What This Bill Does
This bill requires Medicare and private health insurance to cover opioid addiction treatments and overdose reversal medications without charging patients copayments or deductibles. It tests a new healthcare model in 15 states where Medicare eliminates cost-sharing for opioid treatments and recovery support services. The bill also increases federal funding for medication-assisted treatment through Medicaid.
Who It Affects
Medicare beneficiaries in the United States, people enrolled in private health insurance plans, state Medicaid programs, healthcare providers treating opioid use disorders, and the Centers for Medicare and Medicaid Services.
Key Provisions
• Medicare must test a new model eliminating copayments, coinsurance and deductibles for drugs treating opioid use disorders, behavioral health services for addiction treatment, and recovery support services like peer counseling and transportation in 15 selected states (Sec. 2)
• Health insurance companies must cover prescription drugs for opioid use disorder treatment and overdose reversal without cost-sharing requirements starting January 1, 2025 (Sec. 3)
• Health insurance companies must cover behavioral health services for opioid addiction treatment in non-hospital residential facilities without cost-sharing requirements (Sec. 3)
• Health insurance companies must cover community recovery support services like peer counseling and transportation without cost-sharing requirements (Sec. 3)
• States receive increased federal funding at 90 percent for medication-assisted treatment costs under Medicaid (Sec. 4)
• States have the option to include recovery support services as part of medication-assisted treatment under Medicaid (Sec. 4)
What Changes
Private health insurance plans will be required to offer opioid addiction treatment and overdose reversal medications with no patient cost-sharing beginning in 2025. Medicare will test eliminating cost-sharing for these treatments in 15 states within six months of the bill becoming law. States will receive higher federal reimbursement rates for Medicaid-covered medication-assisted treatment.
Important Definitions
• Evidence-based opioid treatments: drugs and services proven effective for treating opioid use disorders or reversing overdoses
• Cost-sharing: charges patients pay out of pocket, including copayments (fixed amounts), coinsurance (percentage of costs), and deductibles (amounts paid before insurance coverage begins)
• Medication-assisted treatment: using medications combined with behavioral health services to treat opioid addiction
• Recovery support services: assistance like peer counseling and transportation to help people maintain healthy lifestyles after addiction treatment
Effective Date
The insurance coverage requirements for private health plans take effect January 1, 2025. The Medicare model must be implemented within six months of the bill becoming law.
II
118TH CONGRESS
1ST SESSION
S. 818
To promote affordable access to evidence-based opioid treatments under the
Medicare program and require coverage of medication assisted treatment
for opioid use disorders, opioid overdose reversal medications, and recov-
ery support services by health plans without cost-sharing requirements.
IN THE SENATE OF THE UNITED STATES
MARCH 15, 2023
Mr. CASEY (for himself, Mr. BLUMENTHAL, Ms. KLOBUCHAR, and Mr.
FETTERMAN) introduced the following bill; which was read twice and re-
ferred to the Committee on Finance
A BILL
To promote affordable access to evidence-based opioid treat-
ments under the Medicare program and require coverage
of medication assisted treatment for opioid use disorders,
opioid overdose reversal medications, and recovery sup-
port services by health plans without cost-sharing re-
quirements.
Be it enacted by the Senate and House of Representa-
1
tives of the United States of America in Congress assembled,
2
SECTION 1. SHORT TITLE.
3
This Act may be cited as the ‘‘Maximizing Opioid Re-
4
covery Emergency Savings Act’’ or the ‘‘MORE Savings
5
Act’’.
6
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•S 818 IS
SEC. 2. TESTING OF ELIMINATION OF MEDICARE COST-
1
SHARING
FOR
EVIDENCE-BASED
OPIOID
2
TREATMENTS.
3
Section 1115A(b)(2) of the Social Security Act (42
4
U.S.C. 1315a(b)(2)) is amended—
5
(1) in subparagraph (A), in the last sentence,
6
by inserting ‘‘, and shall include the model described
7
in subparagraph (D) (which shall be implemented by
8
not later than six months after the date of the en-
9
actment of the Maximizing Opioid Recovery Emer-
10
gency Savings Act)’’ before the period at the end;
11
and
12
(2) by adding at the end the following new sub-
13
paragraph:
14
‘‘(D) AFFORDABLE ACCESS TO EVIDENCE-
15
BASED OPIOID TREATMENTS.—
16
‘‘(i) IN
GENERAL.—The model de-
17
scribed in this subparagraph is a model
18
that seeks to provide affordable access to
19
evidence-based opioid treatments and com-
20
munity-based recovery support services by
21
eliminating coinsurance, copayments, and
22
deductibles
otherwise
applicable
under
23
parts B and D of title XVIII (including as
24
such parts are applied under part C of
25
such title) for the following items and serv-
26
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3
•S 818 IS
ices that are otherwise covered under such
1
parts:
2
‘‘(I) Drugs and biologicals pre-
3
scribed or furnished to treat opioid
4
use disorders or reverse overdose.
