BILL ANALYSIS Ó SENATE COMMITTEE ON APPROPRIATIONS Senator Ricardo Lara, Chair 2015 - 2016 Regular Session SB 1174 (McGuire) - Medi-Cal: children: prescribing patterns: psychotropic medications ----------------------------------------------------------------- | | | | | | ----------------------------------------------------------------- |--------------------------------+--------------------------------| | | | |Version: March 28, 2016 |Policy Vote: B., P. & E.D. 8 - | | | 0 | | | | |--------------------------------+--------------------------------| | | | |Urgency: No |Mandate: No | | | | |--------------------------------+--------------------------------| | | | |Hearing Date: April 25, 2016 |Consultant: Brendan McCarthy | | | | ----------------------------------------------------------------- This bill meets the criteria for referral to the Suspense File. Bill Summary: SB 1174 would require the Department of Health Care Services to provide quarterly data to the Medical Board related to the prescribing of psychotropic medications through the Medi-Cal program to foster youth. The bill would require the Medical Board to review the data to determine if there is excessing prescribing. The bill would require the Medical Board to prioritize cases of excessive prescribing of psychotropic medications to minors for investigation. Fiscal Impact: Ongoing costs up to $280,000 per year for the Department of Health Care Services to analyze prescription drug claims data and compile required information for the Medical Board (General Fund and federal funds). The Department's information technology systems contain prescription drug claims data (when combined with information from the SB 1174 (McGuire) Page 1 of ? Department of Social Services on foster care placements) to provide the data required to fulfill the requirements in the bill. The Department indicates that it will need two additional staff positions to compile the required data, stratify it into the required data categories, and report to the Medical Board. However, as part of recent efforts to reduce overprescribing of psychotropic medications to foster youth, the Department has been working with the Department of Social Services and counties to identify foster youth being prescribed such medications. The Governor's budget proposal includes an additional permanent position to continue this work. If approved by the Legislature, that new position may be able to also perform some or all of the requirements of this bill as well. Uncertain costs for the Medical Board of California to review the information provided by the Department of Health Care Services and investigate instances where excessive prescribing may be occurring (Contingent Fund of the Medical Board of California). According to the Medical Board, its staff are already reviewing data provided by the Department to look for cases of excessing prescribing. However, to the extent that such data analysis does uncover instances of excessing prescribing, this would lead to increased costs for investigations and potential disciplinary action by the Medical Board. While those instances of excessing prescribing may already be actionable by the Medical Board under current law and regulation, the data analysis required in the bill makes such investigations more likely to occur. Unknown potential cost savings in the Medi-Cal program due to reduced inappropriate utilization of psychotropic medications by foster youth. To the extent that this bill contributes to ongoing efforts to reduce inappropriate use of those drugs by Medi-Cal beneficiaries, the bill is likely to reduce spending. Ongoing efforts in other states to reduce inappropriate prescribing have substantially reduced the use of these frequently expensive medications. The amount of any decrease in spending that could be attributed to this bill is uncertain, in part because there are several efforts underway by the state and the counties to reduce inappropriate prescribing of psychotropic drugs to foster youth. SB 1174 (McGuire) Page 2 of ? Background: Under current law, only a juvenile court judicial officer may order the administration of psychotropic medications for a minor who is a dependent of the court (i.e. a foster youth). Foster youth are categorically eligible for Medi-Cal benefits and hence Medi-Cal provides coverage for those psychotropic medications. Psychotropic medications are intended to treat a variety of mental health conditions. While many patients benefit from the use of psychotropic medications, there are often serious side effects, particularly when taken in combination. In general, the use of psychotropic medications on children and adolescents is "off label" meaning that those drugs have not been specifically approved for use in children or adolescents. According to the Department of Social Services, about 11% of foster youth under age 17 are authorized to receive psychotropic medications. Concerns have been raised by advocates for foster youth that many foster youth are being prescribed these medications to sedate them, rather than to appropriately address their mental health and behavioral health needs. In response to concerns about the high rate of psychotropic drugs administered to foster youth, the Department of Health Care Services expanded its existing policy requiring treatment authorization requests for psychotropic drugs for Medi-Cal beneficiaries. Previously, the Department required a prior treatment authorization request before Medi-Cal would authorize psychotropic drugs for Medi-Cal beneficiaries under age six. In October 2014, the Department expanded this requirement for children and adolescents up to age 17. The treatment authorization request process allows for emergency prescriptions while the request is under review. In addition, in April 2015 the Department of Health Care Services and the Department of Social Services released guidelines for the use of psychotropic medications in foster youth. Proposed Law: SB 1174 would require the Department of Health Care Services to provide quarterly data to the Medical Board related to prescribing of psychotropic medications through the Medi-Cal program to foster youth. SB 1174 (McGuire) Page 3 of ? The bill would require the Medical Board to review the data to determine if there is excessing prescribing. If instances of excessing prescribing are found, the bill would require the Medical Board to take disciplinary action against the prescribing physician. The Medical Board would be required to report quarterly to the Legislature on the results of its analysis. The bill would require the Medical Board to prioritize cases of excessive prescribing of psychotropic medications to minors for investigation. -- END --