[Congressional Record Volume 164, Number 102 (Tuesday, June 19, 2018)]
[House]
[Pages H5261-H5264]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




 STOP EXCESSIVE NARCOTICS IN OUR RETIREMENT COMMUNITIES PROTECTION ACT 
                                OF 2018

  Mr. ROSKAM. Mr. Speaker, I move to suspend the rules and pass the 
bill (H.R. 5676) to amend title XVIII of the Social Security Act to 
authorize the suspension of payments by Medicare prescription drug 
plans and MA-PD plans pending investigations of credible allegations of 
fraud by pharmacies, as amended.
  The Clerk read the title of the bill.
  The text of the bill is as follows:

                               H.R. 5676

       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 ``Stop Excessive Narcotics in 
     our Retirement Communities Protection Act of 2018'' or the 
     ``SENIOR Communities Protection Act of 2018''.

[[Page H5262]]

  


     SEC. 2. 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, 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 gentleman from 
Illinois (Mr. Roskam) and the gentlewoman from California (Ms. Judy 
Chu) each will control 20 minutes.
  The Chair recognizes the gentleman from Illinois.


                             General Leave

  Mr. ROSKAM. Mr. Speaker, I ask unanimous consent that all Members 
have 5 legislative days to revise and extend their remarks and include 
extraneous material on H.R. 5676, currently under consideration.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Illinois?
  There was no objection.
  Mr. ROSKAM. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I stand today in strong support of H.R. 5676, a 
bipartisan bill centered on protecting Medicare beneficiaries from 
abusive opioid prescribing, while ensuring appropriate access to 
medically necessary medications. This bill strikes a balance, which we 
need.
  H.R. 5676, introduced by our colleagues--Mr. MacArthur, Mr. 
Blumenauer, Mr. Schweikert, Mr. Collins, Ms. Kuster, and Mr. Tonko--
extends an existing authority in the Medicare fee-for-service program 
to Medicare Advantage and prescription drug plans.
  According to a recent report released by the Department of Health and 
Human Services' Office of Inspector General, one-third of Medicare part 
D beneficiaries received an opioid prescription in 2016, costing the 
program $4.1 billion and representing as many as 79.4 million 
prescriptions. The report found that as many as half a million part D 
beneficiaries received high amounts of opioids, with almost 70,000 
receiving extreme amounts of opioids, many of them as a result of 
doctor shopping.
  For years, the Medicare fee-for-service program has been able to 
suspend payments to a provider or a supplier pending an investigation 
of a credible allegation of fraud against the provider or supplier. 
Extending this authority to the Medicare Advantage and prescription 
drug plans will help bridge the gap in the care of beneficiaries and 
halt the fraudulent activity that contributes to the opioid crisis.
  I would like to thank my colleagues on both sides of the aisle on the 
Ways and Means Committee for their commitment to working cooperatively 
on this, and also our colleagues on the Energy and Commerce Committee, 
particularly Congressman Burgess, who chairs the Health Subcommittee, 
and also Chairman Walden. They played a role in laying the groundwork 
for policies like this that crack down on abusers.
  Mr. Speaker, I look forward to continuing to work on this issue on 
both sides of the aisle and with the administration on policies that 
will further strengthen the integrity of the Medicare program.
  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.
       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, I am pleased to support H.R. 5676, the SENIOR 
Communities Protection Act.
  The Affordable Care Act granted the Department of Health and Human 
Services the authority to suspend payments to Medicare's part A and B 
providers pending investigations into credible allegations of fraud or 
abuse.
  The SENIOR Communities Protection Act would grant that same authority 
to Medicare part D plans. This bill would only allow plans to suspend 
these payments if doing so would not cause an access or network 
adequacy problem for the beneficiaries served by the pharmacies or 
hinder any law enforcement efforts.
  This change would give Medicare an additional tool to help crack down 
on bad actors who put seniors at risk. For example, this could help 
plans and Medicare crack down on the practice of

