[Congressional Record Volume 164, Number 138 (Monday, August 20, 2018)]
[Senate]
[Page S5727]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
SA 3768. Mr. MANCHIN submitted an amendment intended to be proposed
by him to the bill H.R. 6157, making appropriations for the Department
of Defense for the fiscal year ending September 30, 2019, and for other
purposes; which was ordered to lie on the table; as follows:
At the appropriate place in title II of division B insert
the following:
SEC. __. BUDGETING FOR OPIOID ADDICTION TREATMENT.
(a) Short Title.--This section may be cited as the
``Budgeting for Opioid Addiction Treatment Act''.
(b) Stewardship Fee on Opioid Pain Relievers.--
(1) In general.--Subchapter E of chapter 32 of the Internal
Revenue Code of 1986 is amended by adding at the end the
following new section:
``SEC. 4192. OPIOID PAIN RELIEVERS.
``(a) In General.--There is hereby imposed on the sale of
any active opioid by the manufacturer, producer, or importer
a fee equal to 1 cent per milligram so sold.
``(b) Active Opioid.--For purposes of this section--
``(1) In general.--The term `active opioid' means any
controlled substance (as defined in section 102 of the
Controlled Substances Act, as in effect on the date of the
enactment of this section) which is opium, an opiate, or any
derivative thereof.
``(2) Exclusion for certain prescription medications.--Such
term shall not include any prescribed drug which is used
exclusively for the treatment of opioid addiction as part of
a medically assisted treatment effort.
``(3) Exclusion of other ingredients.--In the case of a
product that includes an active opioid and another
ingredient, subsection (a) shall apply only to the portion of
such product that is an active opioid.''.
(2) Clerical amendments.--
(A) The heading of subchapter E of chapter 32 of the
Internal Revenue Code of 1986 is amended by striking
``Medical Devices'' and inserting ``Other Medical Products''.
(B) The table of subchapters for chapter 32 of such Code is
amended by striking the item relating to subchapter E and
inserting the following new item:
``subchapter e. other medical products''.
(C) The table of sections for subchapter E of chapter 32 of
such Code is amended by adding at the end the following new
item:
``Sec. 4192. Opioid pain relievers.''.
(3) Effective date.--The amendments made by this subsection
shall apply to sales on or after the date that is 1 year
after the date of the enactment of this Act.
(4) Rebate or discount program for certain cancer and
hospice patients.--
(A) In general.--The Secretary of Health and Human
Services, in consultation with patient advocacy groups and
other relevant stakeholders as determined by such Secretary,
shall establish a mechanism by which--
(i) any amount paid by an eligible patient in connection
with the stewardship fee under section 4192 of the Internal
Revenue Code of 1986 (as added by this subsection) shall be
rebated to such patient in as timely a manner as possible, or
(ii) amounts paid by an eligible patient for active opioids
(as defined in section 4192(b) of such Code) are discounted
at time of payment or purchase to ensure that such patient
does not pay any amount attributable to such fee, with as
little burden on the patient as possible. The Secretary shall
choose whichever of the options described in clause (i) or
(ii) is, in the Secretary's determination, most effective and
efficient in ensuring eligible patients face no economic
burden from such fee.
(B) Eligible patient.--For purposes of this subsection, the
term ``eligible patient'' means--
(i) a patient for whom any active opioid (as so defined) is
prescribed to treat pain relating to cancer or cancer
treatment;
(ii) a patient participating in hospice care; and
(iii) in the case of the death or incapacity of a patient
described in clause (i) or (ii) or any similar situation as
determined by the Secretary of Health and Human Services, the
appropriate family member, medical proxy, or similar
representative or the estate of such patient.
(c) Block Grants for Prevention and Treatment of Substance
Abuse.--
(1) Grants to states.--Section 1921(b) of the Public Health
Service Act (42 U.S.C. 300x-21(b)) is amended by inserting
``, and, as applicable, for carrying out section 1923A''
before the period.
(2) Nonapplicability of prevention program provision.--
Section 1922(a)(1) of the Public Health Service Act (42
U.S.C. 300x-22(a)(1)) is amended by inserting ``except with
respect to amounts made available as described in section
1923A,'' before ``will expend''.
(3) Opioid treatment programs.--Subpart II of part B of
title XIX of the Public Health Service Act (42 U.S.C. 300x-21
et seq.) is amended by inserting after section 1923 the
following:
``SEC. 1923A. ADDITIONAL SUBSTANCE ABUSE TREATMENT PROGRAMS.
``A funding agreement for a grant under section 1921 is
that the State involved shall provide that any amounts made
available by any increase in revenues to the Treasury in the
previous fiscal year resulting from the enactment of section
4192 of the Internal Revenue Code of 1986, reduced by any
amounts rebated or discounted under subsection (b)(4) of the
Budgeting for Opioid Addiction Treatment Act (as described in
section 1933(a)(1)(B)(i)) be used exclusively for substance
abuse (including opioid abuse) treatment efforts in the
State, including--
``(1) treatment programs--
``(A) establishing new addiction treatment facilities,
residential and outpatient, including covering capital costs;
``(B) establishing sober living facilities;
``(C) recruiting and increasing reimbursement for certified
mental health providers providing substance abuse treatment
in medically underserved communities or communities with high
rates of prescription drug abuse;
``(D) expanding access to long-term, residential treatment
programs for opioid addicts (including 30-, 60-, and 90-day
programs);
``(E) establishing or operating support programs that offer
employment services, housing, and other support services to
help recovering addicts transition back into society;
``(F) establishing or operating housing for children whose
parents are participating in substance abuse treatment
programs, including capital costs;
``(G) establishing or operating facilities to provide care
for babies born with neonatal abstinence syndrome, including
capital costs; and
``(H) other treatment programs, as the Secretary determines
appropriate; and
``(2) recruitment and training of substance use disorder
professionals to work in rural and medically underserved
communities.''.
(4) Additional funding.--Section 1933(a)(1)(B)(i) of the
Public Health Service Act (42 U.S.C. 300x-33(a)(1)(B)(i)) is
amended by inserting ``, plus any increase in revenues to the
Treasury in the previous fiscal year resulting from the
enactment of section 4192 of the Internal Revenue Code of
1986, reduced by any amounts rebated or discounted under
subsection (b)(4) of the Budgeting for Opioid Addiction
Treatment Act'' before the period.
(d) Report.--Not later than 2 years after the date
described in subsection (b)(3), the Secretary of Health and
Human Services shall submit to Congress a report on the
impact of the amendments made by subsections (b) and (c) on--
(1) the retail cost of active opioids (as defined in
section 4192 of the Internal Revenue Code of 1986, as added
by subsection (b));
(2) patient access to such opioids, particularly cancer and
hospice patients, including the effect of the discount or
rebate on such opioids for cancer and hospice patients under
section (b)(4);
(3) how the increase in revenue to the Treasury resulting
from the enactment of section 4192 of the Internal Revenue
Code of 1986 is used to improve substance abuse treatment
efforts in accordance with section 1923A of the Public Health
Service Act (as added by subsection (c)); and
(4) suggestions for improving--
(A) access to opioids for cancer and hospice patients; and
(B) substance abuse treatment efforts under such section
1923A.
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