HF 2474 (LSB 5755YH (11) 87)

HOUSE FILE 2474

BY  ISENHART

A BILL FOR

An Act relating to substance use disorder prevention and treatment, including creating an excise tax on the gross receipts of certain controlled substances sold at wholesale and an opioid abuse prevention and treatment fund, making appropriations, and providing penalties.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:

    Section 1.  NEW SECTION.  124.309  Prescriptions for opioids —— physician-patient contracts.
   1.  The boards of medicine, dentistry, and nursing shall adopt rules requiring a practitioner to furnish, and a practitioner and patient to sign, a contract regarding the risks and responsibilities associated with opioid use prior to a practitioner issuing a prescription for more than a seven-day supply of an opioid to a patient and prior to issuing any additional opioid prescriptions to the patient.
   2.  The form and content of a contract under this section shall be determined by the board of medicine but shall be based upon evidence regarding the responsible prescribing of opioids.
    Sec. 2.  NEW SECTION.  135.192  Opioid abuse prevention and treatment fund.
   1.  An opioid abuse prevention and treatment fund is created in the state treasury under the control of the department. The fund is established to expand treatment for and access to treatment for opioid use disorders and to assist opioid drug abuse prevention and treatment programs in the state including but not limited to medication-assisted treatment programs that provide appropriate holistic services and treatment programs licensed by the department, in accordance with programs sponsored by community organizations, programs that provide emergency responders with affordable access to opioid antagonists, and programs that assist in paying treatment costs for individuals who are ineligible for Medicaid services or private insurance coverage. The fund shall also provide support for the expansion of substance abuse and pain management curricula at the university of Iowa college of medicine, evidence-based public health research on nonnarcotic pain treatment and management alternatives, and expanded mental health and substance abuse education and training for emergency medical care providers as defined in section 147A.1.
   2.  Distribution of moneys from the opioid abuse prevention and treatment program shall be made to eligible applicants in the following order of priority:
   a.  A public entity, including but not limited to a state, county, or local community health clinic and federally qualified health center, or a public health agency, as defined in section 135D.2, that provides opioid use disorder treatment.
   b.  A nonpublic entity that, in addition to opioid use disorder treatment services, provides required primary health services as described in 42 U.S.C. §254b(b)(1)(A).
   c.  A nonpublic entity that provides opioid use disorder treatment but does not provide required primary health services as described in 42 U.S.C. §254b(b)(1)(A).
   3.  The fund shall consist of all moneys deposited in the fund pursuant to section 423G.4 and any other moneys available to, obtained, or accepted by the department for placement in the fund. Moneys in the fund are not subject to section 8.33. Notwithstanding section 12C.7, interest or earnings on moneys in the fund shall be credited to the fund.
    Sec. 3.  NEW SECTION.  135.193  Opioid abuse prevention and treatment workgroup.
   1.  An opioid abuse prevention and treatment workgroup shall be established by the state board of health. The workgroup shall be composed of nine members appointed by the governor based on recommendations by the department, including the following:
   a.  One physician licensed under chapter 148.
   b.  One pharmacist licensed under chapter 155A.
   c.  One social worker licensed under chapter 154C.
   d.  One advanced registered nurse practitioner licensed under chapter 152.
   e.  One representative of a county board of health.
   f.  One representatives of a substance abuse treatment program licensed under chapter 125.
   g.  One person who has been treated for and has recovered from opioid abuse.
   h.  Two persons who are not licensed to practice medicine, pharmacy, social work, or nursing who shall represent the general public.
   2.  The workgroup shall do all of the following:
   a.  Promote meetings and programs for the discussion of methods to reduce opioid abuse and disseminate information in cooperation with any other department, agency, or other governmental or nongovernmental entity on the prevention, evaluation, care, treatment, and rehabilitation of persons affected by opioid abuse.
   b.  Study and review current prevention, evaluation, care, treatment, and rehabilitation programs and strategies and recommend appropriate preparation, training, retraining, and distribution of personnel and resources in the provision of services to persons with opioid abuse issues through treatment programs licensed in accordance with the administrative rules of the department.
   c.  Make recommendations to the department to expend moneys deposited in the opioid abuse prevention and treatment fund created in section 135.191 to carry out the recommendations of the workgroup in accordance with section 135.191, subject to the approval of the department.
   d.  Meet at least quarterly.
   e.  Make recommendations regarding approval by the state board of health of administrative rules for adoption by the department pursuant to chapter 17A.
