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Rebecca Farley

Director, Policy & Advocacy, National Council for Behavioral Health

Breaking Addiction Act Introduced in Congress

July 24, 2014 | Addictions | Comments
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New legislation introduced in Congress would improve Americans’ access to substance use treatment by scaling back a federal payment exclusion for services provided in residential settings. Introduced by Congresswoman Marcia Fudge (D-OH) and Congressman Tim Ryan (D-OH) with eight cosponsors, the Breaking Addiction Act of 2014 (H.R. 5136) would establish a five-year demonstration project for 8-10 states in which federal reimbursement would be permitted for Medicaid services provided in certain residential settings known as “Institutes for Mental Disease.”

Current law – known as the “IMD exclusion” – imposes a federal payment prohibition on Medicaid services provided to patients who are residents of such institutions. Originally intended to prevent states from warehousing individuals with mental illness in institutions, the payment exclusion has posed a challenge for some residential mental health and substance use treatment centers. In a fact sheet accompanying the legislation, the bill’s authors state that “the IMD exclusion keeps nearly 15 million Medicaid beneficiaries from receiving the treatment they need, and indirectly, it limits the number of treatment beds available for more than 23 million Americans, regardless of health coverage status.”

The new legislation carves out a narrow exception to the IMD exclusion in the 8-10 states participating in the $300 million demonstration program. It allows federal reimbursement for Medicaid services provided to individuals receiving treatment for a substance use disorder in a “community-based Institute for Mental Disease.” “Community-based” refers to facilities such as chemical dependency treatment facilities or rehabilitation centers and excludes hospitals. The bill also requires an evaluation and report from the Secretary of Health and Human Services on the impact this change would have on the provision of substance use disorder services in the U.S.

The bill’s authors cite the growing heroin and opioid epidemic as an urgent rationale for making this payment change, stating that this demonstration offers a model to expand cost-efficient and timely community-based treatment options for opioid abuse and misuse.

The National Council supports this legislation. Stay tuned for our action alerts and other opportunities to urge your legislators’ support for the Breaking Addiction Act.