2021-10-04 00:00:00 - Joint Committee on Mental Health, Substance Use and Recovery
2021-10-04 00:00:00 - Joint Committee on Mental Health, Substance Use and Recovery
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this is the Joint committee on Mental health substitution recovery. I apologize for running a little behind been some uh laptop issues this morning, but it sounds like it is all in working order now. I want to thank you for joining us today and for participating in today's hearing.25 My name is Adrian madre, proud to service the House chair of this committee and I'm joined today by my good friend and senate co chair, a wonderful leader in the space. Senator Julian Sear I'm asking so joined by some members of the committee from the house trying to see which of my colleagues are on, but I do not um I do not have a list of participants. Uh I see Representative Kerans is here. Um I'm sorry that my colleagues will have to get to in a little bit. I had to join through my browser rather than the app today so I cannot see the participants participants right now, but I will make sure sort of recognized folks shortly. Uh thank God for good staff were also here today with Representative Donnie Berthiaume rep dan carry rep Michele Dubois who is the wonderful vice chair of this committee. Representative tammy Gouveia Representative O'Day and Representative Kushmerek I want to thank my colleagues86 from the house uh for joining today and without further ado I'll turn it over to chair Cyr who would probably like to say a few words and recognize the Senate members of the committee. Thank you john Madaro good to be with you as always. Uh you know not, I don't think we have members of the Senate who joined just yet. Let me just check the teams here. Uh
uh
we have we have Senate staff for listening in. I'm sure Senate members will be joining us shortly as uh there uh to not run on122 time. But anyway this is an important hearing. Always good to be with you uh looking forward to listening128 and learning as we always do. So back to you sir. Great, thank you Chair today. We'll be hearing testimony on bills regarding parody and equity for people who use substances. Um I do want to recognize Representative Natalie Higgins is here as well. We look forward to hearing from speakers today about potential solutions to address the issues faced regarding these important topics. And again, I want to thank you all for being here before we begin the testimony. I do just want to provide a quick review of the process. So please be aware that this hearing is being recorded and streamed live. An archived copy will be made available on the Legislature's website. We will be hearing oral testimony today on Bills before us related to the subject matter. Um but due to the remote nature of this hearing, those wishing to provide oral testimony were required to sign up in advance. So if you were not able to sign up in advance to provide179 oral testimony or you no longer wish to do so you may submit written183 testimony to the committee any time testimony can be emailed to committee staff listening the hearing description or you can simply send it to myself or chair Cyr Uh Those testifying today are also welcome to submit their testimony in writing uh due to their scheduled to talk a policy to take legislative testimony out of turn. So I was to testify. All other speakers will be called to testify in the order of the bills being heard in209 order to accommodate everyone testifying today, speakers are asked to please limit your testimony to no more than three minutes. Again three minutes is the a lot of time for testimony. So if you have comments that will go beyond three minutes again we encourage you to submit them in written form. Staff will be226 keeping time in the media being chat as well as with the timer. So when you hear the time to go off after three minutes you'll know that that's your alarm. So please wrap up your testimony and I want to emphasize again that the oral testimony should be kept to three minutes max. Um and once again you will hear uh sometimes uh and staff keeping245 the time in the chat after each testimony. Committee members will be given the chance to ask some questions. Uh we do ask that all individuals not currently speaking to please keep your microphone muted just as a heads up. I I got to give this disclaimer before every hearing um that I'm sharing but my wife and I welcome their first child about four months ago and since I am working from home today, there may be times we need to step away from the camera momentarily to take care of my son Matteo. So please bear with me. Uh this should be a relatively short hearing as we did not receive as many request to testify as in previous hearings. That being said, if we run longer than an hour and a half we will take a short mental health break as this tradition for this committee. And finally I want to thank L. I. S for facilitating this virtual meeting and of course our incredible committee staff for their diligent work and putting today's hearing together. And I want to once again thank all of you for joining us today to testify for your time and perspective on these important pieces of legislation. Uh I will start with any elected who are here to testify if you wouldn't mind raising your hand or somehow alerting me again, I cannot see everyone. Uh so I do see Representative I believe Gouveia saying it just went up uh rep you testifying? No excuse me. Was that rep O'Day his hand? Oh
Sure I was shaking it was shaking hands at the same time. High five.
Well uh Representative Gouveia I did, I did mention your name first if you're if you're testifying on a bill please feel free to take and I'd love for district attorney mary and Ryan to also join sort of like a little bit of a panel since this is legislation that we've worked on together both last session in this session. Um, D a Ryan Would you like to go first or would you like me to go first you made please? Okay, great, well
[REP GOUVEIA:] [HB2096] Thank you. Mr Chair Madaro and Mr chair Cyr and members of the committee. It's really great to be here with all of you on such a critically important topic. You know, we have been ravaged by the opioid crisis since, you know, around 2006 is when our state started to address it using federal375 dollars through the State and, grant. Just really proud that as a state, we have, you know, really tried to get a solid handle on how to support our families and our individuals who are um, you know, struggling with addiction and who have been so gravely impacted by this crisis. We know that we've already lost over 1000 people to the opioid epidemic this year alone. And um, you know, we know we'll probably see unfortunately more overdose deaths before the end of the calendar year.
408 Particularly exacerbated because of the Covid-19 crisis. So the legislation that we're here to testify on is to House 2096 which will create essentially a418 stewardship fund for naloxone. We know that naloxone is a lifesaving intervention for those who are experiencing an overdose and we just want to make sure that, uh, with this bill, there are two things that this, that this legislation does. First of all, it holds manufacturers and distributors of opioids accountable for contributing to uh, supporting naloxone program that people can access free of charge or at extremely reduced costs because we don't want costs to447 be a barrier to making sure that people um, to prohibiting people from being able to access the lifesaving intervention that naloxone is.
So that's what this legislation does, is it holds manufacturers and distributors accountable for that. And we know that in large part what's driving the opioid crisis in our state are a couple major factors. The loss of a manufacturing base which has contributed to the economic downturn of a number of our communities. So families are suffering economically, we know that's going to be even worse through Covid and after Covid. Um, but also just, you know, this is the beginning of the epicenter in so many ways. And fentanyl is essentially in every single drug that is identified as contributing to someone um passing away from an494 overdose.
And a lot in large part, you know, we have a fentanyl market because we had first and foremost an OxyContin and opioid market that was created by the manufacturers and distributors of opioids. Had it not been for that, we may not have had the struggle that we have with fentanyl um, in our state. Unlike what is seen in other states. And so just you know, respectfully request support from moving517 this legislation forward so that we can create this stewardship fund so that people can get access to the needed intervention um free of charge so that they can save Um a527 loved one, a neighbor, a complete stranger who they might come upon and also support our law enforcement and first responders and their work. So thank you all and I will stop there and see if there are any questions and then perhaps turn it over to district attorney Marian Ryan.
