The House on Friday passed a bill that will serve as the legislative vehicle for many of the 55 other House-passed bills designed to curb opioid addiction, ending two weeks of floor votes on opioids measures.
The catchall bill, which advanced 396-14, would incorporate a number of proposals from the Energy and Commerce and the Ways and Means committees relating to Medicaid, Medicare, and public health. A group of 161 patient advocacy groups wrote to Speaker Paul D. Ryan and Minority Leader Nancy Pelosi this week in support of the legislation.
“We in this body have the opportunity nearly every day to approve legislation of great consequences to millions of people, but rarely do the consequences feel so immediate, so vital, as for the opioid package that we’re considering,” said Majority Leader Kevin McCarthy on the House floor before the vote.
The package was largely put together by Energy and Commerce Chairman Greg Walden of Oregon and ranking member Frank Pallone Jr. on New Jersey, along with Ways and Means Chairman Kevin Brady of Texas and ranking member Richard E. Neal of Massachusetts.
“This is one of the most significant congressional efforts against the drug crisis in our nation’s history, but we must continue to legislate, evaluate, conduct oversight and work together to provide new solutions … so we can rise to this ever-challenging solution,” Walden said.
Pallone, while supportive of the legislation, voiced some concerns.
“This bill makes incremental changes to support those affected by the opioid crisis, but is far from perfect,” Pallone said. “HR 6 does not adequately deal with the magnitude of the crisis that this country is facing, and there are provisions that I did not support at the subcommittee or full committee markups, including provisions that most Democrats voted against.”
The Medicaid parts of the bill include language to block state Medicaid programs from ending a juvenile’s medical coverage eligibility because of incarceration. Another provision would allow former foster youth previously enrolled in Medicaid to retain coverage under the program until they turn 26.
It would also have the Centers for Medicare and Medicaid Services issue guidance on ways to treat neonatal abstinence syndrome under Medicaid.
One section would also require state Medicaid programs to have a beneficiary assignment program that would monitor patients at risk for substance use disorder and enroll them in a pharmaceutical home program that limits how many prescribers and dispensers those beneficiaries may use.
The proposed Medicare changes include incentivizing the use of post-surgical injections instead of opioids for pain management by reinstating a reimbursement for them. The bill would also require electronic prescriptions for medications that are controlled substances under Medicare Part D. It would also require CMS to evaluate the effectiveness of telehealth in treating substance use disorder.
The bill includes a proposal from Rep. Paul Tonko that was not originally marked up in committee. The New York Democrat’s original legislation would authorize clinical nurse specialists, certified registered nurse anesthetists and certified nurse midwives to prescribe buprenorphine, which is used to treat opioid use disorder, for five years. The bill would also permit certain providers to treat up to 100 patients in their first year instead of 30 as the law currently allows.
Brady also spoke in favor of a provision in the bill by Ways and Means Health Subcommittee Chairman Peter Roskam that would create drug management programs for at-risk beneficiaries.
That “will prevent abuse by making sure folks are not able to game the system by visiting multiple doctors’ offices in order to receive an opioid,” Brady said.
The House considered seven amendments to the legislation. Six were adopted by voice vote. Those were:
• An amendment from Republicans Joe L. Barton and Mark Meadows and Democrat Ann McLane Kuster that would require the Food and Drug Administration commissioner to develop evidence-based prescribing guidelines for treating acute forms of pain.
• An amendment from Republican John Curtis to require the Department of Health and Human Services to issue a report on current practices for prescribing opioids during pregnancy.
• An amendment from Meadows that would require the Government Accountability Office to report on any policy changes that could have exacerbated the increase in opioid-related deaths.
• An amendment from Democrat Maxine Waters to require HHS to survey groups that treat substance abuse to develop a plan to determine any gaps in services or funding for treating drug addiction.
• An amendment from Walden, Pallone, Brady and Neal to make technical changes to the bill.
Another amendment from Phil Roe, Andy Harris and Neal Dunn, all members of the GOP Doctors Caucus, would have eliminated language that would expand which types of health care workers are able to dispense certain forms of medication-assisted treatment. It was withdrawn.
An eighth potential amendment from Kuster and Republican Michael R. Turner ultimately was not offered.
The bill includes offsets that would change Medicaid and Medicare.
One proposal would give states a financial incentive to require Medicaid managed care organizations to spend at least 85 percent of the money they get from the government on actual medical care rather than on administrative costs and profits. Those that fall short of that percentage, known as a medical loss ratio, would have to pay some money back to states and the federal government. Managed care plans have expressed concerns about the idea.
The second would bill an individual’s private insurance first before Medicare for patients with end-stage renal disease for 33 months. Currently this is done for 30 months.
Another offset would extend reporting requirements for prescription drug coverage under Medicare Part D. This offset aims to guarantee that HHS and Medicare sponsors have the necessary information from primary group health plans so that officials know when other insurance should pay first before Medicare is billed.
Watch: Congress’ Proposals on Opioids Aren’t Keeping Up With Epidemic