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1 | AN ACT concerning health.
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2 | Be it enacted by the People of the State of Illinois,
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3 | represented in the General Assembly:
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4 | Section 1. Short title. This Act may be cited as the Needle | ||||||||||||||||||||||||||||
5 | and Hypodermic Syringe Access Program Act. | ||||||||||||||||||||||||||||
6 | Section 5. Needle and hypodermic syringe access program. | ||||||||||||||||||||||||||||
7 | (a) Any governmental or nongovernmental organization, | ||||||||||||||||||||||||||||
8 | including a local health department, community-based | ||||||||||||||||||||||||||||
9 | organization, or a person or entity, that promotes | ||||||||||||||||||||||||||||
10 | scientifically proven ways of mitigating health risks | ||||||||||||||||||||||||||||
11 | associated with drug use and other high-risk behaviors may | ||||||||||||||||||||||||||||
12 | establish and operate a needle and hypodermic syringe access | ||||||||||||||||||||||||||||
13 | program. The objective of the program shall be accomplishing | ||||||||||||||||||||||||||||
14 | all of the following: | ||||||||||||||||||||||||||||
15 | (1) reducing the spread of HIV, AIDS, viral hepatitis, | ||||||||||||||||||||||||||||
16 | and other bloodborne diseases; | ||||||||||||||||||||||||||||
17 | (2) reducing the potential for needle stick injuries | ||||||||||||||||||||||||||||
18 | from discarded contaminated equipment; and | ||||||||||||||||||||||||||||
19 | (3) facilitating connections or linkages to | ||||||||||||||||||||||||||||
20 | evidence-based treatment.
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21 | (b) Programs established under this Act shall provide all | ||||||||||||||||||||||||||||
22 | of the following: | ||||||||||||||||||||||||||||
23 | (1) Disposal of used needles and hypodermic syringes. |
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1 | (2) Needles, hypodermic syringes, and other safer drug | ||||||
2 | consumption supplies, at no cost and in quantities | ||||||
3 | sufficient to ensure that needles, hypodermic syringes, or | ||||||
4 | other supplies are not shared or reused. | ||||||
5 | (3) Educational materials or training on: | ||||||
6 | (A) overdose prevention and intervention; and | ||||||
7 | (B) the prevention of HIV, AIDS, viral hepatitis, | ||||||
8 | and other common bloodborne diseases resulting from | ||||||
9 | shared drug consumption equipment and supplies. | ||||||
10 | (4) Access to opioid antagonists approved for the | ||||||
11 | reversal of an opioid overdose, or referrals to programs | ||||||
12 | that provide access to opioid antagonists approved for the | ||||||
13 | reversal of an opioid overdose.
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14 | (5) Linkages to needed services, including mental | ||||||
15 | health treatment, housing programs, substance use disorder | ||||||
16 | treatment, and other relevant community services. | ||||||
17 | (6) Individual consultations from a trained employee | ||||||
18 | tailored to individual needs. | ||||||
19 | (7) If feasible, a hygienic, separate space for | ||||||
20 | individuals who need to administer a prescribed injectable | ||||||
21 | medication, such as insulin, that can also be used as a | ||||||
22 | quiet space to gather composure in the event of an adverse | ||||||
23 | on-site incident, such as a nonfatal overdose. | ||||||
24 | (8) If feasible, access to on-site drug adulterant | ||||||
25 | testing supplies such as reagents, test strips, or | ||||||
26 | quantification instruments that provide critical real-time |
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1 | information on the composition of substances obtained for | ||||||
2 | consumption. | ||||||
3 | (c) Notwithstanding any provision of the Illinois | ||||||
4 | Controlled Substances Act, the Drug Paraphernalia Control Act, | ||||||
5 | or any other law, no employee or volunteer of or participant in | ||||||
6 | a program established under this Act shall be charged with or | ||||||
7 | prosecuted for possession of any of the following: | ||||||
8 | (1) Needles, hypodermic syringes, or other drug | ||||||
9 | consumption paraphernalia obtained from or returned, | ||||||
10 | directly or indirectly, to a program established under this | ||||||
11 | Act. | ||||||
12 | (2) Residual amounts of a controlled substance | ||||||
13 | contained in used needles, used hypodermic syringes, or | ||||||
14 | other used drug consumption paraphernalia obtained from or | ||||||
15 | returned, directly or indirectly, to a program established | ||||||
16 | under this Act. | ||||||
17 | (3) Drug adulterant testing supplies such as reagents, | ||||||
18 | test strips, or quantification instruments obtained from | ||||||
19 | or returned, directly or indirectly, to a program | ||||||
20 | established under this Act. | ||||||
21 | (4) Any residual amounts of controlled substances used | ||||||
22 | in the course of testing the controlled substance to | ||||||
23 | determine the chemical composition and potential threat of | ||||||
24 | the substances obtained for consumption that are obtained | ||||||
25 | from or returned, directly or indirectly, to a program | ||||||
26 | established under this Act.
