[House Report 109-116]
[From the U.S. Government Publishing Office]



109th Congress                                            Rept. 109-116
                        HOUSE OF REPRESENTATIVES
 1st Session                                                     Part 1

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                 DRUG ADDICTION TREATMENT EXPANSION ACT

                                _______
                                

                  June 9, 2005.--Ordered to be printed

                                _______
                                

    Mr. Barton of Texas, from the Committee on Energy and Commerce, 
                        submitted the following

                              R E P O R T

                        [To accompany H.R. 869]

      [Including cost estimate of the Congressional Budget Office]

  The Committee on Energy and Commerce, to whom was referred 
the bill (H.R. 869) to amend the Controlled Substances Act to 
lift the patient limitation on prescribing drug addiction 
treatments by medical practitioners in group practices, and for 
other purposes, having considered the same, report favorably 
thereon without amendment and recommend that the bill do pass.

                                CONTENTS

                                                                   Page
Purpose and Summary..............................................     1
Background and Need for Legislation..............................     2
Hearings.........................................................     2
Committee Consideration..........................................     2
Committee Votes..................................................     2
Committee Oversight Findings.....................................     2
Statement of General Performance Goals and Objectives............     3
New Budget Authority, Entitlement Authority, and Tax Expenditures     3
Committee Cost Estimate..........................................     3
Congressional Budget Office Estimate.............................     3
Federal Mandates Statement.......................................     4
Advisory Committee Statement.....................................     4
Constitutional Authority Statement...............................     4
Applicability to Legislative Branch..............................     4
Section-by-Section Analysis of the Legislation...................     4
Changes in Existing Law Made by the Bill, as Reported............     4

                          Purpose and Summary

    The purpose of H.R. 869, the Drug Addiction Treatment 
Expansion Act, is to amend Section 303(g)(1)(B) of the 
Controlled Substances Act thereby increasing access to drug 
addiction therapy.

                  Background and Need for Legislation

    In 2000, Congress passed the Drug Addiction Treatment Act, 
Public Law 106-310. Section 2(a)(2) of the Act established a 
new waiver mechanism for schedule IV or V treatment programs 
and placed it in paragraph 303(g)(2) of the Controlled 
Substances Act. The waiver is available to qualified physicians 
for maintenance treatment and detoxification treatment using 
approved schedule IV or V narcotic drugs, either alone or in 
combination.
    Physicians who wish to use the waiver must notify the 
Secretary of their intentions, certifying (1) that they meet 
one or more of the training and experience demands defined in 
section 303(g)(2)(G); (2) that they have the capacity to refer 
patients to counseling and other ancillary services as 
appropriate; and, (3) that they will honor the limitations 
placed on the number of patients they may treat at any one 
time. Subject to regulatory adjustment by the Secretary, 
neither sole practitioners nor any collection of physicians 
practicing as a group may treat more than 30 patients at any 
one time.
    The 30 patient limitation on group practices has proven to 
be an unnecessary barrier to addiction treatment medication. 
H.R. 869 lifts the 30 patient limitation for group practices. 
The individual physician limitation of 30 patients remains in 
place. This small but substantive change in Section 303 of the 
Controlled Substances Act will improve access to drug addiction 
therapy.

                                Hearings

    The Committee on Energy and Commerce has not held hearings 
on the legislation.

                        Committee Consideration

    On Wednesday, April 27, 2005, the Subcommittee on Health 
met in open markup session and approved H.R. 869 for Full 
Committee consideration, without amendment, by a voice vote, a 
quorum being present. On Wednesday, May 4, 2005, the Full 
Committee met in open markup session and ordered H.R. 869 
favorably reported to the House, without amendment, by a voice 
vote, a quorum being present.

                            Committee Votes

    Clause 3(b) of rule XIII of the Rules of the House of 
Representatives requires the Committee to list the record votes 
on the motion to report legislation and amendments thereto. 
There were no record votes taken in connection with ordering 
H.R. 869 reported. A motion by Mr. Barton to order H.R. 869 
reported to the House, without amendment, was agreed to by a 
voice vote.

                      Committee Oversight Findings

    Pursuant to clause 3(c)(1) of rule XIII of the Rules of the 
House of Representatives, the Committee has not held oversight 
or legislative hearings on this legislation.

         Statement of General Performance Goals and Objectives

    The objective of this legislation is to expand access to 
addiction treatment therapy.

   New Budget Authority, Entitlement Authority, and Tax Expenditures

    In compliance with clause 3(c)(2) of rule XIII of the Rules 
of the House of Representatives, the Committee finds that H.R. 
869, the Drug Addiction Treatment Expansion Act, would result 
in no new or increased budget authority, entitlement authority, 
or tax expenditures or revenues.

                        Committee Cost Estimate

    The Committee adopts as its own the cost estimate prepared 
by the Director of the Congressional Budget Office pursuant to 
section 402 of the Congressional Budget Act of 1974.

                  Congressional Budget Office Estimate

    Pursuant to clause 3(c)(3) of rule XIII of the Rules of the 
House of Representatives, the following is the cost estimate 
provided by the Congressional Budget Office pursuant to section 
402 of the Congressional Budget Act of 1974:

                                     U.S. Congress,
                               Congressional Budget Office,
                                      Washington, DC, May 12, 2005.
Hon. Joe Barton,
Chairman, Committee on Energy and Commerce,
House of Representatives, Washington, DC.
    Dear Mr. Chairman: The Congressional Budget Office has 
prepared the enclosed cost estimate for H.R. 869, a bill to 
amend the Controlled Substances Act to lift the patient 
limitation on prescribing drug addiction treatments by medical 
practitioners in group practices, and for other purposes.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Eric Rollins.
            Sincerely,
                                     Elizabeth M. Robinson,
                               (For Douglas Holtz-Eakin, Director).
    Enclosure.

H.R. 869--A bill to amend the Controlled Substances Act to lift the 
        patient limitation on prescribing drug addiction treatments by 
        medical practitioners in group practices, and for other 
        purposes

    H.R. 869 would allow medical group practices to prescribe 
and dispense narcotic drugs in schedules III, IV, or V (the 
drugs rated the lowest risk for abuse) for drug addiction 
treatment to more than 30 patients at a time without first 
registering with the Drug Enforcement Administration (DEA). The 
bill would prohibit individual practitioners within such groups 
from treating more than 30 patients at a time. Individual 
practitioners and group practices that treat fewer than 30 
patients are already exempt from the requirement to register 
with DEA.
    CBO estimates that this bill would have no significant 
budgetary effect. Enacting the bill could affect direct 
spending, but any such effects would likely be negligible. H.R. 
869 contains no intergovernmental or private-sector mandates as 
defined in the Unfunded Mandates Reform Act and would impose no 
costs on state, local, or tribal governments.
    The CBO staff contact for this estimate is Eric Rollins. 
This estimate was approved by Peter H. Fontaine, Deputy 
Assistant Director for Budget Analysis.

                       Federal Mandates Statement

    The Committee adopts as its own the estimate of Federal 
mandates prepared by the Director of the Congressional Budget 
Office pursuant to section 423 of the Unfunded Mandates Reform 
Act.

                      Advisory Committee Statement

    No advisory committees within the meaning of section 5(b) 
of the Federal Advisory Committee Act were created by this 
legislation.

                   Constitutional Authority Statement

    Pursuant to clause 3(d)(1) of rule XIII of the Rules of the 
House of Representatives, the Committee finds that the 
Constitutional authority for this legislation is provided in 
Article I, section 8, clause 3, which grants Congress the power 
to regulate commerce with foreign nations, among the several 
States, and with the Indian tribes.

                  Applicability to Legislative Branch

    The Committee finds that the legislation does not relate to 
the terms and conditions of employment or access to public 
services or accommodations within the meaning of section 
102(b)(3) of the Congressional Accountability Act.

             Section-by-Section Analysis of the Legislation


Section 1. Maintenance of detoxification treatment with certain 
        narcotic drugs; elimination of 30-patient limit for group 
        practices.

    Subsection (a) amends Section 303(g)(2)(B) of the 
Controlled Substance Act (21 U.S.C. 823(g)(2)(B) by striking 
clause (iv). Striking clause (iv) would lift the 30 patient 
limitation for group practices that dispense narcotic drugs for 
maintenance or detoxification treatment.
    Subsection (b) is a conforming amendment to ensure that the 
individual physician limit of 30 patients still applies to 
physicians in group practices.
    Subsection (c) states the section shall take affect on the 
date of enactment of the Act.

         Changes in Existing Law Made by the Bill, as Reported

  In compliance with clause 3(e) of rule XIII of the Rules of 
the House of Representatives, changes in existing law made by 
the bill, as reported, are shown as follows (existing law 
proposed to be omitted is enclosed in black brackets, new 
matter is printed in italics, existing law in which no change 
is proposed is shown in roman):

              SECTION 303 OF THE CONTROLLED SUBSTANCE ACT


                       registration requirements

  Sec. 303. (a) * * *

           *       *       *       *       *       *       *

  (g)(1) * * *
  (2)(A) * * *
  (B) For purposes of subparagraph (A), the conditions 
specified in this subparagraph with respect to a practitioner 
are that, before the initial dispensing of narcotic drugs in 
schedule III, IV, or V or combinations of such drugs to 
patients for maintenance or detoxification treatment, the 
practitioner submit to the Secretary a notification of the 
intent of the practitioner to begin dispensing the drugs or 
combinations for such purpose, and that the notification 
contain the following certifications by the practitioner:
          (i) * * *

           *       *       *       *       *       *       *

          (iii) [In any case in which the practitioner is not 
        in a group practice, the total] The total number of 
        such patients of the practitioner at any one time will 
        not exceed the applicable number. For purposes of this 
        clause, the applicable number is 30, except that the 
        Secretary may by regulation change such total number.
          [(iv) In any case in which the practitioner is in a 
        group practice, the total number of such patients of 
        the group practice at any one time will not exceed the 
        applicable number. For purposes of this clause, the 
        applicable number is 30, except that the Secretary may 
        by regulation change such total number, and the 
        Secretary for such purposes may by regulation establish 
        different categories on the basis of the number of 
        practitioners in a group practice and establish for the 
        various categories different numerical limitations on 
        the number of such patients that the group practice may 
        have.]

           *       *       *       *       *       *       *


                                  
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