Amended in Senate March 28, 2016

Senate Bill No. 1174

Introduced by Senator McGuire

(Coauthors: Senators Beall, Hancock, Liu, and Mitchell)

February 18, 2016

An act to begin insert amend Section 2220.05 of, and to add Section 2245 to, the Business and Professions Code, and to end insert add Section 14028 to the Welfare and Institutions Code, relating to Medi-Cal.

LEGISLATIVE COUNSEL’S DIGEST

SB 1174, as amended, McGuire. Medi-Cal: children: prescribing begin delete patterns. end delete begin insert patterns: psychotropic medications. end insert

begin insert

Existing law, the Medical Practice Act, among other things provides for the licensure and regulation of physicians and surgeons by the Medical Board of California. Under existing law, the board’s responsibilities include enforcement of the disciplinary and criminal provisions of the act.

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Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services, including early and periodic screening, diagnosis, and treatment for any individual under 21 years of age. The Medi-Cal program is, in part, governed and funded by federal Medicaid Program provisions. Existing law establishes a statewide system of child welfare services, administered by the State Department of Social Services, with the intent that all children are entitled to be safe and free from abuse and neglect.

This bill would require the begin delete State Department of Health Care Services and the State Department of Social Services to, on an ongoing basis, conduct end delete begin insert Medical Board of California to conduct on a quarterly basis end insert an analysis of data regarding Medi-Cal prescribers and their prescribing patterns begin delete for all children enrolled in and receiving services pursuant to the Medi-Cal program. end delete begin insert of psychotropic medications and related services using data provided by the State Department of Health Care Services and the State Department of Social Services. end insert The bill would require begin delete the analysis to include end delete begin insert the data to include end insert a breakdown begin delete of data end delete by specified population begin delete categories, end delete begin insert categories of children, end insert including children in foster care. Commencing July 1, 2017, the bill would require the begin delete State Department of Health Care Services and the State Department of Social Services to report quarterly to the Medical Board of California and to the Legislature of the ongoing analysis. end delete begin insert Medical Board of California to report quarterly to the Legislature, the State Department of Health Care Services, and the State Department of Social Services the results of the analysis of the data. end insert The bill would require the Medical Board of California to review the begin delete analysis end delete begin insert data end insert in order to determine if any potential violations of law or begin delete departures from end delete begin insert excessive prescribing of psychotropic medications inconsistent with end insert the standard of care exist and conduct an investigation, if warranted, and would require the board to take disciplinary action, as specified. begin insert The bill would require the board to handle on a priority basis investigations of repeated acts of excessive prescribing, furnishing, or administering psychotropic medications to a minor, as specified. end insert

Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: no.

The people of the State of California do enact as follows:

begin insert

begin insert SECTION 1. end insert   

end insert

begin insert Section 2220.05 of the end insert begin insert Business and Professions
Code end insert begin insert is amended to read: end insert

2220.05.  

(a) In order to ensure that its resources are maximized
for the protection of the public, the Medical Board of California
shall prioritize its investigative and prosecutorial resources to
ensure that physicians and surgeons representing the greatest threat
of harm are identified and disciplined expeditiously. Cases
involving any of the following allegations shall be handled on a
priority basis, as follows, with the highest priority being given to
cases in the first paragraph:

(1) Gross negligence, incompetence, or repeated negligent acts
that involve death or serious bodily injury to one or more patients,
such that the physician and surgeon represents a danger to the
public.

(2) Drug or alcohol abuse by a physician and surgeon involving
death or serious bodily injury to a patient.

(3) Repeated acts of clearly excessive prescribing, furnishing,
or administering of controlled substances, or repeated acts of
prescribing, dispensing, or furnishing of controlled substances
without a good faith prior examination of the patient and medical
reason therefor. However, in no event shall a physician and surgeon
prescribing, furnishing, or administering controlled substances for
intractable pain consistent with lawful prescribing, including, but
not limited to, Sections 725, 2241.5, and 2241.6 of this code and
Sections 11159.2 and 124961 of the Health and Safety Code, be
prosecuted for excessive prescribing and prompt review of the
applicability of these provisions shall be made in any complaint
that may implicate these provisions.

(4) Repeated acts of clearly excessive recommending of cannabis
to patients for medical purposes, or repeated acts of recommending
cannabis to patients for medical purposes without a good faith
prior examination of the patient and a medical reason for the
recommendation.

(5) Sexual misconduct with one or more patients during a course
of treatment or an examination.

