Transcript CBHDA Policy/ Legislative Update

Policy/Legislative Report
SAPT Committee Meeting
March 23, 2016
County Behavioral Health Directors Association of
California
Federal Budget/Legislation
2017 Federal Budget Proposal
• $1 billion to expand access to treatment for prescription drug abuse and heroin
use and help ensure the every American who wants treatment can access it.
$920 million would be for mandatory funding for states to increase
medication-assisted treatment;
$50 million for the National Health Service Corps to support training of
approximately 700 providers to provide SUD treatment services, including
MAT, in areas most in need of behavioral health providers;
$30 million to support effectiveness evaluations of MAT programs and
identify opportunities to improve treatment.
Federal Budget/Legislation (cont.)
• $500 million to build on current HHS and DOJ efforts to expand state-level
prescription drug overdose prevention strategies, increase the availability of MAT
programs, improve access to naloxone, and support targeted enforcement
activities. A portion of this funding is directed specifically to rural areas.
Federal Legislation:
• Comprehensive Addictions & Recovery Act (CARA – S. 524)
Authorizes $600 million for grants to address prescription opioid and heroin
addiction. Funds can be used for treatment & recovery services, diversion alternatives
for nonviolent offenders, law enforcement initiatives, and programs to prevent
overdose deaths.
Expands prevention and educational efforts to prevent the abuse of opioids.
Expands the availability of naloxone to law enforcement and first responders.
Federal Budget/Legislation (cont.)
Strengthens prescription drug monitoring programs.
Launches an evidence-based opioid and heroin treatment and interventions program to
expand best practices.
• Comprehensive Behavioral Health Reform & Recovery Act (HR 4435)
SAMHSA Administrator would also serve as Assistant Secretary for Mental Health &
Substance Use Disorders within the Executive Office of the Secretary of HHS.
Codifies in statute a new SAMHSA Center for Behavioral Health Quality and
Statistics, which would include new grants and TA programs to advance innovation
and adoption of evidence-based practices.
Enacts payment for same-day behavioral health and primary care services.
Modifies IMD exclusion under Medicaid managed care.
Expands EPSDT services.
Federal Budget/Legislation (cont.)
Provides for suspension, not termination, of Medicaid benefits for at-risk youth in
correctional facilities.
Strengthens the behavioral health workforce and improves access to care by
authorizing SAMHSA to develop a national workforce strategy and implement grant
programs to develop the workforce (including peer support specialists).
SUD Prevention is boosted through training and new grants.
Provides grants for needle exchange programs and expanded naloxone availability to
address the opioid crisis.
Raises to 100 the number of consumers able to be treated with buprenorphine by a
single physician.
Pilots a program to extend perinatal treatment to outpatient settings.
Targets intervention programs to high need areas.
Creates programs to improve adolescent care, youth recovery and support services.
Federal Budget/Legislation (cont.)
• Medicaid Coverage for Addiction Recovery Expansion (CARE) Act – S. 2605
Increases the bed limit in residential SUD settings to qualify for Medicaid funding
from 16 to no more than 40.
Allows these facilities to provide treatment services for up to 60 consecutive days.
• Recovery Enhancement for Addiction Treatment Act (S. 1455)
Raises the patient cap from 30 to 100 patients that a qualifying practitioner can treat at
any given time using buprenorphine.
After 1 year a qualifying practitioner can petition to treat an unlimited number of
patients, provided that the practitioner agrees to participate in the prescription drug
monitoring program of the state in which he/she is licensed.
Amends the classification of “qualifying practitioner” to include a licensed nurse
practitioner or physician assistant who meets all of the requirements for prescribing
MAT for opioid addiction.
Federal Budget/Legislation (cont.)
• Co-Prescribing Saves Lives Act (S. 2256)
Establishes programs for health care provider training in all Federal health care and
medical facilities, including FQHCs and Indian Health Service Facilities, to establish
Federal co-prescribing guidelines with regard to the prescription of naloxone in
conjunction with an opioid prescription for patients at an elevated risk of overdose.
Establishes a grant program to state departments of health to expand naloxone coprescribing.
• National All Schedules Prescription Electronic Reporting Reauthorization
Act (S. 480)
Amends the National All Schedules Prescription Electronic Reporting Act of 2005 to
include state-administered controlled prescription drug monitoring systems that
ensure access to prescription history information.
Federal Budget/Legislation (cont.)
Allows grants under the Public Health Service Act to be used to maintain and operate
existing state controlled prescription drug monitoring programs.
• Protecting Our Infants Act (S. 799)
Requires the Department of Health and Human Services (HHS) to review its activities
related to prenatal opioid use, including neonatal abstinence syndrome, and develop a
strategy to address gaps in research and gaps and overlap in programs.
Requires HHS to develop recommendations for preventing and treating prenatal
opioid abuse, and for treating infants born dependent on opioids.
State Legislation
• AB 1554 (Irwin)/SB 819 (Huff)
Companion bills to prohibit the manufacture and sale of powdered alcohol in
California.
