*Companion to HB1331
Opioid use disorder is a public health crisis. To address the opioid epidemic throughout the state, this act leverages the direction provided by the Washington state Inter-agency Opioid Working Plan.
The bill declares that substance use disorders are medical conditions and should be treated in a manner similar to other medical conditions by using evidence-based interventions.
The goals of treatment for persons with opioid use disorder are to cease use of un-prescribed opioids, to reduced morbidity, and ultimately to lead a productive and fulfilling life. With these goals in mind, the state may seek, receive and expend Title XIX funding in response to the opioid crisis, must partner with appropriate agencies and entities to leverage Medicaid funding, and also seeks a section 1115 Demonstration Waiver to fund opioid treatment.
State agencies must increase access to evidence-based opioid use disorder treatment services, promote coordination of services within the substance use disorder treatment and recovery support system, strengthen partnerships between opioid use disorder treatment providers and their allied community partners, expand the use of the Washington state prescription drug monitoring program, and support comprehensive school and community-based substance use prevention services.
The act notes with concern increased use of opioids among pregnant women. It requires these women are informed about the health risks of medication to treat opioid disorder to themselves and their baby, and the possibility of treatment to manage neonatal opioid or other drug withdrawal.
Further, it requires (and names) health care providers who prescribe opioids to inform patients about the risks and pain management alternatives to opioids.
It amends current RCW to include opioid reversal medication in a variety of settings.
The bill also establishes a statewide electronic emergency medical services data system and adopts rules requiring licensed ambulance and aid services to report and furnish patient encounter data to the electronic emergency medical services data system and expands integration of prescription monitoring program data into certified electronic health record technologies.
Finally, the bill asserts that the Health Care Authority must work with the department and the authority's Medicaid Managed Care organizations to eliminate barriers and promote access to effective medications known to address opioid use disorders at state-certified opioid treatment programs.
Bill requires all city and county jails in Washington to adopt requirements by January 1, 2021 that address the behavioral health needs of incarcerated individuals with an opioid use disorder.
Supports prevention of opioid use disorders and requires the authority develop and recommend coverage for non-pharmacologic treatments for acute, subacute, and chronic non-cancer pain and report to the governor and the appropriate committees of the legislature, including any requests for necessary funding to implement the recommendations.
Updated on 4.12.19:
The substitute bill:
- Modifies the definition of opioid-related overdose to remove extreme physical illness as a condition and include non-responsiveness as a condition.
- Exempts the prepackaged opioid overdose reversal medications provided by emergency departments from certain Pharmacy Commission labeling requirements.
- Adds patient navigators, outreach workers and other professionals as appropriate to the services that may be provided to an individual identified by the electronic emergency medical services data system.
- Removes the requirement that certain health care providers integrate their EHRs with the PMP by January 1, 2020.
- Modifies the requirements of DOH's EHR/PMP integration collaboration with health care provider and facility associations.
- Removes the requirement that the health care facility or entity must be a trading partner with state's health information exchange to receive PMP patient data.
- Permits PMP data with direct patient identifiers to be provided for research that has been approved by the Washington State Institutional review board and DOH Permits PMP data to be provided to the Department of Labor and Industries and HCA for certain circumstances.
- Clarifies that PMP data reports provided to the prescriber associations may contain indirect patient identifiers.
- Removes the requirement that therapeutic courts receiving criminal justice treatment accounts funds implement the National Association of Drug Court Professionals best practice standards by January 30, 2020.
- Modifies the state's declaration regarding substance use disorders by removing references to co-occurring disorders, and specifying individuals with opioid use disorder must be informed about FDA approved medications for the treatment of opioid use disorder.
House (Updated on 4.12.19):
The amended bill:
- Removed requirements that the Department of Health (DOH) study a number of issues related to integration of the prescription monitoring program (PMP) into electronic health records (EHRs) in Washington;
- Stated that it is the intent of the Legislature that a person with opioid use disorder should be provided with a well-coordinated plan of interventions based on evidence while preserving the patient voice, rather than a patient must be provided with a well-coordinated plan of interventions based on evidence while preserving the patient voice;
- Changed the requirement that the Health Care Authority (HCA) must replicate effective treatment approaches such as the opioid hub and spoke treatment networks to broaden outreach and patient navigation, so that the HCA may replicate these approaches;
- Modified the requirements on city and county jails:
- To provide medication assisted treatment (MAT) to persons in custody who were receiving medication for the treatment of opioid use disorder before incarceration or provide medication to persons in custody 30 days before release if treatment is determined to be medically necessary, so that jails must only provide MAT to the extent that funding is provided through either an appropriation or approval of a Section 1115 waiver; and
- To make every possible effort to directly connect incarcerated individuals receiving medication for the treatment of opioid use disorder to an appropriate provider or treatment site before release; instead, city and county jails are required to only make reasonable efforts to connect incarcerated individuals to an appropriate provider or treatment site.
- Added physician assistants to the definition of "prescribing professions" for purposes of the PMP, allowing the largest health professional association representing each of the prescribing professions to include physician assistants in the prescriber feedback reports; and
- Dispensers to submit certain controlled substances prescriptions electronically beginning January 1, 2021;
- Entities or facilities with ten or more providers to integrate EHRs with the PMP beginning January 1, 2021, unless the DOH grants a waiver;
- The Department of Corrections to develop policies to prioritize services based on available grant funding and funds appropriated specifically for opioid use disorder treatment; and
Medicaid and all state regulated plans to provide coverage of at least one prescription drug, without prior authorization, within the drug class of substance use disorder—opioid partial agonists as established in the Medicaid preferred drug list.