DATE: July 11, 2017
TO: Board of Supervisors
SUBMITTED BY: Delfino E. Neira, Director, Department of Social Services
SUBJECT: Agreement with California Department of Social Services and California Department of Health Care Services
RECOMMENDED ACTION(S):
TITLE
Approve and authorize the Chairman to execute an Agreement with California Department of Social Services and California Department of Health Care Services to participate in a Global Data Sharing Agreement, effective upon execution ($0).
REPORT
Approval of the recommended action will allow the Department to improve the oversight and monitoring of foster youth and non-minor dependents receiving psychotropic medication through the exchange of confidential and non-confidential data and record matching with the California Department of Social Services (CDSS) and the California Department of Health Care Services (DHCS). Participation will meet the State’s mandate to address issues related to the administration of psychotropic drugs in the foster care system, pursuant to Senate Bill 238 (2015). The recommended Agreement will not expire until cancelled by the Departments, does not require compensation for participation and includes no Net County Cost.
ALTERNATIVE ACTION(S):
Your Board can decide not to allow participation. This will impact the Department’s ability to improve services to children in foster care and meet the requirements under Senate Bill 238.
FISCAL IMPACT:
There is no increase to Net County Cost associated with the recommended action. The recommended Agreement requires no monetary exchange between CDSS, DHCS, and the Department. The Department assigns staff to monitor foster youth and non-minor dependents as a normal course of their functions. Salary and benefit costs associated with these functions will be included in the FY 2017-18 Recommended Budget for the Department, Organization 5610 and will be included in subsequent budgets.
DISCUSSION:
Since 2008, CDSS and DHCS have collaborated to implement Federal and State legislative mandates designed to improve the oversight and monitoring of psychotropic drugs prescribed to youth in foster care. In general, there are multiple issues in regard to the use of these drugs and foster youth. In California, foster youth are 3.5 times more likely to be on psychotropic medications than children in general and are more likely to be prescribed antipsychotics and multiple medications. Currently, in Fresno County, 12% of foster youth are prescribed psychotropic medication, the ninth highest county in California. Although use of psychotropic drugs may be appropriate, there is significant concern with regard to: over prescribing of medications, high dosages, use at too early a juncture, use with younger children, duration of use, use of non-tested medications, and use of psychotropic medications independent of therapy, counseling or other therapeutic interventions.
As a result of Senate Bill 238 (2015), CDSS, in conjunction with DHCS, is required to develop and implement system improvements to provide counties with data in regard to psychotropic medication use. To this end, CDSS and DHCS entered into a data sharing agreement to exchange and match data from their respective data systems cross-referencing foster children, health information and psychotropic medications paid through Medi-Cal claims. CDSS requires counties to participate in a State data sharing agreement to receive this data and approval of the recommended action will meet this requirement.
The recommended Global Data Sharing Agreement will allow the Department to receive confidential and non-confidential data on youth receiving child welfare services in Fresno County. Specific data exchanged will include demographic, case and placement, medication details, pharmacy and prescriber, eligibility, payment and mental health information. In addition, the Department will also receive county-specific reports that will provide information on several data indicators and measures that will include children under five on at least one psychotropic medication, children on multiple psychotropic medications and overall use of psychotropic and antipsychotic medications.
The recommended Agreement will be effective upon execution and will not expire until cancelled by any party by written notice provided no later than 180 days prior to the specified cancellation date. The Agreement varies from the standard County boilerplate as it is drafted by CDSS and DHCS. It includes provisions to ensure data confidentiality and security and HIPPA business associate language to ensure the protection of Protected Health Information and personal information. The Agreement also includes a provision to allow substantive changes or amendment to the terms by mutual approval of the parties and can be executed by the Department Director or designee. In the event of a request to substantively change the Agreement, the amendment will include County Counsel review and the Auditor’s review, if changes are monetary in nature, as part of the approval process.
ATTACHMENTS INCLUDED AND/OR ON FILE:
On File with Clerk - Agreement 15-MOU-00576
CAO ANALYST:
Ronald Alexander