Congress nears fin­ish line on opi­oid leg­is­la­tion

Modern Healthcare - - The Week Ahead - — Su­san­nah Luthi

Law­mak­ers in both cham­bers of Congress this week will start wrapping up work

on leg­is­la­tion aimed at cur­tail­ing the opi­oid epidemic. They hope to pass a ma­jor pack­age, likely the last ef­fort ahead of Novem­ber’s midterm elec­tions, by the end of May.

In its fi­nal hear­ing in a se­ries of meet­ings on the topic, the House En­ergy and Com­merce Com­mit­tee will con­sider bills that would har­ness Med­i­caid and Medi­care to help man­age the epidemic.

The bun­dle of bills in­cludes a long-de­bated fur­ther ex­pan­sion of the so-called IMD ex­clu­sion that cur­rently bans group homes with more than 16 beds from get­ting Med­i­caid re­im­burse­ment for stays longer than 15 days per month. Law­mak­ers are con­sid­er­ing ex­pand­ing the time limit for sub­stance use dis­or­der pa­tients to 90 days per year. A sim­i­lar mea­sure pro­posed in 2016 was dis­carded be­cause it was deemed too costly by the Con­gres­sional Bud­get Of­fice.

In the Se­nate, the health com­mit­tee re­leased a dis­cus­sion draft of a sub­stan­tial, mul­ti­pronged bill called the Opi­oid Cri­sis Re­sponse Act of 2018. On Wed­nes­day morn­ing, the com­mit­tee is sched­uled to mark up the draft, which was de­vel­oped through a se­ries of hear­ings held by Chair­man La­mar Alexan­der (R-Tenn.) and rank­ing member Patty Mur­ray (D-Wash.). It in­cludes sev­eral mea­sures aimed at Food and Drug Ad­min­is­tra­tion reg­u­la­tion of new pack­ag­ing for opi­oids and safer dis­posal, as well as devel­op­ment of non-ad­dic­tive painkillers.

Also up for dis­cus­sion is a pro­vi­sion doc­tors have been watch­ing: a study of pre­scrib­ing lim­its that could im­pose an ex­tra bur­den on physi­cians. Leg­is­la­tion in­tro­duced ear­lier this year by Sen. Rob Port­man (R-Ohio), a fol­low-up to his 2016 Com­pre­hen­sive Ad­dic­tion and Re­cov­ery Act, called for lim­it­ing ini­tial opi­oid pre­scrip­tions for pain treat­ment to a three-day sup­ply, which some providers op­posed. They con­tend it’s ar­bi­trary and could in­ter­fere with pa­tient treat­ment.

The Cen­ters for Dis­ease Con­trol and Preven­tion rec­om­mends the three-day limit for new pre­scrip­tions. In­sur­ers also have sup­ported caps.

The Se­nate draft in­cludes “Jessie’s Law,” a bill named for a re­cov­ered heroin ad­dict who died of an opi­oid over­dose af­ter she was given oxy­codone pills fol­low­ing hip surgery. The leg­is­la­tion would let doc­tors ac­cess a con­sent­ing pa­tient’s prior his­tory with sub­stance use be­fore de­cid­ing on treat­ment.

Other mea­sures of in­ter­est to providers in­clude support for states to bol­ster their prescription-drug-mon­i­tor­ing pro­grams to push in­ter­state shar­ing of data, which can help doc­tors and phar­ma­cies spot pa­tients who may have a his­tory of opi­oid abuse; and support for state ef­forts on neona­tal ab­sti­nence syn­drome, which has led to es­ca­lat­ing costs for hos­pi­tals.

The re­cent $1.3 tril­lion, two-year spend­ing pack­age signed into law in­creased state grants by $1 bil­lion, al­though House law­mak­ers in a March En­ergy and Com­merce opi­oids hear­ing pressed gov­ern­ment of­fi­cials on the ef­fec­tive­ness of ex­ist­ing grants and whether the money was be­ing spent ap­pro­pri­ately.

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