IMD CARE Act

Mr. Speaker, by direction of the Committee on Rules, I call up House Resolution 949 and ask for its immediate consideration.

Mr. Speaker, for the purpose of debate only, I yield the customary 30 minutes to the gentleman from Massachusetts (Mr. McGovern), pending which I yield myself such time as I may consume. During consideration of this resolution, all time yielded is for the purpose of debate only.

General Leave

Mr. Speaker, I ask unanimous consent that all Members may have 5 legislative days to revise and extend their remarks.

Mr. Speaker, House Resolution 949 provides for the consideration of three important bills aimed at curbing the deadly opioid epidemic plaguing this country and providing Americans with the tools to overcome their addictions: H.R. 6, the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act, or the SUPPORT Act; H.R. 5797, the Individuals in Medicaid Deserve Care that is Appropriate and Responsible in its Execution Act; and H.R. 6082, the Overdose Prevention and Patient Safety Act.

The three bills included in today's rule all seek to accomplish one goal: assist Americans struggling with opioid addiction in controlling their addictions and moving forward in achieving productive and healthy lives.

The rule provides for 1 hour of debate on H.R. 6, equally divided and controlled by the chair and ranking minority member of the Committee on Energy and Commerce. The rule makes in order eight amendments offered by both Republicans and Democrats. Further, the rule provides the minority with one motion to recommit with or without instructions.

The resolution also provides for a structured rule for H.R. 5797, allowing 1 hour of debate to be divided and controlled between the chair and ranking minority member of the Energy and Commerce Committee. The rule also provides for debate on an amendment by Mrs. Mimi Walters of California, an active member of the Energy and Commerce Committee. Finally, the rule provides the minority with the customary motion to recommit with or without instructions.

The final bill included in today's resolution, H.R. 6082, will also receive 1 hour of debate on the House floor, equally divided and controlled by the chair and ranking member of the Energy and Commerce Committee. As the Committee on Rules received no germane amendments to H.R. 6082, no amendments were made in order in today's rule. The minority does receive the customary motion to recommit with or without instructions.

The statistics that many of us have heard on numerous occasions--at our district townhalls, in opioid roundtables with stakeholders, constituent meetings in our offices, and in our committee hearings--are truly heartbreaking stories, with more than 115 people dying in the United States every day from an opioid overdose. That is five people per hour.

According to national reports, emergency room visits and opioid overdose deaths have more than quadrupled in the last 15 years, and a preliminary analysis indicates those numbers are to rise. The misuse of and addiction to opioids--including prescription pain medications, heroin, and synthetic opioids such as fentanyl--is, indeed, an urgent national crisis that continues to threaten our public health, social fabric, and economic welfare. Both community hospitals and local paramedics are frequently coming across people overdosing on an opioid drug or a drug laced with fentanyl.

The opioid epidemic has affected families not only in my district in north Texas, but in communities large and small from Maine to California. It has also impacted American employers and businesses due to lost productivity and difficulty finding qualified candidates for employment. President Trump is right to call this epidemic the ``crisis next door.''

The efforts of the Energy and Commerce Committee in the Comprehensive Addiction and Recovery Act and the 21st Century Cures Act in the previous Congress were a good start, delivering critical funding and resources to communities hit most hard by the opioid epidemic. But there was much more we still could do.

To start this process, the Energy and Commerce Health Subcommittee, which I chair, held a Member Day last October, where more than 50 bipartisan Members of this body, both on and off the committee, shared their personal stories from their districts and offered their solutions. This was followed by a series of three legislative hearings with markups where nearly 60 bills were considered and advanced to the full Energy and Commerce Committee that acted on these bills shortly thereafter.

The culmination of the work from the Energy and Commerce Committee and other House committees has brought us to consider many of these policies over the course of the last 2 weeks on the House floor. It required an all-hands-on-deck approach, and I believe the American people will see that, by this week's end, we did, indeed, come together in a bipartisan fashion and worked to address this crisis.

Today's rule provides for consideration of three important bills that will expand treatment options, deliver lifesaving services, and make necessary public health reforms, including Medicare and Medicaid, to bolster prevention and recovery efforts.

First, H.R. 5797, the Individuals in Medicaid Deserve Care that is Appropriate and Responsible in its Execution Act, the IMD CARE Act, allows State Medicaid programs to remove the institutions for mental diseases exclusion for beneficiaries aged 21 to 64 with an opioid use disorder for 5 years' time. The bill provides the continuum of care

by removing a barrier of care under current law, so Medicaid can cover up to a total of 30 days of care in an institute for mental disease during a 12-month period, and eligible enrollees can get the care that they actually need.

The IMD exclusion is one of the treatment barriers consistently identified by State Medicaid directors, health policy experts, and many provider groups. Currently, this exclusion under Medicaid significantly limits the circumstances under which Federal Medicaid matching funds are available for inpatient services or for outpatient treatments.

Unfortunately, this policy has barred individuals with an opioid use disorder and mental illness from accessing short-term, acute care in psychiatric hospitals, or receiving treatment in residential substance use disorder treatment facilities. A 2017 Medicaid and CHIP Payment and Access Commission report stated that the Medicaid IMD exclusion is one of the few examples in the Medicaid program where Federal financial participation cannot be used for medically necessary and otherwise covered services for a specific Medicaid population receiving treatment in a specific setting.

In the midst of the opioid crisis, States must leverage all available tools to combat this epidemic. Section 1115 demonstration waivers are an important tool, but, so far, less than half of the States have sought or received an appropriate waiver from the Centers for Medicare and Medicaid Services to help patients with substance use disorder.

The IMD CARE Act also allows States the option to use the State plan amendment process, which is generally faster than using waivers. Under this process, once a State plan amendment is submitted, the Centers for Medicare and Medicaid Services has 90 days to decide or the proposed change will automatically go into effect.

H.R. 5797 amends an outdated law that has been in effect since the enactment of the Medicaid program in 1965. Since that time, there have been advances in behavioral health, and there have been advances in addiction treatment services where more, improved treatment options now exist.

It is long overdue to revisit this policy so that State Medicaid programs can better meet patients' needs and physicians can determine the most appropriate setting for care based on an individual's treatment plan.

Next, H.R. 6082, the Overdose Prevention and Patient Safety Act, makes timely reforms to a privacy law that affects patient access to healthcare and creates barriers to treatment. Specifically, the bill updates the Public Health Service Act to permit substance use disorder records to be shared among covered entities and 42 CFR part 2 programs by aligning part 2 with the Health Insurance Portability and Accountability Act of 1996 for the purposes of treatment, payment, and healthcare operations.

As a physician, I believe it is vital that when making clinical decisions, I have all of the appropriate information to make the correct determination in the treatment of a particular patient. Those suffering from substance use disorder should receive the same level of treatment and care as other individuals.

Patients afflicted with substance use disorder deserve to be treated by physicians who are armed with all of the necessary information to provide the best possible care.

I certainly do understand and respect that patient privacy protection is paramount and should be held in the highest regard.

