[Congressional Record Volume 164, Number 102 (Tuesday, June 19, 2018)]
[House]
[Pages H5249-H5254]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
DR. TODD GRAHAM PAIN MANAGEMENT, TREATMENT, AND RECOVERY ACT OF 2018
Mrs. WALORSKI. Mr. Speaker, I move to suspend the rules and pass the
bill (H.R. 6110) to amend title XVIII of the Social Security Act to
provide for the review and adjustment of payments under the Medicare
outpatient prospective payment system to avoid financial incentives to
use opioids instead of non-opioid alternative treatments, and for other
purposes.
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The Clerk read the title of the bill.
The text of the bill is as follows:
H.R. 6110
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 ``Dr. Todd Graham Pain
Management, Treatment, and Recovery Act of 2018''.
SEC. 2. REVIEW AND ADJUSTMENT OF PAYMENTS UNDER THE MEDICARE
OUTPATIENT PROSPECTIVE PAYMENT SYSTEM TO AVOID
FINANCIAL INCENTIVES TO USE OPIOIDS INSTEAD OF
NON-OPIOID ALTERNATIVE TREATMENTS.
(a) Outpatient Prospective Payment System.--Section 1833(t)
of the Social Security Act (42 U.S.C. 1395l(t)) is amended by
adding at the end the following new paragraph:
``(22) Review and revisions of payments for non-opioid
alternative treatments.--
``(A) In general.--With respect to payments made under this
subsection for covered OPD services (or groups of services),
including covered OPD services assigned to a comprehensive
ambulatory payment classification, the Secretary--
``(i) shall, as soon as practicable, conduct a review (part
of which may include a request for information) of payments
for opioids and evidence-based non-opioid alternatives for
pain management (including drugs and devices, nerve blocks,
surgical injections, and neuromodulation) with a goal of
ensuring that there are not financial incentives to use
opioids instead of non-opioid alternatives;
``(ii) may, as the Secretary determines appropriate,
conduct subsequent reviews of such payments; and
``(iii) shall consider the extent to which revisions under
this subsection to such payments (such as the creation of
additional groups of covered OPD services to classify
separately those procedures that utilize opioids and non-
opioid alternatives for pain management) would reduce payment
incentives to use opioids instead of non-opioid alternatives
for pain management.
``(B) Priority.--In conducting the review under clause (i)
of subparagraph (A) and considering revisions under clause
(iii) of such subparagraph, the Secretary shall focus on
covered OPD services (or groups of services) assigned to a
comprehensive ambulatory payment classification, ambulatory
payment classifications that primarily include surgical
services, and other services determined by the Secretary
which generally involve treatment for pain management.
``(C) Revisions.--If the Secretary identifies revisions to
payments pursuant to subparagraph (A)(iii), the Secretary
shall, as determined appropriate, begin making such revisions
for services furnished on or after January 1, 2020. Revisions
under the previous sentence shall be treated as adjustments
for purposes of application of paragraph (9)(B).
``(D) Rules of construction.--Nothing in this paragraph
shall be construed to preclude the Secretary--
``(i) from conducting a demonstration before making the
revisions described in subparagraph (C); or
``(ii) prior to implementation of this paragraph, from
changing payments under this subsection for covered OPD
services (or groups of services) which include opioids or
non-opioid alternatives for pain management.''.
(b) Ambulatory Surgical Centers.--Section 1833(i) of the
Social Security Act (42 U.S.C. 1395l(i)) is amended by adding
at the end the following new paragraph:
``(8) The Secretary shall conduct a similar type of review
as required under paragraph (22) of section 1833(t)),
including the second sentence of subparagraph (C) of such
paragraph, to payment for services under this subsection, and
make such revisions under this paragraph, in an appropriate
manner (as determined by the Secretary).''.
SEC. 3. EXPANDING ACCESS UNDER THE MEDICARE PROGRAM TO
ADDICTION TREATMENT IN FEDERALLY QUALIFIED
HEALTH CENTERS AND RURAL HEALTH CLINICS.
