Congress moves forward with opioid crisis legislation

Optum for Workers' Compensation
| Sep 28, 2018

The U.S. House and Senate have reached a tentative agreement on a comprehensive opioid policy bill as their legislative efforts wind down in this election year. This week, the House and Senate agreed upon bi-partisan language found in H.R. 6 called “The SUPPORT for Patients and Community Act.” The legislation embodies a comprehensive approach to the opioid crisis and contains multiple policy developments and opportunities for federal, state and local governments to engage in the fight against opioid abuse, misuse and addiction.

The bill – among other issues – specifically outlines policy efforts that will be required under state Medicaid programs, the federal Medicare program and both state and federal public health agencies. And it provides funding for various programs and other community efforts against opioid addiction. Highlights of the bill include:

  • Development of safety edits related to utilization of opioids within state Medicaid programs
  • Development of treatment guidelines to help improve care for infants with neonatal abstinence syndrome and treatment of pregnant/postpartum women with substance abuse disorder
  • Enhanced patient access to non-opioid treatment options and assessment of barriers to opioid-use disorder treatment
  • Ensuring secure and safe transmission of prescription data (ePrescribing) for controlled substances under Medicare Part D prescription programs
  • Coverage for certain services furnished by opioid treatment programs under Medicare
  • Better data-sharing across federal and state agencies and borders to combat the opioid crisis
  • Enhanced efforts and coordination by law enforcement to prevent opioid diversion, as well as funding and training for first responders when administering opioid antagonists

The current bill structure is over 600 pages with numerous other provisions intended to provide the necessary tools in the fight against the opioid crisis. While the House has agreed in terms to combined language with the Senate, the date of final Senate action is unknown; however, the bill is expected to be approved and sent to President Trump soon.

Provisions of interest to workers’ compensation

While development of any public policy to fight the opioid crisis is important to the Optum Workers’ Comp and Auto No-fault division (OWCA) and our efforts to ensure safe treatment for injured perties, a few specific segments of the agreed bill language are of specific interest.

First, the bill includes a funding mechanism for state prescription drug monitoring programs (PDMPs) starting in fiscal year 2019 through 2023. This funding is significant to state PDMP programs sometimes desperately in need of operational support. While the bill provides funding for PDMPs, it also creates potentially new requirements for PDMP program compliance in order to secure funding. Pursuant to the bill, states will be required to work with various policy-making bodies to enhance the data collecting ability and scope of their PDMP programs. These enhancements include expanding collection of PDMP data to other streams within the state such as PBMs and the reporting of workers’ compensation data (Section 7161 and 7162). While none of these enhanced requirements are of immediate impact, eventual engagement in regulatory and legislative action – at the state and federal levels – can be expected moving forward.

Second, the bill includes language relating to the reporting of drug coverage information/data by drug plan sponsors and participants. The bill revises the Social Security Act to require enhanced reporting of data by prescription drug plans and would permit the Secretary of Health and Human Services to collect information on Medicare Part D prescription plan sponsors and participants to help identify primary payer status for certain situations (see Section 4002). Obviously, this modification of existing statute will eventually require regulatory action by CMS, which will be monitored by our government affairs team.

Continued updates

Our government affairs team will continue to dive through various provisions of H.R. 6 to identify further impact to our workers’ compensation and auto no-fault processes and may provide further updates related to the impact of this momentous effort in the fight against the opioid crisis. Full text of the bill can be found here.

Should you have any questions about this policy change, please feel free to contact us at

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