Legislation Addressing Opioid Epidemic Becomes Law
Over the past several months, Congress has been developing new legislation aimed at addressing the nation’s opioid epidemic, providing additional funding, and building on the Comprehensive Addiction and Recovery Act (CARA) that became law in 2016. Following Congress passing H.R. 6 - the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act - President Donald Trump signed it into law on October 24, 2018, one year after declaring the opioid crisis a public health emergency.
The SUPPORT for Patients and Communities Act grants permanent authority for nurse practitioners (NP) and physician assistants to prescribe buprenorphine through medication-assisted treatment (MAT), permanently extending authority granted originally by CARA. Nurse practitioners are now eligible to treat up to 100 patients. In addition, clinical nurse specialists (CNSs), certified registered nurse anesthetists (CRNAs) and certified nurse midwives (CNMs) were given the MAT prescribing authority for a period of five years. The Secretary of Health and Human Services (HHS) and the Drug Enforcement Administration (DEA) will be required to write a report within two years of this legislation detailing the treatment of individuals receiving MAT by qualifying practitioners.
There are multiple provisions pertaining to telehealth and the ability for providers to use telehealth as a way to treat substance abuse disorder. One provision allows the Secretary of HHS to amend the Social Security Act, allowing the geographical requirements to be waived for individuals receiving telehealth for substance use disorder or a co-occurring mental health disorder. Within five years of implementation, the Secretary will be required to submit a report detailing the impact of telehealth on events such as overdose deaths and emergency department visits. Although this provision waives geographical requirements, it does not affect state licensing laws. Providers still must be licensed in the state where the patient is located in order to treat via telehealth.
In addition, this legislation allows the Center for Medicare and Medicaid Services to establish guidelines for states on how to receive federal reimbursement for treatment and services for substance abuse disorder delivered via telehealth within one year of enactment. Treatment options include assessment, MAT, counseling, medication management, and medication adherence with prescribed medication regimes. This provision will address the needs of high-risk individuals including American Indians, Alaska Natives, adults under the age of 40, individuals with a history of non-fatal overdose and individuals with a co-occurring serious mental illness and substance use disorder.
This legislation also requires the Justice Department to issue a rule explaining when providers are eligible to prescribe controlled substances via telemedicine within one year of the legislation becoming law. This provision is intended to give clarity for providers prescribing MAT via telemedicine.
More broadly, the legislation includes provisions that expand Medicaid coverage for services such as MAT, short-term inpatient treatment programs and increases funding for prescription drug monitoring programs (PDMP). The bill also expands Medicare funding to cover opioid treatment, bundled payments for care and e-health requirements. Individual states would be required to cover MAT, including methadone and counseling services, for opioid use disorders from fiscal years 2021 – 2025. States that implement PDMPs in 2019 and 2020 would be provided fully matched federal funds and be required to hold agreements with bordering states to allow provider access. In 2022, providers will be required by the state to check a patient’s prescription history through a PDMP before they could prescribe a controlled substance.
The Department of Health and Human Services (HHS) would provide a bundled payment for Medicare coverage services across a full cycle of care, and would provide $8 million in reimbursement for certain communities and rural health centers for training expenses incurred by physicians who provide opioid treatment. The legislation authorizes many grants, including $500 million annually through fiscal year 2021 for Opioid State Targeted Response Grants created by the 21st Century Cures Act. With regard to disclosure of a patient privacy, HHS would be required to determine the most effective ways for displaying a patient’s opioid addictions in their medical records with the patient’s permission. It would also require HHS to notify health-care providers about permitted disclosures under privacy laws during emergencies.