[Congressional Record Volume 164, Number 102 (Tuesday, June 19, 2018)]
[House]
[Pages H5239-H5243]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
ADVANCING HIGH QUALITY TREATMENT FOR OPIOID USE DISORDERS IN MEDICARE
ACT
Mr. WALDEN. Mr. Speaker, I move to suspend the rules and pass the
bill (H.R. 5605) to amend title XVIII of the Social Security Act to
provide for an opioid use disorder treatment demonstration program, as
amended.
The Clerk read the title of the bill.
The text of the bill is as follows:
H.R. 5605
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 ``Advancing High Quality
Treatment for Opioid Use Disorders in Medicare Act''.
SEC. 2. OPIOID USE DISORDER TREATMENT DEMONSTRATION PROGRAM.
Title XVIII of the Social Security Act (42 U.S.C. 1395 et
seq.) is amended by inserting after section 1866E (42 U.S.C.
1395cc-5) the following new section:
``SEC. 1866F. OPIOID USE DISORDER TREATMENT DEMONSTRATION
PROGRAM.
``(a) Implementation of 4-year Demonstration Program.--
``(1) In general.--Not later than January 1, 2021, the
Secretary shall implement a 4-year demonstration program
under this title (in this section referred to as the
`Program') to increase access of applicable beneficiaries to
opioid use disorder treatment services, improve physical and
mental health outcomes for such beneficiaries, and to the
extent possible, reduce expenditures under this title. Under
the Program, the Secretary shall make payments under
subsection (e) to participants (as defined in subsection
(c)(1)(A)) for furnishing opioid use disorder treatment
services delivered through opioid use disorder care teams, or
arranging for such service to be furnished, to applicable
beneficiaries participating in the Program.
``(2) Opioid use disorder treatment services.--For purposes
of this section, the term `opioid use disorder treatment
services'--
``(A) means, with respect to an applicable beneficiary,
services that are furnished for the treatment of opioid use
disorders and that utilize drugs approved under section 505
of the Federal Food, Drug, and Cosmetic Act for the treatment
of opioid use disorders in an outpatient setting; and
``(B) includes--
``(i) medication assisted treatment;
``(ii) treatment planning;
``(iii) psychiatric, psychological, or counseling services
(or any combination of such services), as appropriate;
``(iv) social support services, as appropriate; and
``(v) care management and care coordination services,
including coordination with other providers of services and
suppliers not on an opioid use disorder care team.
``(b) Program Design.--
``(1) In general.--The Secretary shall design the Program
in such a manner to allow for the evaluation of the extent to
which the Program accomplishes the following purposes:
``(A) Reduces hospitalizations and emergency department
visits.
``(B) Increases use of medication-assisted treatment for
opioid use disorders.
``(C) Improves health outcomes of individuals with opioid
use disorders, including by reducing the incidence of
infectious diseases (such as hepatitis C and HIV).
``(D) Does not increase the total spending on items and
services under this title.
``(E) Reduces deaths from opioid overdose.
``(F) Reduces the utilization of inpatient residential
treatment.
``(2) Consultation.--In designing the Program, including
the criteria under subsection (e)(2)(A), the Secretary shall,
not later than 3 months after the date of the enactment of
this section, consult with specialists in the field of
addiction, clinicians in the primary care community, and
beneficiary groups.
``(c) Participants; Opioid Use Disorder Care Teams.--
``(1) Participants.--
``(A) Definition.--In this section, the term `participant'
means an entity or individual--
``(i) that is otherwise enrolled under this title and that
is--
``(I) a physician (as defined in section 1861(r)(1));
``(II) a group practice comprised of at least one physician
described in subclause (I);
``(III) a hospital outpatient department;
``(IV) a federally qualified health center (as defined in
section 1861(aa)(4));
``(V) a rural health clinic (as defined in section
1861(aa)(2));
``(VI) a community mental health center (as defined in
section 1861(ff)(3)(B));
``(VII) a clinic certified as a certified community
behavioral health clinic pursuant to section 223 of the
Protecting Access to Medicare Act of 2014; or
``(VIII) any other individual or entity specified by the
Secretary;
``(ii) that applied for and was selected to participate in
the Program pursuant to an application and selection process
established by the Secretary; and
``(iii) that establishes an opioid use disorder care team
(as defined in paragraph (2)) through employing or
contracting with health care practitioners described in
paragraph (2)(A), and uses such team to furnish or arrange
for opioid use disorder treatment services in the outpatient
setting under the Program
``(B) Preference.--In selecting participants for the
Program, the Secretary shall give preference to individuals
and entities that are located in areas with a prevalence of
opioid use disorders that is higher than the national average
prevalence.
