BILL ANALYSIS Ó
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Date of Hearing: June 21, 2016
ASSEMBLY COMMITTEE ON HEALTH
Jim Wood, Chair
SB
1174 (McGuire) - As Amended June 15, 2016
SENATE VOTE: 36-3
SUBJECT: Medi-Cal: children: prescribing patterns: psychotropic
medications.
SUMMARY: Requires the Medical Board of California (MBC) to
conduct an analysis of Medi-Cal and managed care prescribing
patterns of psychotropic medications to determine if excessive
prescribing exists and, if so, to take appropriate action. Adds
repeated acts of clearly excessive prescribing psychotropic
medications to a minor without a good faith prior examination to
the list of cases that MBC must prioritize investigating and
prosecuting. Specifically, this bill:
1)Requires MBC to conduct on a quarterly basis an analysis of
Medi-Cal physicians and their prescribing patterns of
psychotropic medications and related services using data
provided quarterly by the Department of Health Care Services
(DHCS) in collaboration with the Department of Social Services
(DSS). Requires that analysis to include, but not be limited
to, the child welfare psychotropic medication measures and the
Healthcare Effectiveness Data and Information Set measures
related to psychotropic medications. Requires the data
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concerning psychotropic medications and related services to be
shared pursuant to a data sharing agreement meeting the
requirements of all applicable state and federal laws and
regulations. Requires MBC, DHCS, and DSS to consult and
revise the methodology every three years, if determined to be
necessary.
2)Requires that the data provided to MBC pursuant to 1) above
identify prescribers with a pattern of prescribing that
includes one or more of the following:
a) Prescriptions for any class of psychotropic medication
for a child who is five years of age or younger;
b) Prescriptions for concurrent administration of two or
more antipsychotic medications that exceed 60 days;
c) Prescriptions for concurrent administration of three or
more psychotropic medications exceeding 60 days; and,
d) Prescriptions for a dosage that exceeds the amount
recommended for children.
3)Requires that the data provided to MBC pursuant to 2) above
include the following information on each identified
prescriber:
a) Prescriber name, specialty, location, and contact
information;
b) The child's gender and year of birth;
c)List of the psychotropic medications prescribed, diagnosis, and
the medication start and end date;
d)Unit of the medication(s), quantity of the medication(s), the
days supply, and prescription fill date: and,
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e) The child's weight.
4)Requires that the data provided to MBC pursuant to 1) above
include a breakdown as follows:
a) Children prescribed psychotropic medications in managed
care and fee-for-service settings;
b) Children adjudged as dependent children, as specified,
and placed in foster care;
c) A minor adjudged a ward of the court who has been
removed from the physical custody of the parent and placed
into foster care; and,
d) Children with developmental disabilities.
5)Requires that the data provided to MBC as described in 1) and
2) above include total rate and specific age stratifications.
6)Requires MBC on a quarterly basis to review the data provided
pursuant to 1) through 5) above 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, to conduct an investigation.
Requires MBC to disseminate guidelines for prescribing of
psychotropic medications to children and adolescents on an
annual basis to any prescriber who has been flagged for
review. Requires MBC to take appropriate action, as
specified, if, after an investigation, MBC concludes that
there was a violation of law or excessive prescribing of
psychotropic medications inconsistent with the standard of
care.
7)Requires MBC to report annually to the Legislature, DHCS, and
DSS the results of the analysis of data described in 1)
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through 5) above.
8)Adds repeated acts of clearly excessive prescribing,
furnishing, or administering psychotropic medications to a
minor without a good faith prior examination and medical
reason therefor to the list of cases that MBC must prioritize
for investigation and prosecution.
EXISTING LAW:
1)Provides for the licensure and regulation of physicians and
surgeons by MBC pursuant to the Medical Practice Act.
2)Requires MBC to take action against a physician who is charged
with unprofessional conduct, as specified.
