The Senate amended H.R. 6 with the text of its Opioid Crisis Response Act, we've transferred our summary of the House-passed SUPPORT for Patients and Communities Act here.

What is it?

This bill — the SUPPORT for Patients and Communities Act — would aim to expand treatment for opioid abuse by reforming numerous programs under Medicaid, Medicare, and other programs administered by the Dept. of Health and Human Services (HHS) among other agencies. An in-depth summary of its provisions can be found below.

Medicaid Provisions

State Medicaid programs would be required to suspend, rather than terminate, a juvenile’s medical assistance eligibility when they’re incarcerated. Coverage would be restored to the juvenile when they’re released without requiring a new application.

Former foster youth would be able to keep their Medicaid coverage across state lines until the age of 26. In 2023 states would be required to adopt this policy for individuals turning the age of 18 that year, although states could choose to adopt the policy sooner. HHS would be required to issue guidance within one year of this bill’s enactment about best practices for enrolling former foster youth in coverage.

The Centers for Medicare and Medicaid Services (CMS) would be required to carry out a demonstration project to provide an enhanced federal matching rate for state Medicaid spending on substance use treatment and recovery services. The project would be carried out in at least 10 states that would receive grants for planning, while five states would be chosen for the federal matching rate portion of the project.

States would be required to operate qualified drug management programs that’d let states enroll at-risk beneficiaries starting in 2020. States that currently operate a drug management program under a fee-for-service financial arrangement would be considered qualified.

HHS would required to issue a guidance to improve care for infants with neonatal abstinence syndrome and their families. The Comptroller General would also be required to conduct a study on gaps in Medicaid coverage for pregnant and postpartum women with substance use disorder.

Medicare Provisions

Medicare coverage would be expanded to include Opioid Treatment Programs (OTPs) for the purpose of delivering Medication-Assisted Treatment (MAT). Currently, OTPs aren’t considered Medicare providers so beneficiaries receiving treatment there must pay out-of-pocket.

Prescription drug plan sponsors under Medicare would be required to develop drug management programs for at-risk beneficiaries by plan year 2021. Currently, offering such programs is voluntary.

Prescriptions for a schedule II, III, IV, or V controlled substance covered under a Medicare Part D prescription drug plan would have to be transmitted using an e-prescribing program by the start of 2021. HHS would be able to waive this requirement in certain circumstances, such as reasonable technological limitations.

A review of current opioid prescriptions for chronic pain and screening for opioid use disorder would be included as part of the initial Welcome to Medicare examination. Practitioners would: review risk factors for opioid use disorder, evaluate the beneficiary’s pain level, provide information about non-opioid treatment options, and provide a referral for additional treatment if needed.

The use of non-opioids for managing post-surgical pain would be encouraged through providing

Other Provisions

The Food and Drug Administration (FDA) would be required to hold at least one public meeting to address the problem of developing non-addictive medical products for treating pain or addiction. Within one year of the meeting, new or updated guidance documents would be issued to address those challenges and how such products could be eligible for accelerated approval or breakthrough therapy designation.

Grants would be available to federal, state, and local agencies to establish and operate laboratories to detect synthetic opioids (like fentanyl). The Centers for Disease Control and Prevention would be required to increase and accelerate data collection on synthetic opioids and new emerging drugs of abuse. A pilot program would be created through which five state or local agencies conduct point-of-use testing of illicit drugs for dangerous contaminants.

Clinical nurse specialists, certified nurse midwives, and certified registered nurse anesthetists would be authorized to prescribe buprenorphine (used in Medication-Assisted Treatment for opioids) for five years.

Offsets

The programs and policies listed above would be offset through:

• Providing an incentive for states to voluntarily adopt a medical loss ratio requirement of 85 percent for Medicaid managed care organization.
• Extending the application of Medicare’s secondary payer rules for beneficiaries with end stage renal disease by three months to a total of 33 months starting on January 1, 2020.
• Requiring reporting by group group health plans would be expanded to include prescription drug programs to better coordinate Medicare Part D benefits starting in 2020.

Impact

People who would receive treatment or other services through Medicaid, Medicare, or other programs covered by the bill; state Medicaid programs; CMS; CDC; and HHS.

Cost

The CBO estimated that enacting a draft version of this bill would decrease deficits by $1.2 billion over the 2018-2028 period.

More Information

In-Depth: The chairs of the House Ways & Means and Energy & Commerce Committees — Reps. Kevin Brady (R-TX) and Greg Walden (R-OR) — along with the committees ranking members, Reps. Richard Neal (D-MA) and Frank Pallone (D-NJ), issued the following statement after introducing this bill:

“All across the country, families and communities have struggled for far too long against the scourge of opioid addiction. These are our friends, our neighbors, and our family members, and we as a Congress are committed to doing all we can to combat the opioid crisis and save lives. H.R. 6 will be an important step forward in our efforts to stem the tide of addiction by improving prevention and public health efforts, enhancing treatment and recovery programs, and providing communities more tools in our fight.”

This legislation has the support of 11 bipartisan cosponsors, including six Republicans and five Democrats.

Media:

• House Ways and Means Committee Press Release
• House Energy and Commerce Committee Press Release
• CBO Cost Estimate
• KDRV

Summary by Eric Revell

(Photo Credit: courtneyk / iStock)