The Overdose Prevention and Patient Safety Act maintains the original intent of the 1970s statute behind 42 CFR part 2 by protecting patients and improving care coordination. In fact, this bill increases protections for those seeking treatment by more severely penalizing those who share patient data to noncovered entities and non-part 2 programs than under the current statute, with certain exceptions.

Lastly, it requires the Secretary of Health and Human Services to, among other things, issue regulations prohibiting discrimination based on disclosed health data and requiring covered entities to provide written notice of privacy practices.

The issue of the stigma associated with substance use disorder has been a constant in many of the discussions members of the Energy and Commerce Committee and the stakeholders have had in both our offices and in our hearings.

This carefully crafted legislation seeks to help break the stigma and help individuals with this complex disease gain access to healthcare and support services critical to getting them on the road to recovery.

We should not continue to silo the substance use disorder treatment information of a select group of patients if we want to ensure that these patients are indeed receiving quality care. This information should be integrated into our medical records and comprehensive care models to prevent situations where physicians, not knowing a patient's substance use disorder, may prescribe medications that have significant drug interactions, or worse, may prescribe a controlled substance that makes their patient's substance use disorder worse.

As it currently stands, 42 CFR part 2 is actively prohibiting physicians from ensuring proper treatment and patient safety and, paradoxically, it is perpetuating that stigma.

Providing high quality healthcare is a team effort, but physicians leading the team must have the necessary information to adequately coordinate care. We must align payment, operations, and treatment to allow coordination of both behavioral and physical health services for individuals with substance use disorder.

There is a reason why the Substance Abuse and Mental Health Services Administration and most of the health stakeholder community are asking for this change. Clearly, there is an issue here that must be addressed. H.R. 6082 achieves the goal and contributes to Congress' effort in trying to stem the current crisis.

Finally, Mr. Speaker, H.R. 6, the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act, is a package of bills that reform Medicare, Medicaid, and other health provisions to further combat this crisis by advancing many critical initiatives.

As we all know, this opioid epidemic is in our hospitals, but it is also in our living rooms and on our streets. Our partners at Federal agencies must rise to the challenge and deliver vital resources for States and communities most devastated by the crisis. The SUPPORT for Patients and Communities Act will provide our Department of Health and Human Services, including the Centers for Medicare and Medicaid Services and the Food and Drug Administration, with the necessary tools to address this crisis.

Title I of H.R. 6 addresses the ways in which Medicaid can be used to increase access to quality care and management for individuals suffering from substance use disorders. Some of these changes in Medicaid reflect the success of our State Medicaid programs by implementing State successes at the Federal level.

Section 101 under title I will expand protection for at-risk youth by requiring State Medicaid programs to restore Medicaid coverage of a juvenile following their release from incarceration. The next section also allows former foster youth to maintain their Medicaid coverage across State lines until they turn 26 years of age. These are vulnerable populations of individuals that will greatly benefit from increased access to treatment.

Section 105 builds on the current State Medicaid drug utilization review, which saves money and promotes patient safety. This section will require State Medicaid programs to have safety edits in place for opioid refills, monitor concurrent prescribing of opioids and certain other drugs, and monitor antipsychotic prescribing for children.

Care for mothers suffering from substance use disorder and their babies who are born with neonatal abstinence syndrome is a growing problem in the face of this epidemic. Section 106 requires HHS to improve care for these infants with neonatal abstinence syndrome and their mothers. It also requires that the General Accountability Office study the gaps in Medicaid coverage for pregnant and postpartum women with substance use disorders.

Section 107 of the bill provides additional incentives for Medicaid health homes for patients with substance use disorder.

Mr. Speaker, these health homes will allow States to create a comprehensive person-centered system of care coordination for primary care, acute and behavioral healthcare, including mental health and substance use. As our healthcare system moves towards caring for the whole person, it is important that we enable our physicians and our payers to provide that comprehensive care.

The SUPPORT for Patients and Communities Act also enables better pain management for our Nation's Medicare beneficiaries, ranging from increased access to substance use disorder treatment, including through the use of telehealth, to modification of physician payment for certain nonopioid treatments in Ambulatory Surgery Centers.

Title II of the bill contains Medicare provisions that encourage the use of nonopioid analgesics where appropriate and also aims to decrease fraud and abuse regarding prescriptions by requiring e-prescribing for the coverage of Medicare Part D controlled substances.

H.R. 6 strives to provide support for at-risk beneficiaries who might fall victim to substance use disorder. Section 206 of the bill accelerates the development and the use of drug management programs for at-risk beneficiaries. While this program is currently voluntary, by plan year 2021, it will become a mandatory program.

Lastly, the bill expands Medicare coverage to include opioid treatment programs for the purpose of providing medication-assisted treatment. Opioid treatment programs are not currently Medicare providers, which forces Medicare beneficiaries who need medication- assisted treatment to pay out-of-pocket costs for those services. These efforts should provide improved access to treatment for Medicare beneficiaries who have substance use disorders while also incentivizing the use of opioid alternatives, which hopefully will prevent the development of substance use disorders.

Even though an estimated 46,000 Americans died from opioid overdoses from October 2016 to October 2017, there is a lack of innovation and a lack of investment in the development of nonaddictive pain and addiction treatment.

A bill that I introduced, H.R. 5806, the 21st Century Tools for Pain and Addiction Treatments, is included in section 301 on H.R. 6 and requires the Food and Drug Administration to hold at least one public meeting to address the challenges and the barriers of developing nonaddictive medical products intended to treat pain or addiction.

The Food and Drug Administration is also required to issue or update existing guidance documents to help address challenges to developing nonaddictive medical products to treat pain or addiction.

Mr. Speaker, I did work closely with the Food and Drug Administration to get the policy in this section correct and to ensure that it will clarify those pathways for products that, in fact, are so desperately needed by America's patients.

I have remaining concerns about the language in section 303 that will allow nonphysician providers to prescribe buprenorphine. While I understand and greatly appreciate the intent to increase access to medication-assisted treatment, as a physician, I also respect how complicated the treatment of patients suffering from substance use disorder may be.

The Hippocratic Oath, we all know, is to first, do no harm. Patient safety should be our highest priority.

This is a complex patient population, Mr. Speaker. On average, people with substance use disorder die 20 years sooner than other Americans.

Additionally, buprenorphine is a schedule III drug that can be misused and could exacerbate the underlying problem. I am unsure about expanding these authorities to additional nonphysician providers at the risk of making the problem worse. I have worked to strengthen the reporting requirements of this section of H.R. 6 and look forward to reviewing that report on this particular policy.

Taken together, H.R. 6, the SUPPORT for Patients and Communities Act, will improve access to care for individuals suffering from substance use disorder, provide our healthcare system with tools and resources that it needs to care for patients, and to help prevent future misuse of opioids.

Before I close, I would like to share a quote from President Trump. He said: ``Together, we will face this challenge as a national family with conviction, with unity, and with a commitment to love and support our neighbors in times of dire need. Working together, we will defeat this opioid epidemic.''

