Chapter 32. Opioid Overdose Treatment and Prevention.
Subchapter I. Treatment and Prevention.
§ 7–3201. Definitions.
For the purposes of this subchapter, the term:
(1) "DBH" means the Department of Behavioral Health.
(2) "DHCF" means the Department of Health Care Finance.
(3) "DISB" means the Department of Insurance, Securities, and Banking.
(4) "DOC" means the Department of Corrections.
(5) "DOH" means the Department of Health.
(6) "Health care provider" means a physician, advance practice registered nurse, clinic, hospital, DBH-certified provider organizations, or neighborhood health center, licensed by the District.
(7) "Health insurer" means any person that provides one or more health benefit plans or insurance in the District, including an insurer, a hospital and medical services corporation, a fraternal benefit society, a health maintenance organization, a multiple employer welfare arrangement, or any other person providing a plan of health insurance subject to the authority of the Commissioner of DISB.
(8) "Hospital" means a facility that provides 24-hour inpatient care, including diagnostic, therapeutic, and other health-related services, for a variety of physical or mental conditions, and may, in addition, provide outpatient services, particularly emergency care.
(9) "In-network health care provider" means the health care providers or health care facilities that have contracted with a health insurer to provide services to plan members for negotiated rates.
(9A) Repealed.
(9B) Repealed.
(9C) Repealed.
(10) "Opioid use disorder" means a pattern of opioid use leading to clinically significant impairment or distress, as manifested by symptoms identified in the most recent publication of the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association.
(11) "Opioid use disorder treatment medication" means all medications approved by the United States Food and Drug Administration for the treatment of opioid use disorders.
(12) "Prescriber" means a person who is licensed, registered, or otherwise authorized by the District to prescribe and administer prescription drugs in the course of a professional practice.
(13) "Telehealth" means the delivery of healthcare services through interactive audio, video, or other electronic media used for the purpose of diagnosis, consultation, or treatment; provided, that services delivered through audio-only telephones, electronic mail messages, or facsimile transmissions are not included.
§ 7–3202. Expanding access to opioid use disorder treatment.
(a)(1) By January 1, 2020, each health insurer shall:
(A) Create a list of its in-network health care providers that treat opioid use disorder, including the in-network health provider's contact information and an indication of whether the in-network health care provider has been certified by the United States Drug Enforcement Agency to prescribe opioid use disorder treatment medication; and
(B) Maintain at least one in-network health care provider who is accepting new patients and is authorized to treat opioid use disorder, including through the use of opioid use disorder treatment medication. Services delivered through telehealth may satisfy the requirement of this subparagraph.
(2) Each health insurer shall update the list required by paragraph (1)(A) of this subsection on a quarterly basis.
(3)(A) Upon the request of a beneficiary or prospective beneficiary of a health insurer, the health insurer shall transmit the list created and updated pursuant to paragraph (1) of this subsection to that beneficiary or prospective beneficiary by mail or by electronic means within 7 days after the receipt of the request.
(B) Each health insurer shall publish the list and instructions on how to access the list created and updated pursuant to paragraphs (1) and (2) of this subsection on its website.
(b) By January 1, 2020, and annually thereafter:
(1) Each health insurer shall submit a report to DBH, DHCF, DISB, and the Council that includes the following:
(A) A list of the health insurer's in-network health care providers that are certified by the United States Drug Enforcement Agency to prescribe opioid use disorder treatment medications, and which type of opioid use disorder treatment medications the health care providers prescribe;
(B) The number of beneficiaries that were treated for opioid use disorder in the prior fiscal year; and
(C) A description of any efforts by the health insurer in the prior fiscal year to ensure that its in-network capacity to treat opioid use disorder meets the needs of its beneficiaries.
(2) The Mayor shall submit a report to the Council that includes:
(A) An analysis of programs in other jurisdictions that have sought to expand access to opioid use disorder treatment medications;
(B) An evaluation of District health care providers' treatment capacity for opioid use disorders in the District, including opportunities for expanding and improving offerings;
(C) An identification of any barriers to expanding access to additional opioid use disorder treatment medications;
(D) An assessment of the financial costs associated with different methods of treating opioid use disorder;
(E) An assessment of the current reimbursement rates for health care providers for opioid use disorder treatment; and
(F) An identification and analysis of any gaps in opioid use disorder treatment options in the District.
§ 7–3203. Hospital protocols for opioid use disorder.