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1 | In addition to any other applicable immunity or limitation | ||||||
2 | on civil liability, a law enforcement officer who, acting on | ||||||
3 | good faith, arrests or charges a person who is thereafter | ||||||
4 | determined to be entitled to immunity from prosecution under | ||||||
5 | this subsection (c) shall not be subject to civil liability for | ||||||
6 | the arrest or filing of charges. | ||||||
7 | (d) Prior to the commencing of operations of a program | ||||||
8 | established under this Act, the governmental or | ||||||
9 | nongovernmental organization shall report to the Illinois | ||||||
10 | Department of Public Health all of the following information: | ||||||
11 | (1) the name of the organization, agency, group, | ||||||
12 | person, or entity operating the program; | ||||||
13 | (2) the areas and populations to be served by the | ||||||
14 | program; and | ||||||
15 | (3) the methods by which the program will meet the | ||||||
16 | requirements of subsection (b) of this Section. | ||||||
17 | Section 100. The Substance Use Disorder Act is amended by | ||||||
18 | changing Section 5-23 and by adding Section 25-13 as follows: | ||||||
19 | (20 ILCS 301/5-23) | ||||||
20 | Sec. 5-23. Drug Overdose Prevention Program. | ||||||
21 | (a) Reports of drug overdose. | ||||||
22 | (1) The Department may publish annually a report on | ||||||
23 | drug overdose trends statewide that reviews State death | ||||||
24 | rates from available data to ascertain changes in the |
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1 | causes or rates of fatal and nonfatal drug overdose. The | ||||||
2 | report shall also provide information on interventions | ||||||
3 | that would be effective in reducing the rate of fatal or | ||||||
4 | nonfatal drug overdose and shall include an analysis of | ||||||
5 | drug overdose information reported to the Department of | ||||||
6 | Public Health pursuant to subsection (e) of Section 3-3013 | ||||||
7 | of the Counties Code, Section 6.14g of the Hospital | ||||||
8 | Licensing Act, and subsection (j) of Section 22-30 of the | ||||||
9 | School Code. | ||||||
10 | (2) The report may include: | ||||||
11 | (A) Trends in drug overdose death rates. | ||||||
12 | (B) Trends in emergency room utilization related | ||||||
13 | to drug overdose and the cost impact of emergency room | ||||||
14 | utilization. | ||||||
15 | (C) Trends in utilization of pre-hospital and | ||||||
16 | emergency services and the cost impact of emergency | ||||||
17 | services utilization. | ||||||
18 | (D) Suggested improvements in data collection. | ||||||
19 | (E) A description of other interventions effective | ||||||
20 | in reducing the rate of fatal or nonfatal drug | ||||||
21 | overdose. | ||||||
22 | (F) A description of efforts undertaken to educate | ||||||
23 | the public about unused medication and about how to | ||||||
24 | properly dispose of unused medication, including the | ||||||
25 | number of registered collection receptacles in this | ||||||
26 | State, mail-back programs, and drug take-back events. |
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1 | (b) Programs; drug overdose prevention. | ||||||
2 | (1) The Department may establish a program to provide | ||||||
3 | for the production and publication, in electronic and other | ||||||
4 | formats, of drug overdose prevention, recognition, and | ||||||
5 | response literature. The Department may develop and | ||||||
6 | disseminate curricula for use by professionals, | ||||||
7 | organizations, individuals, or committees interested in | ||||||
8 | the prevention of fatal and nonfatal drug overdose, | ||||||
9 | including, but not limited to, drug users, jail and prison | ||||||
10 | personnel, jail and prison inmates, drug treatment | ||||||
11 | professionals, emergency medical personnel, hospital | ||||||
12 | staff, families and associates of drug users, peace | ||||||
13 | officers, firefighters, public safety officers, needle | ||||||
14 | exchange program staff, and other persons. In addition to | ||||||
15 | information regarding drug overdose prevention, | ||||||
16 | recognition, and response, literature produced by the | ||||||
17 | Department shall stress that drug use remains illegal and | ||||||
