The Vermont Statutes Online

Title 18: Health

Chapter 093: Opioid Use Disorder

• Subchapter 001: Treatment of Opioid Use Disorder

• § 4750. Definitions

  As used in this chapter:

  (1) “Health insurance plan” has the same meaning as in 8 V.S.A. § 4089b.

  (2) “Medication for opioid use disorder” means the use of U.S. Food and Drug Administration-approved medications, in combination with counseling and behavioral therapies, to provide a whole patient approach to the treatment of substance use disorders. (Added 2017, No. 153 (Adj. Sess.), § 1a, eff. May 21, 2018; amended 2017, No. 176 (Adj. Sess.), § 2; 2019, No. 14, § 51, eff. April 30, 2019; 2019, No. 43, § 2; 2023, No. 22, § 6a, eff. May 25, 2023.)

• § 4751. Purpose

  It is the purpose of this chapter to authorize the Departments of Health and of Vermont Health Access to establish a regional system of opioid addiction treatment. (Added 2011, No. 135 (Adj. Sess.), § 1, eff. May 14, 2012; amended 2015, No. 173 (Adj. Sess.), § 3.)

• § 4752. Opioid use disorder treatment system

  (a) The Departments of Health and of Vermont Health Access shall establish by rule in accordance with 3 V.S.A. chapter 25 a regional system of opioid use disorder treatment.

  (b) The rules may address requirements for pharmacological treatment, including initial assessments, ongoing follow-up, provider education, and diversion prevention.

  (c) Controlled substances for treating opioid use disorder shall be dispensed only by:

  (1) a treatment program authorized by the Department of Health; or

  (2) a health care provider who is not affiliated with an authorized treatment program but who meets federal requirements for use of controlled substances in the pharmacological treatment of opioid use disorder.

  (d) Controlled substances for use in treatment of opioid use disorder may be prescribed via telehealth in accordance with federal requirements.

  (e) The Department of Vermont Health Access or the Department’s pharmacy benefits manager shall not require a health care provider to document a patient’s adverse reaction to a medication prior to prescribing an alternative medication for opioid use disorder to the patient. (Added 2011, No. 135 (Adj. Sess.), § 1, eff. May 14, 2012; amended 2015, No. 173 (Adj. Sess.), § 3; 2023, No. 22, § 6b, eff. May 25, 2023.)

• § 4753. Care coordination

  Prescribing physicians and collaborating health care and addictions professionals may coordinate care for patients receiving medication for opioid use disorder, which may include monitoring adherence to treatment, coordinating access to recovery supports, and providing counseling, contingency management, and case management services. (Added 2015, No. 173 (Adj. Sess.), § 3; amended 2023, No. 22, § 6c, eff. May 25, 2023.)

• § 4754. Limitation on prior authorization requirements

  (a) A health insurance plan shall not require prior authorization for prescription drugs for a patient who is receiving medication-assisted treatment if the dosage prescribed is within the U.S. Food and Drug Administration’s dosing recommendations.

  (b) A health insurance plan shall not require prior authorization for all counseling and behavioral therapies associated with medication-assisted treatment for a patient who is receiving medication-assisted treatment. (Added 2019, No. 43, § 3, eff. Jan. 1, 2020.)

• Subchapter 002: Opioid Settlement

• § 4771. Purpose

  It is the purpose of this subchapter to comply with any opioid litigation settlements to which the State or municipalities within the State were a party regarding the management and expenditure of monies received by the State. While an opioid litigation settlement may designate a portion of the monies for local or State use, this subchapter applies to only monies from abatement accounts funds. (Added 2021, No. 118 (Adj. Sess.), § 1, eff. May 16, 2022.)

• § 4772. Opioid Settlement Advisory Committee

  (a) Creation. There is created the Opioid Settlement Advisory Committee to provide advice and recommendations regarding remediation spending from the Opioid Abatement Special Fund established pursuant to this subchapter.

  (b) Membership.

