Sweeping Opioid Legislation Passed by Senate

What you Need to Know About STOP & OCRA  

By: Jody Lutz

Reading Time: 6 minutes

Date: 09/25/2018

On Monday, in a bipartisan move, the Senate overwhelmingly passed legislation aimed at combating the opioid epidemic.

The legislative package which includes 70 provisions, garnered overwhelming support from five Senate committees and contributions from more than 70 lawmakers. The bill passed after a 99-1 vote, with only Utah Sen. Mike Lee dissenting. The House passed a similar package earlier this summer.

The Hill summarizes the bill’s key points:

  • The Trump-endorsed STOP ACT, sponsored by Sen. Rob Portman (R-Ohio), targets the flow of fentanyl and other illicit drugs to the U.S. from other countries.
  • Authorize the NIH to research potential non-addictive painkillers
  • Reauthorize a $500 million a year state grant program
  • Permanently allow nurse practitioners and physician assistants to prescribe medication-assisted treatment (a previous bill only allowed this through 2021.)
  • Allow physicians to prescribe MAT for up to 275 patients (previously 100) to improve access to treatment.
  • Authorizes a number of grant programs for nonprofits and other entities fighting the epidemic, including one that would fund the establishment or operation of opioid recovery centers. 

STOP Act: Synthetics Trafficking and Overdose Prevention Act 

The STOP Act establishes parameters on shipments coming in from overseas. This is in response to shipments of Fentanyl, a synthetic opioid, from coming into the U.S. in greater numbers. We discuss Fentanyl, its street value and how it comes into the US here.

The U.S. Postal Service is the only transportation carrier that does not collect electronic information on overseas cargo. These limitations prevent Customs and Border Protection agents from comprehensively screening packages for hidden drugs.Specifically, the STOP Act will require USPS to transmit advance electronic data to Customs and Border Protection on at least 70 percent of international mail arriving in the United States by Dec. 31, and on 100 percent of such mail on Dec. 31, 2020, before these shipments reach the U.S. border, according to a legislative summary.

IT Initiatives for Ongoing Opioid Epidemic

The Senate Bill also focused resources on specific IT initiatives related to the ongoing opioid epidemic. Healthcare IT News outlines the many new proposals in the Senate Bill specifically related to information technology. Among them:

  • Call for the U.S. Department of Health and Human Services to "develop best practices for prominently displaying substance use treatment information in electronic health records, when requested by the patient."
  • Enable the Centers for Medicare and Medicaid Services to test various models that "provide incentive payments to behavioral health providers for the adoption and use of certified electronic health record technology to improve the quality and coordination of care through the electronic documentation and exchange of health information."
  • Require physicians to prescribe Part D-covered controlled substances electronically and direct CMS specify a list of exceptions and outline the penalty for failure to comply when the e-prescribing requirements.
  • Require that prior authorizations related to Part D e-prescriptions use a standard format to improve the way the authorizations are processed.
  • Provide support for states and localities to improve their Prescription Drug Monitoring Programs and "implement other evidence-based prevention strategies, encourages data sharing between states, and supports other prevention and research activities related to controlled substances."
  • Reauthorize HHS's NASPER grant program, allowing states to "develop, maintain, or improve PDMPs and improve the interoperability of PDMPs with other states and with other health information technology."
  • Authorize new program through the Substance Abuse and Mental Health Services Administration for the establishment of comprehensive opioid recovery centers. "These entities may utilize the ECHO model, which supports care coordination and services delivery through technology."
  • Give support for states to collaborate on strategies to improve care substance-exposed infants, including the development and upgrades of new technology and monitoring systems to more effectively implement plans of safe care.
  • Require CMS to set up an online portal to enhance communication between the agency, Medicare Advantage plans with prescription drug plans, stand-alone drug plans and Medicare Drug Integrity Contractors. 

OCRA: THE OPIOID CRISIS RESPONSE ACT of 2018

This legislation directs funding to federal agencies to establish or expand programs dealing with prevention, treatment and recovery. Other proposals included in OCRA that have broad support include provisions to speed National Institutes of Health (NIH) research, support for Prescription Drug Monitoring Programs (PDMPs), a study on efficacy of prescribing limits as well as grants for certain drug take-back programs.

Addiction Policy Forum provides the following summary:

The Opioid Crisis Response Act (OCRA) of 2018 (S. 2680), improves federal agencies’ ability to address our nation's drug crisis, and strengthen families and communities nationwide. Introduced by Senator Lamar Alexander (R-TN) and Patty Murray (D-WA):

  • Help keep our first responders safe when assisting individuals who have overdosed;
  • Expand support services to help patients achieve long-term recovery;
  • Encourage emergency departments to notify families when a loved one has overdosed;
  • Provide resources to operate substance use disorder (SUD) treatment and recovery centers;
  • Educate doctors to prevent, detect, and treat SUD; and
  • Expand the use of technology services for the treatment of additional SUD patients.

So…What’s the verdict?

The American Society of Anesthesiologists (ASA) released a statement that says in part, “The ASA commends the Senate for the inclusion of the provision that would provide technical assistance and grants to hospitals and other acute care settings on alternatives to opioids for pain management. This will support the development of best practices on the use of alternatives to opioids; technologies or techniques to identify patients at risk for opioid use disorder; disseminating information on the use of alternatives to opioids; and collecting data and reporting on health outcomes associated with the use of alternatives to opioids.”

The Chicago Tribune editorial board summed it up best Tuesday, writing: "The package is heartening and frustrating: heartening because it offers some positive steps, and frustrating because it doesn’t do more."

The Washington Post added, “Most public health advocates and experts say that while the bill tackled some important issues, it's a relatively incremental effort. To really address an opioid crisis that, according to preliminary data released by the Centers for Disease Control and Prevention in August, killed more than 49,000 of the 72,000 overall deaths from drug overdoses in 2017, would require a considerable infusion of new funding for treatment programs and a long-term commitment from the federal government.  

So...what's next?

After passing the comprehensive, bipartisan opioids package, Senators will now have to reach compromises with their House counterparts before sending the legislative package to President Donald J. Trump next week for his signature.

Senator Lamar Alexander (R-TN), who leads the chamber's health committee, said the goal is to have a combined bill ready by Friday, allowing for a vote in the House next week. The Senate would then clear this measure shortly after, Alexander added.

Axios outlines several of the most notable differences lawmakers will need to reconcile:

The IMD exclusion 

The House bill lifts the so-called "IMD exclusion" — a ban on federal Medicaid funding for mental health treatment facilities with more than 16 beds. It would allow coverage for up to 30 days a year, until 2023. The Senate bill does not include this provision, at least partially because it's expensive and senators didn't like the way it was paid for.

Mental health records

The House bill, unlike the Senate version, includes a provision that addiction-related health records easier to share between insurance plans and doctors. It updates a law that requires mental health records to remain separate from other health records.

Buprenorphine prescribing 

The House bill expands the list of health care providers who can prescribe this form of medication-assisted treatment to include clinical nurse specialists, certified nurse midwives and certified registered nurse anesthetists. The goal is to expand access to MAT.

Additional Resources:

What's In the Bill and What's Not

Summary of Senate Bill Language

 

The next several weeks will be busy as lawmakers prepare to launch a new phase on the war against the opioid epidemic. Stay up to date on this issue and many more by subscribing to the AffirmHealth blog:

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