On June 22, the U.S. House of Representatives approved a comprehensive opioid legislative package titled the Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act (H.R. 6). The package serves as a legislative vehicle for the dozens of narrowly-focused opioid bills considered across multiple House committees in recent months.

The measures outlined in H.R. 6 contain key supports for counties struggling to address the opioid epidemic in their jurisdictions. These measures center on adjustments to federal programs such as Medicaid that could expand addiction treatment options, as well as the creation of education and technical assistance programs for health care providers treating patients with substance use disorders.

Several of the programs included in H.R. 6 would be administered through state and local governments and could bolster counties’ response to the epidemic by providing additional resources and coordination across agencies. Key measures potentially affecting counties are highlighted below:

• At-Risk Youth Medicaid Protection Act (H.R. 1925): This bill would streamline the delivery of addiction treatment services for juveniles released from county correctional facilities and could help counties provide effective treatment and care coordination services pre- and post-release.
   
• Medicaid Reentry Act (H.R. 4005): This bill would direct the U.S. Department of Health and Human Services (HHS) to issue best practices around providing health care for justice-involved individuals returning to their communities from county correctional facilities.
   
• Improving Access to Behavioral Health Information Technology Act (S. 1732/H.R. 3331): This bill would direct the Centers for Medicare and Medicaid Innovation (CMMI) to incentivize health information technology demonstrations for behavioral health providers, including approximately 750 county-based behavioral health authorities.
   
• Individuals in Medicaid Deserve Care that is Appropriate and Responsible in its Execution Act (H.R. 5797): This bill would temporarily allow states to receive federal Medicaid payments for services provided in Institutions for Mental Diseases (IMDs) and for other medical services related to opioid and cocaine addiction.

In addition to these bills, the House also passed separate pieces of legislation that could positively impact counties’ ability to respond to opioid overdoses and deaths. These include the following bills:

• Overdose Prevention and Patient Safety Act (H.R. 6082): This bill would align privacy provisions governing substance use disorder records with 42 CFR, Part 2 laws – a long-standing NACo legislative priority that could allow for information-sharing between behavioral health and other health providers treating addiction.

• Coordinated Response through Interagency Strategy and Information Sharing (CRISIS) Act (H.R. 5925): This bill would reauthorize the Office of National Drug Control Policy (ONDCP), which operates as a key coordinating agency between the many federal entities responding to the opioid epidemic. In addition, the bill would implement the recommendations put forth in 2017 by the White House’s opioid commission, promote evidence-based drug control policies and maintain the High-Intensity Drug Trafficking Areas (HIDTA) and the Drug-Free Communities (DFC) programs under ONDCP’s jurisdiction.

Following the House’s passage of a sweeping legislative package, the focus now turns to the Senate, where legislators on multiple committees have advanced dozens of separate proposals.

As part of the Senate’s efforts around the opioid crisis, the Health, Education, Labor and Pensions (HELP) Committee in May advanced the Opioid Crisis Response Act (S. 2680), a single, but wide-ranging bill that includes measures intended to expand patients’ access to medication-assisted treatment (MAT) and train first responders to administer overdose antidote drugs.

Other Senate committees have also approved proposals that could be combined with S. 2680 into a broader set of bills. In June, the Senate Finance Committee passed the Helping to End Addiction and Lessen (HEAL) Substance Use Disorders Act (bill not yet numbered), and the Judiciary Committee advanced five pieces of legislation that focus on the public safety and law enforcement aspects of the epidemic.

The timeline for a Senate vote on a comprehensive package remains unclear. As the Senate weighs these proposals, however, Congress must also balance legislative priorities beyond opioid legislation, including reauthorization of the farm bill and the completion of spending bills before the end of Fiscal Year (FY) 2018 on September 30.

In May, NACo released a legislative analysis of bills moving through congressional committees, as well as the projected impact of each measure on county governments. The analysis is available on the NACo website and will be updated to reflect legislative developments. NACo will continue to engage with Congress and the administration to ensure county priorities are represented as a final opioid legislative package takes shape.