Report 2015-131 Recommendation 36 Responses

Report 2015-131: California's Foster Care System: The State and Counties Have Failed to Adequately Oversee the Prescription of Psychotropic Medications to Children in Foster Care (Release Date: August 2016)

Recommendation #36 To: Medical Board of California

To the extent that its analysis (described in Recommendation 34) is able to identify physicians who may have inappropriately prescribed psychotropic medications to foster children, the Medical Board should enter into an agreement with Health Care Services and Social Services within six months of completing its initial review to periodically obtain the data necessary to perform the same or similar analyses.

6-Month Agency Response

Pursuant to SB 1174 (McGuire, Chapter 840, Statutes of 2016), the Medical Board of California (Board) is required to receive data on an on-going basis from the Department of Health Care Services (DHCS) and the Department of Social Services (DSS). This data is required for all foster children who are or have been on three or more psychotropic medications for 90 days or more. For each foster child that falls into this category, the following information is required to be submitted to the Board: the start and stop dates, if any, for each psychotropic medication prescribed; the prescriber's name and contact information; the child or adolescent's year of birth; the unit and quantity of the medication and the number of days' supply of the medication; and any other information that is de-identified and necessary to the Board to allow the Board to exercise its statutory authority as an oversight entity. The data required to be received is the same data that is in the existing DUA. The Board worked with DHCS and DSS on an updated DUA that conforms with the requirements of SB 1174, and this DUA was finalized on February 15, 2017.

California State Auditor's Assessment of 6-Month Status: Resolved

60-Day Agency Response

Although the Medical Board of California (Board) has not entered into a new agreement with the Department of Health Care Services (DHCS) and the Department of Social Services (DSS), however, this is no longer necessary as SB 1174 (McGuire, Chapter 840, Statutes of 2016) was signed into law by the Governor.

SB 1174 requires DHCS and DSS to provide data to the Board on an annual basis, pursuant to a data-sharing agreement, including, but not limited to, pharmacy claims data for all foster children who are or have been on three or more psychotropic medications for 90 days or more. For each foster child who falls into this category, the following information shall be submitted to the Board: a list of the psychotropic medications prescribed; the start and stop dates, if any, for each psychotropic medication prescribed; the prescriber's name and contact information; the child or adolescent's year of birth; the unit and quantity of the medication and the number of days' supply of the medication; and any other information that is de-identified and necessary to the Board to allow the Board to exercise its statutory authority as an oversight entity.

This bill requires the Board to review this data on a quarterly basis to determine if any potential violations of law or excessive prescribing of psychotropic medications inconsistent with the standard of care exist and, if warranted, conduct an investigation. If the Board investigates a physician for inappropriate prescribing and concludes that there is a violation of law, the Board must take appropriate disciplinary action. This bill requires the Board to report this data annually to the Legislature in its annual report.

Since SB 1174 has been signed into law, this prescribing data will now be provided to the Board on an on-going basis.

California State Auditor's Assessment of 60-Day Status: Partially Implemented

The enactment of SB 1174 (Chapter 840, Statutes of 2016) addresses future data sharing by the Departments of Health Care Services and Social Services to the Medical Board of California for purposes of monitoring physicians who prescribed psychotropic medications to foster children. SB 1174's provisions become effective January 1, 2017.

All Recommendations in 2015-131

Agency responses received are posted verbatim.