BILL NUMBER: SB 484 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY AUGUST 28, 2015
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 Sections 1507.6
and 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.
Under existing law, a child in a group home may receive mental
health services, as deemed necessary by the placing agency and under
the case management of that agency. Under existing law, only a
juvenile court judicial officer may make orders regarding the
administration of psychotropic medications to a child adjudged a
dependent or ward of the court and removed from the physical custody
of the parent. Existing law requires that the order be based on a
request from a physician, indicating the reasons for the request and
a description of the child's diagnosis and behavior, among other
requirements.
This bill would provide that psychotropic medications may be used
at a group home, other than at a runaway and homeless youth shelter,
only in accordance with the written directions of the physician
prescribing the medication and as authorized by the juvenile court.
The bill would require the group home to maintain in the child's
records specified information regarding the administration of those
medications.
(2) Existing law requires the
department director, Director of Social Services,
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 the administration of
psychotropic medications to children in those facilities
group homes and to post that information
to on the department's Internet Web
site. The bill would require the department
department, in consultation with the State Department of Health Care
Services and stakeholders, to establish a methodology to
identify those group homes that have disproportionately high
and inappropriate levels of psychotropic drug
usage, based on specified criteria. utilization
warranting additional review, as specified. 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. The bill would require a
facility that is found to have disproportionately high and
inappropriate levels of psychotropic drug usage, which may be caused
by inadequate alternative and less invasive psychosocial services,
crisis management, and other services, facility, for
which the department, based on that inspection, finds a risk to the
health, safety, or personal rights of clients in care, to
submit a plan of correction to address steps the
facility shall take to reduce inappropriate prescribing and treatment
regimens the department within 30 days of
receiving notice of the department's determination.
findings. The bill would require the department
to monitor the facility's implementation of that plan of
correction and make a report, as provided.
to determine that the concerns identified during the inspection
have been addressed. Because this bill would create a
new crime, the failure of the facility to
comply with these provisions would be a misdemeanor, the bill
would impose a state-mandated local program.
(2)
(3) 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 alternative
programs and services to reduce utilization of
psychotropic medications for children in group homes. The bill would
also delete an obsolete provision. services, as
specified.
(3)
(4) 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 1507.6 of the Health
and Safety Code is amended to read:
1507.6. (a) Mental health services, as
deemed necessary by the placing agency, may be provided to children
in a group home. Except for the physical safety and direct care and
supervision of children so placed, the State Department of Social
Services and its agents shall not evaluate or have responsibility or
liability for the evaluation of mental health services provided in
those homes. Supervision of mental health treatment services provided
to a child in a group home shall be a case management responsibility
of the placing agency.
(b) (1) Psychotropic medications shall be used only in accordance
with the written directions of the physician prescribing the
medication and as authorized by the juvenile court pursuant to
Section 369.5 or 739.5 of the Welfare and Institutions Code.
(2) The facility shall maintain in a child's records all of the
following information:
(A) A copy of any court order authorizing the psychotropic
medication for the child.
(B) A separate log for each psychotropic medication prescribed for
the child, showing all of the following:
(i) The name of the medication.
(ii) The date of the prescription.
(iii) The quantity of medication and number of refills initially
prescribed.
(iv) When applicable, any additional refills prescribed.
(v) The required dosage and directions for use as specified in
writing by the physician prescribing the medication, including any
changes directed by the physician.
(vi) The date and time of each dose taken by the child.
(3) This subdivision does not apply to a runaway and homeless
youth shelter, as defined in Section 1502.
SECTION 1. SEC. 2. Section 1536 of
the Health and Safety Code is amended to read:
1536. (a) (1) At least annually, the director
department 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
on its Internet Web site a statewide summary
report of the data
information gathered pursuant to Sections 1538.8 and 1538.9.
The summary report shall exclude all
personally identifiable information and shall not identify individual
group homes. include only de-identified and aggregate
information that does not violate the confidentiality of a child's
identity and records.
SEC. 2. SEC. 3. Section 1538.8 is
added to the Health and Safety Code, to read:
1538.8. (a) (1) In order to
identify group homes in which review and evaluate the
use of psychotropic medications may be inappropriately
administered to children the director in group homes,
the department shall compile, to the extent feasible and
not otherwise prohibited by law and based on information received
from the State Department of Health Care Services, at least
annually, the following information concerning
each home: group home, including, but not
limited to, the child welfare psychotropic medication measures
developed by the department and the following Healthcare
Effectiveness Data and Information Set (HEDIS) measures related to
psychotropic medications:
(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.
(A) Follow-Up Care for Children Prescribed Attention Deficit
Hyperactivity Disorder Medication (HEDIS ADD), which measures the
number of children six to 12 years of age, inclusive, who have a
visit with a provider with prescribing authority within 30 days of
the new prescription.
(B) Use of Multiple Concurrent Antipsychotics in Children and
Adolescents (HEDIS APC), which does both of the following:
(i) Measures the number of children receiving an antipsychotic
medication for at least 60 out of 90 days and the number of children
who additionally receive a second antipsychotic medication that
overlaps with the first.
(ii) Reports a total rate and age stratifications including 6 to
11 years of age, inclusive, and 12 to 17 years of age, inclusive.