3)Requires MBC to prioritize its investigative and prosecutorial
resources to ensure that physicians and surgeons representing
the greatest threat of harm are identified and disciplined
expeditiously. Requires cases involving excessive
prescribing, furnishing or administering of controlled
substances, or repeated acts of prescribing, dispensing or
furnishing of controlled substance without a good faith prior
examination of the patient and medical reason to be handled as
a high priority. Prohibits physicians and surgeons from being
prosecuted for excessive prescribing when prescribing,
furnishing or administering controlled substances for
intractable pain as authorized under current law. (BPC
§2220.05)
4)Provides that only a juvenile court judicial officer has the
authority to make orders regarding the administration of
psychotropic medications for a minor who is a dependent of the
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court. Requires that court authorization for the
administration of psychotropic medications be based on a
request from a physician, indicating the reasons for the
request, a description of the child's diagnosis and behavior,
the expected results of the medication, and a description of
any side effects of the medication. Requires the Judicial
Council, on or before July 1, 2016, to adopt rules and develop
appropriate forms for implementing this requirement. Requires
the rules and forms to address all of the following:
a) The child and his or her caregiver and Court Appointed
Special Advocate (CASA), if any, have an opportunity to
provide input on the medications being prescribed;
b) Information regarding the child's overall mental health
assessment and treatment plan is provided to the court;
and,
c) Information regarding the rationale for the proposed
medication, provided in the context of past and current
treatment efforts, is provided to the court; and,
d) Guidance is provided to the court on how to evaluate the
request for authorization.
5)Requires that the court either approve or deny a physician's
request, pursuant to 4) above, within seven business days of
its receipt.
6)Establishes a program of public health nursing in the child
welfare services (CWS) program that provides health-related
case management services from a foster care public health
nurse to coordinate with CWS workers to provide health care
services to children in foster care. Includes among the
duties of public health nurses the monitoring and oversight of
psychotropic medications.
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7)Requires DSS, in consultation with DHCS, and other specified
stakeholders to develop county-specific monthly reports that
describe each child for whom one or more psychotropic
medications have been paid for under Medi-Cal, including paid
claims and managed care encounters. Requires DSS to develop
training, in consultation DHCS and various other agencies that
may be provided to county child welfare social workers and
others that addresses the use of psychotropic medications.
FISCAL EFFECT: According to the Senate Appropriations
Committee:
1)Ongoing costs up to $280,000 per year for DHCS to analyze
prescription drug claims data and compile required information
for MBC (General Fund and federal funds). The DHCS'
information technology systems contain prescription drug
claims data (when combined with information from DSS on foster
care placements) to provide the data required to fulfill the
requirements in the bill. DHCS indicates that it will need
two additional staff positions to compile the required data,
stratify it into the required data categories, and report to
MBC.
However, as part of recent efforts to reduce overprescribing
of psychotropic medications to foster youth, DHCS has been
working with DSS 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.
2)Uncertain costs for MBC to review the information provided by
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DHCS and investigate instances where excessive prescribing may
be occurring (Contingent Fund of MBC). According to MBC, its
staff is already reviewing data provided by DHCS 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 MBC.
While those instances of excessing prescribing may already be
actionable by MBC, under current law and regulation, the data
analysis required in the bill makes such investigations more
likely to occur.
3)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, this 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.
COMMENTS:
1)PURPOSE OF THIS BILL. According to the author, this bill
stems from a growing and significant concern over the
excessive prescribing of psychotropic medication to foster
youth in California. It follows a series of hearings held by
the California Senate Committees on Health and Human Services
regarding the oversight and monitoring of psychotropic
medication and mental health services for youth in foster
care. Even with the growing attention to this situation, the
problem is now more severe than ever and California's 63,000
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foster youth are the ones who are suffering the consequences
of our state's inaction and lack of oversight over the past 15
years. According to the author, despite our current
safeguards in place - the JV-220 process, whereby judges
decide what medications and at what dosage are provided to
foster youth, over the past fifteen years the rate of foster
youth prescribed psychotropic medication has increased 14
fold. The author states that nearly one in four California
foster teens are prescribed psychotropic drugs; of those
nearly 60% were prescribed an anti-psychotic (an estimated 75%
of them for an off label use) and 36% are prescribed multiple
medications.
