OVERDOSE PREVENTION AND PATIENT SAFETY ACT; Congressional Record Vol. 164, No. 103
(House of Representatives - June 20, 2018)

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               OVERDOSE PREVENTION AND PATIENT SAFETY ACT

  Mr. BURGESS. Mr. Speaker, pursuant to House Resolution 949, I call up 
the bill (H.R. 6082) to amend the Public Health Service Act to protect 
the confidentiality of substance use disorder patient records, and ask 
for its immediate consideration in the House.
  The Clerk read the title of the bill.
  The SPEAKER pro tempore. Pursuant to House Resolution 949, an 
amendment in the nature of a substitute consisting of the text of Rules 
Committee Print 115-75 is adopted, and the bill, as amended, is 
considered read.
  The text of the bill, as amended, is as follows:

                               H.R. 6082

       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 ``Overdose Prevention and 
     Patient Safety Act''.

     SEC. 2. CONFIDENTIALITY AND DISCLOSURE OF RECORDS RELATING TO 
                   SUBSTANCE USE DISORDER.

       (a) Conforming Changes Relating to Substance Use 
     Disorder.--Subsections (a) and (h) of section 543 of the 
     Public Health Service Act (42 U.S.C. 290dd-2) are each 
     amended by striking ``substance abuse'' and inserting 
     ``substance use disorder''.
       (b) Disclosures to Covered Entities Consistent With 
     HIPAA.--Paragraph (2) of section 543(b) of the Public Health 
     Service Act (42 U.S.C. 290dd-2(b)) is amended by adding at 
     the end the following:
       ``(D) To a covered entity or to a program or activity 
     described in subsection (a), for the purposes of treatment, 
     payment, and health care operations, so long as such 
     disclosure is made in accordance with HIPAA privacy 
     regulation. Any redisclosure of information so disclosed may 
     only be made in accordance with this section.''.
       (c) Disclosures of De-identified Health Information to 
     Public Health Authorities.--Paragraph (2) of section 543(b) 
     of the Public Health Service Act (42 U.S.C. 290dd-2(b)), as 
     amended by subsection (b), is further amended by adding at 
     the end the following:
       ``(E) To a public health authority, so long as such content 
     meets the standards established in section 164.514(b) of 
     title 45, Code of Federal Regulations (or successor 
     regulations) for creating de-identified information.''.
       (d) Definitions.--Subsection (b) of section 543 of the 
     Public Health Service Act (42 U.S.C. 290dd-2) is amended by 
     adding at the end the following:
       ``(3) Definitions.--For purposes of this subsection:
       ``(A) Covered entity.--The term `covered entity' has the 
     meaning given such term for purposes of HIPAA privacy 
     regulation.
       ``(B) Health care operations.--The term `health care 
     operations' has the meaning given such term for purposes of 
     HIPAA privacy regulation.

[[Page H5326]]

       ``(C) HIPAA privacy regulation.--The term `HIPAA privacy 
     regulation' has the meaning given such term under section 
     1180(b)(3) of the Social Security Act.
       ``(D) Individually identifiable health information.--The 
     term `individually identifiable health information' has the 
     meaning given such term for purposes of HIPAA privacy 
     regulation.
       ``(E) Payment.--The term `payment' has the meaning given 
     such term for purposes of HIPAA privacy regulation.
       ``(F) Public health authority.--The term `public health 
     authority' has the meaning given such term for purposes of 
     HIPAA privacy regulation.
       ``(G) Treatment.--The term `treatment' has the meaning 
     given such term for purposes of HIPAA privacy regulation.''.
       (e) Use of Records in Criminal, Civil, or Administrative 
     Investigations, Actions, or Proceedings.--Subsection (c) of 
     section 543 of the Public Health Service Act (42 U.S.C. 
     290dd-2) is amended to read as follows:
       ``(c) Use of Records in Criminal, Civil, or Administrative 
     Contexts.--Except as otherwise authorized by a court order 
     under subsection (b)(2)(C) or by the consent of the patient, 
     a record referred to in subsection (a) may not--
       ``(1) be entered into evidence in any criminal prosecution 
     or civil action before a Federal or State court;
       ``(2) form part of the record for decision or otherwise be 
     taken into account in any proceeding before a Federal agency;
       ``(3) be used by any Federal, State, or local agency for a 
     law enforcement purpose or to conduct any law enforcement 
     investigation of a patient; or
       ``(4) be used in any application for a warrant.''.
       (f) Penalties.--Subsection (f) of section 543 of the Public 
     Health Service Act (42 U.S.C. 290dd-2) is amended to read as 
     follows:
       ``(f) Penalties.--The provisions of sections 1176 and 1177 
     of the Social Security Act shall apply to a violation of this 
     section to the extent and in the same manner as such 
     provisions apply to a violation of part C of title XI of such 
     Act. In applying the previous sentence--
       ``(1) the reference to `this subsection' in subsection 
     (a)(2) of such section 1176 shall be treated as a reference 
     to `this subsection (including as applied pursuant to section 
     543(f) of the Public Health Service Act)'; and
       ``(2) in subsection (b) of such section 1176--
       ``(A) each reference to `a penalty imposed under subsection 
     (a)' shall be treated as a reference to `a penalty imposed 
     under subsection (a) (including as applied pursuant to 
     section 543(f) of the Public Health Service Act)'; and
       ``(B) each reference to `no damages obtained under 
     subsection (d)' shall be treated as a reference to `no 
     damages obtained under subsection (d) (including as applied 
     pursuant to section 543(f) of the Public Health Service 
     Act)'.''.
       (g) Antidiscrimination.--Section 543 of the Public Health 
     Service Act (42 U.S.C. 290dd-2) is amended by adding at the 
     end the following:
       ``(i) Antidiscrimination.--
       ``(1) In general.--No entity shall discriminate against an 
     individual on the basis of information received by such 
     entity pursuant to a disclosure made under subsection (b) 
     in--
       ``(A) admission or treatment for health care;
       ``(B) hiring or terms of employment;
       ``(C) the sale or rental of housing; or
       ``(D) access to Federal, State, or local courts.
       ``(2) Recipients of federal funds.--No recipient of Federal 
     funds shall discriminate against an individual on the basis 
     of information received by such recipient pursuant to a 
     disclosure made under subsection (b) in affording access to 
     the services provided with such funds.''.
       (h) Notification in Case of Breach.--Section 543 of the 
     Public Health Service Act (42 U.S.C. 290dd-2), as amended by 
     subsection (g), is further amended by adding at the end the 
     following:
       ``(j) Notification in Case of Breach.--
       ``(1) Application of hitech notification of breach 
     provisions.--The provisions of section 13402 of the HITECH 
     Act (42 U.S.C. 17932) shall apply to a program or activity 
     described in subsection (a), in case of a breach of records 
     described in subsection (a), to the same extent and in the 
     same manner as such provisions apply to a covered entity in 
     the case of a breach of unsecured protected health 
     information.
       ``(2) Definitions.--In this subsection, the terms `covered 
     entity' and `unsecured protected health information' have the 
     meanings given to such terms for purposes of such section 
     13402.''.
       (i) Sense of Congress.--It is the sense of the Congress 
     that any person treating a patient through a program or 
     activity with respect to which the confidentiality 
     requirements of section 543 of the Public Health Service Act 
     (42 U.S.C. 290dd-2) apply should access the applicable State-
     based prescription drug monitoring program as a precaution 
     against substance use disorder.
       (j) Regulations.--
       (1) In general.--The Secretary of Health and Human 
     Services, in consultation with appropriate Federal agencies, 
     shall make such revisions to regulations as may be necessary 
     for implementing and enforcing the amendments made by this 
     section, such that such amendments shall apply with respect 
     to uses and disclosures of information occurring on or after 
     the date that is 12 months after the date of enactment of 
     this Act.
       (2) Easily understandable notice of privacy practices.--Not 
     later than 1 year after the date of enactment of this Act, 
     the Secretary of Health and Human Services, in consultation 
     with appropriate experts, shall update section 164.520 of 
     title 45, Code of Federal Regulations, so that covered 
     entities provide notice, written in plain language, of 
     privacy practices regarding patient records referred to in 
     section 543(a) of the Public Health Service Act (42 U.S.C. 
     290dd-2(a)), including--
       (A) a statement of the patient's rights, including self-pay 
     patients, with respect to protected health information and a 
     brief description of how the individual may exercise these 
     rights (as required by paragraph (b)(1)(iv) of such section 
     164.520); and
       (B) a description of each purpose for which the covered 
     entity is permitted or required to use or disclose protected 
     health information without the patient's written 
     authorization (as required by paragraph (b)(2) of such 
     section 164.520).
       (k) Development and Dissemination of Model Training 
     Programs for Substance Use Disorder Patient Records.--
       (1) Initial programs and materials.--Not later than 1 year 
     after the date of the enactment of this Act, the Secretary of 
     Health and Human Services (referred to in this subsection as 
     the ``Secretary''), in consultation with appropriate experts, 
     shall identify the following model programs and materials (or 
     if no such programs or materials exist, recognize private or 
     public entities to develop and disseminate such programs and 
     materials):
       (A) Model programs and materials for training health care 
     providers (including physicians, emergency medical personnel, 
     psychiatrists, psychologists, counselors, therapists, nurse 
     practitioners, physician assistants, behavioral health 
     facilities and clinics, care managers, and hospitals, 
     including individuals such as general counsels or regulatory 
     compliance staff who are responsible for establishing 
     provider privacy policies) concerning the permitted uses and 
     disclosures, consistent with the standards and regulations 
     governing the privacy and security of substance use disorder 
     patient records promulgated by the Secretary under section 
     543 of the Public Health Service Act (42 U.S.C. 290dd-2), as 
     amended by this section, for the confidentiality of patient 
     records.
       (B) Model programs and materials for training patients and 
     their families regarding their rights to protect and obtain 
     information under the standards and regulations described in 
     subparagraph (A).
       (2) Requirements.--The model programs and materials 
     described in subparagraphs (A) and (B) of paragraph (1) shall 
     address circumstances under which disclosure of substance use 
     disorder patient records is needed to--
       (A) facilitate communication between substance use disorder 
     treatment providers and other health care providers to 
     promote and provide the best possible integrated care;
       (B) avoid inappropriate prescribing that can lead to 
     dangerous drug interactions, overdose, or relapse; and
       (C) notify and involve families and caregivers when 
     individuals experience an overdose.
       (3) Periodic updates.--The Secretary shall--
       (A) periodically review and update the model programs and 
     materials identified or developed under paragraph (1); and
       (B) disseminate such updated programs and materials to the 
     individuals described in paragraph (1)(A).
       (4) Input of certain entities.--In identifying, reviewing, 
     or updating the model programs and materials under this 
     subsection, the Secretary shall solicit the input of relevant 
     stakeholders.
       (l) Rules of Construction.--Nothing in this Act or the 
     amendments made by this Act shall be construed to limit--
       (1) a patient's right, as described in section 164.522 of 
     title 45, Code of Federal Regulations, or any successor 
     regulation, to request a restriction on the use or disclosure 
     of a record referred to in section 543(a) of the Public 
     Health Service Act (42 U.S.C. 290dd-2(a)) for purposes of 
     treatment, payment, or health care operations; or
       (2) a covered entity's choice, as described in section 
     164.506 of title 45, Code of Federal Regulations, or any 
     successor regulation, to obtain the consent of the individual 
     to use or disclose a record referred to in such section 
     543(a) to carry out treatment, payment, or health care 
     operation.
       (m) Sense of Congress.--It is the sense of the Congress 
     that--
       (1) patients have the right to request a restriction on the 
     use or disclosure of a record referred to in section 543(a) 
     of the Public Health Service Act (42 U.S.C. 290dd-2(a)) for 
     treatment, payment, or health care operations; and
       (2) covered entities should make every reasonable effort to 
     the extent feasible to comply with a patient's request for a 
     restriction regarding such use or disclosure.

