Recognizing Early Childhood Trauma Related to Substance Abuse Act of 2018

Mr. Speaker, I move to suspend the rules and agree to the resolution (H. Res. 1099) providing for the concurrence by the House in the Senate amendment to H.R. 6, with an amendment.

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 material in the Record on the resolution.

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

I have dozens and dozens of letters of support for this legislation; 90 or 100 different letters of support from different groups, 124 names, it looks like, that I will include in the Record.

Statements and Letters of Support from:

U.S. Chamber--Key Vote Alert, American Society of Addiction

Medicine--Statement, Advocates for Opioid Recovery--advocacy

e-mail, Corporate Health Care Coalition--support letter,

First Focus Campaign for Children--statement, National

Association for Behavioral Healthcare--Statement, National

Association of Community Health Centers--Letter, Catholic

Health Association--Letter, American Benefits Council--

Letter, A Coalition letter signed by 124 addiction advocacy

groups:

1. A New PATH, San Diego, California

2. Addiction Policy Forum

3. AIDS United

4. Alabama, Addiction Policy Forum

5. Alaska, Addiction Policy Forum

6. American Correctional Association

7. Arizona, Addiction Policy Forum

8. Association of Prosecuting Attorneys

9. Beyond Addiction Ministry, WI

10. Brave Health

11. CADA of Northwest Louisiana

12. California Consortium of Addiction Programs &

Professionals (CCAPP)

