	Introduction

On October 24, 2018, President Trump signed into law the Substance Use-Disorder Prevention That Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT Act; P.L. 115-271 ). The conference report on the bill was approved by the House 393-8 on September 28, 2018, and it cleared the Senate 98-1 on October 3, 2018. The law was enacted in response to growing concerns among the U.S. public and lawmakers about increasing numbers of drug overdose deaths. Opioid overdose deaths, in particular, have increased significantly since 2002. In 2015, an estimated 33,091 Americans died of opioid-related overdoses, almost three times as many as in 2002, around the beginning of the opioid epidemic in the United States. In 2016, that number had increased to 42,249. In October 2017, President Trump declared the opioid epidemic a national public health emergency. The SUPPORT Act is a sweeping measure designed to address widespread overprescribing and abuse of opioids in the United States. The act includes provisions to bolster law enforcement, public health, and health care financing and coverage, including under Medicare and Medicaid. The legislation imposes tighter oversight of opioid production and distribution; requires additional reporting and safeguards to address fraud; and limits coverage of prescription opioids. It also expands coverage of and access to opioid addiction treatment services. In addition, the act authorizes programs that seek to expand consumer and provider education on opioid use and train additional providers to treat individuals with opioid use disorders (OUDs). This report describes specific programmatic changes in the Medicare program in the SUPPORT Act. Overall, the Congressional Budget Office (CBO) estimated the SUPPORT Act would increase the on-budget deficit by $1,001 million over 5 years (FY2019-2023) but reduce the on-budget deficit by $52 million over 10 years (FY2019-FY2028). During the 114 th Congress, the Comprehensive Addiction and Recovery Act of 2016 (CARA; P.L. 114-198 ) was enacted. CARA addressed substance use issues broadly, targeting the opioid crisis predominantly through public health and law enforcement strategies. T he 21 st Century Cures Act (Cures Act; P.L. 114-255 ), also enacted in 2016, largely addressed cures and treatment research by authorizing new funding for medical research, amending the Food and Drug Administration (FDA) drug approval process, and authorizing additional funding to combat opioid addiction, among other things. SUPPORT ACT Provisions

The SUPPORT Act consists of eight titles
Title I: Medicaid Provisions to Address the Opioid Crisis Title II: Medicare Provisions to Address the Opioid Crisis Title III: FDA and Controlled Substance Provisions Title IV: Offsets Title V: Other Medicaid Provisions Title VI: Other Medicare Provisions Title VII: Public Health Provisions Title VIII: Miscellaneous
The Congressional Research Service is publishing a series of reports on this law, organized by title. This report covers Medicare provisions in Title II and Title VI and one Medicare budget offset in Title IV. Another area of suggested action is improving Medicare coverage of medication-assisted treatment (MAT), which combines medications with counseling and behavioral therapies to provide a holistic approach to addressing OUD. However, Medicare does not cover MAT services in federally registered opioid treatment programs (OTPs, or methadone clinics). A section-by-section analysis of the SUPPORT Act follows Table 1 . CARA allows Part D plans to limit ( lock in ) the number of prescribers and pharmacies used by enrollees at risk of opioid overutilization, starting in 2019. Legislative and administrative options for improving coverage of and payment for non-opioid pain management therapies and for FDA-approved medical devices and non-opioid pharmacological and non-pharmacological therapies for treatment of pain as alternatives to or to augment opioid therapy; improving and disseminating treatment strategies for beneficiaries with psychiatric or substance use disorders, who are at risk of suicide, or who have comorbidities and require consultation or management by specialists in pain management, mental health, or addiction treatment, and to address health disparities related to opioid use and opioid abuse treatment; educating providers about the risks of co-administration of opioids and other drugs; ensuring appropriate management of transitions between inpatient and outpatient care or between opioid and non-opioid therapy; expanding outreach for and education of providers on alternative and non-opioid therapies for acute and chronic pain management; and creating a beneficiary education tool on opioid alternatives for chronic pain management.
On October 24, 2018, President Trump signed into law the Substance Use-Disorder Prevention That Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT Act; P.L. 115-271). The conference report on the bill was approved by the House 393-8 on September 28, 2018, and it cleared the Senate 98-1 on October 3, 2018.
The law was enacted in response to growing concerns among the U.S. public and lawmakers about increasing numbers of drug overdose deaths. Opioid overdose deaths, in particular, have increased significantly since 2002. In 2015, an estimated 33,091 Americans died of opioid-related overdoses, almost three times as many as in 2002, around the beginning of the opioid epidemic in the United States. In 2016, that number had increased to 42,249. In October 2017, President Trump declared the opioid epidemic a public health emergency.
The SUPPORT Act is a sweeping measure designed to address widespread overprescribing and abuse of opioids in the United States. The act includes provisions to bolster law enforcement, public health, and health care financing and coverage, including under Medicare and Medicaid. It imposes tighter oversight of opioid production and distribution; requires additional reporting and safeguards to address fraud; alters programs related to the provision of support to children in the child welfare system because of their parent's or caregiver's opioid use; and limits coverage of prescription opioids. It also expands coverage of and access to opioid addiction treatment services. In addition, the act authorizes programs to expand consumer education on opioid use and train additional providers to treat individuals with opioid use disorders (OUDs). The Congressional Budget Office (CBO) forecast that the SUPPORT Act would increase the on-budget deficit by $1,001 million over 5 years (FY2019-2023) but reduce the on-budget deficit by $52 million over 10 years (FY2019-FY2028).
The SUPPORT Act is one of several recent laws aimed at addressing the opioid epidemic. The 114th Congress enacted the Comprehensive Addiction and Recovery Act of 2016 (CARA; P.L. 114-198). CARA addressed substance use issues broadly, targeting the opioid crisis predominantly through public health and law enforcement strategies. The 21st Century Cures Act (Cures Act; P.L. 114-255), also enacted in 2016, authorized new funding for medical research, amended the Food and Drug Administration (FDA) drug approval process, and authorized additional funding to combat opioid addiction, among other provisions.
The SUPPORT Act consists of eight titles. The Congressional Research Service is publishing a series of reports on this law, organized by title. This report provides a section-by-section description of Medicare provisions in Titles II and VI, as well as one Medicare budget offset in Title IV.
Among significant Medicare changes, the law creates a Medicare bundled payment for an incident of medication-assisted treatment (MAT), which combines medications with counseling and behavioral therapies to provide a holistic approach to treating OUD and makes federally registered opioid treatment programs (OTPs) approved Medicare providers. It also requires private insurers that offer Medicare Part D prescription drug plans to implement "lock-in" programs, starting in CY2022, that limit the number of pharmacies and prescribers used by enrollees identified as at risk of opioid abuse. This report is intended to reflect the SUPPORT Act at enactment (i.e., October 24, 2018); it does not track the act's implementation or funding. This report will not be updated.