[House Report 114-555]
[From the U.S. Government Publishing Office]
114th Congress } { Report
HOUSE OF REPRESENTATIVES
2d Session } { 114-555
======================================================================
LALI'S LAW
_______
May 10, 2016.--Committed to the Committee of the Whole House on the
State of the Union and ordered to be printed
_______
Mr. Upton, from the Committee on Energy and Commerce, submitted the
following
R E P O R T
[To accompany H.R. 4586]
[Including cost estimate of the Congressional Budget Office]
The Committee on Energy and Commerce, to whom was referred
the bill (H.R. 4586) to amend the Public Health Service Act to
authorize grants to States for developing standing orders and
educating health care professionals regarding the dispensing of
opioid overdose reversal medication without person-specific
prescriptions, and for other purposes, having considered the
same, report favorably thereon with an amendment and recommend
that the bill as amended do pass.
CONTENTS
Page
Purpose and Summary.............................................. 3
Background and Need for Legislation.............................. 3
Hearings......................................................... 4
Committee Consideration.......................................... 4
Committee Votes.................................................. 4
Committee Oversight Findings..................................... 4
Statement of General Performance Goals and Objectives............ 4
New Budget Authority, Entitlement Authority, and Tax Expenditures 4
Earmark, Limited Tax Benefits, and Limited Tariff Benefits....... 4
Committee Cost Estimate.......................................... 4
Congressional Budget Office Estimate............................. 5
Federal Mandates Statement....................................... 6
Duplication of Federal Programs.................................. 6
Disclosure of Directed Rule Makings.............................. 6
Advisory Committee Statement..................................... 6
Applicability to Legislative Branch.............................. 6
Section-by-Section Analysis of the Legislation................... 6
Changes in Existing Law Made by the Bill, as Reported............ 7
The amendment is as follows:
Strike all after the enacting clause and insert the
following:
SECTION 1. SHORT TITLE.
This Act may be cited as ``Lali's Law''.
SEC. 2. OPIOID OVERDOSE REVERSAL MEDICATION ACCESS AND EDUCATION GRANT
PROGRAMS.
(a) Technical Clarification.--Effective as if included in the
enactment of the Children's Health Act of 2000 (Public Law 106-310),
section 3405(a) of such Act (114 Stat. 1221) is amended by striking
``Part E of title III'' and inserting ``Part E of title III of the
Public Health Service Act''.
(b) Amendment.--Title III of the Public Health Service Act is amended
by inserting after part D of such title (42 U.S.C. 254b et seq.) the
following new part E:
``PART E--OPIOID USE DISORDER
``SEC. 341. OPIOID OVERDOSE REVERSAL MEDICATION ACCESS AND EDUCATION
GRANT PROGRAMS.
``(a) Grants to States.--The Secretary may make grants to States
for--
``(1) developing standing orders for pharmacies regarding
opioid overdose reversal medication;
``(2) encouraging pharmacies to dispense opioid overdose
reversal medication pursuant to a standing order;
``(3) implementing best practices for persons authorized to
prescribe medication regarding--
``(A) prescribing opioids for the treatment of
chronic pain;
``(B) co-prescribing opioid overdose reversal
medication with opioids; and
``(C) discussing the purpose and administration of
opioid overdose reversal medication with patients;
``(4) developing or adapting training materials and methods
for persons authorized to prescribe or dispense medication to
use in educating the public regarding--
``(A) when and how to administer opioid overdose
reversal medication; and
``(B) steps to be taken after administering opioid
overdose reversal medication; and
``(5) educating the public regarding--
``(A) the public health benefits of opioid overdose
reversal medication; and
``(B) the availability of opioid overdose reversal
medication without a person-specific prescription.
``(b) Certain Requirement.--A grant may be made under this section
only if the State involved has authorized standing orders regarding
opioid overdose reversal medication.
``(c) Preference in Making Grants.--In making grants under this
section, the Secretary shall give preference to States that--
``(1) have not issued standing orders regarding opioid
overdose reversal medication;
``(2) authorize standing orders that permit community-based
organizations, substance abuse programs, or other nonprofit
entities to acquire, dispense, or administer opioid overdose
reversal medication;
``(3) authorize standing orders that permit police, fire, or
emergency medical services agencies to acquire and administer
opioid overdose reversal medication;
``(4) have a higher per capita rate of opioid overdoses than
other applicant States; or
``(5) meet any other criteria deemed appropriate by the
Secretary.
``(d) Grant Terms.--
``(1) Number.--A State may not receive more than 1 grant
under this section.
``(2) Period.--A grant under this section shall be for a
period of 3 years.
``(3) Amount.--A grant under this section may not exceed
$500,000.
``(4) Limitation.--A State may use not more than 20 percent
of a grant under this section for educating the public pursuant
to subsection (a)(5).
``(e) Applications.--To be eligible to receive a grant under this
section, a State shall submit an application to the Secretary in such
form and manner and containing such information as the Secretary may
require, including detailed proposed expenditures of grant funds.
``(f) Reporting.--Not later than 3 months after the Secretary
disburses the first grant payment to any State under this section and
every 6 months thereafter for 3 years, such State shall submit a report
to the Secretary that includes the following:
``(1) The name and ZIP Code of each pharmacy in the State
that dispenses opioid overdose reversal medication under a
standing order.
``(2) The total number of opioid overdose reversal medication
doses dispensed by each such pharmacy, specifying how many were
dispensed with or without a person-specific prescription.
``(3) The number of pharmacists in the State who have
participated in training pursuant to subsection (a)(4).
``(g) Definitions.--In this section:
``(1) Opioid overdose reversal medication.--The term `opioid
overdose reversal medication' means any drug, including
naloxone, that--
``(A) blocks opioids from attaching to, but does not
itself activate, opioid receptors; or
``(B) inhibits the effects of opioids on opioid
receptors.
