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AB-2174 Heroin and Opioid Public Education (HOPE) Act.(2017-2018)

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Date Published: 03/16/2018 04:00 AM
AB2174:v98#DOCUMENT

Amended  IN  Assembly  March 15, 2018

CALIFORNIA LEGISLATURE— 2017–2018 REGULAR SESSION

Assembly Bill No. 2174


Introduced by Assembly Member Waldron

February 12, 2018


An act to amend Section 1367.005 add and repeal Article 5 (commencing with Section 11774) of Chapter 1 of Part 2 of Division 10.5 of the Health and Safety Code, relating to health care coverage. drug abuse.


LEGISLATIVE COUNSEL'S DIGEST


AB 2174, as amended, Waldron. Health care coverage: essential health benefits. Heroin and Opioid Public Education (HOPE) Act.
Existing law tasks the State Department of Public Health with certain specified duties related to health information and strategic planning, including opioid misuse and overdose prevention. Among other duties, existing law directs the department, upon appropriation by the Legislature, to award naloxone grant funding to local health departments, local government agencies, or other entities, as specified, in order to reduce the rate of fatal overdose from opioid drugs including heroin and prescription opioids.
This bill would require the department, in consultation with stakeholders, to develop, coordinate, implement, and oversee a comprehensive multicultural public awareness campaign, to be known as “Heroin and Opioid Public Education (HOPE),” upon appropriation by the Legislature or receipt of state or federal grant funding, until January 1, 2023. The bill would require the HOPE program to provide for the coordinated and widespread public dissemination of individual case stories and other generalized information that focuses on, among other things, the effects and warning signs of heroin use and opioid medication and identifying available pathways for individuals seeking help. The bill would require the HOPE program to effectuate the dissemination of information by using appropriate types of media, as specified, employing a variety of complementary educational themes and messages that are tailored to appeal to different target audiences, and using culturally and linguistically appropriate means.
The bill would require the department to submit a report to the Governor and Legislature on at least an annual basis, that summarizes the actions that have been undertaken by the department to implement the bill and includes an assessment of the effectiveness of the HOPE program, as specified.

The Knox-Keene Health Care Service Plan Act of 1975 provides for the licensure and regulation of health care service plans by the Department of Managed Health Care. The act requires an individual or small group health care service plan contract issued, amended, or renewed on or after January 1, 2017, to, at a minimum, cover essential health benefits, and defines “essential health benefits” to include health benefits covered by other particular benchmark plans, including a certain plan offered during the first quarter of 2014. A willful violation of the act is a crime.

This bill would make technical, nonsubstantive changes to this provision.

Vote: MAJORITY   Appropriation: NO   Fiscal Committee: NOYES   Local Program: NO  

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


SECTION 1.

 This act shall be known, and may be cited, as the “HOPE Act.”

SEC. 2.

 Article 5 (commencing with Section 11774) is added to Chapter 1 of Part 2 of Division 10.5 of the Health and Safety Code, to read:
Article  5. Heroin and Opioid Public Education (HOPE)

11774.
 The Legislature finds and declares all of the following:
(a) There is an epidemic in this state stemming from the use of heroin and the abuse of opioid medications.
(b) Prescription drug overdoses now kill more people than car accidents.
(c) Every day, 2,500 children 12 to 17, inclusive, years of age abuse a prescription painkiller for the first time, and more people are becoming addicted to prescription drugs.
(d) Data from the federal Centers for Disease Control and Prevention suggests that the nonmedical use of prescription painkillers costs public and private health insurers seventy-two billion eight hundred million dollars ($72,800,000,000) annually.
(e) In order for the state to combat this epidemic, citizens in all walks of life shall be alerted to the problem, and shall be armed with information that will allow them to recognize, and undertake appropriate actions, when they or their loved ones are at risk of, or are succumbing to, a heroin or opioid medication addiction.
(f) The widespread dissemination of information necessary to combat the state’s heroin and opioid medication epidemic could be successfully achieved through the institution and maintenance of a multicultural statewide public awareness campaign, which would be carefully coordinated through all available multimedia channels to reach a wide variety of audiences, including drug users, their family members and friends, medical practitioners and nurses, emergency personnel, and employers.

