If 2010 was noteworthy as the year of the Affordable Care Act, then 2016 will likely be remembered as the year of the Comprehensive Addiction and Recovery Act (CARA). It’s the first stand-alone piece of federal healthcare legislation specifically designed to offer multiple strategies to improve our national agenda around addiction, with an emphasis on treatment and recovery.
Along the journey, CARA’s iterations saw very few “no” votes, and that’s not surprising considering addiction has caused devastating effects on every community in every district. Addiction is an issue that clearly crosses party lines.
One thing that struck me as a telling indicator of the new national attitude was a statement in the final conference committee report:
“It is the sense of the Congress that decades of experience and research have demonstrated that a fiscally responsible approach to addressing the opioid abuse epidemic and other substance abuse epidemics requires treating such epidemics as a public health emergency emphasizing prevention, treatment, and recovery.”
Additionally, the legislators who spoke in favor of passing the bill—from both sides of the aisle—really seemed to echo the messages that leaders in the behavioral health community have been communicating to them so earnestly. It speaks volumes about the way lawmakers have adjusted their posture, acknowledging that treatment and recovery are the cornerstones of the solutions.
“This legislation I think helps to establish the fact that this is a disease,” said Rob Portman (R-Ohio) on the Senate floor the day CARA was passed.
Potential business impact
Experts I’ve spoken to have highlighted two key points in CARA that have the potential to impact a treatment center’s bottom line. First, it grants midlevel clinicians, such as nurse practitioners and physician assistants, the authority to prescribe buprenorphine, similar to the way they are able to prescribe a number of other drugs for their patients. This is significant not just because it broadens the pool of potential prescribers who can offer the treatment, but also because it opens the door for not-for-profit or smaller providers to hire more midlevel clinicians who might be less of a strain on payroll than medical doctors.
Second, experts also note that CARA allows federal health officials to award grants to states and community organizations for improving or expanding treatment and recovery. This move can lead to much-needed financial support to launch new clinical programs that will attract potential patients long after the grants run out.
The biggest sticking point for CARA obviously was funding. Lawmakers have vowed to get the earmarked funds appropriated, but that still won’t be enough to fully implement CARA’s provisions. More advocacy is needed and quickly while the spotlight is on the addiction crisis.