House File 208 - IntroducedA Bill ForAn Act 1relating to substance use disorder prevention and
2treatment, including creating an excise tax on the gross
3receipts of certain controlled substances sold at wholesale
4and an opioid abuse prevention and treatment fund, making
5appropriations, and providing penalties.
6BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
1   Section 1.  NEW SECTION.  124.309  Prescriptions for opioids
2— physician-patient contracts.
   31.  The boards of medicine, dentistry, and nursing shall
4adopt rules requiring a practitioner to furnish, and a
5practitioner and patient to sign, a contract regarding the
6risks and responsibilities associated with opioid use prior to
7a practitioner issuing a prescription for more than a seven-day
8supply of an opioid to a patient and prior to issuing any
9additional opioid prescriptions to the patient.
   102.  The form and content of a contract under this section
11shall be determined by the board of medicine but shall be based
12upon evidence regarding the responsible prescribing of opioids.
13   Sec. 2.  NEW SECTION.  135.192  Opioid abuse prevention and
14treatment fund.
   151.  An opioid abuse prevention and treatment fund is created
16in the state treasury under the control of the department.
17The fund is established to expand treatment for and access
18to treatment for opioid use disorders and to assist opioid
19drug abuse prevention and treatment programs in the state
20including but not limited to medication-assisted treatment
21programs that provide appropriate holistic services and
22treatment programs licensed by the department, in accordance
23with programs sponsored by community organizations, programs
24that provide emergency responders with affordable access
25to opioid antagonists, and programs that assist in paying
26treatment costs for individuals who are ineligible for Medicaid
27services or private insurance coverage. The fund shall also
28provide support for the expansion of substance abuse and pain
29management curricula at the university of Iowa college of
30medicine, evidence-based public health research on nonnarcotic
31pain treatment and management alternatives, and expanded mental
32health and substance abuse education and training for emergency
33medical care providers as defined in section 147A.1.
   342.  Distribution of moneys from the opioid abuse prevention
35and treatment program shall be made to eligible applicants in
-1-1the following order of priority:
   2a.  A public entity, including but not limited to a state,
3county, or local community health clinic and federally
4qualified health center, or a public health agency, as defined
5in section 135D.2, that provides opioid use disorder treatment.
   6b.  A nonpublic entity that, in addition to opioid use
7disorder treatment services, provides required primary health
8services as described in 42 U.S.C.§254b(b)(1)(A).
   9c.  A nonpublic entity that provides opioid use disorder
10treatment but does not provide required primary health services
11as described in 42 U.S.C.§254b(b)(1)(A).
   123.  The fund shall consist of all moneys deposited in the
13fund pursuant to section 423H.4 and any other moneys available
14to, obtained, or accepted by the department for placement in
15the fund. Moneys in the fund are not subject to section 8.33.
16Notwithstanding section 12C.7, interest or earnings on moneys
17in the fund shall be credited to the fund.
18   Sec. 3.  NEW SECTION.  135.193  Opioid abuse prevention and
19treatment workgroup.
   201.  An opioid abuse prevention and treatment workgroup shall
21be established by the state board of health. The workgroup
22shall be composed of nine members appointed by the governor
23based on recommendations by the department, including the
24following:
   25a.  One physician licensed under chapter 148.
   26b.  One pharmacist licensed under chapter 155A.
   27c.  One social worker licensed under chapter 154C.
   28d.  One advanced registered nurse practitioner licensed under
29chapter 152.
   30e.  One representative of a county board of health.
   31f.  One representatives of a substance abuse treatment
32program licensed under chapter 125.
   33g.  One person who has been treated for and has recovered
34from opioid abuse.
   35h.  Two persons who are not licensed to practice medicine,
-2-1pharmacy, social work, or nursing who shall represent the
2general public.
   32.  The workgroup shall do all of the following:
   4a.  Promote meetings and programs for the discussion of
5methods to reduce opioid abuse and disseminate information
6in cooperation with any other department, agency, or other
7governmental or nongovernmental entity on the prevention,
8evaluation, care, treatment, and rehabilitation of persons
9affected by opioid abuse.
