudsman and
stakeholder quality improvement workgroups
the Quality Improvement Project Clinical Workgroup to establish
a methodology to identify for identifying
those group homes that have disproportionately high and
inappropriate levels of psychotropic drug usage warranting
additional review of the facility. facility.
The criteria for determining if a group home has disproportionately
high and inappropriate levels of psychotropic drug usage shall be
based upon the California Guidelines for the Use of
Psychotropic Medication with Children and Youth in Foster Care
and shall take into consideration, among other things, the factors
listed in paragraphs (1) to (13), inclusive, of subdivision (a) of
Section 1538.8. The methodology shall be adopted on or before July 1,
2016.
(B) On or after January 1, 2020, Every
three years after adopting the methodology developed under
subparagraph (A), or earlier if needed, the department shall
consult with the foster care ombudsman and stakeholder
quality improvement workgroups and the Quality
Improvement Project Clinical Workgroup and revise, if
necessary, revise the methodology
developed under subparagraph (A). methodology.
(2) If the department, applying the methodology described in
paragraph (1), determines that a facility appears to have
disproportionately high and inappropriate levels of psychotropic drug
usage, which may be caused by, among other things, inadequate
alternative and less invasive psychosocial services, crisis
management, and other services, it shall inspect the facility at
least once a year.
(2) The department shall visit facilities identified in paragraph
(1) at least once a year to review the facilities' plans 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.
(3) The inspection of the facility shall include, but not be
limited to, the following:
(A) A review of the facility's:
(i) Plan of operation, policies, procedures, and practices.
(ii) Child-to-staff ratios.
(iii) Staff qualifications and training.
(iv) Implementation of children's needs and services plan.
(v) Availability of psychosocial and other alternative treatments
to the use of psychotropic medications.
(vi) Other factors that the department determines contribute to
disproportionately high and inappropriate levels of psychotropic drug
usage.
(B) Confidential interviews with youth residing in the facility at
the time of the inspection, with youth who resided in the facility
within the last six months, 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 prescribers.
(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.
(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.
(b) If, during a visit as a result of an
inspection pursuant to subdivision (a), the department
finds finds, based on measures established pursuant
to this section, that the facility has a high
utilization of dangerous psychotropic medication regimens, based on
measures established pursuant to this section and
disproportionately high and inappropriate levels of psychotropic drug
usage, which may be caused by, among other things, inadequate
alternative, alternative and less
invasive psychosocial, psychosocial services,
crisis management, and other services, the facility shall
submit to the department a plan to address of
correction describing the steps that the facility
it shall take to reduce or eliminate
inappropriate prescribing and treatment regimens within 60
days of the visit. psychotropic drug usage. The plan
of correction shall be submitted to the department within 30 days
after the facility has received the department's notice of a
determination of disproportionately high and inappropriate levels of
psychotropic drug usage at the facility. The plan
shall do the following: of correction may include, but
not be limited to, the following:
(1) Include an An improved crisis
management plan, including deescalation techniques and procedures in
which their staff will be trained.
(2) Include an An overall behavioral
management plan which shall be a trauma-informed plan.
(3) Identify a 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.
(4) Identify a A
quantifiable goal of for improving
appropriate metabolic monitoring as set forth in the state
prescribing guidelines California Guidelines for the Use of
Psychotropic Medication with Children and Youth in Foster Care
, and increasing psychosocial, physical, mental,
behavioral, and nutritional services for children previously
or currently prescribed psychotropic medications while
placed in that facility.
(c) The department shall monitor a facility's implementation of
the plan submitted pursuant to subdivision (b) to determine all of
the following:
(1) Whether the facility has reduced the rate at which residents
are administered pro re nata, multiple, and off-label 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 residents, and, if so, the
percentage increase in the provision of those services.
(3) Whether and to what extent appropriate metabolic monitoring is
being conducted and, if so, the percentage increase in the provision
of appropriate monitoring.
(d) (1) 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.
(2) If, as a result of the inspection, the Community Care
Licensing Division suspects that a prescriber has failed to comply
with Section 2242 of the Business and Professions Code, or with the
California Guidelines for the Use of Psychotropic Medication with
Children and Youth in Foster Care, it shall report its concerns to
the Medical Board of California.
(3) If, as a result of the inspection, the Community Care
Licensing Division suspects there has been a violation of applicable
requirements prescribed by statutes or regulations of this state, it
shall conduct the appropriate investigation pursuant to Section 1538
of the Health and Safety Code.
(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.
(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.
(f) Nothing in this section is intended to replace or alter other
requirements for responding to complaints and making inspections or
visits to group homes, including, but not limited to, those set forth
in Sections 1534 and 1538.
SEC. 4. 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 Association of California,
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 Association of California, 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 Association of California, 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.
SEC. 5. 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.