The Senate delayed a vote on an opioids package of legislation until this week. The Opioid Crisis Response Act of 2018, addresses a range of programs and agencies, sometimes building on 2016 Congressional action though the CARA and CURES acts of that year. Senators had intended to debate the bill on Thursday but put off the debate until next week due to the hurricane.

Generally speaking bill would :

• Expand research and efforts on substance use through the National Institutes of Health (NIH)
• Enact tighter controls and monitoring of prescription drug and pain relief medications through Medicare and Medicaid
• Modify oversight through the Food and Drug Administration (FDA)
• Expand funding and drug treatment efforts through a grant program through the Substance Abuse and Mental Health Services Administration (SAMHSA)
• Direct HHS to provide best practices in housing substance abuse recovery programs
• Modify the IMD exclusion regarding pregnant and post-partum woman, clarifying the IMD exclusion in managed care plans
• Expand prescription drug recovery programs through the Department of Justice
• Expand and authorizes several programs through the Justice Department and the Office of National Drug Control Policy (Drug Czar) including the funding of Sobriety Treatment and Recovery Teams (START) to assess the effectiveness of pairing social workers and mentors with families that are struggling with substance use disorder and child abuse or neglect.

In addition to this last item the bill includes several provisions that address children and families. There is some new funding to establish youth services through prevention and recovery centers targeted to addressing young people with substance use disorders. The legislation also outlines how funds provided under CAPTA can be distributed and used to advance Plans of Safe Care for infant exposed to substance abuse.

The legislation also includes the three legislative pieces that were authorized under the Senate Finance Committee. Those three bills, 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 are not in the House opioids package meaning they will be a topic of negotiation. (Technically a conference committee addresses only the differences between the two bills and includes all the common pieces.)

Starting on October 1, the Family First Act allows states to draw federal foster care maintenance payments for a child in  foster care regardless of the AFDC income eligibility 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 caring costs while in the facility without regard to the current foster care link to the 1996 AFDC (look-back) eligibility standards which over recent years has resulted in approximately 60 percent of foster children to be ineligible for federal coverage. In other words, regardless of income eligibility restrictions for children in foster care. 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 the Family First Act, 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. This bill if enacted would provide these funds directly (mandatory funds) and would not be dependent on a new appropriations.

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 2019 Senate appropriations bill for Labor-HHS working its way through Congress includes a new $20 million in competitive Regional Partnership Grants (RPGs) to fund and build these evidenced based models.

The Senate bill will be negotiated with the House and it is expected that this will have to wait until after the election.