   10b.  Study and review current prevention, evaluation, care,
11treatment, and rehabilitation programs and strategies and
12recommend appropriate preparation, training, retraining, and
13distribution of personnel and resources in the provision of
14services to persons with opioid abuse issues through treatment
15programs licensed in accordance with the administrative rules
16of the department.
   17c.  Make recommendations to the department to expend moneys
18deposited in the opioid abuse prevention and treatment fund
19created in section 135.192 to carry out the recommendations
20of the workgroup in accordance with the purposes of section
21135.192, subject to the approval of the department.
   22d.  Meet at least quarterly.
   23e.  Make recommendations regarding approval by the state
24board of health of administrative rules for adoption by the
25department pursuant to chapter 17A.
   263.  The department may receive gifts, grants, or donations
27made for any of the purposes of the workgroup’s duties and
28disburse and administer them in accordance with their terms.
29   Sec. 4.  NEW SECTION.  135.194  Substance abuse treatment
30programs.
   311.  The general assembly declares that it is the public
32policy of the state to increase the percentage of people
33receiving treatment for substance use disorders from ten
34percent to eighty percent and to ensure that all effective
35evidence-based substance use disorder treatments are covered
-3-1by the authorization and payment policies of all public and
2private payers.
   32.  The department, in consultation with the Iowa poison
4control center and the Iowa health care collaborative, shall
5develop addiction, addiction treatment, overdose, and overdose
6death surveillance metrics, standards, and requirements for
7data collected through county boards of health.
8   Sec. 5.  NEW SECTION.  137.105A  County boards of health —
9opioid epidemic response.
   10Each county board, in cooperation with a mental health and
11disability services region formed in accordance with section
12331.389 and substance abuse programs licensed pursuant to
13chapter 125, shall include opioid abuse and substance use
14disorder treatment in each community health needs assessment
15and each county health improvement plan shall include
16provisions related to prevention, harm reduction, and treatment
17associated with substance use disorders.
18   Sec. 6.  NEW SECTION.  155A.28A  Labeling and packaging of
19opioids.
   20Beginning January 1, 2020, any packaging, including
21unit dose packaging, of an opioid that is prescribed by a
22practitioner or directly dispensed by a pharmacist and that
23is not for immediate administration to an ultimate user shall
24contain a label including information about the risks of opioid
25use and abuse and the risks of addiction and overdose pursuant
26to rules of the board.
27   Sec. 7.  NEW SECTION.  272C.2D  Continuing education minimum
28requirements — emergency physicians.
   29The board of medicine shall adopt rules requiring emergency
30physicians to receive training on mental illness and substance
31use disorders as a condition of license renewal.
32   Sec. 8.  Section 356.5, Code 2019, is amended by adding the
33following new subsection:
34   NEW SUBSECTION.  7.  Ensure that each prisoner currently
35receiving medication-assisted treatment for a substance use
-4-1disorder under the direction of a licensed health care provider
2shall continue to receive such treatment while the prisoner is
3confined in jail.
4   Sec. 9.  NEW SECTION.  423H.1  Definitions.
   51.  For purposes of this chapter, unless the context
6otherwise requires:
   7a.  “Gross receipts” means the total revenues received from
8the wholesale sale of schedule II controlled substances to
9practitioners in this state.
   10b.  “Practitioner” means the same as defined in section
11124.101.
   12c.  “Schedule II controlled substance” means a controlled
13substance listed in the schedule provided in section 124.206.
   14d.  “Wholesaler” means a person operating or maintaining,
15either within or outside this state, a wholesale distribution
16center, wholesale business, or any other business in which
17prescription drugs or devices, medicinal chemicals, medicines,
18or poisons are sold, dispensed, stocked, exposed, distributed
19from, or offered for sale at wholesale in this state.