(a) Federally Qualified Health Centers.--Section 1834(o) of
the Social Security Act (42 U.S.C. 1395m(o)) is amended by
adding at the end the following new paragraph:
``(3) Additional payments for certain fqhcs with physicians
or other practitioners receiving data 2000 waivers.--
``(A) In general.--In the case of a Federally qualified
health center with respect to which, beginning on or after
January 1, 2019, Federally-qualified health center services
(as defined in section 1861(aa)(3)) are furnished for the
treatment of opioid use disorder by a physician or
practitioner who meets the requirements described in
subparagraph (C) the Secretary shall, subject to availability
of funds under subparagraph (D), make a payment (at such time
and in such manner as specified by the Secretary) to such
Federally qualified health center after receiving and
approving an application submitted by such Federally
qualified health center under subparagraph (B). Such a
payment shall be in an amount determined by the Secretary,
based on an estimate of the average costs of training for
purposes of receiving a waiver described in subparagraph
(C)(ii). Such a payment may be made only one time with
respect to each such physician or practitioner.
``(B) Application.--In order to receive a payment described
in subparagraph (A), a Federally-qualified health center
shall submit to the Secretary an application for such a
payment at such time, in such manner, and containing such
information as specified by the Secretary. A Federally-
qualified health center may apply for such a payment for each
physician or practitioner described in subparagraph (A)
furnishing services described in such subparagraph at such
center.
``(C) Requirements.--For purposes of subparagraph (A), the
requirements described in this subparagraph, with respect to
a physician or practitioner, are the following:
``(i) The physician or practitioner is employed by or
working under contract with a Federally qualified health
center described in subparagraph (A) that submits an
application under subparagraph (B).
``(ii) The physician or practitioner first receives a
waiver under section 303(g) of the Controlled Substances
Acton or after January 1, 2019.
``(D) Funding.--For purposes of making payments under this
paragraph, there are appropriated, out of amounts in the
Treasury not otherwise appropriated, $6,000,000, which shall
remain available until expended.''.
(b) Rural Health Clinic.--Section 1833 of the Social
Security Act (42 U.S.C. 1395l) is amended--
(1) by redesignating the subsection (z) relating to medical
review of spinal subluxation services as subsection (aa); and
(2) by adding at the end the following new subsection:
``(bb) Additional Payments for Certain Rural Health Clinics
With Physicians or Practitioners Receiving DATA 2000
Waivers.--
``(1) In general.--In the case of a rural health clinic
with respect to which, beginning on or after January 1, 2019,
rural health clinic services (as defined in section
1861(aa)(1)) are furnished for the treatment of opioid use
disorder by a physician or practitioner who meets the
requirements described in paragraph (3), the Secretary shall,
subject to availability of funds under paragraph (4), make a
payment (at such time and in such manner as specified by the
Secretary) to such rural health clinic after receiving and
approving an application described in paragraph (2). Such
payment shall be in an amount determined by the Secretary,
based on an estimate of the average costs of training for
purposes of receiving a waiver described in paragraph (3)(B).
Such payment may be made only one time with respect to each
such physician or practitioner.
``(2) Application.--In order to receive a payment described
in paragraph (1), a rural health clinic shall submit to the
Secretary an application for such a payment at such time, in
such manner, and containing such information as specified by
the Secretary. A rural health clinic may apply for such a
payment for each physician or practitioner described in
paragraph (1) furnishing services described in such paragraph
at such clinic.
``(3) Requirements.--For purposes of paragraph (1), the
requirements described in this paragraph, with respect to a
physician or practitioner, are the following:
``(A) The physician or practitioner is employed by or
working under contract with a rural health clinic described
in paragraph (1) that submits an application under paragraph
(2).
``(B) The physician or practitioner first receives a waiver
under section 303(g) of the Controlled Substances Acton or
after January 1, 2019.
``(4) Funding.--For purposes of making payments under this
subsection, there are appropriated, out of amounts in the
Treasury not otherwise appropriated, $2,000,000, which shall
remain available until expended.''.
SEC. 4. STUDYING THE AVAILABILITY OF SUPPLEMENTAL BENEFITS
DESIGNED TO TREAT OR PREVENT SUBSTANCE USE
DISORDERS UNDER MEDICARE ADVANTAGE PLANS.
(a) In General.--Not later than 2 years after the date of
the enactment of this Act, the Secretary of Health and Human
Services (in this section referred to as the ``Secretary'')
shall submit to Congress a report on the availability of
supplemental health care benefits (as described in section
1852(a)(3)(A) of the Social Security Act (42 U.S.C. 1395w-
22(a)(3)(A))) designed to treat or prevent substance use
disorders under Medicare Advantage plans offered under part C
of title XVIII of such Act. Such report shall include the
analysis described in subsection (c) and any differences in
the availability of such benefits under specialized MA plans
for special needs individuals (as defined in section
1859(b)(6) of such Act (42 U.S.C. 1395w-28(b)(6))) offered to
individuals entitled to medical assistance under title XIX of
such Act and other such Medicare Advantage plans.
