[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.
____________________