20“Wholesaler” does not include those wholesalers who sell only
21proprietary or over-the-counter medicines. “Wholesaler” also
22does not include a commercial carrier that temporarily stores
23prescription drugs or devices, medicinal chemicals, medicines,
24or poisons while in transit.
   252.  All other words and phrases used in this chapter and
26defined in section 423.1 have the meaning given them by section
27423.1 for purposes of this chapter.
28   Sec. 10.  NEW SECTION.  423H.2  Tax imposed.
   29A tax of five percent is imposed on the gross receipts of
30a schedule II controlled substance sold at wholesale to a
31practitioner in this state. The tax imposed under this section
32shall be collected and paid over to the department by the
33wholesaler.
34   Sec. 11.  NEW SECTION.  423H.3  Administration by director.
   351.  The director of revenue shall administer the excise tax
-5-1on the gross receipts of schedule II controlled substances as
2nearly as possible in conjunction with the administration of
3the state sales and use tax law, except that portion of the law
4that implements the streamlined sales and use tax agreement.
5The director shall provide appropriate forms, or provide on the
6regular state tax forms, for reporting tax liability pursuant
7to this chapter.
   82.  The director may require all wholesalers subject to tax
9liability under this chapter to register with the department.
10The director may also require a tax permit applicable only to
11this chapter for any wholesaler not collecting taxes under
12chapter 423.
   133.  Section 422.25, subsection 4, sections 422.30, 422.67,
14and 422.68, section 422.69, subsection 1, sections 422.70,
15422.71, 422.72, 422.74, and 422.75, section 423.14, subsection
161, and sections 423.23, 423.24, 423.25, 423.31 through
17423.35, 423.37 through 423.42, and 423.47, consistent with
18the provisions of this chapter, shall apply with respect to
19the tax authorized under this chapter, in the same manner
20and with the same effect as if the excise tax on the gross
21receipts of schedule II controlled substances by a wholesaler
22was a retail sales tax within the meaning of those provisions.
23Notwithstanding this subsection, the director shall provide for
24quarterly filing of returns and for other than quarterly filing
25of returns both as prescribed in section 423.31. All taxes
26collected under this chapter by a wholesaler are deemed to be
27held in trust for the state of Iowa.
   284.  The director of revenue may adopt rules, not
29inconsistent with this chapter, necessary and advisable for its
30administration and enforcement.
31   Sec. 12.  NEW SECTION.  423H.4  Deposit of revenues.
   321.  All moneys received and all refunds shall be deposited in
33or withdrawn from the general fund of the state.
   342.  Subsequent to the deposit in the general fund of the
35state, the department shall transfer the revenues collected
-6-1under this chapter to the opioid abuse prevention and treatment
2fund created in section 135.192.
3   Sec. 13.  NEW SECTION.  423H.5  Violation — enforcement.
   41.  A wholesaler who violates this chapter is guilty of a
5fraudulent practice.
   62.  The director may designate employees to administer
7and enforce the provisions of this chapter, including
8the collection of taxes imposed by this chapter. In the
9enforcement of this chapter, the director may request aid from
10the attorney general, the special agents of the state, any
11county attorney, or any peace officer.
12   Sec. 14.  SUBSTANCE USE DISORDER TREATMENT — INSURANCE
13COVERAGE.
  The insurance division of the department of commerce
14shall prepare a comprehensive report on insurance coverage
15and payment policies for services related to the treatment of
16substance use disorders by commercial insurance companies and
17self-funded plans, as well as data on current utilization and
18expenditures associated with such benefit plans. The report
19shall be submitted to the general assembly by January 1, 2020.
20   Sec. 15.  OPIOIDS — USAGE — SUBSTANCE USE TREATMENT.
   211.  The department of administrative services shall, in
22cooperation with any health insurance plans or health plan
23administrators of benefits extended to state employees, create
24a model benefit plan designed to incentivize or otherwise
25promote the effective, evidence-based prescription and
26use of opioids to members receiving benefits through state
27plans, document the current use of benefits for substance
28use disorders, identify gaps or unnecessary restrictions in
29coverage, and expand access to evidence-based treatments and
30therapies, including nonpharmacological treatments.
