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Senate Reaches Opioid Deal, Vote Delayed

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Stephanie Pellitt

Policy Associate, National Council for Behavioral Health

Senate Reaches Opioid Deal, Vote Delayed

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Senate leaders have finalized a sweeping legislative package aimed at addressing the opioid epidemic, clearing the way for a Senate vote next week. The Senate had hoped to vote on the measure on Thursday, but inclement weather from Hurricane Florence caused the vote to be cancelled. The bipartisan Opioid Crisis Response Act (S. 2680) comprises more than 70 bills reported out of five Senate committees and touches on many elements of the epidemic. The bill’s provisions support many National Council priorities including expanding access to addiction treatment, strengthening the addiction treatment workforce, improving behavioral health information technology and more.

WHAT’S IN?

The package includes a number of important measures for which the National Council has strongly advocated, including:

  • Telemedicine: Enables behavioral health providers to register with the Drug Enforcement Agency (DEA) to prescribe controlled substances via telemedicine. This would remove barriers to accessing medication-assisted treatment for opioid use disorders in rural and frontier areas, and is a direct result of National Council advocacy efforts.
  • Workforce: Addiction treatment professionals and sites would be allowed to participate in the National Health Service Corps program, making addiction treatment professionals eligible for federal student loan forgiveness. This bill and a similar measure were introduced as a result of education and advocacy by the National Council and the Association for Behavioral Health in Massachusetts. Additionally, the package includes a National Council-supported bill that would expand the options of eligible sites in which behavioral health National Health Service Corps participants may work to include schools and other community-based settings.
  • Behavioral Health Information Technology: Provides incentivize payments to behavioral health providers to adopt electronic health records (EHRs). The National Council has been working for passage of this legislation since 2009, when behavioral health was left out of a law that created financial incentives for providers and hospitals to implement EHR systems to improve patient care.
  • Recovery Housing: The bill would require HHS to issue best practices for operating recovery housing to states and identify or facilitate the development of common indicators that could be used to identify potentially fraudulent recovery housing operators.
  • 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) not be 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.

Additionally, the bill reauthorizes the Opioid State Targeted Response Grants (Opioid STR) at $500 million a year from FY 2019-2021. Although funding for these grants will still need to be secured in the annual appropriations process, reauthorization is an important step to ensuring states continue to have access to STR funds, which have primarily supported states’ efforts to expand medication-assisted treatment (MAT) access.

WHAT’S NOT?

Most notably, both the House and Senate’s opioid packages contain little funding for expanding opioid addiction treatment capacity. The funding that is authorized in bill would come in time-limited grants, depriving communities and providers of the sustainable funding streams needed to make long-term plans and systems changes. The National Council will continue to push for sustainable investments in the full continuum of addiction care, such as that offered by the Excellence in Mental Health and Addiction Treatment Act Expansion Act, as the two chambers work to reconcile their respective packages. The bill would expand the current eight-state, two-year Certified Community Behavioral Health Clinics (CCBHC) program, which has shown tremendous results in dramatically improving access to opioid addiction treatment and other addiction care.

The Senate’s package leaves out several major provisions passed by the House, including two controversial measures. The House-passed IMD CARE Act (H.R. 5797) would have lifted the “IMD exclusion” in limited circumstances to provide Medicaid payments for in-patient opioid use disorder (OUD) treatment for individuals for up to 30 days in certain facilities. The National Council has long supported lifting the IMD exclusion, but the bill’s exclusive focus on individuals with opioid addiction raises concerns about accessibility of services for individuals living with addiction to other substances. Moreover, a continued lack of investment in community-based care could hinder individuals’ progress toward recovery if they are unable to access timely, high-quality outpatient services upon leaving residential care.

Another controversial measure – the Overdose Prevention and Patient Safety Act (H.R. 6082), which would have rolled back the regulation governing the sharing of substance use disorder treatment records (42 CFR Part 2) to more closely resemble the Health Insurance Portability and Accountability Act (HIPAA) requirements, was not included in the Senate package.

It is important to note that both of these provisions could still make it to the President’s desk should they be added back into the final bill during conference committee.

NEXT STEPS

Senate Majority Leader Mitch McConnell (R-KY) has announced that the Senate’s opioid vote has been rescheduled for Monday, Sept. 17th. After the Senate’s vote, the bill will need to be reconciled with the House-passed opioid measure (H.R. 6) prior to becoming law. It is expected that Congress would send a compromise package to the President shortly before or after the November midterm elections.

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