Introduced Version
Senate Bill 89 History
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Senate Bill No. 89
(By Senators Walters and Blair)
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[Introduced February 13, 2013; referred to the Committee on
Government Organization; and then to the Committee on Finance.]
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A BILL to amend and reenact §16-1-4 of the Code of West Virginia,
1931, as amended, relating to the state public health system;
proposal of rules by the secretary; and mandating requiring
the installation of water-free urinals in public rest areas,
institutions and schools.
Be it enacted by the Legislature of West Virginia:
That §16-1-4 of the Code of West Virginia, 1931, as amended,
be amended and reenacted to read as follows:
ARTICLE 1. STATE PUBLIC HEALTH SYSTEM.
§16-1-4. Proposal of rules by the secretary.
(a) The secretary may propose rules in accordance with the
provisions of article three, chapter twenty-nine-a of this code
that are necessary and proper to effectuate the purposes of this
chapter. The secretary may appoint or designate advisory councils of professionals in the areas of hospitals, nursing homes, barbers
and beauticians, postmortem examinations, mental health and
intellectual disability centers and any other areas necessary to
advise the secretary on rules.
(b) The rules may include, but are not limited to, the
regulation of:
(1) Land usage endangering the public health: Provided, That
no rules may be promulgated or enforced restricting the subdivision
or development of any parcel of land within which the individual
tracts, lots or parcels exceed two acres each in total surface area
and which individual tracts, lots or parcels have an average
frontage of not less than one hundred fifty feet even though the
total surface area of the tract, lot or parcel equals or exceeds
two acres in total surface area, and which tracts are sold, leased
or utilized only as single-family dwelling units. Notwithstanding
the provisions of this subsection, nothing in this section may be
construed to abate the authority of the department to:
(A) Restrict the subdivision or development of a tract for any
more intense or higher density occupancy than a single-family
dwelling unit;
(B) Propose or enforce rules applicable to single-family
dwelling units for single-family dwelling unit sanitary sewerage
disposal systems; or
(C) Restrict any subdivision or development which might endanger the public health, the sanitary condition of streams or
sources of water supply;
(2) The sanitary condition of all institutions and schools,
whether public or private, public conveyances, dairies,
slaughterhouses, workshops, factories, labor camps, all other
places open to the general public and inviting public patronage or
public assembly, or tendering to the public any item for human
consumption and places where trades or industries are conducted;
(3) Occupational and industrial health hazards, the sanitary
conditions of streams, sources of water supply, sewerage facilities
and plumbing systems and the qualifications of personnel connected
with any of those facilities, without regard to whether the
supplies or systems are publicly or privately owned; and the design
of all water systems, plumbing systems, sewerage systems, sewage
treatment plants, excreta disposal methods and swimming pools in
this state, whether publicly or privately owned: Provided, That
the rules shall require that when urinals in all public rest areas,
institutions and schools need to be replaced, they shall be
replaced with water free urinals;
(4) Safe drinking water, including:
(A) The maximum contaminant levels to which all public water
systems must conform in order to prevent adverse effects on the
health of individuals and, if appropriate, treatment techniques
that reduce the contaminant or contaminants to a level which will not adversely affect the health of the consumer. The rule shall
contain provisions to protect and prevent contamination of
wellheads and well fields used by public water supplies so that
contaminants do not reach a level that would adversely affect the
health of the consumer;
(B) The minimum requirements for: Sampling and testing; system
operation; public notification by a public water system on being
granted a variance or exemption or upon failure to comply with
specific requirements of this section and rules promulgated under
this section; record keeping; laboratory certification; as well as
procedures and conditions for granting variances and exemptions to
public water systems from state public water systems rules; and
(C) The requirements covering the production and distribution
of bottled drinking water and may establish requirements governing
the taste, odor, appearance and other consumer acceptability
parameters of drinking water;
(5) Food and drug standards, including cleanliness,
proscription of additives, proscription of sale and other
requirements in accordance with article seven of this chapter as
are necessary to protect the health of the citizens of this state;
(6) The training and examination requirements for emergency
medical service attendants and emergency medical care technician-
paramedics; the designation of the health care facilities, health
care services and the industries and occupations in the state that must have emergency medical service attendants and emergency
medical care technician-paramedics employed and the availability,
communications and equipment requirements with respect to emergency
medical service attendants and to emergency medical care
technician-paramedics. Any regulation of emergency medical service
attendants and emergency medical care technician-paramedics may not
exceed the provisions of article four-c of this chapter;
(7) The health and sanitary conditions of establishments
commonly referred to as bed and breakfast inns. For purposes of
this article, "bed and breakfast inn" means an establishment
providing sleeping accommodations and, at a minimum, a breakfast
for a fee. The secretary may not require an owner of a bed and
breakfast providing sleeping accommodations of six or fewer rooms
to install a restaurant-style or commercial food service facility.