   312.  The department of human services and the Iowa
32Medicaid enterprise shall, in cooperation with managed care
33organizations, design benefit plans to incentivize or otherwise
34promote the effective, evidence-based prescription and use
35of opioids to members receiving benefits through managed
-7-1care organizations, document the current use of benefits
2for substance use disorders, identify gaps or unnecessary
3restrictions in coverage, and expand access to evidence-based
4treatment and therapies, including nonpharmacological
5treatments, by application for a Medicaid waiver if necessary.
6   Sec. 16.  PROFESSIONAL LICENSING BOARDS — SUBSTANCE
7USE TREATMENT PROGRAMS.
  Each professional licensing board
8designated in section 147.13 shall consider the adoption of
9a program modeled after the Iowa nurse assistance program
10and the Iowa physician health program for the identification
11and treatment of licensees who may be at risk for license
12discipline due to a substance use disorder.
13   Sec. 17.  SUBSTANCE USE DISORDERS — RECOVERY HIGH
14SCHOOLS.
  The department of education shall, in collaboration
15with the department of public health and the department
16of human services, make recommendations regarding the
17establishment of one or more recovery high schools in Iowa
18designed for the education of students in recovery from
19substance use disorders or dependency or co-occurring
20disorders such as anxiety, depression, and attention deficit
21hyperactivity disorder. Such schools shall meet state
22requirements for awarding a secondary school diploma and
23support students engaged in a program of recovery. The
24department of education shall submit its recommendations to the
25governor and the general assembly by November 1, 2019.
26   Sec. 18.  OPIOID ABUSE PREVENTION AND TREATMENT FUND —
27APPROPRIATION.
  There is appropriated from the opioid abuse
28prevention and treatment fund created in section 135.192, as
29enacted in this Act, to the department of public health for the
30fiscal year beginning July 1, 2019, and ending June 30, 2020,
31the following amounts, or so much thereof as is necessary, to
32be used for the purposes designated:
   331.  For contracting with the Iowa health care collaborative
34to develop and pilot protocols for the treatment of emergency
35room patients experiencing opioid or heroin overdoses, only to
-8-1the extent that funding is matched on a dollar-for-dollar basis
2from private or public sources secured by the Iowa health care
3collaborative:
..................................................  $4100,000
   52.  For the psychiatric residency programs involved
6with coordinated, collaborative care at newly established,
7community-based behavioral health treatment facilities offering
8residential substance use disorder treatment for twenty-nine
9days or more:
..................................................  $101,000,000
11   Sec. 19.  OPIOID ABUSE PREVENTION AND TREATMENT FUND —
12APPROPRIATION.
  There is appropriated from the opioid abuse
13prevention and treatment fund created in section 135.192, as
14enacted in this Act, to the state board of regents for the
15fiscal year beginning July 1, 2019, and ending June 30, 2020,
16the following amounts, or so much thereof as is necessary, to
17be used for the purposes designated:
   181.  For the funding of research on medication-assisted
19treatment for substance use disorders conducted at the college
20of public health at the state university of Iowa to identify
21variability in outcomes, demonstrate efficacy of treatment, and
22refine evidence-based protocols:
..................................................  $23500,000
   242.  For the funding of research and education conducted at
25the Carver college of medicine at the state university of Iowa
26for the nonnarcotic treatment of pain:
..................................................  $271,000,000
28   Sec. 20.  IMPLEMENTATION OF ACT.  Section 25B.2, subsection
293, shall not apply to this Act.
30EXPLANATION
31The inclusion of this explanation does not constitute agreement with
32the explanation’s substance by the members of the general assembly.
   33This bill relates to the treatment of substance use disorder
34prevention and treatment, including creating an excise tax on
35the gross receipts of certain controlled substances sold at
-9-1wholesale and an opioid abuse prevention and treatment fund,
2makes appropriations, and provides penalties.
