Opioid legislation includes slew of provisions to curb misuse

When Kidney News went to print, the U.S. House of Representatives had passed H.R. 6, the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act. Passed with bipartisan support, H.R. 6 combines provisions from more than 50 bills approved individually by the House.

The bill is designed to help overall efforts to combat the opioid crisis by advancing treatment and recovery initiatives, bolstering prevention efforts, and trying to counter deadly illicit synthetic drugs like fentanyl.

A last-minute addition to the legislative package in the House would extend by three months the period people with chronic kidney failure must wait before they become eligible for Medicare coverage. Lawmakers inserted the change—which is projected to save the government $290 million over a decade—to help pay for their slew of new initiatives aimed at curbing opioid misuse. The bill passed the House by a vote of 396–14.

The bill then headed to the Senate, where lawmakers were planning to take up their own opioid legislation. At press time, a House Republican aide said leadership hopes to conference the bills in July, although it could slide later into the summer depending on the Senate’s schedule. Senate Health, Education, Labor and Pensions Committee Chair Lamar Alexander (R–TN) is leading efforts to combine bills from his committee and the Senate Finance and Judiciary committees into a package that would go to the Senate floor.

Here are the major provisions of the legislation.

Medicaid

  • Require state Medicaid programs to not terminate a juvenile’s medical assistance eligibility because the juvenile is incarcerated. A state may suspend coverage while the juvenile is an inmate, but must restore coverage upon release without requiring a new application unless the individual no longer meets the eligibility requirements for medical assistance (H.R. 1925)
  • Enable former foster youth who are in care by their 18th birthday and previously enrolled in Medicaid to receive health care until the age of 26 if they move out of state (H.R. 4998)
  • Require the Centers for Medicare & Medicaid Services (CMS) to carry out a demonstration project to provide an enhanced federal matching rate for state Medicaid expenditures related to the expansion of substance-use treatment and recovery services targeting provider capacity (H.R. 5477)
  • Require all state Medicaid programs to have a beneficiary assignment program that identifies Medicaid beneficiaries at risk for substance use disorder (SUD) and assigns them to a pharmaceutical home program, which must set reasonable limits on the number of prescribers and dispensers that beneficiaries may utilize (H.R. 5808)
  • Require state Medicaid programs to have safety edits in place for opioid refills, monitor concurrent prescribing of opioids and certain other drugs, and monitor antipsychotic prescribing for children (H.R. 5799)
  • Require CMS to issue guidance on Neonatal Abstinence Syndrome (NAS) treatment options under Medicaid and require a study by the nonpartisan Government Accountability Office (GAO) on coverage gaps for pregnant women with SUD (H.R. 5789)
  • Provide additional incentives for Medicaid health homes for patients with substance use disorder (H.R. 5810)


Medicare

  • Instruct CMS to evaluate the utilization of telehealth services in treating SUD (H.R. 5603)
  • Create a pass-through payment extension under Medicare to encourage the development of non-opioid drugs (H.R. 5809)
  • Add a review of current opioid prescriptions and, as appropriate, a screening for opioid use disorder (OUD) as part of the Welcome to Medicare initial examination (H.R. 5798)
  • Incentivize post-surgical injections as a pain treatment alternative to opioids by reversing a reimbursement cut for these treatments in the Ambulatory Service Center setting, as well as collect data on a subset of codes related to these treatments (H.R. 5804)
  • Require e-prescribing, with exceptions, for coverage of prescription drugs that are controlled substances under the Medicare Part D program (H.R. 3528)
  • Require prescription drug plan sponsors under the Medicare program to establish drug management programs for at-risk beneficiaries (H.R. 5675)
  • Provide access to Medication-Assisted Treatment (MAT) in Medicare through bundled payments made to Opioid Treatment Programs for holistic service (Section 2 of H.R. 5776)


Public health

  • Direct the Food and Drug Administration (FDA) to issue or update guidance on ways existing pathways can be used to bring novel non-addictive treatments for pain and addiction to patients. (H.R. 5806)
  • Authorize grants to state and local agencies for the establishment or operation of public health laboratories to detect fentanyl, its analogues, and other synthetic opioids (H.R. 5580)
  • Make the buprenorphine prescribing authority for physician assistants and nurse practitioners permanent. Temporarily allow advanced practice registered nurses to prescribe buprenorphine. In addition, H.R. 6 will permit a waivered-practitioner to immediately start treating 100 patients at a time with buprenorphine (skipping the initial 30 patient cap) if the practitioner has board certification in addiction medicine or addiction psychiatry; or if practitioner provides MAT in a qualified practice setting.