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Opioid Legislation Nearing Finish Line Following Passage of Senate Bill

Capitol Connector
Your source for the latest updates from Capitol Hill. We translate policy into practice so you can learn how policy trends will affect your work and how best to prepare.

Shelley Starkey

Opioid Legislation Nearing Finish Line Following Passage of Senate Bill

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The Senate passed its version of a sweeping legislative package to address the opioid crisis on Monday in a 99 to 1 vote. The bipartisan Opioid Crisis Response Act (S. 2680) supports many National Council priorities, including expanding access to treatment, strengthening the behavioral health workforce and supporting behavioral health information technology. The House and Senate will now need to reconcile the differences between the two different versions of legislation to finalize a bill for the President’s signature.

While the National Council for Behavioral Health (National Council) is pleased to see many important policy changes included in the Senate’s opioid package, it ultimately falls short on investments in prevention, treatment and recovery for Americans living with substance use disorders (SUD). “To truly address the root causes of the opioid crisis, we need to invest in the full continuum of behavioral health services,” said Linda Rosenberg, President and CEO of the National Council. “We need a comprehensive solution. This package of bills does not achieve that.” In particular, the National Council is disappointed that Congress missed this opportunity to expand the current eight-state, two-year Certified Community Behavioral Health Clinic (CCBHC) program via the Excellence in Mental Health and Addiction Treatment Expansion Act.

WHAT’S IN?

Throughout Congress’ efforts to address the opioid crisis, the National Council has been advocating for a number of important measures, some of which have been included in the Senate bill:

  • The Special Registration for Telemedicine Clarification Act will remove barriers to accessing medication-assisted treatment (MAT) for opioid use disorders in rural and frontier areas, and is a direct result of National Council advocacy efforts.
  • Substance Use Disorder Workforce: The bill amends the existing National Health Service Corps (NHSC) program, which provides student loan forgiveness to qualified health care professionals, to be more inclusive of substance use disorder treatment professionals. However, the House-passed opioid package contained a more robust workforce initiative entitled the Substance Use Disorder Workforce Loan Repayment Act, which would create a new loan forgiveness program that is targeted to address the shortages of SUD treatment providers in the areas that need it most. The National Council is actively advocating for members of Congress to include the House’s workforce provision in the final compromise opioid package.
  • The Improving Access to Behavioral Health Information Technology Act incentivizes behavioral health providers to adopt electronic health records (EHRs), a change that the National Council has been advocating for since 2009.
  • The Ensuring Access to Quality Sober Living Act requires the Substance Abuse and Mental Health Services Administration to disseminate best practices for operating recovery housing to states and help them adopt those standards. The National Council has been a longtime supporter of imposing more robust standards. To this end, in partnership with the National Alliance for Recovery Residences, we recently issued Building Recovery: State Policy Guide for Supporting Recovery Housing to assist states with the creation of recovery housing certification programs that standardize recovery housing operations to protect and support residents.
  • MAT Treatment Capacity: The bill pulls a provision from the TREAT Act to codify a change that expanded the number of patients that a practitioner can treat with buprenorphine at any one time to 275 patients. The National Council is disappointed to see that other MAT-related provisions from House’s opioid package (H.R. 6) are not included in the Senate’s package. Those provisions would 1) eliminate the sunset date for nurse practitioners’ (NPs) and physician assistants’ (PAs) prescribing authority for buprenorphine, 2) temporarily expand the definition of “qualifying practitioner” to include nurse anesthetists, clinical nurse specialists, and nurse midwives, and 3) permit a waivered-practitioner to start immediately treating 100 patients at a time with buprenorphine (in lieu of the initial 30 patient cap) if the practitioner meets certain requirements.
  • The Improving Access to Mental Health Services Act will allow behavioral health National Health Service Corps participants to work in schools and other community-based settings, thereby lowering barriers to access, particularly for rural and frontier communities.

WHAT’S NEXT?

The Senate’s package will now need to be reconciled with the House’s version, which passed in late June, before a final version can move to the President’s desk for his signature. A few more controversial measures that made it into the House package but were left out of the Senate version must now be resolved in conference negotiations including lifting the Institutions for Mental Disease (IMD) exclusion for residential SUD treatment and changing privacy laws that govern the sharing of substance use disorder treatment records.

As of this writing, Congressional leaders are aiming to finalize a combined bill for both chambers to approve in the coming weeks in hopes to get it signed into law before the midterm elections. Follow Capitol Connector each week for continued updates as negotiations are finalized.