Congress' renewed legislative attempt to lift the Medicaid payment cap on institutional stays, this time for opioid addicted patients, has hit a wall in the Senate for now. But the bill could still move through both chambers pending ongoing negotiations, according to a GOP aide close to talks.
The hang-up came Thursday when the Senate Finance Committee released its package of opioids legislation due for debate next week but left out a bill spearheaded by Sens. Rob Portman (R-Ohio) and Dick Durbin (D-Ill.) that would let Medicaid pay for stays for opioid-addicted patients. The legislation includes a measure that essentially codifies the Obama administration's regulation that frees Medicaid funding for stays of up to 15 days at institutions of mental diseases.
Still, the measure isn't dead yet. Portman has been working with the House Energy and Commerce Committee on its companion bill that is expected to get a vote on the House floor in the next two weeks, according to Energy and Commerce Chair Greg Walden (R-Ore.).
The proposed legislation has seen pushback from the mental health community and some lawmakers although it addresses a provision of the Medicaid statute that many view as outdated. Over the past few months, House lawmakers have tangled over how to loosen the federal funding restrictions on what is known as the IMD exclusion, which since the 1970s has largely banned Medicaid funds from paying for stays at institutions with more than 16 beds.
An attempt during the last Congress to loosen the restrictions ended because of the exorbitant cost ($40 billion to $60 billion) projected by the nonpartisan Congressional Budget Office. Lawmakers and mental health advocates argue states simply don't have the data on IMDs or patients for the CBO to give an accurate cost analysis.
The House Energy and Commerce Committee is using its opioids legislation to take another stab at loosening the provision by targeting it at substance use disorder patients only, as did the Portman and Durbin bill.
But this has brought a fresh wave of criticism from members of the mental health community who say the bill is discriminatory because it funnels Medicaid funds to substance abuse treatment rather than psychiatric treatment.
Others say that the bill overemphasizes inpatient stays when more money is needed for outpatient treatment and some in the mental health community say they don't want to see a scenario where patients detox in a facility and are released without ongoing treatment.
At the same time, the IMD exclusion has frustrated mental health providers for years. Frankie Berger of the Treatment Advocacy Center said Congress would miss an opportunity if it doesn't tackle the issue through its opioids legislation.
"If all they are doing with IMD is codifying the regulations, then they are just squandering an opportunity to make real change and taking credit for work already done," Berger said of the regulatory clarification included in the Finance Committee's legislation. "States can already make decisions within their state plans to reimburse for acute substance use and psychiatric IMD stays less than 15 days."
The House is still slated to move its version of the bill shortly, although Walden told Modern Healthcare the language will be tweaked from the version that was debated in the Energy and Commerce Committee last month. He acknowledged that not everyone is happy with the legislation.
"There are a couple of these (bills) where there is difference of opinion, and it is legitimate and people are where they are, but we'll have votes to pass it," Walden said.
It's not clear when the revised Energy and Commerce bill will be released, or how extensive the changes will be. A committee spokesperson did not have an update to announce as of deadline.
Portman has been working within the Finance Committee to find ways to offset the cost of loosening the funding restrictions and had been hoping the upper chamber could move it. He told Modern Healthcare he has been talking extensively with the Energy and Commerce Committee to make sure their resulting bill would work for both chambers.
"We have helped them look at it in different ways too, so we'd like to end up where we can all be together and expand the opportunity for not just treatment but for treatment that is inclusive of various types of medication assisted treatment," Portman said.
