IMD changes trump emergency declaration

President Donald Trump on Thursday announced he has ordered Acting Secretary of Health and Human Services (HHS) Eric Hargan to declare the ongoing opioid epidemic a public health emergency. It was his announcement of a new federal policy to expedite the waiver process for states requesting a workaround for the IMD exclusion, however, that could have bigger implications for providers.

“A number of states have reached out to us asking for relief, and you should expect to see approvals that will unlock treatment for people in need. And those approvals will come very fast,” Trump said during his remarks Thursday to announce the public health emergency declaration.

Mark Dunn, public policy director for the National Association of Addiction Treatment Providers, tells Behavioral Healthcare Executive that the association was pleased by the decision regarding the IMD exclusion.

 “Our association has long held that the IMD exclusion was a parity violation, so we’re glad to see that can be waived now,” he says.

Robert J. Budsock, president and CEO of Integrity House in New Jersey, says the IMD workaround could have much larger implications for treatment centers than the public health emergency declaration itself.

“When things are put into motion to expedite the IMD workarounds on a state-by-state basis, you will see access and resources expanding for addiction treatment,” says Budsock. “I know [New Jersey Gov. Chris Christie] referred to repealing IMD exclusion as the single fastest way to increase drug treatment availability across the nation. Although the president stopped short of repealing the IMD exclusion, it was encouraging that he indicated that he would make sure individual waivers submitted by states would be expedited and not held up by [the Centers for Medicare and Medicaid Services].”

As for the public health emergency declaration itself, the measure allows for expanded access to telehealth services, gives states increased flexibility for how they use federal funds and waives certain regulations.

Still, it falls short of the recommendation of Trump’s own Commission on Combating Drug Addiction and the Opioid Crisis, which in July published a report calling for the president declare a national state of emergency—a move with broader implications, including allowing states to access to the Federal Emergency Management Agency’s Disaster Relief Fund.

Practical actions

Originally designed to address short-term disasters and illnesses, a public health emergency declaration lasts for 90 days, but may be renewed by the HHS secretary. The opioid crisis public health emergency declaration is the first such nationwide declaration since the outbreak of the H1N1 virus in 2009-2010.

Among the actions it will trigger:

• Access to telehealth services will be expanded. This includes remote prescribing of medication used to treat substance use and mental health disorders, which will be especially beneficial to rural areas with high incidences of opioid addiction and limited access to in-person treatment.
• The Department of Labor will be able to issue dislocated worker grants to help workers displaced from the workforce as a result of the opioid crisis.
• Resources within HIV/AIDS programs will be shifted to help those eligible for such programs to receive substance use disorder treatment.

“We feel like it’s a very positive step forward. It wasn’t the recommendation [Trump’s] own commission made, but the fact he chose to declare a public health emergency is better than nothing,” Dunn says. “While there’s no new money, it will free up some existing sources to deal with the problem.”