18 | highly dangerous and that complete abstinence from illegal | ||||||
19 | drug use is the healthiest choice. The literature shall | ||||||
20 | provide information and resources for substance use | ||||||
21 | disorder treatment. | ||||||
22 | The Department may establish or authorize programs for | ||||||
23 | prescribing, dispensing, or distributing opioid | ||||||
24 | antagonists for the treatment of drug overdose. Such | ||||||
25 | programs may include the prescribing of opioid antagonists | ||||||
26 | for the treatment of drug overdose to a person who is not |
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1 | at risk of opioid overdose but who, in the judgment of the | ||||||
2 | health care professional, may be in a position to assist | ||||||
3 | another individual during an opioid-related drug overdose | ||||||
4 | and who has received basic instruction on how to administer | ||||||
5 | an opioid antagonist. | ||||||
6 | (2) The Department may provide advice to State and | ||||||
7 | local officials on the growing drug overdose crisis, | ||||||
8 | including the prevalence of drug overdose incidents, | ||||||
9 | programs promoting the disposal of unused prescription | ||||||
10 | drugs, trends in drug overdose incidents, and solutions to | ||||||
11 | the drug overdose crisis. | ||||||
12 | (3) The Department may support drug overdose | ||||||
13 | prevention, recognition, and response projects by | ||||||
14 | facilitating the bulk acquisition of low-cost opioid | ||||||
15 | antagonist medication approved for opioid overdose | ||||||
16 | reversal, providing trainings in overdose prevention best | ||||||
17 | practices, connecting programs to medical resources, | ||||||
18 | establishing a statewide standing order for the | ||||||
19 | acquisition of needed medication, establishing learning | ||||||
20 | collaboratives between localities and programs, and | ||||||
21 | assisting programs in navigating any regulatory | ||||||
22 | requirements for establishing or expanding such programs. | ||||||
23 | (c) Grants. | ||||||
24 | (1) The Department may award grants, in accordance with | ||||||
25 | this subsection, to create or support local drug overdose | ||||||
26 | prevention, recognition, and response projects. Local |
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1 | health departments, correctional institutions, hospitals, | ||||||
2 | universities, community-based organizations, and | ||||||
3 | faith-based organizations may apply to the Department for a | ||||||
4 | grant under this subsection at the time and in the manner | ||||||
5 | the Department prescribes. | ||||||
6 | (2) In awarding grants, the Department shall consider | ||||||
7 | the necessity for overdose prevention projects in various | ||||||
8 | settings and shall encourage all grant applicants to | ||||||
9 | develop interventions that will be effective and viable in | ||||||
10 | their local areas. | ||||||
11 | (3) The Department shall give preference for grants to | ||||||
12 | proposals that distribute opioid antagonists approved for | ||||||
13 | the reversal of an opioid overdose directly to individuals | ||||||
14 | who use drugs. , in addition to providing life-saving | ||||||
15 | interventions and responses, provide information to drug | ||||||
16 | users on how to access substance use disorder treatment or | ||||||
17 | other strategies for abstaining from illegal drugs. In | ||||||
18 | addition, the The Department shall give preference to drug | ||||||
19 | overdose prevention programs proposals that include one or | ||||||
20 | more of the following elements: | ||||||
21 | (A) Programs that conduct street and community | ||||||
22 | outreach to work directly with people who use drugs. | ||||||
23 | (B) Programs that work directly with people who use | ||||||
24 | drugs to provide access to new syringes and other drug | ||||||
25 | consumption equipment, infectious disease testing, | ||||||
26 | referrals to needed medical treatment, and other |
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1 | public health interventions. | ||||||
2 | (C) Programs that employ community health workers | ||||||
3 | or peer recovery specialists who are familiar with the | ||||||
4 | communities served and can provide culturally | ||||||