[[Page H5263]]

pill dumping, where a small pharmacy receives millions of opioid pills 
from a distributor that far exceeds the population of patients it 
serves.
  In one case, it was found that a single small town pharmacy received 
the equivalent of more than 9,000 pills per resident over the course of 
a decade. In another case, an opioid distributor shipped 9 million 
pills to a town of 406 residents over just a 2-year period. That is an 
average of 717 pills per person per year.
  While opioid distributors are required to report suspicious activity, 
congressional investigations have revealed that distributors did not 
perform sufficient oversight of these shipments. As our communities are 
flooded with these drugs, it is important that Medicare plans have the 
ability to stop the bad actors when they are identified.
  Mr. Speaker, I reserve the balance of my time.
  Mr. ROSKAM. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I just want to go into a little bit more detail and 
focus on how it is that we are here today and why there is an urgency 
to this.
  The gentlewoman just mentioned some staggering statistics: 9,000 
pills per individual over a decade in a particular town. It tells you 
that the system has gotten entirely out of balance.
  There are a lot of explanations and there are not a lot of clean 
hands:
  We know that there have been government policies that have driven, in 
part, the opioid crisis by evaluating providers on whether or not pain 
satisfaction has been completed on the patient side of things;
  We know that in some cases there have been healthcare providers that 
have not gone into the detail of getting to the root of a problem;
  We know that we, as a culture, put extraordinary pressure on 
healthcare providers when we tell them we want them to help us get out 
of pain; and when we do that, sometimes, Mr. Speaker, unfortunately, we 
put ourselves at risk, and we know that pharma has a lot to answer for.
  All of those things we know are true, and I think what is encouraging 
to me is this idea of people coming together on both sides and 
recognizing we don't have to live this way anymore. We don't have to 
have a system that drives people in this direction.
  Let me just go back to this inspector general report from the 
Department of Health and Human Services that says that 79 million 
prescriptions involving opioids were prescribed in 2016 alone. That is 
a staggering number.
  And I think that, if we are diligent, if we are forward thinking, and 
if we continue to work together, both sides of the aisle coming 
together, Mr. Speaker, I think that, in 10 years, our country will be 
having a different conversation on opioids. It may take that long, but 
I think, in 10 years' time, if we do the work, if we are committed to 
this, we can look back and we can say: That was a time when the United 
States came together around a public health crisis; that was a time 
when people had a general understanding that they needed to get over 
the normal approaches on things; and that was a time that people came 
together with holistic approaches.
  Mr. Speaker, I reserve the balance of my time.
  Ms. JUDY CHU of California. Mr. Speaker, I reserve the balance of my 
time.

