[Congressional Record Volume 164, Number 102 (Tuesday, June 19, 2018)]
[House]
[Pages H5247-H5249]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                    OPIOID ADDICTION ACTION PLAN ACT

  Mr. GUTHRIE. Mr. Speaker, I move to suspend the rules and pass the 
bill (H.R. 5590) to require the Secretary of Health and Human Services 
to provide for an action plan on recommendations for changes under 
Medicare and Medicaid to prevent opioids addictions and enhance access 
to medication-assisted treatment, and for other purposes, as amended.
  The Clerk read the title of the bill.
  The text of the bill is as follows:

                               H.R. 5590

       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 ``Opioid Addiction Action Plan 
     Act''.

     SEC. 2. ACTION PLAN ON RECOMMENDATIONS FOR CHANGES UNDER 
                   MEDICARE AND MEDICAID TO PREVENT OPIOIDS 
                   ADDICTIONS AND ENHANCE ACCESS TO MEDICATION-
                   ASSISTED TREATMENT.

       (a) In General.--Not later than January 1, 2019, the 
     Secretary of Health and Human Services (in this section 
     referred to as the ``Secretary''), in collaboration with the 
     Pain Management Best Practices Inter-Agency Task Force 
     convened under section 101(b) of the Comprehensive Addiction 
     and Recovery Act of 2016 (Public Law 114-198), shall develop 
     an action plan that provides recommendations described in 
     subsection (b).
       (b) Action Plan Components.--Recommendations described in 
     this subsection are, based on an examination by the Secretary 
     of potential obstacles to an effective response to the opioid 
     crisis, recommendations, as determined appropriate by the 
     Secretary, on the following:
       (1) Recommendations on changes to the Medicare program 
     under title XVIII of the Social Security Act and the Medicaid 
     program under title XIX of such Act that would enhance 
     coverage and payment under such programs of all medication-
     assisted treatment approved by the Food and Drug 
     Administration for the treatment of opioid addiction and 
     other therapies that manage chronic and acute pain and treat 
     and minimize risk of opioid addiction, including 
     recommendations on changes to the Medicare prospective 
     payment system for hospital inpatient department services 
     under section 1886(d) of

[[Page H5248]]

     such Act (42 U.S.C. 1395ww(d)) and the Medicare prospective 
     payment system for hospital outpatient department services 
     under section 1833(t) of such Act (42 U.S.C. 1395l(t)) that 
     would allow for separate payment for such therapies, if 
     medically appropriate and if necessary to encourage 
     development and adoption of such therapies.
       (2) Recommendations for payment and service delivery models 
     to be tested by the Center for Medicare and Medicaid 
     Innovation and other federally authorized demonstration 
     projects, including value-based models, that may encourage 
     the use of appropriate medication-assisted treatment approved 
     by the Food and Drug Administration for the treatment of 
     opioid addiction and other therapies that manage chronic and 
     acute pain and treat and minimize risk of opioid addiction.
       (3) Recommendations for data collection that could 
     facilitate research and policy making regarding prevention of 
     opioid addiction and coverage and payment under the Medicare 
     and Medicaid programs of appropriate opioid addiction 
     treatments.
       (4) Recommendations for policies under the Medicare program 
     and under the Medicaid program that can expand access for 
     rural, or medically underserved communities to the full range 
     of medication-assisted treatment approved by the Food and 
     Drug Administration for the treatment of opioid addiction and 
     other therapies that manage chronic and acute pain and 
     treatment and minimize risk of opioid addiction.
       (5) Recommendations on changes to the Medicare program and 
     the Medicaid program to address coverage or payment barriers 
     to patient access to medical devices that are non-opioid 
     based treatments approved by the Food and Drug Administration 
     for the management of acute pain and chronic pain, for 
     monitoring substance use withdrawal and preventing overdoses 
     of controlled substances, and for treating substance use 
     disorder.
       (c) Stakeholder Meetings.--
       (1) In general.--Beginning not later than 3 months after 
     the date of the enactment of this Act, the Secretary shall 
     convene a public stakeholder meeting to solicit public 
     comment on the components of the action plan recommendations 
     described in subsection (b).
       (2) Participants.--Participants of meetings described in 
     paragraph (1) shall include representatives from the Food and 
     Drug Administration and National Institutes of Health, 
     biopharmaceutical industry members, medical researchers, 
     health care providers, the medical device industry, the 
     Medicare program, the Medicaid program, and patient 
     advocates.
       (d) Request for Information.--Not later than 3 months after 
     the date of the enactment of this section, the Secretary 
     shall issue a request for information seeking public feedback 
     regarding ways in which the Centers for Medicare & Medicaid 
     Services can help address the opioid crisis through the 
     development of and application of the action plan.
       (e) Report to Congress.--Not later than June 1, 2019, the 
     Secretary shall submit to Congress, and make public, a report 
     that includes--
       (1) a summary of recommendations that have emerged under 
     the action plan;
       (2) the Secretary's planned next steps with respect to the 
     action plan; and
       (3) an evaluation of price trends for drugs used to reverse 
     opioid overdoses (such as naloxone), including 
     recommendations on ways to lower such prices for consumers.
       (f) Definition of Medication-Assisted Treatment.--In this 
     section, the term ``medication-assisted treatment'' includes 
     opioid treatment programs, behavioral therapy, and 
     medications to treat substance abuse disorder.