``(2) Standing order.--The term `standing order' means a
document prepared by a person authorized to prescribe
medication that permits another person to acquire, dispense, or
administer medication without a person-specific prescription.
``(h) Authorization of Appropriations.--
``(1) In general.--To carry out this section, there is
authorized to be appropriated $5,000,000 for the period of
fiscal years 2017 through 2019.
``(2) Administrative costs.--Not more than 3 percent of the
amounts made available to carry out this section may be used by
the Secretary for administrative expenses of carrying out this
section.''.
SEC. 3. CUT-GO COMPLIANCE.
Subsection (f) of section 319D of the Public Health Service Act (42
U.S.C. 247d-4) is amended by inserting before the period at the end the
following: ``(except such dollar amount shall be reduced by $5,000,000
for fiscal year 2017)''.
Purpose and Summary
H.R. 4586, ``Lali's Law,'' was introduced by Rep. Bob Dold
(R-IL) and Rep. Katherine Clark (D-MA) on February 23, 2016.
This legislation amends the Public Health Service Act to
authorize grants to states for developing standing orders and
educating health care professionals regarding the dispensing of
opioid overdose reversal medication without person-specific
prescriptions.
Background and Need for Legislation
In 1999, there were 6.1 overdose deaths per 100,000
Americans involving opioid analgesics and heroin. By 2014, that
number more than doubled to 14.7 overdose deaths. The rate of
overdose for individuals aged 24 to 34 nearly tripled, going
from 8.1 overdose deaths per 100,000 to 23.1 overdose
deaths.\1\ Naloxone is an opioid antagonist that can prevent
opioid overdose deaths by binding to the opioid receptors in
the body and preventing the overdose. The World Health
Organization estimated that if naloxone was more widely
available in the United States, 20,000 overdose deaths could be
prevented annually.\2\ This legislation is a first step in
promoting wider access of naloxone or other opioid overdose
reversal drugs that may come to market. Standing orders are
prescriptions that are not person-specific. If a pharmacy has a
standing order, anyone needing the medication may come and fill
a prescription for it. Naloxone, while incredibly effective at
stopping opioid overdose, does have severe side effects if used
incorrectly or if used when not needed. Many states have
standing order laws in place, but need help bridging the gap
between law and a functioning program. The grants funded by
this legislation will help aid that process.
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\1\http://www.cdc.gov/nchs/data/hus/hus15.pdf.
\2\http://www.reuters.com/article/us-health-who-naloxone-
idUSKBN0IO12420141104.
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Hearings
The Committee on Energy and Commerce has not held hearings
on the legislation.
Committee Consideration
On April 20, 2016, the Subcommittee on Health met in open
markup session and forwarded H.R. 4586, as amended, to the full
Committee, by a voice vote. On April 26, 27, and 28, 2016, the
full Committee on Energy and Commerce met in open markup
session and ordered H.R. 4586 reported to the House, as
amended, by a voice vote.
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. 4586 reported.
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 hearings
on this legislation.
Statement of General Performance Goals and Objectives
The goal of this legislation is to authorize grants to
states for developing standing orders and educating health care
professionals regarding the dispensing of opioid overdose
reversal medication without person-specific prescriptions.
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.
4586 would result in no new or increased budget authority,
entitlement authority, or tax expenditures or revenues.
Earmark, Limited Tax Benefits, and Limited Tariff Benefits
In compliance with clause 9(e), 9(f), and 9(g) of rule XXI
of the Rules of the House of Representatives, the Committee
finds that H.R. 4586 contains no earmarks, limited tax
benefits, or limited tariff benefits.
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 9, 2016.
Hon. Fred Upton,
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. 4586, Lali's Law.
If you wish further details on this estimate, we will be
pleased to provide them. The CBO staff contact is Rebecca Yip.
Sincerely,
Keith Hall.
Enclosure.
H.R. 4586--Lali's Law
H.R. 4586 would allow the Centers for Disease Control and
Prevention (CDC) to provide grants to states to enable and
encourage pharmacies to dispense medications that reverse
opioid overdoses pursuant to a standing order. A standing order
is a prescription that permits another person to acquire,
dispense, or administer medication without the prescription
specifying who will be treated with the medication. The grants
would be limited to $500,000 per state. The bill also would
allow states to use the grant funds to implement best practices
and to develop training materials on the purpose,
administration, and availability of those medications. H.R.
4586 would authorize the appropriation of a total of $5 million
of fiscal years 2017 through 2019 to carry out these
activities. Assuming the availability of appropriated funds,
CBO estimates those funds would be spent over the 2017-2021
period.
Under current law, an authorization of appropriations
totaling $138 million exists for 2017 for CDC for activities
related to bioterrorism and public health emergencies. H.R.
4586 would reduce the amount authorized by $5 million in 2017.
Assuming appropriation actions consistent with the bill, CBO
estimates that implementing this provision would result in $5
million less in discretionary outlays for that program over the
2017-2021 period.
On net, CBO estimates that implementing H.R. 4586 would not
affect discretionary costs over the 2017-2021 period. Enacting
H.R. 4586 would not affect direct spending or revenues;
therefore, pay-as-you-go procedures do not apply. CBO estimates
that enacting H.R. 4586 would not increase net direct spending
or on-budget deficits in any of the four consecutive 10-year
periods beginning in 2027.
H.R. 4586 contains no intergovernmental or private-sector
mandates as defined in the Unfunded Mandates Reform Act. Any
costs incurred by states that apply for grants authorized by
the bill would be incurred voluntarily as a condition of
assistance.
