The House and Senate agreed to the Substance Use–Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act’’ or the ‘‘SUPPORT for Patients and Communities Act’’ or HR 6.

The House has passed the bill and left town until November. The Senate is expected to take up the bill this week.

In June, the House had passed H.R. 6, the SUPPORT for Patients and Communities Act with the Senate acting on September 17, with their Opioid Crisis Response Act of 2018. Both bills had included numerous bills, in the case of the House over 60 bills.

The bill affects any number of departments, agencies, funding sources and programs. In addition to the fixes in Medicaid for youth exiting foster care or in juvenile justice, it includes amendments to CAPTA to help regulate how the new $60 million in CAPTA funding will be spent on plans of safe care. It also includes the Senate Finance Committee bills (one of which is already included in the FY ’19 appropriations).

The three child welfare-related Senate bills were S. 2924, S. 2926, and S. 2923. The bills attempt to build on the Family First Act. The FFA allows states to provide up to 12 months of foster care maintenance payments for a child in foster care regardless of the AFDC eligibility link if the child is placed with his/her parent in a family-based treatment program. The maintenance payments help to offset the child caring costs while in the facility. Current federal foster care funding generally covers only 40 percent of the current foster care population based on HHS 2018 budget estimates. This provision would disregard the limited coverage regardless of income eligibility restrictions for children in foster care. The challenges are that there are few such treatment centers. The provision took effect on October 1 but there can be challenges if there are multiple children, a male child in an all-female facility—for example, and other capacity and availability issues.

The first bill, S 2924 directs HHS to assist states in this part of Family First provisions by providing state instruction and guidance on how to use Medicaid and IV-E funding for these treatment/placements. S 2923 builds on the first bill except it provides $20 million in FY 2019 for funding projects to develop family-focused treatment facilities (already provided in the new FY ’19 just signed). Eligible programs are various applicants including the state and tribal governments.

S. 2926, the third bill, builds on a state waiver project that focused on reunification services involving recovery coaches and other intensive family-focused services. It provides $15 million for HHS projects to replicate and study the projects. Again, if further developed and proven, it could serve as a program that could be funded as a “well-supported” program under the Family First Act. The $15 million is embedded into the legislation as mandatory funding so appropriations are not required.

The legislation cuts across a wide range of programs and services here are some:

• Section 1003 provides Medicaid planning and demonstration grants to build capacity in drug treatment. This includes improved reimbursement and expansion of treatment capacity in addressing treatment or recovery in such areas of neo-abstinence syndrome (NAS), pre-natal and post-partum treatment, youth treatment (ages 12-21) and tribal community treatment needs.
• HHS will issue guidance within a year to improve care for infants with NAS and their families. The guidance is to include best practices regarding innovative or evidenced-based payment models that focus on prevention, screening, treatment, plans of safe care, and post discharge services for mothers and fathers with substance use disorders. The guidance will include coverage of babies with NAS that improve care and clinical outcomes and recommendations for states on financing options under the Medicaid program, under CHIP and home-visiting services.
• Guidance and technical assistance to state Medicaid agencies regarding additional flexibilities and incentives related to screening, prevention, and post discharge services, including parenting supports, and infant-caregiver bonding, including breastfeeding when it is appropriate;
• A Government Accountability Office (GAO) report addressing gaps in coverage for pregnant women with substance use disorder under Medicaid and gaps in coverage for postpartum women with substance use disorder that had coverage during their pregnancy under the Medicaid.

• Section 1007 a state option under Medicaid to provide for medical assistance on an inpatient or outpatient basis at a residential pediatric recovery center to infants with NAS.

• Section 1012 expansion of the IMD Medicaid exclusion in the case of pregnant women and infants in substance use treatment.

• Section 5011 MACPAC (Medicaid and CHIP Payment and Access Commission) will conduct a study of the IMD issue including issues of state coverage, restrictions and waivers issued by CMS. The report is due by January 2020.

• Section 5052 a temporary expansion of the use of IMD services for substance use treatment.

• Section 7061 Protecting Moms and Infants includes a report by HHS to Congress on strategies to address NAS and prenatal exposure to substances.
• CDC is to develop educational materials for clinicians to use with pregnant women for shared decision-making regarding pain management and the prevention of substance use disorders during pregnancy. CDC is to develop strategies along with public health and other entities to promote public-private partnerships and other actions to train health providers on substance use disorders regarding pregnant woman and infants.

• Section 7065 Plans of Safe Care under the Child Abuse Prevention and Treatment Act (CAPTA) creates formula grants of at least $500,000 to each state and a set-aside of three percent for tribal communities to develop plans of safe care for addressing the needs of NAS infants and infants born exposed to other substances or infants with a fetal alcohol spectrum disorder. Remaining funds after the minimum will be based on the number of live births in each state in the previous years.
• States must submit a plan that is based on the impact of substance use disorder in the state, including information on the substances with the highest incidence of abuse in the previous year including the births of infants exposed and the rates within the state.
• Included in the plan such items as the challenges faced within the state, the lead agency and how it will coordinate with other agencies, how services and treatment will be monitored, whether or not there is use of Title IV-E funds are used, and an assessment of treatment options and services.
• Use of grant funds has to be described including how plans of care will be improved and parent engagement.
• Funds may be used for improving assess to treatment, improving assessments, improving case management, and keeping families safe.
• Training for various health professionals on plans and training on various professions in health, child welfare and substance use treatment professionals on mandatory reporting child abuse laws, co-occurrence disorders, and clinical guidance issues and practices and laws, appropriate screening practices and multiple-generation approaches to treatment
• Establish partnerships through agreements, memorandums of understanding to facilitate a comprehensive strategy, appropriate treatment and services and access to evidence based treatment where available.
• Each state will report a number of data elements including numbers of infants born exposed, the number of children separated, reunified and those that received services.
• HHS is directed to report the data collected and to provide states with a range of services and technical assistance in implementing and carrying out plans of safe care.

• Section 7102 Youth Prevention and Recovery HHS along with the Secretary of Education will administer a program to provide support for communities to support the prevention of, treatment of, and recovery from, substance use disorders for children, adolescents, and young adults.
• Entities eligible include local educational agencies, one or more high schools; a state educational agency; institution of higher education or consortia, a non-profit, a local workforce board or local government or tribal organization.
• The targeted population include various youth populations including young people in foster care, homeless or members of a tribal community
• Funds may be used for recovery programs that include a program to help children, adolescents, or young adults who are recovering from substance use disorders to initiate, stabilize, and maintain healthy and productive lives.
• Programs include peer-to-peer support delivered by individuals with lived experience in recovery, and communal activities to build recovery skills and supportive social networks.
• The Department of Education is to disseminate best practices and guidance on primary prevention and appropriate recovery methods and practices.
• Grants are authorized at $10 million per year and will be awarded on a competitive grant basis based on plans submitted.

• Section 7131 Trauma Informed Care information and best practices will be developed through a task force that will include more than two dozen HHS department and agencies including ACF and others outside of HHS. They are to evaluate the issue, approaches and training and a national strategy to implement such practices.
• Federal authorities including the Departments of Education, Health and Human Services, Justice, Labor, Interior, and other relevant agencies are to disseminate best practices on, provide training in, or delivery of services through, trauma-informed practices, and disseminate such information.

• Section 7134 establishes $50 million in grants to implement trauma informed care grants to assist in the implementation of best practices in trauma informed practices

• Section 8081 are the Finance Committee provisions described earlier