Bill Overview
Title: Medicare Opioid Use Disorder Outreach Act
Description: This bill requires the Centers for Medicare & Medicaid Services to (1) conduct outreach to providers and beneficiaries about the availability of opioid use disorder treatment services through opioid treatment programs under Medicare, and (2) report on the utilization of such services.
Sponsors: Rep. Kelly, Mike [R-PA-16]
Target Audience
Population: Medicare beneficiaries potentially impacted by opioid use disorder
Estimated Size: 63000000
- Medicare primarily serves individuals who are aged 65 and older, or who qualify due to certain disabilities or conditions, implying the target population includes a large number of older adults.
- Opioid use disorder can affect individuals from all age groups, but this act focuses specifically on those eligible for Medicare.
- The outreach and reporting requirements indicate that both providers (healthcare professionals serving Medicare beneficiaries) and beneficiaries (Medicare recipients who may benefit from opioid treatment programs) are impacted.
- In the United States, there are approximately 63 million Medicare beneficiaries as of 2023.
- A significant subset of these beneficiaries are likely to have or be at risk of opioid use disorder.
- Globally, opioid use disorder is a major public health issue, but this bill is specific to the United States and its Medicare system.
Reasoning
- Opioid use disorder can significantly affect older adults who are Medicare beneficiaries. The policy aims to provide them with accessible treatment options, which might improve their quality of life and well-being.
- Outreach programs under Medicare can boost awareness about opioid treatment services, leading to higher utilization rates, which can benefit providers and beneficiaries.
- Given the budget constraints, the policy is likely to focus on creating impactful awareness and utilization of services, potentially improving wellbeing scores over time.
- Not all Medicare beneficiaries will be affected due to varying degrees of opioid use disorder, but those who are would likely see a marked improvement in their wellbeing if the policy succeeds.
- Providers play a critical role as they are key to implementing outreach and treatment, thus impacting their practice and interaction with Medicare beneficiaries.
- Some beneficiaries may not be directly impacted because they do not suffer from opioid use disorder, or they already have access to adequate treatment services.
Simulated Interviews
Retired teacher (Pennsylvania)
Age: 70 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 5.0 years
Commonness: 12/20
Statement of Opinion:
- I have chronic back pain and occasionally use opioids. It's reassuring that Medicare is focusing on this issue, even though I'm not yet using any disorder treatment.
- The additional awareness might help others who are struggling more than me.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 6 |
| Year 2 | 6 | 5 |
| Year 3 | 6 | 5 |
| Year 5 | 7 | 5 |
| Year 10 | 7 | 5 |
| Year 20 | 6 | 4 |
Retired coal miner (Kentucky)
Age: 66 | Gender: male
Wellbeing Before Policy: 4
Duration of Impact: 10.0 years
Commonness: 8/20
Statement of Opinion:
- I've struggled with opioid addiction after years of back-breaking work. Knowing that Medicare might make it easier to get treatment is a huge relief.
- Even if it's just outreach, it's a start. I want to get better.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 4 |
| Year 2 | 6 | 4 |
| Year 3 | 7 | 3 |
| Year 5 | 7 | 3 |
| Year 10 | 8 | 3 |
| Year 20 | 7 | 2 |
Retired nurse (Florida)
Age: 68 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 7.0 years
Commonness: 10/20
Statement of Opinion:
- My husband has been struggling with opioid dependency. We felt a little lost about where to turn for help.
- This policy might give us clearer options through Medicare.
- I hope it will make things less stressful.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 5 |
| Year 2 | 6 | 5 |
| Year 3 | 7 | 4 |
| Year 5 | 6 | 4 |
| Year 10 | 6 | 3 |
| Year 20 | 5 | 3 |
Retired engineer (California)
Age: 72 | Gender: male
Wellbeing Before Policy: 7
Duration of Impact: 0.0 years
Commonness: 15/20
Statement of Opinion:
- I don't have opioid issues myself, but I support outreach efforts to help those who need it.
