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RESOLUTION APPROVING THE TERMS OF AND AUTHORIZING THE COUNTY MAYOR OR COUNTY MAYOR�S DESIGNEE TO EXECUTE A MEMORANDUM OF UNDERSTANDING AND A BUSINESS ASSOCIATE AGREEMENT AND QUALIFIED SERVICE ORGANIZATION AGREEMENT WITH AIROJEN CENTER, CORP., D/B/A COMPREHENSIVE PSYCHIATRIC CENTER, FOR THE PROVISION OF BEHAVIORAL HEALTH COUNSELING, TOXICOLOGY AND INFECTIOUS DISEASE SCREENINGS, AND SUPPORTIVE SERVICES, AS WELL AS STORAGE AND ADMINISTRATION OF METHADONE TO CERTAIN INDIVIDUALS RECEIVING MEDICATION ASSISTED TREATMENT AT NEW DIRECTION RESIDENTIAL TREATMENT FACILITY, FOR A TWO-YEAR TERM WITH THREE ONE-YEAR OPTIONS TO RENEW; AND AUTHORIZING THE COUNTY MAYOR OR COUNTY MAYOR�S DESIGNEE TO EXERCISE THE PROVISIONS SET FORTH IN SAID DOCUMENTS, PROVIDED THAT ANY AMENDMENTS ARE CONSISTENT WITH THE PURPOSE DESCRIBED HEREIN

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WHEREAS, this Board desires to accomplish the purposes outlined in the accompanying County Mayor�s memorandum, a copy of which is incorporated herein by reference,

NOW, THEREFORE, BE IT RESOLVED BY THE BOARD OF COUNTY COMMISSIONERS OF MIAMI-DADE COUNTY, FLORIDA, that this Board:

Section 1. Approves the foregoing recital, which is incorporated herein by reference.

Section 2. Approves the terms of and authorizes the County Mayor or County Mayor�s designee to execute a Memorandum of Understanding (�MOU�), in substantially the form attached to the accompanying memorandum as Attachment A, on behalf of Miami-Dade County, through the Community Services Department (�CSD�) or any successor entity, with Airojen Center, Corp., d/b/a Comprehensive Psychiatric Center (�CPC�). The MOU authorizes CPC to provide a comprehensive range of services to individuals being treated at the County�s New Direction Residential Treatment Facility, currently located at 3140 NW 76th Street, Miami, FL 33147, which includes: (a) psychiatric evaluation and treatment; (b) individual and group behavioral health counseling; (c) toxicology screening; (d) screenings for infectious diseases and sexually transmitted infections; (e) supportive services such as information and referrals to assist individuals obtain employment, social security benefits, food stamps, Medicaid, housing, and other services; and (f) the storage and administration of Methadone utilized in Medication Assisted Treatment for individuals who are opiate-dependent. The MOU is for an initial term of two years with three one-year automatic options to renew unless terminated by either party.

Section 3. Approves the terms of and authorizes the County Mayor or County Mayor�s designee to execute a Business Associate Agreement and Qualified Service Agreement (�BAA�), in substantially the form incorporated in the MOU, Attachment A, as Exhibit A, on behalf of Miami-Dade County, through CSD, with CPC. The BAA shall be effective during the term of the MOU and shall terminate immediately with the expiration or termination of the MOU.

Section 4. Authorizes the County Mayor or County Mayor�s designee to exercise the provisions set forth in the MOU and BAA, provided that any amendments thereto are consistent with the purposes described in section 2 or as may be required by law and following approval for form and legal sufficiency by the County Attorney�s Office.

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Date:
To: Honorable Chairman Anthony Rodriguez
and Members, Board of County Commissioners

From: Daniella Levine Cava
Mayor

Subject: Resolution Seeking to Expand Medication Assisted Treatment Services at the County�s New Direction Residential Treatment Facility by Entering into Agreements with Airojen Center, Corp., d/b/a Comprehensive Psychiatric Center

STAFF RECOMMENDATION
Executive Summary
This item seeks approval from the Board of County Commissioners (�Board�) for the Miami-Dade County (�County�) Mayor or County Mayor�s designee to execute a Memorandum of Understanding (�MOU�) and a Business Associate Agreement and Qualified Service Organization Agreement (�BAA�) with Airojen Center, Corp., d/b/a Comprehensive Psychiatric Center (�CPC�), and exercise the provisions set forth in said documents for behavioral health counseling, toxicology and infectious disease screenings, supportive services, and the temporary storage, and subsequent administration of Methadone utilized for administering Medication Assisted Treatment (�MAT�) to individuals diagnosed with Substance Use Disorder including Opioid Use Disorder that are being treated at New Direction Residential Treatment Facility (�New Direction�), currently located at 3140 NW 76th Street, Miami, FL 33147.

MAT is considered a best practice in the field of Substance Use Disorder treatment and is provided through existing County programming. CPC is licensed by the Florida Department of Children and Families (�DCF�) and the U.S. Drug Enforcement Agency, and accredited and certified by the Joint Commission and Substance Abuse and Mental Health Services Administration (�SAMSHA�) to provide MAT to opiate-dependent individuals and as such is currently the only Methadone clinic in the County that is authorized to provide services to participants who are funded by Thriving Mind South Florida (�Thriving Mind�). Services include prescribing and administering Methadone to individuals as a form of MAT. The County, as a recipient of grant funding from the State of Florida for the provision of rehabilitative services, is required to care for patients that have individual Methadone prescriptions. Entering into the MOU will allow for the storage of such prescriptions on-site, as is currently allowed by the County�s licensing for other MAT medications, or similarly restricted medications.