11774.1.
 (a) The State Department of Public Health, upon appropriation by the Legislature or receipt of adequate state or federal grant funding, and in consultation with stakeholders, as appropriate, shall develop, coordinate, implement, and oversee a comprehensive multicultural public awareness campaign, to be known as “Heroin and Opioid Public Education (HOPE),” which shall allow for the coordinated and widespread dissemination of information designed to combat the growing heroin and opioid medication epidemic in the state.
(b) Using the means described in subdivision (c), HOPE shall provide for the coordinated and widespread public dissemination of individual case stories and other generalized information that focuses on any of the following:
(1) Identifying the pathways that can lead to opioid medication abuse and heroin use, and the reasons why opioid medication abuse may evolve into heroin use.
(2) Showing the many faces of heroin and opioid medication addiction and rebutting the commonly accepted myths and stereotypes about heroin users and opioid medication abusers.
(3) Educating the public on the negative impact of abuse and diversion of opioid medication, while recognizing the legitimate use of those same opioid drugs as medications.
(4) Describing the effects and warning signs of heroin use and opioid medication abuse, so as to better enable members of the public to determine when help is needed.
(5) Showing the link that exists between heroin and opioid medication addiction and suicidal behavior.
(6) Identifying the pathways that are available for individuals to seek help in association with their own, or another person’s, heroin or opioid medication addiction, and indicating the various telephone hotline systems that exist in the state for persons who wish to report a case of drug abuse or engage in substance abuse treatment.
(7) Highlighting the availability of naloxone hydrochloride as a means to avert death from a heroin or opioid medication overdose, identifying pathways for members of the public to obtain a prescription for naloxone hydrochloride and training in the emergency administration of naloxone hydrochloride, and promoting the proper use of naloxone hydrochloride in crisis situations.
(8) Highlighting the benefits of substance abuse treatment and the potential for treatment to allow for the reclaiming of lives that have been upset by addiction, and underscoring the fact that relapses occur not because treatment is ineffective, but because of the nature of addiction, which is a recurring and relapsing disorder.
(9) Highlighting the benefits of medication-assisted therapy using medications approved by the federal Food and Drug Administration, such as methadone, buprenorphine, extended-release injectable naltrexone, or other similar drugs, and destigmatizing the use of that medication-assisted therapy.
(10) Identifying the methods that can be used by an individual to help finance the costs of substance abuse treatment.
(11) Identifying the steps that individuals can take to prevent and deter family members, friends, students, patients, coworkers, and others from first experimenting with inappropriately obtained opioid medications, and from misusing or mismanaging lawful opioid medications.
(12) Identifying the proper methods for safeguarding, and for safely disposing of, legitimate opioid medications.
(13) Addressing any other issues that the department may deem appropriate and necessary to proactively educate the public about the state’s heroin and opioid medication epidemic and the actions that can be taken by members of the public to reduce the likelihood of heroin or opioid medication addiction, or to otherwise respond to, or mitigate the effects of, heroin or opioid medication addiction in cases in which it is present.
(c) (1) The HOPE program shall effectuate the dissemination of information described in subdivision (b) by using appropriate types of media to achieve the goal efficiently and effectively, including new technologies in media, print media, television and radio, and Internet and social media.
(2) In disseminating the information described in subdivision (b), the HOPE program shall employ a variety of complementary educational themes and messages that shall be tailored to appeal to different target audiences in the state. At a minimum, the HOPE program shall incorporate all of the following:
(A) At least one message that is directed at, and is tailored to influence and resonate with, individuals who are personally at risk of heroin use or opioid medication abuse or who have already started down a pathway to addiction.
(B) At least one message that is directed at, and is tailored to influence and resonate with, the family members and friends of addicted persons, teachers, school nurses, medical practitioners, and employers.
(C) At least one message that is directed at the dangers of teen drug pilfering from the household medicine cabinet and how this could be avoided through the use of safe storage products.
(3) Information under the HOPE program shall be disseminated using culturally and linguistically appropriate means, in a manner that demonstrates respect for individual dignity and cultural differences. Where feasible and appropriate, the information shall be made available in a variety of languages.
(4) The department may enter into public-private partnerships with pharmaceutical or health care insurance companies, nonprofit social services organizations, mental health services providers and clinics, law enforcement, health care agencies, and school districts, that provide services in the state in order to facilitate the dissemination of information under the HOPE program.