The number of bills and policies advanced on the House floor in the last 2 weeks illustrates our shared commitment, and I am confident that we will make significant progress in defeating this epidemic.

Mr. Speaker, I urge my colleagues to support today's rule and the three underlying bills that are critical to our Nation's effort to stem the opioid crisis.

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

Mr. Speaker, I yield 3 minutes to the gentleman from Pennsylvania (Mr. Costello), a fellow member on the Committee of Energy and Commerce.

I yield the gentleman from Pennsylvania an additional 1 minute.

Mr. Speaker, I yield myself 1 minute.

I do want to remind everyone that 18 months ago, in the previous Congress, with the passage of the 21st Century Cures Act and the Comprehensive Addiction Recovery Act, CARA, $1 billion was made available for treating people with substance use disorder. That was then supplemented with the passage of the more recent appropriations bill last month--2 months ago, with $4 billion.

Unprecedented amounts of money have been made available in the last 18 months to combat this crisis.

And then, finally, it is very, very difficult to integrate care if you don't reform the 42 CFR part 2, which is before us today.

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

Mr. Speaker, I yield myself 2 minutes.

Mr. Speaker, the good news is that all forms of medication-assisted treatment are required for 5 years under H.R. 6. So I look forward to the gentleman's support when we get to the vote, and I reserve the balance of my time.

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

Mr. Speaker, I don't need to remind anyone that the lie of the year for 2012 was: If you like your doctor, you can keep your doctor--words that will ring through this body probably for the rest of time.

I want to read from the Statement of Administration Policy, back to the business at hand, the rule on the three bills that we are considering today. This is the Statement of Administration Policy: ``Addressing the opioid crisis has been a top priority of the President since day one, and the administration welcomes legislation that complements its efforts to end the opioid crisis. The administration strongly supports House passage of bipartisan bills to protect patients enrolled in Medicare and Medicaid, create targeted programs for at-risk populations, expand access to medication-assisted treatment for opioid use disorders, and provide resources for States and communities struggling to deal with the scale of the opioid crisis.''

The statement goes on, and it concludes: ``These initiatives represent bold, evidence-based steps to prevent and treat opioid abuse, and will help save the lives of countless Americans. The administration commends the House on taking up these important bills. . . . The administration supports House passage of H.R. 5797, H.R. 6082, and H.R. 6. . . .''

Mr. Speaker, today's rule provides for the consideration of these three important pieces of legislation aimed at

addressing the opioid crisis affecting so many of our fellow Americans.

H.R. 6, the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act; H.R. 5797, the Individuals in Medicaid Deserve Care that is Appropriate and Responsible in its Execution Act; and H.R. 6082, the Overdose Prevention and Patient Safety Act, will all play a critical role in treating patients and providing Americans the tools to put the pieces of their lives back together again.

I commend Chairman Walden for his efforts on bringing so many Members of this body into the discussion and taking the many ideas offered by Members, incorporating them into the legislative products. The result of those efforts is a legislative trio that this entire body can be proud of, and this entire body can support.

I, therefore, urge my colleagues to support today's rule and the three underlying pieces of legislation.

The text of the material previously referred to by Mr. McGovern is as follows:

An Amendment to H. Res. 949 Offered by Mr. McGovern

At the end of the resolution, add the following new

sections:

Sec. 5. Immediately upon adoption of this resolution the

Speaker shall, pursuant to clause 2(b) of rule XVIII, declare

the House resolved into the Committee of the Whole House on

the state of the Union for consideration of the bill (H.R.

4501) to increase funding for the State response to the

opioid misuse crisis and to provide funding for research on

addiction and pain related to the substance misuse crisis.

The first reading of the bill shall be dispensed with. All

points of order against consideration of the bill are waived.

General debate shall be confined to the bill and shall not

exceed one hour equally divided and controlled by the chair

and ranking minority member of the Committee on Energy and

Commerce. After general debate the bill shall be considered

for amendment under the five-minute rule. All points of order

against provisions in the bill are waived. At the conclusion

of consideration of the bill for amendment the Committee

shall rise and report the bill to the House with such

amendments as may have been adopted. The previous question

shall be considered as ordered on the bill and amendments

thereto to final passage without intervening motion except

one motion to recommit with or without instructions. If the

Committee of the Whole rises and reports that it has come to

no resolution on the bill, then on the next legislative day

the House shall, immediately after the third daily order of

business under clause 1 of rule XIV, resolve into the

Committee of the Whole for further consideration of the bill.

Sec. 6. Clause 1(c) of rule XIX shall not apply to the

consideration of H.R. 4501.

The Vote on the Previous Question: What It Really Means

This vote, the vote on whether to order the previous

question on a special rule, is not merely a procedural vote.

A vote against ordering the previous question is a vote

against the Republican majority agenda and a vote to allow

the Democratic minority to offer an alternative plan. It is a

vote about what the House should be debating.

Mr. Clarence Cannon's Precedents of the House of

Representatives (VI, 308-311), describes the vote on the

previous question on the rule as ``a motion to direct or

control the consideration of the subject before the House

being made by the Member in charge.'' To defeat the previous

question is to give the opposition a chance to decide the

subject before the House. Cannon cites the Speaker's ruling

of January 13, 1920, to the effect that ``the refusal of the

House to sustain the demand for the previous question passes

the control of the resolution to the opposition'' in order to

offer an amendment. On March 15, 1909, a member of the

majority party offered a rule resolution. The House defeated

the previous question and a member of the opposition rose to

a parliamentary inquiry, asking who was entitled to

recognition. Speaker Joseph G. Cannon (R-Illinois) said:

``The previous question having been refused, the gentleman

from New York, Mr. Fitzgerald, who had asked the gentleman to

yield to him for an amendment, is entitled to the first

recognition.''

The Republican majority may say ``the vote on the previous

question is simply a vote on whether to proceed to an

immediate vote on adopting the resolution . . . [and] has no

substantive legislative or policy implications whatsoever.''

But that is not what they have always said. Listen to the

Republican Leadership Manual on the Legislative Process in

the United States House of Representatives, (6th edition,

page 135). Here's how the Republicans describe the previous

question vote in their own manual: ``Although it is generally

not possible to amend the rule because the majority Member

controlling the time will not yield for the purpose of

offering an amendment, the same result may be achieved by

voting down the previous question on the rule. . . . When the

motion for the previous question is defeated, control of the

time passes to the Member who led the opposition to ordering

the previous question. That Member, because he then controls

the time, may offer an amendment to the rule, or yield for

the purpose of amendment.''

In Deschler's Procedure in the U.S. House of

Representatives, the subchapter titled ``Amending Special

Rules'' states: ``a refusal to order the previous question on

such a rule [a special rule reported from the Committee on

Rules] opens the resolution to amendment and further

debate.'' (Chapter 21, section 21.2) Section 21.3 continues:

``Upon rejection of the motion for the previous question on a

resolution reported from the Committee on Rules, control

shifts to the Member leading the opposition to the previous

question, who may offer a proper amendment or motion and who

controls the time for debate thereon.''