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Yeah, do we have546 any questions from representative Gouveia Um Chair here.
Good to see you, thank you for being here. Thank555 you so much. Great seeing you both. Wonderful um rep O'Day560 I don't know if that hand is up to testify on your bill, I'm564 assuming it is.565 If not, please let me know otherwise we could just stretch it. Adrian. Alright, alright, get those, get those limbs loose and limber. All right, so without further ado will turn it over to a District Attorney Marion Ryan Thank you for being here.
[MARIAN RYAN (MIDDLESEX COUNTY):] [HB2096] Thank you. Thank you to the583 chairs and co-chairs for giving us this opportunity. I know you spoke earlier at the beginning of the hearing about parity. This is completely a parity issue. We all know the value of naloxone. We also know that naloxone is not a product you can save when you open it, you use it and it's gone. We have already created a trust fund to provide a store of naloxone to public service to public and first responders. We also, my612 office has already put 11,000 doses of naloxone on the street. What we have begun to see and the impetus for this bill was people who although they can get it, they can go to the pharmacy and they can get naloxone. The amount of their copay depends on the kind of insurance they have.
So that copay can range from $7 to close to $50. And very often as you can easily imagine you you are living with someone for instance who's struggling. They have an incident where you use the naloxone, it's the middle of the month. You don't have the $45 to pay the copay and you wait and that person suffers an overdose and you don't have a replacement. That is a tragedy that does not need to happen. And this bill to create the fund is modeled on a fund that was created in New York State. It was the first of its kind, it was created in 2018. It is based and assessed against the companies based on their market share of either what they sell, distribute or deliver of opioids within the state. New York was the first since then, Delaware Minnesota and Rhode Island have683 also established a similar fund. It's very simple.
We know naloxone works, we want as many people as possible to have it. Some people691 are not going to go to learn to cope or someplace else to get it. They want to go to the pharmacy and get it and they just can't afford it. And with respect to any challenge to the bill and I haven't even had a chance to share this with Representative Gouveia because it literally happened 20 minutes ago. Um the manufacturers in New York state challenge the constitutionality of the stewardship fund that was created in New York this morning as part of the opening of the session of the Supreme Court of the719 United States. They ruled in favor of the state.
Said that given the number of deaths that had occurred, the need for naloxone and the profit that was being made by those selling, delivering and distributing opioids that they could well afford to pay this. And it was a relatively modest what the court said was, it738 was a relatively modest amount that they were contributing. So this is just a very common sense measure. It is something that without question will save lives. And when749 we look to parity having a loved one die because you lack $40 or $50 is really paramount in those kinds of issues. So I would ask for favorable action to advance the bill and I'm happy to take any questions.
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Thank you very much. No questions on my side, Senator.
None. Thank you. Okay. Any questions from committee members?
Okay, I don't see any. So with that we will move on. I want to thank rep Gouveia and District Attorney Ryan for joining us. Thank you. I do want to also recognize as that rep whips and rep Kane are members of the committee who joined us as well and without further ado we will have Representative O'Day
[REP O'DAY:] [HB2122] [HB2123] Thank you. Mr. Chairman, thank you for taking me out of order. Good afternoon to you and Senator Cyr Thank you. Chairman, Chair Cyr and members of the esteemed committee. I'm actually here, am I gonna do both? Mr. Chairman. I'm here to testify on two separate pieces of legislation that I filed. House Bill 2122. An act relative to the824 safe care of residents with active substance use disorder accessing skills.
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Okay,
Representative, you're muted yourself. We can no longer hear you.
Impossible.
[O'DAY:] Uh So so I'm going to testify, I'm going to testify on two bills 2123 and 2122. Um and if I may in a full disclosure both of these bills have to do with recovery and one way or another again in full disclosure I'm a person in long term recovery. And so these topics are ones that I have a great deal of passion for. House Bill 2122 um deals with those individuals who have active substance use disorders who for one reason or another may be discharged from a medical facility from a hospital and referred to a skilled nursing facility. When they come into their skilled nursing facility there are no um policies necessarily in place. There is no necessarily in place AA or NA meetings going on.
The staff is probably not um educated to the level that they need to be if they're going to be dealing with individuals that are coming in with active substance use disorders. Um You know, these would be people who being discharged maybe with some sort of uh long-lasting infections where they need to be uh continuing to receive care from a long term from a skilled nursing facility. Yet they are still ambulatory and able to leave that facility. And so you know, staff in those facilities are not necessarily trained to deal with those kinds of activities that one may find some individuals that are still actively using uh substances.
When a call is put out to these skilled nursing facilities from the referring hospitals, uh you know the medical conditions up to and including that they may have histories of substance use uh disorders. Many of these skilled nursing facilities are denying access to these patients. So you know there are a lot of issues to be dealt with. I think it certainly can be addressed997 uh through these skilled nursing facilities but999 we I think have to find a way to help um support those efforts. And so I think you will hear today from some folks that are in the field that can give you some better ideas of how they are requesting that those issues issues be addressed from us as the commonwealth.
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So that's that's House 2122. Happy to take questions on that if you want to do that first, before I get onto House 2123, or should I just go ahead? Mr. Chairman, just roll right into it and we'll take questions at the end, robert. Thank you. Mr. Chairman.
[O'DAY:] Second one, House 2123. An act to expand access to treatment for health professionals with substance use disorder. As I mentioned at the beginning of this testimony, I've been a personal long term recovery and an individual who has a professional license I am a licensed social worker. And the good news is that there are some professions that our boards of registry um understand the nuances and some of the struggles that us in the healthcare profession may run1082 into as a result of having a substance use disorder. Again, I'm not looking to take anything away from some of those professions that have strong uh support systems for their professionals for their profession.
However, a number of healthcare professions, uh nurses, health are workers, social workers and a number of others do not have the same type of support. And my my point is the point of this bill is punitive nature, punitive actions are not in the best interest of those who are suffering from substance use disorder. Now, I certainly understand the higher level of concern that those in the healthcare field may have with making certain that those that are receiving treatment and care from an individual who may be suffering from a substance use disorder is of of of high of high concern to them.
Yet we still need to look at those in the field who are suffering from substance use disorder, who are willing to be in treatment, who are willing to, you know, find the right course of action um to get them into recovery uh certainly works better with the carrot than it does with the stick. And so this bill ask for a commission to be established with those that are in the field of recovery, those that are in substance use disorder field to look at best practices and how we can ensure that those that have the training, those who have been in the field providing services, even though they've run into some substance use disorders are still highly qualified, highly capable to provide1200 services even in early recovery. As long as they're getting uh the, you know, the strong type of quality treatment that is required and that is available, but we need to take the time to find that. So I hope that both of these bills will be1219 given a favorable report from your committee and thank you very much for your time this afternoon. Thank you.