The CBO staff contact for this estimate is Rebecca Yip. The
estimate was approved by Holly Harvey, 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.
Duplication of Federal Programs
No provision of H.R. 4586 establishes or reauthorizes a
program of the Federal Government known to be duplicative of
another Federal program, a program that was included in any
report from the Government Accountability Office to Congress
pursuant to section 21 of Public Law 111-139, or a program
related to a program identified in the most recent Catalog of
Federal Domestic Assistance.
Disclosure of Directed Rule Makings
The Committee estimates that enacting H.R. 4586
specifically directs to be completed 0 rule makings within the
meaning of 5 U.S.C. 551.
Advisory Committee Statement
No advisory committees within the meaning of section 5(b)
of the Federal Advisory Committee Act were created by this
legislation.
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. Short title
Section 1 states that the legislation may be cited as
``Lali's Law.''
Section 2. Opioid overdose reversal medication access and education
grant programs
Under section 2, the Secretary of Health and Human Services
is authorized to make grants for: developing standing orders
for pharmacies regarding opioid overdose reversal medication;
encouraging pharmacies to dispense opioid overdose reversal
medication pursuant to a standing order; implementing best
practices; and developing or adapting training materials.
Grantees must report on a number of metrics including: the
name and ZIP codes of each pharmacy dispensing opioid overdose
reversal drugs under a standing order, the total number of
opioid overdose reversal medication doses dispensed by each
pharmacy, and the number of pharmacists in the State who have
participated in training also funded by the grant.
Finally, this section authorizes an appropriation of $5
million over the period of fiscal years 2017 through 2019.
Section 3. Cut-go compliance
Section 3 reduces the authorization of Section 319D of the
Public Health Service Act for $5,000,000 for fiscal year 2017
to bring the legislation into compliance with Cut-Go. This
reduction in authorization is equal to the authorization of
appropriations in section 2.
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, and existing law in which no
change is proposed is shown in roman):
CHILDREN'S HEALTH ACT OF 2000
* * * * * * *
DIVISION B--YOUTH DRUG AND MENTAL HEALTH SERVICES
* * * * * * *
TITLE XXXIV--PROVISIONS RELATING TO FLEXIBILITY AND ACCOUNTABILITY
* * * * * * *
SEC. 3405. REPEAL OF OBSOLETE ADDICT REFERRAL PROVISIONS.
(a) Repeal of Obsolete Public Health Service Act
Authorities.--[Part E of title III] Part E of title III of the
Public Health Service Act (42 U.S.C. 257 et seq.) is repealed.
(b) Repeal of Obsolete NARA Authorities.--Titles III and IV
of the Narcotic Addict Rehabilitation Act of 1966 (Public Law
89-793) are repealed.
(c) Repeal of Obsolete Title 28 Authorities.--
(1) In general.--Chapter 175 of title 28, United
States Code, is repealed.
(2) Table of contents.--The table of contents to part
VI of title 28, United States Code, is amended by
striking the items relating to chapter 175.
* * * * * * *
----------
PUBLIC HEALTH SERVICE ACT
TITLE III--GENERAL POWERS AND DUTIES OF PUBLIC HEALTH SERVICE
* * * * * * *
Part B--Federal-State Cooperation
* * * * * * *
SEC. 319D. REVITALIZING THE CENTERS FOR DISEASE CONTROL AND PREVENTION.
(a) Facilities; Capacities.--
(1) Findings.--Congress finds that the Centers for
Disease Control and Prevention has an essential role in
defending against and combatting public health threats
domestically and abroad and requires secure and modern
facilities, and expanded and improved capabilities
related to bioterrorism and other public health
emergencies, sufficient to enable such Centers to
conduct this important mission.
(2) Facilities.--
(A) In general.--The Director of the Centers
for Disease Control and Prevention may design,
construct, and equip new facilities, renovate
existing facilities (including laboratories,
laboratory support buildings, scientific
communication facilities, transshipment
complexes, secured and isolated parking
structures, office buildings, and other
facilities and infrastructure), and upgrade
security of such facilities, in order to better
conduct the capacities described in section
319A, and for supporting public health
activities.
(B) Multiyear contracting authority.--For any
project of designing, constructing, equipping,
or renovating any facility under subparagraph
(A), the Director of the Centers for Disease
Control and Prevention may enter into a single
contract or related contracts that collectively
include the full scope of the project, and the
solicitation and contract shall contain the
clause ``availability of funds'' found at
section 52.232-18 of title 48, Code of Federal
Regulations.
(3) Improving the capacities of the centers for
disease control and prevention.--The Secretary shall
expand, enhance, and improve the capabilities of the
Centers for Disease Control and Prevention relating to
preparedness for and responding effectively to
bioterrorism and other public health emergencies.
Activities that may be carried out under the preceding
sentence include--
(A) expanding or enhancing the training of
personnel;
(B) improving communications facilities and
networks, including delivery of necessary
information to rural areas;
(C) improving capabilities for public health
surveillance and reporting activities, taking
into account the integrated system or systems
of public health alert communications and
surveillance networks under subsection (b); and
(D) improving laboratory facilities related
to bioterrorism and other public health
emergencies, including increasing the security
of such facilities.
(b) National Communications and Surveillance Networks.--
(1) In general.--The Secretary, directly or through
awards of grants, contracts, or cooperative agreements,
shall provide for the establishment of an integrated
system or systems of public health alert communications
and surveillance networks between and among--
(A) Federal, State, and local public health
officials;
(B) public and private health-related
laboratories, hospitals, poison control
centers, and other health care facilities; and
(C) any other entities determined appropriate
by the Secretary.
