With U.S. Sen. Rob Portman taking a leading role, Congress recently passed and President Obama signed into law a bill aimed at helping communities across the country take a comprehensive approach to fighting the sharp rise in prescription drug and opioid addiction. Cities such as Akron, the Ohio Republican noted, are swamped with overdoses, local officials scrambling to get addicts the treatment they need.
The Comprehensive Addiction and Recovery Act (CARA) authorizes $181 million in annual spending for new prevention, treatment and recovery programs. Although Congress still must appropriate the money, which would be a modest down payment on a growing problem, the bill marks a step in the right direction, and it deservedly received strong bipartisan support.
Worth adding is that CARA makes just passing mention of a longstanding rule that has blocked the expansion of treatment options for those with substance use disorders. The rule, which dates back to Medicaid’s enactment in 1965, prohibits using Medicaid money to cover care for most mental health and substance abuse patients in residential treatment facilities with more than 16 beds. The rule covers any hospital, nursing facility or other institution that is primarily engaged in providing mental health services, including treatment for addicts.
When the rule went into effect, treatment programs for those addicted to drugs were far fewer in number than they are today. The intent of the rule was to limit the expense. If states or localities wanted to do more, they would be on the hook for the cost. Today, cost would be an issue to both federal and state governments if the exclusion were lifted, Medicaid being a jointly funded program.
Yet with local resources badly strained, lifting the exclusion would bring a much-needed flow of additional resources to bear on the problem. It would result in larger, more efficient facilities to handle the patient load instead encouraging many smaller facilities.
For its part, CARA offers just study. It requires the comptroller general to submit a report to Congress on the impact of the exclusion on those who have a substance abuse problem.
Long before the act surfaced, efforts were made to relax the exclusion, for example by allowing 14 days of Medicaid funding for treatment of drug addictions at larger facilities or making a blanket exception to the rule for those suffering from drug addiction. Neither has advanced.
With the public now clamoring for action as overdoses and deaths increase, it is important to expand the number of residential treatment beds and develop stronger treatment networks, not ones consisting of many small facilities. Opening the flow of federal and state Medicaid dollars to larger treatment centers is a must to deal with a crisis threatening to overwhelm the ability of local officials to provide treatment in time to rescue and save lives.