EXPLANATION: CAPITALS INDICATE MAT TER ADDED TO EXISTIN G LAW. [Brackets] indicate matter deleted from existing law. Underlining indicates amendments to bill. Strike out indicates matter stricken from the bill by amendment or deleted from the law by amendment. Italics indicate opposite chamber/conference committee amendments. *sb1071* SENATE BILL 1071 J1, J3 (4lr1663) ENROLLED BILL — Finance/Health and Government Operations — Introduced by Senator McKay Read and Examined by Proofreaders: _______________________________________________ Proofreader. _______________________________________________ Proofreader. Sealed with the Great Seal and presented to the Governor, for his approval this _______ day of _______________ at _________________ _______ o’clock, ________M. ______________________________________________ President. CHAPTER ______ AN ACT concerning 1 Hospitals – Opioid Overdose – Medication–Assisted Treatment and 2 Opioid–Related Emergency Medical Conditions – Treatment 3 FOR the purpose of requiring hospitals to establish and maintain certain protocols and 4 capacity related to the treatment of patients who are being treated for an 5 opioid–related overdose or opioid–related emergency medical condition; requiring 6 hospitals to connect make a referral for patients who are diagnosed with opioid use 7 disorder or administered or prescribed medication–assisted treatment medication 8 for opioid use disorder to an appropriate provider to voluntarily continue treatment 9 in the community under certain circumstances and work with peer support 10 professionals for a certain purpose; requiring the Governor to include in the annual 11 budget bill for a certain fiscal year a certain appropriation from the Opioid 12 Restitution Fund for hospitals to provide training and resources to implement the 13 requirements of this Act; and generally relating to hospitals and treatment for opioid 14 use disorder and opioid–related emergency medical conditions. 15 2 SENATE BILL 1071 BY adding to 1 Article – Health – General 2 Section 19–308.10 3 Annotated Code of Maryland 4 (2023 Replacement Volume) 5 BY repealing and reenacting, with amendments, 6 Article – State Finance and Procurement 7 Section 7–331 8 Annotated Code of Maryland 9 (2021 Replacement Volume and 2023 Supplement) 10 SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 11 That the Laws of Maryland read as follows: 12 Article – Health – General 13 19–308.10. 14 (A) (1) IN THIS SECTION THE FOLLOWING WORDS HAVE THE MEANINGS 15 INDICATED. 16 (2) “MEDICATION” MEANS, “MEDICATION FOR OPIOI D USE 17 DISORDER”: 18 (1) MEANS A DRUG APPROVED BY T HE U.S. FOOD AND DRUG 19 ADMINISTRATION FOR TH E TREATMENT OF OPIOI D USE DISORDER ; AND 20 (2) DOES NOT INCLUDE A DR UG ADMINISTERED TO M ITIGATE 21 OPIOID–RELATED OVERDOSE SYM PTOMS. 22 (3) “MEDICATION–ASSISTED TREATMENT ” MEANS THE USE OF 23 MEDICATION, IN COMBINATION WITH COUNSELING AND BEHAV IORAL HEALTH 24 THERAPIES, TO PROVIDE A HOLISTI C APPROACH TO THE TR EATMENT OF OPIOID US E 25 DISORDER. 26 (4) “OPIOID USE DISORDER ” MEANS A MEDICALLY DI AGNOSED 27 PROBLEMATIC PATTERN OF OPIOID USE THAT C AUSES A SIGNIFICANT IMPAIRMENT 28 OR DISTRESS. 