A4749

An Act concerning the coordinated provision of mental health services, substance use disorder treatment services, and reentry services in each county and supplementing Title 30 of the Revised Statutes.

Be It Enacted by the Senate and General Assembly of the State of New Jersey:

1. The Legislature finds and declares the following:

a. The opioid epidemic, declared to be a national public health emergency in 2017, has become a defining health issue in New Jersey and the nation and has resulted in more than 200,000 deaths over the last two decades.

b. Over 2.1 million Americans currently suffer from an opioid use disorder, more than 70,000 die per year from opioid addiction, and an opioid overdose death now occurs less than every 11 minutes across the nation, a rate that exceeds the death rate experienced at the height of the HIV/AIDS epidemic.

c. The overwhelming majority of fatalities in New Jersey are now opioid-related. From January 2014 to June 2018, the State suffered 9,512 fatalities from opioid overdose, five times more than the number of deaths that resulted from both car accidents and firearms, respectively.

d. The State and nation have experienced consistently rising costs associated with drug use, disorders, and overdoses. New Jersey spends $635 million per year on inpatient and emergency department overdose visits alone. The State additionally spends approximately $217 million per year in association with the incarceration, parole, and probation of persons who engage in drug-related crimes, and it loses an estimated $1.2 billion in productivity every year as a result of the inability of individuals to contribute to the workforce because they are being treated for substance use disorders, are incarcerated in prisons, are residing in halfway houses, or have died from addiction.

e. The Governor’s Council on Alcoholism and Drug Abuse (GCADA) has indicated that the State has insufficient treatment capacity and quality standards, has insufficient access to effective and affordable treatment, and provides insufficient intervention and support services for the populations most vulnerable to addiction.

f. According to the New Jersey Substance Abuse Monitoring System, there are currently 384 total providers of substance use disorder treatment in the State, 244 of which are fee-for-service (FFS), State-contracted sites. Among these providers, 27 offer long-term residential treatment, 18 offer short-term residential treatment, 309 offer intensive outpatient treatment, 35 offer outpatient opioid maintenance treatment, 18 offer detoxification services, and 24 are halfway houses. Of the 244 FFS providers in the State, only 54 offer any form of medication-assisted treatment (MAT), which is deemed to be the gold standard of care for the effective treatment of opioid use disorders. In addition, less than half of these providers offer mentoring services, peer support services, employment services, and housing assistance services, and only 60 percent offer referrals to social service providers.

g. Nearly 90 percent of the substance use disorder treatment costs expended by the State are for services utilized by individuals who have already received some form of treatment, but for whom initial treatment was ineffective.

h. The number of patients who need substance use disorder treatment and do not receive it has increased steadily in recent years, with 41.4 percent of patients self-reporting in 2016 that they did not receive necessary care.

i. Forty percent of adults with a substance use disorder also have a co-occurring mental health disorder, which often makes it more difficult for them to overcome addiction. In order to ensure that these individuals are capable of successfully completing substance use disorder treatment, it is important to ensure that patients with co-occurring disorders have sufficient access to coordinated mental health care and substance use disorder treatment as may be necessary to properly and contemporaneously address all of their co-occurring conditions.

j. Substance use and co-occurring mental health disorders are particularly acute among the population that is involved with the justice system. Approximately 70 percent of incarcerated individuals suffer from addiction, and at least a quarter are addicted to opioids. Moreover, the rate of co-occurring disorders is significantly higher in the incarcerated population than in the general population.

k. Incarceration typically compounds the dangers associated with an opioid use disorder, as appropriate treatment is often lacking in correctional facilities. Fewer than 30 of the more than 5,100 prisons and jails in the United States currently offer inmates the medication-assisted treatment that is most effective in treating these disorders.

l. Despite the high rate of addiction in New Jersey’s incarcerated population, the State’s prison system currently has dedicated beds sufficient to provide substance use disorder treatment to only 3.9 percent of the existing prison population.

m. The risk of drug relapse and overdose skyrockets for recently incarcerated individuals, because these individuals have a lower tolerance to their drugs of choice and often lack access to appropriate medication. Fewer than 10 percent of previously incarcerated individuals in New Jersey enter substance use disorder treatment following their release from incarceration, and nearly 75 percent of previously incarcerated individuals with an opioid use disorder relapse within three months of release from incarceration. The risk of overdose death for the reentry population is approximately 130 times greater than the risk posed to the general population, and many reentry clients die of overdose within weeks of rejoining the community. Such deaths are only likely to increase as highly potent synthetic opioids, such as fentanyl, continue to flood the market.