                              {time}  1630

  Mr. ROSKAM. Mr. Speaker, I yield 3 minutes to the gentleman from New 
Jersey (Mr. MacArthur)
  Mr. MacARTHUR. Mr. Speaker, I thank my friend for yielding.
  As co-chair of the Bipartisan Heroin Task Force, I have spent a lot 
of my time working on this opioid crisis. Congress must do everything 
we can to ensure that our communities have the resources for 
prevention, treatment, and enforcement.
  My district is also home to 140,000 seniors, among the highest in the 
country. As we work together in a bipartisan way to fight this 
epidemic, we cannot forget about our seniors and how this crisis 
affects them.
  More than 42 million Americans get their prescription drugs through 
Medicare. They rely on Medicare part D, the prescription drug program, 
for the drugs that they need.
  A 2017 report by the HHS Office of the Inspector General found that 
500,000 Medicare part D beneficiaries received high amounts of opioids. 
High means in excess of what the manufacturer and CDC recommend--in 
other words, dangerous amounts.
  Too many senior communities are being flooded with opioids. We must 
protect our seniors, and that means we need to protect Medicare from 
those who would abuse it. We need to fight the fraudulent abuse of 
Medicare by people who do not have seniors' best interests at heart.
  In some cases, seniors are having their Medicare numbers stolen and 
then used to fraudulently bill Medicare for opioids. So-called pill 
dumping has resulted in millions of painkillers flooding small towns 
across the country through just a few pharmacies, much of it paid for 
by Medicare.
  Last year, the Department of Justice announced the biggest healthcare 
fraud bust in its history. They arrested 412 defendants for billing the 
government $1.2 billion in fraudulent charges, including prescription 
opioids which were then distributed in our communities.
  The SENIOR Communities Protection Act gives Medicare a new tool to 
crack down on those who would fraudulently use senior Medicare dollars 
to flood communities with unneeded drugs. The bill gives Medicare part 
D plan sponsors the ability to suspend payments to a pharmacy that is 
under investigation due to a credible allegation of fraud or abuse. 
This should make it easier to respond to harmful fraud and abusive 
activity more quickly. This protects Medicare dollars for those whom 
they are intended--for our seniors.
  If a criminal is fraudulently billing Medicare and distributing 
prescription drugs, Medicare should not have to pay for it while an 
investigation is underway. Those dollars are for seniors.
  This is the same tool available to other programs in Medicare, and 
this bill simply extends it to the prescription drug program. It is a 
good and smart tool. It is designed to make sure that seniors keep 
getting the drugs they do need, while protecting pharmacies that have 
done nothing wrong.
  The SPEAKER pro tempore. The time of the gentleman has expired.
  Mr. ROSKAM. Mr. Speaker, I yield an additional 1 minute to the 
gentleman from New Jersey.
  Mr. MacARTHUR. The bill is designed to make sure that seniors keep 
the drugs they do need and protect pharmacies that have done nothing 
wrong, while allowing us to go after those who abuse Medicare.
  I am grateful to the bipartisan sponsors of this bill. I am grateful 
for the bipartisan support it has received in committee. I would like 
to just mention those bipartisan Members who lent their support to it: 
Representatives Chris Collins,  David Schweikert, Ann Kuster, Earl 
Blumenauer, and Paul Tonko.
  Mr. Speaker, I urge support of this bill.
  Ms. JUDY CHU of California. Mr. Speaker, I yield myself the balance 
of my time.
  Mr. Speaker, a 2017 report from the Office of the Inspector General 
of the Department of Health and Human Services found that about 70,000 
seniors on Medicare received prescriptions for what the report 
described as an extreme amount of opioids during a single year. This 
means that these seniors were receiving 2.5 times the level the Centers 
for Disease Control recommends for patients with chronic pain. Another 
22,000 beneficiaries were identified as doctor shopping, which means 
that they received a high number of opioids from multiple prescribers 
and pharmacies. The opioid crisis is not exclusive to young people.
  That same OIG report found that one-third of Medicare part D 
beneficiaries received an opioid prescription in 2016, which is about 
79.4 million prescriptions. While there are certainly individuals who 
have a legitimate need for these drugs, H.R. 5676 will help Medicare 
part D plans crack down on the bad actors who are flooding our 
communities with excessive opioid pills.
  Mr. Speaker, I urge my colleagues to support this bill, and I yield 
back the balance of my time.
  Mr. ROSKAM. Mr. Speaker, I yield myself the balance of my time.
  Mr. Speaker, in closing, in a nutshell, I think the gentlewoman from 
California put it well. What she was arguing was this bill strikes a 
balance,

[[Page H5264]]

which it does. It is designed to focus our time, our attention, and our 
energies on making sure that the bad actors are weeded out, that the 
abuse is stopped, and that we can bring balance to the system.
  The Stop Excessive Narcotics in Our Retirement Communities Protection 
Act, or SENIOR Communities Protection Act, is another step in this 
direction to protect our Nation's seniors. This bill was brought to the 
floor through a bipartisan committee process, and I urge its passage.
  Mr. Speaker, I yield back the balance of my time.
  The SPEAKER pro tempore. The question is on the motion offered by the 
gentleman from Illinois (Mr. Roskam) that the House suspend the rules 
and pass the bill, H.R. 5676, as amended.
  The question was taken.
  The SPEAKER pro tempore. In the opinion of the Chair, two-thirds 
being in the affirmative, the ayes have it.
  Mr. ROSKAM. Mr. Speaker, on that I demand the yeas and nays.
  The yeas and nays were ordered.
  The SPEAKER pro tempore. Pursuant to clause 8 of rule XX, further 
proceedings on this motion will be postponed.

                          ____________________