Clearly, the vote on the previous question on a rule does

have substantive policy implications. It is one of the only

available tools for those who oppose the Republican

majority's agenda and allows those with alternative views the

opportunity to offer an alternative plan.

Mr. Speaker, I yield back the balance of my time, and I move the previous question on the resolution.

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

(Mr. McGOVERN asked and was given permission to revise and extend his remarks.)

Mr. Speaker, I thank the gentleman from Texas (Mr. Burgess) for yielding me the customary 30 minutes.

Mr. Speaker, my Republican colleagues are rushing to congratulate themselves for finally addressing opioid addiction. But, Mr. Speaker, what took them so long? This is an epidemic that fueled more drug overdoses in America in 2016 than died in the Vietnam war. In fact, opioids now kill more people every year than breast cancer. 115 Americans are dying from them every single day.

These statistics aren't new. They have been staring the Republicans in the face for months. The public has been pushing this Congress to act. Democrats have been pushing measure after measure after measure to address opioid addiction, but the majority has used their restrictive amendment process to block them from even getting a vote on the House floor.

More than a dozen amendments dealing with opioids have been blocked by the majority from even getting a debate. One of these amendments had bipartisan support, but it was blocked all the same.

This from a Republican majority that has already turned this Congress into the most closed Congress in history. Let me say that again. These guys, my Republican colleagues, have presided over the most closed Congress in history. There have already been 86 completely closed rules during the 115th Congress, and it is only June.

That number is expected to grow later this week as the majority considers their partisan immigration bills under a closed process.

Mr. Speaker, as well-intentioned as these bills may be, we aren't considering them in a vacuum. And here is the deal: We are taking them up at a time when Republicans are continuing their crusade against the Affordable Care Act, a law that has helped millions of Americans suffering from substance use disorders.

The Trump administration is refusing to defend the ACA. And get this: its Justice Department recently asked in a legal filing for the courts to invalidate this law's protections for preexisting conditions.

Mr. Speaker, does the majority realize that substance use disorders are a preexisting condition?

If Republicans are successful, they will make the opioid crisis even worse. And it doesn't stop there. Some conservative groups are pushing the majority to try repealing the ACA completely again before the summer is out.

This, after Republicans came within a few votes of taking healthcare from 23 million Americans last year, including those suffering from opioid addiction.

These rightwing groups released their latest repeal plan yesterday, so the words from my Republican friends today ring particularly hollow.

Mr. Speaker, we all know that the best answer to an epidemic is to get as many people as possible into treatment and to provide them and their families the support that they need. And one of the most effective ways to accomplish

this is to expand Medicaid and expand treatment options for substance abuse through the ACA.

Last October, the Republicans made clear what they think of the hundreds of thousands of Americans suffering from opioid addiction and alcohol and drug abuse. They passed a budget that makes $1.3 trillion in cuts to healthcare, including a 30 percent cut to Medicaid.

Mr. Speaker, Republicans can't bemoan the opioid epidemic on one hand and vote time and time again to cut the very healthcare systems required to treat addiction.

Nor can you set up a biased, tiered system that grants access to treatment for opioid addiction at the expense of providing treatment for addiction and abuse of other substances, like key provisions in H.R. 5797. Not only is that inhumane and immoral, but it is also ineffective. It undermines the entire health system of treating substance abuse.

Mr. Speaker, many Democrats have joined the majority in supporting one of these bills, H.R. 6, the SUPPORT for Patients and Communities Act. It is a good bill. It would help Medicare and Medicaid better respond to substance use disorders. We are working with the majority here.

So, Mr. Speaker, why won't they work with us to defend the ACA, preserve protections for preexisting conditions, and expand Medicaid.

Now, I know asking Congressional Republicans to show some empathy right now is a tall order. This is the group that has furthered President Trump's spin on family separations at the border, a policy he can change unilaterally, right now if he wanted to. I mean, children are being ripped out of their parents' arms in tears and kept in cages, warehouses, and tent cities. It is appalling and it is un-American.

You don't have to take my word for it. Republicans, like First Lady Laura Bush and Senator John McCain, have spoken out against it. And a U.S. attorney in Texas made clear it was President Trump's policy choice alone. And get this: This is a U.S. attorney who the President himself appointed.

But change is possible. Congressional Republicans can see the error of their ways. They can reject these calls for repeal. They can stop sitting idly by as President Trump attacks the Affordable Care Act. And they can start standing up for the 133 million Americans with preexisting conditions. That includes those suffering from addiction.

They could stop giving the President cover when he falsely claims that Democrats caused the chaos at the border that he clearly caused.

Stop playing with people's lives. We are talking about their healthcare. We are talking about getting treatment for addiction. For God's sake, we are talking about taking children out of the arms of their mothers. This isn't a handful of cases, it is thousands of cases. It is outrageous.

It is time for the adults in Congress, men and women of conscience, to stand up for what is right, not only on the opioid crisis, but on so many other important issues facing this country. I hope the majority comes to its senses before it is too late.

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

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

Just let me remind my colleagues again, because I think it is worth emphasizing, that no matter what we do in the next couple of days with these bills that are going to be before the House, they are rendered meaningless if the Republicans continue in their effort to cut Medicaid and to take away protections for people with preexisting conditions.

Substance use disorder is a preexisting condition and Republicans, working with the White House, are trying to eliminate that protection for people. I don't get it. It doesn't make sense. But we ought to make sure that we keep this debate in context and people know what is going on out there.

Mr. Speaker, I yield 6 minutes to the gentlewoman from California (Ms. Matsui).

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

Mr. Speaker, again, none of what we are doing here today is going to matter if the Republicans and the Trump administration are successful in cutting Medicaid and in basically removing the guarantee that people who have preexisting conditions cannot be denied insurance.

I mean, if the Trump administration is successful, individuals with preexisting conditions all across the country, including individuals suffering from opioid use disorders, both in the individual and in the employer market, could face a denial of coverage or skyrocketing premiums beyond anything anybody could afford.

I don't get it. I don't understand the hypocrisy here. I know that the efforts here today are well intentioned and people are trying to do the right thing, but then you ruin it all when you gut the funding sources that help people deal with the treatment they need.

This has to stop.

I know some of my friends have ideological blinders on when it comes to anything that was passed during the Obama administration, but we have got to put the American people first, and this is a crisis that affects every single community in this country. If this administration is successful in what they are trying to do to undercut the ACA, then countless people will not have access to healthcare and will not have access to the treatment they need.

Mr. Speaker, our Nation is in the midst of a devastating opioid crisis that is spiraling out of control. Every day, more than 115 people in the United States die after overdosing on opioids, according to the National Institute on Drug Abuse. The Centers for Disease Control and Prevention has also found that opioids are responsible for 6 out of 10 overdose deaths in the United States.

The American people are in desperate need of strong action by Congress to stem the tide of the opioid scourge. We need serious public investment to quell this exploding crisis, not just legislation on the peripherals. We must direct resources to the States and local communities on the front lines of this devastating public health crisis where assistance is needed the most.

