Requires insurers to file an annual report with the Insurance Commissioner demonstrating compliance with the requirement that coverage for biologically based mental illnesses be under the same terms and conditions as physical illnesses. The House amended the bill to instead add stricter requirements for mental health coverage to match primary care coverage. This bill also limits the ability of insurers to deny coverage for medication assisted treatment for substance use disorder.
Heroin Addiction: Treatment Funding
Heroin addiction can be treated through behavioral therapies or medication, or a combination of both.
- Medications like methadone can reduce withdrawal symptoms and craving or block opioid receptors in the brain so that heroin no longer has an effect on the user.
- Naloxone (Narcan) counteracts the effects of a heroin overdose and is often used as an emergency treatment.
- Both cognitive behavioral therapy and contingency management therapy have been used to effectively fight heroin addiction.
Addiction therapies can be delivered through either residential or outpatient programs.
Finding addiction treatment services in NH
Those seeking help with addiction to heroin or other drugs for themselves or a loved one can find immediate assistance through The Doorway. The program, launched in 2019, identifies hospitals around the state as "hubs" where those struggling with substance abuse issues can come at any time of day or night and be connected to resources for addiction treatment in their area. Patients can also get referrals for other recovery-related help such as job training, education, assistance with food or housing, childcare, and more. There are nine such "hubs" scattered across New Hampshire.
Learn more online or dial 2-1-1 for help.
Funding for treatment in NH
Actual costs of addiction treatment vary widely depending on the nature of the services required, but overall, the mean cost of treating addiction in New Hampshire is around $2,895 per person. Costs are higher for residential or intensive outpatient care, such as detoxification treatment.
The Affordable Care Act prevents insurance companies from turning away applicants based on their history of substance abuse and requires that all health care plans offered through state or federal insurance exchanges cover substance abuse treatment services at a level comparable to coverage for physical health services.
Medicaid expansion patients (under the New Hampshire Granite Advantage program) are covered for a range of substance abuse treatments, from counseling services, methadone or buprenorphine administration, and outpatient care to residential programs. Traditional Medicaid subscribers (under New Hampshire Healthy Families) may access a more limited range of services, which does not include ambulatory detox services. Limits and requirements for coverage vary.
Alcohol abuse prevention and treatment fund
In 2000, the Legislature authorized the creation of a dedicated fund for alcohol and drug abuse prevention, treatment and intervention (RSA 176-A:1). The fund is scheduled to receive 5% of profits from sales at state liquor stores, as well as a portion of funds from fines and penalties related to alcohol abuse or violations of alcoholic beverage laws. However, the fund only received its full statutory appropriation in 2003, the first year it was created. Since then, a portion of funds has regularly been diverted to the general fund or other line items.
Availability of treatment in NH
Insurance coverage for substance abuse treatment does not necessarily mean that such services are readily available. A 2014 survey by the New Hampshire Department of Health and Human Services found that:
- Demand currently exceeds capacity for residential substance abuse services and intensive outpatient counseling.
- The availability of services is not evenly distributed through the state.
- Some regions lack any residential treatment centers.
- Others have no providers of medication assisted treatment, or only one for the region.
- Some regions have low numbers of licensed drug counselors.
- Not all providers accept insurance or Medicaid, with 22% of independent providers and 13% of private practice groups only accepting self-pay patients.
- Many service providers plan to expand their capacity and/or range of offered services in the near future.
Possible policy responses
Suggested policy responses related to the expansion of heroin addiction treatment funding in New Hampshire include:
- Fully funding the Alcohol Abuse Prevention and Treatment Fund
- Continuing to renew Medicaid expansion
- Increasing substance abuse benefits for traditional Medicaid patients
- Simplifying licensing requirements for substance abuse treatment centers
- Increasing state subsidies for uninsured or underinsured patients
PROS & CONS
"NH should provide more funding for heroin treatment."
- Heroin treatment programs represent a smart investment, saving lives and reducing crime by reducing incarcerations and the risk of reoffending.
