DR. TODD GRAHAM PAIN MANAGEMENT, TREATMENT, AND RECOVERY ACT OF 2018; Congressional Record Vol. 164, No. 102
(House of Representatives - June 19, 2018)

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[Pages H5249-H5254]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




  DR. TODD GRAHAM PAIN MANAGEMENT, TREATMENT, AND RECOVERY ACT OF 2018

  Mrs. WALORSKI. Mr. Speaker, I move to suspend the rules and pass the 
bill (H.R. 6110) to amend title XVIII of the Social Security Act to 
provide for the review and adjustment of payments under the Medicare 
outpatient prospective payment system to avoid financial incentives to 
use opioids instead of non-opioid alternative treatments, and for other 
purposes.

[[Page H5250]]

  The Clerk read the title of the bill.
  The text of the bill is as follows:

                               H.R. 6110

       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 ``Dr. Todd Graham Pain 
     Management, Treatment, and Recovery Act of 2018''.

     SEC. 2. REVIEW AND ADJUSTMENT OF PAYMENTS UNDER THE MEDICARE 
                   OUTPATIENT PROSPECTIVE PAYMENT SYSTEM TO AVOID 
                   FINANCIAL INCENTIVES TO USE OPIOIDS INSTEAD OF 
                   NON-OPIOID ALTERNATIVE TREATMENTS.

       (a) Outpatient Prospective Payment System.--Section 1833(t) 
     of the Social Security Act (42 U.S.C. 1395l(t)) is amended by 
     adding at the end the following new paragraph:
       ``(22) Review and revisions of payments for non-opioid 
     alternative treatments.--
       ``(A) In general.--With respect to payments made under this 
     subsection for covered OPD services (or groups of services), 
     including covered OPD services assigned to a comprehensive 
     ambulatory payment classification, the Secretary--
       ``(i) shall, as soon as practicable, conduct a review (part 
     of which may include a request for information) of payments 
     for opioids and evidence-based non-opioid alternatives for 
     pain management (including drugs and devices, nerve blocks, 
     surgical injections, and neuromodulation) with a goal of 
     ensuring that there are not financial incentives to use 
     opioids instead of non-opioid alternatives;
       ``(ii) may, as the Secretary determines appropriate, 
     conduct subsequent reviews of such payments; and
       ``(iii) shall consider the extent to which revisions under 
     this subsection to such payments (such as the creation of 
     additional groups of covered OPD services to classify 
     separately those procedures that utilize opioids and non-
     opioid alternatives for pain management) would reduce payment 
     incentives to use opioids instead of non-opioid alternatives 
     for pain management.
       ``(B) Priority.--In conducting the review under clause (i) 
     of subparagraph (A) and considering revisions under clause 
     (iii) of such subparagraph, the Secretary shall focus on 
     covered OPD services (or groups of services) assigned to a 
     comprehensive ambulatory payment classification, ambulatory 
     payment classifications that primarily include surgical 
     services, and other services determined by the Secretary 
     which generally involve treatment for pain management.
       ``(C) Revisions.--If the Secretary identifies revisions to 
     payments pursuant to subparagraph (A)(iii), the Secretary 
     shall, as determined appropriate, begin making such revisions 
     for services furnished on or after January 1, 2020. Revisions 
     under the previous sentence shall be treated as adjustments 
     for purposes of application of paragraph (9)(B).
       ``(D) Rules of construction.--Nothing in this paragraph 
     shall be construed to preclude the Secretary--
       ``(i) from conducting a demonstration before making the 
     revisions described in subparagraph (C); or
       ``(ii) prior to implementation of this paragraph, from 
     changing payments under this subsection for covered OPD 
     services (or groups of services) which include opioids or 
     non-opioid alternatives for pain management.''.
       (b) Ambulatory Surgical Centers.--Section 1833(i) of the 
     Social Security Act (42 U.S.C. 1395l(i)) is amended by adding 
     at the end the following new paragraph:
       ``(8) The Secretary shall conduct a similar type of review 
     as required under paragraph (22) of section 1833(t)), 
     including the second sentence of subparagraph (C) of such 
     paragraph, to payment for services under this subsection, and 
     make such revisions under this paragraph, in an appropriate 
     manner (as determined by the Secretary).''.

     SEC. 3. EXPANDING ACCESS UNDER THE MEDICARE PROGRAM TO 
                   ADDICTION TREATMENT IN FEDERALLY QUALIFIED 
                   HEALTH CENTERS AND RURAL HEALTH CLINICS.

