83R14889 MCK-F
By: Kolkhorst, N. Gonzalez of El Paso, H.B. No. 915
Burkett, Naishtat, Dukes, et al.
Substitute the following for H.B. No. 915:
By: Zedler C.S.H.B. No. 915
A BILL TO BE ENTITLED
AN ACT
relating to the administration and monitoring of health care
provided to foster children.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 107.002, Family Code, is amended by
adding Subsection (b-1) to read as follows:
(b-1) In addition to the duties required by Subsection (b),
a guardian ad litem appointed for a child in a proceeding under
Chapter 262 or 263 shall:
(1) review the medical care provided to the child; and
(2) in a developmentally appropriate manner, seek to
elicit the child's opinion on the medical care provided.
SECTION 2. Section 107.003, Family Code, is amended to read
as follows:
Sec. 107.003. POWERS AND DUTIES OF ATTORNEY AD LITEM FOR
CHILD AND AMICUS ATTORNEY. (a) An attorney ad litem appointed to
represent a child or an amicus attorney appointed to assist the
court:
(1) shall:
(A) subject to Rules 4.02, 4.03, and 4.04, Texas
Disciplinary Rules of Professional Conduct, and within a reasonable
time after the appointment, interview:
(i) the child in a developmentally
appropriate manner, if the child is four years of age or older;
(ii) each person who has significant
knowledge of the child's history and condition, including any
foster parent of the child; and
(iii) the parties to the suit;
(B) seek to elicit in a developmentally
appropriate manner the child's expressed objectives of
representation;
(C) consider the impact on the child in
formulating the attorney's presentation of the child's expressed
objectives of representation to the court;
(D) investigate the facts of the case to the
extent the attorney considers appropriate;
(E) obtain and review copies of relevant records
relating to the child as provided by Section 107.006;
(F) participate in the conduct of the litigation
to the same extent as an attorney for a party;
(G) take any action consistent with the child's
interests that the attorney considers necessary to expedite the
proceedings;
(H) encourage settlement and the use of
alternative forms of dispute resolution; and
(I) review and sign, or decline to sign, a
proposed or agreed order affecting the child;
(2) must be trained in child advocacy or have
experience determined by the court to be equivalent to that
training; and
(3) is entitled to:
(A) request clarification from the court if the
role of the attorney is ambiguous;
(B) request a hearing or trial on the merits;
(C) consent or refuse to consent to an interview
of the child by another attorney;
(D) receive a copy of each pleading or other
paper filed with the court;
(E) receive notice of each hearing in the suit;
(F) participate in any case staffing concerning
the child conducted by an authorized agency; and
(G) attend all legal proceedings in the suit.
(b) In addition to the duties required by Subsection (a), an
attorney ad litem appointed for a child in a proceeding under
Chapter 262 or 263 shall:
(1) review the medical care provided to the child;
(2) in a developmentally appropriate manner, seek to
elicit the child's opinion on the medical care provided; and
(3) for a child at least 16 years of age, advise the
child of the child's right to request the court to authorize the
child to consent to the child's own medical care under Section
266.010.
SECTION 3. Section 263.306(a), Family Code, is amended to
read as follows:
(a) At each permanency hearing the court shall:
(1) identify all persons or parties present at the
hearing or those given notice but failing to appear;
(2) review the efforts of the department or another
agency in:
(A) attempting to locate all necessary persons;
(B) requesting service of citation; and
(C) obtaining the assistance of a parent in
providing information necessary to locate an absent parent, alleged
father, or relative of the child;
(3) review the efforts of each custodial parent,
alleged father, or relative of the child before the court in
providing information necessary to locate another absent parent,
alleged father, or relative of the child;
(4) return the child to the parent or parents if the
child's parent or parents are willing and able to provide the child
with a safe environment and the return of the child is in the
child's best interest;
(5) place the child with a person or entity, other than
a parent, entitled to service under Chapter 102 if the person or
entity is willing and able to provide the child with a safe
environment and the placement of the child is in the child's best
interest;
(6) evaluate the department's efforts to identify
relatives who could provide the child with a safe environment, if
the child is not returned to a parent or another person or entity
entitled to service under Chapter 102;
(7) evaluate the parties' compliance with temporary
orders and the service plan;
(8) review the medical care provided to the child as
required by Section 266.007;
(9) ensure the child has been provided the
opportunity, in a developmentally appropriate manner, to express
the child's opinion on the medical care provided;
(10) for a child receiving psychotropic medication,
determine whether the child:
(A) has been provided appropriate psychosocial
therapies, behavior strategies, and other non-pharmacological
interventions; and
(B) has been seen by the prescribing physician at
least once every 90 days for purposes of the review required by
Section 266.011;
(11) determine whether:
(A) the child continues to need substitute care;
(B) the child's current placement is appropriate
for meeting the child's needs, including with respect to a child who
has been placed outside of the state, whether that placement
continues to be in the best interest of the child; and
(C) other plans or services are needed to meet
the child's special needs or circumstances;
(12) [(9)] if the child is placed in institutional
care, determine whether efforts have been made to ensure placement
of the child in the least restrictive environment consistent with
the best interest and special needs of the child;
(13) [(10)] if the child is 16 years of age or older,
order services that are needed to assist the child in making the
transition from substitute care to independent living if the
services are available in the community;
(14) [(11)] determine plans, services, and further
temporary orders necessary to ensure that a final order is rendered
before the date for dismissal of the suit under this chapter;
(15) [(12)] if the child is committed to the Texas
Juvenile Justice Department [Youth Commission] or released under
supervision by the Texas Juvenile Justice Department [Youth
Commission], determine whether the child's needs for treatment,
rehabilitation, and education are being met; and
(16) [(13)] determine the date for dismissal of the
suit under this chapter and give notice in open court to all parties
of:
(A) the dismissal date;
(B) the date of the next permanency hearing; and
(C) the date the suit is set for trial.