(2) Requirements.--The Secretary shall ensure that
networks under paragraph (1) allow for the timely
sharing and discussion, in a secure manner, of
essential information concerning bioterrorism or
another public health emergency, or recommended methods
for responding to such an attack or emergency, allowing
for coordination to maximize all-hazards medical and
public health preparedness and response and to minimize
duplication of effort.
(3) Standards.--Not later than one year after the
date of the enactment of the Public Health Security and
Bioterrorism Preparedness and Response Act of 2002, the
Secretary, in cooperation with health care providers
and State and local public health officials, shall
establish any additional technical and reporting
standards (including standards for interoperability)
for networks under paragraph (1) and update such
standards as necessary.
(c) Modernizing Public Health Situational Awareness and
Biosurveillance.--
(1) In general.--Not later than 2 years after the
date of enactment of the Pandemic and All-Hazards
Preparedness Reauthorization Act of 2013, the
Secretary, in collaboration with State, local, and
tribal public health officials, shall establish a near
real-time electronic nationwide public health
situational awareness capability through an
interoperable network of systems to share data and
information to enhance early detection of rapid
response to, and management of, potentially
catastrophic infectious disease outbreaks, novel
emerging threats, and other public health emergencies
that originate domestically or abroad. Such network
shall be built on existing State situational awareness
systems or enhanced systems that enable such
connectivity.
(2) Strategy and implementation plan.--Not later than
180 days after the date of enactment of the Pandemic
and All-Hazards Preparedness Reauthorization Act of
2013, the Secretary shall submit to the appropriate
committees of Congress a coordinated strategy and an
accompanying implementation plan that identifies and
demonstrates the measurable steps the Secretary will
carry out to--
(A) develop, implement, and evaluate the
network described in paragraph (1), utilizing
the elements described in paragraph (3);
(B) modernize and enhance biosurveillance
activities; and
(C) improve information sharing,
coordination, and communication among disparate
biosurveillance systems supported by the
Department of Health and Human Services.
(3) Elements.--The network described in paragraph (1)
shall include data and information transmitted in a
standardized format from--
(A) State, local, and tribal public health
entities, including public health laboratories;
(B) Federal health agencies;
(C) zoonotic disease monitoring systems;
(D) public and private sector health care
entities, hospitals, pharmacies, poison control
centers or professional organizations in the
field of poison control, community health
centers, health centers and clinical
laboratories, to the extent practicable and
provided that such data are voluntarily
provided simultaneously to the Secretary and
appropriate State, local, and tribal public
health agencies; and
(E) such other sources as the Secretary may
deem appropriate.
(4) Rule of construction.--Paragraph (3) shall not be
construed as requiring separate reporting of data and
information from each source listed.
(5) Required activities.--In establishing and
operating the network described in paragraph (1), the
Secretary shall--
(A) utilize applicable interoperability
standards as determined by the Secretary, and
in consultation with the Office of the National
Coordinator for Health Information Technology,
through a joint public and private sector
process;
(B) define minimal data elements for such
network;
(C) in collaboration with State, local, and
tribal public health officials, integrate and
build upon existing State, local, and tribal
capabilities, ensuring simultaneous sharing of
data, information, and analyses from the
network described in paragraph (1) with State,
local, and tribal public health agencies; and
(D) in collaboration with State, local, and
tribal public health officials, develop
procedures and standards for the collection,
analysis, and interpretation of data that
States, regions, or other entities collect and
report to the network described in paragraph
(1).
(6) Consultation with the national biodefense science
board.--In carrying out this section and consistent
with section 319M, the National Biodefense Science
Board shall provide expert advice and guidance,
including recommendations, regarding the measurable
steps the Secretary should take to modernize and
enhance biosurveillance activities pursuant to the
efforts of the Department of Health and Human Services
to ensure comprehensive, real-time, all-hazards
biosurveillance capabilities. In complying with the
preceding sentence, the National Biodefense Science
Board shall--
(A) identify the steps necessary to achieve a
national biosurveillance system for human
health, with international connectivity, where
appropriate, that is predicated on State,
regional, and community level capabilities and
creates a networked system to allow for two-way
information flow between and among Federal,
State, and local government public health
authorities and clinical health care providers;
(B) identify any duplicative surveillance
programs under the authority of the Secretary,
or changes that are necessary to existing
programs, in order to enhance and modernize
such activities, minimize duplication,
strengthen and streamline such activities under
the authority of the Secretary, and achieve
real-time and appropriate data that relate to
disease activity, both human and zoonotic; and
(C) coordinate with applicable existing
advisory committees of the Director of the
Centers for Disease Control and Prevention,
including such advisory committees consisting
of representatives from State, local, and
tribal public health authorities and
appropriate public and private sector health
care entities and academic institutions, in
order to provide guidance on public health
surveillance activities.
(d) State and Regional Systems To Enhance Situational
Awareness in Public Health Emergencies.--
(1) In general.--To implement the network described
in subsection (c), the Secretary may award grants to
States or consortia of States to enhance the ability of
such States or consortia of States to establish or
operate a coordinated public health situational
awareness system for regional or Statewide early
detection of, rapid response to, and management of
potentially catastrophic infectious disease outbreaks
and public health emergencies, in collaboration with
appropriate public health agencies, sentinel hospitals,
clinical laboratories, pharmacies, poison control
centers, other health care organizations, and animal
health organizations within such States.
(2) Eligibility.--To be eligible to receive a grant
under paragraph (1), the State or consortium of States
shall submit to the Secretary an application at such
time, in such manner, and containing such information
as the Secretary may require, including an assurance
that the State or consortium of States will submit to
the Secretary--
(A) reports of such data, information, and
metrics as the Secretary may require;
(B) a report on the effectiveness of the
systems funded under the grant; and
(C) a description of the manner in which
grant funds will be used to enhance the
timelines and comprehensiveness of efforts to
detect, respond to, and manage potentially
catastrophic infectious disease outbreaks and
public health emergencies.