       (a) Federally Qualified Health Centers.--Section 1834(o) of 
     the Social Security Act (42 U.S.C. 1395m(o)) is amended by 
     adding at the end the following new paragraph:
       ``(3) Additional payments for certain fqhcs with physicians 
     or other practitioners receiving data 2000 waivers.--
       ``(A) In general.--In the case of a Federally qualified 
     health center with respect to which, beginning on or after 
     January 1, 2019, Federally-qualified health center services 
     (as defined in section 1861(aa)(3)) are furnished for the 
     treatment of opioid use disorder by a physician or 
     practitioner who meets the requirements described in 
     subparagraph (C) the Secretary shall, subject to availability 
     of funds under subparagraph (D), make a payment (at such time 
     and in such manner as specified by the Secretary) to such 
     Federally qualified health center after receiving and 
     approving an application submitted by such Federally 
     qualified health center under subparagraph (B). Such a 
     payment shall be in an amount determined by the Secretary, 
     based on an estimate of the average costs of training for 
     purposes of receiving a waiver described in subparagraph 
     (C)(ii). Such a payment may be made only one time with 
     respect to each such physician or practitioner.
       ``(B) Application.--In order to receive a payment described 
     in subparagraph (A), a Federally-qualified health center 
     shall submit to the Secretary an application for such a 
     payment at such time, in such manner, and containing such 
     information as specified by the Secretary. A Federally-
     qualified health center may apply for such a payment for each 
     physician or practitioner described in subparagraph (A) 
     furnishing services described in such subparagraph at such 
     center.
       ``(C) Requirements.--For purposes of subparagraph (A), the 
     requirements described in this subparagraph, with respect to 
     a physician or practitioner, are the following:
       ``(i) The physician or practitioner is employed by or 
     working under contract with a Federally qualified health 
     center described in subparagraph (A) that submits an 
     application under subparagraph (B).
       ``(ii) The physician or practitioner first receives a 
     waiver under section 303(g) of the Controlled Substances 
     Acton or after January 1, 2019.
       ``(D) Funding.--For purposes of making payments under this 
     paragraph, there are appropriated, out of amounts in the 
     Treasury not otherwise appropriated, $6,000,000, which shall 
     remain available until expended.''.
       (b) Rural Health Clinic.--Section 1833 of the Social 
     Security Act (42 U.S.C. 1395l) is amended--
       (1) by redesignating the subsection (z) relating to medical 
     review of spinal subluxation services as subsection (aa); and
       (2) by adding at the end the following new subsection:
       ``(bb) Additional Payments for Certain Rural Health Clinics 
     With Physicians or Practitioners Receiving DATA 2000 
     Waivers.--
       ``(1) In general.--In the case of a rural health clinic 
     with respect to which, beginning on or after January 1, 2019, 
     rural health clinic services (as defined in section 
     1861(aa)(1)) are furnished for the treatment of opioid use 
     disorder by a physician or practitioner who meets the 
     requirements described in paragraph (3), the Secretary shall, 
     subject to availability of funds under paragraph (4), make a 
     payment (at such time and in such manner as specified by the 
     Secretary) to such rural health clinic after receiving and 
     approving an application described in paragraph (2). Such 
     payment shall be in an amount determined by the Secretary, 
     based on an estimate of the average costs of training for 
     purposes of receiving a waiver described in paragraph (3)(B). 
     Such payment may be made only one time with respect to each 
     such physician or practitioner.
       ``(2) Application.--In order to receive a payment described 
     in paragraph (1), a rural health clinic shall submit to the 
     Secretary an application for such a payment at such time, in 
     such manner, and containing such information as specified by 
     the Secretary. A rural health clinic may apply for such a 
     payment for each physician or practitioner described in 
     paragraph (1) furnishing services described in such paragraph 
     at such clinic.
       ``(3) Requirements.--For purposes of paragraph (1), the 
     requirements described in this paragraph, with respect to a 
     physician or practitioner, are the following:
       ``(A) The physician or practitioner is employed by or 
     working under contract with a rural health clinic described 
     in paragraph (1) that submits an application under paragraph 
     (2).
       ``(B) The physician or practitioner first receives a waiver 
     under section 303(g) of the Controlled Substances Acton or 
     after January 1, 2019.
       ``(4) Funding.--For purposes of making payments under this 
     subsection, there are appropriated, out of amounts in the 
     Treasury not otherwise appropriated, $2,000,000, which shall 
     remain available until expended.''.

     SEC. 4. STUDYING THE AVAILABILITY OF SUPPLEMENTAL BENEFITS 
                   DESIGNED TO TREAT OR PREVENT SUBSTANCE USE 
                   DISORDERS UNDER MEDICARE ADVANTAGE PLANS.

