To promote affordable access to evidence-based opioid treatments under the Medicare program and require coverage of medication assisted treatment for opioid use disorders, opioid overdose reversal medications, and recovery support services by health plans without cost-sharing requirements.
Summary
What This Bill Does
The bill creates CMMI model eliminating Medicare cost-sharing for opioid treatments in 15 states with high overdose rates and rural areas, with 5-year budget neutrality waiver, requires mandate group and individual health plans under PHSA to cover opioid treatment drugs, behavioral health, residential treatment, and recovery support without cost-sharing, and requires PHSA Section 2799A-11 requiring group and individual health plan coverage of opioid treatments without cost-sharing. It relies on compliance mandates, grants, and exemptions. The main policy areas are Healthcare and Finance.
Who Benefits and How
Medicare beneficiaries with opioid use disorders could see lower costs, State Medicaid programs could see lower costs, and Plan participants and beneficiaries could see lower costs.
Who Bears the Burden and How
Health insurance issuers could face higher costs, Federal budget could face higher costs, and Medicare program (cost impact) could face higher costs.
Key Provisions
- Creates CMMI model eliminating Medicare cost-sharing for opioid treatments in 15 states with high overdose rates and rural areas, with 5-year budget neutrality waiver.
- Requires mandate group and individual health plans under PHSA to cover opioid treatment drugs, behavioral health, residential treatment, and recovery support without cost-sharing.
- Requires PHSA Section 2799A-11 requiring group and individual health plan coverage of opioid treatments without cost-sharing.
- Requires ERISA Section 726 requiring group health plans to cover opioid treatment without cost-sharing for employer-sponsored plans.
- Requires IRC Section 9826 requiring group health plans to cover opioid treatment without cost-sharing (parallel tax code provision).
Evidence Chain:
This summary is generated from the full bill text using AI analysis. Expand "Detailed Analysis" below for identified beneficiaries/burden bearers with clause-level evidence links.
At a Glance
What This Bill Does
The bill creates CMMI model eliminating Medicare cost-sharing for opioid treatments in 15 states with high overdose rates and rural areas, with 5-year budget neutrality waiver, requires mandate group and individual health plans under PHSA to cover opioid treatment drugs, behavioral health, residential treatment, and recovery support without cost-sharing, and requires PHSA Section 2799A-11 requiring group and individual health plan coverage of opioid treatments without cost-sharing.
Key Policy Areas
Healthcare, Finance
Primary Purpose
The bill creates CMMI model eliminating Medicare cost-sharing for opioid treatments in 15 states with high overdose rates and rural areas, with 5-year budget neutrality waiver, requires mandate group and individual health plans under PHSA to cover opioid treatment drugs, behavioral health, residential treatment, and recovery support without cost-sharing, and requires PHSA Section 2799A-11 requiring group and individual health plan coverage of opioid treatments without cost-sharing.
Policy Domains
Section 2 - Medicare Innovation Model
Identified Gains
- Medicare beneficiaries with opioid use disorders
- State Medicaid programs
- Plan participants and beneficiaries
- Individuals with opioid use disorders in private plans
- Group and individual health plan enrollees
Identified Costs
- Health insurance issuers
- Federal budget
- Medicare program (cost impact)
- Group health plan sponsors
- Employers sponsoring group health plans
Sponsors
Legislative Progress
IntroducedMr. Blumenthal (for himself, Mr. Fetterman, Mr. Heinrich, Mr. Luján, …
Stakeholder Effects
cui bono?How this legislation distributes effects. Mention counts reflect frequency, not effect magnitude.
Employees with opioid use disorders, Group and individual health plan enrollees, Individuals with opioid use disorders in private plans
Medication-assisted treatment providers, Non-hospital residential treatment facilities, Opioid treatment providers
Federal budget, Medicare program (cost impact), State Medicaid programs
Positive-direction: State Medicaid programs
Negative-direction: Federal budget, Medicare program (cost impact)
Employers sponsoring group health plans, Group health plan sponsors
Bill Structure & Actor Mappings
Who is "The Secretary" in each section?
- "cmi"
- → Center for Medicare and Medicaid Innovation
We use a combination of our own taxonomy and classification in addition to large language models to assess meaning and potential beneficiaries. High confidence means strong textual evidence. Always verify with the original bill text.
Learn more about our methodology