[Congressional Record Volume 164, Number 102 (Tuesday, June 19, 2018)]
[House]
[Pages H5264-H5266]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




   EXPANDING OVERSIGHT OF OPIOID PRESCRIBING AND PAYMENT ACT OF 2018

  Mr. ROSKAM. Mr. Speaker, I move to suspend the rules and pass the 
bill (H.R. 5723) to require the Medicare Payment Advisory Commission to 
report on opioid payment, adverse incentives, and data under the 
Medicare program, as amended.
  The Clerk read the title of the bill.
  The text of the bill is as follows:

                               H.R. 5723

       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 ``Expanding Oversight of 
     Opioid Prescribing and Payment Act of 2018''.

     SEC. 2. MEDICARE PAYMENT ADVISORY COMMISSION REPORT ON OPIOID 
                   PAYMENT, ADVERSE INCENTIVES, AND DATA UNDER THE 
                   MEDICARE PROGRAM.

       Not later than March 15, 2019, the Medicare Payment 
     Advisory Commission shall submit to Congress a report on, 
     with respect to the Medicare program under title XVIII of the 
     Social Security Act, the following:
       (1) A description of how the Medicare program pays for pain 
     management treatments (both opioid and non-opioid pain 
     management alternatives) in both inpatient and outpatient 
     hospital settings.
       (2) The identification of incentives under the hospital 
     inpatient prospective payment system under section 1886 of 
     the Social Security Act (42 U.S.C. 1395ww) and incentives 
     under the hospital outpatient prospective payment system 
     under section 1833(t) of such Act (42 U.S.C. 1395l(t)) for 
     prescribing opioids and incentives under each such system for 
     prescribing non-opioid treatments, and recommendations as the 
     Commission deems appropriate for addressing any of such 
     incentives that are adverse incentives.
       (3) A description of how opioid use is tracked and 
     monitored through Medicare claims data and other mechanisms 
     and the identification of any areas in which further data and 
     methods are needed for improving data and understanding of 
     opioid use.

     SEC. 3. NO ADDITIONAL FUNDS AUTHORIZED.

       No additional funds are authorized to be appropriated to 
     carry out the requirements of this Act. Such requirements 
     shall be carried out using amounts otherwise authorized to be 
     appropriated.

  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 may 
have 5 legislative days within which to revise and extend their remarks 
and include extraneous material on H.R. 5723, 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 rise today in support of H.R. 5723, the Expanding 
Oversight of Opioid Prescribing and Payment Act of 2018, sponsored by 
my colleague, Representative Tenney, along with Representatives 
McKinley and DelBene. H.R. 5723 is the result of work by Members and 
staff on both sides of the aisle, and I am pleased to have taken part 
in these important efforts to address the opioid epidemic.
  This legislation responds to a crucial recommendation from the 
Commission on Combating Drug Addiction and the opioid crisis by 
directing the Medicare Payment Advisory Commission, or MedPAC, to 
investigate financial incentives for prescribing opioids. These 
incentives may discourage providers from prescribing evidence-based 
nonopioid treatments for pain management that can reduce patients' 
exposure to opioids and slow the epidemic.
  The report will take a close look at these financial incentives, 
while also examining the use of data to track and monitor opioid use to 
more fully understand opioid utilization patterns in Medicare so that 
we may cultivate better solutions to combat the epidemic itself. MedPAC 
may also make recommendations to address perverse incentives in 
Medicare's payment systems that may encourage opioid overprescribing.
  Mr. Speaker, I encourage all of my colleagues to vote in favor of 
H.R. 5723, the Expanding Oversight of Opioid Prescribing and Payment 
Act of 2018.
  Opioids took the lives of 42,000 Americans in 2016, and the issue 
affects countless families in Illinois and in my congressional 
district, and I know that is true all across the country. This 
legislation brings us one step closer to providing our communities and 
families with the tools necessary to combat the epidemic.
  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

[[Page H5265]]

