Amended in Assembly August 14, 2014

Amended in Assembly June 2, 2014

Amended in Senate April 29, 2014

Amended in Senate March 28, 2014

Amended in Senate March 26, 2014

Senate BillNo. 973


Introduced by Senator Hernandez

February 10, 2014


An act to amend Sections 11839.3, 11839.22, and 11839.24 of the Health and Safety Code, relating to narcotic treatment.

LEGISLATIVE COUNSEL’S DIGEST

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.begin delete The bill would also specify that the program operation guidelines for narcotic treatment programs may include reliable and medically necessary body fluid analysis other than urinalysis, as specified.end delete

Existing law specifies the intent of the Legislature that self-administered 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 doses to be provided to patients who are clearly adhering to the requirements of the program if 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 require a narcotic treatment program medical director to determine whether or not to dilute take-home doses.

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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.

end delete
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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.

end delete
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This bill would make technical, nonsubstantive changes to these provisions.

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Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: no.

The people of the State of California do enact as follows:

P2    1

SECTION 1.  

Section 11839.3 of the Health and Safety Code
2 is amended to read:

3

11839.3.  

(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
P3    1physician and surgeon’s legal prescription, except that the Research
2Advisory Panel shall have authority to approve methadone or
3LAAM research programs. The department shall establish and
4enforce the criteria for the eligibility of patients to be included in
5the programs, program operation guidelines,begin delete includingend deletebegin insert such asend insert
6 dosage levels, recordkeeping and reporting,begin delete requirements for
7urinalysis or other reliable and medically necessary body fluid
8analysis that is at least as accurate as, or more accurate than, current
9testing methods,end delete
begin insert urinalysis requirements,end insert take-home doses of
10controlled substances authorized for use pursuant to Section
1111839.2, security against redistribution of the narcotic replacement
12drugs, and any other regulations that are necessary to protect the
13safety and well-being of the patient, the local community, and the
14public, and to carry out this chapter. A program may admit a patient
15to narcotic maintenance or narcotic detoxification treatment at the
16discretion of the medical director. The program shall assign a
17 unique identifier to, and maintain an individual record for, each
18patient of the program. The arrest and conviction records and the
19records of pending charges against a person seeking admission to
20a narcotic treatment program shall be furnished to narcotic
21treatment program directors upon written request of the narcotic
22treatment program director provided the request is accompanied
23by a signed release from the person whose records are being
24requested.

25(2) Inspect narcotic treatment programs in this state and ensure
26that programs are operating in accordance with the law and
27regulations. The department shall have sole responsibility for
28compliance inspections of all programs in each county. Annual
29compliance inspections shall consist of an evaluation by onsite
30review of the operations and records of licensed narcotic treatment
31programs’ compliance with applicable state and federal laws and
32regulations and the evaluation of input from local law enforcement
33and local governments, regarding concerns about the narcotic
34treatment program. At the conclusion of each inspection visit, the
35department shall conduct an exit conference to explain the cited
36deficiencies to the program staff and to provide recommendations
37to ensure compliance with applicable laws and regulations. The
38department shall provide an inspection report to the licensee within
3930 days of the completed onsite review describing the program
40deficiencies. A corrective action plan shall be required from the
P4    1program within 30 days of receipt of the inspection report. All
2corrective actions contained in the plan shall be implemented
3within 30 days of receipt of approval by the department of the
4corrective action plan submitted by the narcotic treatment program.
5For programs found not to be in compliance, a subsequent
6inspection of the program shall be conducted within 30 days after
7the receipt of the corrective action plan in order to ensure that
8corrective action has been implemented satisfactorily. Subsequent
9inspections of the program shall be conducted to determine and
10ensure that the corrective action has been implemented
11satisfactorily. For purposes of this requirement, “compliance” shall
12mean to have not committed any of the grounds for suspension or
13revocation of a license provided for under subdivision (a) of
14Section 11839.9 or paragraph (2) of subdivision (b) of Section
1511839.9. Inspection of narcotic treatment programs shall be based
16on objective criteria including, but not limited to, an evaluation of
17the programs’ adherence to all applicable laws and regulations and
18input from local law enforcement and local governments. Nothing
19in this section shall preclude counties from monitoring their
20contract providers for compliance with contract requirements.

