Press Release

#SubHealth Announces Details for Third Opioid Legislative Hearing, Focused on Coverage and Payment Issues


04.04.18

WASHINGTON, DC – The Health Subcommittee, chaired by Rep. Michael C. Burgess, M.D. (R-TX), announced a hearing for Wednesday, April 11, 2018, at 2:15 p.m. in room 2322 of the Rayburn House Office Building. The hearing is entitled, “Combating the Opioid Crisis: Improving the Ability of Medicare and Medicaid to Provide Care For Patients.”

This will be the third of three legislative hearings to examine the opioid crisis and possible legislative solutions. In February, #SubHealth reviewed eight bills pertaining to the Controlled Substances Act that will improve patient safety and bolster enforcement tools. In March, #SubHealth held a rare two-day hearing examining 25 prevention and public health solutions (read a recap of day one here and a recap of day two here).

“Continuing our collaborative effort in the fight against the opioid crisis, next week we will consider more than two-dozen bipartisan bills exploring a wide array of coverage and payment issues,” said #SubHealth Chairman Burgess. “As we consider issues within Medicaid and Medicare, I expect another robust discussion about these potential solutions and how they can help us combat the opioid crisis.”

Bills the Health Subcommittee will consider include:

NOTE: Some bills have not yet received formal titles and instead are denoted by working descriptions.

Medicaid

H.R. __, Provide IMD Services Up to 90 Days for Medicaid Beneficiaries with SUD, will allow states to receive federal Medicaid matching dollars for up to a total of 90 days per year for services in an IMD for Medicaid beneficiaries with a substance use disorder. Beneficiaries would need to be assessed after the first 30 days to determine if continued care (up to 60 more days) is medically necessary.

H.R. __, the Medicaid Pharmacy Home Act, will require all states to have a lock-in program that identifies at-risk Medicaid beneficiaries and assigns them to a pharmacy home program that sets reasonable limits on the number of prescribers and dispensers they may utilize, whether under a fee-for-service or managed care arrangement.

H.R. __, the Medicaid Drug Review, Utilization, Good governance (DRUG) Improvement Act, will require all state Medicaid programs to use common sense drug utilization review activities to help combat the opioid crisis. States will be required to have state-determined limitations in place for opioid refills, monitor concurrent prescribing of opioids and other drugs (such as benzodiazepines and antipsychotics), monitor antipsychotic prescribing for children, and have at least one buprenorphine/naloxone combination drug on the Medicaid drug formulary.

H.R. __, the Medicaid Providers And pharmacists Required To Note Experiences in Record Systems to Help In-need Patients (PARTNERSHIP) Act, will require the Medicaid program in each state to integrate prescription drug monitoring program (PDMP) usage into Medicaid providers’ and pharmacists’ clinical workflow. This bill also establishes basic standard criteria (based on industry best practices) that a PDMP must meet to be counted as a qualified PDMP. The bill would require states to report to the Centers for Medicare and Medicaid Services (CMS) on how their PDMPs are working and the number of covered providers who are using the PDMPs, as well statewide trends in controlled substance utilization.

H.R. __, Medicaid Incentives for Health Homes to Treat Substance Use Disorder, will amend Section 1945 of Title XIX to incentivize states to create health homes for Medicaid beneficiaries with substance use disorder. This bill extends the enhanced match from 8 quarters to 12 quarters so long as states meet quality, cost, and access targets.

H.R. __, the Medicaid Institutes for Mental Disease Are Decisive in Delivering Inpatient Treatment for Individuals but Opportunities for Needed Access are Limited without Information Needed about Facility Obligations Act (The Medicaid IMD ADDITIONAL INFO Act), will direct the Medicaid and CHIP Payment and Access Commission (MACPAC) to conduct a study on IMDs. The study will report on the requirements, standards, and oversight that state Medicaid programs have for IMDs. MACPAC, considering input from stakeholders, will summarize the findings and make recommendations on improvements and best practices by January 2020.

