What This Bill Does
This bill requires health insurance plans to cover opioid addiction treatment and overdose reversal medications without charging patients any out-of-pocket costs. The bill also directs Medicare to test a program that eliminates copayments and deductibles for these treatments in 15 states and increases federal funding to states that provide these services through Medicaid (a health program for low-income people).
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Who It Affects
- Medicare beneficiaries (people age 65 and older, and some younger people with disabilities) in the 15 selected states
- People with private health insurance through employers or individual plans
- Medicaid recipients in all states
- Health insurance companies and health plans that offer coverage to groups or individuals
- State governments administering Medicaid programs
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Key Provisions
- The Centers for Medicare and Innovation (a federal office that tests new payment models) must set up a program in 15 states that eliminates patient out-of-pocket costs for drugs that treat opioid addiction or reverse overdose, along with behavioral health services and recovery support services like peer counseling and transportation (Sec. 2)
- Health insurance plans must provide coverage for prescription drugs to treat opioid addiction or reverse overdose without charging patients any copayments (fixed fees), coinsurance (percentage of costs), or deductibles (minimum amount patients pay before insurance kicks in) (Sec. 3)
- Health insurance plans must cover behavioral health services (counseling and therapy services) for opioid addiction treatment without cost-sharing requirements (Sec. 3)
- Health insurance plans must cover community recovery support services like peer counseling and transportation to help people maintain healthy lifestyles after treatment, without charging patients (Sec. 3)
- States may choose to include recovery support services as part of medication-assisted treatment under their Medicaid programs (Sec. 4)
- The federal government will pay 90 percent of state costs for medication-assisted treatment and recovery support services provided through Medicaid (Sec. 4)
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What Changes
If this bill becomes law, patients with Medicare in the 15 selected states will pay nothing out-of-pocket for opioid addiction treatments. Starting in 2025, all people with private health insurance will pay nothing for prescription drugs to treat opioid addiction, behavioral health services for addiction, and recovery support services. States that provide medication-assisted treatment through Medicaid will receive higher federal reimbursement at 90 percent instead of standard rates. The 15 states selected must have high numbers of Medicare beneficiaries, high overdose death rates, and significant rural areas.
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Important Definitions
**Medication-assisted treatment**: Using prescribed drugs combined with counseling and behavioral therapy to treat opioid addiction
**Cost-sharing**: Payments that patients make when they use health care, including copayments, coinsurance, and deductibles
**Opioid use disorder**: A medical condition involving problematic use of opioid drugs
**Recovery support services**: Non-medical services that help people maintain recovery, such as peer counseling and transportation
**Behavioral health services**: Counseling and therapy services to address addiction and mental health
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Effective Date
The requirement for health insurance plans to cover opioid treatments without cost-sharing begins for plan years starting on or after January 1, 2025 (Sec. 3). The Medicare testing program must be implemented by not later than six months after the bill becomes law (Sec. 2).
I
118TH CONGRESS
1ST SESSION H. R. 1620
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 HOUSE OF REPRESENTATIVES
MARCH 17, 2023
Ms. DEAN of Pennsylvania (for herself and Mr. MCGARVEY) introduced the
following bill; which was referred to the Committee on Energy and Com-
merce, and in addition to the Committee on Ways and Means, for a pe-
riod to be subsequently determined by the Speaker, in each case for con-
sideration of such provisions as fall within the jurisdiction of the com-
mittee concerned
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
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•HR 1620 IH
SECTION 1. SHORT TITLE.
1
This Act may be cited as the ‘‘Maximizing Opioid Re-
2
covery Emergency Savings Act’’ or the ‘‘MORE Savings
3
Act’’.
4
SEC. 2. TESTING OF ELIMINATION OF MEDICARE COST-
5
SHARING
FOR
EVIDENCE-BASED
OPIOID
6
TREATMENTS.
7
Section 1115A(b)(2) of the Social Security Act (42
8
U.S.C. 1315a(b)(2)) is amended—
9
(1) in subparagraph (A), in the last sentence,
10
by inserting ‘‘, and shall include the model described
11
in subparagraph (D) (which shall be implemented by
12
not later than six months after the date of the en-
13
actment of the Maximizing Opioid Recovery Emer-
14
gency Savings Act)’’ before the period at the end;
15
and
16
(2) by adding at the end the following new sub-
17
paragraph:
18
‘‘(D) AFFORDABLE ACCESS TO EVIDENCE-
19
BASED OPIOID TREATMENTS.—
20
‘‘(i) IN
GENERAL.—The model de-
21
scribed in this subparagraph is a model
22
that seeks to provide affordable access to
23
evidence-based opioid treatments and com-
24
munity-based recovery support services by
25
eliminating coinsurance, copayments, and
26
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•HR 1620 IH
deductibles
otherwise
applicable
under
1
parts B and D of title XVIII (including as
2
such parts are applied under part C of
3
such title) for the following items and serv-
4
ices that are otherwise covered under such
5
parts:
6
‘‘(I) Drugs and biologicals pre-
7
scribed or furnished to treat opioid
8
use disorders or reverse overdose.
