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



109th Congress                                            Rept. 109-116
                        HOUSE OF REPRESENTATIVES
 1st Session                                                     Part 2

======================================================================



 
 MAINTENANCE OR DETOXIFICATION TREATMENT WITH CERTAIN NARCOTIC DRUGS; 
          ELIMINATION OF 30-PATIENT LIMIT FOR GROUP PRACTICES

                                _______
                                

 July 11, 2005.--Committed to the Committee of the Whole House on the 
              State of the Union and ordered to be printed

                                _______
                                

 Mr. Sensenbrenner, from the Committee on the Judiciary, 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 the Judiciary, 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 the Legislation..........................     2
Hearings.........................................................     3
Committee Consideration..........................................     3
Vote of the Committee............................................     3
Committee Oversight Findings.....................................     3
New Budget Authority and Tax Expenditures........................     3
Congressional Budget Office Cost Estimate........................     3
Performance Goals and Objectives.................................     4
Constitutional Authority Statement...............................     4
Section-by-Section Analysis and Discussion.......................     4
Changes in Existing Law Made by the Bill, as Reported............     5
Markup Transcript................................................     6

                          Purpose and Summary

    H.R. 869 amends current law with regard to limitations in 
the Controlled Substances Act on the number of patients which 
can receive prescription drug addiction treatment by medical 
practitioners in group practices. Current law allows individual 
doctors and medical practices to prescribe drug addiction 
treatments to no more than 30 patients at a time. H.R. 869 
would eliminate the 30-patient limitation for group medical 
practices but would retain such a limitation on individual 
doctors.

                Background and Need for the Legislation

    In the 106th Congress, the Drug Addiction Treatment Act 
(``DATA'') was enacted to expand treatment options for patients 
addicted to opiates. The legislation allowed individual 
physicians to prescribe medications such as methadone or 
buprenorphine to patients who are addicted to drugs such as 
heroin or prescription painkillers such as Oxycontin, Percocet, 
or Vicodin. Such treatment was previously only available 
through public methadone clinics.
    A limit of 30 patients per treating physician was included 
in the legislation to address concerns about potential abuse or 
diversion of the treatment medications. The legislation also 
included a provision applying the 30-patient cap to group 
practices. This language had the effect of limiting large group 
practices regardless of their capacity to treat more clients, 
therefore denying addiction treatment to thousands of patients.
    The DATA law was intended to alleviate the growing number 
of patients in need of treatment by increasing the treatment 
capacity for opiate dependent patients. According to the 
American Academy of Addiction Psychiatry, ``The Drug Addiction 
Treatment Act of 2000 was an important beginning but had the 
unintended effect of limiting treatment of addiction patients 
to only 30 per physician or group practice, regardless of how 
many physicians worked in that practice. Effectively then, 
large group practices could see only a handful of patients, 
even though the resources existed to help many more. . . .''
    Current law requires an individual physician who seeks to 
treat patients in his or her office to obtain 8 hours of 
training and obtain a special waiver from the DEA. However, 
even if a number of physicians in a practice are authorized by 
the DEA to prescribe treatment, the limitations mean that large 
group practices such as an academic medical center or a large 
HMO can only treat 30 patients out of the thousand of potential 
individuals who could receive treatment.
    Currently, the Substance Abuse and Mental Health Services 
Administration (SAMHSA) is working on a regulatory fix to 
expand access to these treatments. The agency views these 
limits as a critical barrier to treatment options. SAMSHA has 
also expressed support for a legislative fix. Additionally, the 
legislation has been endorsed by the National Association of 
Counties, the National Association of County Behavioral Health 
Directors, the American Psychiatric Association, the American 
Academy of Addiction Psychiatry, the Association of American 
Medical Colleges, the Alliance of Community Health Plans, the 
American Medical Group Association, American Osteopathic 
Academy Addiction Medicine, the Partnership for a Drug-Free 
America, the American Society of Addiction Medicine, the 
American Association for the Treatment of Opioid Dependence, 
the legal Action Center, the National Association of Drug Court 
Professionals, the National Alliance of Methadone Advocates, 
the National Council on Alcoholism and Drug Dependence, and the 
State Associations of Addiction Services.
    H.R. 869 was introduced on February 16, 2005, and referred 
to the Committee on Energy and Commerce and the Committee on 
the Judiciary. H.R. 869 was ordered reported favorably by voice 
vote by the Committee on Energy and Commerce on May 4, 2005. 
The Committee on Energy and Commerce filed a report H. Rept. 
No. 109-116, part 1, on June 9, 2005. The Committee on the 
Judiciary was granted an extension for further consideration 
until July 11, 2005.

