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#SubHealth Reviews Medicare and Medicaid Solutions to Help Combat the Opioid Crisis


Subcommittee Hears from Two Panels over Two Days on 34 Bills Examining Coverage and Payment Issues

WASHINGTON, DC – The Health Subcommittee, chaired by Rep. Michael C. Burgess, M.D. (R-TX), today concluded a hearing, stretched over two days, examining 34 bills to improve the ability of Medicare and Medicaid to provide care for patients.

“Certainly, both programs play key roles in identifying at-risk beneficiaries, providing treatment, and decreasing overdose deaths,” said #FullCmte Chairman Greg Walden (R-OR), who used his opening remarks to highlight the importance of the two programs, which serve roughly one in three Americans. “The bills we will consider today cover a range of important issues – including provisions to: remove barriers to treatment, improve data to identify and help at-risk patients, provide incentives for greater care coordination and enhanced care.”

#SubHealth Chairman Michael C. Burgess, M.D. (R-TX) talked about the urgency and collective responsibility in responding to the opioid crisis, stating, “With the opioid crisis devastating our country and eroding our economic productivity, all of us must be willing to take a fresh and fair look at each of the policies presented today. We should think creatively about how to help strengthen Medicaid and Medicare’s ability to combat the scourge of opioid abuse – because without adequate tools and accountability, our largest public payers will be unable to handle the challenge before them.

Ms. Brandt delivers her opening statement at Wednesday’s portion of the hearing

Ms. Kimberly Brandt, Principal Deputy Administrator for Operations, Centers for Medicare and Medicaid Services (CMS), was the sole government witness on Wednesday’s panel. Ms. Brandt began her testimony by highlighting the severity of the epidemic, stating, “The number of Americans who are struggling with an opioid use disorder (OUD), is staggering. In 2016 alone, nearly 64,000 Americans died from drug overdoses, the majority (over 42,000) of them involved opioids.”

Ms. Brandt went on to walk through CMS’ three priorities in their efforts to combat the opioid crisis, explaining, “CMS is keenly focused on three areas – preventing and reducing OUDs by promoting CDC guidelines for opioid prescriptions and encouraging non-opioid pain treatments; increasing access to evidence-based treatment for OUD; and leveraging data to target prevention and treatment efforts and to support fraud, waste, and abuse detection efforts.”

Mr. Toby Douglas, Senior Vice President for Medicaid Solutions, Centene Corporation, spoke to how Medicaid beneficiaries have been impacted in this epidemic, saying, “Medicaid beneficiaries age 18-64 have a higher rate of opioid use disorder than privately insured individuals… Opioid addiction is estimated to be 10 times as high in Medicaid as in commercial populations.”

Mr. Douglas gives his opening statement

Mr. Douglas also noted that Medicaid beneficiaries tend to be prescribed pain medication at higher rates and are at a greater risk of overdosing. To help address these concerns, he highlighted how states and MCOs are working to limit early refills and try to “lock in high-risk individuals to one prescriber for all opioids and/or one pharmacy to fill opioid prescriptions.”

During his testimony, Mr. Douglas also spoke about the importance of reforming 42 CFR Part 2. “The lack of alignment between Part 2 and HIPAA [Health Insurance Portability and Accountability Act] creates challenges across the health care system, from state Medicaid agencies to managed care plans and down to individual provider practices. Congress should prioritize reform of 42 CFR Part 2 to align SUD [substance use disorder] privacy protections with HIPAA, while maintaining appropriate protections for patient SUD information…”

Mr. David Guth, CEO, Centerstone America, also touched on the outdated policy in his testimony, stating, “In moving towards more robust integrated care models where every member of a patient’s treatment team needs to understand a patient’s full medical/SUD history, Part 2 stands as a hindrance to whole-person care. Part 2 has never been applied universally: only federally assisted alcohol and drug abuse programs providing SUD diagnosis or treatment are subject to the Confidentiality of Substance Use Disorder Patient Records Rule – 42 CFR Part 2. …Thus, we urge lawmakers to align 42 CFR Part 2 with HIPAA for the purposes of treatment, payment, and health care operations.”

Mr. Guth specifically highlighted the Amendment in the Nature of a Substitute (AINS) to H.R. 3545, the Overdose and Patient Safety Act, authored by Rep. Markwayne Mullin (and the subject of a March #SubHealth hearing), saying the AINS “has strengthened language regarding penalties for improper re-disclosures.”

Mr. John Kravitz, Chief Information Officer, Geisinger Health System, highlighted the results of some of their efforts to combat the crisis highlighting how initiatives like shifting to electronic or e-prescribing and the utilization of information technology have helped reduce opioid prescriptions and the cost of care.

“Our results are encouraging, as we have reduced opioid prescriptions by about half after launching these initiatives – from a monthly average of 60,000 opioid prescriptions down to 31,000,” testified Mr. Kravitz. “We are now working to integrate this multifaceted approach for reducing opioid prescriptions throughout our entire organization. And we continue to look for other innovative ways to address the opioid crisis.”

Mr. Srivastava answers a member’s question

Mr. Sam Srivastava, CEO, Magellan Healthcare, highlighted the subcommittee’s work putting forth legislative solutions to combat these issues within the opioid crisis, stating, “While we have not thoroughly reviewed each of the bills being discussed by the subcommittee today, our initial analysis is the passage of this package of legislation would be a major step in the right direction. We agree with the subcommittee: we must expand capacity for treatment and recovery services. We must develop specific programs for at-risk populations. We must develop thoughtful, evidence-based mechanisms to limit access to these highly addictive pharmacological pain management therapies to only those where it is clinically appropriate. We must put in place faster, accessible, and more comprehensive information-sharing systems to help health care providers and care coordinators understand and clinically respond to an individual’s controlled substance history, identify misuse, and mitigate unforeseen co-prescribing risks. …We must modernize outdated privacy laws that limit a provider’s ability to share information on substance use, which may hinder a provider from being able to make informed health care recommendations to patients. Each of these critical, individual policy components form an overall legislative framework to help address the opioid crisis in the Medicare and Medicaid programs.”

Mr. Michael Botticelli, Executive Director, Grayken Center for Addiction, Boston Medical Center, spoke to his unique perspective reviewing the bills before the committee, noting his current position, his previous service as the director of the White House Office of National Drug Control Policy (ONDCP), as Director of the Massachusetts Bureau of Substance Addiction Services, as well as a patient in recovery. Mr. Botticelli noted, “Among the many bills under consideration by your committee are numerous opportunities for Medicaid to play a more substantial role in addressing the opioid crisis.”

Mr. Botticelli also noted that that the prescribing of opioids still appears to have a role in fueling this epidemic, testifying, “Medicaid and Medicare should ensure that prescribers have continuing education around safe prescribing, as well as that they register for and use state-based Prescription Drug Monitoring Databases, in order to more appropriately treat pain and diligently track prescribing patterns to limit forum shopping for opioids.”

For more information on today’s hearing, including a background memo, witness testimony, and archived webcast, click here.


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