October 4, WMS Medigram
A bill that aims to address the opioid crisis at the national level has overwhelmingly passed in both the U.S. House of Representatives and Senate. Last Friday, lawmakers in the House passed the bill 393-8, and yesterday the Senate followed suit, with a 98-1. The bill now goes to President Trump for his signature.
The Substance Use–Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act (H.R. 6) is a cumulation of House and Senate opioid efforts over the last year. The bill encompasses more than 170 distinct provisions, which include regulatory measures as well as guidance on existing programs, grants, prescribing practices and procedures related to handling and disposing of opioids.
Prior to the Congressional votes, the Wisconsin Medical Society weighed in on in some of the bill’s provisions in a letter from Michael McNett, MD, chair of the Society’s Opioid Task Force to Speaker Paul Ryan. In it, Dr McNett asked for support of the temporary repeal of the Institutes for Mental Diseases exclusions for Medicaid beneficiaries, increased Medicare payments for non-opioid treatments for post-surgical pain, and increased access to medication assisted therapy (MAT) and codifying increasing patient caps on MAT.
“Much work remains to be done in fighting the opioid crisis. Specifically, the Society would like to see increased and continued funding for MAT and non-opioid treatments for pain, along with grants for training both physicians and medical students on proper prescribing methods,” Dr. McNett wrote. “The current actions of both the House and the Senate represent a positive step in addressing opioid crisis and lay the foundation for future efforts.”
With an overall fiscal impact estimated at $1.024 billion by the Congressional Budget Office, H.R. 6 authorizes over $850 million in new grants to create projects aimed at increasing access to substance use disorder (SUD) treatment, first responder training, creating recovery centers and education programs. It also requires that the Department of Health and Human Services (HHS) and its subsequent agencies conduct studies, issue reports and collect data to better understand the opioid epidemic, determine possible solutions and facilitate data sharing.
H.R. 6 is organized into to the following sections.
Medicaid—The Medicaid provisions of H.R. 6 consist of the following categories: coverage and access to services for children and mothers, increasing access to substance use disorder (SUD) and MAT treatments, improving data and data sharing/reporting as it relates to the opioid crisis and changing regulations surrounding exclusions for the Institutes for Mental Diseases (IMD). There are also provisions to allow Medicaid SUD services to be provided via telehealth and to require prescribers to check a prescription drug monitoring program when prescribing a Schedule II controlled substance for Medicaid beneficiaries.
Medicare—Similar to the Medicaid provisions, the Medicare aspects of H.R. 6 expand access to treatment, including MAT, for both traditional Medicare recipients and those with Medicare Advantage plans. H.R. 6 also places an emphasis on the secure prescribing of opioids under Medicare, including a provision that by 2021 all opioid prescriptions be prescribed electronically. These provisions also place an emphasis on opioid education for both prescribers and patients pertaining to proper prescribing protocols, alternative nonopioid treatments and storage and disposal of opioids. Other provisions include specific requests for studies and programs aimed at either creating new payment models under Medicare, studying prescribing incentives under Medicare or creating new opioid prescribing models/education for Medicare patients.
Food and Drug Administration (FDA) & Controlled Substances—The FDA section of H.R. 6 also contains provisions related to MAT, specifically codifying into law caps on the number of patients a trained and certified physician can treat with MAT. It also lifts the time limits on MAT prescribing for nurse practitioners and physician assistants and would allow clinical nurse specialists, certified nurse midwives and certified nurse anesthetists to prescribe MAT for five years. These provisions also include significant guidance and regulation of pain medicines, safety packaging, importation of illegal narcotics, safety and disposal and data sharing to help prevent diversion of opioid medications.
Public Health—The public health provisions of H.R. 6 aim to address numerous issues including the following: improving awareness and training for first responders; indexing narcotics, fentanyl and opioids; pain research; communication of patient records during emergencies; studies and guidance for programs aimed at helping pregnant women and infants; SUD and workforce concerns; emergency department procedures; funding for comprehensive opioid recovery centers; trauma informed care procedures; and peer supports. This section also reauthorizes the targeted state response grants from the 21st Century Cures Act.
Miscellaneous—H.R. 6 also features a number of “miscellaneous” provisions that include addressing trafficking concerns and overdose protections; fraud prevention; grants for workforce improvement; peer supports for veterans; pilot housing programs; residential treatment; drug testing; and reauthorization of funds for existing federal offices and programs such as the Office of National Drug Control Policy, Drug Free Communities and the High Intensity Drug Trafficking Areas program.