[Congressional Record Volume 162, Number 108 (Wednesday, July 6, 2016)]
[House]
[Pages H4392-H4419]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
CONFERENCE REPORT ON S. 524, COMPREHENSIVE ADDICTION AND RECOVERY ACT
OF 2016
Mr. UPTON submitted the following conference report and statement on
the bill (S. 524) to authorize the Attorney General to award grants to
address the national epidemics of prescription opioid abuse and heroin
use:
Conference Report (H. Rept. 114-669)
The committee of conference on the disagreeing votes of the
two Houses on the amendments of the House do the bill (S.
524), to authorize the Attorney General to award grants to
address the national epidemics of prescription opioid abuse
and heroin use, having met, after full and free conference,
have agreed to recommend and do recommend to their respective
Houses as follows:
That the Senate recede from its disagreement to the
amendment of the House to the text of the bill and agree to
the same with an amendment as follows:
In lieu of the matter proposed to be inserted by the House
amendment, insert the following:
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the
``Comprehensive Addiction and Recovery Act of 2016''.
(b) Table of Contents.--The table of contents for this Act
is as follows:
Sec. 1. Short title; table of contents.
TITLE I--PREVENTION AND EDUCATION
Sec. 101. Task force on pain management.
Sec. 102. Awareness campaigns.
Sec. 103. Community-based coalition enhancement grants to address local
drug crises.
Sec. 104. Information materials and resources to prevent addiction
related to youth sports injuries.
Sec. 105. Assisting veterans with military emergency medical training
to meet requirement for becoming civilian health care
professionals.
Sec. 106. FDA opioid action plan.
Sec. 107. Improving access to overdose treatment.
Sec. 108. NIH opioid research.
Sec. 109. National All Schedules Prescription Electronic Reporting
Reauthorization.
Sec. 110. Opioid overdose reversal medication access and education
grant programs.
TITLE II--LAW ENFORCEMENT AND TREATMENT
Sec. 201. Comprehensive Opioid Abuse Grant Program.
Sec. 202. First responder training.
Sec. 203. Prescription drug take back expansion.
TITLE III--TREATMENT AND RECOVERY
Sec. 301. Evidence-based prescription opioid and heroin treatment and
interventions demonstration.
Sec. 302. Building communities of recovery.
Sec. 303. Medication-assisted treatment for recovery from addiction.
TITLE IV--ADDRESSING COLLATERAL CONSEQUENCES
Sec. 401. GAO report on recovery and collateral consequences.
TITLE V--ADDICTION AND TREATMENT SERVICES FOR WOMEN, FAMILIES, AND
VETERANS
Sec. 501. Improving treatment for pregnant and postpartum women.
Sec. 502. Veterans treatment courts.
Sec. 503. Infant plan of safe care.
Sec. 504. GAO report on neonatal abstinence syndrome (NAS).
TITLE VI--INCENTIVIZING STATE COMPREHENSIVE INITIATIVES TO ADDRESS
PRESCRIPTION OPIOID ABUSE
Sec. 601. State demonstration grants for comprehensive opioid abuse
response.
TITLE VII--MISCELLANEOUS
Sec. 701. Grant accountability and evaluations.
Sec. 702. Partial fills of schedule II controlled substances.
Sec. 703. Good samaritan assessment.
Sec. 704. Programs to prevent prescription drug abuse under Medicare
parts C and D.
Sec. 705. Excluding abuse-deterrent formulations of prescription drugs
from the Medicaid additional rebate requirement for new
formulations of prescription drugs.
Sec. 706. Limiting disclosure of predictive modeling and other
analytics technologies to identify and prevent waste,
fraud, and abuse.
Sec. 707. Medicaid Improvement Fund.
Sec. 708. Sense of the Congress regarding treatment of substance abuse
epidemics.
TITLE VIII--KINGPIN DESIGNATION IMPROVEMENT
Sec. 801. Protection of classified information in Federal court
challenges relating to designations under the Narcotics
Kingpin Designation Act.
TITLE IX--DEPARTMENT OF VETERANS AFFAIRS
Sec. 901. Short title.
Sec. 902. Definitions.
Subtitle A--Opioid Therapy and Pain Management
Sec. 911. Improvement of opioid safety measures by Department of
Veterans Affairs.
Sec. 912. Strengthening of joint working group on pain management of
the Department of Veterans Affairs and the Department of
Defense.
Sec. 913. Review, investigation, and report on use of opioids in
treatment by Department of Veterans Affairs.
Sec. 914. Mandatory disclosure of certain veteran information to State
controlled substance monitoring programs.
Sec. 915. Elimination of copayment requirement for veterans receiving
opioid antagonists or education on use of opioid
antagonists.
[[Page H4393]]
Subtitle B--Patient Advocacy
Sec. 921. Community meetings on improving care furnished by Department
of Veterans Affairs.
Sec. 922. Improvement of awareness of patient advocacy program and
patient bill of rights of Department of Veterans Affairs.
Sec. 923. Comptroller General report on patient advocacy program of
Department of Veterans Affairs.
Sec. 924. Establishment of Office of Patient Advocacy of the Department
of Veterans Affairs.
Subtitle C--Complementary and Integrative Health
Sec. 931. Expansion of research and education on and delivery of
complementary and integrative health to veterans.
Sec. 932. Expansion of research and education on and delivery of
complementary and integrative health to veterans.
Sec. 933. Pilot program on integration of complementary and integrative
health and related issues for veterans and family members
of veterans.
Subtitle D--Fitness of Health Care Providers
Sec. 941. Additional requirements for hiring of health care providers
by Department of Veterans Affairs.
Sec. 942. Provision of information on health care providers of
Department of Veterans Affairs to State medical boards.
Sec. 943. Report on compliance by Department of Veterans Affairs with
reviews of health care providers leaving the Department
or transferring to other facilities.
Subtitle E--Other Matters
Sec. 951. Modification to limitation on awards and bonuses.
TITLE I--PREVENTION AND EDUCATION
SEC. 101. TASK FORCE ON PAIN MANAGEMENT.
(a) Definitions.--In this section:
(1) Secretary.--The term ``Secretary'' means the Secretary
of Health and Human Services.
(2) Task force.--The term ``task force'' means the Pain
Management Best Practices Inter-Agency Task Force convened
under subsection (b).
(b) Inter-Agency Task Force.--Not later than 2 years after
the date of enactment of this Act, the Secretary, in
cooperation with the Secretary of Veterans Affairs and the
Secretary of Defense, shall convene a Pain Management Best
Practices Inter-Agency Task Force.
(c) Membership.--The task force shall be comprised of--
(1) representatives of--
(A) the Department of Health and Human Services and
relevant agencies within the Department of Health and Human
Services;
(B) the Department of Veterans Affairs;
(C) the Department of Defense; and
(D) the Office of National Drug Control Policy;
(2) currently licensed and practicing physicians, dentists,
and nonphysician prescribers;
(3) currently licensed and practicing pharmacists and
pharmacies;
(4) experts in the fields of pain research and addiction
research, including adolescent and young adult addiction
research;
(5) representatives of--
(A) pain management professional organizations;
(B) the mental health treatment community;
(C) the addiction treatment community, including
individuals in recovery from substance use disorder;
(D) pain advocacy groups, including patients;
(E) veteran service organizations;
(F) groups with expertise on overdose reversal, including
first responders;
(G) State medical boards; and
(H) hospitals;
(6) experts on the health of, and prescription opioid use
disorders in, members of the Armed Forces and veterans; and
(7) experts in the field of minority health.
(d) Representation.--The Secretary shall ensure that the
membership of the task force includes individuals
representing rural and underserved areas.
(e) Duties.--The task force shall--
(1) identify, review, and, as appropriate, determine
whether there are gaps in or inconsistencies between best
practices for pain management (including chronic and acute
pain) developed or adopted by Federal agencies;
(2) not later than 1 year after the date on which the task
force is convened under subsection (b), propose updates to
best practices and recommendations on addressing gaps or
inconsistencies identified under paragraph (1), as
appropriate, and submit to relevant Federal agencies and the
general public such proposed updates and recommendations,
taking into consideration--
(A) existing pain management research and other relevant
research;
(B) recommendations from relevant conferences and existing
relevant evidence-based guidelines;
(C) ongoing efforts at the State and local levels and by
medical professional organizations to develop improved pain
management strategies, including consideration of differences
within and between classes of opioids, the availability of
opioids with abuse deterrent technology, and pharmacological,
nonpharmacological, and medical device alternatives to
opioids to reduce opioid monotherapy in appropriate cases;
(D) the management of high-risk populations who receive
opioids in the course of medical care, other than for pain
management;
(E) the 2016 Guideline for Prescribing Opioids for Chronic
Pain issued by the Centers for Disease Control and
Prevention; and
(F) private sector, State, and local government efforts
related to pain management and prescribing pain medication;
(3) provide the public with at least 90 days to submit
comments on any proposed updates and recommendations under
paragraph (2); and
(4) develop a strategy for disseminating information about
best practices for pain management (including chronic and
acute pain) to stakeholders, if appropriate.
(f) Limitation.--The task force shall not have rulemaking
authority.
(g) Sunset.--The task force under this section shall sunset
after 3 years.
SEC. 102. AWARENESS CAMPAIGNS.
(a) In General.--The Secretary of Health and Human
Services, in coordination with the heads of other departments
and agencies, shall, as appropriate, through existing
programs and activities, advance the education and awareness
of the public (including providers, patients, and consumers)
and other appropriate entities regarding the risk of abuse of
prescription opioids if such drugs are not taken as
prescribed.
(b) Topics.--The education and awareness campaigns under
subsection (a) shall address--
(1) the dangers of opioid abuse;
(2) the prevention of opioid abuse, including through safe
disposal of prescription medications and other safety
precautions; and
(3) the detection of early warning signs of addiction.
(c) Other Requirements.--The education and awareness
campaigns under subsection (a) shall, as appropriate--
(1) take into account any association between prescription
opioid abuse and heroin use;
(2) emphasize--
(A) the similarities between heroin and prescription
opioids; and
(B) the effects of heroin and prescription opioids on the
human body; and
(3) bring greater public awareness to the dangerous effects
of fentanyl when mixed with heroin or abused in a similar
manner.
SEC. 103. COMMUNITY-BASED COALITION ENHANCEMENT GRANTS TO
ADDRESS LOCAL DRUG CRISES.
(a) Definitions.--In this section:
(1) Administrator.--The term ``Administrator'' means the
Administrator of the Substance Abuse and Mental Health
Services Administration.
(2) Director.--The term ``Director'' means the Director of
the Office of National Drug Control Policy.
(3) Drug-free communities act of 1997.--The term ``Drug-
Free Communities Act of 1997'' means chapter 2 of the
National Narcotics Leadership Act of 1988 (21 U.S.C. 1521 et
seq.).
(4) Eligible entity.--The term ``eligible entity'' means an
organization that--
(A) on or before the date of submitting an application for
a grant under this section, receives or has received a grant
under the Drug-Free Communities Act of 1997; and
(B) has documented, using local data, rates of abuse of
opioids or methamphetamines at levels that are--
(i) significantly higher than the national average as
determined by the Secretary (including appropriate
consideration of the results of the Monitoring the Future
Survey published by the National Institute on Drug Abuse and
the National Survey on Drug Use and Health published by the
Substance Abuse and Mental Health Services Administration);
or
(ii) higher than the national average, as determined by the
Secretary (including appropriate consideration of the results
of the surveys described in clause (i)), over a sustained
period of time.
(5) Emerging drug abuse issue.--The term ``emerging drug
abuse issue'' means a substance use disorder within an area
involving--
(A) a sudden increase in demand for particular drug abuse
treatment services relative to previous demand; and
(B) a lack of resources in the area to address the emerging
problem.
(6) Local drug crisis.--The term ``local drug crisis''
means, with respect to the area served by an eligible
entity--
(A) a sudden increase in the abuse of opioids or
methamphetamines, as documented by local data;
(B) the abuse of prescription medications, specifically
opioids or methamphetamines, that is significantly higher
than the national average, over a sustained period of time,
as documented by local data; or
(C) a sudden increase in opioid-related deaths, as
documented by local data.
(7) Opioid.--The term ``opioid'' means any drug having an
addiction-forming or addiction-sustaining liability similar
to morphine or being capable of conversion into a drug having
such addiction-forming or addiction-sustaining liability.
(b) Program Authorized.--The Director, in coordination with
the Administrator, may make grants to eligible entities to
implement comprehensive community-wide strategies that
address local drug crises and emerging drug abuse issues
within the area served by the eligible entity.
(c) Application.--
(1) In general.--An eligible entity seeking a grant under
this section shall submit an application to the Director at
such time, in such manner, and accompanied by such
information as the Director may require.
(2) Criteria.--As part of an application for a grant under
this section, the Director shall require an eligible entity
to submit a detailed, comprehensive, multisector plan for
addressing the local drug crisis or emerging drug abuse issue
within the area served by the eligible entity.
[[Page H4394]]
(d) Use of Funds.--An eligible entity shall use a grant
received under this section--
(1) for programs designed to implement comprehensive
community-wide prevention strategies to address the local
drug crisis in the area served by the eligible entity, in
accordance with the plan submitted under subsection (c)(2);
(2) to obtain specialized training and technical assistance
from the organization funded under section 4 of Public Law
107-82 (21 U.S.C. 1521 note); and
(3) for programs designed to implement comprehensive
community-wide strategies to address emerging drug abuse
issues in the community.
(e) Supplement Not Supplant.--An eligible entity shall use
Federal funds received under this section only to supplement
the funds that would, in the absence of those Federal funds,
be made available from other Federal and non-Federal sources
for the activities described in this section, and not to
supplant those funds.
(f) Evaluation.--A grant under this section shall be
subject to the same evaluation requirements and procedures as
the evaluation requirements and procedures imposed on the
recipient of a grant under the Drug-Free Communities Act of
1997, and may also include an evaluation of the effectiveness
at reducing abuse of opioids or methamphetamines.
(g) Limitation on Administrative Expenses.--Not more than 8
percent of the amounts made available to carry out this
section for a fiscal year may be used to pay for
administrative expenses.
(h) Delegation Authority.--The Director may enter into an
interagency agreement with the Administrator to delegate
authority for the execution of grants and for such other
activities as may be necessary to carry out this section.
(i) Authorization of Appropriations.--For the purpose of
carrying out this section, there are authorized to be
appropriated $5,000,000 for each of fiscal years 2017 through
2021.
SEC. 104. INFORMATION MATERIALS AND RESOURCES TO PREVENT
ADDICTION RELATED TO YOUTH SPORTS INJURIES.
(a) Report.--The Secretary of Health and Human Services
(referred to in this section as the ``Secretary'') shall, not
later than 24 months after the date of the enactment of this
section, make publicly available on the appropriate website
of the Department of Health and Human Services a report
determining the extent to which informational materials and
resources described in subsection (c) are available to
teenagers and adolescents who play youth sports, families of
such teenagers and adolescents, nurses, youth sports groups,
and relevant health care provider groups.
(b) Development of Informational Materials and Resources.--
The Secretary may, for purposes of preventing substance use
disorder in teenagers and adolescents who are injured playing
youth sports and are subsequently prescribed an opioid, not
later than 12 months after the report is made publicly
available under subsection (a), and taking into consideration
the findings of such report and in coordination with relevant
health care provider groups, facilitate the development of
informational materials and resources described in subsection
(c) for teenagers and adolescents who play youth sports,
families of such teenagers and adolescents, nurses, youth
sports groups, and relevant health care provider groups.
(c) Materials and Resources Described.--For purposes of
this section, the informational materials and resources
described in this subsection are informational materials and
resources with respect to youth sports injuries for which
opioids are potentially prescribed, including materials and
resources focused on the risks associated with opioid use and
misuse, treatment options for such injuries that do not
involve the use of opioids, and how to seek treatment for
addiction.
(d) No Additional Funds.--No additional funds are
authorized to be appropriated for the purpose of carrying out
this section. This section shall be carried out using amounts
otherwise available for such purpose.
SEC. 105. ASSISTING VETERANS WITH MILITARY EMERGENCY MEDICAL
TRAINING TO MEET REQUIREMENT FOR BECOMING
CIVILIAN HEALTH CARE PROFESSIONALS.
Part B of title III of the Public Health Service Act (42
U.S.C. 243 et seq.) is amended by inserting after section 314
the following:
``SEC. 315. ASSISTING VETERANS WITH MILITARY EMERGENCY
MEDICAL TRAINING TO MEET REQUIREMENTS FOR
BECOMING CIVILIAN HEALTH CARE PROFESSIONALS.
``(a) Program.--
``(1) In general.--The Secretary may establish a program,
in consultation with the Secretary of Labor, consisting of
awarding demonstration grants to States to streamline State
requirements and procedures in order to assist veterans who
held certain military occupational specialties related to
medical care or who have completed certain medical training
while serving in the Armed Forces of the United States to
meet certification, licensure, and other requirements
applicable to civilian health care professions (such as
emergency medical technician, paramedic, licensed practical
nurse, registered nurse, physical therapy assistant, or
physician assistant professions) in the State.
``(2) Consultation and collaboration.--In determining the
eligible military occupational specialties or training
courses and the assistance required as described in paragraph
(1), the Secretary shall consult with the Secretary of
Defense, the Secretary of Veterans Affairs, and the Assistant
Secretary of Labor for Veterans' Employment and Training, and
shall collaborate with the initiatives carried out under
section 4114 of title 38, United States Code, and sections
1142 through 1144 of title 10, United States Code.
``(b) Use of Funds.--Amounts received as a demonstration
grant under this section shall be used to--
``(1) prepare and implement a plan to streamline State
requirements and procedures as described in subsection (a),
including by--
``(A) determining the extent to which the requirements for
the education, training, and skill level of civilian health
care professions (such as emergency medical technicians,
paramedics, licensed practical nurses, registered nurses,
physical therapy assistants, or physician assistants) in the
State are equivalent to requirements for the education,
training, and skill level of veterans who served in medical
related fields while a member of the Armed Forces of the
United States; and
``(B) identifying methods, such as waivers, for veterans
who served in medical related fields while a member of the
Armed Forces of the United States to forgo or meet any such
equivalent State requirements; and
``(2) if necessary to meet workforce shortages or address
gaps in education, training, or skill level to meet
certification, licensure or other requirements applicable to
becoming a civilian health care professional (such as an
emergency medical technician, paramedic, licensed practical
nurse, registered nurse, physical therapy assistant, or
physician assistant professions) in the State, develop or
expand career pathways at institutions of higher education to
support veterans in meeting such requirements.
``(c) Report.--Upon the completion of the demonstration
program under this section, the Secretary shall submit to
Congress a report on the program.
``(d) Funding.--No additional funds are authorized to be
appropriated for the purpose of carrying out this section.
This section shall be carried out using amounts otherwise
available for such purpose.
``(e) Sunset.--The demonstration program under this section
shall not exceed 5 years.''.
SEC. 106. FDA OPIOID ACTION PLAN.
(a) In General.--
(1) New drug application.--
(A) In general.--Subject to subparagraph (B), prior to the
approval pursuant to an application submitted under section
505(b) of the Federal Food, Drug, and Cosmetic Act (21 U.S.C.
355(b)) of a new drug that is an opioid, the Secretary of
Health and Human Services (referred to in this section as the
``Secretary'') shall refer the application to an advisory
committee of the Food and Drug Administration to seek
recommendations from such advisory committee.
(B) Public health exemption.--A referral to an advisory
committee under subparagraph (A) is not required with respect
to a new opioid drug or drugs if the Secretary--
(i) finds that such a referral is not in the interest of
protecting and promoting public health;
(ii) finds that such a referral is not necessary based on a
review of the relevant scientific information; and
(iii) submits a notice containing the rationale for such
findings to the Committee on Health, Education, Labor, and
Pensions of the Senate and the Committee on Energy and
Commerce of the House of Representatives.
(2) Pediatric opioid labeling.--The Secretary shall convene
the Pediatric Advisory Committee of the Food and Drug
Administration to seek recommendations from such Committee
regarding a framework for the inclusion of information in the
labeling of drugs that are opioids relating to the use of
such drugs in pediatric populations before the Secretary
approves any labeling or change to labeling for any drug that
is an opioid intended for use in a pediatric population.
(3) Sunset.--The requirements of paragraphs (1) and (2)
shall cease to be effective on October 1, 2022.
(b) Prescriber Education.--Not later than 1 year after the
date of the enactment of this Act, the Secretary, acting
through the Commissioner of Food and Drugs, as part of the
Food and Drug Administration's evaluation of the Extended-
Release/Long-Acting Opioid Analgesics Risk Evaluation and
Mitigation Strategy, and in consultation with relevant
stakeholders, shall develop recommendations regarding
education programs for prescribers of opioids pursuant to
section 505-1 of the Federal Food, Drug, and Cosmetic Act (21
U.S.C. 355-1), including recommendations on--
(1) which prescribers should participate in such programs;
and
(2) how often participation in such programs is necessary.
(c) Guidance on Evaluating the Abuse Deterrence of Generic
Solid Oral Opioid Drug Products.--Not later than 18 months
after the end of the period for public comment on the draft
guidance entitled ``General Principles for Evaluating the
Abuse Deterrence of Generic Solid Oral Opioid Drug Products''
issued by the Center for Drug Evaluation and Research of the
Food and Drug Administration in March 2016, the Commissioner
of Food and Drugs shall publish in the Federal Register a
final version of such guidance.
SEC. 107. IMPROVING ACCESS TO OVERDOSE TREATMENT.
(a) Grants for Reducing Overdose Deaths.--Part D of title V
of the Public Health Service Act (42 U.S.C. 290dd et seq.) is
amended by adding at the end the following:
``SEC. 544. GRANTS FOR REDUCING OVERDOSE DEATHS.
``(a) Establishment.--
``(1) In general.--The Secretary shall award grants to
eligible entities to expand access to drugs or devices
approved or cleared under the Federal Food, Drug, and
Cosmetic Act for emergency treatment of known or suspected
opioid overdose.
``(2) Maximum grant amount.--A grant awarded under this
section may not be for more than $200,000 per grant year.
[[Page H4395]]
``(3) Eligible entity.--For purposes of this section, the
term `eligible entity' means a Federally qualified health
center (as defined in section 1861(aa) of the Social Security
Act), an opioid treatment program under part 8 of title 42,
Code of Federal Regulations, any practitioner dispensing
narcotic drugs pursuant to section 303(g) of the Controlled
Substances Act, or any other entity that the Secretary deems
appropriate.
``(4) Prescribing.--For purposes of this section, the term
`prescribing' means, with respect to a drug or device
approved or cleared under the Federal Food, Drug, and
Cosmetic Act for emergency treatment of known or suspected
opioid overdose, the practice of prescribing such drug or
device--
``(A) in conjunction with an opioid prescription for
patients at an elevated risk of overdose;
``(B) in conjunction with an opioid agonist approved under
section 505 of the Federal Food, Drug, and Cosmetic Act for
the treatment of opioid use disorder;
``(C) to the caregiver or a close relative of patients at
an elevated risk of overdose from opioids; or
``(D) in other circumstances in which a provider identifies
a patient is at an elevated risk for an intentional or
unintentional drug overdose from heroin or prescription
opioid therapies.
``(b) Application.--To be eligible to receive a grant under
this section, an eligible entity shall submit to the
Secretary, in such form and manner as specified by the
Secretary, an application that describes--
``(1) the extent to which the area to which the entity will
furnish services through use of the grant is experiencing
significant morbidity and mortality caused by opioid abuse;
``(2) the criteria that will be used to identify eligible
patients to participate in such program; and
``(3) a plan for sustaining the program after Federal
support for the program has ended.
``(c) Use of Funds.--An eligible entity receiving a grant
under this section may use amounts under the grant for any of
the following activities, but may use not more than 20
percent of the grant funds for activities described in
paragraphs (3) and (4):
``(1) To establish a program for prescribing a drug or
device approved or cleared under the Federal Food, Drug, and
Cosmetic Act for emergency treatment of known or suspected
opioid overdose.
``(2) To train and provide resources for health care
providers and pharmacists on the prescribing of drugs or
devices approved or cleared under the Federal Food, Drug, and
Cosmetic Act for emergency treatment of known or suspected
opioid overdose.
``(3) To purchase drugs or devices approved or cleared
under the Federal Food, Drug, and Cosmetic Act for emergency
treatment of known or suspected opioid overdose, for
distribution under the program described in paragraph (1).
``(4) To offset the co-payments and other cost sharing
associated with drugs or devices approved or cleared under
the Federal Food, Drug, and Cosmetic Act for emergency
treatment of known or suspected opioid overdose.
``(5) 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.
``(d) Evaluations by Recipients.--As a condition of receipt
of a grant under this section, an eligible entity shall, for
each year for which the grant is received, submit to the
Secretary an evaluation of activities funded by the grant
which contains such information as the Secretary may
reasonably require.
``(e) Reports by the Secretary.--Not later than 5 years
after the date on which the first grant under this section is
awarded, the Secretary shall submit to the appropriate
committees of the House of Representatives and of the Senate
a report aggregating the information received from the grant
recipients for such year under subsection (d) and evaluating
the outcomes achieved by the programs funded by grants
awarded under this section.
``(f) Authorization of Appropriations.--There is authorized
to be appropriated to carry out this section, $5,000,000 for
the period of fiscal years 2017 through 2021.''.
(b) Improving Access to Overdose Treatment.--
(1) Information on best practices.--Not later than 180 days
after the date of enactment of this Act:
(A) The Secretary of Health and Human Services may provide
information to prescribers within 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, on best
practices for prescribing or co-prescribing a drug or device
approved or cleared under the Federal Food, Drug, and
Cosmetic Act (21 U.S.C. 301 et seq.) for emergency treatment
of known or suspected opioid overdose, including for patients
receiving chronic opioid therapy and patients being treated
for opioid use disorders.
(B) The Secretary of Defense may provide information to
prescribers within Department of Defense medical facilities
on best practices for prescribing or co-prescribing a drug or
device approved or cleared under the Federal Food, Drug, and
Cosmetic Act (21 U.S.C. 301 et seq.) for emergency treatment
of known or suspected opioid overdose, including for patients
receiving chronic opioid therapy and patients being treated
for opioid use disorders.
(C) The Secretary of Veterans Affairs may provide
information to prescribers within Department of Veterans
Affairs medical facilities on best practices for prescribing
or co-prescribing a drug or device approved or cleared under
the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 301 et
seq.) for emergency treatment of known or suspected opioid
overdose, including for patients receiving chronic opioid
therapy and patients being treated for opioid use disorders.
(2) Rule of construction.--Nothing in this subsection
should be construed to establish or contribute to a medical
standard of care.
SEC. 108. NIH OPIOID RESEARCH.
(a) In General.--The Director of the National Institutes of
Health (referred to in this section as the ``NIH'') may
intensify and coordinate fundamental, translational, and
clinical research of the NIH with respect to--
(1) the understanding of pain;
(2) the discovery and development of therapies for chronic
pain; and
(3) the development of alternatives to opioids for
effective pain treatments.
(b) Priority and Direction.--The prioritization and
direction of the Federally funded portfolio of pain research
studies shall consider recommendations made by the
Interagency Pain Research Coordinating Committee in concert
with the Pain Management Best Practices Inter-Agency Task
Force, and in accordance with the National Pain Strategy, the
Federal Pain Research Strategy, and the NIH-Wide Strategic
Plan for Fiscal Years 2016-2020, the latter of which calls
for the relative burdens of individual diseases and medical
disorders to be regarded as crucial considerations in
balancing the priorities of the Federal research portfolio.
SEC. 109. NATIONAL ALL SCHEDULES PRESCRIPTION ELECTRONIC
REPORTING REAUTHORIZATION.
(a) Amendment to Purpose.--Paragraph (1) of section 2 of
the National All Schedules Prescription Electronic Reporting
Act of 2005 (Public Law 109-60) is amended to read as
follows:
``(1) foster the establishment of State-administered
controlled substance monitoring systems in order to ensure
that health care providers have access to the accurate,
timely prescription history information that they may use as
a tool for the early identification of patients at risk for
addiction in order to initiate appropriate medical
interventions and avert the tragic personal, family, and
community consequences of untreated addiction; and''.