``(2) Opioid use disorder care teams.--
``(A) In general.--For purposes of this section, the term
`opioid use disorder care team' means a team of health care
practitioners established by a participant described in
paragraph (1)(A) that--
``(i) shall include--
``(I) at least one physician (as defined in section
1861(r)(1)) furnishing primary care services or addiction
treatment services to an applicable beneficiary; and
``(II) at least one eligible practitioner (as defined in
paragraph (3)(A)), who may be a physician who meets the
criterion in subclause (I); and
``(ii) may include other practitioners licensed under State
law to furnish psychiatric, psychological, counseling, and
social services to applicable beneficiaries.
``(B) Requirements for receipt of payment under program.--
In order to receive payments under subsection (e), each
participant in the Program shall--
``(i) furnish opioid use disorder treatment services
through opioid use disorder care teams to applicable
beneficiaries who agree to receive the services;
``(ii) meet minimum criteria, as established by the
Secretary; and
``(iii) submit to the Secretary, in such form, manner, and
frequency as specified by the Secretary, with respect to each
applicable beneficiary for whom opioid use disorder treatment
services are furnished by the opioid use disorder care team,
data and such other information as the Secretary determines
appropriate to--
``(I) monitor and evaluate the Program;
``(II) determine if minimum criteria are met under clause
(ii); and
``(III) determine the incentive payment under subsection
(e).
``(3) Eligible practitioners; other provider-related
definitions and application provisions.--
``(A) Eligible practitioners.--For purposes of this
section, the term `eligible practitioner' means a physician
or other health
[[Page H5240]]
care practitioner, such as a nurse practitioner, that--
``(i) is enrolled under section 1866(j)(1);
``(ii) is authorized to prescribe or dispense narcotic
drugs to individuals for maintenance treatment or
detoxification treatment; and
``(iii) has in effect a waiver in accordance with section
303(g) of the Controlled Substances Act for such purpose and
is otherwise in compliance with regulations promulgated by
the Substance Abuse and Mental Health Services Administration
to carry out such section.
``(B) Addiction specialists.--For purposes of subsection
(e)(1)(B)(iv), the term `addiction specialist' means a
physician that possesses expert knowledge and skills in
addiction medicine, as evidenced by appropriate certification
from a specialty body, a certificate of advanced
qualification in addiction medicine, or completion of an
accredited residency or fellowship in addiction medicine or
addiction psychiatry, as determined by the Secretary.
``(d) Participation of Applicable Beneficiaries.--
``(1) Applicable beneficiary defined.--In this section, the
term `applicable beneficiary' means an individual who--
``(A) is entitled to, or enrolled for, benefits under part
A and enrolled for benefits under part B;
``(B) is not enrolled in a Medicare Advantage plan under
part C;
``(C) has a current diagnosis for an opioid use disorder;
and
``(D) meets such other criteria as the Secretary determines
appropriate.
Such term shall include an individual who is dually eligible
for benefits under this title and title XIX if such
individual satisfies the criteria described in subparagraphs
(A) through (D).
``(2) Voluntary participation; limitation on number of
participants.--An applicable beneficiary may participate in
the Program on a voluntary basis and may terminate
participation in the Program at any time. Not more than
20,000 applicable beneficiaries may participate in the
Program at any time.
``(3) Services.--In order to participate in the Program, an
applicable beneficiary shall agree to receive opioid use
disorder treatment services from a participant. Participation
under the Program shall not affect coverage of or payment for
any other item or service under this title for the applicable
beneficiary.
``(4) Beneficiary access to services.--Nothing in this
section shall be construed as encouraging providers to limit
applicable beneficiary access to services covered under this
title and applicable beneficiaries shall not be required to
relinquish access to any benefit under this title as a
condition of receiving services from a participant in the
Program.
