Kelly, Higgins Introduce 'Medicare Opioid Use Disorder Outreach Act'

Press Release

This week, U.S. Rep. Mike Kelly (R-PA) and Rep. Brian Higgins (D-NY) introduced bipartisan legislation that will improve health care outcomes of beneficiaries living with Opioid Use Disorder (OUD) by ensuring the providers and beneficiaries alike are aware of the effective treatment options covered under Medicare.

H.R. 8884, The Medicare Opioid Use Disorder Outreach Act, directs the Secretary of the Department of Health and Human Services (HHS) to conduct educational outreach to Medicare-participating health care providers to increase awareness and access to opioid use disorder (OUD) treatment services for Medicare beneficiaries.

"Very sadly, communities across the country are all too familiar with the opioid crisis that continues to plague our nation. Watching a neighbor or loved one suffer from a substance use crisis is hard enough. Struggling to get treatment from providers when the existing coverage and service options are unclear is even harder", Rep. Kelly said. "This bill provides doctors and their patients with the tools they need so our communities can heal. I am proud to lead the Medicare Opioid Use Disorder Outreach Act and look forward to working with my colleagues to advance this bipartisan legislation."

"Tackling Opioid Use Disorder is complex, and the COVID-19 pandemic has only made the challenges associated with addiction more difficult to contend with," said Congressman Brian Higgins (NY-26). "This measure will provide physicians with the tools to expand community access to live-saving treatments that lead to recovery. I am proud to join in leading this legislation that will make a difference for countless families in Western New York and across the country."

BACKGROUND
Since January 1, 2020, the Medicare program has covered OUD treatment, including coverage for medication assisted treatment (MAT) services furnished in an office-based setting or at a Substance Abuse Mental Health Services Administration (SAMHSA)-certified opioid treatment program (OTP). MAT is widely considered an effective treatment option for OUD and generally combines the use of certain medications with counseling and behavioral therapy to help patients overcome or manage their addiction.

Although at least one million Medicare beneficiaries were diagnosed with OUD in 2020, many did not receive covered MAT treatment. A recent report by the HHS Office of Inspector General (OIG) found that less than 16 percent of Medicare beneficiaries diagnosed with OUD received MAT medication. Of those beneficiaries who received medication, less than half received behavioral therapy to treat their OUD. Consequently, OIG recommended that additional outreach efforts are necessary to increase awareness and provision of covered OUD treatment.

This policy instructs the Secretary of HHS to conduct outreach to physicians and appropriate non-physician practitioners participating in Medicare to encourage greater provision of OUD treatment services. Specifically, the outreach is to include a one-time, comprehensive education initiative that informs relevant providers that OUD treatment services are a covered benefit under Medicare, describes the requirements to bill for the codes, and communicates the requirements for beneficiaries to be eligible for such services. The bill also requires the Secretary to submit a Report to Congress describing the outreach conducted one year after the completion of the education initiative. The Secretary is further instructed to submit a Report to Congress describing the utilization rates of the OUD treatment services 18 months after the outreach.

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