   3The bill directs the board of medicine to adopt rules
4requiring practitioners to present, and practitioners
5and patients to sign, a contract regarding the risks and
6responsibilities associated with opioid use prior to a
7practitioner’s prescription of a course of treatment including
8opioids to a patient lasting longer than seven days and
9prior to issuing a second or subsequent prescription for an
10opioid to the patient. The bill requires the department of
11medicine to determine the form and content of the contract but
12requires that the contract be based on evidence regarding the
13responsible prescription of opioids.
   14The bill establishes an opioid abuse prevention and
15treatment workgroup within the department of public health.
16Under the bill, the membership of the workgroup includes one
17physician, one pharmacist, one social worker, one advanced
18registered nurse practitioner, one representative of a county
19board of health, one representative of a substance abuse
20treatment program licensed under Code chapter 125, one person
21who has been treated for and has recovered from opioid abuse,
22and two persons who are not licensed to practice medicine,
23pharmacy, social work, or nursing who shall represent the
24general public.
   25Under the bill, the workgroup is required to promote
26meetings and programs for the discussion of methods to reduce
27opioid abuse and disseminate information in cooperation
28with any other department, agency, or other governmental
29or nongovernmental entity on the prevention, evaluation,
30care, treatment, and rehabilitation of persons affected by
31opioid abuse. The bill also requires the workgroup to study
32and review current prevention, evaluation, care, treatment,
33and rehabilitation programs and strategies and recommend
34appropriate preparation, training, retraining, and distribution
35of personnel and resources in the provision of services to
-10-1persons with opioid abuse issues through treatment programs
2licensed in accordance with the administrative rules of the
3department.
   4The bill directs the workgroup to make recommendations to
5the department to expend moneys deposited in the opioid abuse
6prevention and treatment fund to carry out the recommendations
7of the workgroup in accordance with the purposes of the fund.
8The bill also directs the workgroup to make recommendations
9to the state board of health to approve administrative rules
10for adoption by the department relating to the workgroup’s
11recommendations.
   12The bill provides that it is the public policy of the
13state of Iowa to increase the percentage of people receiving
14treatment for substance use disorders from 10 percent to
1580 percent and to ensure that all effective evidence-based
16treatments for substance use disorder treatments are covered
17by the authorization and payment policies of all public and
18private payers. The bill directs the department of public
19health, in consultation with the Iowa poison control center
20and the Iowa health care collaborative, to develop addiction,
21addiction treatment, overdose, and overdose death surveillance
22metrics, standards, and requirements for data collected through
23county boards of health.
   24The bill requires each county board of health, in
25cooperation with the relevant mental health and disability
26services region formed in accordance with Code section
27331.389 and substance abuse programs licensed pursuant to Code
28chapter 125, to include information regarding opioid abuse and
29substance use disorder treatment in each community health needs
30assessment, as well as in each health improvement plan when the
31county board of health deems it appropriate.
   32The bill directs the board of pharmacy to adopt rules
33requiring that packaging for certain opioids contain a label
34including information regarding the dangers of opioid use and
35abuse and the risks of addiction and overdose beginning January
-11-11, 2020.
   2The bill directs the board of medicine to adopt rules
3requiring emergency physicians to receive training on mental
4illness and substance use disorders as a condition of license
5renewal.
   6The bill requires the appropriate administrative officer
7of each county jail to ensure that each prisoner currently
8receiving medication-assisted treatment for a substance use
9disorder under the direction of a licensed health care provider
10continue to receive such treatment while confined in jail.
   11The bill imposes an excise tax of 5 percent on the gross
12receipts of schedule II controlled substances sold at wholesale
13to practitioners in the state. The tax shall be collected and
14paid over to the department of revenue by the wholesaler. The
15bill contains definitions for “gross receipts”, “practitioner”,
16“schedule II controlled substance”, and “wholesaler”.
   17The bill requires the director of revenue to administer
18the excise tax as nearly as possible in conjunction with the
19administration of the state sales and use tax laws, and, to
20that end, the bill incorporates by reference several Code
21sections that relate to general tax administration and the
22sales and use tax laws.