Mr. Speaker, I am going to ask my colleagues to defeat the previous question, and if we do, I will offer an amendment to bring up Representative Loebsack's legislation, H.R. 4501, the Combating the Opioid Epidemic Act. This bill would provide badly needed funding for State grants for the prevention, detection, surveillance, and treatment of opioid abuse.

Mr. Speaker, I ask unanimous consent to insert the text of my amendment in the Record, along with extraneous material, immediately prior to the vote on the previous question.

Mr. Speaker, I yield 3 minutes to the gentleman from California (Mr. Ruiz).

Mr. Speaker, I yield an additional 2 minutes to the gentleman from California.

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

Mr. Speaker, today, we are on the floor discussing the opioid crisis. This is an epidemic that is plaguing every community in the country, and it is killing 115 people every single day. It is heartbreaking, and, quite frankly, I am ashamed it is taking Congress so long to act.

I would again point out that anything we do in the next few days and anything we have done gets erased if the Republicans succeed in cutting Medicaid and if the President succeeds in basically eliminating protections for people with preexisting conditions.

But, Mr. Speaker, I think it is also important that people know there is a lot of stuff going on this week, and we are also awaiting word from the House Republicans when the Rules Committee will have an emergency meeting, I guess today, on two immigration bills that were posted after 9 p.m. last night.

These bills were drafted without any Democratic input, and from what we can tell, they are dangerous and they are certainly not a comprehensive solution to immigration reform. They harm children, and they leave many Dreamers behind.

This is not what our constituents want us to do. They want the President to do what he could easily do and stop separating children from their parents.

The President says that he wants Democrats to come to the table, but we never get invited to anything. I tried to go and see the President yesterday when the Republicans were meeting with him, but I was not allowed to go into the room.

I tried to shout at the President as he was walking by, but he was quickly escorted by. I wanted to show him the pictures on the border of these young children who are being taken away from their parents.

The President continues to spread mistruths about immigration and practically every other issue that is before this Congress and before this Nation, and it seems just to be getting worse.

There are such things as facts. There are such things as truth.

Yesterday, The Washington Post published an article, entitled: ``President Trump Seems to be Saying More and More Things That Aren't True.'' Well, I would like to take a few minutes to read this article, because these aren't my words, Mr. Speaker. They are the words of The Washington Post, specifically, Ashley Parker, who wrote the piece.

If the President is watching, I think it is helpful for me to read because I know he doesn't read, so maybe he can hear this.

``He's done it on Twitter. He's done it in the White House driveway. And he's done it in a speech to a business group.

``President Trump, a man already known for trafficking in mistruths and even outright lies--has been outdoing himself with falsehoods in recent days, repeating and amplifying bogus claims on several of the most pressing controversies facing his Presidency.

``Since Saturday, Trump has tweeted false or misleading information at least seven times on the topic of immigration and at least six times on a Justice Department inspector general report into the FBI's handling of its investigation into Hillary Clinton's private email server. That is more than a

dozen obfuscations on just two central topics--a figure that does not include falsehoods on other issues, whether in tweets or public remarks.

``The false claims come as the President--emboldened by fewer disciplinarians inside the West Wing--indulges in frequent Twitter screeds. A Washington Post analysis found that in June, Trump has been tweeting at the fastest rate of his Presidency so far, an average of 11.3 messages per day.

``Inside the White House, aides and advisers say they believe the media is unwilling to give Trump a fair shot and is knee-jerk ready to accuse him of lying, even in cases where the facts support his point.

``The President often seeks to paint a self-serving and self- affirming alternate reality for himself and his supporters. Disparaging the `fake news' media, Trump offers his own filter through which to view the world--offering a competing reality on issues including relationships forged (or broken) at the Group of Seven summit in Canada, the success of the Singapore summit with the North Koreans, and his administration's `zero tolerance' policy on illegal immigration.

`` `It's extraordinary how he is completely indifferent to the truth. There's just no relationship between his statements--anything he utters--and the actual truth of the matter,' said Thomas Murray, president emeritus of the Hastings Center, the founding institution in the field of bioethics. `As far as I can tell, the best way to understand anything he says is what will best serve his interests in the moment. It's irrespective to any version of the truth.'

``According to an analysis by The Post's Fact Checker through the end of May, Trump has made 3,251 false or misleading claims in 497 days, an average of 6.5 such claims per day of his Presidency.''

``And within the past week, Trump seems to have ramped up both the volume and the intensity of his false statements on two of the most prominent topics currently facing his administration: the hardline immigration policy that has led to the separation of thousands of children from their parents--which Trump erroneously blames on others-- and the 500-page inspector general report that he claims, incorrectly, exonerates him in special counsel Robert S. Mueller III's probe of Russian interference in the 2016 election.

``Bella DePaulo, a psychology researcher at the University of California Santa Barbara, said Trump's use of repetition is a particularly effective technique for convincing his supporters of the veracity of his false claims, in part because most people have a `truth bias' or an initial inclination to accept what others say as true.

`` `When liars repeat the same lie over and over again, they can get even more of an advantage, at least among those who want to believe them or are not all that motivated either way,' DePaulo said in an email. `So when people hear the same lies over and over again-- especially when they want to believe those lies--a kind of new reality can be created. What they've heard starts to seem like it is just obvious, and not something that needs to be questioned.'

``On immigration, Trump and many top administration officials have said that existing U.S. laws and court rulings have given them no choice but to separate families trying to cross illegally into the United States. But it is the administration's decision, announced in April, to prosecute all southern border crossings that has led to the separation of families.

``That hasn't stopped the President from blaming Democrats for his administration's decisions. `Democrats are the problem,' Trump wrote in one tweet. In another, he was even more blunt: `The Democrats are forcing the breakup of families at the border with their horrible and cruel legislative agenda. . . .' ''

Mr. Speaker, let me divert a little bit here. The truth is that the President caused this crisis, and it is not just me saying it and The Washington Post saying it. Listen to what some of the Republicans have said, Lindsey Graham said: ``President Trump could stop this policy with a phone call. I'll go tell him: If you don't like families being separated, you can tell DHS, `Stop doing it.' ''

Senator John McCain: ``The administration's current family separation policy is an affront to the decency of the American people, and contrary to principles and values upon which our Nation was founded. The administration has the power to rescind this policy. It should do so now.''

Senator Susan Collins, former First Lady Laura Bush--and I can go on and on and on--a whole bunch of Republicans now are all agreeing with us that the President is not telling us the truth.

So let me go back to the article: ``While Congress could pass a legislative fix, Republicans control both the House and the Senate-- making it disingenuous at best to finger the opposing party, as the President has repeatedly done.

``Speaking to the National Federation of Independent Business on Tuesday, Trump again falsely painted the humanitarian crisis as a binary choice. `We can either release all illegal immigrant families and minors who show up at the border from Central America, or we can arrest the adults for the Federal crime of illegal entry,' he said. `Those are the only two options.'