11774.2.
 (a) The department shall submit to the Governor and the Legislature on at least an annual basis, a report that summarizes the actions that have been undertaken by the department to implement this article and includes an assessment of the effectiveness of the program, including, but not limited to, effects on the rate of new opioid and heroin addictions by populations, mitigation of the effects of opioid or heroin addiction, crime rates, hospitalization rates, death rates, and other calculable results as determined by the department. The report shall provide any recommendations for legislative or executive action that may be necessary to facilitate the ongoing success of the program.
(b) A report to be submitted to the Legislature pursuant to this section shall be submitted in compliance with Section 9795 of the Government Code.

11774.3.
 The department may adopt regulations in accordance with the rulemaking provisions of the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code) as necessary to implement this article.

11774.4.
 This article shall remain in effect only until January 1, 2023, and as of that date is repealed, unless a later enacted statute, that is enacted before January 1, 2023, deletes or extends that date.

SECTION 1.Section 1367.005 of the Health and Safety Code is amended to read:
1367.005.

(a)An individual or small group health care service plan contract issued, amended, or renewed on or after January 1, 2017, shall, at a minimum, include coverage for essential health benefits pursuant to PPACA and as outlined in this section. For purposes of this section, “essential health benefits” shall mean all of the following:

(1)The health benefits within the categories identified in Section 1302(b) of PPACA: ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder services, including behavioral health treatment, prescription drugs, rehabilitative and habilitative services and devices, laboratory services, preventive and wellness services and chronic disease management, and pediatric services, including oral and vision care.

(2)(A)The health benefits covered by the Kaiser Foundation Health Plan Small Group HMO 30 plan (federal health product identification number 40513CA035) as this plan was offered during the first quarter of 2014, as follows, regardless of whether the benefits are specifically referenced in the evidence of coverage or plan contract for that plan:

(i)Medically necessary basic health care services, as defined in subdivision (b) of Section 1345 and in Section 1300.67 of Title 28 of the California Code of Regulations.

(ii)The health benefits mandated to be covered by the plan pursuant to statutes enacted before December 31, 2011, as described in the following sections: Sections 1367.002, 1367.06, and 1367.35 (preventive services for children); Section 1367.25 (prescription drug coverage for contraceptives); Section 1367.45 (AIDS vaccine); Section 1367.46 (HIV testing); Section 1367.51 (diabetes); Section 1367.54 (alpha-fetoprotein testing); Section 1367.6 (breast cancer screening); Section 1367.61 (prosthetics for laryngectomy); Section 1367.62 (maternity hospital stay); Section 1367.63 (reconstructive surgery); Section 1367.635 (mastectomies); Section 1367.64 (prostate cancer); Section 1367.65 (mammography); Section 1367.66 (cervical cancer); Section 1367.665 (cancer screening tests); Section 1367.67 (osteoporosis); Section 1367.68 (surgical procedures for jaw bones); Section 1367.71 (anesthesia for dental); Section 1367.9 (conditions attributable to diethylstilbestrol); Section 1368.2 (hospice care); Section 1370.6 (cancer clinical trials); Section 1371.5 (emergency response ambulance or ambulance transport services); subdivision (b) of Section 1373 (sterilization operations or procedures); Section 1373.4 (inpatient hospital and ambulatory maternity); Section 1374.56 (phenylketonuria); Section 1374.17 (organ transplants for HIV); Section 1374.72 (mental health parity); and Section 1374.73 (autism/behavioral health treatment).