(b) Consultation.--The Secretary shall develop the report
described in subsection (a) in consultation with relevant
stakeholders, including--
(1) individuals entitled to benefits under part A or
enrolled under part B of title XVIII of the Social Security
Act;
(2) entities who advocate on behalf of such individuals;
(3) Medicare Advantage organizations;
(4) pharmacy benefit managers; and
(5) providers of services and suppliers (as such terms are
defined in section 1861 of such Act (42 U.S.C. 1395x)).
(c) Contents.--The report described in subsection (a) shall
include an analysis on the following:
(1) The extent to which plans described in such subsection
offer supplemental health care benefits relating to coverage
of--
[[Page H5251]]
(A) medication-assisted treatments for opioid use,
substance use disorder counseling, peer recovery support
services, or other forms of substance use disorder treatments
(whether furnished in an inpatient or outpatient setting);
and
(B) non-opioid alternatives for the treatment of pain.
(2) Challenges associated with such plans offering
supplemental health care benefits relating to coverage of
items and services described in subparagraph (A) or (B) of
paragraph (1).
(3) The impact, if any, of increasing the applicable rebate
percentage determined under section 1854(b)(1)(C) of the
Social Security Act (42 U.S.C. 1395w-24(b)(1)(C)) for plans
offering such benefits relating to such coverage would have
on the availability of such benefits relating to such
coverage offered under Medicare Advantage plans.
(4) Potential ways to improve upon such coverage or to
incentivize such plans to offer additional supplemental
health care benefits relating to such coverage.
SEC. 5. CLINICAL PSYCHOLOGIST SERVICES MODELS UNDER THE
CENTER FOR MEDICARE AND MEDICAID INNOVATION;
GAO STUDY AND REPORT.
(a) CMI Models.--Section 1115A(b)(2)(B) of the Social
Security Act (42 U.S.C. 1315a(b)(2)(B) is amended by adding
at the end the following new clauses:
``(xxv) Supporting ways to familiarize individuals with the
availability of coverage under part B of title XVIII for
qualified psychologist services (as defined in section
1861(ii)).
``(xxvi) Exploring ways to avoid unnecessary
hospitalizations or emergency department visits for mental
and behavioral health services (such as for treating
depression) through use of a 24-hour, 7-day a week help line
that may inform individuals about the availability of
treatment options, including the availability of qualified
psychologist services (as defined in section 1861(ii)).''.
(b) GAO Study and Report.--Not later than 18 months after
the date of the enactment of this Act, the Comptroller
General of the United States shall conduct a study, and
submit to Congress a report, on mental and behavioral health
services under the Medicare program under title XVIII of the
Social Security Act, including an examination of the
following:
(1) Information about services furnished by psychiatrists,
clinical psychologists, and other professionals.
(2) Information about ways that Medicare beneficiaries
familiarize themselves about the availability of Medicare
payment for qualified psychologist services (as defined in
section 1861(ii) of the Social Security Act (42 U.S.C.
1395x(ii)) and ways that the provision of such information
could be improved.
SEC. 6. PAIN MANAGEMENT STUDY.
(a) In General.--Not later than 1 year after the date of
enactment of this Act, the Secretary of Health and Human
Services (referred to in this section as the ``Secretary'')
shall conduct a study analyzing best practices as well as
payment and coverage for pain management services under title
XVIII of the Social Security Act and submit to the Committee
on Ways and Means and the Committee on Energy and Commerce of
the House of Representatives and the Committee on Finance of
the Senate a report containing options for revising payment
to providers and suppliers of services and coverage related
to the use of multi-disciplinary, evidence-based, non-opioid
treatments for acute and chronic pain management for
individuals entitled to benefits under part A or enrolled
under part B of title XVIII of the Social Security Act. The
Secretary shall make such report available on the public
website of the Centers for Medicare & Medicaid Services.
