Standardizing Electronic Prior Authorization for Safe Prescribing Act of 2018

Mr. Speaker, I rise to support H.R. 5605, the Advancing High Quality Treatment for Opioid Use Disorders in Medicare Act.

I introduced the bill to give older Americans across our Nation more access to comprehensive addiction treatment services through Medicare. Seniors are frequently prescribed opioids to treat chronic illnesses with constant, lasting pain issues, such as arthritis and other issues related to their musculoskeletal system.

The frequency and chronicity of this prescribing puts them at risk of developing a dependency, as seniors are more physiologically vulnerable to experiencing dependency and overdose effects. That is because as you get older your physiology changes, which makes seniors less able to deal with the side effects of opioids and more prone to respiratory depression, the leading cause of opioid-related death.

When you consider that roughly one-third of Medicare beneficiaries received an opioid prescription in 2016, with over half a million receiving a high dose, it makes sense that the hospitalization rate related to opioid misuse in patients over 65 has increased by 500 percent in the past two decades.

Despite these heightened risk factors, many seniors still do not have access to comprehensive, evidence-based treatment under traditional Medicare, and we cannot leave our seniors behind as we work to address this national crisis. Our seniors deserve access to the gold standard of care for treating opioid addiction. It is that simple.

My bill, H.R. 5605, the Advancing High Quality Treatment for Opioid Use Disorders in Medicare Act, will open doors for older Americans to get that gold standard of care by strengthening Medicare for our seniors. My bill does this by creating an alternative payment model demonstration program through Medicare for comprehensive treatment and care programs for opioid misuse disorder and will establish quality measures that reward comprehensive treatment programs that actually produce the best patient outcomes.

It works by giving providers and institutions that choose to participate a case management payment, which they would use to provide wraparound services for Medicare beneficiaries. Teams with an addiction specialist would also receive a higher incentive. Seniors participating in this program will receive medication-assisted treatment alongside psychosocial support, such as psychotherapy, treatment planning, and appropriate social services.

This coordinated care approach is considered the gold standard of care, and if we want to successfully address this crisis, we need to ensure that individuals have access to treatments that will result in successful outcomes. I have seen firsthand the importance of this with my own patients in the emergency department. Getting medication- assisted treatment is important, and the success of that treatment is enhanced if that patient is also participating in psychotherapy and receiving the appropriate social services.

That is why this demo is supported by the American Society of Addiction Medicine and the California Medical Association, among others. It is critical that all Americans, regardless of their age or how much money they make, have access to high quality, comprehensive treatment. My bill will strengthen Medicare so we can help seniors address opioid dependence by ensuring they get the care they need.

I also want to thank Ranking Member Pallone and Chairman Walden for their support of this legislation and of our seniors.

Also included in my bill is H.R. 3528, the Every Prescription Conveyed Securely Act, introduced by Representative Katherine Clark from Massachusetts, with the assistance of Representative Mullin.

I want to thank Representative Clark for her hard work to address this crisis by expanding the use of technology to reduce fraudulent prescribing.

Her legislation will direct providers to use electronic prescribing for controlled substances technology for Medicare part D by 2021 to cut down on fraud and overprescribing. Already, seven States have implemented this system in an effort to combat this crisis and keep illicit opioids off the streets.

According to the Department of Justice, most fraudulent opioid prescriptions are obtained either through doctor shopping, forged prescriptions, or theft, all of which can be addressed by an effective electronic prescribing for controlled substances system.

As amended, my bill, H.R. 5605, will improve care for our seniors and help get illegally obtained opioids off the streets.

Mr. Speaker, I move to suspend the rules and pass the bill (H.R. 5605) to amend title XVIII of the Social Security Act to provide for an opioid use disorder treatment demonstration program, as amended.

Mr. Speaker, I ask unanimous consent that all Members may have 5 legislative days in which to revise and extend their remarks and insert extraneous materials in the Record on the bill.

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

Mr. Speaker, I want to commend Representative Ruiz, Representative Clark, and Representative Mullin; they all worked together to make this bipartisan bill a success.

This bill would authorize a 4-year demonstration project to test new ways to treat opioid use disorder among the Medicare population.

In addition, this bill will help secure the prescribing of controlled substances in Medicare by requiring the use of e-prescribing. Pretty important work.