(a) By October 1, 2019, and annually thereafter, each hospital shall develop protocols governing the identification, treatment, discharge, and referral of patients with opioid use disorder, and submit the protocols to DOH.
(b) By June 1, 2020, and annually thereafter, DOH shall submit an analysis of the sufficiency of each hospital's protocols to the chairperson of the Council committee with jurisdiction over matters related to health.
§ 7–3204. DOC treatment of inmates with opioid use disorder.
(a) An individual charged with treating DOC inmates for opioid use disorder shall be certified in the treatment of opioid use disorder by the American Society of Addiction Medicine, the American Academy of Addiction Psychiatry, the American Medical Association, the American Osteopathic Association, the American Psychiatric Association, or any other organization that the Director of DOH determines is appropriate. The requirements for certification in the treatment of opioid use disorder may be completed in a classroom setting or through online instruction.
(b) DOC, in consultation with DOH, shall ensure that all opioid use disorder treatment medications are administered to inmates:
(1) In the manner in which the medication was prescribed; and
(2) For the entirety of the time an inmate is in DOC's custody, unless an individual charged with treating DOC inmates for opioid use disorder determines otherwise, in their clinical judgment, based on the specific inmate's treatment plan, or if an inmate is awaiting designation to Federal Bureau of Prisons custody.
§ 7–3204.01. District government use of opioid antagonists. [Repealed]
Repealed.
§ 7–3205. Rules.
The Mayor, pursuant to subchapter I of Chapter 5 of Title 2, may issue rules to implement the provisions of this subchapter.
Subchapter II. Opioid Litigation Proceeds.
§ 7–3211. Definitions.
For the purposes of this subchapter, the term:
(1) "Commission" means the Opioid Abatement Advisory Commission established by § 7-3212.
(2) "Evidence-based" means that an activity, practice, program, service, support, or strategy has undergone multiple randomized controlled trials and observational studies demonstrating that it helps individuals avoid the development and progression of opioid and other substance use disorders or drug-related harms, reduces the adverse consequences of opioid and other substance use, or manages, slows the progression of, or supports recovery from an opioid use disorder or co-occurring substance use or mental health disorder.
(3) "Evidence-informed" means an activity, practice, program, service, support, or strategy that incorporates the best available evidence, patient needs, values, and preferences, and practitioner expertise into the decision-making process.
(4) "Fund" means the Opioid Abatement Fund established by § 7-3221.
(5) "Harm reduction" means an activity, practice, program, service, support, or strategy that addresses both conditions that precede and occur as a result of substance use and attempts to reduce the adverse consequences of opioid and other substance use among persons who continue to use those substances.
(6) "Infrastructure" means the resources, such as personnel, buildings, or equipment, required for the District or another entity to provide evidence-based and evidence-informed harm reduction, prevention, recovery, and treatment activities, practices, programs, services, supports, and strategies to individuals with opioid use disorder and co-occurring substance use and mental health disorders.
(7) "Office" means the Office of Opioid Abatement established by § 7-3213.
(8) "Prevention" means primary, secondary, and tertiary efforts to help individuals avoid the development and progression of opioid use disorder and co-occurring substance use and mental health disorders and drug-related harms.
(9) "Recovery" means a process through which an individual develops a healthier life, which may include:
(A) Improving the individual's quality of life, including the individual's physical and mental health;
(B) The individual's consistent pursuit of abstinence from the substances or behaviors that have negatively impacted them, their family, and their community;
(C) Relief of the individual's symptoms, including substance craving; and
(D) Improvement of the individual's relationships, social connectedness, and interpersonal skills.
(10) "Treatment" means:
(A) An evidence-based or evidence-informed activity, practice, program, service, support, or strategy to intervene upon, care for, manage, slow the progression of, or support recovery from opioid use disorder or co-occurring substance use or mental health disorders;
(B) That is individualized to address each individual's medical needs; and
(C) That includes screening for and diagnosis of substance use disorders or co-occurring mental or physical health disorders, as well as pharmacological and non-pharmacological therapeutic interventions for opioid use disorder or co-occurring substance use or mental health disorders.
§ 7–3212. Opioid Abatement Advisory Commission.
(a) There is established an Opioid Abatement Advisory Commission.
