(Updated 9/27/18) This bill would implement more than 70 bipartisan proposals aimed at stopping illegal drugs at the border, such as synthetic opioids, reduce over-prescription of opioids, and develop alternatives to opioids. In its current form, it's serving as the conference report combining provisions of the House- and Senate-passed versions of this bill. A breakdown of its provisions, including the major individual bills that were included along with Justice Department & Food and Drug Administration reforms, can be found below.
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.
CMS would also issue a guidance to explain options for states to provide substance use disorder treatment via telehealth and managing beneficiaries’ pain through non-opioid treatment.
States’ ability to provide care under Medicaid for infants with neonatal abstinence syndrome in recovery centers would be clarified, as would those centers’ option to provide counseling or other services to mothers or caretakers.
This section would require that the annual “Medicare & You” handbook for Medicare beneficiaries include references to educational resources on opioid use and pain management, a description of categories of alternative, non-opioid Medicare-covered pain management treatments, and a suggestion that beneficiaries talk to their physicians about the subject.
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.
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.
It’d also make the following changes to Medicare:
Prescription drug plan sponsors under Medicare would be required to develop drug management programs for at-risk beneficiaries by plan year 2022. Currently, offering such programs is voluntary.
The Medicare Initial Preventive Physical Examination and annual wellness visits would include a review of the beneficiary’s current opioid prescriptions and screening for potential substance use disorder.
Opioid prescriptions under Medicare Part D would be prescribed electronically to improve tracking of opioid use and prevent diversion.
Beneficiaries with a history of opioid-related overdose would be monitored in the Medicare system to enable prescription drug plans to take steps that inform prescribers and dispensing pharmacies to improve care.
A wide variety of anti-drug trafficking and substance abuse prevention programs within the Dept. of Justice (DOJ) would be reauthorized. DOJ would also be allowed to issue grants for drug disposal programs administered by collectors designated by the state for five years in at least five states, at least three of which would be chosen from states with low participation rates for drug take-back programs.
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).
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.
The Drug Enforcement Administration (DEA) would be required to make anonymized information available in the ARCOS database to help drug manufacturers and distributors identify, report, and stop suspicious orders of opioid to reduce drug diversion. Civil and criminal penalties for drug manufacturers would be increased.
Other provisions include;
The Transportation Dept. would be directed to create regulations related to drug testing within the agency.
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.
Required reporting by group health plans would be expanded to include prescription drug programs to better coordinate Medicare Part D benefits starting in 2020.