[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.

                          ____________________