``On Twitter, the President twice in the past 4 days has singled out Germany as facing an increase in crime. `Crime in Germany is up 10 percent-plus (officials do not want to report these crimes) since migrants were accepted,' Trump wrote. `Others countries are even worse. Be smart, America.' ''

That is his tweet.

``In fact, the opposite is true. Reported crime in Germany was actually down by 10 percent last year and, according to German Interior Minister . . . the country's reported crime rate last year was actually at its lowest point in three decades.

``The President has also falsely claimed that the inspector general report `exonerated' him from Mueller's probe, when the report did not delve into the Russia investigation. When he made this argument Friday during an impromptu press gaggle in the White House driveway, a reporter pressed him on the falsehood.

`` `Sir, that has nothing to do with collusion,' the reporter said. `Why are you lying about it, sir?' ''

The bottom line, Mr. Speaker, is, we have a President who has a problem with the truth, and Congress needs to stand up and do the right thing. We need to speak the truth; we need to embrace the truth; and we need to solve some of the issues that are before the American people.

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

Mr. Speaker, on that I demand the yeas and nays.

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

Mr. Chair, I stand in opposition to H.R. 5797, the IMD CARE Act.

I think we all agree that we need all the tools available to us to address the opioid crisis. Inpatient treatment centers that focus on the treatment of behavioral health needs of patients with substance use disorder are part of that. Congress must do what we can to ease access to care.

But I believe this legislation, as drafted, is misguided. It is also counterproductive and an ineffective use of scarce Medicaid dollars. But more importantly, it may undermine the ongoing efforts to improve the full continuum of care for people with substance use disorders.

This policy spends more than $1 billion in Medicaid to pay for a policy that is far narrower in both scope and flexibility than what many of our States already have and any State could do through Medicaid substance use disorder waivers.

In addition, as countless data has indicated, there are many gaps in treatment for Medicaid beneficiaries with substance use disorder. Yet this bill does nothing to incentivize States to provide the full continuum of care.

Community-based services are necessary for both people not treated in residential inpatient facilities and also for people who leave residential inpatient treatment and need community-based services to continue their treatment and recovery.

We already face a shortage of community-based care for substance use disorder and should be working with States to increase this capacity. Yet this bill doesn't tie Federal funds for IMD care to improvements in community-based services. Without that connection, States simply will not pursue these needed improvements.

Without incentives to improve access to treatment more broadly, repealing the IMD exclusion to only a narrow population--in this case, opioid use--through legislation may simply encourage greater use of expensive inpatient treatment, including for people for whom it may not be the best option.

We can't push a system where people cycle in and out of institutions. People with substance use disorders need a range of supports to stay well and sober long term, not just a limited stay in an IMD.

Existing guidance from both the Obama and Trump administrations allows States to waive the IMD exclusions if the States also take steps to ensure that people with substance use disorder have access to other care they need, including preventive, treatment and recovery services.

So far, there are 22 States, Mr. Chair, that have waivers approved or pending before the administration. I think these waivers are important to support.

My home State of New Jersey has approval for a waiver right now. Under that waiver, they expanded access to all substance use disorder services in their Medicaid program. We should build on that policy, which emphasizes the full continuum of care, with any bills that repeal the IMD exclusion.

In addition, I have concerns about creating a system in States whereby only some of our Medicaid beneficiaries with substance use disorder have access to the full continuum of care they need.

This bill specifically limits residential treatment to adults with opioid use disorders, with the possible addition of an amendment for cocaine use disorders. But it doesn't help the overwhelming majority of individuals with other substance use disorders, such as alcohol, which is far more commonly abused.

Treatment for substance use disorder, especially in the midst of our opioid crisis, must include a comprehensive approach that addresses the entirety of a patient's medical and psychological conditions. This legislation creates a perverse incentive toward individuals reporting opioid abuse or going out and getting addicted to opioids, for instance, in the hopes of gaining access to the treatment they need.

Expanding access to inpatient residential treatment in a vacuum I think would undermine State efforts to ensure the availability of substance use disorder treatment that meets the needs of all patients in the most appropriate environment.

In the short time this legislation has been publicly available, countless stakeholders have weighed in vehemently on particulars of this bill, echoing my concerns today. In fact, coalitions with more than 300 groups as well as other mental health, substance use, and disability groups have sent letters in opposition. I think we need to work with stakeholders. This issue is too important to get wrong.

For these reasons, Mr. Chair, I oppose H.R. 5797. I urge my colleagues to vote ``no,'' and I reserve the balance of my time.

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

Mr. Chair, I want to speak briefly on a point that I think is being lost here.

This bill presumes that expanding access to residential treatment is the answer, and it is not necessarily. Without any requirement that States address gaps in Medicaid community-based services, I think there is a possibility that we risk more harm than good.

The former director of national drug control policy has reminded us that most of these IMD facilities provide detoxification services. But detoxification is only the first stage of addiction treatment. Indeed, it may increase the potential for overdose if patients do not remain or have any support when released, since, with detoxification, their tolerance for opioids is significantly reduced.

The proposal before the House will likely create an overreliance on institutional treatment and may exacerbate

the dearth of community-based health services.

People with substance use disorder often find themselves unable to access intensive community-based behavioral health services when they need it. Likewise, many cannot access services in the community when they are discharged following a crisis.

Incentivizing inpatient care may actually increase opioid overdose, the very harm that Congress is seeking to prevent. Experts have raised serious concerns with this bill's institutional focus because recent data suggests that inpatient detoxification is an important predictor of overdose, largely because many who receive inpatient care aren't then connected to community-based treatment programs or put on medication, leaving them extremely vulnerable.

Again, I am concerned that we may be contributing to this crisis with this legislation.

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

Mr. Chair, I yield myself the balance of my time.

Mr. Chair, in closing and in urging opposition to this bill from my colleagues, the reason the IMD exclusion was put in place in the beginning was because of the fear that people who had overdosed, who had opiate problems, would be put into institutions, if you will, and then throw away the key. In other words, they put them in there, maybe they get detoxed, and then they come out. But without any treatment or any followup, community-based treatment, they would just go back to the same thing again; they would overdose again and end up back in the facility.

So the fear was that we would have these large facilities where they go in and, without any kind of continuum of care, the cycle just keeps repeating itself. I just want my colleagues to be mindful of that.

What happened was, during the Obama administration, States had asked for waivers from the IMD exclusion, and the Obama administration decided they would do that if they provided a continuum of care and community-based services so that the problem that led to the IMD exclusion would not repeat itself.

I guess my fear is, today, that this seems like such a simple solution: Okay. We will get rid of the 16-bed exclusion because we need people to go into these institutions.

However, since we are not providing any continuum of care or community care in eliminating this exclusion, it goes back to the same problem, which is we don't want people to just be warehoused to detox, come out again, overdose again, and go back in without any kind of community services.

That is why I am making the argument that the actual waivers that exist now, which I think almost half of the States have, is a much better alternative than just lifting and getting rid of the exclusion. That is why I believe that this bill is misplaced and why I would urge my colleagues to oppose it, because I think it may actually go back to the days where we were just warehousing people and we are not actually giving them the kind of treatment that they need.

