SB 149-FN - AS INTRODUCED
2021 SESSION
21-1074
10/04
SENATE BILL 149-FN
AN ACT adopting omnibus legislation on health and human services.
SPONSORS: Sen. Sherman, Dist 24
COMMITTEE: Health and Human Services
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ANALYSIS
This bill adopts legislation relative to:
I. Nursing home standards.
II. Clarifying Medicaid spend-down requirements and requiring a report to the oversight
committee on health and human services.
III. Establishing a harm reduction and overdose prevention program in the department of
health and human services.
IV. Automated pharmacy systems.
V. Establishing a rehabilitation bed pilot program.
VI. Health facilities providing care in the declared emergency.
VII. Confidential sharing of information under the controlled drug prescription health and
safety program.
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Explanation: Matter added to current law appears in bold italics.
Matter removed from current law appears [in brackets and struckthrough.]
Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
 SB 149-FN - AS INTRODUCED
21-1074
10/04
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Twenty One
AN ACT adopting omnibus legislation on health and human services.
Be it Enacted by the Senate and House of Representatives in General Court convened:
1 1 Sponsorship. This act consists of the following proposed legislation:
2 Part I. LSR 21-0208, relative to nursing home standards, sponsored by Sen. Ward,
3 Prime/Dist 8.
4 Part II. LSR 21-0427, clarifying Medicaid spend-down requirements and requiring a report
5 to the oversight committee on health and human services, sponsored by Sen. Rosenwald, Prime/Dist
6 13; Sen. Hennessey, Dist 1; Sen. Whitley, Dist 15; Sen. Sherman, Dist 24; Sen. Bradley, Dist 3; Rep.
7 Guthrie, Rock. 13; Rep. McMahon, Rock. 7; Rep. Marsh, Carr. 8; Rep. Knirk, Carr. 3; Rep. Mullen,
8 Hills. 7.
9 Part III. LSR 21-0837, establishing a harm reduction and overdose prevention program in
10 the department of health and human services, sponsored by Sen. Watters, Prime/Dist 4; Sen.
11 Sherman, Dist 24; Sen. Whitley, Dist 15; Sen. D'Allesandro, Dist 20; Rep. Amanda Bouldin, Hills 12;
12 Rep. Woods, Merr. 23; Rep. Conley, Straf. 13.
13 Part IV. LSR 21-0936, relative to automated pharmacy systems, sponsored by Sen. Carson,
14 Prime/Dist 14.
15 Part V. LSR 21-0997, establishing a rehabilitation bed pilot program, sponsored by Sen.
16 Bradley, Prime/Dist 3.
17 Part VI. LSR 21-1006, relative to health facilities providing care in the declared emergency,
18 sponsored by Sen. Gray, Prime/Dist 6.
19 Part VII. LSR 21-0833, relative to confidential sharing of information under the controlled
20 drug prescription health and safety program, sponsored by Sen. Giuda, Prime/Dist 2; Sen.
21 Rosenwald, Dist 13; Sen. Carson, Dist 14; Sen. Prentiss, Dist 5; Sen. D'Allesandro, Dist 20; Sen.
22 Soucy, Dist 18; Rep. M. Pearson, Rock. 34; Rep. Marsh, Carr. 8; Rep. Merchant, Sull. 4.
23 2 Legislation Enacted. The general court hereby enacts the following legislation:
24
25 PART I
26 Relative to nursing home standards.
27 1 New Section; Nursing Home Facilities. Amend RSA 151 by inserting after section 12-b the
28 following new section:
29 151:12-c Placement in Nursing Home Facilities. A resident of New Hampshire who receives
30 Medicaid and who requires nursing home care shall not be placed in any out-of-state facility which
31 does not meet the requirements of this chapter and other standards of care under New Hampshire
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1 2 Effective Date. Part I of this act shall take effect January 1, 2022.
2
3 PART II
4 Clarifying Medicaid spend-down requirements
5 and requiring a report to the oversight committee on health and human services.
6 1 New Section; Spend-Down Requirements for Medical Expenses. Amend RSA 167 by inserting
7 after section 4-d the following new section:
8 167:4-e Spend-down Requirements for Medical Expenses. For the purposes of off-setting the
9 Medicaid spend-down requirements, mental health expenses shall be included as medical expenses.
10 2 Report to Oversight Committee on Health and Human Services.
11 I. The department of health and human services shall submit an interim report on or before
12 October 1, 2021, to the oversight committee on health and human services, established pursuant to
13 RSA 126-A:13, relative to actions taken to ensure the uniform application of spend-down
14 requirements. The report shall include a description of how spend-down requirements were
15 addressed in remedial staff training programs, updates to the policy manual, and updates to the
16 brochure and any other department publications.