- Wait lists mean that patients seeking help may be turned away when they are in most need of assistance.
- Additional subsidies would help to expand capacity and subsidize the cost of treatment for those who cannot afford it.
- Funding is necessary to provide important services not normally covered by Medicaid or insurance, such as recovery programs or early intervention.
"More funding is not the answer to NH’s heroin problem."
- More money does not necessarily equal better results, and lawmakers should acquire data on the effectiveness of programs before approving increased funding.
- Drug treatment programs can serve as a ‘revolving door’, with patients relapsing and returning for additional services.
- Heroin addiction is a private problem based on an individual’s choice, so it should be an individual’s responsibility to find the funds for treatment.
- In tight budgetary times, there are higher priorities for limited state dollars than funding heroin treatment.
Requires insurers providing benefits for mental health and substance use disorders to reimburse covered individuals for benefits delivered through the collaborative care model.
Allows healthcare providers to prescribe medication to treat substance use disorder by telemedicine, so long as the provider has a special registration under federal law. The bill specifically allows telemedicine to prescribe medication for substance use disorder in county jails and state prisons, as well. According to the House committee, "this bill creates four safe harbors where opioids may be prescribed by telemedicine without an initial face-to-face visit so that we can expand the availability of medically assisted treatment (MAT) for substance use disorder in NH. This would allow MAT via telemedicine in Veterans Affairs (VA) clinics across our state, as is already happening in Maine. This would allow MAT via telemedicine in county correctional facilities, as qualified clinicians are not available everywhere. This would allow MAT via telemedicine in hospital emergency rooms (ER), as ER doctors are not trained in this field, and patients presenting to ERs need to initiate treatment when they need it. Lastly, it would allow MAT via telemedicine in each of the Doorways programs, expanding capacity in these programs. "
Establishes the New Hampshire drug overdose fatality review commission to review information and data related to drug overdose fatalities in New Hampshire.
Requires one of the public members of the board of licensing for alcohol and other drug use professionals to be a certified peer support specialist.
Authorizes the use of drug court funds in the circuit courts to establish family drug courts.
Requires insurance coverage for yoga therapy as an alternative or substitute for opioids.
Establishes an Opioid Abatement Trust Fund, funded by any lawsuits the state wins against opioid manufacturers or distributors. The fund would pay for programs associated with the prevention, treatment, and recovery of substance use disorders.
Transfers control over the Drug Forfeiture Fund from the Attorney General to the Governor and Executive Council. This bill also limits the use of the fund to either reimburse the costs arising from drug-related arrests and prosecutions or to fund programs designed to prevent drug use or prevent substance abuse disorders. At the time of this bill's submission the Drug Forfeiture Fund is also used to fund drug control law enforcement programs within New Hampshire.
Authorizes municipalities, governmental entities, and private entities to establish take-back programs for schedule I and unscheduled drugs.
Requires the courts to refer any minor with three or more alcohol and drug-related convictions to the Department of Health and Human Services for mental health and substance abuse evaluation. This bill also requires the courts to refer each minor for evaluation and treatment at least twice before proceeding with additional charges under the relevant section.
Prohibits health insurers from requiring prior authorization prior to emergency services, including transport, if emergency services are a covered benefit. This bill similarly prohibits health insurers from requiring prior authorization for medication-assisted treatment if substance use disorder services are a covered benefit.
Provides that qualified residential treatment programs accredited under federal law shall be deemed licensed under state law.
Modifies the circumstances under which a driver's license may be suspended or revoked, or restored. For example, this bill removes the authority to suspend a license solely for failure to pay a fine. The House amended the bill to study the creation of restricted driving licenses for participants in drug court.
Replaces references to "alcohol and drug free housing" with "recovery housing" in the law. This bill also requires the Department of Health and Human Services to adopt rules for the voluntary registration and certification of recovery housing.
Clarifies medication assisted treatment (MAT) by telemedicine and telehealth services.