13. California, Addiction Policy Forum

14. Campaign for Youth Justice

15. Caron Treatment Centers

16. CFC Loud N Clear Foundation, Farmingdale, New Jersey

17. Chicago Recovering Communities Coalition, Chicago,

Illinois

18. Colorado, Addiction Policy Forum

19. Community Anti-Drug Coalitions of America (CADCA)

20. Connecticut Certification Board

21. Connecticut Community for Addiction Recovery (CCAR),

Hartford, Connecticut

22. Connecticut, Addiction Policy Forum

23. COPES

24. DarJune Recovery Support Services & Cafe, Green Bay,

Wisconsin

25. Delaware, Addiction Policy Forum

26. Delphi Behavioral Health Group

27. DisposeRx

28. El Paso Alliance, El Paso, Texas

29. Faces & Voices of Recovery

30. FAVOR Low Country, Charleston, South Carolina

31. FAVOR Tri-County, Rock Hill, South Carolina

32. FedCURE

33. Fellowship Foundation Recovery Community Organization,

Margate, Florida

34. Floridians for Recovery, West Palm Beach, Florida

35. Foundation for Recovery, Las Vegas, Nevada

36. Friends of Emmett

37. H.O.P.E.S. Forever

38. Healthcare Leadership Council

39. IC & RC

40. Idaho, Addiction Policy Forum

41. Illinois Association of Behavioral Health

42. Illinois, Addiction Policy Forum

43. Indiana, Addiction Policy Forum

44. Institute for Behavior and Health (IBH)

45. Iowa, Addiction Policy Forum

46. Jackson Area Recovery Community, Jackson, Michigan

47. Kansas, Addiction Policy Forum

48. Kentucky, Addiction Policy Forum

49. Kingston NH Lions Foundation

50. Lifehouse Recovery Connection, San Diego, California

51. Maine Alliance for Addiction Recovery, Augusta, Maine

52. Maine, Addiction Policy Forum

53. Maryland House Detox

54. Maryland, Addiction Policy Forum

55. Massachusetts, Addiction Policy Forum

56. Michigan, Addiction Policy Forum

57. Minnesota Recovery Connection, Minneapolis, Minnesota

58. Minnesota, Addiction Policy Forum

59. Missouri Recovery Network, Jefferson City, Missouri

60. Missouri, Addiction Policy Forum

61. Montana, Addiction Policy Forum

62. National Association of Social Workers (NASW)

63. National Prevention Science Coalition

64. National Safety Council

65. Navigate Recovery Gwinnett, Gwinnett County, Georgia

66. Navigating Recovery of the Lakes Region, Laconia, New

Hampshire

67. Nevada, Addiction Policy Forum

68. New Hampshire, Addiction Policy Forum

69. New Jersey, Addiction Policy Forum

70. New Mexico, Addiction Policy Forum

71. New York, Addiction Policy Forum

72. North Carolina, Addiction Policy Forum

73. North Dakota, Addiction Policy Forum

74. Ohio Citizen Advocates for Addiction Recovery,

Columbus, Ohio

75. Ohio, Addiction Policy Forum

76. Oklahoma, Addiction Policy Forum

77. Oregon, Addiction Policy Forum

78. PEER Wellness Center

79. PEER360 Recovery Alliance, Bay City, Michigan

80. Pennsylvania Recovery Organization, Achieving Community

Together (PRO-ACT), Philadelphia, Pennsylvania

81. Pennsylvania, Addiction Policy Forum

82. People Advocating Recovery, Louisville, Kentucky

83. Phoenix House Recovery Residences

84. PLR Athens, Athens, Georgia

85. Reality Check, Jaffrey, New Hampshire

86. Recover Wyoming, Cheyenne, Wyoming

87. Recovery Communities of North Carolina, Raleigh, North

Carolina

88. Recovery Community Connection, Williamsport,

Pennsylvania

89. Recovery Community of Durham, Durham, North Carolina

90. Recovery Data Solutions

91. Rhode Island, Addiction Policy Forum

92. ROCovery Fitness, Rochester, New York

93. Shatterproof

94. Smart Approaches to Marijuana Action (SAM Action)

95. SMART Recovery, Nationwide

96. Sobriety Matters

97. Solutions Recovery, Oshkosh, Wisconsin

98. South Dakota, Addiction Policy Forum

99. SpiritWorks Foundation, Williamsburg, Virginia

100. Springs Recovery Connection, Colorado Springs,

Colorado

101. Strengthening the Mid-Atlantic Region for Tomorrow

(SMART)

102. Tennessee, Addiction Policy Forum

103. Texas, Addiction Policy Forum

104. The DOOR--DeKalb Open Opportunity for Recovery,

Decatur, Georgia

105. The McShin Foundation, Richmond, Virginia

106. The Moyer Foundation

107. The Phoenix, Nationwide

108. The RASE Project, Harrisburg, Pennsylvania

109. The Solano Project, Fairfield, California

110. Treatment Communities of America

111. Trilogy Recovery Community, Walla Walla, Washington

112. Trust for America's Health

113. Utah, Addiction Policy Forum

114. Vermont, Addiction Policy Forum

115. Virginia, Addiction Policy Forum

116. Voices of Hope Lexington, Lexington, Kentucky

117. Voices of Recovery San Mateo County, San Mateo,

California

118. WAI-IAM, Inc. and RISE Recovery Community, Lansing,

Michigan

119. Washington, Addiction Policy Forum

120. Washtenaw Recovery Advocacy Project (WRAP), Ann Arbor,

Michigan

121. West Virginia, Addiction Policy Forum

122. Wisconsin Voices for Recovery, Madison, Wisconsin

123. Wisconsin, Addiction Policy Forum

124. Wyoming, Addiction Policy Forum

Mr. Speaker, I rise today in support of H.R. 6. This is the SUPPORT for Patients and Communities Act that your Energy and Commerce Committee has worked on diligently for nearly 2 years.

In my own case, in 10 roundtables throughout Oregon, I have heard from everyday people on the frontlines of this fight in our communities. They are the victims. They are the families. They are medical providers and treatment advocates. They are local law enforcement, and they are first responders. They are our neighbors. They are our loved ones.

Each of these people puts a name and a face to what I would say is the worst drug epidemic we have seen in America, the opioid crisis.

I have heard from Oregon families, I have heard from Mike and Winnie, from Grants Pass, who have seen their loved one struggle with addiction. Mike's sister who died, she was a nurse, became addicted, and overdosed. He told me that at a townhall in a community forum. Their son struggles with his addiction to this day from a sports injury starting with opioids, ending with heroin.

We will never know what could have become of the 72,000 Americans who died last year.

Every 24 hours, 1,000 people go to emergency rooms overdosing from opioids. Roughly 115 die.

I heard it from Paula, whose two sons and stepson struggle with their opioid addiction today.

As a parent, I can only imagine what parents of children with opioid addiction must feel every time the phone rings. They think it may be that call.

For the millions of people currently struggling with addiction, please know, don't give up. It is never too late to seek help. We stand with you.

Mr. Speaker, this legislation is a product of months of bipartisan, bicameral work, eight House committees involved, I think probably every Member of this House, five Senate committees, dozen and dozens of Members of Congress.

And the faces that we came to know are the parents and the children whom they lost, Amanda Beatrice Gray being one of them, a beautiful young woman, talented, struggling with her issues, overdosed on heroin heavily laced with fentanyl.

We are here for them, Mr. Speaker. We are here for our neighbors, for our

loved ones, who deal with this crisis every day of their life, and in the great joined cause of those who lost.

Mr. Speaker, because we are going to hear from a lot of our Members who have put so much work into this, I reserve the balance of my time.

Mr. Speaker, I am honored to yield 1 minute to the gentleman from Texas (Mr. Brady), the distinguished and talented chairman of the House Ways and Means Committee.

Mr. Speaker, I yield 30 seconds to the gentlewoman from Indiana (Mrs. Brooks), and concur in my colleague's comments in praise of the staff that we worked with to get this done. The gentlewoman has been a real leader.

Mr. Speaker, it is my great honor and high privilege to yield 1 minute to the gentleman from Wisconsin (Mr. Ryan), the Speaker of the House and my dear friend and classmate from the class of `98.

Mr. Speaker, I yield 1 minute to the distinguished gentleman from Texas (Mr. Burgess). The country is well served by his chairmanship of the Subcommittee on Health.

Mr. Speaker, it is now my privilege to yield 30 seconds to the gentleman from Ohio (Mr. Latta), the very effective chairman of our Digital Commerce and Consumer Protection Subcommittee.

Mr. Speaker, I am privileged to yield 30 seconds to the gentleman from New Jersey (Mr. Lance).

Mr. Speaker, I am privileged to yield 30 seconds to the gentleman from Kentucky (Mr. Guthrie).

