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 also authorize the program operation guidelines for narcotic treatment programs to include accurate, reliable, and medically necessary body fluid analysis.
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 wouldbegin delete authorizeend deletebegin insert requireend insert 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
13the programs, program operation guidelines, including dosage
14
levels, recordkeeping and reporting, urinalysis or other accurate,
15reliable, and medically necessary body fluid analysis requirements,
16take-home doses of controlled substances authorized for use
P3 1pursuant to Section 11839.2, security against redistribution of the
2narcotic replacement drugs, and any other regulations that are
3necessary to protect the safety and well-being of the patient, the
4local community, and the public, and to carry out this chapter. A
5program may admit a patient to narcotic maintenance or narcotic
6detoxification treatment at the discretion of the medical director.
7The program shall assign a unique identifier to, and maintain an
8individual record for, each patient of the program. The arrest and
9conviction records and the records of pending charges against a
10person seeking admission to a narcotic treatment program shall be
11furnished to narcotic treatment program directors
upon written
12request of the narcotic treatment program director provided the
13request is accompanied by a signed release from the person whose
14records are being requested.
15(2) Inspect narcotic treatment programs in this state and ensure
16that programs are operating in accordance with the law and
17regulations. The department shall have sole responsibility for
18compliance inspections of all programs in each county. Annual
19compliance inspections shall consist of an evaluation by onsite
20review of the operations and records of licensed narcotic treatment
21programs’ compliance with applicable state and federal laws and
22regulations and the evaluation of input from local law enforcement
23and local governments, regarding concerns about the narcotic
24treatment program. At the conclusion of each inspection visit, the
25department shall conduct an exit
conference to explain the cited
26deficiencies to the program staff and to provide recommendations
27to ensure compliance with applicable laws and regulations. The
28department shall provide an inspection report to the licensee within
2930 days of the completed onsite review describing the program
30deficiencies. A corrective action plan shall be required from the
31program within 30 days of receipt of the inspection report. All
32corrective actions contained in the plan shall be implemented
33within 30 days of receipt of approval by the department of the
34corrective action plan submitted by the narcotic treatment program.
35For programs found not to be in compliance, a subsequent
36inspection of the program shall be conducted within 30 days after
37the receipt of the corrective action plan in order to ensure that
38corrective action has been implemented satisfactorily. Subsequent
39inspections of the program shall be
conducted to determine and
40ensure that the corrective action has been implemented
P4 1satisfactorily. For purposes of this requirement, “compliance” shall
2mean to have not committed any of the grounds for suspension or
3revocation of a license provided for under subdivision (a) of
4Section 11839.9 or paragraph (2) of subdivision (b) of Section
511839.9. Inspection of narcotic treatment programs shall be based
6on objective criteria including, but not limited to, an evaluation of
7the programs’ adherence to all applicable laws and regulations and
8input from local law enforcement and local governments. Nothing
9in this section shall preclude counties from monitoring their
10contract providers for compliance with contract requirements.
11(3) Charge and collect licensure fees. In calculating the licensure
12fees, the department shall include staff salaries and
benefits, related
13travel costs, and state operational and administrative costs. Fees
14shall be used to offset licensure and inspection costs, not to exceed
15actual costs.
16(4) Study and evaluate, on an ongoing basis, narcotic treatment
17programs including, but not limited to, the adherence of the
18programs, to all applicable laws and regulations and the impact of
19the programs on the communities in which they are located.
20(5) Provide advice, consultation, and technical assistance to
21narcotic treatment programs to ensure that the programs comply
22with all applicable laws and regulations and to minimize any
23negative impact that the programs may have on the communities
24in which they are located.
25(6) In its
discretion, to approve local agencies or bodies to assist
26it in carrying out this chapter provided that the department may
27not delegate responsibility for inspection or any other licensure
28activity without prior and specific statutory approval. However,
29the department shall evaluate recommendations made by county
30alcohol and drug program administrators regarding licensing
31activity in their respective counties.
32(7) The director may grant exceptions to the regulations adopted
33under this chapter if he or she determines that this action would
34improve treatment services or achieve greater protection to the
35health and safety of patients, the local community, or the general
36public. No exception may be granted if it is contrary to, or less
37stringent than, the federal laws and regulations that govern narcotic
38treatment programs.
39(b) It is the intent of the Legislature in enacting this section, in
40order to protect the general public and local communities, that
P5 1
take-home dosage shall only be provided when the patient is clearly
2adhering to the requirements of the program, and where daily
3attendance at a clinic would be incompatible with gainful
4employment, education, responsible homemaking, retirement or
5medical disability, or if the program is closed on Sundays or
6holidays and providing a take-home dose is not contrary to federal
7laws and regulations governing narcotic treatment programs. The
8department shall define “satisfactory adherence” and shall ensure
9that patients not satisfactorily adhering to their programs shall not
10be provided take-home dosage. A narcotic treatment program shall
11not provide a take-home dosage that requires dilution.
12(c) There is established in the State Treasury the Narcotic
13Treatment Program Licensing Trust Fund. All licensure fees
14collected from the
providers of narcotic treatment services shall
15be deposited in this fund. Except as otherwise provided in this
16section, if funds remain in this fund after appropriation by the
17Legislature and allocation for the costs associated with narcotic
18treatment licensure actions and inspection of narcotic treatment
19programs, a percentage of the excess funds shall be annually
20rebated to the licensees based on the percentage their licensing fee
21is of the total amount of fees collected by the department. A reserve
22equal to 10 percent of the total licensure fees collected during the
23preceding fiscal year may be held in each trust account to reimburse
24the department if the actual cost for the licensure and inspection
25exceed fees collected during a fiscal year.
26(d) Notwithstanding any provision of this code or regulations
27to the contrary, the department
shall have sole responsibility and
28authority for determining if a state narcotic treatment program
29license shall be granted and for administratively establishing the
30maximum treatment capacity of a license. However, the department
31shall not increase the capacity of a program unless it determines
32that the licensee is operating in full compliance with applicable
33laws and regulations.
Section 11839.22 of the Health and Safety Code is
35amended to read:
The state department shall require a system to detect
37multiple registrations by narcotic treatment program patients.
Section 11839.24 of the Health and Safety Code is
39amended to read:
(a) Substance abuse testing for narcotic treatment
2programs operating in the state shall be performed only by a
3laboratory approved and licensed by the State Department of Public
4Health for the performance of those tests.
5(b) A narcotic treatment programbegin delete mayend deletebegin insert shallend insert have samples from
6each patient’s urinalysis or other bodily fluid test collected and
7analyzed for evidence of the following substances in a patient’s
8system:
9(1) Methadone and its primary metabolite.
10(2) Opiates.
11(3) Cocaine.
12(4) Amphetamines.
13(5) Benzodiazepines.
14(c) A narcotic treatment program may have samples from each
15patient’s urinalysis or other bodily fluid test collected and analyzed
16for evidence of other illicit drugs if those drugs are commonly
17used in the area served by the narcotic treatment program.
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