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H.R. 6: SUPPORT for Patients and Communities Act

H.R. 6 includes Medicaid, Medicare, and public health reforms to combat the opioid crisis by advancing treatment and recovery initiatives, improving prevention, protecting communities, and bolstering efforts to combat illicit synthetic drugs like fentanyl. The policies contained in the legislation were advanced through regular order by the House Energy and Commerce Committee and the Ways and Means Committee. A detailed section-by-section can be found here. Major provisions include:

Medicaid

  • Require state Medicaid programs to not terminate a juvenile’s medical assistance eligibility because the juvenile is incarcerated. A state may suspend coverage while the juvenile is an inmate, but must restore coverage upon release without requiring a new application unless the individual no longer meets the eligibility requirements for medical assistance (H.R. 1925)
  • Enable former foster youth who are in care by their 18th birthday and previously enrolled in Medicaid to receive health care until the age of 26 if they move out of state (H.R. 4998)
  • Require the Centers for Medicare and Medicaid Services (CMS) to carry out a demonstration project to provide an enhanced federal matching rate for state Medicaid expenditures related to the expansion of substance-use treatment and recovery services targeting provider capacity (H.R. 5477)
  • Require all state Medicaid programs to have a beneficiary assignment program that identifies Medicaid beneficiaries at-risk for substance use disorder (SUD) and assigns them to a pharmaceutical home program, which must set reasonable limits on the number of prescribers and dispensers that beneficiaries may utilize (H.R. 5808)
  • Require state Medicaid programs to have safety edits in place for opioid refills, monitor concurrent prescribing of opioids and certain other drugs, and monitor antipsychotic prescribing for children (H.R. 5799)
  • Require CMS to issue guidance on Neonatal Abstinence Syndrome (NAS) treatment options under Medicaid and require a study by the nonpartisan Government Accountability Office (GAO) on coverage gaps for pregnant women with SUD (H.R. 5789)
  • Provide additional incentives for Medicaid health homes for patients with substance use disorder (H.R. 5810)

Medicare

  • Instruct CMS to evaluate the utilization of telehealth services in treating SUD (H.R. 5603)
  • Creates a pass-through payment extension under Medicare to encourage the development of clinically superior nonopioid drugs (H.R. 5809)
  • Add a review of current opioid prescriptions and, as appropriate, a screening for opioid use disorder (OUD) as part of the Welcome to Medicare initial examination (H.R. 5798)
  • Incentivize post-surgical injections as a pain treatment alternative to opioids by reversing a reimbursement cut for these treatments in the Ambulatory Service Center setting, as well as collect data on a subset of codes related to these treatments (H.R. 5804)
  • Require e-prescribing, with exceptions, for coverage of prescription drugs that are controlled substances under the Medicare Part D program (H.R. 3528)
  • Require prescription drug plan sponsors under the Medicare program establish drug management programs for at-risk beneficiaries (H.R. 5675)
  • Provide access to Medication-Assisted Treatment (MAT) in Medicare through bundled payments made to Opioid Treatment Programs for holistic service (Section 2 of H.R. 5776)

Public Health

  • Direct the Food and Drug Administration (FDA) to issue or update guidance on ways existing pathways can be used to bring novel non-addictive treatments for pain and addiction to patients. Several approaches have proven successful in speeding the availability of treatments for serious conditions through the FDA (H.R. 5806)
  • Authorize grants to state and local agencies for the establishment or operation of public health laboratories to detect fentanyl, its analogues, and other synthetic opioids (H.R. 5580)
  • Enable clinical nurse specialists, certified nurse midwives, and certified registered nurse anesthetists to prescribe buprenorphine; and make the buprenorphine prescribing authority for physician assistants and nurse practitioners permanent. In addition, H.R. 6 will permit a waivered-practitioner to immediately start treating 100 patients at a time with buprenorphine (skipping the initial 30 patient cap) if the practitioner has board certification in addiction medicine or addiction psychiatry; or if practitioner provides MAT in a qualified practice setting. Medications, such as buprenorphine, in combination with counseling and behavioral therapies, provide a whole-patient approach to the treatment of opioid use disorder (H.R. 3692)
Last updated Jun 20, 2018. Source: Republican Policy Committee

The summary below was written by the Congressional Research Service, which is a nonpartisan division of the Library of Congress, and was published on Jan 3, 2017.


Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act or the SUPPORT for Patients and Communities Act

This bill makes several changes to state Medicaid programs to address opioid and substance use disorders. Specifically, the bill:

modifies provisions related to coverage for juvenile inmates and former foster care youth, establishes a demonstration project to increase provider treatment capacity for substance use disorders, requires the establishment of drug management programs for at-risk beneficiaries, establishes drug review and utilization requirements, extends the enhanced federal matching rate for expenditures regarding substance use disorder health home services, and temporarily requires coverage of medication-assisted treatment. The bill also alters Medicare requirements to address opioid use. Specifically, the bill:

exempts substance use disorder telehealth services from specified requirements, requires the initial examination for new enrollees to include an opioid use disorder screening, modifies provisions regarding electronic prescriptions and post-surgical pain management, requires prescription drug plan sponsors to establish drug management programs for at-risk beneficiaries, and requires coverage for services provided by certified opioid treatment programs. The bill also addresses other opioid-related issues. Specifically, the bill:

establishes and expands programs to support increased detection and monitoring of fentanyl and other synthetic opioids, and increases the maximum number of patients that health care practitioners may initially treat with medication-assisted treatment (i.e., under a buprenorphine waiver). Additionally, the bill temporarily eliminates the enhanced federal matching rate for Medicaid expenditures regarding specified medical services provided by certain managed care organizations.