   3.  The department may receive gifts, grants, or donations made for any of the purposes of the workgroup’s duties and disburse and administer them in accordance with their terms.
    Sec. 4.  NEW SECTION.  135.194  Substance abuse treatment programs.
   1.  The general assembly declares that it is the public policy of the state to increase the percentage of people receiving treatment for substance use disorders from ten percent to eighty percent and to ensure that all effective evidence-based substance use disorder treatments are covered by the authorization and payment policies of all public and private payers.
   2.  The department, in consultation with the Iowa poison control center and the Iowa health care collaborative, shall develop addiction, addiction treatment, overdose, and overdose death surveillance metrics, standards, and requirements for data collected through county boards of health.
    Sec. 5.  NEW SECTION.  137.105A  County boards of health —— opioid epidemic response.
   Each county board, in cooperation with a mental health and disability services region created in section 331.389 and substance abuse programs licensed pursuant to chapter 125, shall include opioid abuse and substance use disorder treatment in each community health needs assessment and each county health improvement plan shall include provisions related to prevention, harm reduction, and treatment associated with substance use disorders.
    Sec. 6.  NEW SECTION.  155A.28A  Labeling and packaging of opioids.
   Beginning January 1, 2019, any packaging, including unit dose packaging, of an opioid that is prescribed by a practitioner or directly dispensed by a pharmacist and that is not for immediate administration to an ultimate user shall contain a label including information about the risks of opioid use and abuse and the risks of addiction and overdose pursuant to rules of the board.
    Sec. 7.  NEW SECTION.  272C.2C  Continuing education minimum requirements —— emergency physicians.
   The board of medicine shall adopt rules requiring emergency physicians to receive training on mental illness and substance use disorders as a condition of license renewal.
    Sec. 8.  Section 356.5, Code 2018, is amended by adding the following new subsection:
   NEW SUBSECTION.  7.  Ensure that each prisoner currently receiving medication-assisted treatment for a substance use disorder under the direction of a licensed health care provider shall continue to receive such treatment while the prisoner is confined in jail.
    Sec. 9.  NEW SECTION.  423G.1  Definitions.
   1.  For purposes of this chapter, unless the context otherwise requires:
   a.  “Gross receipts” means the total revenues received from the wholesale sale of schedule II controlled substances to practitioners in this state.
   b.  “Practitioner” means the same as defined in section 124.101.
   c.  “Schedule II controlled substance” means a controlled substance listed in the schedule provided in section 124.206.
   d.  “Wholesaler” means a person operating or maintaining, either within or outside this state, a wholesale distribution center, wholesale business, or any other business in which prescription drugs or devices, medicinal chemicals, medicines, or poisons are sold, dispensed, stocked, exposed, distributed from, or offered for sale at wholesale in this state. “Wholesaler” does not include those wholesalers who sell only proprietary or over-the-counter medicines. “Wholesaler” also does not include a commercial carrier that temporarily stores prescription drugs or devices, medicinal chemicals, medicines, or poisons while in transit.
   2.  All other words and phrases used in this chapter and defined in section 423.1 have the meaning given them by section 423.1 for purposes of this chapter.
    Sec. 10.  NEW SECTION.  423G.2  Tax imposed.
   A tax of five percent is imposed on the gross receipts of a schedule II controlled substance sold at wholesale to a practitioner in this state. The tax imposed under this section shall be collected and paid over to the department by the wholesaler.
    Sec. 11.  NEW SECTION.  423G.3  Administration by director.
   1.  The director of revenue shall administer the excise tax on the gross receipts of schedule II controlled substances as nearly as possible in conjunction with the administration of the state sales and use tax law, except that portion of the law that implements the streamlined sales and use tax agreement. The director shall provide appropriate forms, or provide on the regular state tax forms, for reporting tax liability pursuant to this chapter.
   2.  The director may require all wholesalers subject to tax liability under this chapter to register with the department. The director may also require a tax permit applicable only to this chapter for any wholesaler not collecting taxes under chapter 423.
