K5885-02 - AMENDMENT 2 - PARTIALY EXECUTED

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Schedule A-2: Statement of Work July 1, 2023-June 30, 2024 1. Purpose. To provide medication for opioid use disorder (MOUD) in jails to incarcerated individuals who are identified with an opioid use disorder (OUD). To support a full MOUD program which includes the following: an OUD screening, discussion of MOUD options between the incarcerated individual and provider, initiation prior to the onset of withdrawal or continuation of MOUD, release and reentry planning to include connection with continued treatment, same day release appointment when possible or MOUD to bridge patient until next appointment and naloxone upon release. Reentry planning may also include assisting the incarcerated individual with sign-up of Medicaid, reestablishing Medicaid and connection with the Managed Care Organizations (MCOs). Health Equity - This project also intends to address inequities in OUD treatment and recovery services by providing medically necessary treatment for opioid use disorder to incarcerated individuals. MOUD in jails programs should understand cultural barriers and provide culturally appropriate services and recognize the need for inclusion of people with lived experiences in the development of the MOUD in jails programs. Additionally, this project intends to identify stigma and educate staff to ensure ongoing collaboration and openness to change. 2. Performance Work Statement. The Contractor shall ensure funds are responsibly used towards the MOUD program in the jail/jails and provide the standard of care core components which include: a. FDA approved medication for opioid use disorder (MOUD) must be available and offered to all incarcerated individuals who are identified with OUD at intake. Individuals with OUD may decline MOUD at any time, but ongoing discussions on MOUD may be offered. b. Methadone, buprenorphine, naltrexone should all be offered unless: (a) an opioid treatment program (OTP) is not within reasonable driving distance from the jail, in which case the jail is not required to offer methadone as an option; or (b) there is no available buprenorphine provider in the community to which the patient will likely release, in which case the jail is not required to offer buprenorphine as an option. Naltrexone may be provided in oral formulation while the patient is incarcerated, but injectable long -acting naltrexone must be offered as an option prior to release. Long -acting injectable buprenorphine can also be offered. MOUD must be continued for those who are already taking MOUD upon entering the facility. MOUD is continued using the same medication, at the same dose unless ordered otherwise by the prescriber based on clinical need (documented in the patient's medical record) with the exception of injectable long -acting naltrexone which may be converted to an equivalent oral dose until just prior to release and the injectable form is restarted. Methadone may be transitioned to buprenorphine if the jail is not a licensed opioid treatment program (OTP) and the nearest OTP is not within reasonable driving distance from the jail. The presence of other illicit or controlled substances should not result in discontinuation of MOUD (consistent with the 2020 ASAM National Practice Guideline for the Treatment of Opioid Use Disorder) Please also review and implement the newly released (June 2023), Bureau of Justice Assistance, Guidelines for Mana_ging Substance Withdrawal in Jails. d. Screening for risk of acute withdrawal must be done upon intake. Screening for opioid use disorder (OUD) absent a risk of acute withdrawal must also be done, but it may be done after HCA Contract No. K5885-02 Page 3 of 7