Mr. Speaker, I yield 30 seconds to the gentleman from Florida (Mr. Bilirakis) to speak about the legislation.

Mr. Speaker, I yield 30 seconds to the gentleman from Ohio (Mr. Johnson), who is a leader on this issue.

Mr. Speaker, I yield 30 seconds to the gentleman from Indiana (Mr. Bucshon), who is a talented physician on our committee.

Mr. BUCSHON: Mr. Speaker, I rise today in support of H.R. 6, the SUPPORT for Patients and Communities Act.

This bipartisan bill will help our struggling communities to combat the opioid epidemic by increasing access and improving care to those in need and preventing new occurrences of opioid misuse and abuse.

Section 2002, which I authored, would provide screening for chronic pain, address possible non-opioid pain alternatives, and increase early detection of opioid use disorder in seniors as they enter Medicare.

Mr. Speaker, I am proud to have worked with my colleagues on solutions to this serious epidemic, and I urge support of H.R. 6.

Mr. Speaker, I yield 30 seconds to the gentleman from Michigan (Mr. Walberg) to speak on the measure.

Mr. Speaker, I yield 30 seconds to the gentleman from Georgia (Mr. Carter), who is our resident pharmacist on the Energy and Commerce Committee.

Mr. Speaker, I yield 30 seconds to the gentleman from Illinois (Mr. Roskam).

Mr. Speaker, I am honored to yield 30 seconds to the gentleman from Minnesota (Mr. Paulsen), who has worked so hard for these issues.

Mr. Speaker, I yield 30 seconds to the gentleman from Ohio (Mr. Renacci) to speak on the measure.

Mr. Speaker, may I inquire as to how much time each side has remaining?

Mr. Speaker, I yield 30 seconds to the distinguished gentleman from Michigan (Mr. Bishop.)

Mr. Speaker, few States have been harder hit than Kentucky in this effort on opioids, a terrible tragedy.

Mr. Speaker, I yield 30 seconds to the distinguished gentleman from Kentucky (Mr. Barr).

Mr. Speaker, I yield 30 seconds to the gentleman from Pennsylvania (Mr. Barletta). There is a lot of enthusiasm for this legislation, Mr. Speaker. We want to hear from Mr. Barletta about his thoughts on it. He has been a real leader on it.

Mr. Speaker, I yield 30 seconds to the gentlewoman from California (Mrs. Mimi Walters) who is from the West Coast and is a real leader on our committee.

Mr. Speaker, I yield 30 seconds to the gentlewoman from Indiana (Mrs. Walorski), who is also a real worker on this legislation, to speak on the measure.

Mr. Speaker, I yield 30 seconds to the gentleman from Michigan (Mr. Mitchell).

Mr. Speaker, we have heard from doctors, we heard from pharmacists, and we have heard from many family members. Now we will hear from somebody who has a distinguished career in law enforcement.

Mr. Speaker, I yield 30 seconds to the gentleman from California (Mr. Knight) to speak on this legislation.

Mr. Speaker, I yield 30 seconds to the gentleman from Virginia (Mr. Brat) to speak on the measure.

Mr. Speaker, I don't believe I have any other speakers on my side of the aisle pending, so with that, I reserve the balance of my time.

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

Mr. Speaker, before I close, I want to especially thank our staff on both sides of the aisle for their incredible work. They have worked day and night, literally, and all through the weekend--also, the folks at the Congressional Budget Office and Legislative Counsel. But I especially thank our team: Josh Trent, Kristen Shatynski, Caleb Graff, Dan Butler, James Paluskiewicz, Danielle Steele, Adam Buckalew, Melissa Froelich, Bijan Koohmaraie, Ryan Long, Peter Keilty, and Jenn Sherman, and the whole team at the Energy and Commerce Committee on both sides of the aisle.

We worked through a lot of difficult issues, issues where we didn't start on the same side, but we ended on the same page as we listened to each other, as we listened to our constituents at home.

Seldom are there times when you are legislating that you can say what you are doing will actually save lives. This is one of those times. What we are doing here today is saving lives.

We will lift people out of addiction who are trapped there today. We will prevent people from ending up in that emergency room because they overdosed. Maybe they will find a better path. We will go after those who perpetrated this on the country and after those who try to smuggle in the illicit synthetics and fentanyl that are cut with heroin and kill our people.

So today's effort is about people like Amanda, who left this world tragically

at a very young age through an overdose. And it is about her parents. It is about Mike and Winnie. It is about Paula, and it is about her sons and sister. It is about a woman I met in Hermiston who had to travel 5 hours to find a physician who could oversee her treatment on Suboxone because nobody was available. We help fix that in this legislation.

It is about my friends at Winding Waters in Enterprise, Oregon, who I was with last week, and the sheriff and others, who talked about the continuing problems and challenges they face and who have given me great guidance on these and other issues.

From one end of my district to another, from one end of our country to another, we have all listened. We have heard. Frankly, we have cried as we have heard the stories of parents who help their children through addiction, only to drop them off at college and a matter of days later retrieve a body.

That is what brings us together here today, Mr. Speaker. It is their stories that are woven deeply into this legislation. It is because of them that we will make a difference and we will do it right.

