Bill Overview
Title: Fighting Stimulant and other Substance Use Disorders Act
Description: This bill directs the Inspector General of the Department of Health and Human Services to conduct a review on whether to establish a safe harbor under the anti-kickback statute for evidence-based contingency management incentives and the parameters for such a safe harbor.
Sponsors: Rep. Estes, Ron [R-KS-4]
Target Audience
Population: Individuals with substance use disorders
Estimated Size: 22000000
- The bill pertains to the anti-kickback statute related to contingency management in healthcare.
- Contingency management is used as a behavioral treatment for substance use disorders, which includes stimulants and other substances.
- Individuals with substance use disorders, particularly those using stimulant drugs, will be directly impacted.
- The healthcare providers and facilities offering treatments such as these will be affected, as the bill could change the legal landscape around incentive programs.
- Contingency management involves providing monetary or other incentives to patients for treatment adherence, which may influence both patients' and providers' approaches to treatment.
Reasoning
- The target population consists of individuals with substance use disorders, with a focus on stimulant use. This includes a significant number of Americans estimated at around 22,000,000 individuals.
- The policy aims to explore legal frameworks to support such individuals through incentive-based treatment plans, specifically contingency management, which is recognized for its effectiveness in treating substance use disorders.
- Given the policy's financial constraints, the immediate reach might be limited, potentially impacting a subset of those directly engaging in contingency management programs initially.
- We included individuals who are both directly and indirectly impacted by the policy, including those in different stages of recovery and healthcare providers.
- Interviews reflect a range of experiences, from those actively undergoing treatment to those who might be potential users of incentivized programs, as well as unaffected individuals, to capture the breadth of the population.
- Several perspectives highlight potential long-term benefits against short-term limitations due to financial constraints, curiousness, and cautious optimism in the interviews.
Simulated Interviews
Chef (Los Angeles, CA)
Age: 32 | Gender: male
Wellbeing Before Policy: 4
Duration of Impact: 5.0 years
Commonness: 3/20
Statement of Opinion:
- I think incentives could be a good push for people like me who struggle with sticking to treatment plans.
- I'm worried it might not be available widely enough to help everyone in need.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 4 |
| Year 2 | 6 | 4 |
| Year 3 | 6 | 5 |
| Year 5 | 7 | 5 |
| Year 10 | 7 | 5 |
| Year 20 | 6 | 4 |
Healthcare provider (New York, NY)
Age: 45 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 10.0 years
Commonness: 4/20
Statement of Opinion:
- Introducing legal protections could expand our capabilities in treating patients effectively.
- There needs to be clarity and support from the top to make it work on the ground.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 8 | 6 |
| Year 3 | 8 | 6 |
| Year 5 | 9 | 6 |
| Year 10 | 9 | 6 |
| Year 20 | 8 | 6 |
Student (Austin, TX)
Age: 28 | Gender: other
Wellbeing Before Policy: 7
Duration of Impact: 3.0 years
Commonness: 2/20
Statement of Opinion:
- I'm skeptical such programs will reach my town, but it seems promising.
- If it does, I'd like to see tangible outcomes quickly.
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 | 8 | 7 |
| Year 10 | 7 | 7 |
| Year 20 | 7 | 7 |
Law enforcement officer (Chicago, IL)
Age: 50 | Gender: male
Wellbeing Before Policy: 5
Duration of Impact: 10.0 years
Commonness: 4/20
Statement of Opinion:
- Addressing substance misuse with incentives may lead to a decrease in related offenses.
- The initial set-up cost and extent of reach seem crucial factors.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 7 | 5 |
| Year 3 | 7 | 6 |
| Year 5 | 8 | 6 |
| Year 10 | 8 | 6 |
| Year 20 | 7 | 6 |
Tech engineer (Seattle, WA)
Age: 36 | Gender: female
Wellbeing Before Policy: 8
Duration of Impact: 0.0 years
Commonness: 18/20
Statement of Opinion:
- I think it's good for society if it's backed with solid evidence but shouldn't distract from other policy needs.
- My concern is broadly about how healthcare priorities are set.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 8 | 8 |
| Year 2 | 8 | 8 |
| Year 3 | 8 | 8 |
| Year 5 | 9 | 8 |
| Year 10 | 9 | 8 |
| Year 20 | 9 | 8 |
Retired nurse (Miami, FL)
Age: 63 | Gender: female
Wellbeing Before Policy: 7
Duration of Impact: 4.0 years
Commonness: 10/20
Statement of Opinion:
- I hope this policy leads to a more equitable healthcare approach for substance use treatment.
- My concern is it could prioritize quick fixes over sustainable solutions.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 7 |
| Year 2 | 8 | 7 |
| Year 3 | 8 | 7 |
| Year 5 | 8 | 7 |
| Year 10 | 8 | 7 |
| Year 20 | 7 | 7 |
Construction worker (Jackson, MS)
Age: 29 | Gender: male
Wellbeing Before Policy: 3
Duration of Impact: 7.0 years
Commonness: 2/20
Statement of Opinion:
- I hope it applies to the programs where I'm seeking help, sounds like it could make a difference.
- I'm worried about eligibility and if I'll actually see any help.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 4 | 3 |
| Year 2 | 5 | 3 |
| Year 3 | 5 | 3 |
| Year 5 | 6 | 3 |
| Year 10 | 7 | 3 |
| Year 20 | 6 | 3 |
Public policy analyst (Denver, CO)
Age: 41 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 5.0 years
Commonness: 5/20
Statement of Opinion:
- This policy's effectiveness might hinge on precise execution and community-tailored incentives.
- I'm watching for implications on general healthcare costs and budget allocations.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 8 | 6 |
| Year 3 | 8 | 6 |
| Year 5 | 9 | 6 |
| Year 10 | 9 | 6 |
| Year 20 | 8 | 6 |
Social worker (Phoenix, AZ)
Age: 37 | Gender: male
Wellbeing Before Policy: 7
Duration of Impact: 6.0 years
Commonness: 6/20
Statement of Opinion:
- Policies like this could be a step toward real change if they're inclusive and fair.
- Budget limits might stifle broader impacts initially.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 7 |
| Year 2 | 8 | 7 |
| Year 3 | 8 | 7 |
| Year 5 | 8 | 7 |
| Year 10 | 9 | 7 |
| Year 20 | 8 | 7 |
Unemployed (Baltimore, MD)
Age: 22 | Gender: male
Wellbeing Before Policy: 4
Duration of Impact: 10.0 years
Commonness: 3/20
Statement of Opinion:
- Incentives might keep me committed to programs.
- I'm unsure how many will benefit immediately, it seems like a small step for a big issue.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 4 |
| Year 2 | 6 | 4 |
| Year 3 | 7 | 4 |
| Year 5 | 7 | 4 |
| Year 10 | 7 | 4 |
| Year 20 | 6 | 4 |
Cost Estimates
Year 1: $5000000 (Low: $3000000, High: $7000000)
Year 2: $0 (Low: $0, High: $0)
Year 3: $0 (Low: $0, High: $0)
Year 5: $0 (Low: $0, High: $0)
Year 10: $0 (Low: $0, High: $0)
Year 100: $0 (Low: $0, High: $0)
Key Considerations
- The bill mandates a review, not immediate direct changes to the anti-kickback statute, which primarily contributes to the project's initial low cost and low immediate fiscal impact.
- Potential long-term impacts and savings depend on future implementation of recommendations resulting from the review.