The secretary may not require an owner of a bed and breakfast
providing sleeping accommodations of more than six rooms to install
a restaurant-type or commercial food service facility if the entire
bed and breakfast inn or those rooms numbering above six are used
on an aggregate of two weeks or less per year;
(8) Fees for services provided by the Bureau for Public Health
including, but not limited to, laboratory service fees,
environmental health service fees, health facility fees and permit
fees;
(9) The collection of data on health status, the health system and the costs of health care;
(10) Opioid treatment programs duly licensed and operating
under the requirements of chapter twenty-seven of this code.
(A) The Health Care Authority shall develop new certificate of
need standards, pursuant to the provisions of article two-d of this
chapter, that are specific for opioid treatment program facilities.
(B) No applications for a certificate of need for opioid
treatment programs may be approved by the Health Care Authority as
of the effective date of the 2007 amendments to this subsection.
(C) There is a moratorium on the licensure of new opioid
treatment programs that do not have a certificate of need as of the
effective date of the 2007 amendments to this subsection, which
shall continue until the Legislature determines that there is a
necessity for additional opioid treatment facilities in West
Virginia.
(D) The secretary shall file revised emergency rules with the
Secretary of State to regulate opioid treatment programs in
compliance with the provisions of this section. Any opioid
treatment program facility that has received a certificate of need
pursuant to article two-d of this chapter by the Health Care
Authority shall be permitted to proceed to license and operate the
facility.
(E) All existing opioid treatment programs shall be subject to
monitoring by the secretary. All staff working or volunteering at opioid treatment programs shall complete the minimum education,
reporting and safety training criteria established by the
secretary. All existing opioid treatment programs shall be in
compliance within one hundred eighty days of the effective date of
the revised emergency rules as required herein. The revised
emergency rules shall provide at a minimum:
(i) That the initial assessment prior to admission for entry
into the opioid treatment program shall include an initial drug
test to determine whether an individual is either opioid addicted
or presently receiving methadone for an opioid addiction from
another opioid treatment program.
(ii) The patient may be admitted to the opioid treatment
program if there is a positive test for either opioids or methadone
or there are objective symptoms of withdrawal, or both, and all
other criteria set forth in the rule for admission into an opioid
treatment program are met. Admission to the program may be allowed
to the following groups with a high risk of relapse without the
necessity of a positive test or the presence of objective symptoms:
Pregnant women with a history of opioid abuse, prisoners or
parolees recently released from correctional facilities, former
clinic patients who have successfully completed treatment but who
believe themselves to be at risk of imminent relapse and HIV
patients with a history of intravenous drug use.
(iii) That within seven days of the admission of a patient, the opioid treatment program shall complete an initial assessment
and an initial plan of care.
(iv) That within thirty days after admission of a patient, the
opioid treatment program shall develop an individualized treatment
plan of care and attach the plan to the patient's chart no later
than five days after the plan is developed. The opioid treatment
program shall follow guidelines established by a nationally
recognized authority approved by the secretary and include a
recovery model in the individualized treatment plan of care. The
treatment plan is to reflect that detoxification is an option for
treatment and supported by the program; that under the
detoxification protocol the strength of maintenance doses of
methadone should decrease over time, the treatment should be
limited to a defined period of time, and participants are required
to work toward a drug-free lifestyle.
(v) That each opioid treatment program shall report and
provide statistics to the Department of Health and Human Resources
at least semiannually which includes the total number of patients;
the number of patients who have been continually receiving
methadone treatment in excess of two years, including the total
number of months of treatment for each such patient; the state
residency of each patient; the number of patients discharged from
the program, including the total months in the treatment program
prior to discharge and whether the discharge was for:
(A) Termination or disqualification;
(B) Completion of a program of detoxification;
(C) Voluntary withdrawal prior to completion of all
requirements of detoxification as determined by the opioid
treatment program;
(D) Successful completion of the individualized treatment care
plan; or
(E) An unexplained reason.
(vi) That random drug testing of all patients shall be
conducted during the course of treatment at least monthly. For
purposes of these rules, "random drug testing" means that each
patient of an opioid treatment program facility has a statistically
equal chance of being selected for testing at random and at
unscheduled times. Any refusal to participate in a random drug
test shall be considered a positive test. Nothing contained in
this section or the legislative rules promulgated in conformity
herewith will preclude any opioid treatment program from
administering such additional drug tests as determined necessary by
the opioid treatment program.
(vii) That all random drug tests conducted by an opioid
treatment program shall, at a minimum, test for the following:
(A) Opiates, including oxycodone at common levels of dosing;
(B) Methadone and any other medication used by the program as
an intervention;
(C) Benzodiazepine including diazepam, lorazepan, clonazepam
and alprazolam;
(D) Cocaine;
(E) Methamphetamine or amphetamine;
(F) Tetrahydrocannabinol, delta-9-tetrahydrocannabinol or
dronabinol or other similar substances; or
(G) Other drugs determined by community standards, regional
variation or clinical indication.
(viii) That a positive drug test is a test that results in the
presence of any drug or substance listed in this schedule and any
other drug or substance prohibited by the opioid treatment program.
