BILL ANALYSIS Ó SB 484 Page 1 SENATE THIRD READING SB 484 (Beall) As Amended September 3, 2015 Majority vote SENATE VOTE: 40-0 -------------------------------------------------------------------- |Committee |Votes|Ayes |Noes | | | | | | | | | | | | | | | | |----------------+-----+-----------------------+---------------------| |Human Services |7-0 |Chu, Mayes, Calderon, | | | | |Lopez, Maienschein, | | | | |Mark Stone, Thurmond | | | | | | | |----------------+-----+-----------------------+---------------------| |Appropriations |17-0 |Gomez, Bigelow, Bloom, | | | | |Bonta, Calderon, | | | | |Chang, Nazarian, | | | | |Eggman, Gallagher, | | | | | | | | | | | | | | |Eduardo Garcia, | | | | |Holden, Jones, Quirk, | | | | |Rendon, Wagner, Weber, | | | | |Wood | | | | | | | | | | | | SB 484 Page 2 -------------------------------------------------------------------- SUMMARY: Requires the collection of information on the administration of psychotropic medications to foster youth placed in group homes, and adopts measures aimed at reforming the practices of those group homes with levels of psychotropic medication utilization that warrant additional review. Specifically, this bill: 1)Requires that psychotropic medications for youth in group homes be used only in accordance with the written directions of the prescribing physician and as authorized by the juvenile court, as specified. 2)Requires group home facilities to maintain in a child's records a copy of any court order authorizing psychotropic medication, as well as a separate log for each prescribed psychotropic medication that contains information about that medication and its administration, as specified. 3)Clarifies that the Department of Social Services (DSS), and not its director, is responsible for publishing and making available a list or lists covering all community care facilities and the services for which they are licensed, as specified. 4)Adds short-term residential treatment centers to the list of community care facility types for which DSS must annually publish information related to licensing complaints and law enforcement contacts, as specified. 5)Includes professional organizations educating foster parents among entities authorized to have disclosed to them, upon SB 484 Page 3 request, the names and addresses of foster homes, as specified. 6)Requires DSS to compile, at least once per year and to the extent feasible, Health Effectiveness Data and Information Set (HEDIS) data, as specified and to include: a) Follow-up care for children prescribed attention deficit hyperactivity disorder medication; b) Use of multiple concurrent antipsychotics in children and adolescents; c) Use of first-line psychosocial care for children and adolescents on antipsychotics; and d) Metabolic monitoring for children and adolescents on antipsychotics. 7)Requires DSS to post the list of data to be collected pursuant to this bill on its Internet Web site. 8)Requires DSS to consult with the Department of Health Care Services (DHCS) and stakeholders to establish a methodology, by July 1, 2016, for identifying group homes that have levels of psychotropic drug utilization warranting further review. Further, requires periodic review of this methodology if necessary. 9)Requires DSS to inspect annually any facility found to have levels of psychotropic drug utilization warranting additional SB 484 Page 4 review. Further, requires this annual inspection to include, but not be limited to, the following: a) A review of the facility's: plan of operation, policies, procedures, and practices; child-to-staff ratios; staff qualifications and training; implementation of children's needs and services plans; availability of psychosocial and other alternative treatments to the use of psychotropic medications; other factors that the department determines contribute to levels of psychotropic drug usage warranting additional review; and b) Confidential interviews with children living in the facility at the time of the inspection. 10)Permits the inspection to also include, but not be limited to, confidential interviews of children who resided in the facility within the last six months and confidential discussions with prescribing physicians. 11)Allows DSS, following an inspection and as it deems appropriate, to do either or both of the following: a) Share relevant information and observations with specified entities; and/or b) Share relevant information and observations with the facility and require the facility to submit a plan of correction, within 30 days of this information being shared, to address any identified risks within the control of the facility related to psychotropic medication. Further, require the department to approve the plan and verify its implementation to determine whether identified SB 484 Page 5 risks have been remedied. 12)Requires DSS to adopt emergency regulations by January 1, 2017, to implement this bill, as specified, and to adopt final regulations by January 1, 2018. Further, permits DSS to implement this bill through all-county letters or similar instructions until emergency regulations are filed with the Secretary of State. 