The author states that, as reported by the San Jose Mercury
News, the federal Food and Drug Administration authorizes
antipsychotics for children only in cases of severe mental
illness, but evidence suggests medical professionals often
prescribe them to California foster children for behavior
problems. According to the author, California spends more on
psychotropic drugs for foster children than on any other kind
of medication. In the last decade, the state spent more than
$226 million on psychotropic meds for foster children, 72% of
total drug spending for this population. Additionally, there
are substantial long-term costs of treating side effects
associated with these medications. Furthermore, teens in
foster care are three and a half times more likely to be
prescribed psych medication than their peers who are not in
foster care. While the federal Child and Family Services
Improvement and Innovation Act of 2011 requires each state to
oversee and monitor the use of psychotropic medications,
California currently has no requirements to identify those who
are over-prescribing medication to foster youth. California
has no system for evaluating the medical soundness of high
rates of prescribing; and no way to measure the efficacy of
these practices.
According to the author, this is unacceptable given that it is
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the state's responsibility, as the guardian to these children,
to monitor the administration of these drugs and to ensure the
health and well-being of foster children. In response to
legislative pressure, MBC and DHCS adopted a one-year trial
Data Use Agreement (DUA) that allows for the sharing of
prescriber data in order to identify the outlying prescribers.
The author argues that such data sharing practices should not
be on a one-time basis, but rather an ongoing process for
improving the quality of prescribing and that this bill
establishes a formal, on-going, process for MBC to
responsively review and confidentially investigate
psychotropic medication prescription patterns outside the
standard of care. With this ongoing data sharing agreement
with DHCS, MBC will have regular, reliable information to work
from instead of depending on the current individual complaint
process.
2)BACKGROUND. For a number of years, the California
Legislature, as well as, the federal government have focused
attention on improving conditions for children in the foster
care system. Among those concerns is the high rate of
prescribing of psychotropic drugs to foster youths. In
February 2014, the Senate Human Services Committee and the
Select Committee on Mental Health held an informational
hearing entitled, "Misuse of Psychotropic Medication in Foster
Care: Improving Child Welfare Oversight and Outcomes within
the Continuum of Care" that highlighted concerns regarding a
statewide trend toward increased prescribing of psychotropic
medications. The hearing included testimony indicating that
California's child welfare and children's mental health
systems are over-reliant on psychotropic medication among
foster youth and do not effectively manage the provision of
such medication leading to unnecessary prescribing,
inappropriately high dosages of medication for children, and
inappropriate use of multiple medications, and usage occurring
at longer durations than appropriate. In response to these
concerns, the hearing focused on oversight of individual
cases, including court authorization procedures which informed
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the development of several bills under consideration by the
Legislature. Additionally, the hearing highlighted concerns
that breakdowns in the provision of effective trauma-informed
psychosocial services has led to system-wide failures in
treating children and youth who later suffer from
trauma-related behavioral health challenges, for which
medication is seen as the only available treatment option.
In August 2015, the Senate Human Services and Health
Committees held a second hearing entitled "Psychotropic
Medication and Mental Health Services for Foster Youth:
Seeking Solutions for a Broken System" that focused on system
wide standards and oversight tools used by state and local
agencies in evaluating the effectiveness of county mental
health plans, county child welfare agencies, contracted
providers, and individual prescribers in providing access to a
broad spectrum of timely, effective, trauma-informed
psychosocial services that minimize the need for psychotropic
medication.