     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. 5723, the Expanding 
Oversight of Opioid Prescribing and Payment Act.
  As I mentioned earlier, 80 percent of low-risk surgery patients 
receive an opioid prescription to treat their postsurgical pain. These 
prescriptions are certainly necessary for many patients, but with such 
a high percentage, we must examine if Medicare payment policies are 
ultimately discouraging the use of nonopioid alternatives.
  This bill, introduced by Representatives Suzan DelBene and Claudia 
Tenney, would require the Medicare Payment Advisory Commission, or 
MedPAC, to submit a report to Congress detailing how Medicare 
reimburses pain management treatments in a hospital setting. This 
report will also examine what incentives exist in the inpatient 
prospective payment system and outpatient prospective payment system 
for overprescribing and how prescribing data is tracked and monitored 
in Medicare claims.
  This crisis was not created in a vacuum, and it will take efforts 
from all aspects of the healthcare system to find a solution, including 
examining how our hospital payment policies have pushed providers 
towards prescribing such addictive medications.
  I support H.R. 5723 and efforts to determine which policies within 
Medicare, if any, have contributed to this opioid epidemic. I am also 
strongly supportive of the directive within this report to realign 
payment policies to increase access to nonopioid alternatives for pain 
management.
  Mr. Speaker, I reserve the balance of my time.
  Mr. ROSKAM. Mr. Speaker, I yield 5 minutes to the gentlewoman from 
New York (Ms. Tenney).
  Ms. TENNEY. Mr. Speaker, I want to thank the gentleman for yielding 
so much time to me in favor of this legislation that I coauthored with 
my colleague, Ms. DelBene, on this bipartisan piece, H.R. 5723, the 
Expanding Oversight of Opioid Prescribing and Payment Act of 2018.
  Mr. Speaker, in my district and across the Nation, the opioid 
epidemic has ravaged communities, torn apart families, and ended the 
lives of everyday Americans. Opioid abuse and drug-related deaths are 
rising at alarming rates. In my rural New York district, drug-related 
deaths rose over 350 percent in the short period from 2012 to 2016.
  Each day, I continue to hear from families across the 22nd district 
that have been impacted by this epidemic. They share deeply moving and 
personal stories of loss and struggle, and they always urge me that 
more needs to be done.
  Mr. Speaker, they are right. This is why the people's House has taken 
significant, bipartisan action to pass record funding for addiction 
treatment and prevention and to stop the flow of illicit drugs coming 
across the border. This is not the time to let up.
  During an opioid roundtable that I held in my district, I heard from 
members of my community who told me that often an opioid prescription 
is the only option for pain management offered after a complicated 
surgery or a procedure as routine as a root canal.
  This anecdotal evidence is backed up by the hard truth that, in 2016, 
there were 66.5 opioid prescriptions per 100 people. Mr. Speaker, that 
amounts to more than 214 million total opioid prescriptions.
  The Expanding Oversight of Opioid Prescribing and Payment Act seeks 
to find out what is fueling these prescriptions. This bipartisan bill 
requires the Medicare Payment Advisory Committee, or MedPAC, to 
research and identify adverse incentives in the Medicare and Medicaid 
programs that lead to an overprescription of opioids versus readily 
available nonopioid alternatives.
  Medicare and other insurance providers often do not cover nonopioid 
alternatives for pain, and this legislation seeks to understand why. 
Once we are able to understand the cause, we can change Medicare policy 
to reduce demand for opioids to address chronic pain and provide 
patients with safer, nonaddictive, nonopioid alternatives for pain.
  Opioid overdose is now the leading cause of death for Americans under 
50. We must take action.
  Mr. Speaker, combating this epidemic starts by eliminating any 
incentives that cause our constituents to become addicted to opioids 
and other prescription drugs in the first place.
  I want to thank my colleagues, Ms. DelBene, Mr. McKinley, and Mr. 
Sanford, for joining me in this bipartisan effort, and I appreciate the 
work of Chairman Brady and every member of the Ways and Means Committee 
who worked to help us get this far. I want to say a special thank you 
to Representative Roskam from Illinois for providing me this 
opportunity to speak on behalf of this important legislation.
  Mr. Speaker, I ask that my colleagues support this legislation.

                              {time}  1645

  Ms. JUDY CHU of California. Mr. Speaker, I yield myself the balance 
of my time.
  Mr. Speaker, I must reiterate that while I support the efforts of 
this bill to direct MedPAC to examine which structural policies within 
Medicare are contributing to this opioid crisis, I believe that we need 
to do more than study the problem. We need to dedicate resources to 
fixing it.
  We need to invest in longer treatment programs and comprehensive 
recovery programs that provide safe housing, peer support, and mental 
health services. And while we should absolutely examine the policies 
that brought us to this crisis in the first place, we need to do more 
to find long-lasting solutions.
  So I implore my colleagues today to ensure that this package of bills 
is not the end of the discussion. I hope to see more hearings, more 
proposals, and more testimony from experts on how we can enact Federal 
policies that will save lives.
  I hope that instead of attacking our existing healthcare system, 
Republicans work with Democrats to improve the Affordable Care Act, 
increase access to coverage, work to bring down premiums, and invest in 
the public health of our Nation. Addiction is a disease, not a choice. 
I look forward to working with my colleagues from both sides of the 
aisle to eradicate this disease from our communities.
  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, I think Ms. Tenney's argument a minute ago is smart, it 
is good policy, it is thoughtful, it is measured, and it is the 
direction we should go.
  In other words, if there are incentives that are misaligned, let's 
understand those and let's absorb them and let's change them. It should 
not be that there is a financial incentive to offer an opioid or for an 
opioid to get into a system as opposed to a nonopioid alternative. So, 
for sure, we need to study this. We need to have a clear understanding.
  I would like to thank the Members on both sides of the aisle for the 
work they did, as well as Chairman Brady for his leadership in moving 
this through the Ways and Means Committee.
  It is such an important time. With 115 deaths from opioid overdoses 
every day, everyone knows that time is not our friend. There is an 
urgency to this. We have to have a clear understanding of what is going 
on. It is imperative that we identify current practices that prevent 
the use of nonopioid treatments for pain management and that we reduce 
financial incentives that have unintentionally led to 
overprescriptions.
  Mr. Speaker, 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 
gentleman from Illinois (Mr. Roskam) that the House suspend the rules 
and pass the bill, H.R. 5723, 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.

[[Page H5266]]

  

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