NCCAOM Advocacy Update Fall 2018

As you know from previous communications, addressing the nationwide opioid crisis has been a priority for the NCCAOM Advocacy Team. Working with the federal government and stakeholders across the health care community to provide expanded access and awareness of acupuncture services for pain management and treating substance use disorders is one of the primary goals for our work with SmithBucklin Advocacy and Government Relations team. We are continue to develop new and innovative strategies to achieve this goal.

On October 24 (AOM Day), President Donald Trump signed the long-awaited omnibus opioid crisis bill, the result of a year of bipartisan legislative efforts in Congress and throughout the health care industry. This legislation, one of the largest bodies of work that Congress has passed this session, will provide the roadmap for the continued response to the crisis over the next several years. NCCAOM will be working carefully with the Administration and Congress to address the portions of this bill that are relevant to the acupuncture community, and we wanted to share an overview of the legislation with our Diplomates to keep the profession informed.

Overview

On October 24, 2018, President Trump signed H.R. 6, the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act. This omnibus legislation contains the work of both houses of Congress to address the nationwide opioid crisis and contains more than 100 individual bills. Included in the over-600 pages of legislation are multiple provisions that are relevant to both the acupuncture and integrative health communities. The NCCAOM Advocacy Team has assembled this update to highlight these provisions and inform NCCAOM National Board-Certified Acupuncturists ™ of some of our next steps to engage Congress and the administration on the implementation of the bill.

Legislative Process

Developing a legislative response to the opioid crisis has been one of the top stated priorities on both sides of the aisle during the 115th Congress. The final bill had a long and winding path to the White House desk, involving separate efforts from leading committees in the House and Senate as well as a variety of standalone bills that were wrapped up into the omnibus vehicle.

On the House side, much of the work addressing the crisis was done through the Energy & Commerce and Ways & Means committees. The Energy & Commerce Committee, under Chairman Greg Walden (R-OR) held several hearings, focusing on combating the opioid crisis through balancing enforcement and patient safety, public health solutions, and Medicare & Medicaid. The Committee advanced 57 bills to the full House.

The Ways & Means Committee solicited input from stakeholders across the health care industry, including the NCCAOM, which submitted comments and recommendations in March 2018. Committee staff released a white paper analyzing the feedback they received, outlining proposals supported by the NCCAOM such as expansion of access to evidence-based, non-opioid treatment options and patient & provider education on non-pharmacological treatments for pain. In response, the Committee passed several legislative packages covering more than 20 bills, including many of the provisions mentioned above.

On June 12, the full House passed 25 bills relating to opioids, including an alternative pain management demonstration for emergency rooms and requirements to include non-opioid pain management information in Medicare beneficiary resources. Following that, the House first passed H.R. 6, the SUPPORT for Patients and Communities Act, which included 58 additional bills and would serve as the Senate package to develop a bicameral response. The legislation passed overwhelmingly (396-14) on June 22.

Five committees in the Senate held jurisdiction over different pieces of the opioid response – Finance, Judiciary, Commerce, Banking, and HELP (Health, Education, Labor, and Pensions). Each committee worked separately to develop their proposals, and each would have legislation wrapped into the eventual Senate bill.

The Senate Finance Committee developed a single, bipartisan bill within the committee, entitled the Helping to End Addiction and Lessen (HEAL) Substance Use Disorders Act of 2018. This bill addressed Medicare, Medicaid, and family services programs, and was created with the input of a wide variety of stakeholders. This included the NCCAOM, which submitted comments to the Committee in February. Provisions supported by NCCAOM ended up in the bill, including opioid safety and pain management education and language to enhance patient access to non-opioid pain care options.

Over the past year, the Senate HELP Committee held seven hearings with government agencies such as the Food and Drug Administration (FDA), the Centers for Disease Control & Prevention (CDC), the National Institutes of Health (NIH), and the Substance Abuse and Mental Health Services Administration (SAMHSA). The resulting legislation, dubbed the Opioid Crisis Response Act of 2018 (OCRA), increased research flexibility for NIH, directed the FDA to issue guidance on a variety of opioid-related issues, and directed SAMHSA to create comprehensive opioid recovery centers, among other provisions.

After each committee advanced their packages, Senate leadership combined the efforts under the OCRA title (S. 2680). The Senate bill included more than 70 individual proposals across the five committees.

Five committees in the Senate held jurisdiction over different pieces of the opioid response – Finance, Judiciary, Commerce, Banking, and HELP (Health, Education, Labor, and Pensions). Each committee worked separately to develop their proposals, and each would have legislation wrapped into the eventual Senate bill.

The Senate Finance Committee developed a single, bipartisan bill within the committee, entitled the Helping to End Addiction and Lessen (HEAL) Substance Use Disorders Act of 2018. This bill addressed Medicare, Medicaid, and family services programs, and was created with the input of a wide variety of stakeholders. This included the NCCAOM, which submitted comments to the Committee in February. Provisions supported by NCCAOM ended up in the bill, including opioid safety and pain management education and language to enhance patient access to non-opioid pain care options.