   3.  Section 422.25, subsection 4, sections 422.30, 422.67, and 422.68, section 422.69, subsection 1, sections 422.70, 422.71, 422.72, 422.74, and 422.75, section 423.14, subsection 1, and sections 423.23, 423.24, 423.25, 423.31 through 423.35, 423.37 through 423.42, and 423.47, consistent with the provisions of this chapter, shall apply with respect to the tax authorized under this chapter, in the same manner and with the same effect as if the excise tax on the gross receipts of schedule II controlled substances by a wholesaler was a retail sales tax within the meaning of those provisions. Notwithstanding this subsection, the director shall provide for quarterly filing of returns and for other than quarterly filing of returns both as prescribed in section 423.31. All taxes collected under this chapter by a wholesaler are deemed to be held in trust for the state of Iowa.
   4.  The director of revenue may adopt rules, not inconsistent with this chapter, necessary and advisable for its administration and enforcement.
    Sec. 12.  NEW SECTION.  423G.4  Deposit of revenues.
   1.  All moneys received and all refunds shall be deposited in or withdrawn from the general fund of the state.
   2.  Subsequent to the deposit in the general fund of the state, the department shall transfer the revenues collected under this chapter to the opioid abuse prevention and treatment fund created in section 135.192.
    Sec. 13.  NEW SECTION.  423G.5  Violation —— enforcement.
   1.  A wholesaler who violates this chapter is guilty of a fraudulent practice.
   2.  The director may designate employees to administer and enforce the provisions of this chapter, including the collection of taxes imposed by this chapter. In the enforcement of this chapter, the director may request aid from the attorney general, the special agents of the state, any county attorney, or any peace officer.
    Sec. 14.  SUBSTANCE USE DISORDER TREATMENT —— INSURANCE COVERAGE.  The insurance division of the department of commerce shall prepare a comprehensive report on insurance coverage and payment policies for services related to the treatment of substance use disorders by commercial insurance companies and self-funded plans, as well as data on current utilization and expenditures associated with such benefit plans. The report shall be submitted to the general assembly by January 1, 2019.
    Sec. 15.  OPIOIDS —— USAGE —— SUBSTANCE USE TREATMENT.
   1.  The department of administrative services shall, in cooperation with any health insurance plans or health plan administrators of benefits extended to state employees, create a model benefit plan designed to incentivize or otherwise promote the effective, evidence-based prescription and use of opioids to members receiving benefits through state plans, document the current use of benefits for substance use disorders, identify gaps or unnecessary restrictions in coverage, and expand access to evidence-based treatments and therapies, including nonpharmacological treatments.
   2.  The department of human services and the Iowa Medicaid enterprise shall, in cooperation with managed care organizations, design benefit plans to incentivize or otherwise promote the effective, evidence-based prescription and use of opioids to members receiving benefits through managed care organizations, document the current use of benefits for substance use disorders, identify gaps or unnecessary restrictions in coverage, and expand access to evidence-based treatment and therapies, including nonpharmacological treatments, by application for a Medicaid waiver if necessary.
    Sec. 16.  PROFESSIONAL LICENSING BOARDS —— SUBSTANCE USE TREATMENT PROGRAMS.  Each professional licensing board designated in section 147.13 shall consider the adoption of a program modeled after the Iowa nurse assistance program and the Iowa physician health program for the identification and treatment of licensees who may be at risk for license discipline due to a substance use disorder.
    Sec. 17.  SUBSTANCE USE DISORDERS —— RECOVERY HIGH SCHOOLS.  The department of education shall, in collaboration with the department of public health and the department of human services, make recommendations regarding the establishment of one or more recovery high schools in Iowa designed for the education of students in recovery from substance use disorders or dependency or co-occurring disorders such as anxiety, depression, and attention deficit hyperactivity disorder. Such schools shall meet state requirements for awarding a secondary school diploma and support students engaged in a program of recovery. The department of education shall submit its recommendations to the governor and the general assembly by November 1, 2018.
