House IMD bill specifies payment for opioid and cocaine patients only

The House passed a number of bills related to the opioid crisis over the past several days. One of the more controversial was HR 5797, the IMD CARE Act, which passed by a vote of 261 to 155 on Wednesday. HR 5797 would allow Medicaid to pay for treatment in inpatient facilities with more than 16 beds, however, it still imposes significant limitations.

First, language in the bill specifies that  coverage is limited to treatment for opioid use disorder only. An amendment that later passed by voice vote expands the coverage to allow for payment of treatment services for cocaine use disorder as well.

Second, in both cases, treatment time is limited to 30 days per service year. A state would also have to file a plan amendment that includes information on how the state will improve access and facilitate transitions to outpatient care.    

The bill has good intent, but it doesn’t do enough to solve the IMD issue because it limits treatment according to the classification of the patient’s substance of choice. Such distinctions are not easily made at the moment of intake, Andrew Kessler, JD, founder and principal of Slingshot Solutions, tells Behavioral Healthcare Executive.

“Clinicians really are hesitant to discriminate among those who suffer from addiction, whether it be alcohol, stimulants or opioids,” Kessler says. “Addiction is addiction. It’s a disease, and our goal is to have all people in need of treatment for substance use disorder receive treatment.”

There’s simply too much polysubstance use among those with addiction disorders to make the bill’s limitation easy to apply in everyday clinical practice. For many providers, the administrative hassle of narrowly defining only those patients with opioid- or cocaine-related substance use disorders could be a deterrent from taking advantage of the new coverage opportunity.

“You really have a headache here for clinicians who do intake,” Kessler says. “While I understand the racial disparities associated with cocaine and crack, the [Bobby Rush (D-Ill.)] amendment doesn’t solve the problem of intake. By adding more exceptions, we really haven’t addressed the IMD problem.”

House is expected to combine the opioid bills into one package known as HR 6, on the agenda for Friday. Ultimately, HR 6 would move to the Senate, where it likely will see some modifications.