SUBSTANCE USE DISORDER WORKFORCE LOAN REPAYMENT ACT OF 2018; Congressional Record Vol. 164, No. 97
(House of Representatives - June 12, 2018)

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[Pages H5045-H5047]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




      SUBSTANCE USE DISORDER WORKFORCE LOAN REPAYMENT ACT OF 2018

  Mr. WALDEN. Mr. Speaker, I move to suspend the rules and pass the 
bill (H.R. 5102) to amend the Public Health Service Act to authorize a 
loan repayment program for substance use disorder treatment employees, 
and for other purposes.
  The Clerk read the title of the bill.
  The text of the bill is as follows:

                               H.R. 5102

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Substance Use Disorder 
     Workforce Loan Repayment Act of 2018''.

     SEC. 2. LOAN REPAYMENT PROGRAM FOR SUBSTANCE USE DISORDER 
                   TREATMENT EMPLOYEES.

       Title VII of the Public Health Service Act is amended--
       (1) by redesignating part F as part G; and
       (2) by inserting after part E (42 U.S.C. 294n et seq.) the 
     following:

          ``PART F--SUBSTANCE USE DISORDER TREATMENT EMPLOYEES

     ``SEC. 781. LOAN REPAYMENT PROGRAM FOR SUBSTANCE USE DISORDER 
                   TREATMENT EMPLOYEES.

       ``(a) In General.--The Secretary, acting through the 
     Administrator of the Health Resources and Services 
     Administration, shall carry out a program under which--
       ``(1) the Secretary enters into agreements with individuals 
     to make payments in accordance with subsection (b) on the 
     principal of and interest on any eligible loan; and
       ``(2) the individuals each agree to complete a period of 
     service in a substance use disorder treatment job, as 
     described in subsection (d).
       ``(b) Payments.--For each year of obligated service by an 
     individual pursuant to an agreement under subsection (a), the 
     Secretary shall make a payment to such individual as follows:
       ``(1) Service in a shortage area.--The Secretary shall 
     pay--
       ``(A) for each year of obligated service by an individual 
     pursuant to an agreement under subsection (a), \1/6\ of the 
     principal of and interest on each eligible loan of the 
     individual which is outstanding on the date the individual 
     began service pursuant to the agreement; and
       ``(B) for completion of the sixth and final year of such 
     service, the remainder of such principal and interest.
       ``(2) Maximum amount.--The total amount of payments under 
     this section to any individual shall not exceed $250,000.
       ``(c) Eligible Loans.--The loans eligible for repayment 
     under this section are each of the following:
       ``(1) Any loan for education or training for a substance 
     use disorder treatment job.
       ``(2) Any loan under part E of title VIII (relating to 
     nursing student loans).
       ``(3) Any Federal Direct Stafford Loan, Federal Direct PLUS 
     Loan, or Federal Direct Unsubsidized Stafford Loan, or 
     Federal Direct Consolidation Loan (as such terms are used in 
     section 455 of the Higher Education Act of 1965).
       ``(4) Any Federal Perkins Loan under part E of title I of 
     the Higher Education Act of 1965.
       ``(5) Any other Federal loan as determined appropriate by 
     the Secretary.
       ``(d) Period of Service.--The period of service required by 
     an agreement under subsection (a) shall consist of up to 6 
     years of full-time employment, with no more than one year 
     passing between any two years of covered employment, in a 
     substance use disorder treatment job in the United States 
     in--
       ``(1) a Mental Health Professional Shortage Area, as 
     designated under section 332; or
       ``(2) a county (or a municipality, if not contained within 
     any county) where the mean drug overdose death rate per 
     100,000 people over the past 3 years for which official data 
     is available from the State, is higher than the most recent 
     available national average overdose death rate per 100,000 
     people, as reported by the Centers for Disease Control and 
     Prevention.
       ``(e) Ineligibility for Double Benefits.--No borrower may, 
     for the same service, receive a reduction of loan obligations 
     or a loan repayment under both--
       ``(1) this subsection; and
       ``(2) any Federally supported loan forgiveness program, 
     including under section 338B, 338I, or 846 of this Act, or 
     section 428J, 428 L, 455(m), or 460 of the Higher Education 
     Act of 1965.
       ``(f) Breach.--
       ``(1) Liquidated damages formula.--The Secretary may 
     establish a liquidated damages formula to be used in the 
     event of a breach of an agreement entered into under 
     subsection (a).
       ``(2) Limitation.--The failure by an individual to complete 
     the full period of service obligated pursuant to such an 
     agreement, taken alone, shall not constitute a breach of the 
     agreement, so long as the individual completed in good faith 
     the years of service for which payments were made to the 
     individual under this section.
       ``(g) Additional Criteria.--The Secretary--
       ``(1) may establish such criteria and rules to carry out 
     this section as the Secretary determines are needed and in 
     addition to the criteria and rules specified in this section; 
     and
       ``(2) shall give notice to the committees specified in 
     subsection (h) of any criteria and rules so established.
       ``(h) Report to Congress.--Not later than 5 years after the 
     date of enactment of the Substance Use Disorder Workforce 
     Loan Repayment Act of 2018, and every other year thereafter, 
     the Secretary shall prepare and submit to the Committee on 
     Energy and Commerce of the House of Representatives and the 
     Committee on Health, Education, Labor, and Pensions of the 
     Senate a report on--
       ``(1) the number and location of borrowers who have 
     qualified for loan repayments under this section; and
       ``(2) the impact of this section on the availability of 
     substance use disorder treatment employees nationally and in 
     shortage areas and counties described in subsection (d).
       ``(i) Definition.--In this section:
       ``(1) The term `municipality' means a city, town, or other 
     public body created by or pursuant to State law, or an Indian 
     Tribe.
       ``(2) The term `substance use disorder treatment job' means 
     a full-time job (including a fellowship)--
       ``(A) where the primary intent and function of the job is 
     the direct treatment or recovery support of patients with or 
     in recovery from a substance use disorder, such as a 
     physician, physician assistant, registered nurse, nurse 
     practitioner, advanced practice registered nurse, social 
     worker, recovery coach, mental health counselor, addictions 
     counselor, psychologist or other behavioral health 
     professional, or any other relevant professional as determine 
     by the Secretary; and
       ``(B) which is located at a substance use disorder 
     treatment program, private physician practice, hospital or 
     health system-affiliated inpatient treatment center or 
     outpatient clinic (including an academic medical center-
     affiliated treatment program), correctional facility or 
     program, youth detention center or program, inpatient 
     psychiatric facility, crisis stabilization unit,

