Senate Bill No. 447
(By Senators Caruth, Prezioso, Stollings, Jenkins, McKenzie and
Guills)
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[Introduced February 2, 2007; referred to the Committee on Health
and Human Resources.]
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A BILL to amend and reenact §16-1-4 of the Code of West Virginia,
1931, as amended, relating generally to the regulation of
opioid treatment centers; and providing for specific minimum
requirements established by the rules provided in said
section.
Be it enacted by the Legislature of West Virginia:
That §16-1-4 of the Code of West Virginia, 1931, as amended,
be amended and reenacted to read as follows:
§16-1-4. Proposal of rules by the secretary.
The secretary may propose rules, in accordance with the
provisions of article three, chapter twenty-nine-a of the code,
that are necessary and proper to effectuate the purposes of this
chapter. The secretary may appoint or designate advisory councils
of professionals in the areas of hospitals, nursing homes, barbers and beauticians, postmortem examinations, mental health and mental
retardation centers and any other areas necessary to advise the
secretary on rules.
The rules may include, but are not limited to, the regulation
of:
(a) Land usage endangering the public health: Provided, That
no rules may be promulgated or enforced restricting the subdivision
or development of any parcel of land within which the individual
tracts, lots or parcels exceed two acres each in total surface area
and which individual tracts, lots or parcels have an average
frontage of not less than one hundred fifty feet even though the
total surface area of the tract, lot or parcel equals or exceeds
two acres in total surface area, and which tracts are sold, leased
or utilized only as single family dwelling units. Notwithstanding
the provisions of this subsection, nothing in this section may be
construed to abate the authority of the department to: (1)
Restrict the subdivision or development of a tract for any more
intense or higher density occupancy than a single family dwelling
unit; (2) propose or enforce rules applicable to single family
dwelling units for single family dwelling unit sanitary sewerage
disposal systems; or (3) restrict any subdivision or development
which might endanger the public health, the sanitary condition of
streams, or sources of water supply;
(b) The sanitary condition of all institutions and schools, whether public or private, public conveyances, dairies,
slaughterhouses, workshops, factories, labor camps, all other
places open to the general public and inviting public patronage or
public assembly, or tendering to the public any item for human
consumption, and places where trades or industries are conducted;
(c) Occupational and industrial health hazards, the sanitary
conditions of streams, sources of water supply, sewerage facilities
and plumbing systems and the qualifications of personnel connected
with any of those facilities, without regard to whether the
supplies or systems are publicly or privately owned; and the design
of all water systems, plumbing systems, sewerage systems, sewage
treatment plants, excreta disposal methods and swimming pools in
this state, whether publicly or privately owned;
(d) Safe drinking water, including:
(1) The maximum contaminant levels to which all public water
systems must conform in order to prevent adverse effects on the
health of individuals, and, if appropriate, treatment techniques
that reduce the contaminant or contaminants to a level which will
not adversely affect the health of the consumer. The rule shall
contain provisions to protect and prevent contamination of
wellheads and well fields used by public water supplies so that
contaminants do not reach a level that would adversely affect the
health of the consumer;
(2) The minimum requirements for: Sampling and testing; system operation; public notification by a public water system on
being granted a variance or exemption or upon failure to comply
with specific requirements of this section and rules promulgated
under this section; record keeping; laboratory certification; as
well as procedures and conditions for granting variances and
exemptions to public water systems from state public water systems
rules; and
(3) The requirements covering the production and distribution
of bottled drinking water and may establish requirements governing
the taste, odor, appearance and other consumer acceptability
parameters of drinking water;
(e) Food and drug standards, including cleanliness,
proscription of additives, proscription of sale and other
requirements in accordance with article seven of this chapter, as
are necessary to protect the health of the citizens of this state;
(f) The training and examination requirements for emergency
medical service attendants and emergency medical care
technician-paramedics; the designation of the health care
facilities, health care services, and the industries and
occupations in the state that must have emergency medical service
attendants and emergency medical care technician-paramedics
employed, and the availability, communications, and equipment
requirements with respect to emergency medical service attendants
and to emergency medical care technician-paramedics: Provided, That any regulation of emergency medical service attendants and
emergency medical care technician-paramedics shall not exceed the
provisions of article four-c of this chapter;
(g) The health and sanitary conditions of establishments
commonly referred to as bed and breakfast inns. For purposes of
this article, "bed and breakfast inn" means an establishment
providing sleeping accommodations and, at a minimum, a breakfast
for a fee: Provided, That the secretary may not require an owner
of a bed and breakfast providing sleeping accommodations of six or
fewer rooms to install a restaurant style or commercial food
service facility: Provided, however, That the secretary may not
require an owner of a bed and breakfast providing sleeping
accommodations of more than six rooms to install a restaurant-type
or commercial food service facility if the entire bed and breakfast
inn or those rooms numbering above six are used on an aggregate of
two weeks or less per year;
(h) Fees for services provided by the bureau for public health
including, but not limited to, laboratory service fees,
environmental health service fees, health facility fees and permit
fees;
(i) The collection of data on health status, the health system
and the costs of health care;
(j) Opioid treatment programs duly licensed and operating
under the requirements of chapter twenty-seven of this code. The secretary shall promulgate
revised
emergency rules to govern such
programs: Provided, That there shall be a moratorium on the
licensure of new opioid treatment programs that do not have a
certificate of need as of the effective date of the 2007 amendments
to this subsection until such time as the secretary files revised
emergency rules with the secretary of state to regulate such
programs in compliance with subsections (1) through (8) below and
thereafter until the legislature has undertaken and completed a
study of the adequacy of the rule regulating opioid treatment
programs and of the necessity for additional opioid treatment
program facilities in addition to the currently licensed and
operating opioid treatment program facilities. The moratorium will
remain in effect unless and until such time as the legislature
determines that there is a necessity for additional opioid
treatment facilities in West Virginia. All existing opioid
treatment programs shall be in compliance within one hundred eighty
days of the effective date of this rule; and the
revised emergency
rules as required herein.
