Bill Text: NJ S3862 | 2018-2019 | Regular Session | Introduced


Bill Title: Establishes pilot program for integrated system of treatment for opioid use disorders.

Spectrum: Slight Partisan Bill (Democrat 2-1)

Status: (Introduced - Dead) 2019-06-03 - Introduced in the Senate, Referred to Senate Health, Human Services and Senior Citizens Committee [S3862 Detail]

Download: New_Jersey-2018-S3862-Introduced.html

SENATE, No. 3862

STATE OF NEW JERSEY

218th LEGISLATURE

 

INTRODUCED JUNE 3, 2019

 


 

Sponsored by:

Senator  PATRICK J. DIEGNAN, JR.

District 18 (Middlesex)

Senator  JOSEPH F. VITALE

District 19 (Middlesex)

 

 

 

 

SYNOPSIS

     Establishes pilot program for integrated system of treatment for opioid use disorders.

 

CURRENT VERSION OF TEXT

     As introduced.

 


An Act concerning treatment for opioid use disorders and supplementing Title 26 of the Revised Statutes.

 

     Be It Enacted by the Senate and General Assembly of the State of New Jersey:

 

      1.   a.  The Division of Mental Health and Addiction Services in the Department of Human Services shall establish a pilot program creating an integrated system of care for the treatment of opioid use disorders.  The integrated system of care shall comprise a centralized opioid treatment program, which shall be primarily responsible for the initial intake and stabilization of patients participating in the integrated system of care, and a system of office-based opioid treatment providers which shall be responsible for the ongoing treatment of patients participating in the integrated system of care upon referral by the centralized opioid treatment program.  The division shall designate an opioid treatment program and an appropriate number of office-based opioid treatment providers to participate in the pilot program, and shall determine the location and the size of the geographic area to be served by the integrated system of care.  Patients shall be considered for admission to the integrated system of care based on referrals from primary health care professionals, behavioral and mental health care professionals, hospitals, hospital emergency departments, urgent care facilities, and other appropriate medical and behavioral and mental health care entities.

      b.   The centralized opioid treatment program shall, at a minimum:

     (1)   stabilize patients admitted to the integrated system of care, including initiating appropriate treatment which may include, but shall not be limited to, medication assisted treatment, inpatient treatment, outpatient treatment, detoxification, counseling, and therapy;

     (2)   develop an individualized long-term treatment plan for each patient, which may include identifying and providing referrals to social services necessary to facilitate the patient's ongoing recovery, including, but not limited to, housing assistance, employment assistance, transportation assistance, family and recovery support services, peer support and recovery services, and child care assistance;

     (3)   link patients with a medical home for ongoing primary health care, behavioral and mental health care, and opioid use disorder treatment;

     (4)   employ a board-certified addiction specialist, who shall provide support and consultation services to office-based treatment providers concerning patients admitted to the integrated system of care;

     (5)   prioritize referrals made by office-based treatment providers pursuant to subparagraph (d) of paragraph (3) of subsection c. of this section; and

     (6)   meet any other requirements and provide any additional services as shall be required by the division.

      c.    (1)  Office-based treatment providers shall be responsible for the ongoing treatment of patients upon referral by the centralized opioid treatment center, including carrying out the patient's individualized long-term treatment plan, making appropriate modifications to the patient's treatment plan based on the patient's current treatment needs, ensuring each patient receives a behavioral and mental  health assessment and counseling services, engaging in ongoing communications with the centralized opioid treatment program and the medication assisted treatment team concerning the patient, and meeting any other requirements and providing any additional services as shall be required by the division.  If the office-based treatment provider is unable to provide a service directly to the patient, the provider shall provide referrals and other assistance as may be necessary to ensure the patient receives the service.

     (2)   Each office-based treatment provider shall comprise at least one physician, physician assistant, or advanced practice nurse authorized to prescribe, administer, and dispense narcotic drugs for maintenance treatment or detoxification treatment pursuant to subsection (g) of 21 U.S.C. s.823.  Office-based treatment providers shall be supported by a medication assisted treatment team that meets the requirements of paragraph (3) of this subsection for each 100 patients served by the office-based treatment provider.  A medication assisted treatment team may provide support services to more than one office-based treatment provider at one time, provided that the total number of patients served by the medication assisted treatment team at one time does not exceed 100 patients.

