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

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 the purposes of the fund. 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.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, 2020. 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.33.7, 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, 2020. The bill 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, 2019.13 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 2019-2020 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.3.2, 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.