BILL NUMBER: SB 1174 ENROLLED
BILL TEXT
PASSED THE SENATE AUGUST 25, 2016
PASSED THE ASSEMBLY AUGUST 23, 2016
AMENDED IN ASSEMBLY AUGUST 19, 2016
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
INTRODUCED BY Senator McGuire
(Coauthors: Senators Beall, Hancock, Liu, and Mitchell)
(Coauthor: Assembly Member Chiu)
FEBRUARY 18, 2016
An act to amend Section 2220.05 of, and to add and repeal Section
2245 of, the Business and Professions Code, and to add and repeal
Section 14028 of the Welfare and Institutions Code, relating to
Medi-Cal.
LEGISLATIVE COUNSEL'S DIGEST
SB 1174, 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, until January 1, 2027, 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, every 5 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, until January 1, 2027, 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 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. 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.
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.
(f) On or before January 1, 2022, and in conjunction with the
consultation with the State Department of Social Services and the
State Department of Health Care Services required by subdivision (a)
of Section 14028 of the Welfare and Institutions Code, the Medical
Board of California shall conduct an internal review of its data
review, investigative, and disciplinary activities undertaken
pursuant to this section for the purpose of determining the efficacy
of those activities and shall revise its procedures relating to those
activities, if determined to be necessary.
(g) This section shall remain in effect only until January 1,
2027, and as of that date is repealed, unless a later enacted
statute, that is enacted before January 1, 2027, deletes or extends
that date.
SEC. 3. Section 14028 is added to the Welfare and Institutions
Code, to read:
14028. (a) (1) 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 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 (c). The data concerning psychotropic medications
and related services shall be drawn from existing data sources
maintained by the departments. Every five 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 90 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:
(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.
(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.
(F) The unit and quantity of the medication and the number of days'
supply of the medication.
(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.
(d) This section shall remain in effect only until January 1,
2027, and as of that date is repealed, unless a later enacted
statute, that is enacted before January 1, 2027, deletes or extends
that date.