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Thank you Representative. Not only for your work in this area, but also for being so open about your own personal story. We talk a lot about stigma on this committee and it's thanks to people in leadership positions like you that we really can help break that stigma by being so open about your own personal history. Thank you appreciate that comment and I meant to talk a little more about stigma. Thank you. You're a tremendous job there. Thank you. Thank you. Do we have any questions from committee members?
Not right seeing none. Thank you. Representative appreciate your time. Thanks Adrian appreciate it. Next up we're going to hear from another House colleague. Representative Kay khan.
[REP KHAN:] [HB2104] Good morning everybody. I'm here. Just want to thank you. Chair Madaro and Chair Cyr and distinguished members of the committee for allowing me to testify today out of turn, I'm here in support of House 2104. An act establishing a substance abuse protection fund. I have filed this bill for many, many sessions and it was previously referred to the Joint Committee on Revenue. This legislation would remove the sales tax exemption on alcohol sales and establish a substance abuse health protection fund to1306 receive the proceeds of this revenue. The resources in this fund would allow the Department of Public Health to administer substance use treatment programs serving individuals across the country, including those who are involved in the criminal justice system or social services agencies.1325
In addition funds would be used to for substance use prevention and cessation programs in schools, workplaces and community outreach programs. The dire need to expand to substance abuse treatment and prevention programs is well documented in our state. In 2017, Massachusetts saw nearly 100,000 admissions to substance use a substance use treatment centers and experienced an opioid overdose death rate twofold higher than the national average. In addition to the human toll, the financial burden to the Commonwealth from substance use disorders is staggering. The opioid epidemic alone cost our state over 15 billion in 2017.
The Department of Corrections reported annual spending of nearly 69,000 per1384 year per inmate in Massachusetts' alcohol and substance use. Uh the substance abuse center in Plymouth Some DOC Officials have also cited cost as a barrier to providing medication assisted treatment to incarcerated individuals with substance use. Addiction is more than a bad habit. It is a chronic relapsing disorder affecting the brain. Additionally, many people who have substance use disorders also have co occurring mental health disorders. While the commonwealth seeks solutions to multi dimensional to this multi dimensional crisis, we absolutely must look for ways to reduce costs and provide adequate public health resources for desperately needed services and my legislation would help us make progress in both.
Prior to its elimination, the alcohol tax generated 93 million in 2010. So the bill was passed actually in 2010. Uh, it was in existence for one year And we received, we were able to generate $93 million that was a state tax on alcohol. And I might add that most people don't even realize that we don't have a tax on alcohol. But the uh, the, the bill or the, this effort went to a uh, was on the ballot because people didn't want to have to pay a tax on alcohol and it was defeated. And so we went back to no tax on alcohol. I just think it's time to really start thinking about this more seriously.
Again, I know people feel like the people spoke, but that was, that was over 10 years ago and I think with the increase in substance use and um, also the co occurring mental health issues I think it's really, really worth noting that putting a sales tax on alcohol should be reconsidered and brought back to really help with all of the issues that we need uh, to be thinking about with regard to alcohol use or substance use. So I just hope that the committee will reconsider this. I think it's again, I think most people1519 don't know that they don't pay a tax on alcohol. We pay a tax on so many different things, but I think that uh, we really should think about this again because having a health protection fund would go a long way to help all of the needs that we're considering and thinking about today. So I thank you very much for this opportunity to present this morning.
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Thank you. Representative appreciate you joining us. Do we have any questions from committee members?
Alright seeing none. Thank you. Representative Khan and we will now take representative Santiago out of order to testify.
[REP SANTIAGO:] [HB2127] Great well, good afternoon everyone chairs Madaro Cyr And members of the committee. Thanks for taking me out of turn and for the opportunity to testify on H 2127. It's an act to establish a commission1571 to study the continuum of care for persons with substance use disorder. It's a bill I filed with co-filed with Rep Rogers and one that we feel can go a long way in helping to address the worsening substance use epidemic. We have uh in this commonwealth it's also one that was largely born out of my experiences working in the emergency room. In fact I just completed a three day weekend in the ER and I can't express enough. The desperate, the need for more psych and substance use disorder resources instincts I'm sure each and every one of you on this committee are intimately familiar with.
Because whether it was the multiple overdoses I took care of or the several dual diagnosis patients who had literally been waiting in the emergency room hallway for hours awaiting some bed to open up across the state. The needs are real. Uh never mind the fact that Mass and Cass is an area that I represent in Boston and it a district I have come to know an area that I've, I've come to know quite well as someone who lives a block from Mass Ave as a physician and as elected official. The needs are real and um it's primarily those experiences and conversations I've had with folks that have informed me and inspired this bill.
So, but simply the bill establishes the commission to study substance use, the substance use disorder continuum of care. Now the continuum of care1651 is something that we'll define as a system in which patients um at a certain treatment level can step up or step down to another level1659 depending on the services or treatment that they require. So what does this mean? Traditionally, people suffering from substance use disorder will start their recovery by entering a medical detox that lasts about a week because you have to address the physical dependence um of opioids or alcohol use. After that they can progress to something called clinical stabilization services or transitional support services, something that we call CSS. Or TSS uh they're beds.
They're often short time recovery beds that last anything from 10 days to three months and oftentimes the CSS TSS bed they regulate the groundwork for recovery because they address the mental emotional and often social factors that resulted in one's addiction. And many times after completing a CSS or TSS program, people go to sober homes or some other long term services. So think of the traditional continuum of care model as detox followed by CSS TSS bed followed by a long term place, like a sober home. Um So how does this work in the real world? Let me give an example.1726
So every shift I work in the ER I'll take care of people who have been overdose if I'm able to get them into detox, which is something I can do because there's quite a few detox services across the commonwealth, I'll discharge them, hope that they complete the detox and then pray that they can get a CSS TSS bed. But the truth is that's rarely the case and quite frankly it's often the exception as opposed to the rule. Instead the overdose patient that I got into detox is1756 unable to go down the continuum of care. Um and because beds are full, he goes back or she goes back to the same environment1765 where they're at, they use the overdose again and then they come back to the ER and this crazy round of overdose detox discharge, which puts them at risk for death.
Because right now what we have is a bottleneck at these downstream services in this continuum of care. So there's a missing this misalignment or bottleneck is what I'm referring to and I'm just going to give a couple more details with respect to it. So detox, as I said four to seven days and it was and as a result of the high turnover you need to quickly place individuals into these CSS TSS beds. However, there only about 700 short term recovery beds across the state Because the average stay in these CSS TSS beds is 10 to 90 days there's a bottleneck that's created and it doesn't provide everyone leaving detox the opportunity to go to these beds.
