Amended in Assembly August 1, 2016

Amended in Assembly June 22, 2016

Amended in Assembly June 15, 2016

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 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 board to conduct on begin delete a quarterly end delete begin insert an annual end insert 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 begin insert drawn from existing data sources maintained by the departments and end insert shared pursuant to a data-sharing agreement and would require that, every 3 years, the 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. begin insert The bill would require the board end insert begin insert to contract for consulting services from, if available, a psychiatrist who has expertise and specializes in pediatric care for the purpose of reviewing the data provided to the board. end insert Commencing July 1, 2017, the bill would require the 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 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 State Department of Health Care Services to disseminate begin insert treatment end insert guidelines on an annual basis begin delete 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. end delete begin insert through its existing communications with Medi-Cal providers, as specified. 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:

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 State Department of Health Care Services shall
disseminate begin insert the treatment end insert guidelines on an annual basis begin delete 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. end delete begin insert through its existing communications with
Medi-Cal providers, such as the department’s Internet Web site
or provider bulletins. end insert

(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)  begin insert (1) end insert begin insert   end insert The Medical Board of California shall conduct
on begin delete a quarterly basis end delete begin insert an annual basis or as requested end insert 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 begin delete (b) end delete begin insert (c) end insert using data provided begin delete quarterly end delete by the department
in collaboration with the State Department of Social begin delete 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. end delete
begin insert Services. end insert The data concerning psychotropic medications and related
services shall be begin insert drawn from existing data sources maintained by
the department and the State Department of Social Services and end insert
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 begin delete State Department of Health Care Services, end delete begin insert department, end insert and
the State Department of Social Services shall consult and revise
the methodology, if determined to be necessary.

begin insert

(2) At minimum, the department, on an annual basis, shall share
with the Medical Board of California data, including, but not
limited to, pharmacy claims data for all foster children who are
or have been on three or more psychotropic medications for 60
days or more, who are five years of age or younger and prescribed
one or more psychotropic medications, and who are or have been
on two or more antipsychotic medications for 60 days or more.
Prior to the release of this data, personal identifiers such as name,
date of birth, address, and social security number shall be removed
and a unique identifier shall be submitted. For each foster child
who falls into these categories, the department shall submit the
following information to the board:

end insert begin insert

(A) A list of the psychotropic medications prescribed.

end insert begin insert

(B) The start and stop dates, if any, for each psychotropic
medication prescribed.

end insert begin insert

(C) The prescriber’s name and contact information.

end insert begin insert

(D) The child’s or adolescent’s year of birth.

end insert begin insert

(E) The diagnoses received on nonpharmacy claims, including
all associated dates of claim and service and the associated CPT
code for the claim or service.

end insert begin insert

(F) The unit and quantity of the medication and the number of
days’ supply of the medication.

end insert begin insert

(G) The child’s or adolescent’s weight.

end insert begin insert

(b) The Medical Board of California shall contract for
consulting services from, if available, a psychiatrist who has
expertise and specializes in pediatric care for the purpose of
reviewing the data provided to the board pursuant to subdivision
(a). The consultant shall consider the treatment guidelines
published by the department and the State Department of Social
Services when assessing prescribing patterns.

end insert begin delete

(b)  (1) The data provided to the Medical Board of California
pursuant to subdivision (a) shall include a breakdown

end delete

begin insert (c) end insert begin insert   end insert begin insert The Medical Board of California, pursuant to subdivision
(a), shall analyze prescribing patterns end insert by population begin delete of all end delete begin insert for both end insert
of the following:

begin delete

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

end delete begin delete

(B)

end delete

begin insert (1) end insert  Children adjudged as dependent children under Section 300
and placed in foster care.

begin delete

(C)

end delete

begin insert (2) end insert  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.

begin delete

(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.

end delete