``(e) Payments.--
``(1) Per applicable beneficiary per month care management
fee.--
``(A) In general.--The Secretary shall establish a schedule
of per applicable beneficiary per month care management fees.
Such a per applicable beneficiary per month care management
fee shall be paid to a participant in addition to any other
amount otherwise payable under this title to the health care
practitioners in the participant's opioid use disorder care
team or, if applicable, to the participant. A participant may
use such per applicable beneficiary per month care management
fee to deliver additional services to applicable
beneficiaries, including services not otherwise eligible for
payment under this title.
``(B) Payment amounts.--In carrying out subparagraph (A),
the Secretary shall--
``(i) consider payments otherwise payable under this title
for opioid use disorder treatment services and the needs of
applicable beneficiaries;
``(ii) pay a higher per applicable beneficiary per month
care management fee for an applicable beneficiary who
receives more intensive treatment services from a participant
and for whom those services are appropriate based on clinical
guidelines for opioid use disorder care;
``(iii) pay a higher per applicable beneficiary per month
care management fee for the month in which the applicable
beneficiary begins treatment with a participant than in
subsequent months, to reflect the greater time and costs
required for the planning and initiation of treatment, as
compared to maintenance of treatment;
``(iv) pay higher per applicable beneficiary per month care
management fees for participants that have established opioid
use disorder care teams that include an addiction specialist
(as defined in subsection (c)(3)(B)); and
``(v) take into account whether a participant's opioid use
disorder care team refers applicable beneficiaries to other
suppliers or providers for any opioid use disorder treatment
services.
``(C) No duplicate payment.--The Secretary shall make
payments under this paragraph to only one participant for
services furnished to an applicable beneficiary during a
calendar month.
``(2) Incentive payments.--
``(A) In general.--Under the Program, the Secretary shall
establish a performance-based incentive payment, which shall
be paid (using a methodology established and at a time
determined appropriate by the Secretary) to participants
based on the performance of participants with respect to
criteria, as determined appropriate by the Secretary, in
accordance with subparagraph (B).
``(B) Criteria.--
``(i) In general.--Criteria described in subparagraph (A)
may include consideration of the following:
``(I) Patient engagement and retention in treatment.
``(II) Evidence-based medication-assisted treatment.
``(III) Other criteria established by the Secretary.
``(ii) Required consultation and consideration.--In
determining criteria described in subparagraph (A), the
Secretary shall--
``(I) consult with stakeholders, including clinicians in
the primary care community and in the field of addiction
medicine; and
``(II) consider existing clinical guidelines for the
treatment of opioid use disorders.
``(C) No duplicate payment.--The Secretary shall ensure
that no duplicate payments under this paragraph are made with
respect to an applicable beneficiary.
``(f) Multipayer Strategy.--In carrying out the Program,
the Secretary shall encourage other payers to provide similar
payments and to use similar criteria as applied under the
Program under subsection (e)(2)(C). The Secretary may enter
into a memorandum of understanding with other payers to align
the methodology for payment provided by such a payer related
to opioid use disorder treatment services with such
methodology for payment under the Program.
``(g) Evaluation.--
``(1) In general.--The Secretary shall conduct an
intermediate and final evaluation of the program. Each such
evaluation shall determine the extent to which each of the
purposes described in subsection (b) have been accomplished
under the Program.
``(2) Reports.--The Secretary shall submit to the Secretary
and Congress--
``(A) a report with respect to the intermediate evaluation
under paragraph (1) not later than 3 years after the date of
the implementation of the Program; and
``(B) a report with respect to the final evaluation under
paragraph (1) not later than 6 years after such date.
``(h) Funding.--
``(1) Administrative funding.--For the purposes of
implementing, administering, and carrying out the Program
(other than for purposes described in paragraph (2)),
$5,000,000 shall be available from the Federal Supplementary
Medical Insurance Trust Fund under section 1841.
``(2) Care management fees and incentives.--For the
purposes of making payments under subsection (e), $10,000,000
shall be available from the Federal Supplementary Medical
Insurance Trust Fund under section 1841 for each of fiscal
years 2021 through 2024.
``(3) Availability.--Amounts transferred under this
subsection for a fiscal year shall be available until
expended.