(b) Amendments to Controlled Substance Monitoring
Program.--Section 399O of the Public Health Service Act (42
U.S.C. 280g-3) is amended--
(1) in subsection (a)(1)--
(A) in the matter preceding subparagraph (A), by inserting
``, in consultation with the Administrator of the Substance
Abuse and Mental Health Services Administration and Director
of the Centers for Disease Control and Prevention,'' after
``the Secretary'';
(B) in subparagraph (A), by striking ``or'';
(C) in subparagraph (B), by striking the period at the end
and inserting ``; or''; and
(D) by adding at the end the following:
``(C) to maintain an existing State-controlled substance
monitoring program.'';
(2) by amending subsection (b) to read as follows:
``(b) Minimum Requirements.--The Secretary shall maintain
and, as appropriate, supplement or revise (after publishing
proposed additions and revisions in the Federal Register and
receiving public comments thereon) minimum requirements for
criteria to be used by States for purposes of clauses (ii),
(v), (vi), and (vii) of subsection (c)(1)(A).'';
(3) in subsection (c)--
(A) in paragraph (1)(B)--
(i) in the matter preceding clause (i), by striking
``(a)(1)(B)'' and inserting ``(a)(1)(B) or (a)(1)(C)'';
(ii) in clause (i), by striking ``program to be improved''
and inserting ``program to be improved or maintained'';
(iii) by redesignating clauses (iii) and (iv) as clauses
(iv) and (v), respectively;
(iv) by inserting after clause (ii), the following:
``(iii) a plan to apply the latest advances in health
information technology, to the extent practicable, in order
to incorporate prescription drug monitoring program data
directly into the workflow of prescribers and dispensers to
ensure timely access to patients' controlled prescription
drug history;'';
(v) in clause (iv) (as so redesignated), by striking ``;
and'' and inserting the following: ``and at least one health
information technology system such as electronic health
records, health information exchanges, or e-prescribing
systems;'';
(vi) in clause (v) (as so redesignated)--
(I) by striking ``public health'' and inserting ``public
health or safety''; and
(II) by striking the period and inserting ``; and''; and
(vii) by adding at the end the following:
``(vi) information, where applicable, on how the controlled
substance monitoring program jointly works with the
applicant's respective State substance abuse agency to ensure
information collected and maintained by the controlled
substance monitoring program is used to inform the provision
of clinically appropriate substance use disorder services to
individuals in need.'';
(B) in paragraph (3)--
(i) by striking ``If a State that submits'' and inserting
the following:
``(A) In general.--If a State that submits'';
(ii) by inserting before the period at the end ``and
include timelines for full implementation of such
interoperability. The State shall also describe the manner in
which it will achieve interoperability between its monitoring
program and health information technology systems, as
allowable under State law, and include timelines for the
implementation of such interoperability''; and
(iii) by adding at the end the following:
``(B) Monitoring of efforts.--The Secretary shall monitor
State efforts to achieve interoperability, as described in
subparagraph (A).''; and
[[Page H4396]]
(C) in paragraph (5)--
(i) by striking ``implement or improve'' and inserting
``establish, improve, or maintain''; and
(ii) by adding at the end the following: ``The Secretary
shall redistribute any funds that are so returned among the
remaining grantees under this section in accordance with the
formula described in subsection (a)(2)(B).'';
(4) in subsection (d)--
(A) in the matter preceding paragraph (1)--
(i) by striking ``In implementing or improving'' and all
that follows through ``(a)(1)(B)'' and inserting ``In
establishing, improving, or maintaining a controlled
substance monitoring program under this section, a State
shall comply, or with respect to a State that applies for a
grant under subparagraph (B) or (C) of subsection (a)(1)'';
and
(ii) by striking ``public health'' and inserting ``public
health or safety''; and
(B) by adding at the end the following:
``(5) The State shall report on interoperability with the
controlled substance monitoring program of Federal agencies,
where appropriate, interoperability with health information
technology systems such as electronic health records, health
information exchanges, and e-prescribing, where appropriate,
and whether or not the State provides automatic, up-to-date,
or daily information about a patient when a practitioner (or
the designee of a practitioner, where permitted) requests
information about such patient.'';
(5) in subsections (e), (f)(1), and (g), by striking
``implementing or improving'' each place it appears and
inserting ``establishing, improving, or maintaining'';
(6) in subsection (f)--
(A) in paragraph (1)--
(i) in subparagraph (B), by striking ``misuse of a schedule
II, III, or IV substance'' and inserting ``misuse of a
controlled substance included in schedule II, III, or IV of
section 202(c) of the Controlled Substances Act''; and
(ii) in subparagraph (D)--
(I) by inserting ``a State substance abuse agency,'' after
``State health department,''; and
(II) by striking ``such department, program, or
administration'' each place it appears and inserting ``such
department, program, agency, or administration'' in each such
place; and
(B) by adding at the end the following:
``(3) Evaluation and reporting.--Subject to subsection (g),
a State receiving a grant under subsection (a) shall provide
the Secretary with aggregate data to enable the Secretary--
``(A) to evaluate the success of the State's program in
achieving its purposes; or
``(B) to prepare and submit the report to Congress required
by subsection (k)(2).
``(4) Research by other entities.--A department, program,
agency, or administration receiving nonidentifiable
information under paragraph (1)(D) may make such information
available to other entities for research purposes.'';
(7) by striking subsection (k);
(8) by redesignating subsections (h) through (j) as
subsections (i) through (k), respectively;
(9) in subsections (c)(1)(A)(iv) and (d)(4), by striking
``subsection (h)'' each place it appears and inserting
``subsection (i)'';
(10) by inserting after subsection (g) the following:
``(h) Education and Access to the Monitoring System.--A
State receiving a grant under subsection (a) shall take steps
to--
``(1) facilitate prescriber and dispenser use of the
State's controlled substance monitoring system, to the extent
practicable; and
``(2) educate prescribers and dispensers on the benefits of
the system.'';
(11) in subsection (k)(2)(A), as so redesignated--
(A) in clause (ii), by striking ``or affected'' and
inserting ``, established or strengthened initiatives to
ensure linkages to substance use disorder services, or
affected''; and
(B) in clause (iii), by striking ``including an
assessment'' and inserting ``and between controlled substance
monitoring programs and health information technology
systems, including an assessment'';
(12) in subsection (l)(1), by striking ``establishment,
implementation, or improvement'' and inserting
``establishment, improvement, or maintenance'';
(13) in subsection (m)(8), by striking ``and the District
of Columbia'' and inserting ``, the District of Columbia, and
any commonwealth or territory of the United States''; and
(14) by amending subsection (n) to read as follows:
``(n) Authorization of Appropriations.--To carry out this
section, there are authorized to be appropriated, $10,000,000
for each of fiscal years 2017 through 2021.''.
SEC. 110. OPIOID OVERDOSE REVERSAL MEDICATION ACCESS AND
EDUCATION GRANT PROGRAMS.
(a) In General.--Part D of title V of the Public Health
Service Act (42 U.S.C. 290dd et seq.), as amended by section
107, is further amended by adding at the end the following:
``SEC. 545. OPIOID OVERDOSE REVERSAL MEDICATION ACCESS AND
EDUCATION GRANT PROGRAMS.
``(a) Grants to States.--The Secretary shall make grants to
States to--
``(1) implement strategies for pharmacists to dispense a
drug or device approved or cleared under the Federal Food,
Drug, and Cosmetic Act for emergency treatment of known or
suspected opioid overdose, as appropriate, pursuant to a
standing order;
``(2) encourage pharmacies to dispense opioid overdose
reversal medication pursuant to a standing order;
``(3) develop or provide training materials that persons
authorized to prescribe or dispense a drug or device approved
or cleared under the Federal Food, Drug, and Cosmetic Act for
emergency treatment of known or suspected opioid overdose may
use to educate the public concerning--
``(A) when and how to safely administer such drug or
device; and
``(B) steps to be taken after administering such drug or
device; and
``(4) educate the public concerning the availability of
drugs or devices approved or cleared under the Federal Food,
Drug, and Cosmetic Act for emergency treatment of known or
suspected opioid overdose without a person-specific
prescription.
``(b) Certain Requirement.--A grant may be made under this
section only if the State involved has authorized standing
orders to be issued for drugs or devices approved or cleared
under the Federal Food, Drug, and Cosmetic Act for emergency
treatment of known or suspected opioid overdose.
``(c) Preference in Making Grants.--In making grants under
this section, the Secretary may give preference to States
that have a significantly higher rate of opioid overdoses
than the national average, and that--
``(1) have not implemented standing orders regarding drugs
or devices approved or cleared under the Federal Food, Drug,
and Cosmetic Act for emergency treatment of known or
suspected opioid overdose;
``(2) authorize standing orders to be issued that permit
community-based organizations, substance abuse programs, or
other nonprofit entities to acquire, dispense, or administer
drugs or devices approved or cleared under the Federal Food,
Drug, and Cosmetic Act for emergency treatment of known or
suspected opioid overdose; or
``(3) authorize standing orders to be issued that permit
police, fire, or emergency medical services agencies to
acquire and administer drugs or devices approved or cleared
under the Federal Food, Drug, and Cosmetic Act for emergency
treatment of known or suspected opioid overdose.
``(d) Grant Terms.--
``(1) Number.--A State may not receive more than one grant
under this section at a time.
``(2) Period.--A grant under this section shall be for a
period of 3 years.
``(3) Limitation.--A State may use not more than 20 percent
of a grant under this section for educating the public
pursuant to subsection (a)(4).
``(e) Applications.--To be eligible to receive a grant
under this section, a State shall submit an application to
the Secretary in such form and manner and containing such
information as the Secretary may reasonably require,
including detailed proposed expenditures of grant funds.
``(f) Reporting.--A State that receives a grant under this
section shall, at least annually for the duration of the
grant, submit a report to the Secretary evaluating the
progress of the activities supported through the grant. Such
reports shall include information on the number of pharmacies
in the State that dispense a drug or device approved or
cleared under the Federal Food, Drug, and Cosmetic Act for
emergency treatment of known or suspected opioid overdose
under a standing order, and other information as the
Secretary determines appropriate to evaluate the use of grant
funds.
``(g) Definitions.--In this section the term `standing
order' means a document prepared by a person authorized to
prescribe medication that permits another person to acquire,
dispense, or administer medication without a person-specific
prescription.
``(h) Authorization of Appropriations.--
``(1) In general.--To carry out this section, there are
authorized to be appropriated $5,000,000 for the period of
fiscal years 2017 through 2019.
``(2) Administrative costs.--Not more than 3 percent of the
amounts made available to carry out this section may be used
by the Secretary for administrative expenses of carrying out
this section.''.
(b) Technical Clarification.--Effective as if included in
the enactment of the Children's Health Act of 2000 (Public
Law 106-310), section 3405(a) of such Act (114 Stat. 1221) is
amended by striking ``Part E of title III'' and inserting
``Part E of title III of the Public Health Service Act''.
TITLE II--LAW ENFORCEMENT AND TREATMENT
SEC. 201. COMPREHENSIVE OPIOID ABUSE GRANT PROGRAM.
(a) Comprehensive Opioid Abuse Grant Program.--
(1) In general.--Title I of the Omnibus Crime Control and
Safe Streets Act of 1968 (42 U.S.C. 3711 et seq.) is amended
by adding at the end the following:
``PART LL--COMPREHENSIVE OPIOID ABUSE GRANT PROGRAM
``SEC. 3021. DESCRIPTION.
``(a) Grants Authorized.--From amounts made available to
carry out this part, the Attorney General may make grants to
States, units of local government, and Indian tribes, for use
by the State, unit of local government, or Indian tribe to
provide services primarily relating to opioid abuse,
including for any one or more of the following:
``(1) Developing, implementing, or expanding a treatment
alternative to incarceration program, which may include--
``(A) prebooking or postbooking components, which may
include the activities described in part DD or HH of this
title;
``(B) training for criminal justice agency personnel on
substance use disorders and co-occurring mental illness and
substance use disorders;
``(C) a mental health court, including the activities
described in part V of this title;
``(D) a drug court, including the activities described in
part EE of this title;
``(E) a veterans treatment court program, including the
activities described in subsection (i) of section 2991 of
this title;
[[Page H4397]]
``(F) a focus on parents whose incarceration could result
in their children entering the child welfare system; and
``(G) a community-based substance use diversion program
sponsored by a law enforcement agency.
``(2) In the case of a State, facilitating or enhancing
planning and collaboration between State criminal justice
agencies and State substance abuse agencies in order to more
efficiently and effectively carry out activities or services
described in any paragraph of this subsection that address
problems related to opioid abuse.
``(3) Providing training and resources for first responders
on carrying and administering an opioid overdose reversal
drug or device approved or cleared by the Food and Drug
Administration, and purchasing such a drug or device for
first responders who have received such training to so carry
and administer.
``(4) Locating or investigating illicit activities related
to the unlawful distribution of opioids.
``(5) Developing, implementing, or expanding a medication-
assisted treatment program used or operated by a criminal
justice agency, which may include training criminal justice
agency personnel on medication-assisted treatment, and
carrying out the activities described in part S of this
title.
``(6) In the case of a State, developing, implementing, or
expanding a prescription drug monitoring program to collect
and analyze data related to the prescribing of schedules II,
III, and IV controlled substances through a centralized
database administered by an authorized State agency, which
includes tracking the dispensation of such substances, and
providing for interoperability and data sharing with each
other such program in each other State, and with any
interstate entity that shares information between such
programs.
``(7) Developing, implementing, or expanding a program to
prevent and address opioid abuse by juveniles.
``(8) Developing, implementing, or expanding a program
(which may include demonstration projects) to utilize
technology that provides a secure container for prescription
drugs that would prevent or deter individuals, particularly
adolescents, from gaining access to opioid medications that
are lawfully prescribed for other individuals.
``(9) Developing, implementing, or expanding a prescription
drug take-back program.
``(10) Developing, implementing, or expanding an integrated
and comprehensive opioid abuse response program.
``(b) Contracts and Subawards.--A State, unit of local
government, or Indian tribe may, in using a grant under this
part for purposes authorized by subsection (a), use all or a
portion of that grant to contract with, or make one or more
subawards to, one or more--
``(1) local or regional organizations that are private and
nonprofit, including faith-based organizations;
``(2) units of local government; or
``(3) tribal organizations.
``(c) Program Assessment Component; Waiver.--
``(1) Program assessment component.--Each program funded
under this part shall contain a program assessment component,
developed pursuant to guidelines established by the Attorney
General, in coordination with the National Institute of
Justice.
``(2) Waiver.--The Attorney General may waive the
requirement of paragraph (1) with respect to a program if, in
the opinion of the Attorney General, the program is not of
sufficient size to justify a full program assessment.
``(d) Administrative Costs.--Not more than 10 percent of a
grant made under this part may be used for costs incurred to
administer such grant.
``(e) Period.--The period of a grant made under this part
may not be longer than 4 years, except that renewals and
extensions beyond that period may be granted at the
discretion of the Attorney General.
``SEC. 3022. APPLICATIONS.
``To request a grant under this part, the chief executive
officer of a State, unit of local government, or Indian tribe
shall submit an application to the Attorney General at such
time and in such form as the Attorney General may require.
Such application shall include the following:
``(1) A certification that Federal funds made available
under this part will not be used to supplant State, local, or
tribal funds, but will be used to increase the amounts of
such funds that would, in the absence of Federal funds, be
made available for the activities described in section
3021(a).
``(2) An assurance that, for each fiscal year covered by an
application, the applicant shall maintain and report such
data, records, and information (programmatic and financial)
as the Attorney General may reasonably require.
``(3) A certification, made in a form acceptable to the
Attorney General and executed by the chief executive officer
of the applicant (or by another officer of the applicant, if
qualified under regulations promulgated by the Attorney
General), that--
``(A) the activities or services to be funded by the grant
meet all the requirements of this part;
``(B) all the information contained in the application is
correct;
``(C) there has been appropriate coordination with affected
agencies; and
``(D) the applicant will comply with all provisions of this
part and all other applicable Federal laws.
``(4) An assurance that the applicant will work with the
Drug Enforcement Administration to develop an integrated and
comprehensive strategy to address opioid abuse.
``SEC. 3023. REVIEW OF APPLICATIONS.
``The Attorney General shall not finally disapprove any
application (or any amendment to that application) submitted
under this part without first affording the applicant
reasonable notice of any deficiencies in the application and
an opportunity for correction of any such deficiencies and
reconsideration.
``SEC. 3024. EQUITABLE DISTRIBUTION OF FUNDS.
``In awarding grants under this part, the Attorney General
shall distribute funds in a manner that--
``(1) equitably addresses the needs of underserved
populations, including rural and tribal communities; and
``(2) focuses on communities that have been
disproportionately impacted by opioid abuse as evidenced in
part by--
``(A) high rates of primary treatment admissions for heroin
and other opioids;
``(B) high rates of drug poisoning deaths from heroin and
other opioids; and
``(C) a lack of accessibility to treatment providers and
facilities and to emergency medical services.
``SEC. 3025. DEFINITIONS.
``In this part:
``(1) The term `first responder' includes a firefighter,
law enforcement officer, paramedic, emergency medical
technician, or other individual (including an employee of a
legally organized and recognized volunteer organization,
whether compensated or not), who, in the course of his or her
professional duties, responds to fire, medical, hazardous
material, or other similar emergencies.
``(2) The term `medication-assisted treatment' means the
use of medications approved by the Food and Drug
Administration for the treatment of opioid abuse.
``(3) The term `opioid' means any drug, including heroin,
having an addiction-forming or addiction-sustaining liability
similar to morphine or being capable of conversion into a
drug having such addiction-forming or addiction-sustaining
liability.
``(4) The term `schedule II, III, or IV controlled
substance' means a controlled substance that is listed on
schedule II, schedule III, or schedule IV of section 202(c)
of the Controlled Substances Act (21 U.S.C. 812(c)).
``(5) The terms `drug' and `device' have the meanings given
those terms in section 201 of the Federal Food, Drug, and
Cosmetic Act (21 U.S.C. 321).
``(6) The term `criminal justice agency' means a State,
local, or tribal--
``(A) court;
``(B) prison;
``(C) jail;
``(D) law enforcement agency; or
``(E) other agency that performs the administration of
criminal justice, including prosecution, pretrial services,
and community supervision.
``(7) The term `tribal organization' has the meaning given
that term in section 4 of the Indian Self-Determination and
Education Assistance Act (25 U.S.C. 450b).
``(8) The term `State substance abuse agency' has the
meaning given that term in section 508(r)(6) of the Public
Health Service Act (42 U.S.C. 290bb-1).''.
(2) Authorization of appropriations.--Section 1001(a) of
title I of the Omnibus Crime Control and Safe Streets Act of
1968 (42 U.S.C. 3793(a)) is amended by inserting after
paragraph (26) the following:
``(27) There are authorized to be appropriated to carry out
part LL $103,000,000 for each of fiscal years 2017 through
2021.''.
(b) Emergency Federal Law Enforcement Assistance.--Section
609Y(a) of the Justice Assistance Act of 1984 (42 U.S.C.
10513(a)) is amended by striking ``September 30, 1984'' and
inserting ``September 30, 2021''.
(c) Inclusion of Services for Pregnant Women Under Family-
Based Substance Abuse Grants.--Part DD of title I of the
Omnibus Crime Control and Safe Streets Act (42 U.S.C. 3797s
et seq.) is amended--
(1) in section 2921(2), by inserting before the period at
the end ``or pregnant women''; and
(2) in section 2927--
(A) in paragraph (1)(A), by inserting ``pregnant or''
before ``a parent''; and
(B) in paragraph (3), by inserting ``or pregnant women''
after ``incarcerated parents''.
(d) GAO Study and Report on Federal Agency Programs and
Research Relative to Substance Use and Substance Use
Disorders Among Adolescents and Young Adults.--
(1) Study.--The Comptroller General of the United States
shall conduct a study on how Federal agencies, through grant
programs, are addressing prevention of, treatment for, and
recovery from, substance use by, and substance use disorders
among, adolescents and young adults. Such study shall include
an analysis of each of the following:
(A) The research that has been, and is being, conducted or
supported pursuant to grant programs operated by Federal
agencies on prevention of, treatment for, and recovery from
substance use by and substance use disorders among
adolescents and young adults, including an assessment of--
(i) such research relative to any unique circumstances
(including social and biological circumstances) of
adolescents and young adults that may make adolescent-
specific and young adult-specific treatment protocols
necessary, including any effects that substance use and
substance use disorders may have on brain development and the
implications for treatment and recovery; and
(ii) areas of such research in which greater investment or
focus is necessary relative to other areas of such research.
(B) Federal agency nonresearch programs and activities that
address prevention of, treatment for, and recovery from
substance use by and substance use disorders among
adolescents and young adults, including an assessment of the
effectiveness of such programs and activities in
[[Page H4398]]
preventing substance use by and substance use disorders among
adolescents and young adults, treating such adolescents and
young adults in a way that accounts for any unique
circumstances faced by adolescents and young adults, and
supports long-term recovery among adolescents and young
adults.
(C) Gaps that have been identified by officials of Federal
agencies or experts in the efforts supported by grant
programs operated by Federal agencies relating to prevention
of, treatment for, and recovery from substance use by and
substance use disorders among adolescents and young adults,
including gaps in research, data collection, and measures to
evaluate the effectiveness of such efforts, and the reasons
for such gaps.
(2) Report.--Not later than 2 years after the date of
enactment of this Act, the Comptroller General shall submit
to the appropriate committees of the Congress a report
containing the results of the study conducted under paragraph
(1), including--
(A) a summary of the findings of the study; and
(B) recommendations based on the results of the study,
including recommendations for such areas of research and
legislative and administrative action as the Comptroller
General determines appropriate.
SEC. 202. FIRST RESPONDER TRAINING.
Part D of title V of the Public Health Service Act (42
U.S.C. 290dd et seq.), as amended by section 110, is further
amended by adding at the end the following:
``SEC. 546. FIRST RESPONDER TRAINING.
``(a) Program Authorized.--The Secretary shall make grants
to States, local governmental entities, and Indian tribes and
tribal organizations (as defined in section 4 of the Indian
Self-Determination and Education Assistance Act) to allow
first responders and members of other key community sectors
to administer a drug or device approved or cleared under the
Federal Food, Drug, and Cosmetic Act for emergency treatment
of known or suspected opioid overdose.
``(b) Application.--
``(1) In general.--An entity seeking a grant under this
section shall submit an application to the Secretary--
``(A) that meets the criteria under paragraph (2); and
``(B) at such time, in such manner, and accompanied by such
information as the Secretary may require.
``(2) Criteria.--An entity, in submitting an application
under paragraph (1), shall--
``(A) describe the evidence-based methodology and outcome
measurements that will be used to evaluate the program funded
with a grant under this section, and specifically explain how
such measurements will provide valid measures of the impact
of the program;
``(B) describe how the program could be broadly replicated
if demonstrated to be effective;
``(C) identify the governmental and community agencies with
which the entity will coordinate to implement the program;
and
``(D) describe how the entity will ensure that law
enforcement agencies will coordinate with their corresponding
State substance abuse and mental health agencies to identify
protocols and resources that are available to overdose
victims and families, including information on treatment and
recovery resources.
``(c) Use of Funds.--An entity shall use a grant received
under this section to--
``(1) make a drug or device approved or cleared under the
Federal Food, Drug, and Cosmetic Act for emergency treatment
of known or suspected opioid overdose available to be carried
and administered by first responders and members of other key
community sectors;
``(2) train and provide resources for first responders and
members of other key community sectors on carrying and
administering a drug or device approved or cleared under the
Federal Food, Drug, and Cosmetic Act for emergency treatment
of known or suspected opioid overdose; and
``(3) establish processes, protocols, and mechanisms for
referral to appropriate treatment, which may include an
outreach coordinator or team to connect individuals receiving
opioid overdose reversal drugs to followup services.
``(d) Technical Assistance Grants.--The Secretary shall
make a grant for the purpose of providing technical
assistance and training on the use of a drug or device
approved or cleared under the Federal Food, Drug, and
Cosmetic Act for emergency treatment of known or suspected
opioid overdose, and mechanisms for referral to appropriate
treatment for an entity receiving a grant under this section.
``(e) Geographic Distribution.--In making grants under this
section, the Secretary shall ensure that not less than 20
percent of grant funds are awarded to eligible entities that
are not located in metropolitan statistical areas (as defined
by the Office of Management and Budget). The Secretary shall
take into account the unique needs of rural communities,
including communities with an incidence of individuals with
opioid use disorder that is above the national average and
communities with a shortage of prevention and treatment
services.
``(f) Evaluation.--The Secretary shall conduct an
evaluation of grants made under this section to determine--
``(1) the number of first responders and members of other
key community sectors equipped with a drug or device approved
or cleared under the Federal Food, Drug, and Cosmetic Act for
emergency treatment of known or suspected opioid overdose;
``(2) the number of opioid and heroin overdoses reversed by
first responders and members of other key community sectors
receiving training and supplies of a drug or device approved
or cleared under the Federal Food, Drug, and Cosmetic Act for
emergency treatment of known or suspected opioid overdose,
through a grant received under this section;
``(3) the number of responses to requests for services by
the entity or subgrantee, to opioid and heroin overdose; and
``(4) the extent to which overdose victims and families
receive information about treatment services and available
data describing treatment admissions.
``(g) Authorization of Appropriations.--To carry out this
section, there are authorized to be appropriated $12,000,000
for each of fiscal years 2017 through 2021.''.
SEC. 203. PRESCRIPTION DRUG TAKE BACK EXPANSION.
(a) Definition of Covered Entity.--In this section, the
term ``covered entity'' means--
(1) a State, local, or tribal law enforcement agency;
(2) a manufacturer, distributor, or reverse distributor of
prescription medications;
(3) a retail pharmacy;
(4) a registered narcotic treatment program;
(5) a hospital or clinic with an onsite pharmacy;
(6) an eligible long-term care facility; or
(7) any other entity authorized by the Drug Enforcement
Administration to dispose of prescription medications.
(b) Program Authorized.--The Attorney General, in
coordination with the Administrator of the Drug Enforcement
Administration, the Secretary of Health and Human Services,
and the Director of the Office of National Drug Control
Policy, shall coordinate with covered entities in expanding
or making available disposal sites for unwanted prescription
medications.
TITLE III--TREATMENT AND RECOVERY
SEC. 301. EVIDENCE-BASED PRESCRIPTION OPIOID AND HEROIN
TREATMENT AND INTERVENTIONS DEMONSTRATION.
Subpart 1 of part B of title V of the Public Health Service
Act (42 U.S.C. 290bb et seq.) is amended by adding at the end
the following:
``SEC. 514B. EVIDENCE-BASED PRESCRIPTION OPIOID AND HEROIN
TREATMENT AND INTERVENTIONS DEMONSTRATION.
``(a) Grants To Expand Access.--
``(1) Authority to award grants.--The Secretary shall award
grants, contracts, or cooperative agreements to State
substance abuse agencies, units of local government,
nonprofit organizations, and Indian tribes and tribal
organizations (as defined in section 4 of the Indian Self-
Determination and Education Assistance Act) that have a high
rate, or have had a rapid increase, in the use of heroin or
other opioids, in order to permit such entities to expand
activities, including an expansion in the availability of
evidence-based medication-assisted treatment and other
clinically appropriate services, with respect to the
treatment of addiction in the specific geographical areas of
such entities where there is a high rate or rapid increase in
the use of heroin or other opioids, such as in rural areas.
``(2) Nature of activities.--Funds awarded under paragraph
(1) shall be used for activities that are based on reliable
scientific evidence of efficacy in the treatment of problems
related to heroin or other opioids.
``(b) Application.--To be eligible for a grant, contract,
or cooperative agreement under subsection (a), an entity
shall submit an application to the Secretary at such time, in
such manner, and accompanied by such information as the
Secretary may reasonably require.
``(c) Evaluation.--An entity that receives a grant,
contract, or cooperative agreement under subsection (a) shall
submit, in the application for such grant, contract, or
agreement a plan for the evaluation of any project undertaken
with funds provided under this section. Such entity shall
provide the Secretary with periodic evaluations of the
progress of such project and an evaluation at the completion
of such project as the Secretary determines to be
appropriate.
``(d) Geographic Distribution.--In awarding grants,
contracts, and cooperative agreements under this section, the
Secretary shall ensure that not less than 15 percent of funds
are awarded to eligible entities that are not located in
metropolitan statistical areas (as defined by the Office of
Management and Budget). The Secretary shall take into account
the unique needs of rural communities, including communities
with an incidence of individuals with opioid use disorder
that is above the national average and communities with a
shortage of prevention and treatment services.
``(e) Additional Activities.--In administering grants,
contracts, and cooperative agreements under subsection (a),
the Secretary shall--
``(1) evaluate the activities supported under such
subsection;
``(2) disseminate information, as appropriate, derived from
evaluations as the Secretary considers appropriate;
``(3) provide States, Indian tribes and tribal
organizations, and providers with technical assistance in
connection with the provision of treatment of problems
related to heroin and other opioids; and
``(4) fund only those applications that specifically
support recovery services as a critical component of the
program involved.
``(f) Authorization of Appropriations.--To carry out this
section, there are authorized to be appropriated $25,000,000
for each of fiscal years 2017 through 2021.''.
[[Page H4399]]
SEC. 302. BUILDING COMMUNITIES OF RECOVERY.
Part D of title V of the Public Health Service Act (42
U.S.C. 290dd et seq.), as amended by section 202, is further
amended by adding at the end the following:
``SEC. 547. BUILDING COMMUNITIES OF RECOVERY.
``(a) Definition.--In this section, the term `recovery
community organization' means an independent nonprofit
organization that--
``(1) mobilizes resources within and outside of the
recovery community to increase the prevalence and quality of
long-term recovery from substance use disorders; and
``(2) is wholly or principally governed by people in
recovery for substance use disorders who reflect the
community served.