A positive drug test result after the first six months in an opioid
treatment program shall result in the following:
(A) Upon the first positive drug test result, the opioid
treatment program shall:
(1) Provide mandatory and documented weekly counseling of no
less than thirty minutes to the patient, which shall include weekly
meetings with a counselor who is licensed, certified or enrolled in
the process of obtaining licensure or certification in compliance
with the rules and on staff at the opioid treatment program;
(2) Immediately revoke the take home methadone privilege for
a minimum of thirty days; and
(B) Upon a second positive drug test result within six months
of a previous positive drug test result, the opioid treatment program shall:
(1) Provide mandatory and documented weekly counseling of no
less than thirty minutes, which shall include weekly meetings with
a counselor who is licensed, certified or enrolled in the process
of obtaining licensure or certification in compliance with the
rules and on staff at the opioid treatment program;
(2) Immediately revoke the take-home methadone privilege for
a minimum of sixty days; and
(3) Provide mandatory documented treatment team meetings with
the patient.
(C) Upon a third positive drug test result within a period of
six months the opioid treatment program shall:
(1) Provide mandatory and documented weekly counseling of no
less than thirty minutes, which shall include weekly meetings with
a counselor who is licensed, certified or enrolled in the process
of obtaining licensure or certification in compliance with the
rules and on staff at the opioid treatment program;
(2) Immediately revoke the take-home methadone privilege for
a minimum of one hundred twenty days; and
(3) Provide mandatory and documented treatment team meetings
with the patient which will include, at a minimum: The need for
continuing treatment; a discussion of other treatment alternatives;
and the execution of a contract with the patient advising the
patient of discharge for continued positive drug tests.
(D) Upon a fourth positive drug test within a six-month
period, the patient shall be immediately discharged from the opioid
treatment program or, at the option of the patient, shall
immediately be provided the opportunity to participate in a twenty-
one day detoxification plan, followed by immediate discharge from
the opioid treatment program: Provided, That testing positive
solely for tetrahydrocannabinol, delta-9-tetrahydrocannabinol or
dronabinol or similar substances shall not serve as a basis for
discharge from the program.
(ix) That the opioid treatment program must report and provide
statistics to the Department of Health and Human Resources
demonstrating compliance with the random drug test rules,
including:
(A) Confirmation that the random drug tests were truly random
in regard to both the patients tested and to the times random drug
tests were administered by lottery or some other objective standard
so as not to prejudice or protect any particular patient;
(B) Confirmation that the random drug tests were performed at
least monthly for all program participants;
(C) The total number and the number of positive results; and
(D) The number of expulsions from the program.
(x) That all opioid treatment facilities be open for business
seven days per week; however, the opioid treatment center may be
closed for eight holidays and two training days per year. During all operating hours, every opioid treatment program shall have a
health care professional as defined by rule promulgated by the
secretary actively licensed in this state present and on duty at
the treatment center and a physician actively licensed in this
state available for consultation.
(xi) That the Office of Health Facility Licensure and
Certification develop policies and procedures in conjunction with
the Board of Pharmacy that will allow physicians treating patients
through an opioid treatment program access to the Controlled
Substances Monitoring Program database maintained by the Board of
Pharmacy at the patient's intake, before administration of
methadone or other treatment in an opioid treatment program, after
the initial thirty days of treatment, prior to any take-home
medication being granted, after any positive drug test, and at each
ninety-day treatment review to ensure the patient is not seeking
prescription medication from multiple sources. The results
obtained from the Controlled Substances Monitoring Program database
shall be maintained with the patient records.
(xii) That each opioid treatment program shall establish a
peer review committee, with at least one physician member, to
review whether the program is following guidelines established by
a nationally recognized authority approved by the secretary. The
secretary shall prescribe the procedure for evaluation by the peer
review. Each opioid treatment program shall submit a report of the peer review results to the secretary on a quarterly basis.
(xiii) The secretary shall propose a rule for legislative
approval in accordance with the provisions of article three,
chapter twenty-nine-a of this code for the distribution of state
aid to local health departments and basic public health services
funds.
The rule shall include the following provisions:
Base allocation amount for each county;
Establishment and administration of an emergency fund of no
more than two percent of the total annual funds of which unused
amounts are to be distributed back to local boards of health at the
end of each fiscal year;
A calculation of funds utilized for state support of local
health departments;
Distribution of remaining funds on a per capita weighted
population approach which factors coefficients for poverty, health
status, population density and health department interventions for
each county and a coefficient which encourages counties to merge in
the provision of public health services;
A hold-harmless provision to provide that each local health
department receives no less in state support for a period of four
years beginning in the 2009 budget year.
The Legislature finds that an emergency exists and, therefore,
the secretary shall file an emergency rule to implement the provisions of this section pursuant to the provisions of section
fifteen, article three, chapter twenty-nine-a of this code. The
emergency rule is subject to the prior approval of the Legislative
Oversight Commission on Health and Human Resources Accountability
prior to filing with the Secretary of State.
(xiv) Other health-related matters which the department is
authorized to supervise and for which the rule-making authority has
not been otherwise assigned.
NOTE: The purpose of this bill is to require the installation
of water free urinals in public rest areas, institutions and
schools.
Strike-throughs indicate language that would be stricken from
the present law, and underscoring indicates new language that would
be added.