Which Path Will They Choose

October 21, 2017 | Jay Ruais

During a press conference on Thursday, August 10, President Trump declared the opioid crisis a national emergency. Following up on the announcement from the President, the White House released the following statement: 

“Building upon the recommendations in the interim report from the President’s Commission on Combating Drug Addiction and the Opioid Crisis, President Donald J. Trump has instructed his Administration to use all appropriate emergency and other authorities to respond to the crisis caused by the opioid epidemic.”

While the President made clear in August that he was declaring a state of emergency, there is a formal process that must be worked through to put words into action that has not yet been completed.

On Monday, October 16, the President stated at a press conference that he will have a major announcement, “probably next week, on the drug crisis and on the opioid massive problem and I want to get that absolutely right.” 

Hopefully, the forthcoming announcement will confirm that the Trump Administration is taking the remaining steps necessary to formalize President Trump’s declaration of a national emergency. 

In the meantime, what does a disaster declaration mean, and how is an emergency response implemented? 

There are two paths currently available to the Administration. 

The first is to use the Stafford Act. This is the Act used to declare emergencies for major events such as hurricanes. Using this route, the President would formally declare an emergency and unlock the monetary reserves in the federal disaster relief fund. 

If the President takes this first path, the declaration could be used in some of the following ways: 

  • Building up law enforcement or addiction treatment in response to the crisis. 
  • Expediting the mobilization and coordination of different federal and state agencies to zero in on the opioid crisis
  • Allowing for the use of waivers for Section 1135 of the Social Security Act
    • This would mean that certain Medicare, Medicaid, and CHIP requirements could be temporarily waived. Most notably, it would allow for the waiving of the IMD or Institution for Mental Disease Exclusion rule that currently prohibits federal Medicaid reimbursement to states for adult patients receiving mental health or substance use disorder treatment in a facility with more than 16 beds. 

The second avenue that the Administration could take would be to declare an emergency under the Public Health Service Act. In this case, the Secretary of Health and Human Services (Acting-Secretary Eric Hargan), would formally declare the opioid crisis a national emergency. 

As the title would suggest, this path would be more medically-based, and could take form in some of the following actions: 

  • Deploying medical staff to areas identified as underserved. 
  • Training providers to use medication-assisted treatment (MAT).
  • Waiving state licensing requirements for doctors, which would enable addiction specialists to work in areas that currently do not have adequate access to specialized care.
  • Giving the Acting Secretary broader authority to tackle this crisis as a public health emergency.
    • Authorizing the federal government to grant states waivers to open more treatment centers, and dedicate resources to train more healthcare professionals on the treatment of opioid use disorder
  • Allowing for the use of waivers for Section 1135 of the Social Security Act, as explained above.

If the President does, in fact, formalize the declaration, it would be an unprecedented investment of federal resources and have a substantial impact on policy. So, which path will he choose? Either declaration would be an unprecedented step in utilizing federal resources, in an emergency setting, for something we now understand fully as a long-term chronic illness. 

There are concerns that the utilization of the Stafford Act could cut into federal funds recently obligated for the rash of large hurricanes that have swept through the United States, but at present, that does not seem prohibitive. Without question, this country is sorely lacking addiction providers and evidence-based treatment centers, particularly in rural and underserved areas. Because this second path has potential to address the deficit of providers, it would be a welcome choice. 

We will be sure to keep you informed every step of the way, and please let me know if we can be of any assistance!

Best, 

Jay Ruais 

Chief Operating Officer

Addiction Policy Forum

 

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