[[Page H5046]]

     community health center, community mental health or other 
     specialty community behavioral health center, recovery 
     center, school, community-based organization, telehealth 
     platform, migrant health center, health program or facility 
     operated by a tribe or tribal organization, Federal medical 
     facility, or any other facility as determined appropriate for 
     purposes of this section by the Secretary.
       ``(j) Authorization of Appropriations.--There are 
     authorized to be appropriated to carry out this section 
     $25,000,000 for each of fiscal years 2019 through 2028.''.

  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from 
Oregon (Mr. Walden) and the gentleman from New Jersey (Mr. Pallone) 
each will control 20 minutes.
  The Chair recognizes the gentleman from Oregon.


                             General Leave

  Mr. WALDEN. I ask unanimous consent that all Members may have 5 
legislative days in which to revise and extend their remarks and insert 
extraneous materials into the Record on the bill.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Oregon?
  There was no objection.
  Mr. WALDEN. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I rise today to express my strong support for H.R. 5102. 
This is the Substance Use Disorder Workforce Loan Repayment Act. It is 
legislation that would create a loan repayment program for substance 
use disorder treatment providers.
  Serious workforce shortages exist for all health professions across 
the United States. We know that. But a delay in addiction treatment for 
a patient with substance use disorder can be a life-or-death situation.
  By offering student loan repayment for those who agree to work as a 
substance use disorder treatment professional in an underserved area, 
this bill encourages more people to enter the substance use disorder 
treatment field and get critical services to areas that are seriously 
in dire need of treatment.
  I would like to thank my colleagues, Representatives Katherine Clark, 
Hal Rogers, John Sarbanes, and Brett Guthrie, for leading this 
important initiative. It is brought to you from your Energy and 
Commerce Committee with a unanimous vote.
  Mr. Speaker, I reserve the balance of my time.
  Mr. PALLONE. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I rise in support of H.R. 5102, the Substance Use 
Disorder Workforce Loan Repayment Act. This bill would create a loan 
repayment program to provide loan repayment assistance to substance use 
disorder providers in exchange for providing substance use disorder 
treatment and recovery support services in areas with high need for 
such services.
  Mr. Speaker, I urge my colleagues to support this legislation.
  I thank the main sponsor, Representative Clark, for her leadership 
and Representative Sarbanes.
  Mr. Speaker, I reserve the balance of my time.
  Mr. WALDEN. Mr. Speaker, I reserve the balance of my time.
  Mr. PALLONE. Mr. Speaker, I yield such time as she may consume to the 
gentlewoman from Massachusetts (Ms. Clark).
  Ms. CLARK of Massachusetts. Mr. Speaker, I thank the gentleman for 
yielding.
  Mr. Speaker, I rise today in support of H.R. 5102, the Substance Use 
Disorder Workforce Loan Repayment Act.
  As families at home know too well, our country is in the midst of a 
devastating public health crisis. The opioid epidemic claims more than 
115 lives every day, and in 2016 alone, more than 42,000 people lost 
their lives to opioid-related drug overdoses, and more than 64,000 died 
from drug overdoses overall. Every one of those lives lost left 
heartbroken families, friends, and communities.
  Part of addressing this epidemic is making sure that everyone who is 
looking for help can access effective treatment and ongoing management 
of this chronic condition. To date, however, we have failed in this 
endeavor. The Surgeon General's 2016 report on addiction estimates that 
only 10 percent of Americans living with substance use disorder receive 
any treatment.
  There are a range of barriers to accessing treatment, but one of the 
most significant is a shortage in the workforce needed to provide it. 