SECTION 4. Section 263.503(a), Family Code, is amended to
read as follows:
(a) At each placement review hearing, the court shall
determine whether:
(1) the child's current placement is necessary, safe,
and appropriate for meeting the child's needs, including with
respect to a child placed outside of the state, whether the
placement continues to be appropriate and in the best interest of
the child;
(2) efforts have been made to ensure placement of the
child in the least restrictive environment consistent with the best
interest and special needs of the child if the child is placed in
institutional care;
(3) the services that are needed to assist a child who
is at least 16 years of age in making the transition from substitute
care to independent living are available in the community;
(4) the child is receiving appropriate medical care;
(5) the child has been provided the opportunity, in a
developmentally appropriate manner, to express the child's opinion
on the medical care provided;
(6) a child who is receiving psychotropic medication:
(A) has been provided appropriate psychosocial
therapies, behavior strategies, and other non-pharmacological
interventions; and
(B) has been seen by the prescribing physician at
least once every 90 days for purposes of the review required by
Section 266.011;
(7) other plans or services are needed to meet the
child's special needs or circumstances;
(8) [(5)] the department or authorized agency has
exercised due diligence in attempting to place the child for
adoption if parental rights to the child have been terminated and
the child is eligible for adoption;
(9) [(6)] for a child for whom the department has been
named managing conservator in a final order that does not include
termination of parental rights, a permanent placement, including
appointing a relative as permanent managing conservator or
returning the child to a parent, is appropriate for the child;
(10) [(7)] for a child whose permanency goal is
another planned, permanent living arrangement, the department has:
(A) documented a compelling reason why adoption,
permanent managing conservatorship with a relative or other
suitable individual, or returning the child to a parent is not in
the child's best interest; and
(B) identified a family or other caring adult who
has made a permanent commitment to the child;
(11) [(8)] the department or authorized agency has
made reasonable efforts to finalize the permanency plan that is in
effect for the child; and
(12) [(9)] if the child is committed to the Texas
Juvenile Justice Department [Youth Commission] or released under
supervision by the Texas Juvenile Justice Department [Youth
Commission], the child's needs for treatment, rehabilitation, and
education are being met.
SECTION 5. Section 264.121, Family Code, is amended by
adding Subsection (g) to read as follows:
(g) For a youth taking prescription medication, the
department shall ensure that the youth's transition plan includes
provisions to assist the youth in managing the use of the medication
and in managing the child's long-term physical and mental health
needs after leaving foster care, including provisions that inform
the youth about:
(1) the use of the medication;
(2) the resources that are available to assist the
youth in managing the use of the medication; and
(3) informed consent and the provision of medical care
in accordance with Section 266.010(l).
SECTION 6. Section 266.001, Family Code, is amended by
adding Subdivision (6) to read as follows:
(6) "Psychotropic medication" means a medication that
is prescribed for the treatment of symptoms of psychosis or another
mental, emotional, or behavioral disorder and that is used to
exercise an effect on the central nervous system to influence and
modify behavior, cognition, or affective state. The term includes
the following categories when used as described by this
subdivision:
(A) psychomotor stimulants;
(B) antidepressants;
(C) antipsychotics or neuroleptics;
(D) agents for control of mania or depression;
(E) antianxiety agents; and
(F) sedatives, hypnotics, or other
sleep-promoting medications.
SECTION 7. Section 266.004, Family Code, is amended by
adding Subsections (h-1) and (h-2) to read as follows:
(h-1) The training required by Subsection (h) must include
training related to informed consent for the administration of
psychotropic medication and the appropriate use of psychosocial
therapies, behavior strategies, and other non-pharmacological
interventions that should be considered before or concurrently with
the administration of psychotropic medications.
(h-2) Each person required to complete a training program
under Subsection (h) must acknowledge in writing that the person:
(1) has received the training described by Subsection
(h-1);
(2) understands the principles of informed consent for
the administration of psychotropic medication; and
(3) understands that non-pharmacological
interventions should be considered and discussed with the
prescribing physician before consenting to the use of a
psychotropic medication.
