House Health and Human Resources engaged in discussions about House Bill 4196, House Bill 4335, and House Bill 4336; HB 4196, HB 4335, and HB 4336 will be moved to markup and passage.
House Bill 4196 plans to require licensed programs to offer long-acting contraceptives, such as an injectable or an implant, to patients recovering from methadone and suboxone. This would include new and current patients in accordance with the Medication-Assisted Treatment Program Licensing Act.
House Bill 4335 is planned to create a quick, standard practice for Medicaid providers and require the electronic submission of credentialing applications. The bill aims for the Department of Human Services to implement an electronic system that is consistent statewide for credentialing of Medicaid providers. Under this bill, the Department of Human Services will be expected to complete enrollment determinations within five business days of a completed application. The credentialing form is expected to be simple, straightforward, and easily accessible.
House Bill 4336 will update the drug testing standards for medication-assisted treatment programs. In addition to West Virginia code, 16B-13-5, the bill plans for drug testing under the medication assisted-treatment program to include one test each month for the first three months; then one test each quarter for the next nine months; and then four tests per year. Under the new addition, the program may drug test a patient when there is a reasonable basis to believe that a patient may be engaging in substance use or diversion that goes against the treatment plan.
The proposed bill includes removing the following language, as stated in §16B-13-5 of the West Virginia Code.
– The medication-assisted treatment program shall be eligible for, and not prohibited from, enrollment with West Virginia Medicaid and other private insurance. Prior to directly billing a patient for any medication-assisted treatment, a medication-assisted treatment program must receive either a rejection of prior authorization, rejection of a submitted claim, or a written denial from a patient’s insurer or West Virginia Medicaid denying coverage for such treatment: Provided, That the director, in consultation with the Inspector General, may grant a variance from this requirement pursuant to §16B-13-6 of this code. The program shall also document whether a patient has no insurance. At the option of the medication-assisted treatment program, treatment may commence prior to billing.
– (h) All employees of an opioid treatment program shall furnish fingerprints for a state and federal criminal records check by the Criminal Identification Bureau of the West Virginia State Police and the Federal Bureau of Investigation. The fingerprints shall be accompanied by a signed authorization for the release of information and retention of the fingerprints by the Criminal Identification Bureau and the Federal Bureau of Investigation. The opioid treatment program shall be subject to the provisions of §16B-15-1 et seq. of this code and subsequent rules promulgated thereunder.
– (s) The physician shall follow the recommended manufacturer’s tapering schedule for the medication-assisted treatment medication. If the schedule is not followed, the physician shall document in the patient’s medical record and the clinical reason why the schedule was not followed. The director may investigate a medication-assisted treatment program if a high percentage of its patients are not following the recommended tapering schedule.
With these removals in mind, delegates engaged in debate with Lee Weingart, a telehealth representative from QuickMD, and Stephen Loyd, director of the West Virginia Office of Drug Control Policy.
Weingart provided reasons for the changes that provisions cause harm over time; the requirement of fingerprinting and federal background checks is overly broad and could include people who do not physically interact with patients. Weingart said the heart of the bill is the reduction of excessive monthly testing. Lastly, he said many medication-assisted treatment programs don’t offer tapering schedules and shared concerns of patients not having the capacity for tapering, and an unnecessary burden on patients.
Main concerns from the delegates include the practice of patients paying cash for treatment using suboxone, reduction in the amount of drug testing for patients being treated for drug addictions, and the removal of background checks for employees in these clinics that treat people with addiction.
Following the debate with Weingart, Loyd provided his perspective as a physician on the bill and the current language included in it. Loyd said he agreed with the bill’s idea on drug screening, adding that there is no proven benefit for excessive drug screening. Loyd recommended patients receive once a week for the first four weeks and for the remainder of the year every 45 days, resulting in eight screenings a year. With consideration of disagreements between the delegates, Loyd expressed a desire to find a happy medium and believes some positives could come out of the bill with amendments.
