[Congressional Record Volume 164, Number 102 (Tuesday, June 19, 2018)]
[House]
[Pages H5237-H5239]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
RESPONSIBLE EDUCATION ACHIEVES CARE AND HEALTHY OUTCOMES FOR USERS'
TREATMENT ACT OF 2018
Mr. WALDEN. Mr. Speaker, I move to suspend the rules and pass the
bill (H.R. 5796) to require the Secretary of Health and Human Services
to provide grants for eligible entities to provide technical assistance
to outlier prescribers of opioids, as amended.
The Clerk read the title of the bill.
The text of the bill is as follows:
H.R. 5796
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Responsible Education
Achieves Care and Healthy Outcomes for Users' Treatment Act
of 2018'' or the ``REACH OUT Act of 2018''.
SEC. 2. GRANTS TO PROVIDE TECHNICAL ASSISTANCE TO OUTLIER
PRESCRIBERS OF OPIOIDS.
(a) Grants Authorized.--The Secretary of Health and Human
Services (in this section referred to as the ``Secretary'')
shall, through the Centers for Medicare & Medicaid Services,
award grants, contracts, or cooperative agreements to
eligible entities for the purposes described in subsection
(b).
(b) Use of Funds.--Grants, contracts, and cooperative
agreements awarded under subsection (a) shall be used to
support eligible entities through technical assistance--
(1) to educate and provide outreach to outlier prescribers
of opioids about best practices for prescribing opioids;
(2) to educate and provide outreach to outlier prescribers
of opioids about non-opioid pain management therapies; and
(3) to reduce the amount of opioid prescriptions prescribed
by outlier prescribers of opioids.
(c) Application.--Each eligible entity seeking to receive a
grant, contract, or cooperative agreement under subsection
(a) shall submit to the Secretary an application, at such
time, in such manner, and containing such information as the
Secretary may require.
(d) Geographic Distribution.--In awarding grants,
contracts, and cooperative agreements under this section, the
Secretary shall prioritize establishing technical assistance
resources in each State.
(e) Definitions.--In this section:
(1) Eligible entity.--The term ``eligible entity'' means--
(A) an organization--
(i) that has demonstrated experience providing technical
assistance to health care professionals on a State or
regional basis; and
(ii) that has at least--
(I) one individual who is a representative of consumers on
its governing body; and
(II) one individual who is a representative of health care
providers on its governing body; or
(B) an entity that is a quality improvement entity with a
contract under part B of title XI of the Social Security Act
(42 U.S.C. 1320c et seq.).
(2) Outlier prescriber of opioids.--The term ``outlier
prescriber of opioids'' means a prescriber, identified by the
Secretary of Health and Human Services (through use of
prescriber information provided by prescriber National
Provider Identifiers included pursuant to section 1860D-
4(c)(4)(A) of the Social Security Act (42 U.S.C. 1395w-
104(c)(4)(A)) on claims for covered part D drugs for part D
eligible individuals enrolled in prescription drug plans
under part D of title XVIII of such Act (42 U.S.C. 1395w-101
et seq.) and MA-PD plans under part C of such title (42
U.S.C. 1395w-21 et seq.)) as prescribing, as compared to
other prescribers in the specialty of the prescriber and
geographic area, amounts of opioids in excess of a threshold
(and other criteria) specified by the Secretary, after
consultation with stakeholders.
(3) Prescribers.--The term ``prescriber'' means any health
care professional, including a nurse practitioner or
physician assistant, who is licensed to prescribe opioids by
the State or territory in which such professional practices.
(f) Funding.--For purposes of implementing this section,
$75,000,000 shall be available from the Federal Supplementary
Medical Insurance Trust Fund under section 1841 of the Social
Security Act (42 U.S.C. 1395t), to remain available until
expended.
SEC. 3. PROMOTING VALUE IN MEDICAID MANAGED CARE.
Section 1903(m) of the Social Security Act (42 U.S.C.
1396b(m)) is amended by adding at the end the following new
paragraph:
``(7)(A) With respect to expenditures described in
subparagraph (B) that are incurred by a State for any fiscal
year after fiscal year 2025 (and before fiscal year 2029), in
determining the pro rata share to which the United States is
equitably entitled under subsection (d)(3), the Secretary
shall substitute the Federal medical assistance percentage
that applies for such fiscal year to the State under section
1905(b) (without regard to any adjustments to such percentage
applicable under such section or any other provision of law)
for the percentage that applies to such expenditures under
section 1905(y).