(3) Use of funds.--A State or consortium of States
that receives an award under this subsection--
(A) shall establish, enhance, or operate a
coordinated public health situational awareness
system for regional or Statewide early
detection of, rapid response to, and management
of potentially catastrophic infectious disease
outbreaks and public health emergencies;
(B) may award grants or contracts to entities
described in paragraph (1) within or serving
such State to assist such entities in improving
the operation of information technology
systems, facilitating the secure exchange of
data and information, and training personnel to
enhance the operation of the system described
in subparagraph (A); and
(C) may conduct a pilot program for the
development of multi-State telehealth network
test beds that build on, enhance, and securely
link existing State and local telehealth
programs to prepare for, monitor, respond to,
and manage the events of public health
emergencies, facilitate coordination and
communication among medical, public health, and
emergency response agencies, and provide
medical services through telehealth initiatives
within the States that are involved in such a
multi-State telehealth network test bed.
(4) Limitation.--Information technology systems
acquired or implemented using grants awarded under this
section must be compliant with--
(A) interoperability and other technological
standards, as determined by the Secretary; and
(B) data collection and reporting
requirements for the network described in
subsection (c).
(5) Independent evaluation.--Not later than 3 years
after the date of enactment of the Pandemic and All-
Hazards Preparedness Reauthorization Act of 2013, the
Government Accountability Office shall conduct an
independent evaluation, and submit to the Secretary and
the appropriate committees of Congress a report
concerning the activities conducted under this
subsection and subsection (c).
(e) Telehealth Enhancements for Emergency Response.--
(1) Evaluation.--The Secretary, in consultation with
the Federal Communications Commission and other
relevant Federal agencies, shall--
(A) conduct an inventory of telehealth
initiatives in existence on the date of
enactment of the Pandemic and All-Hazards
Preparedness Act, including--
(i) the specific location of network
components;
(ii) the medical, technological, and
communications capabilities of such
components;
(iii) the functionality of such
components; and
(iv) the capacity and ability of such
components to handle increased volume
during the response to a public health
emergency;
(B) identify methods to expand and
interconnect the regional health information
networks funded by the Secretary, the State and
regional broadband networks funded through the
rural health care support mechanism pilot
program funded by the Federal Communications
Commission, and other telehealth networks;
(C) evaluate ways to prepare for, monitor,
respond rapidly to, or manage the events of, a
public health emergency through the enhanced
use of telehealth technologies, including
mechanisms for payment or reimbursement for use
of such technologies and personnel during
public health emergencies;
(D) identify methods for reducing legal
barriers that deter health care professionals
from providing telemedicine services, such as
by utilizing State emergency health care
professional credentialing verification
systems, encouraging States to establish and
implement mechanisms to improve interstate
medical licensure cooperation, facilitating the
exchange of information among States regarding
investigations and adverse actions, and
encouraging States to waive the application of
licensing requirements during a public health
emergency;
(E) evaluate ways to integrate the practice
of telemedicine within the National Disaster
Medical System; and
(F) promote greater coordination among
existing Federal interagency telemedicine and
health information technology initiatives.
(2) Report.--Not later than 12 months after the date
of enactment of the Pandemic and All-Hazards
Preparedness Act, the Secretary shall prepare and
submit a report to the Committee on Health, Education,
Labor, and Pensions of the Senate and the Committee on
Energy and Commerce of the House of Representatives
regarding the findings and recommendations pursuant to
subparagraphs (A) through (F) of paragraph (1).
(f) Authorization of Appropriations.--There are authorized to
be appropriated to carry out this section, $138,300,000 for
each of fiscal years 2014 through 2018 (except such dollar
amount shall be reduced by $5,000,000 for fiscal year 2017).
(g) Definition.--For purposes of this section the term
``biosurveillance'' means the process of gathering near real-
time biological data that relates to human and zoonotic disease
activity and threats to human or animal health, in order to
achieve early warning and identification of such health
threats, early detection and prompt ongoing tracking of health
events, and overall situational awareness of disease activity.
* * * * * * *
[Part E--Narcotic Addicts and Other Drug Abusers
[care and treatment
[Sec. 341. (a) The Surgeon General is authorized to provide
for the confinement, care, protection, treatment, and
discipline of persons addicted to the use of habit-forming
narcotic drugs who are civilly committed to treatment under the
Narcotic Addict Rehabilitation Act of 1966, addicts and other
persons with drug abuse and drug dependence problems who
voluntarily submit themselves for treatment, and addicts
convicted of offenses against the United States, including
persons convicted by general courts-martial and consular
courts. Such care and treatment shall be provided at hospitals
of the Service especially equipped for the accommodation of
such patients or elsewhere where authorized under other
provisions of law, and shall be designed to rehabilitate such
persons, to restore them to health, and, where necessary, to
train them to be self-supporting and self-reliant; but nothing
in this section or in this part shall be construed to limit the
authority of the Surgeon General under other provisions of law
to provide for the conditional release of patients and for
aftercare under supervision. In carrying out this subsection,
the Secretary shall establish in each hospital and other
appropriate medical facility of the Service a treatment and
rehabilitation program for drug addicts and other persons with
drug abuse and drug dependence problems who are in the area
served by such hospital or other facility; except that the
requirement of this sentence shall not apply in the case of any
such hospital or other facility with respect to which the
Secretary determines that there is not sufficient need for such
a program in such hospital or other facility.