(b) Consultation.--In developing the report described in
subsection (a), the Secretary shall consult with--
(1) relevant agencies within the Department of Health and
Human Services;
(2) licensed and practicing osteopathic and allopathic
physicians, behavioral health practitioners, physician
assistants, nurse practitioners, dentists, pharmacists, and
other providers of health services;
(3) providers and suppliers of services (as such terms are
defined in section 1861 of the Social Security Act (42 U.S.C.
1395x));
(4) substance abuse and mental health professional
organizations;
(5) pain management professional organizations and advocacy
entities, including individuals who personally suffer chronic
pain;
(6) medical professional organizations and medical
specialty organizations;
(7) licensed health care providers who furnish alternative
pain management services;
(8) organizations with expertise in the development of
innovative medical technologies for pain management;
(9) beneficiary advocacy organizations; and
(10) other organizations with expertise in the assessment,
diagnosis, treatment, and management of pain, as determined
appropriate by the Secretary.
(c) Contents.--The report described in subsection (a) shall
include the following:
(1) An analysis of payment and coverage under title XVIII
of the Social Security Act with respect to the following:
(A) Evidence-based treatments and technologies for chronic
or acute pain, including such treatments that are covered,
not covered, or have limited coverage under such title.
(B) Evidence-based treatments and technologies that monitor
substance use withdrawal and prevent overdoses of opioids.
(C) Evidence-based treatments and technologies that treat
substance use disorders.
(D) Items and services furnished by practitioners through a
multi-disciplinary treatment model for pain management,
including the patient-centered medical home.
(E) Medical devices, non-opioid based drugs, and other
therapies (including interventional and integrative pain
therapies) approved or cleared by the Food and Drug
Administration for the treatment of pain.
(F) Items and services furnished to beneficiaries with
psychiatric disorders, substance use disorders, or who are at
risk of suicide, or have comorbidities and require
consultation or management of pain with one or more
specialists in pain management, mental health, or addiction
treatment.
(2) An evaluation of the following:
(A) Barriers inhibiting individuals entitled to benefits
under part A or enrolled under part B of such title from
accessing treatments and technologies described in
subparagraphs (A) through (F) of paragraph (1).
(B) Costs and benefits associated with potential expansion
of coverage under such title to include items and services
not covered under such title that may be used for the
treatment of pain, such as acupuncture, therapeutic massage,
and items and services furnished by integrated pain
management programs.
(C) Pain management guidance published by the Federal
Government that may be relevant to coverage determinations or
other coverage requirements under title XVIII of the Social
Security Act.
(3) An assessment of all guidance published by the
Department of Health and Human Services on or after January
1, 2016, relating to the prescribing of opioids. Such
assessment shall consider incorporating into such guidance
relevant elements of the ``Va/DoD Clinical Practice Guideline
for Opioid Therapy for Chronic Pain'' published in February
2017 by the Department of Veterans Affairs and Department of
Defense, including adoption of elements of the Department of
Defense and Veterans Administration pain rating scale.
(4) The options described in subsection (d).
(5) The impact analysis described in subsection (e).
(d) Options.--The options described in this subsection are,
with respect to individuals entitled to benefits under part A
or enrolled under part B of title XVIII of the Social
Security Act, legislative and administrative options for
accomplishing the following:
(1) Improving coverage of and payment for pain management
therapies without the use of opioids, including
interventional pain therapies, and options to augment opioid
therapy with other clinical and complementary, integrative
health services to minimize the risk of substance use
disorder, including in a hospital setting.
(2) Improving coverage of and payment for medical devices
and non-opioid based pharmacological and non-pharmacological
therapies approved or cleared by the Food and Drug
Administration for the treatment of pain as an alternative or
augment to opioid therapy.
(3) Improving and disseminating treatment strategies for
beneficiaries with psychiatric disorders, substance use
disorders, or who are at risk of suicide, and treatment
strategies to address health disparities related to opioid
use and opioid abuse treatment.
(4) Improving and disseminating treatment strategies for
beneficiaries with comorbidities who require a consultation
or comanagement of pain with one or more specialists in pain
management, mental health, or addiction treatment, including
in a hospital setting.
(5) Educating providers on risks of coadministration of
opioids and other drugs, particularly benzodiazepines.
(6) Ensuring appropriate case management for beneficiaries
who transition between inpatient and outpatient hospital
settings, or between opioid therapy to non-opioid therapy,
which may include the use of care transition plans.