``(B) Expenditures described in this subparagraph, with
respect to a fiscal year to which subparagraph (A) applies,
are expenditures incurred by a State for payment for medical
assistance provided to individuals described in subclause
(VIII) of section 1902(a)(10)(A)(i) by a managed care entity,
or other specified entity (as defined in subparagraph
(D)(iii)), that are treated as remittances because the
State--
``(i) has satisfied the requirement of section 438.8 of
title 42, Code of Federal Regulations (or any successor
regulation), by electing--
``(I) in the case of a State described in subparagraph (C),
to apply a minimum medical loss ratio (as defined in
subparagraph (D)(ii)) that is at least 85 percent but not
greater than the minimum medical loss ratio (as so defined)
that such State applied as of May 31, 2018; or
``(II) in the case of a State not described in subparagraph
(C), to apply a minimum medical loss ratio that is equal to
85 percent; and
``(ii) recovered all or a portion of the expenditures as a
result of the entity's failure to meet such ratio.
``(C) For purposes of subparagraph (B), a State described
in this subparagraph is a State that as of May 31, 2018,
applied a minimum medical loss ratio (as calculated under
subsection (d) of section 438.8 of title 42, Code of Federal
Regulations (as in effect on June 1, 2018)) for payment for
services provided by entities described in such subparagraph
under the State plan under this title (or a waiver of the
plan) that is equal to or greater than 85 percent.
``(D) For purposes of this paragraph:
``(i) The term `managed care entity' means a medicaid
managed care organization described in section
1932(a)(1)(B)(i).
``(ii) The term `minimum medical loss ratio' means, with
respect to a State, a minimum medical loss ratio (as
calculated under subsection (d) of section 438.8 of title 42,
Code of Federal Regulations (as in effect on June 1, 2018))
for payment for services provided by entities described in
subparagraph (B) under the State plan under this title (or a
waiver of the plan).
``(iii) The term `other specified entity' means--
``(I) a prepaid inpatient health plan, as defined in
section 438.2 of title 42, Code of Federal Regulations (or
any successor regulation); and
``(II) a prepaid ambulatory health plan, as defined in such
section (or any successor regulation).''.
The SPEAKER pro tempore. Pursuant to the rule, the gentleman from
Oregon (Mr. Walden) and the gentleman from Massachusetts (Mr. Kennedy)
each will control 20 minutes.
The Chair recognizes the gentleman from Oregon.
General Leave
Mr. WALDEN. Mr. Speaker, I ask unanimous consent that all Members may
have 5 legislative days in which to revise and extend their remarks and
insert extraneous materials on the bill under consideration.
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from Oregon?
There was no objection.
Mr. WALDEN. Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, I want to commend my colleague Representative
Fitzpatrick, who is here on the floor with us today, as well as
Representative Curbelo and Representative Thompson. They all worked
very hard to make this bipartisan legislation a success.
H.R. 5796 would establish technical assistance grants to make best
practices available to those providers who are identified as opioid-
prescribing outliers. This bill would establish a means of identifying
statistical outliers and then notifying providers if they are an
outlier.
In addition, the bill authorizes quality improvement organizations
and other grant recipients to review prescribing patterns and to share
educational materials and best practices. This legislation will ensure
that best prescribing practices are clinically appropriate for patients
and are implemented throughout the Medicare program.
House of Representatives,
Committee on Energy and Commerce,
Washington, DC, June 7, 2018.
Hon. Kevin Brady,
Chairman, Committee on Ways and Means,
Washington, DC.
Dear Chairman Brady: On May 9 and 17, 2018, the Committee
on Energy and Commerce ordered favorably reported over 50
[[Page H5238]]
bills to address the opioid epidemic facing communities
across our nation. Several of the bills were also referred to
the Committee on Ways and Means.
