In the News

WASHINGTON -- Thirty-two bills aimed at targeting the opioid epidemic advanced through a House committee on Thursday after an 8-hour markup session.

The same House Energy and Commerce Committee passed 25 other opioid-related bills last week, bringing the total to 57 bills, which now advance to the House.

Many of the measures discussed on Thursday moved handily through the committee, but members wrestled with a few with controversial elements.

These included a bill to relax confidentiality standards around substance use disorders; a bill to temporarily reverse the ban on Medicaid paying for inpatient treatment in certain facilities; and a bill -- rewritten as an amendment -- which would have permanently let certain non-physicians such as nurse midwives prescribe medication-assisted treatment.

Access to Patient Information

One of the bills discussed Thursday, "The Overdose Prevention and Patient Safety Act," would overhaul substance-abuse confidentiality standards, known as 42 CFR Part 2, or just "Part 2,"and realign them with the Health Insurance Portability and Accountability Act (HIPAA), which governs all other medical information.

Specifically, the act would allow anyone involved in treatment, payment, or healthcare operations -- e.g., healthcare providers, health plans, and healthcare clearinghouses -- access to patient information without first requiring a patient's consent.

The bill was the subject of a House Energy & Commerce subcommittee hearing last week.

Rep. Doris Matsui (D-Calif.) worried that the "freer flow of information" might increase the risk of a patient's health information being breached, and she cautioned her colleagues not to take the elimination of the patient consent process lightly.

But Rep. Raul Ruiz, MD (D-Calif.), joined with physician colleagues across the aisle in supporting changing such standards. Having more information improves patient outcomes, he said simply. Ruiz also noted that the bill strengthened penalties for inappropriate disclosures.

An amendment from Rep. Frank Pallone (D-N.J.) that would have eliminated access for those involved in treatment -- essentially gutting the bill -- was voted down, and the legislation advanced to the full House in a vote of 35-17.

Access to Inpatient Care

Another bill, introduced by Rep. Mimi Walters (R-Calif.) would repeal the Institutions for Mental Diseases (IMD) exclusion for 5 years. The IMD exclusion bars Medicaid from reimbursing care in facilities with more than 16 beds.

Currently, states can apply for Medicaid waivers to receive exemptions from the ban, but Walters said the review and approval process takes too long.

Pallone said focusing only on those with opioid use disorders, and not alcohol, cocaine, or methamphetamines, was too limited a step.

Rep. Debbie Dingell (D-Mich.), whose sister died of a drug overdose, agreed.

"If you've ever lived with someone who has a drug addiction, they'll take whatever they can get on the street.... We need to fix the problem... for everybody," Dingell added.

Matsui said she worried that this bill did not allow for resources to be directed to the entire spectrum of care, including community supports.

Walters countered that states could still opt to apply for waivers if they chose to, but her bill provided a quicker option.

The bill passed in a voice vote.

Expanding MAT

A third bill, the "Addiction Treatment Access Improvement Act," authored by Reps. Paul Tonko (D-N.Y.) and Ben Ray Lujan (D-N.M.), aimed to codify 2016 provisions that raised the cap on the number of patients to whom qualified providers could prescribe medication-assisted treatment (MAT) to 275.

The new bill would also expand the type of providers authorized to provide MAT to include clinical nurse specialists, certified registered nurse anesthetists, and certified nurse midwives. (Under the 2016 provisions, physician assistants and nurse practitioners were authorized to provide MAT, and the bill would also incorporate those clinicians.)

The bill was not brought forward for a vote, so Tonko attempted to tack it onto another bill as an amendment, but it was viewed as not "germane" and was tabled.

Rep. Anna Eshoo (D-Calif.) said she felt Tonko had not been treated fairly.

She criticized Committee Chair Greg Walden (R-Ore.) for citing the Drug Enforcement Administration (DEA)'s opposition to the bill in his remarks. Walden read from a DEA letter that said allowing non-physicians to provide MAT was a "risky proposition."

When has a DEA agent taken care of and rehabilitated a patient? she asked. "That's pretty hard for me to swallow. It's [like] asking the last time a corporation changed a diaper."

Rep. Larry Bucshon, MD (R-Ind.), responded, "It's laudable to try to expand treatment, but we need to do that very carefully."

Bucshon said he worried the amendment lacked "adequate patient protections," particularly to prevent diversion of buprenorphine -- which he called "one of the most diverted drugs in America."

Other legislation that advanced through the committee would:

• Require states to identify and address inappropriate prescribing as a condition of receiving their federal medical assistance percentage (FMAP) under Medicaid
• Require providers covered by Medicaid to check Prescription Drug Monitoring Programs before providing a controlled substance, beginning in 2021
• Order the Department of Health and Human Services to report on obstacles to responding to the opioids addiction crisis
• Expand access to telemedicine for opioid-use disorders or co-occurring mental health issues
• Establish standards for sober living houses and prevent "patient brokering"

Committee members also debated legislation to temporarily reverse cuts to reimbursement for outpatient postsurgical injections.

Rep. John Shimkus (R-Ill.), who introduced the measure, said the recent reduction in reimbursement for non-opioid medications like epidurals by Centers for Medicare & Medicaid Services incentivizes was unwise.

His bill would "turn back the clock" on the cuts for a "targeted number" of procedures for 5 years and would ask the Government Accountability Office to collect data to determine whether the procedures are performed in the most appropriate setting.

Pallone said he saw no evidence to suggest that the bill would decrease opioid prescribing or addiction and that Congress should not be choosing "winners" and "losers" among different therapies.

Rep. Peter Welch (D-Vt.) introduced an amendment calling for a systematic review of all opioid alternatives currently on the market, which he said he preferred over "micromanaging" payments.

But Shimkus said more and more patients would become addicted to opioids and die from overdoses while Congress waited for yet another study.

Welch's amendment failed to pass; Shimkus' bill did pass.

Among the 25 other opioid-related bills passed last week were measures to increase access to comprehensive treatment, to prevent over-prescription and diversion, and to expand funding for research on nonaddictive pain medications.