(b) The purpose of the Commission shall be to:
(1) Ensure that the monies the District receives and deposits into the Fund are appropriately expended on evidence-based and evidence-informed harm reduction, prevention, recovery, and treatment activities, practices, programs, services, supports, and strategies for opioid use disorder and co-occurring substance use and mental health disorders;
(2) Prioritize and facilitate public involvement, accountability, and transparency in allocating and accounting for these monies; and
(3) Ensure that the monies the District receives and deposits into the Fund have the effect of preventing, treating, and reducing opioid use disorder and co-occurring substance use and mental health disorders and reducing fatalities.
(c) The Commission shall be composed of 21 members, or the member's designee, as follows:
(1) The Director of the Department of Behavioral Health;
(2) The Director of the Department of Health;
(3) The Director of the Department of Health Care Finance;
(4) The Deputy Mayor for Health and Human Services;
(5) The Deputy Mayor for Public Safety and Justice;
(6) The Chief Medical Examiner;
(7) The Attorney General;
(8) The Chairperson of the Council committee with jurisdiction over health matters;
(9) Five members appointed by the Mayor, with the following qualifications:
(A) One member with experience in providing prevention, recovery, treatment, or harm reduction services for opioid use disorder and co-occurring substance use and mental health disorders;
(B) Two members, respectively, with professional expertise and educational backgrounds in:
(i) Medicine; and
(ii) Mental health services;
(C) One member who has experienced opioid use disorder and co-occurring substance use and mental health disorders and recovery; and
(D) One family member of a person or decedent who experienced opioid use disorder and co-occurring substance use and mental health disorders;
(10) One representative each from the:
(A) District of Columbia Behavioral Health Association;
(B) Medical Society of the District of Columbia;
(C) District of Columbia Primary Care Association; and
(D) District of Columbia Hospital Association; and
(11) Four members appointed by the Chairman of the Council, with the following qualifications:
(A) Two members with current experience as direct service providers of prevention, recovery, treatment, or harm reduction services for opioid use disorder and co-occurring substance use and mental health disorders;
(B) One member with professional expertise and an educational background in public health policy or research; and
(C) One member who has experienced opioid use disorder and co-occurring substance use and mental health disorders and recovery.
(d) The Commission shall elect a Chair from among its members.
(e)(1) Each member appointed pursuant to subsection (c)(9) and (11) of this section shall serve a 3-year term; except, that:
(A) Of the Mayor's initial appointments, 2 members shall be appointed for terms of one year, and 2 members shall be appointed for terms of 2 years; and
(B) Of the Council's initial appointments, one member shall be appointed for a term of one year, and 2 members shall be appointed for terms of 2 years.
(2) Members shall serve:
(A) Following the expiration of their terms until their successors have been appointed;
(B) For a maximum of 2 full terms, with partial term service not counted toward this maximum; and
(C) Without compensation; provided, that they shall be reimbursed for necessary expenses incurred in carrying out Commission duties.
(3) Vacancies shall be filled in the same manner as the original appointment for the remainder of the term.
(f) The Commission shall hold public meetings at least quarterly, with meetings called by the Chair or a majority of Commission members. All Commission meetings shall be subject to subchapter IV of Chapter 5 of Title 2.
(g) A majority of the Commission's members shall constitute a quorum, and actions of the Commission shall be taken by an affirmative vote of a majority of the members in attendance at a meeting where a quorum is present. Members may attend in person or remotely through audio or audiovisual means.
(h) The Commission shall have the power and duty to:
(1) Establish procedures for the Commission's operations; and
(2) Make recommendations to the Mayor and Council regarding:
(A) District-wide goals, objectives, and performance indicators relating to:
(i) Prevention, recovery, treatment, and harm reduction infrastructure, activities, practices, programs, services, supports, and strategies for opioid use disorder and co-occurring substance use and mental health disorders;
(ii) Reducing disparities in access to prevention, recovery, treatment, and harm reduction infrastructure, activities, practices, programs, services, supports, and strategies; and
(iii) Improving outcomes and reducing mortality in traditionally underserved populations, including for communities of color and current or formerly incarcerated individuals, with regard to prevention, recovery, treatment, and harm reduction infrastructure, activities, practices, programs, services, supports, and strategies;
(B) Governing principles, policies, and procedures for the application for and awarding of monies and grants from the Fund;
(C) Awards of monies and grants from the Fund;
(D) The performance and outcomes of Fund awardees and grantees;
(E) Management of the Fund; and
(F) Any changes to the Fund's purposes.
