I. Summary of Revised PMA Process:

A. The prescribing physician faxes the JV-220(A)[1] – Prescribing Physician’s Statement – to either the DCFS D-Rate Unit (Dependent Youth) at (562) 941-7205 or the Probation Placement Unit (Probation Youth) at (323) 730-5491.

B. The DCFS D-Rate Unit or the Probation Placement Unit receives the JV-220(A) and returns incomplete or illegible forms to the physician to complete. The Units fill in information on the JV-220 – Application Regarding Psychotropic Medication – and send L.A. Superior Court cover letter and JV-222 – Opposition to Application Regarding Psychotropic Medication – to child’s parents or legal guardians [Note that there are separate letters for Children’s Court and McCourtney Court]. The Units then complete page 1 of JV-221 – Proof of Notice: Application Regarding Psychotropic Medication – and send JV-220 and JV-220(A) to youth’s CSW/DPO [the Probation Placement Unit also faxes JV-220 and JV-220(A) to Juvenile Court Mental Health Services (JCMHS) Unit]. The Units finally fax JV-220, JV220(A), page 1 of JV-221, and copies of the L.A. Superior Court cover letters sent to the parents to either the Dependency Court Psychotropic Desk Clerk or the Delinquency Court Psychotropic Desk Clerk at the appropriate Delinquency Court location.

C. The Dependency Court Psychotropic Desk Clerk or the Delinquency Court Psychotropic Desk Clerk receives PMA forms, assigns a log number, and enters the data into the psychotropic medication tracking system. For both DCFS and Probation youth, the appropriate clerks give copies of the JV-220, JV-220(A), and JV-222 to the child’s attorney. For DCFS youth, the Dependency Court Psychotropic Desk Clerk then provides the youth’s CASA and the parents’ attorneys with the same forms, in addition to presenting the parents’ attorneys with a copy of the parents’ cover letter. The Clerk for either Dependency or Delinquency Court then completes page 2 of JV-221 for DCFS and Probation youth and sends JV-220 and JV-220(A) to JCMHS.

D. JCMHS reviews the PMA forms and sends recommendations/comments to either the Dependency Court Psychotropic Desk Clerk or the appropriate Delinquency Court Psychotropic Desk Clerk. Upon request, JCMHS provides a copy of the recommendations/comments to the youth’s attorney. JCMHS then returns the PMA forms and submits recommendations/comments to the Psychotropic Desk Clerk for the appropriate court.

E. The Court Psychotropic Desk Clerks record the date and pull the child’s court file. The Clerk then provides the Judicial Officer at the Court with the court file, JV-220, JV-220(A), JV-221 (pages 1 and 2), JCMHS recommendation/comment form, any JV-222 received, and JV-223 – Order Regarding Application for Psychotropic Medication. [For DCFS McCourtney Court cases, the Dependency Psychotropic Desk Clerk faxes above items to McCourtney Court Clerk’s office, which pulls file and delivers the paperwork to the Court.]

F. The Judicial Officer at the Court approves, modifies, or denies the JV-223.

G. The Court/Judicial Assistant sends a copy of the JV-223 back to the Dependency or Delinquency Psychotropic Desk Clerk.

1. For DCFS youth, the Assistant places JV-220, JV-220(A), JV-221, JV-222, and JV-223 plus JCMHS recommendation/comment forms in child’s confidential legal envelope in court file, and returns file to courtroom.

2. For Probation youth, these forms are sent back to the Delinquency Psychotropic Desk Clerk along with the JV-223.

H. The Court Psychotropic Desk Clerks log in date that the JV-223 (and additional paperwork for Probation youth) is received.

1. For DCFS Children’s Court cases (as opposed to McCourtney Court cases), the Clerk distributes a copy of the signed form to the child’s attorney, the parents’ attorneys, and CASA (if applicable). For all DCFS cases, the Clerk provides copies of JV-223 to JCMHS, the DCFS D-Rate Unit, and the prescribing physician.

2. For Probation youth, the Clerk distributes copies of the JV-223 to the child’s attorney, JCMHS, the Probation Placement Unit, and the prescribing physician. The Clerk then places the JV-220, JV-220(A), JV-221, JV-222, and JV-223 plus JCMHS recommendations/comments form, in youth’s confidential legal envelope in court file, and returns file to courtroom.

I. The DCFS D-Rate Unit enters completed JV-223 into CWS/CMS. The D-Rate Unit or the Probation Placement Unit distributes a copy of the signed JV-223 to the CSW/DPO (and the PHN for DCFS youth). The Units then provide copies of JV-223, JV-220, and JV-220(A) to the child’s caregiver (including the FFA) or the Probation youth’s parents if youth is Home on Probation (HOP).

