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California's Opioid Settlements
Expenditure Reporting Form
Participating Subdivisions receiving funds from California's Opioid Settlements are required to complete annual reporting to the Department of Health Care Services (DHCS). Opioid settlement funds in this instance refers to final and proposed agreements between California and opioid distributors and manufacturers: McKesson, Cardinal Health and AmerisourceBergen (collectively, the Distributors); Janssen Pharmaceuticals, Inc.; Teva; Allergan; and pharmacies Walmart, Walgreens, and CVS (collectively, the Pharmacies).
This reporting form covers the period of July 1, 2022 – June 30, 2023.
Please ensure all
responses reflect the 2022 – 2023 State Fiscal Year (SFY).
This report is due September
30, 2023.
This form is intended to collect expenditure information from California Participating Subdivisions and Plaintiff Subdivisions receiving allocations from the California Abatements Account and California Subdivision Fund as part of California's Opioid Settlements.
A Participating Subdivision is a city or county eligible to receive funds from one or more of the settlements listed above. A definition for Participating Subdivisions can be found in Section 2(a) of the California State Subdivision Agreements.
A Plaintiff Subdivision is a Subdivision located in California, other than a Litigating Special District, that filed a lawsuit, on behalf of the Subdivision and/or through an official Special District, that filed a lawsuit, on behalf of the Subdivision and/or through an official of the Subdivision on behalf of the People of the State of California, against one or more Opioid Defendants prior to October 1, 2020.
A list of Participating and Plaintiff Subdivisions can be found in both the California State Agreements in Appendix 1. If you have questions about your Subdivision’s status, please reference this appendix, or contact your City, County, or outside Counsel.
If you have any questions filling out this form, please review the Q&A document
.
If you need to submit a revision to already submitted data, please contact the UCLA Evaluation team by emailing
[email protected].
Necessary Materials
To see a comprehensive list of necessary materials and information, please view the Necessary Materials Checklist
. You will need the following information to complete this form:
The amount of funds received by your Participating Subdivision by settlement in SFY 2022-2023;
The amount of funds expended by your Participating Subdivision, by activity, in SFY 2022-2023;
Interest earned on settlement funds allocated to your Participating Subdivision in SFY 2022-2023;
Reallocations to/from other Participating Subdivisions; The amount of settlement funds spent on administrative costs; and A description of planned activities/programs for the next fiscal year, including an indication of how each activity/program correlates in the settlements All Expenditure Reporting Forms must be submitted online. Word Document and PDF versions will not be accepted, they are for reference only.
If you would like to see a copy of the entire reporting form prior to completing it, please download the
Opioid Settlement Funds Expenditure Reporting F
orm
. All Expenditure
Reporting Forms must be submitted online
.
Submission Requirements
Participating Subdivisions shall only submit one (1) expenditure report annually for funds received from all settlements.
Do not send the expenditure reporting form to contractors or sub grantees to whom you may have awarded your opioid settlement funds.
It is the Participating Subdivision’s
responsibility to collect all required information regarding the opioid settlement funds they have received and to compile it into a singular report.
The preparer of the Expenditure Report should be the only person to submit one (1) expenditure report for your Participating Subdivision.
1. General Information
This section of the survey will ask for general information about your subdivision and the person preparing the expenditure report for your subdivision.
Participating Subdivision:
(Select the Participating Subdivision for which you are reporting.
A list of Participating
Subdivisions
can be found on the
DHCS OSF website
.)
Participating Subdivision address:
(Please format as 0000 Street Name, City, State Initials Zip Code.) Name of preparer:
(Please include the first and last name of the individual preparing this form.) Preparer email address:
(This email will receive confirmation of the report submitted. Please ensure that it is correct.) Confirm email address:
Preparer phone Number:
(xxx-xxx-xxxx)
2. Settlement Funds Information
This section will cover which settlement funds your Participating Subdivision has received.
Merced City
678 W. 18th St.,
Merced, CA
95340
M. Venus Rodriguez
[email protected]
[email protected]
209-385-8547
This section will cover which settlement funds your Participating Subdivision has received.
Please select all settlement agreements for which your Participating Subdivision received opioid settlement funds.
You must report expenditures on all settlement agreements that your Participating Subdivision received.
