Congressional Spending Package Solidifies Medicare SUD Coverage

The President signed March 9 a six-bill Congressional funding package to avoid a federal government shutdown that evening. The funding package included several healthcare provisions, including a measure expanding access to substance use disorder (SUD) services.

Specifically, the legislation permanently requires state Medicaid plans to cover medication-assisted treated for opioid use disorder. This includes counseling services, behavioral therapy and methadone. The bills also add the option for states to cover care in Certified Community Behavioral Health Clinics, as well as Institutions of Mental Disease, regardless of the size of the facility, for up to 30 days per 12-month period. The MHA will follow-up with the Michigan Department of Health and Human Services  to ensure the Michigan Medicaid program is prepared to comply.

Finally, the package calls for states to monitor the prescribing of antipsychotic medications to adults in institutional care setting, home health and community-based settings and requires the U.S. Department of Health and Human Services to issue guidance on integrating behavioral health services with other medical services under Medicaid and the Children’s Health Insurance Program.

The following healthcare measures were also included in the funding package:

  • Eliminated Medicaid Disproportionate Share Hospital cuts for fiscal year (FY) 2024 and delays FY 2025 cuts until Jan. 1, 2025.
  • Provides partial relief for Medicare physician reimbursement rates by increasing the Medicare conversation factor adjustment from 1.25% to 2.93%. This results in a final cut of 1.66%, compared to a previously expected 3.4% cut.
  • Extends incentive payments for alternative payment models though calendar year 2026.
  • Extends the Work Geographic Index Floor (GPCI) under the Medicare program by extending a 1.0 floor on the GPCI through Dec. 31, 2024.
  • Extends the Medicare-dependent hospital and enhanced low-volume hospital programs for three months through Dec. 31, 2024 opposed to Sept. 30, 2024.

Members with questions should contact Megan Blue at the MHA.