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By Monica E. Oss

Yesterday, we highlighted a new wave of statistics-rising suicide rates and declining life expectancy numbers—that are both the likely result of the effects of the increase in addiction rates in the U.S. (see Suicide Stats, Addiction Stats – But Not A Lot Of Solutions). There is rarely a day that goes by without some news coverage of some aspect of this wave. And, these numbers have the attention of educators, corrections officials, child welfare managers, health care policymakers, and legislators-for obvious reasons.

Legislators have responded with a parallel wave of legislation related to addiction and addiction treatment. This recent legislation is sweeping in scope and in funding—and I think there are three big strategic implications of the legislation that health and human service executive should keep in mind.

First, there is more funding available for addiction treatment and addiction-related education and support services. In March, Congress approved an omnibus spending bill that built on the 21st Century Cures Act and appropriated $3.3 billion to address the opioid and mental health crisis in fiscal year 2018 (see How Far Does $3.3 Billion Go? and Congress Passes 21st Century Cures Act, With Major Provisions For Mental Health Reform & Addiction Treatment Funding). This funding was allocated to multiple federal departments for program grants, research, drug monitoring programs, and mental health programming.

Part of this funding was allocated in September by the Department of Health and Human Services (HHS), which awarded more than $1 billion in grants targeting opioid use disorder prevention and treatment for community health centers, academic institutions, and rural organizations (see HHS Awards More Than $1 Billion In Grants To Combat Opioid Crisis). As part of those grants, the Health Resources & Services Administration (HRSA) awarded over $396 million to expand access to integrated addiction disorder and mental health services. The HRSA grants were for the following grant activities:

  1. $352 million awarded to increase access to addiction disorder and mental health services through the Expanding Access to Quality Substance Use Disorder and Mental Health Services to 1,232 community health centers across the nation.
  2. $18.5 million to support Behavioral Health Workforce Education and Training and Enhancing Behavioral Health Workforce awards.
  3. $25.5 million to over 120 rural organizations to increase access to addiction prevention and treatment services serving rural populations across the country. This includes: $19 million awarded to 95 organizations under the Federal Office of Rural Health Policy’s Rural Communities Opioid Response Program-Planning, and nearly $6.5 million to 26 rural organizations to expand the reach of the Rural Health Opioid Program.

The second takeaway from new legislation is that rules and regulations are being changed to increase access to treatment—more access to residential treatment and comprehensive services. In October, the Substance Use Disorder Prevention That Promotes Opioid Recovery & Treatment For Patients & Communities Act (SUPPORT Act) was signed into law in October and included a provision that directed the Centers for Medicare & Medicaid Services (CMS) to end the Medicaid exclusion on addiction treatment at IMDs (see Congress Sends SUPPORT Act Addiction Treatment Bill To President). Under this legislation, starting next year, state Medicaid programs will have the option under a state plan amendment (SPA) to cover care in certain IMDs for beneficiaries ages 21 to 64 with addiction disorder through 2023 (see CMS To Allow State Medicaid Plans To Cover Residential Addiction Treatment).

Additionally, access to treatment is still expanding as state’s modify their Medicaid programs in response to the substance use disorder (SUD) delivery system transformation 1115 waiver. In July 2015 CMS’ gave states the option to submit a 1115 waiver to improve the care and outcome of consumers with addiction disorders. Under the delivery system transformation, states are encouraged to better identify consumers with substance use disorder, improve access to treatment, provide a comprehensive and effective array of services, and use quality metrics to evaluate the success of demonstrations (see Keeping Up With The Changing Medicaid Addiction Treatment Landscape and An Update On States With Medicaid 1115 Waivers For Addiction Treatment).

Finally, the growing acceptance of medication assisted treatment (MAT) has gotten an extra “shot in the arm” as there has been an expansion of the types of professionals who can prescribe MAT, as well renewed focus on MAT development. As part of the SUPPORT Act, the federal Department of Health and Human Services (HHS) will allow more types of professionals to prescribe buprenorphine as MAT for opioid use disorder (see HHS To Expand Buprenorphine Prescribing). And the month before that, in August, the U.S. Food and Drug Administration (FDA) issued new clinical endpoints to drug sponsors to encourage MAT drug development for the treatment of opioid use disorder (see FDA Issues Recommendations To Encourage Development Of Opioid Use Disorder Treatment Medications).

The task at hand for executive teams is to assess the impact of these changes on their competitive market positioning and sustainability. Will these legislative changes allow competitors to gain more traction? Will they provide new opportunities? The answer to these questions, like many strategic questions, is “it depends.” The challenge is tracking the effects of these national legislative changes on a state and local level—and developing a plan to build organizational capacity in a changing landscape. For more, join John F. Talbot, Ph.D., OPEN MINDS Advisory Board Member on June 5 at The 2019 OPEN MINDS Strategy & Innovation Institute for his session, “Addressing The Opioid Crisis: An Opportunity For Innovation In Serving High-Risk Consumers.”

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