29 (B) EACH HOSPITAL SHALL E STABLISH AND MAINTAI N, AS PART OF ITS 30 EMERGENCY SERVICES , PROTOCOLS AND CAPACI TY TO: 31 SENATE BILL 1071 3 (1) PROVIDE TO A PATIENT BEFORE DISCHARGING T HE PATIENT 1 APPROPRIATE , EVIDENCE–BASED INTERVENTIONS THAT REDUCE THE RISK OF 2 SUBSEQUENT HARM AND FATALITY FOLLOWING A N OPIOID–RELATED OVERDOSE OR 3 A VISIT FOR AN OPIOI D–RELATED EMERGENCY ME DICAL CONDITION ; 4 (2) POSSESS, DISPENSE, ADMINISTER, AND PRESCRIBE 5 MEDICATION–ASSISTED TREATMENT , INCLUDING AT LEAST ONE FORMULA TION OF 6 EACH U.S. FOOD AND DRUG ADMINISTRATION –APPROVED FULL OPIOID AGONIST, 7 AND PARTIAL OPIOID AGONI ST, AND LONG–ACTING OPIOID ANTAGO NIST USED FOR 8 THE TREATMENT OF OPIOID USE DISORDER ; AND 9 (3) TREAT A PATIENT WHO P RESENTS IN A HOSPITA L EMERGENCY 10 DEPARTMENT FOR CARE AND TREATMENT OF AN OPIOID–RELATED OVERDOSE OR 11 OPIOID–RELATED EMERGENCY ME DICAL CONDITION WITH A MEDICATION FOR 12 OPIOID USE DISORDER IF THE TREATMENT : 13 (I) OCCURS AS RECOMMENDED BY THE TREATING HEAL TH 14 CARE PRACTITIONER ; AND 15 (II) IS VOLUNTARILY AGREED TO BY THE PATIENT . 16 (C) A PROTOCOL ESTABLISHED BY A HOSPITAL UNDER THIS SECTION SHALL 17 COMPLY WITH INCLUDE: 18 (1) APPLICABLE TRAINING AND WAIVER REQUIREME NTS 19 ESTABLISHED BY THE F EDERAL DRUG ENFORCEMENT AGENCY; AND 20 (2) ANY REQUIREMENT BY TH E DEPARTMENT REGARDING 21 PRESCRIBING OPIOID A GONIST TREATMENT ; 22 (2) UNIFORM PRACTICES FOR SCREENING AND DIAGNO SING 23 INDIVIDUALS WHO PRES ENT WITH AN O PIOID–RELATED OVERDOSE OR 24 OPIOID–RELATED EMERGENCY ME DICAL CONDITION FOR AN OPIOID USE DISORD ER 25 BASED ON THE CRITERI A IN THE MOST RECENT EDITION OF THE DIAGNOSTIC AND 26 STATISTICAL MANUAL OF MENTAL DISORDERS; 27 (3) UNIFORM PRACTICES FOR OFFERING AND ADMINI STERING 28 OPIOID AGONIST MEDIC ATION TO TREAT AN OP IOID–RELATED OVERDOSE OR 29 OPIOID USE DISORDER ; AND 30 (4) UNIFORM PRACTICES TO IDENTIFY COMMUNITY –BASED 31 TREATMENT SERVICES T HAT ARE APPROPRIATE FOR: 32 (I) TREATING OPIOID USE D ISORDERS; AND 33 4 SENATE BILL 1071 (II) ASSISTING PATIENTS TO VOLUNTARILY ACCESS O NGOING 1 COMMUNITY –BASED TREATMENT AT D ISCHARGE. 2 (D) BEFORE DISCHARGING A PATIENT WHO IS DIAGNOSED WITH AN OP IOID 3 USE DISORDER OR ADMINISTERED OR PRES CRIBED MEDICATION–ASSISTED 4 TREATMENT MEDICATION FOR OPIOI D USE DISORDER, A HOSPITAL SHALL CONNECT 5 THE PATIENT WITH AN APPROPRIATE PROVIDER OR FACILITY TO VOLUN TARILY 6 CONTINUE TREATMENT : 7 (1) MAKE A REFERRAL OF TH E PATIENT TO AN APPR OPRIATE 8 PROVIDER OR FACILITY FOR A TIMELY APPOINT MENT, WHEN POSSIBLE , TO 9 VOLUNTARILY CONTINUE TREATMENT I N THE COMMUNITY ; AND 10 (2) WORK WITH PEER SUPPOR T PROFESSIONALS , AS AVAILABLE, OR 11 OTHER RESOURCES TO A SSIST THE PATIENT IN ACCESSING THE IDENTI FIED 12 TREATMENT SERVICES . 13 Article – State Finance and Procurement 14 7–331. 15 (a) In this section, “Fund” means the Opioid Restitution Fund. 16 (b) There is an Opioid Restitution Fund. 17 (c) The purpose of the Fund is to retain the amount of settlement revenues 18 deposited to the Fund in accordance with subsection (e)(1) of this section. 19 (d) (1) The Fund is a special, nonlapsing fund that is not subject to § 7–302 of 20 this subtitle. 21 (2) The State Treasurer shall hold the Fund separately, and the 22 Comptroller shall account for the Fund. 23 (e) The Fund consists of: 24 (1) all revenues received by the State from any source resulting, directly or 25 indirectly, from any judgment against, or settlement with, opioid manufacturers, opioid 26 research associations, or any other person in the opioid industry relating to any claims 27 made or prosecuted by the State to recover damages for violations of State law; and 28 (2) the interest earnings of the Fund. 29 (f) The Fund may be used only to provide funds for: 30 SENATE BILL 1071 5 (1) programs, services, supports, and resources for evidence–based 1 substance use disorder prevention, treatment, recovery, or