H.R. __, the Improving Medicaid Data Timeliness Act, will reduce the filing window for Medicaid claims from two years to one year. Currently, under a provision of law added in 1980, it is possible to submit claims for up to two years after the date of service. However, medical billing technologies and practices have been dramatically modernized in the last three decades. Today, 99 percent of claims are submitted within one year. This straightforward change will help give CMS, Congress, and others more timely, accurate, and complete expenditure data on all categories of Medicaid spending, including Medicaid drug spending. With Medicaid as one of the nation’s largest payers of behavioral health services and substance use disorder treatment, more timely and complete information will improve the ability of Congress to properly oversee the Medicaid program and help individuals the program serves.

H.R. __, the Improving the Transparency for Graduate Medical Education Funded by Medicaid Act, will improve transparency in the Graduate Medical Education (GME) program by requiring state Medicaid programs to periodically report to CMS data and information on how GME funds are being used to support physician training. Additionally, the state Medicaid program is required to report specific information on how physicians are trained in specialties that are essential in the opioid crisis (i.e., psychiatry, addiction medicine, etc.) and how GME recipients are using Medicaid funds to train physicians on substance use disorder.

H.R. __, the Medicaid Helping Unite Managers who have Abilities with Novel Chances to Activate the Possibilities of Innovation, Transformation, And Leadership (HUMAN CAPITAL), will provide enhanced federal medical assistance percentage to use toward hiring and retaining senior leadership for Medicaid programs who meet certain quantifiable professional standards. This policy change improves the ability of state Medicaid programs to recruit and retain high caliber private sector talent to manage state Medicaid programs, and will help reduce the short duration of most Medicaid directors (which averages about 18 months). The enhanced funding will sunset in 2026.

H.R. ___, Require HHS to act within a certain timeframe in implementing GAO’s recommendation for HHS to execute a strategy related to infants with neonatal abstinence syndrome. This bill requires the Department of Health and Human Services to establish a strategy to implement the recommendations in a recent Substance Abuse and Mental Health Services Administration (SAMHSA) report that will enhance the treatment and care of newborns suffering from Neonatal Abstinence Syndrome. The strategy must include a timeline for the implementation, how the Department plans to disseminate best practices to state health agencies, and any additional statutory authorities the Department needs to complete this strategy.

H.R. 3192, the CHIP Mental Health Parity Act, authored by Rep. Joseph Kennedy, III (D-MA). The Children’s Health Insurance Program (CHIP) provides health coverage to eligible children, through both Medicaid and separate CHIP programs. H.R. 3192 will require all CHIP plans to cover treatment of mental illness and substance use disorders.

H.R. 4998, the Health Insurance for Former Foster Youth Act, authored by Rep. Karen Bass (D-CA). Under current law, foster youth who are enrolled in Medicaid before they turn 18 may stay in Medicaid until the age of 26. However, such foster youth lost Medicaid coverage if they move out of their state. This bill will amend current law to allow such foster youth to continue to receive Medicaid benefits even if they move to another state.

H.R. __, Creation of a demonstration project for five years for up to 10 states that have committed to Medicaid delivery system advancements through substance use disorder demonstration waivers. This measure would allow certain states to receive an enhanced match for training and technical assistance and other incentive activities to enroll new providers treating substance use disorder in Medicaid or expand existing substance use disorder provider capacity.

H.R. __, Require state Medicaid programs to report on the 10 behavioral health measures that are included in CMS’ 2018 Core Set of Adult Health Care Quality Measures for Medicaid. A more complete view of behavioral health quality of care will inform Congress, CMS, and stakeholders on how to target improvement moving forward.  

H.R. 4005, the Medicaid Reentry Act, authored by Rep. Paul Tonko (D-NY), will amend title XIX (Medicaid) of the Social Security Act to allow state Medicaid programs to receive federal matching dollars for medical services furnished to an incarcerated individual during the 30-day period preceding the individual’s release.