We will know that, as we pass this today and the Senate after us, that more work does remain to be done. We are on a journey together, though, and we will find solutions.

Mr. Speaker, I thank my colleagues on both sides of the aisle. I thank our staffs. I thank the American people who have reached out to us, counseled us, and helped us.

Mr. Speaker, I urge my colleagues to strongly support passage of the SUPPORT Act. For patients and for communities, H.R. 6 needs to become law, and it will shortly.

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

Mr. Speaker, I include the following letters in the Record.

Corporate Health Care Coalition,

September 26, 2018.

Hon. Paul Ryan,

Speaker, House of Representatives,

Washington, DC.

Hon. Mitch McConnell,

Majority Leader, U.S. Senate,

Washington, DC.

Hon. Nancy Pelosi,

Minority Leader, House of Representatives,

Washington, DC.

Hon. Charles Schumer,

Minority Leader, House of Representatives,

Washington, DC.

Dear Speaker Ryan, Leader McConnell, Leader Pelosi and

Leader Schumer: The Corporate Health Care Coalition (CHCC) is

writing to commend both the House of Representatives and the

Senate on finalizing the SUPPORT for Patients and Communities

Act (H.R. 6), bipartisan legislation to address the nation's

opioid crisis. CHCC is comprised of companies from varying

industries that compete in the global marketplace and sponsor

health plans for the benefit of our employees and other

beneficiaries. Collectively, CHCC member companies provide

health benefits for nearly 5 million Americans across every

state in the nation.

The depth and devastation associated with the opioid crisis

is being felt by families and communities nationwide. CHCC

therefore applauds lawmakers for working on a bipartisan

basis to reach consensus on H.R. 6, which represents a

critical step forward in providing necessary resources for

treatment and prevention efforts related to opioids.

We urge the House and Senate to pass this important

legislation.

Sincerely,

Corporate Health Care Coalition.

Mr. Speaker, I include the following letters in the Record.

American Benefits Council,

Washington, DC, September 27, 2018.

Hon. Mitch McConnell,

Majority Leader, U.S. Senate,

Washington, DC.

Hon. Chuck Schumer,

Minority Leader, U.S. Senate,

Washington, DC.

Hon. Paul Ryan,

Speaker, House of Representatives,

Washington, DC.

Hon. Nancy Pelosi,

Minority Leader, House of Representatives,

Washington, DC.

Dear Leader McConnell, Leader Schumer, Speaker Ryan and

Leader Pelosi: The American Benefits Council (the Council)

supports the Substance Use-Disorder Prevention that Promotes

Opioid Recovery and Treatment (SUPPORT) for Patients and

Communities Act (H.R. 6). We urge Congress to approve this

measure as an important step toward addressing the nation's

opioid addiction crisis.

The Council is a public policy organization representing

principally Fortune 500 companies and other organizations

that assist employers of all sizes in providing employee

benefits. Collectively, the Council's members sponsor

directly or provide services to retirement and health plans

covering over 100 million Americans.

The opioid epidemic has touched workers and families across

the country and employers have been on the front lines of

this battle, striving to stem the tide of prescription drug

abuse through innovative plan design and outreach. A Kaiser

Family Foundation analysis found that the use of prescription

opioids among people with employer-based health coverage

declined in 2016 to its lowest levels in over a decade.

Nevertheless, the annual cost of treating addiction and

overdoses has increased more than eight-fold since 2004, from

$0.3 billion dollars to $2.6 billion in 2016, and pain-

related conditions have resulted in up to $635 billion in

medical costs and lost productivity for employers.

H.R. 6 makes a number of important improvements to current

law by reducing the use and supply of opioids, encouraging

recovery, supporting caregivers and families and driving

innovation and long-term solutions to the opioid addiction

epidemic. The bill also imposes tighter control on opioid

prescription and treatment under the Medicare and Medicaid

programs while also clarifying FDA regulation of nonaddictive

pain and addiction therapies and allowing for more

flexibility with respect to medication-assisted treatment.

We are particularly pleased that the conference committee

wisely excluded from the bill a harmful, unrelated provision

that would have revised the Medicare secondary payer rules to

require private insurers--including employer plans--to pay

for an additional three months of care for end-stage renal

disease (ESRD) patients before Medicare assumes

responsibility for the payments.

The Council strongly opposed this provision, as employers

already shoulder significant costs for workers and family

members and should not be required to bear unrelated

additional costs by expanding the length of time plans must

cover ESRD.

We applaud Congress for developing legislation that will

make America healthier, including many of the 181 million

people covered by employer-provided health plans.

Sincerely,

James A. Klein,

President.

Mr. Speaker, I include the following letters in the Record.

September 26, 2018.

To The Members of the U.S. House of Representatives: The

U.S. Chamber of Commerce strongly supports the bipartisan

H.R. 6, the ``Opioid Crisis Response Act of 2018.'' The

Chamber will consider including votes related to this bill in

our annual How They Voted scorecard.

The opioid epidemic is ravaging families and destroying the

lives of thousands each year, and it is crippling

communities' and employers' efforts to staff workforce needs,

create new jobs, and expand commerce.