``(b) Grants Authorized.--The Secretary shall award grants
to recovery community organizations to enable such
organizations to develop, expand, and enhance recovery
services.
``(c) Federal Share.--The Federal share of the costs of a
program funded by a grant under this section may not exceed
50 percent.
``(d) Use of Funds.--Grants awarded under subsection (b)--
``(1) shall be used to develop, expand, and enhance
community and statewide recovery support services; and
``(2) may be used to--
``(A) build connections between recovery networks, between
recovery community organizations, and with other recovery
support services, including--
``(i) behavioral health providers;
``(ii) primary care providers and physicians;
``(iii) the criminal justice system;
``(iv) employers;
``(v) housing services;
``(vi) child welfare agencies; and
``(vii) other recovery support services that facilitate
recovery from substance use disorders;
``(B) reduce the stigma associated with substance use
disorders; and
``(C) conduct outreach on issues relating to substance use
disorders and recovery, including--
``(i) identifying the signs of addiction;
``(ii) the resources available to individuals struggling
with addiction and to families with a family member
struggling with, or being treated for, addiction, including
programs that mentor and provide support services to
children;
``(iii) the resources available to help support individuals
in recovery; and
``(iv) related medical outcomes of substance use disorders,
the potential of acquiring an infectious disease from
intravenous drug use, and neonatal abstinence syndrome among
infants exposed to opioids during pregnancy.
``(e) Authorization of Appropriations.--There are
authorized to be appropriated to carry out this section
$1,000,000 for each of fiscal years 2017 through 2021.''.
SEC. 303. MEDICATION-ASSISTED TREATMENT FOR RECOVERY FROM
ADDICTION.
(a) In General.--
(1) In general.--Section 303(g)(2) of the Controlled
Substances Act (21 U.S.C. 823(g)(2)) is amended--
(A) in subparagraph (B), by striking clauses (i), (ii), and
(iii) and inserting the following:
``(i) The practitioner is a qualifying practitioner (as
defined in subparagraph (G)).
``(ii) With respect to patients to whom the practitioner
will provide such drugs or combinations of drugs, the
practitioner has the capacity to provide directly, by
referral, or in such other manner as determined by the
Secretary--
``(I) all drugs approved by the Food and Drug
Administration for the treatment of opioid use disorder,
including for maintenance, detoxification, overdose reversal,
and relapse prevention; and
``(II) appropriate counseling and other appropriate
ancillary services.
``(iii)(I) The total number of such patients of the
practitioner at any one time will not exceed the applicable
number. Except as provided in subclause (II), the applicable
number is 30.
``(II) The applicable number is 100 if, not sooner than 1
year after the date on which the practitioner submitted the
initial notification, the practitioner submits a second
notification to the Secretary of the need and intent of the
practitioner to treat up to 100 patients.
``(III) The Secretary may by regulation change such
applicable number.
``(IV) The Secretary may exclude from the applicable number
patients to whom such drugs or combinations of drugs are
directly administered by the qualifying practitioner in the
office setting.'';
(B) in subparagraph (D)--
(i) in clause (ii), by striking ``Upon receiving a
notification under subparagraph (B)'' and inserting ``Upon
receiving a determination from the Secretary under clause
(iii) finding that a practitioner meets all requirements for
a waiver under subparagraph (B)''; and
(ii) in clause (iii)--
(I) by inserting ``and shall forward such determination to
the Attorney General'' before the period at the end of the
first sentence; and
(II) by striking ``physician'' and inserting
``practitioner'';
(C) in subparagraph (G)--
(i) by amending clause (ii)(I) to read as follows:
``(I) The physician holds a board certification in
addiction psychiatry or addiction medicine from the American
Board of Medical Specialties.'';
(ii) by amending clause (ii)(II) to read as follows:
``(II) The physician holds an addiction certification or
board certification from the American Society of Addiction
Medicine or the American Board of Addiction Medicine.'';
(iii) in clause (ii)(III), by striking ``subspecialty'';
(iv) by amending clause (ii)(IV) to read as follows:
``(IV) The physician has, with respect to the treatment and
management of opiate-dependent patients, completed not less
than 8 hours of training (through classroom situations,
seminars at professional society meetings, electronic
communications, or otherwise) that is provided by the
American Society of Addiction Medicine, the American Academy
of Addiction Psychiatry, the American Medical Association,
the American Osteopathic Association, the American
Psychiatric Association, or any other organization that the
Secretary determines is appropriate for purposes of this
subclause. Such training shall include--
``(aa) opioid maintenance and detoxification;
``(bb) appropriate clinical use of all drugs approved by
the Food and Drug Administration for the treatment of opioid
use disorder;
``(cc) initial and periodic patient assessments (including
substance use monitoring);
``(dd) individualized treatment planning, overdose
reversal, and relapse prevention;
``(ee) counseling and recovery support services;
``(ff) staffing roles and considerations;
``(gg) diversion control; and
``(hh) other best practices, as identified by the
Secretary.''; and
(v) by adding at the end the following:
``(iii) The term `qualifying practitioner' means--
``(I) a qualifying physician, as defined in clause (ii); or
``(II) during the period beginning on the date of enactment
of the Comprehensive Addiction and Recovery Act of 2016 and
ending on October 1, 2021, a qualifying other practitioner,
as defined in clause (iv).
``(iv) The term `qualifying other practitioner' means a
nurse practitioner or physician assistant who satisfies each
of the following:
``(I) The nurse practitioner or physician assistant is
licensed under State law to prescribe schedule III, IV, or V
medications for the treatment of pain.
``(II) The nurse practitioner or physician assistant has--
``(aa) completed not fewer than 24 hours of initial
training addressing each of the topics listed in clause
(ii)(IV) (through classroom situations, seminars at
professional society meetings, electronic communications, or
otherwise) provided by the American Society of Addiction
Medicine, the American Academy of Addiction Psychiatry, the
American Medical Association, the American Osteopathic
Association, the American Nurses Credentialing Center, the
American Psychiatric Association, the American Association of
Nurse Practitioners, the American Academy of Physician
Assistants, or any other organization that the Secretary
determines is appropriate for purposes of this subclause; or
``(bb) has such other training or experience as the
Secretary determines will demonstrate the ability of the
nurse practitioner or physician assistant to treat and manage
opiate-dependent patients.
``(III) The nurse practitioner or physician assistant is
supervised by, or works in collaboration with, a qualifying
physician, if the nurse practitioner or physician assistant
is required by State law to prescribe medications for the
treatment of opioid use disorder in collaboration with or
under the supervision of a physician.
The Secretary may, by regulation, revise the requirements for
being a qualifying other practitioner under this clause.'';
and
(D) in subparagraph (H)--
(i) in clause (i), by inserting after subclause (II) the
following:
``(III) Such other elements of the requirements under this
paragraph as the Secretary determines necessary for purposes
of implementing such requirements.''; and
(ii) by amending clause (ii) to read as follows:
``(ii) Not later than 18 months after the date of enactment
of the Opioid Use Disorder Treatment Expansion and
Modernization Act, the Secretary shall update the treatment
improvement protocol containing best practice guidelines for
the treatment of opioid-dependent patients in office-based
settings. The Secretary shall update such protocol in
consultation with experts in opioid use disorder research and
treatment.''.
(2) Opioid defined.--Section 102(18) of the Controlled
Substances Act (21 U.S.C. 802(18)) is amended by inserting
``or `opioid' '' after ``The term `opiate' ''.
(3) Reports to congress.--
(A) In general.--Not later than 3 years after the date of
enactment of this Act and not later than 3 years thereafter,
the Secretary of Health and Human Services, in consultation
with the Drug Enforcement Administration and experts in
opioid use disorder research and treatment, shall--
(i) perform a thorough review of the provision of opioid
use disorder treatment services in the United States,
including services provided in opioid treatment programs and
other specialty and nonspecialty settings; and
(ii) submit a report to the Congress on the findings and
conclusions of such review.
(B) Contents.--Each report under subparagraph (A) shall
include an assessment of--
(i) compliance with the requirements of section 303(g)(2)
of the Controlled Substances Act (21 U.S.C. 823(g)(2)), as
amended by this section;
(ii) the measures taken by the Secretary of Health and
Human Services to ensure such compliance;
(iii) whether there is further need to increase or decrease
the number of patients a practitioner, pursuant to a waiver
under section 303(g)(2) of the Controlled Substances Act (21
U.S.C. 823(g)(2)), is permitted to treat;
(iv) the extent to which, and proportions with which, the
full range of Food and Drug Administration-approved
treatments for opioid use disorder are used in routine health
care settings
[[Page H4400]]
and specialty substance use disorder treatment settings;
(v) access to, and use of, counseling and recovery support
services, including the percentage of patients receiving such
services;
(vi) changes in State or local policies and legislation
relating to opioid use disorder treatment;
(vii) the use of prescription drug monitoring programs by
practitioners who are permitted to dispense narcotic drugs to
individuals pursuant to a waiver described in clause (iii);
(viii) the findings resulting from inspections by the Drug
Enforcement Administration of practitioners described in
clause (vii); and
(ix) the effectiveness of cross-agency collaboration
between Department of Health and Human Services and the Drug
Enforcement Administration for expanding effective opioid use
disorder treatment.
(b) State Flexibility.--Section 303(g)(2) of the Controlled
Substances Act (21 U.S.C. 823(g)(2)) is amended by striking
subparagraphs (I) and (J), and inserting the following:
``(I) Notwithstanding section 708, nothing in this
paragraph shall be construed to preempt any State law that--
``(i) permits a qualifying practitioner to dispense
narcotic drugs in schedule III, IV, or V, or combinations of
such drugs, for maintenance or detoxification treatment in
accordance with this paragraph to a total number of patients
that is more than 30 or less than the total number applicable
to the qualifying practitioner under subparagraph
(B)(iii)(II) if a State enacts a law modifying such total
number and the Attorney General is notified by the State of
such modification; or
``(ii) requires a qualifying practitioner to comply with
additional requirements relating to the dispensing of
narcotic drugs in schedule III, IV, or V, or combinations of
such drugs, including requirements relating to the practice
setting in which the qualifying practitioner practices and
education, training, and reporting requirements.''.
(c) Update Regulations.--Not later than 18 months after the
date of enactment of this Act, the Attorney General and the
Secretary of Health and Human Services, as appropriate, shall
update regulations regarding practitioners described in
subsection (a)(3)(B)(vii) (as amended by this section) to
include nurse practitioners and physician assistants to
ensure the quality of patient care and prevent diversion.
TITLE IV--ADDRESSING COLLATERAL CONSEQUENCES
SEC. 401. GAO REPORT ON RECOVERY AND COLLATERAL CONSEQUENCES.
(a) Report Required.--Not later than 1 year after the date
of enactment of this Act, the Comptroller General of the
United States shall submit to the Committee on the Judiciary
of the Senate and the Committee on the Judiciary of the House
of Representatives a report that--
(1) describes the collateral consequences for individuals
with convictions for nonviolent drug-related offenses;
(2) describes the effect of the collateral consequences
described in paragraph (1) on individuals in resuming their
personal and professional activities, especially, to the
extent data are available, the effect on individuals who are
participating in or have completed a recovery program for a
substance use disorder;
(3) discusses policy bases and justifications for imposing
collateral consequences on individuals convicted of
nonviolent drug-related offenses identified under paragraph
(1); and
(4) provides perspectives on the potential for mitigating
the effect of the collateral consequences described in
paragraph (1) on individuals who are participating in or have
completed a recovery program, while also taking into account
the policy interests described in paragraph (3).
(b) Definition.--In this section, the term ``collateral
consequence''--
(1) means a penalty, disability, or disadvantage imposed
upon an individual as a result of a criminal conviction for a
drug-related offense--
(A) automatically by operation of law; or
(B) by authorized action of an administrative agency or
court on a case-by-case basis; and
(2) does not include a direct consequence imposed as part
of the judgment of a court at sentencing, including a term of
imprisonment or community supervision, or a fine.
TITLE V--ADDICTION AND TREATMENT SERVICES FOR WOMEN, FAMILIES, AND
VETERANS
SEC. 501. IMPROVING TREATMENT FOR PREGNANT AND POSTPARTUM
WOMEN.
(a) General Amendments to the Residential Treatment Program
for Pregnant and Postpartum Women.--Section 508 of the Public
Health Service Act (42 U.S.C. 290bb-1) is amended--
(1) in subsection (a)--
(A) in the matter preceding paragraph (1)--
(i) by inserting ``(referred to in this section as the
`Director')'' after ``Substance Abuse Treatment'';
(ii) by striking ``grants, cooperative agreement,'' and
inserting ``grants, including the grants under subsection
(r), cooperative agreements''; and
(iii) by striking ``for substance abuse'' and inserting
``for substance use disorders''; and
(B) in paragraph (1), by inserting ``or receive outpatient
treatment services from'' after ``reside in'';
(2) in subsection (b)(2), by inserting ``and her children''
before the period at the end;
(3) in subsection (c)--
(A) in paragraph (1), by striking ``to the woman of the
services'' and inserting ``of services for the woman and her
children''; and
(B) in paragraph (2)--
(i) in subparagraph (A), by striking ``substance abuse''
and inserting ``substance use disorders''; and
(ii) in subparagraph (B), by striking ``such abuse'' and
inserting ``such a disorder'';
(4) in subsection (d)--
(A) in paragraph (3)(A), by striking ``maternal substance
abuse'' and inserting ``a maternal substance use disorder'';
(B) by amending paragraph (4) to read as follows:
``(4) Providing therapeutic, comprehensive child care for
children during the periods in which the woman is engaged in
therapy or in other necessary health and rehabilitative
activities.'';
(C) in paragraphs (9), (10), and (11), by striking
``women'' each place such term appears and inserting
``woman'';
(D) in paragraph (9), by striking ``units'' and inserting
``unit''; and
(E) in paragraph (11)--
(i) in subparagraph (A), by striking ``their children'' and
inserting ``any child of such woman'';
(ii) in subparagraph (B), by striking ``; and'' and
inserting a semicolon;
(iii) in subparagraph (C), by striking the period and
inserting ``; and''; and
(iv) by adding at the end the following:
``(D) family reunification with children in kinship or
foster care arrangements, where safe and appropriate.'';
(5) in subsection (e)--
(A) in paragraph (1)--
(i) in the matter preceding subparagraph (A), by striking
``substance abuse'' and inserting ``substance use
disorders''; and
(ii) in subparagraph (B), by striking ``substance abuse''
and inserting ``substance use disorders''; and
(B) in paragraph (2)--
(i) by striking ``(A) Subject'' and inserting the
following:
``(A) In general.--Subject'';
(ii) in subparagraph (B)--
(I) by striking ``(B)(i) In the case'' and inserting the
following:
``(B) Waiver of participation agreements.--
``(i) In general.--In the case''; and
(II) by striking ``(ii) A determination'' and inserting the
following:
``(ii) Donations.--A determination''; and
(iii) by striking ``(C) With respect'' and inserting the
following:
``(C) Nonapplication of certain requirements.--With
respect'';
(6) in subsection (g)--
(A) by striking ``who are engaging in substance abuse'' and
inserting ``who have a substance use disorder''; and
(B) by striking ``such abuse'' and inserting ``such
disorder'';
(7) in subsection (j)--
(A) in the matter preceding paragraph (1), by striking ``to
on'' and inserting ``to or on''; and
(B) in paragraph (3), by striking ``Office for'' and
inserting ``Office of'';
(8) by amending subsection (m) to read as follows:
``(m) Allocation of Awards.--In making awards under
subsection (a), the Director shall give priority to an
applicant that agrees to use the award for a program serving
an area that is a rural area, an area designated under
section 332 by the Secretary as a health professional
shortage area, or an area determined by the Director to have
a shortage of family-based substance use disorder treatment
options.''; and
(9) in subsection (q)--
(A) in paragraph (3), by striking ``funding agreement under
subsection (a)'' and inserting ``funding agreement''; and
(B) in paragraph (4), by striking ``substance abuse'' and
inserting ``a substance use disorder''.
(b) Reauthorization of Program.--Section 508 of the Public
Health Service Act (42 U.S.C. 290bb-1), as amended by
subsection (a), is further amended--
(1) in subsection (p), in the first sentence, by inserting
``(other than subsection (r))'' after ``section''; and
(2) in subsection (r), by striking ``such sums'' and all
that follows through ``2003'' and inserting ``$16,900,000 for
each of fiscal years 2017 through 2021''.
(c) Pilot Program Grants for State Substance Abuse
Agencies.--
(1) In general.--Section 508 of the Public Health Service
Act (42 U.S.C. 290bb-1), as amended by subsections (a) and
(b), is further amended--
(A) by redesignating subsection (r), as amended by
subsection (b), as subsection (s); and
(B) by inserting after subsection (q) the following new
subsection:
``(r) Pilot Program for State Substance Abuse Agencies.--
``(1) In general.--From amounts made available under
subsection (s), the Director of the Center for Substance
Abuse Treatment shall carry out a pilot program under which
competitive grants are made by the Director to State
substance abuse agencies--
``(A) to enhance flexibility in the use of funds designed
to support family-based services for pregnant and postpartum
women with a primary diagnosis of a substance use disorder,
including opioid use disorders;
``(B) to help State substance abuse agencies address
identified gaps in services furnished to such women along the
continuum of care, including services provided to women in
nonresidential-based settings; and
``(C) to promote a coordinated, effective, and efficient
State system managed by State substance abuse agencies by
encouraging new approaches and models of service delivery.
``(2) Requirements.--In carrying out the pilot program
under this subsection, the Director shall--
[[Page H4401]]
``(A) require State substance abuse agencies to submit to
the Director applications, in such form and manner and
containing such information as specified by the Director, to
be eligible to receive a grant under the program;
``(B) identify, based on such submitted applications, State
substance abuse agencies that are eligible for such grants;
``(C) require services proposed to be furnished through
such a grant to support family-based treatment and other
services for pregnant and postpartum women with a primary
diagnosis of a substance use disorder, including opioid use
disorders;
``(D) not require that services furnished through such a
grant be provided solely to women that reside in facilities;
``(E) not require that grant recipients under the program
make available through use of the grant all the services
described in subsection (d); and
``(F) consider not applying the requirements described in
paragraphs (1) and (2) of subsection (f) to an applicant,
depending on the circumstances of the applicant.
``(3) Required services.--
``(A) In general.--The Director shall specify a minimum set
of services required to be made available to eligible women
through a grant awarded under the pilot program under this
subsection. Such minimum set of services--
``(i) shall include the services requirements described in
subsection (c) and be based on the recommendations submitted
under subparagraph (B); and
``(ii) may be selected from among the services described in
subsection (d) and include other services as appropriate.
``(B) Stakeholder input.--The Director shall convene and
solicit recommendations from stakeholders, including State
substance abuse agencies, health care providers, persons in
recovery from substance abuse, and other appropriate
individuals, for the minimum set of services described in
subparagraph (A).
``(4) Duration.--The pilot program under this subsection
shall not exceed 5 years.
``(5) Evaluation and report to congress.--
``(A) In general.--The Director of the Center for
Behavioral Health Statistics and Quality shall evaluate the
pilot program at the conclusion of the first grant cycle
funded by the pilot program.
``(B) Report.--The Director of the Center for Behavioral
Health Statistics and Quality, in coordination with the
Director of the Center for Substance Abuse Treatment shall
submit to the relevant committees of jurisdiction of the
House of Representatives and the Senate a report on the
evaluation under subparagraph (A). The report shall include,
at a minimum--
``(i) outcomes information from the pilot program,
including any resulting reductions in the use of alcohol and
other drugs;
``(ii) engagement in treatment services;
``(iii) retention in the appropriate level and duration of
services;
``(iv) increased access to the use of medications approved
by the Food and Drug Administration for the treatment of
substance use disorders in combination with counseling; and
``(v) other appropriate measures.
``(C) Recommendation.--The report under subparagraph (B)
shall include a recommendation by the Director of the Center
for Substance Abuse Treatment as to whether the pilot program
under this subsection should be extended.
``(6) State substance abuse agencies defined.--For purposes
of this subsection, the term `State substance abuse agency'
means, with respect to a State, the agency in such State that
manages the Substance Abuse Prevention and Treatment Block
Grant under part B of title XIX.''.
(2) Funding.--Subsection (s) of section 508 of the Public
Health Service Act (42 U.S.C. 290bb-1), as amended by
subsection (a) and redesignated by paragraph (1), is further
amended by adding at the end the following new sentences:
``Of the amounts made available for a year pursuant to the
previous sentence to carry out this section, not more than 25
percent of such amounts shall be made available for such year
to carry out subsection (r), other than paragraph (5) of such
subsection. Notwithstanding the preceding sentence, no funds
shall be made available to carry out subsection (r) for a
fiscal year unless the amount made available to carry out
this section for such fiscal year is more than the amount
made available to carry out this section for fiscal year
2016.''.
SEC. 502. VETERANS TREATMENT COURTS.
Section 2991 of the Omnibus Crime Control and Safe Streets
Act of 1968 (42 U.S.C. 3797aa) is amended--
(1) by redesignating subsection (i) as subsection (j); and
(2) by inserting after subsection (h) the following:
``(i) Assisting Veterans.--
``(1) Definitions.--In this subsection:
``(A) Peer-to-peer services or programs.--The term `peer-
to-peer services or programs' means services or programs that
connect qualified veterans with other veterans for the
purpose of providing support and mentorship to assist
qualified veterans in obtaining treatment, recovery,
stabilization, or rehabilitation.
``(B) Qualified veteran.--The term `qualified veteran'
means a preliminarily qualified offender who--
``(i) served on active duty in any branch of the Armed
Forces, including the National Guard or Reserves; and
``(ii) was discharged or released from such service under
conditions other than dishonorable, unless the reason for the
dishonorable discharge was attributable to a substance abuse
disorder.
``(C) Veterans treatment court program.--The term `veterans
treatment court program' means a court program involving
collaboration among criminal justice, veterans, and mental
health and substance abuse agencies that provides qualified
veterans with--
``(i) intensive judicial supervision and case management,
which may include random and frequent drug testing where
appropriate;
``(ii) a full continuum of treatment services, including
mental health services, substance abuse services, medical
services, and services to address trauma;
``(iii) alternatives to incarceration; or
``(iv) other appropriate services, including housing,
transportation, mentoring, employment, job training,
education, or assistance in applying for and obtaining
available benefits.
``(2) Veterans assistance program.--
``(A) In general.--The Attorney General, in consultation
with the Secretary of Veterans Affairs, may award grants
under this subsection to applicants to establish or expand--
``(i) veterans treatment court programs;
``(ii) peer-to-peer services or programs for qualified
veterans;
``(iii) practices that identify and provide treatment,
rehabilitation, legal, transitional, and other appropriate
services to qualified veterans who have been incarcerated; or
``(iv) training programs to teach criminal justice, law
enforcement, corrections, mental health, and substance abuse
personnel how to identify and appropriately respond to
incidents involving qualified veterans.
``(B) Priority.--In awarding grants under this subsection,
the Attorney General shall give priority to applications
that--
``(i) demonstrate collaboration between and joint
investments by criminal justice, mental health, substance
abuse, and veterans service agencies;
``(ii) promote effective strategies to identify and reduce
the risk of harm to qualified veterans and public safety; and
``(iii) propose interventions with empirical support to
improve outcomes for qualified veterans.''.
SEC. 503. INFANT PLAN OF SAFE CARE.
(a) Best Practices for Development of Plans of Safe Care.--
Section 103(b) of the Child Abuse Prevention and Treatment
Act (42 U.S.C. 5104(b)) is amended--
(1) by redesignating paragraphs (5) through (8) as
paragraphs (6) through (9), respectively; and
(2) by inserting after paragraph (4) the following:
``(5) maintain and disseminate information about the
requirements of section 106(b)(2)(B)(iii) and best practices
relating to the development of plans of safe care as
described in such section for infants born and identified as
being affected by substance abuse or withdrawal symptoms, or
a Fetal Alcohol Spectrum Disorder;''.
(b) State Plans.--Section 106(b)(2)(B) of the Child Abuse
Prevention and Treatment Act (42 U.S.C. 5106a(b)(2)(B)) is
amended--
(1) in clause (ii), by striking ``illegal substance abuse''
and inserting ``substance abuse''; and
(2) in clause (iii)--
(A) by striking ``illegal substance abuse'' and inserting
``substance abuse''; and
(B) by inserting before the semicolon at the end the
following: ``to ensure the safety and well-being of such
infant following release from the care of health care
providers, including through--
``(I) addressing the health and substance use disorder
treatment needs of the infant and affected family or
caregiver; and
``(II) the development and implementation by the State of
monitoring systems regarding the implementation of such plans
to determine whether and in what manner local entities are
providing, in accordance with State requirements, referrals
to and delivery of appropriate services for the infant and
affected family or caregiver''.
(c) Data Reports.--
(1) In general.--Section 106(d) of the Child Abuse
Prevention and Treatment Act (42 U.S.C. 5106a(d)) is amended
by adding at the end of the following:
``(17) The number of infants--
``(A) identified under subsection (b)(2)(B)(ii);
``(B) for whom a plan of safe care was developed under
subsection (b)(2)(B)(iii); and
``(C) for whom a referral was made for appropriate
services, including services for the affected family or
caregiver, under subsection (b)(2)(B)(iii).''.
(2) Redesignation.--Effective on May 29, 2017, section
106(d) of the Child Abuse Prevention and Treatment Act (42
U.S.C. 5106a(d)) is amended by redesignating paragraph (17)
(as added by paragraph (1)) as paragraph (18).
(d) Monitoring and Oversight.--
(1) Amendment.--Title I of the Child Abuse Prevention and
Treatment Act (42 U.S.C. 5101 et seq.) is amended by adding
at the end the following:
``SEC. 114. MONITORING AND OVERSIGHT.
``The Secretary shall conduct monitoring to ensure that
each State that receives a grant under section 106 is in
compliance with the requirements of section 106(b), which--
``(1) shall--
``(A) be in addition to the review of the State plan upon
its submission under section 106(b)(1)(A); and
``(B) include monitoring of State policies and procedures
required under clauses (ii) and (iii) of section
106(b)(2)(B); and
``(2) may include--
``(A) a comparison of activities carried out by the State
to comply with the requirements of section 106(b) with the
State plan most recently approved under section 432 of the
Social Security Act;
``(B) a review of information available on the website of
the State relating to its compliance with the requirements of
section 106(b);
``(C) site visits, as may be necessary to carry out such
monitoring; and
[[Page H4402]]
``(D) a review of information available in the State's
Annual Progress and Services Report most recently submitted
under section 1357.16 of title 45, Code of Federal
Regulations (or successor regulations).''.
(2) Table of contents.--The table of contents in section
1(b) of the Child Abuse Prevention and Treatment Act (42
U.S.C. 5101 note) is amended by inserting after the item
relating to section 113, the following:
``Sec. 114. Monitoring and oversight.''.
(e) Rule of Construction.--Nothing in this section, or the
amendments made by this section, shall be construed to
authorize the Secretary of Health and Human Services or any
other officer of the Federal Government to add new
requirements to section 106(b) of the Child Abuse Prevention
and Treatment Act (42 U.S.C. 5106a(b)), as amended by this
section.
SEC. 504. GAO REPORT ON NEONATAL ABSTINENCE SYNDROME (NAS).
(a) In General.--Not later than 1 year after the date of
the enactment of this Act, the Comptroller General of the
United States shall submit to the Committee on Energy and
Commerce of the House of Representatives and the Committee on
Finance and the Committee on Health, Education, Labor, and
Pensions of the Senate a report on neonatal abstinence
syndrome (in this section referred to as ``NAS'') in the
United States.
(b) Information To Be Included in Report.--Such report
shall include information on the following:
(1) The prevalence of NAS in the United States, including
the proportion of children born in the United States with NAS
who are eligible for medical assistance under State Medicaid
programs under title XIX of the Social Security Act (42
U.S.C. 1396 et seq.) at birth, and the costs associated with
coverage under such programs for treatment of infants with
NAS.
(2) The services for which coverage is available under
State Medicaid programs for treatment of infants with NAS.
(3) The settings (including inpatient, outpatient,
hospital-based, and other settings) for the treatment of
infants with NAS and the reimbursement methodologies and
costs associated with such treatment in such settings.
(4) The prevalence of utilization of various care settings
under State Medicaid programs for treatment of infants with
NAS and any Federal barriers to treating such infants under
such programs, particularly in non-hospital-based settings.
(5) What is known about best practices for treating infants
with NAS.
(c) Recommendations.--Such report also shall include such
recommendations as the Comptroller General determines
appropriate for improvements that will ensure access to
treatment for infants with NAS under State Medicaid programs.
TITLE VI--INCENTIVIZING STATE COMPREHENSIVE INITIATIVES TO ADDRESS
PRESCRIPTION OPIOID ABUSE
SEC. 601. STATE DEMONSTRATION GRANTS FOR COMPREHENSIVE OPIOID
ABUSE RESPONSE.
Part D of title V of the Public Health Service Act (42
U.S.C. 290dd et seq.), as amended by section 302, is further
amended by adding at the end the following:
``SEC. 548. STATE DEMONSTRATION GRANTS FOR COMPREHENSIVE
OPIOID ABUSE RESPONSE.