  The SPEAKER pro tempore. The bill, as amended, shall be debatable for 
1 hour equally divided and controlled by the chair and the ranking 
minority member of the Committee on Energy and Commerce.
  The gentleman from Texas (Mr. Burgess) and the gentleman from New 
Jersey (Mr. Pallone) each will control 30 minutes.
  The Chair recognizes the gentleman from Texas.


                             General Leave

  Mr. BURGESS. Mr. Speaker, I ask unanimous consent that all Members 
may have 5 legislative days within which to revise and extend their 
remarks and insert extraneous material on H.R. 6082.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Texas?
  There was no objection.
  Mr. BURGESS. Mr. Speaker, I yield myself such time as I may consume.

[[Page H5327]]

  Mr. Speaker, over the course of the past several months, the Energy 
and Commerce's Subcommittee on Health held four legislative hearings on 
bills to address the opioid epidemic and reported 57 bills to the full 
committee. Of those 57 bills, only one received its own discrete 
hearing. That bill was H.R. 6082, the Overdose Prevention and Patient 
Safety Act, introduced by Representatives Mullin and Blumenauer.

                              {time}  1245

  As a physician, I believe it is vital that doctors have all of the 
appropriate information to determine the proper course of treatment for 
a patient, ensuring patient safety and privacy, as required by Federal 
regulation known as HIPAA. The Overdose Prevention and Patient Safety 
Act maintains the original intent of the 1970s statute behind 42 CFR 
part 2 by protecting patients and improving care coordination.
  In fact, the bill increases protections for those seeking treatment 
by more severely penalizing those who illegally share patient data than 
under the current statute. Current part 2 law does not protect 
individuals from discrimination based on their treatment records and, 
to this date, there have been no criminal actions undertaken to enforce 
part 2.
  This bill has a wide range of support from national and State 
organizations. Since the bill was introduced, the Energy and Commerce 
Committee has heard from over 100 organizations in its support.
  Arguably, the most notable support for this legislation comes from 
the Substance Abuse and Mental Health Services Administration in the 
Department of Health and Human Services. Dr. Elinore McCance-Katz, the 
Assistant Secretary for Mental Health and Substance Use, wrote to Mr. 
Mullin in March, stating that SAMHSA ``is encouraged to see Congress 
examine the benefits of aligning part 2 with HIPAA. Patient privacy is, 
of course, critical but so too is patient access to safe, effective, 
and coordinated treatment.''
  I agree with Dr. McCance-Katz that in order to ensure patient safety, 
physicians must have secure access to patient records, including 
substance use disorder information. When this information is not 
provided to healthcare professionals, they may end up prescribing 
medications that have dangerous drug interactions or may lead a patient 
who is in recovery to be inappropriately prescribed an opioid and fall 
back into addiction.
  One particular complication driven by 42 CFR part 2 directly impacts 
the care for pregnant women and their infants. For women who are 
pregnant, part 2 does not allow redisclosure of substance use disorder 
medical documentation to the women's OB/GYN doctor, primary care 
physician, or health home without their written consent. This leads to 
fragmented care, which opens up the mother and her baby to potential 
harm.
  Centerstone, one of the Nation's largest not-for-profit healthcare 
organizations, notes that ``mothers who continue to use during 
pregnancy and who do not wish to sign secondary releases to allow their 
care providers to treat them comprehensively put their unborn children 
at risk for addiction.''
  Centerstone watches these women and their infants suffer right before 
their eyes, but, because of part 2, Centerstone cannot share the 
information to ensure that the mother and baby are getting proper care.
  As an OB/GYN physician myself, I cannot imagine having this 
information withheld. Such a situation would leave me with the 
inability to treat the whole patient and ensure that the mother is 
healthy and her baby is not on a path for addiction.
  In another situation, a patient was referred to a treatment center 
following an emergency room visit for an overdose. The patient was not 
able to give written consent to his providers due to acute 
intoxication. Due to a lack of written consent and 42 CFR part 2, the 
treatment facility could not communicate to the ER and learn about the 
patient's condition or confirm that the patient had, indeed, enrolled 
in a drug treatment center, further delaying critical care 
coordination.
  There is clear evidence that part 2 is a massive roadblock to 
providing safe, quality, and coordinated care to individuals suffering 
from substance use disorder.
  The issue of the stigma associated with substance use disorder has 
been a constant in all of the discussions that we have had, both in our 
offices and in our hearings. In April, we heard from numerous 
individuals who were parents of children who died from opioid 
overdoses. Some noted that their children were afraid to seek help from 
their families or from healthcare professionals because they were 
embarrassed or they felt stigmatized.
  We should enable physicians to fully care for these patients 
suffering from substance use disorder as if they had any other disease. 
The Overdose Prevention and Patient Safety Act will do just that.
  The first step in addressing a problem is admitting that it exists. I 
would like to pose a question to those who are arguing against this 
legislation:
  If we continue to silo the substance use disorder treatment 
information of a select group of patients rather than integrating it 
into our medical records and comprehensive care models, how can we 
ensure that these patients are, in fact, receiving quality care? How 
can we really treat substance use disorder like all other complex 
health conditions?
  H.R. 6082 ensures adequate patient data protection in accordance with 
Federal law, with HIPAA. There are provisions in the language that 
ensure that the data may only be used for purposes of treatment, 
payment, or healthcare operations. Substance use disorder data cannot 
be used in criminal, civil, or administrative investigations, actions, 
or proceedings without patient consent or a court order.
  Additionally, the legislation explicitly prohibits discrimination 
against an individual on the basis of their patient needs. Currently, 
part 2 includes no antidiscrimination protections and no protections 
for individuals if there is a data breach or improper disclosure.
  Think about that for a minute, Mr. Speaker. This was a 1970s-era law. 
There were not data breaches back in the 1970s. 42 CFR part 2 was never 
intended to protect a patient in the instance of a data breach.
  Should any entity or individual share patient data under H.R. 6082, 
they, in fact, will be severely penalized.
  There is a reason why SAMHSA and most of the healthcare stakeholder 
community is asking for this change. Clearly, there is an issue here 
that must be addressed. This opioid crisis is devastating our country. 
Passing the Overdose Prevention and Patient Safety Act will enable 
greater coordination among healthcare providers in providing quality, 
effective care for individuals across the country who are battling 
substance use disorder.