n. Because addiction often leads to incarceration, and because neither incarcerated individuals nor individuals released from incarceration have sufficient access to appropriate care for their substance use disorders or co-occurring mental illnesses, addiction can, and often does, lead to a recurring cycle where a person with a substance use disorder is incarcerated, released, recidivates, and is re-incarcerated, without ever receiving the care the person needs to escape this cycle.

o. For the foregoing reasons, it is both reasonable and necessary for the Legislature to facilitate the improved, coordinated provision of mental health and substance use disorder treatment in the State, particularly for those persons who are reentering the community following incarceration, by requiring each county to establish a local committee to identify and redress weaknesses in each county’s system of care and to take other appropriate action to coordinate the provision of mental health care services, substance use disorder treatment services, and reentry services at the local level.

2. a. Within one year after the effective date of this act, the governing body of each county in the State shall, by duly adopted ordinance or resolution, establish a Reentry, Mental Health, and Addiction Services Coordination Committee. Each such committee shall be responsible for implementing and overseeing a local service coordination program to ensure and facilitate the more effective, efficient, and coordinated provision of mental health care services, substance use disorder treatment services, and reentry services by relevant service providers in the county, with a particular focus on the coordination of care and services offered to individuals who are reentering the community following a period of incarceration.

b. A Reentry, Mental Health, and Addiction Services Coordination Committee established pursuant to this section shall be composed of a minimum of five members, to be appointed by the county board of freeholders or the county executive, as the case may be. Each committee’s membership shall include, but need not be limited to: at least one mental health care professional who works and resides in the county; at least one substance use disorder treatment professional who works and resides in the county and has particular expertise in the treatment of opioid use disorders; and at least one professional who works and resides in the county and is either employed by the New Jersey Reentry Corporation or otherwise provides direct assistance to individuals who are reentering the community after a period of incarceration.

c. A Reentry, Mental Health, and Addiction Services Coordination Committee established pursuant to this section shall have the duty to:

(1) identify, and designate as authorized service providers in the county’s service coordination program: (a) all county-based non-profit organizations, private physicians, hospitals, psychiatric facilities, federally qualified health centers (FQHCs), certified community behavioral health clinics (CCBHCs), detoxification centers, peer support and self-help groups, and other entities, whether public or private and whether operating on a for-profit or not-for-profit basis, which are engaged in the provision of mental health care services, substance use disorder treatment services, or associated support services in the county; and (b) all entities, whether public or private and whether operating on a for-profit or not-for-profit basis, which are engaged in the provision of reentry services to county residents who are reentering to the community following a period of incarceration;

(2) annually perform a community needs assessment to evaluate the level of need that exists for mental health and substance use disorder treatment services in the county, with a particular, but non-exclusive, focus on evaluating the level of need that is evident among county residents who are reentering the community following a period of incarceration;

(3) annually identify gaps and weaknesses that are preventing or limiting the effective, efficient, and coordinated provision of mental health care services, substance use disorder treatment services, and reentry services in the county to persons who are in need of such services, and develop and implement plans, strategies, and guidelines to address and eliminate those gaps and weaknesses;

(4) develop and annually update a comprehensive service blueprint that identifies and describes all existing mental health, substance use disorder treatment, and reentry services and resources that are available in the county, as well as the location where each type of service or resource can be obtained and the coordinated care linkages that exist to facilitate a person’s transfer or warm hand-off between and among available service types and providers. The service blueprint shall specifically highlight the services, resources, and service linkages that are available in the county for persons who are reentering the community following a period of incarceration;

(5) encourage and take appropriate action to facilitate: (a) the centralization, coordination, and improved linkage of the county-based services and resources identified in the blueprint developed pursuant to paragraph (4) of this subsection; and (b) the more efficient, effective, and coordinated provision of mental health care services, substance use disorder treatment services, reentry services, and associated support services by the facilities and providers identified pursuant to paragraph (1) of this subsection;

(6) publish, on the county’s Internet website, and advertise through other appropriate means, the list of service providers developed pursuant to paragraph (1) of this subsection, the plans, strategies, and guidelines annually adopted pursuant to paragraph (3) of this subsection, the service blueprint annually adopted pursuant to paragraph (4) of this subsection, and any other information the committee deems to be relevant for the purposes of this act; and

(7) annually prepare and submit a written report of the committee’s activities to: (a) the board of county freeholders or the county executive, as the case may be; (b) the Department of Human Services; and (c) each State legislator who represents the district.

