Portman, Durbin, Cardin, Brown Secure Victory on Lifting IMD Exclusion to Help More Americans Get Treatment for Addiction

September 26, 2018 | Press Releases

Final House-Senate Opioid Package Includes Bipartisan IMD Solution Introduced by Senators 

WASHINGTON, D.C. – U.S. Senators Rob Portman (R-OH), Dick Durbin (D-IL), Ben Cardin (D-MD) and Sherrod Brown (D-OH) today secured a key victory in the final House-Senate opioid package with the inclusion of their bipartisan proposal to lift the Institutions for Mental Disease (IMD) exclusion, which will expand Americans’ access to treatment for opioid addiction.  The IMD exclusion is an arcane, decades-old policy that prohibits states from using federal Medicaid dollars to pay for treatment at residential mental health or substance abuse facilities with more than 16 beds.  This policy limits access to treatment, hampers behavioral health parity, and prevents many Americans from getting the help they need. The senators’ bipartisan bill would lift this outdated cap for five years, covering all substance-use disorders, so more Americans can access treatment services at these inpatient facilities. The full text of the legislation is here.  

“This is great news and an important victory in our efforts to expand access to treatment for those who truly need it,” said Senator Portman.  “We know that access to treatment is one of the biggest obstacles we face in helping more Americans who are suffering from addiction.  This legislation will significantly expand access to treatment, and I’d like to thank Chairman Hatch and Senator Alexander for working with us on this effort and including it in the final package.” 

“For years, I have fought to expand access to treatment options for those suffering from addiction by lifting the Medicaid IMD Exclusion,” Senator Durbin said.  “This final opioid package breaks down this outdated barrier to care, and I’m pleased we could come together to truly help families and communities across America confront this epidemic.”  

“This is a positive first step in showing the value of allowing individuals enrolled in Medicaid to have access to residential treatment for substance use disorders.  This will save lives by expanding options at a time they are most needed,” said Senator Cardin. “Addiction is a disease and eliminating the IMD exclusion is one tool to help individuals with recovery. Those suffering from substance use disorders also need access to mental health services and I will continue to work with my colleagues to push for Medicaid to cover the full range of behavioral health services.” 

“There isn’t a community in Ohio that hasn’t been touched by the addiction crisis,” said Senator Brown. “We are doing all we can to fight it, but we have to make it just as easy for Ohioans to seek treatment as it is to get opioids. Lifting this outdated cap on the number of people facilities can treat will allow more Ohioans to access the potentially life-saving help they need.” 

NOTE: Building on their earlier legislative efforts to lift the IMD Exclusion through the Medicaid CARE Act (S.1169), the final House-Senate opioid package includes language based on the Improving CARE Act (S. 3462) introduced recently that would lift the IMD cap and allow states to use Medicaid dollars to pay for coverage at any sized accredited residential addiction treatment facilities.  The current IMD policy created in 1965 limits Medicaid funding for residential treatment to facilities with just 16 beds or less.  The final House-Senate opioid package would lift this outdated and unnecessary barrier for five years so more Americans can access services at these inpatient facilities.  More specifically, the bill would: 

  • Expand access to inpatient care for individuals with a diagnosis of substance use disorder, regardless of the size of the facility;
  • Require participating facilities to:
    • Have plans for transitioning individuals to outpatient treatment, or other forms of care, after their inpatient stays.
    • Offer antagonist and partial agonist as forms of medication-assisted therapies onsite and to contract with, when possible, an opioid treatment program to offer methadone as an additional form of medication-assisted therapy.
  • As a condition for expanding access to care, require that state Medicaid programs cover six of the nine ASAM continuum levels of care, in order to ensure coverage continuity after leaving inpatient care; and
  • Establish a maintenance of effort for states to maintain their current level of IMD funding as a condition for receiving new IMD funding, in order to target federal dollars towards new services and care. 

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