ABC News: State attorneys general seek more beds for drug treatment

“A bipartisan coalition of state attorneys general on Monday called on Congress to allow Medicaid funding to flow to larger drug treatment centers, potentially expanding the number of addicts who can get help as the nation grapples with an overdose crisis. The government lawyers for 38 states and Washington, D.C., sent a letter to congressional leaders requesting the change. They say it's needed to help fight the opioid abuse and overdose epidemic, which continues to claim tens of thousands of lives a year…”

ICYMI: This week, AGs from 38 states urged Congress to act on bipartisan legislation introduced by Congressman Brian Fitzpatrick (R-PA) to end the outdated and ineffective IMD Exclusion. Fitzpatrick, vice chair of the Bipartisan Heroin Task Force and a certified EMT, is the author of the  Road to Recovery Act [H.R. 2938] - legislation eliminating the Medicaid Institutions for Mental Diseases (IMD) exclusion for substance use disorder and help states expand access to inpatient treatment for Medicaid enrollees. 

“The ‘IMD exclusion’ blocks access to treatment for people who need inpatient treatment for addiction including some of society’s most vulnerable: veterans, pregnant addicted women, women with dependent children, and low-level drug offenders,” said Fitzpatrick at the time of introduction. “This bipartisan bill will eliminate the IMD exclusion for substance use disorder and help states expand access to inpatient addiction services for Medicaid enrollees in a fiscally responsible manner while not intruding on a state’s flexibility to implement care.”

The Road to Recovery Act is now the official policy of the National Association of Attorneys General and the proposal has been endorsed by President Trump's Commission on Combating Drug Addiction and the Opioid Crisis.

The IMD exclusion is a long-standing policy that prohibits the federal Medicaid matching funds to states for services rendered to Medicaid-eligible individuals who are patients for SUD and mental health treatment. Some states – including Pennsylvania - have used an “in lieu of services” provision allowing for inpatient treatment, but with limitations on patient population, facility size, and length of stay.  These limitations disproportionately affect Medicaid beneficiaries. 

Drug overdoses involving prescription opioids and heroin have nearly quadrupled since 1999 and are now the leading cause of accidental death. According the US Department of Health and Human Services, substance abuse costs the country over $600 billion annually and based on conservative estimates, each dollar invested in addiction treatment programs yields a return of between $4 and $7 in reduced drug-related crime, criminal justice costs, and theft. When the return on investment is applied to healthcare costs, the total savings can exceed a ratio of 12:1.

Joining Fitzpatrick in introducing the Road to Recovery Act were Representatives Stephanie Murphy (D-FL), Bipartisan Heroin Task Force co-chairs Tom MacArthur (R-NJ) and Ann Kuster (D-NH), and vice-chair Donald Norcross (D-NJ).

WHAT THEY’RE SAYING:

• Pennsylvania State Representative Gene DiGirolamo: “I applaud Congressman Fitzpatrick for his leadership on this life-saving legislation. Thousands of lives will be saved.”

• Pennsylvania Attorney General Josh Shapiro: "Heroin and opioids are the number one public health and safety threat in Pennsylvania and we can’t arrest our way out of this epidemic – we need more access to treatment. I commend Representative Fitzpatrick, who worked with Pennsylvania law enforcement to craft this legislation, for being a leader in fighting this crisis. This bill will remove bureaucratic barriers to treatment so everyday Americans can get the help they need.”  

• Bucks County Drug & Alcohol Commission: “Now, more than ever, our residents require extensive, sustained and long term treatment, in order to develop the necessary skills to establish long-term recovery. The proposed bill will enhance our residents’ chances to their recovery taking root, as they will be allowed an appropriate length of stay in residential treatment… We are enthusiastic about the potential to assist our county residents as they seek treatment and recovery.” - Diane Rosati, Executive Director

• Drug & Alcohol Service Providers Organization of PA (DASPOP): “The Fitzpatrick legislation fixes a major gap in the treatment system.  Make no mistake about it – this legislation will save lives.” – Deb Beck, President                                            

• Rehabilitation and Community Providers Association (RCPA): "On behalf of the Rehabilitation and Community Providers Association (RCPA) and its members, I would like to thank Congressman Fitzpatrick for introducing the Road to Recover Act. This bipartisan bill addresses the antiquated and problematic IMD Final Rule and will enable Pennsylvania to expand access to residential treatment for substance use disorders, while not intruding on a state’s flexibility to implement care.” - Richard S. Edley, President & CEO

