BILL ANALYSIS
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|SENATE RULES COMMITTEE | AB 1308|
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THIRD READING
Bill No: AB 1308
Author: Goldberg (D), et al
Amended: 9/8/03 in Senate
Vote: 21
SENATE PUBLIC SAFETY COMMITTEE : 4-1, 7/8/03
AYES: Vasconcellos, Burton, Romero, Sher
NOES: Margett
ABSENT/NO VOTE RECORDED: McPherson
ASSEMBLY FLOOR : 54-15, 5/5/03 - See last page for vote
SUBJECT : Drug treatment: local correctional facilities:
indigent addicts
SOURCE : California Quality Addiction Treatment Coalition
(California Society of Addiction Medicine;
Patients Advisory & Advocacy Group; Bi-Valley
Medical Group; Aegis Medical Systems; California
Opioid Maintenance Providers)
DIGEST : This bill states that it is the intent of the
Legislature to sustain and enhance the system of care for
all persons needing specified drug and alcohol abuse
services.
Senate Floor Amendments of 9/8/03:
1.The amendments delete provisions describing and allowing
a sliding scale for narcotic replacement therapy for
CONTINUED
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patients not eligible for Medi-Cal. Instead, the
amendments create a framework for the Department of
Alcohol and Drug Programs (DADP) to establish a sliding
scale for such care.
2.Change provisions of the bill that describe protocols for
treatment of acute withdrawal sickness in jails. The
bill as currently drafted sets grant priority for
counties that establish specified protocols for such
treatment. Direct DADP to develop model protocols for
treatment of acute withdrawal sickness. The counties may
adopt the protocols and thereby become eligible for grant
priority.
3.Clarify applicable terms and definitions, including what
constitutes the applicable "standard of care" for acute
withdrawal treatment and related matters.
ANALYSIS : Existing law provides that it is the intent of
the Legislature in licensing narcotic treatment programs to
provide a means whereby the patient may be rehabilitated
and will no longer need to support a dependency on heroin,
and declares that the ultimate goal of all narcotic
treatment programs shall be to aid the patient in altering
his or her lifestyle and eventually to eliminate all
dependency on drugs.
This bill specifies that narcotic treatment programs
licensed by the state are those that use prescription
medications to help rehabilitate patients and by declaring
that the ultimate goal of all narcotic treatment programs
is aiding the patient to eliminate dependence on all
illicit drugs.
This bill also provides that a criminal defendant or a
probationer in a court supervised rehabilitation program
who is a heroin addiction patient may be directed by that
court to discontinue narcotic replacement therapy only when
the person's direct narcotics replacement treatment
provider recommends discontinuation and the court agrees
that discontinuation is a necessary component of an
effective treatment plan for the defendant.
Existing law:
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1.Sets forth specified legislative intent language
regarding Medi-Cal drug treatment programs.
2.Provides that reimbursement to narcotic treatment
providers for narcotic replacement therapy dosing and
ancillary services shall be limited to the lower of
either the uniform statewide monthly reimbursement rate
or the provider's usual and customary charge to the
general public for the same or similar service.
3.Provides that the uniform statewide monthly reimbursement
rate is required to be established after consultation
with narcotic treatment program providers and county
alcohol and drug administrators.
4.Existing law provides for programs for the treatment of
the addiction of state prison and local correctional
facilities inmates to alcohol or controlled substances,
as specified.
This bill:
1. Would instead state legislative intent to sustain and
enhance the system of care for all persons needing
alcohol and other drug abuse services, to reduce
administrative overhead and department costs by
encouraging the development of a clear, legal, and
complete fee system that is fair to persons needing
services, public and private providers, counties and the
state, and to make effective use of limited public
resources.
2. Provides that after consultation with treatment
providers, counties, and other interested parties
identified by the department, the department may specify
one or more fee systems for alcohol and other drug abuse
services funded directly or indirectly, in whole or in
part, by the department. The systems may include a
uniform method of determining ability to pay, a sliding
scale system for determining indigent client status, and
other details as the department may require. The system
or systems may be in lieu of, an alternative to, or a
replacement of, the county-approved and
provider-approved fee systems at the department may
determine.
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3. Requires on or before January 1, 2007, the department,
after consultation with local correctional facilities,
treatment providers, and others, as determined by the
department, shall publish a model protocol for the
treatment of in-custody addiction withdrawal from
alcohol or controlled substances that is based on
available standards of care, such as the American
Society of Addiction Medicine guidelines, and other
medically appropriate community standards.
