Congress Passes Long-Awaited Opioid Crisis Response Legislation

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Congress Passes Long-Awaited Opioid Crisis Response Legislation

What ASCs need to know

On October 3, Congress passed a final legislative agreement on the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act (HR 6). This bill combines US House of Representatives and US Senate legislation and includes policy related to Medicaid, Medicare, tele-health, the Federal Drug Administration (FDA), research programs, community health services and health information technology, among other issues.

A key provision of the SUPPORT Act, the Dr. Todd Graham Pain Management, Treatment, and Recovery Act of 2018, directs the US Department of Health and Human Services (HHS) to review and adjust payments under the Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgery Center (ASC) Payment System to “avoid financial incentives to use opioids instead of non-opioid alternative treatments.” If necessary, HHS will revise payments through rulemaking.

Other Medicare provisions in the bill that might impact ASCs:

  • Medicare opioid safety – HHS will establish an action plan, with subsequent reports to Congress, on recommendations for changes under Medicare and Medicaid to prevent opioids addictions and enhance access to medication-assisted treatment.
  • Electronic prior authorization for covered Medicare Part D drugs – HHS will establish a standard and secure electronic prior authorization system for prescribing covered Medicare Part D drugs no later than January 1, 2021.
  • Medicare Payment Advisory Commission (MeDPAC) report – MedPAC will submit a report to Congress on: (1) how Medicare pays for pain management treatments in inpatient and outpatient hospital settings; (2) current incentives for prescribing opioid and non-opioid treatments under Medicare inpatient and outpatient prospective payment systems; and (3) how opioid use data is tracked and monitored through Medicare claims data.
  • Pain management study – HHS, in consultation with stakeholders, will submit a report to Congress on how to improve reimbursement and coverage for multi-disciplinary, evidence-based non-opioid chronic pain management.
  • Review of quality measures related to opioids – Within six months, HHS will to convene a Technical Expert Panel (TEP) to review quality measures related to opioids and opioid use disorders. The TEP will: (1) review existing measures; (2) identify gaps in quality measurement and prioritize development in gap areas; and (3) make recommendations regarding revisions of existing measures, development of new measures and recommendations for inclusion of such measures in value-based payment programs.
  • Reducing opioid use in surgical settings – Within six months, HHS will convene a TEP consisting of medical and surgical specialty societies and hospital organizations to recommend best practices for pain management in surgical settings. HHS must issue a public report within one year.
  • Updates to opioid prescribing guidance – Within six months, the Centers for Medicare & Medicaid Services will post online all opioid prescribing guidance published after January 1, 2016, applicable to Medicare beneficiaries.

Original House provisions, previously reported in Digital Debut, to freeze certain pain management codes at their 2016 reimbursement rate and establish separate payment for non-opioid analgesics were not included in the final legislative agreement.

For more information on congressional appropriations and other federal legislative activity, write Jeff Evans.