[Congressional Bills 114th Congress]
[From the U.S. Government Publishing Office]
[S. 2256 Introduced in Senate (IS)]

<DOC>






114th CONGRESS
  1st Session
                                S. 2256

  To establish programs for health care provider training in Federal 
health care and medical facilities, to establish Federal co-prescribing 
guidelines, to establish a grant program with respect to naloxone, and 
                          for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                            November 5, 2015

Mr. Kaine (for himself and Mrs. Capito) introduced the following bill; 
     which was read twice and referred to the Committee on Health, 
                     Education, Labor, and Pensions

_______________________________________________________________________

                                 A BILL


 
  To establish programs for health care provider training in Federal 
health care and medical facilities, to establish Federal co-prescribing 
guidelines, to establish a grant program with respect to naloxone, and 
                          for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Co-Prescribing Saves Lives Act of 
2015''.

SEC. 2. FINDINGS.

    Congress finds as follows:
            (1) Together, the misuse of heroin and opioids account for 
        approximately 25,000 deaths in the United States per year.
            (2) Drug overdose was the leading cause of injury death in 
        the United States in 2013, and among people 25 to 64 years old, 
        drug overdose caused more deaths than motor vehicle fatalities 
        in 2013.
            (3) According to the Centers for Disease Control and 
        Prevention, in the United States, fatal opioid-related drug 
        overdose rates have more than quadrupled since 1990 and have 
        never been higher. Each day in the United States, 46 people die 
        from an overdose of prescription painkillers. Nearly 2,000,000 
        Americans aged 12 or older either abused or were dependent on 
        opioids in 2013.
            (4) Naloxone is a safe and effective antidote to all 
        opioid-related overdoses, including heroin and fentanyl, and is 
        a critical tool in preventing fatal opioid overdoses in both 
        health care and at-home settings.
            (5) The opioid overdose antidote naloxone has reversed more 
        than 26,000 overdose cases between 1996 and 2014, according to 
        the Centers for Disease Control and Prevention.

SEC. 3. HEALTH CARE PROVIDER TRAINING IN FEDERAL HEALTH CARE AND 
              MEDICAL FACILITIES.

    (a) Guidelines.--
            (1) HHS guidelines.--The Secretary of Health and Human 
        Services shall establish health care provider training 
        guidelines for all Federal health care facilities, including 
        Federally qualified health centers (as defined in paragraph (4) 
        of section 1861(aa) of the Social Security Act (42 U.S.C. 
        1395x(aa))) and facilities of the Indian Health Service, and 
        shall provide training to all providers described in subsection 
        (b), in accordance with subsection (c).
            (2) Department of veterans affairs guidelines.--The 
        Secretary of Veterans Affairs shall establish health care 
        provider training guidelines for all medical facilities of the 
        Department of Veterans Affairs, and shall provide training to 
        all providers described in subsection (b), in accordance with 
        subsection (c).
            (3) Department of defense guidelines.--The Secretary of 
        Defense shall establish health care provider training 
        guidelines for all medical facilities of the Department of 
        Defense, and shall provide training to all providers described 
        in subsection (b), in accordance with subsection (c).
    (b) Affected Health Care Providers.--The guidelines developed under 
paragraphs (1) through (3) of subsection (a) shall ensure that training 
on the appropriate and effective prescribing of opioid medications is 
provided to all health care providers who are--
            (1) Federal employees and who prescribe controlled 
        substances as part of their official responsibilities and 
        duties as Federal employees;
            (2) contractors in a health care or medical facility of an 
        agency described in paragraph (1), (2), or (3) of subsection 
        (a) who--
                    (A) spend 50 percent or more of their clinical time 
                under contract with the Federal Government; and
                    (B) prescribe controlled substances under the terms 
                and conditions of their contract or agreement with the 
                Federal Government; or
            (3) clinical residents and other clinical trainees who 
        spend 50 percent or more of their clinical time practicing in 
        health care or medical facility of an agency described in 
        paragraph (1), (2), or (3) of subsection (a).
    (c) Training Requirements.--
            (1) Training topics.--The training developed under 
        paragraphs (1) through (3) of subsection (a) shall address, at 
        a minimum, best practices for appropriate and effective 
        prescribing of pain medications, principles of pain management, 
        the misuse potential of controlled substances, identification 
        of potential substance use disorders and referral to further 
        evaluation and treatment, and proper methods for disposing of 
        controlled substances.
            (2) Training approaches.--The training approaches developed 
        in accordance with this section may include both traditional 
        continuing education models and models that pair intensive 
        coaching for the highest volume prescribers with case-based 
        courses for other prescribers.
            (3) Consistency with consensus guidelines.--To the extent 
        practicable, training adopted under subsection (a) shall be 
        consistent with consensus guidelines on pain medication 
        prescribing developed by the Centers for Disease Control and 
        Prevention.
            (4) Training frequency.--Each agency described in 
        paragraphs (1) through (3) of subsection (a) shall provide 
        training of the health care providers in accordance with this 
        section not later than 18 months after the date of enactment of 
        this Act, and every 3 years thereafter.
    (d) Definitions.--For purposes of this section, the term 
``controlled substance'' has the meaning given such term in section 102 
of the Controlled Substances Act (21 U.S.C. 802).

SEC. 4. NALOXONE CO-PRESCRIBING IN FEDERAL HEALTH CARE AND MEDICAL 
              FACILITIES.