21(3) Charge and collect licensure fees. In calculating the licensure
22fees, the department shall include staff salaries and benefits, related
23travel costs, and state operational and administrative costs. Fees
24shall be used to offset licensure and inspection costs, not to exceed
25actual costs.

26(4) Study and evaluate, on an ongoing basis, narcotic treatment
27programs including, but not limited to, the adherence of the
28 programs, to all applicable laws and regulations and the impact of
29the programs on the communities in which they are located.

30(5) Provide advice, consultation, and technical assistance to
31narcotic treatment programs to ensure that the programs comply
32with all applicable laws and regulations and to minimize any
33negative impact that the programs may have on the communities
34in which they are located.

35(6) In its discretion, to approve local agencies or bodies to assist
36it in carrying out this chapter provided that the department may
37not delegate responsibility for inspection or any other licensure
38activity without prior and specific statutory approval. However,
39the department shall evaluate recommendations made by county
P5    1alcohol and drug program administrators regarding licensing
2activity in their respective counties.

3(7) The director may grant exceptions to the regulations adopted
4under this chapter if he or she determines that this action would
5improve treatment services or achieve greater protection to the
6health and safety of patients, the local community, or the general
7public. No exception may be granted if it is contrary to, or less
8stringent than, the federal laws and regulations that govern narcotic
9treatment programs.

10(b) It is the intent of the Legislature in enacting this section, in
11order to protect the general public and local communities, that
12 take-home doses shall only be provided when the patient is clearly
13adhering to the requirements of the program, and if daily attendance
14at a clinic would be incompatible with gainful employment,
15education, responsible homemaking, retirement or medical
16disability, or if the program is closed on Sundays or holidays and
17providing a take-home dose is not contrary to federal laws and
18regulations governing narcotic treatment programs. The department
19shall define “satisfactory adherence” and shall ensure that patients
20not satisfactorily adhering to their programs shall not be provided
21take-home doses. A narcotic treatment program medical director
22shall determine whether or not to dilute take-home doses.

23(c) There is established in the State Treasury the Narcotic
24Treatment Program Licensing Trust Fund. All licensure fees
25collected from the providers of narcotic treatment services shall
26be deposited in this fund. Except as otherwise provided in this
27section, if funds remain in this fund after appropriation by the
28Legislature and allocation for the costs associated with narcotic
29treatment licensure actions and inspection of narcotic treatment
30programs, a percentage of the excess funds shall be annually
31rebated to the licensees based on the percentage their licensing fee
32is of the total amount of fees collected by the department. A reserve
33equal to 10 percent of the total licensure fees collected during the
34preceding fiscal year may be held in each trust account to reimburse
35the department if the actual cost for the licensure and inspection
36exceed fees collected during a fiscal year.

37(d) Notwithstanding any provision of this code or regulations
38to the contrary, the department shall have sole responsibility and
39authority for determining if a state narcotic treatment program
40license shall be granted and for administratively establishing the
P6    1maximum treatment capacity of a license. However, the department
2shall not increase the capacity of a program unless it determines
3that the licensee is operating in full compliance with applicable
4laws and regulations.

5

SEC. 2.  

Section 11839.22 of the Health and Safety Code is
6amended to read:

7

11839.22.  

The state department shall require a system to detect
8multiple registrations by narcotic treatment program patients.

9

SEC. 3.  

Section 11839.24 of the Health and Safety Code is
10amended to read:

11

11839.24.  

begin delete(a)end deletebegin deleteend deleteSubstance abuse testing for narcotic treatment
12programs operating in the state shall be performed only by a
13laboratory approved and licensed by the State Department of Public
14Health for the performance of those tests.

begin delete

15(b) A narcotic treatment program shall have samples from each
16patient’s urinalysis or other bodily fluid test collected and analyzed
17for evidence of the following substances in a patient’s system:

end delete
begin delete

18(1) Methadone and its primary metabolite.

end delete
begin delete

19(2) Opiates.

end delete
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20(3) Cocaine.

end delete
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21(4) Amphetamines.

end delete
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22(5) Benzodiazepines.

end delete
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23(c) A narcotic treatment program may have samples from each
24patient’s urinalysis or other bodily fluid test collected and analyzed
25for evidence of other illicit drugs if those drugs are commonly
26used in the area served by the narcotic treatment program.

end delete


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