SH22-011 - WA STATE HCA MOUD IN JAILS - AMENDMENT 5 FULLY EXECUTED

Home Browse Search

HCA Contract No. K5885-05 Page 10 of 13 ATTACHMENT 1-A EXAMPLE - MOUD & MAUD in Jails Program Monthly Progress Report NOTE: Example below provided for reference only, the HCA Contract Manager will provide the fillable form for Contractor use prior to the July 1, 2026, implementation date. CONTRACTOR NAME: PROJECT MANAGER(S): MONTH REPORTING ON: CONTRACT FUNDING START: CONTRACT FUNDING END: July 1, 2026 June 30, 2027 1. INTAKE ☐ Screen all newly admitted individuals for risk of acute withdrawal from opioids and alcohol upon intake. ☐ MOUD3, MAUD 4, and other medications which support the relief of withdrawal symptoms, such as alpha-2 adrenergic agonists (e.g., lofexidine), anti-emetics, anti-diarrheals, analgesics, and fluid and electrolyte replacement (e.g., Gatorade®) must be offered to individuals at no charge to the individual. ☐ Offer initiation of MOUD treatment to individuals who are physically dependent on opioids, may have withdrawal symptoms, or have disclosed recent use and anticipate withdrawal. Facilities shall not require tapering from the illicit opioid unless clinically indicated. ☐ Offer treatment for withdrawal with benzodiazepines to individuals entering the facility who are physically dependent on alcohol, if clinically appropriate. ☐ Continue MOUD and MAUD for individuals who are already taking these medications upon entering the facility. Continue the individual on the same medication at the same dose unless ordered otherwise by the prescriber based on clinical need, unless one of the following exceptions is applicable: • Injectable long-acting naltrexone may be converted to an equivalent oral dose until just prior to release at which time the injectable form shall be restarted. • Injectable long-acting buprenorphine may be converted to an equivalent oral dose until just prior to release at which time the injectable form shall be restarted. • Oral buprenorphine may be converted to any of the three formulations available: film, tablet with naloxone, or tablet without naloxone. • If the individual is not pregnant, methadone may be transitioned to buprenorphine if one of the following is applicable: o Contractor is not a licensed Opioid Treatment Program (OTP) and the nearest OTP willing to collaborate with the jail to provide methadone is not within reasonable driving distance from the jail, and the jail does not have nursing staff on site seven (7) days a week. The individual must be started back on methadone prior to release if they plan to resume methadone in the community. o There is no OTP within reasonable distance of the individual’s release residence. 3 Methadone, buprenorphine, naltrexone 4 Naltrexone, acamprosate Docusign Envelope ID: 700826AD-3CE3-815C-8194-013EF364AA04