[(b) Upon the admittance to, and departure from, a hospital
of the Service of a person who voluntarily submitted himself
for treatment pursuant to the provisions of this section, and
who at the time of his admittance to such hospital was a
resident of the District of Columbia, the Surgeon General shall
furnish to the Commissioners of the District of Columbia or
their designated agent, the name, address, and such other
pertinent information as may be useful in the rehabilitation to
society of such person.
[(c) The Secretary may enter into agreements with the
Secretary of Veterans Affairs, the Secretary of Defense, and
the head of any other department or agency of the Government
under which agreements hospitals and other appropriate medical
facilities of the Service may be used in treatment and
rehabilitation programs provided by such department or agency
for drug addicts and other persons with drug abuse and other
drug dependence problems who are in areas served by such
hospitals or other facilities.
[employment of addicts or other persons with drug abuse and drug
dependence problems
[Sec. 342. Narcotic addicts or other persons with drug abuse
and drug dependence problems in hospitals of the Service
designated for their care shall be employed in such manner and
under such conditions as the Surgeon General may direct. In
such hospitals the Surgeon General may, in his discretion,
establish industries, plants, factories, or shops for the
production and manufacture of articles, commodities, and
supplies for the United States Government. The Secretary of the
Treasury may require any Government department, establishment,
or other institution, for whom appropriations are made directly
or indirectly by the Congress of the United States, to purchase
at current market prices, as determined by him or his
authorized representative, such of the articles, commodities,
or supplies so produced or manufactured as meet their
specifications; and the Surgeon General shall provide for
payment to the inmates or their dependents of such pecuniary
earnings as he may deem proper. The Secretary shall establish a
working-capital fund for such industries, plants, factories,
and shops out of any funds appropriated for Public Health
Service hospitals at which addicts or other persons with drug
abuse and drug dependence problems are treated and cared for;
and such fund shall be available for the purchase, repair, or
replacement of machinery or equipment, for the purchase of raw
materials and supplies, for the purchase of uniforms and other
distinctive wearing apparel of employees in the performance of
their official duties, and for the employment of necessary
civilian officers and employees. The Surgeon General may
provide for the disposal of products of the industrial
activities conducted pursuant to this section, and the proceeds
of any sales thereof shall be covered into the Treasury of the
United States to the credit of the working-capital fund.
[convicts
[Sec. 343. (a) The authority vested with the power to
designate the place of confinement of a prisoner shall transfer
to hospitals of the Service especially equipped for the
accommodation of addicts or other persons with drug abuse and
drug dependence problems, if accommodations are available, all
addicts or other persons with drug abuse and drug dependence
problems who have been or are hereafter sentenced to
confinement, or who are now or shall hereafter be confined, in
any penal, correctional, disciplinary, or reformatory
institution of the United States, including those addicts or
other persons with drug abuse and drug dependence problems
convicted of offenses against the United States who are
confined in State and Territorial prisons, penitentiaries, and
reformatories, except that no addict or other person with a
drug abuse or other drug dependence problem shall be
transferred to a hospital of the Service who, in the opinion of
the officer authorized to direct the transfer, is not a proper
subject for confinement in such an institution either because
of the nature of the crime he has committed or because of his
apparent incorrigibility. The authority vested with the power
to designate the place of confinement of a prisoner shall
transfer from a hospital of the Service to the institution from
which he was received, or to such other institution as may be
designated by the proper authority, any addict or other person
with a drug abuse or other drug dependence problem whose
presence at a hospital of the Service is detrimental to the
well-being of the hospital or who does not continue to be a
narcotic addict or other person with a drug abuse or other drug
dependence problem. All transfers of such prisoners to or from
a hospital of the Service shall be accompanied by necessary
attendants as directed by the officer in charge of such
hospital and the actual and necessary expenses incident to such
transfers shall be paid from the appropriation for the
maintenance of such Service hospital except to the extent that
other Federal agencies are authorized or required by law to pay
expenses incident to such transfers. When sentence is
pronounced against any person whom the prosecuting officer
believes to be an addict or other person with a drug abuse or
other drug dependence problem such officer shall report to the
authority vested with the power to designate the place of
confinement, the name of such person, the reasons for his
belief, all pertinent facts bearing on such addiction, drug
abuse, or drug dependence and the nature of the offense
committed. Whenever an alien addict or other person with a drug
abuse or other drug dependence problem transferred to a Service
hospital pursuant to this subsection is entitled to his
discharge but is subject to deportation, in lieu of being
returned to the penal institution from which he came he shall
be deported by the authority vested by law with power over
deportation.
[(c) Not later than one month prior to the expiration of the
sentence of any addict or other person with a drug abuse or
other drug dependence problem confined in a Service hospital,
he shall be examined by the Surgeon General or his authorized
representative. If the Surgeon General believes the person to
be discharged is still an addict or other person with a drug
abuse or other drug dependence problem and that he may by
further treatment in a Service hospital be cured of his
addiction, drug abuse, or drug dependence the addict or other
person with a drug abuse or other drug dependence problem shall
be informed, in accordance with regulations, of the
advisability of his submitting himself to further treatment.
The addict or other person with a drug abuse or other drug
dependence problem may then apply in writing to the Surgeon
General for further treatment in a Service hospital for a
period not exceeding the maximum length of time considered
necessary by the Surgeon General. Upon approval of the
application by the Surgeon General or his authorized agent, the
addict or other person with a drug abuse or other drug
dependence problem may be given such further treatment as is
necessary to cure him of his addiction, drug abuse, or drug
dependence.
[(d) Every person convicted of an offense against the United
States, upon discharge, or upon release on parole or supervised
release from a hospital of the Service, shall be furnished with
the gratuities and transportation authorized by law to be
furnished to prisoners upon release from a penal, correctional,
disciplinary, or reformatory institution.