Expands the family centered early supports and services program to children under the age of 3 who are born substance exposed. The House amended the bill to direct the Department of Health and Human Services to administer a family-centered early supports and services program for children with developmental delays, including children under 3 with prenatal substance exposure.
Establishes August 31 as Overdose Awareness Day.
Requires the superintendent of a county correctional facility to provide a prisoner with medication-assisted treatment for substance use disorders where medically appropriate.
Establishes a commission to create a New Hampshire recovery memorial.
Sends $5 million to the Department of Health and Human Services to create and upgrade substance use disorder treatment and recovery housing facilities.
Reduces the number of hours or work experience required for licensure as a master licensed alcohol and drug counselor, a licensed alcohol and drug counselor, a licensed clinical supervisor, a clinical social worker, and a clinical mental health counselor. The House amended the bill to instead provide that supervision of candidates for licensure as mental health counselors or alcohol and drug counselors shall be at locations convenient to both the supervisor and the candidate.
Constitutional amendment that requires 5% of liquor commission profits to go to alcohol and other drug abuse prevention, treatment, and recovery services.
Allows a municipality to adopt an ordinance regulating the occupancy and safety of sober living facilities. The House amended the bill to instead allow sober living facilities to apply to the state fire marshal for an exemption to local and state fire codes.
Establishes a committee to study the effect the opioid crisis and domestic violence has on New Hampshire children. The House amended the bill to specifically study "the effect of the opioid crisis, substance misuse, adverse childhood experiences (ACEs), and domestic violence as a cause of post-traumatic stress disorder syndrome (PTSD) and other mental health and behavioral problems in New Hampshire children and students."
Authorizes counties to establish drug and alcohol use prevention and treatment programs.
Authorizes municipalities, governmental entities, and private entities to establish take-back programs for illegal drugs.
Sends $3 million to the Department of Health and Human Services to raise reimbursement rates for mental health and addiction treatment services. The Senate amended the bill to also send $450,000 to the Department of Health and Human Services for "emergency shelter and stabilization services for persons experiencing substance misuse."
Clarifies that the Department of Health and Human Services may use federal or other funds to pay for needle exchange programs, but may not use money from the general fund of all tax revenue.
Permits the use of up to 10% of the Rainy Day Fund to address a public health emergency, as declared by the Governor or the Legislature.
Makes a supplemental appropriation to address estimated budget shortfalls in relation to the Sununu Youth Services Center. This bill also requires health care providers to report any child born with substance abuse or withdrawal symptoms and to develop a plan of safe care in conjunction with the Department of Health and Human Services. The Senate amended the bill to remove the funding for the Sununu Youth Services Center.
Requires the Department of Health and Human Services (DHHS) to establish a three year pilot program providing therapeutic intervention to infants diagnosed with neonatal abstinence syndrome (NAS). The Senate amended the bill to require DHHS to develop a plan for a pilot program, which would need approval from the legislature before it started.
Establishes a business tax credit for donations made to the Community Development Finance Authority for recovery friendly workplace initiatives. According to the bill, "'recovery friendly workplace initiatives' means evidence-based practices that reduce substance misuse in the workplace and create a work environment that is conducive to enabling persons in addiction and mental health recovery to sustain and re-enter the workforce as productive members of society."
Allows the Department of Health and Human Services to waive the work requirement in the child care scholarship program for applicants or recipients participating in a mental health or substance use treatment program. The child care scholarship program gives working parents under 250% of the federal poverty level financial assistance for child care.
Broadens a definition in the Safe School Zones law to require reporting of a broader list of crimes by school employees. The Senate amended the bill to allow needle exchange programs to operate within drug-free school zones with permission of the school district. The Senate voted down an amendment to this bill that would have allowed schools to ban firearms; current law allows adults with concealed carry permits to carry firearms on school grounds.
Makes various changes to the regulation of dentists and dental hygienists, including requiring criminal history records checks for new applicants. This bill also requires the Board of Dental Examiners provide a rehabilitative program for impaired dentists, including dentists with substance abuse disorder.
