May 28-June 1: Senate to Focus on Opioid Impacts in Medicare, Medicaid

Hospital advocates have been able to advance a measure aimed at reducing barriers to sharing mental health conditions of patients among providers, despite some opposition.

May 24—The primary Senate committee overseeing Medicare and Medicaid will begin its look at the opioid crisis next week amid a quickly advancing body of bills targeting the issue.

The examination by the Finance Committee’s Health Care Subcommittee of the role of Medicare and Medicaid in the opioid crisis follows recent congressional testimony by the Department of Health and Human Services (HHS) Office of Inspector General (OIG).

Gary Cantrell, deputy inspector general for investigations at OIG, told the Senate Special Committee on Aging in a May 23 hearing that in 2016, one in three Medicare Part D beneficiaries received opioids and 90,000 beneficiaries were at serious risk of opioid misuse or overdose.

OIG also identified 22,308 Medicare beneficiaries who appeared to be doctor shopping and about 400 prescribers with questionable opioid prescribing practices for beneficiaries at serious risk.

Among OIG’s recommendations was that Medicare restrict certain beneficiaries to a limited number of pharmacies or prescribers.

The Comprehensive Addiction and Recovery Act of 2016 includes language that could be implemented to restrict certain beneficiaries to a limited number of pharmacies or prescribers when warranted, with the goal of reducing inappropriate use of opioids among Medicare beneficiaries and Part D fraud.

“This policy would provide coordination of care for beneficiaries being harmed by overprescribing and address beneficiaries who are doctor shopping or intentionally seeking unnecessary prescriptions,” Cantrell said.

However, the decision of whether to implement the lock-in authority rests with health plans that operate as Part D sponsors.

Other Legislative Initiatives

The Senate Judiciary Committee approved five opioid bills on May 24, including a measure to require the Drug Enforcement Administration (DEA) to consider public health when adjusting opioid production quotas and a bill reauthorizing the White House Office of National Drug Control Policy.

That approval followed the House Energy and Commerce Committee’s recent approval of 32 bills to address the opioid crisis, including 12 supported by the American Hospital Association (AHA).

Those bills included provisions requiring state Children’s Health Insurance Programs to cover mental health benefits, instructing the Centers for Medicare & Medicaid Services (CMS) to remove geographic barriers to telehealth services that are provided to treat substance use disorders or a co-occurring mental health disorder, and establishing Medicaid coverage protections for pregnant and postpartum women while they are receiving inpatient treatment for a substance use disorder.

On May 17, the Energy and Commerce Committee approved another hospital-backed bill that would expand physicians’ access to patients’ mental health and substance abuse records. The Overdose Prevention and Patient Safety Act, which would scale back regulatory restrictions on sharing patients’ mental health information, has drawn some congressional opposition over concerns that patients would lose control of such data.

Hospital advocates have argued that HHS regulation 42 CFR Part 2, which requires explicit patient consent to share behavioral health data, blocks coordinated care.

The full House is scheduled to vote June 11 on a package of opioid bills, according to published reports.

Other new bills include a set of measures introduced this week by Sen. Mark Warner (D-Va.) to increase Medicare and Medicaid access to telemedicine-based treatment for substance use disorders.

Tuesday, May 29

Webinar by the American Academy of Medical Colleges titled “PCORI’s Achievements in Health Research and Future Outlook.” Learn more.

Deadline through June 8 for CAHPS Clinician & Group Survey users who administered the survey in 2017 to submit their data for inclusion in the CAHPS Database. Learn more.

Webinar by the Advisory Board titled “How to Move from Cost-Cutting Campaigns to Permanent Savings Solutions.” Learn more.

Wednesday, May 30

Webinar by CMS titled “ Hospice Quality Reporting Program Data Submission and Reporting.” Learn more.

End of the CMS Open Payments data correction period. Learn more.

Webinar by America’s Health Insurance Plans titled “Improve the Member Experience: Lessons from a Lab Provider.” Learn more.

Thursday, May 31

Webinar by HFMA titled “How Reliable Cost Data Supports Strategic Decision Making at ProHealth Care.” 

Conference call by CMS titled “Special Open Door Forum: For Durable Medical Equipment, Orthotics and Supplies (DMEPOS) Dietary Related Items Templates and Clinical Data Elements (CDEs).”  Learn more.

Webinar by Frost & Sullivan titled “The Rise of Digital Enterprise: Growth Strategies for Healthcare Companies.” Learn more.

Friday, June 1

Deadline for physicians who qualify under Medicare’s Merit-based Incentive Payment System (MIPS) to submit candidate measures for the CMS 2018 Measures under Consideration (MUC) List. Learn more.