    (a) Naloxone Co-Prescribing Guidelines.--Not later than 180 days 
after the date of enactment of this Act:
            (1) The Secretary of Health and Human Services shall 
        establish naloxone co-prescribing guidelines applicable to all 
        Federally qualified health centers (as defined in paragraph (4) 
        of section 1861(aa) of the Social Security Act (42 U.S.C. 
        1395x(aa))) and the health care facilities of the Indian Health 
        Service.
            (2) The Secretary of Defense shall establish co-prescribing 
        guidelines applicable to all Department of Defense medical 
        facilities.
            (3) The Secretary of Veterans Affairs shall establish co-
        prescribing guidelines applicable to all Department of Veterans 
        Affairs medical facilities.
    (b) Requirement.--The guidelines established under subsection (a) 
shall address naloxone co-prescribing for both pain patients receiving 
chronic opioid therapy and patients being treated for opioid use 
disorders.
    (c) Definitions.--In this section:
            (1) Co-prescribing.--The term ``co-prescribing'' means, 
        with respect to an opioid overdose reversal drug, the practice 
        of prescribing such drug in conjunction with an opioid 
        prescription for patients at an elevated risk of overdose, or 
        in conjunction with an opioid agonist approved under section 
        505 of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 355) 
        for the treatment of opioid use disorders, or in other 
        circumstances in which a provider identifies a patient at an 
        elevated risk for an intentional or unintentional drug overdose 
        from heroin or prescription opioid therapies.
            (2) Elevated risk of overdose.--The term ``elevated risk of 
        overdose'' has the meaning given such term by the Secretary of 
        Health and Human Services, which--
                    (A) may be based on the criteria provided in the 
                Opioid Overdose Toolkit published by the Substance 
                Abuse and Mental Health Services Administration; and
                    (B) may include patients on a first course opioid 
                treatment, patients using extended-release and long-
                acting opioid analgesic, and patients with a 
                respiratory disease or other co-morbidities.

SEC. 5. GRANT PROGRAM TO STATE DEPARTMENTS OF HEALTH TO EXPAND NALOXONE 
              CO-PRESCRIBING.

    (a) Establishment.--Not later than 180 days after the date of the 
enactment of this Act, the Secretary of Health and Human Services 
(referred to in this section as the ``Secretary'') shall establish a 
competitive 4-year co-prescribing opioid overdose reversal drugs grant 
program to provide State departments of health with resources to 
develop and apply co-prescribing guidelines, and to provide for 
increased access to naloxone.
    (b) Application.--To be eligible to receive a grant under this 
section, a State shall submit to the Secretary, in such form and manner 
as the Secretary may require, an application that--
            (1) identifies community partners for a co-prescribing 
        program;
            (2) identifies which providers will be trained in such 
        program and the criteria that will be used to identify eligible 
        patients to participate in such program; and
            (3) describes how the program will seek to identify State, 
        local, or private funding to continue the program after 
        expiration of the grant.
    (c) Prioritization.--In awarding grants under this section, the 
Secretary shall give priority to eligible State departments of health 
that propose to base State guidelines on guidelines on co-prescribing 
already in existence at the time of application, such as guidelines of 
the Department of Veterans Affairs or national medical societies, such 
as the American Society of Addiction Medicine or American Medical 
Association.
    (d) Use of Funds.--A State department of health receiving a grant 
under this section may use the grant for any of the following 
activities:
            (1) To establish a program for co-prescribing opioid 
        overdose reversal drugs, such as naloxone.
            (2) To expand innovative models of naloxone distribution, 
        as defined by the Secretary.
            (3) To train and provide resources for health care 
        providers and pharmacists on the co-prescribing of opioid 
        overdose reversal drugs.
            (4) To establish mechanisms and processes for tracking 
        patients participating in the program described in paragraph 
        (1) and the health outcomes of such patients, and ensuring that 
        health information is de-identified so as to protect patient 
        privacy.
            (5) To purchase opioid overdose reversal drugs for 
        distribution under the program described in paragraph (1).
            (6) To offset the copayments and other cost-sharing 
        associated with opioid overdose reversal drugs to ensure that 
        cost is not a limiting factor for eligible individuals, as 
        determined by the Secretary and the applicable State department 
        of health, giving priority to individuals not otherwise insured 
        for such services.
            (7) To conduct community outreach, in conjunction with 
        community-based organizations, designed to raise awareness of 
        co-prescribing practices, and the availability of opioid 
        overdose reversal drugs.
            (8) To establish protocols to connect patients who have 
        experienced a drug overdose with appropriate treatment, 
        including medication assisted treatment and appropriate 
        counseling and behavioral therapies. Such protocols shall be 
        consistent with nationally recognized patient placement 
        criteria, such as the criteria of the American Society of 
        Addiction Medicine.
    (e) Evaluations by Recipients.--As a condition of receipt of a 
grant under this section, a State department of health shall, for each 
year for which grant funds are received, submit to the Secretary 
information on appropriate outcome measures specified by the Secretary 
to assess the outcomes of the program funded by the grant.
    (f) Definition.--In this section, the term ``co-prescribing'' has 
the meaning given such term in section 4.

SEC. 6. AUTHORIZATION OF APPROPRIATIONS.

    There is authorized to be appropriated to carry out this Act 
$2,500,000 for each of fiscal years 2016 through 2020.
                                 <all>