Protecting Patient Access to Emergency Medications Act of 2017

Mr. President, I wish to submit to the Senate the budget scorekeeping report for February 2018. The report compares current-law levels of spending and revenues with the amounts the Senate agreed to in the budget resolution for fiscal year 2018, H. Con. Res. 71. This information is necessary for the Senate Budget Committee to determine whether budget points of order lie against pending legislation. The Republican staff of the Senate Budget Committee and the Congressional Budget Office, CBO, prepared this report pursuant to section 308(b) of the Congressional Budget Act, CBA.

The enforceable levels included in this report reflect all of the numerical adjustments made to the resolution since its passage. The information contained in this report captures legislative activity from the passage of the budget resolution through February 26, 2018.

Republican Budget Committee staff prepared tables 1-4 of this report.

Table 1 gives the amount by which each Senate authorizing committee exceeds or is below its allocation for budget authority and outlays under the most recently adopted budget resolution. This information is used for enforcing committee allocations pursuant to section 302 of the CBA. For this reporting period, 11 of the 16 authorizing committees are in compliance with their allocations. As previously reported, the Senate Veterans' Affairs, Energy and Natural Resources, and Health, Education, Labor, and Pensions Committees remain in breach of their allocations. Since my last report on January 18, 2018, both the Finance and Agriculture, Nutrition, and Forestry Committees have increased spending beyond allowable levels. Through the enactment of both the fourth continuing resolution, H.R. 195, P.L. 115-120, and the Bipartisan Budget Act of 2018, BBA18, H.R. 1892, P.L. 115-123, which contained packages of healthcare extenders, the Finance Committee breached its allocation by $76.9 billion in budget authority and $7.8 billion in outlays over 10 years. Enactment of the BBA18 also produced the Agriculture Committee breach. That law changed the treatment of seed cotton, dairy, and livestock under Federal farm programs, increasing both budget authority and outlays by $1.2 billion over the 2018-2027 period.

Table 2 gives the amount by which the Senate Committee on Appropriations is below or exceeds the statutory spending limits. This information is used to determine points of order related to the spending caps found in section 312 and section 314 of the CBA. While no full-year appropriations bills have been enacted for fiscal year 2018, subcommittees are charged with permanent and advanced appropriations that first become available in that year and any full-year standalone provisions included in continuing resolutions. This table reflects one change from my January report. The continuing resolution portion of the BBA18 included full-year authority for the Secretary of Energy to draw down and sell oil from the Strategic Petroleum Reserve, reducing budget authority and outlays by $315 million in 2018.

The budget resolution contains two points of order limiting the use of changes in mandatory programs in appropriations bills, CHIMPS. Tables 3 and 4 show compliance with fiscal year 2018 limits for overall CHIMPS and the Crime Victims Fund CHIMP, respectively. This information is used for determining points of order under sections 4102 and 4103 of H. Con. Res. 71, respectively. Notably, there have not been any full- year bills enacted thus far for fiscal year 2018 that include CHIMPS.

In addition to the tables provided by Budget Committee Republican staff, I am submitting CBO tables, which I will use to enforce budget totals approved by the Congress.

CBO provided a spending and revenue report for fiscal year 2018, which helps enforce aggregate spending levels in budget resolutions under CBA section 311. In its report, CBO annualizes the temporary effects of the latest continuing resolution, which provides funding through March 23, 2018. For the enforcement of budgetary aggregates, the Budget Committee excludes this temporary funding. As such, the committee views current-law levels as being $814.6 billion and $463.7 billion below budget resolution levels for budget authority and outlays, respectively. Details on fiscal year 2018 levels can be found in CBO's second table.

Current-law revenues continue to be in excess of the levels assumed by the budget resolution. On-budget revenue levels currently exceed assumed levels by $3.5 billion in fiscal year 2018, $41.9

billion over the fiscal year 2018-2022 period, and $98.4 billion over the fiscal year 2018-2027 period. Since my last filing both the fourth continuing resolution and BBA18 contained provisions that reduced revenues compared with current law. The fourth continuing resolution included $25.4 billion in on-budget revenue loss over 10 years related to delays in several health-related taxes. The BBA18 contained an $11.6 billion revenue loss largely as a consequence of a package of tax extenders. This BBA18 figure omits $1.8 billion in revenue increases attributable to language related to Federal Reserve Surplus Funds, which are required to be omitted under current scorekeeping rules.

