ARIZONA HOUSE OF REPRESENTATIVES

SB 1535: AHCCCS; opioid treatment programs; requirements

PRIME SPONSOR: Senator Brophy McGee, LD 28

BILL STATUS: Caucus & COW

                                Health & Human Services: DP 9-0-0-0

Overview

Establishes reporting requirements for Opioid Treatment Programs (OTPs) that receive reimbursement from the Arizona Health Care Cost Containment System Administration (AHCCCS) and its contractors. The bill directs AHCCCS to suspend reimbursement for OTP providers who do not meet prescribed reporting requirements. The bill establishes the Opioid Use Disorder Review Council (Council).

History

The federal Substance Abuse and Mental Health Services Administration’s (SAMSHA)  Guidelines for OTPs outline and describe how prescribed opioid treatment standards are to be satisfied by OTPs, and include standards for OTP facility management, administrative organization, provider responsibilities, quality improvement, community relations and diversion control. An OTP is a licensed and accredited program, also referred to as a medication-assisted treatment program that is authorized to dispense medications for the treatment of opioid use disorder through highly structured protocols as prescribed by federal and state law. AHCCCS serves as the State Opioid Treatment Authority and is the entity responsible for providing administrative and clinical oversight to certified OTPs, including planning, developing, educating and implementing policies and procedures to ensure that opioid dependency treatment is provided at an optimal level.

Federal law requires that OTPs have a current and valid accreditation status, SAMSHA certification and U.S. Drug Enforcement Administration (DEA) registration before OPTs are permitted to administer or dispense opioid drugs for medication-assisted treatment. These requirements apply to opioid agonist treatment medications that are approved by the U.S. Food and Drug Administration including methadone and other pharmaceutical products containing buprenorphine (42 C.F.R. § 8).

Arizona Health Care Cost Containment System is Arizona's Medicaid program. Medicaid is a federal healthcare program jointly funded by the federal and state governments for individuals and families who may qualify for acute or long-term services. AHCCCS is a $12 billion program that operates under an integrated managed care model that coordinates and pays for the medical services delivered by more than 70,000 health care providers for 1.9 million individuals and families in Arizona. There is no anticipated fiscal impact to the state General Fund associated with this legislation.

Provisions

Opioid Treatment Programs

1. Allows AHCCCS and its contractors to reimburse an OTP provider if the provider demonstrates enforcement of each plan contained in the annual report and the report is approved by AHCCCS. (Sec. 1)

2. Requires an OTP provider that receives reimbursement from AHCCCS to submit an annual report that includes:

a. A security plan that incorporates standards from SAMSHA as well as the DEA. The plan must include patient management strategies that are designed to reduce potential harm to patients and lower the risk of exposure to illicit transactions and other consequences of overcrowding and poor patient management;

b. A neighborhood engagement plan that outlines engagement with key stakeholders in the neighborhood where the OTP is located, including homeowner associations, school administrators, neighboring businesses, community organizations, the city or town council and local law enforcement. The plan must include information about ensuring consideration of a response to reasonable safety security and trash removal concerns, concerns regarding adequate parking for patients and staff and other matters of concern to the entities prescribed;

c. A comprehensive plan related to the care of all patients to demonstrate how the opioid treatment program ensures that appropriate standards of care are met for medication-assisted treatment (MAT), including dosing, the provision of or referral to appropriate counseling and behavioral therapy services and peer support services, as required by SAMSHA. The plan must include whether the opioid treatment program provides the therapy services directly or refers patients for services through a separate provider. If the program refers patients for services through a separate provider, the report must include strategies employed to ensure patients are able to access referred services in a timely manner;

d. A community relations and education plan that includes policies and procedures to measure and minimize the negative impact the OTP may have on the community to promote peaceful coexistence and to plan for change in the program and program growth, including:

i. Considering community needs and impacts when selecting a site for the program or program growth;

ii. Considering community input on the potential impact the program may have on the community;

iii. Maintaining a clean and orderly facility that does not impede pedestrian or traffic flow;

iv. Communicating with community leaders to foster food community relations;

v. Developing and implementing a community relations plan that is specified to the needs of the program within its community and that includes the following actions:

Ø Establishing a liaison with community representatives to share information, concerns and issues;

Ø Identifying program personnel who will function as community relations coordinators and define the goals and procedures of the community relations plan;

Ø Serving as a community resource on substance use and related health and social issues as well as promoting the benefit of MAT in preserving the public health;

Ø Soliciting community input about MAT and the program's presence in the community;

Ø Developing program policies and procedures to effectively address and resolve community problems, including patient loitering and medication diversion, and ensuring that program operations do not affect community life adversely;

Ø Documenting community contacts and community relations efforts and evaluating the effectiveness of activities over time in addressing outstanding problems or deficiencies;

