H.R. 10254: Maximizing Opioid Recovery Emergency Savings Act

This bill would make it easier for people with opioid use disorder to get treatment and related support without having to pay out of pocket, and it would do so through Medicare, Medicaid, and most private health plans.

Medicare changes

The bill directs Medicare to run a model test in 15 states to see what happens if Medicare stops charging copayments, coinsurance, and deductibles for certain opioid-related services. The states would be chosen based on three factors:

• a high share of Medicare beneficiaries,
• a high opioid overdose death rate, and
• a significant rural population.

The services covered in the model would include:

• drugs used to treat opioid use disorder or reverse overdoses,
• behavioral health and community support services for opioid use disorder, including treatment in licensed non-hospital residential facilities, and
• recovery support services such as peer counseling and transportation.

The bill says this model should be put in place within six months after enactment. It also says certain termination or modification rules would not apply during the first five years of the model.

Private health insurance changes

The bill would require group health plans and health insurance issuers offering group or individual coverage to cover certain opioid-related services and to not charge cost-sharing for them. This would apply to:

• prescription drugs used to treat opioid use disorder or reverse overdose,
• behavioral health services for opioid use disorder, including treatment in licensed non-hospital residential facilities, and
• community recovery support services used alongside medication-assisted treatment, such as peer counseling and transportation.

These requirements would apply starting with plan years beginning on or after January 1, 2027.

Medicaid changes

The bill would increase the federal Medicaid matching rate to 90% for state spending on medication-assisted treatment for opioid use disorder. In practice, that means the federal government would pay a larger share of those costs for states and the District of Columbia.

It would also give states the option to include recovery support services, such as peer counseling and transportation, as part of medication-assisted treatment when those services are provided together with treatment drugs and biological products.

Overall effect

In plain terms, the bill is designed to reduce financial barriers to opioid treatment, overdose-reversal medications, and recovery support services for people covered by Medicare, Medicaid, or many private health plans.

Relevant Companies

None found