Support These Bills!

ADMINISTRATIVE burden, opioid addiction and treatment barriers were top issues for the Chicago Medical Society team that lobbied in Washington, DC, last Feb. 12-14. The CMS team of eight pressed lawmakers to support important bills in play. Making personal contact with elected officials, CMS continues these talks throughout the year, and urges physicians to add to this momentum by calling or writing their representatives on the following:

Stop Cuts to Physician Office-based Labs
As of Jan. 1, 2018, reimbursement for clinical testing services provided by physician office-based labs were subject to dramatic payment reductions. These cuts will likely result in reimbursement levels below the cost of providing the tests, and are a result of the new reimbursement structure for all clinical testing services included in the Protecting Access to Medicare Act of 2014. Not only will the cuts result in loss of access to rapid testing services in a physician's office, but they will undermine Congressional efforts to leverage new technological breakthroughs to pursue patient-centered care in the 21st Century Cures Act of 2016.

Accelerate Use of ePrescribing for Controlled Substances
Take-up rates of electronic prescribing of controlled substances (EPCS) have been very low, largely due to barriers imposed by the DEA. In 2010 the DEA established the requirements for the type of biometrics to be used for EPCS. Since then, biometrics has significantly advanced and the DEA’s regulation has not caught up with the technology. To accelerate the use of EPCS and help address the opioid epidemic, the DEA should allow lower-cost, high-performing biometric devices—such as fingerprint readers on laptop computers and mobile phones—to be used for authentication.

Increase Treatment Capacity
When Medicaid was created, coverage of treatment at Institutions for Mental Diseases (IMD) with more than 15 psychiatric beds was excluded. The provision was intended, in part, to discourage the “warehousing” of patients with mental disorders in state hospitals and nursing homes. However, as evidenced-based treatment for addiction progressed, the provision now serves as an obstacle to access treatment.
Medicaid expansion under the Affordable Care Act has improved access to treatment for millions of people. Yet the capacity to provide these services remains limited. While increasing numbers of physicians and other providers are caring for these patients in the outpatient setting, existing limits on the size of inpatient facilities continue to hamper access.

The Medicaid Coverage for Addiction Recovery Expansion Act (Medicaid CARE Act, HR 2687 and S 1169)
Would allow for coverage in facilities with up to 40 beds. The Road to Recovery Act (HR 2938) Would repeal the current IMD exclusion.

The Medicaid Reentry Act (HR 4005)
Provides states with the flexibility to restart Medicaid coverage for eligible incarcerated individuals up to 30 days prior to their release. (Individuals who are released back into the community post-incarceration are eight times more likely to die of an opioid overdose in the first two weeks after being released compared to other times.) Federal law currently prohibits the use of Medicaid funds for the cost of any services provided to an inmate of a public institution, except when the individual is a patient in a medical institution.

The Medicare Beneficiary Opioid Addiction Treatment Act (HR 4097)
Would allow Medicare beneficiaries access to methadone and other Medication Assisted Treatments (MAT) for the treatment of opioid addiction in outpatient and physician settings. Currently, methadone is covered under Medicare Part D only when prescribed for pain, but not when given as part of an opioid use disorder treatment program.

The Prescriber Support Act (HR 1375)
Would authorize a new public health grant program to establish comprehensive state-based resources for physicians and other prescribers to consult when treating patients with pain and identifying signs of substance misuse and substance use disorders. The grants would be used to create a peer-to-peer consultation program that would enable prescribers to receive real-time expert consultation, both in-person or remotely, with a pain or addiction specialist when treating patients.

The Good Samaritan Health Professionals Act of 2017 (HR 1876 and S 781)
Protects healthcare professionals from liability exposure when they volunteer during a federally declared disaster such as the recent wildfires in California and the hurricanes and subsequent flooding in Texas, Puerto Rico and Gulf Coast. The current patchwork of federal and state laws are inconsistent and often unclear, especially when applied to large-scale disasters that may cross state lines. The bill respects existing medical liability laws in individual states, is narrowly tailored to apply only to licensed healthcare providers acting within the scope of their license, and it will not apply in cases involving a willful or criminal act, or where the healthcare professional is intoxicated.