August saw several regulatory moves by the Substance Abuse and Mental Health Services Administration (SAMHSA. Here are three which affect opioid treatment programs (OTPs) in particular:
On 8/14, SAMHSA issued its proposed rule regarding Medicare coverage for medical-assisted treatment (buprenorphine, methadone, naltrexone), which will take effect in January. Only OTPs are allowed to dispense methadone for opioid use disorder. No additional regulations are required for Medicare patients going to OTPs, because, SAMHSA said, the OTP regulations alone are sufficient, they are so rigorous.
“[W]e believe the existing SAMHSA certification and accreditation requirements are both appropriate and sufficient to ensure the health and safety of individuals being furnished services by OTPs, as well as the effective and efficient furnishing of such services. We also believe that creating additional conditions at this time for participation in Medicare by OTPs could create unnecessary regulatory duplication and could be potentially burdensome for OTPs. Therefore, CMS is not proposing any additional conditions for participation in Medicare by OTPs at this time.”
The proposed rule was published August 14 in the Federal Register and has a comment period ending September 27.
For more information, go to the source: https://www.federalregister.gov/documents/2019/08/14/2019-16041/medicare-program-cy-2020-revisions-to-payment-policies-under-the-physician-fee-schedule-and-other
In a final rule published August 16 in the Federal Register, the Center for Medicare and Medicaid Services said that information did not need to be collected on patients on methadone or buprenorphine receiving benzodiazepines as part of palliative care. (It also said it didn’t need to include cancer care.)
“Some commenters recommended excluding patients receiving medication for the treatment of opioid use disorder (OUD). A few commenters specifically recommended that the measure exclude patients being treated with buprenorphine or methadone for OUD, with a commenter citing guidance from the U.S. Food & Drug Administration regarding buprenorphine.”Continue Reading
In a “comment request” published in the Federal Register August 13, SAMHSA has reiterated its certification requirements for OTPs. Comments are due by September 12.
For more information, go to the source: https://www.federalregister.gov/documents/2019/08/13/2019-17261/agency-information-collection-activities-submission-for-omb-review-comment-request
What’s up with 42 CFR Part 2? We are still awaiting the rulemaking announcement on 42 CFR Part 2 from SAMHSA. As soon as that comes out, we will issue a news alert for AT Forum readers on it.
The National Survey on Drug Use and Health (NSDUH) was released August 20, and surprised us by showing a decrease in treatment for illicit drug use in 2018, following an increase every year since 2015. Why was this? “While we do not know for certain, our thought is that the structure of the survey question may not be capturing all types of treatment being delivered,” a SAMHSA spokesperson said. “For example, as noted in the video presentation, MAT actually increases — although this is not captured by the current NSDUH.” As a result, the survey will include MAT in the FY 2020 version.
But MAT has been in existence for decades, in the form of methadone/OTPs, and then buprenorphine.Continue Reading
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- Your Methadone History Could Soon be Shared Without Your Consent
- AAFP Supports Methadone Treatment in Primary Care
- Medicine-Assisted Treatment for Addiction Offered on Peninsula
- Why Aren’t More People With Opioid Use Disorder Getting Buprenorphine?
- Delaware Prisons to get Opioid Treatment Program
- NIH Establishes Network to Improve Opioid Addiction Treatment in Criminal Justice Settings
- Trump Administration Tightens Opioid Prescriptions for Feds
- Employers Walk Fine Line With Opioid-Addicted Workers
- The Importance of Treating Opioid Use Disorder in the Justice System
A major hole in the healthcare system has many hospitals and health systems fueling the nation’s opioid epidemic — unintentionally or not.
To shed more light on the problem, Becker’s caught up with Gregory Rudolf, MD. Dr. Rudolf is board-certified in pain medicine and addiction medicine, and since 2004 has worked in a multidisciplinary pain management clinic at Swedish Medical Center in Seattle. “We deal with the issue of opioid management every day and try to be at forefront of best practices,” he told Becker’s.
“One thing that hospitals can do in the short-term is become as familiar as possible with local resources in the community and who provides inpatient and outpatient treatment for substance use disorders. There are also methadone maintenance clinics available in some communities for those with longer-term opioid addiction who might benefit from a more structured and monitored approach, typically involving daily observed dosing. Is there a methadone clinic locally you can make sure your doctors know about?”