(7) Expanding outreach activities designed to educate
providers of services and suppliers under the Medicare
program and individuals entitled to benefits under part A or
under part B of such title on alternative, non-opioid
therapies to manage and treat acute and chronic pain.
(8) Creating a beneficiary education tool on alternatives
to opioids for chronic pain management.
(e) Impact Analysis.--The impact analysis described in this
subsection consists of an analysis of any potential effects
implementing the options described in subsection (d) would
have--
(1) on expenditures under the Medicare program; and
(2) on preventing or reducing opioid addiction for
individuals receiving benefits under the Medicare program.
SEC. 7. SUSPENSION OF PAYMENTS BY MEDICARE PRESCRIPTION DRUG
PLANS AND MA-PD PLANS PENDING INVESTIGATIONS OF
CREDIBLE ALLEGATIONS OF FRAUD BY PHARMACIES.
(a) In General.--Section 1860D-12(b) of the Social Security
Act (42 U.S.C. 1395w-112(b)) is amended by adding at the end
the following new paragraph:
``(7) Suspension of payments pending investigation of
credible allegations of fraud by pharmacies.--
``(A) In general.--The provisions of section 1862(o) shall
apply with respect to a PDP sponsor with a contract under
this part,
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a pharmacy, and payments to such pharmacy under this part in
the same manner as such provisions apply with respect to the
Secretary, a provider of services or supplier, and payments
to such provider of services or supplier under this title.
``(B) Rule of construction.--Nothing in this paragraph
shall be construed as limiting the authority of a PDP sponsor
to conduct postpayment review.''.
(b) Application to MA-PD Plans.--Section 1857(f)(3) of the
Social Security Act (42 U.S.C. 1395w-27(f)(3)) is amended by
adding at the end the following new subparagraph:
``(D) Suspension of payments pending investigation of
credible allegations of fraud by pharmacies.--Section 1860D-
12(b)(7).''.
(c) Conforming Amendment.--Section 1862(o)(3) of the Social
Security Act (42 U.S.C. 1395y(o)(3)) is amended by inserting
``, section 1860D-12(b)(7) (including as applied pursuant to
section 1857(f)(3)(D)),'' after ``this subsection''.
(d) Clarification Relating to Credible Allegation of
Fraud.--Section 1862(o) of the Social Security Act (42 U.S.C.
1395y(o)) is amended by adding at the end the following new
paragraph:
``(4) Credible allegation of fraud.--In carrying out this
subsection, section 1860D-12(b)(7) (including as applied
pursuant to section 1857(f)(3)(D)), and section
1903(i)(2)(C), a fraud hotline tip (as defined by the
Secretary) without further evidence shall not be treated as
sufficient evidence for a credible allegation of fraud.''.
(e) Effective Date.--The amendments made by this section
shall apply with respect to plan years beginning on or after
January 1, 2020.
The SPEAKER pro tempore. Pursuant to the rule, the gentlewoman from
Indiana (Mrs. Walorski) and the gentlewoman from California (Ms. Judy
Chu) each will control 20 minutes.
The Chair recognizes the gentlewoman from Indiana.
General Leave
Mrs. WALORSKI. Mr. Speaker, I ask unanimous consent that all Members
may have 5 legislative days within which to revise and extend their
remarks and include extraneous material on H.R. 6110, currently under
consideration.
The SPEAKER pro tempore. Is there objection to the request of the
gentlewoman from Indiana?
There was no objection.
Mrs. WALORSKI. Mr. Speaker, I yield myself such time as I may
consume.
Mr. Speaker, I rise today in support of H.R. 6110, the Dr. Todd
Graham Pain Management, Treatment, and Recovery Act.
Solving the opioid epidemic requires everyone to work together at all
levels, from the Federal Government down to those on the front lines of
this fight.
My legislation focuses on increasing access to pain management
alternatives that do not involve opioids and improving recovery
treatment options for those suffering from opioid use disorder.
Additionally, my legislation contains the following provisions that
will also be vital in overcoming this crisis: H.R. 5778, the Promoting
Outpatient Access to Non-Opioid Treatments Act introduced by
Representative Kenny Marchant and Health Subcommittee Ranking Member
Sander Levin, which requires the Secretary of Health and Human
Services, or HHS, to require payments made to hospital outpatient
departments and ambulatory surgery centers to ensure there are no
financial incentives to use opioids over nonopioid alternatives; H.R.
