I_OpioidSubstance_2018A 08/14/2018 09:38:25 AM Committee Summary

Gretchen Hammer, Medicaid Director, Department of Health Care Policy and Financing (HCPF), presented to the committee.  She summarized House Bill 18-1136, which adds inpatient and residential substance use treatment as a covered Medicaid benefit, upon federal approval.

Ms. Hammer updated the committee on the implementation of HB 18-1136, and described discussions with the federal officials.  She noted that HCPF has hired a contractor to conduct research on the federal waiver process and is receiving technical assistance from the federal government.

Ms. Hammer described the plan to engage stakeholders on implementation of HB 18-1136.

In response to questions, Ms. Hammer discussed states that have implemented a similar waiver using a different process and budget neutrality requirements for some Medicaid services.  She responded to questions regarding the timeline for federal approval of the waiver, the capacity of the delivery system for services, and accuracy of the cost projections for implementation of HB 18-1136.

Ms. Hammer continued to respond to questions regarding innovative federal funding opportunities.

Laurel Karabatsos, Deputy Medicaid Director, HCPF, responded to questions on communication and collaboration between state agencies on substance use disorder services.

Nancy VanDeMark, Mental Health Colorado, presented to the committee and distributed a handout (Attachment B).

Ms. VanDeMark distributed a packet to the committee and gave examples of the barriers to treatment and recovery that persons with substance use disorders (SUD) have experienced (Attachment C).  Ms. VanDeMark responded to committee questions.

Ms. VanDeMark described challenges to accessing care and provided policy recommendations, including ensuring immediate access to care, additional treatment delivery options, and equal insurance coverage for SUD.

Ms. VanDeMark gave examples of effective state and local initiatives.  She discussed providing one point of contact for SUD treatment, proper screening for SUD, and coordination of care for all individuals in treatment.  Ms. VanDeMark responded to questions on detoxification services.

Lauren Snyder, Mental Health Colorado, provided the committee with policy ideas including implementing a system to track SUD, psychiatric, and medication assisted treatment (MAT) program capacity, and increasing the continuum of treatment capacity.  In response to a question, Ms. VanDeMark explained the criteria used to determine level of care for SUD treatment.

Ms. VanDeMark responded to questions on systemic changes to prevent SUD and a centralized contact or phone number for SUD issues.

Ms. Snyder provided suggestions to strengthen the law to ensure that SUD treatment is covered by insurance similar to coverage for physical illnesses.  She responded to questions regarding insurance denials for care, insurance parity, and the committee's focus on prevention of SUD.

Lisa Raville, Harm Reduction Action Center, described Colorado efforts related to harm reduction for intravenous drug users.

Ms. Raville provided statistics on overdose deaths from opioids and other drugs.  Dr. Rob Valuck came to the table to respond to a question on the number of overdose deaths by county.

Ms. Raville updated the committee on the syringe exchange program, naloxone distribution, HIV and Hepatitis C testing, and health education programs in the Harm Reduction Action Center.  She described SUD demographics and responded to questions.

Ms. Raville discussed barriers to proper syringe disposal, proper treatment for SUD, and access to health care providers.

Ms. Raville provided policy suggestions, including supervised consumption sites, increased syringe disposal sites, and increased naloxone distribution.  She described the groups that are supportive of supervised consumption sites.  She responded to questions on opposition to supervised consumption sites.

Ms. Raville responded to comments on supervised consumption sites. Committee discussion ensued.

Dr. Don Stader, American College of Emergency Physicians, presented to the committee on opioid prescribing in the emergency department. He updated the committee on results of the Colorado Hospital Association's (CHA) opioid safety pilot program, which was administered in ten Colorado hospitals for a six month duration.  He explained that the pilot program had reduced the use of opioid administration in the emergency department and that patient satisfaction has not decreased due to the policy.

Dr. Stader explained that CHA is encouraging all hospitals to utilize alternatives to opioids in emergency departments.  He discussed his experience training clinicians and providers on alternatives to opioids.  Dr. Stader noted recognition that CHA has received due to the success of the pilot program.

Dr. Stader described the Denver Health emergency department induction program that enrolls participants in MAT treatment immediately.  He explained that two more hospital systems will roll out programs to transition SUD patients into MAT treatment.  Dr. Stader described efforts related to naloxone distribution and reducing SUD stigma.

Dr. Stader responded to questions about a patient satisfaction survey, the cost and insurance coverage of alternatives to opioids, and barriers to providing MAT in a hospital setting.

Representative Pettersen recessed the committee for lunch.

Representative Pettersen called the meeting back to order.

Tonya Haas Davidson, Colorado Municipal League, presented to the committee and distributed a handout (Attachment D).

