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SCHEDULE A-1 <br />Statement of Work <br />July 1, 2022 -June 30, 2023 <br />Purpose. To provide medication for opioid use disorder (MOUD) in jails to incarcerated individuals who <br />present with an opioid use disorder (OUD). To support a full MOUD program which includes the following: <br />an OUD assessment, discussion of MOUD options between the incarcerated individual and provider, <br />initiation prior to the onset of withdrawal or continuation of MOUD, release and reentry planning to <br />include connection with continued treatment, same day release appointment when possible or MOUD to <br />bridge patient until next appointment and naloxone upon release. Reentry planning may also include <br />assisting the incarcerated individual with sign-up of Medicaid, reestablishing Medicaid and connection <br />with the Managed Care Organizations (MCOs). <br />Health Equity - This project also intends to address inequities in OUD treatment and recovery services by <br />providing medically necessary treatment for opioid use disorder to incarcerated individuals. MOUD in jails <br />programs should understand cultural barriers and provide culturally appropriate services and recognize <br />the need for inclusion of people with lived experiences in the development of the MOUD in jails programs. <br />Additionally, this project intends to identify stigma and educate staff to ensure ongoing collaboration and <br />openness to change. <br />2. Performance Work Statement. The Contractor shall ensure funds are responsibly used towards the MOUD <br />program in the jail/jails and provide the core components or a progressive plan to achieve the core <br />components which include: <br />a. FDA approved medication for opioid use disorder (MOUD) must be available and offered to all <br />incarcerated individuals who present with OUD at intake. Individuals with OUD may decline MOUD <br />at any time, but ongoing discussions on MOUD may be offered. <br />b. Methadone, buprenorphine, naltrexone should all be offered unless: (a) an opioid treatment <br />program (OTP) is not within reasonable driving distance from the jail, in which case the jail is not <br />required to offer methadone as an option; or (b) there is no available buprenorphine provider in <br />the community to which the patient will likely release, in which case the jail is not required to offer <br />buprenorphine as an option. Naltrexone may be provided in oral formulation while the patient is <br />incarcerated, but injectable long-acting naltrexone must be offered as an option prior to release. <br />c. MOUD must be continued for those who are already taking MOUD upon entering the facility. <br />MOUD is continued using the same medication, at the same dose unless ordered otherwise by the <br />prescriber based on clinical need (documented in the patient's medical record) with the exception <br />of injectable long-acting naltrexone which may be converted to an equivalent oral dose until just <br />prior to release and the injectable form is restarted. Methadone may be transitioned to <br />buprenorphine if the jail is not a licensed opioid treatment program (OTP) and the nearest OTP is <br />not within reasonable driving distance from the jail. The presence of other illicit or controlled <br />substances should not result in discontinuation of MOUD (consistent with the 2020 ASAM <br />National Practice Guideline for the Treatment of Opioid Use Disorder). <br />d. Assessing for risk of acute withdrawal must be done upon intake. Assessing for opioid use <br />disorder (OUD) absent a risk of acute withdrawal must also be done, but it may be done after <br />intake, as long as the delay does not impair the ability to begin treatment prior to release. The <br />incarcerated individual must be educated on treatment choices and the process for continuation of <br />access to MOUD, during incarceration, and upon release. (See resources for validated tool <br />suggestions.) <br />e. Individuals entering the facility who are physically dependent on opioids, must be offered MOUD <br />treatment; withdrawal (including withdrawal using buprenorphine or methadone) is not acceptable <br />unless the patient provides an informed refusal of treatment or the patient elects MOUD treatment <br />with naltrexone, in which case withdrawal is clinically required. Use of other medications <br />(clonidine, anti -emetics, anti-diarrheals, analgesics) may be used as adjuncts or may be used in <br />Washington State <br />Health Care Authority Page 3 HCA Contract No. K5885-1 <br />