3)Media Reports. A recent series of stories published in the
San Jose Mercury News and most recently in the Los Angeles
Times, highlighted growing concerns that psychotropic
medications have been relied on by California's child welfare
and children's mental health systems as a means of
controlling, instead of treating, youth who suffer from
trauma-related behavioral health challenges. These articles
detailed significant challenges in accessing pharmacy benefits
claims data held by the DHCS, eventually overcome through a
Public Records Act request and lengthy negotiations, and
demonstrated that prescribing rates were far higher than had
been anticipated by child welfare system experts.
4)Court Oversight Mechanisms. SB 543 (Bowen), Chapter 552,
Statutes of 1999, mandated that, once a child has been
adjudged a dependent of the state, only the court may
authorize psychotropic medications for the child, based on a
request from a physician that includes the following:
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a) The reasons for the request;
b) A description of the child's diagnosis and behavior;
c) The expected results of the medication; and,
d) A description of any side effects of the medication.
Under SB 543, psychotropic medications are defined as those
"administered for the purpose of affecting the central nervous
system to treat psychiatric disorders or illnesses." In
accordance with SB 543, the Administrative Office of the
Courts established a series of court documents generally
referred to as "the JV 220," which includes a statement
completed and signed by the prescribing physician that
includes the child's diagnosis, relevant medical history,
other therapeutic services, the medication to be administered,
and the basis for the recommendation.
In addition, a form must be included indicating notice has
been provided to the parents or legal guardians, their
attorneys of record, the child's attorney of record, the
child's guardian ad litem, the child's current caregiver, the
child's CASA, if any, and if a child has been determined to be
a Native American child, the child's tribe. The procedure for
notification varies by county - the responsibility may fall
primarily to the child welfare agency, or it may be shared
with the juvenile court clerk's office that may be responsible
for notifying the attorney and the CASA. Within four court
days after notification, a parent or guardian, the child, the
attorney for either, the guardian ad litem, or the Indian
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child's tribe may file an objection to the application.
Following this period, the court files a final order.
5)Quality Improvement Project. In 2012, DHCS and DSS convened a
statewide Quality Improvement Project (QIP) to design, pilot,
and evaluate effective practices to improve psychotropic
medication use among children and youth in foster care. Three
workgroups were established for the project-the Clinical
Workgroup, the Data and Technology Workgroup, and the Youth,
Family, and Education Workgroup to jointly conduct analysis of
child welfare data, develop tools to assist prescribers,
pharmacists, and juvenile courts, as well as develop and
disseminate training materials and information about
psychotropic medications for youths and caregivers.
QIP's Data and Technology Workgroup released a summary report in
December 2014 matching data from CWS/Case Management System
and DHCS that detailed fee-for-service and Medi-Cal managed
care encounter data pharmacy paid claim records for
psychotropic medication for children in foster care during
Federal Fiscal Year (FFY) 2012-13. The report found that of
10,557 children (under the age of 21) in California who
received at least one paid claim for psychotropic medication
during FFY 2012-13, 10,419 (or 98%) of these children were
identified as youth in an active out-of-home placement. The
report further broke down the data based on age, gender,
ethnic group, placement type, responsible agency, time in
care, and time in placement.
Although the data produced a wide scope of the breakdown
surrounding psychotropic drug prescriptions to foster youth,
the report also cautions that there are a number of key
analytical considerations when reviewing the data. The report
states that the figures presented are not necessarily
representative of youth for whom court authorizations for
psychotropic medications are required, as it includes youths
aged 18-20 years old placed with non-dependent legal guardians
and other non-foster care placements as well as youth for whom
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court authorizations for psychotropic medications are
required. In addition, the report states that since only the
most recent paid claim for youth under 21 years old was used
to examine the case and placement information, this data might
not necessarily be reflective of their experience in care or
the experiences of youth before and after the period of study.