We have heard from providers that have not only cut down on the abuse of fraudulent prescriptions by switching to e-prescribing but also have saved time for themselves and their nurses, all while saving millions of dollars in the process. So these are really important, substantive steps forward, another piece of the puzzle in addressing the opioid crisis.

Mr. Speaker, I urge passage of the legislation, and I reserve the balance of my time.

House of Representatives,

Committee on Energy and Commerce,

Washington, DC, June 7, 2018.

Hon. Kevin Brady,

Chairman, Committee on Ways and Means,

Washington, DC.

Dear Chairman Brady: On May 9 and 17, 2018, the Committee

on Energy and Commerce ordered favorably reported over 50

bills to address the opioid epidemic facing communities

across our nation. Several of the bills were also referred to

the Committee on Ways and Means.

I ask that the Committee on Ways and Means not insist on

its referral of the following bills so that they may be

scheduled for consideration by the Majority Leader:

H.R. 1925, At-Risk Youth Medicaid Protection Act of 2017;

H.R. 3331, To amend title XI of the Social Security Act to

promote testing of incentive payments for behavioral health

providers for adoption and use of certified electronic health

record technology;

H.R. 3528, Every Prescription Conveyed Securely Act;

H.R. 4841, Standardizing Electronic Prior Authorization for

Safe Prescribing Act of 2018;

H.R. 5582, Abuse Deterrent Access Act of 2018;

H.R. 5590, Opioid Addiction Action Plan Act;

H.R. 5603, Access to Telehealth Services for Opioid Use

Disorder;

H.R. 5605, Advancing High Quality Treatment for Opioid Use

Disorders in Medicare Act;

H.R. 5675, To amend title XVIII of the Social Security Act

to require prescription drug plan sponsors under the Medicare

program to establish drug management programs for at-risk

beneficiaries;

H.R. 5684, Protecting Seniors from Opioid Abuse Act;

H.R. 5685, Medicare Opioid Safety Education Act;

H.R. 5686, Medicare Clear Health Options in Care for

Enrollees (CHOICE) Act;

H.R. 5715, Strengthening Partnerships to Prevent Opioid

Abuse Act;

H.R. 5716, Commit to Opioid Medical Prescriber

Accountability and Safety for Seniors (COMPASS) Act;

H.R. 5796, Responsible Education Achieves Care and Healthy

Outcomes for Users' Treatment (REACH OUT) Act of 2018;

H.R. 5798, Opioid Screening and Chronic Pain Management

Alternatives for Seniors Act;

H.R. 5804, Post-Surgical Injections as an Opioid

Alternative Act; and

H.R. 5809, Postoperative Opioid Prevention Act of 2018.

This concession in no way affects your jurisdiction over

the subject matter of these bills, and it will not serve as

precedent for future referrals. In addition, should a

conference on the bills be necessary, I would support your

request to have the Committee on Ways and Means on the

conference committee. Finally, I would be pleased to include

this letter and your response in the bill reports and the

Congressional Record.

Thank you for your consideration of my request and for the

extraordinary cooperation shown by you and your staff over

matters of shared jurisdiction. I look forward to further

opportunities to work with you this Congress.

Sincerely,

Greg Walden,

Chairman.

Mr. Speaker, I yield back the balance of my time.

Mr. Speaker, I support H.R. 5605, the ``Advancing High Quality Treatment for Opioid Use Disorders in Medicare Act.''

This important bill provides applicable beneficiaries increased access to opioid use disorder treatment services and will improve physical and mental health outcomes for such beneficiaries.

In 2016, approximately one-third of Medicare beneficiaries received an opioid prescription, 500,000 of which received high doses of opioids yet many lack access to quality treatment for substance abuse.

This legislation would create an Alternative Payment Model (APM) demonstration program to incentivize the delivery of high quality, evidence-based substance use disorder treatment services.

The voluntary program would enroll eligible beneficiaries who agree to receive Substance Use Disorder (SUD) treatment services through providers and institutions participating in the Program.

To support those who are suffering from opioid use disorders, we must employ a multi-faceted approach that actually achieves results.

The purpose of the Advancing High Quality Treatment for Opioid Use Disorders in Medicare Act is to assist states in the implementation of a variety of strategies, including:

Reducing hospitalizations and emergency department visits;

Increasing the use of medication-assisted treatment for opioid use disorders;

Improving health outcomes of individuals with opioid use disorders, including by reducing the incidence of infectious diseases (such as hepatitis C and HIV);

Reducing deaths from opioid overdose; and

Reducing the utilization of inpatient residential treatment.