• National Association of County and City Health Officials (NACCHO):“Local health departments are key players in connecting those seeking treatment with appropriate services. Removing barriers to treatment covered by Medicaid and CHIP will increase inpatient treatment access for substance use. Local health departments are on the frontlines of the opioid epidemic and support solutions along the prevention-treatment continuum. The focus here is treatment and ensuring there is access to treatment for the most vulnerable in our communities.” - Laura Hanen, Interim Executive Director

• American Society of Addiction Medicine: “On behalf of the American Society of Addiction Medicine (ASAM), the nation’s oldest and largest medical specialty society representing more than 4,300 physicians and allied health professionals who specialize in the treatment of addiction, I am writing to offer our support for your bill which would lift the Medicaid Institutions for Mental Diseases (IMD) exclusion for mental health and substance use disorder residential treatment facilities. ASAM thanks you for your leadership on this important issue. Repealing the IMD exclusion is critical to improving access to addiction treatment and we are pleased to endorse your legislation.” - Kelly Clark, MD, MBA, DFASAM, President

• Partnership for Drug-Free Kids: “With 144 people dying from drug overdoses each day in our country, it is imperative that we remove every possible barrier to getting people the treatment that they need, including addressing the IMD exclusion, an antiquated law which makes it impossible for many institutions to provide substance use disorder treatment to Medicaid patients.  The fix for this problem is long overdue and is a necessary step to increase access to treatment services.” - Marcia Lee Taylor, President & CEO

• NAADAC, the Association for Addiction Professionals  - “The Road to Recovery Act of 2017 is an important and long overdue piece of legislation that NAADAC fully supports. Removing the 16 bed limit on treatment facilities and the cap on length of stay are imperative steps for expanding access to and the effectiveness of impatient treatment for those living with substance use disorder and co-occurring disorders. The proposed legislation will allow residential treatment facilities to have increased funding available for all types of treatment, become more self-sustainable, increase the quality of their work, and ultimately save more lives.” – Cynthia Moreno Tuohy, Executive Director

• American Academy of Emergency Medicine (AAEM): “Emergency physicians are on the front lines of the opioid epidemic and encounter patients every day dealing with substance use disorder. We are very concerned about the current misuse of prescription pain medications and the subsequent adverse health consequences. Our goal is to provide the most appropriate, highest quality medical care to our patients. By expanding access to inpatient treatment for substance use disorder we will increase our capacity to serve all patients in the emergency department” – Kevin Rodgers, MD FAAEM, President

• Rehabilitation and Community Providers Association (RCPA): "On behalf of the Rehabilitation and Community Providers Association (RCPA) and its members, I would like to thank Congressman Fitzpatrick for introducing the Road to Recovery Act. This bipartisan bill addresses the antiquated and problematic IMD Final Rule and will enable Pennsylvania to expand access to residential treatment for substance use disorders, while not intruding on a state’s flexibility to implement care.” - Richard S. Edley, President/CEO

• Treatment Communities of America: "The IMD Exclusion is an antiquated policy that unjustly bars access to community based treatment for those in greatest need of care. TCA is pleased to support this bill to end this inequity and restore appropriate access to the full continuum of care." - Dr. Kathy Icenhower, President

National organizations supporting the Road to Recovery Act include:

·         Community Anti-Drug Coalition (CADCA)

• NAADAC- the Association for Addiction Professionals
• Partnership for Drug-Free Kids
• American Medical Association (AMA)
• America’s Health Insurance Plans (AHIP)
• Addiction Policy Forum (APF)
• Healthcare Leadership Council (HLC)
• Anthem
• American College of Emergency Physicians (ACEP)
• National Association of City and County Health Officials (NACCHO)
• National Council on Alcoholism and Drug Dependence (NCADD)
• Medicaid Health Plans of America (MHPA)
• Association for Behavioral Health & Wellness (ABHW)
• Association for Community Affiliated Plans
• American Academy of Emergency Medicine (AAEM)
• Caron Treatment Centers

Local and state organizations supporting the Road to Recovery Act include:

• Drug & Alcohol Service Providers Organization of Pennsylvania
• Life Sciences Pennsylvania
• California Consortium of Addiction Programs & Professionals
• Independence Blue Cross
• Council on Alcoholism & Drug Abuse of Northwest Louisiana
• Pennsylvania College of Emergency Physicians
• AmeriHealth Caritas
• UPMC Health Plan
• Gaudenzia
• CareSource
• Livengrin Foundation
• Illinois Association of Behavioral Health
• Pennsylvania Bucks County Drug & Alcohol Commission
• Pennsylvania Attorney General
• AmeriHealth Caritas