(i) The Commission's recommendations for the awarding of monies and grants pursuant to subsection (h)(2)(C) of this section shall include the consideration of:
(1) The number of individuals, per capita, with an opioid use disorder, and the number of overdose deaths per capita, in the area that a prospective awardee or grantee seeks to serve;
(2) Disparities in access to care and health outcomes in the area that a prospective awardee or grantee seeks to serve; and
(3) The infrastructure, activities, practices, programs, services, supports, and strategies currently available to individuals with an opioid use disorder in an area that a prospective awardee or grantee seeks to serve.
§ 7–3213. Office of Opioid Abatement.
(a)(1) There is established within the Department of Behavioral Health the Office of Opioid Abatement.
(2) The Office shall be led by a Director with at least 10 years' professional experience and education in prevention, recovery, treatment, and harm reduction efforts for opioid use disorder and co-occurring substance use and mental health disorders.
(b) The Office shall have the power and duty to:
(1) Conduct a District-wide needs assessment to identify structural gaps and needs related to opioid use disorder and co-occurring substance use and mental health disorders;
(2) Support the Commission's activities by providing staffing, research and policy expertise, facilities, technical assistance, and other resources;
(3) Assist the Commission in preparing its recommendations regarding goals, objectives, and performance indicators pursuant to § 7-3212(h)(2)(A);
(4) Integrate the work of the Office and Commission and Fund expenditures with existing District strategic planning related to opioid use disorder and co-occurring substance use and mental health disorders;
(5) Develop governing principles, policies, and procedures for the application and awarding of monies and grants from the Fund;
(6) Oversee expenditures from the Fund, including by preparing a quarterly accounting of expenditures from the Fund and the Fund balance;
(7) Issue, manage, and oversee awards and grants from the Fund, including collecting and publicly reporting data from awardees and grantees concerning the effectiveness of infrastructure, activities, practices, programs, services, supports, and strategies funded;
(8) Prepare the annual report required by § 7-3221(f); and
(9) Create and maintain a public website that includes:
(A) Commission meeting attendance, agendas, and minutes;
(B) The governing principles, policies, and procedures developed pursuant to paragraph (5) of this subsection;
(C) The quarterly accountings of Fund expenditures and Fund balance prepared pursuant to paragraph (6) of this subsection;
(D) A listing of awards and grants from the Fund and awardee and grantee data collected pursuant to paragraph (7) of this subsection; and
(E) The annual reports prepared pursuant to§ 7-3221(f).
(c)(1) If the Office decides not to follow a Commission recommendation in whole or in part, the Office shall provide the Commission with a written explanation for its decision within 14 days after the decision is made.
(2) The Commission shall have at least 7 days after receipt of the Office's written explanation provided pursuant to paragraph (1) of this subsection to provide a written response before the Office proceeds with its decision.
§ 7–3214. Rules.
The Mayor, pursuant to subchapter I of Chapter 5 of Title 2, may issue rules to implement the provisions of this subchapter.
Subchapter III. Opioid Abatement Fund.
§ 7–3221. Opioid Abatement Fund.
(a) There is established as a special fund the Opioid Abatement Fund ("Fund"), which shall be administered by the Department of Behavioral Health in accordance with this section.
(b) Monies from the following sources shall be deposited into the Fund:
(1) Funds received by the District, regardless of whether such funds are received as a lump sum or series of payments to be made over time, pursuant to the settlement and trust-distribution agreements entered in the following cases:
(A) District of Columbia v. Johnson & Johnson, et al., Case No. 2022-CA-001441-B (D.C. Super. Ct.);
(B) District of Columbia v. McKesson Corp.,, et al., Case No. 2022-CA-001401-B (D.C. Super. Ct.);
(C) District of Columbia v. McKinsey & Co., Case No. 2021-CA-00327-B (D.C. Super. Ct.); and
(D) In re Mallinckrodt PLC, No. 20-BK-12522 (Bankr. D. Del.);
(1A) Funds received by the District pursuant to any pre- or post-suit settlement, judgment, or consent decree that the Attorney General designates as an opioid-related settlement, judgment, or consent decree; provided, that the Attorney General shall notify the Mayor and Council of any such designation within 30 days after the settlement, judgment, or consent decree becoming final; and
(2) Monies otherwise appropriated to, or transferred to, the Fund in accordance with law.