Ø Disclosing the process for community contacts to notify AHCCCS' clinical resolution unit of unresolved problems or deficiencies that includes coordination with the state opioid treatment authority when appropriate; and

Ø Developing communication mechanisms to provide interested parties and potential patients with information about the program outside of regular business hours;

e. A current diversion control plan that contains specific measures to reduce the diversion of controlled substances from legitimate treatment use. (Sec. 1)

3. Directs AHCCCS to:

a. Post received reports on its public website;

b. Notify each city or town where an OTP is located of the report;

c. Allow 30 days for the city or town to provide comments on the report;

d. Consider the city or town's comments on the report;

e. Approve or reject the report within 30 days of the close of the comment period;

f. Provide an OTP with 30 days to revise a report if AHCCCS identifies areas of concern regarding compliance with federal and state OTP regulations; and

g. Take any appropriate regulatory action based on deficiencies identified in a report. (Sec. 1)

4. Requires AHCCCS and its contractors to suspend reimbursement to an OTP with appropriate notification to the provider if:

a. An OTP does not submit a report as required;

b. An OTP does not demonstrate enforcement of each plan contained in the report; or

c. AHCCCS does not approve the report initially or after revisions. (Sec. 1)

5. Requires AHCCCS by January 15 of each year to submit a report to the governor and the legislature on OTPs. (Sec. 1)

6. Defines terms. (Sec. 1)

7. Requires AHCCCS and the Department of Health Services (DHS) to establish standards for designating Centers of Excellence (COEs) for treating opioid use disorder in Arizona by December 31, 2019. AHCCCS must publish the draft standards on their website and hold at least two public hearings to receive input before implementing the standards. AHCCCS must publish the final standards for designating COEs for treating opioid use disorder on its website. (Sec. 2)

8. Establishes that minimum standards COEs include:

a. Information regarding OTP providers and facilities including off-based OTP providers;

b. Parameters to ensure coordination of care that includes behavioral health, physical health, and MAT for opioid use disorder;

c. Tracking and reporting requirements that identify treatment capacity and quantitative metrics related to quality of care and patient outcomes, qualitative metrics related to patient satisfaction; and

d. An annual evaluation by a third-party auditor of the accuracy and completeness of data provided by the centers. (Sec. 2)

9. Requires AHCCCS to maintain an accurate list of designated COEs on their website.

10. Requires COEs to:

a. Increase capacity for treating opioid use disorder in the OTPs and office-based opioid agonist treatment statewide;

b. Demonstrate the effective delivery of MAT for opioid use disorder using evidence-based practices as defined by SAMSHA;

c. Comply with tracking, reporting and evaluation requirements; and

d. Participate in the statewide learning collaborative. (Sec. 2)

11. Directs AHCCCS to establish a statewide learning collaborative to share the best practices and establish peer to peer support between COEs.

12. Requires AHCCCS to submit a report to the governor and the legislature by January 15 of each year that outlines:

a. The standards for designating COEs;

b. The statewide list of designated COEs; and

c. A summary of the performance of the COEs. (Sec. 2)

Opioid Disorder Review Council

13. Establishes the Council which is made up of the following members:

a. The chairpersons of the Health and Human Services committees in the Senate and the House of Representatives, who will serve as the co-chairpersons;

b. The director of AHCCCS or the director's designee;

c. The director of DHS or the director's designee; and

d. The following members, who are appointed by the governor;

i. Two family members of individuals who currently receive MAT for opioid use disorder;

ii. A representative from a managed care organization contracted with AHCCCS;

iii. A representative from an OTP;

iv. A representative from an office-based opioid agonist treatment program;

v. An administrator of a publicly funded OTP;

vi. A representative of a commercial health care insurer;

vii. A representative from a municipality with a population of more than 1.4 million people;

viii. A representative from a county with a population of more than 1 million people;

ix. A representative from a county with a population of more than 200,000 and less than 210,000 people. (Sec. 2)

14. Outlines the powers and duties of the Council as follows:

a. Review and make recommendations to AHCCCS regarding:

i. Standards for designating COEs for MAT for opioid use disorder;

ii. Reporting requirements for care delivery activities in designated centers;

iii. Availability of and barriers to access to all FDA-approved medications for treating opioid use disorder and whether utilization controls are appropriate;

iv. Other state licensure and treatment models that provide outpatient opioid treatment; and

v. Patient outcomes that are reported to AHCCCS administration by contracted providers who receive reimbursement for MAT for opioid use disorder;

b. Recommend to the legislature changes to the laws regarding MAT for opioid use disorder;

c. Submit a report regarding the Council's activities and recommendations to the governor, and the legislature by December 15 of each year (Sec. 2).

15. Requires AHCCCS and DHS to provide technical assistance to the Council (Sec. 2).

16. Repeals the Council on December 31, 2023 (Sec. 2).

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20. Fifty-fourth Legislature                       SB 1535

21. First Regular Session                            Version 2: Caucus & COW

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