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Lawmakers are Pressing CMS to Expand Coverage of Substance Use Disorders and Close Gaps in Care

  • Lawmakers called for the institution to use existing authority and new funding to expand Medicare coverage for these disorders. 
  • 1.7 million Medicare beneficiaries were estimated to have past-year substance use disorders. Of them, only 11% received treatment for their condition. 
  • The Centers for Disease Control and Prevention reported that 92,000 people died in 2020 from a drug overdose. 

Lawmakers wrote a letter to the Centers for Medicare & Medicaid Services (CMS) to raise their concern about the higher rates of substance use disorders among older Americans. In the letter, Congress Member Lauren Underwood, and U.S. Senator, Richard J. Durbin urged the CMS to take every action to address this growing crisis. 

In the letter to CMS Administrator Chiquita Brooks-LaSure, Underwood and Durbin called out the institution to use existing authority and new funding to expand Medicare coverage. 

“We urge you to use your existing authorities and the funding you have received from Congress to strengthen initiatives that will help people prevent and treat substance use disorders among Medicare beneficiaries,” they added. 

According to a recent study, approximately 1.7 million Medicare beneficiaries were estimated to have past-year substance use disorders. Of those who had past-year substance use disorders, 11% received treatment for their condition. 

While Medicare covers low-intensive levels of substance use disorders like therapy and high-levels of care such as inpatient treatment, according to Fierce Healthcare, experts and advocates worry that CMS does not cover the complete continuum of care for beneficiaries. Related to this, Durbin & Underwood called on CMS to expand Medicare coverage of residential substance use and inpatient addiction services. 

Substance use disorders and addiction  

According to CMS, these disorders can result from all types of substance abuse that interferes with being able to meet life’s responsibilities, interferes with physical health, or is an illegal substance. These substances include alcohol, marijuana, drugs, opioids, heroine, etc. 

Addiction to these substances or others is a chronic illness, and just like any other chronic illness, it is hard to manage without help. Addiction deaths have also spiked since the start of the COVID-19 pandemic. The Centers for Disease Control and Prevention reported that 92,000 people died in 2020 from a drug overdose. 

Efforts to address the mental health crisis  

The lawmakers added that Congress had taken significant steps to address this issue, including providing $6.5 billion for the Substance Abuse and Mental Health Services Administration in the FY (Fiscal Year) 2022 government funding package. The legislation also included a $50 million increase in funding for CMS specifically. 

CMS told Fierce Healthcare that it is working to address the substance use disorders issue. The agency said it had developed a new behavioral health strategy. Additionally, the Department of Health and Human Services (HHS) recently announced a funding opportunity to expand behavioral health clinics. Read more about this in the article HHS Released a $15M Funding Program to Tackle the Mental Health Crisis

Stay tuned for this and more industry news through our November 2022 newsletter. Subscribe to our monthly newsletter and our Health Prime blog for ongoing leading industry medical practice articles and policy updates. 

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