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ARIZONA STATE SENATE
Fifty-Sixth Legislature, Second Regular Session
AMENDED
firefighters; peace offices; PTSD; therapy
Purpose
Conditionally upon the U.S. Food and Drug Administration (FDA) approval of methylenedioxymethamphetamine-assisted therapy (MDMA-AT) for treatment of post-traumatic stress disorder (PTSD) by December 31, 2025, authorizes one course of MDMA-AT treatment to firefighters and certified peace officers diagnosed with PTSD, if certain requirements are met. Prescribes key treatment stipulations and reporting requirements.
Background
The Industrial Commission of Arizona administers workers' compensation laws and adjudicates workers' compensation claims. An injured employee, or a dependent of a deceased employee, is entitled to receive workers' compensation for an accident arising out of and in the course of employment (A.R.S. § 23-921).
MDMA is a synthetic drug that alters mood and perception and is chemically similar to both stimulants and hallucinogens. MDMA increases the activity of dopamine, norepinephrine and serotonin in the brain and its effects last about three to six hours. MDMA is currently in clinical trials as a possible treatment aid for PTSD, anxiety in terminally ill patients and for social anxiety in autistic adults (National Institute on Drug Abuse). Recently, the FDA designated MDMA-AT for PTSD as a breakthrough therapy drug, which are intended to treat a serious or life-threatening disease or condition. A breakthrough therapy designation also means that preliminary clinical evidence indicates that the drug may demonstrate substantial improvement over existing therapies on one or more clinically significant endpoints (FDA).
Current statute requires the state or a political subdivision to establish a traumatic event counseling program to provide peace officers and firefighters who are exposed to a traumatic event while in the course of duty up to 12 employer-paid visits of licensed counseling. A peace officer or firefighter may qualify for up to 24 additional visits if a licensed mental health professional determines that additional visits are likely to improve their condition. An employer may not require a peace officer or firefighter who is receiving treatment from using accrued paid vacation leave, personal leave or sick leave if the leave is to attend a treatment visit. An employer must ensure no loss of pay and benefits for up to 30 calendar days per incident for a peace officer or firefighter that is determined to be unfit for duty (A.R.S. § 38-673).
The Joint Legislative Budget Committee (JLBC) fiscal note on S.B. 1677 estimates that requiring payment of MDMA-AT for firefighters and certified peace officers would increase workers' compensation coverage costs depending on the number of eligible firefighters and peace officers and the cost per patient (JLBC Fiscal Note).
Provisions
1. Requires the ICA, on notification from DHS, to consider whether to incorporate MDMA-AT into its treatment guidelines and, if incorporated, to include the treatment of MDMA-AT in its schedule of fees.
2. Stipulates
that, if an independent medical examination reveals a treatment protocol of
MDMA-AT is deemed reasonable and necessary treatment and the ICA has integrated
MDMA-AT treatment into its treatment guidelines, workers' compensation coverage
may include one course of a treatment protocol of MDMA-AT as prescribed by a
psychiatrist.
3. Requires the state or a political subdivision to include, in its statutorily established traumatic counseling program, coverage for one treatment protocol of MDMA-AT for firefighters and certified peace officers who have been exposed to a traumatic event and who have been diagnosed with PTSD by a licensed mental health professional, if a psychiatrist deems the treatment is reasonable and necessary.
4. Allows a firefighter or certified peace officer to receive one treatment protocol of MDMA-AT during their employment as a firefighter or certified peace officer through either workers' compensation coverage or an established traumatic counseling program.
5. Specifies that MDMA-AT treatment by a psychiatrist supplants licensed counseling.
6. Requires any treatment protocol of MDMA-AT to comply with the treatment guidelines and schedule of fees established by the ICA.
7. Requires MDMA-AT to meet statutory controlled substance requirements.
8. Requires any costs associated with the treatment protocol of MDMA-AT for a firefighter or certified peace officer to be reported to the ICA.
9. Requires
a firefighter or certified peace officer participating in a treatment protocol
of
MDMA-AT to notify their employer prior to beginning one treatment protocol of
MDMA-AT.
10. Prohibits an employer from requiring a firefighter or certified peace officer who is receiving one treatment protocol of MDMA-AT to use the firefighter's or certified peace officer's accrued paid vacation leave, personal leave or sick leave if the firefighter or certified peace officer leaves work to attend a treatment visit.