  My thanks to Mr. Mullin on the Energy and Commerce Committee and to 
Mr. Blumenauer for introducing this legislation that is of utmost 
importance.
  I urge strong support for the bill, and 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 opposition to H.R. 6082, the Overdose 
Prevention and Patient Safety Act. This legislation would greatly harm 
our efforts to combat the opioid epidemic. If we really want to turn 
the tide on this crisis, we must find ways to get more people into 
treatment for opioid use disorder.
  In 2016, there were about 21 million Americans aged 12 or older in 
need of substance use disorder treatment, but only 4 million of those 
21 million actually received treatment. That means 17 million people 
are going without the treatment they need. Failure to get individuals 
with opioid use disorder into treatment increases risk of fatal and 
nonfatal overdoses as people continue to seek out illicit opioids as 
part of their addiction. The increasing presence of fentanyl in our 
drug supply only heightens this concern.
  Strategies that increase the number of people getting into and 
remaining in treatment are particularly important because, as these 
treatment statistics show, major challenges exist to getting people 
with substance use disorders to enter treatment in the first place. And 
this House should not--and I stress ``should not''--take any action 
that puts at risk people seeking treatment for any substance use 
disorder, but particularly opioid use disorders.
  Unfortunately, this bill risks doing just that: reducing the number 
of people willing to come forward and remain

[[Page H5328]]

in treatment because they worry about the negative consequences that 
seeking treatment can have on their lives. And this is a very real 
concern.
  This bill weakens privacy protections that must be in place for some 
people to feel comfortable about starting treatment for their substance 
use disorder. Ensuring strong privacy protections is critical to 
maintaining an individual's trust in the healthcare system and a 
willingness to obtain needed health services, and these protections are 
especially important where very sensitive information is concerned.
  The information that may be included in the treatment records of a 
substance use disorder patient are particularly sensitive because 
disclosure of substance use disorder information can create tangible 
vulnerabilities that are not the same as other medical conditions. For 
example, you are not incarcerated for having a heart attack; you cannot 
legally be fired for having cancer; and you are not denied visitation 
to your children due to sleep apnea.
  According to SAMHSA, the negative consequences that can result from 
the disclosure of an individual's substance use disorder treatment 
record can include loss of employment, loss of housing, loss of child 
custody, discrimination by medical professionals and insurers, arrest, 
prosecution, and incarceration. These are real risks that keep people 
from getting treatment in the first place.
  While I understand that the rollback of the existing privacy 
protections to the HIPAA standard would limit permissible disclosures 
without patient consent to healthcare organizations, this ignores the 
reality: It may be illegal for information to be disclosed outside 
these healthcare organizations, but we know, Mr. Speaker, that 
information does get out. Breaches do happen.
  Remember the recent large-scale Aetna breach that disclosed some of 
its members' HIV status?
  But there are also small-scale breaches that don't make the news that 
can have devastating consequences for patients trying to recover and 
get treatment. For example, a recent ProPublica investigation detailed 
instances where a healthcare organization's employee peeked at the 
record of a patient 61 times and posted details on Facebook, while 
another improperly shared a patient's health information with the 
patient's parole officer. Breaches such as this are very concerning and 
could occur more often as a result of this legislation.
  While I appreciate the sponsor's efforts to alleviate these concerns, 
I do not believe the potential harm that could be caused by eliminating 
the patient consent requirement under existing law for treatment, 
payment, and healthcare operations can be remedied through the measures 
included in this bill. The inclusion of these provisions cannot 
compensate for the risk of stigma, discrimination, and negative health 
and life outcomes for individuals with opioid use disorder that could 
result from the weakening of the existing privacy protections, and that 
is why every substance use disorder patient group has come out in 
opposition to this bill.
  According to the Campaign to Protect Patient Privacy Rights, a 
coalition of more than 100 organizations: ``Using the weaker HIPAA 
privacy rule standard of allowing disclosure of substance use disorder 
information without patient consent for treatment, payment, and 
healthcare operations will contribute to the existing level of 
discrimination and harm to people living with substance use 
disorders.''
  The Campaign goes on to say: ``This will only result in more people 
who need substance use disorder treatment being discouraged and afraid 
to seek the healthcare they need during the Nation's worst opioid 
crisis.''
  This is a risk we simply should not take, and yet the majority is 
bringing this bill to the floor today, despite the very real concerns 
of these experts. These groups uniquely understand what is at stake 
from this legislation because many of their members live with or are in 
fear of the negative consequences that result from the disclosure of 
substance use disorder diagnosis and treatment information.

  In fact, the negative consequences that will result from the 
disclosure of someone's substance use disorder would solely affect that 
individual and their family. They will bear the burden if we get this 
wrong. They could be at risk of potentially losing custody of their 
child and their freedom by the increased risk of improper disclosure of 
their medical record if this bill becomes law.
  These risks may simply just keep them from seeking potentially 
lifesaving treatment. That is why substance use disorder treatment 
providers have also raised concerns.
  The South Carolina Association of Opioid Dependence explained: ``Even 
with the growing awareness that substance use disorders are a disease, 
the unfortunate truth is that persons with substance use disorder are 
still actively discriminated against . . . such as a baby being taken 
away from a new mother because she is on methadone for an opioid use 
disorder, despite longstanding compliance with her treatment and 
abstinence from illegal drug use.''
  Another provider, Raise the Bottom Addiction Treatment, one of two 
medical-assisted treatment facilities in Idaho, explained that ``our 
patients come from every walk of life, including professionals and 
executives within our community. Their anonymity and privacy is of 
utmost importance because their careers, families, and livelihood often 
depend on it.
  ``Knowing that people may seek treatment without fear of backlash and 
discrimination is often a deciding factor when considering entering 
treatment.
  ``To undo this protection will deeply affect one's ability and 
willingness to seek help. . . . Not only can the members of our 
community not afford to lose their right to confidentiality, but we as 
a nation cannot afford to move backwards in our fight to combat this 
opiate crisis.''

                              {time}  1300

  So again, Mr. Speaker, these are the words of experts on the 
frontline fighting this epidemic. People who suffer from substance use 
disorder should be able to decide with whom to share their treatment 
records from programs and for what purposes. Those rights are taken 
away from them under this legislation, and I believe that is wrong.
  As we face a tragic national drug abuse problem, the scale of which 
our country has never seen, I believe maintaining the heightened 
privacy protections under existing law remains vital to ensuring all 
individuals with substance use disorder can seek treatment for their 
substance use disorder with confidence that their right to privacy will 
be protected. To do otherwise at this time is just too great a risk, 
and I strongly urge my colleagues to listen to the experts on the 
subject and to vote ``no'' on this legislation.
  Mr. Speaker, I reserve the balance of my time.
  Mr. BURGESS. Mr. Speaker, I yield 3 minutes to the gentleman from 
Oklahoma (Mr. Mullin), the principal sponsor of the bill and a valuable 
member of the Energy and Commerce Committee.
  Mr. MULLIN. Mr. Speaker, I rise today to speak in support of my bill, 
H.R. 6082, the Overdose Prevention and Patient Safety Act.
  My colleague Mr. Blumenauer and I introduced this bill to help 
physicians fight the opioid epidemic. The Overdose Prevention and 
Patient Safety Act allows the flow of information among healthcare 
providers and health planners for the purpose of treatment, payment, 
and healthcare operations.
  Unfortunately, there is an outdated Federal Government mandate, 42 
CFR part 2, which is creating a firewall between doctors and patients.
  My bill, the Overdose Prevention and Patient Safety Act, will give 
doctors access to patients' addiction medical information that can 
integrate their care, prevent tragic overdoses, and improve patient 
safety.
  SAMHSA has stated: ``The practice of requiring substance use disorder 
information to be any more private than information regarding other 
chronic illnesses, such as cancer or heart disease, may in itself be 
stigmatizing. Patients with substance use disorders seeking treatment 
for any condition have a right to healthcare providers who are fully 
equipped with the information needed to provide the highest quality 
care available.''
  When a person violates part 2, it is referred to the Justice 
Department,

[[Page H5329]]

