Scott: Widen Medicare to cover addiction

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WASHINGTON — Gov. Phil Scott and members of his administration encouraged lawmakers in Congress Tuesday to consider expanding Medicare to cover opioid addiction services.

Scott and Human Services Secretary Al Gobeille appeared before a subcommittee of House Ways and Means to testify on Vermont's experience combating the opioid crisis.

Loosening restrictions that currently bar the Medicare program from covering substance abuse services, like those offered through Vermont's hub and spoke system, could help fight the opioid addiction crisis, they told the committee.

"If you want to break down the stigma, this is one way to do it," Scott said. "Treat them the same."

Scott said there are other changes Vermont would like to see, included adjusting billing practices to allow a screening to be used more widely, eliminating a Medicaid regulation that caps beds in some residential treatment facilities at 16, and funding of more research at the national level for pain management alternatives to opioids.

The hearing was Scott's first time testifying before a congressional panel. It was also his first time in the Capitol at all, he said after the hearing.

Scott and his team, which also included Health Commissioner Mark Levine and Blueprint for Health Director Beth Tanzman, came to the capital only for the day.

Rep. Peter Welch, D-Vt., introduced the governor to the subcommittee, touting Vermont's approach to the opioid crisis as a bipartisan model.

Scott told the panel that when he watched then-Gov. Peter Shumlin's 2014 State of the State address about Vermont's opioid abuse problem he was "more than just a little bit skeptical." At the time, he was concerned the speech would tarnish the state's reputation.

In his congressional remarks, the governor lauded his predecessor for addressing the issue early. Over the past four years, Vermont has established a system of treatment that has begun to curb the crisis. Scott said Vermont still has a long way to go.

"Today I approach you humbly because we have not yet solved this problem," he told the committee.

In reference to the final number in his administration's oft-repeated "6-3-1" slogan, the governor told the committee that on average, one baby exposed to opioids is born every day in Vermont.

Opioid-related overdose fatalities have increased dramatically in recent years, and the most recent data suggests that the numbers are not going down, Scott said.

There were 106 opioid-related deaths in 2016, according Vermont Department of Health data. Preliminary data suggests there were a similar number in 2017. Year-end data is not yet available, but through October, 83 opioid-related fatalities were recorded.

Over the course of about an hour, Scott and Gobeille fielded questions from committee members on topics ranging from the state's prescription drug monitoring program, the collaboration between the administration and the Legislature and how people are referred to treatment.

One Democrat asked the Vermont officials about a belief among some that the Medicaid expansion under the Affordable Care Act fueled the opioid crisis. Gobeille refuted that perception.

"To be clear," Gobeille said, "we don't believe that Medicaid expansion caused this crisis."

Another lawmaker asked about what role Scott believed marijuana could play in abating the crisis. Vermont recently became the first state to legalize marijuana through the Legislature, rather than by ballot measure.

"We just need everything on the table," Scott said. "We can't allow ourselves to put blinders in terms of what might work."

The committee members also asked about the recommendation to change the restrictions on Medicare regarding substance use.

"We have to embrace this as a chronic condition, and then if we do we should make Medicare, Medicaid and commercial insurers treat this as an essential health benefit, like we would kidney disease," Gobeille said.

Vermont is in the process of seeking to expand Medicare's coverage of opioid addiction treatment in the state. State officials have reached out to the Centers for Medicare and Medicaid Services for support of a proposed pilot program in Vermont that would allow Medicare to cover services through the hub and spoke system and others, according to Gobeille.

For Medicare to adopt the change more broadly in Vermont and nationally, Congress would need to act, he said.

After the hearing, Scott and the members of his administration paid a visit to Sen. Patrick Leahy, D-Vt. As he walked up the street toward the Capitol, Scott said he was impressed by how collegial the atmosphere was in Washington.

"'Course I've only been here for two hours," he said.

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