While the House of Representatives spent time on more than two dozen opioids-related measures this week, the Senate Finance Committee approved their bills that will eventually be combined with other Senate bills that in turn will be a response to a House package.
The Senate Finance bill, the Helping to End Addiction and Lessen (HEAL) Act of 2018, is a combination of bipartisan bills mainly dealing with the Medicare and Medicaid programs. Included in the overall package, however, is Title III which is three separate bills dealing with child welfare. The health care portions of the legislation deals with the use of telemedicine, monitoring of prescription drug use, and greater access to substance use treatment and alternatives in pain management. Senator Debbie Stabenow (D-MI) does have a bill called the “Help for Moms and Babies Act,” which modifies the Institution for Mental Diseases (IMD) restrictions under Medicaid and allows for extended treatment after a pregnancy regardless of the restrictions imposed through the current Medicaid-IMD rules.
The three child welfare-related Senate bills are: S. 2924, Supporting Family-Focused Residential Treatment Act, sponsored by Senator Tim Scott (R-NC) and Senator Robert Menendez (D-NJ), S. 2926, Improving Recovery and Reunifying Families Act sponsored by Senator Menendez and Senator Scott and S. 2923, Building Capacity for Family-Focused Residential Treatment Act, sponsored by Senator Charles Grassley (R-IA) and Senator Menendez.
The bills attempt to build on the Family First Act, the parts that deal with family-based treatment and treatment facilities. The Family First Act allows states to provide foster care maintenance payments for a child considered a candidate for foster care if the child is placed with his/her parent in a family-based treatment program. The maintenance payments of up to twelve months can be provided to offset the child care costs while in the facility without regard to the current foster care link to the 1996 AFDC (look-back) eligibility standards. In other words, regardless of income eligibility restrictions for children in foster care.
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. The challenge right now is that despite the modifications made by Family First, there are a limited number of facilities and beds for these parent-child treatment facilities. Some of the challenges have to do with whether treatment centers accept children, have capacity, can handle sibling groups or handle older children.
S. 2926, also builds on a state waiver project that focused on reunification services involving recovery coachers 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 under the Family First Act.
S 2923 builds on the first bill except it provides $20 million in FY 2019 for funding projects to develop family-focused treatment facilities. Eligible programs include various applicants including the state and tribal governments.
The Senate bills come in response to a February request by the Finance Committee to the public asking for suggestions on how the Committee could address the opioid challenge through programs under their jurisdiction. A collection of 181 state and national organizations including CWLA offered recommendations, the various recommendations can be found here.
On the House side, a bipartisan group including Ways and Means Committee Chairman Congressman Kevin Brady (R-TX) introduced H.R. 6, the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act. The members announced that H.R. 6 will serve as the underlying vehicle for the majority of House-passed bills on opioid to move over to the Senate.
The House was voting all last week and will continue into this week. On Tuesday they voted on 25 different measures that deal with a range of issues from treatment to emergency room services to health care worker loan forgiveness.
There will be additional debate in both houses. Some senators were disappointed on the restrictions placed on amendments during the Finance Committee debate but its likely these issues including expanded treatment and items such as assuring continued Medicaid for youth formerly in foster care and possible other actions regarding the Medicaid IMD restrictions may surface again on the Senate floor as amendments.