We applaud Congress for crafting comprehensive legislation

to tackle the myriad of causes, such as the flood of illicit

drugs into the United States, while removing a litany of

barriers that inhibit prevention, recovery, and treatment

options.

The Chamber is pleased that H.R. 6 does not include the end

stage renal disease (ESRD) provision included in an earlier

version of the bill. That policy would have burdened

employers already struggling to provide robust health

benefits with hundreds of millions of dollars in additional

health care costs.

While H.R. 6 is important, more remains to be done. The

Chamber urges Congress to address the 42 CFR Part 2 statute

as hundreds of health care organizations have called for.

Congress should align currently conflicting protections and

allow providers access to a patient's entire medical record,

including substance use disorder information, at a patient's

request.

We urge you to support H.R. 6.

Sincerely,

Suzanne P. Clark,

Senior Executive Vice President,

U.S. Chamber of Commerce.

Mr. Speaker, I include the following letters in the Record.

[From the American Society of Addiction Medicine]

Rockville, MD, September 26, 2018.

American Society of Addiction Medicine Applauds Inclusion of Key

Provisions in Historic Opioid Legislative Package

Key Provisions to Teach, Standardize, and Cover Addiction Medicine Will Help Close Treatment Gap and Save Lives, Addiction Medicine Experts Say

The American Society of Addiction Medicine (ASAM) today

applauds US House and Senate leaders for announcing a

bipartisan agreement on an opioid legislative package that

includes key provisions to bolster the country's addiction

treatment workforce, help provide standardized evidence-based

treatment for individuals with a substance use disorder

(SUD), and help ensure coverage and payment models facilitate

comprehensive, coordinated care for patients seeking

treatment for a SUD.

``On behalf of America's addiction medicine physicians and

other clinicians on the frontlines of this crisis, ASAM

applauds our Congressional leaders for working together to

include key provisions that will help close the current

treatment gap, bolster the addiction medicine workforce, and

save more lives,'' said Kelly J. Clark, MD, MBA, DFASAM,

president of ASAM. ``Reversing course on the deadly opioid

overdose crisis requires bold policy solutions that help

teach, standardize, and cover addiction medicine so more

patients benefit from evidence-based treatment. The agreement

reached last night is an important step toward realizing this

critical goal.''

Key provisions in the legislative package to teach,

standardize, and cover evidence-based addiction medicine

include:

Making permanent buprenorphine prescribing authority for

physician assistants and nurse practitioners and allowing

waivered practitioners to treat immediately up to 100

patients at a time (in lieu of 30) if the practitioner is

board certified in addiction medicine or addiction

psychiatry; or if the practitioner provides medication

assisted treatment (MAT) in a qualified practice setting.

Certain qualified physicians would also be allowed to treat

up to 275 patients at a time with buprenorphine, codifying an

existing rule;

Allowing physicians who have recently graduated in good

standing from an accredited school of allopathic or

osteopathic medicine, and who meet the other training

requirements during school to prescribe MAT, to obtain a

waiver to prescribe MAT;

Providing loan repayment relief to addiction treatment

professionals who practice in high-need areas;

Creating a Medicare demonstration program to increase

access to evidence-based outpatient treatment for

beneficiaries with opioid use disorder that includes

medication as well as psychosocial supports, care management,

and treatment planning;

Partially repealing the Institutions for Mental Diseases

(IMD) exclusion and allowing state Medicaid programs to cover

care in certain IMDs that can deliver services consistent

with certain requirements, including evidence-based

assessments and levels of care;

Directing the Departments of Justice and Health and Human

Services to finalize special registration regulations

concerning the prescribing of medications for addiction via

telemedicine within one year of enactment;

Expanding Medicare coverage to include payment for Opioid

Treatment Programs through bundled payments for wholistic

services;

Convening a stakeholder group to produce a report of best

practices for states to consider in health care related

transitions for inmates of public correctional facilities;

and

Requiring the Substance Abuse and Mental Health Services

Administration (SAMHSA) to provide information to SAMHSA

grantees to encourage the implementation and replication of

evidence-based practices.

``Substance use disorder is both treatable and

preventable--but from where we stand today, delivering high-

quality care to the millions of Americans who live with the

disease of addiction will require significant investments in

our workforce, coverage, and payment models that facilitate

coordinated and comprehensive care, and structural changes

that incentivize the use of evidence-based approaches,'' said

Clark. ``And while we celebrate this bipartisan announcement

today, ASAM knows there is still much more work to be done to

ensure all Americans living with a substance use disorder get

the treatment they need. ASAM will continue to advocate for

building an addiction treatment system that fully integrates

mental health, substance use disorder, and primary care

services in order to produce the best patient outcomes. This

includes supporting final passage of legislation that would

more closely align 42 CFR Part 2 with the Health Insurance

Portability and Accountability Act.''

For more information about the American Society of

Addiction Medicine, please visit www.ASAM.org.

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

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

I rise today in support of H.R. 6, the SUPPORT for Patients and Communities Act. This bill is the product of many months of hard work by several committees in the House and Senate. It is important that we pass this bill today as another step in addressing the opioid crisis that is ravaging every community in our Nation.