  (1) The Advisory Committee shall be composed of the following members and shall reflect the diversity of Vermont in terms of gender, race, age, ethnicity, sexual orientation, gender identity, disability status, and socioeconomic status and ensure inclusion of individuals with lived experience of opioid use disorder and their family members whenever possible:

  (A) the Commissioner of Health or designee, who shall serve as a nonvoting chair;

  (B) the Chief Prevention Officer established pursuant to 3 V.S.A. § 2321;

  (C) one current member of the House of Representatives, appointed by the Speaker of the House;

  (D) one current member of the Senate, appointed by the Committee on Committees;

  (E) a primary care prescriber with experience providing medication-assisted treatment within the Blueprint for Health hub and spoke model, appointed by the Executive Director of the Blueprint for Health, to provide a statewide perspective on the provision of medication-assisted treatment services;

  (F) a provider with academic research credentials, appointed by the University of Vermont, to provide a statewide perspective on academic research relating to opioid use disorder;

  (G) two individuals with lived experience of opioid use disorder, including at least one of whom is in recovery, one member appointed by the Howard Center’s Safe Recovery program and one member appointed by the Vermont Association of Mental Health and Addiction Recovery, to provide a statewide perspective on the experience of living with opioid use disorder;

  (H) an assistant judge, appointed by the Vermont Association of County Judges; and

  (I) seven individuals, each employed by or an agent of a different city or town that collectively reflect Vermont’s diverse population and geography, appointed by the Vermont League of Cities and Towns.

  (2)(A) The term of office of each appointed member shall be four years. Of the members first appointed, eight shall be appointed for a term of three years and eight shall be appointed for a term of four years. Members shall hold office for the term of their appointments and until their successors have been appointed. All vacancies shall be filled for the balance of the unexpired term in the same manner as the original appointment. Members are eligible for reappointment.

  (B) A member may be removed from the Advisory Committee by the member’s appointing entity for cause, which includes only neglect of duty, gross misconduct, conviction of a crime, or inability to perform the responsibilities of the office. The Chair of the Advisory Committee shall simultaneously notify the Governor, the Speaker of the House, and the President Pro Tempore that the member has been removed from the Advisory Committee.

  (c) Powers and duties. The Advisory Committee shall demonstrate broad ongoing consultation with individuals living with opioid use disorder about their direct experience with related systems, including medication-assisted treatment, residential treatment, recovery services, harm reduction services, overdose, supervision by the Department of Corrections, and involvement with the Department for Children and Families’ Family Services Division. To that end, the Advisory Committee shall demonstrate consultation with individuals with direct lived experience of opioid use disorder, frontline support professionals, the Substance Misuse Oversight Prevention and Advisory Council, and other stakeholders to identify spending priorities as related to opioid use disorder prevention, intervention, treatment, and recovery services and harm reduction strategies for the purpose of providing recommendations to the Governor, the Department of Health, and the General Assembly on prioritizing spending from the Opioid Abatement Special Fund. The Advisory Committee shall consider:

  (1) the impact of the opioid crisis on communities throughout Vermont, including communities’ abatement needs and proposals for abatement strategies and responses;

  (2) the perspectives of and proposals from opioid use disorder prevention coalitions, recovery centers, and medication-assisted treatment providers; and

  (3) the ongoing challenges of the opioid crisis on marginalized populations, including individuals who have a lived experience of opioid use disorder.

  (d) Assistance. The Advisory Committee shall have the administrative, technical, and legal assistance of the Department of Health.

  (e) Presentation. Annually, the Advisory Committee shall present its recommendations for expenditures from the Opioid Abatement Special Fund established pursuant to this subchapter to the Department of Health and concurrently submit its recommendations in writing to the House Committees on Appropriations and on Human Services and the Senate Committees on Appropriations and on Health and Welfare.

  (f) Meetings.

  (1) The Commissioner of Health shall call the first meeting of the Advisory Committee to occur on or before June 30, 2022.

  (2) The Advisory Committee shall meet at least quarterly but not more than six times per calendar year.