Between the rising cost of education, low salaries, and a high burnout 
rate from the stressful and emotional work, it is a struggle to attract 
new people to the treatment field and keep those who work in it long 
term.
  In my district, I have heard time and again from families and 
providers that there simply aren't enough treatment specialists 
available to help the growing number of people who desperately need 
treatment. I have heard from families who have tried to get their loved 
ones into treatment and lost them to an overdose before they were able 
to get them the help they needed.
  No one should have to live with that heartbreak. That is why I 
authored this legislation with my esteemed colleague from Kentucky, 
Chairman Hal Rogers. This bill will help recruit and retain more 
treatment experts by offering up to $250,000 in student loan repayment 
for participants who agree to work in the treatment field for up to 6 
years.
  The program will cover professionals who represent the whole spectrum 
of treatment, from physicians to nurses, to social workers, to recovery 
coaches, promoting the kind of wraparound treatment approach that we 
know gives patients the best chance for success.
  By providing a portion of loan repayment for each year of service, 
the program encourages treatment professionals to stay in the field 
longer.
  Further, this legislation is designed to send help where it is needed 
the most. Participants in the program must work in a county or 
municipality with either a shortage of mental health professionals or 
an above-average rate of overdose deaths. Whether you live in an urban 
or rural area, from Massachusetts to Kentucky, more need will mean more 
available treatment.
  Mr. Speaker, I thank Chairman Rogers for his partnership on this 
important legislation and the other original cosponsors, as well as the 
Energy and Commerce Committee and their staff for their work throughout 
this process.
  We need to make significant long-term investments in the 
professionals who make recovery possible. People's lives depend on it. 
Mr. Speaker, I urge my colleagues to vote in favor of this legislation.
  Mr. WALDEN. Mr. Speaker, I yield myself such time as I may consume.
  Before I recognize my colleague from Kentucky, I just want to say, 
Mr. Rogers has spent many, many years leading nationally not only here 
in the Congress, but nationally and in Kentucky on this issue of 
addiction and the scourge of opioids as they have flooded into our 
area. His leadership has been very, very valuable in this endeavor.
  Mr. Speaker, I yield such time as he may consume to the gentleman 
from Kentucky (Mr. Rogers).
  Mr. ROGERS of Kentucky. Mr. Speaker, I thank Chairman Walden for 
those words.
  This is a fight that is critical to the country, and I want to thank 
the chairman of the committee, Mr. Walden, and Mr. Pallone and the 
other members of the Energy and Commerce Committee for reporting out 
for consideration today this multipronged assault on this cruel 
epidemic that is ravaging the country. The committee has responded, and 
I thank Chairman Walden for all of these bills that are here with us 
today, especially the bill that we are debating now, and that is the 
Substance Use Disorder Workforce Loan Repayment Act.
  We have invested billions of dollars in treatment and recovery 
services. As the gentlewoman from Massachusetts has just said, only 10 
percent of Americans with a disorder actually receive treatment; 90 
percent go without treatment.
  That situation is even more dire in small communities. Far too often, 
when our rural constituents recognize their addiction, they are not 
able to find treatment or recovery services anywhere close to home or 
at all.
  Those who do enter the treatment profession often don't stay long due 
to the stress of the job. They don't work in areas most in need of 
their services, or they have difficulty repaying these sizeable student 
loans. If we want to maximize our downpayment for the future, these 
professionals are the key.
  H.R. 5102 creates a substantial student loan repayment benefit for a

[[Page H5047]]

