Senate Expected to Vote on Opioid Legislation includes Expansion of Open Payments to NP’s and PA’s

Last Thursday, Senate leaders announced that they had reached an agreement to bring a package of bills to address the nation’s opioid crisis to the Senate floor in the coming days.

The deal was first announced in a tweet Thursday night by Majority Leader Mitch McConnell, who wrote that Democrats lifted a hold placed on the bill and that a floor vote was likely next week. Soon after, Senator Rob Portman – who has several bills that are part of the package including an effort to combat synthetic drugs like fentanyl – released a statement saying that the bill would be voted on next week.

In terms of procedure, the Senate will consider a substitute amendment to the opioids package the House passed in June. The Senate bill had stalled over Democratic objections to a grant program they said was written too narrowly to benefit only one addiction advocacy group, the Addiction Policy Forum. The amendment (#4013) merges wide-ranging, prevention-focused measures advanced by the Finance, Judiciary, Commerce, and Health, Education, Labor and Pensions (HELP) committees earlier this year.

Negotiations had stalled over hot-button issues like requiring Medicaid to cover treatment at more inpatient facilities and loosening privacy restrictions for medical records for substance-abuse patients. While neither provision made it into the final amendment, the provisions remain part of an opioid package passed by the House earlier this year. Save for those exceptions, the measure that is expected to be passed in the Senate largely matches the House’s legislation.

The legislation would authorize new funding for states to fight drug addiction, expand access to medication-assisted treatment, grant the National Institutes of Health (NIH) more authority to research and develop non-opioid pain therapies and require the U.S. Postal Service to crack down on shipments of illicit fentanyl. It would also reauthorize the Office of National Drug Control Policy.

Open Payments

Among the 70+ provisions is the “Fighting the Opioid Epidemic with Sunshine Provision from Senators Grassley and Blumenthal which Enhances the CMS-run Open Payments, or “sunshine”, program by expanding the types of professionals for whom a drug and device manufacturer is required to report when the manufacturer provides something of value to include: physician assistants, nurse practitioners, clinical nurse specialists, certified registered nurse anesthetists, and certified nurse midwives.

the legislation also sunsets the prohibition that prevents inclusion of the unique identification number, known as the National Provider Identifier, for all professionals and other entities displayed on the CMS Open Payments website.

Telemedicine

Expands the use of telehealth services for the treatment of opioid use disorder and other substance use
disorders.  Eliminating the requirement for treatment to substance abuse treatment to be initiated at a site and allows for payments of telehealth substance abuse payments.    The proposal also allows for controlled substances under restricted circumstances to be prescribed via telehealth.

Education

Authorizes a grant program for education on overdose prevention, the establishment or implementation of policies and procedures to treat and support recovery for individuals who have experienced a non-fatal overdose.   Includes a provision for targeting high prescribers of Opioids to notify them and encourage education on opioid prescribing.  Grant recipients will also be required to develop a comprehensive education and training plan.

Other Provisions

Additionally, states would get a total of $500 million per year through 2021 for grants created under the 21st Century Cures Act to combat drug addiction. The bill would also create new comprehensive opioid recovery centers offering an array of treatment services, and it would require the Department of Health and Human Services (HHS) to develop guidelines for recovery housing.

The bill would also require HHS and the Department of Justice to conduct a study on the effect that federal and state opioid prescribing limits have had on patients — and specifically whether such limits are associated with higher suicide rates.

The Senate package would also promote the use of telemedicine for substance use disorder by waiving the restrictions that typically prevent reimbursement beyond rural and disadvantaged areas.

While the Senate is expected to pass its opioids package sometime next week, both chambers still need to agree on a reconciled version of the legislation. Over the summer, House and Senate staff have been working to iron out differences between their respective packages. With the announcement of a deal in the Senate, it is possible Congress could clear a compromise package to send to the President before the midterm elections.