TITLE
Title
OPIOID SETTLEMENT FUNDING AUTHORIZATION FOR LOW BARRIER SUPPORTS FOR RECOVERY SERVICES AT DAYMARK
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SPONSOR
Sponsor
Victor Isler, Assistant County Manager for Successful People
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BACKGROUND
Background
Guilford County Commissioners and staff, in cooperation with Daymark Recovery Services, have 1) identified a need for and opportunity to provide low barrier medication assisted treatment induction at the facility at Gibson Park operated by Daymark and 2) begun discussions to develop architectural and project plans to build out a new recovery treatment center at a County-owned facility on Lee's Chapel Road.
1) Low Barrier MAT:
The low-barrier medication assisted treatment (MAT) will be provided in addition and will be complementary to the existing residential recovery program operated at Gibson Park by Daymark and will allow individuals who need to start medication-assisted treatment (MAT) or who are already on MAT to do so while also participating in the residential recovery programs on-site. Currently, Daymark is unable to accept individuals on MAT at Gibson Park due to limits on prescribing and administering the necessary medication.
The service will require Daymark to add or allocate an additional 1.6 FTEs of staff - 0.6 of an advance practice provider and 1.0 of a nurse - to prescribe the medication and oversee its administration and some additional administrative costs. Daymark will attempt to charge Medicaid for the pharmacy cost of the medication itself whenever possible based on eligibility. The hours of admission will be determined as the additional staff are brought on board - there are certain intake requirements including an initial assessment and a signed medication order which requires an available medical staff person and a prescriber to be available. Daymark will work to communicate this additional service to the Guilford County community.
Daymark currently operates 40 beds at the Gibson Park site due to staffing and patient ratio requirements. Based on this capacity, they estimate that they can serve up to 360 persons per year in this MAT service, assuming a minimum stay of 30 days each and 75% of the beds being used by MAT participants. Longer average stay lengths and a lower percentage of bed usage by MAT participants will change this service number.
The estimated timeline to start this service is 60-90 days, depending on the time that it takes Daymark to fill the staffing needs. The full year cost is $487,652 annually:
$162,240 for 0.6 FTE advance practice provider
$63,000 for 1.0 FTE nurse (RN)
$56,310 for fringe employee benefits
$150,000 for pharmacy costs (MAT medication and pharmacy consulting)
$56,102 for administrative expenses and overhead
County staff recommends authorizing funding in the amount of $365,739, estimated to provide nine months of operational costs, with the funding authorization effective on November 2, 2023 and running until June 30, 2024. A full-year funding authorization for FY 2024-25 will be brought as part of the FY 2024-25 budget. No additional County positions are needed for this program. Staff also recommends that the County enter into direct service agreement with Daymark for this program to facilitate compliance, monitoring, and reporting in accordance with the Opioid Settlement MOA. Such an agreement needs to be developed upon the County Commissioners' approval of the program.
The use and effectiveness of MAT for opioid use disorder (OUD) is recommended and supported by leading substance abuse and medical organizations including the Substance Abuse and Mental Health Services Administration (SAMHSA), the American Society of Addiction Medicine (ASAM) and the National Academies of Sciences, Engineering and Medicine. The use of MAT alongside other recovery supports was recommended by the U.S. Surgeon General in 2016. The National Academies of Sciences, Engineering and Medicine also published a report in 2019 showing the effectiveness of MAT in a wide variety of treatment settings and concluding that long-term use of MAT is associated with improved outcomes for individuals with opioid use disorder. SAMHSA and ASAM have both published guidelines documents on the administration of MAT in for OUD, including as a low barrier solution.
While the service will promote low barrier access, individuals with complex medical histories, acute medical needs or who have more complex needs will need to be referred to other acute care service providers They may, however, return once they are medically stable and stabilized on MAT to participate in the residential programs.
2) New Recovery Treatment Facility Architectural Design and Project Planning:
Daymark and County staff have done initial site tours of the Lee's Chapel facility and discussed general plans and potential upfits and renovations needed to bring the facility up to building code and standards set by the State's Division of Health Service Regulations (DHSR) for the licensure required for use as a residential recovery/treatement facility. At this time, staff recommend engaging an architect to perform a gap analysis assessment to achieve DHSR requirements for this facility and provide schematic design services for DHSR submission. The design scope will include a site review and schematic design including architecture; interior design; mechanical, electrical, plumbing and fire protection systems; structure; food service; and civil engineering. The architect will develop schematic designs based on the planned use of the facility in coordination with the County and Daymark, submit the schematic design documents to DHSR for initial review, and will update the documents to incorporate DHSR's review comments. Finally, the architect will provide preliminary cost estimates to assist in project budget development.
Total cost for this work is $50,000. County staff also recommend approving an additional $50,000 for any additional needs that may arise during the facility preparation and design process which brings the recommended total for this work or activity to $100,000. Staff recommends authorizing this funding for an initial period November 2, 2023 until June 30, 2024. If this phase of the work lasts beyond June 30, 2024, staff will bring an additional authorization as part of the FY 2024-25 budget.
These two activities are both allowable under the Opioid Settlement in Exhibit A, Strategy 2. The necessary opioid spending authorization for both of these activities is attached to this item.
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BUDGET IMPACT
Budget Impact
Opioid Settlement Fund
$465,739 Increase in Other Revenue
$465,739 Increase in Opioid Settlement
NO ADDITIONAL COUNTY FUNDS REQUIRED
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REQUESTED ACTION
Requested Action
Approve the attached Opioid Settlement Spending Resolution for the use of $465,739 of Opioid Settlement funds to fund, first, Low Barrier Supports for Recovery Services at Daymark's Gibson Park facility under Exhibit A, Strategy 2, in the amount of $365,739, starting November 2, 2023 and ending June 30, 2024, and, second, Architectural and Engineering Design Services for a New Residential Treatment Facility under Exhibit A, Strategy 2, in the amount of $100,000, starting November 2, 2023 and ending June 30, 2024; approve an increase of the Opioid Settlement Fund budget by $465,739 in Other Revenue and the same amount in appropriation to Opioid Settlement for these activities; and authorize the County Manager or designee to enter into an appropriate to-be-developed service agreement or contract with Daymark for the provision of this service up to the amount and within the effective dates of the spending authorization.
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