And as that bottleneck grows tighter and tighter as you go down to continue care. It puts people at risk of getting out of care in the first place. So this bill really attempts to address that misalignment of services1831 that bottleneck if you will by creating a commission made up of experts, Public health officials, obviously people in recovery as well to recommend an appropriate level of capacity throughout the continuum of care. Um This commission will help us to study the evolving epidemic and ensure that we are better address better prepared to address the substance use issue that we face. So it's for those reasons that I humbly ask that you give this bill a favorable reading and look forward to working with you. Thank you. SHOW NON-ESSENTIAL DIALOGUE
Thank you representative. Not only for your work in the legislature but also just as importantly for your work as an er doctor serving some of our most vulnerable here in boston. Thank you. You bring an1864 important perspective on these issues. Uh Do we have any questions for Representatives? Santiago
Okay, seeing none. We will move on at this point to the scheduled testify IRS1878 we are going back to Representative O'Day's Bill H. 21 23. An act to expand access to treatment for health professionals with substance use disorder.1888 We have a panel coming up consisting of Madeleine Pearson, senior vice president and chief nursing officer at Brigham and Women's Amanda Stefan check over Lee's chief executive officer, Organization of nurse leaders. Um Katie Murphy A resident nurse and president of the Mn. A Mass nurses association Carol Malia A resident nurse from the massachusetts nurses Association of Georgie. Let feel free to start it up. Mhm.
Um I think I'm first, this is Maggie Pearson.
[MADELYN PEARSON (BRIGHAM AND WOMEN'S HOSPITAL):] [HB2123] Good afternoon Chairman Madaro and Chairman Cyr and members of the committee. Thank you so much for the opportunity to testify today. My name is Madelyn Pearson and I'm the chief nursing1937 officer at Brigham and Women's Hospital. I'm here today to offer Mass General Brigham's strong support for House Bill 2123 an act to expand access to treatment for health professionals with substance use disorders. I've been a nurse for nearly four decades and I love this profession. The job is physically and emotionally demanding. The challenges nurses face have been exacerbated by the pandemic and recent surges in patient volume and hospitals throughout the state.
The critical role that nurses hold in healthcare in our communities cannot be overstated and they need and deserve our support. In 2018, approximately 20 million people in the US were1981 diagnosed with SUD Substance use disorder, Including about 300,000 practising nurses. Here in Massachusetts, nurses with suspected SUD are referred to the Substance Abuse Rehabilitation Program or SARP through the Board of Nursing. SARP combines regular toxicity screening and self reports with group2005 and individual therapy therapy. Unfortunately, the program is very underutilized. We have about 140,000 nurses in the state, just 16 or 0.01% enrolled in SARP in fiscal year 18. Why? The stringent eligibility criteria prevent nurses with a mental health history from applying.
Wait times are long and sometimes exceeding six months. Participants must initially relinquish their right to practice. If a nurse has a relapse, he or she must wait a minimum of one year to request monitored reentry to practice. We know that relapse is a normal part of the recovery process and should be treated with the same level of understanding given those who have relapses and treatment for other chronic diabetes illnesses like diabetes et cetera. The current program isn't meeting the nurse of the needs of our the the needs of our nurses. What's more, there is a lack of parity between SARP and the Physicians Health Services Program in Massachusetts.
Some states, some neighbouring states have adopted programs that help nurses receive the necessary treatment while maintaining2080 an unencumbered2081 nursing license. Amending SARP to mirror successful programs would not only increase enrollment but also foster a supportive environment where nurses can recover and safely work in their practice. This translates to a safer care environment for our patients. In summary, we must eliminate SARP's exclusion criteria, decrease wait times, implement a non punitive approach to enrollment and allow um for insurance reimbursement or cost support strategies.
House Bill 2123 would establish a special commission to further study these issues identify best practices and make recommendations for modernizing and improving the programs in Massachusetts. Without the right support for substance use disorder, nurses may not comply and even turn away from practice. And2132 we know this is this is a we are at2135 an alarming time when we're facing nursing shortages throughout the country. In closing, I ask that we treat nurses with the same compassion that they show to each one of us when we find ourselves in their care. Thank you very much for your time.
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Thank you Miss Pearson. Before we turn to the question, I'll just invite your fellow Panelist uh Miss A Burley's the chief2158 executive officer of the organization of Nurse Leaders. Are you here to join us? I am. Can you hear me? Yes. Okay.
[AMANDA OBERLIES (ONL):] [HB2123] Good afternoon Chairman Madaro Chairman Cyr and members of the committee. Thank you for the opportunity to testify today. My name is Amanda Oberlies. I am a doctorally prepared nurse with more than 20 years of experience and I'm the CEO for the Organization of Nurse Leaders which is a multi state organization that represents the full range of current and emerging nurse leaders. A large portion of our members nurse managers and directors played a critical role in situations involving a nurse with substance use disorder. On behalf of our organization and its members ONL appreciates the opportunity to submit testimony in strong support of House Bill 2123.
An act to expand access to treatment for health professionals with substance use disorder disorder sponsored by Representative O'Day. Substance use disorders are a national health program. Excuse me, a national health problem. And we've2218 heard Dr. Maddy Pearson share some of the statistics with you. We know healthcare professionals are 10-15% more likely to develop substance use disorder than the general population. Nurses are2229 sharing that they are experiencing symptoms of PTSD as a result of working through the pandemic and I'm fearful that some may inadvertently fall victim to substance use disorder as a method of coping.
Many nurses with substance use disorders are unidentified unreported untreated and may continue to practice where their impairment may impact patient safety. These nurses need to be identified and supported through treatment. ONL would like to see a compassionate, responsible approach toward nurse well-being. We would like to see a stronger recovery support program that is less punitive and that offers more treatment and support. Creating a commission to study alternative to discipline programs for health care providers with substance use disorder is needed in the commonwealth.
We know there are best practices from other states and it would be useful to understand those practices and recommend changes and updates to our state's current program. In neighboring Connecticut, for example, HAVEN or the Health Assistance Intervention Education Network is considered a model program. Founded by the Connecticut State Medical Society, the Connecticut Nurses Association Connecticut State Dental Association Connecticut Veterinary Medicine Association and the Connecticut Academy of Physician Assistants HAVEN has is authorized by state law to serve virtually all health care professionals licensed in Connecticut.
The program provides confidential consultation and support to healthcare professionals facing health concerns related to alcoholism, substance abuse, behavioral or mental health issues and physical and or physical illness. We can do better in this space and we owe that to the thousands of nurses working so very hard to provide care to the residents of the commonwealth. They are helping to keep us and our communities healthy and we should do the same for them. On behalf of ONL and our 1000 plus leaders that we represent. It is our pleasure to offer strong support for House Bill 2123. Thank you2344 for your time.
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Thank you Mr Burley's and Miss Pearson. Do we have any questions for the panelists? Mr chair please.
[SEN CYR:] I just want to chime in lot less of a question and more of a comment. You know, this is this is policy that seems to make a really good sense um and particularly that there is a gap between you know, our existing program that certain healthcare providers have. Uh this2369 is something when the Senate took up the Mental ABC Act in February 2020 we included uh and I just this is this is this is good policy. Um with healthcare providers including nurses doing so much to take care2383 of all of us. We need to make sure that we're taking care of them and particularly in the context of COVID-19 where there's been been so much stress and and and and angst and certainly um I think we need to make sure that we have the service in place. I think it makes good2400 sense. Um and I also want to recognize2404 my colleague Senator john keenan2405 who has joined us. Thank you.