Opioid settlement funds in this instance refers to final and proposed agreements between California and opioid distributors and manufacturers: McKesson, Cardinal Health and AmerisourceBergen (collectively, the Distributors); Janssen Pharmaceuticals, Inc.; Teva; Allergan; and pharmacies Walmart, Walgreens, and CVS (collectively, the Pharmacies).
More information on each settlement agreement can be found on the DHCS OSF website
.
3. CA Abatement Account - Payments
This section will cover settlement dollars received as payments as well as interest earned from settlement accounts that were allocated to the CA Abatement Account.
1. List all
settlement dollars received as payments
to your Participating Subdivisions from
the CA Abatement Account
by each settlement. If there were no payments made for a particular settlement, write in 0.
Note:
Due to delays with receiving settlement funds, multiple payments were made for the Janssen and Distributor settlements within the 2022-2023 fiscal year. Please indicate the total amount received for the below settlements within FY 22-23.
2. List all
interest earned
from your payments from the CA Abatement Account
by each
settlement. If no interest was earned, please write in 0.
Allergan
CVS
Distributors
Janssen
Teva
Walgreens
Walmart
CA Abatement Account Payments Received in SFY 22-23
Distributors
68,649.66
Janssen
39717.22
CA Abatement Account Interest Earned in SFY 22-23
Reallocations
To
Other Participating Subdivisions
Participating Subdivisions may agree to reallocate their shares received from the CA Abatement Account among themselves, provided that any direct distribution may only be to a Participating Subdivision and any Participating Subdivision must agree to their share being reallocated.
Reallocations are defined as funds that have been received by a Participating Subdivision from the National Settlement Administrator (BrownGreer) and then transferred to another Participating Subdivision.
When cities opt out of receiving direct settlement payments, their payments are automatically directed to the county in which that city is located.
These payments to counties are not
considered reallocations.
If your city opted out of the settlement and the funds were sent to your county, those payments do not need to be reported.
3. Did you reallocate any of your Participating Subdivision's funds received from the Settlement Administrator from the period of July 1, 2022 - June 30, 2023 from the
CA
Abatement
Account
to another Participating Subdivision?
Reallocations
Received
From Other Participating Subdivisions
Participating Subdivisions may agree to reallocate their shares received from the
CA
Abatement
Account
among themselves, provided that any direct distribution may only be to a Participating Subdivision and any Participating Subdivision must agree to their share being reallocated.
Reallocations are defined as funds that have been received by a Participating Subdivision from the National Settlement Administrator (BrownGreer) and then transferred to another Participating Subdivision.
When cities opt out of receiving direct settlement payments, their payments are automatically directed to the county in which that city is located.
These payments to counties are not
considered reallocations.
If your county received allocations from cities that opted out of the settlement, these payments do not need to be reported separately.
CA Abatement Account Interest Earned in SFY 22-23
Distributors
3894.96
Janssen
664.53
CA Abatement Account Interest Earned in SFY 22-23
Yes
No
4. Did you
receive
any of funds from another Participating Subdivision's during the period of July 1, 2022 - June 30, 2023 from their
CA
Abatement
account
?
4. CA Abatement Account - Expenditures
In this section, Participating Subdivisions will report their expenditures of all opioid settlement funds from the
CA Abatement Account
.
List all settlement dollars
expended from payments received from the CA
Abatement
Account
by each settlement. If there were no funds expended for a particular settlement, put
0. Note:
Due to delays with receiving settlement funds, multiple payments were made for the Janssen and Distributor settlements within the 2022-2023 fiscal year. Please indicate the total amount expended for the below settlements within FY 22-23.
5. Plaintiff Subdivision
This section will cover information about Plaintiff Subdivisions.
Is your Participating Subdivision also a Plaintiff Subdivision? A Plaintiff Subdivision is
a Subdivision located in California, other than a Litigating Special District, that filed a lawsuit, on behalf of the Subdivision and/or through an official of the Subdivision on behalf of the People of the State of California, against one or more Opioid Defendants prior to October 1, 2020.
10. Administrative Expenses
Yes
No
CA Abatement Account Funds Expended in SFY 22-23
Distributors
0.00 Janssen
0.00 Yes
No
Pursuant to Section 1 of the settlement agreements, qualifying expenditures may include reasonable related administrative expenses. Please refer to DHCS Administrative Costs
Policy
for additional guidance.