(6) Practicing medicine while under the influence of drugs or
alcohol.

begin insert

(7) Repeated acts of clearly excessive prescribing, furnishing,
or administering psychotropic medications to a minor without a
good faith prior examination of the patient and medical reason
therefor.

end insert

(b) The board may by regulation prioritize cases involving an
allegation of conduct that is not described in subdivision (a). Those
cases prioritized by regulation shall not be assigned a priority equal
to or higher than the priorities established in subdivision (a).

(c) The Medical Board of California shall indicate in its annual
report mandated by Section 2312 the number of temporary
restraining orders, interim suspension orders, and disciplinary
actions that are taken in each priority category specified in
subdivisions (a) and (b).

begin insert

begin insert SEC. 2. end insert   

end insert

begin insert Section 2245 is added to the end insert begin insert Business and Professions
Code end insert begin insert , to read: end insert

begin insert

begin insert 2245. end insert   

(a) The Medical Board of California on a quarterly
basis shall review the data provided pursuant to Section 14028 of
the Welfare and Institutions Code by the State Department of
Health Care Services and the State Department of Social Services
in order to determine if any potential violations of law or excessive
prescribing of psychotropic medications inconsistent with the
standard of care exist and, if warranted, shall conduct an
investigation.

(b) If, after an investigation, the Medical Board of California
concludes that there was a violation of law, the board shall take
disciplinary action, as appropriate, as authorized by Section 2227.

(c) If, after an investigation, the Medical Board of California
concludes that there was excessive prescribing of psychotropic
medications inconsistent with the standard of care, the board shall
take action, as appropriate, as authorized by Section 2227.

(d) (1) Notwithstanding Section 10231.5 of the Government
Code, commencing July 1, 2017, the Medical Board of California
shall report quarterly to the Legislature, the State Department of
Health Care Services, and the State Department of Social Services
the results of the analysis of data described in Section 14028 of
the Welfare and Institutions Code.

(2) A report to be submitted pursuant to this subdivision shall
be submitted in compliance with Section 9795 of the Government
Code.

end insert

begin insert

begin insert SEC. 3. end insert   

end insert

begin insert Section 14028 is added to the end insert begin insert Welfare and Institutions
Code end insert begin insert , to read: end insert

begin insert

begin insert 14028. end insert   

(a) The Medical Board of California shall conduct on
a quarterly basis an analysis of Medi-Cal and managed care
prescribers and their prescribing patterns of psychotropic
medications and related services using data provided quarterly
by the department in collaboration with the State Department of
Social Services that shall include, but is not limited to, the child
welfare psychotropic medication measures and the Healthcare
Effectiveness Data and Information Set measures related to
psychotropic medications.

(b) (1) The data provided to the Medical Board of California
pursuant to subdivision (a) shall include a breakdown by
population of all of the following:

(A) Children prescribed psychotropic medications in managed
care and fee-for-service settings.

(B) Children adjudged as dependent children under Section 300
and placed in foster care.

(C) Children in juvenile halls, as described in Section 850, and
children placed in ranches, camps, or other facilities, as described
in Section 880.

(D) A minor adjudged a ward of the court under Section 601
or 602 who has been removed from the physical custody of the
parent and placed into foster care.

(E) Children with developmental disabilities, as described in
Section 4512.

(2) The data provided to the medical board as described in
paragraph (1) shall include total rate and age stratifications that
include the following:

(A) Birth to five years of age, inclusive.

(B) Six to 11 years of age, inclusive.

(C) Twelve to 17 years of age, inclusive.

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begin delete

SECTION 1.  

Section 14028 is added to the Welfare and
Institutions Code, to read:

14028.  

(a) The department and the State Department of Social
Services shall, on an ongoing basis, conduct an analysis of data
regarding Medi-Cal prescribers and their prescribing patterns for
all children enrolled in and receiving services pursuant to, the
Medi-Cal program. The analysis shall include a breakdown of data
by population of:

(1) Children in foster care.

(2) Children in juvenile hall, as described in Section 850.

(3) Children placed in out-of-home care.

(4) Children with developmental disabilities.

(b) (1) Notwithstanding Section 10235.1 of the Government
Code, commencing July 1, 2017, the department and the State
Department of Social Services shall report quarterly to the Medical
Board of California and to the Legislature the results of the ongoing
analysis of data described in subdivision (a). The Medical Board
of California shall review the analysis in order to determine if any
potential violations of law or departures from the standard of care
exist and, if warranted, shall conduct an investigation. If after the
investigation, the Medical Board of California concludes that there
was a violation of law or departure from the standard of care, the
board shall take disciplinary action, as appropriate, as authorized
by Section 2220.5 of the Business and Professions Code.

(2) A report to be submitted pursuant to this subdivision shall
be submitted in compliance with Section 9795 of the Government
Code.

end delete