Last year, a record 72,000 Americans died of drug overdoses; that is about 200 people dying every day, and this is a national crisis that is devastating families and that this Congress must act on.

And while this legislation will not solve every problem, I do believe it includes important policies that will help turn the tide of this tragic opioid epidemic. It will also improve treatment options for those battling other substance-use disorders.

I am proud that H.R. 6 builds upon CARA, the Comprehensive Addiction and Recovery Act, by including a provision championed by my colleague, Congressman Tonko, that would allow all advanced practice registered nurses to treat patients with bupe for opioid-use disorder. It also gives nurse practitioners and physician assistants the authority to treat patients with bupe permanently, and it codifies the 275 patient physician cap. This is a critical step in expanding access to the treatment of these drugs, one of the major challenges that we continue to face in the fight against this epidemic.

Mr. Speaker, the legislation also expands access to coverage. It includes an important provision that I worked on with Ways and Means Committee Ranking Member Neal that expands Medicare coverage of opioid treatment programs and medication-assisted treatment.

In the Medicaid space, I am pleased to see the inclusion of several Democratic priorities. This bill requires State Medicaid programs to cover all forms of medication-assisted treatment, which plays a critical and lifesaving role in treating opioid use disorder.

It provides grants to State Medicaid programs to help increase the number of substance use disorder providers and services. It increases access to mental health and substance use disorder treatment for children and pregnant women covered by CHIP, and it ensures former foster youth are able to keep their Medicaid coverage across State lines up to the age of 26. And it improves the continuity of Medicaid coverage for juveniles in the justice system.

I am also pleased that we have been able to improve upon the House- passed IMD policy. This bill adds new safeguards to ensure that States continue to provide an adequate level of outpatient services and offer medication-assisted treatment. It does this by making clear that this policy does not impact the more comprehensive efforts to provide care in IMDs that is ongoing in many States today.

H.R. 6 also includes provisions from my legislation, the SCREEN Act, that would give the Food and Drug Administration the ability to take action against illicit controlled substances coming in through international mail facilities across the country.

FDA will now be able to prohibit the importation of drugs by people who have repeatedly imported illicit drugs. It also allows the agency to cease distribution of or recall controlled substances, like opioids, if they are endangering patients.

These provisions also provide FDA expanded authority and capacity needed to more effectively combat the influx of deadly synthetic opioids, like fentanyl, from reaching our shores through the mail in the first place.

It also provides the Federal Trade Commission with stronger enforcement tools to go after bad actors that are taking advantage of the suffering of individuals combating addictions.

Mr. Speaker, there is one provision that is concerning and that I do want to mention. It did not go through regular order and was not properly vetted. In fact, it was added at the very last minute. That is a proposal by Senator Rubio to create a new criminal antikickback statute.

I know this proposal is well-intentioned in addressing the serious problem of patient brokers who are taking advantage of individuals with opioid use disorders and referring them to substandard or fraudulent providers in exchange for kickbacks. This is an issue, but since the bill was introduced last Tuesday night, multiple stakeholders have raised concerns that the language does not do what we think it does. It may have unintended consequences.

Mr. Speaker, I hope this is a good lesson to all of us that passing legislation that has not been properly vetted, and that the public has not had an adequate chance to review, is unwise. I hope to get a commitment from Chairman Walden and Chairman Goodlatte to work to address any technical problems with this provision in the upcoming months.

In closing, Mr. Speaker, these are all policies that have the potential to make a real impact on this epidemic, but our work here is not complete. An epidemic of this size will take a long-term commitment to improving health insurance coverage, treatment, access, and affordability.

This bill is an important step, but I want to stress that we have to do a lot more. The opioid crisis continues to get worse. A lot more needs to be done to provide treatment and expand the treatment infrastructure. More resources are needed to support the families and communities impacted by this crisis. So what we are doing today is clearly helpful, but it is not enough.

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

Mr. Speaker, I yield 4 minutes to the gentleman from Massachusetts (Mr. Neal), the ranking member of the Ways and Means Committee who worked so hard on this legislation as well.

Mr. Speaker, I yield 4 minutes the gentleman from Maryland (Mr. Cummings), the ranking member of the Oversight and Government Reform Committee.

Mr. Speaker, I yield 2 minutes to the gentleman from New York (Mr. Tonko), a member of the committee.

Mr. Speaker, I yield an additional 30 seconds to the gentleman from New York.

Mr. Speaker, I yield 2 minutes to the gentlewoman from Michigan (Mrs. Dingell), also a member of the committee.

Mr. Speaker, I yield 2 minutes to the gentleman from Texas

(Mr. Gene Green), the ranking member of our Health Subcommittee.

Mr. Speaker, may I inquire as to how much time remains on each side.

Mr. Speaker, I yield 1 minute to the gentleman from New Mexico (Mr. Ben Ray Lujan).

Mr. Speaker, I yield myself 1 minute.

Mr. Speaker, before we conclude debate, let me just take a moment to thank everyone for all of their hard work getting this bill across the finish line.