[(e) Any court of the United States having the power to
suspend the imposition or execution of sentence and to place a
defendant on probation under any existing laws may impose as
one of the conditions of such probation that the defendant, if
an addict, or other person with a drug abuse or other drug
dependence problem shall submit himself for treatment at a
hospital of the Service especially equipped for the
accommodation of addicts or other persons with drug abuse and
drug dependence problems until discharged therefrom as cured
and that he shall be admitted thereto for such purpose. Upon
the discharge of any such probationer from a hospital of the
Service, he shall be furnished with the gratuities and
transportation authorized by law to be furnished to prisoners
upon release from a penal, correctional, disciplinary, or
reformatory institution. The actual and necessary expense
incident to transporting such probationer to such hospital and
to furnishing such transportation and gratuities shall be paid
from the appropriation for the maintenance of such hospital
except to the extent that other Federal agencies are authorized
or required by law to pay the cost of such transportation:
Provided, That where existing law vests a discretion in any
officer as to the place to which transportation shall be
furnished or as to the amount of clothing and gratuities to be
furnished, such discretion shall be exercised by the Surgeon
General with respect to addicts or other persons with drug
abuse and drug dependence problems discharged from hospitals of
the Service.
[voluntary patients
[Sec. 344. (a) Any addict, or other person with a drug abuse
or other drug dependence problem whether or not he shall have
been convicted of an offense against the United States, may
apply to the Surgeon General for admission to a hospital of the
Service especially equipped for the accommodation of addicts or
other persons with drug abuse and drug dependence problems.
[(b) Any applicant shall be examined by the Surgeon General
who shall determine whether the applicant is an addict, or
other person with a drug abuse or other drug dependence problem
whether by treatment in a hospital of the Service he may
probably be cured of his addiction, drug abuse, or drug
dependence and the estimated length of time necessary to effect
his cure. The Surgeon General may, in his discretion, admit the
applicant to a Service hospital. No such addict or other person
with drug abuse or other drug dependence problem shall be
admitted unless he agrees to submit to treatment for the
maximum amount of time estimated by the Surgeon General to be
necessary to effect a cure, and unless suitable accommodations
are available after all eligible addicts or other persons with
drug abuse and drug dependence problems convicted of offenses
against the United States have been admitted. Any such addict
or other person with a drug abuse or other drug dependence
problem may be required to pay for his subsistence, care, and
treatment at rates fixed by the Surgeon General and amounts so
paid shall be covered into the Treasury of the United States to
the credit of the appropriation from which the expenditure for
his subsistence, care, and treatment was made. Appropriations
available for the care and treatment of addicts or other
persons with drug abuse and drug dependence problems admitted
to a hospital of the Service under this section shall be
available, subject to regulations, for paying the cost of
transportation to any place within the continental United
States, including subsistence allowance while traveling, for
any indigent addict or other person with a drug abuse or other
drug dependence problem who is discharged as cured.
[(c) Any addict or other person with a drug abuse or other
drug dependence problem admitted for treatment under this
section, including any addict, or other person with a drug
abuse or other drug dependence problem not convicted of an
offense, who voluntarily submits himself for treatment, may be
confined in a hospital of the Service for a period not
exceeding the maximum amount of time estimated by the Surgeon
General as necessary to effect a cure of the addiction, drug
abuse, or drug dependence or until such time as he ceases to be
an addict or other person with a drug abuse or other drug
dependence problem.
[(d) Any addict or other person with a drug abuse or other
drug dependence problem admitted for treatment under this
section shall not thereby forfeit or abridge any of his rights
as a citizen of the United States; nor shall such admission or
treatment be used against him in any proceeding in any court;
and the record of his voluntary commitment shall, except as
otherwise provided by this Act, be confidential and shall not
be divulged.
[persons committed from district of columbia
[Sec. 345. (a) The Surgeon General is authorized to admit for
care and treatment in any hospital of the Service suitably
equipped therefor, and thereafter to transfer between hospitals
of the Service in accordance with section 321(b), any addict
who is committed, under the provisions of the Act of June 24,
1953 (Public Law 76, Eighty-third Congress), to the Service or
to a hospital thereof for care and treatment and who the
Surgeon General determines is a proper subject for care and
treatment. No such addict shall be admitted unless (1)
committed prior to July 1, 1958; and (2) at the time of
commitment, the number of persons in hospitals of the Service
who have been admitted pursuant to this subsection is less than
100; and (3) suitable accommodations are available after all
eligible addicts convicted of offenses against the United
States have been admitted.
[(b) Any person admitted to a hospital of the Service
pursuant to subsection (a) shall be discharged therefrom (1)
upon order of the Superior Court of the District of Columbia,
or (2) when he is found by the Surgeon General to be cured and
rehabilitated. When any such person is so discharged, the
Surgeon General shall give notice thereof to the Superior Court
of the District of Columbia and shall deliver such person to
such court for such further action as such court may deem
necessary and proper under the provisions of the Act of June
24, 1953 (Public Law 76, Eighty-third Congress).
[(c) With respect to the detention, transfer, parole, or
discharge of any person committed to a hospital of the Service
in accordance with subsection (a), the Surgeon General and the
officer in charge of the hospital, in addition to authority
otherwise vested in them, shall have such authority as may be
conferred upon them, respectively, by the order of the
committing court.
[(d) The cost of providing care and treatment for persons
admitted to a hospital of the Service pursuant to subsection
(a) shall be a charge upon the District of Columbia and shall
be paid by the District of Columbia to the Public Health
Service, either in advance or otherwise, as may be determined
by the Surgeon General. Such cost may be determined for each
addict or on the basis of rates established for all or
particular classes of patients, and shall include the cost of
transportation to and from facilities of the Public Health
Service. Moneys so paid to the Public Health Service shall be
covered into the Treasury of the United States as miscellaneous
receipts. Appropriations available for the care and treatment
of addicts admitted to a hospital of the Service under this
section shall be available, subject to regulations, for paying
the cost of transportation to the District of Columbia,
including subsistence allowance while traveling, for any such
addict who is discharged.