Under the Program, the Secretary of the Health and Human Services shall make payments to participants for:

Furnishing opioid use disorder treatment services delivered through opioid use disorder care teams; or

Arranging for such service to be furnished, to applicable beneficiaries participating in the Program.

The current surge of opioid usage requires a strong, national response, and with passage of the Advancing High Quality Treatment for Opioid Use Disorders in Medicare Act, we are addressing this issue.

Opioid use disorder leads to physical and functional changes to parts of the brain affecting impulse, reward, and motivation.

In recent years, it is estimated that 2.1 million individuals in the United States have an opioid use disorder.

This legislation would require APM demonstration program participants to provide both medication as well as psychosocial supports, such as care management, psychotherapy, treatment planning and appropriate social services to treat substance use disorder, which is considered the gold standard of care.

Voluntary APM demonstration program participation would be prioritized in regions with high prevalence of opioid use disorders.

Care teams would require inclusion of health care providers who are licensed to dispense opioid medications for the purpose of detoxification or maintenance treatment for opioid use disorder, as well as appropriate providers of psychosocial treatment.

In addition, in conjunction with stakeholders, the Health and Human Services Secretary would develop quality and outcome measures to assess the care beneficiaries receive through the Program.

Participating providers or institutes will receive a monthly case management fee for all beneficiaries receiving opioid treatment services.

Program participants will receive a higher case management fee if their care team includes an addiction specialist, and for the initiation of treatment period, which is treatment and resource intensive.

Participants would be eligible to receive an additional incentive payment for providing quality substance use disorder treatment care.

The demonstration program is authorized for four years and capped at 20,000 participants.

I am confident that the comprehensive approach we are taking to address those suffering from Opioid Use Disorder will help address the nation's growing epidemic.

For these reasons, I support the Advancing High Quality Treatment for Opioid Use Disorders in Medicare Act and the goal of ensuring the best possible response to treat opioid use disorder in America.

Mr. Speaker, let me take this time to express my appreciation to Chairman Walden and Ranking Member Pallone, for their leadership in addressing the opioid epidemic in the U.S. House of Representatives.

On April 24th of this year, I had the opportunity to work across the aisle in introducing bipartisan legislation with my Energy and Commerce colleague, Congressman Adam Kinzinger of Illinois.

We were joined by two additional colleagues as original co-sponsors, who sit on the House Ways and Means Committee--Rep. Darrin LaHood, my Republican colleague from Illinois and Rep. Danny K. Davis, my CBC Colleague who hails from Illinois as well.

Our bill, The Opioid Addiction Action Plan of 2018, is a roadmap to not only abating the opioid epidemic, but to engaging industry to be innovative in the development of new pain management therapies.

There are many players and much is at stake.

According to the National Institutes of Drug Abuse, there are more than 115 opioid related deaths per day.

The CDC estimates that the economic burden of prescription opioid misuse is roughly $78.5 billion a year--and that's in the U.S. alone.

Since we know the enormity of this issue plaguing our country, passing H.R. 5590 would require that the Centers for Medicare and Medicaid Services (CMS) seeks stakeholder feedback as well as public comment, before producing an Opioid Addiction Act Plan report to Congress.

It is going to take all of us to tackle this national opioid epidemic.

And Mr. Speaker, with the opioid crisis at epic levels, government cannot do this alone.

That is why we are calling on all of our partners to aide in the fight against opioid addiction in our communities--for both addiction to prescription painkillers and addiction to synthetics, including heroin and fentanyl.

Overdose deaths that were once perceived as largely a rural white problem have now become widespread among black Americans in urban communities who are dying from horrific rates of fentanyl overdoses.

While white Americans die at greater rates of overdose deaths, overdose death rates have been steadily increasing among black Americans since 2011--at the time that fentanyl and heroin, as well as other synthetics began to climb.

One of the solutions to the ever-growing problem to the opioid crisis in the black community is access to addiction care treatment.

Traditionally, African Americans have had unequal access to quality health care in comparison to our white counterparts.

This legislation would also mandate improved data collection to better understand the opioid crisis.

H.R. 5590 directs the CMS to develop an Opioid Addiction Action Plan to address challenges for treatment of substance abuse disorders.

