BILL ANALYSIS
AB 631
Page 1
Date of Hearing: April 5, 2005
ASSEMBLY COMMITTEE ON HEALTH
Wilma Chan, Chair
AB 631 (Leno) - As Amended: March 30, 2005
SUBJECT : Narcotic treatment programs: mobile service units.
SUMMARY : Creates a licensing category for mobile narcotic
treatment programs. Specifically, this bill :
1)Requires the California Department of Alcohol and Drug
Programs (ADP) to establish a program for the operation and
regulation of mobile narcotic treatment programs (MNTP).
2)Requires a MNTP to meet one of the following conditions:
a) Hold a primary narcotic treatment program license; or,
b) Be affiliated and associated with a primary licensed
narcotic treatment program. A MNTP meeting this
requirement from being required to have a license separate
from the primary licensed narcotic treatment program with
which it is affiliated.
3)Defines a MNTP as a program in which interested and
knowledgeable physicians, surgeons, counselors and authorized
licensed professionals provide addiction treatment services
and that may obtain medication directly through the
manufacturer or through the affiliated licensed narcotic
treatment program for distribution to patients and through
direct administration and specified dispensing services.
4)States that regardless of any other provision of law or
regulation, a MNTP that is affiliated or associated with a
licensed narcotic treatment program may be approved by the
department if all of the following conditions are met:
a) Each mobile office patient is registered as a patient in
the licensed narcotic treatment program and both the
licensed narcotic treatment program and the MNTP ensure
that all services, as required, for the management of
narcotic addiction are provided to all parties treated in
the remote site;
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b) The primary licensed narcotic treatment program is
limited to its total licensed capacity as established by
ADP, including the patients of physicians in the mobile
narcotic treatment program;
c) Pharmacologic treatment that has been approved by the
federal Food and Drug Administration is administered; and,
d) Protocols are developed to prevent the diversion of
medication.
5)Requires ADP, in considering a MNTP application, to
independently weigh the treatment needs and concerns of the
county, city, or areas to be served by the program.
6)Specifies that nothing in this bill is intended to expand the
scope of the practice of pharmacy.
7)Requires the MNTPs to be located at predetermined sites
approved by ADP.
EXISTING LAW :
1)Establishes the ADP to develop and implement a statewide plan
to alleviate problems related to inappropriate alcohol use,
and licenses alcoholism and drug abuse recovery or treatment
facilities that provide a broad range of services in a
supportive environment for adults who are addicted to alcohol
or drugs.
2)Specifies that ADP is the single agency authorized to receive
federal funds for substance abuse and to expend those funds,
as specified.
3)Requires ADP to apply for federal block grant funds from the
federal Substance Abuse and Mental Health Services
Administration (SAMHSA) and may expend those funds only upon
appropriation of and approval by the Legislature.
FISCAL EFFECT : Unknown
COMMENTS :
1)PURPOSE OF THIS BILL . According to the author, this bill will
make services offered by MNTPs eligible for Medi-Cal and will
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expand access to effective treatment services. In
illustrating the need for this bill, the author cites the
mobile narcotic treatment pilot project in San Francisco which
provides narcotic treatment services to various individuals.
Although 21 percent of the patients receiving services from
the pilot project are eligible for Medi-Cal, the services are
currently not reimbursed because the program is not licensed
by ADP.
In addition, the author states that locating traditional
methadone clinics is made difficult by community resistance to
the presence of treatment programs in their neighborhoods.
Mobile narcotic treatment programs would address this issue by
providing services in neighborhoods where the services are
needed without creating a permanent clinic site.
2)SAN FRANCISCO PILOT PROJECT . In May 2002, the San Francisco
Board of Supervisors passed a resolution allowing the San
Francisco Department of Public Health to establish a mobile
medication unit pilot program as an extension to the city's
narcotic treatment program. To support the pilot program,
federal funding was granted by SAMHSA. On September 10, 2002,
ADP allowed San Francisco to operate a mobile medication unit
pilot program to provide replacement narcotic therapy from a
van. This van provides services daily at two locations for up
to 75 patients in each location. The van provides dispensing
services, urinalysis sample collection and emergency crisis
counseling. Scheduled counseling sessions are provided in an
office space at the community clinics where the van is
securely parked.
3)NARCOTIC TREATMENT PROGRAM (NTP) . In California, individuals
who are addicted to heroin or other opiates may be admitted to
a state approved NTP for replacement narcotic therapy (RNT)
using FDA approved medications. NTP's use Methadone and
Levo-alpha-acetylmethadol for RNT. To receive these
medications in a licensed NTP, all patients must participate
in a comprehensive treatment program which includes a medical
evaluation and screening for diseases that are
disproportionately represented in the opiate-addicted
populations. Patients are evaluated and provided counseling
for medical, alcohol, criminal, and psychological problems and
are required to undergo regular urinalysis to ensure that
illicit drugs are not being used during treatment. According
to ADP, methadone maintenance treatment costs an average $11
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to $13 per day.
4)LICENSING REQUIREMENT . The NTP licensing branch at ADP is
responsible for licensing NTPs and regulating the delivery of
replacement narcotic therapy services to patients. ADP
ensures that patients enrolled in NTP programs receive
therapeutic care and ensure the health and safety of each
patient is upheld. Annual inspections monitor NTPs for
compliance with state and federal laws and regulations. In
addition, programs are required to be certified by SAMHSA and
to obtain a Drug Enforcement Administration (DEA) registration
prior to licensure. For purposes of the San Francisco mobile
medication unit pilot program, DEA required the NTP to equip
the van with a Global Positioning System and a security system
that provides security for the safe that stores the
medication, panic buttons throughout the van and a monitoring
device which allows a security company to monitor the interior
of the van in an emergency.
5)DRUG MEDI-CAL (DMC) . ADP receives Medi-Cal funding from the
Department of Health Services for eligible services provided
to Medi-Cal beneficiaries through an Interagency Agreement.
DMC benefits are optional Medi-Cal benefits. DMC services
provide medically necessary alcohol and other drug treatment
to eligible Medi-Cal recipients. The services include
Outpatient Drug Free Treatment, Narcotic Treatment Program and
Naltrexone Treatment. In addition, Day Care Rehabilitative
Treatment and Residential Treatment are available to full
scope Medi-Cal beneficiaries under the age of 21 and to
pregnant and postpartum women.
6)PROPOSITION 36 . In 2000, California voters approved
Proposition 36 or the Substance Abuse and Crime Prevention Act
of 2000 (SACPA), which requires probation and drug treatment
instead of incarceration for individuals convicted of
possession, use, transportation for personal use, or being
under the influence of controlled substances and similar
parole violations, but not for the sale or manufacture of
drugs. Eligible offenders receive up to one year of drug
treatment and six months of after care. In 2001, SACPA
appropriated $120 million to be distributed to counties to
provide drug treatment and other services. Funding is subject
to terminate after FY 2005-2006.
REGISTERED SUPPORT / OPPOSITION :
AB 631
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Support
City and County of San Francisco (sponsor)
California Medical Association
Opposition
None on file
Analysis Prepared by : Rosielyn Pulmano / HEALTH / (916)
319-2097