       (a) In General.--Not later than 2 years after the date of 
     the enactment of this Act, the Secretary of Health and Human 
     Services (in this section referred to as the ``Secretary'') 
     shall submit to Congress a report on the availability of 
     supplemental health care benefits (as described in section 
     1852(a)(3)(A) of the Social Security Act (42 U.S.C. 1395w-
     22(a)(3)(A))) designed to treat or prevent substance use 
     disorders under Medicare Advantage plans offered under part C 
     of title XVIII of such Act. Such report shall include the 
     analysis described in subsection (c) and any differences in 
     the availability of such benefits under specialized MA plans 
     for special needs individuals (as defined in section 
     1859(b)(6) of such Act (42 U.S.C. 1395w-28(b)(6))) offered to 
     individuals entitled to medical assistance under title XIX of 
     such Act and other such Medicare Advantage plans.
       (b) Consultation.--The Secretary shall develop the report 
     described in subsection (a) in consultation with relevant 
     stakeholders, including--
       (1) individuals entitled to benefits under part A or 
     enrolled under part B of title XVIII of the Social Security 
     Act;
       (2) entities who advocate on behalf of such individuals;
       (3) Medicare Advantage organizations;
       (4) pharmacy benefit managers; and
       (5) providers of services and suppliers (as such terms are 
     defined in section 1861 of such Act (42 U.S.C. 1395x)).
       (c) Contents.--The report described in subsection (a) shall 
     include an analysis on the following:
       (1) The extent to which plans described in such subsection 
     offer supplemental health care benefits relating to coverage 
     of--

[[Page H5251]]

       (A) medication-assisted treatments for opioid use, 
     substance use disorder counseling, peer recovery support 
     services, or other forms of substance use disorder treatments 
     (whether furnished in an inpatient or outpatient setting); 
     and
       (B) non-opioid alternatives for the treatment of pain.
       (2) Challenges associated with such plans offering 
     supplemental health care benefits relating to coverage of 
     items and services described in subparagraph (A) or (B) of 
     paragraph (1).
       (3) The impact, if any, of increasing the applicable rebate 
     percentage determined under section 1854(b)(1)(C) of the 
     Social Security Act (42 U.S.C. 1395w-24(b)(1)(C)) for plans 
     offering such benefits relating to such coverage would have 
     on the availability of such benefits relating to such 
     coverage offered under Medicare Advantage plans.
       (4) Potential ways to improve upon such coverage or to 
     incentivize such plans to offer additional supplemental 
     health care benefits relating to such coverage.

     SEC. 5. CLINICAL PSYCHOLOGIST SERVICES MODELS UNDER THE 
                   CENTER FOR MEDICARE AND MEDICAID INNOVATION; 
                   GAO STUDY AND REPORT.

       (a) CMI Models.--Section 1115A(b)(2)(B) of the Social 
     Security Act (42 U.S.C. 1315a(b)(2)(B) is amended by adding 
     at the end the following new clauses:
       ``(xxv) Supporting ways to familiarize individuals with the 
     availability of coverage under part B of title XVIII for 
     qualified psychologist services (as defined in section 
     1861(ii)).
       ``(xxvi) Exploring ways to avoid unnecessary 
     hospitalizations or emergency department visits for mental 
     and behavioral health services (such as for treating 
     depression) through use of a 24-hour, 7-day a week help line 
     that may inform individuals about the availability of 
     treatment options, including the availability of qualified 
     psychologist services (as defined in section 1861(ii)).''.
       (b) GAO Study and Report.--Not later than 18 months after 
     the date of the enactment of this Act, the Comptroller 
     General of the United States shall conduct a study, and 
     submit to Congress a report, on mental and behavioral health 
     services under the Medicare program under title XVIII of the 
     Social Security Act, including an examination of the 
     following:
       (1) Information about services furnished by psychiatrists, 
     clinical psychologists, and other professionals.
       (2) Information about ways that Medicare beneficiaries 
     familiarize themselves about the availability of Medicare 
     payment for qualified psychologist services (as defined in 
     section 1861(ii) of the Social Security Act (42 U.S.C. 
     1395x(ii)) and ways that the provision of such information 
     could be improved.

     SEC. 6. PAIN MANAGEMENT STUDY.