``(i) Waivers.--The Secretary may waive any provision of
this title as may be necessary to carry out the Program under
this section.''.
SEC. 3. REQUIRING E-PRESCRIBING FOR COVERAGE OF COVERED PART
D CONTROLLED SUBSTANCES.
(a) In General.--Section 1860D-4(e) of the Social Security
Act (42 U.S.C. 1395w-104(e)) is amended by adding at the end
the following:
``(7) Requirement of e-prescribing for controlled
substances.--
``(A) In general.--Subject to subparagraph (B), a
prescription for a covered part D drug under a prescription
drug plan (or under an MA-PD plan) for a schedule II, III,
IV, or V controlled substance shall be transmitted by a
health care practitioner electronically in accordance with an
electronic prescription drug program that meets the
requirements of paragraph (2).
``(B) Exception for certain circumstances.--The Secretary
shall, pursuant to rulemaking, specify circumstances with
respect to which the Secretary may waive the requirement
under subparagraph (A), with respect to a covered part D
drug, including in the case of--
``(i) a prescription issued when the practitioner and
dispenser are the same entity;
``(ii) a prescription issued that cannot be transmitted
electronically under the most recently implemented version of
the National Council for Prescription Drug Programs SCRIPT
Standard;
``(iii) a prescription issued by a practitioner who has
received a waiver or a renewal thereof for a specified period
determined by the Secretary, not to exceed one year, from the
requirement to use electronic prescribing, pursuant to a
process established by regulation by the Secretary, due to
demonstrated economic hardship, technological limitations
that are not reasonably within the control of the
practitioner, or other exceptional circumstance demonstrated
by the practitioner;
``(iv) a prescription issued by a practitioner under
circumstances in which, notwithstanding the practitioner's
ability to submit a prescription electronically as required
by this subsection, such practitioner reasonably determines
that it would be impractical for the individual involved to
obtain substances prescribed by electronic prescription in a
timely manner, and such delay would adversely impact the
individual's medical condition involved;
``(v) a prescription issued by a practitioner allowing for
the dispensing of a non-patient specific prescription
pursuant to a standing order, approved protocol for drug
therapy,
[[Page H5241]]
collaborative drug management, or comprehensive medication
management, in response to a public health emergency, or
other circumstances where the practitioner may issue a non-
patient specific prescription;
``(vi) a prescription issued by a practitioner prescribing
a drug under a research protocol;
``(vii) a prescription issued by a practitioner for a drug
for which the Food and Drug Administration requires a
prescription to contain elements that are not able to be
included in electronic prescribing, such as a drug with risk
evaluation and mitigation strategies that include elements to
assure safe use; and
``(viii) a prescription issued by a practitioner for an
individual who--
``(I) receives hospice care under this title; or
``(II) is a resident of a skilled nursing facility (as
defined in section 1819(a)), or a medical institution or
nursing facility for which payment is made for an
institutionalized individual under section 1902(q)(1)(B), for
which frequently abused drugs are dispensed for residents
through a contract with a single pharmacy, as determined by
the Secretary in accordance with this paragraph.
``(C) Dispensing.--Nothing in this paragraph shall be
construed as requiring a sponsor of a prescription drug plan
under this part, MA organization offering an MA-PD plan under
part C, or a pharmacist to verify that a practitioner, with
respect to a prescription for a covered part D drug, has a
waiver (or is otherwise exempt) under subparagraph (B) from
the requirement under subparagraph (A). Nothing in this
paragraph shall be construed as affecting the ability of the
plan to cover or the pharmacists' ability to continue to
dispense covered part D drugs from otherwise valid written,
oral or fax prescriptions that are consistent with laws and
regulations. Nothing in this paragraph shall be construed as
affecting the ability of the beneficiary involved to
designate a particular pharmacy to dispense a prescribed drug
to the extent consistent with the requirements under
subsection (b)(1) and under this paragraph.
``(D) Enforcement.--The Secretary shall, pursuant to
rulemaking, have authority to enforce and specify appropriate
penalties for non-compliance with the requirement under
subparagraph (A).''.
(b) Effective Date.--The amendment made by subsection (a)
shall apply to coverage of drugs prescribed on or after
January 1, 2021.
