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AB-395 Substance abuse treatment providers.(2017-2018)

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Date Published: 03/20/2017 09:00 PM
AB395:v97#DOCUMENT

Amended  IN  Assembly  March 20, 2017
Amended  IN  Assembly  March 02, 2017

CALIFORNIA LEGISLATURE— 2017–2018 REGULAR SESSION

Assembly Bill No. 395


Introduced by Assembly Member Bocanegra

February 09, 2017


An act to amend Sections 11839.1, 11839.2, and 11839.6 of the Health and Safety Code, and to amend Section 14021.6 of the Welfare and Institutions Code, relating to substance abuse treatment providers.


LEGISLATIVE COUNSEL'S DIGEST


AB 395, as amended, Bocanegra. Substance abuse treatment providers.
Existing law generally requires the State Department of Health Care Services to be responsible for licensing license narcotic treatment programs to use narcotic replacement therapy in the treatment of addicted persons and makes legislative findings in support of coordinated narcotic treatment programs in this regard. Existing law specifies the controlled substances a licensed narcotic treatment program may use for narcotic replacement therapy. Existing law authorizes the department to approve an office-based narcotic treatment program in a remote site, if certain conditions are met, that include, among others, a physician at a remote site may treat up to a maximum number of 20 patients, who are provided with a specific pharmacological treatment.
This bill would make legislative findings and declarations that it is in the best interest of the health and welfare of the people of this state to also coordinate medication-assisted treatments for substance abuse disorders. The bill would modify the specific controlled substances authorized for use in narcotic replacement therapy to include medication-assisted treatment and refer to medications, rather than controlled substances. The bill would modify the conditions for the department to authorize an office-based narcotic treatment program in a remote site to authorize a physician to treat a number of patients specified under the United States Drug Enforcement Administration registration and modify the types of authorized pharmacological treatments.
Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Existing law establishes the Drug Medi-Cal Treatment Program (Drug Medi-Cal), under which the department is authorized to enter into contracts with each county for the provision of various alcohol and drug treatment services, including substance use disorder services, narcotic treatment program services, naltrexone services, and outpatient drug-free services, to Medi-Cal beneficiaries. Existing law generally requires bills for service under the Medi-Cal program to be submitted not more than 6 months after the month in which the service is rendered. Existing federal law requires providers to submit all claims no later than 12 months from the date of service.
This bill, consistent with federal law, bill would require bills for services under Drug Medi-Cal to be submitted no later than 12 6 months from the date of service.
Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: NO  

The people of the State of California do enact as follows:


SECTION 1.

 Section 11839.1 of the Health and Safety Code is amended to read:

11839.1.
 The Legislature finds and declares that it is in the best interests of the health and welfare of the people of this state to coordinate narcotic treatment programs to use narcotic replacement therapy and medication-assisted treatments for substance abuse disorders in the treatment of addicted persons whose addiction was acquired or supported by the use of a narcotic drug or drugs, not in compliance with a physician and surgeon’s legal prescription, and to establish and enforce minimum requirements for the operation of all these treatment programs in this state.

SEC. 2.

 Section 11839.2 of the Health and Safety Code is amended to read:

11839.2.
 The following medications are authorized for use in narcotic replacement therapy and medication-assisted treatment by licensed narcotic treatment programs:
(a) Methadone.
(b) Levo-alpha-acetylmethadol (LAAM) as specified in paragraph (10) of subdivision (c) of Section 11055.
(c) Buprenorphine products or combination of products approved by the federal Food and Drug Administration for maintenance or detoxification of opioid dependence.
(d) Any other federally approved medications used for the purpose of narcotic replacement treatment and medication-assisted treatment.

SEC. 3.

 Section 11839.6 of the Health and Safety Code is amended to read:

