SB 973, as amended, Hernandez. Narcotic treatment programs.
Existing law requires the State Department of Health Care Services to administer prevention, treatment, and recovery services for alcohol and drug abuse. Existing law requires the department to license the establishment of narcotic treatment programs in this state to use narcotic replacement therapy in the treatment of addicted persons whose addiction was acquired or supported by the use of a narcotic drug or drugs, not in compliance with a physician and surgeon’s legal prescription. Existing law authorizes a program to admit a patient to narcotic maintenance or narcotic detoxification treatment 7 days after completion of a prior withdrawal treatment episode.
This bill, instead, would authorize a program to admit a patient to narcotic maintenance or narcotic detoxification treatment at the discretion of the medical director and would require
the program to assign a unique identifier to, and maintain an individual record of, each patient of the program. The bill would alsobegin delete authorizeend deletebegin insert specify thatend insert the program operation guidelines for narcotic treatment programsbegin delete toend deletebegin insert mayend insert includebegin delete accurate, reliable,end deletebegin insert reliableend insert and medically necessary body fluid analysisbegin insert other than urinalysisend insert.
Existing law specifies the intent of the Legislature that take-home dosage of the narcotic replacement only be provided when the patient is clearly adhering to the requirements of the program and where daily attendance at a clinic would be incompatible with gainful employment, education, and responsible homemaking.
This bill, in addition, would authorize take-home dosage to be provided to patients who are clearly adhering to the requirements of the program where daily attendance at a clinic would be incompatible with retirement or medical disability or if the program is closed on Sundays or holidays and providing a take-home dose is not contrary to federal laws and regulations. The bill would prohibit a narcotic treatment program from providing a take-home dosage that requires dilution.
Existing law requires substance abuse testing for narcotic treatment programs to be performed by a laboratory approved and licensed by the State Department of Public Health.
This bill would require a narcotic treatment program to have samples from each patient’s urinalysis or other body fluid test collected and analyzed for evidence of specified substances, including methadone, opiates, and cocaine, and would authorize the program to test for evidence of other illicit drugs if those drugs are commonly used in the area served by the program.
Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: no.
The people of the State of California do enact as follows:
Section 11839.3 of the Health and Safety Code
2 is amended to read:
(a) In addition to the duties authorized by other
4statutes, the department shall perform all of the following:
5(1) License the establishment of narcotic treatment programs
6in this state to use narcotic replacement therapy in the treatment
7of addicted persons whose addiction was acquired or supported
8by the use of a narcotic drug or drugs, not in compliance with a
9physician and surgeon’s legal prescription, except that the Research
10Advisory Panel shall have authority to approve methadone or
11LAAM research programs. The department shall establish and
12enforce the criteria for the eligibility of patients to be included in
P3 1the programs, program operation guidelines, including dosage
2
levels, recordkeeping and reporting,begin insert requirements forend insert urinalysis
3or otherbegin delete accurate, reliable,end deletebegin insert reliableend insert and medically necessary body
4fluid analysisbegin delete requirements,end deletebegin insert that is at least as accurate as, or more
5accurate than, current testing methods,end insert take-home doses of
6controlled substances authorized for use pursuant to Section
711839.2, security against redistribution of the narcotic replacement
8drugs, and any other regulations that are necessary to protect the
9
safety and well-being of the patient, the local community, and the
10public, and to carry out this chapter. A program may admit a patient
11to narcotic maintenance or narcotic detoxification treatment at the
12discretion of the medical director. The program shall assign a
13unique identifier to, and maintain an individual record for, each
14patient of the program. The arrest and conviction records and the
15records of pending charges against a person seeking admission to
16a narcotic treatment program shall be furnished to narcotic
17treatment program directors upon written request of the narcotic
18treatment program director provided the request is accompanied
19by a signed release from the person whose records are being
20requested.
21(2) Inspect narcotic treatment programs in this state and ensure
22that programs are operating in accordance with the law and
23regulations.
The department shall have sole responsibility for
24compliance inspections of all programs in each county. Annual
25compliance inspections shall consist of an evaluation by onsite
26review of the operations and records of licensed narcotic treatment
27programs’ compliance with applicable state and federal laws and
28regulations and the evaluation of input from local law enforcement
29and local governments, regarding concerns about the narcotic
30treatment program. At the conclusion of each inspection visit, the
31department shall conduct an exit conference to explain the cited
32deficiencies to the program staff and to provide recommendations
33to ensure compliance with applicable laws and regulations. The
34department shall provide an inspection report to the licensee within
3530 days of the completed onsite review describing the program
36deficiencies. A corrective action plan shall be required from the
37program within 30
days of receipt of the inspection report. All
38corrective actions contained in the plan shall be implemented
39within 30 days of receipt of approval by the department of the
40corrective action plan submitted by the narcotic treatment program.
