1. Policy/Legislative Report SAPT Committee Meeting March 23, 2016 County Behavioral Health Directors Association of California

2. 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.

3. 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.

4. 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.

5. 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.

6. 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.

7. 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 co- prescribing. 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.

8. 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.

9. 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.

10. 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.

11. 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.

12. 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.

13. 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.

14. 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).

15. 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?

16. Contact Information Kirsten Barlow, Executive Director kbarlow@cbhda.org Mary Adèr, Deputy Director, Legislative Affairs mader@cbhda.org Tom Renfree, Deputy Director, Substance Use Disorder Services trenfree@cbhda.org County Behavioral Health Directors Association of California www.cbhda.org 16