       (a) In General.--Not later than 1 year after the date of 
     enactment of this Act, the Secretary of Health and Human 
     Services (referred to in this section as the ``Secretary'') 
     shall conduct a study analyzing best practices as well as 
     payment and coverage for pain management services under title 
     XVIII of the Social Security Act and submit to the Committee 
     on Ways and Means and the Committee on Energy and Commerce of 
     the House of Representatives and the Committee on Finance of 
     the Senate a report containing options for revising payment 
     to providers and suppliers of services and coverage related 
     to the use of multi-disciplinary, evidence-based, non-opioid 
     treatments for acute and chronic pain management for 
     individuals entitled to benefits under part A or enrolled 
     under part B of title XVIII of the Social Security Act. The 
     Secretary shall make such report available on the public 
     website of the Centers for Medicare & Medicaid Services.
       (b) Consultation.--In developing the report described in 
     subsection (a), the Secretary shall consult with--
       (1) relevant agencies within the Department of Health and 
     Human Services;
       (2) licensed and practicing osteopathic and allopathic 
     physicians, behavioral health practitioners, physician 
     assistants, nurse practitioners, dentists, pharmacists, and 
     other providers of health services;
       (3) providers and suppliers of services (as such terms are 
     defined in section 1861 of the Social Security Act (42 U.S.C. 
     1395x));
       (4) substance abuse and mental health professional 
     organizations;
       (5) pain management professional organizations and advocacy 
     entities, including individuals who personally suffer chronic 
     pain;
       (6) medical professional organizations and medical 
     specialty organizations;
       (7) licensed health care providers who furnish alternative 
     pain management services;
       (8) organizations with expertise in the development of 
     innovative medical technologies for pain management;
       (9) beneficiary advocacy organizations; and
       (10) other organizations with expertise in the assessment, 
     diagnosis, treatment, and management of pain, as determined 
     appropriate by the Secretary.
       (c) Contents.--The report described in subsection (a) shall 
     include the following:
       (1) An analysis of payment and coverage under title XVIII 
     of the Social Security Act with respect to the following:
       (A) Evidence-based treatments and technologies for chronic 
     or acute pain, including such treatments that are covered, 
     not covered, or have limited coverage under such title.
       (B) Evidence-based treatments and technologies that monitor 
     substance use withdrawal and prevent overdoses of opioids.
       (C) Evidence-based treatments and technologies that treat 
     substance use disorders.
       (D) Items and services furnished by practitioners through a 
     multi-disciplinary treatment model for pain management, 
     including the patient-centered medical home.
       (E) Medical devices, non-opioid based drugs, and other 
     therapies (including interventional and integrative pain 
     therapies) approved or cleared by the Food and Drug 
     Administration for the treatment of pain.
       (F) Items and services furnished to beneficiaries with 
     psychiatric disorders, substance use disorders, or who are at 
     risk of suicide, or have comorbidities and require 
     consultation or management of pain with one or more 
     specialists in pain management, mental health, or addiction 
     treatment.
       (2) An evaluation of the following:
       (A) Barriers inhibiting individuals entitled to benefits 
     under part A or enrolled under part B of such title from 
     accessing treatments and technologies described in 
     subparagraphs (A) through (F) of paragraph (1).
       (B) Costs and benefits associated with potential expansion 
     of coverage under such title to include items and services 
     not covered under such title that may be used for the 
     treatment of pain, such as acupuncture, therapeutic massage, 
     and items and services furnished by integrated pain 
     management programs.
       (C) Pain management guidance published by the Federal 
     Government that may be relevant to coverage determinations or 
     other coverage requirements under title XVIII of the Social 
     Security Act.
       (3) An assessment of all guidance published by the 
     Department of Health and Human Services on or after January 
     1, 2016, relating to the prescribing of opioids. Such 
     assessment shall consider incorporating into such guidance 
     relevant elements of the ``Va/DoD Clinical Practice Guideline 
     for Opioid Therapy for Chronic Pain'' published in February 
     2017 by the Department of Veterans Affairs and Department of 
     Defense, including adoption of elements of the Department of 
     Defense and Veterans Administration pain rating scale.
       (4) The options described in subsection (d).
       (5) The impact analysis described in subsection (e).
       (d) Options.--The options described in this subsection are, 
     with respect to individuals entitled to benefits under part A 
     or enrolled under part B of title XVIII of the Social 
     Security Act, legislative and administrative options for 
     accomplishing the following:
       (1) Improving coverage of and payment for pain management 
     therapies without the use of opioids, including 
     interventional pain therapies, and options to augment opioid 
     therapy with other clinical and complementary, integrative 
     health services to minimize the risk of substance use 
     disorder, including in a hospital setting.
       (2) Improving coverage of and payment for medical devices 
     and non-opioid based pharmacological and non-pharmacological 
     therapies approved or cleared by the Food and Drug 
     Administration for the treatment of pain as an alternative or 
     augment to opioid therapy.
       (3) Improving and disseminating treatment strategies for 
     beneficiaries with psychiatric disorders, substance use 
     disorders, or who are at risk of suicide, and treatment 
     strategies to address health disparities related to opioid 
     use and opioid abuse treatment.
       (4) Improving and disseminating treatment strategies for 
     beneficiaries with comorbidities who require a consultation 
     or comanagement of pain with one or more specialists in pain 
     management, mental health, or addiction treatment, including 
     in a hospital setting.
       (5) Educating providers on risks of coadministration of 
     opioids and other drugs, particularly benzodiazepines.
       (6) Ensuring appropriate case management for beneficiaries 
     who transition between inpatient and outpatient hospital 
     settings, or between opioid therapy to non-opioid therapy, 
     which may include the use of care transition plans.
       (7) Expanding outreach activities designed to educate 
     providers of services and suppliers under the Medicare 
     program and individuals entitled to benefits under part A or 
     under part B of such title on alternative, non-opioid 
     therapies to manage and treat acute and chronic pain.
       (8) Creating a beneficiary education tool on alternatives 
     to opioids for chronic pain management.
       (e) Impact Analysis.--The impact analysis described in this 
     subsection consists of an analysis of any potential effects 
     implementing the options described in subsection (d) would 
     have--
       (1) on expenditures under the Medicare program; and
       (2) on preventing or reducing opioid addiction for 
     individuals receiving benefits under the Medicare program.