Ms. Haas Davidson described federal, state, and municipal laws related to sober living group homes.  She described one municipality's experience with a sober living home and the confusion over the legality of the home.  She explained the application process for sober living homes and site visit requirements.

Ms. Haas Davidson suggested that rules be created to regulate or certify sober living homes.  She responded to questions about sober living facility best practices.

Ronie Fuller, Colorado Association of Recovery Residences (CARR), presented to the committee and distributed a handout (Attachment E). She described CARR's efforts to create sober living facility standards and accreditation in Colorado, and highlighted recent federal legislation on recovery housing.  She suggested that a definition for recovery residences be included in law.

Rourke Weaver, CARR, discussed the stigma surrounding recovery residences.  Ms. Fuller and Mr. Weaver responded to questions regarding ethical standards and drug testing by recovery residences.

Chris Coddington and Jim Wiseman, Old San Rafael Neighborhood Organization, presented to the committee and distributed handouts (Attachment F).  Mr. Wiseman discussed neighborhood interaction with proprietors of sober living residences.

Mr. Coddington described challenges Denver has faced in cooperating with recovery residences.  He suggested that sober living homes be required to be licensed, recovery residences be defined in law, and that local municipalities be given more flexibility to create rules around recovery residences.

Theresa Anselmo, Colorado Association of Local Public Health Officials, presented to the committee and distributed handouts (Attachment G).  She explained the role of local public health agencies in the opioid epidemic, including in data collection and prevention efforts.

Jamie Feld, Boulder County Public Health, discussed the work and membership of the Boulder County Opioid Advisory Group.  She provided data on local efforts involving Naloxone distribution, safe syringe disposal, and law enforcement diversions.  She discussed policy suggestions including funding local efforts, funding recovery services, consistent treatment options, and increased prevention efforts.

Mary Steiner, Community Health Partnership, discussed lack of funding for the SUD epidemic compared to other public health crises.  She expressed concerns regarding syringe access and transmittable diseases.

Jeff Hanley, Jefferson County Public Health Department, discussed harm reduction efforts in Jefferson County including syringe access and disposal programs, testing for infectious diseases, Naloxone distribution, and counseling services for SUD.

Jessica Eaddy, Colorado Consortium for Prescription Drug Abuse Prevention (consortium), discussed survey results from counties regarding policy recommendations.  The suggestions include expanding the behavioral health workforce and access to mental health providers, and supporting local programs.  Ms. Eaddy responded to committee questions regarding counties sharing resources and employees related to SUD.

Jade Woodard, Illuminate Colorado, presented to the committee and distributed a handout (Attachment H).  She described her work as co-chair of the Substance Exposed Newborn Steering Committee, which is housed in the consortium.  Ms. Woodward described the membership and initiatives of the steering committee.

Ms. Woodard provided data on substance use by pregnant and postpartum women.  She described long waits for short term treatment programs for pregnant women because of lack of providers.  She responded to questions regarding the effects of marijuana and other substance use on unborn children.

Ms. Woodward provided data on substance exposed newborns and noted that it can be difficult to identify these newborns right after birth.  She discussed work group successes including privacy protections for pregnant women, provider education efforts, the success rate of the Special Connections program, and creation of a pilot program on Fetal Alcohol Spectrum Disorder.

Ms. Woodward described challenges in treating pregnant women for SUD, including lack of providers and lack of standardized screenings.  She suggested revisions to the Colorado Children's Code and support for policies to improve caregiver behavioral health.  She described other policy considerations including increased data collection, home visitation, increased child care options, and changes to the juvenile justice system for youth with fetal alcohol syndrome.

J.K. Costello, representing himself, testified regarding SUD treatment in jails and prisons.

Denise Vincioni, Denver Recovery Group, testified regarding MAT programs in jail.  She responded to committee questions.

Judy Solano, Southern Colorado Hard Reduction (SCHR), testified regarding various SUD policy recommendations.

Dr. Jonathan Clapp, Colorado Pain Society, testified regarding the prescribing of pain medications.

Nobalie Force, Homeward Pikes Peak, testified regarding sober living homes.

Ellen Stern, Children's Hospital Colorado, testified regarding prenatal substance use.

Erin Miller, Colorado Children's Campaign, testified regarding maternal deaths from SUD.

Michele Ryan, representing herself, testified regarding MAT and recovery services.

Lilly Purrier, representing herself, testified regarding chronic pain management.

Representative Pettersen discussed the development and submission of bill ideas with the committee.

Committee discussion ensued regarding bill topics and the number of bill drafts to request.  Representative Pettersen discussed a working lunch to talk about bill ideas.  She asked for public feedback on policy suggestions related to SUD.