California Senate Bill SB484 Amended / Bill

 BILL NUMBER: SB 484AMENDED BILL TEXT AMENDED IN ASSEMBLY AUGUST 28, 2015 AMENDED IN ASSEMBLY JULY 8, 2015 AMENDED IN SENATE JUNE 2, 2015 AMENDED IN SENATE APRIL 22, 2015 INTRODUCED BY Senator Beall (Principal coauthor: Assembly Member Chiu) (Coauthors: Senators Mitchell and Monning) FEBRUARY 26, 2015 An act to amend  Section   Sections 1507.6 and  1536 of, and to add Sections 1538.8 and 1538.9 to, the Health and Safety Code, and to amend Section 11469 of the Welfare and Institutions Code, relating to juveniles. LEGISLATIVE COUNSEL'S DIGEST SB 484, as amended, Beall. Juveniles. (1) The California Community Care Facilities Act provides for the licensure and regulation of community care facilities, including foster family homes and group homes, by the State Department of Social Services. A violation of this act is a misdemeanor.  Under existing law, a child in a group home may receive mental health services, as deemed necessary by the placing agency and under the case management of that agency. Under existing law, only a juvenile court judicial officer may make orders regarding the administration of psychotropic medications to a child adjudged a dependent or ward of the court and removed from the physical custody of the parent. Existing law requires that the order be based on a request from a physician, indicating the reasons for the request and a description of the child's diagnosis and behavior, among other requirements.   This bill would provide that psychotropic medications may be used at a group home, other than at a runaway and homeless youth shelter, only in accordance with the written directions of the physician prescribing the medication and as authorized by the juvenile court. The bill would require the group home to maintain in the child's records specified information regarding the administration of those medications.   (2)    Existing law requires the  department director,   Director of Social Services,  at least annually, to publish and make available to interested persons a list covering all licensed community care facilities, except as specified, and the services for which each facility has been licensed or issued a special permit. This bill would require the department  director  to compile specified information regarding the administration of psychotropic medications to children in  those facilities   group homes  and to post that information  to   on  the department's Internet Web site. The bill would require the  department   department, in consultation with the State Department of Health Care Services and stakeholders,  to establish a methodology to identify those group homes that have disproportionately high and inappropriate  levels of psychotropic drug  usage, based on specified criteria.   utilization warranting additional review, as specified.  The bill would also require the department, for the facilities identified by the methodology that it establishes, to visit those facilities at least once a year to examine specified factors. The bill would require a  facility that is found to have disproportionately high and inappropriate levels of psychotropic drug usage, which may be caused by inadequate alternative and less invasive psychosocial services, crisis management, and other services,   facility, for which the department, based on that inspection, finds a risk to the health, safety, or personal rights of clients in care,  to submit a plan  of correction  to  address steps the facility shall take to reduce inappropriate prescribing and treatment regimens   the department  within 30 days of receiving notice of the department's  determination.   findings.  The bill would require the department to monitor the facility's implementation of that plan  of correction   and make a report, as provided.   to determine that the concerns identified during the inspection have been addressed.  Because  this bill would create a new crime,   the   failure of the facility to comply with these provisions would be a misdemeanor,  the bill would impose a state-mandated local program.  (2)   (3)  Existing law requires the department, on or before January 1, 2016, in consultation with specified associations and other stakeholders, to develop additional performance standards and outcome measures that require group homes to implement programs and services to minimize law enforcement contacts with minors in group homes or under supervision of group home staff. This bill would require the department, on or before January 1, 2017, in consultation with specified associations and other stakeholders, to develop additional performance standards and outcome measures that require group homes to implement  alternative  programs and  services to reduce utilization of psychotropic medications for children in group homes. The bill would also delete an obsolete provision.   services, as specified.   (3)   (4)  The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement. This bill would provide that no reimbursement is required by this act for a specified reason. Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: yes. THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:  SECTION 1.   Section 1507.6 of the   Health and Safety Code   is amended to read:  1507.6.  (a)    Mental health services, as deemed necessary by the placing agency, may be provided to children in a group home. Except for the physical safety and direct care and supervision of children so placed, the State Department of Social Services and its agents shall not evaluate or have responsibility or liability for the evaluation of mental health services provided in those homes. Supervision of mental health treatment services provided to a child in a group home shall be a case management responsibility of the placing agency.  (b) (1) Psychotropic medications shall be used only in accordance with the written directions of the physician prescribing the medication and as authorized by the juvenile court pursuant to Section 369.5 or 739.5 of the Welfare and Institutions Code.   (2) The facility shall maintain in a child's records all of the following information:   (A) A copy of any court order authorizing the psychotropic medication for the child.   (B) A separate log for each psychotropic medication prescribed for the child, showing all of the following:   (i) The name of the medication.   (ii) The date of the prescription.   (iii) The quantity of medication and number of refills initially prescribed.   (iv) When applicable, any additional refills prescribed.   (v) The required dosage and directions for use as specified in writing by the physician prescribing the medication, including any changes directed by the physician.   (vi) The date and time of each dose taken by the child.   (3) This subdivision does not apply to a runaway and homeless youth shelter, as defined in Section 1502.   SECTION 1.   SEC. 2.  Section 1536 of the Health and Safety Code is amended to read: 1536. (a) (1) At least annually, the  director   department  shall publish and make available to interested persons a list or lists covering all licensed community care facilities, other than foster family homes and certified family homes of foster family agencies providing 24-hour care for six or fewer foster children, and the services for which each facility has been licensed or issued a special permit. (2) For a group home, transitional housing placement provider, community treatment facility, or runaway and homeless youth shelter, the list shall include both of the following: (A) The number of licensing complaints, types of complaint, and outcomes of complaints, including citations, fines, exclusion orders, license suspensions, revocations, and surrenders. (B) The number, types, and outcomes of law enforcement contacts made by the facility staff or children, as reported pursuant to subdivision (a) of Section 1538.7. (b) Subject to subdivision (c), to encourage the recruitment of foster family homes and certified family homes of foster family agencies, protect their personal privacy, and to preserve the security and confidentiality of the placements in the homes, the names, addresses, and other identifying information of facilities licensed as foster family homes and certified family homes of foster family agencies providing 24-hour care for six or fewer children shall be considered personal information for purposes of the Information Practices Act of 1977 (Chapter 1 (commencing with Section 1798) of Title 1.8 of Part 4 of Division 3 of the Civil Code). This information shall not be disclosed by any state or local agency pursuant to the California Public Records Act (Chapter 3.5 (commencing with Section 6250) of Division 7 of Title 1 of the Government Code), except as necessary for administering the licensing program, facilitating the placement of children in these facilities, and providing names and addresses only to bona fide professional foster parent organizations upon request. (c) Notwithstanding subdivision (b), the department, a county, or a foster family agency may request information from, or divulge information to, the department, a county, or a foster family agency, regarding a prospective certified parent, foster parent, or relative caregiver for the purpose of, and as necessary to, conduct a reference check to determine whether it is safe and appropriate to license, certify, or approve an applicant to be a certified parent, foster parent, or relative caregiver. (d) The department may issue a citation and, after the issuance of that citation, may assess a civil penalty of fifty dollars ($50) per day for each instance of a foster family agency's failure to provide the department with the information required by subdivision (h) of Section 88061 of Title 22 of the California Code of Regulations. (e) The Legislature encourages the department, when funds are available for this purpose, to develop a database that would include all of the following information: (1) Monthly reports by a foster family agency regarding family homes. (2) A log of family homes certified and decertified, provided by a foster family agency to the department. (3) Notification by a foster family agency to the department informing the department of a foster family agency's determination to decertify a certified family home due to any of the following actions by the certified family parent: (A) Violating licensing rules and regulations. (B) Aiding, abetting, or permitting the violation of licensing rules and regulations. (C) Conducting oneself in a way that is inimical to the health, morals, welfare, or safety of a child placed in that certified family home. (D) Being convicted of a crime while a certified family parent. (E) Knowingly allowing any child to have illegal drugs or alcohol. (F) Committing an act of child abuse or neglect or an act of violence against another person. (f) At least annually, the department shall post  to   on  its Internet Web site a statewide summary  report  of the  data   information  gathered pursuant to Sections 1538.8 and 1538.9. The summary  report  shall  exclude all personally identifiable information and shall not identify individual group homes.   include only de-identified and aggregate information that does not violate the confidentiality of a child's identity and records.   SEC. 2.   SEC. 3.  Section 1538.8 is added to the Health and Safety Code, to read: 1538.8. (a)  (1)    In order to  identify group homes in which   review and evaluate the use of  psychotropic medications  may be inappropriately administered to children the director   in group homes, the department  shall compile,  to the extent feasible and not otherwise prohibited by law and based on information received from the State Department of Health Care Services,  at least annually,  the following  information concerning each  home:   group home, including, but not limited to, the child welfare psychotropic medication measures developed by the department and the following Healthcare Effectiveness Data and Information Set (HEDIS) measures related to psychotropic medications:   (1) The number of children in the facility to whom psychotropic medications were administered.   (2) The number of children in the facility who are 6 to 11 years of age, inclusive, to whom psychotropic medications were administered.   (3) The number of children in the facility who are 12 to 17 years of age, inclusive, to whom psychotropic medications were administered.  (4) The number of children for whom the juvenile court preauthorized the administration of psychotropic medication.   (5) The number of children to whom psychotropic medications were administered on an emergency basis.   (6) The number of children to whom antipsychotic, mood stabilizing, or antidepressant medications were administered.   (7) The number of children who received two or more drugs from the same class, including, but not limited to, antidepressants, antipsychotics, and antianxiety medications.   (8) The number of children who received two or more psychotropic medications concurrently, and whether those children received two, three, four, or more than four psychotropic medications concurrently.   (9) The number of children who received one or more medications for more than 90 days.   (10) The number of children who received psychosocial services while in a group home placement while they received a psychotropic medication.   (11) The number of children who received a dosage of a psychotropic medication at a dosage above the maximum dosage approved by the federal Food and Drug Administration.   (12) The number of children who received metabolic monitoring in accordance with professional standards of care while they received psychotropic medication.   (13) The number of children who were prescribed antipsychotic medications for a use not approved by the federal Food and Drug Administration.   (A) Follow-Up Care for Children Prescribed Attention Deficit Hyperactivity Disorder Medication (HEDIS ADD), which measures the number of children six to 12 years of age, inclusive, who have a visit with a provider with prescribing authority within 30 days of the new prescription.   (B) Use of Multiple Concurrent Antipsychotics in Children and Adolescents (HEDIS APC), which does both of the following:   (i) Measures the number of children receiving an antipsychotic medication for at least 60 out of 90 days and the number of children who additionally receive a second antipsychotic medication that overlaps with the first.   (ii) Reports a total rate and age stratifications including 6 to 11 years of age, inclusive, and 12 to 17 years of age, inclusive.   (C) Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics (HEDIS APP), which measures whether a child has received psychosocial services 90 days before through 30 days after receiving a new prescription for an antipsychotic medication.   (D) Metabolic Monitoring for Children and Adolescents on Antipsychotics (HEDIS APM), which does both of the following:   (i) Measures testing for glucose or HbA1c and lipid or cholesterol of a child who has received at least two different antipsychotic prescriptions on different days.   (ii) Reports a total rate and age stratifications including 6 to 11 years of age, inclusive, and 12 to 17 years of age, inclusive.   (2) The department shall post the list of data to be collected pursuant to this subdivision on the department's Internet Web site.  (b) The data in subdivision (a) concerning psychotropic medication, mental health services, and placement shall be drawn from existing data  systems, including, but not limited to, the Medicaid Management Information System's medical and pharmacy claims data, and the Child Welfare Services/Case Management System, through the data sharing agreement between   maintained by  the State Department of Health Care Services and the State Department of Social  Services.   Services and shared pursuant to a data sharing agreement meeting the requirements of all applicable state and federal laws and regulations.   (c) This section does not apply to a runaway and homeless youth shelter, as defined in Section 1502.   SEC. 3.   SEC. 4.  Section 1538.9 is added to the Health and Safety Code, to read: 1538.9. (a) (1) (A) The department shall consult with the  foster care ombudsman   State Department of Health Care Services and  the Quality Improvement Project Clinical Workgroup   stakeholders  to establish a methodology for identifying those group homes  providing services under the AFDC-FC program pursuant to Sections 11460 and 11462 of the Welfare and Institutions Code  that have  disproportionately high and inappropriate  levels of psychotropic drug  usage   utilization  warranting additional  review of the facility. The criteria for determining if a group home has disproportionately high and inappropriate levels of psychotropic drug usage shall be based upon the  California Guidelines for the Use of Psychotropic Medication with Children and Youth in Foster Care  and shall take into consideration, among other things, the factors listed in paragraphs (1) to (13), inclusive, of subdivision (a) of Section 1538.8.   review.  The methodology shall be adopted on or before July 1, 2016. (B) Every three years after adopting the methodology developed under subparagraph (A), or earlier if needed, the department shall consult with the  foster care ombudsman and the Quality Improvement Project Clinical Workgroup  State Department of Health Care Services and stakeholders  and revise the  methodology.   methodology, if necessary.  (2) If the department, applying the methodology described in paragraph (1), determines that a facility appears to have  disproportionately high and inappropriate  levels of psychotropic drug  usage, which may be caused by, among other things, inadequate alternative and less invasive psychosocial services, crisis management, and other services,   utilization warranting additional review,  it shall inspect the facility at least once a year. (3) The inspection of the facility shall include, but not be limited to,  a review of  the following:  (A) A review of the facility's:   (i)   (A)  Plan of operation, policies, procedures, and practices.  (ii)   (B)  Child-to-staff ratios.  (iii)   (C)  Staff qualifications and training.  (iv)   (D)  Implementation of children's needs and services plan.  (v)   (E)  Availability of psychosocial and other alternative treatments to the use of psychotropic medications.  (vi)   (F)  Other factors that the department determines contribute to  disproportionately high and inappropriate  levels of psychotropic drug  usage.   utilization that warrant additional review.   (B)   (G)  Confidential interviews  with youth   of children  residing in the facility at the time of the  inspection, with youth who resided in the facility within the last six months, and confidential discussions with physicians identified as prescribing the medications. The State Department of Health Care Services and the State Department of Social Services shall, using existing data systems, identify prescribers' names, addresses, and contact information in order to facilitate interviews with prescribers.   inspection.   (b) If, as a result of an inspection pursuant to subdivision (a), the department finds, based on measures established pursuant to this section, that the facility has disproportionately high and inappropriate levels of psychotropic drug usage, which may be caused by, among other things, inadequate alternative and less invasive psychosocial services, crisis management, and other services, the facility shall submit to the department a plan of correction describing the steps it shall take to reduce or eliminate inappropriate psychotropic drug usage. The plan of correction shall be submitted to the department within 30 days after the facility has received the department's notice of a determination of disproportionately high and inappropriate levels of psychotropic drug usage at the facility. The plan of correction may include, but not be limited to, the following:   (1) An improved crisis management plan, including deescalation techniques and procedures in which their staff will be trained.   (2) An overall behavioral management plan which shall be a trauma-informed plan.   (3) A quantifiable goal to decrease the use of antipsychotic medications for behavioral control, to decrease polypharmacy, and to decrease the use of pro re nata medications.   (4) A quantifiable goal for improving appropriate metabolic monitoring as set forth in the California Guidelines for the Use of Psychotropic Medication with Children and Youth in Foster Care, and increasing psychosocial, physical, mental, behavioral, and nutritional services for children prescribed psychotropic medications while placed in that facility.   (c) The department shall monitor a facility's implementation of the plan submitted pursuant to subdivision (b) to determine all of the following:   (1) Whether the facility has reduced the rate at which residents are administered pro re nata, multiple, and off-label psychotropic medications, and, if so, the percentage decrease in the administration of those medications.   (2) Whether and to what extent alternative, less invasive treatments are being provided to residents, and, if so, the percentage increase in the provision of those services.   (3) Whether and to what extent appropriate metabolic monitoring is being conducted and, if so, the percentage increase in the provision of appropriate monitoring.   (d) (1) Following an inspection pursuant to subdivision (a), the Community Care Licensing Division shall provide a report to the department's Children and Family Services Division and to any other public agency that has certified the facility's program or any component of the facility's program, including, but not limited to, the State Department of Health Care Services, which certifies group homes pursuant to Section 4096.5 of the Welfare and Institutions Code.   (2) If, as a result of the inspection, the Community Care Licensing Division suspects that a prescriber has failed to comply with Section 2242 of the Business and Professions Code, or with the California Guidelines for the Use of Psychotropic Medication with Children and Youth in Foster Care, it shall report its concerns to the Medical Board of California.   (3) If, as a result of the inspection, the Community Care Licensing Division suspects there has been a violation of applicable requirements prescribed by statutes or regulations of this state, it shall conduct the appropriate investigation pursuant to Section 1538 of the Health and Safety Code.   (4) The inspection of the facility may include, but is not limited to, the following:   (A) Confidential interviews of children who resided in the facility within the last six months.   (B) Confidential discussions with physicians identified as prescribing the medications.   (b) Based upon an inspection conducted pursuant to subdivision (a), the department shall share relevant information or observations with county placing agencies, social workers, probation officers, the court, dependency counsel, or the Medical Board of California. If, as a result of the inspection conducted pursuant to subdivision (a), the department finds a risk to the health, safety, or personal rights of clients in care, the facility shall submit a plan of correction to the department. The plan of correction shall be submitted to the department within 30 days after the facility has received the department's notice of findings. The department shall monitor the implementation of the plan of correction to determine that the concerns identified during the inspection have been addressed. This subdivision does not prevent the department from taking any other corrective action as permitted under any other law or any regulation adopted pursuant to this chapter.   (e)   (c)  (1) Notwithstanding the rulemaking provisions of the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code), until emergency regulations are filed with the Secretary of State, the department may implement this section through all-county letters or similar  instructions from the director.   instructions.  (2) On or before January 1, 2017, the department shall adopt regulations to implement this section. The initial adoption, amendment, or repeal of a regulation authorized by this subdivision is deemed to address an emergency, for purposes of Sections 11346.1 and 11349.6 of the Government Code, and the department is hereby exempted for that purpose from the requirements of subdivision (b) of Section 11346.1 of the Government Code. After the initial adoption, amendment, or repeal of an emergency regulation pursuant to this section, the department may twice request approval from the Office of Administrative Law to readopt the regulation as an emergency regulation pursuant to Section 11346.1 of the Government Code. The department shall adopt final regulations on or before January 1, 2018.  (f)   (d)  Nothing in this section is intended to replace or alter other requirements for responding to complaints and making inspections or visits to group homes, including, but not limited to, those set forth in Sections 1534 and 1538.  (e) This section does not apply to a runaway and homeless youth shelter, as defined in Section 1502.   SEC. 4.   SEC. 5.  Section 11469 of the Welfare and Institutions Code is amended to read: 11469. (a) The  department, in   department shall develop, following  consultation with group home providers, the County Welfare Directors Association of California, the Chief Probation Officers of California, the  California Mental Health Directors Association, and   County Behavioral Health Directors Association of California,  the State Department of Health Care Services,  shall develop   and stakeholders,  performance standards and outcome measures for determining the effectiveness of the care and supervision, as defined in subdivision (b) of Section 11460, provided by group homes under the AFDC-FC program pursuant to Sections 11460 and 11462. These standards shall be designed to measure group home program performance for the client group that the group home program is designed to serve. (1) The performance standards and outcome measures shall be designed to measure the performance of group home programs in areas over which the programs have some degree of influence, and in other areas of measurable program performance that the department can demonstrate are areas over which group home programs have meaningful managerial or administrative influence. (2) These standards and outcome measures shall include, but are not limited to, the effectiveness of services provided by each group home program, and the extent to which the services provided by the group home assist in obtaining the child welfare case plan objectives for the child. (3) In addition, when the group home provider has identified as part of its program for licensing, ratesetting, or county placement purposes, or has included as a part of a child's case plan by mutual agreement between the group home and the placing agency, specific mental health, education, medical, and other child-related services, the performance standards and outcome measures may also measure the effectiveness of those services. (b) Regulations regarding the implementation of the group home performance standards system required by this section shall be adopted no later than one year prior to implementation. The regulations shall specify both the performance standards system and the manner by which the AFDC-FC rate of a group home program shall be adjusted if performance standards are not met. (c) Except as provided in subdivision (d), effective July 1, 1995, group home performance standards shall be implemented. Any group home program not meeting the performance standards shall have its AFDC-FC rate, set pursuant to Section 11462, adjusted according to the regulations required by this section. (d) A group home program shall be classified at rate classification level 13 or 14 only if all of the following are met: (1) The program generates the requisite number of points for rate classification level 13 or 14. (2) The program only accepts children with special treatment needs as determined through the assessment process pursuant to paragraph (2) of subdivision (a) of Section 11462.01. (3) The program meets the performance standards designed pursuant to this section. (e) Notwithstanding subdivision (c), the group home program performance standards system shall not be implemented prior to the implementation of the AFDC-FC performance standards system. (f) On or before January 1, 2016, the  department, in   department shall develop, following  consultation with the County Welfare Directors Association of California, the Chief Probation Officers of California, the  California Mental Health Directors Association,   County Behavioral Health Directors Association of California,  research entities, foster  youth,   children,  advocates for foster  youth,   children,  foster care provider business entities organized and operated on a nonprofit basis, Indian tribes, and other stakeholders,  shall develop  additional performance standards and outcome measures that require group homes to implement programs and services to minimize law enforcement contacts and delinquency petition filings arising from incidents of allegedly unlawful behavior by minors occurring in group homes or under the supervision of group home staff, including individualized behavior management programs, emergency intervention plans, and conflict resolution processes. (g) On or before January 1, 2017, the  department, in   department shall develop, following  consultation with the County Welfare Directors Association of California, the Chief Probation Officers of California, the  California Mental Health Directors Association,   County Behavioral Health Directors Association of California, the Medical Board of California,  research entities, foster  youth,   children  advocates for foster  youth,   children,  foster care provider business entities organized and operated on a nonprofit basis, Indian tribes, and other stakeholders,  shall develop  additional performance standards and outcome measures that require group homes to implement  alternative  programs and  services to reduce the utilization of psychotropic medications for children in group homes,   services,  including individualized behavior management programs, emergency intervention plans, and conflict resolution processes.  SEC. 5.   SEC. 6.  No reimbursement is required by this act pursuant to Section 6 of Article XIII B of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIII B of the California Constitution.