     SEC. 7. SUSPENSION OF PAYMENTS BY MEDICARE PRESCRIPTION DRUG 
                   PLANS AND MA-PD PLANS PENDING INVESTIGATIONS OF 
                   CREDIBLE ALLEGATIONS OF FRAUD BY PHARMACIES.

       (a) In General.--Section 1860D-12(b) of the Social Security 
     Act (42 U.S.C. 1395w-112(b)) is amended by adding at the end 
     the following new paragraph:
       ``(7) Suspension of payments pending investigation of 
     credible allegations of fraud by pharmacies.--
       ``(A) In general.--The provisions of section 1862(o) shall 
     apply with respect to a PDP sponsor with a contract under 
     this part,

[[Page H5252]]

     a pharmacy, and payments to such pharmacy under this part in 
     the same manner as such provisions apply with respect to the 
     Secretary, a provider of services or supplier, and payments 
     to such provider of services or supplier under this title.
       ``(B) Rule of construction.--Nothing in this paragraph 
     shall be construed as limiting the authority of a PDP sponsor 
     to conduct postpayment review.''.
       (b) Application to MA-PD Plans.--Section 1857(f)(3) of the 
     Social Security Act (42 U.S.C. 1395w-27(f)(3)) is amended by 
     adding at the end the following new subparagraph:
       ``(D) Suspension of payments pending investigation of 
     credible allegations of fraud by pharmacies.--Section 1860D-
     12(b)(7).''.
       (c) Conforming Amendment.--Section 1862(o)(3) of the Social 
     Security Act (42 U.S.C. 1395y(o)(3)) is amended by inserting 
     ``, section 1860D-12(b)(7) (including as applied pursuant to 
     section 1857(f)(3)(D)),'' after ``this subsection''.
       (d) Clarification Relating to Credible Allegation of 
     Fraud.--Section 1862(o) of the Social Security Act (42 U.S.C. 
     1395y(o)) is amended by adding at the end the following new 
     paragraph:
       ``(4) Credible allegation of fraud.--In carrying out this 
     subsection, section 1860D-12(b)(7) (including as applied 
     pursuant to section 1857(f)(3)(D)), and section 
     1903(i)(2)(C), a fraud hotline tip (as defined by the 
     Secretary) without further evidence shall not be treated as 
     sufficient evidence for a credible allegation of fraud.''.
       (e) Effective Date.--The amendments made by this section 
     shall apply with respect to plan years beginning on or after 
     January 1, 2020.

  The SPEAKER pro tempore. Pursuant to the rule, the gentlewoman from 
Indiana (Mrs. Walorski) and the gentlewoman from California (Ms. Judy 
Chu) each will control 20 minutes.
  The Chair recognizes the gentlewoman from Indiana.