5 | competent services. | ||||||
6 | (D) Programs that collaborate with other | ||||||
7 | community-based organizations, drug treatment centers, | ||||||
8 | or health care providers who are engaged in treating | ||||||
9 | active drug users. | ||||||
10 | (E) Programs that engage individuals who are | ||||||
11 | exiting jails or prisons and who are at high risk of | ||||||
12 | overdose. | ||||||
13 | (F) Programs that can provide linkages for | ||||||
14 | individuals to obtain evidence-based drug treatment, | ||||||
15 | such as agonist medication assisted treatment. | ||||||
16 | (G) Programs that provide education and training | ||||||
17 | projects to community-based organizations who work | ||||||
18 | directly with drug users and their families and | ||||||
19 | communities. | ||||||
20 | (A) Policies and projects to encourage persons, | ||||||
21 | including drug users, to call 911 when they witness a | ||||||
22 | potentially fatal drug overdose. | ||||||
23 | (B) Drug overdose prevention, recognition, and | ||||||
24 | response education projects in drug treatment centers, | ||||||
25 | outreach programs, and other organizations that work | ||||||
26 | with, or have access to, drug users and their families |
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1 | and communities. | ||||||
2 | (C) Drug overdose recognition and response | ||||||
3 | training, including rescue breathing, in drug | ||||||
4 | treatment centers and for other organizations that | ||||||
5 | work with, or have access to, drug users and their | ||||||
6 | families and communities. | ||||||
7 | (D) The production and distribution of targeted or | ||||||
8 | mass media materials on drug overdose prevention and | ||||||
9 | response, the potential dangers of keeping unused | ||||||
10 | prescription drugs in the home, and methods to properly | ||||||
11 | dispose of unused prescription drugs. | ||||||
12 | (E) Prescription and distribution of opioid | ||||||
13 | antagonists. | ||||||
14 | (F) The institution of education and training | ||||||
15 | projects on drug overdose response and treatment for | ||||||
16 | emergency services and law enforcement personnel. | ||||||
17 | (G) A system of parent, family, and survivor | ||||||
18 | education and mutual support groups. | ||||||
19 | (4) In addition to moneys appropriated by the General | ||||||
20 | Assembly, the Department may seek grants from private | ||||||
21 | foundations, the federal government, and other sources to | ||||||
22 | fund the grants under this Section and to fund an | ||||||
23 | evaluation of the programs supported by the grants. | ||||||
24 | (d) Health care professional prescription of opioid | ||||||
25 | antagonists. | ||||||
26 | (1) A health care professional who, acting in good |
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1 | faith, directly or by standing order, prescribes or | ||||||
2 | dispenses an opioid antagonist to: (a) a patient who, in | ||||||
3 | the judgment of the health care professional, is capable of | ||||||
4 | administering the drug in an emergency, or (b) a person who | ||||||
5 | is not at risk of opioid overdose but who, in the judgment | ||||||
6 | of the health care professional, may be in a position to | ||||||
7 | assist another individual during an opioid-related drug | ||||||
8 | overdose and who has received basic instruction on how to | ||||||
9 | administer an opioid antagonist shall not, as a result of | ||||||
10 | his or her acts or omissions, be subject to: (i) any | ||||||
11 | disciplinary or other adverse action under the Medical | ||||||
12 | Practice Act of 1987, the Physician Assistant Practice Act | ||||||
13 | of 1987, the Nurse Practice Act, the Pharmacy Practice Act, | ||||||
14 | or any other professional licensing statute or (ii) any | ||||||
15 | criminal liability, except for willful and wanton | ||||||
16 | misconduct. | ||||||
17 | (2) A person who is not otherwise licensed to | ||||||
18 | administer an opioid antagonist may in an emergency | ||||||
19 | administer without fee an opioid antagonist if the person | ||||||
20 | has received the patient information specified in | ||||||
21 | paragraph (4) of this subsection and believes in good faith | ||||||
22 | that another person is experiencing a drug overdose. The | ||||||