                                Hearings

    The Committee on the Judiciary held no hearings on H.R. 
869.

                        Committee Consideration

    On June 23, 2005, the Subcommittee on Crime, Terrorism, and 
Homeland Security met in open session and ordered favorably 
reported the bill H.R. 869, by a voice vote, a quorum being 
present. On June 29, 2005, the Committee met in open session 
and ordered favorably reported the bill H.R. 869 without an 
amendment, by voice vote, a quorum being present.

                         Vote of the Committee

    In compliance with clause 3(b) of rule XIII of the Rules of 
the House of Representatives, the Committee notes that there 
were no recorded votes during the committee consideration of 
H.R. 869.

                      Committee Oversight Findings

    In compliance with clause 3(c)(1) of rule XIII of the Rules 
of the House of Representatives, the Committee reports that the 
findings and recommendations of the Committee, based on 
oversight activities under clause 2(b)(1) of rule X of the 
Rules of the House of Representatives, are incorporated in the 
descriptive portions of this report.

               New Budget Authority and Tax Expenditures

    Clause 3(c)(2) of rule XIII of the Rules of the House of 
Representatives is inapplicable because this legislation does 
not provide new budgetary authority or increased tax 
expenditures.

               Congressional Budget Office Cost Estimate

    In compliance with clause 3(c)(3) of rule XIII of the Rules 
of the House of Representatives, the Committee sets forth, with 
respect to the bill, H.R.869, the following estimate and 
comparison prepared by the Director of the Congressional Budget 
Office under section 402 of the Congressional Budget Act of 
1974:

                                                     July 11, 2005.
Hon. F. James Sensenbrenner, Jr.,
Chairman, Committee on the Judiciary,
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,
                                               Douglas Holtz-Eakin.
    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.
    On May 12, 2005, CBO issued a cost estimate for H.R. 869 as 
ordered reported by the Committee on Energy and Commerce on May 
4, 2005. The two versions of the bill and CBO's estimates of 
their budgetary effect are identical.
    The CBO staff contact for this estimate is Eric Rollins. 
This estimate was approved by Peter H. Fontaine, Deputy 
Assistant Director for Budget Analysis.

                    Performance Goals and Objectives

    The Committee states that pursuant to clause 3(c)(4) of 
rule XIII of the Rules of the House of Representatives, H.R. 
869 will help to alleviate the shortage of treatment options 
for opiate dependent patients.

                   Constitutional Authority Statement

    Pursuant to clause 3(d)(1) of rule XIII of the Rules of the 
House of Representatives, the Committee finds the authority for 
this legislation in article I, section 8 of the Constitution.

               Section-by-Section Analysis and Discussion

    The section-by-section represents H.R. 869 as reported by 
the Committee on the Judiciary.

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

    This section eliminates the provision in current law which 
applies the 30-patient limitation to group practices, but 
preserves it for individual physicians. It also specifies that 
such change will be effective upon enactment of this 
legislation.

         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 italic, existing law in which no change is 
proposed is shown in roman):

              SECTION 303 OF THE CONTROLLED SUBSTANCES 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.]

