WASHINGTON DC — This week, U.S. Representative Mike Kelly (R-PA) and Representative Brian Higgins (D-NY) introduces bipartisan legislation that will improve health care outcomes for beneficiaries living with opioid use disorder (OUD) by ensuring providers and beneficiaries are aware of effective treatment options covered by Medicare.
HR 8884, The Medicare Opioid Use Disorder Awareness Actdirects the Secretary of the Department of Health and Human Services (HHS) to conduct outreach activities with Medicare-participating health care providers to increase awareness and access to treatment services for alcohol-related disorders Opioid Use (OUD) for Medicare Beneficiaries.
“Very sadly, communities across the country know all too well the opioid crisis that continues to plague our country. Watching a neighbor or loved one go through a drug addiction crisis is hard enough. Fighting to get treatment from providers when existing coverage and service options are unclear is even harder,” representing said Kelly. “This bill gives doctors and their patients the tools they need so our communities can heal. I am proud to lead the Medicare Opioid Use Disorder Outreach Act and look forward to working with my colleagues to advance this bipartisan legislation.
“Addressing opioid use disorder is complex, and the COVID-19 pandemic has only made the challenges associated with addiction harder to overcome,” said Congressman Brian Higgins (NY-26). “This measure will provide physicians with the tools to expand community access to treatments that save lives and lead to recovery. I am proud to join in leading this legislation that will make a difference for countless families in Western New York and across the country.
As of January 1, 2020, the Medicare program covers OUD treatment, including coverage for medication-assisted treatment (MAT) services provided in an opioid treatment practice or program certified by the Substance Abuse Mental Health Services Administration ( SAMHSA) (OTP). MAT is widely considered an effective treatment option for OUD and typically combines the use of certain medications with counseling and behavioral therapy to help patients overcome or manage their addiction.
Although at least one million Medicare beneficiaries were diagnosed with OUD in 2020, many did not receive covered MAT treatment. A recent report from the HHS Office of Inspector General (OIG) found that less than 16% of Medicare beneficiaries diagnosed with OUD received MAT medications. Of the beneficiaries who received medication, less than half received behavioral therapy to treat their OUD. Therefore, the OIG recommended that additional outreach efforts are required to increase awareness and provision of covered treatment of OUD.
This policy directs the Secretary of HHS to conduct outreach to physicians and appropriate non-physician practitioners participating in Medicare to encourage greater provision of UDO treatment services. Specifically, outreach should include a comprehensive and unique education initiative that informs affected providers that OUD treatment services are a Medicare-covered benefit, outlines billing requirements for codes, and communicates requirements for beneficiaries to be eligible for such services. The bill also requires the secretary to submit a report to Congress outlining the outreach conducted one year after the completion of the education initiative. The Secretary is further tasked with submitting a report to Congress outlining utilization rates for OUD treatment services 18 months after outreach.