23 | person shall not, as a result of his or her acts or | ||||||
24 | omissions, be (i) liable for any violation of the Medical | ||||||
25 | Practice Act of 1987, the Physician Assistant Practice Act | ||||||
26 | of 1987, the Nurse Practice Act, the Pharmacy Practice Act, |
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1 | or any other professional licensing statute, or (ii) | ||||||
2 | subject to any criminal prosecution or civil liability, | ||||||
3 | except for willful and wanton misconduct. | ||||||
4 | (3) A health care professional prescribing an opioid | ||||||
5 | antagonist to a patient shall ensure that the patient | ||||||
6 | receives the patient information specified in paragraph | ||||||
7 | (4) of this subsection. Patient information may be provided | ||||||
8 | by the health care professional or a community-based | ||||||
9 | organization, substance use disorder program, or other | ||||||
10 | organization with which the health care professional | ||||||
11 | establishes a written agreement that includes a | ||||||
12 | description of how the organization will provide patient | ||||||
13 | information, how employees or volunteers providing | ||||||
14 | information will be trained, and standards for documenting | ||||||
15 | the provision of patient information to patients. | ||||||
16 | Provision of patient information shall be documented in the | ||||||
17 | patient's medical record or through similar means as | ||||||
18 | determined by agreement between the health care | ||||||
19 | professional and the organization. The Department, in | ||||||
20 | consultation with statewide organizations representing | ||||||
21 | physicians, pharmacists, advanced practice registered | ||||||
22 | nurses, physician assistants, substance use disorder | ||||||
23 | programs, and other interested groups, shall develop and | ||||||
24 | disseminate to health care professionals, community-based | ||||||
25 | organizations, substance use disorder programs, and other | ||||||
26 | organizations training materials in video, electronic, or |
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1 | other formats to facilitate the provision of such patient | ||||||
2 | information. | ||||||
3 | (4) For the purposes of this subsection: | ||||||
4 | "Opioid antagonist" means a drug that binds to opioid | ||||||
5 | receptors and blocks or inhibits the effect of opioids | ||||||
6 | acting on those receptors, including, but not limited to, | ||||||
7 | naloxone hydrochloride or any other similarly acting drug | ||||||
8 | approved by the U.S. Food and Drug Administration. | ||||||
9 | "Health care professional" means a physician licensed | ||||||
10 | to practice medicine in all its branches, a licensed | ||||||
11 | physician assistant with prescriptive authority, a | ||||||
12 | licensed advanced practice registered nurse with | ||||||
13 | prescriptive authority, an advanced practice registered | ||||||
14 | nurse or physician assistant who practices in a hospital, | ||||||
15 | hospital affiliate, or ambulatory surgical treatment | ||||||
16 | center and possesses appropriate clinical privileges in | ||||||
17 | accordance with the Nurse Practice Act, or a pharmacist | ||||||
18 | licensed to practice pharmacy under the Pharmacy Practice | ||||||
19 | Act. | ||||||
20 | "Patient" includes a person who is not at risk of | ||||||
21 | opioid overdose but who, in the judgment of the physician, | ||||||
22 | advanced practice registered nurse, or physician | ||||||
23 | assistant, may be in a position to assist another | ||||||
24 | individual during an overdose and who has received patient | ||||||
25 | information as required in paragraph (2) of this subsection | ||||||
26 | on the indications for and administration of an opioid |
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1 | antagonist. | ||||||
2 | "Patient information" includes information provided to | ||||||
3 | the patient on drug overdose prevention and recognition; | ||||||
4 | how to perform rescue breathing and resuscitation; opioid | ||||||
5 | antagonist dosage and administration; the importance of | ||||||
6 | calling 911; care for the overdose victim after | ||||||
7 | administration of the overdose antagonist; and other | ||||||
8 | issues as necessary.
