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September 18, 2018

House, Senate prepare to combine opioid packages. Here's the 3 biggest provisions they're divided on.

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    The Senate on Monday voted 99-1 to pass a legislative package to address the opioid misuse epidemic.

    New tool: Access the Medicare Opioid Prescription Assessment

    The Senate bill must now be reconciled with a House-passed legislative package (HR 6) that combines more than 50 opioid-related bills. But a Senate aide told InsideHealthPolicy that a separate bipartisan package negotiated by Senate lawmakers will be taken to conference with the House-passed bill, Inside Health Policy reports.

    According to the aide, Senate Republicans and Democrats have reportedly agreed to changes in the yet-to-be seen revised bill that did not make it into the Senate-passed version. The aide declined to state what those changes are, InsideHealthPolicy reports.

    Inside the Senate bill

    The Senate's legislative package, called the Opioid Crisis Response Act of 2018, includes more than 70 bills and aims to expand access to opioid misuse treatments, promote the development of alternative treatments for pain, and prevent the entry of illicit drugs into the United States.

    For example, the package would authorize $500 million in annual grants under the 21st Century Cures Act to provide state-level funding to address the opioid misuse epidemic. The annual grants would be authorized through 2021.

    The bill also contains a provision from Sen. Rob Portman (R-Ohio) to require the U.S. Postal Service to collect electronic data on overseas cargo and screen those items for drugs, such as illicit fentanyl.

    In addition, the Senate package includes measures that would:

    • Authorize FDA to require drug manufacturers to special safety packaging for opioids, such as sealing them in plastic blister packs and restricting doses to three to seven days;
    • Expand a program that authorizes first responders to administer the opioid overdose reversal drug naloxone;
    • Grant the NIH additional authority to research and develop non-opioid pain treatments;
    • Offer loan repayments to behavioral health providers practicing in substance use disorder facilities in locations where there is a shortage of mental health professionals; and
    • Reauthorize the Office of National Drug Control Policy.

    The 3 biggest differences between the House and Senate bills

    While it's not clear what may be inside the rumored revised Senate package, the Senate-passed version and the House-passed version contain several key differences.

    For example, the Senate bill does not include a controversial, House-passed provision to partially repeal a decades-old rule known as the Institutions for Mental Diseases exclusion rule to allow Medicaid to cover inpatient substance misuse treatment in large facilities with 16 or more beds. Sen. Rob Portman (R-Ohio) said the rule was originally created "to get people out of institutional care, mostly mental health-focused." However, today some advocates see it as a barrier to treatment for those in need.

    The Senate-passed legislative package also does not include a provision to ease privacy restrictions for medical records for individuals with past substance misuse treatment. The House earlier this year passed a standalone bill that would revise those restrictions. The provision is one of the more contentious, as supporters argue it would improve care coordination while opponents say it could lead to discrimination and discourage individuals with substance use disorders from seeking treatment.

    In addition, the Senate-passed package does not contain a House-passed provision to permanently authorize nurse practitioners and physician assistants to prescribe medication-assisted treatment (MAT). NPs and PAs MAP prescribing authority is currently set to expire Oct. 1, 2021, Health Policy News reports.

    Senate Health, Education, Labor, and Pensions Committee Chair Lamar Alexander (R-Tenn.) said Senate staffers have already begun negotiations with their House counterparts. According to InsiderHealthPolicy, lawmakers aim to have both a combined bill and a Congressional Budget Office estimate ready by Friday, which would allow the House to vote on the compromise package next week.

    According to USA Today, Alexander said lawmakers aim to have the final package passed in both chambers and to President Trump early next month (Itkowitz, "PowerPost," Washington Post, 9/17; Wang/Romoser, InsideHealthPolicy, 9/17 [subscription required]; Sotomayor, NBC News, 9/17; Collins, USA Today, 9/17).

    Your top resources for combatting the opioid epidemic—in one place

    The opioid epidemic is a complex, multi-dimensional public health problem. Use this list of helpful resources on how hospitals and health systems can play a role to treat opioid addiction and prevent further increase in opioid abuse.

    Access our Opioid Resources Here

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