  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from 
Kentucky (Mr. Guthrie) and the gentleman from Massachusetts (Mr. 
Kennedy) each will control 20 minutes.
  The Chair recognizes the gentleman from Kentucky.


                             General Leave

  Mr. GUTHRIE. Mr. Speaker, I ask unanimous consent that all Members 
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 Kentucky?
  There was no objection.

                              {time}  1530

  Mr. GUTHRIE. Mr. Speaker, I yield myself as much time as I may 
consume.
  Mr. Speaker, I want to commend Representative Kinzinger, 
Representative Clarke, Representative LaHood, and Representative Davis 
for their work on this important bipartisan bill.
  H.R. 5590 requires the Department of Health and Human Services to 
develop an opioid addiction plan to evaluate what HHS is doing across 
the department to address the opioid crisis and how it can be improved. 
This action plan will include an evaluation of coverage and 
reimbursement rates for nonopioid pain treatments, the potential role 
of medical devices in addressing this crisis, and the availability of 
treatment for rural and medically underserved communities, among other 
components.
  In addition, Medicare and Medicaid are on the front lines of this 
epidemic, and we need to be sure that they are not creating adverse 
incentives that can harm beneficiaries with coverage and reimbursement 
decisions.
  The issues addressed in this bill will also provide an informative 
review of how CMS can continue to fight this national crisis.
  Mr. Speaker, I urge my colleagues to support and pass this bipartisan 
bill, 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 Ways and Means,
     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;

[[Page H5249]]