harm reduction that have the 2 purpose of: 3 (i) improving access to medications proven to prevent or reverse an 4 overdose; 5 (ii) supporting peer support specialists and screening, brief 6 intervention, and referral to treatment services for hospitals, correctional facilities, and 7 other high–risk populations; 8 (iii) increasing access to medications that support recovery from 9 substance use disorders; 10 (iv) expanding the Heroin Coordinator Program, including for 11 administrative expenses; 12 (v) expanding access to crisis beds and residential treatment 13 services for adults and minors; 14 (vi) expanding and establishing safe stations, mobile crisis response 15 systems, and crisis stabilization centers; 16 (vii) supporting the behavioral health crisis hotline; 17 (viii) organizing primary and secondary school education campaigns 18 to prevent opioid use, including for administrative expenses; 19 (ix) enforcing the laws regarding opioid prescriptions and sales, 20 including for administrative expenses; 21 (x) research regarding and training for substance use treatment and 22 overdose prevention, including for administrative expenses; and 23 (xi) supporting and expanding other evidence–based interventions 24 for overdose prevention and substance use treatment; 25 (2) evidence–informed substance use disorder prevention, treatment 26 recovery, or harm reduction pilot programs or demonstration studies that are not 27 evidence–based if the Opioid Restitution Fund Advisory Council, established under § 28 7.5–902 of the Health – General Article: 29 (i) determines that emerging evidence supports the distribution of 30 money for the pilot program or that there is a reasonable basis for funding the 31 demonstration study with the expectation of creating an evidence–based program; and 32 6 SENATE BILL 1071 (ii) approves the use of money for the pilot program or demonstration 1 study; and 2 (3) evaluations of the effectiveness and outcomes reporting for substance 3 use disorder abatement infrastructure, programs, services, supports, and resources for 4 which money from the Fund was used, including evaluations of the impact on access to 5 harm reduction services or treatment for substance use disorders and the reduction in 6 drug–related mortality. 7 (g) (1) The State Treasurer shall invest the money of the Fund in the same 8 manner as other State money may be invested. 9 (2) Any interest earnings of the Fund shall be credited to the Fund. 10 (h) (1) Expenditures from the Fund may be made only in accordance with the 11 State budget. 12 (2) FOR FISCAL YEAR 2026, THE GOVERNOR SHALL INCLUD E IN THE 13 ANNUAL BUDGET BILL A N APPROPRIATION OF $500,000 FROM THE FUND TO 14 PROVIDE TRAINING AND RESOURCES TO HOSPITA LS TO IMPLEMENT THE 15 REQUIREMENTS OF § 19–308.10 OF THE HEALTH – GENERAL ARTICLE. 16 [(2)] (3) For settlement funds received in accordance with the final 17 distributor agreement of July 21, 2021, with McKesson Corporation, Amerisource Bergen 18 Corporation, and Cardinal Health Incorporated, as amended, the Janssen settlement 19 agreement of July 21, 2021, as amended, or any other opioid–related court or 20 administrative judgment or settlement agreement involving the State and one or more of 21 its political subdivisions: 22 (i) appropriations from the Fund in the State budget shall be made 23 in accordance with the allocation and distribution of funds to the State and its political 24 subdivisions: 25 1. as agreed on in the State–subdivision agreement of 26 January 21, 2022, as amended; or 