``(a) Definitions.--In this section:
``(1) Dispenser.--The term `dispenser' has the meaning
given the term in section 102 of the Controlled Substances
Act (21 U.S.C. 802).
``(2) Prescriber.--The term `prescriber' means a dispenser
who prescribes a controlled substance, or the agent of such a
dispenser.
``(3) Prescriber of a schedule ii, iii, or iv controlled
substance.--The term `prescriber of a schedule II, III, or IV
controlled substance' does not include a prescriber of a
schedule II, III, or IV controlled substance that dispenses
the substance--
``(A) for use on the premises on which the substance is
dispensed;
``(B) in a hospital emergency room, when the substance is
in short supply;
``(C) for a certified opioid treatment program; or
``(D) in other situations as the Secretary may reasonably
determine.
``(4) Schedule ii, iii, or iv controlled substance.--The
term `schedule II, III, or IV controlled substance' means a
controlled substance that is listed on schedule II, schedule
III, or schedule IV of section 202(c) of the Controlled
Substances Act.
``(b) Grants for Comprehensive Opioid Abuse Response.--
``(1) In general.--The Secretary shall award grants to
States, and combinations of States, to implement an
integrated opioid abuse response initiative.
``(2) Purposes.--A State receiving a grant under this
section shall establish a comprehensive response plan to
opioid abuse, which may include--
``(A) education efforts around opioid use, treatment, and
addiction recovery, including education of residents, medical
students, and physicians and other prescribers of schedule
II, III, or IV controlled substances on relevant prescribing
guidelines, the prescription drug monitoring program of the
State described in subparagraph (B), and overdose prevention
methods;
``(B) establishing, maintaining, or improving a
comprehensive prescription drug monitoring program to track
dispensing of schedule II, III, or IV controlled substances,
which may--
``(i) provide for data sharing with other States; and
``(ii) allow all individuals authorized by the State to
write prescriptions for schedule II, III, or IV controlled
substances to access the prescription drug monitoring program
of the State;
``(C) developing, implementing, or expanding prescription
drug and opioid addiction treatment programs by--
``(i) expanding the availability of treatment for
prescription drug and opioid addiction, including medication-
assisted treatment and behavioral health therapy, as
appropriate;
``(ii) developing, implementing, or expanding screening for
individuals in treatment for prescription drug and opioid
addiction for hepatitis C and HIV, and treating or referring
those individuals if clinically appropriate; or
``(iii) developing, implementing, or expanding recovery
support services and programs at high schools or institutions
of higher education;
``(D) developing, implementing, and expanding efforts to
prevent overdose death from opioid abuse or addiction to
prescription medications and opioids; and
``(E) advancing the education and awareness of the public,
providers, patients, consumers, and other appropriate
entities regarding the dangers of opioid abuse, safe disposal
of prescription medications, and detection of early warning
signs of opioid use disorders.
``(3) Application.--A State seeking a grant under this
section shall submit to the Secretary an application in such
form, and containing such information, as the Secretary may
reasonably require.
``(4) Use of funds.--A State that receives a grant under
this section shall use the grant for the cost, including the
cost for technical assistance, training, and administration
expenses, of carrying out an integrated opioid abuse response
initiative as outlined by the State's comprehensive response
plan to opioid abuse established under paragraph (2).
``(5) Priority considerations.--In awarding grants under
this section, the Secretary shall, as appropriate, give
priority to a State that--
``(A)(i) provides civil liability protection for first
responders, health professionals, and family members who have
received appropriate training in administering a drug or
device approved or cleared under the Federal Food, Drug, and
Cosmetic Act for emergency treatment of known or suspected
opioid overdose; and
``(ii) submits to the Secretary a certification by the
attorney general of the State that the attorney general has--
``(I) reviewed any applicable civil liability protection
law to determine the applicability of the law with respect to
first responders, health care professionals, family members,
and other individuals who--
``(aa) have received appropriate training in administering
a drug or device approved or cleared under the Federal Food,
Drug, and Cosmetic Act for emergency treatment of known or
suspected opioid overdose; and
``(bb) may administer a drug or device approved or cleared
under the Federal Food, Drug, and Cosmetic Act for emergency
treatment of known or suspected opioid overdose; and
``(II) concluded that the law described in subclause (I)
provides adequate civil liability protection applicable to
such persons;
``(B) has a process for enrollment in services and benefits
necessary by criminal justice agencies to initiate or
continue treatment in the community, under which an
individual who is incarcerated may, while incarcerated,
enroll in services and benefits that are necessary for the
individual to continue treatment upon release from
incarceration;
``(C) ensures the capability of data sharing with other
States, where applicable, such as by making data available to
a prescription monitoring hub;
``(D) ensures that data recorded in the prescription drug
monitoring program database of the State are regularly
updated, to the extent possible;
``(E) ensures that the prescription drug monitoring program
of the State notifies prescribers and dispensers of schedule
II, III, or IV controlled substances when overuse or misuse
of such controlled substances by patients is suspected; and
``(F) has in effect one or more statutes or implements
policies that maximize use of prescription drug monitoring
programs by individuals authorized by the State to prescribe
schedule II, III, or IV controlled substances.
``(6) Evaluation.--In conducting an evaluation of the
program under this section pursuant to section 701 of the
Comprehensive Addiction and Recovery Act of 2016, with
respect to a State, the Secretary shall report on State
legislation or policies related to maximizing the use of
prescription drug monitoring programs and the incidence of
opioid use disorders and overdose deaths in such State.
``(7) States with local prescription drug monitoring
programs.--
``(A) In general.--In the case of a State that does not
have a prescription drug monitoring program, a county or
other unit of local government within the State that has a
prescription drug monitoring program shall be treated as a
State for purposes of this section, including for purposes of
eligibility for grants under paragraph (1).
``(B) Plan for interoperability.--In submitting an
application to the Secretary under paragraph (3), a county or
other unit of local government shall submit a plan outlining
the methods such county or unit of local government shall use
to ensure the capability of data sharing with other counties
and units of local government within the state and with other
States, as applicable.
``(c) Authorization of Funding.--For the purpose of
carrying out this section, there are authorized to be
appropriated $5,000,000 for each of fiscal years 2017 through
2021.''.
TITLE VII--MISCELLANEOUS
SEC. 701. GRANT ACCOUNTABILITY AND EVALUATIONS.
(a) Department of Justice Grant Accountability.--Part LL of
title I of the Omnibus
[[Page H4403]]
Crime Control and Safe Streets Act of 1968 (42 U.S.C. 3711 et
seq.), as added by section 201, is amended by adding at the
end the following:
``SEC. 3026. GRANT ACCOUNTABILITY.
``(a) Definition of Applicable Committees.--In this
section, the term `applicable committees' means--
``(1) the Committee on the Judiciary of the Senate; and
``(2) the Committee on the Judiciary of the House of
Representatives.
``(b) Accountability.--All grants awarded by the Attorney
General under this part shall be subject to the following
accountability provisions:
``(1) Audit requirement.--
``(A) Definition.--In this paragraph, the term `unresolved
audit finding' means a finding in the final audit report of
the Inspector General of the Department of Justice that the
audited grantee has utilized grant funds for an unauthorized
expenditure or otherwise unallowable cost that is not closed
or resolved within 12 months after the date on which the
final audit report is issued.
``(B) Audit.--Beginning in the first fiscal year beginning
after the date of enactment of this section, and in each
fiscal year thereafter, the Inspector General of the
Department of Justice shall conduct audits of recipients of
grants awarded by the Attorney General under this part to
prevent waste, fraud, and abuse of funds by grantees. The
Inspector General shall determine the appropriate number of
grantees to be audited each year.
``(C) Mandatory exclusion.--A recipient of grant funds
under this part that is found to have an unresolved audit
finding shall not be eligible to receive grant funds under
this part during the first 2 fiscal years beginning after the
end of the 12-month period described in subparagraph (A).
``(D) Priority.--In awarding grants under this part, the
Attorney General shall give priority to eligible applicants
that did not have an unresolved audit finding during the 3
fiscal years before submitting an application for a grant
under this part.
``(E) Reimbursement.--If an entity is awarded grant funds
under this part during the 2-fiscal-year period during which
the entity is barred from receiving grants under subparagraph
(C), the Attorney General shall--
``(i) deposit an amount equal to the amount of the grant
funds that were improperly awarded to the grantee into the
General Fund of the Treasury; and
``(ii) seek to recoup the costs of the repayment to the
fund from the grant recipient that was erroneously awarded
grant funds.
``(2) Nonprofit organization requirements.--
``(A) Definition.--For purposes of this paragraph and the
grant programs under this part, the term `nonprofit
organization' means an organization that is described in
section 501(c)(3) of the Internal Revenue Code of 1986 and is
exempt from taxation under section 501(a) of such Code.
``(B) Prohibition.--A nonprofit organization that holds
money in offshore accounts for the purpose of avoiding paying
the tax described in section 511(a) of the Internal Revenue
Code of 1986 may not--
``(i) be party to a contract entered into under section
3021(b); or
``(ii) receive a subaward under section 3021(b).
``(C) Disclosure.--Each nonprofit organization that
receives a subaward or is party to a contract entered into
under section 3021(b) and uses the procedures prescribed in
regulations to create a rebuttable presumption of
reasonableness for the compensation of its officers,
directors, trustees, and key employees, shall disclose, in
the application for such contract or subaward, the process
for determining such compensation, including the independent
persons involved in reviewing and approving such
compensation, the comparability data used, and
contemporaneous substantiation of the deliberation and
decision. Upon request, the Attorney General shall make the
information disclosed under this subparagraph available for
public inspection.
``(3) Conference expenditures.--
``(A) Limitation.--No amounts made available to the
Attorney General under this part may be used by the Attorney
General, or by any State, unit of local government, or entity
awarded a grant, subaward, or contract under this part, to
host or support any expenditure for conferences that uses
more than $20,000 in funds made available by the Attorney
General, unless the head of the relevant agency, bureau, or
program office provides prior written authorization that the
funds may be expended to host or support the conference.
``(B) Written authorization.--Written authorization under
subparagraph (A) shall include a written estimate of all
costs associated with the conference, including the cost of
all food, beverages, audio-visual equipment, honoraria for
speakers, and entertainment.
``(C) Report.--The Deputy Attorney General shall submit to
the applicable committees an annual report on all conference
expenditures approved by the Attorney General under this
paragraph.
``(4) Annual certification.--Beginning in the first fiscal
year beginning after the date of enactment of this section,
the Attorney General shall submit to the applicable
committees an annual certification--
``(A) indicating whether--
``(i) all audits issued by the Inspector General of the
Department of Justice under paragraph (1) have been completed
and reviewed by the appropriate Assistant Attorney General or
Director;
``(ii) all mandatory exclusions required under paragraph
(1)(C) have been issued; and
``(iii) all reimbursements required under paragraph (1)(E)
have been made; and
``(B) that includes a list of any grant recipients excluded
under paragraph (1) from the previous year.
``(c) Preventing Duplicative Grants.--
``(1) In general.--Before the Attorney General awards a
grant to an applicant under this part, the Attorney General
shall compare potential grant awards with other grants
awarded under this part by the Attorney General to determine
if duplicate grant awards are awarded for the same purpose.
``(2) Report.--If the Attorney General awards duplicate
grants under this part to the same applicant for the same
purpose, the Attorney General shall submit to the applicable
committees a report that includes--
``(A) a list of all duplicate grants awarded under this
part, including the total dollar amount of any duplicate
grants awarded; and
``(B) the reason the Attorney General awarded the duplicate
grants.''.
(b) Evaluation of Performance of Department of Justice
Programs.--
(1) Evaluation of justice department comprehensive opioid
abuse grant program.--Not later than 5 years after the date
of enactment of this Act, the Attorney General shall complete
an evaluation of the effectiveness of the Comprehensive
Opioid Abuse Grant Program under part LL of title I of the
Omnibus Crime Control and Safe Streets Act of 1968, as added
by section 201, administered by the Department of Justice
based upon the information reported under paragraph (4).
(2) Interim evaluation.--Not later than 3 years after the
date of enactment of this Act, the Attorney General shall
complete an interim evaluation assessing the nature and
extent of the incidence of opioid abuse and illegal opioid
distribution in the United States.
(3) Metrics and outcomes for evaluation.--Not later than
180 days after the date of enactment of this Act, the
Attorney General shall identify outcomes that are to be
achieved by activities funded by the Comprehensive Opioid
Abuse Grant Program and the metrics by which the achievement
of such outcomes shall be determined.
(4) Metrics data collection.--The Attorney General shall
require grantees under the Comprehensive Opioid Abuse Grant
Program (and those receiving subawards under section 3021(b)
of part LL of title I of the Omnibus Crime Control and Safe
Streets Act of 1968, as added by section 201) to collect and
annually report to the Department of Justice data based upon
the metrics identified under paragraph (3).
(5) Publication of data and findings.--
(A) Publication of outcomes and metrics.--The Attorney
General shall, not later than 30 days after completion of the
requirement under paragraph (3), publish the outcomes and
metrics identified under that paragraph.
(B) Publication of evaluation.--In the case of the interim
evaluation under paragraph (2), and the final evaluation
under paragraph (1), the entity conducting the evaluation
shall, not later than 90 days after such an evaluation is
completed, publish the results of such evaluation and issue a
report on such evaluation to the Committee on the Judiciary
of the House of Representatives and the Committee on the
Judiciary of the Senate. Such report shall also be published
along with the data used to make such evaluation.
(6) Independent evaluation.--For purposes of paragraphs
(1), (2), and (3), the Attorney General shall--
(A) enter into an arrangement with the National Academy of
Sciences; or
(B) enter into a contract or cooperative agreement with an
entity that is not an agency of the Federal Government, and
is qualified to conduct and evaluate research pertaining to
opioid use and abuse, and draw conclusions about overall
opioid use and abuse on the basis of that research.
(c) Department of Health and Human Services Grant
Accountability.--
(1) Definitions.--In this subsection:
(A) Applicable committees.--The term ``applicable
committees'' means--
(i) the Committee on Health, Education, Labor and Pensions
of the Senate; and
(ii) the Committee on Energy and Commerce of the House of
Representatives.
(B) Covered grant.--The term ``covered grant'' means a
grant awarded by the Secretary under a program established
under this Act (or an amendment made by this Act, other than
sections 703 through 707), including any grant administered
by the Administrator of the Substance Abuse and Mental Health
Services Administration under section 103.
(C) Grantee.--The term ``grantee'' means the recipient of a
covered grant.
(D) Secretary.--The term ``Secretary'' means the Secretary
of Health and Human Services.
(2) Accountability measures.--Each covered grant shall be
subject to the following accountability requirements:
(A) Effectiveness report.--The Secretary shall require
grantees to report on the effectiveness of the activities
carried out with amounts made available to carry out the
program under which the covered grant is awarded, including
the number of persons served by such grant, if applicable,
the number of persons seeking services who could not be
served by such grant, and such other information as the
Secretary may prescribe.
(B) Report on prevention of fraud, waste, and abuse.--
(i) In general.--Not later than 1 year after the date of
the enactment of this Act, the Secretary, in coordination
with the Inspector General of the Department of Health and
Human Services, shall submit to the applicable committees a
report on the policies and procedures the Department has in
place to prevent waste,
[[Page H4404]]
fraud, and abuse in the administration of covered grants.
(ii) Contents.--The policies and procedures referred to in
clause (i) shall include policies and procedures that are
designed to--
(I) prevent grantees from utilizing funds awarded through a
covered grant for unauthorized expenditures or otherwise
unallowable costs; and
(II) ensure grantees will not receive unwarranted duplicate
grants for the same purpose.
(C) Conference expenditures.--
(i) In general.--No amounts made available to the Secretary
under this Act (or in a provision of law amended by this Act,
other than sections 703 through 707) may be used by the
Secretary, or by any individual or entity awarded
discretionary funds through a cooperative agreement under a
program established under this Act (or in a provision of law
amended by this Act), to host or support any expenditure for
conferences that uses more than $20,000 in funds made
available by the Secretary, unless the head of the relevant
operating division or program office provides prior written
authorization that the funds may be expended to host or
support the conference. Such written authorization shall
include a written estimate of all costs associated with the
conference, including the cost of all food, beverages, audio-
visual equipment, honoraria for speakers, and entertainment.
(ii) Report.--The Secretary (or the Secretary's designee)
shall submit to the applicable committees an annual report on
all conference expenditures approved by the Secretary under
this subparagraph.
(d) Evaluation of Performance of Department of Health and
Human Services Programs.--
(1) Evaluations.--
(A) In general.--Not later than 5 years after the date of
enactment of this Act, except as otherwise provided in this
section, the Secretary of Health and Human Services (in this
subsection referred to as the ``Secretary'') shall complete
an evaluation of any program administered by the Secretary
included in this Act (or an amendment made by this Act,
excluding sections 703 through 707), including any grant
administered by the Administrator of the Substance Abuse and
Mental Health Services Administration under section 103, that
provides grants for the primary purpose of providing
assistance in addressing problems pertaining to opioid abuse
based upon the outcomes and metrics identified under
paragraph (2).
(B) Publication.--With respect to each evaluation completed
under subparagraph (A), the Secretary shall, not later than
90 days after the date on which such evaluation is completed,
publish the results of such evaluation and issue a report on
such evaluation to the appropriate committees. Such report
shall also be published along with the data used to make such
evaluation.
(2) Metrics and outcomes.--
(A) In general.--Not later than 180 days after the date of
enactment of this Act, the Secretary shall identify--
(i) outcomes that are to be achieved by activities funded
by the programs described in paragraph (1)(A); and
(ii) the metrics by which the achievement of such outcomes
shall be determined.
(B) Publication.--The Secretary shall, not later than 30
days after completion of the requirement under subparagraph
(A), publish the outcomes and metrics identified under such
subparagraph.
(3) Metrics data collection.--The Secretary shall require
grantees under the programs described in paragraph (1)(A) to
collect, and annually report to the Secretary, data based
upon the metrics identified under paragraph (2)(A).
(4) Independent evaluation.--For purposes of paragraph (1),
the Secretary shall--
(A) enter into an arrangement with the National Academy of
Sciences; or
(B) enter into a contract or cooperative agreement with an
entity that--
(i) is not an agency of the Federal Government; and
(ii) is qualified to conduct and evaluate research
pertaining to opioid use and abuse and draw conclusions about
overall opioid use and abuse on the basis of that research.
(5) Exception.--If a program described in paragraph (1)(A)
is subject to an evaluation similar to the evaluation
required under such paragraph pursuant to another provision
of Federal law, the Secretary may opt not to conduct an
evaluation under such paragraph with respect to such program.
(e) Additional Report.--In the case of a report submitted
under subsection (c) to the applicable committees, if such
report pertains to a grant under section 103, that report
shall also be submitted, in the same manner and at the same
time, to the Committee on Oversight and Government Reform of
the House of Representatives and to the Committee on the
Judiciary of the Senate.
(f) No Additional Funds Authorized.--No additional funds
are authorized to be appropriated to carry out this section.
SEC. 702. PARTIAL FILLS OF SCHEDULE II CONTROLLED SUBSTANCES.
(a) In General.--Section 309 of the Controlled Substances
Act (21 U.S.C. 829) is amended by adding at the end the
following:
``(f) Partial Fills of Schedule II Controlled Substances.--
``(1) Partial fills.--A prescription for a controlled
substance in schedule II may be partially filled if--
``(A) it is not prohibited by State law;
``(B) the prescription is written and filled in accordance
with this title, regulations prescribed by the Attorney
General, and State law;
``(C) the partial fill is requested by the patient or the
practitioner that wrote the prescription; and
``(D) the total quantity dispensed in all partial fillings
does not exceed the total quantity prescribed.
``(2) Remaining portions.--
``(A) In general.--Except as provided in subparagraph (B),
remaining portions of a partially filled prescription for a
controlled substance in schedule II--
``(i) may be filled; and
``(ii) shall be filled not later than 30 days after the
date on which the prescription is written.
``(B) Emergency situations.--In emergency situations, as
described in subsection (a), the remaining portions of a
partially filled prescription for a controlled substance in
schedule II--
``(i) may be filled; and
``(ii) shall be filled not later than 72 hours after the
prescription is issued.
``(3) Currently lawful partial fills.--Notwithstanding
paragraph (1) or (2), in any circumstance in which, as of the
day before the date of enactment of this subsection, a
prescription for a controlled substance in schedule II may be
lawfully partially filled, the Attorney General may allow
such a prescription to be partially filled.''.
(b) Rule of Construction.--Nothing in this section shall be
construed to affect the authority of the Attorney General to
allow a prescription for a controlled substance in schedule
III, IV, or V of section 202(c) of the Controlled Substances
Act (21 U.S.C. 812(c)) to be partially filled.
SEC. 703. GOOD SAMARITAN ASSESSMENT.
(a) Finding.--The Congress finds that the executive branch,
including the Office of National Drug Control Policy, has a
policy focus on preventing and addressing prescription drug
misuse and heroin use, and has worked with States and
municipalities to enact Good Samaritan laws that would
protect caregivers, law enforcement personnel, and first
responders who administer opioid overdose reversal drugs or
devices.
(b) GAO Study on Good Samaritan Laws Pertaining to
Treatment of Opioid Overdoses.--The Comptroller General of
the United States shall submit to the Committee on the
Judiciary of the House of Representatives, the Committee on
Oversight and Government Reform of the House of
Representatives, the Committee on the Judiciary of the
Senate, and the Committee on Homeland Security and
Governmental Affairs of the Senate a report on--
(1) the extent to which the Director of National Drug
Control Policy has reviewed Good Samaritan laws, and any
findings from such a review, including findings related to
the potential effects of such laws, if available;
(2) efforts by the Director to encourage the enactment of
Good Samaritan laws; and
(3) a compilation of Good Samaritan laws in effect in the
States, the territories, and the District of Columbia.
(c) Definitions.--In this section--
(1) the term ``Good Samaritan law'' means a law of a State
or unit of local government that exempts from criminal or
civil liability any individual who administers an opioid
overdose reversal drug or device, or who contacts emergency
services providers in response to an overdose; and
(2) the term ``opioid'' means any drug, including heroin,
having an addiction-forming or addiction-sustaining liability
similar to morphine or being capable of conversion into a
drug having such addiction-forming or addiction-sustaining
liability.
SEC. 704. PROGRAMS TO PREVENT PRESCRIPTION DRUG ABUSE UNDER
MEDICARE PARTS C AND D.
(a) Drug Management Program for At-Risk Beneficiaries.--
(1) In general.--Section 1860D-4(c) of the Social Security
Act (42 U.S.C. 1395w-10(c)) is amended by adding at the end
the following:
``(5) Drug management program for at-risk beneficiaries.--
``(A) Authority to establish.--A PDP sponsor may establish
a drug management program for at-risk beneficiaries under
which, subject to subparagraph (B), the PDP sponsor may, in
the case of an at-risk beneficiary for prescription drug
abuse who is an enrollee in a prescription drug plan of such
PDP sponsor, limit such beneficiary's access to coverage for
frequently abused drugs under such plan to frequently abused
drugs that are prescribed for such beneficiary by one or more
prescribers selected under subparagraph (D), and dispensed
for such beneficiary by one or more pharmacies selected under
such subparagraph.
``(B) Requirement for notices.--
``(i) In general.--A PDP sponsor may not limit the access
of an at-risk beneficiary for prescription drug abuse to
coverage for frequently abused drugs under a prescription
drug plan until such sponsor--
``(I) provides to the beneficiary an initial notice
described in clause (ii) and a second notice described in
clause (iii); and
``(II) verifies with the providers of the beneficiary that
the beneficiary is an at-risk beneficiary for prescription
drug abuse.
``(ii) Initial notice.--An initial notice described in this
clause is a notice that provides to the beneficiary--
``(I) notice that the PDP sponsor has identified the
beneficiary as potentially being an at-risk beneficiary for
prescription drug abuse;
``(II) information describing all State and Federal public
health resources that are designed to address prescription
drug abuse to which the beneficiary has access, including
mental health services and other counseling services;
``(III) notice of, and information about, the right of the
beneficiary to appeal such identification under subsection
(h) and the option of an automatic escalation to external
review;
``(IV) a request for the beneficiary to submit to the PDP
sponsor preferences for which prescribers and pharmacies the
beneficiary would prefer the PDP sponsor to select under
subparagraph (D) in the case that the beneficiary is
[[Page H4405]]
identified as an at-risk beneficiary for prescription drug
abuse as described in clause (iii)(I);
``(V) an explanation of the meaning and consequences of the
identification of the beneficiary as potentially being an at-
risk beneficiary for prescription drug abuse, including an
explanation of the drug management program established by the
PDP sponsor pursuant to subparagraph (A);
``(VI) clear instructions that explain how the beneficiary
can contact the PDP sponsor in order to submit to the PDP
sponsor the preferences described in subclause (IV) and any
other communications relating to the drug management program
for at-risk beneficiaries established by the PDP sponsor; and
``(VII) contact information for other organizations that
can provide the beneficiary with assistance regarding such
drug management program (similar to the information provided
by the Secretary in other standardized notices provided to
part D eligible individuals enrolled in prescription drug
plans under this part).
``(iii) Second notice.--A second notice described in this
clause is a notice that provides to the beneficiary notice--
``(I) that the PDP sponsor has identified the beneficiary
as an at-risk beneficiary for prescription drug abuse;
``(II) that such beneficiary is subject to the requirements
of the drug management program for at-risk beneficiaries
established by such PDP sponsor for such plan;
``(III) of the prescriber (or prescribers) and pharmacy (or
pharmacies) selected for such individual under subparagraph
(D);
``(IV) of, and information about, the beneficiary's right
to appeal such identification under subsection (h) and the
option of an automatic escalation to external review;
``(V) that the beneficiary can, in the case that the
beneficiary has not previously submitted to the PDP sponsor
preferences for which prescribers and pharmacies the
beneficiary would prefer the PDP sponsor select under
subparagraph (D), submit such preferences to the PDP sponsor;
and
``(VI) that includes clear instructions that explain how
the beneficiary can contact the PDP sponsor.
``(iv) Timing of notices.--
``(I) In general.--Subject to subclause (II), a second
notice described in clause (iii) shall be provided to the
beneficiary on a date that is not less than 30 days after an
initial notice described in clause (ii) is provided to the
beneficiary.
``(II) Exception.--In the case that the PDP sponsor, in
conjunction with the Secretary, determines that concerns
identified through rulemaking by the Secretary regarding the
health or safety of the beneficiary or regarding significant
drug diversion activities require the PDP sponsor to provide
a second notice described in clause (iii) to the beneficiary
on a date that is earlier than the date described in
subclause (I), the PDP sponsor may provide such second notice
on such earlier date.
``(C) At-risk beneficiary for prescription drug abuse.--
``(i) In general.--For purposes of this paragraph, the term
`at-risk beneficiary for prescription drug abuse' means a
part D eligible individual who is not an exempted individual
described in clause (ii) and--
``(I) who is identified as such an at-risk beneficiary
through the use of clinical guidelines that indicate misuse
or abuse of prescription drugs described in subparagraph (G)
and that are developed by the Secretary in consultation with
PDP sponsors and other stakeholders, including individuals
entitled to benefits under part A or enrolled under part B,
advocacy groups representing such individuals, physicians,
pharmacists, and other clinicians, retail pharmacies, plan
sponsors, entities delegated by plan sponsors, and
biopharmaceutical manufacturers; or
``(II) with respect to whom the PDP sponsor of a
prescription drug plan, upon enrolling such individual in
such plan, received notice from the Secretary that such
individual was identified under this paragraph to be an at-
risk beneficiary for prescription drug abuse under the
prescription drug plan in which such individual was most
recently previously enrolled and such identification has not
been terminated under subparagraph (F).
``(ii) Exempted individual described.--An exempted
individual described in this clause is an individual who--
``(I) receives hospice care under this title;
``(II) is a resident of a long-term care facility, of a
facility described in section 1905(d), or of another facility
for which frequently abused drugs are dispensed for residents
through a contract with a single pharmacy; or
``(III) the Secretary elects to treat as an exempted
individual for purposes of clause (i).
``(iii) Program size.--The Secretary shall establish
policies, including the guidelines developed under clause
(i)(I) and the exemptions under clause (ii)(III), to ensure
that the population of enrollees in a drug management program
for at-risk beneficiaries operated by a prescription drug
plan can be effectively managed by such plans.
``(iv) Clinical contact.--With respect to each at-risk
beneficiary for prescription drug abuse enrolled in a
prescription drug plan offered by a PDP sponsor, the PDP
sponsor shall contact the beneficiary's providers who have
prescribed frequently abused drugs regarding whether
prescribed medications are appropriate for such beneficiary's
medical conditions.
