AB 1081

This bill makes various changes to administrative rules promulgated by the Department of Health Services relating to the regulation of opioid treatment programs (OTPs). Among other things, the bill eliminates a requirement in current administrative rules that persons under the age of 18 have a one-year opioid addiction history and two documented instances of unsuccessful treatment in order to be admitted to an OTP.

Mirroring federal regulations, the bill creates an administrative rule defining “practitioner” as a health care professional who is appropriately licensed by a state to prescribe or dispense medications for opioid use disorders and, as a result, is authorized to practice within an OTP. The bill then also expands certain administrative rules that reference physicians to instead refer to practitioners.

The bill modifies current administrative rules to provide that screening examinations for admission to an OTP may be completed by a non-OTP practitioner up to seven days prior to admission and that a full examination must be completed within 14 days and may be completed by a non-OTP practitioner with review by an OTP provider.

Under current administrative rules, an OTP must have a registered nurse on staff to supervise the dosing process, and a registered nurse must be physically on the premises any time dosing is occurring. The bill modifies this rule, eliminating the requirement for a registered nurse to be on site any time dosing is occurring and allowing either a registered nurse or licensed practical nurse to administer medication.

The bill repeals administrative rules relating to take-home medications and replaces those rules with new rules relating to the criteria for unsupervised use of medication for the treatment of opioid use disorders, restrictions for unsupervised use of methadone hydrochloride, and certain exceptions to those restrictions. Under the administrative rules created by the bill, a patient in an OTP may receive their individual take-home doses as ordered for days that the clinic is closed for business, on one weekend day, and on state and federal holidays, no matter their length of time in treatment, as permitted by federal regulations. For take-home doses beyond that, a practitioner must review and document the criteria set forth under federal regulations when determining whether dispensing medication for a patient’s unsupervised use is safe and it is appropriate to set, increase, or extend the amount of time between visits to the OTP. That determination, including the basis for the determination, must be documented by a practitioner in the patient’s medical record. Under the rules established by the bill, if a practitioner assesses, determines, and documents that a patient meets the federal criteria and can safely manage unsupervised doses of methadone, the number of take-home doses is limited by federal regulations. When a practitioner has reason to accelerate the number of unsupervised doses of methadone hydrochloride, they must comply with the requirements under applicable federal regulations and the criteria for unsupervised use and must use the exception process provided by the federal Center for Substance Abuse Treatment Division of Pharmacologic Therapies. The bill establishes a rule that DHS has the authority to monitor a program for compliance with federal regulations and may take licensing actions on the basis of a DHS determination of noncompliance.

Current administrative rules generally require patients receiving guest dosing (administration of a medication used for the treatment of opioid addiction to a person who is not a client of the program that is administering or dispensing the medication) to have been enrolled at their home clinic for a minimum of 30 days before being eligible for a guest dose. The bill eliminates that requirement.

With certain limited exceptions, current administrative rules provide that the maximum initial dose of methadone may not exceed 30 milligrams. The bill increases the maximum initial dose to 50 milligrams, unless the practitioner finds sufficient medical rationale, including if the patient is transferring from another OTP on a higher dose that has been verified, and documents in the patient’s record that a higher dose was clinically indicated. The bill also changes the current rule regarding the maximum number of days during any 12-month period that an individual may be provided interim maintenance treatment from 120 days to 180 days.

The bill creates a new administrative rule that an OTP may provide split dosing when, in the clinical judgment of the OTP practitioner, such dosing is medically appropriate. Under the bill, the practitioner’s determination and clinical rationale must be documented in the patient’s medical record. The new administrative rule created by the bill provides that no additional testing or documentation beyond routine clinical practice may be required, and any laboratory testing must be at the discretion of the practitioner.

Under current administrative rules, an OTP must employ at least one substance abuse counselor, substance abuse counselor-in training, licensed marriage and family therapist, licensed professional counselor, licensed clinical social worker, certified advanced practice social worker, certified independent social worker, or clinical substance abuse counselor who is under the supervision of a clinical supervisor. The rules also provide that an OTP must employ such a clinician for a minimum of one full-time equivalent of 40 hours per week for every 55 enrolled patients in the service. The bill eliminates that requirement.

The bill also requires DHS to update, each January 1, beginning January 1, 2027, the rates for substance use disorder treatment services with medications for opioid use disorder to be equivalent to the corresponding state-specific, locality-adjusted Medicare rates for the same or comparable services in the calendar year in which the services are provided. The bill provides that those rates do not apply to federally qualified health centers, rural health centers, Indian health services facilities, or certified community behavioral health centers.