Creates a new account, funded by a surplus from the Children's Health Insurance Program, to fund more child protective service workers. In particular, this bill funds twenty-five new child protection social workers, two new supervisors, two new executive secretaries, two licensed alcohol and drug counselors, and two attorneys. The bill also authorizes $500,000 for foster care and adoption programs, $250,000 for home visiting services, $250,000 for child care services, and $1.5 million for voluntary services offered to families in "unfounded but with reasonable concern" cases of possible child abuse or neglect. The bill requires the state to pay for those voluntary services. This bill also authorizes $500,000 for the Department of Health and Human Services to develop community-based parental assistance programs. Much of this funding will come from federal Temporary Assistance for Needy Families (TANF) funds. Lastly, this bill establishes a committee to study family drug courts.
Directs the Juvenile Justice Advisory Board and the Governor's Commission on Alcohol and Drug Abuse Prevention, Treatment, and Recovery to develop a procedure to refer minors to the John H. Sununu Youth Services Center for drug treatment after being revived with Narcan.
Establishes the position of state demographer, establishes a commission on demographic trends, requires state agencies to prepare 10-year cost projections, and requires the legislative budget assistant to include demographic impact notes on legislation. A conference committee amended the bill to add many new provisions. First, the amendment raises some state employee salaries. The amended bill also appropriates $20 million for red list bridge repair and $10.4 million municipally-owned high traffic volume bridge projects, and sends $10 million to the Rainy Day Fund. Another $2.5 million is appropriated for transitional housing for those leaving mental health and substance use disorder treatment facilities. $300,000 is sent to the state loan repayment program, which helps employees in certain critical fields pay back student loans. The amended bill also appropriates $1 million to support "recovery friendly workplace programs" offered by nonprofits, such as programs that train employers how to reduce substance misuse in the workplace. Lastly, the conference committee revised the formula for "disproportionate share hospital payments," which go to hospitals for providing uncompensated care to low income patients.
Adds illicit drugs and drug paraphernalia to the drug take-back programs.
Constitutional amendment requiring 5% of liquor profits to be spent on alcohol and other drug abuse prevention, treatment, and recovery services.
Authorizes the Department of Health and Human Services to contract with a physician to provide guidance related to medication assisted treatment and non-medication related treatment for substance use disorders.
Requires the Department of Health and Human Services, in conjuction with the governor's Commission on Alcohol and Drug Abuse Prevention, Treatment and Recovery, to make an annual report on the cost effectiveness and outcomes of programs funded by the commission.
Establishes a nursing professionals' health program for aiding nurses impaired by mental or physical illness, including substance abuse. A similar program exists for physicians, dentists and pharmacists and is funded through their license fees.
Sends 40% of the money from the Drug Forfeiture Fund to the Alcohol Drug Abuse Prevention and Treatment Fund.
Increases the share of gross liquor profits deposited into the Alcohol Abuse Prevention and Treatment Fund, from 3.4% to 5%. This bill also repeals a law that gave the governor power to transfer funds to cover costs at the Sununu Youth Services Center in the event of an emergency. A conference committee amended the bill to instead appropriate up to $2.7 million for the Sununu Youth Services Center, require a monthly report from the Center, and establish a committee to study alternatives to the continued use Center.
Establishes a state substance use disorder treatment services program in the Department of Health and Human Services (DHHS). According to the House Executive Departments and Administration committee, the bill codifies DHHS oversight of drug and alcohol misuse treatment centers. This bill also adds a certified recovery support worker on the Board of Licensing for Alcohol and Other Drug Use Professionals. Lastly, this bill modifies the requirements for licensure as a clinical social worker, clinical mental health counselor, or marriage and family therapist, particularly the amount of training required.
Requires health carrier network adequacy rules to include access to providers for persons with substance use disorder. This bill also requires health carriers to notify covered persons of their rights, including the ability to appeal decisions and seek care out-of-network.