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 in the Record on the bill.
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 Representative Ruiz, Representative
Clark, and Representative Mullin; they all worked together to make this
bipartisan bill a success.
This bill would authorize a 4-year demonstration project to test new
ways to treat opioid use disorder among the Medicare population.
In addition, this bill will help secure the prescribing of controlled
substances in Medicare by requiring the use of e-prescribing. Pretty
important work.
We have heard from providers that have not only cut down on the abuse
of fraudulent prescriptions by switching to e-prescribing but also have
saved time for themselves and their nurses, all while saving millions
of dollars in the process. So these are really important, substantive
steps forward, another piece of the puzzle in addressing the opioid
crisis.
Mr. Speaker, I urge passage of the legislation, and I reserve the
balance of my time.
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
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; fl 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.
[[Page H5242]]
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. KENNEDY. Mr. Speaker, I yield such time as he may consume to the
gentleman from California (Mr. Ruiz), my colleague.
Mr. RUIZ. Mr. Speaker, I rise to support H.R. 5605, the Advancing
High Quality Treatment for Opioid Use Disorders in Medicare Act.
I introduced the bill to give older Americans across our Nation more
access to comprehensive addiction treatment services through Medicare.
Seniors are frequently prescribed opioids to treat chronic illnesses
with constant, lasting pain issues, such as arthritis and other issues
related to their musculoskeletal system.
The frequency and chronicity of this prescribing puts them at risk of
developing a dependency, as seniors are more physiologically vulnerable
to experiencing dependency and overdose effects. That is because as you
get older your physiology changes, which makes seniors less able to
deal with the side effects of opioids and more prone to respiratory
depression, the leading cause of opioid-related death.
When you consider that roughly one-third of Medicare beneficiaries
received an opioid prescription in 2016, with over half a million
receiving a high dose, it makes sense that the hospitalization rate
related to opioid misuse in patients over 65 has increased by 500
percent in the past two decades.
Despite these heightened risk factors, many seniors still do not have
access to comprehensive, evidence-based treatment under traditional
Medicare, and we cannot leave our seniors behind as we work to address
this national crisis. Our seniors deserve access to the gold standard
of care for treating opioid addiction. It is that simple.
My bill, H.R. 5605, the Advancing High Quality Treatment for Opioid
Use Disorders in Medicare Act, will open doors for older Americans to
get that gold standard of care by strengthening Medicare for our
seniors. My bill does this by creating an alternative payment model
demonstration program through Medicare for comprehensive treatment and
care programs for opioid misuse disorder and will establish quality
measures that reward comprehensive treatment programs that actually
produce the best patient outcomes.
It works by giving providers and institutions that choose to
participate a case management payment, which they would use to provide
wraparound services for Medicare beneficiaries. Teams with an addiction
specialist would also receive a higher incentive. Seniors participating
in this program will receive medication-assisted treatment alongside
psychosocial support, such as psychotherapy, treatment planning, and
appropriate social services.
This coordinated care approach is considered the gold standard of
care, and if we want to successfully address this crisis, we need to
ensure that individuals have access to treatments that will result in
successful outcomes. I have seen firsthand the importance of this with
my own patients in the emergency department. Getting medication-
assisted treatment is important, and the success of that treatment is
enhanced if that patient is also participating in psychotherapy and
receiving the appropriate social services.
That is why this demo is supported by the American Society of
Addiction Medicine and the California Medical Association, among
others. It is critical that all Americans, regardless of their age or
how much money they make, have access to high quality, comprehensive
treatment. My bill will strengthen Medicare so we can help seniors
address opioid dependence by ensuring they get the care they need.
I also want to thank Ranking Member Pallone and Chairman Walden for
their support of this legislation and of our seniors.
Also included in my bill is H.R. 3528, the Every Prescription
Conveyed Securely Act, introduced by Representative Katherine Clark
from Massachusetts, with the assistance of Representative Mullin.
I want to thank Representative Clark for her hard work to address
this crisis by expanding the use of technology to reduce fraudulent
prescribing.
Her legislation will direct providers to use electronic prescribing
for controlled substances technology for Medicare part D by 2021 to cut
down on fraud and overprescribing. Already, seven States have
implemented this system in an effort to combat this crisis and keep
illicit opioids off the streets.