27 2. required under any other opioid –related court or 28 administrative judgment or settlement agreement, or any similar agreement reached under 29 an opioid–related court or administrative judgment or settlement agreement, involving the 30 State and one or more of its political subdivisions; and 31 (ii) the Secretary of Health shall establish and administer a grant 32 program for the distribution of funds to political subdivisions of the State in accordance 33 with: 34 SENATE BILL 1071 7 1. the State–subdivision agreement of January 21, 2022, as 1 amended; or 2 2. the requirements of any other opioid–related court or 3 administrative judgment or settlement agreement, or any similar agreement reached under 4 an opioid–related court or administrative judgment or settlement agreement, involving the 5 State and one or more of its political subdivisions. 6 [(3)] (4) The Attorney General shall identify and designate the 7 controlling version of any agreement or amendment described under paragraph [(2)] (3) of 8 this subsection. 9 (i) (1) Money expended from the Fund for the programs and services described 10 under subsection (f) of this section is supplemental to and is not intended to take the place 11 of funding that otherwise would be appropriated for the programs and services. 12 (2) Except as specified in subsection (f) of this section, money expended 13 from the Fund may not be used for administrative expenses. 14 (j) The Governor shall: 15 (1) develop key goals, key objectives, and key performance indicators 16 relating to substance use treatment and prevention efforts; 17 (2) subject to subsection [(h)(2)] (H)(3) of this section, at least twice 18 annually, consult with the Opioid Restitution Fund Advisory Council to identify 19 recommended appropriations from the Fund; and 20 (3) report on or before November 1 each year, in accordance with § 2–1257 21 of the State Government Article, to the General Assembly on: 22 (i) an accounting of total funds expended from the Fund in the 23 immediately preceding fiscal year, by: 24 1. use; 25 2. if applicable, jurisdiction; and 26 3. budget program and subdivision; 27 (ii) the performance indicators and progress toward achieving the 28 goals and objectives developed under item (1) of this subsection; and 29 (iii) the recommended appropriations from the Fund identified in 30 accordance with item (2) of this subsection. 31 8 SENATE BILL 1071 SECTION 2. AND BE IT FURTHER ENACTED, Th at: 1 (a) The Maryland Department of Health shall study whether and how funding 2 from the Opioid Restitution Fund can be used to provide training and resources to hospitals 3 to implement Section 1 of this Act, including a recommended funding amount. 4 (b) On or before January 1, 2025, the Department shall report its findings and 5 recommendations to the Senate Finance Committee and House Health and Government 6 Operations Committee, in accordance with § 2–1257 of the State Government Article. 7 SECTION 3. AND BE IT FURTHER ENACTED, That Section 1 of this Act shall take 8 effect January 1, 2025. 9 SECTION 2. 4. 2. AND BE IT FURTHER ENACTED, That , except as provided in 10 Section 3 of this Act, this Act shall take effect October 1, 2024 January 1, 2025. 11 Approved: ________________________________________________________________________________ Governor. ________________________________________________________________________________ President of the Senate. ________________________________________________________________________________ Speaker of the House of Delegates.