5769, the Expanding Access to Treatment Act introduced by
Representatives Keith Rothfus and Danny Davis, which provides payments
to federally qualified health centers and rural health clinics to
offset the cost of their providers receiving training so they are able
to provide medication-assisted treatment that will help individuals
recover from opioid use disorder; H.R. 5725, the Benefit Evaluation of
Safe Treatment Act introduced by Health Subcommittee Chairman Peter
Roskam and Representatives Linda Sanchez, John Shimkus, and Raul Ruiz,
which directs the Secretary of HHS to evaluate the extent to which MA
plans offer medication-assisted treatments and cover nonopioid
alternative treatments not otherwise covered under a Medicare fee for
service as part of a supplemental benefit; and H.R. 5790, the Medicare
Nurse Hotline Act introduced by Representatives Kristi Noem and Judy
Chu, which directs the Secretary of HHS to educate patients on the
availability of psychologist services and explore the use of hotlines
to reduce unnecessary hospitalizations and Medicare.
The bill is named after my friend Dr. Todd Graham. He was a double
board certified physician in both physical medicine and rehabilitation
and pain medicine who lived and worked in my district in northern
Indiana.
Last year, he was senselessly murdered after refusing to prescribe an
opioid to a patient.
Dr. Graham prided himself on serving his patients in a friendly and
caring fashion. He treated each person individually, taking the time to
offer specific steps to treat their issues.
One day last year, he had an interaction with a patient demanding
opioids, a situation that has become disturbingly all too common. He
stood firm in refusing to write a prescription for her, but her
husband, who was also there, became increasingly angry throughout that
visit. Two hours after they left his office, the husband returned and
murdered him in cold blood.
Dr. Graham's loss has been a heavy blow, but his legacy of compassion
and enthusiasm lives on through his wife, Julie; their two daughters;
and their son, who plans to follow in his father's footsteps.
We are lucky to have the Graham family with us here today to witness
the passage of this important bill.
Mr. Speaker, I reserve the balance of my time.
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: I write to you regarding several
opioid bills the Committee on Ways and Means ordered
favorably reported to address the opioid epidemic. The
following bills were also referred to the Committee on Energy
and Commerce.
I ask that the Committee on Energy and Commerce waive
formal consideration of the following bills so that they may
proceed expeditiously to the House Floor:
H.R. 5774, Combatting Opioid Abuse for Care in Hospitals
(COACH) Act;
H.R. 5775, Providing Reliable Options for Patients and
Educations Resources (PROPER) Act;
H.R. 5776, Medicare and Opioid Safe Treatment (MOST) Act;
H.R. 5773, Preventing Addition for Susceptible Seniors
(PASS) Act;
H.R. 5676, Stop Excessive Narcotics in our Retirement
(SENIOR) Communities Protection Act; and
H.R. 5723, Expanding Oversight of Opioid Prescribing and
Payment Act.
I acknowledge that by waiving formal consideration of the
bills, the Committee on Energy and Commerce is in no way
waiving its jurisdiction over the subject matter contained in
those provisions of the bills that fall within your Rule X
jurisdiction. I would support your effort to seek appointment
of an appropriate number of conferees on any House-Senate
conference involving this legislation.
I will include a copy of our letters in the Congressional
Record during consideration of this legislation on the House
floor.
Sincerely,
Kevin Brady,
Chairman.
____
House of Representatives,
Committee on Energy and Commerce,
Washington, DC, June 8, 2018.
Hon. Kevin Brady,
Chairman, Committee on Ways and Means,
Washington, DC.
Dear Chairman Brady: Thank you for your letter regarding
the following bills, which were also referred to the
Committee on Energy and Commerce:
H.R. 5774, Combatting Opioid Abuse for Care in Hospitals
(COACH) Act;
H.R. 5775, Providing Reliable Options for Patients and
Educations Resources (PROPER) Act;
H.R. 5776, Medicare and Opioid Safe Treatment (MOST) Act;
H.R. 5773, Preventing Addition for Susceptible Seniors
(PASS) Act;
H.R. 5676, Stop Excessive Narcotics in our Retirement
(SENIOR) Communities Protection Act; and
H.R. 5723, Expanding Oversight of Opioid Prescribing and
Payment Act.
I wanted to notify you that the Committee will forgo action
on these bills so that they may proceed expeditiously to the
House floor.