What amount of your total allocation from the
California Abatement Account
was spent on
administrative costs? Please list the total administrative expenses for each opioid settlement your Participating Subdivision received.
I acknowledge that Participating Subdivisions may not exceed a cap of 10% of the total allocation from the California Abatement Account for administrative costs.
11. Allowable Expenses Reporting
In this section, Participating Subdivisions will be asked to categorize expenditures by activities and by Exhibit E allowable expenses. Please read the
Allowable Expenses document
prior to
completing this section.
Programs or Activities are defined as specific projects or uses of opioid settlement funds.
Programs may be a set of related activities to accomplish a project or outcome. Activities may be smaller scale or a singular use of funds. For example, a program may be a syringe exchange program while an activity may be passing out flyers for prevention education.
Examples of program or activity names and descriptions:
Activity or Program Name: Naloxone purchase
Activity or Program Description: Our Participating Subdivision purchased 1,200 units of naloxone in February 2023 to distribute to unhoused individuals in Los Angeles City during a community distribution even led by a county community partner, Harm Reduction Organization.
Activity or Program Name: Expanded a recovery treatment center
Administrative Expenses for SFY 22-23
Distributors
0.00 Janssen
0.00 ×
clear
Activity or Program Name: Expanded a recovery treatment center Activity or Program Description: Our Participating Subdivision expanded a recovery treatment center by adding two additional staff members and expanded the physical building to include extra rooms and beds.
Activity or Program Name: Expanded syringe services in San Francisco City Activity or Program Description: Our Participating Subdivision expanded safe syringe services in San Francisco City by installing safe syringe disposal units across the city. We also purchased safer drug use supplies to distribute at syringe exchanges and harm reduction centers in the city.
How many total activities or programs will you be reporting on for the SFY 2022-2023 (period of July 1, 2022 - June 30, 2023)? Please enter a number.
12. Additional Activities
Do you have any other activities to report on?
13. Planned Activities Reporting for SFY
2023 - 2024
In this section, Participating Subdivisions will report their planned activities for opioid settlement funds for the State Fiscal Year 2023-2024.
Participating Subdivisions will be asked to categorize planned expenditures by activities and by Exhibit E Allowable Expenses. Please read the
Allowable Expenses document
prior to
completing this section.
Programs or Activities are defined as specific projects or uses of opioid settlement funds.
Programs may be a set of related activities to accomplish a project or outcome. Activities may be smaller scale or singular uses of funds. For example, a program may be a syringe exchange program while an activity may be passing out flyers for prevention education.
1. Does your Participating Subdivision plan to
maintain the same activities
in the SFY 2023
– 2024 (period of July 1, 2023 – June 30, 2024)?
0 Yes
No
Yes
No
2. Does your Participating Subdivision plan to
add new or change activities
in the SFY
2023-2024 (period of July 1, 2023 – June 30, 2024)?
How many total activities do you anticipate reporting for SFY 2023-2024 (period of July 1, 2023 – June 30, 2024)? Please enter a number.
14. Planned Activities Reporting
This section is where your Participating Subdivision will note planned activities and programs for the upcoming fiscal year.
Please answer the following questions for
planned
activity
#1.
1. Activity or Program Name:
2. Activity or Program description (2-4 sentences):
3. Select all Allowable Expenditure types that apply for this
activity.
To see the types of
expenses under each category, please see the
Allowable Expenses document
.
No
Unsure
Yes
No
1 Drug Awareness Campaign
Spread Awareness through social media, community events, and school presentations.
Also have
focused drug enforcement operations.
Treat Opioid Use Disorder
(OUD)
Support People in Treatment and
Recovery
Connect People Who Need Help to the Help They Need (Connections to Care)
Address the Needs of Criminal Justice-Involved
Persons
Address the Needs of Pregnant or Parenting Women and Their Families, Including Babies with NAS
Prevent Over-Prescribing and Ensure Appropriate Prescribing and Dispensing of Select the specific strategies for
Connect People Who Need Help to the Help They Need
(Connections to Care)
that your activity or program meets.