Mr. Chair, I would urge my colleagues to vote against the bill, and I yield back the balance of my time.

Mr. Chairman, I thank the chairman for yielding.

Mr. Chairman, I support Mr. Rush's amendment, but I remain in strong opposition to the underlying bill. I support my colleague's, Mr. Rush's, work to add cocaine use disorder.

As Mr. Rush noted in our committee, cocaine use claims more African American lives than opioid use and has been a larger problem than opioid use disorder for more than 20 years, yet incarceration, not treatment, is far too often the response.

Unfortunately, adding a single additional drug does not make this legislation whole. Nearly half of all States already reimburse for IMDs for all individuals with substance use disorder. We can and should build on that policy and strengthen the full continuum of care with any IMD policy this body passes.

There is no good reason, policy or otherwise, for us to leave the overwhelming majority of Medicaid beneficiaries out in the cold because they have the misfortunate to be addicted to, for instance, alcohol or meth instead of cocaine or opioids.

So, again, I support the amendment, but I remain in strong opposition to the underlying bill.

Mr. Chairman, I thank the gentlewoman for yielding.

Mr. Chairman, I support my colleague's, Representative Kildee's, amendment to this legislation. It is certainly important to require States to report information on individuals with co-occurring disorders and what disorders are suffered, and it is equally important to have information on access to community care for individuals suffering from a behavioral health issue other than a substance use disorder.

Mr. Chairman, I want to stress that this information is important, but the underlying problem with the IMD CARE Act continues. I believe this bill is, at best, an ineffective use of scarce Medicaid dollars. More importantly, it may undermine ongoing efforts to improve the full continuum of care for people with substance use disorders.

Mr. Speaker, I ask unanimous consent that all Members may have 5 legislative days to revise and extend their remarks and to include extraneous material on the bill, H.R. 5797.

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

Mr. Chairman, the opioid epidemic is ravaging this Nation. Families have been torn apart; lives have been destroyed; and communities are endangered.

This crisis does not discriminate. Americans from all walks of life in all 50 States are being held hostage by the scourge of opioids.

Tragically, the opioid epidemic claims the lives of 115 Americans on average each day. In my home of Orange County, California, 361 people died from opioid overdoses in 2015. That accounts for a 50 percent increase in overdose deaths since 2006.

According to the OC Health Care Agency's 2017 ``Opioid Overdose and Death in Orange County'' report, the rate of opioid-related emergency room visits increased by more than 140 percent since 2005. Between 2011 and 2015, Orange County emergency rooms treated nearly 7,500 opioid overdose and abuse cases.

We can put an end to these tragic statistics by providing full access to various treatment options to those seeking help with their addictions. While many of these patients may benefit from outpatient help, others need highly specialized inpatient treatment to ensure they are receiving the most clinically appropriate care.

The IMD CARE Act will increase access to care for certain Medicaid beneficiaries with opioid use disorder who need the most intensive care possible: inpatient care.

Current law prohibits the Federal Government from providing Federal Medicaid matching funds to States to provide mental disease care to Medicaid-eligible patients aged 21 to 64 in facilities defined as institutes of mental diseases, commonly known as IMDs. This IMD exclusion means that Federal dollars may not be provided for the care of Medicaid-eligible patients in this age group for substance use disorder treatments at hospitals, nursing facilities, or other institutions with more than 16 beds.

It is time to repeal the IMD exclusion and remove this outdated barrier to inpatient treatment. The IMD CARE Act would allow States to repeal for 5 years the IMD exclusion for adult Medicaid beneficiaries who have an opioid use disorder, which includes heroin and fentanyl.

These beneficiaries would receive treatment in an IMD for up to 30 days over a 12-month period, during which time the beneficiary would be regularly assessed to ensure their treatment and health needs require inpatient care. The bill would also require the IMD to develop an outpatient plan for the individual's ongoing treatment upon discharge.

Throughout the Energy and Commerce Committee's work on the opioid crisis, the IMD exclusion is consistently identified as a significant barrier to care for Medicaid patients. Not every patient needs treatment in an IMD, but those who do are often among the most vulnerable. What once was a well-intended exclusion on Federal Medicaid spending has since prevented individuals from seeking treatment.

In the light of the opioid epidemic, I believe my legislation strikes the right balance. I know some have suggested States continue to seek CMS waivers to allow Medicaid to pay for IMD care. Waivers can be a good option for some States, but not all States want a waiver. In fact, less than half of the States have applied for a waiver. Additionally, a waiver can take a substantial amount of time to develop, review, and approve.

We are losing too many friends and family members to force States to navigate a lengthy and uncertain waiver process. The IMD CARE Act allows

States to act now to ensure patients who are suffering from addiction get the care they need.

The National Governors Association and the American Hospital Association have endorsed this legislation. Other organizations, such as the National Association of State Medicaid Directors and the National Association of State Mental Health Directors, have supported the idea of Congress addressing the IMD.

While the repeal of the IMD exclusion would increase mandatory outlays and add costs to the Medicaid system, the IMD CARE Act is fully paid for by curbing unnecessary Federal and State Medicaid outlays.

I want to thank Chairman Walden and my colleagues on the House Energy and Commerce Committee for their support of this bill, which will provide much needed care to Americans suffering from opioid use disorder. Through the IMD CARE Act, Congress has a unique opportunity to remove a barrier to care and bring specialized treatment to Medicaid patients who desperately need it.

Mr. Chairman, I urge all Members to support this important bill today, and I reserve the balance of my time.

Mr. Chairman, I yield 3 minutes to the gentleman from Texas (Mr. Burgess).

Mr. Chair, I yield 5 minutes to the gentleman from Oregon (Mr. Walden), chairman of the Committee on Energy and Commerce.

Mr. Chair, I yield myself the balance of my time.

Mr. Chair, the opioid crisis requires us to act now. The IMD exclusion is consistently identified as a significant barrier to care by State Medicaid directors and numerous other stakeholder groups. We need to pass this bill in order to increase access to acute, short-term inpatient treatment. I urge my colleagues to support this bill and help individuals suffering with opioid addiction.

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

Mr. Chairman, I claim the time in opposition, but I am not opposed to the amendment.

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

Mr. Chairman, I thank the gentleman from Michigan (Mr. Kildee), my colleague, for offering this amendment to H.R. 5797.

This amendment seeks to add several components to a State report that is included in H.R. 5797. I appreciate Mr. Kildee's work on this amendment. I think that this information would be valuable, and I am happy to accept the amendment. However, I want to note that we will need to talk to States about the information this amendment would have, and then report. Changes may have to be made, depending on that feedback.

I am committed to working out the technical details of the amendment as we move into conference.

Mr. Chairman, I yield to the gentleman from New Jersey (Mr. Pallone).

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

Mr. Speaker, I withdraw my point of order.

Mr. Speaker, I claim the time in opposition to the motion.

Mr. Speaker, the Energy and Commerce Committee has worked hard to make this monumental first step in removing a decades-old barrier.

