policy

Dear Chairman Brady and Ranking Member Neal:

On behalf of the Association for Community Affiliated Plans (ACAP), I am writing to applaud the House Ways and Means Committee’s commitment to move bipartisan legislation to address America’s devastating opioid crisis.

ACAP represents 61 member plans in 29 states serving more than 20 million Americans receiving coverage through Medicaid, CHIP, Medicare Advantage D-SNPs, and the Health Insurance Marketplaces. ACAP’s members are on the front lines of working to address the opioid crisis facing the country. States and the Federal governments have turned to managed care organizations (MCOs) to provide coordinated care services for people who rely on publicly sponsored health coverage programs. Because of their prominent role in coordinating care for Americans enrolled in these programs, Safety Net Health Plans are uniquely situated to provide high-value care coordination for individuals in need of treatment for substance use disorders. Access to coverage (along with comprehensive, integrated physical and behavioral health care) is essential to address the needs of those suffering from mental illness and/or substance use disorders (SUD).

In the normal course of operations, Safety Net Health Plans assess member needs, identify treatment gaps, engage members, encourage medication adherence, develop individualized care plans, and coordinate care. These programs are particularly important to facilitate integrated physical and behavioral health care and social services for enrollees with substance use disorders. In our analysis, the legislation being considered by the Committee will use the power of the Medicare and Medicare Advantage programs to help in the fight against opioid abuse among Medicare beneficiaries. As such, we support the Committee’s efforts.

In addition, we want to bring to the Committee’s attention a significant hurdle to effective care coordination for Medicare Advantage plan enrollees suffering from SUD. Federal law governing the confidentiality of drug and alcohol treatment and prevention records (42 CFR Part 2) sets requirements limiting the use and disclosure of patients’ substance use records from certain substance use treatment programs. Under Medicare Advantage, obtaining multiple consents from the enrollee is challenging and creates barriers to whole-person, integrated approaches to care, which are an essential part of the Medicare Advantage program. Part 2 may lead to a doctor treating a patient and writing prescriptions for opioid pain medication for that individual without knowing the person has a SUD. Separation of a patient’s addiction record from the rest of that person’s medical record creates several problems and hinders patients from receiving safe, effective, high quality substance use treatment and coordinated care. Legislative action is also necessary in order to modify Part 2 and bring substance use records into the 21st Century. And although 42 CFR Part 2 falls under the Energy and Commerce Committee’s jurisdiction, we urge the Committee to work with Energy and Commerce to address this important issue that impacts care coordination under Medicare Part C.

View the full article »