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Thank you Mr Chair, do you have any other questions or comments from committee members?
Okay, seeing none, we will move on to Uh the next person testifying on age 21 30 21 23. KT Murphy resident nurse and president of the Massachusetts Nurses Association.
[KATIE MURPHY (MNA):] [HB2123] Thank you very much. Chair Cyr and Madaro and distinguished members of the committee. My name is Katie Murphy and I'm an ICU nurse at the Brigham and Women's Hospital and president of the Massachusetts Nurses Association representing over 23,000 members across the commonwealth and I'm here today to testify in support of House 2123. This would create a commission to just to study alternative to discipline programs for health professionals with substance use disorders. Review existing programs, identify best practices and make2465 recommendations for improvements that will facilitate recovery, reduce stigma and allow for successful return to practice.
The current substance abuse rehab program as administered under the Board of Registration of Nursing Is counterproductive to the recovery process. This is very unfortunate as nearly 40 years ago Massachusetts was one of the first states in the nation to introduce an alternative to discipline program to address substance use disorder in nurses. But several years ago we began to see a dramatic shift in the administration of the program. What had once been a model program to support recovery, ensure confidentiality and provide a path back to the bedside has devolved into one that is a roadblock to these very things.
Some examples include the loss of confidentiality for nurses enrolled in the program, the elimination of the substance abuse rehab executive committee, removal of the peer support groups as a requirement for participation in the program, consolidation of meeting and testing sites requiring nurses to travel long distances for testing and support, and policy changes that don't recognize addiction2535 as a potentially relapsing disease. In addition to2538 this, we've received numerous reports over the past few years about the unresponsive nature of the program. Nurses who call email and otherwise contact the program, get no response for weeks or months at a time.
Sometimes a response is not forthcoming until the nurse involves an attorney at great financial expense. This can and has led to an unnecessary extension to nurses' enrollment in the program. Another policy change regarding the nurses return to practice requires the nurse to receive BORN approval prior to accepting a position. Employers are unlikely to hold positions open for months while the SARP participant awaits approval.2580 So, due to SARP and BORN's extremely slow response times nurses lose out on these employment opportunities.
This creates a restriction of trade issue for the SARP participants and further hinders the nurse from returning to practice. Several nurses wanted to be here today to tell their stories, but they feared retaliation for speaking out. That in and of itself speaks volumes about what is wrong with this2603 program. In 2019, the MNA sent a letter to the BORN outlining these concerns. But nothing has changed.2608 A copy of this letter will be included with our written testimony and I'm here to implore you to take action. The program as currently administered is broken. Thank you.
SHOW NON-ESSENTIAL DIALOGUE
Uh, it's the chair. You're muted.
Thank you, apologies. Uh Miss Murphy thank you for your testimony. Do we have any questions from committee members.
Okay, before we continue with folks testifying on this bill. I do just want to recognize senator keenan who is going to testify on a bill notice. Senator Great,
[SEN KEENAN:] [SB1292] [HB2116] thank you Mr Chair chairs of the committee, I appreciate this opportunity test type briefly on Senate bill 1292 which is an act providing access to full spectrum addiction treatment services. And there's a companion bill, House 2116 I believe is a number that was filed by Representative Liz Malia. Back in back in 2014. You may recall that we passed Chapter 258 which was resulted to the legislature working with advocates to establish lifesaving coverage under Medicaid and commercial plans For addiction treatment up2688 to 14 days. There was no prior authorization required and this covered acute treatment services, ATS otherwise known as withdrawal management or detox and also clinical stabilization services.
Those two types of treatment basically gets you to about 14 days of treatment that is covered by insurers. And we know that that's not oftentimes enough in most cases is not enough. So, these limitations the 14 days only pose challenges for individuals who seek out substance use treatment and need longer than 14 days Of treatment. And we hear from the insurers that may oppose this act this piece of legislation rather that 14 days isn't working because it shows that people are being held longer than 14 days Well. And they'll also point out2735 that the data shows that those who are released at 14 days end up back in the emergency department. So 14 days isn't working.
Instead I think that clearly shows that 14 days is not working because 30 days is really what's needed. Certainly if somebody goes through detox and then2752 step down services and are released at 14 days, they are more prone to overdose, more prone to relapse and more likely to end up in emergency departments and more likely than to end up in detox services. It's what they call the spin cycle. You go in, you get some sort of and certainly not even treatment, but you get some sort of initial attention through detox and some treatment and then You're right back into the system again.
So this bill would require insurers to cover up to 30 days because again, 14 days doesn't work. It would cover transitional support services. And it would cover up the 30 days if the treating clinician deems it medically necessary without prior or preauthorizations. So it takes away the ability of insurance companies to say, well, we don't think that's necessary or we don't have time to review this for purposes of authorization. Can you hold for another day or two? And then there's that squeeze on those spaces that because we have so many people who are seeking treatment.
So we know that medication for opioid use disorder is, is the goal standard of care for individuals with2817 substance use disease. But um, But we also know that the treatment that works best for an individual can be one of many, whether it be 12 step medication intensive outpatient treatment or inpatient. And this bill would prevent individuals in treatment and recovery from leaving facilities before they are ready simply due to a lack of insurance. If inpatient treatment is what's best for them, This would ensure that they get 30 days of coverage. And there was a cost mandated benefit review2847 that was done2848 on this legislation and CHIA2849 had determined that premiums would have risen one to three cents per member per month had this bill been in effect in 2020.
Back in 1987. After many years of struggling with alcoholism, my father with kind of an impromptu intervention by my brothers and sisters and I finally decided to get treatment. After years of trying, after years of struggling with alcoholism, he finally decided to get treatment. And at that moment in 1987 we were able to pick up the phone and find him a bed And know that he had2890 30 days of coverage by his2892 insurance company. In 1987 that was pretty much the standard since then instead of going in the direction of offering more care and more coverage for people, we've retreated, we've gone backward. So that now we can't guarantee placement in a treatment program and we can guarantee that they'll be insurance coverage available. So I think it's it's critically important that we respect that everybody has a need perhaps for a different type of treatment. We have to find the2922 treatment that works best. And for those for whom inpatient treatment works best 30 days. It works better than 14 and that's what they should get. That's what should be covered. It's critically important. And I urge that the committee look at this legislation and vote it out favorably happy to answer any questions. Thank you.
SHOW NON-ESSENTIAL DIALOGUE
Thank you. Senator. Appreciate your testimony and your service on this committee. Any questions from committee members?
