After a long summer of compiling numerous bills and working out differences between the two Congressional chambers, the SUPPORT for Patients and Communities Act has finally been signed into law. The bill reauthorizes funding for the 21st Century Act, which put $500 million a year toward the opioid crisis.
The final legislation includes provisions that:
- Expand access to telehealth for substance use disorder (SUD) treatment
- Incentivize the use of opioid alternatives for pain management
- Increase federal reimbursement for SUD treatment
- Ensure access to quality recovery housing and
- Increase providers’ flexibility to use medication-assisted treatment (MAT) for opioid addiction and other SUD.
MAT is the combination of counseling or therapy with U.S. Food and Drug Administration (FDA) approved medications. The three medications approved by the FDA for use in MAT are methadone, buprenorphine and naltrexone. Each drug is subject to numerous regulations with those applying to methadone being the strictest.
Studies show that MAT is highly effective and increases the likelihood that someone with SUD will seek long term treatment. Despite this evidence, there have been some who have criticized the use of MAT because it treats addiction with other medications rather than complete abstinence.
Another caveat to the use of MAT is that it can only be used in conjunction with a Substance Abuse and Mental Health Services Administration (SAMHSA) approved opioid treatment program (OTP). OTPs are operational in nearly every state but are regulated and overseen by SAMHSA at the federal level.
The SUPPORT for Patients and Communities Act or H.R. 6, includes a few provisions aimed at ensuring access to MAT for SUD treatment, such as:
- Requiring state Medicaid plans to include coverage for MAT for the period October 1, 2020 – September 30, 2025
- States with a shortage of qualified providers or facilities to furnish MAT are excluded
- Increases the number of patients that a qualified practitioner or physician can provide narcotics to for purposes of SUD treatment from 30 to 100
- Qualified physician must be properly credentialed and provide MAT in an approved setting
- Eliminating the time limitation that qualified other practitioners (e.g. nurse practitioners [NPs] and physician assistants [PAs]) may be considered qualified for purposes of prescribing narcotics
- Previously, NPs and PAs were only allowed to become qualified practitioners between July 22, 2016 and October 1, 2021
- Expands the definition of “qualifying other practitioner” to include clinical nurse specialists, certified registered nurse anesthetists, or certified nurse midwives
- Imposes a time limitation to become qualifying practitioners for the period October 1, 2018 – October 1, 2023
- Requires the U.S. Department of Health and Human Services (HHS) to submit recommendations for different value-based payment and delivery models to be tested by the Center for Medicare and Medicaid Innovation (CMMI)
- Models should encourage the use of FDA approved MAT and other pain management therapies to reduce risk of SUD
Some public health experts criticize H.R. 6 as lacking “the urgency, breadth and steady long-term funding” needed to end the opioid crisis and prevent addiction. Despite the bill’s shortcomings, experts agree that it’s a step in the right direction.