The Policy Committee invites all State Rural Health Associations to join the monthly meeting of the NOSORH Policy Committee. Updates will be provided on federal regulatory issues, efforts to reauthorize the SORH program and other policy issues.

SORH Reauthorization Bill Update

While the House and Senate were out of session for most of October, the House version of the State Office of Rural Health Reauthorization bill (H.R. 5641) continued to gain momentum picking up three new cosponsors. In addition to gaining House Energy and Commerce member Morgan Griffith (VA), Reps. Steve Russell (OK) and Elise Stefanik (NY) also signed on a cosponsor. NOSORH met with the Energy and Commerce Committee this fall and believes it is likely the SORH reauthorization bill advances next time the committee addresses public health legislation. The Senate has already passed the reauthorization bill. If there is a House member of the Energy and Commerce Committee in your state, please contact their staff and urge them to cosponsor H.R. 5641.

President Signs Opioid Reform into Law

On October 3, 2018, the “Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act” or short hand—the SUPPORT for Patients and Communities Act (the “SUPPORT Act”)—was approved by the Senate and sent to the President. The President has now signed the SUPPORT Act into law. The SUPPORT Act is the compromise version of the opioid response bills approved by the House and Senate earlier this year.

The bill package includes a broad array of new programs and reforms specific to the opioid crisis and substance use disorders (SUDs) generally advocated by the healthcare industry. The final compromise opioid package contains over 70 opioid-related bills. For a comprehensive summary of the package’s provisions, see the section-by-section summary at: https://tinyurl.com/y9vlrsmy. Some of the key issues addressed in the SUPPORT Act are:

  • Partial repeal of the “IMD exclusion”: This provision partially lifts the ban on use of federal Medicaid program funding for SUD treatment at facilities that are an institute for mental disease (IMD) with more than 16 beds (commonly known as the “IMD exclusion”). Under the provision, Medicaid programs may pay for care at an IMD facility for up to 30 days of residential SUD treatment annually per beneficiary, regardless of severity of diagnosis. The partial lifting of the IMD exclusion is only effective for the next five years. This provision does not mandate the coverage benefit by the states. It remains to be seen whether SUD treatment providers will enroll in the Medicaid program for such limited relief from the IMD exclusion.
  • CAREER Act and Telehealth: The CAREER Act provides a grant program to incentivize initiatives that support individuals in SUD treatment and recovery to live independently and participate in the workforce. Grant funding is earmarked for defined activities, including promoting telemedicine infrastructure and technology adoption, as well as case management, case coordination, or peer recovery support services. Grant funds will be awarded to the states based upon the rate of drug overdose deaths, rate of unemployment, and rate of labor force participation in the state. In addition to expanding some access to SUD treatment to Medicare beneficiaries via telehealth services, the bill also directs CMS to issue guidance to states on options for providing services via telehealth that address SUDs under Medicaid, including for federal reimbursement of services addressing high-risk individuals, for provider education, and for telehealth services to students in school-based health centers.
  • Medicare SUD Treatment Access: The bill creates a four-year demonstration project, to be developed by CMS in consultation with specialists in the field of addiction, clinicians in primary care, and a beneficiary group, that would allow Medicare beneficiaries to receive MAT and certain wraparound services at an Opioid Treatment Program (OTP). Currently, OTPs are not recognized as Medicare providers, meaning that Medicare beneficiaries receiving MAT at OTPs must pay out-of-pocket.

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