I appreciate your acknowledgment that by forgoing formal
consideration of these bills, the Committee on Energy and
Commerce is in no way waiving its jurisdiction over the
subject matter contained in those provisions of the bills
that fall within its Rule X jurisdiction. I also appreciate
your offer to support the Committee's request for the
appointment of conferees in the event of a House-Senate
conference involving this legislation.
[[Page H5253]]
Thank you for your assistance on this matter.
Sincerely,
Greg Walden,
Chairman.
Ms. JUDY CHU of California. Mr. Speaker, I yield myself such time as
I may consume.
Mr. Speaker, according to the Centers for Disease Control and
Prevention, more than 42,000 Americans died from opioid-related drug
overdoses in 2016. That is five times more than the overdose rate in
1999.
As we have heard from countless Members in this Chamber, there is no
congressional district that hasn't been impacted by the opioid crisis.
No town or city is immune from the devastating impact of addiction, and
I hope that the steps we take today are the first of many to address
the needs of our communities.
The Substance Abuse and Mental Health Services Administration, or
SAMHSA, estimated that in 2016, 11.8 million Americans over the age of
12 had misused opioids in the past year and 3.8 million were currently
misusing prescription pain relievers.
But while we are seeing news reports of the devastating toll this
crisis is taking on our Nation's young people, it is important to note
that our seniors are also suffering. From 2005 to 2014, individuals 65
years and older experienced an 85 percent cumulative increase in
opioid-related inpatient stays and a 112 percent cumulative increase in
emergency department visits, the largest increase of any age group.
Compared to other age groups, individuals 65 and older have the
highest rate of opioid-related inpatient stays in 13 States, including
my home State of California.
This crisis is especially acute for the nonelderly Medicare
population. In 2015, nonelderly Medicare beneficiaries, or those who
qualify on the basis of disability, had opioid utilization rates more
than twice that of elderly beneficiaries.
The bill before us, H.R. 6110, contains numerous provisions aimed at
improving access to treatment for Medicare beneficiaries suffering from
opioid use disorders, including access to nondrug opioid alternatives.
While every alternative will not work for every person, when dealing
with a crisis of this magnitude, I believe that we must use every tool
in the toolbox.
This bill contains two bipartisan provisions I authored with my
colleagues on the Ways and Means Committee.
Mr. Speaker, I thank the gentlewoman from Indiana (Mrs. Walorski) for
working with me on language that would direct CMS to study barriers to
patient access to nondrug alternatives for opioids in chronic care
settings.
Studies conducted by the NIH have concluded that alternative
treatments, like acupuncture, can be effective in treating conditions
like chronic pain. This issue is very important to me, because I have
been working to expand access to acupuncture since I first arrived in
the California State legislature many years ago. I have heard firsthand
what a difference acupuncture can make in the lives of patients.
I remember very clearly when I heard the testimony of a woman who had
severe back pain, but did not want invasive surgery and risk possible
addiction to morphine.
{time} 1545
Instead, she sought acupuncture, and it worked for her. She avoided
the risks associated with surgery and certain pain medications.
Furthermore, we know access to physical and occupational therapy also
helps alleviate pain and eliminates the need for an opioid
prescription.
By asking CMS to examine where barriers to these alternatives exist,
we can open the door to more treatment alternatives for beneficiaries.
I am also proud that this bill includes a provision I authored with
the gentlewoman from North Dakota (Mrs. Noem) to address the need for
more psychologists in the Medicare program. This bill would direct the
Centers for Medicare and Medicaid Innovation to examine ways for
beneficiaries to familiarize themselves with coverage for psychologist
services and request a study from the General Accountability Office on
the viability of mental and behavioral health services in the Medicare
program.
As one of only two psychologists in Congress, I firmly believe that
expanding access to psychologist services in Medicare is one of the
most important things we can do to improve the mental health of our
senior population.
We know that those who suffer from depression or other mental health
disorders are particularly vulnerable to addiction. For those who have
already taken the incredibly difficult step of seeking treatment, we
need to ensure that they have access to the full range of mental health
professionals who can support them on the journey to recovery.
H.R. 6110 also contains a number of provisions from my colleagues on
the Ways and Means Committee. Congress Members Levin and Marchant
authored a provision to review certain Medicare payments in outpatient
settings to determine whether there are financial incentives in the
Medicare program to use or prescribe opioids instead of evidence-based,
nonopioid alternatives.
