[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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