17 II. The department shall submit a final report by October 1, 2022, on the application of
18 spend-down requirements. The report shall include data indicating how spend-down requirements
19 have been applied since the interim report was filed.
20 3 Effective date. Part II of this act shall take effect upon its passage.
21
22 PART III
23 Establishing a harm reduction and overdose prevention program
24 in the department of health and human services.
25 1 Findings. The legislature finds and declares all of the following:
26 I. Overdose deaths in New Hampshire are an urgent public health crisis. For many years,
27 overdose has been the leading cause of accidental death in the United States and in New Hampshire.
28 II. Harm reduction and overdose prevention programs (OPPs) are an evidence-based harm
29 reduction strategy that allow individuals to consume drugs in a hygienic environment under the
30 supervision of trained staff, who are able to intervene if the patient overdoses. OPPs also provide
31 sterile consumption equipment and offer general medical advice and referrals to drug treatment and
32 other community social services.
33 III. There are approximately 165 overdose prevention programs operating in 10 countries
34 around the world, and numerous peer-reviewed studies have confirmed that those programs are
35 effective in reducing overdose deaths and HIV transmission, and in increasing access to counseling,
36 treatment, and other risk reduction services. Research has also demonstrated that those programs
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1 decrease use of emergency medical services, reduce public drug use, reduce syringe debris, and do
2 not increase crime or drug use.
3 IV. An analysis published in the Journal of Drug Issues in 2016, OPPs in New Hampshire
4 would save the state and municipalities substantial funds by reducing other costs due to opioid use
5 and overdose.
6 V. An increase in overdose deaths was observed nationwide in 2020 according to the Office
7 of National Drug Control Policy, rising 16.6 percent, based on a comparison of January to April,
8 inclusive, of 2019 with the same time frame of 2020.
9 VI. As demands for reform of the criminal legal system reverberate around the country,
10 OPPs offer an alternative framework for addressing both drug use as well as the enforcement of drug
11 laws. OPPs bring people inside to a safe and therapeutic space, instead of leaving them vulnerable
12 to police intervention, arrest, and incarceration.
13 VII. It is the intent of the legislature to promote the health and safety of communities by
14 evaluating the health impacts of OPPs. It is the intent of the legislature to prevent fatal and
15 nonfatal drug overdoses, reduce drug use by providing a pathway to drug treatment, as well as
16 medical and social services for high-risk drug users, many of whom are homeless or uninsured or
17 very low income, prevent the transmission of HIV and hepatitis C, reduce nuisance and public safety
18 problems related to public use of controlled substances, reduce emergency room use and hospital
19 utilization related to drug use, reserving precious space, including intensive care beds, for treatment
20 of COVID-19, and other life-threatening conditions.
21 VIII. Further, it is the intent of the legislature that OPPs should be evaluated in New
22 Hampshire municipalities that authorize them, as OPPs show great promise to save lives, enhance
23 public safety, improve access to drug treatment, medical care, and related services, reduce
24 emergency department and hospital utilization related to drug overdose, and reduce the human,
25 social, and financial costs of epidemics of drug misuse, homelessness, and COVID-19.
26 2 New Subdivision; Harm Reduction and Overdose Prevention Programs. Amend RSA 318-B by
27 inserting after section 45 the following new subdivision:
28 Harm Reduction and Overdose Prevention Programs
29 318-B:45-a Harm Reduction and Overdose Prevention Programs
30 I.(a) Notwithstanding any other law, a New Hampshire municipality may approve entities
31 within its jurisdiction to establish and operate overdose prevention programs for persons 18 years of
32 age or older that satisfy the requirements set forth in paragraph IV.
33 II. Prior to approving an entity within its jurisdiction pursuant to paragraph I, a
34 municipality shall provide local law enforcement officials, local public health officials, and the public
35 with an opportunity to comment in a public meeting. The notice of the meeting to the public shall be
36 sufficient to ensure adequate participation in the meeting by the public. The meeting shall be
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1 noticed in accordance with all state laws and local ordinances, and as local officials deem
2 appropriate.
3 III.(a) The following entities, if self-funded, may operate an OPP upon approval of the
4 municipality’s governing body in New Hampshire to prevent the transmission of disease and reduce
5 morbidity and mortality among individuals who inject drugs:
6 (1) Federally qualified health centers.
7 (2) Community health centers.
8 (3) Public health networks.
9 (4) AIDS service organizations.
10 (5) Substance misuse support or treatment organizations.
11 (6) Community based organizations.