Additionally, this bill also identifies non-opioid pain management options and make considerations for Medicare and Medicaid coverage and reimbursement of medication-assisted treatment (MAT) for opioid use disorders.

In addition to making sure our communities have access to medication- assisted treatment, it is important that we help them in the event someone is in the midst of an overdose.

Mr. Speaker, we cannot leave those behind who need us most.

We are our brother's and our sister's keepers.

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

Madam Speaker, I am pleased to support H.R. 5773, the PASS Act, introduced by Congress Members Sewell and Roskam.

This bill focuses on policies to help Medicare plans prevent opioid use in the Medicare program without limiting access to needed medications for our seniors.

First, H.R. 5773 requires that Medicare prescription drug plans establish mandatory lock-in programs for seniors who are at risk of opioid overuse.

These programs curb fraud, abuse, and misuse of prescribed medications, while at the same time ensuring that seniors who have legitimate need of these medications can access them.

For example, these controls prevent doctor and pharmacy shopping and will prevent duplicative and medically inappropriate drug therapies that can lead to prescription drug abuse. This bill would also require that any beneficiaries who are at risk for opioid overuse be eligible for the benefits provided under the Medication Therapy Management Program.

This program helps patients understand all of their medications and how they are working together. It allows a pharmacist or other health professional to give beneficiaries a comprehensive review of all of their medications and talk to them about any interactions, risks, or side effects.

This bill would also include a provision introduced by Representatives Mike Thompson and David Schweikert that would streamline the electronic prior authorization system, which is meant to ensure that certain drugs are covered by an insurer before the drug is dispensed.

The PASS Act also includes a provision introduced by Representatives Sewell and Renacci which streamlines communications between the Center for Medicare and Medicaid Services and Medicare part C and D plans regarding program integrity.

Finally, H.R. 5773 would direct the Secretary of the Department of Health and Human Services to annually notify Medicare part D prescribers who are identified as outlier prescribers compared to their colleagues in their specialty and region. This has certain exclusions, for example, patients receiving hospice care, but will be used to help prescribers, who may not realize

that they are an outlier, to reevaluate their practices and make adjustments before any harm is done.

I encourage my colleagues to support this legislation, and I reserve the balance of my time.

Madam Speaker, I yield myself the balance of my time.

Our country is truly facing a crisis when it comes to opioids, and the Medicare population isn't immune from this. We must be careful in our approach and ensure that the policies we enact in Congress don't leave out those who have a legitimate medical need for these medications, like those with cancer, those in hospice, or those with genetic conditions like sickle cell disease.

H.R. 5773 is a modest step in the right direction, and I look forward to continuing to work with my colleagues on ways to address the opioid crisis within the Medicare program.

Madam Speaker, I urge my colleagues to support this bill, and I yield back the balance of my time.

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

Mr. Speaker, I rise in support of H.R. 3331, sponsored by Representative Lynn Jenkins and Representative Doris Matsui, and I commend my colleagues for their work on the bill.

One of the reasons why the opioid crisis is so intractable is the lack of access to behavioral health services in all of our communities, and the continued segregation of behavioral health from physical health.

For decades, we have neglected our behavioral health infrastructure, and siloed behavioral health from our broader healthcare system. The lack of integration between behavioral and physical health has had serious consequences for patients, including poor to non-existent coordination of care, severe provider shortages, and poor health outcomes.

One barrier in addressing true integration has been that behavioral health providers in large part don't have access to electronic health records, and were left out of the push to update electronic health records systems. That is an unfortunate legacy that we are still dealing with today.

H.R. 3331 takes an important step in addressing this problem. It is a bipartisan bill that would incentivize behavioral health providers to adopt electronic health record technology, through the Centers for Medicare & Medicaid Innovation.

While this is an important bill, I want to underscore that it is incremental and it is limited. I want to reiterate my continuing concern that while Democrats support working on a legislative package to address the opioid crisis, we must first assure that we do no harm.

And I must remind everyone that Republican efforts to dismantle and sabotage the ACA would do serious harm to our healthcare system, and to folks with substance use disorders specifically.

Just last week, the Trump Administration requested that a federal court eliminate the protections in the ACA for people with preexisting conditions. That includes people with opioid use disorders, whose access to health insurance and vital treatment for opioid use disorders would be taken away if the Trump Administration is successful.