     (3)   A medication assisted treatment team providing support to an office-based treatment provider shall:

     (a)   include at least one advanced practice nurse, who shall be responsible for meeting with new patients, reviewing contracts and consents, arranging for insurance authorizations, arranging for urine drug screenings, authorizing buprenorphine refills to pharmacies, and overseeing diversion control through random call backs and reviewing the patient's prescription monitoring information;

     (b)   include at least one certified behavioral health professional with at least a masters-level education, who shall be responsible for coordinating counseling services, managing acute crises, providing brief supportive counseling and check-ins, coordinating referrals between the centralized opioid treatment program and the office-based treatment provider, and assisting with social services necessary to facilitate the patient's ongoing recovery, including, but not limited to, housing assistance, employment assistance, transportation assistance, family and recovery support services, peer support and recovery services, and child care assistance;

     (c)   engage in regular, ongoing communications with the office-based treatment provider to discuss cases, protocols, and communications among staff; and

     (d)   take appropriate actions to respond to situations in which a patient has a positive drug screen, which shall include evaluating the patient's current treatment needs, providing additional clinical support as needed, and, if necessary, referring the patient back to the centralized opioid treatment provider for stabilization.  Referrals to the centralized opioid treatment provider shall be at the discretion of the medication assisted treatment team in consultation with the office-based treatment provider.

     d.    The division shall establish an educational program for physicians, physician assistants, and advanced practice nurses providing services through an office-based treatment provider and for medication assisted treatment team staff concerning safe prescribing, the use of evaluation tools, developing treatment plans, responding to patient relapses, addressing patient noncompliance, and diversion control.  The educational program may include both in-person and online training materials, and shall focus on evidence-based best practices to facilitate communications among, and the use of standardized practices, protocols, and procedures by, the centralized opioid treatment provider, office-based treatment providers, and medication assisted treatment teams.

     e.     The division shall develop a screening tool to be used to assess patients upon intake into the integrated system of care to evaluate the severity of the patient's opioid use disorder and facilitate the process of linking patients with appropriate care and treatment resources.  The division may adapt the screening tool to serve additional pilot program purposes, and may develop additional screening and assessment tools as needed.

     f.     The division is authorized to solicit, receive, and accept grants, funds, or anything of value from any public or private entity and receive and accept contributions of money, property, labor, or any other thing of value from any legitimate source for the purpose of establishing an integrated system of care pursuant to this section.  The Commissioner of Human Services shall apply for such State plan amendments or waivers as may be necessary to implement the provisions of this section and to secure federal financial participation for State expenditures under the federal Medicaid program in connection with services provided through the integrated system of care.

     g.    No later than two years after the effective date of this act, and annually thereafter for the duration of the pilot program, the division shall submit a report to the Legislature pursuant to section 2 of P.L.1991, c.164 (C.52:14-19.1) concerning the pilot program, which shall include: the number of patients receiving treatment through the integrated system of care; the number of primary health care and behavioral and mental health care professionals providing services to patients through the integrated system of care; the number of incidents involving patient relapses, violations, and noncompliance with program requirements and the actions taken in response to those incidents; patient outcomes, including the number of patients who complete an individualized treatment plan and the number of patients who leave the integrated system of care without completing an individualized treatment plan, as well as long-term recovery statistics, to the extent available; any differences in the wait times for pilot program patients to receive treatment and services in connection with an opioid use disorder as compared with non-pilot program patients; funding sources for the pilot program; the overall costs and savings associated with the pilot program; and the division's recommendations as to whether the pilot program should be continued, expanded, modified, or terminated, including any recommendations for legislation or other action.

 

     2.    The Director of the Division of Mental Health and Addiction Services in the Department of Human Services shall, pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), adopt rules and regulations as may be necessary to implement the provisions of this act.

 

     3.    This act shall take effect immediately.

 

 

STATEMENT

 

     This bill requires the Division of Mental Health and Addiction Services (DMHAS) in the Department of Human Services to establish a pilot program creating an integrated system of care for the treatment of opioid use disorders.  The integrated system of care will comprise a centralized opioid treatment program, which will provide initial intake and stabilization for patients entering the integrated system of care, and a system of office-based opioid treatment providers which will be responsible for the ongoing treatment of patients following stabilization.  The division will designate providers to participate in the pilot program and will determine the location and the size of the geographic area to be served by the integrated system of care.