and there is only a $50 penalty. There have been zero cases--let me 
repeat that--there have been zero cases in which part 2 was enforced or 
any action taken by the Department of Justice or SAMHSA.
  The penalties for noncompliance underneath HIPAA are based on the 
level of negligence and can range from $100 to $50,000 per violation, 
with a maximum of $1.5 million per year.
  There have been 173,472 HIPAA violations since 2003, with 97 percent 
of those complaints resolved.
  Patients, doctors, hospitals, and a broad spectrum of stakeholders 
agree we need to end this outdated Federal Government mandate helping 
prevent the private sector's innovation.
  Mr. Speaker, I encourage my colleagues to support the Overdose 
Prevention and Patient Safety Act.
  Mr. PALLONE. Mr. Speaker, I yield 3 minutes to the gentleman from 
Oregon (Mr. Blumenauer).
  Mr. BLUMENAUER. Mr. Speaker, I appreciate Mr. Pallone's courtesy in 
permitting me to speak on this bill. I respect his efforts, and I 
respect a number of his concerns. But I do think that the work that we 
have done with Mr. Mullin, with the committee, and I appreciate the 
subcommittee's extra efforts to work through these elements, listen to 
people's objections, and to do it right.
  There has been no argument that this provision has cost lives. The 
failure in emergency rooms, other circumstances, for people to not be 
able to get the full picture of a patient's condition ends up sometimes 
with tragic consequences. We have yet to hear any reason why we 
shouldn't coordinate.
  Now, I appreciate concerns about patient privacy, but as Dr. Burgess 
and my friend from Oklahoma point out, we are strengthening provisions 
under this bill for disclosure. People don't want to stigmatize those 
with substance abuse, we agree. But having a separate system that 
people have to go through just for substance abuse implies a stigma. 
People will think there is something wrong with these people. You don't 
do this for AIDS anymore. This harmonizes with all the other HIPAA 
provisions.
  Candidly, forcing people to go through yet another step probably 
raises questions about the validity of disclosure, raising questions in 
the minds of those who go through that.
  Mr. Speaker, we have made, I think, tremendous progress dealing with 
stigma, dealing with patient protection, what we have done for mental 
health, which has devastating consequences in some cases if people's 
records were revealed. Think what has happened with HIV/AIDS. There was 
a time when that would end up with people not just having a stigma but 
at risk of losing their jobs, being ostracized.
  These are the same provisions in this bill that are there for HIV/
AIDS or mental health, for everything under HIPAA.
  I really do think that we take a step back, understanding that having 
separate authorizations complicates the coordination and integration of 
treatment. Oftentimes, behavioral health information doesn't arrive in 
an orderly fashion. It is another step of complication that could have 
tragic consequences.
  In fact, the subcommittee's record demonstrates that. There have been 
examples where people have died because the medical providers did not 
have the full picture of the patient. This legislation will fix it.
  Mr. BURGESS. Mr. Speaker, I yield 5 minutes to the gentleman from 
Oregon (Mr. Walden), the chairman of the full committee.
  Mr. WALDEN. Mr. Speaker, I want to thank Dr. Burgess, the chairman of 
the Subcommittee on Health, for his fine leadership on this issue, 
along with our colleagues, Mr. Mullin and my friend from Oregon and 
colleague, Mr. Blumenauer, who put a lot of work into this. I commend 
my colleague from Oregon for his strong statement in support of this 
legislation.
  Combating the opioid epidemic has been a top priority of all of us in 
this Congress and especially on the Energy and Commerce Committee, 
which I chair.
  We have committed the last year and a half to examining the ways we 
can respond to save lives, to help people in our communities, and to 
end this deadly, deadly epidemic.
  During that time, I have heard a lot of stories, both at the hearings 
here in the Nation's Capital and back home in Oregon, where I have held 
multiple roundtables and meetings in the communities about what we need 
to do to help the outcome of patients; our neighbors, our friends, in 
some cases family members, who are dealing with these addictions.
  An extraordinary array of people, including patients, parents of 
those suffering with addiction, the Oregon Hospital Association, Oregon 
Governor Kate Brown, physicians, and substance use disorder treatment 
providers, have all told me and our committee that existing Federal 
confidentiality regulations and statute known as 42 CFR part 2, or 
simply part 2, are working against--working against--patients and 
making it harder to effectively treat addiction. There is hardly anyone 
in the healthcare sector that we have not heard from on this issue.
  One story that really comes to mind is that of Brandon McKee. 
Brandon's brother, Dustin, testified before our Health Subcommittee 
when we reviewed a near identical version of this legislation back in 
May.
  Tragically, Brandon had died of an opioid overdose at just 36 years 
of age. He left behind three young children.
  Speaking about his passing, his brother Dustin told the subcommittee: 
``Brandon's death was preventable. However, in part because of the 
antiquated provisions contained within 42 CFR part 2, the medical 
professionals that prescribed him opiate-based pain medications were 
not able to identify him as a high-risk individual.''
  You see, Brandon was prescribed opioids after back surgery on two 
separate occasions despite his history of substance use disorder. 
Within a few months of his second surgery, Brandon fatally overdosed on 
heroin. That is why this bill is so important.
  Health records for substance use disorder are the only--only--records 
that are siloed in this way, preventing physicians from seeing the 
complete picture of a patient they are treating. The doctors don't 
know.
  All other protected health information for every other disease falls 
under HIPAA. The Overdose Prevention and Patient Safety Act will help 
align Federal privacy standards for substance use disorder treatment 
information more closely with HIPAA so that our doctors and our 
addiction specialists can provide the highest and safest level of 
treatment.
  In short, this bill will improve coordination of care for patients 
suffering from substance use disorder and save lives by helping to 
prevent overdoses and dangerous drug interactions.
  Now, I fully respect and understand the privacy concerns that some 
still have, and the sensitivities about the idea of making changes to a 
statute that has been in place since the 1970s, long before HIPAA. That 
is why Representatives Mullin and Blumenauer worked in a bipartisan 
fashion to include strong unlawful disclosure penalties, discrimination 
protections, and breach notification requirements in this bill.
  Doing so, H.R. 6082 will actually improve the ability to penalize 
those who illegally disclose a patient's information. This isn't about 
using this information for any other purpose than treating that patient 
safely.
  To be clear, there is no legal way for a patient's substance use 
disorder treatment information to be used against them under this bill. 
This bill, instead, expands protections for individuals seeking 
addiction treatment above and beyond existing law, and it will help us 
turn the tide on the opioid scourge.
  I want to thank Mr. Mullin and Mr. Blumenauer once again for their 
work, and the other Members on the committee. This bipartisan bill will 
save lives. It is critically importantly to our efforts to combat the 
opioid crisis, and I urge my colleagues to support H.R. 6082.
  Mr. PALLONE. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, proponents of this legislation argue that taking away 
patients' privacy rights related to substance use disorder treatment 
records is okay because we would be applying the HIPAA standard that 
applies to other sensitive health conditions like HIV, but I strongly 
disagree.

[[Page H5330]]

  Individuals with substance use disorder face risk because of their 
medical conditions that those with other medical conditions do not. 
According to SAMHSA, those negative consequences include loss of 
employment, loss of housing, loss of child custody, discrimination by 
medical professionals and insurers, arrests, prosecution, and 
incarceration.
  Unlike other medical conditions, including HIV, you can be 
incarcerated, legally fired, and denied visitation with your children 
due to your substance use disorder.
  So let me paint this picture with a few examples.
  A 20-year-old pregnant woman in Wisconsin voluntarily went to a 
hospital to seek treatment for addiction to the opiate OxyContin. 
Rather than providing treatment, the hospital called State authorities 
to report this woman. She was taken into custody and held for several 
weeks before a judge ordered her released.
  Another example provided to the committee from a provider in Maryland 
explained:

       Some time ago, we had a young lady in our methadone 
     maintenance program who committed suicide. She had turned her 
     life around. She was in college, working full time, owned her 
     own car, was purchasing a house, and was no longer using 
     illicit substances. She had to complete probation for her 
     crimes that she had committed while she was actively using 
     these drugs.
       Her mother did not know she was in methadone treatment. She 
     did not want her mother to know because her mother did not 
     agree with methadone, and the judge found out she was in the 
     methadone maintenance program and disclosed it in a court 
     hearing with her mother present.
       The judge and her mother insisted that she ``get off that 
     stuff,'' and she complied only because of the pressure from 
     both to do so.
       She began abusing illicit substances and participating in 
     illegal activity to obtain those substances. The guilt and 
     shame of returning to what she described as a life of hell 
     led her to write a suicide note and end her life.

                              {time}  1315

  Experiences like this, in addition to stories of individuals with 
substance use disorder who have lost jobs, housing, and child custody 
because of their substance use disorder, are reasons that some 
individuals with substance use disorder fear coming forward to enter 
treatment due to the negative consequences that result. It is why more 
than 100 groups, including AIDS United, joined the campaign to protect 
patient privacy rights. They have joined together to fight to protect 
the heightened privacy protections that exist under existing law.
  Further, unlike the proponents of this legislation contend, the 
existing law is not an anomaly. States like Florida have laws requiring 
written patient consent for the sharing of a patient's substance use 
disorder and mental health treatment records, while others like New 
York, Kentucky, and Texas have such requirements for the sharing of HIV 
records. Other States have such requirements for reproductive health 
treatment records.
  Further, the existing law is consistent with the confidentiality 
protections applied to substance use disorder treatment records. In 
fact, the law governing the confidentiality of VA medical records, 38 
U.S.C. 7332, is consistent with and broader than part 2. Unlike that 
law, the VA cannot share a patient's substance use disorder, HIV, or 
sickle cell anemia treatment records with another provider without 
written patient consent.
  So, Mr. Speaker, I want to stress that I do believe that we can learn 
an important lesson from our response to HIV, particularly during the 
height of the AIDS epidemic. A critical part of this Nation's response 
to the AIDS epidemic was increasing the privacy protections applied to 
HIV medical records. Such action was taken because people were afraid 
to enter treatment for HIV/AIDS because of the negative consequences 
that could result.
  In the midst of the opioid epidemic, this bill would result in doing 
just the opposite: lowering the privacy protections applied to 
substance use disorder medical records despite the fact that, like 
during the AIDS epidemic, some individuals with substance use disorder 
remain afraid to enter treatment because of the negative consequences 
that result. And in many cases, they only do so out of the part 2 
assurances that they can control to whom and for what purposes their 
treatment record is shared.
  The increased stigma, discrimination, and criminalization faced by 
people with substance use disorder support the maintenance of the 
heightened privacy protections under existing law, in my opinion. And 
for some individuals, it is these privacy protections that make them 
feel safe to enter and remain in treatment for their substance use 
disorder. I am afraid that by passing this bill we could be creating a 
barrier that will keep people from getting the treatment they need, and 
that is a risk I am simply not willing to take.
  Mr. Speaker, I reserve the balance of my time.
  Mr. BURGESS. Mr. Speaker, I yield myself 2 minutes for the purpose of 
response before I yield to Dr. Bucshon.
  Mr. Speaker, the tragic story that was just related to us really only 
reinforces the need to change the statute behind 42 CFR part 2. There 
are some important facts missing from the description of the situation 
that occurred.
  It appears evident that at least one or both of the parties involved, 
the judge, and/or the methadone maintenance program, violated existing 
regulations under both part 2 and HIPAA.
  Under part 2, patient records may only be disclosed without patient 
consent if the disclosure is authorized by an appropriate order of a 
court of competent jurisdiction. There must be a showing of good cause 
in which the court must weigh the public interest and need for 
disclosure against the injury to the patient, the physician-patient 
relationship, and treatment services. Further, the court must impose 
appropriate safeguards against unauthorized disclosure.
  It is not clear from the description provided in the letter how the 
judge found out about the patient's participation in a methadone 
maintenance program. If the information to the judge was provided 
without an appropriate court order, then the methadone maintenance 
program likely violated the requirements under part 2 to safeguard the 
patient's records from such disclosure. If the information was provided 
as a result of a court order, then it is possible that the judge 
violated his or her ethical obligations to appropriately weigh the need 
for the information and safeguard the information once received.
  Under HIPAA, there is still an obligation for the parties seeking 
information to confirm that reasonable efforts have been made to ensure 
that the individual has been given notice of the request for personal 
health information and the opportunity to object or that reasonable 
efforts have been made to secure a qualified protective order. 
Compliance with either of these requirements appears to have been 
lacking in the situation described in the letter.
  All of this suggests that part 2 currently is insufficient to protect 
patients in these situations. The legislation before us today does not 
decrease the protections against the use of the records in criminal 
proceedings that already exist under part 2, but HIPAA makes the 
protections stronger.
  I yield 3 minutes to the gentleman from Indiana (Mr. Bucshon), a 
valuable member of our committee and our subcommittee that has heard 
the testimony on this legislation.
  Mr. BUCSHON. Mr. Speaker, I rise today to speak in strong support of 
H.R. 6082, the Overdose Prevention and Patient Safety Act. This 
legislation will improve the ability of medical professionals to 
properly care for patients by allowing physicians access to a 
patient's full medical record, including information about substance 
use disorder treatment, while ensuring robust privacy protections.

