D.C. Update – July 11, 2016

News from the States

Maryland Court of Appeals rules that adults providing alcohol to underage drinkers responsible for associated deaths and injuries

Around the Agencies

ASPE issues report examining the effects of the Affordable Care Act’s Medicaid Expansion in 2014 and 2015
Obama Administration issues final rule on MAT for opioid use disorders
CDC issues report examining the relationship between methadone sales, diversion, and overdose deaths

In the News

Obama Administration issues final rule on MAT for opioid use disorders
House of Representatives passes Comprehensive Addiction & Recovery Act (CARA)
Helping Families in Mental Health Crisis (H.R. 2646) passes House of Representatives
National Governors Association releases opioid road map detailing State efforts to combat opioid epidemic
Legal Action Center releases guide detailing federal mental health and substance use disorder parity law
Ellen Weber rejoins Legal Action Center to serve as Vice President for Health Initiatives

News from the States

Maryland Court of Appeals rules that adults providing alcohol to underage drinkers responsible for associated deaths and injuries
Maryland’s Court of Appeals has issued a ruling holding adults who provide alcohol to underage drinkers responsible for any deaths and injuries that occur as a result. The ruling follows several years of deliberation by the Maryland General Assembly on how to penalize adults who hold parties and supply alcohol to underage drinkers. The court stated that, “Children under 21 are often less able to make responsible decisions regarding the consumption of alcohol and, as a result, are more susceptible to harming themselves or others when presented with the opportunity to drink . . . The adult increases the risk of harm to themselves and others by facilitating the improper conduct of another.” This is the first time the Maryland Court of Appeals has addressed “social host liability”—referring to individuals who negligently serve alcohol. Maryland’s legislature passed a bill increasing fines and jail time for adults providing alcohol to underage drinkers last May.

Read more about this story here.

Around the Agencies

ASPE issues report examining the effects of the Affordable Care Act’s Medicaid expansion in 2014 and 2015
Last month the Office of the Assistant Secretary for Planning and Evaluation (ASPE) released a report examining the effects of the Affordable Care Act’s (ACA) Medicaid expansion. The report is broken down into four sections: 1) examining the evidence to date on the impact of Medicaid expansion on health insurance coverage; 2) exploring the impact on beneficiaries by examining access to care and utilization; 3) examining research to date on affordability; and 4) examining quality including enrollee financial well-being, satisfaction and experience. Key findings include that Medicaid expansion States experienced a 9.2 percent reduction in the number of uninsured adults, compared to a 7.9 percent reduction in non-expansion States. ASPE’s report also finds that Medicaid expansion has increased access to primary care and prescription medicine, and that low-income adults reporting problems paying medical bills declined by 10.5 percent, from 34.7 percent pre-expansion to 24.2 percent post-expansion.

Read the full report here.

CDC issues report examining the relationship between methadone sales, diversion, and overdose deaths
The Centers for Disease Control and Prevention (CDC) issued a report last week examining the relationship between methadone sales, diversion, and overdose deaths. The report, published in the CDC’s Morbidity and Mortality Weekly Report (MMWR), highlights the study performed by Dr. Chris Jones, Director of the Division of Science Policy in the Office of the Assistant Secretary for Planning and Evaluation (ASPE) within HHS. The report’s main findings include that methadone overdose rates for most demographics peaked between 2005 and 2007 before declining in subsequent years. The observed decline in methadone overdose rates is suggested to be a result of national and State actions reducing the use of methadone in pain treatment. The report concludes that methadone-related harms may be further reduced by implementing additional clinical guidelines restricting the use of methadone for pain, increasing the use of care coordination plans, and strengthening public health policies for pain management.

Read the full report here.

In the News

Obama Administration issues final rule on MAT for opioid use disorders

Last week the Administration released its final rule on Medication-Assisted Treatment for Opioid Use Disorders, which allows eligible practitioners to request approval to treat up to 275 patients. Before being able to treat 275 patients, qualified practitioners must undergo a one year trial period where they are only allowed to treat a maximum of 30 patients at a time.

The final rule can be found here.

House of Representatives passes Comprehensive Addiction & Recovery Act (CARA)
The House of Representatives passed the conference report for the Comprehensive Addiction & Recovery (CARA; S. 524) with a vote of 407-5 on Friday afternoon. During floor statements preceding the vote, House Democrats reiterated the need for funding to address the opioid crisis, but ultimately showed support for the bill and indicated the need for resources to be allocated through the regular appropriations process. The bill now requires a vote by the Senate. Senate Majority Leader Mitch McConnell (R-KY) has indicated that he hopes to hold a vote on the conference report before adjourning for recess this week.

