The key to keeping methadone and opioid treatment programs (OTPs) in the sights of appropriators is the phrase “all three medications” when referring to “MAT” (medication-assisted treatment) to treat opioid use disorder (OUD). That’s because there are only three medications approved by the Food and Drug Administration to treat OUD—methadone, buprenorphine, and naltrexone—and only one of them can be dispensed only by an OTP—methadone. That point will be key to remember as funders in Washington move forward with continued increases in treatment funding for OUD.
Appropriations—the process by which Congress funds programs in the federal government—went well in the House of Representatives for substance use disorder in May. Next stop: The Senate.
House Funds Many SAMHSA Items
On May 8, the House Appropriations Committee approved the fiscal year 2020 Labor, Health and Human Services, Education, and Related Agencies bill on a vote of 30 to 23, which includes funding for the Substance Abuse and Mental Health Services Administration (SAMHSA) and other agencies within the Department of Health and Human Services, as well as the Departments of Labor and Education and other agencies.
Below are selected items from the bill:
- In total, the draft bill includes $189.8 billion in discretionary funding, an increase of $11.7 billion over the 2019 enacted level and $47.8 billion over the President’s 2020 budget request.
- $140 million to support CDC’s efforts to reduce new HIV infections by 90% in 10 years.
- The bill funds SAMHSA at $5.9 billion—$115 million above the 2019 enacted level and $179 million above the President’s budget request.
- Substance use treatment: $3.8 billion, an increase of $14 million, including continued funding for opioid use disorder prevention and treatment, and three new behavioral health programs to enhance treatment efforts.
- State Opioid Response (SOR) grants: $1.5 billion “for carrying out activities pertaining to opioids undertaken by the State agency responsible for administering the substance abuse prevention and treatment block grant” (level funding compared to FY 2019 and the President’s request).
- $50,000,000 of the $1.5 billion for SOR shall be made available to Indian Tribes or tribal organizations.
- 15% of the remaining amount shall be for the States with the highest opioid-related mortality rate .
- Substance use treatment within SAMHSA: $3.751 billion, “an increase of $14 million, including continued funding for opioid prevention and treatment, and three new behavioral health programs to enhance treatment efforts.”
- National Institute on Drug Abuse (NIDA): $1,489,237,000 ($70 million above FY 2019; $193 million above President’s request).
- National Institute on Alcohol Abuse and Alcoholism (NIAAA): $551 million ($25 million above FY 2019; $99 million above President’s request).
- Centers for Disease Control and Prevention (CDC)—Injury Prevention and Control: $697,559,000 ($49 million above FY 2019; $69 million above President’s request).
- CDC—Chronic Disease Prevention and Health Promotion: $1,073,121,000 ($114 million cut compared to FY 2019; $122 million above President’s request).
Importance of Payment
In a policy paper issued earlier this year (see http://staging3.atforum.com/2018/12/aatod-policy-methadone-buprenorphine/ for an advance review), AATOD president Mark Parrino made it clear that the biggest problem is lack of reimbursement. “Unless payors recognize that there is a need to reimburse treatment wherever patients receive care for their OUD, there will be no way out of this public health crisis,” the paper stated, noting that 11 states still do not provide Medicaid reimbursement for OTPs. However, soon, Medicare beneficiaries will be able to receive reimbursement for OTP services (see http://staging3.atforum.com/2019/04/cms-samhsa-visit-otps-bundled-rate/). Medicare reimbursement was a huge success for AATOD and for OTPs, which saw patients having to drop out of treatment when they turned 65 and lost Medicaid.
Earlier this year, the Bipartisan Policy Center released a report tracking federal funding of the opioid crisis (for the report, go to https://bipartisanpolicy.org/library/tracking-federal-fundingto-combat-the-opioid-crisis/), which focused on states that relied on SAMHSA’s STR and SOR grants. It’s also important to expand Medicaid, the report noted.
For the AATOD policy paper, go to http://www.aatod.org/wp-content/uploads/2019/02/2019-Policy-Paper.pdf
For the full text of the House HHS/Labor/Education appropriations bill:
The Senate will take up appropriations this summer. Vigilance will be required to make sure that OTPs and methadone are kept in appropriators’ mindset, so that comprehensive care is available for patients who need it, especially in the early stages of their treatment.