Source: Becker’s Hospital Review
The federal government wants to weaken confidentiality rules for patients with addictions. This means people who have been in any kind of treatment—even years ago—but will mainly affect methadone patients, because protections for other patients have already been chipped away at.
Patients who have been treated for substance use disorder (SUD) are currently entitled to consent—or not—to the release of their information, under 42 CFR Part 2. And now—in the context of all regulatory authorities wanting to get rid of that consent provision by turning 42 CFR Part 2 into HIPAA, which has no such requirement—SAMHSA is formally proposing a regulatory change. Sometime in May, SAMHSA quietly sent over its proposal to the US Office of Management and Budget, which governs rulemakings to determine if they impact finances. There was no announcement, and I only found out thanks to a tip.
We don’t know precisely what the proposed rule will say; it’s currently in review. But the summary on OMB’s website makes the broad intent clear:
SAMHSA is proposing broad changes to Confidentiality of Alcohol and Drug Abuse Patient Records, 42 Code of Federal Regulations (CFR) 2, also known as 42 CFR part 2 to remove barriers to coordinated care and permit additional sharing of information among providers and part 2 programs assisting patients with substance use disorders (SUDs).
Read more at: https://filtermag.org/methadone-information-consent/
One resolution at this year’s meeting of the American Association of Family Physicians (AAFP) with family physicians’ inability to prescribe methadone in the primary care setting for treatment of opioid use disorder. Resolution co-author Taylor Boland, M.D., of the University of Wisconsin Department of Family and Community Health’s Madison Family Medicine Residency Program, told a reference committee that physicians need more options for battling OUD. “As we all know, [buprenorphine] is a recent option for OUD, and that can be prescribed in the primary care setting with an eight-hour training session. And even though we’re able to prescribe methadone for our primary care patients for chronic pain and pain conditions, we can’t prescribe it for OUD,” said Boland. The resolution noted that the Narcotic Addiction Treatment Act of 1974 allows for treatment of OUD with methadone only by federally licensed narcotic treatment programs.
Unfortunately, some patients can’t tolerate [buprenorphine], said Boland. “Methadone is another option for them, but I can’t prescribe it in my primary care clinic, so I have to send them to a methadone clinic. I work in a rural area. Patients aren’t going to travel 30, 40, 55 minutes into town every day to get methadone,” she said. “These patients are at extreme risk of relapse if we’re stumbling to find an option for treatment.”
Erika Rothgeb, M.D., of the Clarkson Family Medicine Residency Program in Omaha, Neb., also co-authored the resolution. “We are very passionate about addiction medicine, and working on the opioid crisis is at the forefront of medicine. You can’t go a day without hearing about the opioid crisis and the new legislation that’s been enacted to address it,” said Rothgeb.
“I come from a largely rural state, and more than half our population lives in rural areas,” she added. However, “92% of methadone clinics are in urban areas, and so this is also about promoting rural care,” she added.
Residents adopted the resolution, which asked that the AAFP advocate for methadone maintenance treatment within primary care clinics without a separate federal license.
The availability of medicine-assisted treatment has increased significantly on the North Olympic Peninsula over recent years. Since 2017 Olympic Medical Physicians in Port Angeles has developed a medicine-assisted treatment program, Nortch Olympic Healthcare Network, also of Port Angeles, started and then expanded its Suboxone program, and new clinics are opening soon. BayMark Health Services, awarded a contract through the Salish Behavioral Health Organization, will open a clinic in Port Angeles later this summer. BayMark is also opening a clinic in Bremerton. BayMark offers Suboxone, Vivitrol and methadone, but primarily distributes methadone.
The Jamestown S’Klallam Tribe is preparing to open a $20 million behavioral health center in Sequim in collaboration with Olympic Medical Center. It will include medicine-assisted treatment for people in both Clallam and Jefferson counties. Construction of the $7.2 million medication-assisted addiction treatment facility will begin in spring 2020 and completed by March 2021, officials said.
Source: Sequim Gazette