PREVENTING OVERDOSES WHILE IN EMERGENCY ROOMS ACT OF 2018; Congressional Record Vol. 164, No. 97
(House of Representatives - June 12, 2018)

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[Pages H5047-H5049]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




       PREVENTING OVERDOSES WHILE IN EMERGENCY ROOMS ACT OF 2018

  Mr. WALDEN. Mr. Speaker, I move to suspend the rules and pass the 
bill (H.R. 5176) to require the Secretary of Health and Human Services 
to provide coordinated care to patients who have experienced a non-
fatal overdose after emergency room discharge, and for other purposes, 
as amended.
  The Clerk read the title of the bill.
  The text of the bill is as follows:

                               H.R. 5176

       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 ``Preventing Overdoses While 
     in Emergency Rooms Act of 2018''.

     SEC. 2. PROGRAM TO SUPPORT EMERGENCY ROOM DISCHARGE AND CARE 
                   COORDINATION FOR DRUG OVERDOSE PATIENTS.

       (a) In General.--The Secretary of Health and Human Services 
     shall establish a program (in this Act referred to as the 
     ``Program'') to develop protocols for discharging patients 
     who have presented with a drug overdose and enhance the 
     integration and coordination of care and treatment options 
     for individuals with substance use disorder after discharge.
       (b) Grant Establishment and Participation.--
       (1) In general.--In carrying out the Program, the Secretary 
     shall award grants on a competitive basis to not more than 20 
     eligible entities described in paragraph (2).
       (2) Eligibility.--
       (A) In general.--To be eligible for a grant under this 
     subsection, an entity shall be--
       (i) a health care site described in subparagraph (B); or
       (ii) a health care site coordinator described in 
     subparagraph (C).
       (B) Health care sites.--To be eligible for a grant under 
     this section, a health care site shall--
       (i) submit an application to the Secretary at such time, in 
     such manner, and containing such information as specified by 
     the Secretary;
       (ii) have an emergency department;
       (iii)(I) have a licensed health care professional onsite 
     who has a waiver under section 303(g) of the Controlled 
     Substances Act (21 U.S.C. 823(g)) to dispense or prescribe 
     covered drugs; or

[[Page H5048]]

       (II) have a demonstrable plan to hire a sufficient number 
     of full-time licensed health care professionals who have 
     waivers described in subclause (I) to administer such 
     treatment onsite;
       (iv) have in place an agreement with a sufficient number 
     and range of entities certified under applicable State and 
     Federal law, such as pursuant to registration or a waiver 
     under section 303(g) of the Controlled Substances Act (21 
     U.S.C. 823(g)) or certification as described in section 8.2 
     of title 42 of the Code of Federal Regulations, to provide 
     treatment for substance use disorder such that the entity or 
     the resulting network of entities with an agreement with the 
     hospital cumulatively are capable of providing all evidence-
     based services for the treatment of substance use disorder, 
     as medically appropriate for the individual involved, 
     including--

       (I) medication-assisted treatment;
       (II) withdrawal and detoxification services that include 
     patient evaluation, stabilization, and readiness for and 
     entry into treatment; and
       (III) counseling;