           *       *       *       *       *       *       *


                           Markup Transcript



                            BUSINESS MEETING

                        WEDNESDAY, JUNE 29, 2005

                  House of Representatives,
                                Committee on the Judiciary,
                                                    Washington, DC.
    The Committee met, pursuant to notice, at 10:04 a.m., in 
Room 2141, Rayburn House Office Building, Hon. F. James 
Sensenbrenner, Jr. [Chairman of the Committee] presiding.
    [Intervening business.]
    Chairman Sensenbrenner. The next item on the agenda is the 
adoption of 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.''
    [The bill, H.R. 869, follows:]
      
      

  


      
      

  


    Chairman Sensenbrenner. The Chair recognizes the gentleman 
from North Carolina, Mr. Coble, the Chairman of the 
Subcommittee on Crime, Terrorism, and Homeland Security for a 
motion.
    Mr. Coble. Mr. Chairman, the Subcommittee on Crime, 
Terrorism, and Homeland Security reports favorably the bill 
H.R. 869 and moves its favorable recommendation to the full 
House.
    Chairman Sensenbrenner. Without objection, the bill will be 
considered as read and open for amendment at any point.
    The Chair recognizes the gentleman from North Carolina to 
strike the last word.
    Mr. Coble. I thank the Chairman and I will not take 5 
minutes.
    The Drug Addiction Treatment Act, popularly known as DATA, 
was enacted to alleviate the growing number of drug addicted 
patients in need of treatment by expanding treatment options. 
Under this law, individual physicians are allowed to prescribe 
medications as part of the treatment for patients who are 
addicted to heroin or prescription painkillers such as 
Oxycontin or Vicodin. Before this law was enacted, this type of 
treatment was only available through public methadone clinics.
    To prevent potential abuse or diversion of treatment 
medications, the legislation limited the number of patients an 
individual physician could treat to 30.
    The legislation also included a provision that applied this 
30 patient cap to group practices. These limitations prevented 
large group practices, such as an academic medical center or a 
large HMO, from treating more than 30 patients regardless of 
their capacity to treat more clients. The result is the denial 
of addiction treatment to thousands of patients.
    This legislation amends the current law to eliminate the 30 
patient limitation for group medical practices but maintains 
the limitation on individual physicians. I urge my colleagues 
to support this legislation.
    Chairman Sensenbrenner. Does the gentleman yield back?
    Mr. Coble. I yield back my time.
    Chairman Sensenbrenner. The gentleman from Virginia, Mr. 
Scott.
    Mr. Scott. Thank you, Mr. Chairman.
    Mr. Chairman, H.R. 869 removes the statutory limitation on 
drug treatment by group practices and corrects an unintended 
restriction on the ability of such practices to treat more 
people. Removal of this limitation will result in the treatment 
of thousands of additional patients by such practices and is 
supported by drug treatment advocates, professionals, as well 
as Governmental entities.
    We passed this provision before, although it did not 
proceed all the way through the legislative process. So I urge 
my colleagues who support it again. I yield back.
    Chairman Sensenbrenner. Without objection, all Members may 
include opening statements in the record at this point.
    Are there amendments? Are there amendments?
    There are no amendments.
    A reporting quorum is not present. Without objection, the 
previous question is ordered on the motion to report the bill 
favorably.
    [Intervening business.]
    Chairman Sensenbrenner. The last item on the agenda is the 
adoption of H.R. 869, which is in the Controlled Substances Act 
Amendment to limit the patient limitation on which the previous 
question was ordered.
    The question occurs. A reporting quorum is present. The 
question occurs on the motion to report the bill H.R. 869 
favorably. Those in favor will say aye. Opposed, no.
    The ayes appear to have it. The ayes have it. The motion to 
report favorably is agreed to.
    Without objection, the staff is directed to make any 
technical and conforming changes and all Members will be given 
2 days, under the House rules, in which to submit additional 
dissenting, supplemental or minority views.
    Now I believe we have concluded the agenda. Without 
objection, the Committee stands adjourned.
    [Whereupon, at 10:24 p.m., the Committee was adjourned.]

                                  
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