What’s in the 21st Century Cures Act?

I haven’t said much about the 21st Century Cures Act because I haven’t really known what to make of it.

Addiction treatment is underfunded, so I’d never argue that funding is not needed. However, recent funding proposals have very heavily emphasized maintenance treatments for opioid addiction. This approach seems likely to reinforce a tiered system where health professionals get one kind of treatment (the gold standard) and people without their status and resources get another kind of treatment (maintenance). The problem is that most people want the outcomes that the gold standard provides and maintenance delivers another set of outcomes.

It’s unclear to me exactly what the the bill’s on-the-ground impact will be. I haven’t spent a lot of time with it, but the bill itself seems pretty vague.

It looks like the incoming Secretary of Health and Human Services is going to have a lot of discretion.

The bill creates an Opioid Grant Program with $500,000,000 for FY 2017 and $500,000,000 for FY 2018. It’s worth noting that the funding model for other health issues in the bill is smaller annual amounts over longer periods of time. This means there will be a lot of money being spent in a short period of time.

The Secretary will make grants to states for the following uses:

(A) Improving State prescription drug monitoring programs.
(B) Implementing prevention activities, and evaluating such activities to identify effective strategies to prevent opioid abuse.
(C) Training for health care practitioners, such as best practices for prescribing opioids, pain management, recognizing potential cases of substance abuse, referral of patients to treatment programs, and overdose prevention.
(D) Supporting access to health care services, including those services provided by Federally certified opioid treatment programs or other appropriate health care providers to treat substance use disorders.
(E) Other public health-related activities, as the State determines appropriate, related to addressing the opioid abuse crisis within the State.

Section 11002 asks the Secretary to review and update 42 CFR part 2, the confidentiality laws regarding treatment records:

Not later than 1 year after the date on which the Secretary of Health and Human Services (in this title referred to as the ‘‘Secretary’’) first finalizes regulations updating part 2 of title 42, Code of Federal Regulations, relating to confidentiality of alcohol and drug abuse patient records, after the date of enactment of this Act, the Secretary shall convene relevant stakeholders to determine the effect of such regulations on patient care, health outcomes, and patient privacy.

Section 13001  asks the Secretary to provide guidance on what previously passed parity legislation requires of health plans.