The revised emergency rules
shall provide
at a minimum:
(1) That the initial admission criteria for entry into the
opioid treatment program shall include an initial drug test to
determine whether an individual is either opioid addicted or
presently receiving methadone for an opioid addiction from another
opioid treatment program. The patient may be admitted to the program if there is a positive test for either opioids or methadone
and all other criteria set forth in the rule for admission into an
opioid treatment program are met.
(2) That after the admission of a patient, the opioid
treatment program shall develop an initial assessment and an
initial plan of care. Subsequently, the opioid treatment program
shall develop a treatment plan of care between the thirtieth and
the sixtieth day after the admission of the patient to the program.
When developing the treatment plan the opioid treatment program
shall include and encourage detoxification as an option available
for treatment.
(3) That each opioid treatment program shall report and
provide statistics to the Department of Health and Human Resources
at least semi annually which includes the total number of patients;
the number of patients who have been continually receiving
methadone treatment for in excess of two years, including the total
number of months of treatment for each such patient who has been
continuously receiving methadone treatment for in excess of two
years; the number of patients who have discontinued the program,
including the total months in the treatment program for each such
discontinued patient and whether such discontinuation was for:
(A) termination or disqualification;
(B) completion of a program of detoxification;
(C) voluntary withdrawal prior to completion of all requirements of detoxification as determined by the opioid
treatment program, or
(D) an unexplained reason
(4) That random drug testing of patients be conducted during
the course of treatment. For purposes of these rules, random drug
testing shall mean that each patient of an opioid treatment program
facility has a substantially equal chance of being selected for
testing at random and at unscheduled times. Any unexcused absence
from a random drug test shall be considered a positive test:
Provided, That nothing contained in this section or the legislative
rules promulgated in conformity herewith will preclude any opioid
treatment program from administering such additional drug tests as
determined necessary by the opioid treatment program.
(5) That all random drug tests conducted by an opioid
treatment program shall, at a minimum, test for any substance
listed in Schedule II contained in section two-hundred six, article
two, chapter sixty-A of this code. A positive test shall be a test
that results in the presence of any drug or substance listed in
this schedule and any other drug or substance prohibited by the
opioid treatment program;
(6) That a positive drug test result after the first six
months in an opioid treatment program shall result in the
following:
(A) Upon the first positive drug test result, the opioid treatment program shall:
(1) Provide mandatory and documented weekly counseling to
the patient, which shall include weekly meetings with a licensed
counselor who is certified in compliance with the rules and on
staff at the opioid treatment program; and
(2)Immediately revoke the take home methadone privelege
for a minimum of thirty days.
(B) Upon a second positive drug test result within six months
of a previous positive drug test result, the opioid treatment
program shall:
(1) Immediately revoke the take home methadone privilege
for a minimum of sixty days; and
(2) Provide mandatory and documented weekly counseling,
which shall include weekly meetings with a licensed counselor who
is certified in compliance with the rules and on staff at the
opioid treatment program; and
(3) Provide mandatory documented treatment team meetings
with the patient.
(C) Upon a third positive drug test result within a period of
six months the opioid treatment program shall:
(1) Immediately revoke the take home methadone privilege
for a minimum of one-hundred twenty days; and
(2) Provide mandatory and documented weekly counseling,
which shall include weekly meetings with a licensed counselor who is certified in compliance with the rules and on staff at the
opioid treatment program; and
(3) Provide mandatory and documented treatment team
meetings with the patient which will include, at a minimum: the
need for continuing treatment; a discussion of other treatment
alternatives; and the execution of a contract with the patient
advising the patient of discharge for continued positive drug
tests.
(D) Upon a fourth positive drug test within a six month
period, the patient shall be immediately discharged from the opioid
treatment program, or, at the option of the patient, shall
immediately be provided the opportunity to participate in a 21 day
detoxification plan, followed by immediate discharge from the
opioid treatment program.
(7) That the opioid treatment program must report and provide
statistics to the Department of Health and Human Resources
demonstrating compliance with the random drug test rules including
confirmation that:
(A) the random drug tests were truly random in regard to
both the patients tested and to the times random drug tests were
scheduled by lottery or some other objective standard so as not to
prejudice or protect any particular patient.
(B) The total number and the times of all drug tests and
the number of positive results; and
(C) the number of expulsions from the program.
(8) That all opioid treatment facilities be open for business
seven days per week.
(k) Other health-related matters which the department is
authorized to supervise and for which the rule-making authority has
not been otherwise assigned.
NOTE: The purpose of this bill is specify certain
requirements that are to be included in the legislative rules
promulgated by the Department of Health and Human Resources that
serve to regulate opioid treatment facilities and to impose a
moratorium on the issuance of further certification of need to
opioid treatment programs pending a legislative study on the need
for and regulation of such opioid treatment programs.
Strike-throughs indicate language that would be stricken from
the present law, and underscoring indicates new language that would
be added.