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  H.B. No. 915
 
 
 
 
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 263.001, Family Code, is amended by
  amending Subdivision (1) and adding Subdivisions (1-a) and (3-a) to
  read as follows:
               (1)  "Advanced practice nurse" has the meaning assigned
  by Section 157.051, Occupations Code.
               (1-a)  "Department" means the Department of Family and
  Protective Services.
               (3-a)  "Physician assistant" has the meaning assigned
  by Section 157.051, Occupations Code.
         SECTION 4.  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,
  physician assistant, or advanced practice nurse 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 5.  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,
  physician assistant, or advanced practice nurse 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 6.  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 7.  Section 266.001, Family Code, is amended by
  amending Subdivision (1) and adding Subdivisions (1-a), (6), and
  (7) to read as follows:
               (1)  "Advanced practice nurse" has the meaning assigned
  by Section 157.051, Occupations Code.
               (1-a) "Commission" means the Health and Human Services
  Commission.
               (6)  "Physician assistant" has the meaning assigned by
  Section 157.051, Occupations Code.
               (7)  "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 8.  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, physician assistant, or advanced practice
  nurse before consenting to the use of a psychotropic medication.
         SECTION 9.  Chapter 266, Family Code, is amended by adding
  Section 266.0042 to read as follows:
         Sec. 266.0042.  CONSENT FOR PSYCHOTROPIC MEDICATION.
  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 for the proposed course of
  treatment.
         SECTION 10.  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 11.  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 12.  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,
  physician assistant, or advanced practice nurse 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 13.  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 been seen by the prescribing physician, physician
  assistant, or advanced practice nurse at least once every 90 days to
  allow the physician, physician assistant, or advanced practice
  nurse to:
               (1)  appropriately monitor the side effects of the
  medication; and
               (2)  determine whether:
                     (A)  the medication is helping the child achieve
  the treatment goals; and
                     (B)  continued use of the medication is
  appropriate.
         SECTION 14.  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 15.  The heading to Subchapter A, Chapter 266,
  Family Code, is repealed.
         SECTION 16.  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 17.  This Act takes effect September 1, 2013.
 
 
  ______________________________ ______________________________
     President of the Senate Speaker of the House     
 
 
         I certify that H.B. No. 915 was passed by the House on April
  19, 2013, by the following vote:  Yeas 138, Nays 0, 1 present, not
  voting; and that the House concurred in Senate amendments to H.B.
  No. 915 on May 16, 2013, by the following vote:  Yeas 140, Nays 0, 2
  present, not voting.
 
  ______________________________
  Chief Clerk of the House   
 
         I certify that H.B. No. 915 was passed by the Senate, with
  amendments, on May 15, 2013, by the following vote:  Yeas 31, Nays
  0.
 
  ______________________________
  Secretary of the Senate   
  APPROVED: __________________
                  Date       
   
           __________________
                Governor