- I doubt it will change anything for me personally.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 7 |
| Year 2 | 7 | 7 |
| Year 3 | 7 | 7 |
| Year 5 | 7 | 7 |
| Year 10 | 7 | 7 |
| Year 20 | 6 | 6 |
Retired banker (New York)
Age: 65 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 4.0 years
Commonness: 11/20
Statement of Opinion:
- The outreach program could illuminate treatment options I didn't know about, should I ever need them.
- I'm glad Medicare is putting resources into trying to solve these issues.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 6 |
| Year 2 | 6 | 5 |
| Year 3 | 6 | 5 |
| Year 5 | 7 | 5 |
| Year 10 | 7 | 5 |
| Year 20 | 6 | 4 |
Retired farmer (Texas)
Age: 74 | Gender: male
Wellbeing Before Policy: 5
Duration of Impact: 5.0 years
Commonness: 10/20
Statement of Opinion:
- Being on opioids for pain management, I'm curious if this will affect my treatment options.
- It might be helpful to learn about alternatives if available.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 5 |
| Year 2 | 6 | 5 |
| Year 3 | 6 | 4 |
| Year 5 | 7 | 4 |
| Year 10 | 7 | 3 |
| Year 20 | 6 | 3 |
Retired librarian (Ohio)
Age: 80 | Gender: female
Wellbeing Before Policy: 4
Duration of Impact: 0.0 years
Commonness: 8/20
Statement of Opinion:
- Even though I'm not affected directly, I feel supportive of policies that address opioid issues.
- My grandson struggles with this, though he's not on Medicare yet. I worry about the future.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 4 | 4 |
| Year 2 | 4 | 4 |
| Year 3 | 4 | 4 |
| Year 5 | 4 | 4 |
| Year 10 | 4 | 3 |
| Year 20 | 3 | 2 |
Retired auto worker (Michigan)
Age: 69 | Gender: male
Wellbeing Before Policy: 3
Duration of Impact: 7.0 years
Commonness: 9/20
Statement of Opinion:
- I've been in treatment for a year, having Medicare cover more services can only help.
- Outreach might get more people the help they need too.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 4 | 3 |
| Year 2 | 5 | 3 |
| Year 3 | 6 | 3 |
| Year 5 | 7 | 3 |
| Year 10 | 7 | 2 |
| Year 20 | 6 | 2 |
Retired school administrator (Maryland)
Age: 67 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 5.0 years
Commonness: 12/20
Statement of Opinion:
- I'm glad there is an effort to inform us about opioid-related help. It's comforting to know options exist.
- While I hope never to need them, it's a safety net.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 6 |
| Year 2 | 6 | 5 |
| Year 3 | 7 | 5 |
| Year 5 | 7 | 5 |
| Year 10 | 7 | 4 |
| Year 20 | 6 | 3 |
Retired postal worker (Illinois)
Age: 75 | Gender: male
Wellbeing Before Policy: 5
Duration of Impact: 6.0 years
Commonness: 9/20
Statement of Opinion:
- Post-surgery pain management is hard. More information on managing opioid use is welcome.
- I'm hopeful for less hassle with Medicare paperwork.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 5 |
| Year 2 | 6 | 5 |
| Year 3 | 6 | 5 |
| Year 5 | 6 | 4 |
| Year 10 | 6 | 4 |
| Year 20 | 5 | 3 |
Cost Estimates
Year 1: $50000000 (Low: $40000000, High: $60000000)
Year 2: $52000000 (Low: $42000000, High: $62000000)
Year 3: $54000000 (Low: $44000000, High: $64000000)
Year 5: $0 (Low: $0, High: $0)
Year 10: $0 (Low: $0, High: $0)
Year 100: $0 (Low: $0, High: $0)
Key Considerations
- Outreach activities may improve the understanding and usage of opioid use disorder services among Medicare beneficiaries.
- Successful implementation could lead to long-term reductions in health costs associated with opioid addiction and its complications.
- Initial costs will primarily cover outreach and reporting infrastructure development.
- Careful monitoring and iteration will be necessary to ensure efficient and effective use of resources.