(iii)Any other benefits mandated to be covered by the plan pursuant to statutes enacted before December 31, 2011, as described in those statutes.

(iv)The health benefits covered by the plan that are not otherwise required to be covered under this chapter, to the extent required pursuant to Sections 1367.18, 1367.21, 1367.215, 1367.22, 1367.24, and 1367.25, and Section 1300.67.24 of Title 28 of the California Code of Regulations.

(v)Any other health benefits covered by the plan that are not otherwise required to be covered under this chapter.

(B)If there are any conflicts or omissions in the plan identified in subparagraph (A) as compared with the requirements for health benefits under this chapter that were enacted prior to December 31, 2011, the requirements of this chapter shall be controlling, except as otherwise specified in this section.

(C)Notwithstanding subparagraph (B) or any other provision of this section, the home health services benefits covered under the plan identified in subparagraph (A) shall be deemed to not be in conflict with this chapter.

(D)For purposes of this section, the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (Public Law 110-343) shall apply to a contract subject to this section. Coverage of mental health and substance use disorder services pursuant to this paragraph, along with any scope and duration limits imposed on the benefits, shall be in compliance with the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (Public Law 110-343), and all rules, regulations, or guidance issued pursuant to Section 2726 of the federal Public Health Service Act (42 U.S.C. Sec. 300gg-26).

(3)With respect to habilitative services, in addition to any habilitative services and devices identified in paragraph (2), coverage shall also be provided as required by federal rules, regulations, and guidance issued pursuant to Section 1302(b) of PPACA. Habilitative services and devices shall be covered under the same terms and conditions applied to rehabilitative services and devices under the plan contract. Limits on habilitative and rehabilitative services and devices shall not be combined.

(4)With respect to pediatric vision care, the same health benefits for pediatric vision care covered under the Federal Employees Dental and Vision Insurance Program vision plan with the largest national enrollment as of the first quarter of 2014. The pediatric vision care benefits covered pursuant to this paragraph shall be in addition to, and shall not replace, any vision services covered under the plan identified in paragraph (2).

(5)With respect to pediatric oral care, the same health benefits for pediatric oral care covered under the dental benefit received by children under the Medi-Cal program as of 2014, including the provision of medically necessary orthodontic care provided pursuant to the federal Children’s Health Insurance Program Reauthorization Act of 2009. The pediatric oral care benefits covered pursuant to this paragraph shall be in addition to, and shall not replace, any dental or orthodontic services covered under the plan identified in paragraph (2).

(b)Treatment limitations imposed on health benefits described in this section shall be no greater than the treatment limitations imposed by the corresponding plans identified in subdivision (a), subject to the requirements set forth in paragraph (2) of subdivision (a).

(c)Except as provided in subdivision (d), nothing in this section shall be construed to permit a health care service plan to make substitutions for the benefits required to be covered under this section, regardless of whether those substitutions are actuarially equivalent.

(d)To the extent permitted under Section 1302 of PPACA and any rules, regulations, or guidance issued pursuant to that section, and to the extent that substitution would not create an obligation for the state to defray costs for any individual, a plan may substitute its prescription drug formulary for the formulary provided under the plan identified in subdivision (a) as long as the coverage for prescription drugs complies with the sections referenced in clauses (ii) and (iv) of subparagraph (A) of paragraph (2) of subdivision (a) that apply to prescription drugs.