                             General Leave

  Mrs. WALORSKI. Mr. Speaker, I ask unanimous consent that all Members 
may have 5 legislative days within which to revise and extend their 
remarks and include extraneous material on H.R. 6110, currently under 
consideration.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentlewoman from Indiana?
  There was no objection.
  Mrs. WALORSKI. Mr. Speaker, I yield myself such time as I may 
consume.
  Mr. Speaker, I rise today in support of H.R. 6110, the Dr. Todd 
Graham Pain Management, Treatment, and Recovery Act.
  Solving the opioid epidemic requires everyone to work together at all 
levels, from the Federal Government down to those on the front lines of 
this fight.
  My legislation focuses on increasing access to pain management 
alternatives that do not involve opioids and improving recovery 
treatment options for those suffering from opioid use disorder.
  Additionally, my legislation contains the following provisions that 
will also be vital in overcoming this crisis: H.R. 5778, the Promoting 
Outpatient Access to Non-Opioid Treatments Act introduced by 
Representative  Kenny Marchant and Health Subcommittee Ranking Member 
Sander Levin, which requires the Secretary of Health and Human 
Services, or HHS, to require payments made to hospital outpatient 
departments and ambulatory surgery centers to ensure there are no 
financial incentives to use opioids over nonopioid alternatives; H.R. 
5769, the Expanding Access to Treatment Act introduced by 
Representatives Keith Rothfus and  Danny Davis, which provides payments 
to federally qualified health centers and rural health clinics to 
offset the cost of their providers receiving training so they are able 
to provide medication-assisted treatment that will help individuals 
recover from opioid use disorder; H.R. 5725, the Benefit Evaluation of 
Safe Treatment Act introduced by Health Subcommittee Chairman Peter 
Roskam and Representatives Linda Sanchez, John Shimkus, and Raul Ruiz, 
which directs the Secretary of HHS to evaluate the extent to which MA 
plans offer medication-assisted treatments and cover nonopioid 
alternative treatments not otherwise covered under a Medicare fee for 
service as part of a supplemental benefit; and H.R. 5790, the Medicare 
Nurse Hotline Act introduced by Representatives Kristi Noem and Judy 
Chu, which directs the Secretary of HHS to educate patients on the 
availability of psychologist services and explore the use of hotlines 
to reduce unnecessary hospitalizations and Medicare.
  The bill is named after my friend Dr. Todd Graham. He was a double 
board certified physician in both physical medicine and rehabilitation 
and pain medicine who lived and worked in my district in northern 
Indiana.
  Last year, he was senselessly murdered after refusing to prescribe an 
opioid to a patient.
  Dr. Graham prided himself on serving his patients in a friendly and 
caring fashion. He treated each person individually, taking the time to 
offer specific steps to treat their issues.
  One day last year, he had an interaction with a patient demanding 
opioids, a situation that has become disturbingly all too common. He 
stood firm in refusing to write a prescription for her, but her 
husband, who was also there, became increasingly angry throughout that 
visit. Two hours after they left his office, the husband returned and 
murdered him in cold blood.
  Dr. Graham's loss has been a heavy blow, but his legacy of compassion 
and enthusiasm lives on through his wife, Julie; their two daughters; 
and their son, who plans to follow in his father's footsteps.
  We are lucky to have the Graham family with us here today to witness 
the passage of this important bill.
  Mr. Speaker, I reserve the balance of my time.

                                         House of Representatives,


                                  Committee on Ways and Means,

                                     Washington, DC, June 8, 2018.
     Hon. Greg Walden,
     Chairman, Committee on Energy and Commerce,
     Washington, DC.
       Dear Chairman Walden: I write to you regarding several 
     opioid bills the Committee on Ways and Means ordered 
     favorably reported to address the opioid epidemic. The 
     following bills were also referred to the Committee on Energy 
     and Commerce.
       I ask that the Committee on Energy and Commerce waive 
     formal consideration of the following bills so that they may 
     proceed expeditiously to the House Floor:
       H.R. 5774, Combatting Opioid Abuse for Care in Hospitals 
     (COACH) Act;
       H.R. 5775, Providing Reliable Options for Patients and 
     Educations Resources (PROPER) Act;
       H.R. 5776, Medicare and Opioid Safe Treatment (MOST) Act;
       H.R. 5773, Preventing Addition for Susceptible Seniors 
     (PASS) Act;
       H.R. 5676, Stop Excessive Narcotics in our Retirement 
     (SENIOR) Communities Protection Act; and
       H.R. 5723, Expanding Oversight of Opioid Prescribing and 
     Payment Act.
       I acknowledge that by waiving formal consideration of the 
     bills, the Committee on Energy and Commerce is in no way 
     waiving its jurisdiction over the subject matter contained in 
     those provisions of the bills that fall within your Rule X 
     jurisdiction. I would support your effort to seek appointment 
     of an appropriate number of conferees on any House-Senate 
     conference involving this legislation.
       I will include a copy of our letters in the Congressional 
     Record during consideration of this legislation on the House 
     floor.
           Sincerely,
                                                      Kevin Brady,
     Chairman.
                                  ____

