Senate set to vote on opioid response package next week


Lamar Alexander

Senate HELP Chairman Lamar Alexander (R-Tenn.) led negotiations on the deal, which includes legislation reported out of his committee. | J. Scott Applewhite/AP Photo

Senators have reached a deal on a bipartisan package to address the opioid crisis, paving the way for a vote next week, Senate Majority Leader Mitch McConnell announced Thursday.

The agreement comes after weeks of slowed negotiations between lawmakers over hot-button provisions like requiring Medicaid to cover treatment at more inpatient facilities and loosening privacy restrictions for substance abuse patients’ medical records. Neither provision made it into the final deal, but they are part of an opioid response package passed by the House earlier this year.

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The sweeping measure otherwise largely matches what the House produced. Senate HELP Chairman Lamar Alexander (R-Tenn.) led negotiations on the deal, which includes legislation reported out of his committee as well as the Judiciary, Finance and Commerce committees.

It would authorize new funding for states to fight drug addiction, expand access to medication-assisted treatment, grant the NIH more authority to research and develop non-opioid pain therapies and require the U.S. Postal Service to crack down on shipments of illicit fentanyl. It would also reauthorize the Office of National Drug Control Policy.

States would get a total of $500 million a year through 2021 for grants created under the 21st Century Cures Act to combat drug addiction. The bill would also create new comprehensive opioid recovery centers offering an array of treatment services, and it would require HHS to develop guidelines for recovery housing, which is currently unregulated.

In surprisingly direct language, the bill would require HHS and DOJ to conduct a study on the effect that federal and state opioid prescribing limits have had on patients — and specifically whether such limits are associated with higher rates of suicide.

The legislation would affect the health technology sector in several ways. It would promote sharing of behavioral health data, for example, by encouraging education and best-practice development initiatives. But it would not specifically target 42 CFR Part 2, a long-standing federal regulation that requires a patient’s direct consent to share behavioral health records. Provider groups and others believe that privacy rule inhibits care coordination by making it harder to access relevant information. The House-passed legislation would alter it.

The Senate package would also promote the use of telemedicine for substance use disorder by waiving the restrictions that typically prevent reimbursement beyond rural and disadvantaged areas. Other technologies receiving a boost from the deal: e-prescriptions for controlled substances; electronic prior authorization; and incentive payments to speed adoption of electronic health records in behavioral health.

Senate leaders are planning to bring the measure up for a vote next week, setting the stage for a conference with the House. An open amendment process is not anticipated, likely killing an attempt to add a controversial transparency provision requiring drugmakers to publicly disclose every grant made to professional, educational and patient advocacy groups that could be seen as part of a stealth marketing campaign.

Congressional aides said a number of issues need to be reconciled in conference, such as the House-passed easing of privacy protections and the costly provision to require Medicaid coverage for substance abuse treatment in larger inpatient centers.

“This is a bipartisan compromise,” a Senate Democratic aide told POLITICO. “It’s not going to be exactly what all Democrats want and it’s not going to be what all Republicans want.”

President Donald Trump declared the opioid epidemic a national public health emergency last October and has renewed that declaration three times since. Congress earlier this year appropriated nearly $4 billion to combat the crisis, including money for law enforcement activities, treatment and prevention.

Meanwhile, overdose deaths continue to climb. The latest CDC provisional data shows total drug-related deaths approaching 72,000 for the 12 months that ended in January, up nearly 7 percent from the same period a year earlier.

The congressional response to the epidemic could factor in the midterm elections — especially for Democrats, like Sen. Joe Manchin of West Virginia, who represent states that Trump won handily in 2016. A POLITICO/Morning Consult poll from July found 69 percent of respondents believed opioids were a serous problem in their state. The conservative American Action Network has poured some $5 million into ads in states with competitive House and Senate races, touting Republicans’ efforts to address the crisis.

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