BILL ANALYSIS Ó
SB 1174
Page 1
Date of Hearing: August 10, 2016
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Lorena Gonzalez, Chair
SB 1174
(McGuire) - As Amended August 3, 2016
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|Policy |Health |Vote:|13 - 0 |
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| |Business and Professions | |16 - 0 |
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Urgency: No State Mandated Local Program: NoReimbursable: No
SUMMARY:
This bill addresses overuse of psychotropic drugs in the foster
care system through data-sharing, analysis, and enforcement.
Specifically, this bill:
1)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
SB 1174
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investigating and prosecuting.
2)Requires the Medical Board of California (MBC) to analyze
Medi-Cal prescribing patterns of psychotropic medications for
foster youth to identify excessive prescribing and, if so
identified, to take appropriate action. Specifically, it
requires MBC to contract for consulting services from a child
psychiatrist with specified credentials.
3)Requires data to be shared with MBC by Department of Health
Care Services (DHCS), in collaboration with the Department of
Social Services (DSS), on an annual basis, and identifies the
minimum data requirements.
FISCAL EFFECT:
Costs to DHCS, MBC, and DSS are expected to be minor and
absorbable, as this bill largely aligns with existing activities
that are not likely to cease in absence of this bill.
COMMENTS:
1)Purpose. 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. This bill is
intended to complement and memorialize existing efforts to
reduce inappropriate prescribing.
SB 1174
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2)Background. There has been significant effort at the state and
federal levels in recent years to improve conditions for
children in the foster care system. One concern is the high
rate of prescribing of psychotropic drugs to foster youths.
Legislative committee hearings were held in 2014 and 2015,
which highlighted overreliance on psychotropic medication
among foster youth, inappropriately high dosages of medication
for children, inappropriate use of multiple medications, and
usage occurring at longer durations than appropriate.
Some current efforts to address the problem include the
following:
a) A 2012 statewide Quality Improvement Project (QIP)
convened DHCS and DSS to design, pilot, and evaluate
effective practices to improve psychotropic medication use
among children and youth in foster care. This project
generated data and guidelines for appropriate use.
b) DHCS and MBC have an existing Data Use Agreement
whereby MBC can receive and analyze Medi-Cal prescribing
data. This bill intends to codify that agreement.
c) MBC has disseminated the guidelines created through
the QIP that specify, among other things, 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."
d) The California State Auditor is currently engaged in
an audit of foster youth and psychotropic medication that
is scheduled to be released later this year.
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3)Support. Advocates for children, foster children, and
consumers support this bill. National Center for Youth Law,
the bill's sponsor, contends 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.
4)Opposition. The California Academy of Child and Adolescent
Psychiatry (Cal-ACAP) express opposition, citing concern that
a broad group of physicians practicing within the standard of
care could be subject to investigation.
5)Prior Legislation. A number of bills have been enacted in
recent years to enhance data-sharing, monitoring, oversight,
and training related to excessive prescribing of psychotropic
medication in the foster system, including SB 238 (Mitchell),
Chapter 534, Statutes of 2015; SB 484 (Beall), Chapter 540,
Statutes of 2015; and SB 319 (Beall), Chapter 535, Statutes of
2015.
Analysis Prepared by:Lisa Murawski / APPR. / (916)
319-2081