SECTION 8. Chapter 266, Family Code, is amended by adding
Section 266.0042 to read as follows:
Sec. 266.0042. CONSENT FOR PSYCHOTROPIC MEDICATION. (a)
Consent to the administration of a psychotropic medication is valid
only if:
(1) the consent is given voluntarily and without undue
influence; and
(2) the person authorized by law to consent for the
foster child receives verbally or in writing information that
describes:
(A) the specific condition to be treated;
(B) the beneficial effects on that condition
expected from the medication;
(C) the probable health and mental health
consequences of not consenting to the medication;
(D) the probable clinically significant side
effects and risks associated with the medication; and
(E) the generally accepted alternative
medications and non-pharmacological interventions to the
medication, if any, and the reasons the physician recommends the
proposed course of treatment.
(b) Consent to the administration of a psychotropic
medication must be evidenced by the completion of a form prescribed
by the department that is signed by the person authorized to consent
to medical care for the foster child and by the health care provider
administering the psychotropic medication or a person designated by
that health care provider.
(c) The completed form must be filed in the child's case
file and in the child's medical records.
SECTION 9. The heading to Section 266.005, Family Code, is
amended to read as follows:
Sec. 266.005. PARENTAL NOTIFICATION OF CERTAIN
[SIGNIFICANT] MEDICAL CONDITIONS.
SECTION 10. Section 266.005, Family Code, is amended by
adding Subsection (b-1) and amending Subsection (c) to read as
follows:
(b-1) The department shall notify the child's parents of the
initial prescription of a psychotropic medication to a foster child
and of any change in dosage of the psychotropic medication at the
first scheduled meeting between the parents and the child's
caseworker after the date the psychotropic medication is prescribed
or the dosage is changed.
(c) The department is not required to provide notice under
Subsection (b) or (b-1) to a parent who:
(1) has failed to give the department current contact
information and cannot be located;
(2) has executed an affidavit of relinquishment of
parental rights;
(3) has had the parent's parental rights terminated;
or
(4) has had access to medical information otherwise
restricted by the court.
SECTION 11. Section 266.007(a), Family Code, is amended to
read as follows:
(a) At each hearing under Chapter 263, or more frequently if
ordered by the court, the court shall review a summary of the
medical care provided to the foster child since the last hearing.
The summary must include information regarding:
(1) the nature of any emergency medical care provided
to the child and the circumstances necessitating emergency medical
care, including any injury or acute illness suffered by the child;
(2) all medical and mental health treatment that the
child is receiving and the child's progress with the treatment;
(3) any medication prescribed for the child, [and] the
condition, diagnosis, and symptoms for which the medication was
prescribed, and the child's progress with the medication;
(4) for a child receiving a psychotropic medication:
(A) any psychosocial therapies, behavior
strategies, or other non-pharmacological interventions that have
been provided to the child; and
(B) the dates since the previous hearing of any
office visits the child had with the prescribing physician as
required by Section 266.011;
(5) the degree to which the child or foster care
provider has complied or failed to comply with any plan of medical
treatment for the child;
(6) [(5)] any adverse reaction to or side effects of
any medical treatment provided to the child;
(7) [(6)] any specific medical condition of the child
that has been diagnosed or for which tests are being conducted to
make a diagnosis;
(8) [(7)] any activity that the child should avoid or
should engage in that might affect the effectiveness of the
treatment, including physical activities, other medications, and
diet; and
(9) [(8)] other information required by department
rule or by the court.
SECTION 12. Chapter 266, Family Code, is amended by adding
Section 266.011 to read as follows:
Sec. 266.011. MONITORING USE OF PSYCHOTROPIC DRUG. The
person authorized to consent to medical treatment for a foster
child prescribed a psychotropic medication shall ensure that the
child has an office visit with the prescribing physician at least
once every 90 days to allow the physician to:
(1) appropriately monitor the side effects of the
medication; and
(2) determine whether:
(A) the medication is helping the child achieve
the physician's treatment goals; and
(B) continued use of the medication is
appropriate.
SECTION 13. Section 533.0161(b), Government Code, is
amended to read as follows:
(b) The commission shall implement a system under which the
commission will use Medicaid prescription drug data to monitor the
prescribing of psychotropic drugs for [children who are]:
(1) children who are in the conservatorship of the
Department of Family and Protective Services[;] and
[(2)] enrolled in the STAR Health Medicaid managed care
program or eligible for both Medicaid and Medicare; and
(2) children who are under the supervision of the
Department of Family and Protective Services through an agreement
under the Interstate Compact on the Placement of Children under
Subchapter B, Chapter 162, Family Code.
SECTION 14. The heading to Subchapter A, Chapter 266,
Family Code, is repealed.
SECTION 15. The changes in law made by this Act apply to a
suit affecting the parent-child relationship pending in a trial
court on or filed on or after the effective date of this Act.
SECTION 16. This Act takes effect September 1, 2013.