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Washington, D.C. – Congressman Tom Emmer (R-MN) and Congressman Bill Foster (D-IL) led a bipartisan letter, along with 24 of their colleagues, encouraging the Centers for Medicare and Medicaid Services (CMS) to do everything in their current authority to expand access to treatment options for those currently fighting substance use disorders. 

As it currently stands, CMS rules and a Medicaid policy known as the Institutions for Mental Disease (IMD) exclusion prevents federal funding from being used for the care of patients in a mental health or substance abuse facility with more than sixteen beds or for stays of more than 15 days - drastically limiting treatment options for those who need help the most.

“Unfortunately, an opioid epidemic is plaguing our nation and my home state of Minnesota has not been immune,” said Emmer. “It is devastating to learn about so many Americans who will never reach their life’s potential as a result of their addictions and to hear from grieving parents who have lost a child to these terrible drugs. But what is perhaps even more heartbreaking is knowing that many of these drug-related deaths may have been prevented if more treatment options were available today. We owe it to each and every one of these individuals to ensure that CMS does everything in their power to make treatment more effective and accessible.”

“Opioid and heroin addiction is a public health crisis, and this epidemic affects too many people nationwide and in Illinois,” Foster said. “We need to stop treating this epidemic like a moral failing and start treating it like the medical condition it is. We also need to make sure medical treatments remain affordable and accessible to everyone who suffers from addiction.” 

This letter was signed by: Rod Blum (R-IA), Judy Chu (D-CA), Katherine Clark (D-MA), Yvette D. Clarke (D-NY), Steve Cohen (D-TN), Kevin Cramer (R-ND), Tammy Duckworth (D-IL), Sean Duffy (R-WI), Tom Emmer (R-MN), Michael Fitzpatrick (R-PA), Bill Foster (D-IL), Michael M. Honda (D-CA), Betty McCollum (D-MN), Raúl Grijalva (D-AZ), Eddie Bernice Johnson (D-TX), Ann McLane Kuster (D-NH), Stephen F. Lynch (D-MA), James McGovern (D-MA), Rick Nolan (D-MN), Beto O’Rourke (D-TX), Collin Peterson (D-MN), Chellie Pingree (D-ME), Bruce Poliquin (R-ME), Adam Smith (D-WA), Christopher Smith (R-NY), and Steve Stivers (R-OH).

Full text of the letter is below:

Dear Administrator Slavitt,

We write to you today with great concern over the current Centers for Medicare and Medicaid Services (CMS) policy that adversely impacts constituents with substance use disorder (SUD) and chemical dependency treatment providers across our districts. We urge CMS to utilize every tool under current statutory authorizations to improve access to treatment options for those struggling with substance use disorders.

From abuse of prescription drugs to cocaine, methamphetamines, and new synthetic drugs, our country has experienced a substance abuse epidemic that has exposed several barriers to patient care. In 2013, 6.7 million Americans took medication not prescribed to them. More than 100 Americans die from drug overdoses every day, and nearly half of those deaths are due to opioids. These trends hit our children the hardest. One in four college age kids have reported using pain pills that are not prescribed to them.

Opioid dependence is a crippling addiction that needs to be treated as the medical condition we know it to be. Currently, numerous chemical dependency treatment facilities exceed the Institutions for Mental Diseases (IMDs) exclusion for Medicaid coverage, which sets a cap of 16-beds. It is not clear whether an exception process exists or if there are any criteria outlined for an exemption to this rule. Many of our states should be recognized for the diverse nature in which services are insured and provided through non-profits, managed care, congregate care and residential community treatment among other options, many of which have more than 16 beds.

Additionally, we have serious concerns about the recent managed care rule that only allows for 15 days of care furnished in an IMD setting over a 30-day period. To cap a patient’s stay at a treatment facility at 15 days is simply unrealistic. These patients need time to recover, not only from physical dependency, but also from mental and emotional trauma. A 15-day limit is just not practical and does not take into account the numerous studies suggesting the cost-savings, readmissions reductions, overdose preventions, and recovery efficacy from longer lengths of stay in residential settings as a patient progresses down the clinical continuum of care.

CMS should be commended for the steps it has taken to increase eligibility and provide care for those most in need. Coordinating behavioral treatment with methods to mitigate physical injuries has reduced costs and improved the lives of patients. Several recent rules have established your willingness to work towards goals that reduce this epidemic.

However, we urge you to continue your efforts to ensure you take every step to remove barriers to substance abuse treatment including removing SUD from the definition of mental disease for the purposes of determining if a treatment facility is an IMD. We would appreciate any guidance on what medical assisted services can be covered in order to mitigate the adverse impact on our nation’s treatment facilities.

We look forward to your timely response.