    Sec. 18.  OPIOID ABUSE PREVENTION AND TREATMENT FUND —— APPROPRIATION.  There is appropriated from the opioid abuse prevention and treatment fund created in section 135.192, as enacted in this Act, to the department of public health for the fiscal year beginning July 1, 2018, and ending June 30, 2019, the following amounts, or so much thereof as is necessary, to be used for the purposes designated:
   1.  For contracting with the Iowa health care collaborative to develop and pilot protocols for the treatment of emergency room patients experiencing opioid or heroin overdoses, only to the extent that funding is matched on a dollar-for-dollar basis from private or public sources secured by the Iowa health care collaborative:
   ...................................................................... $    100,000

   2.  For the psychiatric residency programs involved with coordinated, collaborative care at newly established, community-based behavioral health treatment facilities offering residential substance use disorder treatment for twenty-nine days or more:
   ...................................................................... $  1,000,000
    Sec. 19.  OPIOID ABUSE PREVENTION AND TREATMENT FUND —— APPROPRIATION.  There is appropriated from the opioid abuse prevention and treatment fund created in section 135.192, as enacted in this Act, to the state board of regents for the fiscal year beginning July 1, 2018, and ending June 30, 2019, the following amounts, or so much thereof as is necessary, to be used for the purposes designated:
   1.  For the funding of research on medication-assisted treatment for substance use disorders conducted at the college of public health at the state university of Iowa to identify variability in outcomes, demonstrate efficacy of treatment, and refine evidence-based protocols:
   ...................................................................... $    500,000

   2.  For the funding of research and education conducted at the Carver college of medicine at the state university of Iowa for the nonnarcotic treatment of pain:
   ...................................................................... $  1,000,000
    Sec. 20.  IMPLEMENTATION OF ACT.  Section 25B.2, subsection 3, shall not apply to this Act.
EXPLANATION
The inclusion of this explanation does not constitute agreement with
the explanation’s substance by the members of the general assembly.
   This bill relates to the treatment of substance use disorder prevention and treatment, including creating an excise tax on the gross receipts of certain controlled substances sold at wholesale and an opioid abuse prevention and treatment fund, makes appropriations, and provides penalties.
   The bill directs the board of medicine to adopt rules requiring practitioners to present, and practitioners and patients to sign, a contract regarding the risks and responsibilities associated with opioid use prior to a practitioner’s prescription of a course of treatment including opioids to a patient lasting longer than seven days and prior to issuing a second or subsequent prescription for an opioid to the patient. The bill requires the department of medicine to determine the form and content of the contract but requires that the contract be based on evidence regarding the responsible prescription of opioids.
   The bill establishes an opioid abuse prevention and treatment workgroup within the department of public health. Under the bill, the membership of the workgroup includes one physician, one pharmacist, one social worker, one advanced registered nurse practitioner, one representative of a county board of health, one representative of a substance abuse treatment program licensed under Code chapter 125, one person who has been treated for and has recovered from opioid abuse, and two persons who are not licensed to practice medicine, pharmacy, social work, or nursing who shall represent the general public.
   Under the bill, the workgroup is required to promote meetings and programs for the discussion of methods to reduce opioid abuse and disseminate information in cooperation with any other department, agency, or other governmental or nongovernmental entity on the prevention, evaluation, care, treatment, and rehabilitation of persons affected by opioid abuse. The bill also requires the workgroup to study and review current prevention, evaluation, care, treatment, and rehabilitation programs and strategies and recommend appropriate preparation, training, retraining, and distribution of personnel and resources in the provision of services to persons with opioid abuse issues through treatment programs licensed in accordance with the administrative rules of the department. 
   The bill directs the workgroup to make recommendations to the department to expend moneys deposited in the opioid abuse prevention and treatment fund to carry out the recommendations of the workgroup in accordance with criteria set forth in Code section 135.191. The bill also directs the workgroup to make recommendations to the state board of health to approve administrative rules for adoption by the department relating to the workgroup’s recommendations.
   The bill provides that it is the public policy of the state of Iowa to increase the percentage of people receiving treatment for substance use disorders from 10 percent to 80 percent and to ensure that all effective evidence-based treatments for substance use disorder treatments are covered by the authorization and payment policies of all public and private payers. The bill directs the department of public health, in consultation with the Iowa poison control center and the Iowa health care collaborative, to develop addiction, addiction treatment, overdose, and overdose death surveillance metrics, standards, and requirements for data collected through county boards of health.
   The bill requires each county board of health, in cooperation with the relevant mental health and disability services region created in Code section 331.389 and substance abuse programs licensed pursuant to Code chapter 125, to include information regarding opioid abuse and substance use disorder treatment in each community health needs assessment, as well as in each health improvement plan when the county board of health deems it appropriate.
   The bill directs the board of pharmacy to adopt rules requiring that packaging for certain opioids contain a label including information regarding the dangers of opioid use and abuse and the risks of addiction and overdose beginning January 1, 2019.
