BILL ANALYSIS
AB 631
Page 1
ASSEMBLY THIRD READING
AB 631 (Leno)
As Amended May 26, 2005
Majority vote
HEALTH 12-0 APPROPRIATIONS 17-1
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|Ayes:|Chan, Aghazarian, Berg, |Ayes:|Chu, Sharon Runner, Bass, |
| |Dymally, De La Torre, | |Berg, Calderon, Emmerson, |
| |Jones, Montanez, | |Mullin, Karnette, Klehs, |
| |Nakanishi, Negrete | |Leno, Nakanishi, Nation, |
| |McLeod, Richman, | |Oropeza, Ridley-Thomas, |
| |Ridley-Thomas, Strickland | |Saldana, Walters, Yee |
| | | | |
|-----+--------------------------+-----+--------------------------|
| | |Nays:|Haynes |
| | | | |
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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 (MNTPs).
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 through which medication may be obtained directly through
the manufacturer or through the affiliated licensed narcotic
treatment program for distribution to patients and through
direct administration and specified dispensing services.
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4)Defines authorized staff as program directors, medical
directors, program physicians, physician extenders, counselors
and other staff, as defined in existing law.
5)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;
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.
6)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.
7)Specifies that nothing in this bill is intended to expand the
scope of the practice of pharmacy.
8)Requires the MNTPs to be located at predetermined sites
approved by ADP.
EXISTING LAW :
1)Establishes 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
AB 631
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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 : According to the Assembly Appropriations
Committee:
1)Unknown General Fund cost pressures in the Drug Medi-Cal
program to the extent this bill increases the number of
counties that start MNTPs and the number of clients served by
newly licensed programs. For example, an increase in 35
patients, served at a rate of $13 per day would result in more
than $160,000 in Drug Medi-Cal costs, which are shared evenly
by the federal and state governments.
2)Unknown and potentially significant off-setting savings to the
extent that this bill reduces societal costs in terms of
incarceration, health care, and public benefits. Some studies
indicate that savings accrue at a rate of $7 in the future to
every $1 spent on addiction treatment in the present.
COMMENTS : According to the author, this bill will make services
offered by MNTPs eligible for Medi-Cal and will 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% 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.
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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.
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 to $13 per
day.
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
AB 631
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interior of the van in an emergency.
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.
Analysis Prepared by : Rosielyn Pulmano / HEALTH / (916)
319-2097
FN: 0010858