As summer quickly approaches, the opioid epidemic continues to dominate the healthcare legislative agenda in Congress. As I indicated previously, Congress plans on passing legislation to address the opioid crisis prior to their August recess. The most recent slate of bills that were passed out of the House Energy and Commerce Committee includes H.R. 5605, “Advancing High Quality Treatment for Opioid Use Disorders in Medicare Act”, and H.R. 4684, “Ensuring Access to Quality Sober Living Act of 2018”, both of which address the need for quality standards within substance use disorder (SUD) treatment and recovery settings.
The need for quality standards in addressing the opioid epidemic is vital. As noted by Rep. Bilirakis (R-FL) in the House and Energy Committee opioid legislation markup on May 17, “without standards…quality outcomes can be jeopardized”. Due to the complex nature of opioid and substance use addiction, it’s important to ensure the delivery of high quality healthcare services. Access to poor quality care may be considered access denied.
H.R. 5605 authorizes the Secretary of the Department of Health and Human Services (HHS), to implement a five-year demonstration program to increase access to opioid use disorder treatment services, improve both physical and mental health outcomes and reduce costs when possible. Under the demonstration program, opioid use disorder care teams will provide outpatient opioid services. This bill requires care teams to include a group of healthcare providers or an entity employing or contracting with providers. Preference in selecting care teams to participate in the demonstration will be given to those that are in areas with a high prevalence of opioid use disorders.
To assess the care rendered by participating care teams, the bill directs the HHS Secretary to develop and implement quality standards and performance measures within nine months of the legislation being enacted. In developing the quality standards and performance measures, the Secretary must seek input from key stakeholders like primary care providers and addiction specialists. HHS also has the option to simply adopt standards already in use for the treatment of opioid use disorders or contract with an appropriate entity to develop standards.
The quality standards must address the following areas:
- Patient engagement in treatment
- Retention in treatment
- Provision of evidence-based medication-assisted treatment
- Any other criteria the HHS Secretary deems appropriate
Each participating care team must submit data to HHS detailing their performance against the quality standards at a frequency and format that is at the HHS Secretary’s discretion. Performance against the quality standards will be used to determine the amount of performance-based incentive paid to each care team.
To evaluate the entire demonstration program, the Comptroller General of the United States must conduct an intermediate and final evaluation to determine how well the program accomplishes the following:
- Reduces hospitalizations and emergency department visits
- Reduces the frequency of opioid overdoses including those originating from a prescription or obtained illegally
- Increases use of medication-assisted treatment for opioid use disorders
- Improves health outcomes of those with opioid use disorders including reducing the incidence of infectious diseases like Hepatitis C and HIV
- Does not increase total spending on health care services
- Reduces deaths from opioid poisoning
- Reduces the utilization of inpatient residential treatment
While H.R. 5605 focuses mainly on the treatment side, H.R. 4684 is concerned with promulgating best practices for operating recovery housing. It directs the HHS Secretary in concert with the Secretary for Housing and Urban Development to identify or aid the development of best practices for recovery housing. It also directs HHS to consider input from key stakeholders like patients with a history of opioid use disorder, accrediting entities and recovery housing organizations. The best practice guidelines may include model laws for implementing proposed minimum standards for operating recovery housing.
Although treatment and recovery centers are sometimes mistakenly used interchangeably, they both serve a distinct purpose. Typically, patients start the journey to recovery by entering a treatment center in which care is more individualized, and then they move to recovery housing which is more group focused. Treatment centers usually begin with a detoxification period followed by withdrawal and counseling to address the underlying cause of the addiction. In contrast, recovery centers are focused more on building support systems to maintain patients’ sobriety and often include peer support groups.
Quality standards to address opioid treatment and recovery centers will share a similar foundation but there are differences to account for, hence the need for two separate bills. House of Representatives leadership has indicated they plan on holding a floor vote on H.R. 5605, H.R. 4684 and other opioid legislation in June after the proposed bills are compiled into one legislative package.