The opioids package cannot be considered in a vacuum. Mark my words-- Republican efforts to tear down the ACA and the Medicaid program will not only reverse any gains we may make from these efforts today, but will to inflict broad, lasting harm to our healthcare system, and to our ability to fight the opioid crisis.

Mr. Speaker, I yield such time as she may consume to the gentlewoman from California (Ms. Matsui).

Mr. Speaker, I have no other speakers.

I urge support of the legislation, and I yield back the balance of my time.

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

Mr. Speaker, I rise in support of H.R. 5590 sponsored by Representatives Kinzinger and Clarke. I commend my colleagues for their hard work on this legislation.

We know that there is more that the Department of Health and Human Services needs to do to address the opioid crisis. We know that we need to do more not only to bring down opioid prescribing, but to expand access to medication-assisted treatment for opioid use disorders.

H.R. 5590 would direct the Secretary of HHS to examine potential obstacles to an effective response to the opioid crisis and issue recommendations for addressing them. It directs the Secretary to look at barriers to both wider use of nonopioid alternatives to manage pain, as well as therapies that treat opioid addiction.

Mr. Speaker, while this is an important bill, I want to underscore that it is incremental.

I also want to reiterate my continuing concern that while Democrats support working on a legislative package to address the opioid crisis, as we have over the course of the day-to-day and over the course of the past several weeks with our Republican colleagues, we must also assure that we first do no harm.

The Trump administration and Republican efforts to dismantle the Affordable Care Act would do serious harm to our healthcare system and to individuals suffering from opioid use disorders specifically.

For instance, the Trump administration continues to undermine the individual market by promoting junk insurance plans, such as short- term, limited duration health plans.

These plans would allow insurers to once again exclude individuals with preexisting conditions, such as opioid use disorder, and charge individuals more based on their health status. It would make coverage for individuals who need comprehensive health coverage, such as individuals with opioid use disorders, less affordable and accessible.

Moreover, apparently Republicans are not done with their efforts to repeal the ACA. Despite public backlash to repeal efforts last year and despite statements today expressing concern about the opioid crisis, news reports indicate that Republicans are once again planning to make another effort to try to repeal the Affordable Care Act.

The opioids package cannot be considered in a vacuum. Ongoing efforts to sabotage and repeal the ACA will not only reverse the gains that we make from these efforts today, but will inflict lasting harm to our healthcare system and our ability to fight the opioid crisis.

Mr. Speaker, I yield back the balance of my time.

Mr. Speaker, the opioid epidemic is devastating my community in Bucks and Montgomery Counties. I talk to these families every day.

As our Nation continues to grapple with the deadly effects of the opioid epidemic, it is crucial we take every step possible to stop prescription medication from falling into the wrong hands. We need to ensure that our medical professionals possess the latest best practices for preventing prescription medication abuse, including nonopioid pain management. This is why I am proud the House is considering my REACH OUT Act, H.R. 5796.

By facilitating outreach to outlier opioid prescribers, the REACH OUT Act seeks to educate physicians on their prescribing behaviors without limiting their ability to deliver patient care. It will be an effective step toward reducing the amount of unnecessary prescription opioids in communities across the Nation.

The Responsible Education Achieves Care and Healthy Outcomes for Users' Treatment Act, the REACH OUT Act, H.R. 5796, will direct the Centers for Medicare and Medicaid Services to work with eligible entities, including quality improvement organizations, to engage in outreach with prescribers identified as clinical outliers to share best practices to evaluate their prescribing behavior.

H.R. 5796 would build on the lessons learned from CMS special innovation projects, by spreading best practices for preventing prescription drug abuse, providing outreach and education about nonopioid pain management, and reducing the number of opioids prescribed by outlier prescribers.

An outlier prescriber is identified by the Secretary of Health and Human Services, in consultation with professional stakeholders, as one who prescribes an excessive number of opioids as compared to other prescribers in their medical specialty or geographic area.

Our Nation's drug epidemic is a complicated issue, and our response must be multifaceted. This means giving providers the tools they need to prevent opioid abuse.

I want to thank my colleagues Carlos Curbelo and Mike Thompson for their support in authoring this bill. And I want to thank our chairman, Greg Walden, and his Energy and Commerce Committee for their relentless effort to combat the opioid epidemic across the country.

Mr. Speaker, I urge my colleagues, Democrat and Republican alike, to support the passage of our REACH OUT Act.