12 (b) The commissioner of the department of health and human services shall adopt rules,
13 pursuant to RSA 541-A, further defining the entities which may operate an overdose prevention
14 program.
15 IV. Any entity operating an OPP in New Hampshire shall:
16 (a) Provide a hygienic space supervised by health care professionals where people who
17 use drugs can consume pre-obtained drugs. For purposes of this paragraph, “health care
18 professional” includes, but is not limited to, a physician, physician assistant, nurse practitioner,
19 licensed vocational nurse, registered nurse, psychiatrist, psychologist, licensed clinical social worker,
20 licensed professional clinical counselor, mental health provider, social service provider, or substance
21 use disorder provider, trained in overdose recognition and reversal.
22 (b) Provide sterile consumption supplies, collect used hypodermic needles and syringes,
23 and provide secure hypodermic needle and syringe disposal services.
24 (d) Administer first aid, if needed, monitor participants for potential overdose, and
25 provide treatment as necessary to prevent fatal overdose.
26 (e) Provide referral and linkage to HIV, viral hepatitis, and substance use disorder
27 prevention, care, and treatment services, as appropriate.
28 (f) Coordinate and collaborate with other local agencies, organizations, and providers
29 involved in comprehensive prevention programs for people who inject drugs to minimize duplication
30 of effort.
31 (g) Attempt to be a part of a comprehensive service program that may include, as
32 appropriate:
33 (1) Providing sterile needles, syringes, and other drug preparation equipment and
34 disposal services.
35 (2) Educating and counseling to reduce sexual, injection, and overdose risks.
36 (3) Providing condoms to reduce risk of sexual transmission of viral hepatitis, HIV,
37 or other STDs.
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1 (4) Screening for HIV, viral hepatitis, STDs, and tuberculosis.
2 (5) Providing naloxone to reverse opioid overdoses.
3 (6) Providing referral and linkage to HIV, viral hepatitis, STD and tuberculosis
4 prevention, treatment, and care services, including antiretroviral therapy for hepatitis C virus
5 (HCV) and HIV, pre-exposure prophylaxis (PrEP), post-exposure prophylaxis (PEP), prevention of
6 mother-to-child transmission, and partner services.
7 (7) Providing referral and linkage to hepatitis A virus (HAV) and hepatitis B virus
8 (HBV) vaccination.
9 (8) Providing referral and linkage to and provision of substance use disorder
10 treatment including medication assisted treatment for opioid use disorder which combines drug
11 therapy such as methadone, buprenorphine, or naltrexone with counseling and behavioral therapy.
12 (9) Providing referral to medical care, mental health services, and other support
13 services.
14 (h) Post its address, phone number, program contact information, if appropriate, hours
15 of operation, and services offered on its Internet website.
16 (i) Provide reasonable security of the program site.
17 (j) Establish operating procedures for the program, made available to the public either
18 through an Internet website or upon request, that are publicly noticed, including, but not limited to,
19 standard hours of operation, a minimum number of personnel required to be on site during those
20 hours of operation, the licensing and training standards for staff present, an established maximum
21 number of individuals who can be served at one time, and an established relationship with the
22 nearest emergency department of a general acute care hospital, as well as eligibility criteria for
23 program participants.
24 (k) Train staff members to deliver services offered by the program.
25 (l) Establish a good neighbor policy that facilitates communication from and to local
26 businesses and residences, to the extent they exist, to address any neighborhood concerns and
27 complaints.
28 (m) Establish a policy for informing local government officials and neighbors about the
29 approved entity’s complaint procedures, and the contact number of the director, manager, or
30 operator of the approved entity.
31 (n) Register with the department of health and human services and confirm registration
32 annually on or before November 1 of each subsequent year; provided however, the registration
33 process shall be limited to notification to the department for data collection purposes only.
34 (o) Report quarterly to the department, which report shall include the following
35 information regarding the program's activities:
36 (1) The number of program participants.
37 (2) Aggregate information regarding the characteristics of program participants.
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1 (3) The number of hypodermic needles and syringes distributed for use on site.
2 (4) The number of overdoses experienced and the number of overdoses reversed on
3 site.
4 (5) The number of persons referred to substance misuse treatment/services.
5 (6) The number of individuals directly and formally referred to other services and
6 the type of service.
7 V. Notwithstanding any other law, a person or entity, including, but not limited to, property
8 owners, managers, employees, volunteers, clients or participants, and employees of the New
9 Hampshire municipalities, state agencies, hospitals, or overdose prevention programs, acting in the
10 course and scope of employment, shall not be arrested, charged, or prosecuted under RSA 318-B:2 for
11 possession of controlled substance