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On Oct. 3, 2018, Congress passed H.R. 6, the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (also known as SUPPORT for Patients and Communities Act). The legislation makes two key Medicaid changes in response to the opioid epidemic.
In an Oct. 23 article for Chain Drug Review, McGuireWoods Consulting senior vice president, Stephanie Kennan, gives an overview of these changes and how state Medicaid programs will change.
The legislation includes provisions to help states provide a better continuum of care and better capacity for treatment. The first key change partially rolls back the Institute of Mental Disease (IMD) exclusion, allowing federal Medicaid money to pay for care at residential treatment centers that have more than 16 beds for the next five years, beginning Oct. 1, 2019.
In addition, the legislation requires a state of maintenance effort for certain services, and states must maintain a certain level of funding for services for patients in eligible IMDs. States must also maintain services provided through outpatient and community-based settings.
“Maintenance of effort requirements were added to the legislation in response to advocates concerned that that inclusion of IMDs would displace resources currently going to community-based and other services,” Kennan said.
The second key change to Medicaid is a provision that allows for planning grants to increase treatment capacity in select states. Selected states will be able to increase treatment capacity with more providers participating under the state plan, or with waivers to provide substance abuse disorder treatment and recovery services.
Other provisions within the SUPPORT for Patients and Communities Act directs the Department of Health and Human Services to develop and disseminate materials, clarifies circumstances of when pharmacists may decline to filled controlled substance prescriptions, and establishes a beneficiary assignment program that identifies beneficiaries as risk for substance abuse disorder and assigns them to a pharmaceutical home program.