       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. KENNEDY. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I rise in support of H.R. 5590 sponsored by 
Representatives Kinzinger and Clarke. I commend my colleagues for their 
hard work on this legislation.
  We know that there is more that the Department of Health and Human 
Services needs to do to address the opioid crisis. We know that we need 
to do more not only to bring down opioid prescribing, but to expand 
access to medication-assisted treatment for opioid use disorders.
  H.R. 5590 would direct the Secretary of HHS to examine potential 
obstacles to an effective response to the opioid crisis and issue 
recommendations for addressing them. It directs the Secretary to look 
at barriers to both wider use of nonopioid alternatives to manage pain, 
as well as therapies that treat opioid addiction.
  Mr. Speaker, while this is an important bill, I want to underscore 
that it is incremental.
  I also want to reiterate my continuing concern that while Democrats 
support working on a legislative package to address the opioid crisis, 
as we have over the course of the day-to-day and over the course of the 
past several weeks with our Republican colleagues, we must also assure 
that we first do no harm.
  The Trump administration and Republican efforts to dismantle the 
Affordable Care Act would do serious harm to our healthcare system and 
to individuals suffering from opioid use disorders specifically.
  For instance, the Trump administration continues to undermine the 
individual market by promoting junk insurance plans, such as short-
term, limited duration health plans.
  These plans would allow insurers to once again exclude individuals 
with preexisting conditions, such as opioid use disorder, and charge 
individuals more based on their health status. It would make coverage 
for individuals who need comprehensive health coverage, such as 
individuals with opioid use disorders, less affordable and accessible.
  Moreover, apparently Republicans are not done with their efforts to 
repeal the ACA. Despite public backlash to repeal efforts last year and 
despite statements today expressing concern about the opioid crisis, 
news reports indicate that Republicans are once again planning to make 
another effort to try to repeal the Affordable Care Act.
  The opioids package cannot be considered in a vacuum. Ongoing efforts 
to sabotage and repeal the ACA will not only reverse the gains that we 
make from these efforts today, but will inflict lasting harm to our 
healthcare system and our ability to fight the opioid crisis.
  Mr. Speaker, I yield back the balance of my time.
  Mr. GUTHRIE. Mr. Speaker, I yield back the balance of my time.
  Ms. CLARKE of New York. Mr. Speaker, let me take this time to express 
my appreciation to Chairman Walden and Ranking Member Pallone, for 
their leadership in addressing the opioid epidemic in the U.S. House of 
Representatives.
  On April 24th of this year, I had the opportunity to work across the 
aisle in introducing bipartisan legislation with my Energy and Commerce 
colleague, Congressman Adam Kinzinger of Illinois.
  We were joined by two additional colleagues as original co-sponsors, 
who sit on the House Ways and Means Committee--Rep. Darrin LaHood, my 
Republican colleague from Illinois and Rep. Danny K. Davis, my CBC 
Colleague who hails from Illinois as well.
  Our bill, The Opioid Addiction Action Plan of 2018, is a roadmap to 
not only abating the opioid epidemic, but to engaging industry to be 
innovative in the development of new pain management therapies.
  There are many players and much is at stake.
  According to the National Institutes of Drug Abuse, there are more 
than 115 opioid related deaths per day.
  The CDC estimates that the economic burden of prescription opioid 
misuse is roughly $78.5 billion a year--and that's in the U.S. alone.
  Since we know the enormity of this issue plaguing our country, 
passing H.R. 5590 would require that the Centers for Medicare and 
Medicaid Services (CMS) seeks stakeholder feedback as well as public 
comment, before producing an Opioid Addiction Act Plan report to 
Congress.
  It is going to take all of us to tackle this national opioid 
epidemic.
  And Mr. Speaker, with the opioid crisis at epic levels, government 
cannot do this alone.
  That is why we are calling on all of our partners to aide in the 
fight against opioid addiction in our communities--for both addiction 
to prescription painkillers and addiction to synthetics, including 
heroin and fentanyl.
  Overdose deaths that were once perceived as largely a rural white 
problem have now become widespread among black Americans in urban 
communities who are dying from horrific rates of fentanyl overdoses.
  While white Americans die at greater rates of overdose deaths, 
overdose death rates have been steadily increasing among black 
Americans since 2011--at the time that fentanyl and heroin, as well as 
other synthetics began to climb.
  One of the solutions to the ever-growing problem to the opioid crisis 
in the black community is access to addiction care treatment.
  Traditionally, African Americans have had unequal access to quality 
health care in comparison to our white counterparts.
  This legislation would also mandate improved data collection to 
better understand the opioid crisis.
  H.R. 5590 directs the CMS to develop an Opioid Addiction Action Plan 
to address challenges for treatment of substance abuse disorders.
  Additionally, this bill also identifies non-opioid pain management 
options and make considerations for Medicare and Medicaid coverage and 
reimbursement of medication-assisted treatment (MAT) for opioid use 
disorders.
  In addition to making sure our communities have access to medication-
assisted treatment, it is important that we help them in the event 
someone is in the midst of an overdose.
  Mr. Speaker, we cannot leave those behind who need us most.
  We are our brother's and our sister's keepers.
  The SPEAKER pro tempore. The question is on the motion offered by the 
gentleman from Kentucky (Mr. Guthrie) that the House suspend the rules 
and pass the bill, H.R. 5590, as amended.
  The question was taken; and (two-thirds being in the affirmative) the 
rules were suspended and the bill, as amended, was passed.
  A motion to reconsider was laid on the table.

                          ____________________