CBHDA supports
• AB 1571 (Lackey)
Requires DUI first offenders with a blood-alcohol level of 0.15% or greater to be
referred by the court to the 9-month DUI program.
Requires that enrollment in an approved program take place within 30 days of
conviction.
Requires the County Alcohol & Drug Program Administrator to coordinate court
referral and tracking documents with the DMV and DHCS.
State Legislation (cont.)
• AB 1975 (Waldron)
Requires a court to impose an ASAM assessment as a condition of probation for a
multiple DUI offender referred to an 18-month or 30-month DUI program, or for a
first offender whose blood-alcohol level was 0.16% or greater, to determine if the
defendant requires treatment for a substance use disorder.
Requires the entity administering the assessment to advise the defendant that:
(1) there are medications that can address alcohol dependence;
(2) the person should consult his or her physician regarding the results of the
assessment;
(3) if the person’s physician determines that SUD treatment is medically
necessary, the person should be referred to a licensed residential or certified
outpatient treatment program.
State Legislation (cont.)
A couple of questions re. AB 1975 that need clarification:
o Who conducts the assessment? A certified SUD counselor?
o Are there any consequences if the defendant does not follow the counselor’s
“advice?”
• AB 2255 (Melendez)
Establishes a statutory definition of “sober living home” as a residence that is
operated as a cooperative living arrangement to provide an alcohol- and drug-free
environment for persons recovering from a substance use disorder, and that has been
registered or approved by a state-recognized nonprofit organization.
Designation as a “sober living home” would require, at minimum: (1) a protocol to
report deaths; (2) a protocol to deal with alcohol and/or drug use by a resident; (3)
CPR certification.
CBHDA has requested an amendment to include county-certified recovery homes.
State Legislation (cont.)
• AB 2403 (Bloom)
Redefines “integral facilities” providing SUD treatment as any combination of two or
more facilities located on the same or different sites that collectively serve 7 or more
persons, and that are under the control or management of the same owner or licensee.
Integral facilities shall include the provision of housing in one facility and SUD
program or treatment at another facility or facilities.
Requires DHCS to issue a single license to integral facilities if certain criteria are met.
• AB 2495 (Eggman)
Authorizes local health departments to allow for public health programs known as
Supervised Consumption Services, and would exempt employees, volunteers, and
clients of these facilities from criminal liability for supervised drug use activities that
would otherwise not be allowed under current law.
State Legislation (cont.)
 The purpose of removing legal barriers to the operation of these programs is to
reduce overdose death, decrease public health concerns like discarded syringes and
public drug injection, reduce the transmission of infectious diseases, and provide
entry to drug treatment services.
• AB 2772 (Chang) – Requires that an individual being ordered by a judge to
participate in residential SUD treatment must receive that treatment in a
residential program licensed by DHCS, and not in a sober living home.
• SB 482 (Lara)
Requires all prescribers of Schedule II or Schedule III controlled substances to consult
a patient’s electronic history in the state’s drug monitoring database (CURES) before
prescribing the controlled substance to the patient for the first time.
Requires the prescriber to consult the CURES database at least annually when the
controlled substance remains part of the patient’s treatment.
State Legislation (cont.)
Prohibits prescribing an additional Schedule II or Schedule III controlled substance to
a patient with an existing prescription until the prescriber determines that there is a
legitimate need for the drug.
On a related note, the federal Centers for Disease Control has issued the first national
standards for prescription painkillers, recommending that physicians try pain relievers
like ibuprofen before prescribing the highly addictive opioid medications, and that
they give most patients only a few days’ supply of painkillers.
• SB 1101 (Wieckowski)
Creates a new state Addiction Counselor license, specifies the minimum qualifications
for a license, and prohibits any person from using the title Licensed Alcohol and Drug
Counselor unless that person has obtained this license.
The licensing program would be administered by the State Department of Public
Health (under the current version of the bill, subject to change).
State Legislation (cont.)
 Transfers the administrative and programmatic functions of DHCS pertaining to
alcohol and drug counselor certification, and the approval and regulation of
certifying organizations, to the Department of Public Health, and requires DPH to
oversee the disciplinary actions of the certifying organizations it approves (under the
current version of the bill, subject to change.)
 Will this bill be amended to establish a career ladder for individual counselors,
beginning with peer counselors/peer support specialists?
• SB 1335 (Mitchell)
Authorizes FQHCs and Rural Health Clinics to elect to have Drug Medi-Cal and
specialty mental health services reimbursed on a fee-for-service basis.
Some issues to consider: Will FQHCs be prepared to undertake the additional
responsibilities that come with being a DMC-ODS provider? How will they handle
42-CFR confidentiality rules? Who will pay the non-federal share of cost?
Contact Information
Kirsten Barlow, Executive Director
[email protected]
Mary Adèr, Deputy Director, Legislative Affairs
[email protected]
Tom Renfree, Deputy Director, Substance Use Disorder Services
[email protected]
County Behavioral Health Directors Association of California
www.cbhda.org
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