  As a physician, I know that patients don't always notify their 
doctors of all the medications they are taking, and not having a 
complete medical record or knowing a patient's background can result in 
potentially life-threatening complications related to medical 
treatment. I have seen this in my own practice, and my wife sees this 
almost daily in her anesthesia practice.
  This is commonsense legislation which will ensure patients receive 
appropriate healthcare, while also ensuring the medical information 
remains private. Mr. Speaker, I urge my colleagues to support H.R. 
6082.
  Mr. PALLONE. Mr. Speaker, I yield myself such time as I may consume.

[[Page H5331]]

  Mr. Speaker, some of the proponents of this bill also mentioned the 
opiate use disorder situations in emergency rooms as a justification 
for the legislation, but I just want to say, Mr. Speaker, I think it is 
important to note that the existing law includes an exception to the 
patient consent requirement. A provider can access a patient's 
substance use disorder treatment records in the case of an emergency as 
determined by the provider without patient consent.
  Additionally, nothing in the existing law prevents any provider from 
asking their patient about their substance use disorder history before 
prescribing any opioid, especially in the midst of the opioid epidemic. 
Every provider should ask patients about their opioid use disorder 
history, and, therefore, under the existing law and every other privacy 
law, the doctor can learn of a patient's opiate use disorder history by 
simply asking the patient that.
  That remains, in my opinion, the optimum way of learning a patient's 
medical history, because currently our electronic health records aren't 
interoperable in many cases. Those underlying interoperability issues 
that prevent information sharing, including the part 2 information in 
cases where a patient has agreed to share their information with 
providers, aren't going to be solved by this bill.
  Mr. Speaker, I reserve the balance of my time.
  Mr. BURGESS. Mr. Speaker, I yield 3 minutes to the gentleman from 
Illinois (Mr. Shimkus), a valuable member of the Energy and Commerce 
Committee.
  (Mr. SHIMKUS asked and was given permission to revise and extend his 
remarks.)
  Mr. SHIMKUS. Mr. Speaker, it is good to be on the floor with my good 
friend and colleague, the ranking member, Congressman Pallone. I know 
his heart is solid and I know he believes that we are challenging some 
privacy concerns, and I take that in the spirit intended.
  As a Republican, I was an early supporter of one of our former 
colleague's--Sue Myrick's--Mental Health Parity Act. And the whole 
intent of that, for many of us, was to say mental health illness is an 
illness and should be accepted as an illness. But what we have done 
under the Federal code is to separate it. So I think the intent of what 
we are trying to do is not separate it and make it part of the health 
records.
  We have heard the debate on both sides, but that is the basic premise 
from which I come. And we have heard the testimony of people for whom 
the information was not shared with the regular doctor versus the 
mental health, and then prescriptions occurring and then catastrophic 
events.
  The intent of this legislation is to help patients and to help 
providers better take care of their patients. This is not about taking 
away privacy but taking care of people. It is about making sure people 
have the appropriate level of privacy for the services they are 
seeking.
  We don't create extra privacy barriers so that people with heart 
disease, HIV, or diabetes can keep their doctors in the dark and 
withhold critical information relevant to the insurer benefits that 
they are using. This goes back to, as we have heard today, a 1970-era 
mandate.
  Gary Mendell, the founder of Shatterproof, lost his son Brian, who 
was recovering from substance use disorder, after he tragically took 
his own life. Gary said the following about aligning part 2 with HIPAA:

       The solution is not to keep this information out of 
     electronic health records and not available. The solution is 
     to end the stigma and to bring this disease and mental 
     illness into the healthcare system, just like diabetes, 
     cancer, or any other disease.

  And I couldn't agree more with Gary.
  He also said:

       If there's an issue related to unintended consequences, 
     let's fix that.

  I think in this piece of legislation, Congressman Mullin and 
Congressman Blumenauer intended to do that.
  Gary also said:

       Let's not keep this out of the healthcare system, unlike 
     diabetes, heart disease, and cancer, because then we just 
     perpetuate the situation that is causing it in the first 
     place.

  I will continue. Individuals with opioid use disorder die, on 
average, a decade sooner than other Americans. This is largely because 
of the strikingly high incidence of poorly managed, co-occurring 
chronic diseases, including HIV/AIDS, cardiac conditions, lung disease, 
and cirrhosis.
  Whatever we as a nation are doing to coordinate care for this highly 
vulnerable population is failing by any reasonable measure.
  The SPEAKER pro tempore. The time of the gentleman has expired.
  Mr. BURGESS. Mr. Speaker, I yield an additional 30 seconds to the 
gentleman from Illinois.
  Mr. SHIMKUS. Mr. Speaker, an extraordinary array of organizations, 
hospitals, physicians, patient advocates, and substance use treatment 
providers have approached this committee to clearly state that existing 
Federal addiction privacy law is actively interfering with case 
management and care coordination efforts. Arguing against this 
legislation preserved a fatal and deadly status quo.
  I support this piece of legislation, and I thank my colleague for the 
time.
  Mr. PALLONE. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I mentioned earlier the various groups that are opposed 
to this legislation because of the privacy concerns, and I actually 
would like to read or go through some sections from this letter that 
was sent to Chairman Walden and me from over 100 groups, including the 
New Jersey Association of Mental Health and Addiction Agencies.
  And they say, Mr. Speaker:

       Dear Chairman Walden and Ranking Member Pallone:
       We, the undersigned national, State, and local 
     organizations strongly support maintaining the core 
     protections of the Federal substance use disorder patient 
     confidentiality law and its regulations, referred to 
     collectively as part 2.

  And they say:

       We remain concerned that using a weaker HIPAA privacy rule 
     standard of allowing disclosure of substance use disorder 
     information without patient consent or other purposes will 
     contribute to the existing level of discrimination and harm 
     to people living with substance use disorders. This will only 
     result in more people who need substance use disorder 
     treatment being discouraged and afraid to seek the healthcare 
     they need during the Nation's worst opioid crisis.
       We strongly support maintaining part 2's current core 
     protections for substance use disorder information instead of 
     those weaker HIPAA privacy standards for the following 
     reasons.

  And there are five.

       One, the heightened privacy protections in part 2 are as 
     critical today as they were when they were enacted more than 
     40 years ago and must be preserved.
       Two, in the midst of the worst opioid epidemic in our 
     Nation's history, we must do everything possible to increase, 
     not decrease, the number of people who seek treatment.

                              {time}  1330

       Three, substance use disorder is unique among medical 
     conditions because of its criminal and civil consequences and 
     the rampant discrimination people face.
       Four, with so much at stake, patients in substance use 
     disorder treatment should retain the right to consent when 
     and to whom their records are disclosed, as currently found 
     in part 2.
       Five, effective integration of substance use disorder 
     treatment with the rest of the healthcare system is 
     critically important, and information exchange in accordance 
     with confidentiality law and current technology is now 
     possible. To facilitate that process, SAMHSA recently amended 
     the part 2 regulations to further promote the integration of 
     confidential substance use disorder information into general 
     health records.

  They finally conclude, Mr. Speaker, by saying:

       We respectfully request that the House Energy and Commerce 
     Committee maintain the current confidentiality protections of 
     part 2 to support individuals entering and staying in 
     substance use disorder treatment and recovery services.

  Mr. Speaker, I include in the Record this letter from these patients.

                                       Campaign To Protect Patient


                                               Privacy Rights,

                                                    June 18, 2018.
     Re Opposition to H.R. 6082--``Overdose Prevention and Patient 
         Safety Act''.

