'Baby step' bill toward oversight of N.H. addiction treatment system fails

State lawmakers want to wait another year before taking on legislation that would provide more oversight of substance use disorder treatment programs in New Hampshire, disappointing advocates and treatment providers.

The bill, first proposed in December, was filed in direct response to NHPR’s investigation into sexual misconduct in recovery communities featured in the podcast, “The 13th Step.”

Despite being introduced with bipartisan support, and getting significantly watered down over the past few months, some lawmakers worried there were still too many unanswered questions about how the proposal would work. The bill was tabled during a conference committee meeting Thursday.

“I think that all throughout this process, there has been universal recognition of the need to better strengthen our substance use treatment system and better serve individuals across the system,” said Jake Berry, vice president of Policy for New Futures, the advocacy group that helped write and lobby for the bill.

However, Berry added, “I think that certain legislators felt like this bill did not answer or clarify their questions on how best to accomplish our shared goals.”

The initial proposal included two ideas: First, the bill created a system that would require any substance use disorder treatment provider to be certified by the New Hampshire Department of Health and Human Services. Addiction treatment facilities without this certification would not be allowed to operate in the state. The bill never specified what that process would look like, leaving the rulemaking to the health department’s discretion, if it passed.

But that component was eventually whittled down to cover just outpatient treatment providers, in response to concerns by some DHHS staff, so as not to overlap with existing state licenses for residential treatment providers. In its final form, the bill was, as Jenny O’Higgins from DHHS put it, “the baby step” the agency needed to start building the rules and staffing required for additional oversight.

As of now, according to DHHS, the state is aware of 65 outpatient treatment organizations that are registered with Medicaid, and yet, the state of New Hampshire only contracts with nine of them. That means there are 56 facilities providing substance use disorder treatment with no state oversight — and those are just the facilities DHHS is aware of.

The second component of the proposed bill would have added a position in the health department’s ombudsman office specifically tasked with fielding and investigating complaints about mental health or substance use disorder facilities. Advocates have long been concerned about a “culture of silence” within the addiction treatment industry, where people seeking recovery are afraid to come forward about wrongdoing because of shame, fear of not being believed, or because the perpetrator of the harassment or abuse is in a position of power or authority. Their goal was to create a clearer path for clients with complaints about harm or the quality of treatment to raise those concerns.

The bill passed the Senate, but the House of Representatives voted to refer the bill to interim study. Advocates attempted to revive the proposal by attaching it to another bill that was moving through the state Legislature. But that last ditch effort ended Thursday.

Throughout the process, lawmakers raised questions about cost and the staffing that would be required. It was also apparent that some lawmakers were not clear on what it was they were protecting people with substance use disorder from, or the problem this legislation could solve for.

During a conference committee Thursday, Republican Rep. Matthew Simon of Grafton, asked Berry if there were any statistics Berry could provide that “indicate the urgency” of misconduct at New Hampshire’s treatment facilities.

“It’s impossible to know, which is part of why we’re here,” Berry said. “There’s no oversight mechanism. There’s no ability for the state to track these things, to take those kind of complaints currently. That’s what we’re trying to put into place here.”

The bill is now moved to interim study, meaning a group of House members will discuss the legislation sometime over the summer and fall, in hopes of introducing new legislation based on it next year.

This story is a production of the New England News Collaborative. It was originally published by New Hampshire Public Media.