11839.6.
 (a) The department shall establish a program for the operation and regulation of office-based narcotic treatment programs. An office-based narcotic treatment program established pursuant to this section shall meet either of the following conditions:
(1) Hold a primary narcotic treatment program license.
(2) Be affiliated and associated with a primary licensed narcotic treatment program. An office-based narcotic treatment program meeting the requirement of this paragraph shall not be required to have a license separate from the primary licensed narcotic treatment program with which it is affiliated and associated.
(b) For purposes of this section, “office-based narcotic treatment program” means a program in which interested and knowledgeable physicians and surgeons provide addiction treatment services, and in which community pharmacies or medication units supply necessary medication both to these physicians and surgeons for distribution to patients and through direct administration and specified dispensing services.
(c) Notwithstanding any other provision of law or regulation, including Section 10020 of Title 9 of the California Code of Regulations, an office-based narcotic treatment program in a remote site that is affiliated and associated with a licensed narcotic treatment program may be approved by the department, if all of the following conditions are met:
(1) A physician may provide office-based addiction services only if each office-based patient is registered as a patient in the licensed narcotic treatment program and both the licensed narcotic treatment program and the office-based narcotic treatment program ensure that all services required under Chapter 4 (commencing with Section 10000) of Division 4 of Title 9 of the California Code of Regulations for the management of narcotic addiction are provided to all patients treated in the remote site.
(2) A physician in an office-based narcotic treatment program may provide treatment for an appropriate number of patients under the appropriate United States Drug Enforcement Administration registration. The primary licensed narcotic treatment program shall be limited to its total licensed capacity as established by the department, including the patients of physicians in the office-based narcotic treatment program.
(3) The physicians in the office-based narcotic treatment program shall dispense or administer pharmacologic treatment for narcotic addiction or a substance use disorder that has been approved by the federal Food and Drug Administration such as buprenorphine, levo-alpha-acetylmethadol (LAAM), methadone, naltrexone, or any other medication approved by the federal Food and Drug Administration.
(4) Office-based narcotic treatment programs, in conjunction with primary licensed narcotic treatment programs, shall develop protocols to prevent the diversion of medication. The department may develop regulations to prevent the diversion of medication.
(d) For purposes of this section, “remote site” means a site that is geographically or physically isolated from any licensed narcotic treatment program. Therefore, the requirements in this subdivision regarding a remote site do not apply to an office-based narcotic treatment program that holds a primary narcotic treatment program license.
(e) In considering an office-based narcotic treatment program application, the department shall independently weigh the treatment needs and concerns of the county, city, or areas to be served by the program.
(f) Nothing in this section is intended to expand the scope of the practice of pharmacy.

SEC. 4.

 Section 14021.6 of the Welfare and Institutions Code is amended to read:

14021.6.
 (a) For the fiscal years prior to fiscal year 2004–05, and subject to the requirements of federal law, the maximum allowable rates for the Drug Medi-Cal Treatment Program shall be determined by computing the median rate from available cost data by modality from the fiscal year that is two years prior to the year for which the rate is being established.
(b) (1) For the fiscal year 2007–08, and subsequent fiscal years, and subject to the requirements of federal law, the maximum allowable rates for the Drug Medi-Cal Treatment Program shall be determined by computing the median rate from the most recently completed cost reports, by specific service codes that are consistent with the federal Health Insurance Portability and Accountability Act of 1996 (42 U.S.C. Sec. 300gg).
(2) For the fiscal years 2005–06 and 2006–07, if the State Department of Health Care Services determines that reasonably reliable and complete cost report data are available, the methodology specified in this subdivision shall be applied to either or both of those years. If reasonably reliable and complete cost report data are not available, the State Department of Health Care Services shall establish rates for either or both of those years based upon the usual, customary, and reasonable charge for the services to be provided, as the department may determine in its discretion. This subdivision is not intended to modify subdivision (h) of Section 14124.24, which requires certain providers to submit performance reports.
(c) Notwithstanding subdivision (a), for the 1996–97 fiscal year, the rates for nonperinatal outpatient methadone maintenance services shall be set at the rate established for the 1995–96 fiscal year.
(d) Notwithstanding subdivision (a), the maximum allowable rate for group outpatient drug free services shall be set on a per person basis. A group shall consist of a minimum of 2 and a maximum of 12 individuals, at least one of which shall be a Medi-Cal eligible beneficiary. For groups consisting of two individuals, if one of the individuals is ineligible for Medi-Cal, the individual who is ineligible for Medi-Cal shall be receiving outpatient drug free services for a substance abuse disorder diagnosed by a physician.
(e) The department shall develop individual and group rates for extensive counseling for outpatient drug free treatment, based on a 50-minute individual or a 90-minute group hour, not to exceed the total rate established for subdivision (d).
(f) The department may adopt regulations as necessary to implement subdivisions (a), (b), and (c), or to implement cost containment procedures. These regulations may be adopted as emergency regulations in accordance with Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code. The adoption of these emergency regulations shall be deemed an emergency necessary for the immediate preservation of the public peace, health and safety, or general welfare.
(g) Notwithstanding Section 14115, bills Bills for services under the Drug Medi-Cal Treatment Program shall be submitted no later than 12 six months from the date of service consistent with Section 447.45 of Title 42 of the Code of Federal Regulations. service.