BILL NUMBER: SB 1174	AMENDED
	BILL TEXT

	AMENDED IN ASSEMBLY  JUNE 22, 2016
	AMENDED IN ASSEMBLY  JUNE 15, 2016
	AMENDED IN SENATE  MARCH 28, 2016

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
  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
  board  to conduct on a quarterly basis an
analysis of data regarding Medi-Cal physicians and their prescribing
patterns of psychotropic medications and related services  for
specified children and minors placed in foster care  using data
provided by the State Department of Health Care Services and the
State Department of Social 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,   board,  the State Department of
Health Care Services, and the State Department of Social Services
consult and revise the methodology, if determined to be necessary.
Commencing July 1, 2017, the bill would require the  Medical
Board of California   board  to report annually 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   board  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. 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.   State Department of Health
Care Services to disseminate guidelines on an annual basis via email
to any prescriber who meets one or more of specified prescribing
patterns, such as prescribing any class of psychotropic medication
for a child who is 5 years of age or younger, or prescribing a dosage
that exceeds the amount recommended for children.  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:

  SECTION 1.  Section 2220.05 of the Business and Professions Code is
amended to read:
   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.
   (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.
   (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).
  SEC. 2.  Section 2245 is added to the Business and Professions
Code, to read:
   2245.  (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) The  Medical Board of California shall 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.   State Department of Health
Care Services shall disseminate guidelines on an annual basis via
email to any prescriber who meets the data requirement threshold for
prescribing psychotropic medications to children and adolescents
established in subdivision (c) of Section 14028 of the Welfare and
Institutions Code. 
   (c) 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.
   (d) 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.
   (e) (1) Notwithstanding Section 10231.5 of the Government Code,
commencing July 1, 2017, the Medical Board of California shall report
annually 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.
  SEC. 3.  Section 14028 is added to the Welfare and Institutions
Code, to read:
   14028.  (a) The Medical Board of California shall conduct on a
quarterly basis an analysis of Medi-Cal physicians and their
prescribing patterns of psychotropic medications and related services
 for individuals described in subparagraphs (B) and (C) of
paragraph (1) of subdivision (b)  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. The data concerning psychotropic
medications and related services shall be shared pursuant to a
data-sharing agreement that meets the requirements of all applicable
state and federal laws and regulations. Every three years, the
Medical Board of California, the State Department of Health Care
Services, and the State Department of Social Services shall consult
and revise the methodology, if determined to be necessary.
   (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) 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. 
   (D) 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.
   (c) (1) The data provided to the Medical Board of California
pursuant to subdivision (a) shall include the information listed in
paragraph (2) for each prescriber with a pattern of prescribing that
includes one or more of the following:
   (A) Prescriptions for any class of psychotropic medication for a
child who is five years of age or younger.
   (B) Prescriptions for concurrent administration of two or more
antipsychotic medications that exceed 60 days.
   (C) Prescriptions for concurrent administration of three or more
psychotropic medications exceeding 60 days.
   (D) Prescriptions for a dosage that exceeds the amount recommended
for children.
   (2) The following information shall be included for each
prescriber described in paragraph (1):
   (A) Prescriber name, specialty, location, and contact information.

   (B) The child's gender and year of birth.
   (C) A list of the psychotropic medications prescribed, diagnosis,
and the medication start and end date.
   (D) Unit of each medication, quantity of each medication, the day'
s supply, and the prescription fill date.
   (E) The child's weight.