6)Guidelines. The QIP's Clinical Workgroup released a set of
guidelines to assist prescribers and caregivers in maintaining
compliance with state and county regulations and guidelines
pertaining to Medi-Cal funded mental health services and
psychotropic prescribing practices for foster homes, group
homes, and residential treatment centers. In addition, the
guidelines include prescriber and caregiver expectations
regarding developing and monitoring treatment plans for
behavioral health care, principles for informed consent to
medications, and governing medication safety. These
guidelines are designed as a statement of best practice for
the treatment of children and youth in out-of-home care and
include:
a) Prescribing standards for psychotropic medication by age
group;
b) Parameters for psychotropic medication indications,
dosing, and monitoring;
c) Recommendations to address challenges in the management
of complex cases; and,
d) Decision "algorithm" to be used by prescribers.
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7)Efforts in Other States. According to information provided by
the author, a number of other states have taken action to
address concerns about psychotropic medication. Alabama
provides a focused mailing to prescribers of any
antipsychotics to children under 18, as well as telephone
outreach by child psychiatrists to prescribers of
antipsychotics to children under age five. Colorado sends
educational alerts and letters to prescribers detailing
information about the psychiatric medication utilization of
their patients. In Colorado, if post-intervention changes are
not observed, follow-up letters and face-to-face meetings with
peer consultants are conducted. Illinois maintains a
watch-list of high-risk prescribers, utilizing this data to
assess the impact of changes in consent policies on prescriber
behaviors. Michigan created a system whereby child
psychiatrists follow-up with prescribing physicians based on
established triggers to review the case and provide
consultation. Missouri uses the Behavioral Pharmacy
Management System to analyze prescribing patterns for children
and adolescents and send letters to prescribers offering
consultation on best prescribing practices. An analysis of
this intervention showed a significant reduction in the
percentage of outlier prescriptions.
8)MBC Guidance on Psychotropic Medication. MBC has made
available to all licensees on its Website, as well as through
an email to its licensee listserv the QIP's Guidelines for the
Use of Psychotropic Medication with Children and Youth in
Foster Care which states that "the use of psychotropic
medication for children and youth is considered a non-routine
intervention, used under specified circumstances and as only
one strategy within a larger, more comprehensive treatment
plan to provide for that child's safety and well-being."
MBC's responsibilities in overseeing their licensees'
prescribing habits of psychotropic medications to foster youth
are also a component of an audit currently being conducted by
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the California State Auditor pertaining to the oversight and
monitoring of children in foster care who have been prescribed
psychotropic medications.
Strategies were discussed at the October 2015 MBC meeting to
help identify physicians who may be inappropriately
prescribing psychotropic medications to foster youth as well
as identify additional information needed from DHCS and DSS.
However, there were concerns raised about the expectations of
physicians based on the quality of information in the QIP's
Psychotropic Data Match Report. The MBC has expressed
concerns that the data presented in the report may not be
sufficient to make a decision as to appropriate prescribing
practices for physicians working with foster youth.
MBC has, in the meantime, developed a notification process
whereby individuals in the healthcare delivery system for
foster youths can directly contact MBC staff if they believe a
physician is inappropriately prescribing medication to
children in foster care. After a complaint or notification is
made, MBC staff will directly contact DSS to obtain all
de-identified patient information for the foster child and the
prescriber. MBC can then determine whether or not it will
need patient records. DSS and the MBC can then obtain these
patient records through a court order so that MBC can proceed
with an investigation into the prescribing physician.
9)Data Sharing Efforts. MBC currently has a DUA with DHCS and
DSS in order to allow the MBC to receive information that does
not breach the confidentiality of a patient. The agreement is
based on conversations dating back to 2014 regarding the data
needed for the MBC to identify physicians who may be
inappropriately prescribing psychotropic medications to foster
children. Upon receipt of its first set of data under the
DUA, MBC enlisted a pediatric psychiatrist review the data.
The physician determined that the information provided through
the agreement was not substantive enough to allow MBC to
identify instances of any inappropriate prescribing and noted
that additional information to assist in this effort would
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include the diagnosis associated with medication prescribed,
the dosage of medication prescribed, the schedule or timing of
dosage of medication prescribed and the weight of child or
adolescent.