  (3) The Advisory Committee shall adopt procedures to govern its proceedings and organization, including voting procedures and how the staggered terms shall be apportioned among members.

  (4) All meetings of the Advisory Committee shall be consistent with Vermont’s Open Meeting Law pursuant to 1 V.S.A. chapter 5, subchapter 2.

  (g) Compensation and reimbursement.

  (1) For attendance at meetings during adjournment of the General Assembly, a legislative member of the Advisory Committee serving in the member’s capacity as a legislator shall be entitled to per diem compensation and reimbursement of expenses pursuant to 2 V.S.A. § 23 for not more than six meetings per year. These payments shall be appropriated from the Opioid Abatement Special Fund.

  (2) Other members of the Advisory Committee shall be entitled to per diem compensation and reimbursement of expenses as permitted under 32 V.S.A. § 1010 for not more than six meetings per year. These payments shall be appropriated from the Opioid Abatement Special Fund. (Added 2021, No. 118 (Adj. Sess.), § 1, eff. May 16, 2022.)

• § 4773. Designation of lead State agency

  The Department of Health shall serve as the lead State agency and single point of contact for submitting requests for funding to the national settlement fund administrator. Approved requests shall be disbursed to the Department for deposit into the Opioid Abatement Special Fund established in section 4774 of this subchapter. (Added 2021, No. 118 (Adj. Sess.), § 1, eff. May 16, 2022.)

• § 4774. Opioid Abatement Special Fund

  (a)(1) There is created the Opioid Abatement Special Fund, a special fund established and managed pursuant to 32 V.S.A. chapter 7, subchapter 5 and administered by the Department of Health. The Opioid Abatement Special Fund shall consist of all abatement account fund monies disbursed to the Department from the national abatement account fund, the national opioid abatement trust, the supplemental opioid abatement fund, or any other settlement funds that must be utilized exclusively for opioid prevention, intervention, treatment, recovery, and harm reduction services.

  (2) The Department shall submit a spending plan to the General Assembly, informed by the recommendations of the Opioid Settlement Advisory Committee established pursuant to section 4772 of this subchapter, annually on or before January 15 and once funding is appropriated by the General Assembly from the Opioid Abatement Special Fund, the Department shall request to have the funds formally released from the national abatement account fund, the national opioid abatement trust, the supplemental opioid abatement fund, or any other settlement funds that must be utilized exclusively for opioid prevention, intervention, treatment, recovery, and harm reduction services. The Department shall disburse monies from the Opioid Abatement Special Fund pursuant to 32 V.S.A. chapter 7, subchapter 3.

  (3) Disbursements from the Opioid Abatement Special Fund shall supplement and not supplant or replace any existing or future local, State, or federal government funding for infrastructure, programs, supports, and resources, including health insurance benefits, federal grant funding, and Medicaid and Medicare funds.

  (b) Expenditures from the Opioid Abatement Special Fund shall be used for the following opioid prevention, intervention, treatment, recovery, harm reduction, and evaluation activities:

  (1) preventing overdose deaths and other harms;

  (2) treatment of opioid use disorder;

  (3) support for individuals in treatment and recovery and their families;

  (4) connecting individuals who need help to the help needed;

  (5) addressing the needs of criminal justice-involved persons;

  (6) addressing the needs of pregnant or parenting individuals and their families, including babies with neonatal abstinence syndrome;

  (7) preventing overprescribing and ensuring appropriate prescribing and dispensing of opioids;

  (8) preventing the misuse of opioids;

  (9) educating law enforcement and other first responders regarding appropriate practices and precautions when dealing with fentanyl or other drugs and providing wellness and support services for first responders and others who experience secondary trauma associated with opioid-related emergency events;

  (10) supporting efforts to provide leadership, planning, coordination, facilitation, training, and technical assistance to abate the opioid epidemic;

  (11) researching opioid abatement;

  (12) implementing other evidence-based or evidence-informed programs or strategies that support prevention, harm reduction, treatment, or recovery of opioid use disorder and any co-occurring substance use or mental health disorder; and

  (13) the cost of the administrative, technical, and legal assistance provided to the Advisory Committee by the Department of Health.