(C) Use of First-Line Psychosocial Care for Children and
Adolescents on Antipsychotics (HEDIS APP), which measures whether a
child has received psychosocial services 90 days before through 30
days after receiving a new prescription for an antipsychotic
medication.
(D) Metabolic Monitoring for Children and Adolescents on
Antipsychotics (HEDIS APM), which does both of the following:
(i) Measures testing for glucose or HbA1c and lipid or cholesterol
of a child who has received at least two different antipsychotic
prescriptions on different days.
(ii) Reports a total rate and age stratifications including 6 to
11 years of age, inclusive, and 12 to 17 years of age, inclusive.
(2) The department shall post the list of data to be collected
pursuant to this subdivision on the department's Internet Web site.
(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 maintained by
the State Department of Health Care Services and the State
Department of Social Services. Services and
shared pursuant to a data sharing agreement meeting the requirements
of all applicable state and federal laws and regulations.
(c) This section does not apply to a runaway and homeless youth
shelter, as defined in Section 1502.
SEC. 3. SEC. 4. Section 1538.9 is
added to the Health and Safety Code, to read:
1538.9. (a) (1) (A) The department shall consult with the
foster care ombudsman State Department of
Health Care Services and the Quality Improvement
Project Clinical Workgroup stakeholders to
establish a methodology for identifying those group homes
providing services under the AFDC-FC program pursuant to Sections
11460 and 11462 of the Welfare and Institutions Code that have
disproportionately high and inappropriate levels
of psychotropic drug usage utilization
warranting additional review of the 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. review. The methodology shall be adopted
on or before July 1, 2016.
(B) 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 the Quality
Improvement Project Clinical Workgroup State Department
of Health Care Services and stakeholders and revise the
methodology. methodology, if necessary.
(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,
utilization warranting additional review, it shall inspect the
facility at least once a year.
(3) The inspection of the facility shall include, but not be
limited to, a review of the following:
(A) A review of the facility's:
(i)
(A) Plan of operation, policies, procedures, and
practices.
(ii)
(B) Child-to-staff ratios.
(iii)
(C) Staff qualifications and training.
(iv)
(D) Implementation of children's needs and services
plan.
(v)
(E) Availability of psychosocial and other alternative
treatments to the use of psychotropic medications.
(vi)
(F) Other factors that the department determines
contribute to disproportionately high and inappropriate
levels of psychotropic drug usage.
utilization that warrant additional review.
(B)
(G) Confidential interviews with youth
of children 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. inspection.
(b) If, as a result of an inspection pursuant to subdivision (a),
the department finds, based on measures established pursuant to this
section, that the facility has 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, the
facility shall submit to the department a plan of correction
describing the steps it shall take to reduce or eliminate
inappropriate 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 of correction may include, but not
be limited to, the following:
(1) An improved crisis management plan, including deescalation
techniques and procedures in which their staff will be trained.
(2) An overall behavioral management plan which shall be a
trauma-informed plan.
(3) 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) A quantifiable goal for improving appropriate metabolic
monitoring as set forth in the 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 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.
(4) The inspection of the facility may include, but is not limited
to, the following:
(A) Confidential interviews of children who resided in the
facility within the last six months.
(B) Confidential discussions with physicians identified as
prescribing the medications.
(b) Based upon an inspection conducted pursuant to subdivision
(a), the department shall share relevant information or observations
with county placing agencies, social workers, probation officers, the
court, dependency counsel, or the Medical Board of California. If,
as a result of the inspection conducted pursuant to subdivision (a),
the department finds a risk to the health, safety, or personal rights
of clients in care, the facility shall submit a plan of correction
to the department. The plan of correction shall be submitted to the
department within 30 days after the facility has received the
department's notice of findings. The department shall monitor the
implementation of the plan of correction to determine that the
concerns identified during the inspection have been addressed. This
subdivision does not prevent the department from taking any other
corrective action as permitted under any other law or any regulation
adopted pursuant to this chapter.
(e)
(c) (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.
instructions.
(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)
(d) 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.
(e) This section does not apply to a runaway and homeless youth
shelter, as defined in Section 1502.
SEC. 4. SEC. 5. Section 11469 of the
Welfare and Institutions Code is amended to read:
11469. (a) The department, in department
shall develop, following 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 County
Behavioral Health Directors Association of California, the
State Department of Health Care Services, shall develop
and stakeholders, 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
department shall develop, following consultation
with the County Welfare Directors Association of California, the
Chief Probation Officers of California, the California
Mental Health Directors Association, County Behavioral
Health Directors Association of California, research entities,
foster youth, children, advocates for
foster youth, children, 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
department shall develop, following consultation
with the County Welfare Directors Association of California, the
Chief Probation Officers of California, the California
Mental Health Directors Association, County Behavioral
Health Directors Association of California, the Medical Board of
California, research entities, foster youth,
children advocates for foster youth,
children, 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
alternative programs and services to reduce the
utilization of psychotropic medications for children in group homes,
services, including individualized behavior
management programs, emergency intervention plans, and conflict
resolution processes.
SEC. 5. SEC. 6. 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.