     The centralized opioid treatment program will be required to: initiate treatment for patients entering the integrated system of care, including, but not limited to, medication assisted treatment (MAT), inpatient treatment, outpatient treatment, detoxification, counseling, and therapy; develop an individualized long-term treatment plan for each patient; link patients with a medical home for ongoing health care, behavioral and mental health care, and opioid use disorder treatment; employ a board-certified addiction specialist, who will provide support and consultation services to office-based treatment providers; prioritize referrals made by office-based treatment providers for patients experiencing a relapse; and meet any other requirements and provide any additional services as are required by the DMHAS.

     Office-based treatment providers will be responsible for the ongoing treatment of patients upon referral by the centralized opioid treatment center, including carrying out the patient's individualized long-term treatment plan, making appropriate modifications to the patient's treatment plan based on the patient's current treatment needs, ensuring each patient receives a behavioral and mental health assessment and counseling services, engaging in ongoing communications with the centralized opioid treatment program and the MAT team concerning the patient, and meeting any other requirements and providing any additional services as are required by the DMHAS.  If the office-based treatment provider is unable to provide a service directly to the patient, the provider is to provide referrals and other assistance as may be necessary to ensure the patient receives the service.  

     Office-based treatment providers will comprise at least one physician, physician assistant, or advanced practice nurse authorized to prescribe, administer, and dispense narcotic drugs for maintenance treatment or detoxification treatment pursuant to federal law, and will be supported by one MAT team for each 100 patients served by the office-based treatment provider.  A MAT team may provide support to more than one office-based treatment provider, provided that the total number of patients supported by the MAT team at any one time does not exceed 100 patients.

     Each MAT team is to include at least one advanced practice nurse and at least one certified behavioral health professional with at least a masters-level education.  The nurse will be responsible for meeting with new patients, reviewing contracts and consents, arranging for insurance authorizations, arranging for urine drug screenings, authorizing buprenorphine refills to pharmacies, and overseeing diversion control through random call backs and reviewing the patient's prescription monitoring information.  The behavioral health professional will be responsible for coordinating counseling services, managing acute crises, providing brief supportive counseling and check-ins, coordinating referrals between the opioid treatment program and the office-based treatment provider, and assisting the patient with obtaining social services necessary to facilitate the patient's ongoing recovery, including housing assistance, employment assistance, transportation assistance, family and recovery support services, peer support and recovery services, and child care assistance. MAT teams will be required to engage in regular, ongoing communications with the office-based treatment provider to discuss cases, protocols, and communications among staff.

     In the event that a patient receiving treatment through an office-based treatment provider has a positive drug screen, the MAT team is to evaluate the patient's needs, provide additional clinical support, and refer the patient back to the centralized opioid treatment provider for stabilization, if necessary.  Referrals to the centralized opioid treatment provider will be at the discretion of the MAT team in consultation with the office-based treatment provider.

     The DMHAS will be required to establish an educational program for physicians, physician assistants, and advanced practice nurses providing services through an office-based treatment provider and for MAT team staff concerning safe prescribing, the use of evaluation tools, developing treatment plans, responding to patient relapse, addressing patient noncompliance, and diversion control.  The educational program may include both in-person and online training materials, and will focus on evidence-based best practices to facilitate communications among, and the use of standardized practices, protocols, and procedures by, the centralized opioid treatment provider, office-based treatment providers, and MAT teams.

     The DMHAS is additionally required to develop a screening tool to be used to assess patients upon intake to evaluate the severity of the patient's opioid use disorder and facilitate the process of linking the patient with appropriate care and treatment resources; the DMHAS may adapt the screening tool to serve additional pilot program purposes and may develop additional screening and assessment tools as needed.

     The DMHAS will be authorized to solicit, receive, and accept grants, funds, or anything of value from any public or private entity and receive and accept contributions of money, property, labor, or any other thing of value from any legitimate source for the purpose of establishing the integrated system of care.  The Commissioner of Human Services will be required to apply for such State plan amendments or waivers as may be necessary to secure federal financial participation for State expenditures under the federal Medicaid program in connection with services provided through the integrated system of care.

     No later than two years after the effective date of the bill, and annually thereafter for the duration of the pilot program, the division will be required to submit a report to the Legislature concerning: the number of patients receiving treatment through the program; the number of primary health care and mental health care professionals providing services to patients through the program; incidents involving patient relapses, violations, and noncompliance and the responses to those incidents; patient outcomes; differences in the wait times for pilot program patients commence treatment and receive services in connection with an opioid use disorder as compared with non-pilot program patients; the overall costs and savings associated with the program; recommendations as to whether the pilot program should be continued, expanded, modified, or terminated; and recommendations for legislation or other action.

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