  (c) Priority for expenditures from the Opioid Abatement Special Fund shall be aimed at reducing overdose deaths, including the following:

  (1) promoting the appropriate use of naloxone and other U.S. Food and Drug Administration-approved drugs to reverse opioid overdoses, specifically:

  (A) expanding training for first responders, schools, community support groups, families; and

  (B) increasing distribution to individuals who are uninsured or whose health insurance does not cover the needed goods and services;

  (2) increasing access to medication-assisted treatment and other opioid-related treatment, specifically:

  (A) increasing distribution of medication-assisted treatment to individuals who are uninsured or whose health insurance does not cover the needed goods and services;

  (B) providing education to school-based and youth-focused programs that discourage or prevent misuse, including how to access opioid use disorder treatment;

  (C) providing medication-assisted education and awareness training to health care providers, emergency medical technicians, law enforcement, and other first responders; and

  (D) providing treatment and recovery support services, such as residential and inpatient treatment, intensive outpatient treatment, outpatient therapy or counseling, and recovery housing that allows or integrates medication and other support services;

  (3) assisting pregnant and postpartum individuals, specifically:

  (A) enhancing services for expanding screening, brief intervention, and referral to treatment (SBIRT) services to non-Medicaid-eligible or uninsured pregnant individuals;

  (B) expanding comprehensive evidence-based or evidence-informed treatment and recovery services, including medication-assisted treatment, for individuals with co-occurring opioid use disorder and other substance or mental health disorders for up to 12 months postpartum; and

  (C) providing comprehensive wraparound services to pregnant and postpartum individuals with opioid use disorder, including housing, transportation, job placement, training, and child care;

  (4) expanding treatment for neonatal abstinence syndrome (NAS), specifically:

  (A) expanding comprehensive evidence-based or evidence-informed recovery support for babies with NAS;

  (B) expanding services for better continuum of care to address infant needs and support the parent-child relationship; and

  (C) expanding long-term treatment and services for medical monitoring of babies with NAS and their families;

  (5) expanding the availability of warm handoff programs and recovery services, specifically:

  (A) expanding services such as navigators and on-call teams to begin medication-assisted treatment in hospital emergency departments;

  (B) expanding warm handoff services to transition to recovery services;

  (C) broadening the scope of recovery services to include co-occurring substance use disorder or mental health conditions;

  (D) providing comprehensive wraparound services to individuals in recovery, including housing, transportation, job placement, training, and child care; and

  (E) hiring additional workers to facilitate the expansions listed in this subdivision (5);

  (6) treating incarcerated populations, specifically:

  (A) providing evidence-based or evidence-informed treatment and recovery support, including medication-assisted treatment for individuals with opioid use disorder or co-occurring substance use or mental health disorders while transitioning out of the criminal justice system; and

  (B) increasing funding for correctional facilities to provide treatment and recovery support to inmates with opioid use disorder;

  (7) supporting prevention programs, specifically:

  (A) funding for media campaigns to prevent opioid misuse;

  (B) funding for evidence-based or evidence-informed prevention in schools;

  (C) funding for health care provider education and outreach regarding best prescribing practices for opioids consistent with current Department of Health and U.S. Centers for Disease Control and Prevention guidelines, including providers at hospitals;

  (D) funding for community drug disposal programs; and

  (E) funding and training for first responders to participate in pre- arrest diversion programs, post-overdose response teams, or similar strategies that connect at-risk individuals to mental health services and supports;

  (8) expanding syringe service programs, specifically providing comprehensive syringe services programs with more wraparound services, including linkages to opioid use disorder treatment, access to sterile syringes, and linkages to care and treatment of infectious diseases; and

  (9) facilitating evidence-based or evidence-informed data collection and research analyzing and evaluating the effectiveness of the abatement strategies within Vermont. (Added 2021, No. 118 (Adj. Sess.), § 1, eff. May 16, 2022; amended 2023, No. 22, § 13, eff. May 25, 2023.)