Currently the law prohibits Medicaid beneficiaries aged 21 to 64 from receiving care in an institution for mental disease, or IMD. This prohibition was set into law in the 1960s, long before the opioid crisis, and the time to repeal it in a targeted manner is now.

Now is the time, because 115 Americans are dying each day from opioid-related deaths. Now is the time, because

on average, 1,000 people are treated in emergency rooms for opioid misuse.

I am happy to work with my colleagues on expanding addiction treatment services, but that should not distract from what we are considering today: increasing access to specialized inpatient treatment for the most vulnerable in society who are struggling with an opioid addiction.

We are helping to ensure that people get the care they need in the midst of this crisis, and most importantly, it will save lives.

A recent MACPAC report clearly stated that the Medicaid IMD exclusion acts as a barrier for individuals with an opioid use disorder and is one of the few instances in Medicaid where Federal financial participation cannot be used for medically necessary and otherwise covered services for a specific Medicaid enrollee population receiving treatment in a specific setting.

The IMD CARE Act is vital to helping our communities end the opioid epidemic by removing that barrier. This bill provides for a targeted repeal of the IMD prohibition. The bill gives States a quicker alternative than Medicaid waivers to provide this much needed care. This bill was carefully crafted to ensure that patients are not being held in IMDs for longer than necessary and the bill also includes an offset.

For these reasons, the National Governors Association and the American Hospital Association support the bill.

Numerous stakeholder groups have identified the IMD exclusion repeal as one of the most significant reforms we can make to end the opioid crisis.

This is such a critical first step.

Mr. Speaker, I urge my colleagues to oppose this motion to recommit and to vote ``yes'' on final passage.

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

Mr. Chair, I want to thank my colleague Mimi Walters and those who have worked so closely with her on this really, really important legislation. That is why I am here to support it, H.R. 5797, the IMD CARE Act.

This is really commonsense legislation, and it will make a meaningful change to the way Medicaid covers opioid use disorder for its beneficiaries. In other words, low-income people in America who get their medical assistance through Medicaid are going to get another option and more help to deal with their addiction.

We are discussing this bill because a severely outdated policy limits Medicaid's coverage in an institution for mental disease--that is what an IMD is, institution for mental disease--for just 30 days. It is old. It is antiquated. It doesn't work with today's treatment regimens.

This exclusion has been in place for decades--decades--certainly long before the opioid crisis ever hit our country, and it is now a barrier to critical care for low-income people on Medicaid when this vulnerable population needs help with their addiction the most.

Representative Walters' thoughtful bill will allow State Medicaid programs, from 2019 through 2023, to remove this antiquated Federal barrier to treatment for those on Medicaid, age 21 to 64, with an opioid use disorder, through a State plan amendment. In doing so, Medicaid would pay for up to 30 total days of a beneficiary's care in an IMD during a 12-month period, year.

So this is limited in scope. It is in partnership with the States. It is low-income people getting more help from Medicaid to pay for this extraordinarily important treatment.

This bill also collects much-needed data on the process. After taking up this option, States will have to report on the number of individuals with opioid use disorder under this plan, their length of stay, and the type of treatment received upon discharge. This will help inform better programs down the line.

As a Congress, we have been focused on combating the opioid crisis for quite some time. This is not our first legislative attempt to help people not only avoid this addiction, but overcome it. It will not be our last. We will legislate; we will evaluate; we will legislate; we will evaluate, as Republicans and Democrats have been doing for some time.

It is an important step, this bill, that can help get people a vital treatment to which they now don't have access. The American Hospital Association, the National Governors Association, Republicans and Democrats, hospitals and Governors across the country, have said: Please do this. This is a need that is unmet. Please help us change this antiquated Federal law.

Many stakeholder groups, including the National Association of State Medicaid Directors, the people who run the Medicaid programs in States; the National Association of State Mental Health Program Directors, the people who know what is needed most to overcome these situations; and many others have talked to us in the committee. They have talked to me personally. They are pleading with Congress to get rid of this barrier to care, this outdated law, and to help people get treatment, especially the low-income among us.

We have an opportunity to deliver, to help. We have an opportunity to save lives. It is our responsibility, and we need to pass this legislation.

Mr. Chair, I commend the gentlewoman from California for bringing this issue to the committee and shepherding it through. It is so important to pass this legislation. Let's help these people get the care they need and want.

Mr. Chair, I claim the time in opposition to the amendment, though I am not opposed to the amendment.

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

Mr. Chair, I rise today in support of the Rush amendment to H.R. 5797, the IMD CARE Act. Earlier today, I spoke in support of the underlying bill. It will make a meaningful change to the way Medicaid covers opioid use disorder for its beneficiaries.

The amendment offered by my friend and colleague from Illinois, Representative Bobby Rush, will expand on that definition. It will allow Medicaid to provide coverage for individuals seeking treatment from cocaine and crack cocaine usage.

Looking at just 2016, opioids and cocaine caused 82 percent of all drug overdose deaths in the United States. Cocaine alone kills more than 10,000 Americans a year. News outlets have also reported fentanyl being mixed in with cocaine, further complicating this tragic opioid crisis.

This is an issue that Mr. Rush has passionately led on in the committee, on the floor, and at home in his community.

We discussed it in the hearing room and at length in private while working to fine-tune this legislation so that the best possible version can become law.

So I want to thank Mr. Rush for this amendment, and I want people to know that it really will improve and expand the scope of this bill.

Mr. Chairman, I urge my colleagues to adopt this amendment and support the underlying bill, which will dramatically aid in our response to the opioid epidemic for all Americans, wherever they live.

Mr. Chairman, how much time do I have remaining?

Mr. Chairman, I yield 1 minute to the gentleman from New Jersey (Mr. Pallone), the ranking Democrat on the committee.

Mr. Chairman, I conclude my comments by expressing my disappointment that I have yet to persuade my friend from New Jersey to support the underlying bill, although I appreciate his support of the Rush amendment.

We know that our Governors, we know that our State Medicaid directors, and we know those most involved in helping those with addiction have pled with us to change this antiquated law so that people of all colors, of all backgrounds, from anywhere in this country, especially the low-income, can get access to meaningful, modern, and helpful assistance to overcome their addiction. That is what this bill does.

Mr. Chairman, I encourage my colleagues to support the amendment, and I encourage them to support the underlying bill.

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

Mr. Chair, I thank Mr. Fitzpatrick and his team for agreeing to work with us on this issue. Unfortunately, this well- thought-out amendment would significantly alter the quality standards we have built into the base bill, and such a change would require more substantial vetting with key stakeholders than we have time for at this point.

Because of that, we are not in position of being able to accept the amendment at this time. However, we do feel that Mr. Fitzpatrick has made a good start, so I will have our team do a comprehensive vetting of the language and work with stakeholders to see if this is something we could add as we move into conference with the Senate.

Mr. Chair, I thank the gentleman for his work and I look forward to continuing to work with him on this and other issues and with the Senate as we continue work on this legislation.