U.S. Sen. Susan Collins (R-ME) led a bipartisan call on Tuesday for the Centers for Medicare and Medicaid Services (CMS) to expand coverage for substance abuse treatment.
Collins co-led a letter to acting CMS Administrator Andy Slavitt that calls for modifications to the Institutions for Mental Disease (IMD) exclusion that curtails access to substance abuse treatment.
The IMD exclusion currently prohibits federal reimbursements for services rendered to Medicaid beneficiaries in certain settings, including mental health and substance abuse treatment facilities with more than 16 beds.
Collins said that the nation’s opioid and heroin epidemic has devastated countless families, and that 272 overdose deaths were recorded in Maine alone in 2015.
“As we look for ways to stymie this burgeoning public health crisis, we must identify and correct outdated federal reimbursement policies that can exacerbate the problem of access to life-saving care,” Collins said. “I have long been concerned that the IMD exclusion limits timely access to needed mental health and substance abuse treatment. To mitigate this problem and help increase access to evidence-based substance abuse treatment, I led my colleagues, including Senator King, in urging CMS to use existing authorities to expand treatment opportunities, including removing substance use disorder treatment and facilities from the IMD exclusion.”
Despite strides made over the last two decades to expand eligibility, protect benefits and improve provider capacity for coverage of substance use disorder (SUD) services under Medicaid, the letter states, these measures are “insufficient to respond to the opioid epidemic.”
“Furthermore, the recent managed care rule only allows for 15 days of care furnished in an IMD setting over a 30-day period to be eligible for (federal financial participation), and it is our understanding that only American Society of Addiction Medicine level 4 facilities are eligible,” the letter continues. “We have serious concerns about limiting eligibility to medically managed intensive inpatient care settings, while precluding all types of level 3 residential treatment facilities when such settings may be more clinically appropriate. Further, we question whether a 15-day length of stay is evidence-based for SUD treatment, considering 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.”
The letter adds that there are numerous congressional efforts underway to address the issue, but urged CMS to use existing authorities to broaden treatment opportunities.
U.S. Sens. Shelley Moore Capito (R-WV), Kelly Ayotte (R-NH), Rob Portman (R-OH) and Mark Kirk (R-IL) were among 29 senators who signed the letter, which Collins co-authored with U.S. Sen. Dick Durbin (D-IL).