broad spectrum of medical professionals who enter this noble vocation. 
It also ensures that these individuals serve in areas most in need of 
their services for the long haul, offering periodic payments over 6 
years.
  With these incentives in place, more of our constituents suffering 
from addiction will receive the quality treatment they so desperately 
need.
  Mr. Speaker, I thank Ms. Clark for her genuine concern about the 
problem and her partnership, and also Dr. Burgess and his team for 
their guidance on this bill.
  Mr. Speaker, I again thank Chairman Walden for bringing this bill 
forward and all of the others that have been reported out today, and I 
thank Mr. Pallone and the rest of the committee for the great work that 
they are doing in a bipartisan fashion.
  Mr. PALLONE. Mr. Speaker, I yield such time as he may consume to the 
gentleman from Maryland (Mr. Sarbanes).
  Mr. SARBANES. Mr. Speaker, I thank Congressman Pallone for yielding.
  I rise in support of H.R. 5102, the Substance Use Disorder Workforce 
Loan Repayment Act of 2018.
  Mr. Speaker, I thank the authors of the bill, my colleagues Katherine 
Clark and Hal Rogers, for putting this together. It is a very carefully 
crafted bill to address the problem which it discovered, really, which 
is there is this serious shortage of substance use disorder 
professionals across the country.
  We are experiencing shortages in a lot of areas of the healthcare 
workforce, that is true, but if we are going to address the opioid 
crisis that we face, this epidemic across the country, we have to bring 
particular attention to the workforce shortages with respect to 
substance use disorder professionals.
  According to SAMHSA, which is the agency which deals with these 
issues, in 2012, the turnover rates in the addiction services workforce 
ranged from 18.5 to over 50 percent. So there is a huge turnover there 
that has to be addressed.
  In a recent survey, nearly half of clinical directors in agencies 
that specialize in substance use disorder treatment acknowledged that 
they have real difficulty filling these open positions.
  In my district, I have heard from many of the community health 
centers--Baltimore Medical System, Health Care for the Homeless, and 
others--that said they can't hire enough of these folks and they can't 
keep enough of these folks to address the opioid crisis.
  We need this workforce to address the millions of people who require 
this important treatment, and this bill does that. It is a very, very 
important step forward. It will create this loan repayment program for 
professionals who are in this area of substance use disorder treatment. 
They can receive up to $250,000 if they agree to work as a treatment 
professional in this area and in a geographical area of high need.
  Again, carefully crafted, this treatment can take place in a number 
of different facilities, community health centers, hospitals, recovery 
programs, correctional facilities, et cetera.
  So the idea was to figure out where those shortages are and direct 
the bill's support to those areas: a broad range of direct care 
providers, physicians, registered nurses, social workers, and other 
behavioral health providers.
  This is going to help address the problem of recruitment, attracting 
new people to the field, as well as help with retention of those 
people. It is a very, very important bill.
  Mr. Speaker, I was proud to join my colleagues, Katherine Clark, Hal 
Rogers on our committee, Brett Guthrie, and others, in supporting this. 
I hope all of my colleagues here today will support this important 
bill.

                              {time}  1600

  Mr. PALLONE. Mr. Speaker, I have no additional speakers, so I urge 
support for the bill, and I yield back the balance of my time.
  Mr. WALDEN. Mr. Speaker, I would do the same, urge passage of the 
bill, and I yield back the balance of my time.
  Ms. JACKSON LEE. Mr. Speaker, I rise in strong support of H.R. 5102, 
the ``Substance Use Disorder Workforce Loan Repayment Act of 2018.''
  H.R. 5102 would establish a loan repayment program for mental health 
professionals practicing in areas with few mental health providers or 
with high death rates from overdose.
  Mr. Speaker, this bill will amend the Public Health Service Act to 
create a loan repayment program for individuals who complete a period 
of service in a substance use disorder treatment job in a mental health 
professional shortage area and counties where the drug overdose death 
rate is higher than the national average.
  This bill authorizes $25 million per year over fiscal years 2019-
2028.
  H.R. 5102 will strengthen America's substance abuse treatment 
workforce and provide for greater access to care for patients who need 
it the most.
  Mr. Speaker, the current trends of substance abuse in the U.S. are 
startling.
  A Columbia University study found that over 40 million Americans age 
12 and over meet the clinical criteria for drug addiction and abuse.
  As substance abuse rates and death from overdose rates increase, 
studies project a shortage of 85,000 physicians in 2020--the impact of 
which will be the most devastating in rural communities.
  In my home state of Texas, 10.1 people die per 100,000 in the 
population from drug overdoses.
  In 2016, in Houston there were 364 drug overdose related deaths 
reported.
  H.R. 5102 addresses these critical issues by providing an additional 
path for health care providers to practice in rural and underserved 
communities, ultimately giving greater access to care for those 
suffering from substance use disorder.
  This piece of legislation will strengthen rural health care systems 
and will improve access to care for patients in these rural 
communities.
  Mr. Speaker, the ``Substance Use Disorder Workforce Loan Repayment 
Act of 2018'' will help build a well-equipped workforce to combat the 
current rise in substance use disorders.
  The SPEAKER pro tempore (Mr. Walberg). The question is on the motion 
offered by the gentleman from Oregon (Mr. Walden) that the House 
suspend the rules and pass the bill, H.R. 5102.
  The question was taken; and (two-thirds being in the affirmative) the 
rules were suspended and the bill was passed.
  A motion to reconsider was laid on the table.

                          ____________________