(e)A health care service plan, or its agent, solicitor, or representative, shall not issue, deliver, renew, offer, market, represent, or sell any product, contract, or discount arrangement as compliant with the essential health benefits requirement in federal law, unless it meets all of the requirements of this section.

(f)This section applies regardless of whether the plan contract is offered inside or outside the California Health Benefit Exchange created by Section 100500 of the Government Code.

(g)This section shall not be construed to exempt a plan or a plan contract from meeting other applicable requirements of law.

(h)This section shall not be construed to prohibit a plan contract from covering additional benefits, including, but not limited to, spiritual care services that are tax deductible under Section 213 of the Internal Revenue Code.

(i)Subdivision (a) does not apply to any of the following:

(1)A specialized health care service plan contract.

(2)A Medicare supplement plan.

(3)A plan contract that qualifies as a grandfathered health plan under Section 1251 of PPACA or any rules, regulations, or guidance issued pursuant to that section.

(j)This section shall not be implemented in a manner that conflicts with a requirement of PPACA.

(k)This section shall be implemented only to the extent essential health benefits are required pursuant to PPACA.

(l)An essential health benefit is required to be provided under this section only to the extent that federal law does not require the state to defray the costs of the benefit.

(m)This section does not obligate the state to incur costs for the coverage of benefits that are not essential health benefits as defined in this section.

(n)A plan is not required to cover, under this section, changes to health benefits that are the result of statutes enacted on or after December 31, 2011.

(o)(1)The department may adopt emergency regulations implementing this section. The department may, on a one-time basis, readopt any emergency regulation authorized by this section that is the same as, or substantially equivalent to, an emergency regulation previously adopted under this section.

(2)The initial adoption of emergency regulations implementing this section and the readoption of emergency regulations authorized by this subdivision shall be deemed an emergency and necessary for the immediate preservation of the public peace, health, safety, or general welfare. The initial emergency regulations and the readoption of emergency regulations authorized by this section shall be submitted to the Office of Administrative Law for filing with the Secretary of State and each shall remain in effect for no more than 180 days, by which time final regulations may be adopted.

(3)The initial adoption of emergency regulations implementing this section made during the 2015–16 Regular Session of the Legislature and the readoption of emergency regulations authorized by this subdivision shall be deemed an emergency and necessary for the immediate preservation of the public peace, health, safety, or general welfare. The initial emergency regulations and the readoption of emergency regulations authorized by this section shall be submitted to the Office of Administrative Law for filing with the Secretary of State and each shall remain in effect for no more than 180 days, by which time final regulations may be adopted.

(4)The director shall consult with the Insurance Commissioner to ensure consistency and uniformity in the development of regulations under this subdivision.

(5)This subdivision shall become inoperative on July 1, 2018.

(p)For purposes of this section, the following definitions apply:

(1)“Habilitative services” shall mean health care services and devices that help a person keep, learn, or improve skills and functioning for daily living. Examples include therapy for a child who is not walking or talking at the expected age. These services may include physical and occupational therapy, speech-language pathology, and other services for people with disabilities in a variety of inpatient or outpatient settings, or both. Habilitative services shall be covered under the same terms and conditions applied to rehabilitative services under the plan contract.

(2)(A)“Health benefits,” unless otherwise required to be defined pursuant to federal rules, regulations, or guidance issued pursuant to Section 1302(b) of PPACA, shall mean health care items or services for the diagnosis, cure, mitigation, treatment, or prevention of illness, injury, disease, or a health condition, including a behavioral health condition.

(B)“Health benefits” does not mean any cost-sharing requirements such as copayments, coinsurance, or deductibles.

(3)“PPACA” shall mean the federal Patient Protection and Affordable Care Act (Public Law 111-148), as amended by the federal Health Care and Education Reconciliation Act of 2010 (Public Law 111-152), and any rules, regulations, or guidance issued thereunder.

(4)“Small group health care service plan contract” shall mean a group health care service plan contract issued to a small employer, as defined in Section 1357.500.