Walden panel sends 57 opioid bills to House floor

Rep. Greg Walden, R-Ore., said Thursday he has fulfilled his commitment to advance legislation to combat the opioid crisis to the House by Memorial Day. The House Energy and Commerce Committee, where Walden serves as Chairman, advanced 32 more bills Thursday — for a total of 57 measures sent to the full House to address the opioid crisis in Oregon and across the country.

“Our communities are counting on us to deliver on solutions to help turn the tide of addiction and death that is ravaging towns from coast to coast,” Walden said in a news release. “These bills are the direct result of hearing from the families impacted by this crisis, those working to remedy it, and compromise by our fellow leaders. Earlier this week, I heard from two such families in southern Oregon whose sons are still struggling with addiction, and I’ve heard from others at roundtables across my state. Their stories are all too familiar.”

Under Walden’s leadership, Energy and Commerce has put forth concrete solutions to combat the opioid crisis, seeking to advance legislation to help stem the tide and investigate some of the root causes of the crisis. Specifically, the committee’s legislative efforts have examined bills to: improve patient safety and bolster enforcement tools, advance prevention and public health solutions, and address coverage and payment issues within Medicare and Medicaid.

“While this Congress has delivered unprecedented resources to combat this crisis, Americans from all backgrounds and walks of life still feel the grasp of this crisis and are asking us for help,” said Walden. “And we will deliver.”

After two Energy and Commerce Committee markups:

57 bills advanced to the House of Representatives 53 passed by voice votes 4 passed by roll call votes

Thursday, the Energy and Commerce Committee advanced the following bills to combat the opioid crisis:

H.R. 5228, the Stop Counterfeit Drugs by Regulating and Enhancing Enforcement Now (SCREEN) Act, authored by Energy and Commerce Committee Ranking Member Frank Pallone, Jr. (D-NJ), will provide the Food and Drug Administration (FDA) with stronger recall and seizure authority to disrupt the entry of counterfeit and illicit drugs through International Mail Facilities (IMFs). The committee adopted an amendment in the nature of a substitute (AINS) offered by Ranking Member Pallone, and an amendment to the AINS offered by Rep. Gene Green (D-TX). H.R. 5228 passed the committee, as amended, by voice vote.

H.R. 5752, the Stop Illicit Drug Importation Act of 2018, authored by Rep. Blackburn, will streamline and enhance FDA’s tools to intercept illegal products. Illicit or unapproved drugs enter the U.S. supply chain through IMFs and pose serious public health threats to individuals across the country. H.R. 5752 passed the committee, as amended, by voice vote.

H.R. 5806, the 21st Century Tools for Pain and Addiction Treatments, authored by Rep. Michael C. Burgess, M.D. (R-TX), Rep. Larry Bucshon (R-IN), and Rep. Morgan Griffith (R-VA), will direct the FDA to issue or update existing guidance on ways existing pathways can be used to bring novel non-addictive treatments for pain and addiction to patients. Several approaches have proven successful in speeding the availability of treatments for serious diseases through the FDA. The FDA’s accelerated approval program facilitates faster approval of medications using surrogate endpoints for serious conditions where there is an unmet medical need. The breakthrough therapy pathway is a process designed to expedite the development and review of drugs, which may demonstrate substantial improvement over available therapy. H.R. 5806 passed the committee by a vote of 31-23.

H.R. 5811, to amend the Federal Food, Drug, and Cosmetic Act with respect to postapproval study requirements for certain controlled substances, and for other purposes. H.R. 5811, authored by Rep. Jerry McNerney (D-CA) and Rep. Griffith will enhance FDA’s authorities and enforcement tools to ensure timely post-marketing studies for chronically administered opioids. Currently, there is limited data on the long-term efficacy of opioids, and their overall place in the treatment of pain. The committee adopted an amendment to the bill, offered by Rep. Griffith, by a vote of 31-22. H.R. 5811 passed the committee, as amended, by voice vote.

H.R. 1925, the At-Risk Youth Medicaid Protection Act of 2017, authored by Rep. Tony Cardenas (D-CA) and Rep. Griffith, will require state Medicaid programs not terminate a juvenile’s medical assistance eligibility because he/she is incarcerated. A state may suspend coverage while the juvenile is an inmate, but must restore coverage upon release without requiring a new application unless the individual no longer meets the eligibility requirements for medical assistance. H.R. 1925 passed the committee by voice vote.

