Trump opioid commission looks to streamline funding requests without additional cash

(Updated at 5 p.m. ET)

While President Donald Trump's opioid commission made several recommendations Wednesday that highlighted the need for greater treatment access, the final report didn't address the insurance and cost issues that affect recovery.

The Commission on Combating Drug Addiction and the Opioid Crisis proposed 56 recommendations in its final report, many of which were designed to ease federal regulations that critics say have hindered efforts to expand access to treatment.

The group also got an assist from the CMS, which said it would approve state demonstrations that waive federal Medicaid rules limiting coverage for inpatient substance abuse treatment in facilities with more than 16 beds to 15 days.

"This new demonstration policy comes as a direct result of the president's commitment to address the opioid crisis and ensure states have immediate relief and flexibility," CMS Administrator Seema Verma said in a written statement. "Previous policies ignored the growing urgency of the national opioid epidemic and instead put onerous requirements on states that ultimately prevented individuals from accessing these needed services. The Trump administration's approach reflects the pressing nature of the issues states are facing on the ground."

While the expansion of inpatient services for substance use disorder treatment will be welcomed, the CMS announcement may have diverted focus away from the lack of additional financial resources for outpatient treatment, which would offer access to more people by comparison.

"It throws more money into a failed model," said Dr. Indra Cidambi, medical director at Center for Network Therapy, a Middlesex, N.J.-based treatment facility and vice president of the New Jersey Society of Addiction Medicine. "Why not look at the outpatient, ambulatory detox model, which will be more cost-effective and higher efficacy?"

The commission's recommendations included a call to increase federal block grants to states, which the panel said would simplify the process to apply for funding for drug prevention, treatment and recovery initiatives. The commission encouraged the White House's Office of National Drug Control Policy to work with other federal agencies to monitor how efficiently states use federal funding.

The report also urged federal agencies to require providers to review their state prescription drug monitoring programs and integrate PDMP data into electronic health records so clinicians can review that information without disrupting workflows.

"It is one of the most basic things, and I think many prescribers have not understood the importance of checking the PDMP before even sitting down with the patient," said Dr. Michael Fiori, director of Addictions for Mount Sinai Health System in New York.

Other recommendations included a proposal for HHS to develop a national standard of care for opioid prescribers, incorporate quality measures that address addiction screenings and treatment referrals, and remove reimbursement barriers to treatment. Hospitals and health systems should screen primary care patients for alcohol and drug use and provide treatment directly or via referral within 24 to 48 hours.

But many felt the report, much like Trump's address last week when he declared the opioid crisis a public health emergency, provided solutions that would have a marginal impact at best, and at worst, signaled an outdated strategy that can't combat the evolving nature of the current epidemic.

"It's a complex problem and a complex proposed strategy," said Dr. Omar Manejwala, chief medical officer at Los Angeles-based firm Catasys, which provides analytics and behavioral health treatment solutions for health insurance plans. "Most of us would view this as having some good stuff in there, but overall will essentially not make a dent and really misguided."

Manejwala felt the report represented a 'missed opportunity' to offer effective solutions by failing to call for what many experts say wold make the biggest impact — more funding.

The report pointed out that the president's budget request calls for $27.8 billion for drug control efforts, about a 1% increase over fiscal year 2017 funding levels. But the Trump's budget would also reduce funding for drug prevention programs by 11% over previous year's figures.

"This is just puzzling that in the middle of a crisis we would reduce prevention funding," Manejwala said.

The commission also didn't address the importance of patients maintaining their healthcare coverage to access treatment and recovery services. Congressional Republicans' efforts to repeal and replace the Affordable Care Act and convert Medicaid into a state block grant program would limit coverage for millions, according to various estimates.

Failure to mention Medicaid coverage was a particular disappointment, said Dr. Leana Wen, Baltimore public health commissioner, given that the program is the single largest payer of substance use disorder treatment and cover one in three patients who have a substance use disorder.

"No other disease is treated only through grants," Wen said.

Read​ the​ full​ report:​ The​ President's​ Commission​ on​ Combatting​ Drug​ Addiction​ and​ the​ Opioid​ Crisis.