Declares that if substance use disorder services are a covered under a health benefit plan, prior authorization for prescribed medications for a substance use disorder is only required once a year.
Makes it easier for grandparents to get guardianship of grandchildren as the result of a parent's substance abuse or dependence.
Repeals the state definition of "mental illness" and replaces it with "mental disorders as defined by the Diagnostic and Statistical Manual of Mental Disorders fifth edition." This bill also allows involuntary commitment for opioid addiction.
Increases the percentage of the previous year's gross liquor profits deposited into the Alcohol Abuse Prevention and Treatment Fund, from 1.7% to 3.4%.
Legalizes trace amounts of drugs in needles, and authorizes persons other than pharmacists to dispense hypodermic syringes and needles. This bill would allow needle exchange programs.
Creates a dedicated fund for the bulk purchase of narcan and naloxone, so that the state can offer Narcan and naloxone at a discounted price. The fund would be supported by public and private sources including, but not limited to gifts, grants, donations, rebates, and funds from agreements or settlements received by the Department of Justice.
If a first responder administers Narcan to a youth age 14-17 for an overdose, this bill requires the state to assess whether the youth should be placed at the Sununu Youth Services Center.
Authorizes community-based needle exchange programs and requires the Department of Health and Human Services to develop rules for such programs.
Requires treatment and recovery programs for substance abuse disorders to use an integrative approach, including homeopathic remedies, when treating patients.
Establishes the position of licensed alcohol and drug counselor in the Department of Safety. The person holding the position shall be responsible for establishing a training program for fire and emergency medical services personnel and developing a pilot program through which local communities hire licensed alcohol and drug counselors.
Establishes a commission to study long-term peer-to-peer recovery services in New Hampshire.
Requires public schools to provide age appropriate drug and alcohol education to pupils in kindergarten through grade 12.
Makes some changes to the licensing of alcohol and drug counselors.
Establishes the statewide drug court grant program.
This bill includes many regulations aimed at combating heroin and prescription drug abuse. For example, this bill increases the penalties for abusing fentanyl and provides funding for an upgrade to the Prescription Drug Monitoring Program.
Requires the insurance commissioner to investigate insurance carriers for conduct which may violate the provisions of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008.
Provides that evidence of a parent's opioid drug abuse creates a presumption of harm under the Child Protection Act. The bill also permits the court to order periodic alcohol or drug testing and provides that the parent may be responsible for the cost of such tests.
Revises prior authorization requirements under the managed care law for substance use services.
Appropriates $51,520 in the biennium ending June 30, 2017 to the TIGER (educational theatre) program at Plymouth State University and establishes the heroin and opiate prevention education (HOPE) grant program for public high schools.
Makes a general fund appropriation of $2 million to the Housing Finance Authority to fund supportive housing for persons with substance use disorders.
Requires the Department of Health and Human Services to evaluate the cost effectiveness of alcohol and drug abuse prevention, recovery, and treatment programs which receive state or federal funds, and requires organizations receiving such funds to spend the money on the most cost effective programs.
Originally written to make various changes to the Prescription Drug Monitoring Program. The Senate amended the bill to instead create a commission to study the overdose-reversing drug Narcan.
Allows the county convention in each county to establish heroin use prevention and treatment programs.
Requires hospitals in Hillsborough county to offer patients who have received Narcan for a drug overdose an opportunity to speak with a recovery coach or receive contact information for a recovery coach.
Expands drug take-back programs to include drugs such as cocaine.
Constitutional amendment that prohibits use of money from the substance abuse treatment fund for anything other than substance abuse treatment.
Increases access to overdose-reversing drugs such as Narcan by allowing doctors to pescribe to friends, family members of addicts.
Establishes a committee to study opioid misuse.
Should NH increase funding for heroin treatment programs?
Currently, the federal government limits using Medicaid to pay for mental health treatment to facilities with 16 beds or less. NH is applying for a waiver that would allow the state to use Medicaid to pay for treatment at places with more beds.
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