Senate, House Pass Major Opioid Legislation Package
October 2018 ~
The Senate and House have passed a package of 70 bills aimed at addressing the country’s opioid crisis. The 650+ page opioid bill is intended to increase access to substance abuse treatment by removing certain exclusions prohibiting Medicare funding, increase the number of medication-assisted therapy (MAT) providers, as well as increase non-addictive pain management alternatives, and strengthen enforcement of illegal medications.
Key provisions from the opioid package include:
Increased Medicaid Funding
One provision, included in the bill, would repeal an obscure rule that currently blocks states from spending federal Medicaid dollars on residential addiction treatment at centers with more than 16 beds.
The Institutes for Mental Disease (IMD) exclusion (written in 1965) was originally intended to discourage warehousing of people with mental illnesses in psychiatric hospitals, but over recent years the rule has resulted in a limited number of beds available for low-income patients suffering from addiction. The bill agreed upon by both House and Senate lifts the rule for all substance use disorders for residential treatment lasting up to 30 days.
Increased Access to Treatment
The bill package also includes provisions to provide Medicare beneficiaries with more information on alternative pain treatments, and expand treatment options for enrollees who are addicted to opioids, while also expanding treatment options for opioid-addicted beneficiaries. The bill also directs CMS to issue guidance to states on options for providing services via telehealth that address substance use disorders under Medicaid.
Additionally, the bill would increase accessibility of family residential treatment programs and would allow mothers undergoing addiction treatment to have their young children stay with them while participating in residential treatment.
The legislation also includes measures that would increase the number providers licensed to administer Medication-Assisted Therapy (MAT). The bill follows evidence-based practices and would require at least two MATs at any IMD.
The American Association of Nurse Practitioners (AANP) has stated that this legislation will allow 248,000 NPs to get trained to use MAT and greatly expand patient access to the treatment.
Strengthen Enforcement of Illegal Medications
The bill also intends to close loopholes that have allowed the drug fentanyl to be illegally brought into the country through postal services. If finalized, the bill would also require that foreign packages reveal their contents and indicate who is sending it and where it originated.
The bill would also require state Medicaid programs to have safety edits in place for opioid refills, to monitor concurrent prescribing of opioids and certain other drugs, and to monitor antipsychotic prescribing for children.
For more information, see the bill’s full text: Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act (pdf); the HHS Press Release; and the HHS’ Five Point Opioid Strategy.