   The bill directs the board of medicine to adopt rules requiring emergency physicians to receive training on mental illness and substance use disorders as a condition of license renewal.
   The bill requires the appropriate administrative officer of each county jail to ensure that each prisoner currently receiving medication-assisted treatment for a substance use disorder under the direction of a licensed health care provider continue to receive such treatment while confined in jail.
   The bill imposes an excise tax of 5 percent on the gross receipts of schedule II controlled substances sold at wholesale to practitioners in the state. The tax shall be collected and paid over to the department of revenue by the wholesaler. The bill contains definitions for “gross receipts”, “practitioner”, “schedule II controlled substance”, and “wholesaler”. 
   The bill requires the director of revenue to administer the excise tax as nearly as possible in conjunction with the administration of the state sales and use tax laws, and, to that end, the bill incorporates by reference several Code sections that relate to general tax administration and the sales and use tax laws. 
   The bill requires excise tax revenues collected pursuant to the bill to be deposited in the general fund of the state, then transferred to the opioid abuse prevention and treatment fund created in the bill. The fund is created in the state treasury under the control of the department of public health. The fund is established to expand treatment for and access to treatment for opioid use disorders and to assist opioid abuse prevention and treatment programs in the state, including but not limited to programs described in the bill. The fund consists of moneys deposited in the fund from the revenues of the excise tax, and any other moneys obtained by the department for placement in the fund. Moneys in the fund are not subject to Code section 8.33. Notwithstanding Code section 12C.7, interest or earnings on moneys in the fund shall be credited to the fund.
   The bill directs the insurance division of the department of commerce to prepare a comprehensive report on insurance coverage and payment policies for services related to the treatment of substance use disorders by commercial insurance companies and self-funded plans, as well as data on current utilization and expenditures associated with such benefit plans. The bill requires this report to be submitted to the general assembly by March 1, 2019.
   The bill also directs the department of administrative services, in cooperation with any health plans or health plan administrators of benefits extended to state employees, to create a model benefit plan designed to incentivize or otherwise promote the effective, evidence-based prescription and use of opioids to members receiving benefits through state plans, document the current use of benefits for substance use disorders, identify gaps or unnecessary restrictions in coverage, and expand access to evidence-based treatments and therapies, including nonpharmacological treatments.
   The bill directs the department of human services and the Iowa Medicaid enterprise, in cooperation with managed care organizations, to design benefit plans to incentivize or otherwise promote the effective, evidence-based prescription and use of opioids to members receiving benefits through managed care organizations, document the current use of benefits for substance use disorders, identify gaps or unnecessary restrictions in coverage, and expand access to evidence-based treatment and therapies, including nonpharmacological treatments, by application for a Medicaid waiver if necessary.
   The bill directs the department of education, in collaboration with the department of public health and the department of human services, to make recommendations to the governor and the general assembly regarding the establishment of recovery high schools for the education of students recovering from substance abuse and related disorders. The bill requires the department of education to submit its recommendations by November 1, 2018.
   The bill requires each professional licensing board designated in Code section 147.13 to consider the adoption of a program modeled after the Iowa nurse assistance program and the Iowa physician health program for the identification and treatment of licensees who may be at risk for license discipline due to a substance use disorder.
   The bill appropriates moneys from the opioid abuse prevention and treatment fund to the department of public health for contracting with the Iowa health care collaborative to develop and pilot protocols for the treatment of emergency room patients experiencing opioid or heroin overdoses contingent on the Iowa health care collaborative receiving dollar-for-dollar matching funding from private or public sources and to support psychiatric residency programs at behavioral health treatment facilities offering residential substance use disorder treatment for 29 days or more. The bill appropriates moneys from the opioid abuse prevention and treatment fund to the state board of regents for FY 2018-2019 for the funding of research conducted at the college of public health at the state university of Iowa for medication-assisted treatment of substance use disorders to identify variability in outcomes, demonstrate efficacy of treatment, and refine evidence-based protocols, and for the funding of research and education conducted at the Carver college of medicine at the state university of Iowa for the nonnarcotic treatment of pain.
   The bill may include a state mandate as defined in Code section 25B.3. The bill makes inapplicable Code section 25B.2, subsection 3, which would relieve a political subdivision from complying with a state mandate if funding for the cost of the state mandate is not provided or specified. Therefore, political subdivisions are required to comply with any state mandate included in the bill.