I ask that the Committee on Ways and Means not insist on
its referral of the following bills so that they may be
scheduled for consideration by the Majority Leader:
H.R. 1925, At-Risk Youth Medicaid Protection Act of 2017;
H.R. 3331, To amend title XI of the Social Security Act to
promote testing of incentive payments for behavioral health
providers for adoption and use of certified electronic health
record technology;
H.R. 3528, Every Prescription Conveyed Securely Act;
H.R. 4841, Standardizing Electronic Prior Authorization for
Safe Prescribing Act of 2018;
H.R. 5582, Abuse Deterrent Access Act of 2018;
H.R. 5590, Opioid Addiction Action Plan Act;
H.R. 5603, Access to Telehealth Services for Opioid Use
Disorder;
H.R. 5605, Advancing High Quality Treatment for Opioid Use
Disorders in Medicare Act;
H.R. 5675, To amend title XVIII of the Social Security Act
to require prescription drug plan sponsors under the Medicare
program to establish drug management programs for at-risk
beneficiaries;
H.R. 5684, Protecting Seniors from Opioid Abuse Act;
H.R. 5685, Medicare Opioid Safety Education Act;
H.R. 5686, Medicare Clear Health Options in Care for
Enrollees (CHOICE) Act;
H.R. 5715, Strengthening Partnerships to Prevent Opioid
Abuse Act;
H.R. 5716, Commit to Opioid Medical Prescriber
Accountability and Safety for Seniors (COMPASS) Act;
H.R. 5796, Responsible Education Achieves Care and Healthy
Outcomes for Users' Treatment (REACH OUT) Act of 2018;
H.R. 5798, Opioid Screening and Chronic Pain Management
Alternatives for Seniors Act;
H.R. 5804, Post-Surgical Injections as an Opioid
Alternative Act; and
H.R. 5809, Postoperative Opioid Prevention Act of 2018.
This concession in no way affects your jurisdiction over
the subject matter of these bills, and it will not serve as
precedent for future referrals. In addition, should a
conference on the bills be necessary, I would support your
request to have the Committee on Ways and Means on the
conference committee. Finally, I would be pleased to include
this letter and your response in the bill reports and the
Congressional Record.
Thank you for your consideration of my request and for the
extraordinary cooperation shown by you and your staff over
matters of shared jurisdiction. I look forward to further
opportunities to work with you this Congress.
Sincerely,
Greg Walden,
Chairman.
____
House of Representatives,
Committee on Ways and Means,
Washington, DC, June 8, 2018.
Hon. Greg Walden,
Chairman, Committee on Energy and Commerce,
Washington, DC.
Dear Chairman Walden: Thank you for your letter concerning
several bills favorably reported out of the Committee on
Energy and Commerce to address the opioid epidemic and which
the Committee on Ways and Means was granted an additional
referral.
As a result of your having consulted with us on provisions
within these bills that fall within the Rule X jurisdiction
of the Committee on Ways and Means, I agree to waive formal
consideration of the following bills so that they may move
expeditiously to the floor:
H.R. 1925, At-Risk Youth Medicaid Protection Act of 2017;
H.R. 3331, To amend title XI of the Social Security Act to
promote testing of incentive payments for behavioral health
providers for adoption and use of certified electronic health
record technology;
H.R. 3528, Every Prescription Conveyed Securely Act;
H.R. 4841, Standardizing Electronic Prior Authorization for
Safe Prescribing Act of 2018;
H.R. 5582, Abuse Deterrent Access Act of 2018;
H.R. 5590, Opioid Addiction Action Plan Act;
H.R. 5603, Access to Telehealth Services for Opioid Use
Disorder;
H.R. 5605, Advancing High Quality Treatment for Opioid Use
Disorders in Medicare Act;
H.R. 5675, To amend title XVIII of the Social Security Act
to require prescription drug plan sponsors under the Medicare
program to establish drug management programs for at-risk
beneficiaries;
H.R. 5684, Protecting Seniors from Opioid Abuse Act;
H.R. 5685, Medicare Opioid Safety Education Act;
H.R. 5686, Medicare Clear Health Options in Care for
Enrollees (CHOICE) Act;
H.R. 5715, Strengthening Partnerships to Prevent Opioid
Abuse Act;
H.R. 5716, Commit to Opioid Medical Prescriber
Accountability and Safety for Seniors (COMPASS) Act;
H.R. 5796, Responsible Education Achieves Care and Healthy
Outcomes for Users' Treatment (REACH OUT) Act of 2018;
H.R. 5798, Opioid Screening and Chronic Pain Management
Alternatives for Seniors Act;
H.R. 5804, Post-Surgical Injections as an Opioid
Alternative Act; and
H.R. 5809, Postoperative Opioid Prevention Act of 2018.
The Committee on Ways and Means takes this action with the
mutual understanding that we do not waive any jurisdiction
over the subject matter contained in this or similar
legislation, and the Committee will be appropriately
consulted and involved as the bill or similar legislation
moves forward so that we may address any remaining issues
that fall within our jurisdiction. The Committee also
reserves the right to seek appointment of an appropriate
number of conferees to any House-Senate conference involving
this or similar legislation and requests your support for
such a request.
Finally, I would appreciate your commitment to include this
exchange of letters in the bill reports and the Congressional
Record.