[penalties
[Sec. 346. (a) Any person not authorized by law or by the
Surgeon General who introduces or attempts to introduce into or
upon the grounds of any hospital of the Service at which
addicts or other persons with drug abuse and drug dependence
problems are treated and cared for, any habit-forming narcotic
drug, or substance controlled under the Controlled Substances
Act, weapon, or any other contraband article or thing, or any
contraband letter or message intended to be received by an
inmate thereof, shall be guilty of a felony and, upon
conviction thereof, shall be punished by imprisonment for not
more than ten years.
[(b) It shall be unlawful for any person properly committed
thereto to escape or attempt to escape from a hospital of the
Service at which addicts or other persons with drug abuse and
drug dependence problems are treated and cared for, and any
such person upon apprehension and conviction in a United States
court shall be punished by imprisonment for not more than five
years, such sentence to begin upon the expiration of the
sentence for which such person was originally confined.
[(c) Any person who procures the escape of any person
admitted to a hospital of the Service at which addicts or other
persons with drug abuse and drug dependence problems are
treated and cared for, or who advises, connives at, aids, or
assists in such escape, or who conceals any such inmate after
such escape, shall be punished upon conviction in a United
States court by imprisonment in the penitentiary for not more
than three years.
[release of patients
[Sec. 347. For purposes of this Act, an individual shall be
deemed cured of his addiction, drug abuse, or drug dependence,
and rehabilitated if the Surgeon General determines that he has
received the maximum benefits of treatment and care by the
Service for his addiction, drug abuse, or drug dependence, or
if the Surgeon General determines that his further treatment
and care for such purpose would be detrimental to the interests
of the Service.]
PART E--OPIOID USE DISORDER
SEC. 341. OPIOID OVERDOSE REVERSAL MEDICATION ACCESS AND EDUCATION
GRANT PROGRAMS.
(a) Grants to States.--The Secretary may make grants to
States for--
(1) developing standing orders for pharmacies
regarding opioid overdose reversal medication;
(2) encouraging pharmacies to dispense opioid
overdose reversal medication pursuant to a standing
order;
(3) implementing best practices for persons
authorized to prescribe medication regarding--
(A) prescribing opioids for the treatment of
chronic pain;
(B) co-prescribing opioid overdose reversal
medication with opioids; and
(C) discussing the purpose and administration
of opioid overdose reversal medication with
patients;
(4) developing or adapting training materials and
methods for persons authorized to prescribe or dispense
medication to use in educating the public regarding--
(A) when and how to administer opioid
overdose reversal medication; and
(B) steps to be taken after administering
opioid overdose reversal medication; and
(5) educating the public regarding--
(A) the public health benefits of opioid
overdose reversal medication; and
(B) the availability of opioid overdose
reversal medication without a person-specific
prescription.
(b) Certain Requirement.--A grant may be made under this
section only if the State involved has authorized standing
orders regarding opioid overdose reversal medication.
(c) Preference in Making Grants.--In making grants under this
section, the Secretary shall give preference to States that--
(1) have not issued standing orders regarding opioid
overdose reversal medication;
(2) authorize standing orders that permit community-
based organizations, substance abuse programs, or other
nonprofit entities to acquire, dispense, or administer
opioid overdose reversal medication;
(3) authorize standing orders that permit police,
fire, or emergency medical services agencies to acquire
and administer opioid overdose reversal medication;
(4) have a higher per capita rate of opioid overdoses
than other applicant States; or
(5) meet any other criteria deemed appropriate by the
Secretary.
(d) Grant Terms.--
(1) Number.--A State may not receive more than 1
grant under this section.
(2) Period.--A grant under this section shall be for
a period of 3 years.
(3) Amount.--A grant under this section may not
exceed $500,000.
(4) Limitation.--A State may use not more than 20
percent of a grant under this section for educating the
public pursuant to subsection (a)(5).
(e) Applications.--To be eligible to receive a grant under
this section, a State shall submit an application to the
Secretary in such form and manner and containing such
information as the Secretary may require, including detailed
proposed expenditures of grant funds.
(f) Reporting.--Not later than 3 months after the Secretary
disburses the first grant payment to any State under this
section and every 6 months thereafter for 3 years, such State
shall submit a report to the Secretary that includes the
following:
(1) The name and ZIP Code of each pharmacy in the
State that dispenses opioid overdose reversal
medication under a standing order.
(2) The total number of opioid overdose reversal
medication doses dispensed by each such pharmacy,
specifying how many were dispensed with or without a
person-specific prescription.
(3) The number of pharmacists in the State who have
participated in training pursuant to subsection (a)(4).
(g) Definitions.--In this section:
(1) Opioid overdose reversal medication.--The term
``opioid overdose reversal medication'' means any drug,
including naloxone, that--
(A) blocks opioids from attaching to, but
does not itself activate, opioid receptors; or
(B) inhibits the effects of opioids on opioid
receptors.
(2) Standing order.--The term ``standing order''
means a document prepared by a person authorized to
prescribe medication that permits another person to
acquire, dispense, or administer medication without a
person-specific prescription.
(h) Authorization of Appropriations.--
(1) In general.--To carry out this section, there is
authorized to be appropriated $5,000,000 for the period
of fiscal years 2017 through 2019.
(2) Administrative costs.--Not more than 3 percent of
the amounts made available to carry out this section
may be used by the Secretary for administrative
expenses of carrying out this section.
* * * * * * *
[all]