H.R. __, Allow women who are pregnant and enrolled in Medicaid or who are and post-partum mothers of newborns and enrolled in Medicaid to continue to receive Medicaid benefits when in an IMD (up to first 12 months after delivery).  

H.R. 1925, the At-Risk Youth Medicaid Protection Act, authored by Rep. Tony Cardenas (D-CA), will prohibit state Medicaid programs from terminating 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. A state must process an application submitted by, or on behalf of, an incarcerated juvenile, notwithstanding that the juvenile is an inmate.

Medicare Part B

H.R. 3331, to amend title XI of the Social Security Act to promote testing of incentive payments for behavioral health providers for adoption and use of certified electronic health record technology, authored by Rep. Lynn Jenkins (R-KS).

H.R. __, Incentivizing Non-Opioid Drugs, will create a temporary pass through payment to encourage the development of non-opioid drugs for post-surgical pain management in Medicare.

H.R. __, CMS Action Plan, will call for the establishment of an Action Plan including studies, reports to Congress, and meetings with stakeholders for the purpose of addressing the opioid crisis.

H.R. __, Use of Telehealth to Treat Opioid Use Disorder, will instruct CMS to evaluate the utilization of telehealth services in treating opioid use disorder.

H.R. __, Alternative Payment Model for Treating Substance Use Disorder, will create demonstration project for an Alternative Payment Model for treating substance use disorder.  This model includes the development of measures to evaluate the quality and outcomes of treatment.

H.R. __, Initial Pain Assessment, will add a pain assessment as part of the Welcome to Medicare initial examination and provide intervention about non-opioid alternatives, as appropriate.

H.R. __, Adding Resources on Non-Opioid Alternatives to the Medicare Handbook, will direct CMS to compile education resources for beneficiaries regarding opioid use, pain management, and alternative pain management treatments, and include these resources in the “Medicare and You” Handbook.

H.R. __, Post-Surgical Injections as an Opioid Alternative, will seek to incentivize post-surgical injections as a pain treatment alternative to opioids by reversing a reimbursement cut for these treatments.

Medicare Part D

H.R. 3528, the Every Prescription Conveyed Securely Act, authored by Reps. Katherine Clark (D-MA) and Markwayne Mullin (R-OK), will require e-prescribing, with exceptions, for coverage of prescription drugs that are controlled substances under the Medicare Part D program.

H.R. __, Mandatory Lock-In, will build off of work done in the Comprehensive Addiction Recovery Act (CARA), and require prescription drug plan sponsors under the Medicare program establish drug management programs for at-risk beneficiaries.

H.R. 4841, the Standardizing Electronic Prior Authorization for Safe Prescribing Act, authored by Rep. David Schweikert (R-AZ), seeks to standardize electronic prior authorization under Medicare Part D.

H.R. __, Beneficiary Education, will require prescription drug plans under Medicare Part D to include information on the adverse effects of opioid overutilization and of coverage of non-pharmacological therapies and non-opioid medications or devices used to treat pain.

H.R. __, Evaluating Abuse Deterrent Formulations, will direct CMS to evaluate the use of abuse-deterrent opioids in Medicare plans.

H.R. __, Prescriber Notification, will require CMS to, in consultation with stakeholders, establish a threshold, based on specialty and geographic area, for which a prescriber would be considered an outlier opioid prescriber. CMS would then be responsible for notifying prescribers identified as outliers of their status.

H.R. __, Prescriber Education, will direct CMS to work with Quality Improvement Organizations to engage in outreach with prescribers identified as clinical outliers to share best practices.

H.R. __, Medication Therapy Management (MTM) Expansion, will add beneficiaries at-risk for prescription drug abuse to the list of targeted beneficiaries to be eligible for MTM under Part D.

H.R. __, CMS/Plan Sharing, will help facilitate communication between MA organizations, Part D plan sponsors, and CMS relating to substantiated fraud, waste, and abuse investigations.

The Majority Memorandum, witness list, and witness testimony for the hearing will be available here as they are posted.

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