Congress recently passed the Substance Use-disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities, or SUPPORT, Act as a multifaceted way of addressing the opioid crisis. The bill passed both houses with overwhelming bipartisan support, an alarming indication of how bad the opioid crisis has become in recent years. In fact, the rate of fatal overdoses has continued to increase in recent years despite increasing public awareness and attempts by governments at every level to address the problem. Nearly 60,000 people died of opioids alone in 2017.
The major aims of the SUPPORT Act include reducing the supply of addictive drugs, encouraging recovery, supporting caregivers and families, and encouraging innovation and research into long-term solutions. The SUPPORT Act draws from more than 60 pieces of legislation already passed by the House in order to attack the opioid crisis on several fronts. Many of these measures have to do with state and federal funding rules, research priorities, and postal regulations and won’t directly affect people seeking addiction treatment. However, there are provisions in the SUPPORT Act that may affect people seeking treatment in the following ways.
Broader use of telemedicine
One of the biggest challenges in addressing the opioid epidemic has been making treatment available to people who need it. Cost is often a barrier to treatment, but it’s not the only one, and sometimes not the biggest one. Too often, there are just no treatment options in an area. The regions hardest hit by the opioid crisis are often rural areas with dispersed populations. Some areas, like West Virginia, are also mountainous, making travel more difficult. Patients may have to drive several hours to get addiction treatment, which isn’t always possible. There is also a high rate of opioid addiction among older populations, who are not especially mobile.
One promising solution to this challenge is telemedicine. In telemedicine, someone seeking addiction treatment can go to her local doctor’s office and teleconference with a doctor certified in addiction medicine. Doctors certified in addiction medicine are already in short supply and they’re even rarer in rural areas. Part of SUPPORT Act makes provisions to secure remote communications with an addiction specialist and make it easier for doctors to remotely prescribe medication such as buprenorphine to patients. The SUPPORT Act aims not only to make telemedicine easier and more acceptable, but actually encourage its use.
Increased access to medication-assisted treatment
The SUPPORT Act increases access to medication-assisted treatment in several ways. First, as noted above, is that it makes prescribing easier for addiction specialists working remotely. Currently, only addiction specialists can prescribe buprenorphine, so telemedicine will also increase access to MAT. Second, the SUPPORT Act requires state Medicaid programs to cover MAT, including all FDA-approved drugs, counselling services, and behavioral therapy. State Medicaid programs that don’t provide this coverage will not receive matching funds from the Federal Government. Currently, most states provide coverage for buprenorphine and naltrexone, but fewer cover methadone.
More protection from fraud and deceptive practices
There are treatment centers and services that use deceptive practices to entice prospective patients. These practices include patient brokering, or selling patient information to the highest bidder and providing kickbacks for referrals based on the number of patients or how much a center can bill the patient’s insurance for. The SUPPORT Act expands existing anti-fraud policies, prohibiting most of these deceptive practices. It is now illegal for a treatment center to offer or receive money for referrals, whether treatment is paid for by federal funds or private insurance. Referrals are not illegal, but they can’t be tied to the number of patients referred or how much those patients are billed. This protects federal programs and private insurers from unnecessary expenses--daily tests, for example--but it also limits the incentives for someone to refer you to a program for purely financial reasons.
Expanded Medicaid and Medicare coverage for treatment
Currently, addiction treatment is less available to lower-income populations. While most insurance will cover addiction treatment, people on Medicaid or Medicare had fewer options. The SUPPORT Act amends a long-standing restriction on the use of federal Medicaid funds in “institutions of mental disease,” which includes addiction treatment programs. Federal Medicaid funds can now be used for this purpose, assuming the state meets certain requirements. This expands access to addiction treatment across the continuum for patients on Medicare. The act also requires that Medicare pay for addiction treatment by certified opioid treatment programs.
The SUPPORT Act also makes it illegal for states to drop Medicaid eligibility for anyone under 21--or anyone former in foster care under 26--while incarcerated. Although Medicaid does not pay for health care while incarcerated, this provision ensures that prisoners will have access to health care and addiction treatment after they are released. This is important because many overdoses happen after a period of forced abstinence while incarcerated. The person’s tolerance drops, he relapses at the old dose, and it’s too much. Increasing treatment options--including MAT--for people leaving state custody could significantly reduce overdose rates.
As part its aim to control the excess supply of addictive drugs, the SUPPORT Act includes provisions to monitor drug prescriptions, including opioid refills, concurrent opioid prescriptions, and antipsychotic medication for children. Medicaid providers will have to check with the prescription monitoring program before prescribing controlled substances. This is should lead to greater safety in prescribing, limiting new cases of substance dependence, and limiting “doctor shopping” for opioid drugs. New Medicare enrollees will have to be screen for opioid use disorder and their prescription history reviewed. New prescriptions for controlled substances will have to be transmitted through electronic prescription programs.
If you or someone you love is struggling with addiction or mental illness, we can help. Recovery Ways is a premier drug and alcohol addiction treatment facility located in Salt Lake City, Utah. We have the resources to effectively treat a dual diagnosis. Our mission is to provide the most cost-effective, accessible substance abuse treatment to as many people as possible. Request information online or call us today at 1-888-986-7848.