II. Additional Information Related to the PMA Process:

A. If the Court denies a PMA request, do not abruptly stop the medication. The medication must be discontinued in a medically appropriate way. If a doctor is not available to determine the most appropriate way to discontinue medication, contact Dr. Charles Sophy, DCFS Medical Director, at (213) 351-5614 (DCFS) and Dr. Gia Krecelius, Juvenile Court Mental Health Services (JCMHS) Unit Director, at (323) 526-6577 (Probation).

B. Emergency or Continued Rx PMAs – In order to avoid sudden discontinuation of medication, current psychotropic medication treatment can continue pending approval of a submitted PMA. When a child is given psychotropic medication in an emergency situation, the physician requesting authorization must document the basis for the emergency on the form [An emergency is defined on page 4 of the PMA Protocol].

C. If a child is placed with your agency from a hospital, from juvenile hall, or is transferred from another agency, the existing approved PMA is valid until the approval expires, runs out, or the prescribed medication regimen is altered in anyway not covered by the approved form. However, it is strongly recommended that the child is seen by a psychiatrist within two weeks of being discharged from the hospital, juvenile hall or other agency. If your agency cannot obtain a doctor’s visit within two weeks, you can contact Dr. Sophy (for dependents) or Dr. Gia Krecelius (for minors) and request an interim psychiatric consultation.

D. In most cases of delays in authorization, the delay is due to incomplete forms. Providers are encouraged to ask doctors to complete the forms in as much detail as possible and to fill out all of the necessary fields. This will help ensure a timely authorization process.

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III. Information Related to Untimely Receipt of PMA Forms:

A. The last step of the PMA process states that the DCFS D-Rate Unit or the Probation Placement Unit provides a copy of three PMA documents (e.g. JV-220(A), JV-220 and JV-22) to the caregiver[2] after the DCFS D-Rate Unit or Probation Placement Unit receives a complete and legible JV-220(A) from the youth’s prescribing physician.

B. If you do not receive the requisite PMA forms from the DCFS D-Rate Unit in a timely manner (e.g. within approximately two weeks from the date the physician submits a PMA request), call the DCFS Psychotropic Medication Desk Clerks at (562) 903-5335 or (562) 903-5336 during regular business hours (8:00 a.m. – 5:00 p.m.) to see if the forms have been received. [For after-hours calls (5:00 p.m. – 8:00 a.m.) providers should use the hotline at (800) 540-4000 and request the nurse on call 24 hours a day for issues regarding the PMA process and paperwork]. If the response is insufficient, call either Marilyn Sklar, DCFS D-Rate Program Manager at (626) 938-1706 (office) and (213) 247-0638 (cell) or e-mail her at . You can also call Tina Mosley, DCFS D-Rate SCSW, at (562) 903-5234 (office) or (818) 635-4740 (cell) or e-email her at .

C. If you need additional assistance, call the Public Health Nurses (PHNs) assigned to the DCFS office where the case-carrying CSW is located to track the forms’ progress [see contact list for the Department of Public Health's (DPH) Health Care for Children in Foster Care Public Health Nursing Supervisors, who oversee the PHNs that serve DCFS children placed in out-of-home care]. PHNs, who receive approved PMAs from the Court Psychotropic Desk, are responsible for reviewing the PMAs, entering the information into the child’s health notebook, and giving the CSWs verbal instructions about the PMA. The PHN can intervene to help get you copies of the PMA forms in a timely manner.

D. If the response is not sufficient, providers may contact Dr. Sophy’s office directly at (213) 351-5614.

E. The Association also revised its Missing PMA Letter template that providers can fax to DCFS in the event that they do not receive the required PMA forms from the Department’s D-Rate Unit. ACHSA is working to develop a similar process for Probation.

F. For delinquent youth, Probation is working to identify dedicated staff similar to DCFS to provide caregivers with timely copies of the PMA forms. In the meantime, providers may contact Dr. Gia Krecelius at JCMHS at (323) 526-6577 or the Delinquency Court Psychotropic Desk Clerk at the appropriate Delinquency Court location until dedicated staff has been identified.

G. If you have questions regarding the PMA process, please call Adam Dewey, ACHSA Child Welfare Policy Analyst, at: (213) 250-5030 ext. 106, or e-mail: . If the JV-220(A) is not in the youth’s placement packet, click here and select “Juvenile” from the form group dropdown box to access the JV forms.

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[1]All references to JV-220(A) include all attachments submitted by Prescribing Physician.

[2] DCFS Procedural Guide #0500-501.20 (Exhibit G in the Contract), Section A: When a Caregiver Requests Case Records states that “the term ‘Caregiver’ specifically includes foster family agencies (FFAs), group homes, foster parents, relative caregivers, non-relative extended family members and foster/adopt placements.”