Senate opioid package lets providers share records, punts IMD bill

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GOP Senate leaders want to hold a roll-call vote on their opioids legislation next week, and two key but controversial measures on the hospital watchlist remain in play, despite political hiccups.

The final legislative package leaves out a bill to align privacy rules for addiction patients with HIPAA as well as the loosening of the so-called IMD exclusion to the final legislative conference with the House. It does however include "Jessie's Law," which would open the door for HHS to relax regulations on treatment records.

Sen. Joe Manchin (D-W.Va.) led the charge for Jessie's Law as well as a separate companion to a House Republican bill that would roll back extra privacy rules around patients' addiction-treatment records. The latter bill would alter the statute barring physicians and other providers from accessing past substance abuse treatment records without explicit permission from the patient and align the privacy rules for opioid addiction treatment with HIPAA.

Although Jessie's Law was included, the broader roll-back of restrictions did not make it into the package. Although the bill has a Democratic champion in the Senate through Manchin, House Democrats of the Energy and Commerce Committee sharply criticized the policy while it was under debate. Originally introduced by former Rep. Tim Murphy (R-Pa.), Rep. Markwayne Mullin (R-Okla.) revived it for the House, where it passed despite objections from Democrats who argued it could jeopardize patients' willingness to seek treatment if they think their addiction history could come to light.

Jessie's Law was named for West Virginian Jessie Grubb, who was sober following a seven-year battle with addiction. After surgery for a running-related injury, a physician discharged her with a prescription for 50 oxycodone pills. Grubb ultimately died from an overdose.

As Senate Majority Leader Mitch McConnell (R-Ky.) told reporters on Tuesday afternoon that Republican leaders had cleared the opioid package on their side and were waiting on Democrats to clear theirs, it was unclear whether they would punt Jessie's Law to conference or let it through. A Senate GOP aide confirmed Wednesday that the measure would be included.

Manchin, who holds one of the GOP's top target seats in the November midterm elections, said he was optimistic about getting portions of the language into the Senate package and that potential exclusion would be "very problematic."

Another controversial measure will also wait on the Senate's conference with the House. Leadership punted a bill by Sen. Rob Portman (R-Ohio) that would loosen the so-called IMD exclusion that bans Medicaid from paying for stays in treatment centers with more than 16 beds, or "institutions of mental disease."

It remains in play, Portman told reporters, since the House passed its own version.

"We weren't able to get the signoff from everybody, so we will try to do it in conference," Portman told reporters late Tuesday, noting that he thinks the House measure can be improved. "Using the same pay-for, I think we can get to the same objective to allow the good treatment centers to expand treatment."

Backed by hospitals, the legislation would open up a significant revenue stream through Medicaid for larger facilities, including hospitals, to treat opioid addicts. Critics worry that the amount of money is so large it would motivate states to sacrifice outpatient treatment for more costly inpatient treatment.

A Congressional Budget Office analysis of the initial version of the House bill priced it at $990 million over 10 years, but the bill was tweaked before it went to the floor and a House GOP aide said the CBO doesn't have a final score.

McConnell announced Tuesday he wants to tee up a vote on the package after Labor Day. Senate health committee Chair Lamar Alexander (R-Tenn.) said that if the legislation can secure unanimous support, senators could pass the bills by a roll-call vote next week.

incorrectly stated that Jessie's Law was the companion bill to the House privacy measure. This error has been corrected.