Okay, hearing none. We will go back to Representative O'Day's Bill H 21 23. Uh Next up, we'll hear from Georgia. Let
[GEORGEANNA LENT (GRANADA HOUSE):] [HB2123] Hi, thank you. My name is Georgeanna Lent. Um I'm honored to have been asked to testify on behalf of in support of Bill number 2123. I was, I am formally a peer support group facilitator for the SARP program. Um I wish that I could tell you better things about it, but I am here to tell you about what an absolute nightmare and horror show that program is and the damage that it does to nurses who are otherwise very good people. Um in my time working for SARP, I worked my contracted for SARP for three years. My initial hiring process consisted of being handed a file. I was never again ever contacted by anyone in SARP administration to have follow up.
There was never any training. There was never any expectation of curriculum. There was never any guidelines. I never received any handbooks. I never received any information about what even the SARP program was As it stands, I am somebody who has worked in the field of addiction recovery services for nearly 15 years. I am a licensed3019 drug and alcohol counselor license number 13200 as issued by the Department of Public Health. I am fluent in both state and federal policies that protect the privacy and the safety of addicts everywhere, including nurses and medical professionals. SARP has for the time that I have contracted with them and since left they stood in3043 violation of HIPAA as interpreting interpreted by 42 CMR part 2. Has disregarded the Americans with Disabilities Act has violated standards established by both the Department of Public Health and the Massachusetts Bureau of Substance Addiction Services.
They operate as if above and exempt from policies and protections that are set forth and enacted to protect persons with a disability of mental health or substance use disorder. Um Nurses when entering this program and through it are provided with absolutely no case management. As I've mentioned, I've worked in this field for nearly 15 years. I struggle to understand and navigate the channels of seeking treatment and understanding the nuances of insurance to pay for that treatment. These nurses are never given any case management, no support and absolutely no services to support their recovery.
At one point said very tongue in cheek to to somebody's voicemail as getting through to anybody in the SARP office is impossible that they should remove the R from the sharp. It should not be called a recovery or rehabilitation program as there is absolutely no recovery nor rehabilitation offered. Um, I have had nurses under my constituency who left the SARP program after due to medical conditions including simple menopause. Were not able to pass the urine screens um, dilution testers. There is an enzyme, a protein called creatinine and it is used to as a way to potentially identify if somebody is diluting a urine specimen given. Um, It is also a sign that a woman is going through menopause.
I had a nurse who had worked in the field for 30 years leave the program after experiencing something akin to a mental3146 a mental breakdown. I apologize, I'll wrap up um, after being going to be terminated from the program despite having doctor's notes from specialists and her primary care physician explaining why her creatinine level was consistently low. She was forced to pay $250 nearly weekly to do mandated testing, which she was then forced to do in front of a random lab technician because she was being accused of diluting her urines. Another friend of3170 mine in the SARP program currently waited 10 months to get a response back from SARP about whether or not she could apply for a job. She nearly lost her house as a result of not being able to get a job. I am begging you to please consider the overhaul of the nurses' programs. SARP as it stands, that is not only um damaging, it is akin to Gitmo Bay, there is no treatment, there's no recovery, only harm. I apologize for the time and I'm happy to answer any questions. Thank you.
SHOW NON-ESSENTIAL DIALOGUE
Thank you so much, much Miss Land for your important testimony and if you do have further comments please we welcome you to submit them in the written form. Uh do committee members have any questions from his lent?
Okay, seeing none, We will now shift back to representative Santiago stability testified at an earlier age 21 27 and its companion as 1316 and Act establishing a commission to study the availability of a continuum of care for persons with substance use3229 disorder. Uh Lydia Connolly president and Ceo of the Association for behavioral Health Care. Are you with us this morning this afternoon? I sure am.
[LYDIA CONLEY (ABH):] [HB2127] [SB1316] Thank you for3243 your good afternoon chair Cyr Chair Madaro Thank you for the3246 opportunity to testify in support of Senate 1316 and House 21 27 act establishing a commission to study the availability of continuum care for persons been substance use disorder. My name is Lydia Conley I'm the president and CEO of the Association for Behavioral Healthcare or ABH. Um as you may know, ABH Is a statewide association representing 80 community based mental health and addiction treatment provider organizations. Our members are the state's primary providers of publicly funded behavioral health care services. We serve approximately 81,000 Massachusetts residents every day in a million and a half annually.
Our members are the commonwealth's safety net system for people living with a mental health and or substance use disorder. And our substance use disorder treatment providers deliver services that span the treatment and recovery continuum from emergency services and acute treatment like clinically monitored withdrawal management to step down care into longer term residential recovery and outpatient programs.3300 This legislation would establish a3303 commission to study the availability of bedded emergency and outpatient substance use treatment services and would assess the appropriate statewide capacity for each level of3312 care.
The commission is made up of legislative leaders, state officials and a range of behavioral health clinical and advocacy organizations to inform that process. As representative Santiago noted, This commission would provide a necessary examination of the substance use treatment system that would aid the Commonwealth and providers with the data and resources necessary to conduct longer-term commissioning and planning around substance use continuum. For example, our members right now are reporting over 100 substance use disorder treatment beds currently offline solely due to staffing shortages. Um capacity and bedded programs. Additionally fluctuates due to covid precautions and public health requirements. So isolation and quarantine capacity.
However, without ongoing assessments of our capacity needs, it really is unclear how temporary and permanent bed closures are impacting the rest of the treatment system. This commission would provide a forum and a means of data collection that ABH and our members would find helpful ensuring that appropriate resources are being invested in the levels of care that need it most. And I would respectfully ask that the committee report these bills out favorably. Thank you for the opportunity to comment.
SHOW NON-ESSENTIAL DIALOGUE
Thank you mr Connolly Great to see you. Uh and before we open it up to questions, I just Representative Dave Rogers has joined us. He is here also to testify on this bill. So why don't we have the representative up and then3394 we can turn it over to questions for the committee. Representative Rogers,
[REP ROGERS:] [HB2127] [SB1316] Great chair Madaro and chair Cyr and uh thank you so much, I appreciate this opportunity. And as you just heard uh from his Connolly who did such a great job, the bill is an effort to uh have the commission3420 do a thoroughgoing3421 investigation and study of the full continuum of care for substance abuse treatment. And as I'm sure you know, we were making progress on the opioid crisis of course. Then the Covid hit and there's been some um backsliding sadly tragically and uh so I am hoping that the committee will give this bill a3448 favorable report so we can do as I say a really more thorough analysis of exactly the services available at all the levels of care.
Because um we know that addicts3463 and alcoholics and others suffering from substance abuse disorder, which of course is recognized by the American Medical3471 Association as a disease um it's not always treated um as a disease, it doesn't always get at all the various levels of care the attention it deserves. So we can save lives, we can make progress on fighting this scourge, and uh thanks for the opportunity to testify.
SHOW NON-ESSENTIAL DIALOGUE
Thank you Representative, do we have any questions from committee members for either rep Rogers or Miss Connolly Yeah.
