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
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|Version: March 28, 2016 |Policy Vote: B., P. & E.D. 8 - |
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|Urgency: No |Mandate: No |
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|Hearing Date: April 25, 2016 |Consultant: Brendan McCarthy |
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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
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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
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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
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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.
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