10)STATE AUDITOR. The California State Auditor (CSA) is
currently engaged in an audit of foster youth and psychotropic
medication. It is expected to be released in July or August
of this year. According to the CSA Website, the audit will
provide independently developed and verified information
related to DSS, DHCS, and a selection of county CWS agencies'
oversight and monitoring of foster children who have been
prescribed psychotropic medications, as well as a review of
the availability and adequacy of other supportive services,
such as mental health and substance abuse counseling. The
audit will select and review four county CWS agencies-two
counties identified as having a high prevalence of the use of
psychotropic medications for foster children and two counties
with a correspondingly low prevalence. The audit will also
determine whether any other states have implemented
innovations or oversight systems that have successfully
reduced the use of psychotropic medications in foster children
or improved their access to non-pharmacological supports, and
evaluate whether California could benefit from some of these
policies or practices.
11)SUPPORT. The National Center for Youth Law (NCYL), the
sponsor of this bill, argues that nearly one in four
California foster teens are prescribed psychotropic drugs; of
those nearly 60% were prescribed an anti-psychotic - the
powerful drug class most susceptible to debilitating side
effects. While the vast majority of doctors prescribing
medication are doing so appropriately, California still needs
an oversight mechanism (among other reforms including funding
robust trauma care services). Currently, California has no
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system for evaluating the medical soundness of high rates of
prescribing; and no way to measure the efficacy of these
practices. NCYL noted that last year, DHCS and MBC adopted a
one-year trial DUA that allows for the sharing of prescriber
data in order to identify outlying prescribers. NCYL argues
that such data sharing practices should not be on a one-time
basis, but rather an ongoing process for improving the quality
of prescribing for our children. This will enable MBC to
confidentially collect and analyze data, and, when warranted,
conduct investigations of physicians who frequently prescribe
over the recognized safety parameters for children. Advokids,
states in support of this bill that it operates the only free
statewide telephone hotline providing legal information to
anyone concerned about a foster child, and receives a high
volume of calls from caregivers who are concerned about the
lack of mental health services available to their foster
children, many of whom have experienced multiple traumas in
their lives. Advokids argues for high quality, accessible
mental health services for foster children and the careful
collection of data surrounding psychotropic medications to
ensure the physical and emotional safety of foster youth and
when warranted to investigate physicians who frequently
prescribe over the recognized safety parameters for children.
12)SUPPORT IF AMENDED. MBC has a support if amended position on
this bill. MBC requests additional information (included in
the most recent version of this bill) and a sunset date so MBC
can determine if the data provided is useful. MBC also has
requested that the author amend this bill so that the
education component is handled by DHCS since they are the
Medi-Cal prescribers and the guidelines were created by DHCS
and DSS. MBC notes that any information that can help MBC
identify inappropriate prescribing can be utilized as a tool
for MBC to use in its complaint and investigation process.
However, once a possible inappropriate prescriber is
identified, MBC will still have to go through its normal
complaint and investigation process.
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13)OPPOSE UNLESS AMENDED. The California Academy of Child and
Adolescent Psychiatry (CACAP) believes that initiating
investigations as proposed will ultimately target prescribing
physicians who specialize with patients with severe mental
health difficulties. CACAP argues that it is unclear how MBC
would make a basis for an accusation of unprofessional conduct
on the data that is proposed to be provided. Additionally,
this process would also discourage physicians from prescribing
a psychotropic medication even when, in their professional
judgement, it is in the best interest for the child. An
investigation by MBC is a significant event. Even if the
investigation should not result in disciplinary action,
questions regarding whether or not a physician has ever been
investigated by MBC come up often in interviews and
credentialing reviews. While these red flag aren't as serious
as a filed accusation, we believe the envisioned process will
have a negative impact on the ability of the Medi-Cal system
to recruit and retain high quality providers for Medi-Cal and
Foster youth. The California Medical Association argues that
this bill adds another bureaucratic layer to a process that is
already highly regulated. Currently, before a prescription
for psychotropic medication can be administered to a foster
youth, a judge must first approve a court order based on the
JV-220 and then a Treatment Authorization Request must be
submitted to DHCS to be reviewed by a pharmacist to ensure
that the prescription is medically necessary. This process
will soon be improved, as required by SB 238 (Mitchell),
Chapter 534, Statutes of 2015, with even more information
included on the JV-220 to better assist the court.