(b-1) Monies in the Fund shall be used only for the following purposes:
(1) Permissible Opioid Abatement Advisory Commission and Office of Opioid Abatement activities and operations, including personnel, pursuant to §§ 7-3211 and 7-3212, respectively;
(2) District-wide needs assessments to identify structural gaps and needs related to opioid use disorder and co-occurring substance use and mental health disorders;
(3) Awards and grants for evidence-based and evidence-informed prevention, recovery, treatment, or harm reduction activities, practices, programs, services, supports, and strategies for opioid use disorder and co-occurring substance use and mental health disorders, including evidence-informed pilot programs or demonstration studies;
(4) Infrastructure required for evidence-based and evidence-informed prevention, recovery, treatment, or harm reduction activities, practices, programs, services, supports, and strategies for opioid use disorder and co-occurring substance use and mental health disorders;
(5) Evaluations of effectiveness and outcomes for activities, practices, programs, services, supports, and strategies for opioid use disorder and co-occurring substance use and mental health disorders for which monies from the Fund were disbursed, such as the impact on access to harm reduction, services, or treatment for disorders, or reduction in drug-related mortality;
(6) Publicly available data interfaces, including to aggregate, track, and report:
(A) Data on opioid use disorder and co-occurring substance use and mental health disorders, overdoses, and drug-related harms; and
(B) Outcomes of activities, practices, programs, services, supports, and strategies for which monies from the Fund were disbursed;
(7) The audit required by subsection (g) of this section; and
(8) Any other opioid abatement activities authorized by any settlement, judgment, or consent decree resulting in funds being deposited into the Fund.
(b-2) Unless otherwise required by court order, monies in the Fund shall be used for prospective purposes and not to reimburse expenditures incurred prior to March 10, 2023.
(b-3) Monies expended from the Fund for the purposes set forth in subsection (b-1) of this section shall supplement, and not supplant, any other funds, including insurance benefits or District or federal funding, that would otherwise have been expended for such purposes.
(b-4) Expenditures for Commission and Office activities and operations, including personnel, and expenditures for audits shall comply with any applicable terms in the settlement agreements, judgments, or consent decrees that limit the use of funds for administrative expenses.
(c) Money deposited into the Fund shall not be obligated or expended until the Council passes legislation setting forth the permissible uses of the money in the Fund.
(d)(1) Money deposited into the Fund shall not revert to the unassigned fund balance of the General Fund of the District of Columbia at the end of any fiscal year or at any other time.
(2) Subject to authorization in an approved budget and financial plan, any funds deposited into the Fund shall be continually available without regard to fiscal year limitation.
(e)(1) Notwithstanding subsection (b)(1) and (1A) of this section, the Attorney General may elect to have no more than 15% of any payment that the District receives prior to October 1, 2022, pursuant to the settlements, judgments, and consent decrees referenced in subsection (b)(1) and (1A) of this section, retained in the Litigation Support Fund established pursuant to § 1-301.86b, and no more than 10% of any payment received thereafter.
(2) The Attorney General shall make an election pursuant to paragraph (1) of this subsection by providing the Mayor, Chief Financial Officer, and Council with written notice of the amount of the election and the relevant payment. In making this election, the Attorney General shall ensure compliance with all applicable settlement terms.
(f)(1) No later than December 31 of each year, the Department of Behavioral Health shall provide a report to the Mayor, Council, and Attorney General detailing the District's use of monies in the Fund during the prior fiscal year.
(2) The annual report required by paragraph (1) of this subsection shall:
(A) Be published on the Office of Opioid Abatement's website; and
(B) Include, for the prior fiscal year:
(i) The opening and closing balance of the Fund;
(ii) An accounting and description of all credits to and expenditures from the Fund;
(iii) An inventory of Fund investments, as of September 30 of the prior fiscal year;
(iv) The net income the Fund earned;
(v) A listing of all applications received for awards and grants of monies from the Fund;
(vi) The name and a description of each awardee or grantee of monies from the Fund, and the amount disbursed to each awardee or grantee;
(vii) A description of the intended use of each award or grant from the Fund, including the activity, practice, program, service, support, or strategy funded, population served, and measures that the awardee or grantee will use to assess the impact of the award;
(viii) The primary criteria used to select each awardee or grantee and its respective award or grant amount;
(ix) A statement as to whether monies disbursed from the Fund supplemented and did not supplant or replace any existing or future local, state, or federal government funding; and
(x) The progress toward achieving the Opioid Abatement Advisory Commission, Office of Opioid Abatement, and Fund's purposes, such as metrics on improving outcomes and reducing mortality and other harms related to opioid use disorder and co-occurring substance use and mental health disorders.
(g) The Office of the District of Columbia Auditor shall audit the Fund every 5 years.
