How the SUPPORT Act Combats the Opioid Crisis

Last week, Congress passed the SUPPORT for Patients and Communities Act (SUPPORT Act) to help combat the country’s ongoing opioid epidemic, and President Trump is expected to sign the measure in the next few days. Reflecting the national scope of the opioid epidemic, the SUPPORT Act was met with overwhelming bipartisan support, passing with a vote of 393-8 in the House of Representatives and 99-1 in the Senate. Many of the SUPPORT Act’s provisions will directly affect how physician practices treat and interact with patients being prescribed opioids.

What is in the SUPPORT Act?

The SUPPORT Act addresses a wide range of activities, including new treatment options and requirements, loan repayment programs for treatment professionals, funding for post-treatment job training and housing programs, training for pharmacists to exercise prescription refusal, and stricter enforcement initiatives.

Some of the provisions included in the bill call for the healthcare industry to create new reports and conduct additional studies rather than carry out immediate action. Other provisions provide additional flexibility to allow (or mandate that) Medicaid and Medicare pay for additional services related to the prevention and treatment of opioid addiction. Some of the provisions most relevant to physician practices include:

• Medicaid drug review and utilization requirements. Beginning Oct. 1, 2019, state Medicaid programs will be required to have safety edits in place for opioid refills and monitor concurrent prescribing of opioids and certain other drugs.
• Telehealth treatment for substance use disorders. Beginning July 1, 2019, Medicare will be permitted to pay for telehealth services furnished for the treatment of substance use disorders, regardless of the originating site (i.e., the patient’s geographic location). Medicaid also must issue guidance covering state options for providing substance use disorder services via telehealth.
• Modifications to the “Institutions for Mental Disease exclusion.” State Medicaid programs will now have the option to cover care in certain Institutions for Mental Diseases (IMDs) for Medicaid beneficiaries aged 21 to 64 with a substance use disorder for fiscal years 2019 to 2023. If certain conditions are met, state Medicaid programs may receive federal reimbursement for up to 30 total days of care per year in an IMD for qualified individuals. Previously, payment for these services were not federally reimbursable under the IMD exclusion. The IMD exclusion will also be revised to ensure that pregnant and post-partum women receiving treatment in an IMD can continue to receive Medicaid-covered services, such as prenatal services, outside of the IMD.
• Comprehensive screenings for Medicare beneficiaries. Beginning Jan. 1, 2020, the Medicare Initial Preventive Physical Examination (also known as the “Welcome to Medicare” visit) for all beneficiaries, as well as all annual wellness visits, must include a review of the beneficiary’s current opioid prescriptions and screen for potential substance use disorders.
• E-prescribing for controlled substances. No later than Jan. 1, 2021, all prescriptions for a Schedule II, III, IV, or V controlled substance covered by Medicare Part D or a Medicare prescription drug plan must be transmitted in accordance with an electronic prescription drug program.
• Coverage of Medication-Assisted Treatment (MAT). Effective Jan. 1, 2020, Medicare coverage will expand to include opioid treatment programs for the purposes of delivering MAT for opioid use disorders.
• Expansion in the number and types of providers that can provide MAT. Qualified practitioners will be permitted to prescribe MAT for up to 275 patients if certain conditions are met. Prescribing authority for physician assistants and nurse practitioners is also made permanent, and clinical nurse specialists, certified nurse midwives, and certified registered nurse anesthetists may receive waivers to prescribe MAT for the five-year period between Oct. 1, 2018 and Oct. 1, 2023.
• Required check of Prescription Drug Monitoring Programs (PDMPs). Beginning Oct. 1, 2021, state Medicaid programs must require Medicaid providers to check relevant PDMPs before prescribing a Schedule II controlled substance.
• Adoption of Electronic Health Record (EHR) technology by behavioral health providers. The Centers for Medicare and Medicaid Innovation is granted the authority to test the provision of incentive payments to behavioral health providers for the adoption and use of certified EHR technology to improve the quality and coordination of care.
• Notifications to outlier prescribers. Not later than Jan. 1, 2021, the Secretary of Health and Human Services must annually notify individuals that have been identified as outlier prescribers of opioids. The “outlier prescriber” determination will be based on a comparison of prescribers in the same specialty and geographic area.
• Expansion of Open Payments reporting requirements. Beginning with information that needs to be submitted to the Open Payments program on Jan. 1, 2022, drug and device manufacturers will be required to report payments (or other transfers of value) to physician assistants, nurse practitioners, clinical nurse specialists, certified registered nurse anesthetists, and certified nurse midwives. Payments to physicians are already required to be reported under this program.

These provisions are just a sampling of the SUPPORT Act’s clauses relevant to physician practices. Additional requirements relating to the prescribing and treatment of opioids are also likely to be implemented in the coming years as the studies and guidelines required by the SUPPORT Act are completed.

We recommended that physicians periodically check in with their respective professional societies and review related opioid articles:

• How Physicians Can Fight Against Opioid Abuse
• 8 Ways to Protect Prescribers from Opioid Litigation
• What Doctors Can Do to Keep Stimulants From Becoming the Next Opioid Crisis