Combating the Opioid Crisis: Smarter Spending to Enhance the Federal Response

Mandatory Spending

Recommendation #1: Ensure Parity and Expand Coverage for SUD Services

• The HHS Secretary and CMS, Alongside DOL and the IRS, Should Coordinate With State Insurance Commissioners and State Medicaid Agencies to Exercise Their Authority to Enforce Parity Rules for SUD Treatment.
• The HHS Secretary Should Direct CMS to Work with Section 1115 Waiver Recipients to Ensure That Funds Are Used Primarily to Finance Evidence-based OUD Interventions.
• The HHS Secretary Should Direct CMS to Promote Medicaid Section 1115 Waivers for Evidence-based Nonmedical Recovery Services.
• CMS Should Promote Medicaid Section 1115 Waivers for Incarcerated Individuals.

Recommendation #2: Increase Medicaid and Medicare Reimbursements for OUD/SUD Treatment

• The HHS Secretary and CMS Should Educate Providers on Recently Added SUD-specific Billing Codes.
• The HHS Secretary and CMS Should Adopt Alternative Payment Models Incentivizing Patient-centered OUD Care.

Recommendation #3: Ensure Qualified Health Providers Can Bill for OUD/SUD Treatment (In-person and via telehealth as appropriate)

• Congress and CMS Should Consider Expanding Provider-type Eligibility for OUD Treatment (e.g., SUD counselors, peer support specialists).
• Maintain Flexibilities for Eligible Behavioral Health Providers to Provide Care Across States (In-person and via telehealth).
• Congress and the DOJ Should Ease Prescribing Restrictions for In-person and Telehealth OUD/SUD Services.

Discretionary Spending

Recommendation #1: Optimize the SOR and SABG grant programs

• Congress Should Reexamine the Formula for the SOR Program.
• Congress Should Enact Multiyear Authorizations for the Formula Grant Programs.
• Congress and the HHS Secretary Should Direct SAMHSA to Work With SOR and SABG Grantees to Ensure That Funds Are Used to Finance Evidence-based OUD Interventions and Promising Innovations.
• The HHS Secretary Should Direct SAMHSA to Promote Funding of Evidence-based Recovery Services.

Recommendation #2: “Braid,” or Coordinate, Federal Funding Streams Thematically

• States Should Be Encouraged to “Braid” Discretionary and Mandatory Funding Streams.
• Congress and the White House, Working With Executive Branch Departments, Should “Braid” Discretionary Funding Streams by Directing Similar Opioid-related Programs to Formally Collaborate.

Data Reporting and Metrics

Recommendation #1: Establish a Set of Evidence-based “Core Metrics” Tied to Surveillance and Health Services Delivery

• ONDCP Should Guide Executive Branch Departments in Establishing “Core Metrics.”
• ONDCP Should Work with the HHS Secretary Who Would Direct SAMHSA to Replace Its GPRA Measures With “Core Metrics” Using an Existing OMB Waiver.

Recommendation #2: Collect “Core Metrics” for OUD/SUD Surveillance and Health Service Delivery More Frequently and Undergo Relevant System Updates

Recommendation #3: Create an OUD/SUD Data Dashboard to Improve Data Sharing and Policymaking While Maintaining Privacy

• HHS Should Create a New Data System Modeled After HHS Protect for OUD/SUD Data.
• HHS Should Establish Anti-discrimination and Privacy Protection Policies for SUD Patient Data Sharing.

Governance

Recommendation #1: Reorient ONDCP’s Role to Focus More on Policy Leadership and Federal Coordination

• Congress Should Restore Cabinet-level Rank of the ONDCP Director and Consider the Appropriate Placement of the HIDTA and DFC Programs.
• The HHS Secretary and ONDCP Should Improve Intradepartmental and Interdepartmental Collaboration.
• ONDCP Should Operate as a “Center of Excellence” for Drug Control Policy and Federal Coordination.

Recommendation #2: Provide Expert Technical Assistance to States

• Congress Should Fill Existing Vacancies at SAMHSA to Enhance State-level Training and Technical Assistance Efforts.
• The Federal Government Should Provide States with Technical Assistance to Direct Opioid Settlement Funding.

Recommendation #3: Leverage ONDCP’s National Drug Control Strategy for Congressional Oversight

All the recommendations included in this report can assist in optimizing federal spending and the federal response to address the opioid crisis. Stronger federal leadership and actionable metrics will more strategically direct money from discretionary and mandatory funding streams, which can then be used to save lives through evidence-based prevention, treatment, harm reduction, and recovery interventions. With so many preventable lives lost to the opioid crisis to date, it is of high national interest to target funding in a sustainable manner and overcome regulatory and legislative barriers to address the needs of vulnerable populations affected by opioid use disorder.