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 Bill No. 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. 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 begin delete urinalysis end delete begin insert urinalysis, as specified end insert .

Existing law specifies the intent of the Legislature that begin delete take-home end delete begin insert self-administered end insert 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 begin delete dosage end delete begin insert doses end insert to be provided to patients who are clearly adhering to the requirements of the program begin delete where end delete begin insert if end insert 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 begin delete prohibit end delete begin insert require end insert a narcotic treatment program begin delete from providing a take-home dosage that requires dilution end delete begin insert medical director to determine whether or not to dilute take-home doses end insert .

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 1.  

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

11839.3.  

(a) In addition to the duties authorized by other
statutes, the department shall perform all of the following:

(1) 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, except that the Research
Advisory Panel shall have authority to approve methadone or
LAAM research programs. The department shall establish and
enforce the criteria for the eligibility of patients to be included in
the programs, program operation guidelines, including dosage
levels, recordkeeping and reporting, requirements for urinalysis
or other reliable and medically necessary body fluid analysis that
is at least as accurate as, or more accurate than, current testing
methods, take-home doses of controlled substances authorized for
use pursuant to Section 11839.2, security against redistribution of
the narcotic replacement drugs, and any other regulations that are
necessary to protect the safety and well-being of the patient, the
local community, and the public, and to carry out this chapter. A
program may admit a patient to narcotic maintenance or narcotic
detoxification treatment at the discretion of the medical director.
The program shall assign a unique identifier to, and maintain an
individual record for, each patient of the program. The arrest and
conviction records and the records of pending charges against a
person seeking admission to a narcotic treatment program shall be
furnished to narcotic treatment program directors upon written
request of the narcotic treatment program director provided the
request is accompanied by a signed release from the person whose
records are being requested.

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

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

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

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

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

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

(b) It is the intent of the Legislature in enacting this section, in
order to protect the general public and local communities, that
take-home begin delete dosage end delete begin insert doses end insert shall only be provided when the patient
is clearly adhering to the requirements of the program, and begin delete where end delete
begin insert if end insert daily attendance at a clinic would be incompatible with gainful
employment, education, responsible homemaking, 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 governing narcotic treatment programs. The
department shall define “satisfactory adherence” and shall ensure
that patients not satisfactorily adhering to their programs shall not
be provided take-home begin delete dosage end delete begin insert doses end insert . A narcotic treatment program
begin delete shall not provide a take-home dosage that requires dilution end delete begin insert medical
director shall determine whether or not to dilute take end insert begin insert -home doses end insert .

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

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

SEC. 2.  

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

11839.22.  

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

SEC. 3.  

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

11839.24.  

(a) Substance abuse testing for narcotic treatment
programs operating in the state shall be performed only by a
laboratory approved and licensed by the State Department of Public
Health for the performance of those tests.

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

(1) Methadone and its primary metabolite.

(2) Opiates.

(3) Cocaine.

(4) Amphetamines.

(5) Benzodiazepines.

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