                                         House of Representatives,


                             Committee on Energy and Commerce,

                                     Washington, DC, June 8, 2018.
     Hon. Kevin Brady,
     Chairman, Committee on Ways and Means,
     Washington, DC.
       Dear Chairman Brady: Thank you for your letter regarding 
     the following bills, which were also referred to the 
     Committee on Energy and Commerce:
       H.R. 5774, Combatting Opioid Abuse for Care in Hospitals 
     (COACH) Act;
       H.R. 5775, Providing Reliable Options for Patients and 
     Educations Resources (PROPER) Act;
       H.R. 5776, Medicare and Opioid Safe Treatment (MOST) Act;
       H.R. 5773, Preventing Addition for Susceptible Seniors 
     (PASS) Act;
       H.R. 5676, Stop Excessive Narcotics in our Retirement 
     (SENIOR) Communities Protection Act; and
       H.R. 5723, Expanding Oversight of Opioid Prescribing and 
     Payment Act.
       I wanted to notify you that the Committee will forgo action 
     on these bills so that they may proceed expeditiously to the 
     House floor.
       I appreciate your acknowledgment that by forgoing formal 
     consideration of these bills, the Committee on Energy and 
     Commerce is in no way waiving its jurisdiction over the 
     subject matter contained in those provisions of the bills 
     that fall within its Rule X jurisdiction. I also appreciate 
     your offer to support the Committee's request for the 
     appointment of conferees in the event of a House-Senate 
     conference involving this legislation.

[[Page H5253]]

       Thank you for your assistance on this matter.
           Sincerely,
                                                      Greg Walden,
                                                         Chairman.

  Ms. JUDY CHU of California. Mr. Speaker, I yield myself such time as 
I may consume.
  Mr. Speaker, according to the Centers for Disease Control and 
Prevention, more than 42,000 Americans died from opioid-related drug 
overdoses in 2016. That is five times more than the overdose rate in 
1999.
  As we have heard from countless Members in this Chamber, there is no 
congressional district that hasn't been impacted by the opioid crisis. 
No town or city is immune from the devastating impact of addiction, and 
I hope that the steps we take today are the first of many to address 
the needs of our communities.
  The Substance Abuse and Mental Health Services Administration, or 
SAMHSA, estimated that in 2016, 11.8 million Americans over the age of 
12 had misused opioids in the past year and 3.8 million were currently 
misusing prescription pain relievers.
  But while we are seeing news reports of the devastating toll this 
crisis is taking on our Nation's young people, it is important to note 
that our seniors are also suffering. From 2005 to 2014, individuals 65 
years and older experienced an 85 percent cumulative increase in 
opioid-related inpatient stays and a 112 percent cumulative increase in 
emergency department visits, the largest increase of any age group.
  Compared to other age groups, individuals 65 and older have the 
highest rate of opioid-related inpatient stays in 13 States, including 
my home State of California.
  This crisis is especially acute for the nonelderly Medicare 
population. In 2015, nonelderly Medicare beneficiaries, or those who 
qualify on the basis of disability, had opioid utilization rates more 
than twice that of elderly beneficiaries.
  The bill before us, H.R. 6110, contains numerous provisions aimed at 
improving access to treatment for Medicare beneficiaries suffering from 
opioid use disorders, including access to nondrug opioid alternatives.
  While every alternative will not work for every person, when dealing 
with a crisis of this magnitude, I believe that we must use every tool 
in the toolbox.
  This bill contains two bipartisan provisions I authored with my 
colleagues on the Ways and Means Committee.
  Mr. Speaker, I thank the gentlewoman from Indiana (Mrs. Walorski) for 
working with me on language that would direct CMS to study barriers to 
patient access to nondrug alternatives for opioids in chronic care 
settings.
  Studies conducted by the NIH have concluded that alternative 
treatments, like acupuncture, can be effective in treating conditions 
like chronic pain. This issue is very important to me, because I have 
been working to expand access to acupuncture since I first arrived in 
the California State legislature many years ago. I have heard firsthand 
what a difference acupuncture can make in the lives of patients.
  I remember very clearly when I heard the testimony of a woman who had 
severe back pain, but did not want invasive surgery and risk possible 
addiction to morphine.