Social Security outlay levels are consistent with the budget resolution's figures for all enforceable periods. Social Security revenues, however, are $446 million below levels assumed for fiscal year 2018, $1.9 billion greater over the next 5 years, and $28.8 billion greater than assumed over the next 10 years. These revenue effects are attributable to the tax provisions from the fourth continuing resolution, BBA18, and the tax reconciliation bill enacted in December 2017.

CBO's report also provides information needed to enforce the Senate pay-as-you-go, PAYGO, rule. The Senate's PAYGO scorecard currently shows deficit reduction of $24 million in fiscal year 2018, $14 million over the fiscal year 2017-2022, and $13 million over fiscal year 2017- 2027 periods. For fiscal year 2018, legislation has been enacted that would reduce outlays by $24 million. Over the fiscal year 2017-2022 period, legislation has been enacted that CBO estimates will decrease outlays by $13 million and increase revenues by $1 million. Over the fiscal year 2017-2027 period, legislation has been enacted that CBO estimates will decrease outlays by $11 million and increase revenues by $2 million. Notably absent from these amounts are the direct spending and revenue effects from the fourth continuing resolution and BBA18. This is due to provisions in those measures that mandated the exclusion of those budgetary effects both from the Senate and statutory PAYGO scorecards. The Senate's PAYGO rule is enforced by section 4106 of H. Con. Res. 71.

Also included in this submission is a table tracking the Senate's budget enforcement activity on the floor since Congress adopted the budget resolution. No points of order have been raised on the floor since my last filing.

All years in the accompanying tables are fiscal years.

I ask unanimous consent that the accompanying tables be printed in the Record.

Mr. President, I wish to submit to the Senate the budget scorekeeping report for April 2018. The report compares current-law levels of spending and revenues with the amounts the Senate agreed to in the budget resolution for fiscal year 2018, H. Con. Res. 71. This information is necessary for the Senate Budget Committee to determine whether budget points of order lie against pending legislation. The Republican staff of the Senate Budget Committee and the Congressional Budget Office, CBO, prepared this report pursuant to section

308(b) of the Congressional Budget Act, CBA.

The enforceable levels included in this report reflect all of the numerical adjustments made to the resolution since its passage. The information contained in this report captures legislative activity from passage of the budget resolution through April 9, 2018. The only law enacted with significant budgetary effects since my last filing, on February 28, 2018, was the Consolidated Appropriations Act, 2018, P.L. 115-141.

Republican Budget Committee staff prepared tables 1 to 4 of this report.

Table 1 gives the amount by which each Senate authorizing committee exceeds or is below its allocation for budget authority and outlays under the most recently adopted budget resolution. This information is used for enforcing committee allocations pursuant to section 302 of the CBA. For this reporting period, 10 of the 16 authorizing committees are in compliance with their allocations. As previously reported, the Senate Veterans' Affairs; Energy and Natural Resources; Health, Education, Labor, and Pensions; Finance; and Agriculture, Nutrition, and Forestry Committees are in breach of their allocations. Since my last report, several committees' allocations were affected by changes in the nonappropriations provisions included in the omnibus appropriations bill. Still, the only new committee creating a breach was the Commerce, Science, and Transportation Committee, which spent $100 million more in both budget authority and outlays through Division P of the omnibus, Ray Baum's Act of 2018, than allowed under the budget resolution.

Table 2 gives the amount by which the Senate Committee on Appropriations is below or exceeds the statutory spending limits. This information is used to determine points of order related to the spending caps found in sections 312 and 314 of the CBA. Appropriations for 2018 are consistent with the statutory limits as modified by the Bipartisan Budget Act of 2018.

The budget resolution contains two points of order limiting the use of changes in mandatory programs in appropriations bills, CHIMPS. Tables 3 and 4 show compliance with fiscal year 2018 limits for overall CHIMPS $17 billion, and the crime victims fund CHIMP, $11.2 billion, respectively. This information is used for determining points of order under sections 4102 and 4103 of H. Con. Res. 71, respectively. CHIMPS included in the 2018 omnibus comply with the existing limits.

In addition to the tables provided by Budget Committee Republican staff, I am submitting CBO tables, which I will use to enforce budget totals approved by Congress.

CBO provided a spending and revenue report for fiscal year 2018, which helps enforce aggregate spending levels in budget resolutions under CBA section 311. CBO's estimates, which now include the full effects of appropriations for this year, show that current-law levels of spending for fiscal year 2018 are above the amounts assumed in the budget resolution by $152.2 billion in budget authority and $105.5 billion in outlays. For fiscal year 2018, Social Security outlay levels remain consistent with the budget resolution's assumption

Current-law revenues continue to be in excess of the levels assumed by the budget resolution. On-budget revenue levels currently exceed assumed levels by $3.2 billion in fiscal year 2018, $39.8 billion over the fiscal year 2018-2022 period, and $94.2 billion over the fiscal year 2018-2027 period. For fiscal year 2018, Social Security revenues are $446 million below levels assumed in the budget resolution.

