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ARIZONA STATE SENATE
Fifty-Fourth Legislature, First Regular Session
AHCCCS; opioid treatment programs; requirements
Purpose
Establishes reporting requirements for opioid treatment programs (OTP) who receive reimbursement from the Arizona Health Care Cost Containment System (AHCCCS) and AHCCCS contractors.
Background
The federal Substance Abuse and Mental Health Services Administration’s (SAMHSA) Guidelines for Opioid Treatment Programs (Guidelines) 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 licensed and accredited program, also referred to as medication-assisted treatment (MAT) 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. The Arizona Health Care Cost Containment System (AHCCCS) serves as Arizona's 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, SAMHSA
certification and Drug Enforcement Administration (DEA) registration before
they are permitted to administer or dispense opioid drugs for MAT. These
requirements apply to opioid agonist treatment medications that are approved by
the Food and Drug Administration, including methadone and other pharmaceutical
products containing buprenorphine. Federal law allows MAT for other
pharmacotherapies if they are provided in a manner consistent with the best
medical practices for each drug. For example, the use of naltrexone is
permitted in OTPs but is not subject to these regulations. The federal
regulations and SAMHSA Guidelines describe a minimum acceptable standard for
the operation of OTPs. According to SAMHSA, the Guidelines are intended to
assure the safety of both the patient and the public (42
Code of Federal Regulations
§ 8).
There is no anticipated fiscal impact to the state General Fund associated with this legislation.
Provisions
1. Establishes that AHCCCS and AHCCCS contractors are only permitted to reimburse OTP providers for enrolled members that manage an average daily census of 250 patients or less per day for every 5,000 spare feet of facility space.
2. Requires that OTP facilities include adequate parking for patients and staff.
3. Directs OTP providers that receive reimbursement from AHCCCS or their contractors to submit an annual report, on a schedule prescribed by AHCCCS, that contains:
a) a detailed security plan that incorporates best practices from SAMHSA and the DEA, and includes patient management strategies designed to reduce potential harm to patients and lower this risk of exposure to illicit transactions and other consequences of overcrowding and poor patient management;
b) a neighborhood engagement plan that outlines engagement with stakeholders in the neighborhood where the OTP is located, including homeowners' associations, school administrators, neighboring businesses, community organizations, municipal governments and local law enforcement;
c) information regarding consideration of and responses to reasonable safety, security, trash removal and other neighborhood stakeholder concerns;
d) a comprehensive plan related to patient care that:
i. demonstrates how the OTP ensures appropriate standards of care are met for MAT, including dosing, and the provision of or referral to counseling, behavioral therapy services and peer support services, as required by SAMHSA;
ii. includes whether the OTP provides therapy services directly or refers patients for services through a separate provider; and
iii. includes strategies employed to ensure patients can access referred services in a timely manner, if patients are referred for services through a separate provider;
e) the average daily census and square footage of the provider's location;
f) the number of patients served by each MAT type offered by the provider; and
g) the average length of treatment by each MAT type offered by the provider.
4. Requires AHCCCS to post the reports on its public website.
5. Directs AHCCCS to notify each city or town where a OTP is located of the report and requires AHCCCS to allow 30 days for the city or town to provide comments on the report.
6. Directs AHCCCS to consider the city or town's comments on the report and approve or reject the report within 30 days of the close of the comment period.
7. Requires AHCCCS to provide an OTP with 30 days to revise a report if AHCCCS identifies areas of concern regarding compliance with federal and state OTP regulations.
8. Requires AHCCCS to take any appropriate regulatory action based on deficiencies identified in a report.
9. Requires AHCCCS and it's contractors to suspend reimbursement to an OTP until the report is approved if:
a) an OTP does not submit a report as required or if the report is not approved; or
b) AHCCCS does not approve the report initially or after revision.
10. Requires AHCCCS, if a process is established to evaluate whether an OTP should be designated as a center of excellence (COE) or a similar designation, to develop standards that apply to such a designation and that allow for at least 45 days of public comment.
11. Requires that COE designation standards include appropriate clinical standards, requirements for security, patient safety, patient management and neighborhood engagement.
12. Requires AHCCCS to submit, by January 15th of each year, a report to the Governor, the President of the Senate and the Speaker of the House of Representatives that summarizes submitted OTP reports and that include prescribed OTP standards.
13. Requires that a copy of the report be submitted to the Secretary of State.
14. Defines relevant terms.
15. Becomes effective on the general effective date.
Prepared by Senate Research
February 18, 2019
CRS/kja