H.R. 3192, the CHIP Mental Health Parity Act, authored by Rep. Joseph Kennedy, III (D-MA), will require state Children’s Health Insurance Programs (CHIP) to cover mental health benefits. All state CHIP programs currently cover such benefits. H.R. 3192 passed the committee, as amended, by voice vote.

H.R. 4005, the Medicaid Reentry Act, authored by Rep. Paul Tonko (D-NY), as amended, will require the Secretary of HHS to convene a stakeholder group that will produce a report of best practices for states to consider in health care related transitions for inmates of public institutions. H.R. 4005 passed the committee, as amended, by voice vote.

H.R. 4998, the Health Insurance for Former Foster Youth Act, authored by Rep. Karen Bass (D-CA). The Patient Protection and Affordable Care Act (PPACA) enabled former foster youth who are in care by their 18th birthday and previously enrolled in Medicaid to receive healthcare until the age of 26. However, PPACA did not extend Medicaid coverage to former foster youth if they move out of state. H.R. 4998 would enable such youth to receive Medicaid coverage if they moved to a different state. The committee adopted an AINS, offered by Rep. G. K. Butterfield (D-NC), which revises the underlying policy and directs the Centers for Medicare and Medicaid Services (CMS) to publish guidance on how states can remove barriers, track coverage status, and conduct outreach to this population. The AINS passed by voice vote. H.R. 4998 passed the committee, as amended, by voice vote.

H.R. 5477, the Rural Development of Opioid Capacity Services Act, authored by Rep. Tom O’Halleran (D-AZ), will require CMS to carry out a demonstration project to provide an enhanced federal matching rate for state Medicaid expenditures related to the expansion of substance-use treatment and recovery services targeting provider capacity. H.R. 5477 passed the committee, as amended, by voice vote.

H.R. 5583, to amend title XI of the Social Security Act to require states to annually report on certain adult health quality measures, and for other purposes, authored by Rep. Yvette Clarke (D-NY), will require state Medicaid programs to report on the 11 behavioral health measures that are included in CMS’ 2018 Core Set of Adult Health Care Quality Measures for Medicaid. H.R. 5583 passed the committee by voice vote.

H.R. 5789, to amend title XIX of the Social Security Act to provide for Medicaid coverage protections for pregnant and postpartum women while receiving inpatient treatment for substance use disorder, authored by Rep. Bill Foster (D-IL) and Rep. Brett Guthrie (R-KY), will improve access to inpatient treatment services for women with substance use disorder who are pregnant or who are suffering from postpartum depression. H.R. 5789 passed the committee, as amended, by voice vote.

H.R. 5797, the IMD CARE Act, authored by Rep. Mimi Walters (R-CA), will allow state Medicaid programs from FY2019 through FY2023 to remove the Institutions for Mental Diseases (IMD) exclusion for Medicaid beneficiaries aged 21-64 with an opioid use disorder. This bill improves the continuum of care by removing a barrier to care under current law, so Medicaid would pay for up to 30 total days of care in an IMD during a 12-month period and eligible individuals can get the care they need. H.R. 5797 passed the committee, as amended, by voice vote.

H.R. 5799, the Medicaid DRUG Improvement Act, authored by Rep. Blackburn, will build on current state Medicaid drug utilization review activities to help combat the opioid crisis. Under H.R. 5799, state Medicaid programs will be required to have safety edits in place for opioid refills, monitor concurrent prescribing of opioids and certain other drugs, and monitor antipsychotic prescribing for children. H.R. 5799 passed the committee, as amended, by voice vote.

H.R. 5800, the Medicaid IMD ADDITIONAL INFO Act, authored by Rep. Fred Upton (R-MI), will direct the Medicaid and CHIP Payment and Access Commission (MACPAC) to conduct a study on institutions for mental disease (IMD) that receive Medicaid reimbursement. The study will report on the requirements and standards that state Medicaid programs have for IMDs. MACPAC, considering input from stakeholders, will summarize the findings and make recommendations on improvements and best practices and data collection. The report would be due no later than January 2020. H.R. 5800 passed the committee by voice vote.

