Congress keeps IMD provision in final opioids package

Congress finalized its deal on opioids legislation late Monday afternoon, including one long-shot measure to free up Medicaid funds for inpatient addiction treatment.

Although the specific legislative text has not been released, the opioid package includes a so-called IMD exclusion bill authored by Sen. Rob Portman (R-Ohio). The proposal would temporarily lift the ban on Medicaid funds for institutional treatment of substance use disorder. Unlike the House bill, Portman's measure would treat all addiction, not just opioids and cocaine.

While hospitals and other inpatient facilities have pushed the legislation because it will fast-track state applications for Medicaid funds to fund patient stays, critics argue that it will pour scarce resources into higher-priced residential treatment over community-based treatment.

Hannah Katch, senior policy analyst at the liberal Center on Budget and Policy Priorities, called the legislation redundant because the Trump administration has been granting waivers for such treatment. Fifteen states now have IMD exclusion waivers, and waivers are pending for 11 additional states.

Lawmakers failed to garner the necessary support to include a roll-back of the additional privacy rules that shroud patient addiction treatment records in the final package.

Hospitals and physicians had rallied behind the measure, which would align the rules around addiction treatment privacy with HIPAA and allow clinicians to share records. The bill's sponsor, Rep. Markwayne Mullin (R-Okla.), fought hard for its inclusion, arguing that it could start saving lives by preventing accidental overdoses when physicians unknowingly prescribe opioids to a patient with addiction history.

"We've seen what's happened because (the current law) is in place," Mullin told Modern Healthcare late last week as negotiations reached a head. "What if we could prevent an accidental overdose from taking place? We know we can."

Critics including Rep. Frank Pallone (D-N.J.) said it could deter people from seeking treatment if they felt their history could be compromised.

House Democrats blocked a technical change to Medicare Part D "donut hole" language pushed by Big Pharma. Insurers that fought the change and lawmakers were keenly aware of the optics of passing a multibillion-dollar pharma request with legislation aimed at curbing the opioid epidemic.

In a February budget deal, Congress increased drugmakers' financial liability for covering Medicare Part D patients' out-of-pocket costs within the coverage gap known as the donut hole from 50% to 70%. Part D insurers saw their financial liability cut from 25% to 5%.

The opioids package provision would have reclaimed $4 billion for the drug industry and Democratic aides estimated it would cost at least twice as much as the opioids package itself. Drug industry lobbyists call the change a technical fix for an error caused by faulty Congressional Budget Office analysis.

Aides close to the talks told Modern Healthcare the proposal will likely be introduced as separate legislation before the end of the year.