``(D) Selection of prescribers and pharmacies.--
``(i) In general.--With respect to each at-risk beneficiary
for prescription drug abuse enrolled in a prescription drug
plan offered by such sponsor, a PDP sponsor shall, based on
the preferences submitted to the PDP sponsor by the
beneficiary pursuant to clauses (ii)(IV) and (iii)(V) of
subparagraph (B) (except as otherwise provided in this
subparagraph) select--
``(I) one, or, if the PDP sponsor reasonably determines it
necessary to provide the beneficiary with reasonable access
under clause (ii), more than one, individual who is
authorized to prescribe frequently abused drugs (referred to
in this paragraph as a `prescriber') who may write
prescriptions for such drugs for such beneficiary; and
``(II) one, or, if the PDP sponsor reasonably determines it
necessary to provide the beneficiary with reasonable access
under clause (ii), more than one, pharmacy that may dispense
such drugs to such beneficiary.
For purposes of subclause (II), in the case of a pharmacy
that has multiple locations that share real-time electronic
data, all such locations of the pharmacy shall collectively
be treated as one pharmacy.
``(ii) Reasonable access.--In making the selections under
this subparagraph--
``(I) a PDP sponsor shall ensure that the beneficiary
continues to have reasonable access to frequently abused
drugs (as defined in subparagraph (G)), taking into account
geographic location, beneficiary preference, impact on
costsharing, and reasonable travel time; and
``(II) a PDP sponsor shall ensure such access (including
access to prescribers and pharmacies with respect to
frequently abused drugs) in the case of individuals with
multiple residences, in the case of natural disasters and
similar situations, and in the case of the provision of
emergency services.
``(iii) Beneficiary preferences.--If an at-risk beneficiary
for prescription drug abuse submits preferences for which in-
network prescribers and pharmacies the beneficiary would
prefer the PDP sponsor select in response to a notice under
subparagraph (B), the PDP sponsor shall--
``(I) review such preferences;
``(II) select or change the selection of prescribers and
pharmacies for the beneficiary based on such preferences; and
``(III) inform the beneficiary of such selection or change
of selection.
``(iv) Exception regarding beneficiary preferences.--In the
case that the PDP sponsor determines that a change to the
selection of prescriber or pharmacy under clause (iii)(II) by
the PDP sponsor is contributing or would contribute to
prescription drug abuse or drug diversion by the beneficiary,
the PDP sponsor may change the selection of prescriber or
pharmacy for the beneficiary without regard to the
preferences of the beneficiary described in clause (iii). If
the PDP sponsor changes the selection pursuant to the
preceding sentence, the PDP sponsor shall provide the
beneficiary with--
``(I) at least 30 days written notice of the change of
selection; and
``(II) a rationale for the change.
``(v) Confirmation.--Before selecting a prescriber or
pharmacy under this subparagraph, a PDP sponsor must notify
the prescriber and pharmacy that the beneficiary involved has
been identified for inclusion in the drug management program
for at-risk beneficiaries and that the prescriber and
pharmacy has been selected as the beneficiary's designated
prescriber and pharmacy.
``(E) Terminations and appeals.--The identification of an
individual as an at-risk beneficiary for prescription drug
abuse under this paragraph, a coverage determination made
under a drug management program for at-risk beneficiaries,
the selection of prescriber or pharmacy under subparagraph
(D), and information to be shared under subparagraph (I),
with respect to such individual, shall be subject to
reconsideration and appeal under subsection (h) and the
option of an automatic escalation to external review to the
extent provided by the Secretary.
``(F) Termination of identification.--
``(i) In general.--The Secretary shall develop standards
for the termination of identification of an individual as an
at-risk beneficiary for prescription drug abuse under this
paragraph. Under such standards such identification shall
terminate as of the earlier of--
``(I) the date the individual demonstrates that the
individual is no longer likely, in the absence of the
restrictions under this paragraph, to be an at-risk
beneficiary for prescription drug abuse described in
subparagraph (C)(i); and
``(II) the end of such maximum period of identification as
the Secretary may specify.
``(ii) Rule of construction.--Nothing in clause (i) shall
be construed as preventing a plan from identifying an
individual as an at-risk beneficiary for prescription drug
abuse under subparagraph (C)(i) after such termination on the
basis of additional information on drug use occurring after
the date of notice of such termination.
``(G) Frequently abused drug.--For purposes of this
subsection, the term `frequently abused drug' means a drug
that is a controlled substance that the Secretary determines
to be frequently abused or diverted.
``(H) Data disclosure.--
``(i) Data on decision to impose limitation.--In the case
of an at-risk beneficiary for prescription drug abuse (or an
individual who is a potentially at-risk beneficiary for
prescription drug abuse) whose access to coverage for
frequently abused drugs under a prescription drug plan has
been limited by a PDP sponsor under this paragraph, the
Secretary shall establish rules and procedures to require the
PDP sponsor to disclose data, including any necessary
individually identifiable health information, in a form and
manner specified by the Secretary, about the decision to
impose such limitations and the limitations imposed by the
sponsor under this part.
``(ii) Data to reduce fraud, abuse, and waste.--The
Secretary shall establish rules and
[[Page H4406]]
procedures to require PDP sponsors operating a drug
management program for at-risk beneficiaries under this
paragraph to provide the Secretary with such data as the
Secretary determines appropriate for purposes of identifying
patterns of prescription drug utilization for plan enrollees
that are outside normal patterns and that may indicate
fraudulent, medically unnecessary, or unsafe use.
``(I) Sharing of information for subsequent plan
enrollments.--The Secretary shall establish procedures under
which PDP sponsors who offer prescription drug plans shall
share information with respect to individuals who are at-risk
beneficiaries for prescription drug abuse (or individuals who
are potentially at-risk beneficiaries for prescription drug
abuse) and enrolled in a prescription drug plan and who
subsequently disenroll from such plan and enroll in another
prescription drug plan offered by another PDP sponsor.
``(J) Privacy issues.--Prior to the implementation of the
rules and procedures under this paragraph, the Secretary
shall clarify privacy requirements, including requirements
under the regulations promulgated pursuant to section 264(c)
of the Health Insurance Portability and Accountability Act of
1996 (42 U.S.C. 1320d-2 note), related to the sharing of data
under subparagraphs (H) and (I) by PDP sponsors. Such
clarification shall provide that the sharing of such data
shall be considered to be protected health information in
accordance with the requirements of the regulations
promulgated pursuant to such section 264(c).
``(K) Education.--The Secretary shall provide education to
enrollees in prescription drug plans of PDP sponsors and
providers regarding the drug management program for at-risk
beneficiaries described in this paragraph, including
education--
``(i) provided by Medicare administrative contractors
through the improper payment outreach and education program
described in section 1874A(h); and
``(ii) through current education efforts (such as State
health insurance assistance programs described in subsection
(a)(1)(A) of section 119 of the Medicare Improvements for
Patients and Providers Act of 2008 (42 U.S.C. 1395b-3 note))
and materials directed toward such enrollees.
``(L) Application under ma-pd plans.--Pursuant to section
1860D-21(c)(1), the provisions of this paragraph apply under
part D to MA organizations offering MA-PD plans to MA
eligible individuals in the same manner as such provisions
apply under this part to a PDP sponsor offering a
prescription drug plan to a part D eligible individual.
``(M) CMS compliance review.--The Secretary shall ensure
that existing plan sponsor compliance reviews and audit
processes include the drug management programs for at-risk
beneficiaries under this paragraph, including appeals
processes under such programs.''.
(2) Information for consumers.--Section 1860D-4(a)(1)(B) of
the Social Security Act (42 U.S.C. 1395w-104(a)(1)(B)) is
amended by adding at the end the following:
``(v) The drug management program for at-risk beneficiaries
under subsection (c)(5).''.
(3) Dual eligibles.--Section 1860D-1(b)(3)(D) of the Social
Security Act (42 U.S.C. 1395w-101(b)(3)(D)) is amended by
inserting ``, subject to such limits as the Secretary may
establish for individuals identified pursuant to section
1860D-4(c)(5)'' after ``the Secretary''.
(b) Utilization Management Programs.--Section 1860D-4(c) of
the Social Security Act (42 U.S.C. 1395w-104(c)), as amended
by subsection (a)(1), is further amended--
(1) in paragraph (1), by inserting after subparagraph (D)
the following new subparagraph:
``(E) A utilization management tool to prevent drug abuse
(as described in paragraph (6)(A)).''; and
(2) by adding at the end the following new paragraph:
``(6) Utilization management tool to prevent drug abuse.--
``(A) In general.--A tool described in this paragraph is
any of the following:
``(i) A utilization tool designed to prevent the abuse of
frequently abused drugs by individuals and to prevent the
diversion of such drugs at pharmacies.
``(ii) Retrospective utilization review to identify--
``(I) individuals that receive frequently abused drugs at a
frequency or in amounts that are not clinically appropriate;
and
``(II) providers of services or suppliers that may
facilitate the abuse or diversion of frequently abused drugs
by beneficiaries.
``(iii) Consultation with the contractor described in
subparagraph (B) to verify if an individual enrolling in a
prescription drug plan offered by a PDP sponsor has been
previously identified by another PDP sponsor as an individual
described in clause (ii)(I).
``(B) Reporting.--A PDP sponsor offering a prescription
drug plan (and an MA organization offering an MA-PD plan) in
a State shall submit to the Secretary and the Medicare drug
integrity contractor with which the Secretary has entered
into a contract under section 1893 with respect to such State
a report, on a monthly basis, containing information on--
``(i) any provider of services or supplier described in
subparagraph (A)(ii)(II) that is identified by such plan
sponsor (or organization) during the 30-day period before
such report is submitted; and
``(ii) the name and prescription records of individuals
described in paragraph (5)(C).
``(C) CMS compliance review.--The Secretary shall ensure
that plan sponsor compliance reviews and program audits
biennially include a certification that utilization
management tools under this paragraph are in compliance with
the requirements for such tools.''.
(c) Expanding Activities of Medicare Drug Integrity
Contractors (MEDICs).--
(1) In general.--Section 1893 of the Social Security Act
(42 U.S.C. 1395ddd) is amended by adding at the end the
following new subsection:
``(j) Expanding Activities of Medicare Drug Integrity
Contractors (MEDICs).--
``(1) Access to information.--Under contracts entered into
under this section with Medicare drug integrity contractors
(including any successor entity to a Medicare drug integrity
contractor), the Secretary shall authorize such contractors
to directly accept prescription and necessary medical records
from entities such as pharmacies, prescription drug plans,
MA-PD plans, and physicians with respect to an individual in
order for such contractors to provide information relevant to
the determination of whether such individual is an at-risk
beneficiary for prescription drug abuse, as defined in
section 1860D-4(c)(5)(C).
``(2) Requirement for acknowledgment of referrals.--If a
PDP sponsor or MA organization refers information to a
contractor described in paragraph (1) in order for such
contractor to assist in the determination described in such
paragraph, the contractor shall--
``(A) acknowledge to the sponsor or organization receipt of
the referral; and
``(B) in the case that any PDP sponsor or MA organization
contacts the contractor requesting to know the determination
by the contractor of whether or not an individual has been
determined to be an individual described in such paragraph,
shall inform such sponsor or organization of such
determination on a date that is not later than 15 days after
the date on which the sponsor or organization contacts the
contractor.
``(3) Making data available to other entities.--
``(A) In general.--For purposes of carrying out this
subsection, subject to subparagraph (B), the Secretary shall
authorize MEDICs to respond to requests for information from
PDP sponsors and MA organizations, State prescription drug
monitoring programs, and other entities delegated by such
sponsors or organizations using available programs and
systems in the effort to prevent fraud, waste, and abuse.
``(B) HIPAA compliant information only.--Information may
only be disclosed by a MEDIC under subparagraph (A) if the
disclosure of such information is permitted under the Federal
regulations (concerning the privacy of individually
identifiable health information) promulgated under section
264(c) of the Health Insurance Portability and Accountability
Act of 1996 (42 U.S.C. 1320d-2 note).''.
(2) OIG study and report on effectiveness of medics.--
(A) Study.--The Inspector General of the Department of
Health and Human Services shall conduct a study on the
effectiveness of Medicare drug integrity contractors with
which the Secretary of Health and Human Services has entered
into a contract under section 1893 of the Social Security Act
(42 U.S.C. 1395ddd) in identifying, combating, and preventing
fraud under the Medicare program, including under the
authority provided under section 1893(j) of the Social
Security Act, added by paragraph (1).
(B) Report.--Not later than 24 months after the date of the
enactment of this Act, the Inspector General shall submit to
Congress a report on the study conducted under subparagraph
(A). Such report shall include such recommendations for
improvements in the effectiveness of such contractors as the
Inspector General determines appropriate.
(d) Treatment of Certain Complaints for Purposes of Quality
or Performance Assessment.--Section 1860D-42 of the Social
Security Act (42 U.S.C. 1395w-152) is amended by adding at
the end the following new subsection:
``(d) Treatment of Certain Complaints for Purposes of
Quality or Performance Assessment.--In conducting a quality
or performance assessment of a PDP sponsor, the Secretary
shall develop or utilize existing screening methods for
reviewing and considering complaints that are received from
enrollees in a prescription drug plan offered by such PDP
sponsor and that are complaints regarding the lack of access
by the individual to prescription drugs due to a drug
management program for at-risk beneficiaries.''.
(e) Sense of Congress Regarding Use of Technology Tools To
Combat Fraud.--It is the sense of Congress that MA
organizations and PDP sponsors should consider using e-
prescribing and other health information technology tools to
support combating fraud under MA-PD plans and prescription
drug plans under parts C and D of the Medicare program.
(f) Reports.--
(1) Report by secretary on appeals process.--
(A) In general.--Not later than 12 months after the date of
the enactment of this Act, the Secretary of Health and Human
Services shall submit to the appropriate committees of
jurisdiction of Congress a report on ways to improve upon the
appeals process for Medicare beneficiaries with respect to
prescription drug coverage under part D of title XVIII of the
Social Security Act. Such report shall include an analysis
comparing appeals processes under parts C and D of such title
XVIII.
(B) Feedback.--In development of the report described in
subparagraph (A), the Secretary of Health and Human Services
shall solicit feedback on the current appeals process from
stakeholders, such as beneficiaries, consumer advocates, plan
sponsors, pharmacy benefit managers, pharmacists, providers,
independent review entity evaluators, and pharmaceutical
manufacturers.
(2) GAO study and report.--
(A) Study.--The Comptroller General of the United States
shall conduct a study on the implementation of the amendments
made by this section, including the effectiveness of the at-
risk
[[Page H4407]]
beneficiaries for prescription drug abuse drug management
programs authorized by section 1860D-4(c)(5) of the Social
Security Act (42 U.S.C. 1395w-10(c)(5)), as added by
subsection (a)(1). Such study shall include an analysis of--
(i) the impediments, if any, that impair the ability of
individuals described in subparagraph (C) of such section
1860D-4(c)(5) to access clinically appropriate levels of
prescription drugs;
(ii) the effectiveness of the reasonable access protections
under subparagraph (D)(ii) of such section 1860D-4(c)(5),
including the impact on beneficiary access and health;
(iii) the types of--
(I) individuals who, in the implementation of such section,
are determined to be individuals described in such
subparagraph (C); and
(II) prescribers and pharmacies that are selected under
subparagraph (D) of such section; and
(iv) other areas determined appropriate by the Comptroller
General.
(B) Report.--Not later than July 1, 2019, the Comptroller
General of the United States shall submit to the appropriate
committees of jurisdiction of Congress a report on the study
conducted under subparagraph (A), together with
recommendations for such legislation and administrative
action as the Comptroller General determines to be
appropriate.
(g) Effective Date; Rulemaking.--
(1) In general.--The amendments made by this section shall
apply to prescription drug plans (and MA-PD plans) for plan
years beginning on or after January 1, 2019.
(2) Stakeholder meetings prior to effective date.--
(A) In general.--Not later than January 1, 2017, the
Secretary of Health and Human Services shall convene
stakeholders, including individuals entitled to benefits
under part A of title XVIII of the Social Security Act or
enrolled under part B of such title, advocacy groups
representing such individuals, physicians, pharmacists, and
other clinicians, retail pharmacies, plan sponsors, entities
delegated by plan sponsors, and biopharmaceutical
manufacturers for input regarding the topics described in
subparagraph (B). The input described in the preceding
sentence shall be provided to the Secretary in sufficient
time in order for the Secretary to take such input into
account in promulgating the regulations pursuant to paragraph
(3).
(B) Topics described.--The topics described in this
subparagraph are the topics of--
(i) the anticipated impact of drug management programs for
at-risk beneficiaries under paragraph (5) of section 1860D-
4(c) of the Social Security Act (42 U.S.C. 1395w-104(c)) on
cost-sharing and ensuring accessibility to prescription drugs
for enrollees in prescription drug plans of PDP sponsors, and
enrollees in MA-PD plans, who are at-risk beneficiaries for
prescription drug abuse (as defined in subparagraph (C) of
such paragraph);
(ii) the use of an expedited appeals process under which
such an enrollee may appeal an identification of such
enrollee as an at-risk beneficiary for prescription drug
abuse under such paragraph (similar to the processes
established under the Medicare Advantage program under part C
of title XVIII of the Social Security Act that allow an
automatic escalation to external review of claims submitted
under such part);
(iii) the types of enrollees that should be treated as
exempted individuals, as described in subparagraph (C)(ii) of
such paragraph;
(iv) the manner in which terms and definitions in such
paragraph should be applied, such as the use of clinical
appropriateness in determining whether an enrollee is an at-
risk beneficiary for prescription drug abuse as defined in
subparagraph (C) of such paragraph;
(v) the information to be included in the notices described
in subparagraph (B) of such paragraph and the standardization
of such notices;
(vi) with respect to a PDP sponsor (or Medicare Advantage
organization) that establishes a drug management program for
at-risk beneficiaries under such paragraph, the
responsibilities of such PDP sponsor (or organization) with
respect to the implementation of such program;
(vii) notices for plan enrollees at the point of sale that
would explain why an at-risk beneficiary has been prohibited
from receiving a prescription at a location outside of the
designated pharmacy;
(viii) evidence-based prescribing guidelines for opiates;
and
(ix) the sharing of claims data under parts A and B of
title XVIII of the Social Security Act with PDP sponsors.
(3) Rulemaking.--Not later than one year after the date of
the enactment of this Act, the Secretary of Health and Human
Services shall, taking into account the input gathered
pursuant to paragraph (2)(A) and after providing notice and
an opportunity to comment, promulgate regulations to carry
out the provisions of, and amendments made by this section.
(h) Deposit of Savings Into Medicare Improvement Fund.--
Section 1898(b)(1) of the Social Security Act (42 U.S.C.
1395iii(b)(1)) is amended by striking ``during and after
fiscal year 2020, $0'' and inserting ``during and after
fiscal year 2021, $140,000,000''.
SEC. 705. EXCLUDING ABUSE-DETERRENT FORMULATIONS OF
PRESCRIPTION DRUGS FROM THE MEDICAID ADDITIONAL
REBATE REQUIREMENT FOR NEW FORMULATIONS OF
PRESCRIPTION DRUGS.
(a) In General.--The last sentence of section 1927(c)(2)(C)
of the Social Security Act (42 U.S.C. 1396r-8(c)(2)(C)) is
amended by inserting before the period at the end the
following: ``, but does not include an abuse-deterrent
formulation of the drug (as determined by the Secretary),
regardless of whether such abuse-deterrent formulation is an
extended release formulation''.
(b) Effective Date.--The amendment made by subsection (a)
shall apply to drugs that are paid for by a State in calendar
quarters beginning on or after the date of the enactment of
this Act.
SEC. 706. LIMITING DISCLOSURE OF PREDICTIVE MODELING AND
OTHER ANALYTICS TECHNOLOGIES TO IDENTIFY AND
PREVENT WASTE, FRAUD, AND ABUSE.
(a) In General.--Title XI of the Social Security Act is
amended by inserting after section 1128J (42 U.S.C. 1320a-7k)
the following new section:
``SEC. 1128K. DISCLOSURE OF PREDICTIVE MODELING AND OTHER
ANALYTICS TECHNOLOGIES TO IDENTIFY AND PREVENT
WASTE, FRAUD, AND ABUSE.
``(a) Reference to Predictive Modeling Technologies
Requirements.--For provisions relating to the use of
predictive modeling and other analytics technologies to
identify and prevent waste, fraud, and abuse with respect to
the Medicare program under title XVIII, the Medicaid program
under title XIX, and the Children's Health Insurance Program
under title XXI, see section 4241 of the Small Business Jobs
Act of 2010 (42 U.S.C. 1320a-7m).
``(b) Limiting Disclosure of Predictive Modeling
Technologies.--In implementing such provisions under such
section 4241 with respect to covered algorithms (as defined
in subsection (c)), the following shall apply:
``(1) Nonapplication of foia.--The covered algorithms used
or developed for purposes of such section 4241 (including by
the Secretary or a State (or an entity operating under a
contract with a State)) shall be exempt from disclosure under
section 552(b)(3) of title 5, United States Code.
``(2) Limitation with respect to use and disclosure of
information by state agencies.--
``(A) In general.--A State agency may not use or disclose
covered algorithms used or developed for purposes of such
section 4241 except for purposes of administering the State
plan (or a waiver of the plan) under the Medicaid program
under title XIX or the State child health plan (or a waiver
of the plan) under the Children's Health Insurance Program
under title XXI, including by enabling an entity operating
under a contract with a State to assist the State to identify
or prevent waste, fraud, and abuse with respect to such
programs.
``(B) Information security.--A State agency shall have in
effect data security and control policies that the Secretary
finds adequate to ensure the security of covered algorithms
used or developed for purposes of such section 4241 and to
ensure that access to such information is restricted to
authorized persons for purposes of authorized uses and
disclosures described in subparagraph (A).
``(C) Procedural requirements.--State agencies to which
information is disclosed pursuant to such section 4241 shall
adhere to uniform procedures established by the Secretary.
``(c) Covered Algorithm Defined.--In this section, the term
`covered algorithm'--
``(1) means a predictive modeling or other analytics
technology, as used for purposes of section 4241(a) of the
Small Business Jobs Act of 2010 (42 U.S.C. 1320a-7m(a)) to
identify and prevent waste, fraud, and abuse with respect to
the Medicare program under title XVIII, the Medicaid program
under title XIX, and the Children's Health Insurance Program
under title XXI; and
``(2) includes the mathematical expressions utilized in the
application of such technology and the means by which such
technology is developed.''.
(b) Conforming Amendments.--
(1) Medicaid state plan requirement.--Section 1902(a) of
the Social Security Act (42 U.S.C. 1396a(a)) is amended--
(A) in paragraph (80), by striking ``and'' at the end;
(B) in paragraph (81), by striking the period at the end
and inserting ``; and''; and
(C) by inserting after paragraph (81) the following new
paragraph:
``(82) provide that the State agency responsible for
administering the State plan under this title provides
assurances to the Secretary that the State agency is in
compliance with subparagraphs (A), (B), and (C) of section
1128K(b)(2).''.
(2) State child health plan requirement.--Section
2102(a)(7) of the Social Security Act (42 U.S.C.
1397bb(a)(7)) is amended--
(A) in subparagraph (A), by striking ``, and'' at the end
and inserting a semicolon;
(B) in subparagraph (B), by striking the period at the end
and inserting ``; and''; and
(C) by adding at the end the following new subparagraph:
``(C) to ensure that the State agency involved is in
compliance with subparagraphs (A), (B), and (C) of section
1128K(b)(2).''.
SEC. 707. MEDICAID IMPROVEMENT FUND.
Section 1941(b)(1) of the Social Security Act (42 U.S.C.
1396w-1(b)(1)) is amended to read as follows:
``(1) In general.--There shall be available to the Fund,
for expenditures from the Fund for fiscal year 2021 and
thereafter, $5,000,000.''.
SEC. 708. SENSE OF THE CONGRESS REGARDING TREATMENT OF
SUBSTANCE ABUSE EPIDEMICS.
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.
[[Page H4408]]
TITLE VIII--KINGPIN DESIGNATION IMPROVEMENT
SEC. 801. PROTECTION OF CLASSIFIED INFORMATION IN FEDERAL
COURT CHALLENGES RELATING TO DESIGNATIONS UNDER
THE NARCOTICS KINGPIN DESIGNATION ACT.
Section 804 of the Foreign Narcotics Kingpin Designation
Act (21 U.S.C. 1903) is amended by adding at the end the
following:
``(i) Protection of Classified Information in Federal Court
Challenges Relating to Designations.--In any judicial review
of a determination made under this section, if the
determination was based on classified information (as defined
in section 1(a) of the Classified Information Procedures Act)
such information may be submitted to the reviewing court ex
parte and in camera. This subsection does not confer or imply
any right to judicial review.''.
TITLE IX--DEPARTMENT OF VETERANS AFFAIRS
SEC. 901. SHORT TITLE.
This title may be cited as the ``Jason Simcakoski Memorial
and Promise Act''.
SEC. 902. DEFINITIONS.
In this title:
(1) The term ``controlled substance'' has the meaning given
that term in section 102 of the Controlled Substances Act (21
U.S.C. 802).
(2) The term ``State'' means each of the several States,
territories, and possessions of the United States, the
District of Columbia, and the Commonwealth of Puerto Rico.
(3) The term ``complementary and integrative health'' has
the meaning given that term, or any successor term, by the
National Institutes of Health.
(4) The term ``opioid receptor antagonist'' means a drug or
device approved or cleared under the Federal Food, Drug, and
Cosmetic Act (21 U.S.C. 301 et seq.) for emergency treatment
of known or suspected opioid overdose.
Subtitle A--Opioid Therapy and Pain Management
SEC. 911. IMPROVEMENT OF OPIOID SAFETY MEASURES BY DEPARTMENT
OF VETERANS AFFAIRS.
(a) Expansion of Opioid Safety Initiative.--
(1) Inclusion of all medical facilities.--Not later than
180 days after the date of the enactment of this Act, the
Secretary of Veterans Affairs shall expand the Opioid Safety
Initiative of the Department of Veterans Affairs to include
all medical facilities of the Department.
(2) Guidance.--The Secretary shall establish guidance that
each health care provider of the Department of Veterans
Affairs, before initiating opioid therapy to treat a patient
as part of the comprehensive assessment conducted by the
health care provider, use the Opioid Therapy Risk Report tool
of the Department of Veterans Affairs (or any subsequent
tool), which shall include information from the prescription
drug monitoring program of each participating State as
applicable, that includes the most recent information to date
relating to the patient that accessed such program to assess
the risk for adverse outcomes of opioid therapy for the
patient, including the concurrent use of controlled
substances such as benzodiazepines, as part of the
comprehensive assessment conducted by the health care
provider.
(3) Enhanced standards.--The Secretary shall establish
enhanced standards with respect to the use of routine and
random urine drug tests for all patients before and during
opioid therapy to help prevent substance abuse, dependence,
and diversion, including--
(A) that such tests occur not less frequently than once
each year or as otherwise determined according to treatment
protocols; and
(B) that health care providers appropriately order,
interpret and respond to the results from such tests to
tailor pain therapy, safeguards, and risk management
strategies to each patient.
(b) Pain Management Education and Training.--
(1) In general.--In carrying out the Opioid Safety
Initiative of the Department, the Secretary shall require all
employees of the Department responsible for prescribing
opioids to receive education and training described in
paragraph (2).
(2) Education and training.--Education and training
described in this paragraph is education and training on pain
management and safe opioid prescribing practices for purposes
of safely and effectively managing patients with chronic
pain, including education and training on the following:
(A) The implementation of and full compliance with the VA/
DOD Clinical Practice Guideline for Management of Opioid
Therapy for Chronic Pain, including any update to such
guideline.
(B) The use of evidence-based pain management therapies and
complementary and integrative health services, including
cognitive-behavioral therapy, non-opioid alternatives, and
non-drug methods and procedures to managing pain and related
health conditions including, to the extent practicable,
medical devices approved or cleared by the Food and Drug
Administration for the treatment of patients with chronic
pain and related health conditions.
(C) Screening and identification of patients with substance
use disorder, including drug-seeking behavior, before
prescribing opioids, assessment of risk potential for
patients developing an addiction, and referral of patients to
appropriate addiction treatment professionals if addiction is
identified or strongly suspected.
(D) Communication with patients on the potential harm
associated with the use of opioids and other controlled
substances, including the need to safely store and dispose of
supplies relating to the use of opioids and other controlled
substances.
(E) Such other education and training as the Secretary
considers appropriate to ensure that veterans receive safe
and high-quality pain management care from the Department.
(3) Use of existing program.--In providing education and
training described in paragraph (2), the Secretary shall use
the Interdisciplinary Chronic Pain Management Training Team
Program of the Department (or successor program).
(c) Pain Management Teams.--
(1) In general.--In carrying out the Opioid Safety
Initiative of the Department, the director of each medical
facility of the Department shall identify and designate a
pain management team of health care professionals, which may
include board certified pain medicine specialists,
responsible for coordinating and overseeing pain management
therapy at such facility for patients experiencing acute and
chronic pain that is non-cancer related.
(2) Establishment of protocols.--
(A) In general.--In consultation with the Directors of each
Veterans Integrated Service Network, the Secretary shall
establish standard protocols for the designation of pain
management teams at each medical facility within the
Department.
