Energy and Commerce Ranking Member Frank Pallone, Jr. (D-NJ) delivered the following remarks on the House Floor today in opposition to H.R. 5797, The IMD CARE Act:
Mr. Speaker, I stand in opposition to H.R. 5797, the IMD CARE Act. I think we all agree that we need all the tools available to us to address the opioid crisis. Inpatient treatment centers that focus on the treatment of behavioral health needs of patients with substance use disorders are part of that. And Congress must do what we can to ease access to care.
But I believe this legislation as drafted is misguided, counterproductive and an ineffective use of scarce Medicaid dollars. But more importantly, it may undermine ongoing efforts to improve the full continuum of care for people with substance use disorders. This policy spends more than $1 billion in Medicaid dollars to pay for a policy that is far narrower, in both scope and flexibility, than what many of our states already have and any state could do through Medicaid substance use disorders waivers.
In addition, as countless data has indicated, there are many gaps in treatment for Medicaid beneficiaries with substance use disorders. Yet this bill does nothing to incentivize states to provide the full continuum of care.
Community-based services are necessary for both people not treated in residential inpatient facilities and also for people who leave residential inpatient treatment and need community-based services to continue their treatment and recovery. We already face a shortage of community-based care for substance use disorders, and should be working with states to increase this capacity. Yet H.R. 5797 doesn’t tie federal funds for IMD care to improvements in community-based services. Without that connection, states simply will not pursue these needed improvements. And, without incentives to improve access to treatment more broadly, repealing the IMD exclusion to only a narrow population -in this case opioid use -through legislation may simply encourage greater use of expensive inpatient treatment, including for people for whom it may not be the best option.
We cannot push a system where people cycle in and out of institutions-people with substance uses disorders need a range of supports to stay well and sober long-term, not just a limited stay in an IMD. Existing guidance from both the Obama and Trump Administrations allow states to waive the IMD exclusion, if the state also takes steps to ensure that people with substance use disorder have access to other care they need, including preventive, treatment, and recovery services.
So far, 22 states have waivers approved or pending before the Administration. I think these waivers are important to support. My own home state of New Jersey has approval for a waiver right now. Under their waiver, they expanded access to ALL substance use disorder services in their Medicaid program.
We should build on that policy, which emphasizes the full continuum of care, with any bills that repeal the IMD exclusion. In addition, I have concerns about creating a system in states whereby only some of our Medicaid beneficiaries with substance use disorders have access to the full continuum of care they need. H.R. 5797 specifically limits residential treatment to adults with opioid use disorders and with the possible addition of an amendment for cocaine use disorders, but does not help the overwhelming majority of individuals with other substance use disorders, such as alcohol, which is far more commonly abused.
Treatment for substance use disorders, especially in the midst of our opioid crisis, must include a comprehensive approach that addresses the entirety of a patient’s medical and psychological conditions. This legislation creates a perverse incentive towards individuals reporting opioid abuse or going out and getting addicted to opioids, for instance, in the hopes of gaining access to the treatment they need.
Expanding access to inpatient residential treatment in a vacuum would undermine state efforts to ensure the availability of substance use disorders treatment that meets the needs of all patients in the most appropriate environment. In the short time this legislation has been publicly available, countless stakeholders have weighed in vehemently on particulars of this bill, echoing my concerns today. In fact, coalitions with over 300 groups, as well as other mental health, substance abuse and disability groups have sent letters in opposition. We need to work with stakeholders; this issue is too important to get wrong.
I oppose H.R. 5797, and I urge my colleagues to vote no. I reserve the balance of my time.
