With more than 115 people in the United States dying every day from opioid-related drug overdoses, the need for help in fighting this public health crisis can’t be overstated. As health care providers struggle to combat this epidemic, the Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act, which President Donald Trump signed into law October 24, 2018, is a meaningful step forward.
The SUPPORT Act creates a seven-year progression of federal activities aimed at curbing the opioid epidemic and reversing its effect on individuals who have substance use disorders. Provisions within the Act lay the groundwork for major regulatory changes, federal guidance and industry best practices for opioid treatment and distribution management.
How the SUPPORT Act impacts health care IT
Stakeholders across the care continuum – including behavioral health, acute and ambulatory care; drug supply chain; law enforcement; and even supply chain logistics providers, such as the United States Postal Service – will feel the wide-ranging impact of this significant law. Here are six areas of change that could bring extensive opportunities for the health care software industry:
1. Behavioral health providers test incentive payments for adoption and use of certified electronic health record (EHR) technology
Centers for Medicare & Medicaid Services (CMS) have the green light to test incentive payments for the adoption and use of certified EHR technology. These incentives will be available to certain behavioral health entities that participate in Medicare. The timeline for this is undetermined, but this is an active opportunity for stakeholders to help develop the program.
The most notable impact to health care technology is the requirement for behavioral health, social work and substance use disorder providers and facilities to use a behavioral health solution that is certified against the program requirements and might be based on the Office of the National Coordinator for Health Information Technology certification criteria.
2. Providers mandated to report behavioral health measures
It is now optional for states to require reporting of behavioral health measures, but in 2024, providers will be mandated to do so in the CMS Adult Core Measure Set for Medicaid beneficiaries. If these reports will be completed electronically, the health care IT industry must determine how to best support providers in efficiently meeting these new requirements.
3. Prior authorization required for Part D drugs
As of January 1, 2021, entities must obtain pre-approval to prescribe any Medicare Part D drugs, which will impact workflows. The new provision might require adoption of the National Council for Prescription Drug Programs’ standards for pharmacy and supplier transactions, which could be subject to health care information technology certification.
4. Mandated electronic prescribing of controlled substances (EPCS) for Schedule Part D drugs
The Act mandates the use of EPCS for all Schedule II-IV Part D-covered drugs as of January 1, 2021. This builds upon current requirements for EPCS, which calls for all Schedule II drugs to follow Promoting Interoperability (formerly Meaningful Use).
On January 1, 2022, there will likely be a policy update that affects EPCS dual authentication for biometric positive identification, which uses biometrics and credentials to ensure that a signing entity’s identity is verified as authentic. It is unclear what elements of the biometric positive identification process will experience changes, but any revisions to the EPCS process will likely mean that providers must get recertified under the Drug Enforcement Administration EPCS program. It would also require providers to adopt updated software.
5. Mandatory Prescription Drug Monitoring Programs (PDMP) checking
Federally mandated checking of medication history for Medicaid beneficiaries and documentation of PDMP checking will begin October 1, 2021. Physicians will be expected to log the checking of medication history in a patient’s medical record. If a query is unsuccessful, the physician will be responsible for documenting good-faith attempts and the reasons for failure. While the checking of medication history is mandated at the federal level, it will be the role of state legislatures to determine requirements for frequency of checking and documenting the event.
This mandate leads into further efforts throughout the Act to advance PDMP development for a more effective, integrated and user-friendly provider workflow. The Centers for Disease Control will provide grants to state agencies to advance inter- and intra-state PDMP data exchange; transmission of data at near, real-time integration of PDMP data into clinician workflows; and push notifications. These enhancements are aimed at efficient and effectual monitoring of patient prescription history, as well as, providing information on prescription opioid attainment and use.
6. Development of best practices for displaying opioid addiction history in patient medical records
The Jessie’s Law provision stems from the fatal overdose of Jessie, a recovering heroin addict who was prescribed opioids after surgery by a physician who did not have access to her substance use disorder history. The Act aims to reduce these instances by allowing patients to request that their substance use disorder information be prominently displayed within their EHR.
On October 24, 2019, best practices for how patients request that their substance use disorder information be displayed, subject to completed consent documentation, are due from the U.S. Department of Health and Human Services. The document is a new form of consent for substance use disorder-related patient records to provide broad consent to the EHR and not to a person or entity.
What’s missing from the SUPPORT Act?
Prior to its last pass through Congress, provisions aimed at normalizing the disclosure of substance use disorder medical records for treatment purposes were removed from the Act. Requirements, such as needing specific written consent to disclose treatment, are intended to ensure patient privacy, yet many feel they restrict providers from understanding the full context of a patient’s medical history and condition.
Reconciling disclosure requirements within the boundaries of 42 Code of Federal Regulations Part 2 and the Health and Insurance Portability and Accountability Act of 1996 was supported by more than 100 health care stakeholders, including the American Psychiatric Association, The Joint Commission, the National Association for Behavioral Healthcare and the Healthcare Leadership Council. A last-minute objection by the American Medical Association might have been the reason for their exclusion from the Act. Nevertheless, these provisions continue to be a topic of conversation in Congress and could be revived in upcoming legislative sessions.
Despite its broad reach, the SUPPORT Act is only the beginning of the battle against the opioid epidemic. As the legislative and regulatory implications roll out over the next seven years, organizations are encouraged to look ahead and prepare for the impacts that this statute will have on health care IT.
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