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9 | (e) Drug overdose response policy. | ||||||
10 | (1) Every State and local government agency that | ||||||
11 | employs a law enforcement officer or fireman as those terms | ||||||
12 | are defined in the Line of Duty Compensation Act must | ||||||
13 | possess opioid antagonists and must establish a policy to | ||||||
14 | control the acquisition, storage, transportation, and | ||||||
15 | administration of such opioid antagonists and to provide | ||||||
16 | training in the administration of opioid antagonists. A | ||||||
17 | State or local government agency that employs a fireman as | ||||||
18 | defined in the Line of Duty Compensation Act but does not | ||||||
19 | respond to emergency medical calls or provide medical | ||||||
20 | services shall be exempt from this subsection. | ||||||
21 | (2) Every publicly or privately owned ambulance, | ||||||
22 | special emergency medical services vehicle, non-transport | ||||||
23 | vehicle, or ambulance assist vehicle, as described in the | ||||||
24 | Emergency Medical Services (EMS) Systems Act, that | ||||||
25 | responds to requests for emergency services or transports | ||||||
26 | patients between hospitals in emergency situations must |
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1 | possess opioid antagonists. | ||||||
2 | (3) Entities that are required under paragraphs (1) and | ||||||
3 | (2) to possess opioid antagonists may also apply to the | ||||||
4 | Department for a grant to fund the acquisition of opioid | ||||||
5 | antagonists and training programs on the administration of | ||||||
6 | opioid antagonists. | ||||||
7 | (Source: P.A. 99-173, eff. 7-29-15; 99-480, eff. 9-9-15; | ||||||
8 | 99-581, eff. 1-1-17; 99-642, eff. 7-28-16; 100-201, eff. | ||||||
9 | 8-18-17; 100-513, eff. 1-1-18; 100-759, eff. 1-1-19 .) | ||||||
10 | (20 ILCS 301/25-13 new) | ||||||
11 | Sec. 25-13. Evidence-based treatment needs assessment. | ||||||
12 | (a) The Department shall contract with a third party | ||||||
13 | research organization to conduct a needs assessment of the | ||||||
14 | Illinois substance use disorder treatment system. The third | ||||||
15 | party research organization must: | ||||||
16 | (1) have experience in conducting population health | ||||||
17 | studies; | ||||||
18 | (2) have the capability to assess the range of | ||||||
19 | organizations and provider types that provide substance | ||||||
20 | use disorder treatment; and | ||||||
21 | (3) not have any conflicts of interest, including | ||||||
22 | existing contracts with or licensure by the Department. | ||||||
23 | (b) The needs assessment shall include, but shall not be | ||||||
24 | limited to, the following: | ||||||
25 | (1) the estimated number of Illinois residents in need |
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1 | of treatment for Opioid Use Disorder or opioid dependence; | ||||||
2 | (2) the number and type of licensed treatment programs | ||||||
3 | in each geographic area of the State; | ||||||
4 | (3) the availability of medication-assisted treatment | ||||||
5 | at each licensed program and which types of | ||||||
6 | medication-assisted treatment are available; | ||||||
7 | (4) the number of individuals receiving | ||||||
8 | medication-assisted treatment at each program and which | ||||||
9 | types of medication-assisted treatment they are receiving; | ||||||
10 | (5) the number of other organizations that provide | ||||||
11 | medication-assisted treatment and other treatment | ||||||
12 | supports, including Federally Qualified Health Centers, | ||||||
13 | hospitals, and medical professionals operating in private | ||||||
14 | practice; | ||||||
15 | (6) the number of recovery homes that accept | ||||||
16 | individuals using medication-assisted treatment in their | ||||||
17 | recovery; | ||||||
18 | (7) the number of medical professionals currently | ||||||
19 | authorized to prescribe buprenorphine and the number of | ||||||
20 | individuals who are currently prescribed the medication by | ||||||
21 | each medical professional; | ||||||
22 | (8) the existence of any partnerships between programs | ||||||
23 | licensed by the Department and other providers of | ||||||
24 | medication assisted treatment; | ||||||
25 | (9) the existence of any wait lists for individuals | ||||||
26 | seeking treatment, including any separate wait lists that |
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1 | exist for Medicaid recipients; | ||||||
2 | (10) any unmet need for treatment and an analysis of | ||||||
3 | the potential causes for that unmet need; | ||||||
4 | (11) any unmet need for medication-assisted treatment | ||||||
5 | and an analysis of the potential causes for that unmet | ||||||
6 | need; and | ||||||
7 | (12) a proposal for how to address any needs or | ||||||
8 | treatment capacity issues in the State. | ||||||
9 | (c) The research organization shall use Department and | ||||||
10 | federal data and records, public health data and research, and | ||||||
11 | direct surveys of treatment providers, medical professionals, | ||||||
12 | treatment participants, and current drug users not connected to | ||||||
13 | treatment in order to conduct the needs assessment. The | ||||||
14 | Department shall cooperate with the research organization to | ||||||
15 | make records and programs available to the greatest extent | ||||||
16 | possible. | ||||||
17 | (d) The needs assessment shall be developed, submitted to | ||||||
18 | the General Assembly, and made public no later than December | ||||||
19 | 31, 2019.
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20 | Section 999. Effective date. This Act takes effect upon | ||||||
21 | becoming law.
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