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CHARLESTON -- With West Virginia still in the grip of a substance use crisis and record overdose deaths, different committees in the West Virginia Legislature are weighing whether to make it easier for new treatment facilities to come to the state or to further regulate them.
The House Health and Human Resources Committee recommended House Bill 2196 for passage Tuesday afternoon. The bill would remove opioid treatment programs, such as methadone clinics, from requiring a certificate of need. Methadone is used to help treat patients to manage withdrawal symptoms from opioid addiction.
Delegate Scot Heckert, R-Wood, raised concerns about whether the bill would open the floodgates for multiple methadone clinics setting up in one community.
"If we do away with this certificate of need, there can be 21 of them open up in the next six months in one county," Heckert said. "I want to make sure we know what we're doing and not create a problem somewhere else in the state like we have in Wood County."
House Health Committee Minority Vice Chairman Mike Pushkin, D-Kanawha, said it was unlikely that methadone clinics would explode in number, but eliminating the certificate of need for them would allow new clinics to open in areas where patients have to drive hours currently for treatment in other parts of the state.
"Years ago, they put a moratorium on (methadone clinics)," Pushkin said. "There's only nine in the entire state with seven of them owned by the same company. When you have one company that owns seven out of nine facilities, there's no competition. Generally, competition is always better."
Earlier Tuesday afternoon in the state Senate Health and Human Resources Committee, senators recommended for passage a committee substitute for Senate Bill 242. That bill would require additional hoops for residential substance use disorder service programs to jump through before they can open. The bill was sent to the Senate Judiciary Committee for further review.
The original version of SB 242 would have created a licensure procedure for residential substance use disorder service programs. Instead, the committee substitute for SB 242 would require the DHHR Office of Inspector General to propose rules to amend the existing behavioral health licensing rules to include residential substance use disorder service programs.
The amended bill would require residential substance use disorder service programs to make referrals for substance use disorder services, HIV and hepatitis screening information, hepatitis A, B and C vaccination, overdose prevention, supplies and education, educational services for birth control and disease prevention. Residential substance use disorder service programs would be required to maintain data and metrics.
The Inspector General would work with multiple DHHR bureaus and other stakeholders, including the Bureau for Medical Services, OHFLAC, the Bureau for Behavioral Health, the Office of Drug Control Policy, the West Virginia Behavioral Health Providers Association, and the West Virginia Municipal League.
Had the bill been left intact, a residential substance use disorder service program would have been regulated twice, as a licensed behavioral health provider and under the new license proposed in the original bill. Mark Drennan, executive director of the West Virginia Behavioral Healthcare Providers Association and a former state senator, said he supported the committee substitute for the bill.
"We're in the business of quality substance abuse treatment," Drennan said. "I think the most important thing is we get people well and get them better."
The committee also adopted two amendments to the committee's substitute bill. One amendment by Sen. Rollan Roberts, R-Raleigh, would exempt faith-based recovery residences from the bill's provisions.
Another amendment from Sen. Eric Tarr, R-Putnam, would require a majority of a county commission express its approval either for a new residential substance use disorder service program license or a license renewal before the program is allowed to start.
"If they don't, then they're not able to get licensed for a service in that county," Tarr said. "That would allow an existing provider who has already given services. They can still continue to give services until their license renewal. Then they have an opportunity to state their case to the county commission to go through the process for the renewal of their license."
Another committee put the brakes on a bill aimed at helping out-of-state patients receiving substance abuse treatment in West Virginia find their way back home but would also prohibit treatment centers from marketing their services outside of the state.
The House Substance Abuse Committee moved to lay over House Bill 2546 Tuesday morning to address several technical issues with the bill.
HB 2546 would require in-state substance use disorder inpatient providers to offer transportation to a patient's state of birth or a state where they have a family support structure to help them with their recovery.
Joe Deacon, business development liaison for Addiction Healing Center with the Thomas Health System in Kanawha County, said they already work on discharge plans for patients to ensure they have someplace to go once they go through the inpatient process.
"My concern is this penalizes all providers when there are a lot of us who are really trying to do a good job no matter what state they're from or what city or county in West Virginia," Deacon said. "We're really trying to make sure they get to the next level of care, whether that be another residential or to a sober living home in another part of the state or to another type of facility out-of-state."
The bill prohibits in-state substance use disorder inpatient providers that receive Medicaid from marketing their services outside of the state or partnering with out-of-state providers to relocate patients to West Virginia and receive state-covered treatment for substance abuse disorder.
HB 2546 also requires Medicaid to seek approval from the Centers for Medicare & Medicaid Services to limit eligibility for any substance use disorder waiver services to individuals that have established residency in West Virginia for at least six months prior to covered services.
According to DHHR, the state saw 1,507 drug overdose deaths in 2021, a 12 percent increase from 1,336 deaths in 2020. Most of those deaths are attributable to synthetic opioids, including fentanyl.