Medicaid IMD exclusion draws fire at House hearing on heroin, opioid abuse
During a March 22 hearing of the House Committee on Oversight and Government Reform, Rep. William Lacy Clay, D-Mo., hit upon a barrier to appropriate care for patients with substance use disorders: a section of the Social Security Act restricting most in-patient mental health treatment programs that serve Medicaid patients to 16 beds.
“If you’re on Medicaid, you’re treated like a second-class citizen, unable to access what may be the appropriate care for your substance use disorder,” Clay said during a line of questioning with Baltimore City Health Commissioner Lena Wen, M.D.
The rule, known as the IMD exclusion, has been a part of the Social Security Act since it was enacted in 1965. (IMD stands for Institutions for Mental Disease.) It prevents non-elderly adult patients with health insurance through Medicaid programs from receiving mental health care in a facility with more than 16 beds.
The result, providers say, are fewer options for patients covered by Medicaid, who are almost entirely low-income, disabled or pregnant.
“The IMD exclusion is not based on evidence,” Wen testified at last week’s hearing. “We desperately need residential substance use disorder treatments and removing the waiver on the federal level will allow us to increase the ability to treat all of our patients regardless of their insurance status.”
Howard Weissman, testifying on behalf of the National Council on Alcoholism and Drug Abuse, told the committee that the solution lies in the hands of Congress.
“It is essential that the government does something to help local treatment facilities increase their capacity," he said. "Congress could fully repeal the IMD exclusion. They could raise the bed limit above 16, or they could exclude substance abuse disorders from the definition of ‘mental disease.'"
Aggressive marketing of opioids. Rep. Elijah Cummings, D-Md., the committee’s ranking member, criticized “aggressive marketing" of certain opioids by drug companies, calling the profits “blood money.”
Cummings directed some of his fire toward Amphastar Pharmaceuticals, which makes naloxone. He accused Amphastar of “corporate greed,” saying it raised the price as more first responders turned to naloxone. The price of the 10-dose pack used by the Baltimore City Health Department jumped from $190 in May 2014 to more than $400 today, according to Cummings.
In her testimony, Wen said “doctors want to do the right thing,” but need resources to respond to “this expectation that there should be a pill prescribed for every pain.” Also testifying at the hearing were officials from the White House Office of National Drug Control Policy, the Drug Enforcement Administration, and the Substance Abuse and Mental Health Services Administration.
FDA announces opioid-related guidance. In other opioid-related news, the Food and Drug Administration (FDA) March 24 issued draft guidance for companies developing generic versions of approved opioids with abuse-deterrent formulations.
“For the millions of Americans who suffer from significant pain, and the health systems that serve them, generic opioids can be an appropriate and affordable option for patient care,” said FDA Commissioner Robert Califf, M.D. “We recognize that abuse-deterrent technology is still evolving and is only one piece of a much broader strategy to combat the problem of opioid abuse. But strongly encouraging innovation to increase access to generic forms of abuse-deterrent opioid medications is an important element in that strategy.”