(B) Consultation on prescription of opioids.--Each protocol
established under subparagraph (A) shall ensure that any
health care provider without expertise in prescribing
analgesics or who has not completed the education and
training under subsection (b), including a mental health care
provider, does not prescribe opioids to a patient unless that
health care provider--
(i) consults with a health care provider with pain
management expertise or who is on the pain management team of
the medical facility; and
(ii) refers the patient to the pain management team for any
subsequent prescriptions and related therapy.
(3) Report.--
(A) In general.--Not later than one year after the date of
enactment of this Act, the director of each medical facility
of the Department shall submit to the Under Secretary for
Health and the director of the Veterans Integrated Service
Network in which the medical facility is located a report
identifying the health care professionals that have been
designated as members of the pain management team at the
medical facility pursuant to paragraph (1).
(B) Elements.--Each report submitted under subparagraph (A)
with respect to a medical facility of the Department shall
include--
(i) a certification as to whether all members of the pain
management team at the medical facility have completed the
education and training required under subsection (b);
(ii) a plan for the management and referral of patients to
such pain management team if health care providers without
expertise in prescribing analgesics prescribe opioid
medications to treat acute and chronic pain that is non-
cancer related; and
(iii) a certification as to whether the medical facility--
(I) fully complies with the stepped-care model, or
successor models, of pain management and other pain
management policies of the Department; or
(II) does not fully comply with such stepped-care model, or
successor models, of pain management and other pain
management policies but is carrying out a corrective plan of
action to ensure such full compliance.
(d) Tracking and Monitoring of Opioid Use.--
(1) Prescription drug monitoring programs of states.--In
carrying out the Opioid Safety Initiative and the Opioid
Therapy Risk Report tool of the Department, the Secretary
shall--
(A) ensure access by health care providers of the
Department to information on controlled substances, including
opioids and benzodiazepines, prescribed to veterans who
receive care outside the Department through the prescription
drug monitoring program of each State with such a program,
including by seeking to enter into memoranda of understanding
with States to allow shared access of such information
between States and the Department;
(B) include such information in the Opioid Therapy Risk
Report tool; and
(C) require health care providers of the Department to
submit to the prescription drug monitoring program of each
State with such a program information on prescriptions of
controlled substances received by veterans in that State
under the laws administered by the Secretary.
(2) Report on tracking of data on opioid use.--Not later
than 18 months after the date of the enactment of this Act,
the Secretary shall submit to the Committee on Veterans'
Affairs of the Senate and the Committee on Veterans' Affairs
of the House of Representatives a report on the feasibility
and advisability of improving the Opioid Therapy Risk Report
tool of the Department to allow for more advanced real-time
tracking of and access to data on--
(A) the key clinical indicators with respect to the
totality of opioid use by veterans;
(B) concurrent prescribing by health care providers of the
Department of opioids in different health care settings,
including data on concurrent prescribing of opioids to treat
mental health disorders other than opioid use disorder; and
(C) mail-order prescriptions of opioids prescribed to
veterans under the laws administered by the Secretary.
(e) Availability of Opioid Receptor Antagonists.--
(1) Increased availability and use.--
(A) In general.--The Secretary shall maximize the
availability of opioid receptor antagonists, including
naloxone, to veterans.
(B) Availability, training, and distributing.--In carrying
out subparagraph (A), not later than 90 days after the date
of the enactment of this Act, the Secretary shall--
(i) equip each pharmacy of the Department with opioid
receptor antagonists to be dispensed to outpatients as
needed; and
[[Page H4409]]
(ii) expand the Overdose Education and Naloxone
Distribution program of the Department to ensure that all
veterans in receipt of health care under laws administered by
the Secretary who are at risk of opioid overdose may access
such opioid receptor antagonists and training on the proper
administration of such opioid receptor antagonists.
(C) Veterans who are at risk.--For purposes of subparagraph
(B), veterans who are at risk of opioid overdose include--
(i) veterans receiving long-term opioid therapy;
(ii) veterans receiving opioid therapy who have a history
of substance use disorder or prior instances of overdose; and
(iii) veterans who are at risk as determined by a health
care provider who is treating the veteran.
(2) Report.--Not later than 120 days after the date of the
enactment of this Act, the Secretary shall submit to the
Committee on Veterans' Affairs of the Senate and the
Committee on Veterans' Affairs of the House of
Representatives a report on carrying out paragraph (1),
including an assessment of any remaining steps to be carried
out by the Secretary to carry out such paragraph.
(f) Inclusion of Certain Information and Capabilities in
Opioid Therapy Risk Report Tool of the Department.--
(1) Information.--The Secretary shall include in the Opioid
Therapy Risk Report tool of the Department--
(A) information on the most recent time the tool was
accessed by a health care provider of the Department with
respect to each veteran; and
(B) information on the results of the most recent urine
drug test for each veteran.
(2) Capabilities.--The Secretary shall include in the
Opioid Therapy Risk Report tool the ability of the health
care providers of the Department to determine whether a
health care provider of the Department prescribed opioids to
a veteran without checking the information in the tool with
respect to the veteran.
(g) Notifications of Risk in Computerized Health Record.--
The Secretary shall modify the computerized patient record
system of the Department to ensure that any health care
provider that accesses the record of a veteran, regardless of
the reason the veteran seeks care from the health care
provider, will be immediately notified whether the veteran--
(1) is receiving opioid therapy and has a history of
substance use disorder or prior instances of overdose;
(2) has a history of opioid abuse; or
(3) is at risk of developing an opioid use disorder, as
determined by a health care provider who is treating the
veteran.
SEC. 912. STRENGTHENING OF JOINT WORKING GROUP ON PAIN
MANAGEMENT OF THE DEPARTMENT OF VETERANS
AFFAIRS AND THE DEPARTMENT OF DEFENSE.
(a) In General.--Not later than 90 days after the date of
enactment of this Act, the Secretary of Veterans Affairs and
the Secretary of Defense shall ensure that the Pain
Management Working Group of the Health Executive Committee of
the Department of Veterans Affairs-Department of Defense
Joint Executive Committee (Pain Management Working Group)
established under section 320 of title 38, United States
Code, includes a focus on the following:
(1) The opioid prescribing practices of health care
providers of each Department.
(2) The ability of each Department to manage acute and
chronic pain among individuals receiving health care from the
Department, including training health care providers with
respect to pain management.
(3) The use by each Department of complementary and
integrative health in treating such individuals.
(4) The concurrent use and practice by health care
providers of each Department of opioids and prescription
drugs to treat mental health disorders, including
benzodiazepines.
(5) The use of care transition plans by health care
providers of each Department to address case management
issues for patients receiving opioid therapy who transition
between inpatient and outpatient care.
(6) The coordination in coverage of and consistent access
to medications prescribed for patients transitioning from
receiving health care from the Department of Defense to
receiving health care from the Department of Veterans
Affairs.
(7) The ability of each Department to properly screen,
identify, refer, and treat patients with substance use
disorders who are seeking treatment for acute and chronic
pain management conditions.
(b) Coordination and Consultation.--The Secretary of
Veterans Affairs and the Secretary of Defense shall ensure
that the working group described in subsection (a)--
(1) coordinates the activities of the working group with
other relevant working groups established under section 320
of title 38, United States Code;
(2) consults with other relevant Federal agencies,
including the Centers for Disease Control and Prevention,
with respect to the activities of the working group; and
(3) consults with the Department of Veterans Affairs and
the Department of Defense with respect to the VA/DOD Clinical
Practice Guideline for Management of Opioid Therapy for
Chronic Pain, or any successor guideline, and reviews and
provides comments before any update to the guideline is
released.
(c) Clinical Practice Guidelines.--
(1) In general.--Not later than 180 days after the date of
the enactment of this Act, the Secretary of Veterans Affairs
and the Secretary of Defense shall issue an update to the VA/
DOD Clinical Practice Guideline for Management of Opioid
Therapy for Chronic Pain.
(2) Matters included.--In conducting the update under
paragraph (1), the Pain Management Working Group, in
coordination with the Clinical Practice Guideline VA/DoD
Management of Opioid Therapy for Chronic Pain Working Group,
shall work to ensure that the Clinical Practical Guideline
includes the following:
(A) Enhanced guidance with respect to--
(i) the co-administration of an opioid and other drugs,
including benzodiazepines, that may result in life-limiting
drug interactions;
(ii) the treatment of patients with current acute
psychiatric instability or substance use disorder or patients
at risk of suicide; and
(iii) the use of opioid therapy to treat mental health
disorders other than opioid use disorder.
(B) Enhanced guidance with respect to the treatment of
patients with behaviors or comorbidities, such as post-
traumatic stress disorder or other psychiatric disorders, or
a history of substance abuse or addiction, that requires a
consultation or co-management of opioid therapy with one or
more specialists in pain management, mental health, or
addictions.
(C) Enhanced guidance with respect to health care
providers--
(i) conducting an effective assessment for patients
beginning or continuing opioid therapy, including
understanding and setting realistic goals with respect to
achieving and maintaining an expected level of pain relief,
improved function, or a clinically appropriate combination of
both; and
(ii) effectively assessing whether opioid therapy is
achieving or maintaining the established treatment goals of
the patient or whether the patient and health care provider
should discuss adjusting, augmenting, or discontinuing the
opioid therapy.
(D) Guidelines to inform the methodologies used by health
care providers of the Department of Veterans Affairs and the
Department of Defense to safely taper opioid therapy when
adjusting or discontinuing the use of opioid therapy,
including--
(i) prescription of the lowest effective dose based on
patient need;
(ii) use of opioids only for a limited time; and
(iii) augmentation of opioid therapy with other pain
management therapies and modalities.
(E) Guidelines with respect to appropriate case management
for patients receiving opioid therapy who transition between
inpatient and outpatient health care settings, which may
include the use of care transition plans.
(F) Guidelines with respect to appropriate case management
for patients receiving opioid therapy who transition from
receiving care during active duty to post-military health
care networks.
(G) Guidelines with respect to providing options, before
initiating opioid therapy, for pain management therapies
without the use of opioids and options to augment opioid
therapy with other clinical and complementary and integrative
health services to minimize opioid dependence.
(H) Guidelines with respect to the provision of evidence-
based non-opioid treatments within the Department of Veterans
Affairs and the Department of Defense, including medical
devices and other therapies approved or cleared by the Food
and Drug Administration for the treatment of chronic pain as
an alternative to or to augment opioid therapy.
(I) Guidelines developed by the Centers for Disease Control
and Prevention for safely prescribing opioids for the
treatment of chronic, non-cancer related pain in outpatient
settings.
(3) Rule of construction.--Nothing in this subsection shall
be construed to prevent the Secretary of Veterans Affairs and
the Secretary of Defense from considering all relevant
evidence, as appropriate, in updating the VA/DOD Clinical
Practice Guideline for Management of Opioid Therapy for
Chronic Pain, as required under paragraph (1), or from
ensuring that the final clinical practice guideline updated
under such paragraph remains applicable to the patient
populations of the Department of Veterans Affairs and the
Department of Defense.
SEC. 913. REVIEW, INVESTIGATION, AND REPORT ON USE OF OPIOIDS
IN TREATMENT BY DEPARTMENT OF VETERANS AFFAIRS.
(a) Comptroller General Report.--
(1) In general.--Not later than two years after the date of
the enactment of this Act, the Comptroller General of the
United States shall submit to the Committee on Veterans'
Affairs of the Senate and the Committee on Veterans' Affairs
of the House of Representatives a report on the Opioid Safety
Initiative of the Department of Veterans Affairs and the
opioid prescribing practices of health care providers of the
Department.
(2) Elements.--The report submitted under paragraph (1)
shall include the following:
(A) An assessment of the implementation and monitoring by
the Veterans Health Administration of the Opioid Safety
Initiative of the Department, including examining, as
appropriate, the following:
(i) How the Department monitors the key clinical outcomes
of such safety initiative (for example, the percentage of
unique veterans visiting each medical center of the
Department that are prescribed an opioid or an opioid and
benzodiazepine concurrently) and how the Department uses that
information--
(I) to improve prescribing practices; and
(II) to identify high prescribing or otherwise
inappropriate prescribing practices by health care providers.
(ii) How the Department monitors the use of the Opioid
Therapy Risk Report tool of the Department (as developed
through such safety initiative) and compliance with such tool
by medical facilities and health care providers of the
Department, including any findings by the Department of
prescription rates or prescription practices by medical
facilities or health care providers that are inappropriate.
[[Page H4410]]
(iii) The implementation of academic detailing programs
within the Veterans Integrated Service Networks of the
Department and how such programs are being used to improve
opioid prescribing practices.
(iv) Recommendations on such improvements to the Opioid
Safety Initiative of the Department as the Comptroller
General considers appropriate.
(B) Information made available under the Opioid Therapy
Risk Report tool with respect to--
(i) deaths resulting from sentinel events involving
veterans prescribed opioids by a health care provider;
(ii) overall prescription rates and, if applicable,
indications used by health care providers for prescribing
chronic opioid therapy to treat non-cancer, non-palliative,
and non-hospice care patients;
(iii) the prescription rates and indications used by health
care providers for prescribing benzodiazepines and opioids
concomitantly;
(iv) the practice by health care providers of prescribing
opioids to treat patients without any pain, including to
treat patients with mental health disorders other than opioid
use disorder; and
(v) the effectiveness of opioid therapy for patients
receiving such therapy, including the effectiveness of long-
term opioid therapy.
(C) An evaluation of processes of the Department in place
to oversee opioid use among veterans, including procedures to
identify and remedy potential over-prescribing of opioids by
health care providers of the Department.
(D) An assessment of the implementation by the Secretary of
Veterans Affairs of the VA/DOD Clinical Practice Guideline
for Management of Opioid Therapy for Chronic Pain, including
any figures or approaches used by the Department to assess
compliance with such guidelines by medical centers of the
Department and identify any medical centers of the Department
operating action plans to improve compliance with such
guidelines.
(E) An assessment of the data that the Department has
developed to review the opioid prescribing practices of
health care providers of the Department, as required by this
subtitle, including a review of how the Department identifies
the practices of individual health care providers that
warrant further review based on prescribing levels, health
conditions for which the health care provider is prescribing
opioids or opioids and benzodiazepines concurrently, or other
practices of the health care provider.
(b) Semi-annual Progress Report on Implementation of
Comptroller General Recommendations.--Not later than 180 days
after the date of the submittal of the report required under
subsection (a), and not less frequently than annually
thereafter until the Comptroller General of the United States
determines that all recommended actions are closed, the
Secretary of Veterans Affairs shall submit to the Committee
on Veterans' Affairs of the Senate and the Committee on
Veterans' Affairs of the House of Representatives a progress
report detailing the actions by the Secretary to address any
outstanding findings and recommendations by the Comptroller
General of the United States under subsection (a) with
respect to the Veterans Health Administration.
(c) Annual Report on Opioid Therapy and Prescription
Rates.--Not later than one year after the date of the
enactment of this Act, and not less frequently than annually
for the following five years, the Secretary shall submit to
the Committee on Veterans' Affairs of the Senate and the
Committee on Veterans' Affairs of the House of
Representatives a report on opioid therapy and prescription
rates for the one-year period preceding the date of the
submission of the report. Each such report shall include each
of the following:
(1) The number of patients and the percentage of the
patient population of the Department who were prescribed
benzodiazepines and opioids concurrently by a health care
provider of the Department.
(2) The number of patients and the percentage of the
patient population of the Department without any pain who
were prescribed opioids by a health care provider of the
Department, including those who were prescribed
benzodiazepines and opioids concurrently.
(3) The number of non-cancer, non-palliative, and non-
hospice care patients and the percentage of such patients who
were treated with opioids by a health care provider of the
Department on an inpatient-basis and who also received
prescription opioids by mail from the Department while being
treated on an inpatient-basis.
(4) The number of non-cancer, non-palliative, and non-
hospice care patients and the percentage of such patients who
were prescribed opioids concurrently by a health care
provider of the Department and a health care provider that is
not a health care provider of the Department.
(5) With respect to each medical facility of the
Department, the collected and reviewed information on opioids
prescribed by health care providers at the facility to treat
non-cancer, non-palliative, and non-hospice care patients,
including--
(A) the prescription rate at which each health care
provider at the facility prescribed benzodiazepines and
opioids concurrently to such patients and the aggregate of
such prescription rate for all health care providers at the
facility;
(B) the prescription rate at which each health care
provider at the facility prescribed benzodiazepines or
opioids to such patients to treat conditions for which
benzodiazepines or opioids are not approved treatment and the
aggregate of such prescription rate for all health care
providers at the facility;
(C) the prescription rate at which each health care
provider at the facility prescribed or dispensed mail-order
prescriptions of opioids to such patients while such patients
were being treated with opioids on an inpatient-basis and the
aggregate of such prescription rate for all health care
providers at the facility; and
(D) the prescription rate at which each health care
provider at the facility prescribed opioids to such patients
who were also concurrently prescribed opioids by a health
care provider that is not a health care provider of the
Department and the aggregate of such prescription rates for
all health care providers at the facility.
(6) With respect to each medical facility of the
Department, the number of times a pharmacist at the facility
overrode a critical drug interaction warning with respect to
an interaction between opioids and another medication before
dispensing such medication to a veteran.
(d) Investigation of Prescription Rates.--If the Secretary
determines that a prescription rate with respect to a health
care provider or medical facility of the Department conflicts
with or is otherwise inconsistent with the standards of
appropriate and safe care, the Secretary shall--
(1) immediately notify the Committee on Veterans' Affairs
of the Senate and the Committee on Veterans' Affairs of the
House of Representatives of such determination, including
information relating to such determination, prescription
rate, and health care provider or medical facility, as the
case may be; and
(2) through the Office of the Medical Inspector of the
Veterans Health Administration, conduct a full investigation
of the health care provider or medical facility, as the case
may be.
(e) Prescription Rate Defined.--In this section, the term
``prescription rate'' means, with respect to a health care
provider or medical facility of the Department, each of the
following:
(1) The number of patients treated with opioids by the
health care provider or at the medical facility, as the case
may be, divided by the total number of pharmacy users of that
health care provider or medical facility.
(2) The average number of morphine equivalents per day
prescribed by the health care provider or at the medical
facility, as the case may be, to patients being treated with
opioids.
(3) Of the patients being treated with opioids by the
health care provider or at the medical facility, as the case
may be, the average number of prescriptions of opioids per
patient.
SEC. 914. MANDATORY DISCLOSURE OF CERTAIN VETERAN INFORMATION
TO STATE CONTROLLED SUBSTANCE MONITORING
PROGRAMS.
Section 5701(l) of title 38, United States Code, is amended
by striking ``may'' and inserting ``shall''.
SEC. 915. ELIMINATION OF COPAYMENT REQUIREMENT FOR VETERANS
RECEIVING OPIOID ANTAGONISTS OR EDUCATION ON
USE OF OPIOID ANTAGONISTS.
(a) Copayment for Opioid Antagonists.--Section 1722A(a) of
title 38, United States Code, is amended by adding at the end
the following new paragraph:
``(4) Paragraph (1) does not apply to opioid antagonists
furnished under this chapter to a veteran who is at high risk
for overdose of a specific medication or substance in order
to reverse the effect of such an overdose.''.
(b) Copayment for Education on Use of Opioid Antagonists.--
Section 1710(g)(3) of such title is amended--
(1) by striking ``with respect to home health services''
and inserting ``with respect to the following:''
``(A) Home health services''; and
(2) by adding at the end the following subparagraph:
``(B) Education on the use of opioid antagonists to reverse
the effects of overdoses of specific medications or
substances.''.
Subtitle B--Patient Advocacy
SEC. 921. COMMUNITY MEETINGS ON IMPROVING CARE FURNISHED BY
DEPARTMENT OF VETERANS AFFAIRS.
(a) Community Meetings.--
(1) Medical centers.--Not later than 90 days after the date
of the enactment of this Act, and not less frequently than
once every 90 days thereafter, the Secretary shall ensure
that each medical facility of the Department of Veterans
Affairs hosts a community meeting open to the public on
improving health care furnished by the Secretary.
(2) Community-based outpatient clinics.--Not later than one
year after the date of the enactment of this Act, and not
less frequently than annually thereafter, the Secretary shall
ensure that each community-based outpatient clinic of the
Department hosts a community meeting open to the public on
improving health care furnished by the Secretary.
(b) Attendance by Director of Veterans Integrated Service
Network or Designee.--
(1) In general.--Each community meeting hosted by a medical
facility or community-based outpatient clinic under
subsection (a) shall be attended by the Director of the
Veterans Integrated Service Network in which the medical
facility or community-based outpatient clinic, as the case
may be, is located. Subject to paragraph (2), the Director
may delegate such attendance only to an employee who works in
the Office of the Director.
(2) Attendance by director.--Each Director of a Veterans
Integrated Service Network shall personally attend not less
than one community meeting under subsection (a) hosted by
each medical facility located in the Veterans Integrated
Service Network each year.
(c) Notice.--The Secretary shall notify the Committee on
Veterans' Affairs of the Senate, the Committee on Veterans'
Affairs of the House of Representatives, and each Member of
Congress (as defined in section 902) who represents the area
in which the medical facility is located of a community
meeting under subsection (a) by not later than 10 days before
such community meeting occurs.
[[Page H4411]]
SEC. 922. IMPROVEMENT OF AWARENESS OF PATIENT ADVOCACY
PROGRAM AND PATIENT BILL OF RIGHTS OF
DEPARTMENT OF VETERANS AFFAIRS.
Not later than 90 days after the date of the enactment of
this Act, the Secretary of Veterans Affairs shall, in as many
prominent locations as the Secretary determines appropriate
to be seen by the largest percentage of patients and family
members of patients at each medical facility of the
Department of Veterans Affairs--
(1) display the purposes of the Patient Advocacy Program of
the Department and the contact information for the patient
advocate at such medical facility; and
(2) display the rights and responsibilities of--
(A) patients and family members of patients at such medical
facility; and
(B) with respect to community living centers and other
residential facilities of the Department, residents and
family members of residents at such medical facility.
SEC. 923. COMPTROLLER GENERAL REPORT ON PATIENT ADVOCACY
PROGRAM OF DEPARTMENT OF VETERANS AFFAIRS.
(a) In General.--Not later than two years after the date of
the enactment of this Act, the Comptroller General of the
United States shall submit to the Committee on Veterans'
Affairs of the Senate and the Committee on Veterans' Affairs
of the House of Representatives a report on the Patient
Advocacy Program of the Department of Veterans Affairs (in
this section referred to as the ``Program'').
(b) Elements.--The report required by subsection (a) shall
include the following:
(1) A description of the Program, including--
(A) the purpose of the Program;
(B) the activities carried out under the Program; and
(C) the sufficiency of the Program in achieving the purpose
of the Program.
(2) An assessment of the sufficiency of staffing of
employees of the Department responsible for carrying out the
Program.
(3) An assessment of the sufficiency of the training of
such employees.
(4) An assessment of--
(A) the awareness of the Program among veterans and family
members of veterans; and
(B) the use of the Program by veterans and family members
of veterans.
(5) Such recommendations and proposals for improving or
modifying the Program as the Comptroller General considers
appropriate.
(6) Such other information with respect to the Program as
the Comptroller General considers appropriate.
SEC. 924. ESTABLISHMENT OF OFFICE OF PATIENT ADVOCACY OF THE
DEPARTMENT OF VETERANS AFFAIRS.
(a) In General.--Subchapter I of chapter 73 of title 38,
United States Code, is amended by adding at the end the
following new section:
``Sec. 7309A. Office of Patient Advocacy
``(a) Establishment.--There is established in the
Department within the Office of the Under Secretary for
Health an office to be known as the `Office of Patient
Advocacy' (in this section referred to as the `Office').
``(b) Head.--(1) The Director of the Office of Patient
Advocacy shall be the head of the Office.
``(2) The Director of the Office of Patient Advocacy shall
be appointed by the Under Secretary for Health from among
individuals qualified to perform the duties of the position
and shall report directly to the Under Secretary for Health.
``(c) Function.--(1) The function of the Office is to carry
out the Patient Advocacy Program of the Department.
``(2) In carrying out the Patient Advocacy Program of the
Department, the Director shall ensure that patient advocates
of the Department--
``(A) advocate on behalf of veterans with respect to health
care received and sought by veterans under the laws
administered by the Secretary;
``(B) carry out the responsibilities specified in
subsection (d); and
``(C) receive training in patient advocacy.
``(d) Patient Advocacy Responsibilities.--The
responsibilities of each patient advocate at a medical
facility of the Department are the following:
``(1) To resolve complaints by veterans with respect to
health care furnished under the laws administered by the
Secretary that cannot be resolved at the point of service or
at a higher level easily accessible to the veteran.
``(2) To present at various meetings and to various
committees the issues experienced by veterans in receiving
such health care at such medical facility.
``(3) To express to veterans their rights and
responsibilities as patients in receiving such health care.
``(4) To manage the Patient Advocate Tracking System of the
Department at such medical facility.
``(5) To compile data at such medical facility of
complaints made by veterans with respect to the receipt of
such health care at such medical facility and the
satisfaction of veterans with such health care at such
medical facility to determine whether there are trends in
such data.
``(6) To ensure that a process is in place for the
distribution of the data compiled under paragraph (5) to
appropriate leaders, committees, services, and staff of the
Department.
``(7) To identify, not less frequently than quarterly,
opportunities for improvements in the furnishing of such
health care to veterans at such medical facility based on
complaints by veterans.
``(8) To ensure that any significant complaint by a veteran
with respect to such health care is brought to the attention
of appropriate staff of the Department to trigger an
assessment of whether there needs to be a further analysis of
the problem at the facility-wide level.
``(9) To support any patient advocacy programs carried out
by the Department.
``(10) To ensure that all appeals and final decisions with
respect to the receipt of such health care are entered into
the Patient Advocate Tracking System of the Department.
``(11) To understand all laws, directives, and other rules
with respect to the rights and responsibilities of veterans
in receiving such health care, including the appeals
processes available to veterans.
``(12) To ensure that veterans receiving mental health
care, or the surrogate decision-makers for such veterans, are
aware of the rights of veterans to seek representation from
systems established under section 103 of the Protection and
Advocacy for Mentally Ill Individuals Act of 1986 (42 U.S.C.
10803) to protect and advocate the rights of individuals with
mental illness and to investigate incidents of abuse and
neglect of such individuals.
``(13) To fulfill requirements established by the Secretary
with respect to the inspection of controlled substances.
``(14) To document potentially threatening behavior and
report such behavior to appropriate authorities.
``(e) Training.--In providing training to patient advocates
under subsection (c)(2)(C), the Director shall ensure that
such training is consistent throughout the Department.
``(f) Controlled Substance Defined.--In this section, the
term `controlled substance' has the meaning given that term
in section 102 of the Controlled Substances Act (21 U.S.C.
802).''.
(b) Clerical Amendment.--The table of sections at the
beginning of chapter 73 of such title is amended by inserting
after the item relating to section 7309 the following new
item:
``7309A. Office of Patient Advocacy.''.
(c) Date Fully Operational.--The Secretary of Veterans
Affairs shall ensure that the Office of Patient Advocacy
established under section 7309A of title 38, United States
Code, as added by subsection (a), is fully operational not
later than the date that is one year after the date of the
enactment of this Act.
Subtitle C--Complementary and Integrative Health
SEC. 931. EXPANSION OF RESEARCH AND EDUCATION ON AND DELIVERY
OF COMPLEMENTARY AND INTEGRATIVE HEALTH TO
VETERANS.
(a) Establishment.--There is established a commission to be
known as the ``Creating Options for Veterans' Expedited
Recovery'' or the ``COVER Commission'' (in this section
referred to as the ``Commission''). The Commission shall
examine the evidence-based therapy treatment model used by
the Secretary of Veterans Affairs for treating mental health
conditions of veterans and the potential benefits of
incorporating complementary and integrative health treatments
available in non-Department facilities (as defined in section
1701 of title 38, United States Code).
(b) Duties.--The Commission shall perform the following
duties:
(1) Examine the efficacy of the evidence-based therapy
model used by the Secretary for treating mental health
illnesses of veterans and identify areas to improve wellness-
based outcomes.
(2) Conduct a patient-centered survey within each of the
Veterans Integrated Service Networks to examine--
(A) the experience of veterans with the Department of
Veterans Affairs when seeking medical assistance for mental
health issues through the health care system of the
Department;
(B) the experience of veterans with non-Department
facilities and health professionals for treating mental
health issues;
(C) the preference of veterans regarding available
treatment for mental health issues and which methods the
veterans believe to be most effective;
(D) the experience, if any, of veterans with respect to the
complementary and integrative health treatment therapies
described in paragraph (3);
(E) the prevalence of prescribing prescription medication
among veterans seeking treatment through the health care
system of the Department as remedies for addressing mental
health issues; and
(F) the outreach efforts of the Secretary regarding the
availability of benefits and treatments for veterans for
addressing mental health issues, including by identifying
ways to reduce barriers to gaps in such benefits and
treatments.
