Letter to the Hon. Andrew Slavitt, Acting Administrator, Centers for Medicare and Medicaid Services - Expanded Substance Abuse Treatment Coverage to Combat Opioid Crisis

Letter

Dear Administrator Slavitt,

We write to you today with great concern over the current Centers for Medicare and Medicaid Services (CMS) policy that adversely impacts constituents with substance use disorder (SUD) and chemical dependency treatment providers across our districts. We urge CMS to utilize every tool under current statutory authorizations to improve access to treatment options for those struggling with substance use disorders.

From abuse of prescription drugs to cocaine, methamphetamines, and new synthetic drugs, our country has experienced a substance abuse epidemic that has exposed several barriers to patient care. In 2013, 6.7 million Americans took medication not prescribed to them. More than 100 Americans die from drug overdoses every day, and nearly half of those deaths are due to opioids. These trends hit our children the hardest. One in four college age kids have reported using pain pills that are not prescribed to them.

Opioid dependence is a crippling addiction that needs to be treated as the medical condition we know it to be. Currently, numerous chemical dependency treatment facilities exceed the Institutions for Mental Diseases (IMDs) exclusion for Medicaid coverage, which sets a cap of 16-beds. It is not clear whether an exception process exists or if there are any criteria outlined for an exemption to this rule. Many of our states should be recognized for the diverse nature in which services are insured and provided through non-profits, managed care, congregate care and residential community treatment among other options, many of which have more than 16 beds.

Additionally, we have serious concerns about the recent managed care rule that only allows for 15 days of care furnished in an IMD setting over a 30-day period. To cap a patient's stay at a treatment facility at 15 days is simply unrealistic. These patients need time to recover, not only from physical dependency, but also from mental and emotional trauma. A 15-day limit is just not practical and does not take into account the numerous studies suggesting the cost-savings, readmissions reductions, overdose preventions, and recovery efficacy from longer lengths of stay in residential settings as a patient progresses down the clinical continuum of care.

CMS should be commended for the steps it has taken to increase eligibility and provide care for those most in need. Coordinating behavioral treatment with methods to mitigate physical injuries has reduced costs and improved the lives of patients. Several recent rules have established your willingness to work towards goals that reduce this epidemic.

However, we urge you to continue your efforts to ensure you take every step to remove barriers to substance abuse treatment including removing SUD from the definition of mental disease for the purposes of determining if a treatment facility is an IMD. We would appreciate any guidance on what medical assisted services can be covered in order to mitigate the adverse impact on our nation's treatment facilities.

We look forward to your timely response.