4.Would provide that any city, county, or city and county
that adopts and implements protocols for in jail
addiction withdrawal from alcohol or controlled
substances that it is consistent with the model protocol
published by the Department of Drug and Alcohol Program
shall receive priority eligibility in the award of
competitive grants, as specified.
5.Directs, beginning January 1, 2007, state agencies with
the authority to award competitive grants to include
consideration of the appropriate standard of care for
in-custody addiction withdrawal treatment in weighing
competitive grant proposals.
6.States that it is not the intent of the Legislature to
create an unreasonable disparity between larger counties
and smaller counties in the grant award process.
Prior legislation
SB 1449 (Vasconcellos), 2002, passed the Senate Floor on
5/29/02, 27-7, but failed passage on Assembly Floor.
FISCAL EFFECT : Appropriation: No Fiscal Com.: No
Local: No
SUPPORT : (Verified 9/8/03)
California Quality Addiction Treatment Coalition
(California Society of
Addiction Medicine; Patient's Advisory & Advocacy Group;
Bi-Valley
Medical Group; Aegis Medical Systems; California Opioid
Maintenance
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Providers) (source)
Los Angeles County Sheriff
California Catholic Conference
California National Organization for Women
California Medical Association
Housing California
Friends Committee on Legislation
Bay Area Addiction Research and Treatment
California Association of Alcohol and Drug Program
Executives
OPPOSITION : (Verified 9/8/03)
County of Madera
California State Sheriffs' Association
California State Association of Counties (CSAC)
ARGUMENTS IN SUPPORT : According to the author:
This bill will enhance the ability of California to
treat narcotic addicts and subsequently conserving
scarce taxpayer resources.
The sponsors, Bi-Valley, the Patient Advisory and
Advocacy Group, the California Society of Addiction
Medicine, and Aegis Medical Systems Inc believes that
unless the Legislature enacts a sliding scale, the
ongoing confusion in the industry will degrade
treatment services for indigent persons.
Class action lawsuits are imminent unless the
Legislature clarifies the lines of authority regarding
the removal of treatment patients from prescription
medication.
The section of the bill relating to jails is intended
to address persons in jail who go through withdrawal,
namely withdrawal from heroin and other opiates.
Physiological effects of withdrawal rarely results in
death, but the experience of withdrawal can drive
addicts to suicide and exacerbate co-existing medical
conditions.
ARGUMENTS IN OPPOSITION : The California State
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Association of Counties (CSAC) states that:
While counties see substantial value in making
treatment available to the in-custody population, we
continue to have significant concerns regarding AB
1308. We understand the intent of the bill is to
create incentives for counties to develop acute
addiction abuse withdrawal treatment programs.
However, we are concerned that despite efforts to
craft the measure in a way to avoid creating the
"haves" and "have-nots," we remain concerned that a
county that does not have the resources to establish a
program would effectively be barred from receiving
state grant support because those funds would
perpetually be out of reach. We join law enforcement
advocates in their concerns that the priority
consideration granted to counties with an approved
plan will create a two-tier system. Perhaps more
importantly, we question the extent to which this
legislation can statutorily make determinations
regarding counties' eligibility for programs that have
neither been authorized nor funded.
The California State Sheriffs' Association (CSSA) states
that:
Although we agree with the spirit of what you are
attempting to do, we are also concerned with the strict
guidelines that your measure would place on local
correctional facilities that are under the control of the
county sheriff. The measure is great for those that have
the resources to staff drug treatment programs in custody
and in the community upon release; however, the measure
will ensure that those counties that do not currently run
programs continue to be disadvantaged in their quest to
develop like programs.
ASSEMBLY FLOOR :
AYES: Bates, Berg, Bermudez, Canciamilla, Chan, Chavez,
Chu, Cohn, Corbett, Correa, Diaz, Dutra, Dymally,
Firebaugh, Frommer, Goldberg, Hancock, Harman, Jerome
Horton, Shirley Horton, Jackson, Koretz, La Suer, Laird,
Leno, Levine, Lieber, Liu, Longville, Lowenthal,
Matthews, Maze, McCarthy, Montanez, Mullin, Nakanishi,
Nation, Negrete McLeod, Nunez, Oropeza, Parra, Pavley,
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Plescia, Reyes, Richman, Ridley-Thomas, Salinas,
Simitian, Steinberg, Vargas, Wiggins, Wolk, Yee, Wesson
NOES: Campbell, Cogdill, Cox, Dutton, Garcia, Haynes,
Keene, La Malfa, Maddox, Maldonado, Mountjoy, Runner,
Samuelian, Strickland, Wyland
RJG:nl 9/8/03 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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