Recommendation
It is recommended that this Board:
(1) Approves the terms of and authorizes the County Mayor or County Mayor�s designee to execute the MOU, on behalf of the County, through the Community Services Department (�CSD�) or any successor entity, with CPC for behavioral health counseling, toxicology and infectious disease screenings, supportive services, and the temporary storage and administration of medication utilized in MAT for individuals diagnosed with Substance Use Disorder, including Opioid Use Disorder, that are being treated at New Direction. The MOU has an initial term of two years and has three one-year automatic options to renew unless terminated by either party, upon 30 calendar days� notice.

(2) Approves the terms of and authorizes the County Mayor or County Mayor�s designee to execute a BAA, in substantially the form incorporated in the MOU, Attachment A, as Exhibit A, on behalf of Miami-Dade County, through CSD, with CPC. The BAA reflects the responsibilities of the parties, as business associates, and their mutual and individual duties concerning Protected Health Information under the Health Insurance Portability and Accountability Act. The BAA shall be effective during the term of the MOU and shall terminate immediately with the expiration or termination of the MOU.

(3) Authorizes the County Mayor or County Mayor�s designee to exercise the provisions set forth in MOU and BAA, provided that any amendments thereto are consistent with the purposes described herein and following approval for form and legal sufficiency by the County Attorney�s Office.

Scope
The scope of this resolution is countywide. The storage and administration of Methadone for MAT will be localized to New Direction currently located at 3140 NW 76th Street, Miami, FL 33147.

Delegation of Authority
Upon adoption of the resolution, the County Mayor or County Mayor�s designee will be authorized to execute and exercise the provisions set forth in the MOU and BAA.

Fiscal Impact/Funding Source
This resolution will not have a fiscal impact to the County.

Track Record/Monitor
Cathy Burgos, LCSW, CSD Director, or other supervisory personnel, will monitor all resulting work and services authorized pursuant to this resolution.

Background
CSD provides evidenced-based interventions and comprehensive treatment for individuals facing challenges with Substance Use Disorder and co-occurring disorders through its Rehabilitative Services Division. This suite of treatment services offered by CSD include a variety of therapeutic interventions and recovery support to help individuals enter and navigate systems of care, remove barriers to recovery, and stay engaged in the recovery process. Recovery support includes services such as group and family therapy, employability skills training, peer support, 12 Steps and Fellowship Groups, linkages to primary health care and housing; CSD expects to serve approximately 1,500 residents through 2025 via New Direction.

New Direction is an in-patient residential treatment facility that provides 24-hour, 7-days-a-week, treatment tailored to meet the needs of individuals with Substance Use Disorder and other co-occurring disorders.

MAT is the use of medications, in combination with counseling and behavioral therapies, to provide a holistic approach to the treatment of Substance Use Disorders. Medications used for MAT are approved by the Food and Drug Administration. MAT programs, inclusive of the programming made available through New Direction, are clinically driven and tailored to meet individualized patient need to maximize the effectiveness of the treatment.

SAMHSA, a federal agency within the U.S. Department of Health and Human Servies that provides resources, grants, data, and evidence-based practices for mental health and Substance Use Disorders has provided the following information regarding the three most widely used MAT medications.

(1) Naltrexone is not an opioid, is not addictive, and does not cause withdrawal symptoms once usage ceases. Naltrexone blocks the euphoric and sedative effects of opioids such as heroin, morphine, and codeine. Naltrexone binds and blocks opioid receptors and reduces and suppresses opioid cravings. There is no abuse and diversion potential with naltrexone.

(2) Buprenorphine is an opioid partial agonist that produces effects such as euphoria or respiratory depression at low to moderate doses. With buprenorphine, however, these effects are weaker than full opioid agonists such as Methadone. When taken as prescribed, buprenorphine is safe and effective. Buprenorphine helps: (a) diminish the effects of physical dependency to opioids, such as withdrawal symptoms and cravings; (b) increase an individual�s safety in cases of an overdose; and (c) lowers the potential for misuse of MAT and other related drugs.

(3) Methadone is a long-acting opioid agonist, reduces opioid cravings and withdrawals, and blunts or blocks the effects of opioids. This medication is meant to be taken daily, and is available in liquid, powder and diskettes forms.

MAT, a best practice in the field of substance misuse treatment, has been shown to effectively reduce the rate of fatal overdoses, increase treatment compliance, and reduce illicit opioid use. It is a critical measure available to the County in combating the opioid epidemic.

At New Direction, Naltrexone and Buprenorphine are currently stored on-site in a manner consistent with applicable laws and policies. While Methadone is not currently stored on-site, there is an anticipated increase in clients that are currently being prescribed Methadone and will continue to be prescribed Methadone. Currently, due to CPC�s policies and practices, the County cannot receive, store, or administer individualized prescription of Methadone without an agreement providing for same. Through this resolution, individual prescriptions would be able to be stored at New Direction and thereby enhance the accessibility and availability of MAT services to vulnerable persons actively suffering from Opioid Use Disorder.

The inclusion of Methadone treatment to New Direction�s MAT programming will further expand service efficacy and accessibility to individuals suffering from Opioid Use Disorder. By entering into the MOU, the County will be able to expand its current service portfolio and store individualized prescriptions for Methadone, which would, therefore, create an opportunity to offer additional support to a historically underserved population and improve the County�s efforts to combat the effects of the opioid epidemic.

Like buprenorphine, Methadone is classified as a Schedule II Drug pursuant to section 893.03, Florida Statutes. Upon approval of this resolution and prior to Methadone being stored at New Direction, all necessary policies and procedures will be updated to include Methadone and maintain safety measures and practices meant to ensure the wellbeing of patients and staff.



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Arnold Palmer
Chief of Public Safety

Attachments:
Attachment A � Memorandum of Understanding