(3) Examine available research on complementary and
integrative health treatment therapies for mental health
issues and identify what benefits could be made with the
inclusion of such treatments for veterans, including with
respect to--
(A) music therapy;
(B) equine therapy;
(C) training and caring for service dogs;
(D) yoga therapy;
(E) acupuncture therapy;
(F) meditation therapy;
(G) outdoor sports therapy;
(H) hyperbaric oxygen therapy;
(I) accelerated resolution therapy;
(J) art therapy;
(K) magnetic resonance therapy; and
(L) other therapies the Commission determines appropriate.
(4) Study the sufficiency of the resources of the
Department to ensure the delivery of quality health care for
mental health issues among veterans seeking treatment within
the Department.
(5) Study the current treatments and resources available
within the Department and assess--
(A) the effectiveness of such treatments and resources in
decreasing the number of suicides per day by veterans;
(B) the number of veterans who have been diagnosed with
mental health issues;
[[Page H4412]]
(C) the percentage of veterans using the resources of the
Department who have been diagnosed with mental health issues;
(D) the percentage of veterans who have completed
counseling sessions offered by the Department; and
(E) the efforts of the Department to expand complementary
and integrative health treatments viable to the recovery of
veterans with mental health issues as determined by the
Secretary to improve the effectiveness of treatments offered
by the Department.
(c) Membership.--
(1) In general.--The Commission shall be composed of 10
members, appointed as follows:
(A) Two members appointed by the Speaker of the House of
Representatives, at least one of whom shall be a veteran.
(B) Two members appointed by the minority leader of the
House of Representatives, at least one of whom shall be a
veteran.
(C) Two members appointed by the majority leader of the
Senate, at least one of whom shall be a veteran.
(D) Two members appointed by the minority leader of the
Senate, at least one of whom shall be a veteran.
(E) Two members appointed by the President, at least one of
whom shall be a veteran.
(2) Qualifications.--Members of the Commission shall be
individuals who--
(A) are of recognized standing and distinction within the
medical community with a background in treating mental
health;
(B) have experience working with the military and veteran
population; and
(C) do not have a financial interest in any of the
complementary and integrative health treatments reviewed by
the Commission.
(3) Chairman.--The President shall designate a member of
the Commission to be the Chairman.
(4) Period of appointment.--Members of the Commission shall
be appointed for the life of the Commission.
(5) Vacancy.--A vacancy in the Commission shall be filled
in the manner in which the original appointment was made.
(6) Appointment deadline.--The appointment of members of
the Commission in this section shall be made not later than
90 days after the date of the enactment of this Act.
(d) Powers of Commission.--
(1) Meetings.--
(A) Initial meeting.--The Commission shall hold its first
meeting not later than 30 days after a majority of members
are appointed to the Commission.
(B) Meeting.--The Commission shall regularly meet at the
call of the Chairman. Such meetings may be carried out
through the use of telephonic or other appropriate
telecommunication technology if the Commission determines
that such technology will allow the members to communicate
simultaneously.
(2) Hearings.--The Commission may hold such hearings, sit
and act at such times and places, take such testimony, and
receive evidence as the Commission considers advisable to
carry out the responsibilities of the Commission.
(3) Information from federal agencies.--The Commission may
secure directly from any department or agency of the Federal
Government such information as the Commission considers
necessary to carry out the duties of the Commission.
(4) Information from nongovernmental organizations.--In
carrying out its duties, the Commission may seek guidance
through consultation with foundations, veteran service
organizations, nonprofit groups, faith-based organizations,
private and public institutions of higher education, and
other organizations as the Commission determines appropriate.
(5) Commission records.--The Commission shall keep an
accurate and complete record of the actions and meetings of
the Commission. Such record shall be made available for
public inspection and the Comptroller General of the United
States may audit and examine such record.
(6) Personnel records.--The Commission shall keep an
accurate and complete record of the actions and meetings of
the Commission. Such record shall be made available for
public inspection and the Comptroller General of the United
States may audit and examine such records.
(7) Compensation of members; travel expenses.--Each member
shall serve without pay but shall receive travel expenses to
perform the duties of the Commission, including per diem in
lieu of substances, at rates authorized under subchapter I of
chapter 57 of title 5, United States Code.
(8) Staff.--The Chairman, in accordance with rules agreed
upon the Commission, may appoint and fix the compensation of
a staff director and such other personnel as may be necessary
to enable the Commission to carry out its functions, without
regard to the provisions of title 5, United States Code,
governing appointments in the competitive service, without
regard to the provision of chapter 51 and subchapter III of
chapter 53 of such title relating to classification and
General Schedule pay rates, except that no rate of pay fixed
under this paragraph may exceed the equivalent of that
payable for a position at level IV of the Executive Schedule
under section 5315 of title 5, United States Code.
(9) Personnel as federal employees.--
(A) In general.--The executive director and any personnel
of the Commission are employees under section 2105 of title
5, United States Code, for purpose of chapters 63, 81, 83,
84, 85, 87, 89, and 90 of such title.
(B) Members of the commission.--Subparagraph (A) shall not
be construed to apply to members of the Commission.
(10) Contracting.--The Commission may, to such extent and
in such amounts as are provided in appropriations Acts, enter
into contracts to enable the Commission to discharge the
duties of the Commission under this Act.
(11) Expert and consultant service.--The Commission may
procure the services of experts and consultants in accordance
with section 3109 of title 5, United States Code, at rates
not to exceed the daily rate paid to a person occupying a
position at level IV of the Executive Schedule under section
5315 of title 5, United States Code.
(12) Postal service.--The Commission may use the United
States mails in the same manner and under the same conditions
as departments and agencies of the United States.
(13) Physical facilities and equipment.--Upon the request
of the Commission, the Administrator of General Services
shall provide to the Commission, on a reimbursable basis, the
administrative support services necessary for the Commission
to carry out its responsibilities under this Act. These
administrative services may include human resource
management, budget, leasing accounting, and payroll services.
(e) Report.--
(1) Interim reports.--
(A) In general.--Not later than 60 days after the date on
which the Commission first meets, and each 30-day period
thereafter ending on the date on which the Commission submits
the final report under paragraph (2), the Commission shall
submit to the Committees on Veterans' Affairs of the House of
Representatives and the Senate and the President a report
detailing the level of cooperation the Secretary of Veterans
Affairs (and the heads of other departments or agencies of
the Federal Government) has provided to the Commission.
(B) Other reports.--In carrying out its duties, at times
that the Commission determines appropriate, the Commission
shall submit to the Committees on Veterans' Affairs of the
House of Representatives and the Senate and any other
appropriate entities an interim report with respect to the
findings identified by the Commission.
(2) Final report.--Not later than 18 months after the first
meeting of the Commission, the Commission shall submit to the
Committee on Veterans' Affairs of the House of
Representatives and the Senate, the President, and the
Secretary of Veterans Affairs a final report on the findings
of the Commission. Such report shall include the following:
(A) Recommendations to implement in a feasible, timely, and
cost-efficient manner the solutions and remedies identified
within the findings of the Commission pursuant to subsection
(b).
(B) An analysis of the evidence-based therapy model used by
the Secretary of Veterans Affairs for treating veterans with
mental health care issues, and an examination of the
prevalence and efficacy of prescription drugs as a means for
treatment.
(C) The findings of the patient-centered survey conducted
within each of the Veterans Integrated Service Networks
pursuant to subsection (b)(2).
(D) An examination of complementary and integrative health
treatments described in subsection (b)(3) and the potential
benefits of incorporating such treatments in the therapy
models used by the Secretary for treating veterans with
mental health issues.
(3) Plan.--Not later than 90 days after the date on which
the Commission submits the final report under paragraph (2),
the Secretary of Veterans Affairs shall submit to the
Committees on Veterans' Affairs of the House of
Representatives and the Senate a report on the following:
(A) An action plan for implementing the recommendations
established by the Commission on such solutions and remedies
for improving wellness-based outcomes for veterans with
mental health care issues.
(B) A feasible timeframe on when the complementary and
integrative health treatments described in subsection (b)(3)
can be implemented Department-wide.
(C) With respect to each recommendation established by the
Commission, including any complementary and integrative
health treatment, that the Secretary determines is not
appropriate or feasible to implement, a justification for
such determination and an alternative solution to improve the
efficacy of the therapy models used by the Secretary for
treating veterans with mental health issues.
(f) Termination of Commission.--The Commission shall
terminate 30 days after the Commission submits the final
report under subsection (e)(2).
SEC. 932. EXPANSION OF RESEARCH AND EDUCATION ON AND DELIVERY
OF COMPLEMENTARY AND INTEGRATIVE HEALTH TO
VETERANS.
(a) Development of Plan To Expand Research, Education, and
Delivery.--Not later than 180 days after the date of the
enactment of this Act, the Secretary of Veterans Affairs
shall develop a plan to expand materially and substantially
the scope of the effectiveness of research and education on,
and delivery and integration of, complementary and
integrative health services into the health care services
provided to veterans.
(b) Elements.--The plan required by subsection (a) shall
provide for the following:
(1) Research on the following:
(A) The effectiveness of various complementary and
integrative health services, including the effectiveness of
such services integrated with clinical services.
(B) Approaches to integrating complementary and integrative
health services into other health care services provided by
the Department of Veterans Affairs.
(2) Education and training for health care professionals of
the Department on the following:
(A) Complementary and integrative health services selected
by the Secretary for purposes of the plan.
(B) Appropriate uses of such services.
[[Page H4413]]
(C) Integration of such services into the delivery of
health care to veterans.
(3) Research, education, and clinical activities on
complementary and integrative health at centers of innovation
at medical centers of the Department.
(4) Identification or development of metrics and outcome
measures to evaluate the effectiveness of the provision and
integration of complementary and integrative health services
into the delivery of health care to veterans.
(5) Integration and delivery of complementary and
integrative health services with other health care services
provided by the Department.
(c) Consultation.--
(1) In general.--In carrying out subsection (a), the
Secretary shall consult with the following:
(A) The Director of the National Center for Complementary
and Integrative Health of the National Institutes of Health.
(B) The Commissioner of Food and Drugs.
(C) Institutions of higher education, private research
institutes, and individual researchers with extensive
experience in complementary and integrative health and the
integration of complementary and integrative health practices
into the delivery of health care.
(D) Nationally recognized providers of complementary and
integrative health.
(E) Such other officials, entities, and individuals with
expertise on complementary and integrative health as the
Secretary considers appropriate.
(2) Scope of consultation.--The Secretary shall undertake
consultation under paragraph (1) in carrying out subsection
(a) with respect to the following:
(A) To develop the plan.
(B) To identify specific complementary and integrative
health practices that, on the basis of research findings or
promising clinical interventions, are appropriate to include
as services to veterans.
(C) To identify barriers to the effective provision and
integration of complementary and integrative health services
into the delivery of health care to veterans, and to identify
mechanisms for overcoming such barriers.
SEC. 933. PILOT PROGRAM ON INTEGRATION OF COMPLEMENTARY AND
INTEGRATIVE HEALTH AND RELATED ISSUES FOR
VETERANS AND FAMILY MEMBERS OF VETERANS.
(a) Pilot Program.--
(1) In general.--Not later than 180 days after the date on
which the Secretary of Veterans Affairs receives the final
report under section 931(e)(2), the Secretary shall commence
a pilot program to assess the feasibility and advisability of
using complementary and integrative health and wellness-based
programs (as defined by the Secretary) to complement the
provision of pain management and related health care
services, including mental health care services, to veterans.
(2) Matters addressed.--In carrying out the pilot program,
the Secretary shall assess the following:
(A) Means of improving coordination between Federal, State,
local, and community providers of health care in the
provision of pain management and related health care services
to veterans.
(B) Means of enhancing outreach, and coordination of
outreach, by and among providers of health care referred to
in subparagraph (A) on the pain management and related health
care services available to veterans.
(C) Means of using complementary and integrative health and
wellness-based programs of providers of health care referred
to in subparagraph (A) as complements to the provision by the
Department of Veterans Affairs of pain management and related
health care services to veterans.
(D) Whether complementary and integrative health and
wellness-based programs described in subparagraph (C)--
(i) are effective in enhancing the quality of life and
well-being of veterans;
(ii) are effective in increasing the adherence of veterans
to the primary pain management and related health care
services provided such veterans by the Department;
(iii) have an effect on the sense of well-being of veterans
who receive primary pain management and related health care
services from the Department; and
(iv) are effective in encouraging veterans receiving health
care from the Department to adopt a more healthy lifestyle.
(b) Duration.--The Secretary shall carry out the pilot
program under subsection (a)(1) for a period of three years.
(c) Locations.--
(1) Facilities.--The Secretary shall carry out the pilot
program under subsection (a)(1) at facilities of the
Department providing pain management and related health care
services, including mental health care services, to veterans.
In selecting such facilities to carry out the pilot program,
the Secretary shall select not fewer than 15 geographically
diverse medical centers of the Department, of which not fewer
than two shall be polytrauma rehabilitation centers of the
Department.
(2) Medical centers with prescription rates of opioids that
conflict with care standards.--In selecting the medical
centers under paragraph (1), the Secretary shall give
priority to medical centers of the Department at which there
is a prescription rate of opioids that conflicts with or is
otherwise inconsistent with the standards of appropriate and
safe care.
(d) Provision of Services.--Under the pilot program under
subsection (a)(1), the Secretary shall provide covered
services to covered veterans by integrating complementary and
integrative health services with other services provided by
the Department at the medical centers selected under
subsection (c).
(e) Covered Veterans.--For purposes of the pilot program
under subsection (a)(1), a covered veteran is any veteran
who--
(1) has a mental health condition diagnosed by a clinician
of the Department;
(2) experiences chronic pain;
(3) has a chronic condition being treated by a clinician of
the Department; or
(4) is not described in paragraph (1), (2), or (3) and
requests to participate in the pilot program or is referred
by a clinician of the Department who is treating the veteran.
(f) Covered Services.--
(1) In general.--For purposes of the pilot program, covered
services are services consisting of complementary and
integrative health services as selected by the Secretary.
(2) Administration of services.--Covered services shall be
administered under the pilot program as follows:
(A) Covered services shall be administered by professionals
or other instructors with appropriate training and expertise
in complementary and integrative health services who are
employees of the Department or with whom the Department
enters into an agreement to provide such services.
(B) Covered services shall be included as part of the
Patient Aligned Care Teams initiative of the Office of
Patient Care Services, Primary Care Program Office, in
coordination with the Office of Patient Centered Care and
Cultural Transformation.
(C) Covered services shall be made available to--
(i) covered veterans who have received conventional
treatments from the Department for the conditions for which
the covered veteran seeks complementary and integrative
health services under the pilot program; and
(ii) covered veterans who have not received conventional
treatments from the Department for such conditions.
(g) Reports.--
(1) In general.--Not later than 30 months after the date on
which the Secretary commences the pilot program under
subsection (a)(1), the Secretary shall submit to the
Committee on Veterans' Affairs of the Senate and the
Committee on Veterans' Affairs of the House of
Representatives a report on the pilot program.
(2) Elements.--The report under paragraph (1) shall include
the following:
(A) The findings and conclusions of the Secretary with
respect to the pilot program under subsection (a)(1),
including with respect to--
(i) the use and efficacy of the complementary and
integrative health services established under the pilot
program;
(ii) the outreach conducted by the Secretary to inform
veterans and community organizations about the pilot program;
and
(iii) an assessment of the benefit of the pilot program to
covered veterans in mental health diagnoses, pain management,
and treatment of chronic illness.
(B) Identification of any unresolved barriers that impede
the ability of the Secretary to incorporate complementary and
integrative health services with other health care services
provided by the Department.
(C) Such recommendations for the continuation or expansion
of the pilot program as the Secretary considers appropriate.
Subtitle D--Fitness of Health Care Providers
SEC. 941. ADDITIONAL REQUIREMENTS FOR HIRING OF HEALTH CARE
PROVIDERS BY DEPARTMENT OF VETERANS AFFAIRS.
As part of the hiring process for each health care provider
considered for a position at the Department of Veterans
Affairs after the date of the enactment of the Act, the
Secretary of Veterans Affairs shall require from the medical
board of each State in which the health care provider has or
had a medical license--
(1) information on any violation of the requirements of the
medical license of the health care provider during the 20-
year period preceding the consideration of the health care
provider by the Department; and
(2) information on whether the health care provider has
entered into any settlement agreement for a disciplinary
charge relating to the practice of medicine by the health
care provider.
SEC. 942. PROVISION OF INFORMATION ON HEALTH CARE PROVIDERS
OF DEPARTMENT OF VETERANS AFFAIRS TO STATE
MEDICAL BOARDS.
Notwithstanding section 552a of title 5, United States
Code, with respect to each health care provider of the
Department of Veterans Affairs who has violated a requirement
of the medical license of the health care provider, the
Secretary of Veterans Affairs shall provide to the medical
board of each State in which the health care provider is
licensed detailed information with respect to such violation,
regardless of whether such board has formally requested such
information.
SEC. 943. REPORT ON COMPLIANCE BY DEPARTMENT OF VETERANS
AFFAIRS WITH REVIEWS OF HEALTH CARE PROVIDERS
LEAVING THE DEPARTMENT OR TRANSFERRING TO OTHER
FACILITIES.
Not later than 180 days after the date of the enactment of
this Act, the Secretary of Veterans Affairs shall submit to
the Committee on Veterans' Affairs of the Senate and the
Committee on Veterans' Affairs of the House of
Representatives a report on the compliance by the Department
of Veterans Affairs with the policy of the Department--
(1) to conduct a review of each health care provider of the
Department who transfers to another medical facility of the
Department, resigns, retires, or is terminated to determine
whether there are any concerns, complaints, or allegations of
violations relating to the medical practice of the health
care provider; and
(2) to take appropriate action with respect to any such
concern, complaint, or allegation.
[[Page H4414]]
Subtitle E--Other Matters
SEC. 951. MODIFICATION TO LIMITATION ON AWARDS AND BONUSES.
Section 705 of the Veterans Access, Choice, and
Accountability Act of 2014 (Public Law 113-146; 38 U.S.C. 703
note) is amended to read as follows:
``SEC. 705. LIMITATION ON AWARDS AND BONUSES PAID TO
EMPLOYEES OF DEPARTMENT OF VETERANS AFFAIRS.
``(a) Limitation.--The Secretary of Veterans Affairs shall
ensure that the aggregate amount of awards and bonuses paid
by the Secretary in a fiscal year under chapter 45 or 53 of
title 5, United States Code, or any other awards or bonuses
authorized under such title or title 38, United States Code,
does not exceed the following amounts:
``(1) With respect to each of fiscal years 2017 through
2018, $230,000,000.
``(2) With respect to each of fiscal years 2019 through
2021, $225,000,000.
``(3) With respect to each of fiscal years 2022 through
2024, $360,000,000.
``(b) Sense of Congress.--It is the sense of Congress that
the limitation under subsection (a) should not
disproportionately impact lower-wage employees and that the
Department of Veterans Affairs is encouraged to use bonuses
to incentivize high-performing employees in areas in which
retention is challenging.''.
And the House agree to the same.
That the Senate recede from its disagreement to the
amendment of the House to the title of the bill and agree to
the same with an amendment as follows:
In lieu of the matter proposed to be inserted by the House
amendment to the title of the bill, insert the following:
``An Act to authorize the Attorney General and Secretary of
Health and Human Services to award grants to address the
prescription opioid abuse and heroin use crisis, and for
other purposes.''.
And the House agree to the same.
For consideration of the Senate bill and the House
amendments, and modifications committed to conference:
Fred Upton,
Joseph R. Pitts,
Leonard Lance,
Brett Guthrie,
Adam Kinzinger,
Larry Bucshon,
Susan W. Brooks,
Bob Goodlatte,
F. James Sensenbrenner, Jr.,
Lamar Smith,
Tom Marino,
Doug Collins,
David A. Trott,
Mike Bishop,
Kevin McCarthy,
From the Committee on Education and the Workforce, for
consideration of title VII of the House amendment, and
modifications committed to conference:
Lou Barletta,
Earl L. ``Buddy'' Carter,
From the Committee on Veterans' Affairs, for consideration of
title III of the House amendment, and modifications committed
to conference:
Gus M. Bilirakis,
Jackie Walorski,
From the Committee on Ways and Means, for consideration of
sec. 705 of the Senate bill, and sec. 804 of the House
amendment, and modifications committed to conference:
Patrick Meehan,
Robert J. Dold,
Managers on the Part of the House.
Chuck Grassley,
Lamar Alexander,
Orrin G. Hatch,
Jeff Sessions,
Managers on the Part of the Senate.
JOINT EXPLANATORY STATEMENT OF THE COMMITTEE OF CONFERENCE
The managers on the part of the House and the Senate at the
conference on the disagreeing votes of the two Houses on the
amendments of the House to the bill (S. 524), to authorize
the Attorney General to award grants to address the national
epidemics of prescription opioid abuse and heroin use, submit
the following joint statement to the House and the Senate in
explanation of the effect of the action agreed upon by the
managers and recommended in the accompanying conference
report:
The House amendment to the text of the bill struck all of
the Senate bill after the enacting clause and inserted a
substitute text.
The Senate recedes from its disagreement to the amendment
of the House with an amendment that is a substitute for the
Senate bill and the House amendment. The difference between
the Senate bill, the House amendment, and the substitute
agreed to in conference are noted below, except for clerical
corrections, conforming changes made necessary by agreements
reached by the conferees, and minor drafting and clarifying
changes.
S. 524, the Comprehensive Addiction and Recovery Act
(CARA), authorizes the Attorney General and the Secretary of
Health and Human Services to award grants to address the
national epidemics of addiction to heroin and prescription
opioids, and makes various other changes to Federal law to
combat opioid addiction and abuse.
TITLE I--PREVENTION AND EDUCATION
Section 101--Task force on pain management
S. 524 included a task force to review best practices for
chronic and acute pain management and prescribing pain
medication. It was unclear which best practices the task
force would review, modify, and update. The task force would
have been required to convene not later than December 14,
2018, and within 180 days, modify and update such best
practices, as appropriate, and amend them further, if
appropriate, after soliciting and taking into consideration
public comment. Not later than 90 days after that, the task
force would have been required to submit a report to
Congress, including a strategy for disseminating best
practices as reviewed, modified, or updated.
The House amendment included the same timeframes and
underlying activities but added a number of participants to
the task force. The House amendment also added considerations
that the task force would have been required to take into
account while reviewing, modifying, and updating best
practices, several of which extended beyond the scope of
chronic and acute pain management.
Section 101 of the conference report requires the Secretary
of Health and Human Services (HHS), within two years of
enactment, to convene a task force comprised of federal
agencies and non-governmental stakeholders to identify,
review, and as appropriate, determine whether there are gaps
or inconsistencies between best practices for chronic and
acute pain management that have been developed or adopted by
Federal agencies. The task force is required to consider a
number of factors, existing research, and related efforts,
and, within one year of convening, propose any updates to
such best practices and recommendations on addressing gaps or
inconsistencies after providing the public with at least 90
days to submit comments. The task force would also develop a
strategy for disseminating information about best practices
prior to disbanding three years after enactment.
Section 102--Awareness campaigns
Section 102 requires that the Secretary of HHS, as
appropriate, to advance education and awareness of issues
related to opioid abuse. The Secretary is directed to carry
out these activities through existing programs and
activities. The awareness campaigns should address
information on prevention and detection of opioid abuse.
Section 102 of S. 524 included a similar provision.
Section 103--Community-based coalition enhancement grants to
address local drug crises
Section 103 authorizes the Office of National Drug Control
Policy (ONDCP) to award grants to implement community-wide
prevention strategies for addressing the local drug crisis or
emerging drug abuse issue in areas with high rates of opioid
or methamphetamine abuse. The section authorizes the
appropriation of $5 million for each of fiscal years 2017
through 2021, and allows ONDCP to delegate authority for
carrying out the grant program. Section 103 of S. 524
included a similar provision.
Section 104--Information materials and resources to prevent
addiction related to youth sports injuries
Section 104 directs the Secretary of HHS to make publically
available a report determining the extent to which
informational materials and resources are available with
respect to youth sports injuries for which opioids are
potentially prescribed. The Secretary may then facilitate the
development of materials if gaps are found in resources that
are currently available. Teenage athletes who are prescribed
an opioid are uniquely susceptible to opioid addiction. The
House amendment included similar language.
Section 105--Assisting veterans with military emergency
medical training to meet requirements for becoming
civilian health care professionals
Section 105 would award demonstration grants to states to
streamline the licensure requirements for veterans who held
military occupational specialties related to medical care or
who completed certain military medical training to more
easily meet civilian health care licensure requirements. The
House amendment included similar language that applied only
to military emergency medical technicians.
Section 106--FDA opioid action plan
Section 106 requires that the Food and Drug Administration
(FDA) consult with advisory committees prior to approval or
labeling of certain new opioids in pediatric populations. FDA
must also issue final guidance for generic drugs that claim
abuse deterrence within 18 months of the date of enactment,
and develop recommendations regarding educational programs
for prescribers of opioids. The House amendment included
similar language.
Section 107--Improving access to overdose treatment
Currently, there are questions as to when co-prescribing or
prescribing of opioid reversal drugs approved by the Federal
Food, Drug and Cosmetic Act for emergency treatment of known
or suspected opioid overdose is appropriate. Section 107
would allow the Secretary of HHS, the Secretary of Veterans
Affairs (VA), and the Secretary of Defense, 180 days after
enactment, to provide information to prescribers on co-
prescribing or prescribing a drug or device for emergency
treatment of known or suspected opioid overdose. It
explicitly states that the best practices in this section are
not to be construed as or to establish a medical standard
of care. This section also establishes a grant program to
increase access to opioid overdose treatment. The House
amendment included similar language.
[[Page H4415]]
Section 108--NIH opioid research
Section 108 allows the National Institutes of Health (NIH)
to intensify and coordinate fundamental, translational, and
clinical research with respect to the understanding of pain,
the discovery and development of therapies for chronic pain,
and the development of alternatives to opioids for effective
pain treatments in order to advance the discovery and
development of novel, safe, non-addictive, effective, and
affordable pharmaceuticals and other therapies for chronic
pain.
Section 109--National All Schedules Prescription Electronic
Reporting reauthorization
Section 109 reauthorizes the National All Schedules
Prescription Electronic Reporting (NASPER) Act within HHS to
provide grants to states to establish, implement, and improve
state-based prescription drug monitoring programs (PDMPs).
NASPER first became law in 2005 but expired in 2010. CARA
will extend funding for NASPER for five years at $10 million
a year for FY 2017 through FY 2021. The House amendment
included similar language.
Section 110--Opioid overdose reversal medication access and
education grant programs
Section 110 would allow the Secretary of HHS to make grants
available for states to implement standing orders for opioid
reversal drugs approved by the Federal Food, Drug and
Cosmetic Act for emergency treatment of known or suspected
opioid overdose. These grants may target states that have a
significantly higher per-capita rate of opioid overdoses than
the national average. Each state that is awarded a grant
under this program must submit a report to the Secretary of
HHS evaluating the grant and the services that were provided.
The House amendment included similar language.
TITLE II--LAW ENFORCEMENT AND TREATMENT
Section 201--Comprehensive opioid abuse grant program
Section 201 includes the provisions of Title II of the
House amendment to S. 524. It creates a comprehensive grant
program at the Department of Justice (DOJ) to address the
problems of opioid addiction and abuse. Though there is no
corresponding provision in S. 524 as passed by the Senate,
the program created by this section includes several
``allowable uses'' that are similar to provisions in that
bill. Minor changes have been made to the conference
provisions for clarity. The allowable uses of grant funds
include:
(1) Alternatives to incarceration programs, which replaces
Section 201 of the Senate bill. The list of allowable
alternatives to incarceration programs is very similar to the
programs in the Senate bill, including pre- and post-booking
treatment programs such as drug courts and veterans treatment
courts, and criminal justice training programs.
(2) Collaboration between criminal justice agencies and
substance abuse systems, which is nearly identical to Section
201 of the Senate bill;
(3) Training for first responders in carrying and
administering opioid overdose reversal drugs and purchasing
such drugs for first responders who have received training;
(4) Investigative purposes related to the unlawful
distribution of opioids;
(5) Medication-assisted treatment by criminal justice
agencies, which is highlighted in Section 302 of the Senate
bill;
(6) Prescription drug monitoring programs administered by
states;
(7) Programs that address juvenile opioid abuse, which does
not have a Senate companion;
(8) Initiatives to prevent pilfering of prescription
opioids, which does not have a Senate companion;
(9) Prescription drug take-back programs; and
(10) Development of a jurisdiction's own comprehensive
opioid abuse reduction program.
$103,000,000 is authorized to be appropriated for each of
fiscal years 2017 through 2021 to carry out this grant
program. This discretionary authorization is fully offset in
accordance with the House's CUTGO protocol.
This section also allows grantees to make subawards to
local or regional nonprofit organizations, including faith-
based organizations, units of local government, and tribal
organizations. This section would permit organizations that
are private and nonprofit to receive subawards, including
organizations that provide alternative complementary mental
health services.