Next, the legislation includes a provision introduced by Congress
Members Sanchez and Roskam that would direct the Secretary of HHS to
evaluate the extent to which Medicare Advantage programs offer
medication-assisted treatment, or MAT, and cover nonopioid alternative
treatments not otherwise covered under traditional Medicare as part of
a supplemental benefit.
Finally, this bill would also include a provision from Congress
Members Danny Davis and Rothfus that would provide grants to federally
qualified centers and rural health clinics to help offset the cost of
training providers to become certified in dispensing medications for
opioid abuse dependence.
While the provisions in the bills before us this afternoon will
certainly move us in the right direction, we cannot stop here. For
example, the Medicaid program pays for the majority of mental health
and substance abuse treatments in this country and, yet, we see
multiple attempts by Republicans over the past 4 years to slash this
program.
We must maintain protections for those with preexisting conditions so
that those who sought treatment for their addiction disorders are not
punished for trying to get sober.
We must maintain the progress we have made with the Affordable Care
Act and work together to bring down the premiums for American families
so that, should they need coverage for mental health counseling or
substance abuse treatment, no one is shut out because of how much money
they make or what State they live in.
So I hope that today represents the first step, and I hope my
colleagues on the other side of the aisle will continue to work with us
to invest in prevention, treatment, and recovery efforts all across the
country.
I encourage my colleagues to support this legislation, and I reserve
the balance of my time.
Mrs. WALORSKI. Mr. Speaker, having no other speakers, I reserve the
balance of my time.
Ms. JUDY CHU of California. Mr. Speaker, I yield myself the balance
of my time.
Mr. Speaker, I am encouraged to see my colleagues on the other side
of the aisle turn their attention to this critical issue. But this is
not a new problem, and the coverage expansions under the Affordable
Care Act have been among the most significant steps the Federal
Government has taken to stem the tide of the opioid crisis. And yet,
Republicans in Congress and President Trump have actively worked to
repeal this landmark law.
The Medicaid expansion and the increased coverage under the
individual market have provided millions of Americans access to health
insurance, and research has shown that Medicaid expansion States have
seen a greater reduction in deaths from opioids than nonexpansion
States.
Again, Medicaid is the biggest payer for substance use disorder
treatment in this country. We simply can't afford to go back.
As we discuss this crisis today and in the week to come, we must
broaden our understanding of the ways in which we, as a Nation,
approach chronic pain. That is exactly what H.R. 6110 does.
While there will always be patients who have a legitimate need for
these medications, we need to look beyond a system where an opioid
prescription is
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the automatic default. This means we need to look to alternative
methods of treating pain, whether it be acupuncture or physical therapy
or a medical device. It means we must examine existing policies that
may have inadvertently incentivized opioid prescribing practices.
But as much as we look forward, we must also address the crisis in
front of us. So I am thrilled to see provisions in this bill that would
study Medicare Advantage plans already doing groundbreaking work in
substance abuse disorder treatment.
I am also glad to see that this bill provides direct resources to the
front lines in the form of grants for federally qualified health
centers to provide additional training for our providers.
I hope that, in the future, we will work to expand access to
alternatives, both within the Medicare program and in the broader
population, and ensure that no matter where someone lives or what kind
of insurance coverage they have, they are able to seek treatment.
I urge my colleagues to support H.R. 6110, and I yield back the
balance of my time.
Mrs. WALORSKI. Mr. Speaker, I yield myself the balance of my time.
Mr. Speaker, this epidemic knows no boundaries. Opioid abuse
continues to devastate families and communities all over this country.
As we continue to work toward commonsense solutions to the opioid
epidemic, this bipartisan legislation will help break down barriers to
nonopioid treatments and give healthcare providers better tools to
prevent addiction and to assist in recovery.
I want to thank Chairman Brady for all of his hard work, as well as
my friend Ms. Judy Chu of California, who helped develop and introduce
this bill.
I urge my colleagues to support this bill, and I yield back the
balance of my time.
The SPEAKER pro tempore. The question is on the motion offered by the
gentlewoman from Indiana (Mrs. Walorski) that the House suspend the
rules and pass the bill, H.R. 6110.
The question was taken; and (two-thirds being in the affirmative) the
rules were suspended and the bill was passed.
A motion to reconsider was laid on the table.
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