H.R. 5801, the Medicaid PARTNERSHIP Act, authored by Rep. Griffith, will require the Medicaid program in each state to integrate prescription drug monitoring program (PDMP) usage into Medicaid provider’s clinical workflow and require such providers to check the PDMP before prescribing a Schedule II controlled substance. H.R. 5801 will also establish a standard criteria that a PDMP must meet to be counted as a qualified PDMP, and requires state Medicaid programs to report to CMS on several PDMP issues. H.R. 5801 passed the committee, as amended, by voice vote.

H.R. 5808, the Medicaid Pharmaceutical Home Act of 2018, authored by Rep. Gus Bilirakis (R-FL), will require all state Medicaid programs to have a beneficiary assignment program that identifies Medicaid beneficiaries at-risk for substance use disorder and assigns them to a pharmaceutical home program, which must set reasonable limits on the number of prescribers and dispensers that beneficiaries may utilize. H.R. 5808 passed the committee by voice vote.

H.R. 5810, the Medicaid Health HOME Act, authored by Rep. Leonard Lance (R-NJ) and Rep. Peter Welch (D-VT), will improve the state option for Medicaid health homes under current law that improve the coordination of, and access to care for Medicaid beneficiaries with substance use disorder. The bill extends the enhanced matching rate for qualified activities from eight quarters to 10 quarters. H.R. 5810 passed the committee, as amended, by voice vote.

H.R. 5715, the Strengthening Partnerships to Prevent Opioid Abuse Act, authored by Reps. James Renacci (R-OH), Terri Sewell (D-AL), Rep. Guthrie, and Scott Peters (D-CA), will help facilitate communication among Medicare Advantage and Part D plan sponsors, and CMS relating to sharing information on substantiated fraud, waste, and abuse investigations. H.R. 5715 passed the committee, as amended, by voice vote.

H.R. 5716, the Commit to Opioid Medical Prescriber Accountability and Safety for Seniors (COMPASS) Act, authored by Reps. Peter Roskam (R-IL), John Larson (D-CT), Susan Brooks (R-IN), and Welch, will require CMS to establish a prescriber threshold based on specialty and geographic area, which could designate a prescriber as an outlier opioid prescriber. CMS would then be responsible for notifying prescribers identified as outliers of their status. H.R. 5716 passed the committee by voice vote.

H.R. 5796, the Responsible Education Achieves Care and Healthy Outcomes for Users’ Treatment (REACH OUT) Act of 2018, authored by Reps. Brian Fitzpatrick (R-PA), Carlos Curbelo (R-FL), and Mike Thompson (D-CA), will direct CMS to work with eligible entities, including Quality Improvement Organizations, to engage in outreach with prescribers identified as clinical outliers to share best practices to evaluate their prescribing behavior. H.R. 5796 passed the committee by voice vote.

H.R. 5590, the Opioid Addiction Action Plan Act, authored by Rep. Adam Kinzinger (R-IL), Reps. Clarke, Darin LaHood (R-IL), and Danny Davis (D-IL), will establish an action plan, including studies, reports to Congress authored by the Department of Health and Human Services (HHS), as well as meetings with stakeholders, for the purpose of addressing the opioid crisis. H.R. 5590 passed the committee, as amended, by voice vote.

H.R. 5603, the Access to Telehealth Services for Opioid Use Disorder, authored by Reps. Doris Matsui (D-CA), Cardenas, and Bill Johnson (R-OH), will instruct CMS to evaluate the utilization of telehealth services in treating substance use disorder. H.R. 5603 passed the committee, as amended, by voice vote.

H.R. 5605, the Advancing High Quality Treatment for Opioid Use Disorders in Medicare Act, authored by Rep. Raul Ruiz (D-CA), will create a demonstration project for treating substance use disorder. This model includes the development of measures to evaluate the quality and outcomes of treatment. H.R. 5605 passed the committee, as amended, by voice vote.

H.R. 5798, the Opioid Screening and Chronic Pain Management Alternatives for Seniors Act, authored by Reps. Bucshon, Debbie Dingell (D-MI), and Erik Paulsen (R-MN), will add a review of current opioid prescriptions and, as appropriate, a screening for opioid use disorder as part of the Welcome to Medicare initial examination. H.R. 5798 passed the committee by voice vote.

