Congress passed the SUPPORT Act. What is important for states to know?
Last week, Congress reached bipartisan, bicameral consensus on an opioids legislation and spending package. The President is expected to sign it this week. The law will be known as the “Substance Use–Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act’’ or, more commonly as the ‘‘SUPPORT for Patients and Communities Act.”
This legislation is largely considered to be an important step forward, but it was not as far-reaching or as generous as most experts agreed would be needed to reverse course on the opioid overdose trend. Last year, over 70,000 people died from overdoses, and approximately 50,000 of those were opioid-related overdoses, a number that has continued to climb annually.
HealthTech Solutions wrote a primer about the opioids public health emergency and also posted what states need to know about the Trump Administration’s efforts to combat this epidemic. If you are new to this topic, the primer is a great way to get acquainted with the challenges of solving this public health issue.
What is in the bill?
- IMD inclusion. The biggest win for states is the partial repeal of the so-called “IMD exclusion,” which currently prevents states from receiving federal Medicaid funds for treatment provided in Institutions for Mental Disease (IMD) with more than 16 beds, which are also known as residential treatment centers. This provision was intended to discourage institutionalization, but it has prevented many states from paying for inpatient treatment for addiction. The final bill allows federal Medicaid funds to be used for up to 30-day stays for inpatient addiction treatment.
- There is a $2.7 billion offset (also known as a “pay for”) related to the Medical Loss Ratio (MLR) and Medicaid managed care organizations (MCO). The current provisions require that a Medicaid MCO spend at least 85% of its premiums on medical care. The new provision requires states to collect the difference from MCOs between this 85% MLR and what MCOs actually spend on medical care.
- Expanded licensure. Mid-level providers such as Nurse Practitioners (NP) and Physician Assistants (PA) will be allowed to permanently prescribe buprenorphine, an anti-addiction drug. Currently, only doctors with special licensure and training may prescribe buprenorphine. The bill also grants flexibility for a special 5-year period to other mid-levels, such as nurse anesthetists, nurse midwives, and clinical nurse specialists to prescribe buprenorphine.
- Mail limitations. Provisions in the bill will limit the sale and exchange of illegal drugs, including synthetic opioids, through the mail.
- Funds for the research and development of non-addictive painkillers.
What is not in the bill?
- The bill may not sufficiently address current chronic pain management. Making addictive opioids harder to get, even with a valid prescription, may have a negative impact on patients who rely on opioids for acute pain.
- Medication-assisted treatment (MAT) is largely considered essential to outpatient and long-term opioids addiction treatment. Some facilities do not include this as part of their protocol, and nothing in this bill will make them do so.
- The final bill is nearly budget neutral due to a number of offsets and projected savings from reducing the public health burden. However, an earlier Senate version was expected to spend approximately $8 billion, not including offsets. This legislation will fall far short of the $45-200 billion many legislators and experts believed would be needed.
This legislation is an important step forward on this crisis. Supplemented by the previous grant opportunities, states are receiving some much-needed relief. As noted in this Health Affairs Blog, states still have options such as:
- Expanding Medicaid to cover some of the uninsured who need treatment
- Engaging in benefit design to promote evidence-based protocols for treatment and prescriptions
- Addressing regulatory hurdles such as licensing, training, and rehabilitation facility oversight
- Offering drug court access and standards
In summary, the bill provides some support for this public health emergency. While it may not be the final federal action on this topic, it does provide funding to accomplish some positive changes. States may go further on their own through regulatory and policy changes.