Okay,
seeing none. Thank you both for your testimony. Thank you. I'm going to circle back to someone I actually missed in the list previously uh when we were taking testimony on age 21-23 Carol Malia resident nurse from the Massachusetts Nurses Association. Thank you. Can you hear me okay? Excellent,
[CAROL MALLIA (MNA):] [HB2123] thank you so much to the committee and Representative O'Day for shining a light on such an important issue. I'm here today to speak in support of House Bill 2123. The current substance abuse program administered by the Board of Nursing today is creating a public safety issue. My name is Carol Mallia I'm one of the associate directors in the division of Nursing at Massachusetts Nurses Association. For over 20 years I have been the program coordinator of the3557 MNA's peer assistance program which operates a free confidential program that is set up to help nurses who are struggling with the disease of addiction. Many of our original members were instrumental in setting up the alternative to discipline program that was one of the best in the country.
I can't say that today. The program has declined dramatically since 2016 with very punitive changes that were made. It was designed as a five year recovery program. It's now down3586 to two or three. Um The essential component of the program was the oversight committee known as the SAREC Committee um which Ms. Lent mentioned and the purpose of that3599 was to provide some confidentially and insulation to that disciplinary process. And at the peak of the SARP program, it was serving probably 500 nurses annually. Now it's closer to 50 because of the stigmatizing program and policies associated with this program.
So what started the decline. It started in 16 when they slowly eroded away with more and more punitive practices. Um they changed the licensing from pending on the website to putting it with disciplinary non disciplinary action with or without practices, a procedure that didn't need to happen and then removed the confidentiality for the nurse. Another treatment occurred or change occurred in 17 when they changed all the regionally located SAREC Committee. This was your oversight committee, moved it all into Boston, turned it into a hearing where nurses had to speak into a microphone. Very intimidating, not supportive in any nature whatsoever.
In 18, the mandate change that graduates needed to be approved by the Board of Nursing seemed simple enough. However, that removed the insulation between the BORN and the SARP program which was there under legislative guidelines. So they removed that installation The BORN records are public, which makes that a problem. They also, as the previous speakers mentioned, they have a return to work policy which is three steps all sounding great. But when you cannot get the BORN or SARP to answer the phone or return an email, most of these nurses lose positions.
It actually had calls to my peer assistant line from active members in the SARP program and I said get an attorney. It's the only way you're going to get a response. And they3707 did within 48 hours after chasing them for two and a half months to give a response. So the biggest change occurred basically in 19 March of 19 where they removed peer support groups who would do that, removing peer support out of a recovery based program. They removed the 20 groups that we had across the country across the state which were the only eyes and face to face as Ms. Lent mentioned is that this was the3735 key support network for nurses.
So basically the program is broken as you've heard from others. It was not even following nationally recognized standards. They don't have a SARP coordinator and they haven't since 18. The current acting person is an attorney with no expertise in addiction, multiple reports as I mentioned, not responding to emails and phone and the BORN has essentially removed the authoritative role of the experts they had employed which was the SAREC Committee. Those were the people who made the decisions.
Now everything goes to the BORN removing all insulation and confidentiality as a nurse with over 20 years experience one line one second I can see firsthand they're burdened by this and the stigma and the shame associated we3781 need to fix this. Send it to Committee for it to be reviewed and evaluated because there are better programs in the country that we could model after. Thank you for your time and I appreciate I went a little long thank you.
SHOW NON-ESSENTIAL DIALOGUE
thank you so much Miss Malia and I I apologize for the chamber that you hear going off we do have a limit of three minutes for testimony so if you have longer comments, please feel free to submit them in the written form and we'd be happy3812 to review them. Ok do we have any questions from committee members?
Alright seeing none. We are now going to circle back to Representative O'day's bill I believe. Uh no, I apologize Senator keenan bill, he testified a little bit of go on s 12 92 in its house companion3834 21 16 an act providing access to full spectrum addiction treatment services. We will now hear from julie bunch of the massachusetts the organization of addiction recovery boston and Northeast regional coordinator. Yeah
Mr country with us
julie bunch from Moore
Well while I do see3867 her on the list while we wait, I did see representative Kerans raised her hand. Did you have a question? I did thank you. Chair Madaro
[REP KERANS:] Just quickly. I'm sure any of you who testified on it could answer the SARP program is run right now by which entity
[MALLIA:] Okay well I'm happy to answer that. It's the Board of Registration and Nursing. It was set up in a legislative process to be separate insulated and confidential alternative to discipline is how it was originally set up. Unfortunately that is not what we can say today.
[KERANS:] Great3909 thank you.
SHOW NON-ESSENTIAL DIALOGUE
Thank you. Thank you. Sorry I didn't see your hand earlier. I was fumbling for the button. Sorry teams is not the easiest platform to use. Uh ok julie bunch I do see you on the list. I see that you're muted. Did you still want to testify? If so please on mute yourself and the floor is yours. Are you having a program?
Okay well we will move on and circle back in this bunch if you'd like to testify we'll come back to you or feel free to submit written testimony. If you no longer wish to provide oral feedback. We will now go back to a bill. Representative O'Day testified on age 21 22. And its Senate companion as 12 73. An act relative to the safe care of residents with active substance use disorder accessing skilled nursing facility care. First up, we will have Roseanna allow win um in uh a doctor for boston Medical Center, apologies if I mispronounced your name.
Um
Okay. We also have signed up to testify on3992 this bill side, parolee. Regional administrator Worcester are HCC Athena health care systems.
Mhm.
[SAEED POURALLI (WORCESTER RHCC):] [HB2122] Good afternoon, dear Chairman Cyr and Chairman Madaro and committee members. My name is Saeed Pouralli and I'm a licensed nursing home administrator at Worcester Rehab and I'm here to today to testify in strong support of Bill 2122 to enable and facilitate individuals with substance use disorder SUD accessing skilled nursing facility care. While Massachusetts, government entities have taken major steps in addressing SUD pandemic. The crisis is still continuing. The missing part of the Massachusetts effort is facilitating skilled nursing care facilities to manage SUD populations, physical clinical and behavioural issues Which could be addressed4052 through this Bill 2122.
Considering skilled nursing homes are subject to heavy regulations that are based on the needs of traditional nursing home population. The current regulations do not satisfy the process of providing needed care for patients with SUD diagnosis who require posts a huge care and long term care facilities. Therefore, the establishment of such criteria for specialty care unit for SUD population in long term care facilities including proper waivers and guidelines. As mentioned in this bill is essential. Athena Healthcare system is the leading skilled nursing care provider to SUD population.
Providing skilled nursing care to over 700 SUD individuals for more than two years. Has provided first-hand experience in challenges involving SUD crisis. In order to provide safe environment in which the SUD individuals experience judgment-free and residents center cave. We have added extra services to our operation including SUD counselor aftercare coordinator smoking attendance ambassador program and 24/7 security guards, which these extra experiences are not currently covered by MassHealth system. Based on our experience. It is important to point out the proper specialty SARP program Could be measured as caring for a for an average of 30 or more SUD residents within each facility as as well as providing essential extra services including SUD counselor aftercare coordinator or smoking attendance Ambassador Program and 24/7 Security Guards.