     Representative Greg Walden,
     Chairman of the U.S. House of Representatives Energy and 
         Commerce Committee, Washington, DC.
     Representative Frank Pallone, Jr.,
     Ranking Member of the U.S. House of Representatives Energy 
         and Commerce Committee, Washington, DC.
       Dear Chairman Walden and Ranking Member Pallone: We, the 
     undersigned national, state, and local organizations strongly 
     support maintaining the core protections of the federal 
     substance use disorder patient confidentiality law (``42 
     U.S.C. 290dd-2'') and its regulations ``42 CFR Part 2,'' 
     (referred to

[[Page H5332]]

     collectively as ``Part 2'') to effectively protect the 
     confidentiality of patients' records. The Substance Abuse and 
     Mental Health Service Administration (``SAMHSA'') recently 
     amended Part 2's patient privacy regulations in 2017 and 
     2018, which accomplishes the bill's proposed objective of 
     providing coordinated care between substance use disorder 
     (``SUD'') and other health care information.
       We remain concerned that using a weaker HIPAA Privacy Rule 
     standard of allowing disclosures of SUD information without 
     patient consent for treatment, payment, health care 
     operations, or other purposes other than those currently 
     allowed by Part 2--will contribute to the existing level of 
     discrimination and harm to people living with substance use 
     disorders. This will only result in more people who need 
     substance use disorder treatment, being discouraged and 
     afraid to seek the health care they need during the nation's 
     worst opioid crisis.
       We strongly support maintaining Part 2's current core 
     protections for SUD information, instead of those of a weaker 
     HIPAA Privacy standard as described in H.R. 6082 for the 
     following reasons:
       1. The heightened privacy protections in Part 2 are as 
     critical today as they were when they were they were enacted 
     more than 40 years ago, and must be preserved.
       2. In the midst of the worst opioid epidemic in our 
     nation's history, we must do everything possible to 
     increase--not decrease--the number of people who seek 
     treatment.
       3. SUD is unique among medical conditions because of its 
     criminal and civil consequences and the rampant 
     discrimination people face.
       4. With so much at stake, patients in SUD treatment should 
     retain the right to consent when and to whom their records 
     are disclosed, as currently found in Part 2.
       5. Effective integration of SUD treatment with the rest of 
     the health care system is critically important, and 
     information exchange in accordance with confidentiality law 
     and current technology is now possible. To facilitate that 
     process, SAMHSA recently amended the Part 2 regulations to 
     further promote the integration of confidential SUD 
     information into general health records.
       We respectfully request that the House Energy and Commerce 
     Committee maintain the current confidentiality protections of 
     Part 2 to support individuals entering and staying in SUD 
     treatment and recovery services.
           Sincerely,
       Campaign to Protect Privacy Rights: A New PATH; Addiction 
     Haven; Addictions Resource Center, Waukesha, WI (ARC, Inc.); 
     Advocates for Recovery Colorado; AIDS United; Alano Club of 
     Portland; Alcohol & Addictions Resource Center, South 
     Bend, IN; American Association for the Treatment of Opioid 
     Dependence (AATOD); American Group Psychotherapy 
     Association; Apricity; Arthur Schut Consulting LLC; 
     Association of Persons Affected by Addiction; Atlantic 
     Prevention Resources; California Consortium of Addiction 
     Programs & Professionals (CCAPP); Capital Area Project 
     Vox--Lansing (MI)'s Voice of Recovery; Center for Recovery 
     and Wellness Resources; CFC Loud N Clear Foundation; 
     Chicago Recovering Communities Coalition; Colorado 
     Behavioral Healthcare Council; Communities for Recovery.
       Community Catalyst; Connecticut Community for Addiction 
     Recovery (CCAR); Council on Addiction Recovery Services 
     (CAReS)-Orlean, NY; DarJune Recovery Support Services & Cafe; 
     Davis Direction Foundation--The Zone; Daystar Center; Delphi 
     Behavioral Health Group--Maryland House Detox; Detroit 
     Recovery Project; The DOOR--DeKalb Open Opportunity for 
     Recovery; Drug and Alcohol Service Providers Organization of 
     Pennsylvania; El Paso Alliance; Faces & Voices of Recovery; 
     Faces and Voices of Recovery (FAVOR)--Grand Strand-SC; Faces 
     and Voices of Recovery (FAVOR)--Greenville, SC; Faces and 
     Voices of Recovery (FAVOR)--Low Country: Charleston, SC; 
     Faces and Voices of Recovery (FAVOR)--Mississippi Recovery 
     Advocacy Project; Faces and Voices of Recovery (FAVOR)--Pee 
     Dee, SC; Faces and Voices of Recovery (FAVOR)--Tri-County: 
     Rock Hill, SC; Facing Addiction; Fellowship Foundation 
     Recovery Community Organization.
       Foundation for Recovery; Friends of Recovery--New York; 
     Georgia Council on Substance Abuse; Greater Macomb Project 
     Vox; Harm Reduction Coalition; Home of New Vision; HOPE for 
     New Hampshire Recovery; Jackson Area Recovery Community--
     Jackson, MI; Latah Recovery Center; Legal Action Center; 
     Lifehouse Recovery Connection; Long Island Recovery 
     Association (LIRA); Lotus Peer Recovery; Maine Alliance for 
     Addiction Recovery; Massachusetts Organization for Addiction 
     Recovery; Message Carriers of Pennsylvania; Mid-Michigan 
     Recovery Services (NCADD Mid-Michigan Affiliate); Minnesota 
     Recovery Connection; Missouri Recovery Network.
       National Advocates for Pregnant Women; National Alliance 
     for Medication Assisted Recovery (NAMA Recovery); National 
     Association for Children of Addiction (NACoA); National 
     Association of County Behavioral Health and Developmental 
     Disability Directors (NACBHDD); National Association for 
     Rural Mental Health (NARMH); National Center on Domestic 
     Violence, Trauma & Mental Health; National Council on 
     Alcoholism and Drug Dependence, Inc. (NCADD); National 
     Council on Alcoholism and Drug Dependence--Central 
     Mississippi Area, Inc.; National Council on Alcoholism and 
     Drug Dependence--Maryland; National Council on Alcoholism 
     and Drug Dependence--Phoenix; National Council on 
     Alcoholism and Drug Dependence--San Fernando Valley; 
     Navigating Recovery of the Lakes Region; New Jersey 
     Association of Mental Health and Addiction Agencies; 
     Northern Ohio Recovery Association; Oklahoma Citizen 
     Advocates for Recovery and Transformation Association 
     (OCARTA); Overcoming Addiction Radio, Inc.; Parent/
     Professional Advocacy League; Peer Coach Academy Colorado; 
     Pennsylvania Recovery Organizations--Alliance (PRO-A).
       People Advocating Recovery (PAR); Pennsylvania Recovery 
     Organization--Achieving Community Together (PRO-ACT); 
     Portland Recovery Community Center; Public Justice Center; 
     REAL--Michigan (Recovery, Education, Advocacy & Leadership); 
     Recover Project/Western MA Training; Recover Wyoming; 
     RecoveryATX; Recovery Alliance of Austin; Recovery Allies of 
     West Michigan; Recovery Cafe; Recovery Communities of North 
     Carolina; Recovery Community of Durham; Recovery Consultants 
     of Atlanta; Recovery Epicenter Foundation, Inc.; Recovery 
     Force of Atlantic County; Recovery is Happening; Recovery 
     Resource Council; Recovery Organization of Support 
     Specialist.
       Revive Recovery, Inc.; Rhode Island Cares About Recovery 
     (RICARES); Rochester Community Recovery Center; ROCovery 
     Fitness; Safe Harbor Recovery Center; SMART Recovery (Self-
     Management and Recovery Training); S.O.S. Recovery Community 
     Organization; SpiritWorks Foundation; Springs Recovery 
     Connection; Tennessee Association of Alcohol, Drug & other 
     Addiction Services (TAADAS); The Bridge Foundation; The 
     Courage Center; The McShin Foundation; The Ohana Center for 
     Recovery; The Serenity House of Flint; The Phoenix; The RASE 
     Project; The Recovery Channel; Tia Hart Community Recovery 
     Program.
       Together Our Recovery Center Heals (T.O.R.C.H.), Inc.; 
     Treatment Trends, Inc.; Trilogy Recovery Community; U MARC 
     (United Mental Health and Addictions Recovery Coalition); 
     Utah Support Advocates for Recovery Awareness (USARA); 
     Vermont Recovery Network; Voices of Hope for Cecil County, 
     MD; Voices of Hope Lexington; Voices of Recovery San Mateo 
     County, CA; WAI-IAM, Inc. and RISE Recovery Community; 
     Wisconsin Voices for Recovery; Young People in Recovery.
  Mr. PALLONE. Mr. Speaker, I reserve the balance of my time.
  Mr. BURGESS. Mr. Speaker, I yield myself 3 minutes.
  Mr. Speaker, I would like to point out that there are over 100 groups 
in support of the Partnership to Amend 42 CFR part 2. A letter from 
that partnership says, in part:

       We are pleased that the bill aligns part 2 with HIPAA's 
     consent requirements for the purposes of treatment, payment 
     and operations, which will allow for the appropriate sharing 
     of substance use disorder records, among covered entities, to 
     ensure persons with opioid use disorder and other substance 
     use disorders receive the integrated care that they need. 
     Additionally, as we do not want patients with substance use 
     disorders to be made vulnerable as a result of seeking 
     treatment for addiction, this legislation strengthens 
     protections and limits the number of institutions that have 
     access to their records.

  I am not going to read all of the names on the list, but some of the 
notable ones are the National Alliance on Mental Illness, Mental Health 
America, Hazelden Betty Ford Foundation, National Governors 
Association, Healthcare Leadership Council, American Hospital 
Association, American Society of Addiction Medicine, Centerstone, New 
Jersey Hospitals, and National Association of Addiction Treatment 
Providers.
  Mr. Speaker, I include in the Record the entire list of all of the 
groups in favor of the Partnership to Amend 42 CFR.