Over the past year, the Senate HELP Committee held seven hearings with government agencies such as the Food and Drug Administration (FDA), the Centers for Disease Control & Prevention (CDC), the National Institutes of Health (NIH), and the Substance Abuse and Mental Health Services Administration (SAMHSA). The resulting legislation, dubbed the Opioid Crisis Response Act of 2018 (OCRA), increased research flexibility for NIH, directed the FDA to issue guidance on a variety of opioid-related issues, and directed SAMHSA to create comprehensive opioid recovery centers, among other provisions.

After each committee advanced their packages, Senate leadership combined the efforts under the OCRA title (S. 2680). The Senate bill included more than 70 individual proposals across the five committees.

Although both the House and the Senate technically passed H.R. 6, the bills in the two chambers looked very different. Congressional rules dictate that the House and Senate convene a conference committee with leadership form each chamber to hammer out the differences in the legislation and provide a unified, compromise bill. This bill then needs to be voted on again by both the House and Senate before being sent to the White House.

In mid-September, the conference committee unveiled the compromise package under the title of House Resolution 1099. The 653-page bill would be offered as an amendment to H.R. 6 and voted on again by each chamber.

The House passed the final agreement on September 28, by a vote of 393-8. The Senate followed suit on October 3, passing the bill 98-1, with Mike Lee again in opposition and Sen. Ted Cruz (R-TX) abstaining. The bill was then sent to the White House for signature, and the formal signing was held during a public ceremony with stakeholders on October 24.

NCCAOM Goals

There are plenty of provisions in the final bill that are relevant to the acupuncture and integrative health communities. NCCAOM Advocacy has identified three areas that will be priorities as we seek to guide implementation of the bill towards expansion of acupuncture services. We will also point out that the bill prominently features references to “non-opioid, non-pharmacological therapies” for pain management. Advocating for this inclusive language was one of the top goals of NCCAOM’s work with the Healthcare Leadership Council and their Opioid Crisis Solutions Roadmap, released in June. These recommendations were disseminated throughout Congress and had a recognizable impact on the solutions proposed throughout the bill.

This provision directs CMS to issue guidance on states’ options for treating and managing Medicaid beneficiaries’ pain through non-opioid pain treatment and management options under Medicaid, specifically, “evidence-based, non-opioid pharmacological therapies and non-pharmacological therapies.” This language provides an opportunity to capitalize on the success of several state Medicaid pilot programs and expand access to acupuncture services for pain management. Since Medicaid is administered (mostly) independently through the states, acupuncture and acupuncturists can be covered in Medicaid even without legislation including them in the Medicare program.

NCCAOM Advocacy Team will engage directly with CMS to include references to the successful pilots and the evidence base for acupuncture for pain management in the guidance they will release to the states. This can act as a stepping stone to more states adopting acupuncture programs within their Medicaid coverage.

This provision requires the Secretary of HHS to submit a report to Congress on how to improve reimbursement and coverage for multi-disciplinary, evidence-based non-opioid chronic pain management. The report also includes options for improving treatment strategies for various high-risk patient populations and options for improving and disseminating pain management education tools. NCCAOM National Board-Certified Acupuncturists ™ will be well aware that acupuncture treatment and acupuncturists are not recognized under the Medicare program. While HHS does not have the ability to change that coverage administratively, this report provides an opportunity for recommendations to improve coverage of acupuncture as an evidence-based procedure that is proven to help manage chronic pain.

The legislative text specifically requires that the report include an analysis of the coverage and payment of treatments that are not covered, or have limited coverage, under Medicare, and to evaluate barriers preventing beneficiaries from accessing such treatments. Additionally, the bill text explicitly declares that the report should include an evaluation of the costs and benefits associated with expansion of Medicare coverage for uncovered services, “such as acupuncture.” The NCCAOM Advocacy Team will work closely with HHS to inform their research and development of this report, and advocate for recommendations to increase access to acupuncture.

This provision updates the scope of the Interagency Pain Research Coordinating Committee (run through NIH) to identify risk factors for, and early warning signs of, substance use disorders, and summarize advances in pain care research supported or conducted by the federal government, including information on best practices for the utilization of non-pharmacological treatments, non-addictive medical products, and other drugs approved, or devices approved or cleared, by the FDA. This language would allow the NIH to conduct innovative research into non-addictive pain treatments, of which acupuncture should be a top priority. The NCCAOM Advocacy Team will engage with the NIH and encourage additional research into the efficacy of acupuncture for pain management to provide additional support for our work on expanded access and awareness.

The opioids bill is a massive piece of legislation, and the ways in which it filters into public policy will continue to evolve as the implementation process begins. However, NCCAOM National Board-Certified Acupuncturists ™ should feel assured that there are multiple avenues within the bill to improve access to acupuncture services, and the NCCAOM Advocacy Team will work to support the profession and our Diplomates in every way possible. If you have any questions on the information relayed above, or on our advocacy work in general, feel free to reach out to the Advocacy Team at advocacy@thenccaom.org.