Bipartisan opioid bill has IMD exclusion, expands MAT
Congress released a 660-page bipartisan opioid bill on Tuesday that includes Medicaid funding for addiction treatment, removes the Institutes for Mental Disease (IMD) exclusion that prohibits federal Medicare dollars from going to large inpatient treatment centers for substance use disorders, allows more providers to give medication-assisted therapy (MAT), opens up non-addictive pain management alternatives and increases enforcement of illegal fentanyl in the U.S.
In an analysis of the legislation, Height Capital Markets said additional IMD funding should increase inpatient behavioral health admissions for health systems, including Acadia Healthcare and Universal Health Services facilities. Analysts said 10% of UHS revenues in March were connected to addiction treatment.
The bill doesn't include a pharmaceutical industry-backed effort to reverse a budget plan in February that requires drug manufacturers to provides discounts on prescription drugs to help with the so-called Medicare Part D "doughnut hole."
The bill comes following months of discussions and multiple bills aimed at tackling the opioid crisis. The bipartisan effort resolved differences between the House-backed SUPPORT for Patients and Communities Act and Senate-backed Opioid Crisis Response Act of 2018.
Height Capital Markets said the exact impact of the legislation on hospitals depends on location and situation. These variables include an area's prevalence of substance use disorder, whether a state uses Medicaid funds to treat such disorders and whether it has expanded Medicaid.
The legislation, which is expected to pass both houses of Congress easily as early as next month, defines an IMD as a facility with more than 16 beds that primarily serves people with mental diseases, follows evidence-based practices and offers at least two MATs. It also allows states to change state plan amendments from CMS.
Healthcare groups differed in their reaction to the proposal with some fully supporting the measures, while others saying it didn't go far enough.
The American Association of Nurse Practitioners praised the legislation, saying it will allow 248,000 NPs to get trained to use MAT and expand patient access to the treatment. "Today, nearly 7,000 NPs can prescribe MATs, and we call on all NPs to complete the required training and waiver this year," AANP President Joyce Knestrick said.
However, the Association for Behavioral Health and Wellness, a group of payers that manage behavioral health insurance benefits for more than 175 million people, wasn't as supportive. It backed multiple parts of the bill, including loosening IMD restrictions, expanding telehealth for substance use disorder treatment, creating recovery housing best practices and testing payment models for behavioral health providers.
ABHW believes, however, that the legislation should have made changes to 42 CFR Part 2, which regulates substance use disorder patient records. Without those changes, the "lifesaving provisions" in the bill won't be effective, it warned. The group said the recently passed Overdose Prevention and Patient Safety in the House would "align Part 2 with the Health Insurance Portability and Accountability Act for treatment, payment and healthcare operations while strengthening protections against the use of addiction records in criminal, civil or administrative proceedings."
Not reforming Part 2 in the new compromise bill may lead to failing to integrate services and potentially dangerous medical situations, including patient relapse, overdose and death, the group said. In a statement, ABHW President Pamela Greenberg called the omission "an unfortunate missed opportunity."
"Without this provision, the opioid bill does not go far enough and the Senate should not leave Washington with such a vital and lifesaving piece of legislation left on their desk" she said.
Most of the money will go to state opioid response grants, which expands access to treatment and recovery support supplies. Almost $400 million will go to Health Resources and Services Administration programs, such as community health systems, rural organizations and academic institutions.
Another $155.5 million will go to the Centers for Disease Control and Prevention to help states with opioid-related programs.