The U.S. House of Representatives passed two controversial bills Wednesday that loosen longtime regulations around inpatient stays for substance use patients and enhanced privacy rules for opioid addicts, despite strong opposition from some House Democrats.
Hospitals backed both pieces of legislation. One would partially repeal what is known as the IMD exclusion, a 1970s-era law that blocks Medicaid funding from inpatient stays in mental health and behavioral health facilities. The other rolls back enhanced privacy protections for addicts that right now forbid any physician or other medical provider from sharing a patient's medical history with another practitioner who is treating that patient.
The American Hospital Association hailed both measures as significant steps to help hospitals step up their capacity to treat opioid addiction in larger residential treatment centers. The group hailed the rollback of extra privacy layers to ease "responsible sharing of substance use disorder treatment records for purposes of treatment, payment and healthcare operations."
But each piece of legislation has drawn fierce Democratic opposition as well as criticisms from various advocates. Some in the mental health community have said the partial rollback of the IMD exclusion to focus solely on addiction neglects key psychiatric treatment. Hannah Katch, an analyst with the liberal Center on Budget and Policy Priorities, worried the money at stake in Medicaid reimbursements could drive states to invest in residential rather than community treatment.
Rep. Frank Pallone (D-N.J.), ranking member of the House Energy & Commerce Committee, blasted the bill on the House floor as "misguided, counterproductive and an ineffective use of scarce Medicaid dollars."
"This policy spends more than $1 billion in Medicaid dollars to pay for a policy that is far narrower, in both scope and flexibility, than what many of our states already have and any state could do through Medicaid substance use disorders waivers," said Pallone, referring to the Trump administration's policy to fast-track waivers that allow addicted patients extended stays in residential facilities."
The privacy debate over the enhanced protections for addicted patients has drawn even more ire.
The measure passed the House Energy & Commerce Committee after testy debate over whether it would raise stigma for addicted patients.
Physicians and hospitals have long advocated for the policy change, which they hoped would be included in the 2016 21st Century Cures Act. If passed, the measure would apply only HIPAA protections to the health records of people who are or have been addicted to opioids.