CBO's report also provides information needed to enforce the Senate pay-as-you-go, PAYGO, rule. The Senate's PAYGO scorecard currently shows deficit reduction of $24 million in fiscal year 2018, but deficit increases of $10 million over the fiscal year 2017-2022 period and $11 million over the fiscal year 2017-2027 period. For fiscal year 2018, legislation has been enacted that would reduce outlays by $24 million. Over the fiscal year 2017-2022 period, legislation has been enacted that CBO estimates will decrease outlays by $13 million and decrease revenues by $23 million. Over the fiscal year 2017-2027 period, legislation has been enacted that CBO estimates will decrease outlays by $11 million and decrease revenues by $22 million. Consistent with recent congressional practice, the direct spending and revenue provisions included in the non-Appropriations Committee portion of the fiscal year 2018 omnibus, which increased deficits by $2.8 billion over 10 years are being excluded from PAYGO calculations. This is due to provisions in the omnibus that mandated the exclusion of those budgetary effects both from the Senate and statutory PAYGO scorecards. The Senate's PAYGO rule is enforced by section 4106 of H. Con. Res. 71.

Also included in this submission is a table tracking the Senate's budget enforcement activity on the floor since Congress adopted the budget resolution. Two points of order were raised since my last filing. On March 14, 2018, Senator Sanders raised a PAYGO point of order against S. 2155, the Economic Growth, Regulatory Relief, and Consumer Protection Act. This point of order was waived by a vote of 67 to 31. On March 21, 2018, Leader McConnell raised a PAYGO point of order against Senator Wyden's amendment, S. Amdt. 2213, to H.R. 1865, the Allow States and Victims to Fight Online Sex Trafficking Act of 2017. This point of order was sustained with a vote of 21 to 78 on Senator Wyden's waiver motion.

All years in the accompanying tables are fiscal years.

I ask unanimous consent that the accompanying tables be printed in the Record.

Madam President, I wish to submit to the Senate the budget scorekeeping report for January 2018. The report compares current-law levels of spending and revenues with the amounts the Senate agreed to in the budget resolution for fiscal year 2018, H. Con. Res. 71. This information is necessary for the Senate Budget Committee to determine whether budget points of order lie against pending legislation. The Republican staff of the Senate Budget Committee and the Congressional Budget Office CBO prepared this report pursuant to section 308(b) of the Congressional Budget Act, CBA.

The enforceable levels included in this report reflect all of the numerical adjustments made to the resolution since its passage. These adjustments include an update to enforceable levels for legislation enacted after the June 2017 CBO baseline was released but before enactment of the resolution, October 30, 2017; a revision to aggregates and allocations to accommodate legislation fulfilling the budget resolution's reconciliation instructions, December 19, 2017; and a revision to aggregates and the Appropriations Committee's allocation for emergency spending found in Fiscal Year 2018's third continuing resolution, H.R. 1370, December 21, 2017.

The information contained in this report captures legislative activity from the passage of the budget resolution through January 11, 2018.

Republican Budget Committee staff prepared tables 1 through 4 of this report.

Table 1 gives the amount by which each Senate authorizing committee exceeds or is below its allocation for budget authority and outlays under the most recently adopted budget resolution. This information is used for enforcing committee allocations pursuant to section 302 of the CBA. For this reporting period, 13 of the 16 authorizing committees are in compliance with their allocations. First, the Veterans' Affairs and Health, Education, Labor, and Pensions Committees violated their allocations in December 2017, the former with a $2.1 billion extension of the Veterans Choice Program and the latter through a package of health extenders. Both of these extensions were included as separate divisions on the Further Additional Continuing Appropriations Act, 2018, P.L. 115-96. The Energy and Natural Resources Committee violated its allocation earlier this month with the passage of the Western Oregon Tribal Fairness Act, P.L. 115-103, which is estimated to increase spending by $5 million over the next 10 years. The Armed Services Committee, on the other hand, reduced spending over the budget window. The National Defense Authorization Act for Fiscal Year 2018, P.L. 115-91, produced $16 million in outlay savings over the enforceable window.

