April 11, 2018

Committees of the House and Senate have introduced a wave of legislation to address the opioid crisis, including more than 30 bills related to Medicare and Medicaid coverage and payment.

Highlights of the Opioid Crisis Response Act of 2018, introduced by the Senate Health, Education, Labor and Pensions Committee, include enhancing state prescription drug monitoring programs (PDMPs), which have shown value in identifying and reducing “doctor shopping” and other practices related to opioid misuse and abuse; enabling the Food and Drug Administration to require pharmaceutical manufacturers to package specified opioids in set supplies, such as “blister packs,” to reduce opportunities for diversion and abuse; and enhancing safe opioid disposal options, also to curb diversion.  The bill also proposes state funding for the establishment of comprehensive opioid treatment centers; state “safe care” programs for opioid-exposed infants; and training programs for first responders in administering opioid overdose medications, among other things.

The goal of the proposed legislation is to rally the agencies of the Department of Health and Human Services, including the Centers for Disease Control and Prevention, the National Institutes of Health and the Substance Abuse and Mental Health Services Administration in a multi-pronged attack on the opioid crisis in the United States, which continues to rage and which StatNews.com estimates could kill nearly half a million Americansduring the next decade as the epidemic accelerates.  Drug overdoses are now the leading cause of death among Americans under the age of 50, the organization states.

A full committee hearing on the bill will be held on Wednesday, April 11, 2018.

The Health Subcommittee of the House Energy and Commerce Committee will also hold a hearing on April 11 on a slate of bills, many of which are related to payment and coverage for opioid addiction treatment through Medicare and Medicaid.

Among other things, the proposals would:

• Offer federal Medicaid matching funds to states for up to a total of 90 days per year for services in an institution for mental disease (IMD) for Medicaid beneficiaries with a substance use disorder.  Beneficiaries would need to be assessed after the first 30 days to determine if continued care (up to 60 more days) is medically necessary.
• Require all state Medicaid programs to set limitations for opioid refills, monitor concurrent prescribing of opioids and other drugs (such as benzodiazepines and antipsychotics), monitor antipsychotic prescribing for children, and have at least one buprenorphine/naloxone combination drug on the Medicaid drug formulary.
• Incentivize states to create health homes for Medicaid beneficiaries with substance use disorder.
• Reduce the filing window for Medicaid claims from two years to one year.  Currently, claims can be submitted up to two years after the date of service.  Today, 99 percent of claims are submitted within one year.  The change would be designed to help CMS, Congress and others collect timelier, more accurate and more complete expenditure data on all categories of Medicaid spending, including Medicaid drug spending.
• Require state Medicaid programs to periodically report to CMS data and information on how graduate medical education (GME) funds are being used to support physician training.   State Medicaid programs would be required to report on how physicians are trained in specialties that are essential in the opioid crisis and how GME recipients are using Medicaid funds to train physicians on substance use disorder.