December 27, 2022

Last week, Congress passed a massive Omnibus spending bill that includes the MAT Act which eliminates the so-called ‘x-waiver’;.  This means that individuals can access buprenophine for opioid use disorder without additional requirements, and that prescribers will no longer be limited in how many patients they can treat.   Specifically, this action eliminates the redundant requirement that practitioners apply for a separate waiver through the Drug Enforcement Administration (DEA) to prescribe buprenorphine for substance use disorder treatment.  Note:  After France took similar action to make buprenorphine available without a specialized waiver, opioid overdose deaths declined by 79 percent over a four-year period.

We owe a debt of thanks to Congressman Paul Tonko for his ongoing commitment and perseverance as he works tirelessly to increase access to Medicaid Assisted Treatment (MAT). 

Key health provisions (in the Omnibus Spending bill) that will help increase access to addiction treatment and related support services include:

• eliminating the “X-waiver” to prescribe buprenorphine for opioid use disorder (and associated patient limits), as called for by the Mainstreaming Addiction Treatment (MAT) Act; 
• requiring controlled medication prescribers to receive education on treating and managing patients with substance use disorder, as called for by the Medication Access and Training Expansion (MATE) Act;
• appropriating $40,000,000 for Fiscal Year 2023 for the Health Resources and Services Administration (HRSA)’s Substance Use Disorder Treatment and Recovery (STAR) Loan Repayment Program;
• appropriating $25,000,000 for Fiscal Year 2023 for HRSA’s Addiction Medicine Fellowship Program to foster robust community-based clinical training of addiction medicine or addiction psychiatry physicians in underserved, community-based settings;
• reauthorizing HRSA’s Addiction Medicine Fellowship Program through 2027;
• reauthorizing a grant program for screening, assessing, and treating maternal mental health conditions and substance use disorders, as well as continued funding of the Maternal Mental Health Hotline;
• authorizing $10,000,000 in grants for each of the first five fiscal years beginning after the date of enactment to support mental health and substance use disorder parity implementation;
• codifying regulations that allow opioid treatment programs (OTPs) to operate mobile medication components without separate DEA registrations, as called for by the Opioid Treatment Access Act;
• extending mental health and addiction parity requirements to nonfederal governmental health plans;
• authorizing $60,000,000 in grants for each of fiscal years 2023 through 2027 to improve uptake and patient access to integrated care services, including the psychiatric collaborative care model;
• extending critical Medicare telehealth flexibilities started during the COVID-19 public health emergency (including delaying the in-person requirements for telemental health services) through December 31, 2024;
• providing for the distribution of 200 additional Medicare-funded graduate medical education (GME) residency positions for Fiscal Year 2026, with 100 of those positions set aside for psychiatry or psychiatry subspecialty residencies;
• revising Medicare’s partial hospitalization benefit beginning on January 1, 2024 to provide coverage of intensive outpatient services;
• directing the Comptroller of the United States to conduct a study to compare the mental health and substance use disorder benefits offered by Medicare Advantage plans to traditional Medicare and to other benefits offered by Medicare Advantage plans;
• directing the Department of Health and Human Services to conduct a review on whether to establish a safe harbor related to the federal anti-kickback statute for evidence-based contingency management incentives for the treatment of substance use disorder and the parameters for such a safe harbor, followed by recommendations to Congress for improving access to evidence-based contingency management interventions while ensuring quality of care;
• establishing Medicare Part B coverage for services rendered by marriage and family therapists and mental health counselors beginning on January 1, 2024, and removing regulatory barriers that prevent physicians who are employed by a hospital from accessing mental health/substance use disorder programs offered by said hospital;
• facilitating consensus-based best practices, which may include model laws for implementing suggested minimum standards for operating, and promoting the availability of, high-quality recovery housing;
• making permanent the option for states to offer 12 months of postpartum Medicaid coverage; and
• amending the Medicaid Inmate Exclusion Policy to allow otherwise eligible juveniles to continue receiving Medicaid-funded health care while awaiting trial, at the option of the State. (Source:  ASAM)

See the attached document for more information on the Mainstreaming Addiction Treatment Act that was included in the Omnibus spending bill.  
Also see an important 12/1 article from Scientific American that speaks to unequal access to treatment:https://www.scientificamerican.com/article/the-opioid-epidemic-now-kills-more-black-people-than-white-ones-because-of-unequal-access-to-treatment/