5
‘‘(II) Behavioral health and com-
6
munity support services furnished for
7
the treatment of opioid use disorders,
8
including treatment of addiction in
9
non-hospital residential facilities li-
10
censed to furnish such treatment.
11
‘‘(III) Recovery support services
12
to maintain a healthy lifestyle fol-
13
lowing opioid misuse treatment, such
14
as peer counseling and transportation.
15
‘‘(ii) SELECTION OF SITES.—The CMI
16
shall select 15 States in which to conduct
17
the model under this subparagraph. A
18
State shall meet each of the following cri-
19
teria in order to be selected under the pre-
20
ceding sentence:
21
‘‘(I) The State has a high pro-
22
portion of Medicare beneficiaries.
23
‘‘(II) The State has a high rate
24
of overdose deaths due to opioids.
25
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•S 818 IS
‘‘(III) The State has a significant
1
percentage of rural areas.
2
‘‘(iii) TERMINATION
AND
MODIFICA-
3
TION
PROVISION
NOT
APPLICABLE
FOR
4
FIRST FIVE YEARS OF THE MODEL.—The
5
provisions of paragraph (3)(B) shall apply
6
to the model under this subparagraph be-
7
ginning on the date that is five years after
8
such model is implemented, but shall not
9
apply to such model prior to such date.’’.
10
SEC. 3. COVERAGE OF OPIOID TREATMENTS.
11
(a) IN GENERAL.—Title XXVII of the Public Health
12
Service Act is amended by inserting after section 2719A
13
(42 U.S.C. 300gg–19a) the following:
14
‘‘SEC. 2720. COVERAGE OF OPIOID TREATMENTS.
15
‘‘A group health plan and a health insurance issuer
16
offering group or individual health insurance coverage
17
shall, at a minimum, provide coverage for and shall not
18
impose any cost-sharing requirements for—
19
‘‘(1) prescription drugs for the treatment of
20
opioid use disorders or to reverse overdose;
21
‘‘(2) behavioral health services for the treat-
22
ment of opioid use disorders, including treatment of
23
opioid use disorders in non-hospital residential facili-
24
ties licensed to provide such treatment; or
25
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•S 818 IS
‘‘(3) community recovery support services that
1
are provided in conjunction with, where appropriate,
2
medication-assisted treatment for an opioid use dis-
3
order, such as peer counseling and transportation, to
4
support the enrollee in maintaining a healthy life-
5
style following opioid misuse treatment.’’.
6
(b) EFFECTIVE DATE.—The amendment made by
7
subsection (a) shall apply with respect to plan years begin-
8
ning on or after January 1, 2025.
9
SEC. 4. ENHANCED FEDERAL MATCH FOR MEDICATION-AS-
10
SISTED TREATMENT AND RECOVERY SUP-
11
PORT SERVICES UNDER MEDICAID.
12
(a) IN GENERAL.—Section 1905(b) of the Social Se-
13
curity Act (42 U.S.C. 1396d(b)) is amended by adding
14
at the end the following: ‘‘Notwithstanding the first sen-
15
tence of this subsection, during the portion of the period
16
described in subsection (a)(29) that begins on the date
17
of enactment of this sentence, the Federal medical assist-
18
ance percentage shall be 90 percent with respect to
19
amounts expended during such portion of such period by
20
a State that is one of the 50 States or the District of
21
Columbia as medical assistance for medication-assisted
22
treatment (as defined in subsection (ee)(1)).’’.
23
(b) STATE OPTION TO PROVIDE RECOVERY SUP-
24
PORT SERVICES
AS PART
OF MEDICATION-ASSISTED
25
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•S 818 IS
TREATMENT.—Section 1905(ee)(1) of the Social Security
1
Act (42 U.S.C. 1396d(ee)(1)) is amended—
2
(1) in subparagraph (A), by striking ‘‘; and’’
3
and inserting a semicolon;
4
(2) in subparagraph (B), by striking the period
5
at the end and inserting ‘‘; and’’; and
6
(3) by adding at the end the following new sub-
7
paragraph:
8
‘‘(C) at the option of a State, includes re-
9
covery support services, such as peer counseling
10
and transportation, that are provided to an in-
11
dividual in conjunction with the provision of
12
such drugs and biological products to support
13
the individual in maintaining a healthy lifestyle
14
following opioid misuse treatment.’’.
15
Æ
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