Sincerely,
Kevin Brady,
Chairman.
Mr. WALDEN. Mr. Speaker, I yield such time as he may consume to the
gentleman from Pennsylvania (Mr. Fitzpatrick), one of the authors of
this important legislation.
Mr. FITZPATRICK. Mr. Speaker, the opioid epidemic is devastating my
community in Bucks and Montgomery Counties. I talk to these families
every day.
As our Nation continues to grapple with the deadly effects of the
opioid epidemic, it is crucial we take every step possible to stop
prescription medication from falling into the wrong hands. We need to
ensure that our medical professionals possess the latest best practices
for preventing prescription medication abuse, including nonopioid pain
management. This is why I am proud the House is considering my REACH
OUT Act, H.R. 5796.
By facilitating outreach to outlier opioid prescribers, the REACH OUT
Act seeks to educate physicians on their prescribing behaviors without
limiting their ability to deliver patient care. It will be an effective
step toward reducing the amount of unnecessary prescription opioids in
communities across the Nation.
The Responsible Education Achieves Care and Healthy Outcomes for
Users' Treatment Act, the REACH OUT Act, H.R. 5796, will direct the
Centers for Medicare and Medicaid Services to work with eligible
entities, including quality improvement organizations, to engage in
outreach with prescribers identified as clinical outliers to share best
practices to evaluate their prescribing behavior.
{time} 1500
H.R. 5796 would build on the lessons learned from CMS special
innovation projects, by spreading best practices for preventing
prescription drug abuse, providing outreach and education about
nonopioid pain management, and reducing the number of opioids
prescribed by outlier prescribers.
An outlier prescriber is identified by the Secretary of Health and
Human Services, in consultation with professional stakeholders, as one
who prescribes an excessive number of opioids as compared to other
prescribers in their medical specialty or geographic area.
Our Nation's drug epidemic is a complicated issue, and our response
must be multifaceted. This means giving providers the tools they need
to prevent opioid abuse.
I want to thank my colleagues Carlos Curbelo and Mike Thompson for
their support in authoring this bill. And I want to thank our chairman,
Greg Walden, and his Energy and Commerce Committee for their
relentless effort to combat the opioid epidemic across the country.
Mr. Speaker, I urge my colleagues, Democrat and Republican alike, to
support the passage of our REACH OUT Act.
Mr. KENNEDY. Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, I rise in support of H.R. 5796, the REACH OUT Act.
This bill creates grants for technical assistance education for
outlier prescribers of opioids. The recipients of these grants, Mr.
Speaker, will educate outlier prescribers on best practices for
prescribing opioids and provide instruction on how to reduce the number
of opioids prescribed in the future.
Coupled with legislation we will also consider today that would
require notification of outlier prescribers of
[[Page H5239]]
opioids, this bill will further provide outlier prescribers with the
tools to return to the appropriate prescribing range for their
specialty to help reduce overprescribing.
Mr. Speaker, I have to say that we have just been informed that there
will be a last-minute change to two of the suspension prints under
consideration today in order to accommodate a request from the
Appropriations Committee.
The minority only received notice of these changes within the last
hour. While they appear to be changes that are technical in nature to
address the jurisdictional issues, we want to highlight our concerns
with the last-minute changes being made to legislative text that are
being considered on the floor with such short notice. It is not the
best way to legislate, especially on bipartisan bills on such an
important topic.
My colleagues and I have expressed some concern about this process,
and this latest issue reinforces those concerns. We urge the Speaker to
commit to continuing to work with us on a bipartisan basis to avoid
some of these changes in the future.
Mr. Speaker, I support this bill. I hope the House will support it as
well, and I yield back the balance of my time.
Mr. WALDEN. Mr. Speaker, I thank my colleagues for their bipartisan
support of this legislation.
We also were just notified not long ago about the appropriations
flag, and we are working out those matters at a higher pay level. So,
we appreciate and understand.
Mr. Speaker, I urge passage of this legislation, and I yield back the
balance of my time.
The SPEAKER pro tempore (Mr. Poe of Texas). The question is on the
motion offered by the gentleman from Oregon (Mr. Walden) that the House
suspend the rules and pass the bill, H.R. 5796, as amended.
The question was taken; and (two-thirds being in the affirmative) the
rules were suspended and the bill, as amended, was passed.
The title of the bill was amended so as to read: ``A bill to require
the Secretary of Health and Human Services to provide grants for
eligible entities to provide technical assistance to outlier
prescribers of opioids, and for other purposes.''.
A motion to reconsider was laid on the table.
____________________