According to the Department of Justice, most fraudulent opioid
prescriptions are obtained either through doctor shopping, forged
prescriptions, or theft, all of which can be addressed by an effective
electronic prescribing for controlled substances system.
As amended, my bill, H.R. 5605, will improve care for our seniors and
help get illegally obtained opioids off the streets.
Mr. KENNEDY. Mr. Speaker, I think Dr. Ruiz has done an extraordinary
job on this legislation. I would urge the House to support it, and I
yield back the balance of my time.
Mr. WALDEN. Mr. Speaker, I yield back the balance of my time.
Ms. JACKSON LEE. Mr. Speaker, I support H.R. 5605, the ``Advancing
High Quality Treatment for Opioid Use Disorders in Medicare Act.''
This important bill provides applicable beneficiaries increased
access to opioid use disorder treatment services and will improve
physical and mental health outcomes for such beneficiaries.
In 2016, approximately one-third of Medicare beneficiaries received
an opioid prescription, 500,000 of which received high doses of opioids
yet many lack access to quality treatment for substance abuse.
This legislation would create an Alternative Payment Model (APM)
demonstration program to incentivize the delivery of high quality,
evidence-based substance use disorder treatment services.
The voluntary program would enroll eligible beneficiaries who agree
to receive Substance Use Disorder (SUD) treatment services through
providers and institutions participating in the Program.
To support those who are suffering from opioid use disorders, we must
employ a multi-faceted approach that actually achieves results.
The purpose of the Advancing High Quality Treatment for Opioid Use
Disorders in Medicare Act is to assist states in the implementation of
a variety of strategies, including:
Reducing hospitalizations and emergency department visits;
Increasing the use of medication-assisted treatment for opioid use
disorders;
Improving health outcomes of individuals with opioid use disorders,
including by reducing the incidence of infectious diseases (such as
hepatitis C and HIV);
Reducing deaths from opioid overdose; and
Reducing the utilization of inpatient residential treatment.
Under the Program, the Secretary of the Health and Human Services
shall make payments to participants for:
Furnishing opioid use disorder treatment services delivered through
opioid use disorder care teams; or
Arranging for such service to be furnished, to applicable
beneficiaries participating in the Program.
The current surge of opioid usage requires a strong, national
response, and with passage of the Advancing High Quality Treatment for
Opioid Use Disorders in Medicare Act, we are addressing this issue.
Opioid use disorder leads to physical and functional changes to parts
of the brain affecting impulse, reward, and motivation.
In recent years, it is estimated that 2.1 million individuals in the
United States have an opioid use disorder.
This legislation would require APM demonstration program participants
to provide both medication as well as psychosocial supports, such as
care management, psychotherapy, treatment planning and appropriate
social services to treat substance use disorder, which is considered
the gold standard of care.
Voluntary APM demonstration program participation would be
prioritized in regions with high prevalence of opioid use disorders.
Care teams would require inclusion of health care providers who are
licensed to dispense opioid medications for the purpose of
detoxification or maintenance treatment for opioid use disorder, as
well as appropriate providers of psychosocial treatment.
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In addition, in conjunction with stakeholders, the Health and Human
Services Secretary would develop quality and outcome measures to assess
the care beneficiaries receive through the Program.
Participating providers or institutes will receive a monthly case
management fee for all beneficiaries receiving opioid treatment
services.
Program participants will receive a higher case management fee if
their care team includes an addiction specialist, and for the
initiation of treatment period, which is treatment and resource
intensive.
Participants would be eligible to receive an additional incentive
payment for providing quality substance use disorder treatment care.
The demonstration program is authorized for four years and capped at
20,000 participants.
I am confident that the comprehensive approach we are taking to
address those suffering from Opioid Use Disorder will help address the
nation's growing epidemic.
For these reasons, I support the Advancing High Quality Treatment for
Opioid Use Disorders in Medicare Act and the goal of ensuring the best
possible response to treat opioid use disorder in America.
The SPEAKER pro tempore. 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. 5605, 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 amend
title XVIII of the Social Security Act to provide for an opioid use
disorder treatment demonstration program, and for other purposes.''.
A motion to reconsider was laid on the table.
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