US Senate Proposes Opioid Crisis Response Act

Last week the US Senate released the Opioid Crisis Response Act of 2018, a bipartisan package to address the opioid epidemic. The Act authorizes funding to expand prevention, research, treatment, and recovery programs- but even if it passes as-is, it would still need to go through the actual appropriations process.

The Senate is expected to vote on the Bill soon without the opportunity for amendments and it’s expected to be approved on a broad bipartisan basis (much like the Arizona Opioid Epidemic Act was). But, after that, it’s unclear whether the House will vote on this version or the Bill or move to conference the Opioid Crisis Response Act with the recently House-approved “SUPPORT for Patients and Communities Act (H.R.6)”.  Here’s a summary of what’s in the bill as it sits today:

Medicaid 

  • Clarifies flexibilities around Medicaid’s "Institutions for Mental Disease" (IMD) exclusion where in some cases managed care plans may provide alternative services in lieu of other services that are not permitted under the state plan. 

  • Modifies IMD exclusion for pregnant and postpartum women to address a subset of the prohibition on Medicaid from paying for otherwise coverable services for certain adults while in institutions for mental disease. 

  • Codifies regulations permitting managed care plans to cover treatment in an IMD facility for a certain number of days in a month in lieu of other types of services.

  • Clarifies states’ ability under Medicaid to provide care for infants with neonatal abstinence syndrome (NAS) in residential pediatric recovery centers.

  • Directs CMS to issue guidance to states on options for providing services via telehealth that address substance use disorders under Medicaid.

  • Directs CMS to issue guidance on states’ options for treating and managing pain through non-opioid pain treatment and management options.

  • Clarifies states’ ability to access and share data from prescription drug monitoring program databases consistent with the parameters established in state law.

  • Directs HHS to provide technical assistance to states to develop and coordinate housing-related supports and services under Medicaid, either through state plans or waivers, and care coordination services for Medicaid enrollees with substance use disorders. 

Prevention

  • Authorizes CDC’s work to combat the opioid crisis through the collection, analysis, and dissemination of data, including through grants for states, localities, and tribes.

  • Authorizes funding through CDC from FY19 - FY24 for states to improve their prescription drug monitoring programs and implement other evidence-based strategies.

  • Authorizes funding from FY19 - FY21 for CDC to support states’ efforts to collect and report data on adverse childhood experiences through existing public health surveys.

  • Authorizes a HHS grant program through 2026 to allow states to develop, maintain, or improve prescription drug monitoring programs and improve their with other states and with other health information technology.

  • Authorizes data collection and analysis through 2023 on neonatal abstinence syndrome or other outcomes related to prenatal substance abuse and misuse, including prenatal opioid abuse and misuse. 

  • Creates an interagency task force to make recommendations regarding best practices to identify, prevent, and mitigate the effects of trauma on infants, children, youth, and their families.

 

Treatment and Recovery

  • Allows physicians who have recently graduated in good standing from medical schools to prescribe medication-assisted treatment (MAT).

  • Authorizes a grant program from FY19-FY23 to support development of curriculum that will help healthcare practitioners obtain a waiver to prescribe MAT.

  • Codifies the ability of qualified physicians to prescribe MAT for up to 275 patients if the practitioner meets certain requirements. 

  • Authorizes a grant program from FY19 - FY23 through SAMHSA for entities to establish or operate comprehensive opioid recovery centers that serve as a resource for the community.

  • Requires HHS to issue best practices for emergency treatment of known or suspected drug overdose, use of recovery coaches after a non-fatal overdose, coordination and continuation of care, and treatment after an overdose and provision of overdose reversal medication as appropriate.

  • Requires HHS to provide technical assistance to hospitals and other acute care settings on alternatives to opioids for pain management and authorizes a grant program to support hospitals and other acute care settings that manage pain with alternatives to opioids. 


Some of these policy measures were also recommended in the ADHS' set of federal policy recommendations in their 2017 report.  Sadly, nothing in here directs HHS to drop its policy of not funding syringe access but all in all this Senate bill looks like it's pretty good public health policy.  Nice to see.