       (v) deploy onsite peer recovery specialists to help connect 
     patients with treatment and recovery support services; and
       (vi) include the provision of overdose reversal medication 
     in discharge protocols for opioid overdose patients.
       (C) Health care site coordinators.--To be eligible for a 
     grant under this section, a health care site coordinator 
     shall--
       (i) be an organization described in section 501(c)(3) of 
     the Internal Revenue Code of 1986 (and exempt from tax under 
     section 501(a) of such Code) or a State, local, or Tribal 
     government;
       (ii) submit an application to the Secretary at such time, 
     in such manner, and containing such information as specified 
     by the Secretary; and
       (iii) have an agreement with multiple eligible health care 
     sites described in subparagraph (B).
       (3) Preference.--In awarding grants under this section, the 
     Secretary may give preference to eligible entities described 
     in paragraph (2) that meet either or both of the following 
     criteria:
       (A) The eligible health care site is, or the eligible 
     health care site coordinator has an agreement described in 
     paragraph (2)(C)(iii) with a site that is, a critical access 
     hospital (as defined in section 1861(mm)(1) of the Social 
     Security Act (42 U.S.C. 1395x(mm)(1))), a low-volume hospital 
     (as defined in section 1886(d)(12)(C)(i) of such Act (42 
     U.S.C. 1395ww(d)(12)(C)(i))), or a sole community hospital 
     (as defined in section 1886(d)(5)(D)(iii) of such Act (42 
     U.S.C. 1395ww(d)(5)(D)(iii))).
       (B) The eligible health care site or the eligible health 
     care site coordinator is located in a geographic area with a 
     drug overdose rate that is higher than the national rate, or 
     in a geographic area with a rate of emergency department 
     visits for overdoses that is higher than the national rate, 
     as determined by the Secretary based on the most recent data 
     from the Centers for Disease Control and Prevention.
       (4) Medication-assisted treatment defined.--For purposes of 
     this section, the term ``medication-assisted treatment'' 
     means the use of a drug approved under section 505 of the 
     Federal Food, Drug, and Cosmetic Act (21 U.S.C. 355) or a 
     biological product licensed under section 351 of the Public 
     Health Service Act (42 U.S.C. 262), in combination with 
     behavioral health services, to provide an individualized 
     approach to the treatment of substance use disorders, 
     including opioid use disorders.
       (c) Period of Grant.--A grant awarded to an eligible entity 
     under this section shall be for a period of at least 2 years.
       (d) Grant Uses.--
       (1) Required uses.--A grant awarded under this section to 
     an eligible entity shall be used for both of the following 
     purposes:
       (A) To establish policies and procedures that address the 
     provision of overdose reversal medication, prescription and 
     dispensing of medication-assisted treatment to an emergency 
     department patient who has had a non-fatal overdose or who is 
     at risk of a drug overdose, and the subsequent referral to 
     evidence-based treatment upon discharge for patients who have 
     experienced a non-fatal drug overdose or who are at risk of a 
     drug overdose.
       (B) To develop best practices for treating non-fatal drug 
     overdoses, including with respect to care coordination and 
     integrated care models for long term treatment and recovery 
     options for individuals who have experienced a non-fatal drug 
     overdose.
       (2) Additional permissible uses.--A grant awarded under 
     this section to an eligible entity may be used for any of the 
     following purposes:
       (A) To hire emergency department peer recovery specialists; 
     counselors; therapists; social workers; or other licensed 
     medical professionals specializing in the treatment of 
     substance use disorder.
       (B) To establish integrated models of care for individuals 
     who have experienced a non-fatal drug overdose which may 
     include patient assessment, follow up, and transportation to 
     treatment facilities.
       (C) To provide for options for increasing the availability 
     and access of medication-assisted treatment and other 
     evidence-based treatment for individuals with substance use 
     disorders.
       (D) To offer consultation with and referral to other 
     supportive services that help in treatment and recovery.
       (e) Reporting Requirements.--
       (1) Reports by grantees.--Each eligible entity awarded a 
     grant under this section shall submit to the Secretary an 
     annual report for each year for which the entity has received 
     such grant that includes information on--
       (A) the number of individuals treated at the site (or, in 
     the case of an eligible health care site coordinator, at 
     sites covered by the agreement referred to in subsection 
     (b)(2)(C)(iii)) for non-fatal overdoses in the emergency 
     department;
       (B) the number of individuals administered each medication-
     assisted treatment at such site or sites in the emergency 
     department;
       (C) the number of individuals referred by such site or 
     sites to other treatment facilities after a non-fatal 
     overdose, the types of such other facilities, and the number 
     of such individuals admitted to such other facilities 
     pursuant to such referrals;
       (D) the frequency and number of patient readmissions for 
     non-fatal overdoses and substance use disorder;
       (E) for what the grant funding was used; and
       (F) the effectiveness of, and any other relevant additional 
     data regarding, having an onsite health care professional to 
     administer and begin medication-assisted treatment for 
     substance use disorders.
       (2) Report by secretary.--Not less than one year after the 
     conclusion of the Program, the Secretary shall submit to 
     Congress a report that includes--
       (A) findings of the Program;
       (B) overall patient outcomes under the Program, such as 
     with respect to hospital readmission;
       (C) what percentage of patients treated by a site funded 
     through a grant under this section were readmitted to a 
     hospital for non-fatal or fatal overdose;
       (D) an evaluation determining the effectiveness of having a 
     practitioner onsite to administer and begin medication-
     assisted treatment for substance use disorder; and
       (E) a compilation of voluntary guidelines and best 
     practices from the reports submitted under paragraph (1).
       (f) Authorization of Appropriations.--There is authorized 
     to be appropriated to carry out this Act $50,000,000 for the 
     period of fiscal years 2019 through 2023.