P4 1For programs found not to be in compliance, a subsequent
2inspection of the program shall be conducted within 30 days after
3the receipt of the corrective action plan in order to ensure that
4corrective action has been implemented satisfactorily. Subsequent
5inspections of the program shall be conducted to determine and
6ensure that the corrective action has been implemented
7satisfactorily. For purposes of this requirement, “compliance” shall
8mean to have not committed any of the grounds for suspension or
9revocation of a license provided for under subdivision (a) of
10Section 11839.9 or paragraph (2) of subdivision (b) of Section
1111839.9. Inspection of narcotic
treatment programs shall be based
12on objective criteria including, but not limited to, an evaluation of
13the programs’ adherence to all applicable laws and regulations and
14input from local law enforcement and local governments. Nothing
15in this section shall preclude counties from monitoring their
16contract providers for compliance with contract requirements.
17(3) Charge and collect licensure fees. In calculating the licensure
18fees, the department shall include staff salaries and benefits, related
19travel costs, and state operational and administrative costs. Fees
20shall be used to offset licensure and inspection costs, not to exceed
21actual costs.
22(4) Study and evaluate, on an ongoing basis, narcotic treatment
23programs including, but not limited to, the adherence of the
24programs, to all
applicable laws and regulations and the impact of
25the programs on the communities in which they are located.
26(5) Provide advice, consultation, and technical assistance to
27narcotic treatment programs to ensure that the programs comply
28with all applicable laws and regulations and to minimize any
29negative impact that the programs may have on the communities
30in which they are located.
31(6) In its discretion, to approve local agencies or bodies to assist
32it in carrying out this chapter provided that the department may
33not delegate responsibility for inspection or any other licensure
34activity without prior and specific statutory approval. However,
35the department shall evaluate recommendations made by county
36alcohol and drug program administrators regarding licensing
37activity in their
respective counties.
38(7) The director may grant exceptions to the regulations adopted
39under this chapter if he or she determines that this action would
40improve treatment services or achieve greater protection to the
P5 1health and safety of patients, the local community, or the general
2public. No exception may be granted if it is contrary to, or less
3stringent than, the federal laws and regulations that govern narcotic
4treatment programs.
5(b) It is the intent of the Legislature in enacting this section, in
6order to protect the general public and local communities, that
7
take-home dosage shall only be provided when the patient is clearly
8adhering to the requirements of the program, and where daily
9attendance at a clinic would be incompatible with gainful
10employment, education, responsible homemaking, retirement or
11medical disability, or if the program is closed on Sundays or
12holidays and providing a take-home dose is not contrary to federal
13laws and regulations governing narcotic treatment programs. The
14department shall define “satisfactory adherence” and shall ensure
15that patients not satisfactorily adhering to their programs shall not
16be provided take-home dosage. A narcotic treatment program shall
17not provide a take-home dosage that requires dilution.
18(c) There is established in the State Treasury the Narcotic
19Treatment Program Licensing Trust Fund. All licensure fees
20collected from the providers
of narcotic treatment services shall
21be deposited in this fund. Except as otherwise provided in this
22section, if funds remain in this fund after appropriation by the
23Legislature and allocation for the costs associated with narcotic
24treatment licensure actions and inspection of narcotic treatment
25programs, a percentage of the excess funds shall be annually
26rebated to the licensees based on the percentage their licensing fee
27is of the total amount of fees collected by the department. A reserve
28equal to 10 percent of the total licensure fees collected during the
29preceding fiscal year may be held in each trust account to reimburse
30the department if the actual cost for the licensure and inspection
31exceed fees collected during a fiscal year.
32(d) Notwithstanding any provision of this code or regulations
33to the contrary, the department shall have
sole responsibility and
34authority for determining if a state narcotic treatment program
35license shall be granted and for administratively establishing the
36maximum treatment capacity of a license. However, the department
37shall not increase the capacity of a program unless it determines
38that the licensee is operating in full compliance with applicable
39laws and regulations.
Section 11839.22 of the Health and Safety Code is
2amended to read:
The state department shall require a system to detect
4multiple registrations by narcotic treatment program patients.
Section 11839.24 of the Health and Safety Code is
6amended to read:
(a) Substance abuse testing for narcotic treatment
8programs operating in the state shall be performed only by a
9laboratory approved and licensed by the State Department of Public
10Health for the performance of those tests.
11(b) A narcotic treatment program shall have samples from each
12patient’s urinalysis or other bodily fluid test collected and analyzed
13for evidence of the following substances in a patient’s system:
14(1) Methadone and its primary metabolite.
15(2) Opiates.
16(3) Cocaine.
17(4) Amphetamines.
18(5) Benzodiazepines.
19(c) A narcotic treatment program may have samples from each
20patient’s urinalysis or other bodily fluid test collected and analyzed
21for evidence of other illicit drugs if those drugs are commonly
22used in the area served by the narcotic treatment program.
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