BILL ANALYSIS Ó
SENATE COMMITTEE ON APPROPRIATIONS
Senator Ricardo Lara, Chair
2015 - 2016 Regular Session
SB 484 (Beall) - Juveniles
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|Version: April 22, 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 18, 2015 |Consultant: Brendan McCarthy |
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This bill meets the criteria for referral to the Suspense File.
Bill
Summary: SB 484 would require the Department of Social Services
to identify group homes in the foster care system that
inappropriately administer psychotropic medications to foster
youth. The bill would require the Department perform inspections
of identified group homes and require plans from those
facilities to reduce inappropriate use of psychotropic
medications.
Fiscal
Impact:
One-time costs of about $250,000 to compile information on
group homes, consult with stakeholders, and develop a
methodology to identify group homes for additional scrutiny
(Technical Assistance Fund).
SB 484 (Beall) Page 1 of
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Ongoing costs of $300,000 to $600,000 per year to conduct
annual site visits at group homes identified as having
disproportionately high levels of psychotropic medication use
by foster youth (Technical Assistance Fund). There are about
1,000 group homes in the state. The costs above assume that
the Department of Social Services identifies the top 10% to
20% of group homes for additional scrutiny.
Background: Under current law, the Department of Social Services licenses
and regulates community care facilities, including group homes
for foster youth. The licensing requirements include specific
requirements and standards for group homes that accept children
with special needs.
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.
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
treatment authorization request before Medi-Cal would authorize
psychotropic drugs for Medi-Cal beneficiaries under age six. In
SB 484 (Beall) Page 2 of
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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 484 would require the Department of Social Services to
identify group homes in the foster care system that
inappropriately administer psychotropic medications to foster
youth. The bill would require the Department to perform
inspections of identified group homes and require plans from
those facilities to reduce inappropriate use of psychotropic
medications.
Specific provisions of the bill would:
Require the Department to compile specified information for
group homes regarding the administration of psychotropic
drugs, by age of the foster youth, the types of medications
administered, the length of administration of psychotropic
drugs, the provision of other services to those foster youth,
and other information;
Require the Department to develop the information above
through existing data sources it has access to, including
information from the Department of Health Care Services;
Require the Department to consult with stakeholders and
develop a methodology to identify group homes with
disproportionately high use of psychotropic drugs;
Require at least annual visits to identified group homes to
review policies and practices and to have confidential
discussions with foster youth and prescribing physicians;
Require a group home to develop a plan to reduce inappropriate
prescribing of psychotropic medications, if the Department
finds high utilization and inadequate alternative services;
Require the Department to monitor the plans submitted by
identified group homes;
Require the Department to adopt implementing regulations, but
also authorize the Department to begin implementation before
regulations are adopted.
SB 484 (Beall) Page 3 of
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Related
Legislation:
SB 319 (Beall) would require counties to contract with local
Child Health and Disability Prevention programs to provide
foster care public health nursing services. The bill would
expand the duties required of foster care public health
nurses. 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: The only costs that may be incurred by a local agency
relate to crimes and infractions. Under the California
Constitution, such costs are not reimbursable by the state.
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