This bill represents a collection of Member ideas and policies across the political spectrum. Many people may not know this, but the staff of the House and Senate committees negotiated this bill in a matter of weeks, and that is no small feat. It took a lot of effort, long hours and weekend work to pull this off. It is a product we can all be proud of.

So let me thank all legislative counsel and CBO for their efforts as well.

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

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

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

Mr. Speaker, I do urge support for this legislation. It is a good bill. It expands access in a number of ways in coverage. But I do also want to point out that there are limitations to the bill. In other words, we do need to do a lot more.

For example, we still haven't expanded Medicaid coverage in many States. Medicaid coverage is crucial, in terms of providing treatment.

The bottom line is that the treatment infrastructure in our country is very much inadequate. Many people really do not have access to treatment in many parts of the country, including my home State.

I want to close by urging everyone to support this bipartisan and bicameral bill, because it does do a lot. At the same time, I remind my colleagues that we have a lot more to do if we are going to address this opioid crisis, which actually is getting worse instead of better.

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

Mr. Speaker, I move to suspend the rules and pass the bill (H.R. 5889) to require the Secretary of Health and Human Services to disseminate information, resources, and if requested, technical assistance to early

childhood care and education providers and professionals working with young children on ways to properly recognize and respond to children who may be impacted by trauma related to substance abuse.

Mr. Speaker, I ask unanimous consent that all Members may have 5 legislative days in which to revise and extend their remarks and include extraneous material on H.R. 5889.

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

Mr. Speaker, I rise today in support of H.R. 5889, Recognizing Early Childhood Trauma Related to Substance Abuse Act of 2018.

Last year, we lost more Virginians to opioid overdoses than any other year in the last decade. For 5 years now, fatal drug overdoses are the leading cause of unnatural death in Virginia.

In 2017, the average overdose rate across Virginia was 14 per 1,000 people. But in Henrico County, the rate has increased from 11.5 in 2015 to 19.6 in 2017. In fact, 87 percent of inmates in Henrico County identified drug involvement as being a direct or an indirect reason for their incarceration. That is 87 percent. Out of the 1,007 inmates jailed for drug involvement, a plurality began using at age 13.

The largest overdose rate last year was in Culpeper County, which increased from about 22.5 per 1,000 people in 2015 to 38 in 2017. We are losing friends, family members, and neighbors every day.

Last November, the Committee on Education and the Workforce held a hearing to examine how opioids are impacting communities across America. During the hearing, members heard testimony from Ms. Toni Miner, a family support partner for Child and Youth Leadership who uses her own past struggle with drug abuse to help other families and children who need help overcoming addiction. In her testimony, Miner told members that: ``Addiction is a family disease, and if the whole family is not treated, history will continue to repeat itself.''

One of the unintended consequences of the opioid epidemic is that addiction has devastated not only the lives of users, but the lives of their families as well. Maybe the most tragic reality of this epidemic is it has devastated the lives of our children.

Half of opioid overdose deaths occur among men and women ages 25 to 44, and many of these individuals are parents. The number of children in the U.S. foster care system is increasing, and a recent study showed almost one in three children who were placed in the foster care system in 2015 entered at least partially due to parental drug abuse.

In Virginia, there were 5,295 children in foster care as of April. These children, and those living with an addicted caregiver, experience unimaginable hardship and trauma and, thus, have unique needs. When these tragedies occur, the children need the community's help.

The professionals working at child care homes and centers, Head Start programs, faith-based organizations, camps, doctors' offices, and many other places are in a special position to identify and assist children affected by substance abuse. However, they may not have the preparation and education needed to recognize the risk factor associated with childhood trauma due to an adult's substance abuse.

Information and resources from the Department of Health and Human Services could help educate child care and early education providers how to identify risk factors and respond appropriately when faced with a child experiencing trauma related to substance abuse. Such information and resources will help keep more children safe while aiding in the healthy development and well-being of the child and promoting whole-family approaches whenever possible.

Mr. Speaker, I urge my colleagues to support this legislation, and I reserve the balance of my time.

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

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

Mr. Speaker, I would like to thank my colleague, Congresswoman Bonamici, for her great work in committee and for her always keen insights and great presentation today as well.

I would also like to personally thank the sheriffs back at home. I am referring to Henrico Sheriff Mike Wade and Chesterfield County Sheriff Karl Leonard. I thank them for helping with the statistics they do and for their recovery programs back at home in Chesterfield and Henrico. They do outstanding work, along with some of the other recovery folks. John Shinholser and many of our faith community work hand in hand on this across the aisle.

Mr. Speaker, I urge my colleagues to vote in favor of H.R. 5889, and I yield back the balance of my time.

Mr. Speaker, I rise to support H.R. 6, the SUPPORT for Patients and Communities Act, a bipartisan bill to address opioid addiction and other forms of substance abuse.

A comprehensive, common-sense, and compassionate approach to substance use disorders is long overdue. For far too long, many communities throughout the United States have been devastated by substance use disorders. However, despite the widespread suffering that millions of people--particularly African Americans during the crack cocaine epidemic--endured and still endure today, our federal, state, and local governments, in many instances, have pursued punitive measures in lieu of effective solutions to ensure that all communities can adequately heal from the devastating impacts of addiction.