Provide connections to care for people who have—or are at risk of developing—OUD and any co-occurring SUD/MH conditions through evidence-based or evidence-informed programs or strategies that may include, but are not limited to, those that:
Opioids
Prevent Misuse of
Opioids
Prevent Overdose Deaths and Other Harms (Harm
Reduction)
First
Responders
Leadership, Planning and
Coordination
Training
Research
Other
Ensure that health care providers are screening for OUD and other risk factors and know how to appropriately counsel and treat (or refer if necessary) a patient for OUD treatment Fund SBIRT programs to reduce the transition from use to disorders, including SBIRT services to pregnant women who are uninsured or not eligible for Medi-Cal Provide training and long-term implementation of SBIRT in key systems (health, schools, colleges, criminal justice, and probation), with a focus on youth and young adults when transition from misuse to opioid disorder is common
Purchase automated versions of SBIRT and support ongoing costs of the technology
Expand services such as navigators and on-call teams to begin MAT in hospital emergency departments
Provide training for emergency room personnel treating opioid overdose patients on post- discharge planning, including community referrals for MAT, recovery case management or support services
Support hospital programs that transition persons with OUD and any co-occurring SUD/MH conditions, or persons who have experienced an opioid overdose, into clinically appropriate follow-up care through a bridge clinic or similar approach Support crisis stabilization centers that serve as an alternative to hospital emergency departments for persons with OUD and any co-occurring SUD/MH conditions or persons that have experienced an opioid overdose
Support the work of Emergency Medical Systems, including peer support specialists, to connect individuals to treatment or other appropriate services following an opioid overdose or other opioid-related adverse event
Provide funding for peer support specialists or recovery coaches in emergency departments, detox facilities, recovery centers, recovery housing, or similar settings; offer services, supports, or connections to care to persons with OUD and any co-occurring SUD/MH Select the specific strategies for
Prevent Misuse of Opioids
that your activity or program
meets.
Support efforts to discourage or prevent misuse of opioids through evidence-based or evidence-informed programs or strategies that may include, but are not limited to, the following:
supports, or connections to care to persons with OUD and any co-occurring SUD/MH conditions or to persons who have experienced an opioid overdose Expand warm hand-off services to transition to recovery services
Create or support school-based contacts that parents can engage with to seek immediate treatment services for their child; and support prevention, intervention, treatment, and recovery programs focused on young people Develop and support best practices on addressing OUD in the workplace
Support assistance programs for health care providers with OUD
Engage non-profits and the faith community as a system to support outreach for treatment
Support centralized call centers that provide information and connections to appropriate services and supports for persons with OUD and any co-occurring SUD/MH conditions Strategy not listed. Please
describe:
Funding media campaigns to prevent opioid
misuse
Corrective advertising or affirmative public education campaigns based on evidence
Public education relating to drug
disposal
Drug take-back disposal or destruction
programs
Funding community anti-drug coalitions that engage in drug prevention efforts
Supporting community coalitions in implementing evidence-informed prevention, such as reduced social access and physical access, stigma reduction—including staffing, educational campaigns, support for people in treatment or recovery, or training of coalitions in evidence- informed implementation, including the Strategic Prevention Framework developed by SAMHSA
Engaging non-profits and faith-based communities as systems to support prevention
Funding evidence-based prevention programs in schools or evidence-informed school and community education programs and campaigns for students, families, school employees, school athletic programs, parent-teacher and student associations, and others School-based or youth-focused programs or strategies that have demonstrated Select the specific strategies for
Prevent Overdose Deaths and Other Harms (Harm
Reduction)
that your activity or program meets.
Support efforts to prevent or reduce overdose deaths or other opioid-related harms through evidence-based or evidence-informed programs or strategies that may include, but are not limited to, the following:
School-based or youth-focused programs or strategies that have demonstrated effectiveness in preventing drug misuse and seem likely to be effective in preventing the uptake and use of opioids
Create or support community-based education or intervention services for families, youth, and adolescents at risk for OUD and any co-occurring SUD/MH conditions Support evidence-informed programs or curricula to address mental health needs of young people who may be at risk of misusing opioids or other drugs, including emotional modulation and resilience skills
Support greater access to mental health services and supports for young people, including services and supports provided by school nurses, behavioral health workers or other school staff, to address mental health needs in young people that (when not properly addressed) increase the risk of opioid or another drug misuse
Strategy not listed. Please
describe:
Increased availability and distribution of naloxone and other drugs that treat overdoses for first responders, overdose patients, individuals with OUD and their friends and family members, schools, community navigators and outreach workers, persons being released from jail or prison, or other members of the general public Public health entities providing free naloxone to anyone in the community
Training and education regarding naloxone and other drugs that treat overdoses for first responders, overdose patients, patients taking opioids, families, schools, community support groups, and other members of the general public Enabling school nurses and other school staff to respond to opioid overdoses, and provide them with naloxone, training, and support
Expanding, improving, or developing data tracking software and applications for overdoses/naloxone revivals
Public education relating to emergency responses to
overdoses
Public education relating to immunity and Good Samaritan laws
Educating first responders regarding the existence and operation of immunity and Good Samaritan laws
Syringe service programs and other evidence-informed programs to reduce harms associated with intravenous drug use, including supplies, staffing, space, peer support services, referrals to treatment, fentanyl checking, connections to care, and the full range of harm reduction and treatment services provided by these programs Expanding access to testing and treatment for infectious diseases such as HIV and Hepatitis Select the specific strategies for
First Responders
that your activity or program meets.
