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 Legislative & Policy Corner

Congress Recesses for a Week Without Acting on Zika
Last week Congress departed for a one-week recess without taking action on the supplemental request for emergency funding to address Zika virus preparedness. AMCHP is working with the ASTHO Affiliate Council and an ad hoc MCH coalition led by the March of Dimes to raise awareness of the urgent need for resources to help states and communities prepare for the potentially devastating consequences of a wider outbreak.  We will be joining efforts throughout May to urge Congress to act swiftly, and appreciate hearing about your perspectives and needs which can be shared with AMCHP Director of Policy and Government Affairs Brent Ewig at bewig@amchp.org

House Committee Passes Dozen of Bills Addressing Opioid Abuse
On Thursday, April 28, the House Energy and Commerce Committee passed a package of twelve bills addressing the opioid crisis – including several focused on pregnant women or neonatal abstinence syndrome.  At one point during their consideration, it appeared the committee was interested in lowering the authorization level of the Title V Maternal and Child Health Services Block Grant to comply with a House rule requiring any new funding authorizations to be offset by decreases in existing program authorizations.  Some members of the committee were concerned about the unfortunate precedent that would create, so in the end the committee used other offsets.  Nonetheless, it alerted AMCHP to a previously unknown potential vulnerability that we will now be vigilant to guard against moving forward.  Summaries of the bills passed by the committee are below.  Action in the Senate is pending and any final package will need to reconcile any differences between the two chambers.

H.R. 4641, to provide for the establishment of an inter agency task force to review, modify, and update best practices for pain management and prescribing pain medication, and for other purposes – Authored by committee members Rep. Susan Brooks (R-IN) and Rep. Joseph Kennedy (D-MA), this legislation would establish an inter-agency task force to review, modify, and update best practices for pain management and how pain medication is prescribed.

H.R. 4978, the Nurturing and Supporting Healthy Babies Act– Authored by Rep. Evan Jenkins (R-WV) and Rep. Cheri Bustos (D-IL), this bipartisan legislation would require the Comptroller General of the United States to issue a report one year after enactment on Neonatal Abstinence Syndrome (NAS). Also passing with the bill was an amendment offered by Health Subcommittee Chairman Joseph Pitts (R-PA) and Rep. John Yarmuth (D-KY), which corrects an error in current law by exempting abuse-deterrent formulations (ADF) of prescription drugs from the definition of "line extension" when calculating Medicaid rebates, thus helping incentivize the development of ADF to combat opioid abuse. The cost of this change was offset by implementing a policy in the President's FY2017 Budget that would prevent the public disclosure of predictive algorithms used to identify fraud in Medicare, Medicaid, and CHIP programs, a policy idea that Rep. Bilirakis (R-FL) first introduced last Congress.

H.R. 1818, the Veteran Emergency Medical Technician Support Act of 2015 – Authored by committee members Rep. Adam Kinzinger (R-IL) and Rep. Lois Capps (D-CA), this bipartisan legislation (which passed the House last Congress) would create a demonstration program to streamline emergency medical technician state requirements and procedures for veterans who have already completed military emergency medical technician training. Also passing with the bill was an amendment offering a technical correction to the bill title.

 H.R. 4981, the Opioid Use Disorder Treatment Expansion and Modernization Act – Authored by committee members Rep. Larry Bucshon, M.D. (R-IN) and Rep. Paul Tonko (D-NY), this legislation would amend the Controlled Substances Act to expand access to medication-assisted treatment, while ensuring that patients receive the full array of quality evidence-based services and minimizing the potential for drug diversion.

 H.R. 4969, the John Thomas Decker Act – Authored by Rep. Pat Meehan (R-PA), Rep. Ron Kind (D-WI), and Rep. Marc Veasey (D-TX), this legislation would amend the Public Health Service Act to direct HHS to study what information and resources are available to youth athletes and their families regarding the dangers of opioid use and abuse, non-opioid treatment options, and how to seek addiction treatment. HHS would then be required to report its findings and work with stakeholders to disseminate resources to students, parents, and those involved in treating a sports related injury. Also passing with the bill was an amendment offering a technical correction to the bill.

 H.R. 4599, the Reducing Unused Medications Act of 2016 – Authored by Rep. Katherine Clark (D-MA) and Rep. Steve Stivers (R-OH), this legislation would amend the Controlled Substances Act (CSA) to clarify when a prescription for a drug listed on Schedule II of the CSA may be partially filled.

H.R. 4976, the Opioid Review Modernization Act– Authored by Rep. Sean Maloney (D-NY) and committee member Rep. Leonard Lance (R-NJ), this legislation would require the FDA to work closely with expert advisory committees before making critical product approval and labeling decisions, and to make recommendations regarding education programs for prescribers of extended-release and long-acting opioids.

