December 21, 2018
Playbook From The Well…

Friday, December 21, 2018



WVALHD endorses legislation allowing MAT

The legislative committee of the West Virginia Association of Local Health Departments, the trade association representing local health departments, is endorsing proposed legislation allowing LHDs to provide medication-assisted treatment for persons with substance abuse disorders. The legislation may be considered during the 2019 session.


In a letter to State Health Officer Dr. Catherine Slemp, commissioner of the Bureau for Public Health, WVALHD Legislative Committee Chairman Lloyd White writes, “The Legislative Committee of the West Virginia Association of Local Health Departments endorses … legislation allowing local health departments the option of providing medication-assisted treatment. The WVALHD will formalize the committee’s endorsement at a meeting scheduled Jan. 10, 2019.

“Thank you for seeking local health department input on this matter. We look forward to working closely with you on public health issues.”


In November, the Legislative Rule-Making Review Committee approved 69CSR12, the legislative rule relating to office-based medication-assisted treatment. The major rule revision comes about because of the passage by the legislature and approval by the governor of SB 273, the governor’s primary 2018 bill to address the state’s opioid crisis. Filed with the agency-approved rule—the second stage in the state’s convoluted rulemaking process–were 64 pages of comments.


According to the initial filing, “This rule is being amended to comply with changes made by the legislature…to significantly reduce the regulatory burden of the rule and to allow the exercise of professional discretion by medical practitioners.”

Committee counsel Jeff Johnson told committee members the rule allows providers to exercise professional discretion in many previously mandated areas. Johnson said DHHR agreed to an amendment to the rule requiring annual testing for long-term clients.


The WVALHD endorsement of medication-assisted treatment comes the same month the Bureau for Behavioral Health held meetings around the state explaining the availability of $28 million in federal funds during the next two years—with more funding on the horizon— to address the opioid epidemic.

The money may change the treatment paradigm in the minds of many recovery community veterans. The shift is away from abstinence and prevention toward medication-assisted treatment.


Beth Morrison, the BBF program manager, explained at a Charleston meeting that most past funding was directed toward prevention—keeping people from getting started on drugs. The new money will be used to prevent overdoses and overdose deaths.


Any MAT programs must offer the three drugs currently in the treatment pantheon: buprenorphine, methadone and naltrexone Counseling must be included in the treatment plan.


Finance Board okays payment bump for state-adjacent facilities

PEIA Finance Board members Thursday, in a brief meeting, rubber-stamped Gov. Jim Justice’s proposal to pay health-care providers in West Virginia-adjacent counties the same rate paid in-state providers. In- state providers are paid on an 80/20 basis: 80 percent is paid by PEIA; 20 percent is paid by the patient. The ratio is 70/30 for out-of-state providers. The governor’s proposals are not to be confused with the Governor’s PEIA Task Force proposals, which extended the 80/20 payment arrangement to all health providers in the PEIA system.


Joe Letnaunchyn, president of the West Virginia Hospital Association argued against extending the 80/20 coverage to all facilities. He said PEIA is the worst of the public payors and said extending the 80/20 rule to out-of-state facilities—that often charge more than PEIA pays in-state for the same services—would create a financial disparity and remove the incentive for PEIA members to go to in-state providers.


Dale Lee, president of the West Virginia Education Association, encouraged the Finance Board to accept the Task Force’s recommendations.


The Finance Board approved an appeal process for third-tier drugs, which are generally expensive, that PEIA officials predict will lower costs for about 70 percent of the PEIA clients now using them.


Task force subcommittee discusses legislative changes

A recently formed legislative subcommittee of the PEIA Task Force convened following the PEIA Finance Board to discuss, but not act upon, several proposals, mostly offered by task force member Perry Bryant.


One would put the PEIA coverage year on a calendar year schedule instead of its current fiscal year schedule. Bryant said this would allow more legislative input into the PEIA budget and would give PEIA staff and the Finance Board more time to act on annual PEIA plans. PEIA Executive Director Ted Cheatham did not argue against the change, but said he would present the committee with a list of pros and cons.


The major change is one dealing with semantics, but important semantics. PEIA is now statutorily locked into an 80/20 premium ratio between employers (mostly state and local governments), and employees. If the legislature appropriates more than 80 percent of the expected program costs, premiums automatically increase by 20 percent. If the legislature doesn’t put in enough money, PEIA can’t adjust premiums to make up the difference. The only alternative is to cut services.


One of Bryant’s proposals is to require the state to pay at least 80 percent of the premiums and employees to pay no more than 20 percent. The change would give the finance board some leeway in making program decisions.


All these proposals will be discussed by the Task Force at a meeting tentatively scheduled Jan. 08.



Cold weather could affect Naloxone. WOWK reports, “With colder temperatures approaching health officials are warning naloxone kits could be effected.”


Drone delivers vaccinations. The New York Times reports, “In the village of Cook’s Bay, on the remote side of the remote island of Erromango, in the remote South Pacific nation of Vanuatu, 1-month-old Joy Nowai was given shots for hepatitis and tuberculosis that were delivered by a flying drone…”


Extraordinarily improbable a first responder be poisoned by ultra-potent opioid. The New York Times reports, “’I would say it’s extraordinarily improbable that a first responder would be poisoned by an ultra-potent opioid,’ Dr. David Juurlink, a clinical researcher at Sunnybrook Health Sciences Centre in Toronto, said. ‘I don’t say it can’t happen. But for it to happen would require extraordinary circumstances, and those extraordinary circumstances would be very hard to achieve.’”


Surgeon general calls for all-hands-on deck to fight teen vaping. NBC reports, “Teen vaping has become a significant public health threat, the Surgeon General said.. , and an all-hands-on-deck response is needed to fight it.”



Hanshaw names new chairmen for Education, Finance. MetroNews reports, “The newly-shaped leadership team for the House of Delegates includes new chairmen of the key Finance and Education committees.”


New Mexico medical marijuana producer challenging state regulations. Santa Fe New Mexican reports, “Ultra Health, New Mexico’s largest producer and seller of medical marijuana, is challenging the way the state regulates makers of edibles, salves, lotions and other cannabis-infused products for sale in dispensaries.”


States ask federal judge to protect ACA coverage. The New York Times reports, “California and 15 other states asked a federal judge … to protect current health care coverage for millions of Americans while courts sort out the implications of his ruling that the Affordable Care Act was invalid in its entirety.”


…Five ways system would change with no replacement. Pacific Standard reports, “Describing all the possible effects of an ACA ‘repeal’ would take many thousands of words, but here are five of the biggest ways the U.S. health-care system would change If the ACA was simply eliminated with no replacement.”



Delaware clinics ensure women get same-day birth control. The New York Times reports, “When a woman of childbearing age goes to the doctor in most places, she gets standard queries about her smoking, drinking, seatbelt use and allergies. In Delaware, she is now also asked: ‘Do you want to get pregnant in the next year?’


“If her answer is no, clinics are being trained to ensure she gets whatever form of birth control she wants that very day, whether a prescription or an implant in her arm.”


Hep A cases spike across the nation. Route Fifty reports, “State and local health authorities across the nation have been reporting spikes in hepatitis A cases.”


Toronto Public Health says flu cases are noticeably higher than average. City News reports, “Toronto Public Health says there are a noticeably higher-than-average number of reported flu cases this year…”


Programming Note

Unless something meteoric occurs, our next publication date is Jan. 03, 2019.

Happy Holidays from all of us at H2C Strategies!

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