3. The Department of Human Services shall annually prepare and publish, on the department’s Internet website, a written report that compiles and summarizes the data annually reported to the department by each of the State’s 21 counties pursuant to section 2 of this act. A copy of each annual report prepared under this section shall also be submitted to the chairs of the Senate Health, Human Services and Senior Citizens Committee and the Assembly Human Services Committee, or their successor committees, at the time of the report’s online publication. Data published on the department’s website, pursuant to this section, shall be searchable both by county and by type of service.

4. This act shall take effect immediately.

STATEMENT

This bill would require each county in the State to establish a Reentry, Mental Health, and Addiction Services Coordination Committee that will be responsible for implementing and overseeing a local service coordination program in the county to ensure and facilitate the more effective, efficient, and coordinated provision of mental health care services, substance use disorder treatment services, and reentry services by relevant service providers, with a particular focus on the coordination of care and services that are offered to individuals who are reentering the community following a period of incarceration.

As indicated in the bill’s Legislative findings and declarations section, data shows that: 1) New Jersey’s health and social service system is failing to provide sufficient and adequately coordinated care for persons with substance use disorders, particularly those who have co-occurring mental health conditions; 2) incarcerated individuals and recently incarcerated individuals face unique difficulties in obtaining adequate care for their substance use and mental health disorders; and 3) the State has failed to adequately address the cycle of, and links that exist between, addiction, incarceration, recidivism, and re-incarceration. By requiring each county to establish a local committee to identify and redress weaknesses in each county’s system of care and take other appropriate actions to coordinate the provision of mental health care services, substance use disorder treatment services, and reentry services at the local level, this bill will better ensure the effective and efficient coordination of mental health and substance use disorder treatment throughout the State and, more specifically, will better ensure that counties Statewide are able to meet the unique treatment needs of the reentry population, as necessary to help these persons escape the recurring cycle that leads from addiction to incarceration to recidivism and back to re-incarceration.

Each Reentry, Mental Health, and Addiction Services Coordination Committee established under the bill is to be composed of a minimum of five members, to be appointed by the county board of freeholders or the county executive, as the case may be. The committee’s membership is to include, but need not be limited to: at least one mental health care professional who works and resides in the county; at least one substance use disorder treatment professional who works and resides in the county and has particular expertise in the treatment of opioid use disorders; and at least one professional who works and resides in the county and is either employed by the New Jersey Reentry Corporation or otherwise provides direct assistance to individuals who are reentering the community after a period of incarceration.

Each committee will have the duty to:

1) identify, and designate as authorized service providers in the county’s service coordination program, all entities that are engaged in the provision of reentry services, mental health care services, substance use disorder treatment services, or associated support services in the county;

2) annually perform a community needs assessment to determine the level of need for mental health and addiction treatment services in the county, with a particular, but non-exclusive, focus on the needs of persons who are reentering the community following a period of incarceration;

3) identify gaps and weaknesses that are preventing or limiting the effective, efficient, and coordinated provision of mental health, addiction, and reentry services in the county to persons who are in need of such services, and develop and implement plans, strategies, and guidelines to address and eliminate those gaps and weaknesses;

4) develop and annually update a comprehensive service blueprint that identifies and describes all existing mental health, substance use disorder treatment, and reentry services and resources that are available in the county, as well as the location where each type of service or resource can be obtained and the coordinated care linkages that exist to facilitate a person’s transfer or warm hand-off between and among available service types and providers. The service blueprint is to specifically highlight the services and resources that are available in the county for persons who are reentering the community following a release from incarceration; and

5) encourage and take appropriate action to facilitate: a) the centralization, coordination, and linkage of the existing county-based services and resources identified in the committee’s comprehensive service blueprint; and b) the more efficient, effective, and coordinated provision of mental health care services, substance use disorder treatment services, reentry services, and associated supports by service providers throughout the county.

Each committee will be required to publish, on the respective county’s Internet website, and advertise through other appropriate means, the list of service providers developed by the committee under the bill, the plans, strategies, and guidelines adopted by the committee to address gaps and weaknesses in the county’s existing service system, and the comprehensive service blueprint that is annually adopted by the committee, as well as any other information the committee deems to be relevant for the bill’s purposes.

Each committee will also be required to prepare an annual written report of the committee’s activities and submit the report to: 1) the board of county freeholders or the county executive, as the case may be; 2) the Department of Human Services (DHS); and 3) each State legislator who represents the district.

The bill requires the DHS to annually prepare and publish, on its Internet website, a written report compiling and summarizing all of the data that has been annually reported to the department by each of the State’s 21 counties pursuant to the bill, which report is to be searchable both by county and by type of service. A copy of the DHS annual report will also need to be submitted to the chairs of the Senate Health, Human Services and Senior Citizens Committee and the Assembly Human Services Committee, or their successor committees, at the time of its online publication.