H.R. 4982, Examining Opioid Treatment Infrastructure Act of 2016 – Authored by Rep. Bill Foster (D-IL) and full committee Ranking Member Rep. Frank Pallone, Jr. (D-NJ), this legislation would require the Comptroller General of the United States to issue a report to Congress on substance abuse treatment availability and infrastructure needs throughout the United States. This report shall include an evaluation of various substance abuse treatment settings including inpatient, outpatient, and detoxification programs. Also passing with the bill were two amendments, one offered by Rep. David McKinley (R-WV) and one offered by Rep. Markwayne Mullin (R-OK). Rep. McKinley's amendment examines barriers to accessing real-time data on overdoses, and Rep. Mullin's amendment studies access to treatment in the Indian health program.

H.R. 3250, the DXM Abuse Prevention Act of 2015 – Authored by committee members Rep. Bill Johnson (R-OH) and Rep. Doris Matsui (D-CA), this legislation would prohibit the sale of a drug containing dextromethorphan (DXM) to an individual under 18, unless the individual has a prescription or is actively enrolled in the military and place restrictions on distribution of bulk DXM. DXM is commonly found in cough syrup. 

 H.R. 4586, Lali's Law – Authored by Rep. Bob Dold (R-IL) and Rep. Katherine Clark (D-MA), this legislation would amend the Public Health Service Act to authorize grants to states for developing standing orders for naloxone prescriptions and educating health care professionals regarding the dispensing of opioid overdose reversal medication without person-specific prescriptions. Also passing with the bill was an amendment offered by Health Subcommittee Chairman Joseph Pitts (R-PA) to make technical corrections and make the bill cut-go compliant.

H.R. 3680, the Co-Prescribing to Reduce Overdoses Act of 2015 – Authored by committee member Rep. John Sarbanes (D-MD), this legislation would create a grant program for co-prescribing opioid reversal drugs for patients who are at a high risk of overdose. Also passing with the bill was an amendment offered by Chairman Pitts to make technical corrections and make the bill cut-go compliant.

H.R. 3691, the Improving Treatment for Pregnant and Postpartum Women Act of 2015 – Authored by committee member Rep. Ben Lujan (D-NM), this legislation would reauthorize a residential treatment program that currently provides numerous services to aide pregnant women or postpartum women engaged in substance abuse. Also passing with the bill were two amendments, one offered by Chairman Pitts and one offered by Lujan. Chairman Pitts' amendment made technical corrections and ensured the bill was cut-go compliant, and Lujan's amendment made additional technical corrections.

Health Reform Implementation

CMS Issues Guidance on "Free Choice of Provider" Requirement under Medicaid
The Centers for Medicare & Medicaid Services (CMS) recently issued a letter to all state Medicaid directors reiterating that providers may not be excluded from participating in Medicaid for reasons other than being unable to perform covered medical services or being unable to bill for those services. The letter further reminds states that they may not target providers for reasons unrelated to their ability to perform covered services or the adequacy of their billing practices. The letter notes that providing a full range of women's health services does not disqualify a provider from participating in Medicaid. Ten states have recently taken action or passed legislation to cut off Medicaid funding to Planned Parenthood. This is the first time CMS has issued a collective notice to all 50 state Medicaid agencies, advising that specific actions may be outside of compliance with federal law.

CMS Releases Medicaid and CHIP Managed Care Final Rule
On April 25, the Centers for Medicare & Medicaid Services (CMS) released the Medicaid and Children's Health Insurance Program (CHIP) Managed Care Final Rule, the first major update to Medicaid and CHIP managed care regulations in more than a decade. Among the revisions, the rule strengthens state efforts to support delivery system reform, authorizes the first-ever Medicaid and CHIP quality rating system, requires electronic notices to beneficiaries and requires online  provider directories. The rule better aligns key regulations and practices with those of the Marketplace and Medicare Advantage plans. It also helps strengthen and improve the delivery of health care to low-income children served by CHIP. The rule will affect the nearly two-thirds of beneficiaries who get Medicaid coverage through private managed care plans.

HHS Grants $5 million to Puerto Rico to Fight Spread of Zika Virus
On April. 26, the Department of Health and Human Services (HHS) announced it will grant $5 million to 20 health centers in Puerto Rico  to combat the spread of the Zika virus. The funds will be used to expand voluntary family planning services, including contraceptive services, outreach and education, and to hire more staff. The 20 health centers and their 84 service delivery sites in Puerto Rico serve over 330,000 people, including nearly 80,000 women age 15 to 45. A list of awardees is here.

California Medicaid to Extend Coverage to Undocumented Children
Starting May 1, roughly 170,000 undocumented children in California will gain access to a full range of health services, following an unprecedented expansion that provides full scope Medicaid coverage to all low-income children in the state regardless of immigration status. Home to more immigrants than any other state, California will join Washington, Illinois, New York, Massachusetts and Washington, D.C., in providing state-financed, full-scope Medicaid services to undocumented low-income children.  The expansion was approved by Gov. Jerry Brown in the October 2015 state budget. More information is available here and here.