WASHINGTON, D.C. – U.S. Senators Rob Portman (R-OH) and Sherrod Brown (D-OH) today introduced new bipartisan legislation to expand Americans’ access to treatment for opioid addiction by lifting the Institutions for Mental Disease (IMD) exclusion.  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 The senators’ bipartisan bill would lift this outdated cap, covering all substance-use disorders, so more Americans can access treatment services at these inpatient facilities. The text of the measure is here.

“Lifting the IMD exclusion is one of the most important things we can to do expand access to treatment right now for those who truly need it,” said Senator Portman.  “I’m pleased that the House and Senate are taking action to combat this opioid epidemic, but we should not let this opportunity pass us by without finally resolving this IMD issue once and for all.  This new legislation represents a thoughtful, bipartisan solution that will expand access to treatment while targeting the cost, and we will push for its inclusion in the final House-Senate opioid package.”

“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 Lifting this outdated cap on the number of people facilities can treat will allow more Ohioans to access the potentially life-saving help they need.”

ASAM applauds Senators Portman and Brown for their commitment to expanding evidence-based, inpatient addiction treatment services,” said American Society of Addiction Medicine president Kelly J. Clark, MD, MBA, DFASAM. “The IMD exclusion has posed a significant obstacle to Medicaid patients with substance use disorder accessing the full continuum of care when clinically appropriate. ASAM is grateful for the work of these Senators for recognizing the need to amend this antiquated policy and crafting legislation that would repeal the IMD exclusion for patients with substance use disorder and require related assessments and levels of care that are based upon the ASAM Criteria. This bill is a critical step in helping combat this nationwide epidemic, and we look forward to working with Senators Portman and Brown and the rest of Congress on getting an IMD bill to the desk of President Trump as soon as possible.”

NOTE: Today’s legislation builds off earlier bipartisan efforts to lift the IMD Exclusion through the Medicaid CARE Act (S.1169).  The Improving Coverage for Addiction Recovery Expansion (Improving CARE) Act introduced today would lift the IMD cap entirely and allow states to use Medicaid dollars to pay for coverage at accredited residential addiction treatment facilities for up to 90 consecutive days.  The current IMD policy created in 1965 limits Medicaid funding for residential treatment to facilities with just 16 beds or less.  The Improving CARE Act would fully lift this outdated and unnecessary barrier 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;
  • Limit stays in participating facilities to 90 days;
  • Require participating facilities to be:
    • Licensed by their state agency on substance abuse.
    • 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.