Partnership To Amend 42 CFR Part 2--A Coalition of Over 40 Health Care 
Stakeholders Committed To Aligning 42 CFR Part 2 (Part 2) With HIPAA To 
 Allow Appropriate Access to Patient Information That Is Essential for 
                      Providing Whole-Person Care

                                                    June 15, 2018.
     Hon. Markwayne Mullin,
     House of Representatives,
     Washington, DC.
     Hon. Earl Blumenauer,
     House of Representatives,
     Washington, DC.
       Dear Representatives Mullin and Blumenauer: The undersigned 
     members of the Partnership to Amend 42 CFR Part 2 
     (Partnership) and additional stakeholder organizations 
     applaud your leadership on the issue of substance use 
     disorder privacy records. We strongly support the Overdose 
     Prevention and Patient Safety (OPPS) Act, H.R. 6082, which 
     will align 42 CFR Part 2 (Part 2) with the Health Insurance 
     Portability and Accountability Act (HIPAA) for the purposes 
     of health care treatment, payment, and operations (TPO). The 
     Partnership is pleased that the OPPS Act was voted out of the 
     Committee on Energy and Commerce with a bipartisan vote.

[[Page H5333]]

       The Partnership is a coalition of more than 40 
     organizations representing stakeholders across the health 
     care spectrum committed to aligning Part 2 with HIPAA to 
     allow appropriate access to patient information that is 
     essential for providing whole-person care.
       We are pleased that the bill aligns Part 2 with HIPAA's 
     consent requirements for the purposes of TPO, which will 
     allow for the appropriate sharing of substance use disorder 
     records, among covered entities, to ensure persons with 
     opioid use disorder and other substance use disorders receive 
     the integrated care they need. Additionally, as we do not 
     want patients with substance use disorders to be made 
     vulnerable as a result of seeking treatment for addiction, 
     this legislation strengthens protections and limits the 
     number of institutions that have access to patient records.
       Thank you both for your leadership on this issue and we 
     look forward to working with you on helping to address the 
     opioid crisis by passing this important bipartisan 
     legislation on the floor of the U.S. House of 
     Representatives.
           Sincerely,


               Partnership to Amend 42 CFR Part 2 Members

       Academy of Managed Care Pharmacy; American Association on 
     Health and Disability; American Health Information Management 
     Association; American Hospital Association; American 
     Psychiatric Association; American Society of Addiction 
     Medicine; American Society of Anesthesiologists; America's 
     Essential Hospitals; America's Health Insurance Plans; AMGA; 
     Association for Ambulatory Behavioral Healthcare; Association 
     for Behavioral Health and Wellness; Association for Community 
     Affiliated Plans; BlueCross BlueShield Association; Catholic 
     Health Association of the U.S.; Centerstone; Confidentiality 
     Coalition; Employee Assistance Professionals Association; 
     Global Alliance for Behavioral Health and Social Justice; 
     Hazelden Betty Ford Foundation.
       Health IT Now; Healthcare Leadership Council; The Joint 
     Commission; InfoMC; Medicaid Health Plans of America; Mental 
     Health America; National Alliance on Mental Illness; National 
     Association for Behavioral Healthcare; National Association 
     of ACOs; National Association of Counties (NACo); National 
     Association of State Mental Health Program Directors 
     (NASMHPD); Netsmart; OCHIN; Otsuka; Pharmaceutical Care 
     Management Association; Premier Healthcare Alliance.


                  Additional Stakeholder Organizations

       ACO Health Partners; Aetna; AMITA Health; Anthem, Inc.; 
     Ascension Health; Avera Health; Banner Health; Baptist 
     Healthcare System; Beacon Health Options; Bon Secours Health 
     System, Inc.; CareSource; Catholic Health Initiatives; 
     Centene Corporation; Change Healthcare; Cigna; College of 
     Healthcare Information Management Executives (CHIME).
       Excellus BlueCross BlueShield; Franciscan Sisters of 
     Christian Charity Sponsored Ministries, Inc.; Greater New 
     York Hospital Association; Henry Ford Health System; Howe 
     Home Designers; Johns Hopkins Medicine; Kern Health 
     Systems; Leidos; Lycoming County; Magellan Health; 
     Marshfield Clinic Health System; Mental Health America of 
     Indiana; Mosaic Life Care; NAMI; NAMI DC; NAMI Delaware.
       NAMI Greene County Tennessee; NAMI Helena; NAMI of Howard 
     County, MD; NAMI Jefferson County, Washington; NAMI Kaufman 
     County; NAMI Kershaw County; NAMI Lewistown; NAMI Lexington; 
     NAMI of the Pee Dee (South Carolina); NAMI Piedmont Tri-
     County; NAMI Sarasota County; NAMI South Suburbs of Chicago; 
     NAMI Sussex, Inc.; NAMI Temple Area; NAMI Utah; NAMI Valley 
     of the Sun.
       National Alliance on Mental Illness (NAMI) Texas; National 
     Association of Addiction Treatment Providers; New Directions 
     Behavioral Health; OPEN MINDS; Optum; PerformCare; Providence 
     St. Joseph Health; SCAN Health Plan; SSM Health; Texas Health 
     Resources; The Center for Health Affairs/Northeast Ohio 
     Hospital Opioid Consortium; The MetroHealth System; Trinity 
     Health; University of Tennessee Medical Center; Valley Health 
     System; Vizient; Wayne Meriwether.

  Mr. BURGESS. Mr. Speaker, I reserve the balance of my time.
  Mr. PALLONE. Mr. Speaker, I yield myself the balance of my time.
  Mr. Speaker, I just want to say in conclusion today, that amidst the 
worst opioid epidemic our country has ever faced, I think it is really 
important that we not take any action that could result in any 
individual with an opiate use disorder not seeking or remaining in 
treatment for this life-threatening condition.
  I understand the opinions on both sides, but I do think that if we 
don't protect the existing privacy and keep the current law with regard 
to privacy that we will see many individuals not seeking treatment or 
remaining in treatment. That is why I strongly oppose this bill, and I 
urge my colleagues to vote ``no.''
  Mr. Speaker, I yield back the balance of my time.
  Mr. BURGESS. Mr. Speaker, I yield myself the balance of my time.
  Mr. Speaker, by continuing to segregate substance use disorder 
records means that we are willing to allow some patients to receive 
care that is potentially lower quality at a higher cost.
  Treating patient substance use disorder in isolation from their 
medical and mental health conditions--which predominated care in the 
1970s--is not the standard for good practice today. There is now 
overwhelming evidence that patients' substance use disorders cannot be 
treated in isolation from other healthcare conditions. In the 1970s 
when part 2 was written, this was not widely accepted, and treatment 
for addiction was largely separate from treatment for other illnesses.
  Mr. Speaker, further, I would say that the problem here is we need to 
treat addiction just like any other medical illness and improve our 
outreach to patients who meet the criteria for treatment. Maintaining a 
decades old, ineffective confidentiality law simply is not going to do 
that.
  I urge my colleagues to support the bill. It is a good bill supported 
by Mr. Mullin and Mr. Blumenauer.
  Mr. Speaker, I yield back the balance of my time.
  The SPEAKER pro tempore (Mr. Bost). All time for debate has expired.
  Pursuant to House Resolution 949, the previous question is ordered on 
the bill, as amended.
  The question is on the engrossment and third reading of the bill.
  The bill was ordered to be engrossed and read a third time, and was 
read the third time.


                           Motion to Recommit

  Mr. PALLONE. Mr. Speaker, I have a motion to recommit at the desk.
  The SPEAKER pro tempore. Is the gentleman opposed to the bill?
  Mr. PALLONE. I am opposed to H.R. 6082.
  Mr. BURGESS. Mr. Speaker, I reserve a point of order against the 
motion.
  The SPEAKER pro tempore. A point of order is reserved.
  The Clerk will report the motion to recommit.
  The Clerk read as follows:

       Mr. Pallone moves to recommit the bill H.R. 6082 to the 
     Committee on Energy and Commerce with instructions to report 
     the same back to the House forthwith with the following 
     amendment:
       Strike page 1, line 4, through page 8, line 20.
       Strike page 11, line 8, through page 12, line 9.
       Page 8, line 21, through page 11, line 7, promote 
     subsection (k) to become a section which reads as follows:

     SEC. 2. DEVELOPMENT AND DISSEMINATION OF MODEL TRAINING 
                   PROGRAMS FOR SUBSTANCE USE DISORDER PATIENT 
                   RECORDS.

       (a) Initial Programs and Materials.--Not later than 1 year 
     after the date of the enactment of this Act, the Secretary of 
     Health and Human Services (referred to in this section as the 
     ``Secretary''), in consultation with appropriate experts, 
     shall identify the following model programs and materials (or 
     if no such programs or materials exist, recognize private or 
     public entities to develop and disseminate such programs and 
     materials):
       (1) Model programs and materials for training health care 
     providers (including physicians, emergency medical personnel, 
     psychiatrists, psychologists, counselors, therapists, nurse 
     practitioners, physician assistants, behavioral health 
     facilities and clinics, care managers, and hospitals, 
     including individuals such as general counsels or regulatory 
     compliance staff who are responsible for establishing 
     provider privacy policies) concerning the permitted uses and 
     disclosures, consistent with the standards and regulations 
     governing the privacy and security of substance use disorder 
     patient records promulgated by the Secretary under section 
     543 of the Public Health Service Act (42 U.S.C. 290dd-2) for 
     the confidentiality of patient records.
       (2) Model programs and materials for training patients and 
     their families regarding their rights to protect and obtain 
     information under the standards and regulations described in 
     paragraph (1).
       (b) Requirements.--The model programs and materials 
     described in paragraphs (1) and (2) of subsection (a) shall 
     address circumstances under which disclosure of substance use 
     disorder patient records is needed to--
       (1) facilitate communication between substance use disorder 
     treatment providers and other health care providers to 
     promote and provide the best possible integrated care;
       (2) avoid inappropriate prescribing that can lead to 
     dangerous drug interactions, overdose, or relapse; and
       (3) notify and involve families and caregivers when 
     individuals experience an overdose.
       (c) Periodic Updates.--The Secretary shall--

[[Page H5334]]

       (1) periodically review and update the model program and 
     materials identified or developed under subsection (a); and
       (2) disseminate such updated programs and materials to the 
     individuals described in subsection (a)(1).
       (d) Input of Certain Entities.--In identifying, reviewing, 
     or updating the model programs and materials under this 
     section, the Secretary shall solicit the input of relevant 
     stakeholders.
       At the end, insert the following new section:

     SEC. 3. REPORT ON PATIENT EXPERIENCE WITH PART 2.