Our experience also indicates that the minimum extra added cost of care is about $35 per person per day. Therefore, the recommendation to MassHealth on funding a special Medicaid nursing facility. SUD rate addon is crucial for the success of such program. I thank you for the4184 opportunity to4185 testify today. I have submitted more detailed information to the committee and I will be available to provide further information as needed.
SHOW NON-ESSENTIAL DIALOGUE
Thank you. Just in the nick of time. Do we have any questions from the committee members?
Okay, seeing none. I did notice that dR law allowing has joined us. Um Are you able to testify? You having technical difficulties. But if you'd like to speak the floor is yours? Can you hear me now? Okay great. Sorry I was trying to push the buttons.
[ROSSANA LAU-NG (BMC):] [HB2122] [SB1273] Great well thank you very much chairman and committee members for your your attention today. My name is Dr Rossana Lau-Ng I am a geriatrician at Boston Medical Center in Boston University School of Medicine. I'm also the medical director for our nursing home program. And I see patients in skilled nursing facilities. So I have seen firsthand how the opioid crisis is spilling into the post acute and long term care setting for my patients. Um In Massachusetts, my patients with substance use disorder definitely have difficulty accessing post acute and skilled nursing facility services.
The barrier is multifaceted and unfortunately stigma and finances. Uh they do play a role. In terms of stigma I think there4281 is a huge need for education. This morning I was actually just holding an in service um at a nursing facility on the care of older adults with opioid use disorder. The staff were actually really interested in the topic. Some they were even affected personally from the opioid crisis. Even though this is not a new problem in general in the community it is a very very much a new population for the staff. Um No one has ever taught them what non stigmatizing words to use.
Why is it inappropriate to call somebody a junkie or call urine dirty. I mean I don't see mud in the urine. Why is it dirty? But these are some of the stigmatizing words that unfortunately that's that's what they hear. Another thing I see that my patients in the skilled nursing facility, they access care in different settings in the hospital, in the community. In order for a patient with substance use disorder to be successfully treated in the nursing home in the skilled nursing facility, there needs to be resources to support the facility's efforts. Um I've personally, for example, I personally connected nursing facilities with outpatient treatment programs or OTP for methadone dozing because the facilities they just don't even know who to talk to. I am in strong support of this bill. I think it is something that's sorely needed um for my patients for the facilities I I go to for the staff that I go to. Um and I thank you very much for hearing my testimony.
SHOW NON-ESSENTIAL DIALOGUE
Thank you dr allow and do we have any questions from the committee?
Okay, seeing none I'd like to invite up next to testify on this bill. Helen Malliotakis, director of regulatory affairs from Mass Senior Care.
[HELEN MAGLIOZZI (MA SENIOR CARE ASSOCIATION):] [HB2122] [SB1273] Thank you very much and thank you for pronouncing my name the way it is pronounced in Italy. Um So thank you for this opportunity on behalf of the Massachusetts Senior Care Association which represents nearly 350 long-term care facilities employing and caring for over 100,000 individuals. We appreciate the opportunity to testify in strong support of Senate Bill 1273 and House Bill 2122 acts relative to the safe care of residents4444 with active substance use disorder accessing skilled nursing care facility.
4448 These bills would establish a post acute care substance use disorder council, under the direction of the Department of Public Health,4454 to better meet the care needs of residents with opioid use disorder living in nursing facilities. The governor and the Legislature have made meaningful progress in addressing the increasing prevalence of opioid use disorder impacting our families and communities. Despite these efforts, skilled nursing facilities are increasingly receiving hospital referrals for younger residents with opioid use disorder who require skilled nursing care services for medical issues related to their opioid use disorder, such as injection site infections, cardiopulmonary complications due to chronic substance use injuries that require short term rehab or chronic disease management.
Yet government regulations for skilled nursing facilities were developed primarily to regulate the care for frail elders who are more dependent on activities of daily living with significant cognitive deficits and individuals with disabilities whose4512 daily care and medical needs can no longer be met at home. The legislatively proposed post-acute care substance use disorder council would work with the Department of Public Health to establish standards for special care units and skilled nursing facilities for the purpose of meeting the care needs of these residents with opioid use disorder who need post acute care.
Specifically the bill proposes that the Department of Public Health and the council make evidence based recommendations in the areas of counseling, assessment, visitation policies, room search policies, medication assisted therapy, staff, behavioral health training and care coordination to ensure safe discharge planning. In addition, the bill would direct the Department of Public Health and the council to develop a resource guide to a skill to assist skilled nursing facilities in accessing counseling services for residents and promote the safe discharge of residents with opioid use disorder.
Lastly, the proposed language directs the Department of Public Health and the council to take into account the physical impact on skilled nursing facilities specific to planning for and developing special care4582 units within their physical plant for the purpose of meeting the care needs of4587 residents with opioid use disorder? Mass. Senior care estimates that a Medicare rate add rate add on of not less than 30 $30 per day would be necessary to establish a specialized substance use disorder program to care for Medicaid rate. Residents with opioid use disorder.
Skilled nursing facilities continue to be strong healthcare partners and quickly respond to community health and social care needs. However, current regulations and inadequate funding remain as barriers for skilled nursing facilities to care for residents with opioid use disorder. We thank you again for the opportunity to submit oral testimony and we will be submitting written testimony as well. SHOW NON-ESSENTIAL DIALOGUE
Thank you for your testimony. Do we have any questions from committee members.
Okay,
seeing none. I do. Just want4637 to circle back to julie bunch. I've been seeing her name pop in and out on the attendees list. Not sure if there technical difficulties but did want to give you return to to speak if you'd still like to.
Mhm. Okay.
Yeah. Yeah
I'll make sure that the committee staff reaches out to miss bunch to figure out what was going on and at least ensure that we get4671 her testimony in the written form. Um I see
I believe that is uh that is everyone who has signed up to testify. Did we miss anyone who signed up? If so Please raise your hand.
Senator sheer anything on your end?
No I think this was a productive hearing. Thank you for those who testified. Very very helpful information. Right. Right well4713 thank you chair. Always a pleasure to host these hearings with you. I want to thank our fellow committee members for your indulgent work and of course I'd like to thank all of those who testified on these important matters today and for those of you4728 who may have got cut off a little bit from the three minute timer again if you4732 have further comments, please submit them in the written form and we'll certainly review the massive committee that basically concludes today's hearing. This is a pretty fast one. Thank you all for your engagement. Thank you for your patience as we work through some of the technical difficulties and we look forward to staying in touch with you all. Thank you. Thank you to the committee. Thanks robs. Take care a great day, folks.
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