BILL ANALYSIS Ó
SB 484
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Date of Hearing: August 19, 2015
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Jimmy Gomez, Chair
SB 484
(Beall) - As Amended July 8, 2015
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Urgency: No State Mandated Local Program: YesReimbursable:
No
SUMMARY: This bill requires the Department of Social Services
(DSS) to collect data on the administration of psychotropic
medications to foster youth placed in group homes, and develop a
methodology to identify those group homes that have
disproportionately high and inappropriate levels of psychotropic
drug usage. The bill requires DSS to perform inspections of
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identified group homes and require plans from those facilities
to reduce inappropriate use of psychotropic medications.
Specifically, this bill:
1)Requires DSS 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;
2)Requires DSS to develop the information above through existing
data sources, including information from the Department of
Health Care Services (DHCS);
3)Requires DSS to consult with stakeholders and develop a
methodology to identify group homes with disproportionately
high and inappropriate levels of psychotropic drug usage;
4)Requires at least annual visits to identified group homes to
review policies and practices and to have confidential
discussions with foster youth and prescribing physicians;
5)Requires an identified group home to submit a plan of
correction to DSS, as specified, and requires DSS to monitor
these plans.
6)Requires DSS's Community Care Licensing Division (CCLD) to
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provide a report to specified entities following an inspection
and to report certain concerns to the Medical Board of
California and/or to conduct appropriate investigations;
7)Requires DSS to adopt implementing regulations, but also
authorizes DSS to begin implementation before regulations are
adopted.
FISCAL EFFECT:
1)Ongoing costs in the range of $300,000 to $600,000 (GF) per
year to DSS to conduct annual site visits at group homes
identified as having disproportionately high and inappropriate
levels of psychotropic medication use by foster youth. There
are about 1,000 group homes in the state. The costs above
assume that DSS identifies the top 10% to 20% of group homes
for additional scrutiny.
2)One-time costs of approximately $250,000 (GF) to DSS to
compile information on group homes, consult with stakeholders,
and develop a methodology to identify group homes for
additional scrutiny.
3)Ongoing costs of $130,000 ($65,000 GF) to DHCS to identify,
evaluate and collate claims data packages to be used for the
purposes of this bill.
COMMENTS:
1)Purpose. This is one of four bills proposing a set of reforms
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aimed at curbing excessive and inappropriate authorization and
administration of psychotropic medications among foster youth.
The National Center for Youth Law, states that, "This bill
addresses a longstanding crisis in many of the group homes in
which California foster children are living - the medication
of children and youth, often with powerful antipsychotic
drugs, to sedate and control behaviors that are natural
responses to grief, suffering, and trauma.
2)Background. Under current law, DSS 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 DSS, 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.
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In response to concerns regarding the high rate of
psychotropic drugs administered to foster youth, DHCS expanded
its existing policy requiring treatment authorization requests
for psychotropic drugs for Medi-Cal beneficiaries. Previously,
DHCS required a prior treatment authorization request before
Medi-Cal would authorize psychotropic drugs for Medi-Cal
beneficiaries under age six. In October 2014, DHCS 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, DHCS and DSS released guidelines for
the use of psychotropic medications in foster youth.
3)Related Legislation. The following bills are part of a
four-bill package (including this bill) regarding the use of
psychotropic medication for children in foster care. All are
before this Committee today.
a) SB 238 (Mitchell), 2015, requires DSS to develop
expanded training for foster parents, social workers, group
home administrators, and others involved in the care and
oversight of dependent children on issues related to
psychotropic medications.
b) SB 253 (Monning), 2015, modifies juvenile court
practices and requirements regarding the authorization of
psychotropic medications for foster youth by, among other
things, requiring clear and convincing evidence that
administration of the medication is in the best interest of
the child and, in specified circumstances, prohibiting the
authorization of psychotropic medication administration for
a child unless a second opinion is obtained from a child
psychiatrist or behavioral pediatrician.
c) SB 319 (Beall), 2015, adds to the duties of foster care
public health nurses, including monitoring each child in
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foster care who is administered one or more psychotropic
medications.
Analysis Prepared by:Jennifer Swenson / APPR. / (916)
319-2081