In addition to items in section C, D and H relating to first responders, support the following:
No less than fifty percent (50%) of the funds received by a Participating Subdivision from the California Abatement Account in each calendar year must be used for one or more of the High Impact Abatement Activities (HIAA).
Which, if any, High Impact Abatement Activities does
planned
activity #1
meet?
Select all that apply and provide no more than 200 words to describe how this activity
meets the selected High Impact Abatement Activity.
Expanding access to testing and treatment for infectious diseases such as HIV and Hepatitis C resulting from intravenous opioid use
Supporting mobile units that offer or provide referrals to harm reduction services, treatment, recovery supports, health care, or other appropriate services to persons that use opioids or persons with OUD and any co-occurring SUD/MH conditions Providing training in harm reduction strategies to health care providers, students, peer recovery coaches, recovery outreach specialists, or other professionals that provide care to persons who use opioids or persons with OUD and any co-occurring SUD/MH conditions Supporting screening for fentanyl in routine clinical toxicology testing
Strategy not listed. Please
describe:
Education of law enforcement or other first responders regarding appropriate practices and precautions when dealing with fentanyl or other drugs Provision of wellness and support services for first responders and others who experience secondary trauma associated with opioid-related emergency events Strategy not listed. Please
describe:
HIAA 1 :
Provision of matching funds or operating costs for substance use disorder facilities within the Behavioral Health Continuum Infrastructure Program Please describe:
HIAA 2:
Creating new or expanded Substance Use Disorder (SUD) treatment infrastructure
Please describe:
HIAA 3:
Addressing the needs of communities of color and vulnerable populations (including You selected: "
HIAA 5: Interventions to prevent drug addiction in vulnerable youth "
Please describe the population(s) this activity or program serves:
Please add anything else you would like to share about
planned
activity #1:
15. Technical Assistance
Does your Participating Subdivision want technical assistance on how to spend opioid settlement funds?
16. Attestations
HIAA 3:
Addressing the needs of communities of color and vulnerable populations (including sheltered and unsheltered homeless populations) that are disproportionately impacted by SUD
Please describe:
HIAA 4:
Diversion of people with SUD from the justice system into treatment, including by providing training and resources to first and early responders (sworn and non-sworn) and implementing best practices for outreach, diversion and deflection, employability, restorative justice, and harm reduction
Please describe:
HIAA 5:
Interventions to prevent drug addiction in vulnerable
youth
Please describe:
Numerous presentation at schools.
Giving away items to enhance message such as
stickers, coloring books, etc.
HIAA 6:
The Purchase of naloxone for distribution and efforts to expand access to naloxone for opioid overdose reversals.
Please describe:
This activity is not a High Impact Abatement Activity and do not meet the criteria as defined above.
Elementary, Junior High and High Schools; Merced Junior College and UC Merced University.
Yes
No
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A
16. Attestations
I certify and attest on behalf of my Participating Subdivision that no less than fifty percent (50%) of the funds received from the California Abatement Account were used for one or more of the High Impact Abatement Activities:
I certify and attest on behalf of my Participating Subdivision that all funds received have been used in compliance with the requirements of the National Settlement Agreements and State Subdivision Agreements. Final versions of these agreements can be found on the CA Attorney General’s website:
https://oag.ca.gov/opioids
.
I certify and attest on behalf of my Participating Subdivision that everything reported on this Opioid Settlement Funds Expenditure Reporting Form is true and correct:
×
clear
×
clear
×
clear