9
‘‘(II) Behavioral health and com-
10
munity support services furnished for
11
the treatment of opioid use disorders,
12
including treatment of addiction in
13
non-hospital residential facilities li-
14
censed to furnish such treatment.
15
‘‘(III) Recovery support services
16
to maintain a healthy lifestyle fol-
17
lowing opioid misuse treatment, such
18
as peer counseling and transportation.
19
‘‘(ii) SELECTION OF SITES.—The CMI
20
shall select 15 States in which to conduct
21
the model under this subparagraph. A
22
State shall meet each of the following cri-
23
teria in order to be selected under the pre-
24
ceding sentence:
25
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•HR 1620 IH
‘‘(I) The State has a high pro-
1
portion of Medicare beneficiaries.
2
‘‘(II) The State has a high rate
3
of overdose deaths due to opioids.
4
‘‘(III) The State has a significant
5
percentage of rural areas.
6
‘‘(iii) TERMINATION
AND
MODIFICA-
7
TION
PROVISION
NOT
APPLICABLE
FOR
8
FIRST FIVE YEARS OF THE MODEL.—The
9
provisions of paragraph (3)(B) shall apply
10
to the model under this subparagraph be-
11
ginning on the date that is five years after
12
such model is implemented, but shall not
13
apply to such model prior to such date.’’.
14
SEC. 3. COVERAGE OF OPIOID TREATMENTS.
15
(a) IN GENERAL.—Title XXVII of the Public Health
16
Service Act is amended by inserting after section 2719A
17
(42 U.S.C. 300gg–19a) the following:
18
‘‘SEC. 2720. COVERAGE OF OPIOID TREATMENTS.
19
‘‘A group health plan and a health insurance issuer
20
offering group or individual health insurance coverage
21
shall, at a minimum, provide coverage for and shall not
22
impose any cost-sharing requirements for—
23
‘‘(1) prescription drugs for the treatment of
24
opioid use disorders or to reverse overdose;
25
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•HR 1620 IH
‘‘(2) behavioral health services for the treat-
1
ment of opioid use disorders, including treatment of
2
opioid use disorders in non-hospital residential facili-
3
ties licensed to provide such treatment; or
4
‘‘(3) community recovery support services that
5
are provided in conjunction with, where appropriate,
6
medication-assisted treatment for an opioid use dis-
7
order, such as peer counseling and transportation, to
8
support the enrollee in maintaining a healthy life-
9
style following opioid misuse treatment.’’.
10
(b) EFFECTIVE DATE.—The amendment made by
11
subsection (a) shall apply with respect to plan years begin-
12
ning on or after January 1, 2025.
13
SEC. 4. ENHANCED FEDERAL MATCH FOR MEDICATION-AS-
14
SISTED TREATMENT AND RECOVERY SUP-
15
PORT SERVICES UNDER MEDICAID.
16
(a) IN GENERAL.—Section 1905(b) of the Social Se-
17
curity Act (42 U.S.C. 1396d(b)) is amended by adding
18
at the end the following: ‘‘Notwithstanding the first sen-
19
tence of this subsection, during the portion of the period
20
described in subsection (a)(29) that begins on the date
21
of enactment of this sentence, the Federal medical assist-
22
ance percentage shall be 90 percent with respect to
23
amounts expended during such portion of such period by
24
a State that is one of the 50 States or the District of
25
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•HR 1620 IH
Columbia as medical assistance for medication-assisted
1
treatment (as defined in subsection (ee)(1)).’’.
2
(b) STATE OPTION TO PROVIDE RECOVERY SUP-
3
PORT SERVICES
AS PART
OF MEDICATION-ASSISTED
4
TREATMENT.—Section 1905(ee)(1) of the Social Security
5
Act (42 U.S.C. 1396d(ee)(1)) is amended—
6
(1) in subparagraph (A), by striking ‘‘; and’’
7
and inserting a semicolon;
8
(2) in subparagraph (B), by striking the period
9
at the end and inserting ‘‘; and’’; and
10
(3) by adding at the end the following new sub-
11
paragraph:
12
‘‘(C) at the option of a State, includes re-
13
covery support services, such as peer counseling
14
and transportation, that are provided to an in-
15
dividual in conjunction with the provision of
16
such drugs and biological products to support
17
the individual in maintaining a healthy lifestyle
18
following opioid misuse treatment.’’.
19
Æ
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