After passing the U.S. House of Representatives on September 28, 2018 by a vote of 393-8 and passing the U.S. Senate on October 3 by a vote of 98-1, H.R. 6, the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act will be sent to President Trump, who is expected to sign the legislation. While Members of Congress praised the bill as an important step forward, they also acknowledge the legislative response must be ongoing.
The SUPPORT for Patients and Communities Act contains a wide range of policy approaches from a number of individual bills, including from over 60 pieces of legislation that previously passed the House. For instance, H.R. 6 expands the use of telemedicine; expands medication-assisted treatment for Medicare beneficiaries; creates a pilot program for electronic health record use for behavioral health professionals; provides grant and demonstration programs to build capacity in drug treatment; develops treatment strategies for neo-abstinence syndrome; addresses addiction and recovery needs of communities; directs Federal agencies to pursue research related to addiction and pain; promotes new education and awareness programs regarding pain treatment for health care providers; streamlines coordination between Federal agencies to improve detection and combat illegal drugs; and expands a program for first responders to address opioid overdoses.
The SUPPORT for Patients and Communities Act includes a provision to partially repeal the current Medicaid Institutions for Mental Diseases (IMD) exclusion, which prohibits the use of Federal Medicaid financing for inpatient care at facilities with more than 16 beds. Subtitle F of H.R. 6, the IMD CARE Act, allows Medicaid funding for up to 30 days per year for services provided to adults who have had a substance use disorder for at least one year. This partial repeal will be effective beginning October 1, 2019 and ending September 30, 2023. The bill also directs the Medicaid and CHIP Payment and Access Commission (“MACPAC”) to conduct a study of the IMD issue.
The SUPPORT for Patients and Communities Act also expands the existing Sunshine Act, which requires pharmaceutical and medical device manufacturers to disclose payments made to health care providers. Section 6111 of H.R. 6 specifies that a health care provider includes physician assistants, nurse practitioners, clinical nurse specialists, certified nurse anesthetists, and certified nurse-midwives.
The final version of H.R. 6 did not contain a House-passed provision to align 42 CFR Part 2 (“Part 2”) with the current Health Insurance Portability and Accountability Act (HIPAA) privacy rule for health care treatment, payment, and operations. Part 2 regulations provide confidentiality for people seeking treatment for substance use disorders but can hinder coordinated care when a patient’s mental health records are kept separate from medical records. Representative Markwayne Mullin (R-OK), lead sponsor of the Overdose Prevention and Patient Safety Act, noted: “Doctors must have the whole picture on a patient’s medical history in order to safely and effectively treat that patient.”