                              {time}  1545

  Instead, she sought acupuncture, and it worked for her. She avoided 
the risks associated with surgery and certain pain medications.
  Furthermore, we know access to physical and occupational therapy also 
helps alleviate pain and eliminates the need for an opioid 
prescription.
  By asking CMS to examine where barriers to these alternatives exist, 
we can open the door to more treatment alternatives for beneficiaries.
  I am also proud that this bill includes a provision I authored with 
the gentlewoman from North Dakota (Mrs. Noem) to address the need for 
more psychologists in the Medicare program. This bill would direct the 
Centers for Medicare and Medicaid Innovation to examine ways for 
beneficiaries to familiarize themselves with coverage for psychologist 
services and request a study from the General Accountability Office on 
the viability of mental and behavioral health services in the Medicare 
program.
  As one of only two psychologists in Congress, I firmly believe that 
expanding access to psychologist services in Medicare is one of the 
most important things we can do to improve the mental health of our 
senior population.
  We know that those who suffer from depression or other mental health 
disorders are particularly vulnerable to addiction. For those who have 
already taken the incredibly difficult step of seeking treatment, we 
need to ensure that they have access to the full range of mental health 
professionals who can support them on the journey to recovery.
  H.R. 6110 also contains a number of provisions from my colleagues on 
the Ways and Means Committee. Congress Members Levin and Marchant 
authored a provision to review certain Medicare payments in outpatient 
settings to determine whether there are financial incentives in the 
Medicare program to use or prescribe opioids instead of evidence-based, 
nonopioid alternatives.
  Next, the legislation includes a provision introduced by Congress 
Members Sanchez and Roskam that would direct the Secretary of HHS to 
evaluate the extent to which Medicare Advantage programs offer 
medication-assisted treatment, or MAT, and cover nonopioid alternative 
treatments not otherwise covered under traditional Medicare as part of 
a supplemental benefit.
  Finally, this bill would also include a provision from Congress 
Members  Danny Davis and Rothfus that would provide grants to federally 
qualified centers and rural health clinics to help offset the cost of 
training providers to become certified in dispensing medications for 
opioid abuse dependence.
  While the provisions in the bills before us this afternoon will 
certainly move us in the right direction, we cannot stop here. For 
example, the Medicaid program pays for the majority of mental health 
and substance abuse treatments in this country and, yet, we see 
multiple attempts by Republicans over the past 4 years to slash this 
program.
  We must maintain protections for those with preexisting conditions so 
that those who sought treatment for their addiction disorders are not 
punished for trying to get sober.
  We must maintain the progress we have made with the Affordable Care 
Act and work together to bring down the premiums for American families 
so that, should they need coverage for mental health counseling or 
substance abuse treatment, no one is shut out because of how much money 
they make or what State they live in.
  So I hope that today represents the first step, and I hope my 
colleagues on the other side of the aisle will continue to work with us 
to invest in prevention, treatment, and recovery efforts all across the 
country.
  I encourage my colleagues to support this legislation, and I reserve 
the balance of my time.
  Mrs. WALORSKI. Mr. Speaker, having no other speakers, I reserve the 
balance of my time.
  Ms. JUDY CHU of California. Mr. Speaker, I yield myself the balance 
of my time.
  Mr. Speaker, I am encouraged to see my colleagues on the other side 
of the aisle turn their attention to this critical issue. But this is 
not a new problem, and the coverage expansions under the Affordable 
Care Act have been among the most significant steps the Federal 
Government has taken to stem the tide of the opioid crisis. And yet, 
Republicans in Congress and President Trump have actively worked to 
repeal this landmark law.
  The Medicaid expansion and the increased coverage under the 
individual market have provided millions of Americans access to health 
insurance, and research has shown that Medicaid expansion States have 
seen a greater reduction in deaths from opioids than nonexpansion 
States.
  Again, Medicaid is the biggest payer for substance use disorder 
treatment in this country. We simply can't afford to go back.
  As we discuss this crisis today and in the week to come, we must 
broaden our understanding of the ways in which we, as a Nation, 
approach chronic pain. That is exactly what H.R. 6110 does.
  While there will always be patients who have a legitimate need for 
these medications, we need to look beyond a system where an opioid 
prescription is

[[Page H5254]]

the automatic default. This means we need to look to alternative 
methods of treating pain, whether it be acupuncture or physical therapy 
or a medical device. It means we must examine existing policies that 
may have inadvertently incentivized opioid prescribing practices.
  But as much as we look forward, we must also address the crisis in 
front of us. So I am thrilled to see provisions in this bill that would 
study Medicare Advantage plans already doing groundbreaking work in 
substance abuse disorder treatment.
  I am also glad to see that this bill provides direct resources to the 
front lines in the form of grants for federally qualified health 
centers to provide additional training for our providers.
  I hope that, in the future, we will work to expand access to 
alternatives, both within the Medicare program and in the broader 
population, and ensure that no matter where someone lives or what kind 
of insurance coverage they have, they are able to seek treatment.

  I urge my colleagues to support H.R. 6110, and I yield back the 
balance of my time.
  Mrs. WALORSKI. Mr. Speaker, I yield myself the balance of my time.
  Mr. Speaker, this epidemic knows no boundaries. Opioid abuse 
continues to devastate families and communities all over this country. 
As we continue to work toward commonsense solutions to the opioid 
epidemic, this bipartisan legislation will help break down barriers to 
nonopioid treatments and give healthcare providers better tools to 
prevent addiction and to assist in recovery.
  I want to thank Chairman Brady for all of his hard work, as well as 
my friend Ms. Judy Chu of California, who helped develop and introduce 
this bill.
  I urge my colleagues to support this bill, and I yield back the 
balance of my time.
  The SPEAKER pro tempore. The question is on the motion offered by the 
gentlewoman from Indiana (Mrs. Walorski) that the House suspend the 
rules and pass the bill, H.R. 6110.
  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.

                          ____________________