Amended in Assembly August 3, 2016

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 begin delete board to conduct on an annual basis an analysis of data end delete begin insert State Department of Health Care Services and the State Department of Social Services, pursuant to a specified data-sharing agreement, to provide the Medical Board of California with information end insert 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 drawn from existing data sources maintained by the departments and 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. The bill would require the board 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. 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 treatment guidelines on an annual basis through its existing communications with Medi-Cal providers, as specified. 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 the treatment guidelines on an annual basis through
its existing communications with Medi-Cal providers, such as the
department’s Internet Web site or provider bulletins.

(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) (1)  begin delete The Medical Board of California shall conduct
on an annual basis or as requested an analysis of end delete begin insert In order to ensure
appropriate oversight of psychotropic medications prescribed for
children, pursuant to Section 2245 of the Business and Professions
Code, the department and the State Department of Social Services,
pursuant to a data-sharing agreement that shall meet the
requirements of all applicable state and federal laws and
regulations, shall provide the Medical Board of California with
information regarding end insert 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 (c) using data provided by the department in
collaboration with the State Department of Social Services. end delete begin insert (c). end insert
The data concerning psychotropic medications and related services
shall be drawn from existing data sources maintained by the begin delete department and the State Department of Social Services and shared
pursuant to a data-sharing agreement that meets the requirements
of all applicable state and federal laws and regulations. end delete
begin insert departments. end insert Every three years, the Medical Board of California,
the department, and the State Department of Social Services shall
consult and revise the methodology, if determined to be necessary.

(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 begin delete 60 end delete begin insert 90 end insert
days or begin delete 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 end delete 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:

(A) A list of the psychotropic medications prescribed.

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

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

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

begin delete

(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 delete begin insert

(E) Any other information that is deidentified and necessary to
the Medical Board of California to allow the board to exercise its
statutory authority as an oversight entity.

end insert

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

begin delete

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

end delete

(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.

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

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

(2) 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.