I am especially pleased that this bill now includes my amendment to the House version of H.R. 6, which requires the Department of Health and Human Services (HHS) to conduct a review of the organizations, government agencies, and other entities that receive federal funding to provide substance use disorder treatment services. In addition, the amendment directs HHS to develop, and submit to Congress, a plan to direct appropriate resources to address the inadequacies in services or funding identified through the review.

I am also pleased that this bill addresses concerns that I raised about the opioid legislation in the House that allowed states to use Medicaid funds to provide treatment to persons with opioid use disorders in Institutions for Mental Disease (IMDs), but did not allow similar treatment for persons with other types of substance use disorders. In order to seriously address substance use disorders in communities throughout the United States, it is critical that we include persons who suffer from all types of substance use disorders, including those that involve alcohol, cocaine, and methamphetamine, as well as opioids.

I offered an amendment to the legislation in the House aimed at addressing my concern about the exclusion of non-opioid forms of substance use disorders from treatment in IMDs. While my amendment was not accepted, I am pleased that efforts were made to address my concern. The final version of H.R. 6 allows states to provide Medicaid coverage in IMDs for persons with all types of substance use disorders and also includes safeguards to ensure that states do not reduce the availability of community-based treatment for persons suffering from substance use disorders.

While I appreciate the work that has been done on many components of this bill, I still have some important concerns. As the Ranking Member of the House Committee on Financial Services, which has jurisdiction over housing programs, I am concerned that this bill falls short when it comes to providing housing for people with substance use disorders. The bill includes a provision that creates a new grant program to provide temporary housing assistance to help people with substance use disorders, but this new funding will only be available in half of the states. This will leave the other half of the states continuing to struggle with the challenges of helping people with substance use disorders who are in need of housing. Furthermore, this bill does nothing to address the overly punitive and unfair policies governing our federal housing programs that create unnecessary barriers to housing for people who have criminal backgrounds related to substance use disorders.

I am encouraged that there is bipartisan support for addressing the housing needs of persons suffering from substance use disorders, but I am disheartened that Congress continues to fall short in its efforts to provide comprehensive solutions that will help people suffering from substance use disorders in every state of the country. As we work to address the opioid crisis at hand, let's not forget that Congress still has a lot of work to do in the way of criminal justice reform to address the ongoing harmful and discriminatory impacts of the war on drugs era.

Despite these concerns, I believe this bill includes some valuable bipartisan solutions that represent a step in the right direction. I urge all of my colleagues to support H.R. 6, and I look forward to continuing to work with my colleagues to address the scourge of substance use disorders in communities throughout the United States.

Mr. Speaker, I thank the gentleman for yielding.

Mr. Speaker, I rise today to talk about something that is really close to all of our hearts. We have reached a point in this country where opioid overdoses claim more than 100 lives each and every single day.

Think about that for a moment, more than 100 lives every day. Mothers and fathers are burying sons and daughters, or in some cases, sons and daughters are burying mothers and fathers.

I bring this up simply to impart the gravity of the situation, which makes our response all the more urgent. But while the situation is certainly grave, that does not mean that we should ever lose hope.

As we have worked on this legislation we will soon send to the President, we all had to go out and gain an understanding of the facts on this issue. Everybody on both sides of the aisle spent so much time on this bill. In doing that, we have gleaned so much understanding.

And that is, after all, how our Republic works. That is what the people's House does. We learn from our constituents. We hear their stories. We see the suffering, and then we act.

This is a fantastic moment of people coming together to solve a problem. I think, in this process, we gained something very special.

Many of us heard the stories from incredible souls who have known unspeakable loneliness and who struggle with drug addiction. They made it through to the other side.

We met family members and friends who have known the pain and the fear that accompanies loving someone wrestling with addiction. Every one of us knows somebody or is related to somebody who has gone through this.

We met those who will never again have the chance to see the ones that they love so much.

Amid the overwhelming darkness, we have gotten to see their spark, their strength. From this pain has come something more powerful: resolve and a passion to make sure that others have a safe place to turn, that this doesn't happen to their family.

Witnessing this kind of strength, witnessing this kind of resilience, that is what helped produce this legislation. Through these bills, we are trying to ensure that anyone who needs help is not too isolated to receive it.

We are giving our communities the resources that they need to provide stronger treatment networks and support systems. That is where the healing happens. That is where Americans are at our best.

If this legislation can save one life and bring help to one person, that is what matters.

It is going to do far more than that.

So I want to thank all of those who were brave enough to share their stories with all of us. I want to thank all of those people who all of us met with

for being brave, for coming here, for meeting us, and for testifying and giving us their stories. And for all of those who are continuing to struggle in silence, I want them to know that there is no shame in their trials. In our own ways, we all fall.

In our Catholic tradition, we look to St. Jude as the patron saint of lost causes, a keeper of those who some in society may have written off. To me, his guardianship is written in this legislation. There are no lost causes. No one is permanently down. It is about offering a helping hand, and it is about opening our hearts.

Mr. Speaker, I am very proud of this legislation. I am so thankful to my colleagues on both sides of the aisle who came together to put these families and to put these communities first.