13)States that nothing in this bill is intended to: a) Replace or alter other requirements regarding group home complaints, inspections, or visits; or b) Prevent or preclude DSS from taking any other action permitted under any other law, as specified. 14)Requires DSS, by January 1, 2017, and in consultation with specified entities, to develop additional performance standards and outcome measures that require group homes to implement alternative programs and services for children in group homes, as specified. 15)Exempts runaway and homeless shelters, as specified, from the bill's data collection and reporting and inspection requirements. 16)Requires DSS to, at least once per year, post a statewide summary of the information gathered pursuant to this bill on its Internet Web site, as specified. SB 484 Page 6 EXISTING LAW: 1)Establishes the California Community Care Facilities Act to provide for the licensure and regulation of community care facilities. (Health and Safety Code (HSC) Section 1500 et seq.) 2)Requires DSS to conduct unannounced visits of each licensed community care facility, except for foster family homes, and requires that no facility or center be visited less frequently than once every five years. Further requires DSS to conduct annual unannounced visits of licensed facilities under specified circumstances, such as when a license is on probation. Additionally requires annual visits of a random sample of at least 20% of facilities and centers not subject to annual inspections for specified circumstances and states that, should the total citations for this 20% of facilities and centers exceed the previous year's by 10%, the random sample subject to annual inspection shall increase in the next year by 10%. Because of this trigger, 30% of eligible facilities and centers are now randomly sampled each year for inspection. (HSC Section 1534) 3)Requires DSS, in consultation with group home providers and other stakeholders, to develop performance standards to measure group home program performance. (Welfare and Institutions Code (WIC) Section 11469) 4)Defines "psychotropic medication" or "psychotropic drugs" as those medications administered for the purpose of affecting the central nervous system to treat psychiatric disorders or illnesses. Further states that these medications include, but are not limited to, anxiolytic agents, antidepressants, mood stabilizers, antipsychotic medications, anti-Parkinson agents, hypnotics, medications for dementia, and psychostimulants. SB 484 Page 7 (WIC Section 369.5 (d)) 5)States that only a juvenile court judicial officer has the authority to make orders for the administration of psychotropic medications for a minor who has been adjudged a dependent of the court. (WIC Section 369.5) FISCAL EFFECT: According to the Assembly Appropriations Committee, this bill may result in the following costs: 1)Ongoing costs in the range of $300,000 to $600,000 (General Fund (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: Psychotropic medications and foster youth: Psychotropic medications include drugs prescribed to manage psychiatric and mental health disorders or issues including depression, SB 484 Page 8 obsessive-compulsive disorder, attention deficit hyperactivity disorder, bipolar disorder, schizophrenia, and others. There continues to be significant concern over the use of psychotropic medications for children, due to a vast array of side effects (which can include aggressive behavior, hostility, seizures, significant weight gain, and more) and due to the fact that the long-term effects for children using these drugs are largely unknown. Research has repeatedly indicated that children and youth in foster care face higher levels of inappropriate or excessive medication use, and that those foster youth placed in group home settings are particularly vulnerable to over-prescription and misuse of psychotropic medications. Data shared by the author's office indicate that, in fiscal year 2013-14, almost 15% of all foster youth in California ages zero to 20 years old were prescribed at least one psychotropic medication; looking specifically at all foster youth ages 12 through 20, this rate was almost 25% and for youth placed in group homes, it was 50%. Need for this bill: According to the author: More than half of the children in our state's institutions for foster children ('group homes') are medicated with powerful psychotropic drugs. Resistance to taking the drugs can be, and is, punished by expulsion from the facility. The most problematic of the medications are the 'antipsychotic' drugs designed to suppress the most uncontrollable behavior of schizophrenics. As a witness at last year's Congressional hearing said, 'these drugs are too often misused as "chemical straitjackets." This is a haphazard attempt to simply control and suppress undesirable behavior, rather than treat, nurture and develop these treasured young people.' Causes of overmedication include: poorly trained staff; sedated SB 484 Page 9 children allow for reduced staffing ratios; lack of therapeutic intervention alternatives; energetic promotion by manufacturers; and lack of state oversight. Analysis Prepared by: Daphne Hunt / HUM. S. / (916) 319-2089 FN: 0002056