News & Perspectives

Legislation enacted to address the opioid crisis

1. November 2018 Tom Entrikin Health

On October 24, 2018, the President signed H.R. 6, the Support for Patients and Communities Act. The new legislation contains amendments to Medicaid, Medicare, and other federal laws to address the opioid crisis.

The Medicaid amendments:

  • Prohibit termination of eligibility for individuals under age 21 based on their admission to correctional facilities.
  • Improve continuity of coverage for former foster care children up to age 26.
  • Offer planning grants in at least 10 states for demonstration projects to increase substance abuse treatment provider capacity.
  • Extend enhanced federal reimbursement percentages for health homes serving individuals with substance use disorders.
  • Require new federal guidance on state options for federal reimbursement of provider education using telehealth through school-based health centers, managed care entities, Medicaid administrative claiming for disease management activities, and under delivery system reform incentive payment systems.
  • Increase drug utilization review requirements related to opioid medications in state Medicaid and managed care provider billing systems.
  • Require coverage of medication-assisted treatment for opioid addiction including the use of methadone with behavioral therapy and counseling.
  • Allow coverage of residential pediatric recovery centers for infants affected by opioid use during pregnancy.
  • Modify the institution for mental diseases (IMD) exclusion as it pertains to pregnant and post-partum women with substance use disorders.
  • Offer a new state option to cover individuals with substance use disorders in IMD facilities.


The Medicare amendments:

  • Enhance screening of beneficiaries to detect potential substance use disorders.
  • Expand coverage of telehealth services for beneficiaries with substance use disorders
  • Expand coverage of medication-assisted treatment for opioid addiction, and requirements for electronic prescriptions of controlled substances.


The new legislation is available here: