SUPPORT for Patients and Communities Act Enables States to Continue Fighting Opioid Epidemic

The opioid addiction epidemic in our nation continues to be one of the most significant public health crises in recent history, as we have noted in recent blogs. Drug overdose deaths involving opioids have more than tripled in the United States from 2000-2015. According to the Centers for Disease Control and Prevention (CDC), there were 63,632 drug overdose deaths in 2016, 66 percent of which involved an opioid. Provisional data for 2017 projects an increase in drug overdose deaths (to 72,287) with an increasing share involving an opioid (68 percent). Recent research from the CDC found that the increase in drug overdose deaths involving opioids has contributed to a reduction in life expectancy across the board in the United States. Harbage Consulting has been assisting states in addressing these issues in multiple ways over the past four years; and improving the behavioral health care system has become a cornerstone of our firm’s work, both in California and nationally.On October 24, 2018, the “Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act,” also referred to as the “SUPPORT for Patients and Communities Act,” was signed into law.  The new law is a bipartisan effort intended to improve prevention, treatment, and recovery efforts for substance use disorders (SUDs), with a specific focus on opioid use disorder (OUD). The law provides new federal funding, flexibility, and tools for states in their ongoing efforts to end the opioid crisis.

Key Provisions in the SUPPORT for Patients and Communities Act

The SUPPORT for Patients and Communities Act includes important changes to federal law and new state funding opportunities. Specifically, the new law:

• Continues the grant funding provided by the 21st Century Cures Act, otherwise known as the State Targeted Response to the Opioid Crisis (STR) and State Opioid Response (SOR) grants. These grants aim to increase access to medication assisted treatment (MAT), address the unmet need for OUD treatment, and reduce opioid-related overdose deaths.

• Creates statutory authority for states to use federal Medicaid funds to cover SUD treatment services provided to adults in an Institution for Mental Disease (IMD) for up to 30 days in a 12-month period without a waiver. Beginning with California in 2015, at least a dozen state Medicaid programs have received Medicaid Section 1115 waivers from CMS to receive federal matching funds for providing SUD treatment services to beneficiaries residing in an IMD. Going forward, states can elect to provide these services through a Medicaid State Plan Amendment. The law also ensures that pregnant and postpartum women with a SUD in an IMD can continue to receive other Medicaid-covered services outside of the IMD.

• Gives clinical nurse specialists, certified nurse midwives, and certified registered nurse anesthetists the ability to prescribe medications to treat OUD and makes permanent the prescribing authority of physician assistants and nurse practitioners authorized by the 21st Century Cures Act.

• Requires state Medicaid programs to cover all Food and Drug Administration (FDA)-approved drugs for MAT. While, as of 2017, all states cover at least one of three FDA-approved drugs for the treatment of OUD – methadone, naltrexone, and buprenorphine – over a quarter of states still do not cover all approved options.

• Requires that state Medicaid programs suspend, rather than terminate, Medicaid eligibility for juveniles (under age 21) while incarcerated, to make it easier to access services upon release.

• Requires all Medicaid providers to check their state’s prescription drug monitoring program (PDMP) before prescribing a controlled substance. According to a recent survey of state Medicaid programs, 32 states currently require providers to check the state’s PDMP before prescribing opioids in their fee-for-service Medicaid programs, and many states also require managed care entities to follow the same policy.

• Directs the creation of various guidance documents and studies to better inform states on best practices for treatment and prevention of SUDs. Topics include managing pain using non-opioid medications, using telehealth for administering SUD services, improving transitions of care for individuals leaving incarceration, strategies for providing housing-related supports, and improving care for infants with neonatal abstinence syndrome. 

Harbage Consulting is Supporting States’ Responses to the SUD Epidemic

Since 2015, Harbage Consulting has been working with the California Department of Health Care Services (DHCS) to build an improved system of care for SUD treatment and recovery, including assisting in the design and implementation of California’s Medicaid Section 1115 waiver program that offers a comprehensive continuum of SUD treatment and recovery services through a managed care system. In 2017, Harbage Consulting assisted DHCS in developing and implementing the state’s $90 million STR grant, which included the development of a Hub and Spoke System (H&SS). Under the H&SS, Opioid Treatment Providers act as “hubs,” managing complex patients and serving as a source of guidance and support to “spokes,” outpatient primary care and SUD treatment providers that extend the reach of the system into rural and underserved areas. In 2018, with the additional funding provided under California’s SOR grant, Harbage Consulting is providing technical assistance to the state as it implements innovative approaches to improve treatment capacity in emergency departments, prisons and jails, and for specific populations such as native tribal communities, veterans, and youth.

In addition, Harbage Consulting has provided policy, clinical and operational support to West Virginia, Minnesota, and Alaska on the design and implementation of Medicaid Section 1115 waivers designed to improve care for Medicaid beneficiaries with SUDs. Our team provides tailored advice to states on how to design and negotiate their waiver proposals to CMS and draws from our experience in California to help other states anticipate implementation issues before they arise.States’ recent efforts have been crucial to stem the tide of overdose deaths across the country, but more policy and financial support is needed to continue building an accessible and effective system for SUD prevention, treatment, and recovery. While the SUPPORT for Patients and Communities Act will not address all the gaps in the system or solve the problem quickly enough, this important, bi-partisan legislation provides a critical path forward to establishing a system that is responsive to the needs of people at risk of or living with SUDs.

---

Authors

Cehelsea Kelleher [Director]

Molly Brassil [Senior Vice President]