14)PREVIOUS LEGISLATION.
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a) SB 238 requires certification and training programs for
foster parents, child welfare social workers, group home
administrators, public health nurses, dependency court
judges and court appointed council to include training on
psychotropic medication, trauma, and behavioral health, as
specified, for children receiving CWS. SB 238 also
requires the Judicial Council to amend and adopt rules of
court and develop appropriate forms pertaining to the
authorization of psychotropic medication for foster youth,
on or before July 1, 2016.
b) SB 253 (Monning) of 2015 would have revised and
strengthened, as juvenile court oversight requirements for
administration of psychotropic medications to wards and
dependents. SB 253 was placed on the Assembly inactive
file.
c) SB 484 (Beall), Chapter 540, Statutes of 2015, requires
DSS to establish a methodology for identifying group homes
that have levels of psychotropic dug utilization warranting
additional review, and to inspect identified facilities at
least once a year, as specified. The bill permitted DSS to
share information and observations with the facility and to
require the facility to submit a plan within 30 days to
address identified risks, as specified.
d) SB 319 (Beall), Chapter 535, Statutes of 2015, expands
the duties of the foster care public health nurse to
include monitoring and oversight of the administration of
psychotropic medication to foster children, as specified.
15)QUESTIONS AND COMMENTS.
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a) According to the author and sponsor, the intent of this
bill is to protect foster youth. However, as drafted, this
bill would apply to all Medi-Cal beneficiaries under age 18
years. The author has agreed to amend this bill so it's
application is limited to foster youth by the following
amendments:
On page 5, line 1, insert between "services" and "using":
for individuals described in subparagraph (B) and (C) of
paragraph (1) of subdivision (b).
On page 5, delete lines 29-30.
b) In response to MBC's concern about providing education,
the author proposes the following amendment: On page 4,
delete lines 13-16 and replace with:
(b) The [State] Department of Health Care Services shall
disseminate guidelines on an annual basis via email to any
prescriber who meets the data requirement threshold for
prescribing of psychotropic medications to children and
adolescents established in subdivision (c) of Section 14028 of
the Welfare and Institutions Code.
c) Information about activities in other states that the
author has provided to the Committee suggests that
individual educational outreach including telephone calls
from child psychiatrists, face-to-face meetings, and
consultations on best prescribing practices. Should
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educational endeavors such as these be included in this
bill?
16)DOUBLE REFERRAL. This bill has been double-referred. Should
this bill pass out of this Committee, it will be referred to
the Assembly Business and Professions Committee.
REGISTERED SUPPORT / OPPOSITION:
Support
National Center for Youth Law (sponsor)
Advokids
Bay Area Youth Center
Family Voices of California
Kids in Common, Planned Parenthood Mar Monte
Madera County Department of Social Services
Peers Envisioning and Engaging in Recovery Services
California Youth Connection
Consumer Attorneys of California
SB 1174
Page 22
Consumer Watchdog
First Focus Campaign for Children
John Burton Foundation
Therapists for Peace and Justice
Western Center on Law and Poverty
Woodland Community College Foster and Kinship Care Education
Youth Law Center
1 Individual
Opposition
California Academy of Child & Adolescent Psychiatry
California Medical Association
SB 1174
Page 23
Analysis Prepared by:John Gilman / HEALTH / (916)
319-2097