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On the Hill: Senate Passes Long-Awaited Opioid Package

With four weeks left before midterm elections, Congress has sent to the president’s desk a long-awaited bill to combat the opioid epidemic.

The Senate voted 98-1 to advance a compromise version of legislation (H.R. 6)  that represents the federal government’s first comprehensive policy response to the nation’s opioid crisis. The final version of the legislation:

  • repeals for five years the Institutions for Mental Diseases (IMD) exclusion, allowing Medicaid coverage of inpatient substance use disorder treatment for up to 30 days in a 12-month period;
  • provides grant funding for opioid addiction prevention, treatment, and recovery efforts;
  • expands Medicare and Medicaid coverage of medication-assisted treatment (MAT) and the list of clinicians eligible to prescribe MAT;
  • provides $10 million in funding for a three-year demonstration program that awards grants to hospitals and emergency facilities to implement alternative pain management protocols and treatments that limit use of opioids; and
  • waives geographic requirements for Medicare telehealth coverage when treating substance use disorder, as well as allows homes to qualify as an originating site for such treatment.

The legislation also includes provisions directing the Medicare Payment Advisory Commission (MedPAC) and the Department of Health and Human Services (HHS) to review and determine whether Medicare reimbursements offer financial incentives to prescribe opioids rather than non-opioid alternative treatments.

The final legislation does not align confidentiality regulations for substance use disorder treatment records (42 CFR Part 2) with HIPAA privacy standards. America’s Essential Hospitals advocated for including the 42 CFR Part 2 provision in the final bill.

Bipartisan Letter Questions OPPS Payment Cuts

A bipartisan House letter to the Centers for Medicare & Medicaid Services (CMS)  raises concerns about the justification for, and possible impact of, proposed cuts to hospital-based outpatient departments.

The letter is led by Committee on Ways and Means Health Subcommittee Chair Peter Roskam (R-IL) and Rep. Mike Thompson (D-CA). The lawmakers express concern that CMS’ proposal conflicts with Congress’ intent for site-neutral payment policy and question the authority the agency cites as its justification for the change. The letter calls on CMS to consider how the payment cuts, proposed for the 2019 Medicare Outpatient Prospective Payment System (OPPS), might affect patient access and efforts to promote value-driven care delivery models. 

America’s Essential Hospitals released an Action Alert asking member hospitals to contact their House representatives and urge them to sign this letter. 

N.H. Senators Introduce Surprise Billing Legislation

Sens. Jeanne Shaheen (D-NH) and Maggie Hassan (D-NH) separately introduced legislation last week to protect patients from surprise medical bills:

  • the Reducing Costs for Out-of-Network Services Act of 2018, introduced by Shaheen, would cap the amount hospitals and physicians could charge uninsured patients and out-of-network patients who have individual market coverage; and
  • the No More Surprise Medical Bills Act of 2018, introduced by Hassan and cosponsored by Shaheen, aims to help eliminate surprise medical bills for people with employer-sponsored health plans.

These legislation comes after Sen. Bill Cassidy (R-LA) and bipartisan members of the Senate health care price transparency working group last month released a discussion draft that seeks to address similar concerns related to surprise bills.

House Heads Home, Senate Remains in D.C.

House members will be on recess for the remainder of the month to campaign for the midterm elections. The Senate remains in session for the time being and is expected to work on clearing judicial nominees and advancing noncontroversial legislation.

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About the Author

Erin Delaney is the legislative affairs associate at America's Essential Hospitals.