       (a) Report.--The Secretary of Health and Human Services (in 
     this section referred to as the ``Secretary'') shall conduct 
     or support a study that examines information sharing 
     behaviors of individuals who obtain substance use disorder 
     treatment through a Part 2 program.
       (b) Topics.--The study pursuant to subsection (a) shall 
     examine the extent to which patients at Part 2 programs agree 
     to share their information, including the following:
       (1) Patient understanding regarding their rights to protect 
     and obtain information under Part 2.
       (2) Concerns or feelings patients have about sharing their 
     Part 2 treatment records with other health care providers and 
     organizations.
       (3) Whether or not patients agree to share their Part 2 
     medical records.
       (4) The extent of providers with which patients agree to 
     share their Part 2 treatment records.
       (5) If patients have shared their Part 2 treatment 
     information--
       (A) at what point in the treatment relationship with the 
     Part 2 program did the patients choose to do so; and
       (B) what prompted the patients to share the information.
       (6) What considerations were taken into account by the 
     patient when deciding whether or not and with whom to share 
     their Part 2 treatment information.
       (7) How did having the choice to decide to what extent and 
     with whom to share Part 2 treatment records affect patients' 
     decision to uptake or remain in treatment.
       (8) Would not having a choice to decide the extent to which 
     to share their treatment records from Part 2 programs affect 
     a patient's decision to participate or stay in treatment.
       (c) Scope.--The study under subsection (a) shall--
       (1) include a nationally representative sample of 
     individuals obtaining treatment at Part 2 programs; and
       (2) consider patients of Part 2 programs being treated for 
     various substance use disorders, including opioid use 
     disorder and alcohol use disorder.
       (d) Report.--Not later than 2 years after the date of 
     enactment of this Act, the Secretary shall submit a report to 
     the Congress on the results of the study under subsection 
     (a).
       (e) Definitions.--In this section:
       (1) The term ``Part 2 program'' means a program described 
     in section 543 of the Public Health Service Act (42 U.S.C. 
     290dd-2).
       (2) The term ``Part 2'' means the program under section 543 
     of the Public Health Service Act (42 U.S.C. 290dd-2).

  Mr. PALLONE (during the reading). Mr. Speaker, I ask unanimous 
consent to dispense with the reading of the motion.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from New Jersey?
  There was no objection.
  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from New 
Jersey is recognized for 5 minutes in support of his motion.
  Mr. PALLONE. Mr. Speaker, this is the final amendment to the bill 
which will not kill the bill or send it back to committee. If adopted, 
the bill will immediately proceed to final passage, as amended.
  Mr. Speaker, this amendment would maintain the privacy rights 
provided to individuals with substance use disorder. Those patients 
would retain their right to determine with whom and for what purpose to 
share their substance use disorder treatment records from part 2 
programs.
  Rather than strip away patients' privacy rights, my amendment would 
incorporate section 509 from the bipartisan Alexander-Murray bill, S. 
2680, the Opioid Crisis Response Act of 2018, that was reported out of 
the Senate HELP Committee on a bipartisan basis, and that was 
incorporated in the underlying legislation.
  That provision requires the Secretary to support the development and 
dissemination of model training programs for substance use disorder 
treatment records under part 2. It would help ensure that more 
patients, families, and providers understand how information can be 
protected and shared under part 2.
  My amendment would also help us to better understand the privacy 
needs of individuals with substance use disorder as well as how to 
balance those needs with the information needs of our health system to 
provide the highest quality care.
  Specifically, my amendment would require the Secretary to conduct or 
support a study to better understand the patient experience with part 2 
through the examination of information-sharing behaviors of individuals 
who obtain substance use disorder treatment at part 2 programs.
  This study will provide critical insight into the central question 
under debate today: What is the appropriate level of privacy 
protections that should be applied to substance use disorder treatment 
records?
  While there are a lot of opinions and persuasive evidence to support 
both sides of this debate, there is a lack of research on this issue 
generally or as it specifically relates to part 2. Such information 
will help us better understand the level of control individuals with 
substance use disorders need over their medical records to ensure their 
privacy concerns are not a barrier for such individuals accessing 
potentially lifesaving treatment.
  It would also help us better understand what is the appropriate 
balance between the needs of these individuals regarding the privacy of 
their substance use disorder treatment information with the needs of a 
coordinated healthcare system to best serve its patients.
  We know that today, under current law, some patients who receive 
substance use disorder treatment from part 2 programs choose not to 
share their treatment records with any provider outside of their 
substance use disorder treatment provider. On the other hand, there are 
others who choose to share with only a few of their nonsubstance use 
disorder treatment providers.
  So I just believe it is critical we understand the reasons why such 
individuals have made these decisions as well as how the right to make 
such a decision affected their willingness to seek or remain in 
treatment.
  This amendment is consistent with the recent recommendations from the 
Medicaid and CHIP Payment and Access Commission. As part of their June 
2018 report to Congress, the commission stated that at this time the 
commission does not recommend alignment of part 2 and HIPAA. Instead, 
the commission recommends additional subregulatory guidance, education, 
and training on part 2.
  As I have made clear, Mr. Speaker, I have concerns that the 
underlying bill would hurt our efforts to respond to the opioid 
epidemic and could increase the odds that fewer individuals with opiate 
use disorder enter and remain in treatment, a risk I believe too great 
to take during the worst drug abuse epidemic our country has ever 
faced.
  However, I realize there is another side of this argument as advanced 
by the proponents of this bill, and we should not be concerned that 
this bill will affect the uptick of treatment, and, in fact, we should 
believe that this will only improve treatment.
  Rather than undertake the 50-State experiment to see which side is 
right, we should support the thorough study of this issue before taking 
any action to weaken the privacy protections provided by part 2. In 
that way, we can determine the actual effect on taking away from 
individuals with substance use disorder the ability to decide how their 
treatment information is shared. That way we would have no doubt on 
both the intended and unintended consequences of eliminating the 
patient consent requirement for treatment, payment, and healthcare 
operation purposes as proposed by the underlying bill.
  I think the stakes are too high to get this wrong. I urge my 
colleagues to support this amendment to increase the awareness of 
patients, families, and providers about how their treatment records are 
protected and can be shared under part 2 as well as to increase our 
understanding of the privacy needs of individuals with substance use 
disorders.
  I yield back the balance of my time, Mr. Speaker.
  Mr. BURGESS. Mr. Speaker, I withdraw my point of order.
  The SPEAKER pro tempore. The reservation of the point of order is 
withdrawn.

[[Page H5335]]

  

  Mr. BURGESS. Mr. Speaker, I claim the time in opposition to the 
motion.
  The SPEAKER pro tempore. The gentleman from Texas is recognized for 5 
minutes.
  Mr. BURGESS. Mr. Speaker, I urge a ``no'' vote on the motion to 
recommit as it will destroy the intent of the bill.

  Eliminating the sharing of records for the purposes of treatment, 
payment, and healthcare operations completely negates the entire 
purpose of this initiative.
  Aligning 42 CFR part 2 with HIPAA for purposes of treatment, payment, 
and healthcare operations is the entire purpose of the legislation.
  Opponents of this bill have offered no evidence or findings to back 
up their claim that HIPAA is inadequate to protect sensitive data 
contained in substance use disorder treatment records.
  HIPAA is currently functioning well in protecting sensitive patient 
information in a number of areas.
  Real integration of behavioral health and primary care simply cannot 
happen until we align 42 CFR part 2 with HIPAA.
  The opposition of H.R. 6082 is not based on protecting privacy. It is 
based on very specific distrust of the healthcare community to properly 
provide care to people with substance use disorder--the very people 
whom we are asking to help us with this.
  Yet, the ranking member is strongly in favor of numerous bills that 
seek to expand access to evidence-based medication-assisted treatment, 
telehealth and integration with mainstream medicine--the very things 
that demand alignment with HIPAA. So the thinking, Mr. Speaker, to be 
kind, is incongruous.
  Prohibiting the sharing of addiction medical records for treatment, 
payment, and healthcare operations makes it impossible to prescribe the 
latest substance use treatment medications safely.
  Like most pharmaceuticals, buprenorphine and methadone have drug 
interactions and interact with other medicines. Adverse events from 
drug interactions can lead to emergency hospital visits, serious 
injuries, or death.
  We must amend part 2 so we can safely prescribe medication-assisted 
treatment for patients. Put simply, standard clinical practices like 
medication reconciliation are not feasible under the current Federal 
law. For that reason, I urge my colleagues to vote ``no'' on the motion 
to recommit. Vote ``yes'' on the underlying motion.
  Mr. Speaker, I yield back the balance of my time.
  The SPEAKER pro tempore. Without objection, the previous question is 
ordered on the motion to recommit.
  There was no objection.
  The SPEAKER pro tempore. The question is on the motion to recommit.
  The question was taken; and the Speaker pro tempore announced that 
the noes appeared to have it.
  Mr. PALLONE. Mr. Speaker, on that I demand the yeas and nays.
  The yeas and nays were ordered.
  The SPEAKER pro tempore. Pursuant to clause 8 of rule XX, further 
proceedings on this question will be postponed.

                          ____________________