  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. Mr. Speaker, I ask unanimous consent that all Members may 
have 5 legislative days in which to revise and extend their remarks and 
insert extraneous materials 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. 5176, 
the Preventing Overdoses While in Emergency Rooms Act, or the POWER 
Act. This legislation will provide needed resources to help hospitals, 
health departments, and health systems to develop discharge protocols 
for patients who have had an opioid overdose, such as the provision of 
naloxone upon discharge, and referrals to treatment and other services 
that best fit the patients' needs.
  By putting rapid referral systems in place, we can better place those 
presenting with an overdose in evidence-based treatment and get 
patients on the road to recovery.
  I want to thank my colleagues, Representatives  David McKinley of 
West Virginia and Mike Doyle of Pennsylvania, for leading this 
initiative. I am going to yield to my colleague from West Virginia, but 
before I do, I just want to say what a leader  David McKinley has been 
on this issue involving opioids.
  We have met on countless occasions. He has brought many initiatives 
to our committee. While he is the lead on this bill, he has been 
instrumental on nearly all the bills that we have considered and has 
been a tireless advocate for the people of West Virginia in this 
matter.
  Mr. Speaker, I yield such time as he may consume to the gentleman 
from West Virginia (Mr. McKinley).
  Mr. McKINLEY. Mr. Speaker, I thank the chairman for those kind 
remarks. This is not just West Virginia, but it is all across this 
country. I think we are speaking for all and trying to give a voice all 
across the country.
  Mr. Speaker, I rise in support of H.R. 5176, the Preventing Overdoses 
While in the Emergency Room Act. The demand

[[Page H5049]]

for these substance abuse services in America's emergency rooms far 
exceeds their availability. Treatment is particularly scarce in rural 
counties, in spite of having an average overdose rate that is 45 
percent higher than more urban areas.
  In March, the Centers for Disease Control reported that the emergency 
room visits for opioid overdoses had risen 30 percent since July of 
2016, in less than 2 years, a 30 percent increase.
  That is why I am honored to be joined by Congressman Doyle in 
introducing this bipartisan act, also known as the POWER Act. This 
legislation will provide competitive grants to ensure that overdose 
patients receive the treatment they need while still in the emergency 
room, giving them a better shot at recovery. This bill, hopefully, is 
intended to reduce repeat overdoses and thereby save lives.
  I want to thank the cosponsor of this bill, Mr. Doyle, and 
particularly our chairman, Mr. Walden, for their work on this important 
issue. I urge my colleagues to support this legislation.
  Mr. PALLONE. Mr. Speaker, I yield myself such time as I may consume.
  I rise in support of H.R. 5176, Preventing Overdoses While in 
Emergency Rooms Act. This legislation would provide grant funding for 
emergency departments to develop protocols for treating and discharging 
patients who have presented with an opioid overdose or are at increased 
risk for overdose.
  These protocols will help increase the uptake of evidence-based 
treatment services by promoting the initiation of medication-assisted 
treatment in emergency departments, as well as referral to community-
based providers for treatment and recovery support services.
  This is particularly important since an individual's willingness to 
seek substance use disorder treatment often increases immediately 
following a nonfatal overdose.
  The protocols also will help reduce the risk of future fatal 
overdoses by such individuals by requiring the provision of naloxone at 
discharge. This helps ensure that these individuals at high risk of 
overdose have this lifesaving drug available if it is needed to reverse 
a potentially fatal overdose.
  So I urge my colleagues to support this legislation, and I yield back 
the balance of my time.
  Mr. WALDEN. Mr. Speaker, I just want to, again, thank our leaders on 
this effort, Mr. Doyle and certainly Mr. McKinley. I would encourage 
passage of the bill, and I yield back the balance of my time.
  The SPEAKER pro tempore (Mr. Francis Rooney of Florida). 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. 5176, as amended.
  The question was taken; and (two-thirds being in the affirmative) the 
rules were suspended and the bill, as amended, was passed.
  A motion to reconsider was laid on the table.

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