H.R. 4684, the Ensuring Access to Quality Sober Living Act of 2017, authored by Reps. Judy Chu (D-CA), Walters, Bilirakis, and Ruiz, will authorize the Substance Abuse and Mental Health Services Administration (SAMHSA) to develop, publish, and disseminate best practices for operating recovery housing that promotes a safe environment for sustained recovery from substance use disorder (SUD). H.R. 4684 passed the committee by voice vote.

H.R. 5329, the Poison Center Network Enhancement Act of 2018, authored by Reps. Brooks, Eliot Engel (D-NY), and Energy and Commerce Committee Vice Chairman Joe Barton (R-TX), will reauthorize the national network of Poison Control Centers, which offer free, confidential, and expert medical advice 24 hours a day, seven days a week. Often times these programs serve as the primary resource for poisoning information and help reduce Emergency Room visits through in-home treatment. H.R. 5329 passed the committee, as amended, by voice vote.

H.R. 5580, the STOP Fentanyl Deaths Act of 2018, authored by Rep. Anne Kuster (D-NH), will authorize grants to federal, state, and local agencies for the establishment or operation of public health laboratories to detect fentanyl, its analogues, and other synthetic opioids. H.R. 5580 passed the committee by voice vote.

H.R. 5587, the Peer Support Communities of Recovery Act, authored by Reps. Ben Ray Lujan (D-NM) and Johnson, will enhance CARA’s Building Communities of Recovery Program and authorize the Department of Health and Human Services to award grants to peer support specialist organizations for the development and expansion of recovery services. Peer support specialists/peer recovery coaches are health workers who are in recovery from SUD. New programs are emerging across the country to use peers in a range of settings, including hospitals, to provide immediate and ongoing support and treatment linkages to individuals who have overdosed from opioids, or support individuals newly in recovery. H.R. 5587 passed the committee, as amended, by voice vote.

H.R. 5804, the Post-Surgical Injections as an Opioid Alternative Act, authored by Rep. John Shimkus (R-IL), and Reps. Raja Krishnamoorthi (D-IL), and Roskam, seeks to incentivize post-surgical injections as a pain treatment alternative to opioids by reversing a reimbursement cut for these treatments in the Ambulatory Service Center setting, as well as collect data on a subset of codes related to these treatments. An amendment offered by Rep. Welch failed by a vote of 23-27. H.R. 5804 passed the committee by a vote of 36-14.

H.R. 5809, Postoperative Opioid Prevention Act of 2018, authored by Reps. Peters and Bucshon, will create a pass-through payment extension to encourage the development of non-opioid drugs for post-surgical pain management in Medicare. An amendment offered by Rep. Dingell failed by a vote of 22-29. H.R. 5809 passed the committee by a vote of 34-17.

H.R. 5795, the Overdose Prevention and Patient Safety Act, authored by Reps. Earl Blumenauer (D-OR) and Markwayne Mullin (R-OK), will align the use of SUD treatment records with the Health Insurance Portability and Accountability Act (HIPAA) for the purposes of treatment, payment, and healthcare operations between covered entities. H.R. 5795 will also enhance the penalties in the event of a disclosure of SUD treatment records, add breach notification requirements, and provide strong discrimination prohibitions to protect people seeking and receiving SUD treatment. An amendment offered by Vice Chairman Barton, which was amended by a secondary amendment by Chairman Walden, passed the committee by voice vote. An amendment offered by Ranking Member Pallone failed by a vote of 23-29. H.R. 5795 passed the committee, as amended, by 35-17.

H.R. 5812, the Creating Opportunities that Necessitate New and Enhanced Connections That Improve Opioid Navigation Strategies (CONNECTIONS) Act, authored by Rep. Griffith and Ranking Member Pallone, will improve current federal support for state-run PDMPs. H.R. 5812 will authorize the Centers for Disease Control and Prevention to carry out certain controlled substances overdose prevention and surveillance activities in order to improve data collection and integration into physician clinical workflow so that timely, complete, and accurate information will get into the hands of providers and dispensers so that they can make the best clinical decisions for their patients. H.R. 5812 passed the committee by voice vote.

Last week, Walden’s committee held the first of two markups on opioid legislation. During that markup, 25 bills were advanced to the House of Representatives, all of which passed by voice vote.

A background memo, electronic copies of the legislation, and live stream of the markup can be found online here. Amendment text and votes will be available at the same link as they are posted.