Amended in Assembly June 15, 2016

Amended in Senate March 28, 2016

Senate BillNo. 1174


Introduced by Senator McGuire

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

February 18, 2016


An act to amend Section 2220.05 of, and to add Section 2245 to, the Business and Professions Code, and to 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 patterns: psychotropic medications.

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.

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 Medical Board of California to conduct on a quarterly basis an analysis of data regarding Medi-Calbegin delete prescribersend deletebegin insert physiciansend insert and their prescribing patterns of psychotropic medications and related services using data provided by the State Department of Health Care Services and the State Department of Socialbegin delete Services. The bill would require the data to include a breakdown by specified population categories of children, including children in foster care.end deletebegin insert Services, as prescribed. The bill would require that the data concerning psychotropic medications and related services be shared pursuant to a data-sharing agreement and would require that, every 3 years, the Medical Board of California, the State Department of Health Care Services, and the State Department of Social Services consult and revise the methodology, if determined to be necessary.end insert Commencing July 1, 2017, the bill would require the Medical Board of California to reportbegin delete quarterlyend deletebegin insert annuallyend insert 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. The bill would require the Medical Board of California to review the data in order to determine if any potential violations of law or excessive prescribing of psychotropic medications inconsistent with 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 Medical Board of California to disseminate guidelines for the prescribing of psychotropic medications to children and adolescents on an annual basis to any prescriber who has been flagged for review.end 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.

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

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

P2    1

SECTION 1.  

Section 2220.05 of the Business and Professions
2Code
is amended to read:

3

2220.05.  

(a) In order to ensure that its resources are maximized
4for the protection of the public, the Medical Board of California
5shall prioritize its investigative and prosecutorial resources to
6ensure that physicians and surgeons representing the greatest threat
7of harm are identified and disciplined expeditiously. Cases
8involving any of the following allegations shall be handled on a
P3    1priority basis, as follows, with the highest priority being given to
2cases in the first paragraph:

3(1) Gross negligence, incompetence, or repeated negligent acts
4that involve death or serious bodily injury to one or more patients,
5such that the physician and surgeon represents a danger to the
6public.

7(2) Drug or alcohol abuse by a physician and surgeon involving
8death or serious bodily injury to a patient.

9(3) Repeated acts of clearly excessive prescribing, furnishing,
10or administering of controlled substances, or repeated acts of
11prescribing, dispensing, or furnishing of controlled substances
12without a good faith prior examination of the patient and medical
13reason therefor. However, in no event shall a physician and surgeon
14prescribing, furnishing, or administering controlled substances for
15intractable pain consistent with lawful prescribing, including, but
16not limited to, Sections 725, 2241.5, and 2241.6 of this code and
17Sections 11159.2 and 124961 of the Health and Safety Code, be
18prosecuted for excessive prescribing and prompt review of the
19applicability of these provisions shall be made in any complaint
20that may implicate these provisions.

21(4) Repeated acts of clearly excessive recommending of cannabis
22to patients for medical purposes, or repeated acts of recommending
23cannabis to patients for medical purposes without a good faith
24prior examination of the patient and a medical reason for the
25recommendation.

26(5) Sexual misconduct with one or more patients during a course
27of treatment or an examination.

28(6) Practicing medicine while under the influence of drugs or
29alcohol.

30(7) Repeated acts of clearly excessive prescribing, furnishing,
31or administering psychotropic medications to a minor without a
32good faith prior examination of the patient and medical reason
33therefor.

34(b) The board may by regulation prioritize cases involving an
35 allegation of conduct that is not described in subdivision (a). Those
36cases prioritized by regulation shall not be assigned a priority equal
37to or higher than the priorities established in subdivision (a).

38(c) The Medical Board of California shall indicate in its annual
39report mandated by Section 2312 the number of temporary
40restraining orders, interim suspension orders, and disciplinary
P4    1actions that are taken in each priority category specified in
2subdivisions (a) and (b).

3

SEC. 2.  

Section 2245 is added to the Business and Professions
4Code
, to read:

5

2245.  