This section requires that the Attorney General ensure
equitable distribution of funds, taking into consideration
the needs of underserved populations such as rural and tribal
communities, and the prevalence of opioid abuse in a
community. It also ensures that entities that provide
services to pregnant women are eligible for grants under the
Family-Based Substance Abuse Grant Program.
Finally, this section directs the Government Accountability
Office (GAO) to study and report on how federal agencies,
including ONDCP, through grant programs, are addressing
prevention, treatment, and recovery from substance abuse
disorders on the part of adolescents and young adults.
Section 202--First responder training
Section 201 of the conference report codifies an existing
grant program at the Substance Abuse and Mental Health
Services Administration (SAMSHA) to expand access to life-
saving opioid overdose reversal drugs by supporting the
purchase and distribution of opioid overdose reversal drugs
and training for first responders and other key community
sectors. S. 524 included similar language.
Section 203--Prescription drug take-back expansion
This section, identical to Section 203 of the Senate bill,
authorizes the Attorney General, in coordination with the
Administrator of the Drug Enforcement Administration (DEA),
the Secretary of HHS, and the Director of ONDCP, to
coordinate with certain entities in expanding or making
available disposal sites for unwanted prescription
medications. These entities include state and local law
enforcement agencies, manufacturers and distributors of
prescription medications, retail pharmacies, narcotic
treatment programs, hospitals with on-site pharmacies, and
long-term care facilities.
TITLE III--TREATMENT AND RECOVERY
Section 301--Evidence-based prescription opioid and heroin
treatment and interventions demonstration
Section 301 of the conference report codifies an existing
grant program at SAMHSA to support states in expanding access
to addiction treatment services for individuals with an
opioid use disorder, including evidence-based medication
assisted treatment. This program is targeted toward areas
where there is a high rate or a rapid increase in the use of
heroin or other opioids, including rural areas. S. 524
included this language.
Section 302--Building communities of recovery
Section 302 of the conference report allows HHS to provide
grants to community organizations to develop, expand, and
enhance recovery services and build connections between
recovery networks, including physicians, the criminal justice
system, employers, and other recovery support systems.
Recovery services help individuals with a substance use
disorder get and stay well and increase long-term recovery
from substance use disorders. S. 524 included this language.
Section 303--Medication-assisted treatment for recovery from
addiction
The House amendment included provisions amending the
Controlled Substances Act to permit nurse practitioners and
physician assistants (NPs and PAs) who meet certain criteria
to receive a waiver from SAMHSA to dispense certain drugs for
maintenance or detoxification treatment in an office-based
setting to up to 30 patients in the first year and up to 100
patients after the first year and going forward. In states
where NPs and PAs are required to practice in collaboration
with, or under the supervision of a physician, such physician
would also need to be a qualifying practitioner (i.e., have
their own waiver from SAMHSA). This new authority for NPs and
PAs would sunset three years after the date of enactment.
Section 303 of the conference report includes similar
operative language to the House amendment, though it requires
the implementing regulations to be updated no later than 18
months after the date of enactment and the new authority for
NPs and PAs expires October 1, 2021. Further, this section
would not preempt any state law that establishes a lower
limit on the number of patients a qualifying practitioner can
treat at any given time or requires a qualifying practitioner
to comply with additional requirements relating to the
dispensing of such drugs.
TITLE IV--ADDRESING COLLATORAL CONSEQUENCES
Section 401--GAO report on recovery and collateral
consequences
This section directs GAO to submit a report to the Senate
and House Judiciary Committees on recovery and the collateral
consequences of drug-related criminal convictions within one
year of the date of the Act's enactment. The report will
study the collateral consequences for individuals with
convictions for non-violent drug-related offenses and the
effects of these collateral consequences on individuals in
recovery on their ability to resume their personal and
professional activities. The report will also discuss the
policy bases and justifications for imposing these collateral
consequences and provide perspectives on the potential for
mitigating the effect of these collateral consequences on
individuals in recovery.
TITLE V--ADDICTION AND TREATMENT SERVICES FOR WOMEN, FAMILIES, AND
VETERANS
Section 501--Improving treatment for pregnant and postpartum
women
Section 501 reauthorizes a grant program for residential
treatment for pregnant and postpartum women who have an
opioid use disorder. This program also provides services for
the children of such women, including those who may be born
with neonatal abstinence syndrome. It creates a new pilot
program to enhance the flexibility of the funds so states can
more broadly support family-based services for pregnant and
postpartum women and their children. S. 524 included language
to reauthorize this program and create a pilot program but at
a lower authorized level than the language included in the
House amendment.
Section 502--Veterans treatment courts
The language in this section is drawn from the House
amendment to S. 524, and replaces the language from Section
503 of the Senate
[[Page H4416]]
bill. However, consistent with the Senate bill, this section
defines ``qualified veterans'' for purposes of the DOJ grant
program as those who have served on active duty in any branch
of the Armed Services and have been discharged under
conditions other than dishonorable, unless the reason for the
dishonorable discharge was attributable to a substance abuse
disorder.
Additionally, this section provides a definitional
framework for ``peer-to peer'' programs, ``veterans treatment
court'' programs, and ``veterans assistance'' programs that
are eligible under this section. This section is cross-
referenced in the ``alternatives to incarceration'' piece of
section 201 of the conference report, and should provide
guidance on how grantees are to use grant funds received for
veterans courts.
Section 503.--Infant plan of safe care
Section 503 incorporates text originally passed as part of
the House amendment to S. 524 and responds to concerns about
the increased number of infants born suffering from opioid
withdrawal symptoms and ensures states are in compliance with
the Child Abuse Prevention and Treatment Act (CAPTA). No
corresponding provision was included in S. 524. This section
requires the Department of HHS to review and confirm states
have CAPTA policies in place as required under the law,
strengthens protections for infants born with substance
exposure by clarifying the intent of safe care plans, and
requires the HHS Secretary to share best practices for
developing plans to keep infants and their caregivers safe
and healthy. It also improves accountability related to the
care of infants and their families by requiring additional
information be shared on incidents of infants exposed and
their subsequent care. Additionally, it encourages the use of
information made available through other child welfare laws
in verifying CAPTA compliance. Finally, section 503 prevents
HHS from adding new requirements to state assurances and
plans.
Section 504--GAO report on Neonatal Abstinence Syndrome (NAS)
Section 504 requires the Comptroller General of the United
States to, one year after enactment, issue a report on
neonatal abstinence syndrome (NAS), including information on
the treatment for infants with NAS under Medicaid.
Specifically, the report will examine what is known about the
prevalence of NAS in the country; the Medicaid-reimbursable
services available to treat NAS; the types of, and
reimbursement for care settings in which infants with NAS
receive care; and any federal policy barriers for treating
infants with NAS and what is known about best practices for
caring for infants with NAS. Similar language was included in
the House amendment.
TITLE VI--INCENTIVIZING STATE COMPREHENSIVE INITIATIVES TO ADDRESS
PRESCRIPTION OPIOID ABUSE
Section 601--State demonstration grants for comprehensive
opioid abuse response
Section 601 of the conference report supports State efforts
to combat opioid abuse by authorizing HHS to award grants to
States and combinations of States to carry out a
comprehensive opioid abuse response, including education,
treatment, and recovery efforts, maintaining prescription
drug monitoring programs, and efforts to prevent overdose
deaths. S. 524 included this language; there was no
corresponding legislation in the House amendment.
TITLE VII--MISCELLANEOUS
Section 701--Grant accountability and evaluations
This section combines language that originated in both the
House and Senate on grant oversight. It requires the DOJ
Inspector General, at his or her discretion, to conduct
audits of covered grantees to prevent waste, fraud, and abuse
of funds. This section prohibits grantees with unresolved
audit findings from receiving grants in the following fiscal
year, and prioritizes grantees that do not have unresolved
audit findings. If a grantee nevertheless receives funds
inappropriately, this section also compels DOJ to reimburse
the Department of the Treasury for the amount awarded, and to
seek to recoup the funds from the grantee.
With respect to nonprofit organizations, this section
prohibits nonprofits that hold money in offshore accounts for
the purpose of avoiding certain federal taxes from receiving
subawards from grant recipients. It also requires nonprofit
organizations to disclose, in a grant application, the
compensation of its board of directors. Finally, this section
limits the use of grant funds for conference expenditures,
and prevents the awarding of duplicative grants.
This section also contains the provisions applicable to DOJ
from Title VI of the House amendment to S. 524, the Opioid
Program Evaluation (OPEN) Act, which did not have a Senate
companion. It requires the Attorney General to complete an
evaluation of the effectiveness of the Comprehensive Opioid
Abuse Grant Program based upon the information reported by
grantees not later than 5 years after the enactment of the
Act. It requires the Attorney General to identify outcomes to
be achieved under the Comprehensive Opioid Grant Abuse
Program, and the metrics by which the achievement of such
outcomes shall be determined, not later than 180 days after
the enactment of the Act.
This section provides that the Attorney General must
require grantees and those receiving subawards to collect and
annually report data on the activities conducted using their
grant funding. It requires that the Attorney General publish
the outcomes and metrics to be used to evaluate the program
not later than 30 days after identifying such outcomes and
metrics, and that the entity conducting the evaluation
publish the results and issue a report to the House and
Senate Judiciary Committees not later than 90 days after
completion of the evaluation. It further requires the data
collected from grantees to be published along with the
report.
Finally, this section requires that the Attorney General
enter into an arrangement with the National Academy of
Sciences--or another non-government entity with expertise in
conducting and evaluating research pertaining to opioid use
and abuse and drawing conclusions about overall opioid use
and abuse on the basis of that research--to identify the
outcomes to be achieved, the metrics by which performance
will be evaluated, and the evaluation of the Comprehensive
Opioid Abuse Grant Program.
Section 701 also authorizes HHS to evaluate grants
authorized within the Comprehensive Addiction Recovery Act
and identify outcomes to be achieved by the programs, and
metrics by which to measure those outcomes.
This section also places restrictions on conference
expenditures using funding under a grant program in this Act.
Section 702--Partial fill of Schedule II controlled
substances
Section 702 clarifies that if a doctor or patient requests
a prescription for a Schedule II substance (such as an
opioid) not be filled in its entirety, in accordance with
state law; pharmacists are permitted to dispense only part of
the prescription. This change could lead to fewer opioids
being dispensed. The House amendment to CARA permitted more
flexibility in filling Schedule II prescriptions such as
opioids.
Section 703--Good Samaritan Assessment
This section includes the provisions of Title V of the
House amendment to S. 524, the Good Samaritan Assessment Act,
which did not have a Senate companion. It directs the GAO to
issue a report to the House and Senate Judiciary Committees,
the House Oversight and Government Reform Committee, and the
Senate Homeland Security and Governmental Affairs Committee,
on the extent to which ONDCP has reviewed Good Samaritan laws
and the findings from such a review; efforts by the ONDCP
Director to encourage the enactment of Good Samaritan laws;
and a compilation of Good Samaritan laws in effect in the
States, the territories, and the District of Columbia.
Currently, more than half the states and the District of
Columbia have some form of Good Samaritan law on the books,
to protect citizens who render help to someone in need--or,
in the context of opioids, to exempt from criminal or civil
liability someone who administers an opioid overdose reversal
drug or device, such as naloxone, or who calls 911 to report
an overdose.
Given the widespread activity in state legislatures on this
issue, and the differences between individual state statutes,
this section directs GAO to study and report to Congress on
the effects of the various Good Samaritan laws at the state
level, and efforts by ONDCP to address the issue.
Section 704--Programs to prevent prescription drug abuse
under Medicare Parts C and D
Section 704 would allow prescription drug plans in
Medicare, including Medicare Part D plans as well as
standalone Medicare Advantage Prescription Drug Plans, to
develop a safe prescribing and dispensing program for
beneficiaries that are at risk of abuse or diversion of drugs
that are frequently abused or diverted. The provision allows
the Secretary of HHS to work with private drug plan sponsors
to facilitate the creation and management of ``lock-in''
programs to curb identified fraud, abuse, and misuse of
prescribed medications while at the same time ensuring that
legitimate beneficiary access to needed medications is not
impeded.
Such controls would prevent doctor/pharmacy shopping as
well as duplicative and inappropriate drug therapies that can
lead to prescription drug abuse. The conference report gives
the Secretary responsibility to define an at-risk beneficiary
using clinical guidelines developed in consultation with
stakeholders. Plans would be able to identify enrolled
Medicare beneficiaries deemed at high risk of abusing
prescription drugs, and to limit such beneficiaries' choice
of prescribers or pharmacies in order to better monitor their
use of these medications. For example, restrictions might be
placed on beneficiaries suspected of abusing or reselling
certain controlled substances, but not placed on
beneficiaries with cancer or other conditions for which those
drugs are considered appropriate. Plan sponsors, under the
conference report, would have to take into consideration
where an at-risk beneficiary lives and works, as well as
other relevant factors when assigning providers and
pharmacies and would also consider the beneficiary's
preferences unless it is deemed the cause of potential abuse.
Plan sponsors also will have to comply with a number of
beneficiary protections including ensuring access,
notifications and disclosure requirements, as well as appeal
rights. S. 524 included similar language.
[[Page H4417]]
Sections 705-707--Exempting abuse-deterrent formulations of
prescription drugs from the Medicaid additional rebate
requirement for new formulations of prescription drugs;
limiting disclosure of predictive modeling and other
analytics technologies to identify and prevent fraud,
waste, and abuse; and Medicaid improvement fund
Sections 705-707 would exempt abuse deterrent formulations
of opioid drugs (ADFs) from the definition of ``line
extension'' for the purpose of calculating Medicaid rebates.
In its Opioids Action Plan, FDA said its goal is to ``expand
access to abuse deterrent formulations to discourage abuse.''
And in its ADF guidance to manufacturers, the agency has said
it ``considers the development of these products a high
public health priority.'' This policy was also included in
the President's FY 2017 Budget, which noted that this
statutory change would ``incentivize continued development of
abuse deterrent formulations.''
The budgetary impact of the ADF policy is being offset by a
policy from the President's budget that prevents the public
disclosure of program integrity algorithms used to identify
and predict waste, fraud, and abuse in Medicare, Medicaid,
and the Children's Health Insurance Program (CHIP) and places
the remaining savings in a Medicaid Improvement Fund. The
mathematical algorithms and predictive technologies the
Centers for Medicare and Medicaid Services (CMS) uses in
Medicare, Medicaid, and CHIP are vital to uncovering fraud,
waste, and abuse. However, if various aspects of these
algorithms were to become publicly known, fraudsters could
utilize the information to re-direct their schemes to other
areas of the Medicare, Medicaid, and CHIP programs or adjust
their schemes to avoid detection. This policy would simply
prevent the disclosure of these anti-fraud tools through
FOIA-related laws while still allowing CMS and state Medicaid
and CHIP programs to freely share algorithms and other
predictive analytical tools.
The conference provision is the same as the provision
included in the House amendment.
Section 708--Sense of Congress regarding treatment of
substance abuse epidemics
This section includes a Sense of 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.
TITLE VIII--KINGPIN DESIGNATION IMPROVEMENT
Section 801--Protection of classified information
This section incorporates the provisions of Title IV of the
House amendment to S. 524, which passed the House on May 10,
2016, and its Senate companion, S. 2914, the ``Kingpin
Designation Improvement Act.'' The section amends Section 804
of the Foreign Narcotics Kingpin Designation Act to include
language to protect classified information from disclosure
during a federal court challenge by a designee.
Under current law, the Treasury Department's Office of
Foreign Assets Control (OFAC) uses the International
Emergency Economic Powers Act (IEEPA) and the Foreign
Narcotics Kingpin Designation Act (the ``Kingpin Act'') to
target and apply sanctions to international narcotics
traffickers and their organizations. The Kingpin Act is the
principal mechanism by which OFAC sanctions foreign persons
tied to global narcotics trafficking.
OFAC's designations are often based upon classified
information. Unlike in a related federal statute, the Kingpin
Act does not contain such a mechanism to protect classified
information from release during a ``de-listing'' process.
That means OFAC may lose the opportunity to designate a high-
level drug kingpin because it cannot risk the disclosure of
classified information.
This section clarifies that OFAC can submit classified
information to defend its designations ex parte and in camera
in the relevant U.S. district court, thereby ensuring
classified information can be protected from disclosure.
TITLE IX--DEPARTMENT OF VETERANS AFFAIRS
Section 901--Short title
Includes the title ``Jason Simcakoski Memorial and Promise
Act.''
Section 902--Definitions
This section includes various definitions of terms used
throughout Title IX.
Section 911--Improvement of opioid safety measures by the
Department of Veterans Affairs
This provision requires the Secretary to expand the Opioid
Safety Initiative to include all VA medical facilities within
180 days of enactment of this act, and would require that all
VA employees who prescribe opioids receive education and
training on pain management and safe opioid prescribing
practices. The Secretary would also be required to establish
enhanced standards with respect to the use of routine and
random drug tests for all patients before and during opioid
therapy. Directors of each medical facility will be required
to designate a pain management team of health care
professionals responsible for coordinating and overseeing
pain management therapy and will provide an annual report
identifying the members of the facility's pain management
team, certification as to education and training, and
compliance with the stepped-care model or other pain
management policies. This provision also requires
participation in state prescription drug monitoring programs;
a report on the feasibility and advisability of advanced
real-time tracking of opioid use data in the Opioid Therapy
Risk Report tool; an increase in the availability of opioid
receptor antagonists such as naloxone and a report on
compliance; inclusion in the Opioid Therapy Risk Report tool
of information identifying when health care providers access
the tool and the most recent urine drug test for each
veteran; and notification of opioid abuse risk in the
computerized patient record system.
Both H.R. 4063 and S. 2921, as reported, included similar
language.
Section 912--Strengthening of joint working group on pain
management of the Department of Veterans Affairs and the
Department of Defense
H.R. 4063 and S. 2921, as reported, require that VA and the
Department of Defense (DOD) ensure that the Health Executive
Committee's Pain Management Working Group (PMWG) includes a
focus on the opioid prescribing practices of health care
providers of each Department; the ability of each Department
to manage acute and chronic pain, including training health
care providers with respect to pain management; the use by
each Department of complementary and integrative health; the
concurrent use by health care providers of each Department of
opioids and prescription drugs to treat mental health
disorders, including benzodiazepines; the use of care
transition plans by health care providers of each Department
to address case management issues for patients receiving
opioid therapy who transition between inpatient and
outpatient settings; coordination in coverage of and
consistent access to medications prescribed for patients
transitioning from receiving health care from DOD to VA; and
the ability of each Department to screen, identify, and treat
patients with substance use disorders who are seeking
treatment for acute and chronic pain.
This provision also ensures the PMWG coordinates its
activities with other relevant working groups; consults with
other relevant federal agencies, including the Centers for
Disease Control and Prevention; consults with the VA and DOD
with respect to the VA/DOD Clinical Practice Guideline for
Management of Opioid Therapy for Chronic Pain; and reviews
and comments on the guideline before any update to such
guideline is released.
This provision requires VA and DOD to jointly update the
VA/DOD Clinical Practice Guideline for Management of Opioid
Therapy for Chronic Pain within 180 days of enactment. This
provision requires that the PMWG, in coordination with the
Clinical Practice Guideline VA/DOD Management of Opioid
Therapy for Chronic Pain Working Group, examine whether the
guidelines should include numerous elements. The elements to
be considered include, but are not limited to, enhanced
guidance with respect to: opioid and other drug prescription
practices; treatment of patients with behaviors or
comorbidities that require co-management of opioid therapy;
patient status assessments conducted by providers; governance
of the methodologies used by VA and DOD providers to taper
opioid therapy; appropriate case management for opioid
patients transitioning from an inpatient setting to an
outpatient setting; appropriate case management for opioid
patients transitioning from active duty to post-military
health care networks; how providers should discuss with
patients options for pain management therapies before
initiating opioid therapy; provision of evidence-based non-
opioid treatments within VA and DOD; and consideration of
guidelines developed by CDC for safely prescribing opioids.
Section 913--Review, investigation, and report on use of
opioids in treatment by Department of Veterans Affairs
This provision requires GAO, not later than 2 years after
enactment, to submit a report on the Opioid Safety Initiative
and the opioid prescribing practices of VA health care
providers. This provision also requires semi-annual progress
reports on the implementation of any GAO recommendations
generated by this report. The Secretary must also review and
report annually on the patient population receiving opioid
therapy and the prescription rates of each medical facility
and conduct investigations, through the Office of the Medical
Inspector, on prescription rates that conflict with or are
otherwise inconsistent with the standards of appropriate and
safe care.
Both H.R. 4063 and S. 2921, as reported, included similar
language.
Section 914--Mandatory disclosure of certain veteran
information to state controlled substance monitoring
programs
This provision includes the H.R. 4063, as reported,
language requiring that VA providers shall disclose certain
veteran information to state controlled substance monitoring
programs.
Section 915--Elimination of copayment requirement for
veterans receiving opioid antagonists or education on use
of opioid antagonists
This provision includes the S. 2921, as reported, language
that would eliminate the copayment requirement for veterans
receiving opioid antagonists or education on the use of
opioid antagonists.
[[Page H4418]]
Section 921--Community meetings on improving care furnished
by Department of Veterans Affairs
This provision requires that, within 90 days of the
enactment of this act, and quarterly thereafter, each VA
medical facility hosts a public community meeting on
improving VA health care; and within one year of the
enactment of this act, and at least annually thereafter, that
each community-based outpatient clinic (CBOC) hosts such a
community meeting. These meetings will require regular senior
leadership attendance and notice will be given to the
Committees on Veterans' Affairs of the House and of the
Senate and the Members of Congress who represent the area in
which the facility is located at least ten days in advance.
Both H.R. 4063 and S. 2921, as reported, included similar
language.
Section 922--Improvement of awareness of Patient Advocacy
Program and Patient Bill of Rights of Department of
Veterans Affairs
This provision would require, within 90 days of the
enactment of this act, the display of, in as many prominent
locations as the Secretary determines appropriate to be seen
by the largest percentage of patients at each VA medical
facility: (1) the purposes of the VA Patient Advocacy Program
and the contact information for the patient advocate at each
medical facility; and (2) the rights and responsibilities of
patients and family members and, with respect to community
living centers and other VA residential facilities.
Both H.R. 4063 and S. 2921, as reported, included similar
language.
Section 923--Comptroller General report on Patient Advocacy
Programs of Department of Veterans Affairs
Both H.R. 4063 and S. 2921 require that, within two years
of the enactment of this act, GAO submit a report on the VA
Patient Advocacy Program to the Committees on Veterans'
Affairs of the House and of the Senate. The report will
include: (1) a description of the Program, including the
Program's purpose, activities, and sufficiency in achieving
its purpose; (2) an assessment of the sufficiency of the
Program's staffing; (3) an assessment of the Program's
employee training; (4) an assessment of veterans' and family
members' awareness of and utilization of the Program; (5)
recommendations for improving the Program; and (6) any other
information the GAO considers appropriate.
Both H.R. 4063 and S. 2921, as reported, included similar
language.
Section 924--Establishment of office of patient advocacy of
the Department of Veterans Affairs
This section establishes an office of patient advocacy
within the Office of the Undersecretary for Health of the
Department of Veterans Affairs. This office will ensure
patient advocates appropriately advocate for veteran patients
and are trained in their responsibilities.
Section 931--Expansion of research and education on and
delivery of complementary and integrative health to
veterans
H.R. 4063, as reported, establishes a Commission to examine
the evidence-based therapy treatment model used by VA for
treating mental health conditions of veterans and the
potential benefits of incorporating complementary and
integrative health as standard practice throughout the
Department. The Commission would: (1) examine the efficacy of
the evidence-based therapy model used by VA to treat mental
health illnesses and identify areas of improvement; (2)
conduct a patient-centered survey within each VISN to
examine: the experiences of veterans with VA facilities
regarding mental health care, the experiences of veterans
with non-VA facilities regarding mental health care, the
preferences of veterans regarding available treatment for
mental health issues and which methods the veterans believe
to be most effective, the experience, if any, of veterans
with respect to the complementary and integrative health
treatment therapies, the prevalence of prescribing medication
to veterans seeking treatment for mental health disorders
through VA, and the outreach efforts of VA regarding the
availability of benefits and treatments for veterans for
addressing mental health issues; (3) examine available
research on complementary and integrative health for mental
health disorders in areas of therapy including: music
therapy, equine therapy, training and caring for service
dogs, yoga therapy, acupuncture therapy, meditation therapy,
outdoor sports therapy, hyperbaric oxygen therapy,
accelerated resolution therapy, art therapy, magnetic
resonance therapy, and others; (4) study the sufficiency of
VA resources to deliver quality mental health care; and (5)
study the current treatments and resources available within
VA and assess: the effectiveness of such treatments and
resources in decreasing the number of suicides per day by
veterans, the number of veterans who have been diagnosed with
mental health issues, the percentage of veterans who
have completed VA counseling sessions, and the efforts of
VA to expand complementary and integrative health
treatments viable to the recovery of veterans with mental
health issues as determined by the Secretary to improve
the effectiveness of treatments offered by VA.
Section 932--Pilot program on integration of complementary
and integrative health and related issues for veterans
and family members of veterans
The provision requires that the Secretary, informed by the
Commission's findings, commence a pilot program to assess the
feasibility and advisability of using wellness-based programs
to complement pain management and related health care
services. The pilot program would last for three years and be
carried out at no fewer than 15 VA facilities providing pain
management, two of which must be polytrauma centers. The
Secretary should prioritize medical centers at which there is
a prescription rate that is inconsistent with the standards
of appropriate care when selecting medical centers for the
pilot. The Secretary will report on findings and conclusions
regarding the use and efficacy of complementary and
integrative health services established under the pilot
program, the outreach conducted by VA about the pilot, and an
assessment of the benefit of the pilot program to covered
veterans, as well as identify any unresolved barriers to VA's
use of complementary and integrative medicine, and make
recommendations for the continuation or expansion of the
pilot program.
Both H.R. 4063 and S. 2921, as reported, included similar
language.
Section 941--Additional requirements for hiring of health
care providers by Department of Veterans Affairs
This provision would require that, as part of the hiring
process for all heath care providers considered for a
position after the date of the enactment of this act, that
the Secretary require from the medical board of the State in
which the applicant is licensed: (1) information on any
violations of the requirements of medical license over the
previous 20 years; and (2) information on whether the
provider has entered into any settlement agreements for
disciplinary charges related to the practice of medicine.
Both H.R. 4063 and S. 2921, as reported, included similar
language.
Section 942--Provision of information on health care
providers of Department of Veterans Affairs to state
medical boards
This provision would require that VA provide to the medical
board of each State in which the provider is licensed
information regarding violations, regardless of whether the
board has requested such information.
Both H.R. 4063 and S. 2921, as reported, included similar
language.
Section 943--Report on compliance by Department of Veterans
Affairs with reviews of health care providers leaving the
department or transferring to other facilities
This provision would require that, within 180 days of the
enactment of this act, that the Secretary submit to the
Committees on Veterans' Affairs of the House and of the
Senate a report on VA's compliance with VA policy to conduct
a review of each provider who transfers from another VA
medical facility, retires, or is terminated, and to take
appropriate actions with respect to any concerns, complaints,
or allegations against the provider.
Both H.R. 4063 and S. 2921, as reported, included similar
language.
Section 951--Modification to limitation on bonus and awards
This provision limits the amounts of funds available for
payment as bonuses and awards and directs those amounts now
available within the budget toward the payment for the
programs and services directed in this title.
This section also includes a Sense of Congress that states
the limitation under this subsection should not
disproportionately impact lower-wage employees within the VA.
Earmark, Limited Tax Benefits, and Limited Tariff Benefits
In compliance with clause 9(e), 9(f), and 9(g) of Rule XXI
of the Rules of the House of Representatives, the conference
report and joint explanatory statement contain no earmarks,
limited tax benefits, or limited tariff benefits.
Constitutional Statement of Authority
Congress has the power to enact this legislation pursuant
to the following: Article I, Section 8, Clause 3 of the
United States Constitution.
For consideration of the Senate bill and the House
amendments, and modifications committed to conference:
Fred Upton,
Joseph R. Pitts,
Leonard Lance,
Brett Guthrie,
Adam Kinzinger,
Larry Bucshon,
Susan W. Brooks,
Bob Goodlatte,
F. James Sensenbrenner, Jr.,
Lamar Smith,
Tom Marino,
Doug Collins,
David A. Trott,
Mike Bishop,
Kevin McCarthy,
From the Committee on Education and the Workforce, for
consideration of title VII of the House amendment, and
modifications committed to conference:
Lou Barletta,
Earl L. ``Buddy'' Carter,
From the Committee on Veterans' Affairs, for consideration of
title III of the House amendment, and modifications committed
to conference:
Gus M. Bilirakis,
Jackie Walorski,
[[Page H4419]]
From the Committee on Ways and Means, for consideration of
sec. 705 of the Senate bill, and sec. 804 of the House
amendment, and modifications committed to conference:
Patrick Meehan,
Robert J. Dold,
Managers on the Part of the House.
Chuck Grassley,
Lamar Alexander,
Orrin G. Hatch,
Jeff Sessions,
Managers on the Part of the Senate.
____________________