   23The bill requires excise tax revenues collected pursuant to
24the bill to be deposited in the general fund of the state, then
25transferred to the opioid abuse prevention and treatment fund
26created in the bill. The fund is created in the state treasury
27under the control of the department of public health. The fund
28is established to expand treatment for and access to treatment
29for opioid use disorders and to assist opioid abuse prevention
30and treatment programs in the state, including but not limited
31to programs described in the bill. The fund consists of moneys
32deposited in the fund from the revenues of the excise tax, and
33any other moneys obtained by the department for placement in
34the fund. Moneys in the fund are not subject to Code section
358.33. Notwithstanding Code section 12C.7, interest or earnings
-12-1on moneys in the fund shall be credited to the fund.
   2The bill directs the insurance division of the department
3of commerce to prepare a comprehensive report on insurance
4coverage and payment policies for services related to the
5treatment of substance use disorders by commercial insurance
6companies and self-funded plans, as well as data on current
7utilization and expenditures associated with such benefit
8plans. The bill requires this report to be submitted to the
9general assembly by March 1, 2020.
   10The bill directs the department of administrative
11services, in cooperation with any health plans or health
12plan administrators of benefits extended to state employees,
13to create a model benefit plan designed to incentivize or
14otherwise promote the effective, evidence-based prescription
15and use of opioids to members receiving benefits through state
16plans, document the current use of benefits for substance
17use disorders, identify gaps or unnecessary restrictions in
18coverage, and expand access to evidence-based treatments and
19therapies, including nonpharmacological treatments.
   20The bill directs the department of human services and the
21Iowa Medicaid enterprise, in cooperation with managed care
22organizations, to design benefit plans to incentivize or
23otherwise promote the effective, evidence-based prescription
24and use of opioids to members receiving benefits through
25managed care organizations, document the current use of
26benefits for substance use disorders, identify gaps or
27unnecessary restrictions in coverage, and expand access
28to evidence-based treatment and therapies, including
29nonpharmacological treatments, by application for a Medicaid
30waiver if necessary.
   31The bill directs the department of education, in
32collaboration with the department of public health and the
33department of human services, to make recommendations to the
34governor and the general assembly regarding the establishment
35of recovery high schools for the education of students
-13-1recovering from substance abuse and related disorders. The
2bill requires the department of education to submit its
3recommendations by November 1, 2019.
   4The bill requires each professional licensing board
5designated in Code section 147.13 to consider the adoption
6of a program modeled after the Iowa nurse assistance program
7and the Iowa physician health program for the identification
8and treatment of licensees who may be at risk for license
9discipline due to a substance use disorder.
   10The bill appropriates moneys from the opioid abuse
11prevention and treatment fund to the department of public
12health for contracting with the Iowa health care collaborative
13to develop and pilot protocols for the treatment of emergency
14room patients experiencing opioid or heroin overdoses
15contingent on the Iowa health care collaborative receiving
16dollar-for-dollar matching funding from private or public
17sources and to support psychiatric residency programs at
18behavioral health treatment facilities offering residential
19substance use disorder treatment for 29 days or more. The
20bill appropriates moneys from the opioid abuse prevention and
21treatment fund to the state board of regents for FY 2019-2020
22for the funding of research conducted at the college of public
23health at the state university of Iowa for medication-assisted
24treatment of substance use disorders to identify variability
25in outcomes, demonstrate efficacy of treatment, and refine
26evidence-based protocols, and for the funding of research and
27education conducted at the Carver college of medicine at the
28state university of Iowa for the nonnarcotic treatment of pain.
   29The bill may include a state mandate as defined in Code
30section 25B.3. The bill makes inapplicable Code section 25B.2,
31subsection 3, which would relieve a political subdivision from
32complying with a state mandate if funding for the cost of
33the state mandate is not provided or specified. Therefore,
34political subdivisions are required to comply with any state
35mandate included in the bill.
-14-
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