As a reminder, the bill includes the following provisions that NASADAD has been tracking throughout the legislative process, among many others:

Evidence-Based Prescription Opioid and Heroin Treatment and Interventions Demonstration: The bill authorizes a grant within CSAT for State substance abuse agencies, local governments, nonprofit organizations, and tribes to support treatment for opioid use disorders where medication-assisted treatment is an allowable use of funds. This mirrors the current CSAT “MAT-PDOA” grant. For the current fiscal year, the MAT-PDOA grant is receiving $25 million. The President proposed $50 million for FY 2017, and the Senate Appropriations has proposed $60 million in FY 2017. However, in the conference report, there is only an authorization of appropriations of $25 million (level with FY 2016). NASADAD expressed the importance of authorizing this program for at least $60 million in CARA (to align with Senate Appropriations Committee’s recommendation), but NASADAD will continue to track the appropriations process as it relates to MAT-PDOA and other priority programs.

Improving Treatment for Pregnant and Postpartum Women: This provision reauthorizes the residential services for pregnant and postpartum women program (PPW) grant program within SAMHSA’s Center for Substance Abuse Treatment (CSAT). This program supports family-centered substance use disorder services for women and young children in residential settings. This provision would also create a pilot program for State substance abuse agencies to use up to 25 percent of funds for services to pregnant and parenting women in non-residential settings. The purpose of the pilot program is to spur innovation and fill gaps in family-centered services across the continuum of care. The legislation would require SAMHSA to lead a process in which State substance abuse agencies, experts in addiction services, and others would meet to develop the new application for the pilot program. A section-by-section summary of the bill as originally introduced can be found here.

The conference report language includes the House “trigger” language, in which the pilot program would not move forward unless funding for the PPW program is above the FY 2016 level ($15.9 million). The conference report would authorize $16.9 million for FY 2017 through FY 2021. Language has also been added that would give award prioritization for the residential services grant program to programs serving rural areas, areas with a health professional shortage, and areas with a shortage of family-based treatment options. Additionally, language has been added that would require the report to Congress on outcomes of the pilot program to also include a recommendation by the Director of CSAT as to whether the pilot program should be extended beyond 5 years.

Opioid Use Disorder Treatment Modernization (Buprenorphine Prescribing): Prior to finalizing the conference report, the House and Senate had markedly different proposals regarding the buprenorphine patient limit cap. The House version would have allowed physician assistants (PAs) and nurse practitioners (NPs) to prescribe for three years, and included a non-binding “Sense of the Congress” that the cap should be raised to 250. The Senate version would permit PAs and NPs to prescribe with no time limit, and it proposed raising the cap to 500 patients, but would require physicians to (1) participate in the State’s PDMP; (2) completed 24 hours of training; (3) maintain records on whether on-site counseling services are provided and the extent such services are provided; the extent to which practitioners refer patients to counseling services off-site and the percentage of patients using such services; the number of times patients terminate services against medical advice; and other data.

The language included in the conference report does not change the current bupe cap of 100 (30 in the first year), but it does include language stating that the Secretary of HHS may change the cap by regulation. The conference report also amends the Controlled Substances Act by adding to the category of “qualifying practitioner” a nurse practitioner who had some nursing courses or physician assistant who satisfies various criteria.

Helping Families in Mental Health Crisis (H.R. 2646) passes House of Representatives
The House of Representatives passed the Helping Families in Mental Health Crisis Act (H.R. 2646) by Rep. Tim Murphy (R-PA) last week with a vote of 422-2. Some of the provisions in the bill that impact the substance use disorder field include: 1) the creation of an Assistant Secretary for Mental Health and Substance Use Disorders, who would assume all the authorities of the SAMHSA Administrator; 2) establishment of a National Mental Health and Substance Use Policy Laboratory that would assume the authorities of the Office of Policy, Planning, and Innovation (OPPI); and 3) amending the section of the Public Health Service Act that authorizes the Center for Substance Abuse Treatment (CSAT) to use “substance use disorders” instead of “substance abuse,” and to incorporate person-first language where appropriate.

National Governors Association releases opioid road map detailing State efforts to combat opioid epidemic
The National Governors Association (NGA) released a resource detailing State efforts to combat the opioid epidemic last week. The resource, titled “Finding Solutions to the Prescription Opioid and Heroin Crisis: A Road Map for States,” aims to help officials determine new policies to address the opioid epidemic in their own States by providing background information on the epidemic, steps to address the crisis, and a summary of evidence-based health care and public safety strategies to reduce the prevalence of opioid misuse and overdose. The resource also includes an appendix containing State data sources and sample State plans for addressing the opioid epidemic.

The NGA plans to continue discussing next steps for addressing the growing prevalence of opioid overdoses at their upcoming Summer Meeting held in Des Moines, IA between July 14^th and July 17^th. Health and Human Services (HHS) Secretary Sylvia Burwell will attend the meeting to discuss State strategies.

Access the opioid road map here.

Access more information about the NGA’s Summer Meeting here.

Legal Action Center releases guide detailing federal mental health and substance use disorder parity law
The Legal Action Center released a new guide exploring the Mental Health Parity and Addiction Equity Act (MHPAEA) last month. The guide, titled “Health Insurance for Addiction & Mental Health Care: A Guide to the Federal Parity Law” aims to provide a summary of federal parity law and the protections it affords. The Legal Action Center’s guide provides a list of “red-flags” indicating than an insurer may be violating the law, and helps educate consumers about their health insurance coverage plan.