11. Stipulates that, if a licensed mental health professional determines that the firefighter or certified peace officer is not fit for duty while the firefighter or certified peace officer is receiving treatment, an employer must ensure the firefighter or certified peace officer has no loss of pay and benefits for up to 30 calendar days.
12. Specifies that the 30-calendar days include both the course of treatment for licensed counseling and for one treatment protocol of MDMA-AT.
13. Deems an employee eligible after the date a licensed mental health professional determines that the employee is not fit for duty, if:
a) the firefighter or certified peace officer is unable to work light duty or the employer does not offer a light duty option;
b) the firefighter or certified peace officer has exhausted their sick leave, vacation leave or other leave that is provided as part of their benefits package;
c) the fire fighter or certified peace officer elected short-term disability benefits, if offered by the employer, but is not eligible to receive short-term disability benefits; and
d) the employer does not have a supplemental program that provides pay and benefits after the occurrence of an injury.
14. Requires an employer to allow a firefighter or certified peace officer to select their own licensed mental health professional within Arizona, except that the employer is not required to secure secures of a licensed mental health professional that declines to provide one treatment protocol of MDMA-AT.
15. Requires an employer to pay the licensed mental health professional pursuant to the schedule of fees fixed by the ICA.
16. Specifies that an employer is not required to pay for a mental health professional who practices outside the state and is allowed to pay for care outside of the county in which the employer is located.
17. Specifies that payment by an employer for one treatment protocol of MDMA-AT does not establish a presumption that a claim is compensable.
18. Requires an employer to provide workers' compensation coverage to firefighters and certified peace officers who have been diagnosed with PTSD by a licensed mental health professional and have accepted a workers' compensation claim for PTSD.
19. Conditions the enactment of this legislation on FDA approval of the use of MDMA-AT for PTSD treatment by December 31, 2025.
20. Requires, by February 2, 2026, the Department of Health Services to notify the Director of the Arizona Legislative Council and the Director of the ICA of the date on which the conditional enactment was met, or that the conditional enactment was not met.
21. Requires, beginning January 1, 2026. the ICA to submit an annual report to JLBC on the costs of MDMA-AT treatment.
22. Defines treatment protocol of MDMA-AT as a process of treatment that has received FDA approval for PTSD and uses MDMA in conjunction with therapy sessions.
23. Defines terms.
24. Becomes effective on the general effective date or later, subject to the provisions of the conditional enactment.
Amendments Adopted by Committee of the Whole
1. Requires the ICA to consider whether to incorporate MDMA-AT into the ICA's treatment guidelines and, if included, requires the ICA to include MDMA-AT in its schedule of fees.
2. Allows firefighters and peace officers to receive one treatment protocol of MDMA-AT, as prescribed, during the course of their employment through either workers' compensation coverage or as part of the state's or state political subdivision's traumatic counseling program.
3. Specifies that a firefighter or certified peace officer must be diagnosed with PTSD by a licensed mental health professional and must have an accepted worker’s compensation claim for PTSD to qualify for potential workers’ compensation coverage for MDMA-AT treatment.
4. Requires, beginning January 1, 2026, the ICA to submit an annual report to JLBC on the costs of MDMA-AT treatment.
5. Requires the state to include in an established traumatic counseling program for peace officers and firefighters exposed to a traumatic event and who have been diagnosed with PTSD by a licensed mental health professional coverage for one treatment protocol of MDMA-AT as prescribed by a psychiatrist if a psychiatrist deems the treatment reasonable and necessary.
6. Specifies that the psychiatric treatment supplants licensed counseling visits.
7. Requires treatment of MDMA-AT to comply with treatment guidelines and the schedule of fees established by ICA and requires MDMA-AT to meet statutory controlled substance requirements.
8. Requires costs associated with MDMA-AT treatment to be reported to the ICA.
9. Requires a peace officer or firefighter participating in MDMA-AT to notify their employer prior to beginning treatment and prescribes leave requirements.
10. Deems an employee eligible after the date the licensed mental health professional determines that the employee is not fit for duty if outlined circumstances are met.
11. Specifies that an employer's payment for MDMA-AT does not establish a presumption that a claim is compensable under statute.
12. Defines terms.
13. Makes technical and conforming changes.
Senate Action
FICO 2/12/24 DP 4-2-1
APPROP 2/20/24 DP 7-2-1
Prepared by Senate Research
March 14, 2024
MG/AB/cs