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 billbegin delete wouldend deletebegin insert would, until January 1, 2027,end insert require the 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 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, everybegin delete 3end deletebegin insert 5end insert 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 billbegin delete wouldend deletebegin insert
would, until January 1, 2027,end insert 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.begin insert The bill would require the board, on or before January 1, 2022, to conduct an internal review of those activities and to revise procedures relating to those activities, if determined to be necessary.end insert 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 2220.05 of the Business and Professions
2Code is amended to read:
(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
9priority basis, as follows, with the highest priority being given to
10cases in the first paragraph:
11(1) Gross negligence, incompetence, or repeated negligent acts
12that involve death or serious bodily injury to one or more patients,
13such that the physician and surgeon represents a danger to the
14public.
15(2) Drug or alcohol abuse by a physician and surgeon involving
16death or serious bodily injury to a patient.
17(3) Repeated acts of clearly excessive prescribing, furnishing,
18or administering of controlled substances, or repeated acts of
19prescribing, dispensing, or furnishing of controlled substances
20without a good faith prior examination of the patient and medical
21reason therefor. However, in no event shall a physician and surgeon
22prescribing, furnishing, or administering controlled substances for
23intractable pain consistent with lawful prescribing, including, but
24not limited to, Sections 725, 2241.5, and 2241.6 of this code and
25Sections 11159.2 and 124961 of the Health and Safety Code, be
26prosecuted for excessive prescribing and prompt review of the
27applicability of these provisions
shall be made in any complaint
28that may implicate these provisions.
29(4) Repeated acts of clearly excessive recommending of cannabis
30to patients for medical purposes, or repeated acts of recommending
31cannabis to patients for medical purposes without a good faith
32prior examination of the patient and a medical reason for the
33recommendation.
P4 1(5) Sexual misconduct with one or more patients during a course
2of treatment or an examination.
3(6) Practicing medicine while under the influence of drugs or
4alcohol.
5(7) Repeated acts of clearly excessive prescribing, furnishing,
6or administering psychotropic medications to a minor without a
7good faith prior
examination of the patient and medical reason
8therefor.
9(b) The board may by regulation prioritize cases involving an
10
allegation of conduct that is not described in subdivision (a). Those
11cases prioritized by regulation shall not be assigned a priority equal
12to or higher than the priorities established in subdivision (a).
13(c) The Medical Board of California shall indicate in its annual
14report mandated by Section 2312 the number of temporary
15restraining orders, interim suspension orders, and disciplinary
16actions that are taken in each priority category specified in
17subdivisions (a) and (b).
Section 2245 is added to the Business and Professions
19Code, to read:
(a) The Medical Board of California on a quarterly basis
21shall review the data provided pursuant to Section 14028 of the
22Welfare and Institutions Code by the State Department of Health
23Care Services and the State Department of Social Services in order
24to determine if any potential violations of law or excessive
25prescribing of psychotropic medications inconsistent with the
26standard of care exist and, if warranted, shall conduct an
27investigation.
28(b) The State Department of Health Care Services shall
29disseminate the treatment guidelines on an annual basis through
30its existing communications with Medi-Cal providers, such as the
31department’s Internet Web site or
provider bulletins.
32(c) If, after an investigation, the Medical Board of California
33concludes that there was a violation of law, the board shall take
34disciplinary action, as appropriate, as authorized by Section 2227.
35(d) If, after an investigation, the Medical Board of California
36concludes that there was excessive prescribing of psychotropic
37medications inconsistent with the standard of care, the board shall
38take action, as appropriate, as authorized by Section 2227.
39(e) (1) Notwithstanding Section 10231.5 of the Government
40Code, commencing July 1, 2017, the Medical Board of California
P5 1
shall report annually to the Legislature, the State Department of
2Health Care Services, and the State Department of Social Services
3the results of the analysis of data described in Section 14028 of
4the Welfare and Institutions Code.
5(2) A report to be submitted pursuant to this subdivision shall
6be submitted in compliance with Section 9795 of the Government
7Code.
8
(f) On or before January 1, 2022, and in conjunction with the
9consultation with the State Department of Social Services and the
10State Department of Health Care Services required by subdivision
11(a) of Section 14028 of the Welfare and Institutions Code, the
12Medical Board of California shall conduct an internal review of
13its data review, investigative, and disciplinary
activities undertaken
14pursuant to this section for the purpose of determining the efficacy
15of those activities and shall revise its procedures relating to those
16activities, if determined to be necessary.
17
(g) This section shall remain in effect only until January 1, 2027,
18and as of that date is repealed, unless a later enacted statute, that
19is enacted before January 1, 2027, deletes or extends that date.
Section 14028 is added to the Welfare and Institutions
21Code, to read:
(a) (1) In order to ensure appropriate oversight of
23psychotropic medications prescribed for children, pursuant to
24Section 2245 of the Business and Professions Code, the department
25and the State Department of Social Services, pursuant to a
26data-sharing agreement that shall meet the requirements of all
27applicable state and federal laws and regulations, shall provide the
28Medical Board of California with information regarding Medi-Cal
29physicians and their prescribing patterns of psychotropic
30medications and related services for individuals described in
31subparagraphs (B) and (C) of paragraph (1) of subdivision (c). The
32data concerning psychotropic
medications and related services
33shall be drawn from existing data sources maintained by the
34departments. Everybegin delete threeend deletebegin insert fiveend insert years, the Medical Board of
35California, the department, and the State Department of Social
36Services shall consult and revise the methodology, if determined
37to be necessary.
38(2) At minimum, the department, on an annual basis, shall share
39with the Medical Board of California data, including, but not
40limited to, pharmacy claims data for all foster children who are or
P6 1have been on three or more psychotropic medications for 90 days
2or more. Prior to the release of this data, personal identifiers such
3as name, date
of birth, address, and social security number shall
4be removed and a unique identifier shall be submitted. For each
5foster child who falls into these categories, the department shall
6submit the following information to the board:
7(A) A list of the psychotropic medications prescribed.
8(B) The start and stop dates, if any, for each psychotropic
9medication prescribed.
10(C) The prescriber’s name and contact information.
11(D) The child’s or adolescent’s year of birth.
12(E) Any other information that is deidentified and necessary to
13the Medical Board of California to allow the board to exercise its
14statutory authority as an oversight entity.
15(F) The unit and quantity of the medication and the number of
16days’ supply of the medication.
17(b) The Medical Board of California shall contract for consulting
18services from, if available, a psychiatrist who has expertise and
19specializes in pediatric care for the purpose of reviewing the data
20provided to the board pursuant to subdivision (a). The consultant
21shall consider the treatment guidelines published by the department
22and the State Department of Social Services when assessing
23prescribing patterns.
24 (c) The
Medical Board of California, pursuant to subdivision
25(a), shall analyze prescribing patterns by population for both of
26the following:
27(1) Children adjudged as dependent children under Section 300
28and placed in foster care.
29(2) A minor adjudged a ward of the court under Section 601 or
30602 who has been removed from the physical custody of the parent
31and placed into foster care.
32
(d) This section shall remain in effect only until January 1, 2027,
33and as of that date is repealed, unless a later enacted statute, that
34is enacted before January 1, 2027, deletes or extends that date.
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