Table 2 gives the amount by which the Senate Committee on Appropriations is below or exceeds the statutory spending limits. This information is used to determine points of order related to the spending caps found in section 312 and section 314 of the CBA. While no full-year appropriations bills have been enacted for Fiscal Year 2018, subcommittees are charged with permanent and advanced appropriations that first become available in that year.

The budget resolution contains two points of order limiting the use of changes in mandatory programs in appropriations bills, CHIMPS. Tables 3 and 4 show compliance with Fiscal Year 2018 limits for overall CHIMPS and the Crime Victims Fund CHIMP, respectively. This information is used for determining points of order under section 4102 and section 4103 of H. Con. Res. 71, respectively. Notably, there have not been any full-year bills enacted thus far for Fiscal Year 2018 that include

Mr. Speaker, I thank my colleagues on the Energy and Commerce Committee for this important piece of legislation, H.R. 304, the Protecting Patient Access to Emergency Medications Act.

This is a bipartisan bill. It was introduced by two of our colleagues from North Carolina, Representatives Hudson and Butterfield. It previously passed the House by voice vote, no objection, back in November; but, unfortunately, it was not taken up by the Senate before the last Congress adjourned, meaning we have to be here today to restart this process.

This, along with three other Energy and Commerce bills that we are considering today, shows that the Energy and Commerce Committee is picking right up where we left off, in a bipartisan way, to produce quality legislation that will improve the public health.

Now, H.R. 304 is really an important bill because it enables our Nation's emergency medical services professionals to continue to provide quality emergency care by recognizing the unique nature of their practice.

Specifically, as you may have heard, the bill clarifies that paramedics and other EMS professionals can administer certain pain and antiseizure medications in emergency situations pursuant to standing or verbal orders. In other words, the doctor has said to the EMS person, you can do these things in emergencies.

Now, think about this. You are in a car wreck. The EMT shows up in the ambulance. They can't communicate with anybody because they are down in a valley or somewhere where they don't have communication. Without this legislation, it is uncertain now, because of this ruling out of the administration, whether or not they can give you antiseizure medication or pain relief medication until they can get in contact. This is not what any of us wants, so this legislation fixes that.

During this process, when this decision was made a while back, I heard from Dr. Paul Rostykus, an emergency physician in Jackson County, Oregon. He said that this is really critical to saving lives and reducing suffering, particularly in our remote and rural areas where these emergency technicians, EMTs, may struggle to call in emergencies and it can take much longer for patients to reach the nearest doctor.

I just implore you to talk to anybody that is running around the ambulances, and they will tell you this is really, really important for patients.

I had an ambulance driver tell me--an EMT tell me it is important for them because sometimes in an accident, somebody is injured and they are kind of out of control and have a seizure. Now, I am not a doctor. We actually have one here who can tell us

more. But they then are able to administer certain medications that will calm the patient, prevent them from hurting themselves or hurting the EMT.

So I urge my colleagues to support H.R. 304 as well as the other bipartisan Energy and Commerce bills that are on the floor today.

Mr. Speaker, I call on my colleagues to pass these important bills.

Mr. Speaker, I yield myself such time as I may consume.

I rise in support of H.R. 304, the Protecting Patient Access to Emergency Medications Act of 2017.

Ensuring that we have access to the right medicine at the right time is critically important in emergency situations. While controlled substances have abuse and diversion potential, they also have lifesaving potential. In fact, they are very often used by emergency medical services--EMS--providers in situations where every minute counts.

Currently, these providers must often administer controlled substances during emergencies using a standing order. However, it is unclear whether or not this is permissible under current law.

To help clarify the current law, H.R. 304 would amend the Controlled Substances Act to make clear that EMS personnel can, in fact, administer controlled substances in emergency situations under a standing order from an EMS medical director.

This bill helps guarantee that patients will have timely access to drugs they need during an emergency. It will also streamline the DEA's emergency medical services registration process by allowing a single registration for a State EMS agency as opposed to a separate registration for each EMS agency location.

To help safeguard against diversion, the bill will hold registered EMS agencies responsible for receiving, storing, and tracking all controlled substances.

This bill passed the Energy and Commerce Committee and the House floor last Congress, and it incorporates important feedback from a wide range of stakeholders. I believe our efforts in this important bill will ensure that EMS professionals have the flexibility that they need to respond during emergencies, while preserving the DEA's ability to enforce controlled substances laws and regulations.

I urge my colleagues to join me in supporting the passage of H.R. 304.

Mr. Speaker, I reserve the balance of my time.

Mr. Speaker, I yield myself such time as I may consume. I thank Congressman Hudson and Congressman Butterfield, both great members of our committee on this very bipartisan bill.

I yield back the balance of my time.