(a) The Medical Board of California on a quarterly basis
6shall review the data provided pursuant to Section 14028 of the
7Welfare and Institutions Code by the State Department of Health
8Care Services and the State Department of Social Services in order
9to determine if any potential violations of law or excessive
10prescribing of psychotropic medications inconsistent with the
11standard of care exist and, if warranted, shall conduct an
12investigation.

begin insert

13
(b) The Medical Board of California shall disseminate guidelines
14for the prescribing of psychotropic medications to children and
15adolescents on an annual basis to any prescriber who has been
16flagged for review.

end insert
begin delete

9 17(b)

end delete

18begin insert(c)end insert If, after an investigation, the Medical Board of California
19concludes that there was a violation of law, the board shall take
20disciplinary action, as appropriate, as authorized by Section 2227.

begin delete

12 21(c)

end delete

22begin insert(d)end insert If, after an investigation, the Medical Board of California
23concludes that there was excessive prescribing of psychotropic
24medications inconsistent with the standard of care, the board shall
25take action, as appropriate, as authorized by Section 2227.

begin delete

16 26(d)

end delete

27begin insert(e)end insert (1) Notwithstanding Section 10231.5 of the Government
28Code, commencing July 1, 2017, the Medical Board of California
29shall reportbegin delete quarterlyend deletebegin insert annuallyend insert to the Legislature, the State
30Department of Health Care Services, and the State Department of
31Social Services the results of the analysis of data described in
32Section 14028 of the Welfare and Institutions Code.

33(2) A report to be submitted pursuant to this subdivision shall
34be submitted in compliance with Section 9795 of the Government
35Code.

36

SEC. 3.  

Section 14028 is added to the Welfare and Institutions
37Code
, to read:

38

14028.  

(a) The Medical Board of California shall conduct on
39a quarterly basis an analysis of Medi-Calbegin delete and managed care
40prescribersend delete
begin insert physiciansend insert and their prescribing patterns of
P5    1psychotropic medications and related services using data provided
2quarterly by the department in collaboration with the State
3Department of Social Services that shall include, but is not limited
4to, the child welfare psychotropic medication measures and the
5Healthcare Effectiveness Data and Information Set measures related
6to psychotropic medications.begin insert The data concerning psychotropic
7medications and related services shall be shared pursuant to a
8data-sharing agreement that meets the requirements of all
9applicable state and federal laws and regulations. Every three
10years, the Medical Board of California, the State Department of
11Health Care Services, and the State Department of Social Services
12shall consult and revise the methodology, if determined to be
13necessary.end insert

14(b) (1) The data provided to the Medical Board of California
15pursuant to subdivision (a) shall include a breakdown by population
16of all of the following:

17(A) Children prescribed psychotropic medications in managed
18care and fee-for-service settings.

19(B) Children adjudged as dependent children under Section 300
20and placed in foster care.

begin delete

21(C) Children in juvenile halls, as described in Section 850, and
22children placed in ranches, camps, or other facilities, as described
23in Section 880.

end delete
begin delete

6 24(D)

end delete

25begin insert(C)end insert A minor adjudged a ward of the court under Section 601 or
26602 who has been removed from the physical custody of the parent
27and placed into foster care.

begin delete

9 28(E)

end delete

29begin insert(D)end insert Children with developmental disabilities, as described in
30Section 4512.

31(2) The data provided to the medical board as described in
32paragraph (1) shall include total rate and age stratifications that
33include the following:

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

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

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

begin insert

37
(c) (1) The data provided to the Medical Board of California
38pursuant to subdivision (a) shall include the information listed in
39paragraph (2) for each prescriber with a pattern of prescribing
40that includes one or more of the following:

end insert
begin insert

P6    1
(A) Prescriptions for any class of psychotropic medication for
2a child who is five years of age or younger.

end insert
begin insert

3
(B) Prescriptions for concurrent administration of two or more
4antipsychotic medications that exceed 60 days.

end insert
begin insert

5
(C) Prescriptions for concurrent administration of three or more
6psychotropic medications exceeding 60 days.

end insert
begin insert

7
(D) Prescriptions for a dosage that exceeds the amount
8recommended for children.

end insert
begin insert

9
(2) The following information shall be included for each
10prescriber described in paragraph (1):

end insert
begin insert

11
(A) Prescriber name, specialty, location, and contact
12information.

end insert
begin insert

13
(B) The child’s gender and year of birth.

end insert
begin insert

14
(C) A list of the psychotropic medications prescribed, diagnosis,
15and the medication start and end date.

end insert
begin insert

16
(D) Unit of each medication, quantity of each medication, the
17day’s supply, and the prescription fill date.

end insert
begin insert

18
(E) The child’s weight.

end insert


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