On October 24, 2018, President Trump signed an expansive bipartisan bill into law aimed at curbing America’s growing opioid epidemic.
Titled the Substance Use-Disorder Prevention that Promoted Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act, H.R. 6, the legislation promotes whole person care and improved child welfare by focusing on vulnerable populations like pregnant women with substance use disorder and increasing access to social determinants of health (SDoH) like healthcare, housing, and education.
The SUPPORT for Patients and Communities Act contains eight different sections and dozens of provisions, but focuses on three initiatives in particular:
- TEACHING addiction medicine
- STANDARDIZING the delivery of addiction medicine
- COVERING addiction medicine in a way that facilitates coordinated and comprehensive treatment
During the last year, the Trump Administration and the Centers for Medicare and Medicaid Services (CMS) released a series of Informational Bulletins outlining approaches states can take to address the opioid overdose epidemic within Medicaid.
The two most recent Informational Bulletins released by CMS highlight two provisions – Section 1007 and Section 1012 – each designed to support and assist pregnant and postpartum women diagnosed with a substance use disorder (SUD).
Section 1007: Caring Recovery For Infants and Babies
Section 1007 of the SUPPORT for Patients and Communities Act introduces a new section, 1902(a)(86), to the Social Security Act. This provision adds an optional provider type of “residential pediatric recovery center” (RPRC) to Medicaid for treatment of infants with Neonatal Abstinence Syndrome (NAS) as long as they don’t have any other significant medical factors.
Using this new provider type, states can treat infants with NAS in their Medicaid programs. Section 1007 also gives states further guidance on implementing new provisions listed in section 1007, including:
- Offering counseling to mothers and other appropriate caretakers
- Offering services covered under the current state plan
By allowing the state to pay for inpatient and outpatient services, including counseling, providers can offer better overall care, lowering the rate of opioid overdoses, improving coordinated care, and ultimately saving lives.
Section 1012: Help for Moms and Babies
Section 1012 of the SUPPORT for Patients and Communities Act provides support for pregnant and postpartum women facing and/or recovering from SUD, including opioid use disorder, and aids in their recovery.
Section 1012 facilitates these efforts by establishing a new limited exception to the institution for mental diseases (IMD) exclusion for pregnant and postpartum women with SUD. In most cases, Medicaid coverage isn’t available for services provided to beneficiaries living in an IMD, defined in statute as a “hospital, nursing facility, or other institution of more than 16 beds that is primarily engaged in providing diagnosis, treatment, or care of persons with mental diseases.”
This new exception means women who are diagnosed with SUD can pay for inpatient and outpatient services using their Medicaid coverage.
Implementing Section 1007 and Section 1012
Now that CMS has issued these guidelines, it’s up to states and medical providers to implement them as quickly as possible. However, there are important considerations to keep in mind.
For example, the guidelines state that for a woman to be eligible for the limited exception to the IMD, she must:
- Be enrolled as a pregnant woman in Medicaid prior to becoming a patient
- Or be within the 60-day postpartum period in Medicaid prior to becoming a patient
It’s also important to note that every state is different. Per section 1012(b), some Medicaid state plans may require additional state legislation in order for the state plan to be amended to add additional coverage requirements.
The Trump Administration and CMS have given states until October 1, 2020 to be in compliance with section 1007 and 1012 of the SUPPORT for Patients and Communities Act.
Legislators and medical professionals are confident these provisions will improve pregnancy and postpartum care for women diagnosed with a SUD. Plus, they will help lower costs and promote better outcomes for children with NAS.